[Congressional Record Volume 142, Number 12 (Tuesday, January 30, 1996)]
[Senate]
[Pages S563-S566]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      VA HEALTH CARE DELIVERY ACT

  Mr. LOTT. Mr. President, I ask that the Chair lay before the Senate a 
message from the House of Representatives on H.R. 2353, a bill to amend 
title 38, United States Code, to extend certain expiring authorities of 
the Department of Veterans Affairs relating to delivery of health and 
medical care, and for other purposes.
  The PRESIDING OFFICER laid before the Senate the following message 
from the House of Representatives:

       Resolved, That the House agree to the amendments of the 
     Senate to the bill (H.R. 2353) entitled ``An Act to amend 
     title 38, United States Code, to extend certain expiring 
     authorities of the Department of Veterans Affairs relating to 
     delivery of health and medical care, and for other 
     purposes'', with the following amendments:
       In lieu of the matter inserted by said amendment, insert:
                    TITLE I--EXTENSIONS OF AUTHORITY

     SEC. 101. EXTENSION OF AUTHORITIES UNDER TITLE 38, UNITED 
                   STATES CODE.

       (a) Authority To Provide Priority Health Care for Certain 
     Veterans Exposed to Toxic Substances.--(1) Section 1710(e)(3) 
     of title 38, United States Code, is amended by striking out 
     ``after June 30, 1995,'' and all that follows through 
     ``December 31, 1995'' and inserting in lieu thereof ``after 
     December 31, 1996''.
       (2) Section 1712(a)(1)(D) of such title is amended by 
     striking out ``December 31, 1995,'' and inserting in lieu 
     thereof ``December 31, 1996,''.
       (b) Drug and Alcohol Abuse and Dependence.--Section 
     1720A(e) of such title is amended by striking out ``December 
     31, 1995'' and inserting in lieu thereof ``December 31, 
     1997''.
       (c) Pilot Program for Noninstitutional Alternatives to 
     Nursing Home Care.--Section 1720C(a) of such title is amended 
     by striking out ``September 30, 1995,'' and inserting in lieu 
     thereof ``December 31, 1997,''.
       (d) Negotiated Interest Rates.--Section 3703(c)(4) of such 
     title is amended by striking out subparagraph (D).
       (e) Mortgages for Energy Efficient Improvements.--Section 
     3710(d) of such title is amended by striking out paragraph 
     (7).
       (f) Enhanced Loan Asset Sale Authority.--Section 3720(h)(2) 
     of such title is amended by striking out ``December 31, 
     1995'' and inserting in lieu thereof ``December 31, 1996''.
       (g) Authority of Lenders of Automatically Guaranteed Loans 
     To Review Appraisals.--Section 3731(f) of such title is 
     amended by striking out paragraph (3).
       (h) Agreements for Housing Assistance for Homeless 
     Veterans.--Section 3735(c) of such title is amended by 
     striking out ``December 31, 1995'' and inserting in lieu 
     thereof ``December 31, 1997''.
       (i) Use of Data on Compensation for Certified Registered 
     Nurse Anesthetists.--Section 7451(d)(3)(C)(iii) of such title 
     is amended by striking out ``April 1, 1995'' and inserting in 
     lieu thereof ``January 1, 1998''.
       (j) Health Professional Scholarship Program.--Section 7618 
     of such title is amended by striking out ``December 31, 
     1995'' and inserting in lieu thereof ``December 31, 1997''.
       (k) Enhanced-Use Leases of Real Property.--Section 8169 of 
     such title is amended by striking out ``December 31, 1995'' 
     and inserting in lieu thereof ``December 31, 1997''.

     SEC. 102. EXTENSION OF AUTHORITIES UNDER OTHER PROVISIONS OF 
                   LAW.

