[Congressional Record Volume 140, Number 145 (Friday, October 7, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: October 7, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                VETERANS HEALTH IMPROVEMENTS ACT OF 1993

  Mr. MONTGOMERY. Mr. Speaker, since the gentleman (Mr. Smith of New 
Jersey) objected to my request, I will make the following request:
  Mr. Speaker, I ask unanimous consent to take from the Speaker's table 
the bill (H.R. 3313), to amend title 38, United States Code, to improve 
health care services of the Department of Veterans Affairs relating to 
women veterans, to extend and expand authority for the Secretary of 
Veterans Affairs to provide priority health care to veterans who were 
exposed to ionizing radiation or to Agent Orange, to expand the scope 
of services that may be provided to veterans through Vet Centers, and 
for other purposes, and concur in the Senate amendments with amendments 
that are at the desk.
  Mr. Speaker, this is the same number, but with different 
nomenclature.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. The Clerk will request the proposed 
amendments.
  The Clerk read the House amendments to the Senate amendments, as 
follows:
       House amendments to the Senate amendments: In lieu of the 
     matter proposed to be inserted by the amendment to the Senate 
     to the text of the bill, insert the following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Veterans 
     Health Programs Extension Act of 1994''.
       (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--GENERAL MEDICAL AUTHORITIES

Sec. 101. Sexual trauma counseling and services.
Sec. 102. Research relating to women veterans.
Sec. 103. Extension of expiring authorities.
Sec. 104. Facilities in Republic of the Philippines.
Sec. 105. Savings provision.

                  TITLE II--CONSTRUCTION AUTHORIZATION

Sec. 201. Authorization of major medical facility projects and major 
              medical facility leases.
Sec. 202. Authorization of appropriations.

     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--GENERAL MEDICAL AUTHORITIES

     SEC. 101. SEXUAL TRAUMA COUNSELING AND SERVICES.

       (a) Authority To Provide Treatment Services for Sexual 
     Trauma; Repeal of Limitation on Time To Seek Services.--
     Subsection (a) of section 1720D is amended--
       (1) by striking out paragraph (2); and
       (2) by inserting after paragraph (1) the following new 
     paragraph (2):
       ``(2) During the period referred to in paragraph (1), the 
     Secretary may provide appropriate care and services to a 
     veteran for an injury, illness, or other psychological 
     condition that the Secretary determines to be the result of a 
     physical assault, battery, or harassment referred to in that 
     paragraph.''.
       (b) Extension of Period of Authority To Provide Sexual 
     Trauma Services.--Such subsection is further amended--
       (1) in paragraph (1), by striking out ``December 31, 
     1995,'' and inserting in lieu thereof ``December 31, 1998,''; 
     and
       (2) in paragraph (3), by striking out ``December 31, 
     1994,'' and inserting in lieu thereof ``December 31, 1998,''.
       (c) Repeal of Limitation on Period of Receipt of 
     Services.--Such section is further amended--
       (1) by striking out subsection (b); and
       (2) by redesignating subsections (c), (d), and (e) as 
     subsections (b), (c), and (d), respectively.
       (d) Coordination of Care.--Paragraph (1) of subsection (b) 
     of such section, as redesignated by subsection (c)(2), is 
     amended to read as follows:
       ``(1) The Secretary shall give priority to the 
     establishment and operation of the program to provide 
     counseling and care and services under subsection (a). In the 
     case of a veteran eligible for counseling and care and 
     services under subsection (a), the Secretary shall ensure 
     that the veteran is furnished counseling and care and 
     services under this section in a way that is coordinated with 
     the furnishing of such care and services under this 
     chapter.''.
       (e) Increased Priority of Care.--Section 1712(i) is 
     amended--
       (1) in paragraph (1)--
       (A) by inserting ``(A)'' after ``To a veteran''; and
       (B) by inserting ``, or (B) who is eligible for counseling 
     and care and services under section 1720D of this title, for 
     the purposes of such counseling and care and services'' 
     before the period at the end; and
       (2) in paragraph (2)--
       (A) by striking out ``, (B)'' and inserting in lieu thereof 
     ``or (B)''; and
       (B) by striking out ``, or (C)'' and all that follows 
     through ``such counseling''.
       (f) Program Revision.--(1) Section 1720D is further 
     amended--
       (A) by striking out ``woman'' in subsection (a)(1);
       (B) by striking out ``women'' in subsection (b)(2)(C) and 
     in the first sentence of subsection (c), as redesignated by 
     subsection (c); and
       (C) by striking out ``women'' in subsection (c)(2), as so 
     redesignated, and inserting in lieu thereof ``individuals''.
       (2)(A) The heading of such section is amended to read as 
     follows:

     ``Sec. 1720D. Counseling and treatment for sexual trauma''.

