[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2792 Introduced in House (IH)]







107th CONGRESS
  1st Session
                                H. R. 2792

 To amend title 38, United States Code, to authorize the Secretary of 
 Veterans Affairs to make service dogs available to disabled veterans 
and to make various other improvements in health care benefits provided 
     by the Department of Veterans Affairs, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 2, 2001

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

_______________________________________________________________________

                                 A BILL


 
 To amend title 38, United States Code, to authorize the Secretary of 
 Veterans Affairs to make service dogs available to disabled veterans 
and to make various other improvements in health care benefits provided 
     by the Department of Veterans Affairs, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Disabled Veterans Service Dog and 
Health Care Improvement Act of 2001''.

SEC. 2. AUTHORIZATION FOR SECRETARY OF VETERANS AFFAIRS TO PROVIDE 
              SERVICE DOGS FOR DISABLED VETERANS.

    (a) Authority.--Section 1714 of title 38, United States Code, is 
amended--
            (1) in subsection (b)--
                    (A) by striking ``seeing-eye or'' the first place 
                it appears;
                    (B) by striking ``who are entitled to disability 
                compensation'' and inserting ``who are enrolled under 
                section 1705 of this title'';
                    (C) by striking ``, and may pay'' and all that 
                follows through ``such seeing-eye or guide dogs''; and
                    (D) by striking ``handicap'' and inserting 
                ``disability''; and
            (2) by adding at the end the following new subsections:
    ``(c) The Secretary may provide--
            ``(1) service dogs trained for the aid of the hearing 
        impaired to veterans who are hearing impaired and are enrolled 
        under section 1705 of this title; and
            ``(2) service dogs trained for the aid of persons with 
        spinal cord injury or dysfunction or other chronic impairment 
        that substantially limits mobility to veterans with such 
        injury, dysfunction, or impairment who are enrolled under 
        section 1705 of this title.
    ``(d) In the case of a veteran provided a dog under subsection (b) 
or (c), the Secretary may pay travel and incidental expenses for that 
veteran under the terms and conditions set forth in section 111 of this 
title to and from the veteran's home for expenses incurred in becoming 
adjusted to the dog.''.
    (b) Clerical Amendments.--
            (1) The heading for such section is amended to read as 
        follows:
``Sec. 1714. Fitting and training in use of prosthetic appliances; 
              guide dogs; service dogs''.
            (2) 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:

``1714. Fitting and training in use of prosthetic appliances; guide 
                            dogs; service dogs.''.

SEC. 3. MAINTENANCE OF CAPACITY FOR SPECIALIZED TREATMENT AND 
              REHABILITATIVE NEEDS OF DISABLED VETERANS.

    (a) Maintenance of Capacity on a Service-Network Basis.--Paragraph 
(1) of section 1706(b) of title 38, United States Code, is amended--
            (1) in the first sentence, by inserting ``(and each 
        geographic service area of the Veterans Health 
        Administration)'' after ``ensure that the Department'';
            (2) in clause (B), by inserting ``(and each geographic 
        service area of the Veterans Health Administration)'' after 
        ``overall capacity of the Department''; and
            (3) by inserting after the first sentence the following new 
        sentence: ``The capacity of the Department (and each geographic 
        service area of the Veterans Health Administration) to provide 
        for the specialized treatment and rehabilitative needs of 
        disabled veterans (including veterans with spinal cord 
        dysfunction, blindness, amputations, and mental illness) within 
        distinct programs or facilities shall be measured by the annual 
        amount (adjusted for inflation) expended for care of such 
        veterans in dedicated programs which provide such specialized 
        treatment and rehabilitative services through specialized 
        staff.''.
    (b) Extension of Annual Report Requirement.--Paragraph (2) of such 
section is amended by striking ``April 1, 1999, April 1, 2000, and 
April 1, 2001'' and inserting ``April 1 of each year through 2004''.

SEC. 4. THRESHOLD FOR VETERANS HEALTH CARE ELIGIBILITY MEANS TEST TO 
              REFLECT LOCALITY COST-OF-LIVING VARIATIONS.

