[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 1359 Reported in Senate (RS)]





                                                       Calendar No. 635

104th CONGRESS

  2d Session

                                S. 1359

                          [Report No. 104-372]

_______________________________________________________________________

                                 A BILL

 To amend title 38, United States Code, to revise certain authorities 
relating to management and contracting in the provision of health care 
                               services.

_______________________________________________________________________

                           September 26, 1996

        Reported with an amendment and an amendment to the title





                                                       Calendar No. 635
104th CONGRESS
  2d Session
                                S. 1359

                          [Report No. 104-372]

 To amend title 38, United States Code, to revise certain authorities 
relating to management and contracting in the provision of health care 
                               services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 24, 1995

  Mr. Simpson introduced the following bill; which was read twice and 
             referred to the Committee on Veterans' Affairs

                           September 26, 1996

  Reported by Mr. Simpson, with an amendment and an amendment to the 
                                 title
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
 To amend title 38, United States Code, to revise certain authorities 
relating to management and contracting in the provision of health care 
                               services.

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

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Veterans Health Care 
Management and Contracting Flexibility Act of 1995''.</DELETED>

<DELETED>SEC. 2. WAITING PERIOD FOR ADMINISTRATIVE 
              REORGANIZATIONS.</DELETED>

<DELETED>    Section 510(b) of title 38, United States Code, is 
amended--</DELETED>
        <DELETED>    (1) in the second sentence, by striking out ``90-
        day period of continuous session of Congress following'' and 
        inserting in lieu thereof ``45-day period beginning on''; 
        and</DELETED>
        <DELETED>    (2) by striking out the third sentence.</DELETED>

<DELETED>SEC. 3. REPEAL OF LIMITATIONS ON CONTRACTS FOR CONVERSION OF 
              PERFORMANCE OF ACTIVITIES OF DEPARTMENT HEALTH-CARE 
              FACILITIES.</DELETED>

<DELETED>    Section 8110 of title 38, United States Code, is amended 
by striking out subsection (c).</DELETED>

<DELETED>SEC. 4. REVISION OF AUTHORITY TO SHARE MEDICAL FACILITIES, 
              EQUIPMENT, AND INFORMATION.</DELETED>

<DELETED>    (a) Statement of Purpose.--The text of section 8151 of 
title 38, United States Code, is amended to read as follows:</DELETED>
<DELETED>    ``It is the purpose of this subchapter to improve the 
quality of health care provided veterans under this title by 
authorizing the Secretary to enter into agreements with health-care 
providers in order to share health-care resources with, and receive 
health-care resources from, such providers while ensuring no diminution 
of services to veterans. Among other things, it is intended by these 
means to strengthen the medical programs at Department facilities 
located in small cities or rural areas which facilities are remote from 
major medical centers.''.</DELETED>
<DELETED>    (b) Definitions.--Section 8152 of such title is amended--
</DELETED>
        <DELETED>    (1) by striking out paragraphs (1), (2) and (3) 
        and inserting in lieu thereof the following new paragraphs (1) 
        and (2):</DELETED>
        <DELETED>    ``(1) The term `health-care resource' includes 
        hospital care (as that term is defined in section 1701(5) of 
        this title), any other health-care service, and any health-care 
        support or administrative resource.</DELETED>
        <DELETED>    ``(2) The term `health-care providers' includes 
        health-care plans and insurers and any organizations, 
        institutions, or other entities or individuals that furnish 
        health-care resources.''; and</DELETED>
        <DELETED>    (2) by redesignating paragraph (4) as paragraph 
        (3).</DELETED>
<DELETED>    (c) Authority To Secure Health-Care Resources.--(1) 
Section 8153 of such title is amended--</DELETED>
        <DELETED>    (A) by striking out paragraph (1) of subsection 
        (a) and inserting in lieu thereof the following new paragraph 
        (1):</DELETED>
<DELETED>    ``(1) The Secretary may, when the Secretary determines it 
to be necessary in order to secure health-care resources which 
otherwise might not be feasibly available or to utilize effectively 
health-care resources, make arrangements, by contract or other form of 
agreement, for the mutual use, or exchange of use, of health-care 
resources between Department health-care facilities and non-Department 
health-care providers. The Secretary may make such arrangements without 
regard to any law or regulation relating to competitive procedures.''; 
and</DELETED>
        <DELETED>    (B) by striking out subsection (e).</DELETED>
<DELETED>    (2)(A) The section heading of such section is amended to 
read as follows:</DELETED>
<DELETED>``Sec. 8153. Sharing of health-care resources''.</DELETED>
<DELETED>    (B) The table of sections at the beginning of chapter 81 
of such title is amended by striking out the item relating to section 
8153 and inserting in lieu thereof the following new item:</DELETED>

<DELETED>``8153. Sharing of health-care resources.''.

</DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Veterans' Medical 
Programs Amendments of 1996''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.

                TITLE I--VETERANS HEALTH ADMINISTRATION

                       Subtitle A--Administration

Sec. 101. Revision of authority to share medical facilities, equipment, 
                            and information.
Sec. 102. Waiting period for administrative reorganizations.
Sec. 103. Repeal of limitations on contracts for conversion of 
                            performance of activities of department 
                            health-care facilities.

                         Subtitle B--Personnel

Sec. 111. Revision of administrative authorities regarding residencies 
                            and internships.
Sec. 112. Renumerated outside professional activities by Veterans 
                            Health Administration personnel.
Sec. 113. Authority to waive special pay agreement refund requirements 
                            for physicians and dentists who enter into 
                            residency training programs.

                         TITLE II--HEALTH CARE

                  Subtitle A--Readjustment Counseling

Sec. 201. Organization of the Readjustment Counseling Service in the 
                            Department of Veterans Affairs.
Sec. 202. Expansion of eligibility for readjustment counseling and 
                            certain related counseling services.
Sec. 203. Advisory Committee on the Readjustment of Veterans.
Sec. 204. Report on collocation of Vet Centers and Department of 
                            Veterans Affairs outpatient clinics.
Sec. 205. Report on provision of limited health care services at 
                            readjustment counseling centers.

                      Subtitle B--Other Provisions

Sec. 211. Payment to States of per diem for veterans receiving adult 
                            day health care.
Sec. 212. Expanded health care sharing agreement authority.
Sec. 213. Evaluation of health status of spouses and children of 
                            Persian Gulf War veterans.
Sec. 214. Transmittal of reports of Special Committee for the Seriously 
                            Mentally Ill Veteran.

                    TITLE III--HEALTH CARE RESEARCH

Sec. 301. Mental illness research, education, and clinical centers.
Sec. 302. Research corporations.

                    TITLE IV--HOSPICE CARE SERVICES

Sec. 401. Short title.
Sec. 402. Programs for furnishing hospice care to veterans.

                     TITLE V--MAMMOGRAPHY STANDARDS

Sec. 501. Short title.
Sec. 502. Mammography quality standards.

SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.

    Except as otherwise expressly provided, whenever in this Act an 
amendment or repeal is expressed in terms of an amendment to or repeal 
of a section or other provision, the reference shall be considered to 
be made to a section or other provision of title 38, United States 
Code.

                TITLE I--VETERANS HEALTH ADMINISTRATION

                       Subtitle A--Administration

SEC. 101. REVISION OF AUTHORITY TO SHARE MEDICAL FACILITIES, EQUIPMENT, 
              AND INFORMATION.

    (a) Statement of Purpose.--The text of section 8151 is amended to 
read as follows:
    ``It is the purpose of this subchapter to improve the quality of 
health care provided veterans under this title by authorizing the 
Secretary to enter into agreements with health-care providers in order 
to share health-care resources with, and receive health-care resources 
from, such providers while ensuring no diminution of services to 
veterans. Among other things, it is intended by these means to 
strengthen the medical programs at Department facilities located in 
small cities or rural areas which facilities are remote from major 
medical centers.''.
    (b) Definitions.--Section 8152 is amended--
            (1) by striking out paragraphs (1), (2), and (3) and 
        inserting in lieu thereof the following new paragraphs (1) and 
        (2):
            ``(1) The term `health-care resource' includes hospital 
        care (as that term is defined in section 1701(5) of this 
        title), any other health-care service, and any health-care 
        support or administrative resource.
            ``(2) The term `health-care providers' includes health-care 
        plans and insurers and any organizations, institutions, or 
        other entities or individuals that furnish health-care 
        resources.''; and
            (2) by redesignating paragraph (4) as paragraph (3).
    (c) Authority To Secure Health-Care Resources.--(1) Section 8153 is 
amended--
            (A) by striking out paragraph (1) of subsection (a) and 
        inserting in lieu thereof the following new paragraph (1):
    ``(1) The Secretary, when the Secretary determines it to be 
necessary in order to secure health-care resources which might not 
otherwise be feasibly available or to utilize effectively health-care 
resources, may make arrangements, by contract or other form of 
agreement, for the mutual use, or exchange of use, of health-care 
resources between Department health-care facilities and non-Department 
health-care providers. The Secretary may make such arrangements without 
regard to any law or regulation relating to competitive procedures.''; 
and
            (B) by striking out subsection (e).
    (2)(A) The section heading of such section is amended to read as 
follows:
``Sec. 8153. Sharing of health-care resources''.
    (B) The table of sections at the beginning of chapter 81 is amended 
by striking out the item relating to section 8153 and inserting in lieu 
thereof the following new item:

``8153. Sharing of health-care resources.''.