       (B) The item relating to such section in the table of 
     sections at the beginning of chapter 17 is amended to read as 
     follows:
``1720D. Counseling and treatment for sexual trauma.''.
       (g) Information by Telephone.--(1) Paragraph (1) of section 
     1720D(c), as redesignated by subsection (c) of this section, 
     is amended to read as follows:
       ``(1) shall include availability of a toll-free telephone 
     number (commonly referred to as an 800 number); and''.
       (2) In providing information on counseling available to 
     veterans as required under section 1720D(c)(1) of title 38, 
     United States Code (as amended by paragraph (1)), the 
     Secretary of Veterans Affairs shall ensure that the 
     Department of Veterans Affairs personnel who provide 
     assistance under such section are trained in the provision to 
     persons who have experienced sexual trauma of information 
     about the care and services relating to sexual trauma that 
     are available to veterans in the communities in which such 
     veterans reside, including care and services available under 
     programs of the Department (including the care and services 
     available under section 1720D of such title) and from non-
     Department agencies or organizations.
       (3) The telephone assistance service shall be operated in a 
     manner that protects the confidentiality of persons who place 
     calls to the system.
       (4) The Secretary shall ensure that information about the 
     availability of the telephone assistance service is visibly 
     posted in Department medical facilities and is advertised 
     through public service announcements, pamphlets, and other 
     means.
       (5) Not later than 18 months after the date of the 
     enactment of this Act, the Secretary shall submit to Congress 
     a report on the operation of the telephone assistance service 
     required under section 1720D(c)(1) of title 38, United States 
     Code (as amended by paragraph (1)). The report shall set 
     forth the following:
       (A) The number of persons who sought information during the 
     period covered by the report through a toll free telephone 
     number regarding services available to veterans relating to 
     sexual trauma, with a separate display of the number of such 
     persons arrayed by State (as such term is defined in section 
     101(20) of title 38, United States Code).
       (B) A description of the training provided to the personnel 
     who provide such assistance.
       (C) The recommendations and plans of the Secretary for the 
     improvement of the service.
       (h) Conforming Repeal.--Section 102(b) of the Veterans 
     Health Care Act of 1992 (Public Law 102-585; 106 Stat. 4946; 
     38 U.S.C. 1720D note) is repealed.

     SEC. 102. RESEARCH RELATING TO WOMEN VETERANS.

       (a) Inclusion of Women and Minorities in Clinical Research 
     Projects.--Section 7303 is amended--
       (1) by transferring the text of subsection (c) to the end 
     of subsection (a)(1); and
       (2) by striking out ``(c)'' and inserting in lieu thereof 
     the following:
       ``(c)(1) In conducting or supporting clinical research, the 
     Secretary shall ensure that, whenever possible and 
     appropriate--
       ``(A) women who are veterans are included as subjects in 
     each project of such research; and
       ``(B) members of minority groups who are veterans are 
     included as subjects of such research.
       ``(2) In the case of a project of clinical research in 
     which women or members of minority groups will under 
     paragraph (1) be included as subjects of the research, the 
     Secretary shall ensure that the project is designed and 
     carried out so as to provide for a valid analysis of whether 
     the variables being tested in the research affect women or 
     members of minority groups, as the case may be, differently 
     than other persons who are subjects of the research.''.
       (b) Health Research.--(1) Such section is further amended 
     by adding after subsection (c), as added by subsection (a), 
     the following new subsection:
       ``(d)(1) The Secretary, in carrying out the Secretary's 
     responsibilities under this section, shall foster and 
     encourage the initiation and expansion of research relating 
     to the health of veterans who are women.
       ``(2) In carrying out this subsection, the Secretary shall 
     consult with the following to assist the Secretary in setting 
     research priorities:
       ``(A) Officials of the Department assigned responsibility 
     for women's health programs and sexual trauma services.
       ``(B) The members of the Advisory Committee on Women 
     Veterans.
       ``(C) Members of appropriate task forces and working groups 
     within the Department (including the Women Veterans Working 
     Group and the Task Force on Treatment of Women Who Suffer 
     Sexual Abuse).''.
       (2) Section 109 of the Veterans Health Care Act of 1992 
     (Public Law 102-585; 38 U.S.C. 7303 note) is repealed.
       (c) Population Study.--Section 110(a) of the Veterans 
     Health Care Act of 1992 (Public Law 102-585; 106 Stat. 4948) 
     is amended by adding at the end of paragraph (3) the 
     following: ``If it is feasible to do so within the amounts 
     available for the conduct of the study, the Secretary shall 
     ensure that the sample referred to in paragraph (1) 
     constitutes a representative sampling (as determined by the 
     Secretary) of the ages, the ethnic, social and economic 
     backgrounds, the enlisted and officer grades, and the 
     branches of service of all veterans who are women.''.

     SEC. 103. EXTENSION OF EXPIRING AUTHORITIES.

       (a) Authority To Provide Priority Health Care for Veterans 
     Exposed to Toxic Substances.--Chapter 17 is amended--
       (1) in section 1710(e)(3)--
       (A) by striking out ``June 30, 1994'' and inserting in lieu 
     thereof ``June 30, 1995''; and
       (B) by striking out ``December 31, 1994'' and inserting in 
     lieu thereof ``December 31, 1995''; and
       (2) in section 1712(a)(1)(D), by striking out ``December 
     31, 1994'' and inserting in lieu thereof ``December 31, 
     1995''.
       (b) Drug and Alcohol Abuse and Dependence.--Section 
     1720A(e) is amended by striking out ``December 31, 1994'' and 
     inserting in lieu thereof ``December 31, 1995''.
       (c) Pilot Program for Noninstitutional Alternatives to 
     Nursing Home Care.--(1) Effective as of October 1, 1994, 
     subsection (a) of section 1720C is amended by striking out 
     ``During the four-year period beginning on October 1, 1990,'' 
     and inserting in lieu thereof ``During the period through 
     September 30, 1995,''.
       (2) Such subsection is further amended by striking out 
     ``care and who--'' and inserting in lieu thereof ``care. The 
     Secretary shall give priority for participation in such 
     program to veterans who--''.
       (d) Enhanced-Use Leases of Real Property.--Section 8169 is 
     amended by striking out ``December 31, 1994'' and inserting 
     in lieu thereof ``December 31, 1995''.
       (e) Authority for Community-based Residential Care for 
     Homeless Chronically Mentally Ill Veterans and Other 
     Veterans.--Section 115(d) of the Veterans' Benefits and 
     Services Act of 1988 (38 U.S.C. 1712 note) is amended by 
     striking out ``September 30, 1994'' and inserting in lieu 
     thereof ``September 30, 1995''.
       (f) Demonstration Program of Compensated Work Therapy.--
     Sction 7(a) of Public Law 102-54 (105 Stat. 269; 38 U.S.C. 
     1718 note) is amended by striking out ``1994'' and inserting 
     in lieu thereof ``1995''.
       (g) Report Deadlines.--Section 201(b) of the Department of 
     Veterans Affairs Nurse Pay Act of 1990 (Public Law 101-366; 
     38 U.S.C. 1720C note) is amended by striking out ``February 
     1, 1994,'' and inserting in lieu thereof ``February 1, 
     1995,''.

