[Congressional Record Volume 145, Number 165 (Friday, November 19, 1999)]
[Senate]
[Pages S14904-S14910]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        VETERANS' MILLENNIUM HEALTH CARE ACT--CONFERENCE REPORT

  Ms. COLLINS. Mr. President, I submit a report of the committee of 
conference on the bill (H.R. 2116) to amend title 38, United States 
Code, to establish a program of extended care services for veterans and 
to make other improvements in health care programs of the Department of 
Veterans Affairs, and ask for its immediate consideration.
  The PRESIDING OFFICER. The report will be stated.
  The legislative clerk read as follows:

       The committee on conference on the disagreeing votes of the 
     two Houses on the amendments of the Senate to the bill, H.R. 
     2116, have agreed to recommend and do recommend to their 
     respective Houses this report, signed by all of the 
     conferees.

  The PRESIDING OFFICER. Without objection, the Senate will proceed to 
the consideration of the conference report.
  (The conference report is printed in the House proceedings of the 
Record of November 16, 1999.)
  Mr. SPECTER. Mr. President, I urge my colleagues to join me in 
support of the Veterans Millennium Health Care and Benefits Act of 
1999. On Veterans Day, many of the members honored America's veterans 
and acknowledged our debt to them for their service. This legislation 
gives the Senate an opportunity to do something tangible to honor our 
veterans.
  The Veterans Millennium Health Care and Benefits Act of 1999 contains 
74 substantive provisions; I refer the Members to the conference report 
text for a complete description. Let me highlight just a few provisions 
now.
  Long-term care for veterans is one of the most pressing issues facing 
America--and the Department of Veterans Affairs (VA). A half century 
ago, the 16 million youthful veterans of World War II looked forward to 
building new civilian lives. Today, only about 6 million survive, and 
their average age is 75. Health care is their primary concern, the 
long-term care is a critical component of their health care needs. 
Simply put, what World War II veterans need from VA is long-term care. 
Soon, so too will the 4 million Korean war veterans, now in their mid-
sixties, and the 8 million Vietnam veterans, now in their fifties, who 
follow them.
  Under current law, VA is not required to provide long-term care to 
any veteran. Such care is purely discretionary to VA; it is supplied on 
a space available basis only. Under this ``discretionary'' authority--
as inadequate as it has been--VA has made a substantial contribution to 
the long term care needs of veterans--by directly providing (at an 
annual cost of $1.1 billion) nursing home care to an average of 
approximately 13,000 veterans per day; by paying for nursing home care 
received by approximately 6,500 veterans per day in private nursing 
homes (at as annual cost of $316.8 million); by subsidizing (at an 
annual cost approximately $200 million per year) nursing home care 
provided to approximately 14,000 veterans per day in State veterans' 
homes; and by providing non-institutional alternatives to nursing home 
care to an average of 11,000 veterans at any given time at an annual 
cost of $154 million.
  Notwithstanding these significant contributions by VA, there is 
increasing evidence that the discretionary nature of VA's long-term 
care mission has created an incentive for VA to divert resources to 
other missions and reduce its capacity to provide long-term care. This 
bill responds to that negative trend by requiring VA to maintain long 
term capacity at least the 1998 level. In addition, this legislation 
would, for the first time, require--not authorize--VA to provide 
nursing home care to veterans who need it to treat service-connected 
conditions, and to severely service-disabled veterans who need it to 
cope with other conditions.
  Nursing home care is the most expensive form of long-term care and, 
from the veterans' standpoint, the form of care which is to be avoided 
if possible, or delayed until it is inevitable. This bill will assure 
that non-institutional alternatives to nursing home care--home-
based primary care, home health aide visits, adult day health care, and 
similar services--will be available to veterans who need such services 
by requiring that VA include them in the package of medical services to 
which each veteran who enrolls for VA care is entitled. The provision 
of such services, as an alternative to much more expensive inpatient 
nursing home care, will save money and improve aging veterans' lives.

  This legislation also directs VA to operate pilot programs to 
identify the best--and most cost-effective--ways to meet veterans' long 
term needs. Armed with the data generated by these pilot programs, 
Congress will reevaluate VA nursing home and non-institutional long 
term care after three years and determine how best to proceed at the 
four-year ``sunset'' point of this legislation. I might add that the 
conferees were all in agreement that, when we get to the point where we 
consider renewal of this legislation, we will be looking for ways to 
improve it, not to repeal it.
  There is one additional key feature of this legislation that merits 
mention: this bill will plug a substantial hole in VA health care 
coverage by allowing VA to fund the emergency care needs of all 
enrolled veterans who do not have other health care coverage to fund 
such care. The President has stated that all Americans should have 
access to emergency care. This bill assures that veterans who rely on 
VA for care will.
  I am particularly pleased that this bill will extend, expand, and 
improve VA's authority to provide counseling to the victims of sexual 
trauma while on active duty. It will also extend and improve services 
for homeless veterans; it will liberalize eligibility for survivors' 
benefits for widows of totally disabled ex-POWs; it will expand 
benefits available to veterans exposed to radiation while in service; 
and--importantly--it will ensure that the World War II Veterans' 
Memorial is constructed in a timely manner by facilitating fund raising 
for that monument.
  This legislation does many positive things, particularly for our 
older veterans. The Committee on Veterans' Affairs, however, must also 
respond to the needs of veterans who are leaving the service today. 
Educational assistance is the most important benefit that our Nation 
provides to young veterans. Earlier this year, the Senate passed 
legislation which would have substantially improved benefits under the 
Montgomery GI bill. Unfortunately, budgetary pressures compelled the 
conferees to set these provisions aside for now. I know, however, that 
the House supports improvements in Montgomery GI bill benefits, and we 
will take that issue up again in the second session.
  This legislation reflects the hard work and dedication of many 
members of the Senate and the other body. I particularly acknowledge 
the contribution of the Ranking Minority Member of the Committee on 
Veterans' Affairs, Senator Rockefeller, and our Committee's longest-
serving member and a member of the conference committee, Senator 
Thurmond. The conference committee could not have reached a successful 
conclusion without them, or without the energy and commitment of the 
chairman of the House Committee, Bob Stump and his ranking member, Lane 
Evans. I thank them. And I urge the Senate to approve this conference 
report.
  Mr. DOMENICI. Mr. President, it is with great pleasure that I rise 
today to talk about the Senate passage of the Veterans' Millennium 
Health Care Act.

