[Congressional Record Volume 142, Number 66 (Monday, May 13, 1996)]
[Senate]
[Pages S4975-S4976]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SIMPSON (by request):
  S. 1750. A bill to amend title 38, United States Code, to modify 
disbursement agreement authority to include residents and interns 
serving in any Department facility providing hospital care or medical 
services; to the Committee on Veterans' Affairs.


                         veterans' legislation

 Mr. SIMPSON. Mr. President, as chairman of the Veterans' 
Affairs Committee, I have today introduced, at the request of the 
Secretary of Veterans Affairs, S. 1750, a bill to modify the 
disbursement agreement authority to the Department of Veterans Affairs 
[VA] to include residents and interns who are serving in any VA 
facility providing hospital care or medical services. The Secretary of 
Veterans Affairs submitted this legislation to the President of the 
Senate by letter dated September 26, 1995.
  My introduction of this measure is in keeping with the policy which I 
have adopted of generally introducing--so that there will be specific 
bills to which my colleagues and others may direct their attention and 
comments--all administration-proposed draft legislation referred to the 
Veterans' Affairs Committee. Thus, I reserve the right to support or 
oppose the provisions of, as well as any amendment to, this 
legislation.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record, together with the transmittal letter and the 
enclosed analysis of the draft legislation.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1750

       Be it enacted by the Senate and the House of 
     Representatives of the United States of America in Congress 
     assembled, That except as otherwise expressly provided, 
     whenever in this Act an amendment is expressed in terms of an 
     amendment to 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.
       Sec. 2. Section 7406(c) is amended--
       (a) by striking ``Department hospital'' wherever it appears 
     and inserting in lieu thereof ``Department facility 
     furnishing hospital care or medical services''.
       (b) in paragraph 4(C) by striking ``hospital'' after 
     ``participating'' and inserting in lieu thereof ``facility''.
       (c) in paragraph 5 by striking ``hospital'' both places it 
     appears and inserting in lieu thereof ``facility''.
                                                                    ____



                               Department of Veterans Affairs,

                                               September 26, 1995.
     The Honorable Al Gore,
     President of the Senate,
     Washington, DC.
       Dear Mr. President: There is transmitted herewith a draft 
     bill, ``To amend title 38, United States Code, to modify 
     disbursement agreement authority to include residents and 
     intense serving in any Department facility providing hospital 
     care or medical services.'' We request that it be referred to 
     the appropriate committee for prompt consideration and 
     enactment.
       Typically, residents and interns are trained at a number of 
     medical institutions and each institution is individually 
     responsible for paying the residents and interns

[[Page S4976]]

     serving there. As a result, residents and interns often 
     receive differing levels of pay and fringe benefits from 
     institution to institution, which sometimes creates confusion 
     and morale problems. Under disbursement agreements, medical 
     institutions that participate in training residents and 
     interns designate one institution to pay all residents and 
     interns a set amount. Thus, pay and fringe benefits do not 
     change when residents and interns rotate among participating 
     institutions.
       The enclosed draft bill would authorize VA to enter into 
     disbursement agreements with participating medical 
     institutions for the centralized administration of pay and 
     other employee benefits to residents and interns training at 
     any Department facility providing hospital care or medical 
     services. Section 7406(c) of title 38, United States Code, 
     currently provides for such agreements only ``for the period 
     that such intern or resident serves in a Department 
     hospital.'' The law does not authorize VA to enter into such 
     agreements to provide pay and fringe benefits for residents 
     and interns serving in VA outpatient clinics, nursing homes 
     or other VA medical facilities.
       This draft bill would allow VA facilities which are not 
     hospitals, such as outpatient clinics and nursing homes, to 
     receive the cost saving and other benefits provided by 
     disbursement agreements. These facilities are an increasingly 
     important component of the VA health care delivery system. 
     With greater emphasis being placed on primary care, the 
     training of residents and interns takes place in nonhospital 
     settings such as outpatient clinics and nursing homes. This 
     draft bill is particularly important in the case of two of 
     our hospitals in California (Martinez and Sepulveda) which, 
     due to earthquakes, have been modified into clinics. Both 
     facilities have had long-standing academic affiliates and 
     residency training programs with disbursement agreements. 
     There are not costs to VA associated with this draft bill.
       The Office of Management and Budget advises that there is 
     no objection from the standpoint of the Administration's 
     program to the submission of this legislative proposal to the 
     Congress.
       Sincerely yours,
     Jesse Brown.
                                                                    ____


                       Analysis of Proposed Bill

       The bill would expand VA authority to enter into 
     disbursement agreements with participating medical 
     institutions for the central administration of pay and other 
     employee benefits for residents and interns who train at 
     Department facilities. Currently, the law authorizes the use 
     of disbursement agreements only for residents and interns 
     serving in Department hospitals, but not those serving in 
     outpatient clinics, nursing homes or other Department medical 
     facilities. The bill would eliminate this restriction and 
     provide authority for VA to enter into disbursement 
     agreements for the central administration of pay and other 
     employee benefits for interns and residents serving in any 
     Department facility providing hospital care or medical 
     services, including outpatient clinics and nursing 
     homes.
                                 ______