     SEC. 104. FACILITIES IN REPUBLIC OF THE PHILIPPINES.

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

     SEC. 105. RATIFICATION OF ACTIONS DURING PERIOD OF LAPSED 
                   AUTHORITY.

       Any action of the Secretary of Veterans Affairs under 
     section 1710(e) of title 38, United States Code, during the 
     period beginning on July 1, 1994, and ending on the date of 
     the enactment of this Act is hereby ratified.
                  TITLE II--CONSTRUCTION AUTHORIZATION

     SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS 
                   AND MAJOR MEDICAL FACILITY LEASES.

       (a) Projects Authorized.--The Secretary of Veterans Affairs 
     may carry out the major medical facility projects for the 
     Department of Veterans Affairs, and may carry out the major 
     medical facility leases for that Department, for which funds 
     are requested in the budget of the President for fiscal year 
     1995. The authorization in the preceding sentence applies to 
     projects and leases which have not been authorized, or for 
     which funds have not been appropriated, in any fiscal year 
     before fiscal year 1995 and to projects and leases which have 
     been authorized, or for which funds were appropriated, in 
     fiscal years before fiscal year 1995.
       (b) Additional Projects.--(1) In addition to the projects 
     authorized in subsection (a), the Secretary may carry out the 
     following major medical facility projects in the amounts 
     specified for such projects:
       (A) The projects that are proposed in the documents 
     submitted to Congress by the Secretary of Veterans Affairs in 
     conjunction with the budget of the President for fiscal year 
     1995 to be financed with funds from the proposed Health Care 
     Investment Fund.
       (B) Construction of a nursing home facility at the 
     Department of Veterans Affairs Medical Center in Charleston, 
     South Carolina, in the amount of $7,300,000.
       (C) Construction of an outpatient care addition at the 
     Department of Veterans Affairs medical center in Phoenix, 
     Arizona, in the amount of $50,000,000.
       (D) A lease/purchase of a nursing home facility near Fort 
     Myers, Florida, in the amount of $12,800,000.
       (2) The authorizations in paragraph (1) apply to projects 
     which have not been authorized, or for which funds have not 
     been appropriated, in any fiscal year before fiscal year 1995 
     and to projects which have been authorized, or for which 
     funds were appropriated, in fiscal years before fiscal year 
     1995.
       (c) Projects for Which Funds Appropriated.--In addition to 
     the projects authorized in subsections (a) and (b), the 
     Secretary may carry out the following major medical facility 
     projects for which funds were appropriated in chapter 7 of 
     the Emergency Supplemental Appropriations Act of 1994 (title 
     I of Public Law 103-211; 108 Stat. 10) in the amounts 
     specified:
       (1) Construction of an ambulatory care/support services 
     facility at the Department of Veterans Affairs Medical Center 
     in Sepulveda, California, $53,700,000.
       (2) Other major medical facility projects required to 
     repair, restore, or replace earthquake-damaged facilities at 
     the Department of Veterans Affairs Medical Center in 
     Sepulveda, California, $50,000,000.

     SEC. 202. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There are authorized to be appropriated to 
     the Secretary of Veterans Affairs for fiscal year 1995--
       (1) $379,370,000 for the major medical facility projects 
     authorized in subsections (a), (b), and (c) of section 201; 
     and
       (2) $15,800,000 for the major medical facility leases 
     authorized in section 201(a).
       (b) Limitation.--The projects authorized in subsections (a) 
     and (b) of section 201 may only be carried out using--
       (1) funds appropriated for fiscal year 1995 pursuant to the 
     authorization of appropriations in subsection (a);
       (2) funds appropriated for Construction, Major Projects for 
     a fiscal year before fiscal year 1995 that remain available 
     for obligation; and
       (3) funds appropriated for Construction, Major Projects for 
     fiscal year 1995 for a category of activity not specific to a 
     project.
       (c) Limitation on Certain Projects.--The projects 
     authorized in subsection (c) of section 201 may only be 
     carried out using--
       (1) funds appropriated to the Construction, Major Projects 
     account under chapter 7 of the Emergency Supplemental 
     Appropriations Act of 1994 (title I of Public Law 103-211; 
     108 Stat. 10) and funds transferred by the President to the 
     Construction, Major Projects account pursuant to chapter 8 of 
     that Act (108 Stat. 14);
       (2) funds appropriated to the Medical Care account by 
     chapter 7 of the Emergency Supplemental Appropriations Act of 
     1994 that are transferred to the Construction, Major Projects 
     account;
       (3) funds appropriated to the Construction, Major Projects 
     account for a fiscal year before fiscal year 1995 that remain 
     available for obligation; and
       (4) funds appropriated to the Construction, Major Projects 
     account for fiscal year 1995 for a category of activity not 
     specific to a project.
       In lieu of the amendment of the Senate to the title of the 
     bill, amend the title so as to read: ``An Act to amend title 
     38, United States Code, to extend certain expiring veterans' 
     health care programs, and for other purposes.''.