    (a) Revised Threshold.--Subsection (b) of section 1722 is amended 
to read as follows:
    ``(b) For purposes of subsection (a)(3), the income threshold 
applicable to a veteran is the greater of the following:
            ``(1) For any calendar year after 2000--
                    ``(A) in the case of a veteran with no dependents, 
                $23,688, as adjusted pursuant to subsection (c); or
                    ``(B) in the case of a veteran with one or more 
                dependents, $28,429, as so adjusted, plus $1,586, as so 
                adjusted, for each dependent in excess of one.
            ``(2) The amount in effect under the HUD Low Income Index 
        that is applicable in the area in which the veteran resides.''.
    (b) HUD Low Income Index.--Subsection (b) of such section is 
further amended by adding at the end the following new paragraph:
    ``(3) For purposes of paragraph (1)(B), the term `HUD Low Income 
Index' means the family income ceiling amounts determined by the 
Secretary of Housing and Urban Development under section 3(b)(2) of the 
United  States Housing Act of 1937 (42 U.S.C. 1437a(b)(2)) for purposes 
of the determination of `low-income families' under that section.''.
    (c) Conforming Amendments.--Such section is further amended--
            (1) in subsection (b)(2), by striking ``December 31, 1990'' 
        and inserting ``December 31, 2001''; and
            (2) in subsection (c), by striking ``subsection (b)'' and 
        inserting ``subsection (b)(1)''.
    (d) Effective Date.--The amendments made by this section shall take 
effect on April 1, 2002.

SEC. 5. PILOT PROGRAM FOR COORDINATION OF AMBULATORY COMMUNITY HOSPITAL 
              CARE.

    (a) In General.--Chapter 17 of title 38, United States Code, is 
amended by inserting after section 1725 the following new section:
``Sec. 1725A. Coordination of hospital benefits: pilot program
    ``(a) Pilot Program.--Subject to the availability of funds 
specified in subsection (g), the Secretary shall carry out a pilot 
program in not more than four geographic areas of the United States to 
improve access to, and coordination of, inpatient care of eligible 
veterans. Under the pilot program, the Secretary, subject to subsection 
(b), shall pay certain costs described in subsection (b) for which an 
eligible veteran would otherwise be personally liable. The authority to 
carry out the pilot program shall expire on September 30, 2006.
    ``(b) Payment of Costs.--In carrying out the program described in 
subsection (a), the Secretary may pay the costs authorized under this 
section for hospital care and medical services furnished on an 
inpatient basis in a non-Department hospital to an eligible veteran 
participating in the program. Such payment may cover the costs for 
applicable plan deductibles and coinsurance and the reasonable costs of 
such inpatient care and medical services not covered by any applicable 
health-care plan of the veteran, but only to the extent such care and 
services are of the kind authorized under this chapter. The Secretary 
shall limit the care and services for which payment may be made under 
the program to general medical and surgical services and shall require 
that such services may be provided only upon preauthorization by the 
Secretary.
    ``(c) Eligible Veterans.--(1) A veteran described in paragraph (1) 
or (2) of section 1710(a) of this title is eligible to participate in 
the pilot program if the veteran--
            ``(A) is enrolled to receive medical services from an 
        outpatient clinic operated by the Secretary which is (i) within 
        reasonable proximity to the principal residence of the veteran, 
        and (ii) located within the geographic area in which the 
        Secretary is carrying out the program described in subsection 
        (a);
            ``(B) has received care under this chapter within the 24-
        month period preceding the veteran's application for enrollment 
        in the pilot program;
            ``(C) as determined by the Secretary before the 
        hospitalization of the veteran (i) requires such hospital care 
        and services for a non-service-connected condition, and (ii) 
        could not receive such services from a clinic operated by the 
        Secretary; and
            ``(D) elects to receive such care under a health-care plan 
        (other than under this title) under which the veteran is 
        entitled to receive such care.
    ``(2) Nothing in this section shall be construed to reduce the 
authority of the Secretary to contract with non-Department facilities 
for care of a service-connected disability of a veteran.
    ``(3) Notwithstanding subparagraph (D) of paragraph (1), the 
Secretary shall ensure that not less than 15 percent of the veterans 
participating in the program are veterans who do not have a health-care 
plan.
    ``(d) Case Management.--As part of the program under this section, 
the Secretary shall, through provision of case-management, coordinate 
the care being furnished directly by the Secretary and care furnished 
under the program in non-Department hospitals to veterans participating 
in the program.
    ``(e) Designation of Participating Sites.--(1) In designating 
geographic areas in which to establish the program under subsection 
(a), the Secretary shall ensure that--
            ``(A) the areas designated are geographically dispersed;
            ``(B) at least 70 percent of the veterans who reside in a 
        designated area reside at least two hours driving distance from 
        the closest medical center operated by the Secretary which 
        provides medical and surgical hospital care; and
            ``(C) the establishment of the program in any such area 
        would not result in jeopardizing the critical mass of patients 
        needed to maintain a Department medical center that serves that 
        area.
    ``(2) Notwithstanding paragraph (1)(B), the Secretary may designate 
for participation in the program at least one area which is in 
proximity to a Department medical center which, as a result of a change 
in mission of that center, does not provide hospital care.
    ``(f) Reports.--(1) Not later than September 30, 2003, the 
Secretary shall submit to the Committees on Veterans' Affairs of the 
Senate and House of Representatives a report on the experience in 
implementing the pilot program under subsection (a).
    ``(2) Not later than September 30, 2005, the Secretary shall submit 
to those committees a report on the experience in operating the pilot 
program during the first two full fiscal years during which the pilot 
program is conducted. That report shall include--
            ``(A) a comparison of the costs incurred by the Secretary 
        under the program and the cost experience for the calendar year 
        preceding establishment of the program at each site at which 
        the program is operated;
            ``(B) an assessment of the satisfaction of the participants 
        in the program; and
            ``(C) an analysis of the effect of the program on access 
        and quality of care for veterans.
    ``(g) Funding Limitations.--(1) The total amount expended for the 
pilot program in any fiscal year (including amounts for administrative 
costs) may not exceed $50,000,000.
    ``(2) Any expenditure of funds for the pilot program shall be made 
from amounts in the Medical Care Collections Fund attributable to 
collections under section 1729 of this title. No funds may be expended 
to support the  purposes of this section from any other funds available 
to the Secretary for the delivery of health care services to veterans, 
including funds appropriated or otherwise available for the care and 
treatment of veterans who require specialized care and resources.
    ``(h) Health-Care Plan Defined.--For purposes of this section, the 
term `health-care plan' has the meaning given that term in section 
1725(f)(3) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1725 the following new item:

