[Congressional Record Volume 142, Number 137 (Saturday, September 28, 1996)]
[House]
[Pages H12111-H12121]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
VETERANS' HEALTH CARE ELIGIBILITY REFORM ACT OF 1996
Mr. STUMP. Mr. Speaker, I ask unanimous consent to take from the
Speaker's table the bill (H.R. 3118) to amend title 38, United States
Code, to reform eligibility for health care provided by the Department
of Veterans Affairs, with Senate amendments thereto, and concur in the
Senate amendments.
The Clerk read the title of the bill.
The Clerk read the Senate amendments, as follows:
Senate amendments:
Strike out all after the enacting clause and insert:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans'
Health Care Eligibility Reform Act of 1996''.
(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--ELIGIBILITY REFORM
Sec. 101. Eligibility for hospital care and medical services.
Sec. 102. Revision in authorities for provision of priority health care
for certain veterans exposed to specified toxic
substances.
Sec. 103. Prosthetics and preventive care.
Sec. 104. Management of health care.
Sec. 105. Authorization of appropriations.
Sec. 106. Assessment of implementation and operation.
TITLE II--CONSTRUCTION AUTHORIZATION
Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of major medical facility leases.
Sec. 203. Authorization of appropriations.
Sec. 204. Strategic planning.
Sec. 205. Revision to prospectus requirements.
Sec. 206. Construction authorization requirements.
Sec. 207. Terminology changes.
TITLE III--HEALTH CARE AND ADMINISTRATION
Subtitle A--Health Care Sharing and Administration
Sec. 301. Revision of authority to share medical facilities, equipment,
and information.
Sec. 302. Improved efficiency in health care resource management.
Sec. 303. Personnel furnishing shared resources.
Sec. 304. Waiting period for administrative reorganizations.
Sec. 305. Repeal of limitations on contracts for conversion of
performance of activities of Department health-care
facilities and revised annual reporting requirement.
Subtitle B--Care of Women Veterans
Sec. 321. Mammography quality standards.
Sec. 322. Patient privacy for women patients.
Sec. 323. Assessment of use by women veterans of Department health
services.
Sec. 324. Reporting requirements.
Subtitle C--Readjustment Counseling and Mental Health Care
Sec. 331. Expansion of eligibility for readjustment counseling and
certain related counseling services.
Sec. 332. Reports relating to Vet Centers.
Sec. 333. Advisory Committee on the Readjustment of Veterans.
Sec. 334. Centers for mental illness research, education, and clinical
activities.
Sec. 335. Committee on Care of Severely Chronically Mentally Ill
Veterans.
Subtitle D--Other Provisions
Sec. 341. Hospice care study.
Sec. 342. Payment to States of per diem for veterans receiving adult
day health care.
Sec. 343. Research corporations.
Sec. 344. Veterans Health Administration headquarters.
Sec. 345. Disbursement agreements relating to medical residents and
interns.
Sec. 346. Authority to suspend special pay agreements for physicians
and dentists who enter residency training programs.
Sec. 347. Remunerated outside professional activities by Veterans
Health Administration personnel.
Sec. 348. Modification of restrictions on real property, Milwaukee
County, Wisconsin.
Sec. 349. Modification of restrictions on real property, Cheyenne,
Wyoming.
Sec. 350. Name of Department of Veterans Affairs Medical Center,
Johnson City, Tennessee.
Sec. 351. Report on health care needs of veterans in east central
Florida.
Sec. 352. Evaluation of health status of spouses and children of
Persian Gulf War veterans.
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--ELIGIBILITY REFORM
SEC. 101. ELIGIBILITY FOR HOSPITAL CARE AND MEDICAL SERVICES.
(a) New Criteria for Eligibility for Care.--Section 1710(a)
is amended to read as follows:
``(a)(1) The Secretary (subject to paragraph (4)) shall
furnish hospital care and medical services, and may furnish
nursing home care, which the Secretary determines to be
needed--
``(A) to any veteran for a service-connected disability;
and
``(B) to any veteran who has a service-connected disability
rated at 50 percent or more.
``(2) The Secretary (subject to paragraph (4)) shall
furnish hospital care and medical services, and may furnish
nursing home care, which the Secretary determines to be
needed to any veteran--
``(A) who has a compensable service-connected disability
rated less than 50 percent;
``(B) whose discharge or release from active military,
naval, or air service was for a compensable disability that
was incurred or aggravated in the line of duty;
``(C) who is in receipt of, or who, but for a suspension
pursuant to section 1151 of this title (or both a suspension
and the receipt of retired pay), would be entitled to
disability compensation, but only to the extent that such
veteran's continuing eligibility for such care is provided
for in the judgment or settlement provided for in such
section;
``(D) who is a former prisoner of war;
``(E) who is a veteran of the Mexican border period or of
World War I;
``(F) who was exposed to a toxic substance, radiation, or
environmental hazard, as provided in subsection (e); or
``(G) who is unable to defray the expenses of necessary
care as determined under section 1722(a) of this title.
``(3) In the case of a veteran who is not described in
paragraphs (1) and (2), the Secretary may, to the extent
resources and facilities are available and subject to the
provisions of subsections (f) and (g), furnish hospital care,
medical services, and nursing home care which the Secretary
determines to be needed.
``(4) The requirement in paragraphs (1) and (2) that the
Secretary furnish hospital care and medical services shall be
effective in any fiscal year only to the extent and in the
amount provided in advance in appropriations Acts for such
purposes.''.
(b) Transfer of Provision.--Chapter 17 is amended--
[[Page H12112]]
(1) by redesignating subsection (g) of section 1710 as
subsection (h); and
(2) by transferring subsection (f) of section 1712 to
section 1710 and inserting such subsection so as to appear
after subsection (f), redesignating such subsection as
subsection (g), and amending such subsection by striking out
``section 1710(a)(2) of this title'' in paragraph (1) and
inserting in lieu thereof ``subsection (a)(3) of this
section''.
(c) Repeal of Separate Outpatient Care Priorities.--(1)
Section 1712 is amended--
(A) by striking out subsections (a) and (i);
(B) by redesignating subsections (b), (c), (d), (h) and
(j), as subsections (a), (b), (c), (d), and (e),
respectively; and
(C) in subsection (b), as so redesignated, by striking out
``subsection (b) of this section'' and inserting in lieu
thereof ``subsection (a)''.
(2)(A) The heading of such section is amended to read as
follows:
``Sec. 1712. Dental care; drugs and medicines for certain
disabled veterans; vaccines''.
(B) The item relating to such section in the table of
sections at the beginning of chapter 17 is amended to read as
follows:
``1712. Dental care; drugs and medicines for certain disabled veterans;
vaccines.''.
(d) Conforming Amendments to Chapter 17.--Chapter 17 is
further amended as follows:
(1) Section 1701(6)(B)(i) is amended--
(A) in subclause (I), by striking out ``section 1712(a)''
and inserting in lieu thereof ``paragraph (1) or (2) of
section 1710(a)''; and
(B) in subclause (II), by striking out ``section
1712(a)(5)(B)'' and inserting in lieu thereof ``paragraph
(1), (2) or (3) of section 1710(a)''.
(2) Section 1710(c)(1) is amended by striking out ``section
1712(b)'' and inserting in lieu thereof ``section 1712(a)''.
(3) Section 1710(e)(1)(C) is amended by striking out
``hospital care and nursing home care under subsection
(a)(1)(G) of this section'' and inserting in lieu thereof
``hospital care, medical services, and nursing home care
under subsection (a)(2)(F)''.
(4) Section 1710(f) is amended--
(A) in paragraph (1), by striking out ``subsection (a)(2)''
and inserting in lieu thereof ``subsection (a)(3)''; and
(B) in paragraph (3)(E)--
(i) by striking out ``section 1712(a) of this title'' and
inserting in lieu thereof ``paragraph (3) of subsection
(a)''; and
(ii) by striking out ``section 1712(f) of this title'' and
inserting in lieu thereof ``subsection (g)''; and
(C) in paragraph (3)(F), by striking out ``section 1712(f)
of this title'' and inserting in lieu thereof ``subsection
(g)''.
(5) Section 1712A is amended--
(A) in subsection (b)(1), by striking out ``under the
conditions specified in section 1712(a)(5)(B) of this
title''; and
(B) in subsection (e)(1), by striking out ``sections
1712(a)(1)(B) and 1703(a)(2)'' and inserting in lieu thereof
``sections 1703(a)(2) and 1710(a)(1)(B)''.
(6) Section 1717(a) is amended--
(A) in paragraph (1), by striking out ``section 1712(a)''
and inserting in lieu thereof ``section 1710(a)''; and
(B) in paragraph (2)--
(i) in subparagraph (A), by striking out ``paragraph (1) of
section 1712(a) of this title'' and inserting in lieu thereof
``section 1710(a)(1) of this title, or for a disability
described in section 1710(a)(2)(C) of this title''; and
(ii) in subparagraph (B), by striking out ``section 1712''
and inserting in lieu thereof ``section 1710(a)(2)''.
(7) Section 1718(e) is amended by striking out ``section
1712(i)'' and inserting in lieu thereof ``section 1705''.
(8) Section 1720(f) is amended--
(A) in paragraph (1)(A)(ii), by striking out ``section
1712(a)(1)(B)'' and inserting in lieu thereof ``paragraph
(1), (2), or (3) of section 1710(a)''; and
(B) by striking out paragraph (3).
(9) Section 1722 is amended--
(A) in subsection (a), by striking out ``section
1710(a)(1)(I)'' and inserting in lieu thereof ``section
1710(a)(2)(G)''; and
(B) in subsection (f)(3), by striking out ``or 1712(f)''.
(10) Section 1729(g)(3)(A) is amended by striking out
``under section 1710(f) of this title for hospital care or
nursing home care, under section 1712(f) of this title for
medical services,'' and inserting in lieu thereof ``under
subsection (f) or (g) of section 1710 of this title for
hospital care, medical services, or nursing home care''.
(e) Other Conforming and Technical Amendments.--
(1) Section 1525 is amended--
(A) in subsection (a), by striking out ``section 1712(h) of
this title'' and all that follows through the period at the
end and inserting in lieu thereof ``section 1712(d) of this
title.''; and
(B) in subsection (b), by striking out ``renumeration'' and
inserting in lieu thereof ``remuneration''.
(2) Section 2104(b) is amended--
(A) in the first sentence, by striking out ``section
1712(a)'' and inserting in lieu thereof ``section
1717(a)(2)''; and
(B) in the second sentence, by striking out ``section
1712(a)'' and inserting in lieu thereof ``section
1717(a)(2)''.
(3) Section 5317(c)(3) is amended by striking out
``sections 1710(a)(1)(I), 1710(a)(2), 1710(b), and
1712(a)(2)(B)'' and inserting in lieu thereof ``subsections
(a)(2)(G), (a)(3), and (b) of section 1710''.
(4) Section 8110(a)(2) is amended by striking out ``section
1712'' and inserting in lieu thereof ``section 1710(a)''.