  Mr. MONTGOMERY (during the reading). Mr. Speaker, I ask unanimous 
consent that the House amendments to the Senate amendments be 
considered as read and printed in the Record.
  The SPEAKER pro tempore. Is there objection to dispensing with the 
reading?
  There was no objection.
  Mr. MONTGOMERY. Mr. Speaker, H.R. 3313 was a comprehensive health 
care bill which the House passed in April after a year of work by our 
Subcommittee on Hospitals and Health Care. The other body would not 
take up our bill. We had to wait months before it acted on a series of 
its own veterans bills. Tough negotiations finally produced a good 
compromise bill. The compromise would have dramatically improved VA 
care for many veterans--particularly women veterans, veterans exposed 
to agent orange and other toxic substances, homeless veterans, and the 
chronically mentally ill. The bill would have allowed VA to participate 
in ongoing State health reform plans, and would have improved VA 
construction planning.
  I deeply regret that our efforts today to bring up that compromise 
were blocked. They were blocked because the bill would have expanded 
services to women veterans. I respect the deep convictions which 
prompted the objection, but I believe the gentleman from New Jersey has 
misread the bill. Despite my repeated efforts to reach an accord, we 
faced continued insistence on language objectionable to the other body.
  Mr. Speaker, we were reluctantly prepared to drop this controversial 
provision in order to salvage a good bill. Our Senate counterparts 
insisted, however, on what amounted to an ``all or nothing'' approach. 
When they didn't get everything they wanted, they rejected every 
provision that was not absolutely critical to them. One provision the 
Senate was prepared to accept would have authorized VA to launch a 
modest pilot program in States undertaking health reforms. The major 
veterans organizations and the administration supported this vital 
provision. But late yesterday, the gentleman from New Jersey announced 
his objection to that provision, a provision he had supported as the 
ranking minority member of the subcommittee that marked it up.
  There will be those who will second-guess us from the sidelines or 
criticize our failure to override these objections through a conference 
agreement. Members should be aware that we discussed legislative 
strategies with leaders in the other body. It became clear that because 
of the nature of the objections being raised in the House, a conference 
agreement could not have been brought up in the Senate.
  I am disappointed that real veterans' needs have been subordinated to 
remote ``what if's'' and ``take-it-or-leave-it'' politics. Veterans are 
the losers when that happens.
  Mr. Speaker, this bill takes very modest steps forward, and we should 
enact it. But we should not--and I pledge that I will not--abandon 
efforts to make real progress for our veterans. I pledge to take up 
early in the 104th Congress the cause of women veterans, mentally ill 
veterans, homeless veterans, and the victims of agent orange, 
radiation, and Persian Gulf service, who are not getting all they 
deserve in this bill today.
  There follows a joint explanatory statement comparing the House bill, 
the Senate amendments, and the compromise agreement.

   Joint Explanatory Statement for H.R. 3313, the Proposed Veterans 
                     Programs Extension Act of 1994

       H.R. 3313, the proposed ``Veterans Health programs 
     Extension Act of 1994'', reflects a compromise agreement that 
     the Senate and House of Representatives Committees on 
     Veterans' Affairs have reached on a number of bills 
     considered in the Senate and House during the 103rd Congress, 
     including: H.R. 3313 as passed by the House on November 16, 
     1993 (hereinafter referred to as the ``House bill'') H.R. 
     4425 as passed by the House on May 23, 1994; S. 1030 as 
     passed by the Senate on July 26, 1994 (hereinafter referred 
     to as the ``Senate bill'') S. 2277 as passed by the Senate on 
     August 19, 1994; and S. 2325, which the Senate Committee on 
     Veterans' Affairs reported on September 27, 1994, but which 
     did not receive Senate consideration prior to the end of the 
     103rd Congress.
       The Committees on Veterans' Affairs have prepared the 
     following explanation of H.R. 3313 as amended (hereinafter 
     referred to as ``compromise agreement''). Differences between 
     the provisions contained in the compromise agreement and the 
     related provisions in the bills listed above are noted in 
     this document, except for clerical corrections and conforming 
     changes made necessary by the compromise agreement, and minor 
     drafting technical and clarifying changes.