       (a) 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, 1995'' and inserting in lieu 
     thereof ``December 31, 1997''.
       (b) Demonstration Program of Compensated Work Therapy.--
     Section 7(a) of Public Law 102-54 (38 U.S.C. 1718 note) is 
     amended by striking out ``fiscal years 1991 through 1995'' 
     and inserting in lieu thereof ``the period beginning on 
     October 1, 1991, and ending on December 31, 1997,''.
       (c) Services and Assistance to Homeless Veterans.--The 
     Homeless Veterans Comprehensive Service Programs Act of 1992 
     (Public Law 102-590; 38 U.S.C. 7721 note) is amended--
       (1) in section 2, by striking out ``September 30, 1995,'' 
     and inserting in lieu thereof ``September 30, 1997,'';
       (2) in section 3(a)--
       (A) by inserting ``(1)'' before ``Subject to'';
       (B) by striking out ``fiscal years 1993, 1994, and 1995,''; 
     and
       (C) by adding at the end the following new paragraph:
       ``(2) The authority of the Secretary to make grants under 
     this section expires on September 30, 1997.''; and
       (3) in section 12, by striking out ``each of the fiscal 
     years 1993, 1994, and 1995'' and inserting in lieu thereof 
     ``each of fiscal years 1993 through 1997''.
       (d) Homeless Veterans' Reintegration Projects.--(1) Section 
     738(e)(1) of the Stewart B. McKinney Homeless Assistance Act 
     (42 U.S.C. 11448(e)(1)) is amended by adding at the end the 
     following:
       ``(D) $10,000,000 for fiscal year 1996.''.
       (2) Section 741 of such Act (42 U.S.C. 11450) is amended by 
     striking out ``October 1, 1995'' and inserting in lieu 
     thereof ``December 31, 1997''.

     SEC. 103. RATIFICATION OF ACTIONS TAKEN DURING PERIOD OF 
                   EXPIRED AUTHORITY.

       Any action taken by the Secretary of Veterans Affairs 
     before the date of the enactment of this Act under a 
     provision of law amended by this title that was taken during 
     the period beginning on the date on which the authority of 
     the Secretary under that provision of law expired and ending 
     on the date of the enactment of this Act shall be considered 
     to have the same force and effect as if the amendment to that 
     provision of law made by this title had been in effect at the 
     time of that action.
                       TITLE II--OTHER PROVISIONS

     SEC. 201. CODIFICATION OF HOUSING REPORTING REQUIREMENTS AND 
                   CHANGES IN THEIR FREQUENCY.

       (a) Codification of Housing Related Reporting 
     Requirements.--(1) Chapter 37 of title 38, United States 
     Code, is amended by adding after section 3735 the following 
     new section:

     ``Sec. 3736. Reporting requirements

       ``The annual report required by section 529 of this title 
     shall include a discussion of the activities under this 
     chapter. Beginning with the report submitted at the close of 
     fiscal year 1996, and every second year thereafter, this 
     discussion shall include information regarding the following:
     
[[Page S564]]

       ``(1) Loans made to veterans whose only qualifying service 
     was in the Selected Reserve.
       ``(2) Interest rates and discount points which were 
     negotiated between the lender and the veteran pursuant to 
     section 3703(c)(4)(A)(i) of this title.
       ``(3) The determination of reasonable value by lenders 
     pursuant to section 3731(f) of this title.
       ``(4) Loans that include funds for energy efficiency 
     improvements pursuant to section 3710(a)(10) of this title.
       ``(5) Direct loans to Native American veterans made 
     pursuant to subchapter V of this chapter.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after the item relating to section 
     3735 the following new item:

``3736. Reporting requirements.''.
       (b) Repeal of Superseded Reporting Requirements.--The 
     Veterans Home Loan Program Amendments of 1992 (Public Law 
     102-547; 106 Stat. 3633) is amended by striking out sections 
     2(c), 3(b), 8(d), 9(c), and 10(b).

     SEC. 202. OTHER REPORT REQUIREMENTS.

       (a) Report on Consolidation of Certain Programs.--The 
     Secretary of Veterans Affairs shall submit to Congress, not 
     later than March 1, 1997, a report on the advantages and 
     disadvantages of consolidating into one program the following 
     three programs:
       (1) The alcohol and drug abuse contract care program under 
     section 1720A of title 38, United States Code.
       (2) The program to provide community-based residential care 
     to homeless chronically mentally ill veterans under section 
     115 of the Veterans' Benefits and Services Act of 1988 (38 
     U.S.C. 1712 note).
       (3) The demonstration program under section 7 of Public Law 
     102-54 (38 U.S.C. 1718 note).
       (b) Health Professional Scholarship Program.--(1) The 
     Secretary shall submit to Congress, not later than March 31, 
     1997, a report setting forth the results of a study 
     evaluating the operation of the health professional 
     scholarship program under subchapter II of chapter 76 of 
     title 38, United States Code. The study shall evaluate the 
     efficacy of the program with respect to recruitment and 
     retention of health care personnel for the Department of 
     Veterans Affairs and shall compare the costs and benefits of 
     the program with the costs and benefits of alternative 
     methods of ensuring adequate recruitment and retention of 
     such personnel.
       (2) The Secretary shall carry out the study under this 
     paragraph through a private contractor. The report under 
     paragraph (1) shall include the report of the contractor and 
     the comments, if any, of the Secretary on that report.
       (c) Enhanced Use Leases.--The Secretary shall submit to 
     Congress, not later than March 31, 1997, a report evaluating 
     the operation of the program under subchapter V of chapter 81 
     of title 38, United States Code.

