[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3643 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 3643

 To amend title 38, United States Code, to extend through December 31, 
  1998, the period during which the Secretary of Veterans Affairs is 
authorized to provide priority health care to certain veterans who were 
 exposed to Agent Orange or who served in the Persian Gulf War and to 
 make such authority permanent in the case of certain veterans exposed 
             to ionizing radiation, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 13, 1996

     Mr. Hutchinson (for himself, Mr. Edwards, Mr. Stump, and Mr. 
 Montgomery) introduced the following bill; which was referred to the 
                     Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To amend title 38, United States Code, to extend through December 31, 
  1998, the period during which the Secretary of Veterans Affairs is 
authorized to provide priority health care to certain veterans who were 
 exposed to Agent Orange or who served in the Persian Gulf War and to 
 make such authority permanent in the case of certain veterans exposed 
             to ionizing radiation, 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. AUTHORITY TO PROVIDE PRIORITY HEALTH CARE.

    (a) Authorized Inpatient Care.--Section 1710(e) of title 38, United 
States Code, is amended--
            (1) in paragraph (1), by striking out subparagraphs (A) and 
        (B) and inserting in lieu thereof the following:
    ``(e)(1)(A) A herbicide-exposed veteran is eligible for hospital 
care and nursing home care under subsection (a)(1)(G) for any disease 
suffered by the veteran that is--
            ``(i) among those diseases for which the National Academy 
        of Sciences, in a report issued in accordance with section 2 of 
        the Agent Orange Act of 1991, has determined--
                    ``(I) that there is sufficient evidence to conclude 
                that there is a positive association between occurrence 
                of the disease in humans and exposure to a herbicide 
                agent;
                    ``(II) that there is evidence which is suggestive 
                of an association between occurrence of the disease in 
                humans and exposure to a herbicide agent, but such 
                evidence is limited in nature; or
                    ``(III) that available studies are insufficient to 
                permit a conclusion about the presence or absence of an 
                association between occurrence of the disease in humans 
                and exposure to a herbicide agent; or
            ``(ii) a disease for which the Secretary, pursuant to a 
        recommendation of the Under Secretary for Health on the basis 
        of a peer-reviewed research study or studies published within 
        20 months after the most recent report of the National Academy 
        under section 2 of the Agent Orange Act of 1991, determines 
        there is credible evidence suggestive of an association between 
        occurrence of the disease in humans and exposure to a herbicide 
        agent.
    ``(B) A radiation-exposed veteran is eligible for hospital care and 
nursing home care under subsection (a)(1)(G) for any disease suffered 
by the veteran that is--
            ``(i) a disease listed in section 1112(c)(2) of this title; 
        or
            ``(ii) any other disease for which the Secretary, based on 
        the advice of the Advisory Committee on Environmental Hazards, 
        determines that there is credible evidence of a positive 
        association between occurrence of the disease in humans and 
        exposure to ionizing radiation.'';
            (2) in paragraph (2)--
                    (A) by striking out ``Hospital'' and inserting in 
                lieu thereof ``In the case of a veteran described in 
                paragraph (1)(C), hospital''; and
                    (B) by striking out ``subparagraph'' and all that 
                follows through ``subsection'' and inserting in lieu 
                thereof ``paragraph (1)(C)'';
            (3) in paragraph (3), by striking out ``of this section 
        after December 31, 1996'' and inserting in lieu thereof ``after 
        December 31, 1998, in the case of care for a veteran described 
        in paragraph (1)(A) or paragraph (1)(C)''; and
            (4) by adding at the end the following new paragraph:
    ``(4) For purposes of this subsection and section 1712 of this 
title:
            ``(A) The term `herbicide-exposed veteran' means a veteran 
        (i) who served on active duty in the Republic of Vietnam during 
        the Vietnam era, and (ii) who the Secretary finds may have been 
        exposed during such service to a herbicide agent.
            ``(B) The term `herbicide agent' has the meaning given that 
        term in section 1116(a)(4) of this title.
            ``(C) The term `radiation-exposed veteran' has the meaning 
        given that term in section 1112(c)(4) of this title.''.
    (b) Authorized Outpatient Care.--Section 1712 of such title is 
amended--
            (1) in subsection (a)(1)--
                    (A) by striking out ``and'' at the end of 
                subparagraph (C);
                    (B) in subparagraph (D)--
                            (i) by striking out ``before December 31, 
                        1996,'' and inserting in lieu thereof ``before 
                        January 1, 1999,''; and
                            (ii) by striking out the period at the end 
                        of subparagraph (D) and inserting in lieu 
                        thereof a semicolon;
                    (C) by adding at the end the following new 
                subparagraphs:
            ``(E) during the period before January 1, 1999, to any 
        herbicide-exposed veteran (as defined in section 1710(e)(4)(A) 
        of this title) for any disease specified in section 
        1710(e)(1)(A) of this title; and
            ``(F) to any radiation-exposed veteran (as defined in 
        section 1112(c)(4) of this title) for any disease covered under 
        section 1710(e)(1)(B) of this title.''; and
            (2) in subsection (i)(3)--
                    (A) by striking out ``(A)''; and
                    (B) by striking out ``, or (B)'' and all that 
                follows through ``title''.
    (c) Savings Provisions.--The provisions of sections 1710(e) and 
1712(a) of title 38, United States Code, as in effect on the day before 
the date of the enactment of this Act, shall continue to apply on and 
after such date with respect to the furnishing of hospital care, 
nursing home care, and medical services for any veteran who was 
furnished such care or services before such date of enactment on the 
basis of presumed exposure to a substance or radiation under the 
authority of those provisions, but only for treatment for a disability 
for which such care or services were furnished before such date.