                  TITLE I--GENERAL MEDICAL AUTHORITIES


                 sexual trauma counseling and services

       Current law.--Section 102 of 1720D of title 38(a) provides 
     that through December 31, 1995, VA may furnish sexual trauma 
     counseling to any woman who seeks counseling within 2 years 
     after her discharge from service; (b) authorizes VA to 
     provide counseling services through contract with non-VA 
     providers through December 31, 1994; (c) prohibits VA from 
     providing counseling for a period in excess of 1 year unless 
     the Secretary determines that a longer period of counseling 
     is needed; and (d) requires the Secretary to provide 
     information on the availability of such counseling.
       Under section 103 of Public Law 102-585, veterans who seek 
     care for sexual trauma have the same priority for care as a 
     veteran who has a service-connected disability rated at 30 
     percent or below and who is being examined to determine the 
     existence or severity of a service-connected disability.
       House bill.--Section 106 would (a) extend the time period 
     during which VA may provide sexual trauma counseling to 
     veterans to December 31, 1998; (b) repeal the limitation on 
     the period within which a veteran could seek sexual trauma 
     counseling; (c) extend VA's authority to provide sexual 
     trauma care through contracts with non-VA providers for 4 
     years, through December 31, 1998; (d) authorize VA to provide 
     sexual trauma counseling to males; (e) require, rather than 
     permit, VA to establish a toll-free telephone number to 
     provide informational services; and (f) require a report on 
     the operation of the telephone program. Section 106(d) would 
     increase the priority for VA outpatient care accorded to 
     veterans for sexual trauma care to that accorded to any 
     veteran seeking care for a service-connected disability or 
     for the treatment of any disability of a veteran who has a 
     service-connected disability rated at 50 percent or above.
       Senate bills.--Section 101 is similar to the house bill, 
     except that it authorizes VA to provide, in addition to 
     counseling for sexual trauma, treatment for physical 
     conditions resulting from that trauma.
       Compromise agreement.--Section 101 contains provisions 
     derived from the two bills, including the provision from the 
     Senate bill relating to treatment for physical conditions.


                  research relating to women veterans

       Current law.--Section 109 of Public Law 102-585 directs the 
     Secretary to foster and encourage research relating to the 
     health of women veterans, section 110 of Public Law 102-585 
     authorizes a population study of women veterans.
       House bill.--Section 105 would (a) require the Secretary to 
     include women and minority veterans in research projects 
     whenever possible and appropriate and ensure that in studies 
     in which such veterans are included, the studies be designed 
     and carried out so as to yield information on such veterans; 
     and (b) amend section 110 of Public Law 102-585 to require 
     that the population study include a sample that is 
     representative of all women veterans.
       Senate bill.--Section 105 would (a) amend section 109(a) of 
     Public Law 102-585, relating to VA research activity, to 
     require the Secretary to consult with other specified VA 
     officials as part of the effort to foster and encourage the 
     initiation and expansion of research into women's health 
     issues, to ensure that certain personnel be engaged in such 
     research, and to include in such research, research into the 
     following matters as they relate to women: (1) breast cancer, 
     (2) gynecological and reproductive health, including 
     gynecological cancer, infertility, sexually transmitted 
     diseases, and pregnancy, (3) Human Immunodeficiency Virus 
     (HIV) and Acquired Immune Deficiency Syndrome (AIDS), (4) 
     mental health, including post-traumatic stress disorder and 
     depression, (5) diseases relating to aging, including 
     menopause, osteoporosis, and Alzheimer's Disease, (6) 
     substance abuse, (7) sexual violence and related trauma, and 
     (8) exposure to toxic chemicals and other environmental 
     hazards; and (b) amend section 109(b), relating to the 
     population study, in a way similar to the House provision.
       Compromise agreement.--Section 102 follows the House bill 
     with respect to the amendment to section 110 of Public Law 
     102-585 relating to the population study. However, rather 
     than amending section 109(a) of Public Law 102-585 with 
     respect to the Secretary's role in encouraging research, the 
     compromise agreement repeals that section and adds a new 
     subsection to section 7303 of title 38. The compromise 
     agreement follows the Senate bill with respect to requiring 
     the Secretary to consult with individuals charged with 
     overseeing women's health programs, including the Director of 
     the Nursing Service, Central Office officials who have the 
     responsibility for women's health programs and sexual trauma 
     services, members of the Advisory Committee on Women 
     Veterans, and other members of appropriate task forces and 
     working groups within the Department.
       The Committees strongly urge the Secretary to improve VA 
     research on women's health issues by establishing research 
     priorities, supporting more research on women's health, and 
     when possible, comparing the efficacy of treatment regimens 
     for male and female patients.