``1725A. Coordination of hospital benefits: pilot program.''.

SEC. 6. PILOT PROGRAM FOR CONTRACT HOSPITALIZATION AND FEE BASIS 
              AMBULATORY CARE.

    (a) Establishment of Program.--The Secretary of Veterans Affairs 
shall conduct a pilot program under which veterans receiving fee basis 
and contract hospitalization under sections 1703 and 1728 of title 38, 
United States Code, in selected service areas of the Veterans Health 
Administration shall be provided such hospitalization through a 
contractor that is a managed care coordinator. The program shall be 
conducted during the three-year period beginning on July 1, 2002.
    (b) Sites for Program.--The Secretary shall conduct the pilot 
program in not less than four geographic service areas of the Veterans 
Health Administration that are selected by the Secretary for 
participation in the program from among such service areas that are 
located in areas that the Secretary determines exhibit mature managed 
care markets. Under the program, to the extent practicable all fee 
basis and contract hospitalization provided by the Secretary in a 
selected geographic service area shall be provided through a managed 
care coordinator contractor.
    (c) Selection of Contractor.--The Secretary shall select a 
contractor for the pilot program not later than six months after the 
date of the enactment of this Act. The contractor shall be an 
experienced managed care coordinator with an in-place network of 
credentialed providers.
    (d) Automatic Enrollment.--Each veteran who is enrolled under 
section 1705 of title 38, United States Code, who resides in a 
geographic service area selected for participation in the pilot 
program, and who as of the commencement of the pilot program is 
authorized use of non-VA care services through fee basis programs of 
the Department, or who is eligible for contract hospitalization under 
section 1703 or 1728 of title 38, United States Code, shall be 
automatically enrolled for participation in the pilot program. Each 
such veteran shall be provided a directory of credentialed health care 
providers from which to choose when approved by the Secretary to 
receive non-VA care or to use in health emergencies in the case of 
contract hospitalization.
    (e) Program Features.--As part of the program, the Secretary shall 
provide for the following:
            (1) Use of commercial-industry standards (or in their 
        absence, Department standards) for access, timeliness, patient 
        satisfaction measures, and utilization management.
            (2) Assignment of a primary care manager at each department 
        medical center participating in the program.
            (3) Establishment by the contractor of a toll-free 
        telephone system staffed by registered nurses to provide advice 
        and health care referral information to veterans enrolled in 
        the pilot program on a 24-hour a day, seven-day a week basis.
            (4) Establishment by the contractor of a veterans service 
        telephone line for the provision of information on eligibility, 
        enrollment, and provider locations.
            (5) Concurrent review.
            (6) Demand management.
            (7) Disease management.
            (8) Health and wellness programs.
    (f) Primary Care Manager Functions.--Each primary care manager 
provided for pursuant to subsection (e)(2) shall have responsibility 
for the coordination and case management of each veteran enrolled under 
section 1705 of title 38, United States Code, through that medical 
center who is enrolled in the pilot program pursuant to subsection (d), 
to ensure that such veterans receive the appropriate care, and that the 
veteran is brought back into the VA system for followup whenever 
possible and appropriate.
    (g) Reports.--(1) Not later than October 1, 2003, the Secretary 
shall submit to Congress a report on the operation of the pilot program 
through June 30, 2003. That report shall include the Secretary's 
assessment of--
            (A) the adequacy of the managed care networks;
            (B) patient satisfaction surveys completed by veterans 
        participating in the program;
            (C) cost savings to the Department as a result of care 
        provided through the program; and
            (D) proposed uses for savings if the pilot program were 
        implemented on a permanent basis throughout the Department for 
        the management of non-VA care.
    (2) Not later than October 1, 2004, the Secretary shall submit a 
report to Congress on the program through June 30, 2004. The Secretary 
shall include in that report the matters specified in paragraph (1) and 
the Secretary's recommendation for implementing on a nationwide basis 
the management system tested in the pilot program.
    (h) GAO Review.--Not later than June 30, 2005, the Comptroller 
General of the United States shall conduct a review of the pilot 
program and shall provide to Congress the Comptroller General's 
findings and recommendations concerning the program.
    (i) Non-VA Care Defined.--For purposes of this section, the term 
``non-VA care'' means care provided in a facility other than a facility 
of the Veterans Health Administration or by a health care provider who 
is not an employee of the Veterans Health Administration.

