Congressional Record, Volume 146 Issue 113 (Thursday, September 21, 2000)

[Congressional Record Volume 146, Number 113 (Thursday, September 21, 2000)]
[House]
[Pages H7949-H7965]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PERSONNEL ACT OF 2000

Ms. PRYCE of Ohio. Mr. Speaker, by direction of the Committee on
Rules, I call up House Resolution 585 and ask for its immediate
consideration.
The Clerk read the resolution, as follows:

H. Res. 585

Resolved, That upon the adoption of this resolution it
shall be in order without intervention of any point of order
to consider in the House the bill (H.R. 5109) to amend title
38, United States Code, to improve the personnel system of
the Veterans Health Administration, and for other purposes.
The bill shall be considered as read for amendment. The
amendment recommended by the Committee on Veterans' Affairs
now printed in the bill shall be considered as adopted. The
previous question shall be considered as ordered on the bill,
as amended, and on any further amendment thereto to final
passage without intervening motion except: (1) one hour of
debate on the bill, as amended, equally divided and
controlled by the chairman and ranking minority member of the
Committee on Veterans' Affairs; (2) the further amendment
printed in the report of the Committee on Rules accompanying
this resolution, if offered by Representative Stump of
Arizona, Representative Evans of Illinois, or a designee,
which shall be in order without intervention of any point of
order or demand for division of the question, shall be
considered as read, and shall be separately debatable for 10
minutes equally divided and controlled by the proponent and
an opponent; and (3) one motion to recommit with or without
instructions.

The SPEAKER pro tempore. The gentlewoman from Ohio (Ms. Pryce) is
recognized for 1 hour.
Ms. PRYCE of Ohio. Mr. Speaker, for the purpose of debate only, I
yield the customary 30 minutes to the ranking member of the Committee
on Rules, the gentleman from Massachusetts (Mr. Moakley), pending which
I yield myself such time as I may consume. During consideration of this
resolution, all time yielded is for the purpose of debate only.
Mr. Speaker, House Resolution 585 is a modified closed rule providing
for consideration of H.R. 5109, the Department of Veterans Affairs
Health Care Personnel Act. This legislation is the culmination of work
done by the House Committee on Veterans' Affairs over the past year to
determine what can be done to improve the VA health care system. We all
recognize the great sacrifices made by those who have bravely served
their country in the armed services. Providing quality health care to
these great Americans and their families is one of the most important
ways that we can extend our gratitude. After numerous hearings,
meetings and oversight conducted by the Committee on Veterans' Affairs,
this legislation was developed to address a range of VA health issues.
The House will have 1 hour to engage in general debate on the bill
which will be equally divided between the chairman and ranking minority
member of the Committee on Veterans' Affairs. Under the rule, the
amendment recommended by the Committee on Veterans' Affairs, now
printed in the bill, shall be considered as adopted. All points of
order against the bill, as amended, and against its consideration are
waived. The rule makes in order one bipartisan amendment which is
printed in the Committee on Rules report which shall be considered as
read and not subject to amendment. All points of order against this
amendment are waived.
Finally, the rule provides for the customary motion to recommit, with
or without instructions.
Mr. Speaker, we all have heard from our constituents about the
problems that riddle the VA health system. I would venture to guess
that all of us share a desire to improve this system to ensure that our
Nation's veterans get the quality care that they so rightly deserve.
Making sure our veterans are treated right starts with treating the
personnel in the VA health system right. That is why much of H.R. 5109
focuses on the providers of health care in the VA system.
Under this legislation, pay for VA nurses will become more equitable
and a guaranteed national comparability pay increase on par with that
received by other Federal workers will improve morale among nurses
which in turn will enhance recruitment and retention of these valued
employees. In addition, these nurses, who often spend more time with
individual patients and who are more intimately familiar with their
care, will be given a greater role in policy and decision-making at the
VA. Dentists will also see their pay rise, as will VA pharmacists under
the provisions of this legislation.
In addition to ensuring that the personnel in the VA system receive
adequate compensation, H.R. 5109 responds to the unique health care
needs of veterans by requiring the VA to incorporate a military history
into medical examinations. Treating the medical conditions that arise
out of military service is at the foundation of the VA system. If such
conditions are left undiagnosed and/or untreated, the long-term
consequences can be very, very severe. This legislation requires that
during a veteran's initial clinical examination, the VA inquire about
and