                   extension of expiring authorities

      Authority to provide priority health care
       Current law.--Under section 1710(e) of title 38, various 
     groups of veterans exposed to hazardous substances during 
     their service--those exposed (a) to ionizing radiation from 
     the detonation of a nuclear device or during service in 
     Hiroshima or Nagasaki, Japan, following World War II; (b) to 
     dioxin or other toxins during service in Vietnam; or (c) to 
     toxins or environmental hazards during the Persian Gulf War--
     are eligible for inpatient and nursing home care for the 
     treatment of any disability not found to have resulted from a 
     cause other than the exposure in question. Veterans exposed 
     to radiation or dioxin are eligible for certain outpatient 
     care for the treatment of such disabilities under section 
     1712(a)(4). Persian Gulf War veterans are eligible under 
     section 1712(a)(1)(D) for comprehensive outpatient care for 
     the treatment of such disabilities. The authority expired on 
     June 30, 1994, as to veterans exposed to radiation or dioxin 
     and expires on December 31, 1994, as to Persian Gulf War 
     veterans.
       House bill.--Section 201 would modify current law so as to 
     (a) limit the treatment of veterans exposed to dioxin to 
     treatment of those diseases as to which the National Academy 
     of Sciences has determined there is sufficient evidence to 
     conclude there is a positive association between the disease 
     in humans and exposure to an herbicide agent, those as to 
     which there is evidence suggestive of an association, but 
     such evidence is limited, and those as to which available 
     studies are insufficient to permit a conclusion of an 
     association; (b) extend the period of eligibility for 
     hospital and nursing home care for those exposed to dioxin 
     until September 30, 1996; (c) limit the treatment of 
     veterans exposed to radiation to treatment of those 
     diseases listed in section 1112(c)(2) of title 38 and 
     those as to which VA determines there is credible evidence 
     of a positive association between disease occurrence and 
     radiation exposure for which the Congress has established 
     presumptive service connection; (d) repeal the sunset date 
     for eligibility for hospital and nursing home care for 
     veterans exposed to radiation; (e) mandate, in the case of 
     veterans exposed to either radiation or dioxin, any needed 
     outpatient treatment for covered illnesses and provide a 
     higher priority to such treatment; and (f) provide that 
     veterans who had received care under the prior authority 
     would not lose eligibility for continued care.
       Senate bill.--Section 201 would amend section 1710(e) of 
     title 38 to extend the period of entitlement to VA inpatient 
     and nursing home care for veterans exposed to dioxin or 
     radiation until December 31, 2003. Section 202 would extend 
     the authority to provide care for veterans of the Persian 
     Gulf War until October 1, 2003.
       Compromise agreement.--Section 103(a) would amend section 
     1710(e) of title 38 to extend current law regarding care for 
     veterans exposed to dioxin or radiation until June 30, 1995, 
     and to extend current law regarding care for Persian Gulf War 
     veterans until December 31, 1995.
     Drug and alcohol abuse and dependence
       Current law.--Section 1720(A) of title 38 authorizes VA, 
     through December 31, 1994, to provide veterans who are 
     suffering from substance abuse disabilities with care on a 
     contract basis through community halfway houses.
       House bill.--No provision.
       Senate bill.--Section 102 of S. 2325 would make permanent 
     VA's authority to contract with non-VA halfway houses for 
     rehabilitation services for veterans with substance abuse 
     problems.
       Compromise agreement.--Section 103(b) would extend the 
     authorization of this program until December 31, 1995.
     Pilot program for noninstitutional alternatives to nursing 
         home care
       Current law.--Section 1720C of title 38 authorizes VA, 
     through October 1, 1994, to conduct a pilot program for 
     furnishing certain services in noninstitutional settings for 
     certain veterans who are in need of nursing home care.
       House bill.--Section 202 of H.R. 4425 would extend, until 
     September 30, 1997, the pilot program, and would expand 
     eligibility for the program to include all veterans who are 
     eligible for and in need of VA nursing home care.
       Senate bill.--No provision.
       Compromise agreement.--Section 103(c) would extend the 
     pilot program until September 30, 1995.
     Enhanced-use leases of real property
       Current law.--Subchapter V of chapter 81, title 38, 
     authorizes the Secretary, through December 31, 1994, to enter 
     into enhanced-use leases under which another party may use VA 
     property so long as at least part of the property will 
     provide for an activity which contributes to the mission of 
     the Department of Veterans Affairs and enhances the use of 
     the property.
       House bill.--No provision.
       Senate bill.--Section 408 of S. 2325 would extend until 
     December 31, 1996, the authority for VA to enter into 
     enhanced-use leases.
       Compromise agreement.--Section 103(d) follows the Senate 
     bill with an extension until December 31, 1995.
     Authority for community-based residential care for homeless 
         chronically mentally ill veterans and other veterans
       Current law.--Public Law 100-322, based on Public Law 100-
     6, authorizes VA to conduct a program, known as the Homeless 
     Chronically Mentally Ill (HCMI) program, through which VA 
     outreach workers contact homeless veterans in the community, 
     assess and refer veterans to community services, and place 
     eligible veterans in contracted community-based residential 
     treatment facilities. Public Law 102-405 extended VA's 
     authority to conduct the HCMI program until September 30, 
     1994.
       House bill.--No provision.
       Senate bill.--Section 104 of S. 2325 would reauthorize 
     until September 30, 1999, the HCMI program and codify the 
     program in title 38, United States Code.
       Compromise agreement.--Section 103(e) would reauthorize the 
     HCMI program until September 30, 1995.
     Demonstration program of compensated work therapy
       Current law.--Section 7 of Public Law 102-54, enacted in 
     1991, authorizes VA to conduct through October 1, 1994, a 
     demonstration program of compensated work therapy and 
     transitional residences (CWT/TR), which shall have two 
     components. Under one component, VA is authorized to purchase 
     and renovate no more than 50 residences as therapeutic 
     transitional houses for chronic substance abusers. Under the 
     second component, VA is authorized to contract with nonprofit 
     corporations which would own and operate the transitional 
     residences in conjunction with existing VA compensated work 
     therapy programs.
       House bill.--Section 402 would (a) extend the CWT/TR 
     demonstration program from fiscal year 1994 through fiscal 
     year 1998, and (b) permit the Department to increase 
     incrementally the number of residences it operates to a 
     maximum of 106 in fiscal year 1998.
       Senate bill.--Section 101 of S. 2325 would extend the 
     authorization of the CWT/TR program to fiscal year 1996.
       Compromise agreement.--Section 103(f) would reauthorize the 
     CWT/TR program until October 1, 1995.


             facilities in the republic of the philippines

       Current law.--Section 1724 of title 38 limits the 
     circumstances under which VA may provide medical care outside 
     the United States, Puerto Rico, and the Virgin Islands. Under 
     that section, VA may furnish non-service-connected treatment 
     in the Philippines only on a contract basis with the Veterans 
     Memorial Medical Center, a non-VA facility.
       House bill.--Section 504 of H.R. 4425 would ratify VA's 
     actions in finding alternative means for caring for patients 
     at the Veterans Memorial Medical Center in the Philippines 
     during the period between February 29 and June 1, 1994, to 
     include the provision of medical services to non-service-
     connected veterans at its Manila outpatient clinic.
       Senate bill.--No provision.
       Compromise agreement.--Section 104 follows the House bill.