(5) Section 8111A(b)(2)(A) is amended by striking out
``subsection (f) of section 1712'' and inserting in lieu
thereof ``subsection (a) of section 1710''.
SEC. 102. REVISION IN AUTHORITIES FOR PROVISION OF PRIORITY
HEALTH CARE FOR CERTAIN VETERANS EXPOSED TO
SPECIFIED TOXIC SUBSTANCES.
(a) Authorized Inpatient Care.--Section 1710(e) is
amended--
(1) in paragraph (1), by striking out subparagraphs (A) and
(B) and inserting in lieu thereof the following:
``(A) A Vietnam-era herbicide-exposed veteran is eligible
(subject to paragraph (2)) for hospital care, medical
services, and nursing home care under subsection (a)(2)(F)
for any disability, notwithstanding that there is
insufficient medical evidence to conclude that such
disability may be associated with such exposure.
``(B) A radiation-exposed veteran is eligible for hospital
care, medical services, and nursing home care under
subsection (a)(2)(F) for any disease suffered by the veteran
that is--
``(i) a disease listed in section 1112(c)(2) of this title;
or
``(ii) any other disease for which the Secretary, based on
the advice of the Advisory Committee on Environmental
Hazards, determines that there is credible evidence of a
positive association between occurrence of the disease in
humans and exposure to ionizing radiation.''; and
(2) by striking out paragraphs (2) and (3) and inserting in
lieu thereof the following:
``(2)(A) In the case of a veteran described in paragraph
(1)(A), hospital care, medical services, and nursing home
care may not be provided under subsection (a)(2)(F) with
respect to--
``(i) a disability that is found, in accordance with
guidelines issued by the Under Secretary for Health, to have
resulted from a cause other than an exposure described in
paragraph (4)(A)(ii); or
``(ii) a disease for which the National Academy of
Sciences, in a report issued in accordance with section 2 of
the Agent Orange Act of 1991, has determined that there is
limited or suggestive evidence of the lack of a positive
association between occurrence of the disease in humans and
exposure to a herbicide agent.
``(B) In the case of a veteran described in paragraph
(1)(C), hospital care, medical services, and nursing home
care may not be provided under subsection (a)(2)(F) with
respect to a disability that is found, in accordance with
guidelines issued by the Under Secretary for Health, to have
resulted from a cause other than an exposure described in
that paragraph.
``(3) Hospital care, medical services, and nursing home
care may not be provided under or by virtue of subsection
(a)(2)(F)--
``(A) in the case of care for a veteran described in
paragraph (1)(A), after December 31, 2002; and
``(B) in the case of care for a veteran described in
paragraph (1)(C), after December 31, 1998.
``(4) For purposes of this subsection--
``(A) The term `Vietnam-era herbicide-exposed veteran'
means a veteran (i) who served on active duty in the Republic
of Vietnam during the Vietnam era, and (ii) who the Secretary
finds may have been exposed during such service to dioxin or
was exposed during such service to a toxic substance found in
a herbicide or defoliant used for military purposes during
such era.
``(B) The term `radiation-exposed veteran' has the meaning
given that term in section 1112(c)(3) of this title.''.
(b) Savings Provisions.--The provisions of sections 1710(e)
and 1712(a) of title 38, United States Code, as in effect on
the day before the date of the enactment of this Act, shall
continue to apply on and after such date with respect to the
furnishing of hospital care, nursing home care, and medical
services for any veteran who was furnished such care or
services before such date of enactment on the basis of
presumed exposure to a substance or radiation under the
authority of those provisions, but only for treatment for a
disability for which such care or services were furnished
before such date.
SEC. 103. PROSTHETICS AND PREVENTIVE CARE.
(a) Eligibility.--Section 1701(6)(A)(i) is amended--
(1) by striking out ``(in the case of a person otherwise
receiving care or services under this chapter)'' and
``(except under the conditions described in section
1712(a)(5)(A) of this title),'';
(2) by inserting ``(in the case of a person otherwise
receiving care or services under this chapter)'' before
``wheelchairs,''; and
(3) by inserting ``except that the Secretary may not
furnish sensori-neural aids other than in accordance with
guidelines which the Secretary shall prescribe,'' after
``reasonable and necessary,''.
(b) Regulations.--Not later than 30 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall prescribe the guidelines required by the amendments
made by subsection (a) and shall furnish a copy of those
guidelines to the Committees on Veterans' Affairs of the
Senate and House of Representatives.
SEC. 104. MANAGEMENT OF HEALTH CARE.
(a) In General.--(1) Chapter 17 is amended by inserting
after section 1704 the following new sections:
``Sec. 1705. Management of health care: patient enrollment
system
``(a) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the
Secretary, in accordance with regulations the Secretary shall
prescribe, shall establish and operate a system of annual
patient enrollment. The Secretary shall manage the enrollment
of veterans in accordance with the following priorities, in
the order listed:
``(1) Veterans with service-connected disabilities rated 50
percent or greater.
``(2) Veterans with service-connected disabilities rated 30
percent or 40 percent.
[[Page H12113]]
``(3) Veterans who are former prisoners of war, veterans
with service-connected disabilities rated 10 percent or 20
percent, and veterans described in subparagraphs (B) and (C)
of section 1710(a)(2) of this title.
``(4) Veterans who are in receipt of increased pension
based on a need of regular aid and attendance or by reason of
being permanently housebound and other veterans who are
catastrophically disabled.
``(5) Veterans not covered by paragraphs (1) through (4)
who are unable to defray the expenses of necessary care as
determined under section 1722(a) of this title.
``(6) All other veterans eligible for hospital care,
medical services, and nursing home care under section
1710(a)(2) of this title.
(7) Veterans described in section 1710(a)(3) of this title.
``(b) In the design of an enrollment system under
subsection (a), the Secretary--
``(1) shall ensure that the system will be managed in a
manner to ensure that the provision of care to enrollees is
timely and acceptable in quality;
``(2) may establish additional priorities within each
priority group specified in subsection (a), as the Secretary
determines necessary; and
``(3) may provide for exceptions to the specified
priorities where dictated by compelling medical reasons.
``(c)(1) Effective on October 1, 1998, the Secretary may
not provide hospital care or medical services to a veteran
under paragraph (2) or (3) of section 1710(a) of this title
unless the veteran enrolls in the system of patient
enrollment established by the Secretary under subsection (a).
``(2) The Secretary shall provide hospital care and medical
services under section 1710(a)(1) of this title, and under
subparagraph (B) of section 1710(a)(2) of this title, for the
12-month period following such veteran's discharge or release
from service, to any veteran referred to in such sections for
a disability specified in the applicable subparagraph of such
section, notwithstanding the failure of the veteran to enroll
in the system of patient enrollment referred to in subsection
(a) of this section.
``Sec. 1706. Management of health care: other requirements
``(a) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the
Secretary shall, to the extent feasible, design, establish
and manage health care programs in such a manner as to
promote cost-effective delivery of health care services in
the most clinically appropriate setting.
``(b)(1) In managing the provision of hospital care and
medical services under such section, the Secretary shall
ensure that the Department maintains its capacity to provide
for the specialized treatment and rehabilitative needs of
disabled veterans (including veterans with spinal cord
dysfunction, blindness, amputations, and mental illness)
within distinct programs or facilities of the Department that
are dedicated to the specialized needs of those veterans in a
manner that (A) affords those veterans reasonable access to
care and services for those specialized needs, and (B)
ensures that overall capacity of the Department to provide
such services is not reduced below the capacity of the
Department, nationwide, to provide those services, as of the
date of the enactment of this section. The Secretary shall
carry out this paragraph in consultation with the Advisory
Committee on Prosthetics and Special Disabilities Programs
and the Committee on Care of Severely Chronically Mentally
Ill Veterans.
``(2) Not later than April 1, 1997, April 1, 1998, and
April 1, 1999, the Secretary shall submit to the Committees
on Veterans' Affairs of the Senate and House of
Representatives a report on the Secretary's compliance, by
facility and by service-network, with the requirements of
this subsection.''.
(2) The table of sections at the beginning of chapter 17 is
amended by inserting after the item relating to section 1704
the following new items:
``1705. Management of health care: patient enrollment system.
``1706. Management of health care: other requirements.''.
(b) Conforming Amendments to Section 1703.--Section 1703(a)
is amended--
(1) in the matter preceding paragraph (1), by striking out
``or 1712'';
(2) in paragraph (2)--
(A) by striking out ``1712(a)(1)(B)'' in subparagraph (A)
and inserting in lieu thereof ``1710(a)(1)(B)'';
(B) by striking out subparagraph (B) and inserting in lieu
thereof the following:
``(B) a veteran who (i) has been furnished hospital care,
nursing home care, domiciliary care, or medical services, and
(ii) requires medical services to complete treatment incident
to such care or services; or''; and
(C) by striking ``section 1712(a)(3) (other than a veteran
who is a former prisoner of war) of this title'' in
subparagraph (C) and inserting in lieu thereof ``section
1710(a)(2)(E) of this title, or a veteran who is in receipt
of increased pension, or additional compensation or
allowances based on the need of regular aid and attendance or
by reason of being permanently housebound (or who, but for
the receipt of retired pay, would be in receipt of such
pension, compensation, or allowance),''; and
(3) in paragraph (7), by striking out ``1712(b)(1)(F)'' and
inserting in lieu thereof ``1712(a)(1)(F)''.
SEC. 105. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated for the Department
of Veterans Affairs for the Medical Care account, for the
purposes specified for that account in Public Law 103-327
(108 Stat. 2300), including the cost of providing hospital
care and medical services under the amendments made by
section this title, not to exceed $17,250,000,000 for fiscal
year 1997 and not to exceed $17,900,000,000 for fiscal year
1998.
SEC. 106. ASSESSMENT OF IMPLEMENTATION AND OPERATION.
(a) Assessment Systems.--The Secretary of Veterans Affairs
shall establish information systems to assess the experience
of the Department of Veterans Affairs in implementing
sections 101, 103, and 104, including the amendments made by
those sections, during fiscal year 1997. The Secretary shall
establish those information systems in time to include
assessments under such systems in the report required under
subsection (b).
(b) Report.--Not later than March 1, 1998, the Secretary
shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report reflecting the
experience of the Department during fiscal year 1997 on--
(1) the effect of implementation of, and provision and
management of care under, sections 101, 103, and 104
(including the amendments made by those sections) on demand
for health care services from the Department of Veterans
Affairs by veterans described in paragraphs (1), (2), and (3)
of section 1710(a) of title 38, United States Code, as
amended by section 101;
(2) any differing patterns of demand on the part of such
veterans relating to such factors as relative distance from
Department facilities and prior experience, or lack of
experience, as recipients of care from the Department;
(3) the extent to which the Department has met such demand
for care; and
(4) changes in health-care delivery patterns in Department
facilities and the fiscal impact of such changes.
(c) Matters To Be Included.--The report under subsection
(b) shall include detailed information with respect to fiscal
year 1997 regarding the following:
(1) The number of veterans enrolled for care at each
Department medical facility and, of such veterans, the number
enrolled at each such facility who had not received care from
the Department during the preceding three fiscal years.