[[Page S14905]]

  I am extremely pleased the act contains a provision that will extend 
the useful life of the Santa Fe National Cemetery in New Mexico. I also 
want to thank Senator Specter for his assistance in making passage of 
this Bill possible.
  The men and women who have served in the United States Armed Forces 
have made immeasurable sacrifices for the principles of freedom and 
liberty that make this Nation unique throughout civilization. The 
service of veterans has been vital to the history of the Nation, and 
the sacrifices made by veterans and their families should not be 
forgotten.
  These veterans at the very least deserve every opportunity to be 
buried at a National Cemetery of their choosing. Unfortunately, 
projections show the Santa Fe National Cemetery will run out of space 
to provide casketed burials for our veterans at the conclusion of 2000. 
However, with Senate passage of this bill we are ensuring the continued 
viability of the Santa Fe National Cemetery.
  I believe all New Mexicans can be proud of the Santa Fe National 
Cemetery that has grown from 39/100 of an acre to its current 77 acres. 
The cemetery first opened in 1868 and within several years was 
designated a National Cemetery in April of 1875.
  Men and women who have fought in all of nation's wars hold an honored 
spot within the hallowed ground of the cemetery. Today the Santa Fe 
National Cemetery contains almost 27,000 graves that are mostly marked 
by upright headstones.
  The Senate's action today guarantees the Santa Fe National Cemetery 
will not be forced to close next year. A provision in the bill passed 
today allows the Secretary of Veterans Affairs to provide for the use 
of flat grave markers that will extend the useful life of the cemetery 
until 2008.
  While I wish the practice of utilizing headstones could continue 
indefinitely if a veteran chose, my wishes are outweighed by my desire 
to extend the useful life of the cemetery. I would note that my desire 
is shared by the New Mexico Chapter of the American Legion, the 
Albuquerque Chapter of the Retired Officers' Association, and the New 
Mexico Chapter of the VFW who have all endorsed the use of flat grave 
markers.
  Finally, this is not without precedent because exceptions to the law 
have been granted on six prior occasions with the most recent action 
occurring in 1994 when Congress authorized the Secretary of Veterans 
Affairs to provide for flat grave markers at the Willamette National 
Cemetery in Oregon.
  Mr. President, I again want to thank Senator Specter for his 
assistance and state how pleased I am with the final passage of this 
important bill.
  Mr. ROCKEFELLER. Mr. President, as the ranking member of the 
Committee on Veterans' Affairs, I am enormously pleased that the 
Congress has passed this comprehensive bill which would make extensive 
changes to a wide range of veterans' benefits and services. This 
legislation is the culmination of extensive oversight and 
investigation, as well as the normal process of developing 
legislation--hearings and markups in both the House and Senate. 
Further, the bill represents compromise on both sides of the aisle and 
in both Houses of Congress. It represents many, many hours of staff and 
Members' work, and for that, I thank everyone involved.
  The bill covers a wide spectrum of issues--from long-term care to new 
educational benefits for servicemembers. I will address some of the 
more substantive provisions.
  Mr. President, H.R. 2116, as amended, represents a comprehensive 
effort to address the long-term care needs of our veterans.
  We know that there is an expanding need for long-term care in our 
country, and in the VA, the demand is even more pressing. About 35 
percent of the veteran population is 65 years or older, and that number 
will grow dramatically in the next few years. With this legislation, we 
are taking an important step forward for our veterans, and I am hopeful 
that it signals a new concern for providing long-term care for all 
elderly Americans.
  For the first time, the VA will be required to provide extended care 
services to enrolled veterans. Section 101 directs the VA to provide 
nursing home care to any veteran who is in need of such care for a 
service-connected condition, or who is 70 percent or more service-
connected disabled. In addition, the VA is directed to provide 
noninstitutional care, such as home care and adult day health care, to 
all enrolled veterans. This latter provision was included in the 
Veterans' Long-term Care Enhancement Act of 1999 which I introduced 
this summer. Within three years of the bill's enactment, VA would 
evaluate and report to the House and Senate Committees on Veterans' 
Affairs on its experience in providing services under both of these 
provisions.
  Under the bill, the VA is also required to operate and maintain 
extended care programs so as to ensure that the level of extended care 
services is not less than the level of such services provided during 
fiscal year 1998.
  Finally, in order to offset the cost of this new program expansion, 
the conference agreement requires new long-term care copayments for 
services exceeding 21 days in any year. Veterans who have compensably 
rated service-connected conditions and veterans with incomes below the 
pension rate are exempted from these copayments. Under this provision, 
VA would be required to develop a methodology for establishing the 
amount of copayments, taking into account the income of the veterans, 
the need to protect the veteran's spouse from financial difficulties, 
and the desire to allow the veteran to retain a personal allowance. 
Further, it was the conferees' desire that copayments would not apply 
to patients who are currently receiving long-term care services.
  Section 102--also based on the Veterans' Long-term Care Enhancement 
Act of 1999 which I authored--mandates that the Secretary of Veterans 
Affairs carry out a series of pilot programs, over a period of three 
years, which would be designed to gauge the best way for VA to meet 
veterans' long-term care needs: either directly, through cooperative 
arrangements with community providers, or by purchasing services from 
non-VA providers.
  While VA has developed significant expertise in long-term care over 
the past 20-plus years, it has not done so with any mandate to share 
its learning with others, nor has it pushed its program development 
beyond that which met the current needs at the time. Some experts even 
believe that VA's expertise is gradually eroding. For VA's expertise to 
be of greatest use to others, it needs both to better capture what it 
has done and to develop new learning that would be most applicable to 
other health care entities.
  A key purpose of the pilot program would be to test and evaluate 
various approaches to meeting the long-term care needs of eligible 
veterans, both to develop approaches that could be expanded across VA, 
as well as to demonstrate to others outside of VA the effectiveness and 
impact of various approaches to long-term care. To this end, the pilot 
program would include specific data collection on matters such as cost 
effectiveness, quality of health care services provided, enrollee and 
health care provider satisfaction, and the ability of participants to 
carry out basic activities of daily living.
  Another provision based on my veterans' long-term care legislation 
would authorize the VA to establish a pilot program for assisted living 
services. Assisted living is the last remaining gap in VA's long-term 
care continuum, and the Federal Advisory Committee on the Future of VA 
Long-Term Care recommended that VA be granted the authority to provide 
assisted living services. I urge VA to undertake this pilot program, as 
it will provide a basis on which to recommend expanding the authority.
  Mr. President, earlier this year I joined with Senator Daschle as an 
original cosponsor to S. 1146, the Veterans' Access to Emergency Care 
Act of 1999. In June, I offered the provisions included in this bill as 
an amendment to a veterans omnibus measure being discussed at a Senate 
Committee on Veterans' Affairs markup. The amendment was agreed to by a 
majority of the Committee members.
  Just this week I was reminded of the need for better coverage for 
non-VA emergency care. The wife of a seriously ill veteran in my state 
of West Virginia called my office. Her husband is a non-

