[Congressional Record Volume 142, Number 139 (Tuesday, October 1, 1996)]
[Extensions of Remarks]
[Pages E1891-E1892]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          VETERANS' HEALTH CARE ELIGIBILITY REFORM ACT OF 1996

                                 ______
                                 

                         HON. TIM Y. HUTCHINSON

                              of arkansas

                    in the house of representatives

                       Monday, September 30, 1996

  Mr. HUTCHINSON. Mr. Speaker, it is with great pride and a resounding 
sense of accomplishment that I stand in support of H.R. 3118, as 
amended, the Veterans Health Care Eligibility Reform Act of 1996. This 
bill represents the culmination of strong bipartisan efforts to move 
Veterans' Administration [VA] health care into the 21st century. I want 
to extend my appreciation to Chairman Stump for his leadership and to 
the ranking members Sonny Montgomery and Chet Edwards of the Veterans 
Affairs' Committee for their steadfast support in doing what is right 
for America's veterans.
  H.R. 3118, within appropriations, directs VA to provide all needed 
hospital and medical care services and establish and manage health care 
programs to promote the cost-effective delivery of health services to 
veterans with compensable service-connected disabilities, former 
prisoners of war, veterans exposed to toxic substances and 
environmental hazards, veterans meeting the ``means test'' as provide 
under existing law, and veterans of World War I.
  The bill requires VA to manage the provision of health care services 
through an annual patient enrollment system that is reflective of the 
priority system, which provides the highest priority for enrollment to 
those with service-connected conditions and also requires that 
effective October 1, 1998, veterans enroll in a VA managed care plan to 
receive health care services. Veterans in need of care for a service-
connected condition of 50 percent or more service-connected disabled 
are exempt from the enrollment requirement.
  The bill eliminates restrictions on VA providing prosthetics, but 
requires VA to establish guidelines for providing hearing aids and 
eyeglasses.
  The bill directs the VA to maintain its capacity for specialized 
services at the current level and within distinct programs and 
facilities dedicated to the specialized needs of those veterans. It 
also requires VA to consult with the Advisory Committee on Prosthetics 
and Special Disabilities Programs and the Committee on Care of Severely 
Chronically Mentally Ill Veterans in the assessment of these 
activities. Furthermore, the VA is required to report to the House and 
Senate Veterans' Affairs Committees by April 1 of the years 1997, 1998, 
and 1999 on VA's compliance with the specialized services provisions of 
the bill.
  To ensure the budget neutrality of the eligibility reform provisions 
of this bill, the authorizations for appropriations are capped at the 
following amounts: $17.25 billion for fiscal year 1997 and $17.9 
billion for fiscal year 1998.
  The bill requires that no later than March 1, 1998, VA report to the 
House and Senate Veterans' Affairs Committees on the impact of the 
implementation of eligibility reform.
  The bill authorizes the following major projects for a total amount 
of $358.15 million: construction of an ambulatory care facility and 
renovation of ``E'' wing, Tripler Army Hospital, Honolulu HI, $43 
million; addition of ambulatory care facilities, Brockton, MA, $13.5 
million; addition of ambulatory care facilities, Shreveport, LA, $25 
million; addition of ambulatory care facilities, Lyons, NJ, $21.1 
million; addition of ambulatory care facilities, Tomah, WI, $12.7 
million; addition of ambulatory care facilities, Asheville, NC, $26.3 
million; addition of ambulatory care facilities, Temple, TX, $9.8 
million; addition of ambulatory care facilities, Tucson, AZ, $35.5 
million; construction of an ambulatory care facility, Leavenworth KS, 
$27.75 million; environmental improvements, Lebanon, PA, $9.5 million; 
environmental improvements, Marion, IL, $11.5 million; environmental 
improvements, Omaha, NE, $7.7 million; environmental improvements, 
Pittsburgh, PA, $17.4 million; environmental improvements, Waco, TX, 
$26 million; environmental improvements, Marion, IN, $17.3 million; 
environmental improvements, Perry Point, MD, $15.1 million; 
environmental enhancement, Salisbury, NC, $18.2 million; and seismic 
corrections of building number 324 at the Department of Veterans 
Affairs medical center, Palo Alto, CA, in the amount of $20.8 million. 
The authorization covers the fiscal years 1997 and 1998.
  The bill authorizes the following major medical facility leases for a 
total of $12.236 million: Allentown, PA, $2.159 million; Beaumont, TX, 
$1.94 million; Boston, MA, $2.358 million; Cleveland, OH, $1.3 million; 
San Antonio, TX, $2.256 million; and Toledo, OH, $2.223 million.
  The bill requires the VA to develop a 5-year strategic plan for its 
health care system which specifically addresses the integration of 
planning efforts at the grassroots level, coordinated within the 
prescribed geographic network, and then formulated into a national 
plan. The plan is required to be updated annually.
  The VA is also required to submit to the House and Senate Veterans' 
Affairs Committees an annual report on the top 20 major medical 
construction projects of the Department which includes the 
justification of the projects and any changes to the report, such as 
the addition, deletion, or change in rank order of any of the projects.
  The bill expands the required documentation and justification of each 
major project and major facility lease proposed in the President's 
budget. The bill redefines a major medical construction project as 
costing at least $4 million and repeals effective fiscal year 1998, a 
provision of law exempting certain previously funded construction 
projects from the law's authorizations requirement. The bill 
also provides that amounts in excess of $500,000 may not be obligated 
from the VA's Advance Planning Fund until VA reports such proposed 
obligations to the House and Senate Veterans' Affairs Committees.