SEC. 2. DEPARTMENT COMMITTEE ON CARE OF SEVERELY CHRONICALLY MENTALLY 
              ILL VETERANS.

    (a) Establishment.--Subchapter II of chapter 73 of title 38, United 
States Code, is amended by adding after section 7318 the following new 
section:
``Sec. 7319. Committee on Care of Severely Chronically Mentally Ill 
              Veterans
    ``(a) Establishment.--The Secretary, acting through the Under 
Secretary for Health, shall establish in the Veterans Health 
Administration a Committee on Care of Severely Chronically Mentally Ill 
Veterans. The Under Secretary shall appoint employees of the Department 
with expertise in the care of the chronically mentally ill to serve on 
the committee.
    ``(b) Duties.--The committee shall assess, and carry out a 
continuing assessment of, the capability of the Veterans Health 
Administration to meet effectively the treatment and rehabilitation 
needs of mentally ill veterans whose mental illness is severe and 
chronic and who are eligible for health care furnished by the 
Department. In carrying out that responsibility, the committee shall--
            ``(1) evaluate the care provided to such veterans through 
        the Veterans Health Administration;
            ``(2) identify systemwide problems in caring for such 
        veterans in facilities of the Veterans Health Administration;
            ``(3) identify specific facilities within the Veterans 
        Health Administration at which program enrichment is needed to 
        improve treatment and rehabilitation of such veterans; and
            ``(4) identify model programs which the committee considers 
        to have been successful in the treatment and rehabilitation of 
        such veterans and which should be implemented more widely in or 
        through facilities of the Veterans Health Administration.
    ``(c) Advice and Recommendations.--The committee shall--
            ``(1) advise the Under Secretary regarding the development 
        of policies for the care and rehabilitation of severely 
        chronically mentally ill veterans; and
            ``(2) make recommendations to the Under Secretary--
                    ``(A) for improving programs of care of such 
                veterans at specific facilities and throughout the 
                Veterans Health Administration;
                    ``(B) for establishing special programs of 
                education and training relevant to the care of such 
                veterans for employees of the Veterans Health 
                Administration;
                    ``(C) regarding research needs and priorities 
                relevant to the care of such veterans; and
                    ``(D) regarding the appropriate allocation of 
                resources for all such activities.
    ``(d) Annual Report.--(1) Not later than April 1, 1997, the 
Secretary shall submit to the Committees on Veterans' Affairs of the 
Senate and House of Representatives a report on the implementation of 
this section. The report shall include the following:
            ``(A) A list of the members of the committee.
            ``(B) The assessment of the Under Secretary for Health, 
        after review of the initial findings of the committee, 
        regarding the capability of the Veterans Health Administration, 
        on a systemwide and facility-by-facility basis, to meet 
        effectively the treatment and rehabilitation needs of severely 
        chronically mentally ill veterans who are eligible for 
        Department care.
            ``(C) The plans of the committee for further assessments.
            ``(D) The findings and recommendations made by the 
        committee to the Under Secretary for Health and the views of 
        the Under Secretary on such findings and recommendations.
            ``(E) A description of the steps taken, plans made (and a 
        timetable for their execution), and resources to be applied 
        toward improving the capability of the Veterans Health 
        Administration to meet effectively the treatment and 
        rehabilitation needs of severely chronically mentally ill 
        veterans who are eligible for Department care.
    ``(2) Not later than February 1, 1998, and February 1 of each of 
the three following years, the Secretary shall submit to the Committees 
on Veterans' Affairs of the Senate and House of Representatives a 
report containing information updating the reports submitted under this 
subsection before the submission of such report.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 73 is amended by inserting after the item relating to section 
7318 the following new item:

``7319. Committee on Care of Severely Chronically Mentally Ill 
                            Veterans.''.

SEC. 3. CENTERS FOR MENTAL ILLNESS RESEARCH, EDUCATION, AND CLINICAL 
              ACTIVITIES.

    (a) In General.--(1) Subchapter II of chapter 73 is amended by 
adding after section 7319, as added by section 2(a), the following new 
section:
``Sec. 7320. Centers for mental illness research, education, and 
              clinical activities
    ``(a) The purpose of this section is to provide for the improvement 
of the provision of health-care services and related counseling 
services to eligible veterans suffering from mental illness (especially 
mental illness related to service-related conditions) through--
            ``(1) the conduct of research (including research on 
        improving mental health service facilities of the Department 
        and on improving the delivery of mental health services by the 
        Department);
            ``(2) the education and training of health care personnel 
        of the Department; and
            ``(3) the development of improved models and systems for 
        the furnishing of mental health services by the Department.
    ``(b)(1) The Secretary shall establish and operate centers for 
mental illness research, education, and clinical activities. Such 
centers shall be established and operated by collaborating Department 
facilities as provided in subsection (c)(1). Each such center shall 
function as a center for--
            ``(A) research on mental health services;
            ``(B) the use by the Department of specific models for 
        furnishing services to treat serious mental illness;
            ``(C) education and training of health-care professionals 
        of the Department; and
            ``(D) the development and implementation of innovative 
        clinical activities and systems of care with respect to the 
        delivery of such services by the Department.
    ``(2) The Secretary shall, upon the recommendation of the Under 
Secretary for Health, designate the centers under this section. In 
making such designations, the Secretary shall ensure that the centers 
designated are located in various geographic regions of the United 
States. The Secretary may designate a center under this section only 
if--
            ``(A) the proposal submitted for the designation of the 
        center meets the requirements of subsection (c);
            ``(B) the Secretary makes the finding described in 
        subsection (d); and
            ``(C) the peer review panel established under subsection 
        (e) makes the determination specified in subsection (e)(3) with 
        respect to that proposal.
    ``(3) Not more than five centers may be designated under this 
section.
    ``(4) The authority of the Secretary to establish and operate 
centers under this section is subject to the appropriation of funds for 
that purpose.
    ``(c) A proposal submitted for the designation of a center under 
this section shall--
            ``(1) provide for close collaboration in the establishment 
        and operation of the center, and for the provision of care and 
        the conduct of research and education at the center, by a 
        Department facility or facilities in the same geographic area 
        which have a mission centered on care of the mentally ill and a 
        Department facility in that area which has a mission of 
        providing tertiary medical care;
            ``(2) provide that no less than 50 percent of the funds 
        appropriated for the center for support of clinical care, 
        research, and education will be provided to the collaborating 
        facility or facilities that have a mission centered on care of 
        the mentally ill; and
            ``(3) provide for a governance arrangement between the 
        collaborating Department facilities which ensures that the 
        center will be established and operated in a manner aimed at 
        improving the quality of mental health care at the 
        collaborating facility or facilities which have a mission 
        centered on care of the mentally ill.
    ``(d) The finding referred to in subsection (b)(2)(B) with respect 
to a proposal for designation of a site as a location of a center under 
this section is a finding by the Secretary, upon the recommendation of 
the Under Secretary for Health, that the facilities submitting the 
proposal have developed (or may reasonably be anticipated to develop) 
each of the following:
            ``(1) An arrangement with an accredited medical school that 
        provides education and training in psychiatry and with which 
        one or more of the participating Department facilities is 
        affiliated under which medical residents receive education and 
        training in psychiatry through regular rotation through the 
        participating Department facilities so as to provide such 
        residents with training in the diagnosis and treatment of 
        mental illness.
            ``(2) An arrangement with an accredited graduate school of 
        psychology under which students receive education and training 
        in clinical, counseling, or professional psychology through 