(2) With respect to the veterans who had not received care
from the Department during the three preceding fiscal years,
the total cost of providing care to such veterans, shown in
total and separately (A) by level of care, and (B) by
reference to whether care was furnished in Department
facilities or under contract arrangements.
(3) With respect to the number of veterans described in
paragraphs (1), (2), and (3) of section 1710(a) of title 38,
United States Code, as amended by section 101, who applied
for health care from the Department during fiscal year 1997--
(A) the number who applied for care (shown in total and
separately by facility);
(B) the number who were denied enrollment (shown in total
and separately by facility); and
(C) the number who were denied care which was considered to
be medically necessary but not of an emergency nature (shown
in total and separately by facility).
(4) The numbers and characteristics of, and the type and
extent of health care furnished to, veterans enrolled for
care (shown in total and separately by facility).
(5) The numbers and characteristics of, and the type and
extent of health care furnished to, veterans not enrolled for
care (shown separately by reference to each class of
eligibility, both in total and separately by facility).
(6) The specific fiscal impact (shown in total and by
geographic health-care delivery areas) of changes in delivery
patterns instituted under the amendments made by this title.
TITLE II--CONSTRUCTION AUTHORIZATION
SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.
(a) Ambulatory Care Addition Projects.--The Secretary of
Veterans Affairs may carry out the following ambulatory care
addition major medical facility projects, with each project
to be carried out in the amount specified for that project:
(1) Construction of an ambulatory care facility and
renovation of ``E'' wing, Tripler Army Hospital, Honolulu,
Hawaii, $43,000,000.
(2) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in Brockton,
Massachusetts, $13,500,000.
(3) Addition of ambulatory care facilities for outpatient
improvements at the Department of Veterans Affairs medical
center in Shreveport, Louisiana, $25,000,000.
(4) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in Lyons, New
Jersey, $21,100,000.
(5) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in Tomah,
Wisconsin, $12,700,000.
(6) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in Asheville,
North Carolina, $26,300,000.
(7) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in Temple,
Texas, $9,800,000.
(8) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in Tucson,
Arizona, $35,500,000.
(9) Construction of an ambulatory care facility at the
Department of Veterans Affairs medical center in Leavenworth,
Kansas, $27,750,000.
(b) Environmental Improvement Projects.--The Secretary may
carry out the following environmental improvement major
medical facility projects, with each project to be carried
out in the amount specified for that project:
(1) Environmental improvements for the renovation of
nursing home facilities at the Department of Veterans Affairs
medical center in Lebanon, Pennsylvania, $9,500,000.
(2) Environmental improvements at the Department of
Veterans Affairs medical center in Marion, Illinois,
$11,500,000.
(3) Environmental improvements for ward renovation for
patient privacy at the Department of
[[Page H12114]]
Veterans Affairs medical center in Omaha, Nebraska,
$7,700,000.
(4) Environmental improvements at the Department of
Veterans Affairs medical center in Pittsburgh, Pennsylvania,
$17,400,000.
(5) Environmental improvements for the renovation of
various buildings at the Department of Veterans Affairs
medical center in Waco, Texas, $26,000,000.
(6) Environmental improvements for the replacement of
psychiatric beds at the Department of Veterans Affairs
medical center in Marion, Indiana, $17,300,000.
(7) Environmental improvements for the renovation of
psychiatric wards at the Department of Veterans Affairs
medical center in Perry Point, Maryland, $15,100,000.
(8) Environmental enhancement at the Department of Veterans
Affairs medical center in Salisbury, North Carolina,
$18,200,000.
(c) Seismic Correction Project.--The Secretary may carry
out seismic corrections to Building Number 324 at the
Department of Veterans Affairs medical center in Palo Alto,
California, in the amount of $20,800,000.
(d) Project Authorization When Partial Funding Provided.--
If the amount of funds appropriated for fiscal year 1997 or
1998 for design and partial construction of a major medical
facility project that is authorized in this section is less
than the amount required to complete the construction of that
project as authorized and if the Secretary obligates funds
for such construction, such project shall be deemed to be
fully authorized. Any such authorization shall cease to have
effect at the close of fiscal year 2001.
SEC. 202. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.
The Secretary of Veterans Affairs may enter into leases for
medical facilities as follows:
(1) Lease of a satellite outpatient clinic in Allentown,
Pennsylvania, in an amount not to exceed $2,159,000.
(2) Lease of a satellite outpatient clinic in Beaumont,
Texas, in an amount not to exceed $1,940,000.
(3) Lease of a satellite outpatient clinic in Boston,
Massachusetts, in an amount not to exceed $2,358,000.
(4) Lease of a parking facility in Cleveland, Ohio, in an
amount not to exceed $1,300,000.
(5) Lease of a satellite outpatient clinic and Veterans
Benefits Administration field office in San Antonio, Texas,
in an amount not to exceed $2,256,000.
(6) Lease of a satellite outpatient clinic in Toledo, Ohio,
in an amount not to exceed $2,223,000.
SEC. 203. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to
the Secretary of Veterans Affairs for fiscal year 1997 and
fiscal year 1998--
(1) for the Construction, Major Projects, account, a total
of $358,150,000 for the projects authorized in section 201;
and
(2) for the Medical Care account, a total of $12,236,000
for the leases authorized in section 202.
(b) Limitation.--The projects authorized in section 201 may
only be carried out using--
(1) funds appropriated for fiscal year 1997 or fiscal year
1998 consistent with the authorization of appropriations in
subsection (a);
(2) funds appropriated for Construction, Major Projects for
a fiscal year before fiscal year 1997 that remain available
for obligation; and
(3) funds appropriated for Construction, Major Projects for
fiscal year 1997 or fiscal year 1998 for a category of
activity not specific to a project.
SEC. 204. STRATEGIC PLANNING.
Section 8107 is amended--
(1) by redesignating subsection (b) as subsection (c);
(2) by striking out subsection (a) and inserting in lieu
thereof the following new subsections:
``(a) In order to promote effective planning for the
efficient provision of care to eligible veterans, the
Secretary, based on the analysis and recommendations of the
Under Secretary for Health, shall submit to each committee an
annual report regarding long-range health planning of the
Department. The report shall be submitted each year not later
than the date on which the budget for the next fiscal year is
submitted to the Congress under section 1105 of title 31.
``(b) Each report under subsection (a) shall include the
following:
``(1) A five-year strategic plan for the provision of care
under chapter 17 of this title to eligible veterans through
coordinated networks of medical facilities operating within
prescribed geographic service-delivery areas, such plan to
include provision of services for the specialized treatment
and rehabilitative needs of disabled veterans (including
veterans with spinal cord dysfunction, blindness,
amputations, and mental illness) through distinct programs or
facilities of the Department dedicated to the specialized
needs of those veterans.
``(2) A description of how planning for the networks will
be coordinated.
``(3) A profile regarding each such network of medical
facilities which identifies--
``(A) the mission of each existing or proposed medical
facility in the network;
``(B) any planned change in the mission for any such
facility and the rationale for such planned change;
``(C) the population of veterans to be served by the
network and anticipated changes over a five-year period and a
ten-year period, respectively, in that population and in the
health-care needs of that population;
``(D) information relevant to assessing progress toward the
goal of achieving relative equivalency in the level of
resources per patient distributed to each network, such
information to include the plans for and progress toward
lowering the cost of care-delivery in the network (by means
such as changes in the mix in the network of physicians,
nurses, physician assistants, and advance practice nurses);
``(E) the capacity of non-Federal facilities in the network
to provide acute, long-term, and specialized treatment and
rehabilitative services (described in section 7305 of this
title), and determinations regarding the extent to which
services to be provided in each service-delivery area and
each facility in such area should be provided directly
through facilities of the Department or through contract or
other arrangements, including arrangements authorized under
sections 8111 and 8153 of this title; and
``(F) a five-year plan for construction, replacement, or
alteration projects in support of the approved mission of
each facility in the network and a description of how those
projects will improve access to care, or quality of care, for
patients served in the network.
``(4) A status report for each facility on progress
toward--
``(A) instituting planned mission changes identified under
paragraph (3)(B);
``(B) implementing principles of managed care of eligible
veterans; and
``(C) developing and instituting cost-effective
alternatives to provision of institutional care.''; and
(3) by adding at the end the following new subsection:
``(d)(1) The Secretary shall submit to each committee, not
later than January 31 of each year, a report showing the
current priorities of the Department for proposed major
medical construction projects. Each such report shall
identify the 20 projects, from within all the projects in the
Department's inventory of proposed projects, that have the
highest priority and, for those 20 projects, the relative
priority and rank scoring of each such project and the
projected cost of such project (including the projected
operating costs, including both recurring and nonrecurring
costs). The 20 projects shall be compiled, and their relative
rankings shall be shown, by category of project (including
the categories of ambulatory care projects, nursing home care
projects, and such other categories as the Secretary
determines).
``(2) The Secretary shall include in each report, for each
project listed, a description of the specific factors that
account for the relative ranking of that project in relation
to other projects within the same category.
``(3) In a case in which the relative ranking of a proposed
project has changed since the last report under this
subsection was submitted, the Secretary shall also include in
the report a description of the reasons for the change in the
ranking, including an explanation of any change in the
scoring of the project under the Department's scoring system
for proposed major medical construction projects.''.
SEC. 205. REVISION TO PROSPECTUS REQUIREMENTS.
(a) Additional Information.--Section 8104(b) is amended--
(1) by striking out the matter preceding paragraph (1) and
inserting in lieu thereof the following:
``(b) Whenever the President or the Secretary submit to the
Congress a request for the funding of a major medical
facility project (as defined in subsection (a)(3)(A)) or a
major medical facility lease (as defined in subsection
(a)(3)(B)), the Secretary shall submit to each committee, on
the same day, a prospectus of the proposed medical facility.
Any such prospectus shall include the following:'';
(2) in paragraph (1)--
(A) by striking out ``a detailed'' and inserting in lieu
thereof ``A detailed''; and
(B) by striking out the semicolon at the end and inserting
in lieu thereof a period;
(3) in paragraph (2)--
(A) by striking out ``an estimate'' and inserting in lieu
thereof ``An estimate''; and
(B) by striking out ``; and'' and inserting in lieu thereof
a period;
(4) in paragraph (3), by striking out ``an estimate'' and
inserting in lieu thereof ``An estimate''; and
(5) by adding at the end the following new paragraphs:
``(4) Demographic data applicable to such facility,
including information on projected changes in the population
of veterans to be served by the facility over a five-year
period and a ten-year period.
``(5) Current and projected workload and utilization data
regarding the facility.
``(6) Current and projected operating costs of the
facility, including both recurring and non-recurring costs.
``(7) The priority score assigned to the project or lease
under the Department's prioritization methodology and, if the
project or lease is being proposed for funding before a
project or lease with a higher score, a specific explanation
of the factors other than the priority score that were
considered and the basis on which the project or lease is
proposed for funding ahead of projects or leases with higher
priority scores.
``(8) In the case of a prospectus proposing the
construction of a new or replacement medical facility, a
description of each alternative to construction of the
facility that was considered.''.