SEC. 102. WAITING PERIOD FOR ADMINISTRATIVE REORGANIZATIONS.

    Section 510(b) is amended by striking out ``90-day period of 
continuous session of Congress following'' in the second sentence and 
inserting in lieu thereof ``45-day period (30 days of which shall be 
days during which Congress shall have been in continuous session) 
beginning on''.

SEC. 103. REPEAL OF LIMITATIONS ON CONTRACTS FOR CONVERSION OF 
              PERFORMANCE OF ACTIVITIES OF DEPARTMENT HEALTH-CARE 
              FACILITIES.

    Section 8110 is amended by striking out subsection (c).

                         Subtitle B--Personnel

SEC. 111. REVISION OF ADMINISTRATIVE AUTHORITIES REGARDING RESIDENCIES 
              AND INTERNSHIPS.

    (a) Covered Residents and Interns.--Section 7406(c) is amended by 
striking out ``Department hospital'' each place it appears (other than 
paragraphs (2)(B) and (4)(C)) and inserting in lieu thereof 
``Department facility furnishing hospital care or medical services''.
    (b) Conforming Amendments.--Such section is further amended--
            (1) in paragraph (2)(B), by striking out ``Department 
        hospital'' and inserting in lieu thereof ``Department 
        facility'';
            (2) in paragraph (4), by striking out ``participating 
        hospital, including a Department hospital'' and inserting in 
        lieu thereof ``participating facility, including a Department 
        facility''; and
            (3) in paragraph (5), by striking out ``hospital'' both 
        places it appears and inserting in lieu thereof ``facility''.

SEC. 112. RENUMERATED OUTSIDE PROFESSIONAL ACTIVITIES BY VETERANS 
              HEALTH ADMINISTRATION PERSONNEL.

    (a) Authority.--Subsection (b) of section 7423 is amended--
            (1) by striking out paragraph (1); and
            (2) by redesignating paragraphs (2) through (6) as 
        paragraphs (1) through (5), respectively.
    (b) Conforming Amendment.--Subsection (c) of such section is 
amended in the matter preceding paragraph (1) by striking out 
``subsection (b)(6)'' and inserting in lieu thereof ``subsection 
(b)(5)''.

SEC. 113. AUTHORITY TO WAIVE SPECIAL PAY AGREEMENT REFUND REQUIREMENTS 
              FOR PHYSICIANS AND DENTISTS WHO ENTER INTO RESIDENCY 
              TRAINING PROGRAMS.

    Section 7432(b)(2) is amended--
            (1) by inserting ``(A)'' after ``(2)''; and
            (2) by adding at the end the following:
    ``(B) The Secretary may suspend the applicability of an agreement 
under this subchapter in the case of a physician or dentist who enters 
a residency training program for the period of the participation of the 
physician or dentist, as the case may be, in the program. The physician 
or dentist shall not be subject to the refund requirements with respect 
to the agreement under paragraph (1) during the period of the 
suspension.''.

                         TITLE II--HEALTH CARE

                  Subtitle A--Readjustment Counseling

SEC. 201. ORGANIZATION OF THE READJUSTMENT COUNSELING SERVICE IN THE 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Revision of Organizational Structure.--(1) The Secretary of 
Veterans Affairs may not alter or revise the organizational structure 
or the administrative structure of the organization (known as the 
Readjustment Counseling Service) within the Veterans Health 
Administration created to implement the programs established under 
section 1712A of title 38, United States Code, until--
            (A) the Secretary has submitted to the Committees on 
        Veterans' Affairs of the Senate and the House of 
        Representatives a report containing a full and complete 
        statement of the proposed alteration or revision; and
            (B) a period of 60 days has elapsed after the date on which 
        the report is received by the committees.
    (2) In the computation of the 60-day period under paragraph (1)(B), 
there shall be excluded any day on which either House of Congress is 
not in session because of an adjournment of more than 3 calendar days 
to a day certain.
    (b) Budget Information Relating to the Service.--Each budget 
submitted to Congress by the President under section 1105 of title 31, 
United States Code, shall set forth the amount requested in the budget 
for the operation of the organization referred to in subsection (a)(1) 
in the fiscal year covered by the budget and shall set forth separately 
the amount requested for administrative oversight of the activities of 
the organization.