        regular rotation through the participating Department 
        facilities so as to provide such students with training in the 
        diagnosis and treatment of mental illness.
            ``(3) An arrangement under which nursing, social work, or 
        allied health personnel receive training and education in 
        mental health care through regular rotation through the 
        participating Department facilities.
            ``(4) The ability to attract scientists who have 
        demonstrated achievement in research--
                     ``(A) into the evaluation of innovative approaches 
                to the design of mental health services; or
                    ``(B) into the causes, prevention, and treatment of 
                mental illness.
            ``(5) The capability to evaluate effectively the activities 
        of the center, including activities relating to the evaluation 
        of specific efforts to improve the quality and effectiveness of 
        mental health services provided by the Department at or through 
        individual facilities.
    ``(e)(1) In order to provide advice to assist the Secretary and the 
Under Secretary for Health to carry out their responsibilities under 
this section, the official within the central office of the Veterans 
Health Administration responsible for mental health and behavioral 
sciences matters shall establish a peer review panel to assess the 
scientific and clinical merit of proposals that are submitted to the 
Secretary for the designation of centers under this section.
    ``(2) The panel shall consist of experts in the fields of mental 
health research, education and training, and clinical care. Members of 
the panel shall serve as consultants to the Department.
    ``(3) The panel shall review each proposal submitted to the panel 
by the official referred to in paragraph (1) and shall submit to that 
official its views on the relative scientific and clinical merit of 
each such proposal. The panel shall specifically determine with respect 
to each such proposal whether that proposal is among those proposals 
which have met the highest competitive standards of scientific and 
clinical merit.
    ``(4) The panel shall not be subject to the Federal Advisory 
Committee Act (5 U.S.C. App.).
    ``(f) Clinical and scientific investigation activities at each 
center established under this section--
            ``(1) may compete for the award of funding from amounts 
        appropriated for the Department of Veterans Affairs medical and 
        prosthetics research account; and
            ``(2) shall receive priority in the award of funding from 
        such account insofar as funds are awarded to projects and 
        activities relating to mental illness.
    ``(g) The Under Secretary for Health shall ensure that at least 
three centers designated under this section emphasize research into 
means of improving the quality of care for veterans suffering from 
mental illness through the development of community-based alternatives 
to institutional treatment for such illness.
    ``(h) The Under Secretary for Health shall ensure that information 
produced by the research, education and training, and clinical 
activities of centers established under this section that may be useful 
for other activities of the Veterans Health Administration is 
disseminated throughout the Veterans Health Administration. Such 
dissemination shall be made through publications, through programs of 
continuing medical and related education provided through regional 
medical education centers under subchapter VI of chapter 74 of this 
title, and through other means. Such programs of continuing medical 
education shall receive priority in the award of funding.
    ``(i) The official within the central office of the Veterans Health 
Administration responsible for mental health and behavioral sciences 
matters shall be responsible for supervising the operation of the 
centers established pursuant to this section and shall provide for 
ongoing evaluation of the centers and their compliance with the 
requirements of this section.
    ``(j)(1) There are authorized to be appropriated to the Department 
of Veterans Affairs for the basic support of the research and education 
and training activities of centers established pursuant to this section 
amounts as follows:
            ``(A) $3,125,000 for fiscal year 1998.
            ``(B) $6,250,000 for each of fiscal years 1999 through 
        2001.
    ``(2) In addition to funds appropriated for a fiscal year pursuant 
to the authorization of appropriations in paragraph (1), the Under 
Secretary for Health shall allocate to such centers from other funds 
appropriated for that fiscal year generally for the Department of 
Veterans Affairs medical care account and the Department of Veterans 
Affairs medical and prosthetics research account such amounts as the 
Under Secretary for Health determines appropriate to carry out the 
purposes of this section.''.
    (2) The table of sections at the beginning of chapter 73 is amended 
by inserting after the item relating to section 7319, as added by 
section 2(b), the following new item:

``7320. Centers for mental illness research, education, and clinical 
                            activities.''.
    (b) Annual Reports.--Not later than February 1 of each of 1998, 
1999, and 2000, the Secretary of Veterans Affairs shall submit to the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives a report on the status and activities during the 
previous fiscal year of the centers for mental illness, research, 
education, and clinical activities established pursuant to section 7320 
of title 38, United States Code (as added by subsection (a)). Each such 
report shall include the following:
            (1) A description of the activities carried out at each 
        center and the funding provided for such activities.
            (2) A description of the advances made at each of the 
        participating facilities of the center in research, education 
        and training, and clinical activities relating to mental 
        illness in veterans.
            (3) A description of the actions taken by the Under 
        Secretary for Health pursuant to subsection (h) of that section 
        (as so added) to disseminate information derived from such 
        activities throughout the Veterans Health Administration.
            (4) The Secretary's evaluations of the effectiveness of the 
        centers in fulfilling the purposes of the centers.
    (c) Implementation.--The Secretary of Veterans Affairs shall 
designate at least one center under section 7320 of title 38, United 
States Code, not later than January 1, 1998.

SEC. 4. DISBURSEMENT AGREEMENTS RELATING TO MEDICAL RESIDENTS AND 
              INTERNS.

    Section 7406(c) of title 38, United States Code, is amended--
            (1) by striking out ``Department hospital'' each place it 
        appears and inserting in lieu thereof ``Department facility 
        furnishing hospital care or medical services'';
            (2) by striking out ``participating hospital'' in paragraph 
        (4)(C) and inserting in lieu thereof ``participating 
        facility''; and
            (3) by striking out ``hospital'' both places it appears in 
        paragraph (5) and inserting in lieu thereof ``facility''.

SEC. 5. AUTHORITY TO SUSPEND SPECIAL PAY AGREEMENTS FOR PHYSICIANS AND 
              DENTISTS WHO ENTER RESIDENCY TRAINING PROGRAMS.

    Section 7432(b)(2) of title 38, United States Code, is amended--
            (1) by inserting ``(A)'' after ``(2)''; and
            (2) by adding at the end the following:
    ``(B) The Secretary may suspend a special pay agreement entered 
into under this section in the case of a physician or dentist who, 
having entered into the special pay agreement, enters a residency 
training program. Any such suspension shall terminate when the 
physician or dentist completes, withdraws from, or is no longer a 
participant in the program. During the period of such a suspension, the 
physician or dentist is not subject to the provisions of paragraph 
(1).''.
                                 <all>