[[Page S14906]]

service-connected, low income veteran with no health insurance. 
Recently, severe chest pains sent him to a VA medical center. Because 
he is a cardiac patient and because he was in so much distress, his 
family wanted to call the rescue squad to transport him to the VA 
medical center. The veteran refused. Why? Because he had used the 
ambulance service before in an emergency situation, leaving the family 
with a sizeable bill that they are unable to pay. So, this sick veteran 
almost crawled to the family car, insisting that his family drive him. 
Once there, the VA medical staff told the veteran and his family that 
by not calling for an ambulance, the veteran was placed at risk.
  Section 111 would authorize the VA to make non-VA emergency care 
reimbursement payments on behalf of enrolled veterans in all priority 
groups, provided the veteran has received VA care within a two-year 
period prior to the emergency and has no other health insurance 
options.
  While this emergency care provision is significantly more restrictive 
than I had wanted, it is a valuable first attempt at ensuring that 
veterans who do not have other health insurance options--like the 
seriously ill West Virginia veteran who refused when his family tried 
to call for an ambulance--will be reimbursed for their non-VA emergency 
care services. In negotiating this provision, I was resolute in pushing 
for all enrolled veterans to have this coverage. I will be watching 
closely to ensure that this more limited emergency care provision is 
working for our veterans.
  Section 112 is based on legislation introduced by Senator Robb. It 
would establish a specific eligibility for VA health care for veterans 
who were awarded the Purple Heart. This provision is designed to 
provide priority for enrollment to these veterans who have no other 
special eligibility for care.
  According to the Military Order of the Purple Heart, there are about 
one-half million veterans with this award. Roughly half of these 
honored veterans already would qualify for high priority care based on 
a service-connected disability or because of income.
  The recipients of the Purple Heart award are American heroes, and I 
thank Senator Robb for his leadership on this measure, which will 
ensure that the remaining 500,000 Purple Heart veterans will have 
unfettered access to VA health care services.
  Military retirees have had a difficult time accessing various health 
care programs. Reductions in military treatment facilities, in 
particular, have restricted military retirees' health care options. 
Section 113 attempts to improve their situation.
  Under the bill, the Secretaries of Defense and Veterans Affairs will 
be directed to enter into an agreement to allow for VA reimbursement 
for health care services provided to military retirees. Veterans who 
have retired from military service and who are not otherwise eligible 
for VA care will not be responsible for copayments.
  In order to protect current enrollees, the Secretary must document 
that VA--in a given area--has the capacity in such an area to provide 
timely care to enrollees and has determined that VA would recover its 
cost of providing such care.
  I am very pleased that House and Senate conferees were able to reach 
agreement on this provision to improve care for military retirees.
  Section 117 is of particular interest to me as it addresses VA's 
specialized mental health services for veterans.
  Last year, I directed my staff on the Committee on Veterans' Affairs 
to undertake a study of the services the Department of Veterans Affairs 
offers to veterans with special needs. Earlier this summer, I received 
the report my Committee staff wrote based on their 8-month oversight 
investigation, which sought to determine if VA is complying with a 
Congressional mandate to maintain capacity in five of the specialized 
programs: Prosthetics and Sensory Aids Services, Blind Rehabilitation, 
Spinal Cord Injury (SCI), Post-Traumatic Stress Disorders (PTSD), and 
Substance Use Disorders. I was dismayed to learn that because of staff 
and funding reductions, with the resulting workload increases and 
excessive waiting times, the latter two programs are failing to sustain 
services at the needed levels.
  With specific regard to PTSD, VA has been moving to reduce inpatient 
treatment of PTSD, while expanding its use of outpatient programs. VA's 
decision has been fueled in part by studies of the cost effectiveness 
of various treatment approaches. The potential to stretch limited VA 
dollars to be able to treat more veterans is appealing. However, VA 
needs to be cautious before subscribing to the idea that outpatient 
care is as good as inpatient care for all veterans with PTSD. For some 
of the more seriously affected veterans--those who have not succeeded 
in shorter inpatient or outpatient programs, are homeless or 
unemployed, or have dual diagnoses--longer inpatient or bed-based care 
may be a necessity.