[[Page H7950]]

document a veteran's military service and any exposures during their
service that may contribute to their health status.
Along these same lines, H.R. 5109 seeks to build on the knowledge
that has grown out of the survey that began in 1984 regarding post-
traumatic stress disorder. This legislation calls for a follow-up study
to determine, among other things, what the long range course of PTSD
is, which veterans are least likely to recover from the disorder, and
how it contributes to subsequent health conditions, such as
cardiovascular disease.
Another concern that many of us have heard about from our veterans
back home is that VA health facilities are inconvenient because they
are so often so far away. Too often we learn of a sick individual who
has to endure the hardship of traveling hours to get to where he or she
needs to be, that is, the VA center. More and more, doctors can treat
patients on an outpatient basis, but if a veteran is traveling 2 or 3
hours to get to an outpatient clinic, he or she may have to spend the
night, particularly if follow-up care is required the next day, as it
so often is.

The legislation we will vote on today improves the situation for
veterans by providing clear authority to the VA to provide overnight
accommodations at or near a VA facility.
Another provision of this legislation offers greater convenience to
veterans by establishing a pilot program that will allow veterans with
Medicare or other health coverage to coordinate their benefits and seek
care in a community hospital rather than a VA facility that may be
hundreds of miles away. The VA would coordinate the care to ensure that
the patient does not incur additional out-of-pocket costs, and VA
approval would be required to ensure that the VA is still responsible
for delivering the specialized care that so many veterans require.
Mr. Speaker, these and other improvements to the VA health care
system are worthy of bipartisan support. The rule before us was
reported by the Committee on Rules by a voice vote. I urge its swift
adoption by the House so that we may move forward with this legislation
which is so very important to our veterans.
I urge a yes vote on the rule and the Department of Veterans Affairs
Health Care Personnel Act.
Mr. Speaker, I reserve the balance of my time.
Mr. MOAKLEY. Mr. Speaker, I thank my dear friend, the gentlewoman
from Ohio (Ms. Pryce), for yielding me the customary half hour, and I
yield myself such time as I may consume.
Mr. Speaker, this veterans health care bill is bipartisan, and it
deserves all of our complete support. Many parts of our country have
far fewer veterans hospitals than they actually need; and veterans who
live in those areas, particularly older veterans, have a very difficult
time obtaining any kind of health care. This bill, bottom line, will
enable veterans who live more than 2 hours away from a veterans
facility to see a non-VA doctor and have the costs absorbed by the
Veterans' Administration.

{time} 1200

This will make it much easier for the elderly veterans to get their
health care, and it will help make sure that our country keeps its
promise to provide health care to our fighting men and women.
Mr. Speaker, this also will help fix some of the problems with pay
for nurses, dentists, and pharmacists; and it will stem what could be a
disastrous departure from the government work for these health care
professionals.
Mr. Speaker, the bill would also help build new veterans hospitals in
California, Virginia, Florida, and Tennessee, because we find as the
veterans get older, they go to warmer climates; and, therefore, there
is an inordinate amount of veterans settling in some of our southern
States.
Mr. Speaker, I thank the gentleman from Arizona (Mr. Stump), my
colleague, who has done a great job on this, and the gentleman from
Illinois (Mr. Evans), my colleague, for his excellent work. They have
improved the health care for American veterans, and this bill as well
as the rule deserve our full support.
Mr. Speaker, I reserve the balance of my time.
Ms. PRYCE of Ohio. Mr. Speaker, I yield such time as he might consume
to the gentleman from Florida (Mr. Goss), my distinguished colleague
and the vice chairman of the Committee on Rules.
(Mr. GOSS asked and was given permission to revise and extend his
remarks.)
Mr. GOSS. Mr. Speaker, I rise in strong support of this rule and the
underlying legislation. I thank the gentlewoman from Ohio (Ms. Pryce),
my good friend for not only her leadership but yielding me this time. I
appreciate very much the observations of the gentleman from
Massachusetts (Mr. Moakley), who well understands the plight of our
veterans.
Mr. Speaker, my home State of Florida has about 1.7 million veterans,
that is a lot of veterans, and it serves as home to thousands more
during our busy winter season, which is about to start. Given what we
are told about the price of heating oil this year, I expect we are
going to have an awful lot of visitors to Florida.
Given the age and special needs of the population, many of these men
and women require extensive medical attention. The lack of timely,
quality health care for our veterans has reached a crisis point across
our Nation, as the gentlewoman from Ohio (Ms. Pryce) has pointed out,
but the problem is even more acute in southwest Florida.
Sadly, the need far exceeds our resources in southwest Florida, and
it is not because we have not been trying. Veterans routinely wait
months, sometimes over a year, just to get an appointment for something
as simple as vision care or hearing care, and to make matters worse,
many are forced to drive hundreds of miles to a VA facility in order to
receive the medical attention they require when high-quality private
facilities are located right around the corner from their homes.
This is sort of an unacceptable way to treat those who have served
our country so honorably when we needed them so much.
H.R. 5109 begins to address this injustice by establishing a program
to allow vets in remote areas to receive care at non-VA facilities at
the VA expense. This program would not only relieve the stress of a
long drive on an ailing veteran, but it would also introduce more
choice into the current VA health system.
Veterans in rural areas would finally have a choice between the
traditional VA care and the utilization of private medical facilities.
Introducing free market values into the VA medical system in my view
will likely improve the quality of medical attention received by our
Nation's veterans, and they deserve the best.
It is time we enable our veterans to have this right to choose, and I
think this bill gets us going on that road. It is also about time we
treat veterans the same, no matter where they live. They certainly
earned that. I think the veterans in southwest Florida should not be
discriminated against just because so many of them have found out that
southwest Florida is a great place to live and have moved there.