(b) Applicability.--The amendments made by subsection (a)
shall apply with respect to any prospectus submitted by the
Secretary of Veterans Affairs after the date of the enactment
of this Act.
SEC. 206. CONSTRUCTION AUTHORIZATION REQUIREMENTS.
(a) Definition of Major Medical Facility Project.--
Paragraph (3)(A) of section 8104(a) is amended by striking
out ``$3,000,000'' and inserting in lieu thereof
``$4,000,000''.
(b) Applicability of Construction Authorization
Requirement.--(1) Subsection (b) of
[[Page H12115]]
section 301 of the Veterans' Medical Programs Amendments of
1992 (Public Law 102-405; 106 Stat. 1984) is repealed.
(2) The amendments made by subsection (a) of such section
shall apply with respect to any major medical facility
project or any major medical facility lease of the Department
of Veterans Affairs, regardless of when funds are first
appropriated for that project or lease, except that in the
case of a project for which funds were first appropriated
before October 9, 1992, such amendments shall not apply with
respect to amounts appropriated for that project for a fiscal
year before fiscal year 1998.
(c) Limitation on Obligations for Advance Planning.--
Section 8104 is amended by adding at the end the following
new subsection:
``(f) The Secretary may not obligate funds in an amount in
excess of $500,000 from the Advance Planning Fund of the
Department toward design or development of a major medical
facility project (as defined in subsection (a)(3)(A)) until--
``(1) the Secretary submits to the committees a report on
the proposed obligation; and
``(2) a period of 30 days has passed after the date on
which the report is received by the committees.''.
SEC. 207. TERMINOLOGY CHANGES.
(a) Definition of ``Construct''.--Section 8101(2) is
amended--
(1) by striking out ``working drawings'' and inserting in
lieu thereof ``construction documents''; and
(2) by striking out ``preliminary plans'' and inserting in
lieu thereof ``design development''.
(b) Parking Facilities.--Section 8109(h)(3)(B) is amended
by striking out ``working drawings'' and inserting in lieu
thereof ``construction documents''.
TITLE III--HEALTH CARE AND ADMINISTRATION
Subtitle A--Health Care Sharing and Administration
SEC. 301. REVISION OF AUTHORITY TO SHARE MEDICAL FACILITIES,
EQUIPMENT, AND INFORMATION.
(a) Statement of Purpose.--The text of section 8151 is
amended to read as follows:
``It is the purpose of this subchapter to strengthen the
medical programs at Department facilities and improve the
quality of health care provided veterans under this title by
authorizing the Secretary to enter into agreements with
health-care providers in order to share health-care resources
with, and receive health-care resources from, such providers
while ensuring no diminution of services to veterans.''.
(b) Definitions.--Section 8152 is amended--
(1) by striking out paragraphs (1), (2), and (3) and
inserting in lieu thereof the following new paragraphs (1)
and (2):
``(1) The term `health-care resource' includes hospital
care and medical services (as those terms are defined in
section 1701 of this title), any other health-care service,
and any health-care support or administrative resource.
``(2) The term `health-care providers' includes health-care
plans and insurers and any organizations, institutions, or
other entities or individuals who furnish health-care
resources.''; and
(2) by redesignating paragraph (4) as paragraph (3).
(c) Authority To Secure Health-Care Resources.--Section
8153 is amended as follows:
(1) Subsection (a) is amended--
(A) in paragraph (1)--
(i) by striking out ``certain specialized medical
resources'' and inserting in lieu thereof ``health-care
resources'';
(ii) by striking out ``other medical resources'' and
inserting in lieu thereof ``other health-care resources'';
and
(iii) by striking out ``of--'' and all that follows through
``section 1742(a) of this title'' and inserting in lieu
thereof ``of health-care resources between Department health-
care facilities and any health-care provider, or other entity
or individual'';
(B) in paragraph (2), by striking out ``only'' and all that
follows through ``are not'' and inserting in lieu thereof
``if such resources are not, or would not be,''; and
(C) by adding at the end the following:
``(3)(A) If the health-care resource required is a
commercial service, the use of medical equipment or space, or
research, and is to be acquired from an institution
affiliated with the Department in accordance with section
7302 of this title, including medical practice groups and
other entities associated with affiliated institutions, blood
banks, organ banks, or research centers, the Secretary may
make arrangements for acquisition of the resource without
regard to any law or regulation that would otherwise require
the use of competitive procedures for acquiring the resource.
``(B)(i) If the health-care resource required is a
commercial service or the use of medical equipment or space,
and is not to be acquired from an entity described in
subparagraph (A), any procurement of the resource may be
conducted without regard to any law or regulation that would
otherwise require the use of competitive procedures for
procuring the resource, but only if the procurement is
conducted in accordance with the simplified procedures
prescribed pursuant to clause (ii).
``(ii) The Secretary, in consultation with the
Administrator for Federal Procurement Policy, may prescribe
simplified procedures for the procurement of health-care
resources under this subparagraph. The Secretary shall
publish such procedures for public comment in accordance with
section 22 of the Office of Federal Procurement Policy Act
(41 U.S.C. 418b). Such procedures shall permit all
responsible sources to submit a bid, proposal, or quotation
(as appropriate) for the resources to be procured and provide
for the consideration by the Department of bids, proposals,
or quotations so submitted.
``(iii) Pending publication of the procedures under clause
(ii), the Secretary shall (except as provided under
subparagraph (A)) procure health-care resources referred to
in clause (i) in accordance with all procurement laws and
regulations.
``(C) Any procurement of health-care resources other than
those covered by subparagraph (A) or (B) shall be conducted
in accordance with all procurement laws and regulations.
``(D) For any procurement to be conducted on a sole source
basis other than a procurement covered by subparagraph (A), a
written justification shall be prepared that includes the
information and is approved at the levels prescribed in
section 303(f) of the Federal Property and Administrative
Services Act of 1949 (41 U.S.C. 253(f)).
``(E) As used in this paragraph, the term `commercial
service' means a service that is offered and sold
competitively in the commercial marketplace, is performed
under standard commercial terms and conditions, and is
procured using firm-fixed price contracts.''.
(2) Subsection (b) is amended by striking out ``reciprocal
reimbursement'' in the first sentence and all that follows
through the period at the end of that sentence and inserting
in lieu thereof ``payment to the Department in accordance
with procedures that provide appropriate flexibility to
negotiate payment which is in the best interest of the
Government.''.
(3) Subsection (d) is amended by striking out ``preclude
such payment, in accordance with--'' and all that follows
through ``to such facility therefor'' and inserting in lieu
thereof ``preclude such payment to such facility for such
care or services''.
(4) Such section is further amended--
(A) by redesignating subsection (e) as subsection (g); and
(B) by inserting after subsection (d) the following new
subsections:
``(e) The Secretary may make an arrangement that authorizes
the furnishing of services by the Secretary under this
section to individuals who are not veterans only if the
Secretary determines--
``(1) that veterans will receive priority under such an
arrangement; and
``(2) that such an arrangement--
``(A) is necessary to maintain an acceptable level and
quality of service to veterans at that facility; or
``(B) will result in the improvement of services to
eligible veterans at that facility.
``(f) Any amount received by the Secretary from a non-
Federal entity as payment for services provided by the
Secretary during a prior fiscal year under an agreement
entered into under this section may be obligated by the
Secretary during the fiscal year in which the Secretary
receives the payment.''.
(d) Clerical Amendments.--(1) The heading of section 8153
is amended to read as follows:
``Sec. 8153. Sharing of health-care resources''.
(2) The item relating to section 8153 in the table of
sections at the beginning of chapter 81 is amended to read as
follows:
``8153. Sharing of health-care resources.''.
SEC. 302. IMPROVED EFFICIENCY IN HEALTH CARE RESOURCE
MANAGEMENT.
(a) Temporary Expansion of Authority for Sharing
Agreements.--Section 201 of the Veterans Health Care Act of
1992 (Public Law 102-585; 38 U.S.C. 8111 note) is amended--
(1) by inserting ``(a) Authority.--'' before ``The
Secretary of Veterans Affairs''; and
(2) by adding at the end thereof the following new
subsection:
``(b) Use of Funds.--Any amount received by the Secretary
from a non-Federal entity as payment for services provided by
the Secretary during a prior fiscal year under an agreement
entered into under this section may be obligated by the
Secretary during the fiscal year in which the Secretary
receives the payment.''.
(b) Repeal of Sunset Provision.--(1) Section 204 of such
Act (38 U.S.C. 8111 note) is repealed.
(2) Any services provided pursuant to agreements entered
into under section 201 of such Act (38 U.S.C. 8111 note)
during the period beginning on October 1, 1996, and ending on
the date of the enactment of this Act are hereby ratified.
(c) Cost Recovery.--Title II of such Act is further amended
by adding at the end the following new section:
``SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.
``(a) Right To Recover.--In the case of a primary
beneficiary (as described in section 201(a)(2)(B)) who has
coverage under a health-plan contract, as defined in section
1729(i)(1)(A) of title 38, United States Code, and who is
furnished care or services by a Department medical facility
pursuant to this title, the United States shall have the
right to recover or collect charges for such care or services
from such health-plan contract to the extent that the
beneficiary (or the provider of the care or services) would
be eligible to receive payment for such care or services from
such health-plan contract if the care or services had not
been furnished by a department or agency of the United
States. Any funds received from such health-plan contract
shall be credited to funds that have been allotted to the
facility that furnished the care or services.
``(b) Enforcement.--The right of the United States to
recover under such a beneficiary's health-plan contract shall
be enforceable in the same manner as that provided by
subsections (a)(3), (b), (c)(1), (d), (f), (h), and (i) of
section 1729 of title 38, United States Code.''.
SEC. 303. PERSONNEL FURNISHING SHARED RESOURCES.
Section 712(b)(2) is amended--
(1) by striking out ``the sum of--'' and inserting in lieu
thereof ``the sum of the following:'';
(2) by capitalizing the first letter of the first word of
each of subparagraphs (A) and (B);
(3) by striking out ``; and'' at the end of subparagraph
(A) and inserting in lieu thereof a period; and
[[Page H12116]]
(4) by adding at the end the following new subparagraph:
``(C) The number of such positions in the Department during
that fiscal year held by persons involved in providing
health-care resources under section 8111 or 8153 of this
title or under section 201 of the Veterans Health Care Act of
1992 (Public Law 102-585; 106 Stat. 4949; 38 U.S.C. 8111
note).''.
SEC. 304. WAITING PERIOD FOR ADMINISTRATIVE REORGANIZATIONS.
Section 510(b) is amended--
(1) in the second sentence, by striking out ``a 90-day
period of continuous session of Congress following the date
of the submission of the report'' and inserting in lieu
thereof ``a 45-day period following the date of the
submission of the report, not less than 30 days of which
shall be days during which Congress shall have been in
continuous session''; and
(2) in the third sentence, by striking out ``such 90-day
period'' and inserting in lieu thereof ``any period of
continuity of session''.