  Substance use disorders also present complex treatment problems and 
have taken the brunt of reductions in specialized programs. Some 
substance use disorder programs have terminated inpatient treatment 
completely, except for veterans requiring short detoxifications in 
extreme situations. While some medical centers have closed inpatient 
substance use disorder beds, they have worked to provide alternative, 
sheltered living arrangements. Unfortunately, not all facilities have 
made these efforts. Many have moved directly to the closure of 
inpatient units without first developing these other alternatives.
  As an outgrowth of this oversight effort, I developed legislation to 
require that VA provide better care for veterans in need. I thank 
Chairman Specter for accepting this legislation and including it in S. 
1076, the Veterans Benefits Act of 1999.
  Under section 117, the Secretary of Veterans Affairs is required to 
carry out programs to enhance the provision of specialized mental 
health services to veterans. The conference agreement specifically 
targets services for those afflicted with PTSD and substance use 
disorders. The legislation also requires that $15 million in funding 
will be made available, in a centralized manner, to fund proposals from 
the VISNs and the individual facilities to provide specialized mental 
health services. The legislation specifically ensures that this $15 
million in grant funding will be over and above what VA currently 
spends on these programs.
  The focus of Section 117 is on expanding outpatient and residential 
treatment facilities, developing better case management, and generally 
improving the availability of services. Though not specifically 
mentioned in the legislation, I encourage VA to carry out programs for 
the following: (1) additional outpatient and residential treatment 
facilities for PTSD in areas that are underserved by existing programs; 
(2) short-term or long-term care services that combine residential 
treatment of PTSD; (3) dedicated case management services on an 
outpatient basis for veterans suffering from PTSD; (4) enhanced 
staffing of existing PTSD programs; (5) additional community-based 
residential treatment facilities for substance use disorder programs; 
(6) expanded opioid treatment services; and (7) enhanced substance use 
disorder services at facilities where such services have been 
eliminated.
  In my view, VA's mental health treatment programs, in general, have 
been cut back to the point that veterans in some areas of the country 
are suffering needlessly. That is why I am so pleased that H.R. 2116 
includes provisions to prompt VA to begin to rebuild some of what has 
been lost.
  Section 201--based on the House bill--would allow the Secretary of 
Veterans Affairs the authority to set copayments, both for 
pharmaceuticals and for outpatient treatment. Currently, all veterans 
who are below 50 percent service-connected disabled, and veterans whose 
income is below the pension level, are required to pay $2 for each 30-
day supply of medication. And all ``category C'' veterans are required 
to pay copayments based on the estimated average cost of an outpatient 
visit--currently $45.80.
  The outpatient copayment rate needs to be adjusted. This charge is 
incurred each and every time a category C veteran receives outpatient 
care, regardless of the services provided. There is no doubt that $45 
for a routine outpatient visit is unreasonable at best, and at its 
worst, may, in fact, discourage veterans from getting the primary care 
they need. I am confident that VA will study this issue closely and 
will

[[Page S14907]]