Mr. Speaker, it seems to me the facilities ought to follow the
veterans. I strongly encourage my colleagues to support the rule, I
think it is noncontroversial, and the bill. And I want to congratulate
the gentleman from Arizona (Chairman Stump) and all of the other people
who have participated in bringing this forward for their leadership and
commitment to veterans.
When we talked at the testimony at the Committee on Rules last
evening, the gentleman from Arizona (Chairman Stump) indicated his
clear awareness of this problem and his sympathy for our problems in
Fort Myers and for that I am grateful.
Mr. MOAKLEY. Mr. Speaker, I yield back the balance of my time.
Ms. PRYCE of Ohio. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I hope all of my colleagues will join me in supporting
this fair rule, which will allow the House to debate a bipartisan bill
that will improve the health care for our Nation's veterans. I also
want to congratulate the gentleman from Arizona (Chairman Stump) for
his fine work on this effort.
These individuals who have been willing to make great sacrifices to
serve their country through their military service deserve not only our
respect, but our deepest gratitude.

[[Page H7951]]

Mr. Speaker, the legislation before us would demonstrate to our
veterans that we are sincere in our desire to repay them for the
sacrifice, in part by ensuring their access to high quality health care
through the VA system.
The Department of Veterans Affairs Health Care Personnel Act is a
thoughtful bipartisan effort to make some of the changes necessary to
improve VA care.
Mr. Speaker, I urge my colleagues to support the bill and this very
fair rule.
Mr. Speaker, I yield back the balance of my time, and I move the
previous question on the resolution.
The previous question was ordered.
The resolution was agreed to.
A motion to reconsider was laid on the table.
Mr. STUMP. Mr. Speaker, pursuant to the provisions of House
Resolution 585, I call up the bill (H.R. 5109) to amend title 38,
United States Code, to improve the personnel system of the Veterans
Health Administration, and for other purposes, and ask for its
immediate consideration in the House.
The Clerk read the title of the bill.
The SPEAKER pro tempore (Mr. Ryan of Wisconsin). Pursuant to House
Resolution 585, the bill is considered read for amendment.
The text of H.R. 5109 is as follows:

H.R. 5109

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Department
of Veterans Affairs Health Care Personnel Act of 2000''.
(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--PERSONNEL MATTERS

Sec. 101. Revised authority for pay adjustments for nurses employed by
the Department of Veterans Affairs.
Sec. 102. Special pay for dentists.
Sec. 103. Exemption for pharmacists from ceiling on special salary
rates.
Sec. 104. Physician assistant advisers to Under Secretary for Health.
Sec. 105. Temporary full-time appointments of certain medical
personnel.
Sec. 106. Qualifications of social workers.
Sec. 107. Extension of temporary early retirement authority.