SEC. 305. REPEAL OF LIMITATIONS ON CONTRACTS FOR CONVERSION
OF PERFORMANCE OF ACTIVITIES OF DEPARTMENT
HEALTH-CARE FACILITIES AND REVISED ANNUAL
REPORTING REQUIREMENT.
Subsection (c) of section 8110 is amended to read as
follows:
``(c) The Secretary shall include in the materials
submitted to Congress each year in support of the budget of
the Department for the next fiscal year a report on
activities and proposals involving contracting for
performance by contractor personnel of work previously
performed by Department employees. The report shall--
``(1) identify those specific activities that are currently
performed at a Department facility by more than 10 Department
employees which the Secretary proposes to study for possible
contracting involving conversion from performance by
Department employees to performance by employees of a
contractor; and
``(2) identify those specific activities that have been
contracted for performance by contractor employees during the
prior fiscal year (shown by location, subject, scope of
contracts, and savings) and shall describe the effect of such
contracts on the quality of delivery of health services
during such year.''.
Subtitle B--Care of Women Veterans
SEC. 321. MAMMOGRAPHY QUALITY STANDARDS.
(a) In General.--(1) Subchapter II of chapter 73 is amended
by adding after section 7318 the following new section:
``Sec. 7319. Mammography quality standards
``(a) A mammogram may not be performed at a Department
facility unless that facility is accredited for that purpose
by a private nonprofit organization designated by the
Secretary. An organization designated by the Secretary under
this subsection shall meet the standards for accrediting
bodies established under subsection (e) of section 354 of the
Public Health Service Act (42 U.S.C. 263b).
``(b) The Secretary, in consultation with the Secretary of
Health and Human Services, shall prescribe quality assurance
and quality control standards relating to the performance and
interpretation of mammograms and use of mammogram equipment
and facilities of the Department of Veterans Affairs
consistent with the requirements of section 354(f)(1) of the
Public Health Service Act. Such standards shall be no less
stringent than the standards prescribed by the Secretary of
Health and Human Services under section 354(f) of the Public
Health Service Act.
``(c)(1) The Secretary, to ensure compliance with the
standards prescribed under subsection (b), shall provide for
an annual inspection of the equipment and facilities used by
and in Department health care facilities for the performance
of mammograms. Such inspections shall be carried out in a
manner consistent with the inspection of certified facilities
by the Secretary of Health and Human Services under section
354(g) of the Public Health Service Act.
``(2) The Secretary may not provide for an inspection under
paragraph (1) to be performed by a State agency.
``(d) The Secretary shall ensure that mammograms performed
for the Department under contract with any non-Department
facility or provider conform to the quality standards
prescribed by the Secretary of Health and Human Services
under section 354 of the Public Health Service Act.
``(e) For the purposes of this section, the term
`mammogram' has the meaning given such term in paragraph (5)
of section 354(a) of the Public Health Service Act.''.
(2) The table of sections at the beginning of such chapter
is amended by inserting after the item relating to section
7318 the following new item:
``7319. Mammography quality standards.''.
(b) Deadline for Prescribing Standards.--The Secretary of
Veterans Affairs shall prescribe standards under subsection
(b) of section 7319 of title 38, United States Code, as added
by subsection (a), not later than the end of the 120-day
period beginning on the date of the enactment of this Act.
(c) Implementation Report.--The Secretary shall submit to
the Committees on Veterans' Affairs of the Senate and House
of Representatives a report on the Secretary's implementation
of section 7319 of title 38, United States Code, as added by
subsection (a). The report shall be submitted not later than
120 days after the date of the enactment of this Act.
SEC. 322. PATIENT PRIVACY FOR WOMEN PATIENTS.
(a) Identification of Deficiencies.--The Secretary of
Veterans Affairs shall conduct a survey of each medical
center under the jurisdiction of the Secretary to identify
deficiencies relating to patient privacy afforded to women
patients in the clinical areas at each such center which may
interfere with appropriate treatment of such patients.
(b) Correction of Deficiencies.--The Secretary shall ensure
that plans and, where appropriate, interim steps to correct
the deficiencies identified in the survey conducted under
subsection (a) are developed and are incorporated into the
Department's construction planning processes and, in cases in
which it is cost-effective to do so, are given a high
priority.
(c) Reports to Congress.--The Secretary shall compile an
annual inventory, by medical center, of deficiencies
identified under subsection (a) and of plans and, where
appropriate, interim steps, to correct such deficiencies. The
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives, not later than
October 1, 1997, and not later than October 1 each year
thereafter through 1999 a report on such deficiencies. The
Secretary shall include in such report the inventory compiled
by the Secretary, the proposed corrective plans, and the
status of such plans.
SEC. 323. ASSESSMENT OF USE BY WOMEN VETERANS OF DEPARTMENT
HEALTH SERVICES.
(a) Reports to Under Secretary for Health.--The Center for
Women Veterans of the Department of Veterans Affairs
(established under section 509 of Public Law 103-446), in
consultation with the Advisory Committee on Women Veterans,
shall assess the use by women veterans of health services
through the Department of Veterans Affairs, including
counseling for sexual trauma and mental health services. The
Center shall submit to the Under Secretary for Health of the
Department of Veterans Affairs a report not later than April
1, 1997, and April 1 of each of the two following years, on--
(1) the extent to which women veterans described in
paragraphs (1) and (2) of section 1710(a) of title 38, United
States Code, fail to seek, or face barriers in seeking,
health services through the Department, and the reasons
therefor; and
(2) recommendations, if indicated, for encouraging greater
use of such services, including (if appropriate) public
service announcements and other outreach efforts.
(b) Reports to Congressional Committees.--Not later than
July 1, 1997, and July 1 of each of the two following years,
the Secretary of Veterans Affairs shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a report containing--
(1) the most recent report of the Center for Women Veterans
under subsection (a);
(2) the views of the Under Secretary for Health on such
report's findings and recommendations; and
(3) a description of the steps being taken by the Secretary
to remedy any problems described in the report.
SEC. 324. REPORTING REQUIREMENTS.
(a) Extension of Annual Report Requirement.--Section 107(a)
of the Veterans Health Care Act of 1992 (Public Law 102-585;
106 Stat. 4947) is amended by striking out ``Not later than
January 1, 1993, January 1, 1994, and January 1, 1995'' and
inserting in lieu thereof ``Not later than January 1 of 1993
and each year thereafter through 1998''.
(b) Report on Health Care and Research.--Section 107(b) of
such Act is amended--
(1) in paragraph (2)(A), by inserting ``(including
information on the number of inpatient stays and the number
of outpatient visits through which such services were
provided)'' after ``facility''; and
(2) by adding at the end the following new paragraph:
``(5) A description of the actions taken by the Secretary
to foster and encourage the expansion of such research.''.
Subtitle C--Readjustment Counseling and Mental Health Care
SEC. 331. EXPANSION OF ELIGIBILITY FOR READJUSTMENT
COUNSELING AND CERTAIN RELATED COUNSELING
SERVICES.
(a) Expansion of Eligibility.--Subsection (a) of section
1712A is amended to read as follows:
``(a)(1)(A) Upon the request of any veteran referred to in
subparagraph (B), the Secretary shall furnish counseling to
the veteran to assist the veteran in readjusting to civilian
life. Such counseling may include a general mental and
psychological assessment of the veteran to ascertain whether
such veteran has mental or psychological problems associated
with readjustment to civilian life.
``(B) Subparagraph (A) applies to the following veterans:
``(i) Any veteran who served on active duty--
``(I) in a theater of combat operations (as determined by
the Secretary in consultation with the Secretary of Defense)
during the Vietnam era; or
``(II) after May 7, l975, in an area at a time during which
hostilities occurred in that area.
``(ii) Any veteran (other than a veteran covered by clause
(i)) who served on active duty during the Vietnam era who
seeks or is furnished such counseling before January 1, 2000.
``(2)(A) Upon the request of any veteran (other than a
veteran covered by paragraph (1)) who served in the active
military, naval, or air service in a theater of combat
operations (as so determined) during a period of war, or in
any other area during a period in which hostilities (as
defined in subparagraph (B)) occurred in such area, the
Secretary may furnish counseling to the veteran to assist the
veteran in readjusting to civilian life.
``(B) For the purposes of subparagraph (A), the term
`hostilities' means an armed conflict in which the members of
the Armed Forces are subjected to danger comparable to the
danger to
[[Page H12117]]
which members of the Armed Forces have been subjected in
combat with enemy armed forces during a period of war, as
determined by the Secretary in consultation with the
Secretary of Defense.''.
(b) Repeal of Referral Provisions.--Subsection (c) of such
section is repealed.
SEC. 332. REPORTS RELATING TO VET CENTERS.
(a) Report on Collocation of Vet Centers and Department
Outpatient Clinics.--(1) Not later than six months after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report on the
feasibility and desirability of providing for the collocation
of Vet Centers and outpatient clinics (including rural mobile
clinics) of the Department of Veterans Affairs as current
leases for such centers and clinics expire.
(2) The report shall include an assessment of the
following:
(A) The results of any collocation of Vet Centers and
outpatient clinics carried out by the Secretary before the
date of the enactment of this Act, including the effects of
such collocation on the quality of care provided at such
centers and clinics.
(B) The effect of such collocation on the capacity of such
centers and clinics to carry out their primary mission.
(C) The extent to which such collocation will impair the
operational independence or administrative integrity of such
centers and clinics.
(D) The feasibility of combining the services provided by
such centers and clinics in the course of such collocation.
(E) The advisability of the collocation of centers and
clinics of significantly different size.
(F) The effect of the locations (including urban and rural
locations) of the centers and clinics on the feasibility and
desirability of such collocation.
(G) The amount of any costs savings to be achieved by
Department as a result of such collocation.
(H) Any other matter that the Secretary considers
appropriate.
(b) Report on Provision of Limited Health Care Services at
Readjustment Counseling Centers.--(1) Not later than six
months after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall submit to the Committees
on Veterans' Affairs of the Senate and House of
Representatives a report on the feasibility and desirability
of providing a limited battery of health care services
(including ambulatory services and health care screening
services) to veterans at Department of Veterans Affairs
readjustment counseling centers.
(2) The report shall include a discussion of the following:
(A) The effect on the advisability of providing health care
services at readjustment counseling centers of the geographic
location of such centers, including the urban location and
rural location of such centers and the proximity of such
centers to Department of Veterans Affairs medical facilities.
(B) The effect on the advisability of providing such
services at such centers of the type and level of services to
be provided, and the demographic characteristics (including
age, socio-economic status, ethnicity, and sex) of veterans
likely to be provided the services.
(C) The effect of providing such services at such centers
on the readjustment counseling center program in general and
on the efficiency and autonomy of the clinical and
administrative operations of the readjustment counseling
centers in particular.
(D) Any other matter that the Secretary considers
appropriate.
(c) Rule of Construction.--Nothing in this section is
intended to preclude the Secretary, during the period before
the submission of the reports under this section, from
providing limited health care services at Vet Centers.
SEC. 333. ADVISORY COMMITTEE ON THE READJUSTMENT OF VETERANS.
