[Congressional Record Volume 140, Number 145 (Friday, October 7, 1994)]
[Senate]
[Page S]
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 PROGRAMS EXTENSION ACT OF 1994

  Mr. ROCKEFELLER. Mr. President, as chairman of the Committee on 
Veterans' Affairs, I urge my colleagues to approve the compromise 
agreement on H.R. 3313, the proposed Veterans Health Programs Extension 
Act of 1994. This compromise is the result of efforts to reach a 
compromise on many issues.
  Mr. President, I am deeply disappointed that we will be unable to 
pursue passage of a more comprehensive veterans health care bill this 
session. The bill we are passing today, the Veterans Health Programs 
Extension Act of 1994, is a much abbreviated version of an omnibus 
measure which was the final result of over a year of hearings, 
discussions, and most recently, successful negotiations involving the 
majority and minority staff of both Committees on Veterans' Affairs. If 
passed in the originally negotiated form, this bill would have been the 
only veterans omnibus health care bill of this year. Unfortunately, at 
the last minute, a Republican member of the House Committee raised 
objections--ones which I believe were without merit--that in light of 
the little time left in the session, made it impossible for the overall 
bill to pass. As a result, we were forced to pare it back to the very 
modest measure that comes before the Senate today.
  Mr. President, this measure originally encompassed many different 
programs and would have helped many more veterans. It is truly sad, 
that because of the intransigence of one Republican Member of the 
House, many groups of deserving veterans will have to wait until next 
Congress to see real improvements in their health care--the health care 
which they have earned by their service.
  Mr. President, the women veterans of this Nation will be particularly 
hurt by the blockage of some of the provisions of this bill. The 
measure would have expanded the list of women's health services offered 
by VA, and assured that women veterans would receive pap smears, breast 
examinations and mammography, services related to menopause and 
osteoporosis, and prenatal care, delivery, and postpartum care.
  Additionally, the bill included provisions to authorize VA to furnish 
readjustment counseling to World War II or Korean conflict veterans, to 
furnish some preventive health services in Vet Centers, and to provide 
bereavement counseling services to family members of certain deceased 
servicemembers.
  The bill would have improved VA's research on mental illness, 
including posttraumatic stress disorder, schizophrenia, and alcohol and 
drug abuse. And the bill, as originally negotiated, would have made it 
easier for VA to recruit nurses and other health professionals.
  Mr. President, I will at this time highlight some of the provisions 
that remain in the compromise. Detailed descriptions of all the 
provisions are set forth in the explanatory statement accompanying the 
compromise agreement which was developed in cooperation with the House 
Committee on Veterans' Affairs. My distinguished counterpart, Chairman 
G.V. ``Sonny'' Montgomery, insert the same explanatory statement in the 
Record during House consideration of this measure.
  Mr. President, the proposed Veterans Health Programs Extension Act of 
1994 has two titles: General Medical Authorities and Construction 
Authorization.


                  TITLE I--GENERAL MEDICAL AUTHORITIES

                 SECUAL TRAUMA COUNSELING AND SERVICES

  Mr. President, the provisions in title I relating to sexual trauma 
services are derived, in part, from S. 2973 of the 102d Congress, which 
was ultimately enacted as the Veterans Health Care Act of 1992 (Public 
law 102-585), an omnibus veterans health measure.
  Mr. President, this legislation would extend the entire sexual trauma 
counseling program within VA. Under current law, VA's authority to 
carry out this program would expire on December 31, 1995. VA needs more 
time to reach the veterans who need these services.
  In addition, this legislation would repeal the restriction in current 
law that requires women veterans to seek sexual trauma counseling 
within 2 years of discharge from active duty, and it would also repeal 
the 1-year time limit during which a veteran could receive VA care for 
sexual trauma.
  Women veterans have served with dignity and courage in all wars since 
the American Revolution, and we must ensure that any veteran who is 
raped or sexually assaulted while serving on active duty, is be able to 
seek care at any point after leaving the service and get care for as 
long as is necessary.


                   extension of expiring authorities

               authority to provide priority health care

  Mr. President, I am pleased that this legislation includes provisions 
relating to eligibility for medical care for exposure to dioxin or 
ionizing radiation.
  These provisions also symbolize Congress' resolve to help veterans 
who were poorly informed or misinformed about their exposures to 
chemicals or atomic radiation. We want to assure these veterans that 
Congress is committed to providing the health care they need, even if 
the nature of their exposure makes it difficult to establish scientific 
proof that their exposures caused specific illnesses.
  The proposed bill would extend, until June 30, 1995, current 
eligibility criteria for dioxin-exposed or radiation-exposed veterans 
to 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.
  Mr. President,, although it may take years to determine all the 
causes of the mysterious illnesses experienced by our Persian Gulf war 
veterans, we must continue to provide medical care to those veterans 
who are suffering from these illnesses.
  In this regard, the pending measure also includes a provision to 
authorize VA to provide inpatient or outpatient care to Persian Gulf 
war veterans until December 31, 1995.