TITLE II--CONSTRUCTION AUTHORIZATION

Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of appropriations.

TITLE III--MILITARY SERVICE ISSUES

Sec. 301. Military service history.
Sec. 302. Study of post-traumatic stress disorder in Vietnam veterans.

TITLE IV--MEDICAL ADMINISTRATION

Sec. 401. Pilot program for coordination of hospital benefits.
Sec. 402. Benefits for persons disabled by participation in compensated
work therapy program.
Sec. 403. Extension of authority to establish research and education
corporations.
Sec. 404. Department of Veterans Affair Fisher Houses.
Sec. 405. Extension of annual report of Committee on Mentally Ill
Veterans.
Sec. 406. Exception of recapture rule.
Sec. 407. Change to enhanced use lease congressional notification
period.
Sec. 408. Technical and conforming changes.
Sec. 409. Appointment of Veterans Benefits Administration claims
examiners (also titled Veterans Service Representatives)
on a fee basis.
Sec. 410. Release of reversionary interest of the United States in
certain real property previously conveyed to the State of
Tennessee.

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--PERSONNEL MATTERS

SEC. 101. ANNUAL NATIONAL PAY COMPARABILITY ADJUSTMENT FOR
NURSES EMPLOYED BY DEPARTMENT OF VETERANS
AFFAIRS.

(a) Revised Pay Adjustment Procedures.--Section 7451 is
amended--
(1) in subsection (d)--
(A) in paragraph (1)--
(i) by striking ``The rates'' and inserting ``Subject to
subsection (e), the rates''; and
(ii) in subparagraph (A), by inserting ``and to be by the
same percentage'' after ``to have the same effective date'';
(B) in paragraph (2), by striking ``Such'' in the second
sentence and inserting ``Except as provided in paragraph
(1)(A), such'';
(C) in paragraph (3)(B)--
(i) by inserting after the first sentence the following new
sentence: ``To the extent practicable, the director shall use
third-party industry wage surveys to meet the requirements of
the preceding sentence.'';
(ii) by inserting before the penultimate sentence the
following new sentence: ``To the extent practicable, all
surveys conducted pursuant to this subparagraph or
subparagraph (A) shall include the collection of salary
midpoints, actual salaries, lowest and highest salaries,
average salaries, bonuses, incentive pays, differential pays,
actual beginning rates of pay and such other information
needed to meet the purpose of this section.''; and
(iii) in the penultimate sentence, by inserting ``or
published'' after ``completed'';
(D) by striking clause (iii) of paragraph (3)(C);
(2) by striking subsection (e) and inserting the following:
``(e)(1) An adjustment in a rate of basic pay under
subsection (d) may not reduce the rate of basic pay
applicable to any grade of a covered position.
``(2) The director of a Department health-care facility, in
determining whether to carry out a wage survey under
subsection (d)(3) with respect to rates of basic pay for a
grade of a covered position, may not consider as a factor in
such determination the absence of a current recruitment or
retention problem for personnel in that grade of that
position. The director shall make such a determination based
upon whether, in accordance with criteria established by the
Secretary, there is a significant pay-related staffing
problem at that facility in any grade for a position. If the
director determines that there is such a problem, or that
such a problem is likely to exist in the near future, the
Director shall provide for a wage survey in accordance with
paragraph (3) of subsection (d).
``(3) The Under Secretary for Health may, to the extent
necessary to carry out the purposes of subsection (d), modify
any determination made by the director of a Department
health-care facility with respect to adjusting the rates of
basic pay applicable to covered positions. Upon such action
by the Under Secretary, any adjustment shall take effect on
the first day of the first pay period beginning after such
action. The Secretary shall ensure that the Under Secretary
establishes a mechanism for the exercise of the authority in
the preceding sentence.
``(4) Each director of a Department health-care facility
shall provide to the Secretary, not later than July 31 each
year, a report on staffing for covered positions at that
facility. The report shall include the following:
``(A) Information on turnover rates and vacancy rates for
each grade in a covered position, including a comparison of
those rates with the rates for the preceding three years.
``(B) The director's findings concerning the review and
evaluation of the facility's staffing situation, including
whether there is, or is likely to be, in accordance with
criteria established by the Secretary, a significant pay-
related staffing problem at that facility for any grade of a
covered position and, if so, whether a wage survey was
conducted, or will be conducted with respect to that grade.
``(C) In any case in which the director conducts such a
wage survey during the period covered by the report,
information describing the survey and any actions taken or
not taken based on the survey, and the reasons for taking (or
not taking) such actions.
``(D) In any case in which the director, after finding that
there is, or is likely to be, in accordance with criteria
established by the Secretary, a significant pay-related
staffing problem at that facility for any grade of a covered
position, determines not to conduct a wage survey with
respect to that position, a statement of the reasons why the
director did not conduct such a survey.
``(5) Not later than September 30 of each year, the
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report on
staffing for covered positions at Department healthcare
facilities. Each such report shall include the following:
``(A) A summary and analysis of the information contained
in the most recent reports submitted by facility directors
under paragraph (4).
``(B) The information for each such facility specified in
paragraph (4).'';
(3) in subsection (f)--
(A) by striking ``February 1 of 1991, 1992, and 1993'' and
inserting ``March 1 of each year''; and
(B) by striking ``subsection (d)(1)(A)'' and inserting
``subsection (d)''; and
(4) by striking subsection (g) and redesignating subsection
(h) as subsection (g).
(b) Required Consultations With Nurses.--(1) Subchapter II
of chapter 73 is amended by adding at the end the following
new section:

``Sec. 7323. Required consultations with nurses

[[Page H7952]]

that medical center to provide recommendations or decisions
on medical center operations or policy affecting clinical
services, clinical outcomes, budget, or resources.''.
(2) The table of sections at the beginning of such chapter
is amended by inserting after the item relating to section
7322 the following new item:

``7323. Required consultations with nurses.''.

SEC. 102. SPECIAL PAY FOR DENTISTS.

(a) Full-Time Status Pay.--Paragraph (1) of section 7435(b)
is amended by striking ``$3,500'' and inserting ``$9,000''.
(b) Special Pay for Post-Graduate Training.--Such section
is amended by adding at the end the following new paragraph:
``(8) For a dentist who has successfully completed a post-
graduate year of hospital-based training in a program
accredited by the American Dental Association, an annual rate
of $2,000 for each of the first two years of service after
successful completion of that training.''.
(c) Tenure Pay.--The table in paragraph (2)(A) of that
section is amended to read as follows:

------------------------------------------------------------------------
Rate
``Length of Service -------------------------
Minimum Maximum
------------------------------------------------------------------------
1 year but less than 2 years.................. $1,000 $2,000
2 years but less than 3 years................. 4,000 5,000
4 years but less than 7 years................. 5,000 8,000
8 years but less than 11 years................ 8,000 12,000
12 years but less than 19 years............... 12,000 15,000
20 years or more.............................. 15,000 18,000.''.
------------------------------------------------------------------------

(d) Scarce Specialty Pay.--Paragraph (3)(A) of that section
is amended by striking ``$20,000'' and inserting ``$30,000''.
(e) Geographic Pay.--Paragraph (6) of that section is
amended by striking ``$5,000'' and inserting ``$12,000''.
(f) Responsibility Pay.--(1) The table in paragraph (4)(A)
is amended to read as follows:

------------------------------------------------------------------------
Rate
``Position -------------------------
Minimum Maximum
------------------------------------------------------------------------
Chief of Staff or in an Executive Grade....... $14,500 $25,000
Director Grade................................ 0 25,000
Service Chief (or in a comparable position as 4,500 15,000.''.
determined by the Secretary).................
------------------------------------------------------------------------

(2) The table in paragraph (4)(B) is amended to read as
follows:

------------------------------------------------------------------------
``Position Rate
------------------------------------------------------------------------
Deputy Service Director.................................... $20,000
Service Director........................................... 25,000
Deputy Assistant Under Secretary for Health................ 27,500
Assistant Under Secretary for Health (or in a comparable 30,000.''.
position as determined by the Secretary)..................
------------------------------------------------------------------------