set the outpatient copayment to be more in line with managed care plans 
which charge either $5 or $10.
  While I am supportive of adjusting the outpatient copayment, I have 
serious concerns about increasing the pharmaceutical drug copayment. 
The House Committee on Veterans' Affairs was adamant that the Senate 
recede to this increase to help offset the Senate-sponsored program 
expansions in long-term care and emergency care. And although the $2 
per prescription charge that veterans are paying now may seem like an 
insignificant amount to some, I can assure my colleagues that to the 
veteran and his family living on a very limited income, it is quite 
significant. I hear from a number of veterans whose income hovers just 
above the pension level, who must pay the assigned copayment for their 
pharmaceuticals. Many of them are older veterans who are on a number of 
different medications for multiple medical conditions.
  It is critically important that we do not place this segment of our 
veteran population in the same situation as many of our aging 
population receiving care in the private sector--having to choose 
between buying their medication or putting food on the table.
  In an effort to prevent this from happening, I strongly urge the VA 
to set maximum monthly and annual copayment amounts which are sensitive 
to the financial situation of veterans for those who have multiple 
outpatient prescriptions. I will be closely watching the implementation 
of this provision to ensure that it does not impose an undue burden on 
our veterans.
  While the Senate was not able to stave off the House in increasing 
prescription copayments, we were able to flatly reject a House 
provision to require copayments for hearing aids and eyeglasses. Such a 
provision would penalize veterans who are taking advantage of a needed 
benefit.
  Section 206 extends the VA's program for the evaluation of the health 
of spouses and children of Gulf War veterans for four years. I pushed 
for the original legislation providing for these health evaluations 
after hearing about Gulf War veterans and their families who reported 
miscarriages, birth defects, and other reproductive problems.
  Last year, the Congress modified this program to allow VA to use fee-
basis care. It seems that these modifications are working well, as many 
new dependants have applied and are now waiting to be seen.
  I am delighted that this program has been extended because the need 
for assessments continues. By this time last year, 2,800 dependents had 
applied for the program, and this year that total is up to 4,000. 
However, although 4,000 dependents have applied for the evaluations, VA 
has only completed 1,140 examinations. I urge VA to process these 
examinations as rapidly as possible. These dependents of servicemembers 
should not be delayed in their quest for answers.
  Section 208 contains provisions to improve VA's enhanced use lease 
authority. I am delighted with these provisions, because I believe 
enhanced use leases are a critical component of VA's management 
strategy for its property. Many terrific projects that better serve 
veterans and assist the VA have been developed under this authority. By 
way of this legislation, we are encouraging VA to develop more enhanced 
use lease projects to leverage its assets, rather than begin to dispose 
of irreplaceable property.
  Since VA received enhanced use authority, it has been used in a 
variety of ways. One approach has been to lease land to companies that 
build nursing homes where VA can place veterans at discounted rates, 
resulting in savings of millions of dollars. Another use has been to 
provide transitional housing for homeless veterans. Other projects have 
created reliable child care and adult day care facilities for VA 
employees' families, so that they can care for veterans without having 
to worry about the health and safety of their loved ones. In other 
locations, VA regional offices are moving onto VA medical center 
campuses, resulting in more convenient access for veterans and better 
cooperation between the Veterans Benefits Administration and the 
Veterans Health Administration.
  Section 208 of H.R. 2116 would remove many of the current barriers 
preventing VA from having an even more successful enhanced use lease 
program. It would allow VA to enter into leases with terms of up to 75 
years, rather than the current 20 and 35 years, while eliminating the 
distinction in lease terms that exists between leases involving new 
construction or substantial renovation, and those involving current 
structures.
  I am very interested in seeing VA engage in more of these projects, 
so I am pleased to see that H.R. 2116 would require the Secretary to 
provide training and outreach regarding enhanced use leasing to 
personnel at VA medical centers. The bill also requires the Secretary 
to contract for independent assessments of opportunities for enhanced 
use leases. These assessments would include surveys of suitable 
facilities, determinations of the feasibility of projects at those 
facilities, and analyses of the resources required to enter into a 
lease. I hope that more training--which until now has been sporadic and 
provided primarily on a by-request basis--and a more systematic and 
centralized approach would assist the VA in maximizing its enhanced use 
lease opportunities.
  While VA currently has a policy which allows for fee-basis care for 
chiropractic care, section 303 of H.R. 2116 requires the VA Under 
Secretary for Health, in consultation with chiropractors, to establish 
a wider VA policy on chiropractic care. While conferees have agreed 
that VA should establish a policy regarding chiropractic care, they 
have remained silent on mandating that VA furnish veterans with 
chiropractic treatment. Indeed, it is Congress' intent that this 
provision not be read as an endorsement for chiropractic care.
  Complementary and alternative medicine, including chiropractic care, 
are important aspects of health care. I urge VA to use this opportunity 
to develop a policy on all forms of complementary and alternative 
medicine. In particular, the report ``VHA Complementary and Alternative 
Medicine Practices and Future Opportunities'' recommended that VHA 
consider providing acupuncture, following guidelines set forth by the 
National Institutes of Health, since NIH has already approved 
acupuncture as an effective treatment for back pain.
  I am extremely disappointed that the House would not move the Senate 
Montgomery GI Bill (MGIB) enhancement legislation. The Senate passed 
MGIB enhancements on three occasions this year, but the House did not 
respond.
  S. 1402, the education bill reported out of the Senate Committee on 
Veterans' Affairs, contained a provision, among others, to increase the 
monthly benefit provided to current servicemembers from $528 to $600. 
This more than 12 percent increase would have followed on the heels of 
a 20 percent increase last year. Additionally, the Senate bill would 
have allowed servicemembers to elect to contribute up to an additional 
$600, in exchange for receiving four times their contribution. Although 
these increases fall short of the full tuition recommended by the so-
called Transition Commission, they would have provided a substantial 
assistance to veterans. The costs of tuition and fees for public and 
private educational institutions rose approximately 90 percent from 
1980-1995, while the MGIB benefit rates only increased 42 percent from 
1985 to 1995.
  The statistics regarding education and employment for veterans are 
also revealing. Despite almost full enrollment in the program by 
servicemembers, the number of eligible veterans who take advantage of 
their MGIB benefits is startlingly low, around 50 percent. Less than 20 
percent of those who use the MGIB attend private institutions. And the 
Transition Commission reports that the unemployment rate for veterans 
ages 20-24 and 35-39 is higher than their non-veteran counterparts. All 
these are reasons why I believe that there is more that we can and must 
do. Unfortunately, we will need to wait until at least next year to 
tackle these issues.
  H.R. 2116 does provide for two provisions--relating to test 
preparation and Officer Candidate Training--which while small, can make 
a significant difference to the individual veterans affected.
  The Department of Veterans Affairs currently has authority to provide 
MGIB benefits for post-graduate exam preparatory courses that are 
required

[[Page S14908]]