                  title ii--construction authorization

  Mr. President, I am pleased that the compromise agreement would 
authorize major medical facility projects--projects for the 
construction, alteration, or acquisition of a medical facility 
currently involving a total expenditure of more than $3 million, as 
requested in the President's budget for fiscal year 1995. The following 
five projects, and the amounts specified, were requested in the 
President's budget submission for fiscal year 1995: (1) Design funds 
for construction of a new medical facility and nursing home in Brevard 
County, FL, $17.2 million; (2) seismic corrections to an existing 
facility in Memphis, TN, $62.3 million; (3) a tower addition to the 
David Grant Medical Center in Travis, CA, $7.3 million; (4) a research 
addition to the Medical Education Building in Huntington, WV, $9.9 
million; (5) a research addition at the Portland, OR, Medical Center, 
$16.1 million.
  As noted by both committees in the explanatory statement, three of 
the 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, United States Code. These projects are at the VA medical 
centers in Memphis, TN--$10.7 million was authorized for FY 1994; 
Travis, CA--$11 million was appropriated for fiscal year 1993; and 
Huntington, WV--$250,000 was appropriated for fiscal year 1991.
  The compromise agreement would also authorize the ambulatory care 
projects that were proposed in the documents submitted to Congress by 
the Secretary of Veterans Affairs in conjunction with the budget, to be 
financed with funds from the Health Care Investment Fund to be 
established under the proposed Health Security Act. These projects will 
be crucial to VA's ability to adapt to changing trends in health care 
practices. They are: (1) $9.6 million for the lease-purchase of an 
outpatient clinic in Bay Pines, FL; (2) $48 million for an ambulatory 
care addition and renovations at the Boston, MA, Medical Center; (3) 
$14 million to renovate the Naval Training Center Hospital in Orlando, 
FL, for use as a VA outpatient clinic and nursing home; (4) $29.2 
million for an ambulatory care addition at the Hampton, VA, Medical 
Center; and (5) $48.6 million for an ambulatory care addition and 
renovations at the West Haven, CT, Medical Center.
  Ambulatory care projects proposed to be constructed through the 
investment fund that do not require authorization are: (1) $17.8 
million for an ambulatory care addition at the Gainesville, FL, Medical 
Center; (2) $22.9 million for an ambulatory care addition at the 
Columbia, MO, Medical Center; and (3) $34.8 million for an ambulatory 
care addition and parking garage at San Juan, PR.
  Mr. President, I am pleased that the compromise agreement would also 
authorize the following additional projects: (1) a nursing home 
facility at the VA Medical Center in Charleston, SC, $7,300,000; (2) a 
lease/purchase of a nursing home facility near Ft. Myers, FL, 
$12,800,000; and (3) an outpatient care addition at the VA Medical 
Center in Phoenix, AZ, $50,000,000.
  The compromise agreement would also authorize funds for construction 
of an ambulatory care facility to replace the earthquake-damaged 
facility in Sepulveda, CA. Funds for this project totaling $103.7 
million have been made available through the Emergency Supplemental 
Appropriations Act of 1994.
  I am pleased also that the compromise agreement would authorize the 
Secretary of Veterans Affairs to carry out two major medical facility 
leases--leases of space for use as a medical facility at an average 
annual rental rate of more than $300,000--for which funds were 
requested in the President's budget submission for fiscal year 1995, 
and would authorize the appropriation of $15,800,000 for those leases.
  The major medical facility leases proposed in the President's budget 
and authorized by the committees are: an outpatient clinic in Ponce, 
PR--$1,175,040; and an outpatient clinic in Winston-Salem, NC--
$844,800.
  Leases for which funding is requested in the President's fiscal year 
1995 budget, but for which authorization is not required are: a 
residential facility in Hilo, HI--$457,200; an outpatient expansion in 
Sacramento, CA--$345,000; a parking garage in Birmingham, AL $546,000; 
and a health care medical education center in Washington, DC--$350,000.
  I am pleased that the compromise agreement also would include an 
authorization of $379,370,000 for the major medical facility projects I 
have outlined.
  It is critical to the VA's mission that it maintain its capital 
investment and modernize the physical plants where appropriate to 
ensure that the VA health care system can provide state-of-the-art 
medical care and respond to the changing needs of our Nation's 
veterans.
  Mr. President, in closing, I thank our committee's ranking Republican 
member, Senator Murkowski, for his cooperation and help with this bill. 
I am also grateful to many other members of the committee for their 
support on this measure.
  I also express my gratitude for their work on this legislation to the 
committee's minority staff, Carrie Gavora, Mickey Thursam, Chris Yoder, 
Bill Tuerk, and John Moseman, and, for all their help to me on this 
measure, majority staff members Kim Lipsky, Tom Hart, Diana Zuckerman, 
Valerie Kessner, Bill Brew, and Jim Gottlieb.
  I also thank the chairman of the House Committee on Veterans' 
Affairs, G.V. ``Sonny'' Montgomery, and the committee's ranking 
Republican member, Bob Stump, as well as the other members of the House 
committee.
  We also owe a debt of gratitude to Charlie Armstrong of the Senate 
Legislative Counsel's office and to Bob Cover of the House Legislative 
Counsel's office for the painstaking care and skill they devoted to the 
drafting of this legislation.
  Thank you, Mr. President.
  Mr. President, I ask unanimous consent that the explanatory statement 
on this compromise agreement prepared by the House and Senate 
Committees on Veterans' Affairs be printed in the Record at this time.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

Joint Explanatory Statement for H.R. 3313, The Proposed Veterans Health 
                     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 103d 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 103d Congress.
       The Committees on Veterans' Affairs have prepared the 
     following explanation of H.R. 3313 as amended (hereinafter 
     referred to as the ``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 seeking care for a non-service-
     connected disability or 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 bill: 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 3, 1994, to provide veterans who are 
     suffering from substance abuse disabilities with care on a 
     contract basis through community halfway houses.
       House bill: No comparable 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 comparable 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 comparable 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 comparable 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, OR, and 
     Huntington, WV. 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 Veteran's 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 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 ($300,00 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).
       Comprise 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; (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. FEINGOLD. Mr. President, I ask unanimous consent that the Senate 
concur in amendments of the House.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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