(a) In General.--(1) Subchapter III of chapter 5 is amended
by inserting after section 544 the following new section:
``Sec. 545. Advisory Committee on the Readjustment of
Veterans
``(a)(1) There is in the Department the Advisory Committee
on the Readjustment of Veterans (hereinafter in this section
referred to as the `Committee').
``(2) The Committee shall consist of not more than 18
members appointed by the Secretary from among individuals
who--
``(A) have demonstrated significant civic or professional
achievement; and
``(B) have experience with the provision of veterans
benefits and services by the Department.
``(3) The Secretary shall seek to ensure that members
appointed to the Committee include individuals from a wide
variety of geographic areas and ethnic backgrounds,
individuals from veterans service organizations, individuals
with combat experience, and women.
``(4) The Secretary shall determine the terms of service
and pay and allowances of the members of the Committee,
except that a term of service may not exceed two years. The
Secretary may reappoint any member for additional terms of
service.
``(b)(1) The Secretary shall, on a regular basis, consult
with and seek the advice of the Committee with respect to the
provision by the Department of benefits and services to
veterans in order to assist veterans in the readjustment to
civilian life.
``(2)(A) In providing advice to the Secretary under this
subsection, the Committee shall--
``(i) assemble and review information relating to the needs
of veterans in readjusting to civilian life;
``(ii) provide information relating to the nature and
character of psychological problems arising from service in
the Armed Forces;
``(iii) provide an on-going assessment of the effectiveness
of the policies, organizational structures, and services of
the Department in assisting veterans in readjusting to
civilian life; and
``(iv) provide on-going advice on the most appropriate
means of responding to the readjustment needs of veterans in
the future.
``(B) In carrying out its duties under subparagraph (A),
the Committee shall take into special account the needs of
veterans who have served in a theater of combat operations.
``(c)(1) Not later than March 31 of each year, the
Committee shall submit to the Secretary a report on the
programs and activities of the Department that relate to the
readjustment of veterans to civilian life. Each such report
shall include--
``(A) an assessment of the needs of veterans with respect
to readjustment to civilian life;
``(B) a review of the programs and activities of the
Department designed to meet such needs; and
``(C) such recommendations (including recommendations for
administrative and legislative action) as the Committee
considers appropriate.
``(2) Not later than 90 days after the receipt of a report
under paragraph (1), the Secretary shall transmit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a copy of the report, together with any
comments and recommendations concerning the report that the
Secretary considers appropriate.
``(3) The Committee may also submit to the Secretary such
other reports and recommendations as the Committee considers
appropriate.
``(4) The Secretary shall submit with each annual report
submitted to the Congress pursuant to section 529 of this
title a summary of all reports and recommendations of the
Committee submitted to the Secretary since the previous
annual report of the Secretary submitted pursuant to that
section.
``(d)(1) Except as provided in paragraph (2), the
provisions of the Federal Advisory Committee Act (5 U.S.C.
App.) shall apply to the activities of the Committee under
this section.
``(2) Section 14 of such Act shall not apply to the
Committee.''.
(2) The table of sections at the beginning of chapter 5 is
amended by inserting after the item relating to section 544
the following new item:
``545. Advisory Committee on the Readjustment of Veterans.''.
(b) Original Members.--(1) Notwithstanding subsection
(a)(2) of section 545 of title 38, United States Code (as
added by subsection (a)), the members of the Advisory
Committee on the Readjustment of Vietnam and Other War
Veterans on the date of the enactment of this Act shall be
the original members of the advisory committee recognized
under such section.
(2) The original members shall so serve until the Secretary
of Veterans Affairs carries out appointments under such
subsection (a)(2). The Secretary of Veterans Affairs shall
carry out such appointments as soon after such date as is
practicable. The Secretary may make such appointments from
among such original members.
SEC. 334. CENTERS FOR MENTAL ILLNESS RESEARCH, EDUCATION, AND
CLINICAL ACTIVITIES.
(a) In General.--(1) Subchapter II of chapter 73 is amended
by adding after section 7319, as added by section 321(a)(1),
the following new section:
``Sec. 7320. Centers for mental illness research, education,
and clinical activities
``(a) The purpose of this section is to provide for the
improvement of the provision of health-care services and
related counseling services to eligible veterans suffering
from mental illness (especially mental illness related to
service-related conditions) through--
``(1) the conduct of research (including research on
improving mental health service facilities of the Department
and on improving the delivery of mental health services by
the Department);
``(2) the education and training of health care personnel
of the Department; and
``(3) the development of improved models and systems for
the furnishing of mental health services by the Department.
``(b)(1) The Secretary shall establish and operate centers
for mental illness research, education, and clinical
activities. Such centers shall be established and operated by
collaborating Department facilities as provided in subsection
(c)(1). Each such center shall function as a center for--
``(A) research on mental health services;
``(B) the use by the Department of specific models for
furnishing services to treat serious mental illness;
``(C) education and training of health-care professionals
of the Department; and
``(D) the development and implementation of innovative
clinical activities and systems of care with respect to the
delivery of such services by the Department.
``(2) The Secretary shall, upon the recommendation of the
Under Secretary for Health, designate the centers under this
section. In making such designations, the Secretary shall
ensure that the centers designated are located in various
geographic regions of the United States. The Secretary may
designate a center under this section only if--
``(A) the proposal submitted for the designation of the
center meets the requirements of subsection (c);
``(B) the Secretary makes the finding described in
subsection (d); and
``(C) the peer review panel established under subsection
(e) makes the determination specified in subsection (e)(3)
with respect to that proposal.
``(3) Not more than five centers may be designated under
this section.
[[Page H12118]]
``(4) The authority of the Secretary to establish and
operate centers under this section is subject to the
appropriation of funds for that purpose.
``(c) A proposal submitted for the designation of a center
under this section shall--
``(1) provide for close collaboration in the establishment
and operation of the center, and for the provision of care
and the conduct of research and education at the center, by a
Department facility or facilities in the same geographic area
which have a mission centered on care of the mentally ill and
a Department facility in that area which has a mission of
providing tertiary medical care;
``(2) provide that no less than 50 percent of the funds
appropriated for the center for support of clinical care,
research, and education will be provided to the collaborating
facility or facilities that have a mission centered on care
of the mentally ill; and
``(3) provide for a governance arrangement between the
collaborating Department facilities which ensures that the
center will be established and operated in a manner aimed at
improving the quality of mental health care at the
collaborating facility or facilities which have a mission
centered on care of the mentally ill.
``(d) The finding referred to in subsection (b)(2)(B) with
respect to a proposal for designation of a site as a location
of a center under this section is a finding by the Secretary,
upon the recommendation of the Under Secretary for Health,
that the facilities submitting the proposal have developed
(or may reasonably be anticipated to develop) each of the
following:
``(1) An arrangement with an accredited medical school that
provides education and training in psychiatry and with which
one or more of the participating Department facilities is
affiliated under which medical residents receive education
and training in psychiatry through regular rotation through
the participating Department facilities so as to provide such
residents with training in the diagnosis and treatment of
mental illness.
``(2) An arrangement with an accredited graduate program of
psychology under which students receive education and
training in clinical, counseling, or professional psychology
through regular rotation through the participating Department
facilities so as to provide such students with training in
the diagnosis and treatment of mental illness.
``(3) An arrangement under which nursing, social work,
counseling, or allied health personnel receive training and
education in mental health care through regular rotation
through the participating Department facilities.
``(4) The ability to attract scientists who have
demonstrated achievement in research--
``(A) into the evaluation of innovative approaches to the
design of mental health services; or
``(B) into the causes, prevention, and treatment of mental
illness.
``(5) The capability to evaluate effectively the activities
of the center, including activities relating to the
evaluation of specific efforts to improve the quality and
effectiveness of mental health services provided by the
Department at or through individual facilities.
``(e)(1) In order to provide advice to assist the Secretary
and the Under Secretary for Health to carry out their
responsibilities under this section, the official within the
central office of the Veterans Health Administration
responsible for mental health and behavioral sciences matters
shall establish a peer review panel to assess the scientific
and clinical merit of proposals that are submitted to the
Secretary for the designation of centers under this section.
``(2) The panel shall consist of experts in the fields of
mental health research, education and training, and clinical
care. Members of the panel shall serve as consultants to the
Department.
``(3) The panel shall review each proposal submitted to the
panel by the official referred to in paragraph (1) and shall
submit to that official its views on the relative scientific
and clinical merit of each such proposal. The panel shall
specifically determine with respect to each such proposal
whether that proposal is among those proposals which have met
the highest competitive standards of scientific and clinical
merit.
``(4) The panel shall not be subject to the Federal
Advisory Committee Act (5 U.S.C. App.).
``(f) Clinical and scientific investigation activities at
each center established under this section--
``(1) may compete for the award of funding from amounts
appropriated for the Department of Veterans Affairs medical
and prosthetics research account; and
``(2) shall receive priority in the award of funding from
such account insofar as funds are awarded to projects and
activities relating to mental illness.
``(g) The Under Secretary for Health shall ensure that at
least three centers designated under this section emphasize
research into means of improving the quality of care for
veterans suffering from mental illness through the
development of community-based alternatives to institutional
treatment for such illness.
``(h) The Under Secretary for Health shall ensure that
information produced by the research, education and training,
and clinical activities of centers established under this
section that may be useful for other activities of the
Veterans Health Administration is disseminated throughout the
Veterans Health Administration. Such dissemination shall be
made through publications, through programs of continuing
medical and related education provided through regional
medical education centers under subchapter VI of chapter 74
of this title, and through other means. Such programs of
continuing medical education shall receive priority in the
award of funding.
``(i) The official within the central office of the
Veterans Health Administration responsible for mental health
and behavioral sciences matters shall be responsible for
supervising the operation of the centers established pursuant
to this section and shall provide for ongoing evaluation of
the centers and their compliance with the requirements of
this section.
``(j)(1) There are authorized to be appropriated to the
Department of Veterans Affairs for the basic support of the
research and education and training activities of centers
established pursuant to this section amounts as follows:
``(A) $3,125,000 for fiscal year 1998.
``(B) $6,250,000 for each of fiscal years 1999 through
2001.
``(2) In addition to funds appropriated for a fiscal year
pursuant to the authorization of appropriations in paragraph
(1), the Under Secretary for Health shall allocate to such
centers from other funds appropriated for that fiscal year
generally for the Department of Veterans Affairs medical care
account and the Department of Veterans Affairs medical and
prosthetics research account such amounts as the Under
Secretary for Health determines appropriate to carry out the
purposes of this section.''.
(2) The table of sections at the beginning of chapter 73 is
amended by inserting after the item relating to section 7319,
as added by section 321(a)(2), the following new item:
``7320. Centers for mental illness research, education, and clinical
activities.''.
(b) Annual Reports.--Not later than February 1 of each of
1999, 2000, 2001, and 2002, the Secretary of Veterans Affairs
shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the status
and activities during the previous fiscal year of the centers
for mental illness research, education, and clinical
activities established pursuant to section 7320 of title 38,
United States Code (as added by subsection (a)). Each such
report shall include the following:
(1) A description of the activities carried out at each
center and the funding provided for such activities.