(g) Crediting of Increased Tenure Pay for Civil Service
Retirement.--Section 7438(b) is amended--
(1) by redesignating paragraph (5) as paragraph (6); and
(2) by inserting after paragraph (4) the following new
paragraph:
``(5) Notwithstanding paragraphs (1) and (2), a dentist
employed as a dentist in the Veterans Health Administration
on the effective date of section 102 of the Department of
Veterans Affairs Health Care Personnel Act of 2000 shall be
entitled to have special pay paid to the dentist under
section 7435(b)(2)(A) of this title (referred to as `tenure
pay') considered basic pay for the purposes of chapter 83 or
84, as appropriate, of title 5 only as follows:
``(A) In an amount equal to the amount that would have been
so considered under such section on the day before such
effective date based on the rates of special pay the dentist
was entitled to receive under that section on the day before
such effective date.
``(B) With respect to any amount of special pay received
under that section in excess of the amount such dentist was
entitled to receive under such section on the day before such
effective date, in an amount equal to 25 percent of such
excess amount for each two years that the physician or
dentist has completed as a physician or dentist in the
Veterans Health Administration after such effective
date.''.
(h) Effective Date.--The amendments made by this section
shall apply with respect to agreements entered into by
dentists under subchapter III of chapter 74 of title 38,
United States Code, on or after the later of--
(1) the date of the enactment of this Act; and
(2) October 1, 2000.
(i) Transition.--(1) In the case of an agreement entered
into by a dentist under subchapter III of chapter 74 of title
38, United States Code, before the date of the enactment of
this Act that expires after the effective date specified in
subsection (h), the Secretary of Veterans Affairs and the
dentist concerned may agree to terminate that agreement as of
that effective date in order to permit a new agreement in
accordance with section 7435 of such title, as amended by
this section, to take effect as of that effective date.
(2) In the case of an agreement entered into under such
subchapter before the date of the enactment of this Act that
expires during the period beginning on the date of the
enactment of this Act and ending on the effective date
specified in subsection (h)(2), an extension or renewal of
that agreement may not extend beyond that effective date.
(3) In the case of a dentist who begins employment with the
Department of Veterans Affairs during the period beginning on
the date of the enactment of this Act and ending on the
effective date specified in subsection (h)(2) who is eligible
for an agreement under subchapter III of chapter 74 of title
38, United States Code, any such agreement may not extend
beyond that effective date.

SEC. 103. EXEMPTION FOR PHARMACISTS FROM CEILING ON SPECIAL
SALARY RATES.

Section 7455(c)(1) is amended by inserting ``,
pharmacists,'' after ``anesthetists''.

SEC. 104. PHYSICIAN ASSISTANT ADVISER TO UNDER SECRETARY FOR
HEALTH.

Section 7306(f) is amended--
(1) by striking ``and'' at the end of paragraph (1);
(2) by striking the period at the end of paragraph (2) and
inserting ``; and''; and
(3) by adding at the end the following new paragraph:
``(3) a physician assistant with appropriate experience
(who may have a permanent duty station at a Department
medical care facility in reasonable proximity to Washington,
DC) advises the Under Secretary on all matters relating to
the utilization and employment of physician assistants in the
Administration.''.

SEC. 105. TEMPORARY FULL-TIME APPOINTMENTS OF CERTAIN MEDICAL
PERSONNEL.

(a) Physician Assistants Awaiting Certification or
Licensure.--Paragraph (2) of section 7405(c) is amended to
read as follows:
``(2) A temporary full-time appointment may not be made for
a period in excess of two years in the case of a person who--
``(A) has successfully completed--
``(i) a full course of nursing in a recognized school of
nursing, approved by the Secretary; or
``(ii) a full course of training for any category of
personnel described in paragraph (3) of section 7401 of this
title, or as a physician assistant, in a recognized education
or training institution approved by the Secretary; and
``(B) is pending registration or licensure in a State or
certification by a national board recognized by the
Secretary.''.
(b) Medical Support Personnel.--That section is further
amended--
(1) by redesignating paragraph (3) as paragraph (4); and
(2) by inserting after paragraph (2) the following new
paragraph (3):
``(3)(A) Temporary full-time appointments of persons in
positions referred to in subsection (a)(1)(D) shall not
exceed three years.
``(B) Temporary full-time appointments under this paragraph
may be renewed for one or more additional periods not in
excess of three years each.''.

SEC. 106. QUALIFICATIONS OF SOCIAL WORKERS.