SEC. 202. EXPANSION OF ELIGIBILITY FOR READJUSTMENT COUNSELING AND 
              CERTAIN RELATED COUNSELING SERVICES.

    (a) Readjustment Counseling.--(1) Subsection (a) of section 1712A 
is amended to read as follows:
    ``(a)(1)(A) Upon the request of any veteran referred to in 
subparagraph (B) of this paragraph, the Secretary shall furnish 
counseling to the veteran to assist the veteran in readjusting to 
civilian life.
    ``(B) Subparagraph (A) applies to the following veterans:
            ``(i) Any veteran who served on active duty in a theater of 
        combat operations (as determined by the Secretary in 
        consultation with the Secretary of Defense) during the Vietnam 
        era.
            ``(ii) Any veteran who served on active duty during the 
        Vietnam era if the veteran seeks such counseling before January 
        1, 2000.
            ``(iii) Any veteran referred to in clause (ii) of this 
        subparagraph if the veteran is furnished counseling under this 
        subsection before the date referred to in that clause.
            ``(iv) Any veteran who served on active military, naval, or 
        air service in a theater of combat operations (as so 
        determined) during a period of war, or in any other area during 
        a period in which hostilities (as defined in subparagraph (D) 
        of this paragraph) occurred in such area.
    ``(C) Upon the request of any veteran other than a veteran covered 
by subparagraph (A) of this paragraph, the Secretary may furnish 
counseling to the veteran to assist the veteran in readjusting to 
civilian life.
    ``(D) For the purposes of subparagraph (B) of this paragraph, the 
term `hostilities' means an armed conflict in which the members of the 
Armed Forces are subjected to danger comparable to the danger to which 
members of the Armed Forces have been subjected in combat with enemy 
armed forces during a period of war, as determined by the Secretary in 
consultation with the Secretary of Defense.
    ``(2) The counseling referred to in paragraph (1) of this 
subsection shall include a general mental and psychological assessment 
of a covered veteran to ascertain whether such veteran has mental or 
psychological problems associated with readjustment to civilian 
life.''.
    (2) Subsection (c) of such section is repealed.
    (b) Other Counseling.--Such section is further amended by inserting 
after subsection (b) the following new subsection (c):
    ``(c)(1) The Secretary shall provide the counseling services 
described in section 1701(6)(B)(ii) of this title to the surviving 
parents, spouse, and children of any member of the Armed Forces who 
dies--
            ``(A) in a theater of combat operations (as determined by 
        the Secretary in consultation with the Secretary of Defense) 
        while on active military, naval, or air service during a period 
        of war;
            ``(B) in an area in which hostilities (as defined in 
        subsection (a)(1)(D) of this section) are occurring while on 
        such service during such hostilities;
            ``(C) as a result of a disease, injury, or condition 
        incurred while on such service in a theater of combat 
        operations (as so determined)
    ``(2) The Secretary may provide the counseling services referred to 
in paragraph (1) of this subsection to the surviving parents, spouse, 
and children of any member of the Armed Forces who dies while serving 
on active duty or from a condition (as determined by the Secretary) 
incurred in or aggravated by such service.''.
    (c) Authority To Contract for Counseling Services.--Subsection (e) 
of such section is amended by striking out ``subsections (a) and (b)'' 
each place it appears and inserting in lieu thereof ``subsections (a), 
(b), and (c)''.

SEC. 203. ADVISORY COMMITTEE ON THE READJUSTMENT OF VETERANS.