(2) A description of the advances made at each of the
participating facilities of the center in research, education
and training, and clinical activities relating to mental
illness in veterans.
(3) A description of the actions taken by the Under
Secretary for Health pursuant to subsection (h) of that
section (as so added) to disseminate information derived from
such activities throughout the Veterans Health
Administration.
(4) The Secretary's evaluations of the effectiveness of the
centers in fulfilling the purposes of the centers.
(c) Implementation.--The Secretary of Veterans Affairs
shall designate at least one center under section 7320 of
title 38, United States Code, not later than January 1, 1998.
SEC. 335. COMMITTEE ON CARE OF SEVERELY CHRONICALLY MENTALLY
ILL VETERANS.
(a) Establishment.--Subchapter II of chapter 73 is amended
by adding after section 7320, as added by section 334(a)(1),
the following new section:
``Sec. 7321. Committee on Care of Severely Chronically
Mentally Ill Veterans
``(a) The Secretary, acting through the Under Secretary for
Health, shall establish in the Veterans Health Administration
a Committee on Care of Severely Chronically Mentally Ill
Veterans. The Under Secretary shall appoint employees of the
Department with expertise in the care of the chronically
mentally ill to serve on the committee.
``(b) The committee shall assess, and carry out a
continuing assessment of, the capability of the Veterans
Health Administration to meet effectively the treatment and
rehabilitation needs of mentally ill veterans whose mental
illness is severe and chronic and who are eligible for health
care furnished by the Department, including the needs of such
veterans who are women. In carrying out that responsibility,
the committee shall--
``(1) evaluate the care provided to such veterans through
the Veterans Health Administration;
``(2) identify systemwide problems in caring for such
veterans in facilities of the Veterans Health Administration;
``(3) identify specific facilities within the Veterans
Health Administration at which program enrichment is needed
to improve treatment and rehabilitation of such veterans; and
``(4) identify model programs which the committee considers
to have been successful in the treatment and rehabilitation
of such veterans and which should be implemented more widely
in or through facilities of the Veterans Health
Administration.
``(c) The committee shall--
``(1) advise the Under Secretary regarding the development
of policies for the care and rehabilitation of severely
chronically mentally ill veterans; and
``(2) make recommendations to the Under Secretary--
``(A) for improving programs of care of such veterans at
specific facilities and throughout the Veterans Health
Administration;
``(B) for establishing special programs of education and
training relevant to the care of such veterans for employees
of the Veterans Health Administration;
``(C) regarding research needs and priorities relevant to
the care of such veterans; and
``(D) regarding the appropriate allocation of resources for
all such activities.
``(d)(1) Not later than April 1, 1997, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate
and House of Representatives a report on the implementation
of this section. The report shall include the following:
[[Page H12119]]
``(A) A list of the members of the committee.
``(B) The assessment of the Under Secretary for Health,
after review of the initial findings of the committee,
regarding the capability of the Veterans Health
Administration, on a systemwide and facility-by-facility
basis, to meet effectively the treatment and rehabilitation
needs of severely chronically mentally ill veterans who are
eligible for Department care.
``(C) The plans of the committee for further assessments.
``(D) The findings and recommendations made by the
committee to the Under Secretary for Health and the views of
the Under Secretary on such findings and recommendations.
``(E) A description of the steps taken, plans made (and a
timetable for their execution), and resources to be applied
toward improving the capability of the Veterans Health
Administration to meet effectively the treatment and
rehabilitation needs of severely chronically mentally ill
veterans who are eligible for Department care.
``(2) Not later than February 1, 1998, and February 1 of
each of the three following years, the Secretary shall submit
to the Committees on Veterans' Affairs of the Senate and
House of Representatives a report containing information
updating the reports submitted under this subsection before
the submission of such report.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 73 is amended by inserting after the
item relating to section 7320, as added by section 334(a)(2)
the following new item:
``7321. Committee on Care of Severely Chronically Mentally Ill
Veterans.''.
Subtitle D--Other Provisions
SEC. 341. HOSPICE CARE STUDY.
(a) Study Required.--The Secretary of Veterans Affairs
shall conduct a research study to determine the desirability
of the Secretary furnishing hospice care to terminally ill
veterans and to evaluate the most cost effective and
efficient way to do so. The Secretary shall carry out the
study using resources and personnel of the Department.
(b) Conduct of Study.--In carrying out the study required
by subsection (a), the Secretary shall--
(1) evaluate the programs, and the program models, through
which the Secretary furnishes hospice care services within or
through facilities of the Department of Veterans Affairs and
the programs and program models through which non-Department
facilities provide such services;
(2) assess the satisfaction of patients, and family members
of patients, in each of the program models covered by
paragraph (1);
(3) compare the costs (or range of costs) of providing care
through each of the program models covered by paragraph (1);
and
(4) identify any barriers to providing, procuring, or
coordinating hospice services through any of the program
models covered by paragraph (1).
(c) Program Models.--For purposes of subsection (b)(1), the
Secretary shall evaluate a variety of types of models for
delivery of hospice care, including the following:
(1) Direct furnishing of full hospice care by the
Secretary.
(2) Direct furnishing of some hospice services by the
Secretary.
(3) Contracting by the Secretary for the furnishing of
hospice care, with a commitment that the Secretary will
provide any further required hospital care for the patient.
(4) Contracting for all required care to be furnished
outside the Department.
(5) Referral of the patient for hospice care without a
contract.
(d) Report.--Not later than April 1, 1998, the Secretary
shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the research
study. The report shall set forth the Secretary's findings
and recommendations. The Secretary shall include in the
report information on the extent to which the Secretary
advises veterans concerning their eligibility for hospice
care and information on the number of veterans (as of the
time of the report) who are in each model of hospice care
described in subsection (c) and the average cost per patient
of hospice care for each such model.
SEC. 342. PAYMENT TO STATES OF PER DIEM FOR VETERANS
RECEIVING ADULT DAY HEALTH CARE.
(a) Payment of Per Diem for Veterans Receiving Adult Day
Care.--Section 1741 is amended--
(1) by inserting ``(1)'' after ``(a)'';
(2) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively; and
(3) by adding at the end the following new paragraph (2):
``(2) The Secretary may pay each State per diem at a rate
determined by the Secretary for each veteran receiving adult
day health care in a State home, if such veteran is eligible
for such care under laws administered by the Secretary.''.
(b) Assistance to States for Construction of Adult Day Care
Facilities.--(1) Section 8131(3) is amended by inserting
``adult day health,'' before ``or hospital care''.
(2) Section 8132 is amended by inserting ``adult day
health,'' before ``or hospital care''.
(3) Section 8135(b) is amended--
(A) in paragraph (2)(C), by inserting ``or adult day health
care facilities'' after ``domiciliary beds''; and
(B) in paragraph (3)(A), by inserting ``or construction
(other than new construction) of adult day health care
buildings'' before the semicolon.
SEC. 343. RESEARCH CORPORATIONS.
(a) Renewal of Authority.--Section 7368 is amended by
striking out ``December 31, 1992'' and inserting in lieu
thereof ``December 31, 2000''.
(b) Clarification of Tax-Exempt Status.--Sections 7361(b)
and 7363(c) are amended by striking out ``section 501(c)(3)
of''.
(c) Periodic Audits.--Subsection (b) of section 7366 is
amended by striking out ``The corporation'' in the second
sentence and all that follows through ``shall include that
report'' and inserting in lieu thereof the following: ``A
corporation with revenues in excess of $300,000 for any year
shall obtain an audit of the corporation for that year. A
corporation with annual revenues between $10,000 and $300,000
shall obtain an independent audit of the corporation at least
once every three years. Any audit under the preceding
sentences shall be performed by an independent auditor. The
corporation shall include the most recent such audit''.
(d) Compliance With Conflict of Interest Laws and
Regulations.--Subsection (c)(2) of section 7366 is amended by
striking out ``an annual statement signed by the director or
employee certifying that the director or'' and inserting in
lieu thereof ``a statement signed by the executive director
of the corporation certifying that each director and''.
(e) Revised Reporting Requirement.--Subsection (d) of
section 7366 is amended to read as follows:
``(d) The Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives
an annual report on the corporations established under this
subchapter. The report shall set forth the following
information:
``(1) The location of each corporation.
``(2) The amount received by each corporation during the
previous year, including--
``(A) the total amount received;
``(B) the amount received from governmental entities;
``(C) the amount received from all other sources; and
``(D) if the amount received from a source referred to in
subparagraph (C) exceeded $25,000, information that
identifies the source.
``(3) The amount expended by each corporation during the
year, including--
``(A) the amount expended for salary for research staff and
for salary for support staff;
``(B) the amount expended for direct support of research;
and
``(C) if the amount expended with respect to any payee
exceeded $35,000, information that identifies the payee.''.
SEC. 344. VETERANS HEALTH ADMINISTRATION HEADQUARTERS.
Section 7306 is amended by adding at the end the following
new subsection:
``(f) In organizing the Office and appointing persons to
positions in the Office, the Under Secretary shall ensure
that--
``(1) the Office is staffed so as to provide the Under
Secretary, through a designated clinician in the appropriate
discipline in each instance, with expertise and direct policy
guidance on--
``(A) unique programs operated by the Administration to
provide for the specialized treatment and rehabilitation of
disabled veterans (including blind rehabilitation, care of
spinal cord dysfunction, mental illness, and long-term care);
and
``(B) the programs established under section 1712A of this
title; and
``(2) with respect to the programs established under
section 1712A of this title, a clinician with appropriate
expertise in those programs is responsible to the Under
Secretary for the management of those programs.''.
SEC. 345. DISBURSEMENT AGREEMENTS RELATING TO MEDICAL
RESIDENTS AND INTERNS.
Section 7406(c) is amended--
(1) by striking out ``Department hospital'' each place it
appears and inserting in lieu thereof ``Department facility
furnishing hospital care or medical services'';
(2) by striking out ``participating hospital'' in paragraph
(4)(C) and inserting in lieu thereof ``participating
facility''; and
(3) by striking out ``hospital'' both places it appears in
paragraph (5) and inserting in lieu thereof ``facility''.
SEC. 346. AUTHORITY TO SUSPEND SPECIAL PAY AGREEMENTS FOR
PHYSICIANS AND DENTISTS WHO ENTER RESIDENCY
TRAINING PROGRAMS.
Section 7432(b)(2) is amended--
(1) by inserting ``(A)'' after ``(2)''; and
(2) by adding at the end the following:
``(B) The Secretary may suspend a special pay agreement
entered into under this section in the case of a physician or
dentist who, having entered into the special pay agreement,
enters a residency training program. Any such suspension
shall terminate when the physician or dentist completes,
withdraws from, or is no longer a participant in the program.
During the period of such a suspension, the physician or
dentist is not subject to the provisions of paragraph (1).''.
SEC. 347. REMUNERATED OUTSIDE PROFESSIONAL ACTIVITIES BY
VETERANS HEALTH ADMINISTRATION PERSONNEL.
(a) Authority.--Subsection (b) of section 7423 is amended--
(1) by striking out paragraph (1); and
(2) by redesignating paragraphs (2) through (6) as
paragraphs (1) through (5), respectively.