                  TITLE II--CONSTRUCTION AUTHORIZATION


  authorization of major medical facility projects and major medical 
                            facility leases

       Current law.--Section 8104(a)(2) of title 38 provides that 
     no funds may be appropriated for any fiscal year, and the 
     Secretary of Veterans Affairs may not obligate or expend 
     funds (other than for advance planning and design), for any 
     major medical facility project or any major medical facility 
     lease, unless funds for that project or lease have been 
     specifically authorized by law.
       House bill.--Section 101(a)(1) of H.R. 4425 would authorize 
     the Secretary, except as provided in section 101(a)(2), to 
     carry out the major medical facility projects and major 
     medical facility leases for the Department of Veterans 
     Affairs for which funds were requested in the President's 
     budget for fiscal year 1995.
       Section 101(a)(2) would prohibit the Secretary from 
     carrying out the projects for the construction of research 
     additions at Huntington, WV, and Portland, OR.
       Section 101(b) would authorize the Secretary to carry out 
     the following additional major medical facility projects in 
     the amounts specified: (1) The projects for ambulatory care 
     facilities that are proposed in the budget for fiscal year 
     1995 to be financed with funds from the Health Care 
     Investment Fund; (2) a nursing home facility at the VA 
     Medical Center in Charleston, SC, $7,300,000; (3) a lease/
     purchase of a nursing home facility near Ft. Myers, FL, 
     $18,630,000; and (4) an outpatient care addition at the VA 
     Medical Center in Phoenix, AZ, $50,000,000.
       Section 201(c) would authorize the construction of an 
     ambulatory care/support services facility and other projects 
     required to repair, restore, or replace, earthquake damage at 
     the VA Medical Center in Sepulveda, CA, for which funds were 
     appropriated in the Emergency Supplemental Appropriations Act 
     of 1994.
       Senate bill.--Section 1(a) of S. 2277 is substantively 
     identical to the House provision in section 101(a), except 
     that it would authorize all of the VA major medical facility 
     projects for which funds are requested for fiscal year 1995, 
     including the research additions in Portland and Huntington. 
     Section 1(a) states that the authorization in section 1(a) 
     includes projects or leases that were previously authorized 
     or funded.
       Section 1(b) would authorize the following additional 
     projects: (1) The projects for ambulatory care facilities 
     that are proposed in the budget for fiscal year 1995 to be 
     financed with funds from the Health Care Investment Fund; (2) 
     a nursing home facility at the VA Medical Center in 
     Charleston SC, $7,300,000; and (3) an outpatient care 
     addition at the VA Medical Center in Phoenix, AZ, 
     $50,000,000.
       Section 1(c) authorizes the construction of an ambulatory 
     care/support services facility and other projects required to 
     repair, restore, or replace, earthquake damage at the VA 
     Medical Center in Sepulveda, CA, for which funds were 
     appropriated in the Emergency Supplemental Appropriations Act 
     of 1994.
       Compromise agreement.--Section 201(a) follows Senate 
     provision section 1(a) and would authorize the VA to enter 
     into the major medical facility projects and major medical 
     facility leases for the Department of Veterans Affairs for 
     which funds were requested in the President's budget for 
     fiscal year 1995.
       Section 201(b) generally follows House provision section 
     101(b) and would authorize the following additional projects: 
     (1) The projects for ambulatory care facilities that are 
     proposed in the budget for fiscal year 1995 to be financed 
     with funds from the Health Care Investment Fund; (2) a 
     nursing home facility at the VA Medical Center in Charleston, 
     SC, $7,300,000; (3) a lease/purchase of a nursing home 
     facility near Ft. Myers, FL, $12,800,000; and (4) an 
     outpatient care addition at the VA Medical Center in Phoenix, 
     AZ, $50,000,000.
       Section 201(c) is identical to House provision section 
     101(c) and Senate provision section 1(c) and would authorize 
     the construction of an ambulatory care/support services 
     facility and other projects required to repair, restore, or 
     replace, earthquake damage at the VA medical Center in 
     Sepulveda, CA, for which funds were appropriated in the 
     Emergency Supplemental Appropriations Act of 1994.
       The Committees note that some major medical facility 
     projects in the VA fiscal year 1995 budget submission were 
     authorized or partially funded in a prior year and therefore 
     do not require authorization under section 8104(a)(2) of 
     title 38. These projects are: (1) Seismic corrections at the 
     Memphis, TN, Medical Center, $62.3 million ($10.7 million was 
     authorized for FY 1994); (2) construction of a medical center 
     in Travis, CA, to replace the Martinez facility, $7.3 million 
     for phase I ($11 million was appropriated for FY 1993); (3) 
     construction of a research facility in Huntington, WV, $9.9 
     million ($250,000 was appropriated for FY 1991); (4) 
     construction of an ambulatory care addition at the Columbia, 
     MO, Medical Center, $22.9 million ($300,000 was appropriated 
     for FY 1993); (5) construction of an ambulatory care addition 
     and parking garage at the San Juan, PR, Medical Center, $34.8 
     million ($46 million was authorized FY 1994); and (6) 
     construction of an outpatient facility at the VA Medical 
     Center in Gainesville, FL, $17.8 million ($8.9 million 
     appropriated for FY 1990).
       Leases for which funding is requested in the budget but for 
     which authorization is not required are: (1) Hilo, HI, 
     residential facility, $457,200 (funds appropriated for FY 
     1992); (2) Sacramento, CA, outpatient expansion, $345,000 
     (funds authorized for FY 1994); (3) Birmingham, AL, Parking 
     garage $546,000 (GSA lease); (4) Washington, DC, health care 
     medical education center, $350,000 (GSA lease).