for a particular profession, such as CPA exam or bar review courses. 
However, it does not have authority to provide for pre-admission 
preparatory coursework.
  Nevertheless, studies by national consulting companies have shown 
improvement of over 100 points on the SAT exam and an average 
improvement of seven points in LSAT scores for students who take exam 
preparatory courses. An article in the April 13, 1998, New Republic 
stated, ``[t]horough, expertly taught preparation can raise a student's 
ability to cope with, and hence succeed on, a particular exam. In many 
cases, then, test prep can make the difference between getting into a 
top-flight law school and settling for the second tier.'' At some of 
the nation's top schools, scores on entrance exams can count for half 
of the total application.
  The problem is that many of these exam preparatory courses are quite 
costly. One national provider charges as much as $750 for a two-month, 
part-time, SAT preparatory course. One educational advocacy group, 
Fairtest, argues that ``[t]he SAT has always favored students who can 
afford coaching over those who cannot . . .'' To be able to compete, it 
is critical that veterans have access to such courses.
  That is why I am pleased that section 701 corrects that disparity by 
allowing veterans to use their MGIB benefits for preparatory courses 
for entrance examinations required for college and graduate school 
admission (``test prep''). By giving veterans the opportunity to better 
their admissions test scores, this amendment would expand the choices 
available to veterans in their course of higher education. It will also 
improve access to the top educational institutions for veterans.
  Section 702 allows servicemembers who failed to complete their 
initial period of service--because of entry to Officer Candidate School 
or Officer Training School (``OCS'')--to retain their eligibility for 
MGIB benefits. This would allow their OCS service to count toward that 
initial obligated period of service (generally three years total).
  In most instances, these servicemembers had already made a $1,200 
contribution to the MGIB, which cannot be refunded, by law. Rather than 
refund this money, the House and Senate agree that we should allow 
these men and women to retain their MGIB eligibility and further their 
education.
  Like the test prep provision, it should be our policy to always 
encourage servicemembers and veterans to strive for greater 
achievement. This provision corrects an oversight in the MGIB statutes 
that penalizes servicemembers for seeking promotions.
  As we are all sadly aware, the veteran population is aging rapidly. 
In 1997, 537,000 veterans died. Projections of the veteran death rate 
show an increase through the year 2008, when the death rate of the WWII 
and Korea-era veterans will peak at 620,000 veterans. Unless expanded, 
21 national cemeteries are scheduled to close to inground burial or 
close completely by FY 2005. National cemeteries take an average of 
seven years to open. That is why I felt it was critical to address now 
VA's plan to provide burial sites for our nation's veterans.
  VA conducted studies in 1987 and 1994 that identified the top 10 
veteran population areas that are not served by a national cemetery. 
Pursuant to those studies, VA has begun, and in some cases completed, 
construction of six cemeteries in: Cleveland (OH), Chicago (IL), 
Seattle (WA), Dallas (TX), Saratoga (NY), and San Joaquin Valley (CA).
  However, there has been no activity in the remaining six locations 
contained on the 1987 and 1994 lists: Detroit (MI), Sacramento (CA), 
Miami (FL), Atlanta (GA), Pittsburgh (PA), and Oklahoma City (OK). That 
is why I am pleased that H.R. 2116 authorizes VA to build cemeteries in 
the top areas in need. I am hopeful that the Appropriations Committee 
will fund construction of these cemeteries, particularly in light of 
their direction of advanced planning funds in this year's VA-HUD 
Appropriations bill.
  Sections 601-603 authorize the American Battle Monuments Commission 
to borrow funds from the Treasury Department to construct the WWII 
memorial on the Mall if it is unable to raise sufficient funds through 
private donations. It also extends the authority to break ground for 
four years. This will ensure that the veterans who are to be honored by 
this memorial will be able to see it constructed.
  I have agreed to a study, based on a House provision, of the current 
state of cemeteries to assess repair needs, ways to improve appearance, 
and the number of cemeteries needed to serve veterans who die after 
2005. Finally, section 621 requires that the VA study the adequacy and 
effectiveness of burial benefits that a veteran's dependents receive, 
as well as options to better serve veterans and their families. In 
light of inflation in the cost of burials, as well as the increase in 
options such as cremation and burial at sea, it is appropriate that VA 
reevaluate this program.
  This bill contains a number of benefits provisions that will aid 
veterans. For example, section 503 will add bronchiolo-alviolar 
carcinoma to the list of presumptive conditions associated with 
exposure to ionizing radiation. Bronchiolo-alviolar carcinoma is a type 
of lung cancer. The Senate has passed provisions adding lung cancer to 
the list of presumptive conditions on several occasions, but the House 
has not moved similar legislation.
  Section 711 will extend the reservist home loan guaranty authority to 
December 31, 2007. The current authority is set to expire in 2003. 
However, a reservist must serve six years before being eligible for the 
home loan guaranty. Therefore, in order for it to be used as a 
recruiting incentive, the authority must be extended beyond 2006.

  I am extremely gratified that section 501 authorizes payment of 
dependency and indemnity compensation (``DIC'') to the surviving spouse 
of a former POW veteran who dies of a non-service-connected condition 
if the former POW was rated totally disabled due to a POW-related 
presumptive condition for a period of one or more years immediately 
prior to death. In the case of former POWs, this reduces the 10-year 
period prior to death that a veteran must be rated 100 percent service-
connected for the spouse to receive DIC if the veteran dies of a non-
service-connected condition. This provision recognizes that former 
POW's suffered extreme hardships and that their spouses cared for them 
throughout the years that VA did not recognize their health conditions 
as being service-related. I am proud that we named this provision of 
the bill the ``John William Rolen Act.'' John passed away this year. He 
was a tireless advocate for America's former POWs, and I will miss him.
  Section 502 of H.R. 2116 corrects an oversight in last year's 
transportation bill (TEA 21) that reinstated DIC to remarried widows of 
veterans whose remarriages have now been terminated. The benefit had 
previously been cut off as a budget reconciliation item. While 
reinstating DIC payments, however, the transportation bill failed to 
restore the limited ancillary benefits that accompany the receipt of 
DIC: CHAMPVA, home loan guaranty, and educational benefits. This bill 
restores those ancillary benefits.
  Finally, I am so glad that we will maintain our commitment to 
homeless veterans by reauthorizing the Homeless Veteran Reintegration 
Program (HVRP). Section 901 authorizes increased funding levels for job 
training for veterans for four consecutive years, beginning with $10 
million additional in the first year, $15 million additional in the 
second year, and $20 million additional in each of the third and fourth 
years. We have also required, in section 903, that VA formulate a 
comprehensive plan that includes the Departments of Labor and Housing 
and Urban Development, to conduct a cross-cutting report evaluating the 
effectiveness of homeless programs beyond six months of placement or 
service delivery.
  Title XI of H.R. 2116 provides VA with authority to offer voluntary 
separation incentives through December 31, 2000, to a specified number 
of FTEE. As is well known, inadequate VA budgets in the last several 
years have forced VA to make sweeping changes, (many of which were 
warranted, including the downsizing of employees. VHA has already 
eliminated thousands of employees via ``reductions in force'' 
(``RIFs''). VHA FTEE staff now stands at 182,000, down from 218,000 in 
1994. VBA FTEE has also declined, from 13,500 in 1994 to

[[Page S14909]]