Section 7402(9) is amended by striking ``a person must''
and all that follows and inserting ``a person must--
``(1) hold a master's degree in social work from a college
or university approved by the Secretary; and
``(2) be licensed or certified to independently practice
social work in a State, except that the Secretary may waive
the requirement of licensure or certification for an
individual social worker for a reasonable period of time
recommended by the Under Secretary for Health.''.

SEC. 107. EXTENSION OF TEMPORARY EARLY RETIREMENT AUTHORITY.

The Department of Veterans Affairs Employment Reduction
Assistance Act of 1999 (title XI of Public Law 106-117; 5
U.S.C. 5597 note) is amended as follows:
(1) Section 1102(c) is amended to read as follows:
``(c) Limitation.--The plan under subsection (a) shall be
limited to 8,110 positions within the Department.''.
(2) Section 1105(a) is amended by striking ``26 percent''
and inserting ``15 percent''.
(3) Section 1109(a) is amended by striking ``December 31,
2000'' and inserting ``December 31, 2002''.

TITLE II--CONSTRUCTION AUTHORIZATION

SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

(a) Fiscal Year 2001 Projects.--The Secretary of Veterans
Affairs may carry out the following major medical facility
projects, with each project to be carried out in the amount
specified for that project:
(1) Construction of a psychogeriatric care building at the
Department of Veterans Affairs Medical Center, Palo Alto,
California, in an amount not to exceed $26,600,000.
(2) Construction of a utility plant and electrical vault at
the Department of Veterans Affairs Medical Center, Miami,
Florida, in an amount not to exceed $23,600,000.
(3) Seismic corrections, clinical consolidation, and other
improvements at the Department of Veterans Affairs Medical
Center, Long Beach, California, in an amount not to exceed
$51,700,000.
(b) Additional Fiscal Year 2000 Project.--The Secretary is
authorized to carry out a project for the renovation of
psychiatric nursing units at the Department of Veterans
Affairs Medical Center, Murfreesboro, Tennessee, in an amount
not to exceed $14,000,000.

SEC. 202. AUTHORIZATION OF APPROPRIATIONS.

[[Page H7953]]

(2) funds appropriated for Construction, Major Projects for
a fiscal year before fiscal year 2001 that remain available
for obligation; and
(3) funds appropriated for Construction, Major Projects for
fiscal year 2001 or 2002 for a category of activity not
specific to a project.

TITLE III--MILITARY SERVICE ISSUES

SEC. 301. MILITARY SERVICE HISTORY.

(a) Military Histories.--The Secretary of Veterans Affairs,
in carrying out the responsibilities of the Secretary under
chapter 17 of title 38, United States Code, shall ensure
that--
(1) during at least one clinical evaluation of a patient in
a facility of the Department, a protocol is used to identify
pertinent military experiences and exposures of the patient
that may contribute to the health status of the patient; and
(2) pertinent information relating to the military history
of the patient is included in the Department's medical
records of the patient.
(b) Report.--Not later than nine months after the date of
the enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a report on the feasibility and desirability
of using a computer-based system in conducting clinical
evaluations referred to in subsection (a)(1).

SEC. 302. STUDY OF POST-TRAUMATIC STRESS DISORDER IN VIETNAM
VETERANS.

(a) Study on Post-Traumatic Stress Disorder.--Not later
than 10 months after the date of the enactment of this Act,
the Secretary of Veterans Affairs shall enter into a contract
with an appropriate entity to carry out a study on post-
traumatic stress disorder.
(b) Follow-Up Study.--The contract under subsection (a)
shall provide for a follow-up study to the study conducted in
accordance with section 102 of the Veterans Health Care
Amendments of 1983 (Public Law 98-160). Such follow-up study
shall use the data base and sample of the previous study.
(c) Information To Be Included.--The study conducted
pursuant to this section shall be designed to yield
information on--
(1) the long-term course of post-traumatic stress disorder;
(2) any long-term medical consequences of post-traumatic
stress disorder;
(3) whether particular subgroups of veterans are at greater
risk of chronic or more severe problems with such disorder;
and
(4) the services used by veterans who have post-traumatic
stress disorder and the effect of those services on the
course of the disorder.
(d) Report.--The Secretary shall submit to the Committees
of Veterans Affairs of the Senate and House of
Representatives a report on the results of the study under
this section. The report shall be submitted no later than
October 1, 2004.