    (a) In General.--(1) Subchapter III of chapter 5 is amended by 
inserting after section 544 the following:
``Sec. 545. Advisory Committee on the Readjustment of Veterans
    ``(a)(1) There is in the Department the Advisory Committee on the 
Readjustment of Veterans (hereinafter in this section referred to as 
the `Committee').
    ``(2) The Committee shall consist of not more than 18 members 
appointed by the Secretary from among individuals who--
            ``(A) have demonstrated significant civic or professional 
        achievement; and
            ``(B) have experience with the provision of veterans 
        benefits and services by the Department.
    ``(3) The Secretary shall seek to ensure that members appointed to 
the Committee include individuals from a wide variety of geographic 
areas and ethnic backgrounds, individuals from veterans service 
organizations, individuals with combat experience, and women.
    ``(4) The Secretary shall determine the terms of service and pay 
and allowances of the members of the Committee, except that a term of 
service may not exceed 2 years. The Secretary may reappoint any member 
for additional terms of service.
    ``(b)(1) The Secretary shall, on a regular basis, consult with and 
seek the advice of the Committee with respect to the provision by the 
Department of benefits and services to veterans in order to assist 
veterans in the readjustment to civilian life.
    ``(2)(A) In providing advice to the Secretary under this 
subsection, the Committee shall--
            ``(i) assemble and review information relating to the needs 
        of veterans in readjusting to civilian life;
            ``(ii) provide information relating to the nature and 
        character of psychological problems arising from service in the 
        Armed Forces;
            ``(iii) provide an on-going assessment of the effectiveness 
        of the policies, organizational structures, and services of the 
        Department in assisting veterans in readjusting to civilian 
        life; and
            ``(iv) provide on-going advice on the most appropriate 
        means of responding to the readjustment needs of veterans in 
        the future.
    ``(B) In carrying out its duties under subparagraph (A), the 
Committee shall take into special account the needs of veterans who 
have served in a theater of combat operations.
    ``(c)(1) Not later than March 31 of each year, the Committee shall 
submit to the Secretary a report on the programs and activities of the 
Department that relate to the readjustment of veterans to civilian 
life. Each such report shall include--
            ``(A) an assessment of the needs of veterans with respect 
        to readjustment to civilian life;
            ``(B) a review of the programs and activities of the 
        Department designed to meet such needs; and
            ``(C) such recommendations (including recommendations for 
        administrative and legislative action) as the Committee 
        considers appropriate.
    ``(2) Not later than 90 days after the receipt of a report under 
paragraph (1), the Secretary shall transmit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a copy of 
the report, together with any comments and recommendations concerning 
the report that the Secretary considers appropriate.
    ``(3) The Committee may also submit to the Secretary such other 
reports and recommendations as the Committee considers appropriate.
    ``(4) The Secretary shall submit with each annual report submitted 
to the Congress pursuant to section 529 of this title a summary of all 
reports and recommendations of the Committee submitted to the Secretary 
since the previous annual report of the Secretary submitted pursuant to 
that section.
    ``(d)(1) Except as provided in paragraph (2), the provisions of the 
Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the 
activities of the Committee under this section.
    ``(2) Section 14 of such Act shall not apply to the Committee.''.
    (2) The table of sections at the beginning of chapter 5 is amended 
by inserting after the item relating to section 544 the following:

``545. Advisory Committee on the Readjustment of Veterans.''.
    (b) Original Members.--(1) Notwithstanding subsection (a)(2) of 
section 545 of title 38, United States Code (as added by subsection 
(a)), the members of the Advisory Committee on the Readjustment of 
Vietnam and Other War Veterans on the date of the enactment of this Act 
shall be the original members of the advisory committee recognized 
under such section.
    (2) The original members shall so serve until the Secretary of 
Veterans Affairs carries out appointments under such subsection (a)(2). 
The Secretary shall carry out such appointments as soon after such date 
as is practicable. The Secretary may make such appointments from among 
such original members.

SEC. 204. REPORT ON COLLOCATION OF VET CENTERS AND DEPARTMENT OF 
              VETERANS AFFAIRS OUTPATIENT CLINICS.

    (a) Requirement.--(1) The Secretary of Veterans Affairs shall 
submit to the Committees on Veterans' Affairs of the Senate and the 
House of Representatives a report on the feasibility and desirability 
of the collocation of Vet Centers and outpatient clinics (including 
rural mobile clinics) of the Department of Veterans Affairs as current 
leases for such centers and clinics expire.
    (2) The Secretary shall submit the report not later than 6 months 
after the date of the enactment of this Act.
    (b) Covered Matters.--The report under this section shall include 
an assessment of the following:
            (1) The results of any collocation of Vet Centers and 
        outpatient clinics carried out by the Secretary before the date 
        of the enactment of this Act, including the effects of such 
        collocation on the quality of care provided at such centers and 
        clinics.
            (2) The effect of such collocation on the capacity of such 
        centers and clinics to carry out their primary mission.
            (3) The extent to which such collocation will impair the 
        operational independence or administrative integrity of such 
        centers and clinics.
            (4) The feasibility of combining the services provided by 
        such centers and clinics in the course of such collocation.
            (5) The advisability of the collocation of centers and 
        clinics of significantly different size.
            (6) The effect of the locations (including urban and rural 
        locations) of the centers and clinics on the feasibility and 
        desirability of such collocation.
            (7) The amount of any costs savings to be achieved by 
        Department as a result of such collocation.
            (8) Any other matters that the Secretary determines 
        appropriate.