11,200 today. All this is occurring at a time when VA is treating more 
patients and deciding more claims.
  Usually, a condition of voluntary separation incentives--or buyouts 
as they are known--is that the FTEE slot is eliminated in a one-for-one 
reduction, i.e. downsizing. But I believe that VA has already reached 
the precipice of staff reductions--the point beyond which we should not 
go if quality of VA health care is to be maintained. However, VA says 
that it still requires buyouts in order to ``rightsize.'' That is, VA 
must let go of employees who do not have the needed skills, in order to 
free up FTEE positions so that VA can hire the most appropriately 
qualified people. The buyout language in this bill prohibits VA from 
eliminating the FTEE positions of employees who have received buyouts.
  If we do not provide VA with buyout authority, VA will proceed down 
the path of reductions regardless. For example, VHA will RIF thousands 
of employees next year. However, RIFs are an inexact management tool. 
RIFs would not necessarily result in the skills mix VA needs, due to 
the civil service employment rights that allow senior employees to take 
the job of junior employees. I believe that buyouts offer a better 
option, but one that must still be used wisely and monitored 
carefully--which is why H.R. 2116 allows only limited buyouts under 
very strict conditions.
  I am very disappointed that we were unable to move the Senate 
provision overturning the ``$1,500 rule.'' Since 1933, the law has 
required VA to suspend the compensation or pension benefits of 
incompetent veterans who have no dependents and are hospitalized at 
government expense. This suspension is triggered when the veteran's 
estate exceeds $1,500, and VA benefits are cut off until the veteran's 
estate is spent down to $500. At that time, the VA commences 
reinstating the veteran's compensation, until such time the veteran is 
hospitalized again and the estate exceeds $1,500, when the benefits are 
cut off again. No similar suspension is made for competent veterans or 
for incompetent veterans who are not hospitalized.
  The rationale for cutting off benefits was that these veterans might 
have been institutionalized for years, and that it was not good policy 
to allow their estates to build up when they have no dependents to 
inherit them. There was also a fear of fraud on the part of the 
veteran's guardian or fiduciary.
  The dollar amounts have not changed since 1933, when $1,500 equaled 
almost three years' worth of VA benefits at a 100 percent rating level. 
In today's dollars, this is less than one month's benefit at a 100 
percent rating level.
  Although veterans are generally being hospitalized for shorter 
periods of time, based on the low dollar limit, the rule may be applied 
very quickly, sometimes immediately, when it does apply. Further, it 
takes VA an average of 66 days to restore the benefits to incompetent 
veterans once their estates have been spent down. Since incompetent 
veterans are no longer routinely institutionalized for years at a time, 
it is very difficult for a non-Medicaid eligible veteran (which would 
be any veteran receiving any significant amount of VA compensation) to 
be released from the hospital and placed in either a private assisted 
living or group home with only $500 in his bank account. I fear some of 
these veterans may end up on the streets because of this policy, 
despite the best efforts of VHA to place them at discharge.
  I believe that this outdated and indefensible policy discriminates 
against incompetent veterans--those who are least likely to be able to 
fight for themselves. The fact is, we are means testing VA compensation 
for this one class of veterans. Why is a competent veteran with no 
dependents entitled to receive his compensation, but an incompetent 
veteran not entitled? There is no justification for this 
discrimination. It may also have some harmful effects for a small 
population of veterans, facilitating their downward spiral into 
homelessness. That may be too much of a price to pay for the government 
to save some money from reverting to the state if that veteran died 
while hospitalized. While we were not successful in addressing this 
issue in this bill, I plan to readdress this policy until it is 
corrected.
  Mr. President, in closing, I want to acknowledge the work of our 
Committee's Chairman, Senator Specter, in developing this comprehensive 
legislation. Through his efforts, and that of his staff--especially the 
former Committee Staff Director, Charles Battaglia, and the new 
Committee Staff Director, William Tuerk--the Senate Committee on 
Veterans' Affairs has fully met its responsibilities and can be proud 
of the legislation we consider today.
  I appreciate the willingness of the House Committee on Veterans' 
Affairs, especially Chairman Bob Stump and Ranking Member Lane Evans, 
to work together to reach compromise on so many vital issues.
  And I would be remiss if I did not acknowledge the efforts of my own 
staff, Minority Staff Director, Jim Gottlieb, Professional Staff 
Member, Kim Lipsky, and Counsel, Mary Schoelen. I am enormously 
grateful for their diligence, and for their commitment to the work we 
do in this Committee on behalf of our Nation's veterans.
  Ms. SNOWE. Mr. President, I rise in support of H.R. 2116, the 
Veterans Millennium Health Care and Benefits Act of 1999.
  I would like to begin by thanking my colleague, Senator Specter, 
chairman of the Senate Veterans' Affairs Committee, for his leadership 
on issues of importance to veterans. H.R. 2116 contains a number of 
provisions that will benefit veterans in Maine and elsewhere because of 
his strong leadership. I applaud Senator Specter for his efforts.
  I would especially like to thank the chairman for his efforts to 
address a concern I had about a specific provision in the House-passed 
version of the bill, which would have jeopardized millions of dollars 
in grant funding for the Maine State Veterans Homes system.
  H.R. 2116 contains a provision which fundamentally reorders the 
manner in which VA construction grants will be awarded in the future, 
placing the focus on renovation of existing facilities so that 
maintenance projects will take precedence in grant awards over 
proposals to construct new facilities. The House-passed version of the 
bill would have made Maine veterans homes and state homes in a number 
of states ineligible for funding, even through they had already 
prepared and filed grant applications under existing law and 
regulations.
  In an effort to address this concern, I worked closely with Senator 
Specter to craft a transition provision balancing the need to treat 
current state home applicants fairly and not change the rules in the 
middle of the game, while at the same time implementing the new rules 
as soon as possible.
  I am very pleased that the conference for H.R. 2116 agreed to the 
measure I helped author that grandfathers proposals already filed by 
veterans homes, thereby exempting them from new criteria in the bill 
that would have precluded funding in this and coming fiscal years.
  I believe this compromise remains true to the intent of the new 
criteria included in the House-passed version of the bill, while at the 
same time protecting the interests of states that had already submitted 
applications for funding.
  In addition to work with Senator Specter personally, I wrote a letter 
to the chairman in September alerting him to my concerns, followed by a 
letter to my colleague from Maine, Senator Collins. In addition, last 
month, I spearheaded a letter with 14 other Senators urging 
modification of the House construction grant provision to grandfather 
proposals made by Maine and other states under existing law, so that it 
would not change the methodology in the middle of the current fiscal 
year--after applications have been filed; after architectural, 
engineering, and legal fees have been incurred, and after local 
matching funds have been appropriated or borrowed by states for these 
projects.
  If the House-passed provision had been enacted without this change, 
many states veterans homes would have lost their positions for Fiscal 
Year 2000 grants because these applications would have been judged 
according to a new set of criteria.
  In Maine, this would have jeopardized funding for the entire Maine 
Veterans Homes system, which earlier this year applied for about $9.3 
million in grant