  The provision of Health Care Sharing and Administration broadens and 
expands VA's ability to share health care resources while ensuring that 
services to veterans are not adversely affected by contractual 
agreements or sharing arrangements that may be established between the 
VA and other health care providers.
  The bill makes permanent VA's ability to enter into sharing 
agreements with the Department of Defense under provisions of DOD's 
CHAMPUS program. The bill clarifies VA's authority to recover or 
collect from insurance

[[Page E1892]]

plans (including CHAMPUS supplemental plans) and directs that all funds 
received under these provisions be credited to the facility that 
provided the care. It also exempts those personnel involved in 
providing care under this provision and other sharing authorities from 
personnel ceilings.
  The effective date for the implementation of an administrative 
reorganization is reduced from 90 to 45 days during which Congress has 
been in continuous session.
  The bill repeals limitations in 38 USC Section 8110(c) on 
contracting-out services currently performed by VA employees. VA is 
required to report annually to the House and Senate Veterans' Affairs 
Committees on those activities which it proposes to study for possible 
contracting out and those which have been contracted out.
  Under Subtitle B of the bill, Care of Women Veterans, it stipulates 
that mammography standards for the VA be as stringent as those 
prescribed by Public Law 102-539 and requires that VA report to the 
Congress within 120 days of enactment of the legislation on the 
implementation of such standards. The bill also requires annual surveys 
through 1999 of all VA medical centers to identify patient privacy 
deficiencies relating to the treatment of women veterans, to develop 
plans for the correction of identified deficiencies, and to give 
priority to correction efforts in the Department's construction 
planning and budgeting process.
  Under Subtitle C, Readjustment Counseling and Mental Health Care, VA 
is required to furnish readjustment counseling to those veterans who 
served in-theater during the Vietnam-era and those Vietnam-era veterans 
who seek or who have sought readjustment counseling before January 1, 
2000. The provision also authorizes Vet Center counseling services to 
veterans of conflicts prior to the Vietnam-era such as Korea and World 
War II. Other provisions of this section require the VA to submit to 
the House and Senate Veterans' Affairs Committees a report on the 
feasibility and desirability of collating Vet Centers and also a report 
on the provision of offering limited health care services at 
readjustment counseling centers. Both reports are due within 6 months 
of enactment of the legislation. The bill also establishes an 18-member 
Advisory Committee on the Readjustment of Veterans which is required to 
submit an annual report on the readjustment of veterans with department 
comments to the Congress.