                    Authorization of Appropriations

       Current law.--Section 8104(a)(2) of title 38 provides that 
     no funds may be appropriated for any fiscal year, and the 
     Secretary of Veterans Affairs may not obligate or expend 
     funds (other than for advance planning and design), for any 
     major medical facility project or any major medical facility 
     lease, unless funds for that project or lease have been 
     specifically authorized by law.
       House bill.--Section 102(a) of H.R. 4425 would authorize to 
     be appropriated to the Secretary of Veterans Affairs for 
     fiscal year 1995 (1) $343,800,000 for the authorized major 
     medical facility projects; and (2) $15,800,000 for the 
     authorized major medical facility leases.
       Section 102(b) would limit the authorized projects to be 
     carried out using only (1) specifically authorized major 
     construction funds appropriated for fiscal year 1995; (2) 
     funds appropriated for Construction, Major Projects, for a 
     fiscal year before fiscal year 1995 that remain available for 
     obligation; and (3) funds appropriated for Construction, 
     Major Projects, for fiscal year 1995 for a category of 
     activity not specific to a project.
       Section 102(c) would limit the project authorized in 
     section 101(c) to be carried out using only (1) funds 
     appropriated as well as funds transferred by the President to 
     the Construction, Major Projects account pursuant to the 
     Emergency Supplemental Appropriations Act of 1994; (2) funds 
     appropriated to the Medical Care Account by the Emergency 
     Supplemental Appropriations Act of 1994 that are transferred 
     by law to the Construction, Major Projects account; (3) funds 
     appropriated to the Construction, Major Projects account for 
     a fiscal year before fiscal year 1994 that remain available 
     for obligation; and (4) funds appropriated for Construction, 
     Major Projects, for fiscal year 1994 for a category of 
     activity not specific to a project.
       Senate bill.--Section 2(a) of S. 2277 would authorize to be 
     appropriated for fiscal year 1995 (1) $395,000,000 for major 
     medical facility projects; and (2) $15,900,000 for major 
     medical facility leases.
       Section 2(b) is substantively identical to the House 
     provision in section 102(b).
       Section 2(c) is substantively identical to the House 
     provision in section 102(c).
       Compromise agreement.--Section 202(a) would authorize to be 
     appropriated to the Secretary of Veterans Affairs for fiscal 
     year 1995 (1) $379,370,000 for the authorized major medical 
     facility projects; and (2) $15,800,000 for the authorized 
     major medical facility leases.
       Section 202(b) is identical to House provision section 
     102(b), and Senate provision section 2(b).
       Section 202(c) would limit the projects authorized in 
     section 101(c) to be carried out using only: (1) Funds 
     appropriated as well as funds transferred by the President to 
     the Construction, Major Projects account pursuant to the 
     Emergency Supplemental Appropriations Act of 1994; (2) funds 
     appropriated to the Medical Care Account by the Emergency 
     Supplemental Appropriations Act of 1994 that are transferred 
     by law to the Construction, Major Projects account; (3) funds 
     appropriated to the Construction, Major Projects account for 
     a fiscal year before fiscal year 1995 that remain available 
     for obligation; and (4) funds appropriated for Construction, 
     Major Projects, for fiscal year 1995 for a category of 
     activity not specific to a project.
  Mr. STUMP. Mr. Speaker, I rise in support of the House amendments to 
the Senate amendments to H.R. 3313. Despite the best efforts of all 
concerned, we were not able to reach agreement on two major issues--the 
scope of women's health care services and a pilot program for VA 
participation in State health care plans. I regret that so many other 
provisions also fell out of the bill in our negotiations with the other 
body.
  This bill does not contain provisions to extend the VA health care 
authorization for veterans who have been exposed to Agent Orange and 
radiation. The bill also expands the VA's authority to provide sexual 
trauma counseling and services to veterans and authorizes the VA to 
establish an 800 number to deal with this important issue.
  As part of these amendments to the Senate amendments, women and 
minorities will be included in the important clinical research programs 
of the VA. Through these new provisions, research relating to the 
health of women veterans will be expanded. Furthermore, understanding 
the need for noninstitutional alternatives to nursing home care, H.R. 
3313 would provide for an emphasis in this evolving program area.
  Most importantly, this bill provides the VA with authority to proceed 
with $379 million of needed construction projects, including funding 
for a new outpatient care addition for the Phoenix VA Medical Center. 
The addition is greatly needed for veterans. Due to the rapid growth of 
the veterans population in the Phoenix area, the outpatient clinic has 
been operating at a patient volume which is far greater than its 
planned capacity.
  I urge my colleagues to support this compromise and we will make 
every effort in the next Congress to act promptly with new legislative 
proposals on the remaining issues.
  The SPEAKER pro tempore. Is there objection to the original request 
of the gentleman from Mississippi?
  There was no objection.
  A motion to reconsider was laid on the table.

                          ____________________