SEC. 205. REPORT ON PROVISION OF LIMITED HEALTH CARE SERVICES AT 
              READJUSTMENT COUNSELING CENTERS.

    (a) Report.--Not later than 6 months after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to the Committees on Veterans' Affairs of the Senate and the House of 
Representatives a report on the feasibility and desirability of 
providing a limited battery of health care services (including 
ambulatory services and health care screening services) to veterans at 
Department of Veterans Affairs readjustment counseling centers.
    (b) Report Elements.--The report under subsection (a) shall include 
a discussion of the following:
            (1) The effect on the advisability of providing health care 
        services at readjustment counseling centers of the geographic 
        location of such centers, including the urban location and 
        rural location of such centers and the proximity of such 
        centers to Department of Veterans Affairs medical facilities.
            (2) The effect on the advisability of providing such 
        services at such centers of the type and level of services to 
        be provided, and the demographic characteristics (including 
        age, socio-economic status, ethnicity, and sex) of veterans 
        likely to be provided the services.
            (3) The effect of providing such services at such centers 
        on the readjustment counseling center program in general and on 
        the efficiency and autonomy of the clinical and administrative 
        operations of the readjustment counseling centers in 
        particular.
            (4) Any other matters that the Secretary considers 
        appropriate.

                      Subtitle B--Other Provisions

SEC. 211. 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 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) is amended by inserting ``adult day 
health,'' before ``or hospital care''.
    (2) Section 8132 is amended by inserting ``adult day health,'' 
before ``or hospital care''.
    (3) 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 construction 
        (other than new construction) of adult day health care 
        buildings'' before the semicolon.

SEC. 212. EXPANDED HEALTH CARE SHARING AGREEMENT AUTHORITY.

    Section 204 of the Veterans Health Care Act of 1992 (Public Law 
102-585; 106 Stat. 4950; 38 U.S.C. 8111 note) is amended by striking 
out ``October 1, 1996'' and inserting in lieu thereof ``December 31, 
1998''.

SEC. 213. EVALUATION OF HEALTH STATUS OF SPOUSES AND CHILDREN OF 
              PERSIAN GULF WAR VETERANS.

    Section 107(b) of the Persian Gulf War Veterans' Benefits Act 
(title I of Public Law 103-446; 108 Stat. 4652; 38 U.S.C. 1117 note) is 
amended by striking out ``September 30, 1996'' and inserting in lieu 
thereof ``December 31, 1998''.

SEC. 214. TRANSMITTAL OF REPORTS OF SPECIAL COMMITTEE FOR THE SERIOUSLY 
              MENTALLY ILL VETERAN.

    (a) Transmittal.--Not later than 60 days after the submittal to the 
Under Secretary for Health of the Department of Veterans Affairs of a 
report referred to in subsection (b), the Secretary of Veterans Affairs 
shall transmit to the Committees on Veterans' Affairs of the Senate and 
the House of Representatives a copy of the report, together with the 
comments of the Under Secretary for Health on the report.
    (b) Covered Reports.--Subsection (a) applies to any report 
submitted to the Under Secretary for Health by the Special Committee 
for the Seriously Mentally Ill Veteran as in existence on July 1, 1996.

                    TITLE III--HEALTH CARE RESEARCH

SEC. 301. MENTAL ILLNESS RESEARCH, EDUCATION, AND CLINICAL CENTERS.