[[Page S14910]]

funding, and is seeking to construct new veterans' residential care 
facilities in Augusta, Bangor, Caribou, and Scarborough. In their 
applications, the Maine Veterans Home System notes that more than half 
of Maine's veterans population is reaching the age where long-term 
nursing care or domicillary care is typically required. Since 1991, the 
number of Maine veterans aged 75-79 has doubled, from 6,000 to 12,500. 
Over the same time period, the numbers of veterans aged 80-84 has 
doubled from 2,400 to 6,000; and veterans over the age of 85 has 
increased by 50 percent from 1,200 to 1,800.
  I would also like to thank Senator Specter for supporting another 
provision in H.R. 2116 based on legislation I introduced in the Senate, 
S. 1579, the Veterans Sexual Trauma Treatment Act. S. 1579 extends a VA 
program that offers counseling and medical treatment to veterans who 
were sexually abused while serving in the military, and requires a VA 
mental health professional to determine when counseling is necessary. 
Currently, the VA Secretary makes this determination. The bill also 
calls for the dissemination of information concerning the availability 
of counseling services to veterans through public service 
announcements.
  According to the Department of Defense, at least 55 percent of active 
duty women and 14 percent of active duty men have been subjected to 
sexual harassment. As a member of the Senate Armed Services Committee, 
I credit the DoD with working to reduce the prevalence of sexual 
harassment in the military. However, as long as there is harassment in 
the military, it is vital that victims have access to treatment, and 
H.R. 2116 provides the tools to do this.
  Finally, I would like to commend the Senate and House Veterans' 
Affairs Committees and the conferees for H.R. 2116 for their efforts to 
expand a whole range of benefits for veterans in this conference 
report. For example, the bill expands long-term care for veterans, and 
will increase home and community-based care and assisted-living options 
for veterans. It expands mental health services, and requires the VA to 
enhance specialized services for PTSD and drug abuse disorders. It 
provides coverage for uninsured veterans who need care but who do not 
have access to a VA facility. It expands VA authority to provide 
services to homeless veterans. It improves Montgomery GI bill benefits 
by providing benefits for students in preparatory courses and to those 
whose enlistment is interrupted to attend officers training school. And 
these are just a few of the important provisions in this bill.
  Mr. President, this is a strong bill, and I urge my colleagues to 
join me in a strong show of support.
  I yield the floor.


                              Section 207

  Mr. SMITH of New Hampshire. Mr. President, I too, would like to 
recognize Senator Specter, for his tremendous work and skillful 
leadership and sensitivity in bringing the Veterans Millennium Health 
Care bill (H.R. 2116) to the floor. As a veteran myself, I can assure 
you that this bill means a great deal in providing for the health and 
welfare of our veterans both in my state of New Hampshire as well as 
those veterans throughout the country. I congratulate Senator Specter's 
leadership on issues that are of particular importance to our veteran 
community.
  If I may also ask the senator to clarify the transition clause of 
Section 207(c) of the bill. Does the Senator mean that provided that 
state home grant applicants covered by the transition clause follow all 
applicable laws and regulations in effect on November 10, 1999, that 
the Secretary of Veterans Affairs shall award grants to all 
applications remaining unfunded for fiscal year 1999 priority one 
projects first, then proceed to awarding grants to priority one 
projects as outlined and in the order in which they appeared in the 
Department of Veteran Affairs Fiscal Year 2000 priority list as covered 
by Section 207(c) of the bill, prior to awarding grants to any other 
applicants?
  Mr. SPECTER. Yes, the Senator is correct. The purpose of this section 
is to reform the priorities under which state home grant applications 
are considered so that much needed renovation and maintenance projects 
will receive more appropriate consideration for funding than under the 
current system.
  I am pleased that we were able to craft a transition provision that 
balanced the desire to ensure that all states had an opportunity to 
participate under the old rules, with the desire to implement the new 
rules as quickly as possible.
  Mr. SMITH of New Hampshire. Thank you Mr. Chairman and again I 
appreciate your consideration and sensitivity to the veteran community. 
Your leadership on this issue will enable the Veterans Home in Tilton, 
New Hampshire to better meet the medical needs of veterans in New 
Hampshire. I yield the floor.
  Ms. SNOWE. I commend my colleague, Senator Specter, chairman of the 
Senate Veteran's Affairs Committee, for the remarkably responsive and 
skillful manner in which he managed the progress of H.R. 2116. This 
bill means a lot to veterans throughout the nation, and especially in 
my home state of Maine. I applaud Senator Specter's leadership on 
issues of importance to veterans.
  I have only one point of clarification. Does the transition clause of 
Section 207(c) of the bill mean, that for all state home grant 
applications covered by the transition clause and otherwise in 
compliance with applicable law and regulations in effect on November 
10, 1999, the Secretary of Veterans Affairs shall award grants first to 
all unfunded applications remaining for fiscal year 1999 priority one 
projects? And that following those projects, the Secretary shall next 
fund those FY 2000 applications and which both meet the criteria set 
forth in the bill and which were accorded priority one status for FY 
2000? And that the Secretary would fund these projects in the order in 
which they would appear on the fiscal year 2000 priority one list, 
prior to awarding grants to any other applications?
  Mr. SPECTER. Yes, the Senator is correct. The purpose of this section 
is to reform the priorities under which state home grant applications 
are considered so that much needed renovation and maintenance projects 
will receive more appropriate consideration for funding than under the 
current system. I am pleased that we were able to craft a transition 
provision that balanced the desire to ensure that all states had an 
opportunity to participate under the old rules, with the desire to 
implement the new rules as quickly as possible.
  Ms. SNOWE. I thank the chairman once again, and I yield the floor.
  Ms. COLLINS. I ask unanimous consent the conference report be agreed 
to, the motion to reconsider be laid upon the table, and any statements 
related to the conference report be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________