(b) Conforming Amendment.--Subsection (c) of such section
is amended in the matter preceding paragraph (1) by striking
out ``subsection (b)(6)'' and inserting in lieu thereof
``subsection (b)(5)''.
SEC. 348. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY,
MILWAUKEE COUNTY, WISCONSIN.
(a) Modification of Reversionary Interest.--The Secretary
of Veterans Affairs is authorized to execute such instruments
as may be necessary to modify the conditions under which the
land described in subsection (b) will revert to the United
States in order--
(1) to permit Milwaukee County, Wisconsin, to grant all or
part of such land to another party
[[Page H12120]]
with a condition on such grant that the grantee use such land
only for civic and recreational purposes; and
(2) to provide that the conditions under which title to all
or any part of such land reverts to the United States are
stated so that any such reversion would occur at the option
of the United States.
(b) Description of Land.--The land covered by this section
is the tract of 28 acres of land, more or less, conveyed to
Milwaukee County, Wisconsin, pursuant to the Act entitled
``An Act authorizing the Administrator of Veterans' Affairs
to convey certain property to Milwaukee County, Wisconsin'',
approved August 27, 1954 (68 Stat. 866).
(c) General Authorities.--The Secretary may carry out this
section subject to such terms and conditions (including
reservations of rights for the United States) as the
Secretary considers necessary to protect the interests of the
United States. In carrying out this section, the Secretary
may eliminate any existing covenant or restriction with
respect to the tract of land described in subsection (b)
which the Secretary determines to be no longer necessary to
protect the interests of the United States.
SEC. 349. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY,
CHEYENNE, WYOMING.
(a) Modification of Reversionary Interest.--The Secretary
of Veterans Affairs of Veterans Affairs is authorized to
execute such instruments as may be necessary to modify the
conditions under which the land described in subsection (b)
will revert to the United States in order to permit the City
of Cheyenne, Wyoming, to grant all or part of such land to
the First Cheyenne Federal Credit Union (formerly known as
the Cheyenne VAF Federal Credit Union) with a condition on
such grant that the First Cheyenne Federal Credit Union use
such land only for the purpose of constructing a building to
house its operations.
(b) Description of Land.--The land covered by this section
is the tract of 27 acres of land, more or less, conveyed to
the City of Cheyenne, Wyoming, pursuant to the Act entitled
``An Act authorizing the Administrator of Veterans' Affairs
to convey certain property to the City of Cheyenne,
Wyoming'', approved November 8, 1965 (79 Stat. 1304).
(c) Terms of Reversionary Interest.--In carrying out this
section, the Secretary may cause the statement of the
conditions under which title to all or any part of the land
described in subsection (b) reverts to the United States to
be revised so that any such reversion would occur at the
option of the United States.
(d) General Authorities.--The Secretary may carry out this
section subject to such terms and conditions (including
reservations of rights for the United States) as the
Secretary considers necessary to protect the interests of the
United States. In carrying out this section, the Secretary
may eliminate any existing covenant or restriction with
respect to the tract of land described in subsection (b)
which the Secretary determines to be no longer necessary to
protect the interests of the United States.
SEC. 350. NAME OF DEPARTMENT OF VETERANS AFFAIRS MEDICAL
CENTER, JOHNSON CITY, TENNESSEE.
(a) Name.--The Mountain Home Department of Veterans Affairs
Medical Center in Johnson City, Tennessee, shall after the
date of the enactment of this Act be known and designated as
the ``James H. Quillen Department of Veterans Affairs Medical
Center''. Any reference to such medical center in any law,
regulation, map, document, record, or other paper of the
United States shall be considered to be a reference to the
James H. Quillen Department of Veterans Affairs Medical
Center.
(b) Effective Date.--Subsection (a) shall take effect at
noon on January 3, 1997.
SEC. 351. REPORT ON HEALTH CARE NEEDS OF VETERANS IN EAST
CENTRAL FLORIDA.
(a) Report Required.--Not later than 60 days after the date
of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report on the
health care needs of veterans in east central Florida. In
preparing the report, the Secretary shall consider the needs
of such veterans for psychiatric and long-term care. The
Secretary shall include in the report the Secretary's views,
based on the Secretary's determination of such needs, as to
the best means of meeting such needs using the amounts
appropriated pursuant to the authorization of appropriations
in this Act and Public Law 103-452 for projects to meet the
health care needs of such veterans. The Secretary may,
subject to the availability of appropriations for such
purpose, use an independent contractor to assist in the
determination of such health care needs.
(b) Limitation.--The Secretary may not obligate any funds,
other than for design work, for the conversion of the former
Orlando Naval Training Center Hospital in Orlando, Florida
(now under the jurisdiction of the Secretary of Veterans
Affairs), to a nursing home care unit until 45 days after the
date on which the report required by subsection (a) is
submitted.
SEC. 352. EVALUATION OF HEALTH STATUS OF SPOUSES AND CHILDREN
OF PERSIAN GULF WAR VETERANS.
(a) Extension of Authority.--Subsection (b) of section 107
of the Persian Gulf War Veterans' Benefits Act (title I of
Public Law 103-446; 108 Stat. 4652; 38 U.S.C. 1117 note) is
amended by striking out ``September 30, 1996'' and inserting
in lieu thereof ``December 31, 1998''.
(b) Ratification of Actions.--Any diagnostic testing and
medical examinations undertaken by the Secretary of Veterans
Affairs for the purpose of the study required by subsection
(a) of such section during the period beginning on October 1,
1996, and ending on the date of the enactment of this Act is
hereby ratified.
Mr. STUMP (during the reading). Mr. Speaker, I ask unanimous consent
that the Senate amendments be considered as read and printed in the
Record.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Arizona?
There was no objection.
The SPEAKER pro tempore. Is there objection to the original request
of the gentleman from Arizona?
Mr. MONTGOMERY. Mr. Speaker, reserving the right to object, and I
will not object, I yield to the gentleman from Arizona so he can
explain this bill.
(Mr. STUMP asked and was given permission to revise and extend his
remarks.)
Mr. STUMP. Mr. Speaker, I thank the gentleman from Mississippi for
yielding.
Mr. Speaker, the House-Senate agreement, which produced this
legislation, includes provisions from several bills passed by the House
during the 104th Congress.
These bills are H.R. 1384, to allow VA employees to work outside the
VA; H.R. 3376, VA major medical construction authorization; H.R. 3643,
expiring authorities legislation; and, of course, H.R. 3118, the
Veterans' Health Care Eligibility Reform Act of 1996, the one we have
all worked so hard on for several years.
Mr. Speaker, I hope that all Members will support this bill.
Mr. MONTGOMERY. Mr. Speaker, further reserving the right to object, I
yield to the gentleman from New York [Mr. Solomon], the chairman of the
Rules Committee.
Mr. SOLOMON. Mr. Speaker, I think we ought to call attention to the
gentleman that has reserved the right to object. His name happens to be
Sonny Montgomery. He is a man who personifies the advocacy for veterans
and veterans families throughout this country for so many years in this
body. He is retiring, he will no longer be with us, but he will be
coming back to keep an eye on all of us because he is still going go
stick up for the veterans of this country the way he always has.
I am proud to be the cosponsor of this legislation along with
Chairman Stump, because this guarantees the medical care delivery
system for the future for veterans of this country. It is a giant step
in the right direction. I commend you, Sonny, and you, Bob, and your
committees and your staff for the great job you did.
I thank the gentleman for yielding.
Mr. MONTGOMERY. Mr. Speaker, further reserving the right to object, I
want to thank the gentleman from New York [Mr. Solomon] and five him a
good salute on the House floor.
Mr. Speaker, I will be brief. Mr. Speaker, this is a very important
bill. I want to commend our Chairman Bob Stump who has be a fair
chairman, we have worked well together, and also the chairman and
ranking member of the Subcommittee on Hospitals and Health Care, the
gentleman from Arkansas, Mr. Hutchinson and the gentleman from Texas,
Mr. Edwards.
Mr. Speaker, this bill opens up the eligibility more for veterans to
get into our veterans hospitals and be treated.
Throughout this Congress, veterans have called on our committee to
adopt eligibility reform. That has been their highest priority, and we
have pledged to achieve that goal. The House has, in fact, twice passed
eligibility reform legislation. But today we join hands with our
colleagues in the Senate, and take up a compromise bill. This bill, the
Veterans' Health Care Eligibility Reform Act of 1996, is landmark
legislation. It not only reforms outdated rules on when and how VA can
care for a veteran, but gives VA important new tools both to streamline
and strengthen its health care system.
Many, many veterans rely on VA for care--from the spinal cord injured
World War II veteran to women veterans of the Persian gulf war. With
this bill, we make it easier for them to get VA care, and provide them
greater assurance that the VA health care system of tomorrow will be an
even better system than the one that serves them today.
I urge my colleagues to support this compromise agreement.
Mr. Speaker, further reserving the right to object, I yield to the
gentleman from Texas [Mr. Edwards].
Mr. EDWARDS. Mr. Speaker, I thank the gentleman for yielding to me. I
will be brief.
[[Page H12121]]
I think I would be remiss if I did not say that this was landmark
legislation in the waning hours of this session of Congress, and I want
to congratulate the gentleman from Arizona [Mr. Stump] and the
gentleman from Mississippi [Mr. Montgomery], because in a Congress that
has sometimes been very difficult, they have shown us that even in
difficult times, civility can prevail.
Mr. Speaker, I think it is appropriate that in the 104th Congress
where we have freely exercised our freedom of speech on both sides of
the aisle, that we finish this Congress by passing major legislation to
honor those who have fought and been willing to give their life to
protect that freedom of speech, both on the floor of this House and for
all Americans across this country. This legislation is a first step,
not a last step.
Mr. Speaker, I will finish by saying that this is landmark
legislation. It is not the final step in the effort toward increasing
care for our veterans, but it is a major step, a significant step that
would not have happened had it not been for the leadership of the
gentleman from Arizona [Mr. Stump] and the gentleman from Mississippi
[Mr. Montgomery]. I want to express my thanks to both the gentlemen for
their efforts on our veterans' behalf.
Finally, this is a win-win, not only for our veterans who will have
simpler eligibility rules; they will know whether they can get VA care
or not, but they will also be able to get outpatient care more easily.
But it is a win also for our taxpayers because by providing outpatient
care rather than more expensive inpatient care, our taxpayers will win
from this major legislation.
To the gentleman from New York [Mr. Solomon] also, the chairman of
the Committee on Rules, I want to express my thanks to him for helping
this bill become the law of the land at the end of this session.
To all, this is a great piece of legislation. It is a great day for
our veterans. Certainly they have earned this right to receive the care
that they were willing to give their lives for our Nation for.
Mr. MONTGOMERY. Mr. Speaker, I thank the gentleman from Texas.
Mr. Speaker, I withdraw my reservation of objection.
The SPEAKER pro tempore. Is there objection to the original request
of the gentleman from Arizona?
There was no objection.
A motion to reconsider was laid on the table.
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