     SEC. 203. CONTRACTS FOR UTILITIES, AUDIE L. MURPHY MEMORIAL 
                   HOSPITAL.

       (a) Authority To Contract.--Subject to subsection (b), the 
     Secretary of Veterans Affairs may enter into contracts for 
     the provision of utilities (including steam and chilled 
     water) to the Audie L. Murphy Memorial Hospital in San 
     Antonio, Texas. Each such contract may--
       (1) be for a period not to exceed 35 years;
       (2) provide for the construction and operation of a 
     production facility on or near property under the 
     jurisdiction of the Secretary;
       (3) require capital contributions by the parties involved 
     for the construction of such a facility, such contribution to 
     be in the form of cash, equipment, or other in-kind 
     contribution; and
       (4) provide for a predetermined formula to compute the cost 
     of providing such utilities to the parties for the duration 
     of the contract.
       (b) Funds.--A contract may be entered into under subsection 
     (a) only to the extent as provided for in advance in 
     appropriations Acts.
       (c) Additional Terms.--The Secretary may include in a 
     contract under subsection (a) such additional provisions as 
     the Secretary considers necessary to secure the provision of 
     utilities and to protect the interests of the United States.

       In lieu of the Senate amendment to the title of the bill, 
     amend the title so as to read: ``An Act to amend title 38, 
     United States Code, to extend the authority of the Secretary 
     of Veterans Affairs to carry out certain programs and 
     activities, to require certain reports from the Secretary of 
     Veterans Affairs, and for other purposes.''.

  Mr. SIMPSON. Mr. President, I am pleased to rise to comment briefly 
today, as chairman of the Veterans' Affairs Committee, on an important 
and, I think, noncontroversial piece of legislation to extend the 
effective dates of certain legal authorities under which the Department 
of Veterans Affairs [VA] operates.
  The extension of each, and all, of legal authorities which are before 
the Senate today has previously been approved by the Senate. 
Specifically, this body approved the extension of each of these 
provisions on January 5, 1996, when it approved S.991, as amended. The 
Senate then substituted the text of S. 991, as so approved, into H.R. 
2353, and sent that legislation back to the other body. We anticipated 
at that time that the House would approve these noncontroversial 
provisions--and, indeed, the House has approved them. The House, 
however, has made certain additional amendments to the Senate-passed 
bill which necessitate further consideration of the bill by this body.
  To summarize, this is what the House has done to change the Senate-
approved bill: first, it made permanent certain authorities pertaining 
to VA's home loan program that the Senate would have extended, on an 
interim basis, for 2 years only; second, it extended the maximum 
allowable timeframe for which VA may enter into a particular lease 
transaction in order to facilitate the construction of a power plant on 
the grounds of the VA Medical Center in San Antonio, TX; and, third, 
with respect to certain programs being extended by the Senate-approved 
bill, the House amendments would either modify existing reporting 
requirements or, in three instances, impose new reporting requirements 
on VA, in order that the Congress might be in a better position in the 
future to decide whether to extend these provisions again.
  Mr. President, these amendments are not objectionable. I will only 
comment at more length on one of them: the House amendment to make 
permanent VA's authority to guarantee home mortgage loans with interest 
rates set by the marketplace--instead of by VA officials. I heartily 
support this amendment.
  Three years ago, the Congress enacted legislation to authorize VA, 
for the first time, to guarantee home mortgage loans having interest 
rates set by the marketplace. Before 1992, the maximum allowable 
interest rate that a veteran could be charged on a VA-guaranteed home 
loan was set by the VA. As I explained in my floor statement on January 
5, 1996, this attempt to ``protect'' veterans caused market disruptions 
and did not result in any real benefit to veteran home purchasers. In 
cases where the VA-set ``ceiling'' rate was set too low, home sellers 
typically upped the price of the house to be sold or, worse, they 
refused to deal with veteran-purchasers.
  When the Senate approved an extension in VA's authority to guarantee 
loans with market-set interest rates on January 5, I said that the 
Committee would be holding hearings on this issue with an eye toward 
making this legal authority permanent. The committee's membership, and 
our colleagues in the other body, however, are willing to make this 
authority permanent now. I certainly have no objection to proceeding 
now to ``let'' the marketplace--rather than VA bureaucrats--set 
mortgage interest rates; I never thought it made sense in the first 
place to put a ``sunset'' date in the provision which allows reliance 
on the marketplace. Therefore, I support the House amendment, and I am 
pleased to be able to make permanent the home loan authorities enacted 
in 1992.
  The other House modifications require less explanation. One would 
extend the maximum term for which a VA Medical Center, in San Antonio, 
TX, could lease its land in order to facilitate the construction by the 
local utility of a power plant on VA grounds from which VA could buy 
inexpensive power. This transaction--at least at this particular 
medical center--clearly appears to make sense. The other amendments 
would ease VA reporting burdens--a concept that I certainly support--
and, in three instances, add new reporting requirements. While I am 
less than enthusiastic about layering yet more statutory reporting 
requirements on VA, perhaps these reports will be useful. In any case, 
I do not intend to delay this overdue legislation further by objecting 
to these reporting requirements.
  Otherwise, Mr. President, the bill contains no significant 
modification relative to the bill already approved by the Senate. As 
explained in greater length in my floor statement of January 5, 1996, 
the bill will extend VA authority to grant to so-called ``environmental 
veterans''--those who were exposed to ionizing radiation during 
service; those who served in the Republic of Vietnam and who are, 
therefore, ``presumed'' to have been exposed to dioxin; and those who 
served in the Persian Gulf War and who may have possibly been exposed 
to some presently unknown toxic substances or other environmental 
hazards--to priority access to VA hospital care services. That 
authority will be extended through this year, during which the 
committee intends to examine closely an entire range of issues 
associated with VA's standards for eligibility for health care 
services. 