  The bill authorizes appropriations for establishment of up to five 
centers of excellence in mental health research, education, and 
clinical care activities (MIRECC's). The MIRECC concept is intended to 
improve the quality of care, particularly at VA psychiatric facilities, 
by fostering collaboration between those facilities with primarily 
psychiatric or mental health missions and non-psychiatric tertiary 
medical centers. MIRECC's are to be modeled after the successful 
Geriatric Research, Education and Clinical Centers (GRECC's). 
Authorizations for appropriations are $3.125 million for fiscal year 
1998 and $6.25 million for fiscal years 1999 through 2001. VA is 
required to submit reports on the operation of MIRECC's for the years 
1999 through 2002.
  The bill requires VA to establish a Committee on the Care of Severely 
Chronically Mentally Ill Veterans to assess VA's capability to meet the 
treatment needs of veterans including women veterans who suffer from 
chronic mental illnesses. The committee is required to submit reports 
for 1998 and the three years following on ways to improve care to this 
group of veterans.
  Subtitle D of the bill contains the following important provisions:


                           HOSPICE CARE STUDY

  This provision requires VA to conduct an in-house research and 
evaluation study on the most effective way of providing hospice care to 
veterans.


                        ADULT DAY CARE PER DIEM

  Authorizes VA to make per diem payments to state veterans' homes in 
conjunction with adult day care provided at such homes. The bill also 
authorizes construction grant support to States for expansion, 
remodeling, or alteration of existing buildings to permit the provision 
of adult day health care.


                         RESEARCH CORPORATIONS

  This provision renews VA's authority to establish additional research 
corporations through the year 2000. It also expands reporting 
requirements to Congress and requires an annual independent audit of 
research corporations with revenues in excess of $300,000. It also 
requires research corporations to more closely mirror reporting 
requirements of the Internal Revenue Service.


              Veterans Health Administration Headquarters

  This provision requires that the Office of the Under Secretary be 
staffed to include designated clinicians to provide expertise and 
direct policy guidance on VA's specialized services programs (including 
the readjustment counseling program) and that the latter be responsible 
for management of the readjustment counseling program.


   Disbursement Agreements Relating to Medical Residents and Interns

  Authorizes VA to make disbursement agreements for residents who train 
at outpatient clinics. nursing homes, or other VA medical facilities.


Authority to Suspend Special Pay Agreements for Physicians and Dentists 
                 Who Enter Residency Training Programs

  This provision suspends special pay agreements during residency 
training.


    Remunerated Outside Professional Activities by Veterans Health 
                        Administration Personnel

  Lifts current law restrictions on title 38 health care professional 
working in their professional capacity in outside employment while 
employed full-time by the VA.


  Modification of Restrictions on Real Property, Milwaukee County, WI

  Authorizes VA to modify conditions under which land previously 
transferred to Milwaukee County for civic and recreational purposes may 
be re-transferred.


      Modification of Restrictions on Real Property, Cheyenne, WY

  Authorizes VA to modify conditions under which land previously 
transferred to grant medical center lands on which the City of 
Cheyenne, WY may be re-transferred to permit First Cheyenne Federal 
Credit Union to build a building to house its operations.


Name of Department of Veterans Affairs Medical Center, Johnson City, TN

  Renames the VA medical center in Johnson City, TN, the ``James H. 
Quillen Department of Veterans Affairs Medical Center''.


    Report on the Health Care Needs of East Central Florida Veterans

  This provision requires VA to submit a report to Congress on the 
health care needs of needs of veterans in east central Florida.


Evaluation of the Health Status of Spouses and Children of Persian Gulf 
                              War Veterans

  Extends VA's authority until December 31, 1998 to offer diagnostic 
examinations to the spouses and children of Persian Gulf veterans.
  Mr. Speaker, I am proud to have been part of the legislative process 
that makes these critical changes which benefit our Nation's veterans. 
I yield back the balance of my time.

                          ____________________