    (a) In General.--Subchapter II of chapter 73 is amended by adding 
at the end the following:
``Sec. 7319. Mental illness research, education, and clinical centers
    ``(a) The purpose of this section is to improve 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 research (including 
research on improving mental health service facilities of the 
Department and on improving the delivery of mental health services by 
the Department), education and training of personnel, and the 
development of improved models and systems for the furnishing of mental 
health services by the Department.
    ``(b)(1) In order to carry out the purpose of this section, the 
Secretary, upon the recommendation of the Under Secretary for Health 
and pursuant to the provisions of this subsection, shall--
            ``(A) designate not more than five health-care facilities 
        of the Department as the locations for a center of research on 
        mental health services, on the use by the Department of 
        specific models for furnishing such services, on education and 
        training, and on the development and implementation of 
        innovative clinical activities and systems of care with respect 
        to the delivery of such services by the Department; and
            ``(B) subject to the appropriation of funds for such 
        purpose, establish and operate such centers at such locations 
        in accordance with this section.
    ``(2) The Secretary shall designate at least one facility under 
paragraph (1) not later than January 1, 1997.
    ``(3) The Secretary shall, upon the recommendation of the Under 
Secretary for Health, ensure that the facilities designated for centers 
under paragraph (1) are located in various geographic regions.
    ``(4) The Secretary may not designate any health-care facility as a 
location for a center under paragraph (1) unless--
            ``(A) the peer review panel established under paragraph (5) 
        has determined under that paragraph that the proposal submitted 
        by such facility as a location for a new center under this 
        subsection is among those proposals which have met the highest 
        competitive standards of scientific and clinical merit; and
            ``(B) the Secretary, upon the recommendation of the Under 
        Secretary for Health, determines that the facility has 
        developed (or may reasonably be anticipated to develop)--
                    ``(i) an arrangement with an accredited medical 
                school which provides education and training in 
                psychiatry and with which the facility is affiliated 
                under which arrangement residents receive education and 
                training in psychiatry through regular rotation through 
                the facility so as to provide such residents with 
                training in the diagnosis and treatment of mental 
                illness;
                    ``(ii) an arrangement with an accredited graduate 
                program of psychology under which arrangement students 
                receive education and training in clinical, counseling, 
                or professional psychology through regular rotation 
                through the facility so as to provide such students 
                with training in the diagnosis and treatment of mental 
                illness;
                    ``(iii) an arrangement under which nursing, social 
                work, counseling, or allied health personnel receive 
                training and education in mental health care through 
                regular rotation through the facility;
                    ``(iv) the ability to attract scientists who have 
                demonstrated creativity and achievement in research--
                             ``(I) into the evaluation of innovative 
                        approaches to the design of mental health 
                        services; or
                            ``(II) into the causes, prevention, and 
                        treatment of mental illness;
                    ``(v) a policymaking advisory committee composed of 
                appropriate mental health-care and research personnel 
                of the facility and of the affiliated school or schools 
                to advise the directors of the facility and the center 
                on policy matters pertaining to the activities of the 
                center during the period of the operation of the 
                center; and
                    ``(vi) the capability to evaluate effectively the 
                activities of the center, including the evaluation of 
                specific efforts to improve the quality and 
                effectiveness of mental health services provided by the 
                Department at or through individual facilities.
    ``(5)(A) In order to provide advice to assist the Under Secretary 
for Health and the Secretary 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 panel to assess the scientific and 
clinical merit of proposals that are submitted to the Secretary for the 
establishment of new centers under this subsection.
    ``(B) The membership of 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 
for a period of no longer than six months.
    ``(C) The panel shall review each proposal submitted to the panel 
by the official referred to in subparagraph (A) and shall submit its 
views on the relative scientific and clinical merit of each such 
proposal to that official.
    ``(D) The panel shall not be subject to the provisions of the 
Federal Advisory Committee Act (5 U.S.C. App.).
    ``(c) Clinical and scientific investigation activities at each 
center established under subsection (b)(1) may compete for the award of 
funding from amounts appropriated for the Department of Veterans 
Affairs medical and prosthetics research account and shall receive 
priority in the award of funding from such account insofar as funds are 
awarded to projects and activities relating to mental illness.
    ``(d) The Under Secretary for Health shall ensure that at least 
three centers designated under subsection (b)(1)(A) 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.
    ``(e) The Under Secretary for Health shall ensure that useful 
information produced by the research, education and training, and 
clinical activities of the centers established under subsection (b)(1) 
is disseminated throughout the Veterans Health Administration through 
publications and 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.
    ``(f) 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 subsection (b)(1).
    ``(g)(1) There are authorized to be appropriated for the Department 
of Veterans Affairs for the basic support of the research and education 
and training activities of the centers established pursuant to 
subsection (b)(1) the following:
            ``(A) $3,125,000 for fiscal year 1997.
            ``(B) $6,250,000 for each of fiscal years 1998 through 
        2000.
    ``(2) In addition to the funds available under the authorization of 
appropriations in paragraph (1), the Under Secretary for Health shall 
allocate to such centers from other funds appropriated 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 
in order to carry out the purposes of this section.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 73 is amended by adding at the end of the matter relating to 
subchapter II the following:

``7319. Mental illness research, education, and clinical centers.''.
    (c) Reports.--Not later than February 1 of each of 1997, 1998, and 
1999, the Secretary of Veterans Affairs shall submit to the Committees 
on Veterans' Affairs of the Senate and the House of Representatives a 
report on the status and activities during the previous fiscal year of 
the mental illness, research, education, and clinical centers 
established pursuant to section 7319 of title 38, United States Code 
(as added by subsection (a)). Each such report shall contain the 
following:
            (1) A description of--
                    (A) the activities carried out at each center and 
                the funding provided for such activities;
                    (B) the advances made at each center in research, 
                education and training, and clinical activities 
                relating to mental illness in veterans; and
                    (C) the actions taken by the Under Secretary for 
                Health pursuant to subsection (d) of such section (as 
                so added) to disseminate useful information derived 
                from such activities throughout the Veterans Health 
                Administration.
            (2) The Secretary's evaluations of the effectiveness of the 
        centers in fulfilling the purposes of the centers.

SEC 302. RESEARCH CORPORATIONS.

    (a) Renewal of Authority.--Section 7368 is amended by striking out 
``December 31, 1992'' and inserting in lieu thereof ``December 31, 
2000''.
    (b) Clarification of Tax-Exempt Status.--(1) Section 7361(b) is 
amended by striking out ``section 501(c)(3) of''.
    (2) Section 7363(c) is amended by striking out ``section 501(c)(3) 
of''.
    (c) Revised Reporting Requirement.--Subsection (d) of section 7366 
is amended to read as follows:
    ``(d) The Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and the House of Representatives an annual report 
on the corporations established under this subchapter. The report shall 
set forth the following information:
            ``(1) The location of each corporation.
            ``(2) The amount received by each corporation during the 
        previous year, including--
                    ``(A) the total amount received;
                    ``(B) the amount received from governmental 
                entities;
                    ``(C) the amount received from entities the income 
                of which is exempt from taxation under section 
                501(c)(3) of the Internal Revenue Code of 1986 (26 
                U.S.C. 501(c)(3));
                    ``(D) the amount received from all other sources; 
                and
                    ``(E) if the amount received from a source referred 
                to in subparagraph (D) exceeded $25,000, information 
                that identifies the source.
            ``(3) The amount expended by each corporation during the 
        year, including--
                    ``(A) the amount expended for salary for research 
                staff and for salary for support staff;
                    ``(B) the amount expended for other direct support 
                of research; and
                    ``(C) if the amount expended with respect to any 
                source exceeded $10,000, information that identifies 
                the source.''.

                    TITLE IV--HOSPICE CARE SERVICES

SEC. 401. SHORT TITLE.

    This title may be cited as the ``Veterans' Hospice Care Services 
Act of 1996''.

SEC. 402. 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(3)(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, 1996, and ending 
on December 31, 2001, the Secretary shall conduct a pilot program in 
order--
            ``(A) to assess the desirability of furnishing hospice care 
        services to terminally ill veterans; and
            ``(B) to determine the most effective and efficient 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, to the maximum extent feasible, ensure 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 in order 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, 1997, and on an annual basis 
thereafter until October 1, 2002, 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, 2000, the Secretary shall submit to 
the committees referred to in subsection (a) a report containing an 
evaluation and assessment by the Under Secretary for Health 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 
desirability of furnishing hospice care services to terminally ill 
veterans.
    ``(c) The report under subsection (b) 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) 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 Under Secretary for 
        Health 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 Under Secretary for Health of 
        the 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 hospice care pilot programs under 
section 1765 of title 38, United States Code (as added by subsection 
(a)), as follows:
            (1) For fiscal year 1997, $1,200,000.
            (2) For fiscal year 1998, $2,500,000.
            (3) For fiscal year 1999, $2,200,000.
            (4) For fiscal year 2000, $100,000.

                     TITLE V--MAMMOGRAPHY STANDARDS

SEC. 501. SHORT TITLE.

    This title may be cited as the ``Women Veterans' Mammography 
Quality Standards Act''.

SEC. 502. 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) Not later than 120 days after the date 
of the enactment of this Act, 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.
    (2) The Secretary of Veterans Affairs shall prescribe standards 
under this subsection in consultation with the Secretary of Health and 
Human Services.
    (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 Service 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 of Veterans Affairs 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)).
            Amend the title so as to read: ``A Bill to amend title 38, 
        United States Code, to improve the provision of health care 
        services to veterans by the Department of Veterans Affairs, and 
        for other purposes.''.