[[Page S565]]

  It would also extend VA's legal authority to contract for drug and 
alcohol abuse treatment services. It would extend a number of legal 
authorities under which VA either itself provides, or contracts for 
others to provide, health care and other services to homeless veterans. 
It would extend VA's current pilot program on noninstitutional 
alternatives to nursing home care. It would also extend: VA's Health 
Professional Scholarship Program; VA's authority to use local pay 
surveys to determine the appropriate level of locality pay for VA nurse 
anesthetists; and VA's authority to enter into certain property leasing 
transactions. It would extend--and make permanent--previously enacted 
home loan authorities including: VA's authority to guarantee home loans 
having market-set interest rates; VA's authority to guarantee ``energy 
efficient'' mortgages; and VA's authority to allow lenders access to 
appraisals on the properties they finance. Finally, it would extend 
VA's ``enhanced loan asset sale authority,'' an authority which 
facilitates the marketing of instruments by which sales of foreclosed 
VA-owned properties are financed.
  As I have noted, Mr. President, these provisions have previously been 
approved by the Senate, and there was no previous controversy with 
respect to any of them. The changes made by the other body are not 
objectionable to me. Nor have any other members of the Veterans' 
Affairs, Committee raised objection. Accordingly, I urge my colleagues 
to approve these measures, as amended by the other body, in order that 
we might put into place now-expired VA legal conditions without further 
delay.
  Mr. President, I appreciate the time that has been afforded me and I 
yield back the remainder of my time.
  Mr. ROCKEFELLER. Mr. President, as the ranking minority member of the 
Committee on Veterans' Affairs, I urge the Senate to give its unanimous 
support to the pending measure, H.R. 2353. This legislation is the 
final compromise on legislation reported by the Committee on Veterans' 
Affairs on September 20, 1995, and originally passed by the Senate on 
January 5, 1996. The debate on the original Senate passage begins on 
page S102 of the Record for January 5. The House passed this compromise 
on January 25, 1996.
  This legislation would extend a variety of veterans programs and 
authorities that have expired. The proposed extensions are relatively 
short-term ones--1 or 2 years--to ensure that the program or authority 
remains in place while the committee takes the opportunity to review 
the various issues in more detail.
  Mr. President, I regret the delay in the final action on this 
legislation--first in the Senate, and now at final passage, when the 
House, rather than passing the bill as passed by the Senate, returned 
it to us after a delay so that certain very minor provisions--which I 
will describe in a moment--could be added to this measure. This is a 
simple extender bill, and it should have been passed months ago. We 
should not be in the situation of allowing Government benefits and 
programs to expire. We must do better.
  Mr. President, there is no objection as far as I know to any of the 
provisions in the bill as it comes before the Senate today. I urge its 
swift enactment so that it can reach the President as soon as possible 
for his signature.