SEC. 7. RECODIFICATION OF BEREAVEMENT COUNSELING AUTHORITY AND CERTAIN 
              OTHER HEALTH-RELATED AUTHORITIES.

    (a) Statutory Reorganization.--Subchapter I of chapter 17 of title 
38, United States Code, is amended--
            (1) in section 1701(6)--
                    (A) by striking subparagraph (B) and the sentence 
                following that subparagraph;
                    (B) by striking ``services--'' in the matter 
                preceding subparagraph (A) and inserting ``services, 
                the following:''; and
                    (C) by striking subparagraph (A) and inserting the 
                following:
            ``(A) Surgical services.
            ``(B) Dental services and appliances as described in 
        sections 1710 and 1712 of this title.
            ``(C) Optometric and podiatric services.
            ``(D) Preventive health services.
            ``(E) In the case of a person otherwise receiving care or 
        services under this chapter--
                    ``(i) wheelchairs, artificial limbs, trusses, and 
                similar appliances;
                    ``(ii) special clothing made necessary by the 
                wearing of prosthetic appliances; and
                    ``(iii) such other supplies or services as the 
                Secretary determines to be reasonable and necessary.
            ``(F) Travel and incidental expenses pursuant to section 
        111 of this title.''; and
            (2) in section 1707--
                    (A) by inserting ``(a)'' at the beginning of the 
                text of the section; and
                    (B) by adding at the end the following:
    ``(b) The Secretary may furnish sensori-neural aids only in 
accordance with guidelines prescribed by the Secretary.''.
    (b) Consolidation of Provisions Relating to Persons Other Than 
Veterans.--Such chapter is further amended by adding at the end the 
following new subchapter:

     ``SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS

``Sec. 1782. Counseling, training, and mental health services for 
              immediate family members
    ``(a) Counseling for Family Members of Veterans Receiving Service-
Connected Treatment.--In the case of a veteran who is receiving 
treatment for a service-connected disability pursuant to paragraph (1) 
or (2) of section 1710(a) of this title, the Secretary shall provide to 
individuals described in subsection (c) such consultation, professional 
counseling, training, and mental health services as are necessary in 
connection with that treatment.
    ``(b) Counseling for Family Members of Veterans Receiving Non-
Service-Connected Treatment.--In the case of a veteran who is eligible 
to receive treatment for a non-service-connected disability under the 
conditions described in paragraph (1), (2), or (3) of section 1710(a) 
of this title, the Secretary may, in the discretion of the Secretary, 
provide to individuals described in subsection (c) such consultation, 
professional counseling, training, and mental health services as are 
necessary in connection with that treatment if--
            ``(1) those services were initiated during the veteran's 
        hospitalization; and
            ``(2) the continued provision of those services on an 
        outpatient basis is essential to permit the discharge of the 
        veteran from the hospital.
    ``(c) Eligible Individuals.--Individuals who may be provided 
services under this subsection are--
            ``(1) the members of the immediate family or the legal 
        guardian of a veteran; or
            ``(2) the individual in whose household such veteran 
        certifies an intention to live.
    ``(d) Travel and Transportation Authorized.--Services provided 
under subsections (a) and (b) may include, under the terms and 
conditions set forth in section 111 of this title, travel and 
incidental expenses of individuals described in subsection (c) in the 
case of--
            ``(1) a veteran who is receiving care for a service-
        connected disability; and
            ``(2) a dependent or survivor receiving care under the last 
        sentence of section 1783(b) of this title.
``Sec. 1783. Bereavement counseling
    ``(a) Deaths of Veterans.--In the case of an individual who was a 
recipient of services under section 1782 of this title at the time of 
the death of the veteran, the Secretary may provide bereavement 
counseling to that individual in the case of a death--
            ``(1) that was unexpected; or
            ``(2) that occurred while the veteran was participating in 
        a hospice program (or a similar program) conducted by the 
        Secretary.
    ``(b) Deaths In Active Service.--The Secretary may provide 
bereavement counseling to an individual who is a member of the 
immediate family of a member of the Armed Forces who dies in the active 
military, naval, or air service in the line of duty and under 
circumstances not due to the person's own misconduct.
    ``(c) Bereavement Counseling Defined.--For purposes of this 
section, the term `bereavement counseling' means such counseling 
services, for a limited period, as the Secretary determines to be 
reasonable and necessary to assist an individual with the emotional and 
psychological stress accompanying the death of another individual.
``Sec. 1784. Humanitarian care
    ``The Secretary may furnish hospital care or medical services as a 
humanitarian service in emergency cases, but the Secretary shall charge 
for such care and services at rates prescribed by the Secretary.''.
    (c) Transfer of CHAMPVA Section.--Section 1713 of such title is--
            (1) transferred to subchapter VIII of chapter 17 of such 
        title, as added by subsection (b), and inserted after the 
        subchapter heading;
            (2) redesignated as section 1781; and
            (3) amended by adding at the end of subsection (b) the 
        following new sentence: ``A dependent or survivor receiving 
        care under the preceding sentence shall be eligible for the 
        same medical services as a veteran, including services under 
        sections 1782 and 1783 of this title.''.
    (d) Repeal of Recodified Authority.--Section 1711 of such title is 
amended by striking subsection (b).
    (e) Cross Reference Amendments.--Such title is further amended as 
follows:
            (1) Section 103(d)(5)(B) is amended by striking ``1713'' 
        and inserting ``1781''.
            (2) Sections 1701(5) is amended by striking ``1713(b)'' in 
        subparagraphs (B) and (C)(i) and inserting ``1781(b)''.
            (3) Section 1712A(b) is amended--
                    (A) in the last sentence of paragraph (1), by 
                striking ``section 1711(b)'' and inserting ``section 
                1784''; and
                    (A) in paragraph (2), by striking ``section 
                1701(6)(B)'' and inserting ``sections 1782 and 1783''.
            (4) Section 1729(f) is amended by striking ``section 
        1711(b)'' and inserting ``section 1784''.
            (5) Section 1729A(b) is amended--
                    (A) by redesignating paragraph (7) as paragraph 
                (8); and
                    (B) by inserting after paragraph (6) the following 
                new paragraph (7):
            ``(7) Section 1784 of this title.''.
            (6) Section 8111(g) is amended--
                    (A) in paragraph (4), by inserting ``services under 
                sections 1782 and 1783 of this title'' after ``of this 
                title,''; and
                    (B) in paragraph (5), by striking ``section 1711(b) 
                or 1713'' and inserting ``section 1782, 1783, or 
                1784''.
            (7) Section 8111A(a)(2) is amended by inserting ``, and the 
        term `medical services' includes services under sections 1782 
        and 1783 of this title'' before the period at the end.
            (8) Section 8152(3) is amended by inserting ``services 
        under sections 1782 and 1783 of this title'' after ``of this 
        title),''.
            (9) Sections 8502(b), 8520(a), and 8521 are amended by 
        striking ``the last sentence of section 1713(b)'' and inserting 
        ``the penultimate sentence of section 1781(b)''.
    (f) Clerical Amendments.--
            (1) The table of sections at the beginning of such chapter 
        is amended--
                    (A) by striking the item relating to section 1707 
                and inserting the following:

``1707. Limitations.'';
                    (B) by striking the item relating to section 1713; 
                and
                    (C) by adding at the end the following:

     ``subchapter viii--health care of persons other than veterans

``1781. Medical care for survivors and dependents of certain veterans.
``1782. Counseling, training, and mental health services for immediate 
                            family members.
``1783. Bereavement counseling.
``1784. Humanitarian care.''.
            (2) The heading for section 1707 is amended to read as 
        follows:
``Sec. 1707. Limitations''.

SEC. 8. EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES.

    Sections 1710(f)(2)(B) and 1729(a)(2)(E) of title 38, United States 
Code, are each amended by striking ``September 30, 2002'' and inserting 
``September 30, 2007''.
                                 <all>