                         SUMMARY OF PROVISIONS

  Mr. President, the bill as amended by the House and now pending in 
the Senate contains 20 substantive provisions--15 of which provide for 
the extension of programs and authorities--the vast majority of which 
are the same as the Senate-passed provisions--and five provisions added 
by the House, four of which require reports from VA and one relating to 
the furnishing of utilities at a VA medical center.
  I will first describe briefly the provisions which extend programs 
and authorities, noting any changes from the provisions as passed by 
the Senate on January 5. I will then briefly describe the provisions 
added by the House.
  The provisions which would provide for extensions of programs and 
authorities would:
  First, extend until December 31, 1996, the special eligibility for VA 
inpatient care which is accorded to certain veterans--those exposed to 
ionizing radiation from nuclear weapons tests or the occupation of 
Japan following World War II; Vietnam veterans exposed to herbicides 
during their service; and Persian Gulf war veterans exposed to 
environmental hazards during their service. Any care furnished to 
veterans exposed to radiation or herbicides pursuant to this authority 
between its expiration on June 30, 1995, and the date of enactment of 
this measure, would be ratified.
  Second, extend until December 31, 1996, the special eligibility for 
VA outpatient care accorded to Persian Gulf war veterans.
  Third, extend until December 31, 1997, VA's authority to contract for 
community-based drug and alcohol care.
  Fourth, extend until December 31, 1997, VA's pilot program of 
noninstitutional alternatives to nursing home care.
  Fifth, make permanent VA's authority to guarantee loans which bear an 
interest rate negotiated between the veteran and the lender. The 
Senate-passed bill would have extended this authority for 2 years.
  Sixth, make permanent VA's authority to guarantee loans that include 
costs related to making energy efficiency improvements to the dwelling 
that is the object of the loan. The Senate-passed bill would have 
extended this authority for 2 years.
  Seventh, extend until December 31, 1996, VA's enhanced loan asset 
sale authority pursuant to which VA guarantees the timely payment of 
principal and interest to purchasers of real estate mortgage investment 
conduits.
  Eighth, make permanent VA's authority to permit a lender who is 
authorized to make loans which are automatically guaranteed to review 
appraisals. The Senate-passed bill would have extended this authority 
for 2 years.
  Ninth, extend until December 31, 1997, VA's authority to enter into 
agreements with nonprofit organizations and State and local governments 
whereby such entities acquire real property, or the use of such 
property, from VA in order to furnish services to homeless veterans.
  Tenth, extend until December 31, 1997, VA's authority to use data on 
compensation paid to nurse anesthetists who work on a contract basis 
for non-VA entities in determining appropriate locality pay for nurse 
anesthetists who work for VA.
  Eleventh, extend until December 31, 1997, VA's Health Professional 
Scholarship Program.
  Twelfth, extend until December 31, 1997, VA's authority to enter into 
enhanced-use leases with non-VA entities.
  Thirteenth, extend until December 31, 1997, VA's program of 
community-based residential care for homeless chronically mentally ill 
veterans.
  Fourteenth, extend until December 31, 1997, VA's authority to carry 
out a demonstration program of compensated work therapy and therapeutic 
transitional housing.
  Fifteenth, extend until September 30, 1997, VA's authority to make 
grants to entities for the purpose of furnishing services and 
assistance to homeless veterans.
  Sixteenth, extend until September 30, 1997, the Department of Labor's 
homeless veterans' reintegration projects and authorize appropriation 
of $10 million for this program.
  Mr. President, as I noted, the House added five provisions to the 
bill as passed by the Senate. Four of these provision would relate to 
reports from VA--on housing programs; on the desirability of 
consolidating certain community-based programs; on the efficacy of VA's 
Health Professional Scholarship Program; and on the operation of VA's 
enhanced-use lease programs. The fifth provision authorizes VA to enter 
into contracts of up to 35 years' duration for the provision of 
utilities at the San Antonio VA medical center.
  Without getting into the merits of any of these provisions--beyond 
wondering, in this time of budgetary constraints, about the costs 
associated with generating the various reports--I must express my 
inability to understand why they were seen as so important at this time 
as to necessitate delaying the extender provisions.


                               CONCLUSION

  Mr. President, the principal point of this legislation is to extend a 
number 

[[Page S566]]
of important VA authorities and programs, and I urge all of my Senate 
colleagues to support it. As I noted at the outset, our consideration 
of this bill was delayed, first in the Senate because of unrelated 
concerns, and more recently, by the House, over the inclusion of the 
report provisions. It is vital that we act as quickly as possible to 
reauthorize the various programs and authorities.
  Mr. President, I express my appreciation to the majority staff of the 
committee, particularly Bill Tuerk, for their work on this legislation.
  Mr. President, I urge the Senate to give its unanimous approval to 
this measure.
  Mr. LOTT. Mr. President, I ask unanimous consent that the Senate 
concur with the amendments of the House to the Senate amendments, and 
that any statements relating to the bill appear at the appropriate 
place in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________