TITLE IV--MEDICAL ADMINISTRATION

SEC. 401. PILOT PROGRAM FOR COORDINATION OF HOSPITAL
BENEFITS.

(a) In General.--Chapter 17 is amended by inserting after
section 1725 the following new section:

Sec. 1725A. Coordination of hospital benefits: pilot program

``(a) The Secretary may carry out a pilot program in not
more than four geographic areas of the United States to
improve access to, and coordination of, inpatient care of
eligible veterans. Under the pilot program, the Secretary,
subject to subsection (b), may pay certain costs described in
subsection (b) for which an eligible veteran would otherwise
be personally liable. The authority to carry out the pilot
program shall expire on September 30, 2005.
``(b) In carrying out the program described in subsection
(a), the Secretary may pay the costs authorized under this
section for hospital care and medical services furnished on
an inpatient basis in a non-Department hospital to an
eligible veteran participating in the program. Such payment
may cover the costs for applicable plan deductibles and
coinsurance and the reasonable costs of such inpatient care
and medical services not covered by any applicable health-
care plan of the veteran, but only to the extent such care
and services are of the kind authorized under this chapter.
The Secretary shall limit the care and services for which
payment may be made under the program to general medical and
surgical services and shall require that such services may be
provided only upon preauthorization by the Secretary.
``(c)(1) A veteran described in paragraph (1) or (2) of
section 1710(a) of this title is eligible to participate in
the pilot program if the veteran--
``(A) is enrolled to receive medical services from an
outpatient clinic operated by the Secretary which is (i)
within reasonable proximity to the principal residence of
the veteran, and (ii) located within the geographic area
in which the Secretary is carrying out the program
described in subsection (a);
``(B) has received care under this chapter within the 24-
month period preceding the veteran's application for
enrollment in the pilot program;
``(C) as determined by the Secretary before the
hospitalization of the veteran (i) requires such hospital
care and services for a non-service-connected condition, and
(ii) could not receive such services from a clinic operated
by the Secretary; and
``(D) elects to receive such care under a health-care plan
(other than under this title) under which the veteran is
entitled to receive such care.
``(2) Nothing in this section shall be construed to reduce
the authority of the Secretary to contract with non-
Department facilities for care of a service-connected
disability of a veteran.
``(3) Notwithstanding subparagraph (C) of paragraph (1),
the Secretary shall ensure that not less than 15 percent of
the veterans participating in the program are veterans who do
not have a health-care plan.
``(d) As part of the program under this section, the
Secretary shall, through provision of case-management,
coordinate the care being furnished directly by the Secretary
and care furnished under the program in non-Department
hospitals to veterans participating in the program.
``(e)(1) In designating geographic areas in which to
establish the program under subsection (a), the Secretary
shall ensure that--
``(A) the areas designated are geographically dispersed;
``(B) at least 70 percent of the veterans who reside in a
designated area reside at least two hours driving distance
from the closest medical center operated by the Secretary
which provides medical and surgical hospital care; and
``(C) the establishment of the program in any such area
would not result in jeopardizing the critical mass of
patients needed to maintain a Department medical center that
serves that area.
``(2) Notwithstanding paragraph (1)(B), the Secretary may
designate for participation in the program at least one area
which is in proximity to a Department medical center which,
as a result of a change in mission of that center, does not
provide hospital care.
``(f)(1) Not later than September 30, 2002, the Secretary
shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the
experience in implementing the pilot program under subsection
(a).
``(2) Not later than September 30, 2004, the Secretary
shall submit to those committees a report on the experience
in operating the pilot program during the first two full
fiscal years during which the pilot program is conducted.
That report shall include--
``(A) a comparison of the costs incurred by the Secretary
under the program and the cost experience for the calendar
year preceding establishment of the program at each site at
which the program is operated;
``(B) an assessment of the satisfaction of the participants
in the program; and
``(C) an analysis of the effect of the program on access
and quality of care for veterans.
``(g) The total amount expended for the pilot program in
any fiscal year (including amounts for administrative costs)
may not exceed $50,000,000.
``(h) For purposes of this section:
``(1) The term `health-care plan' has the meaning given
that term in section 1725(f)(3) of this title.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1725 the following new item:

``1725A. Coordination of hospital benefits: pilot program.''.

SEC. 402. BENEFITS FOR PERSONS DISABLED BY PARTICIPATION IN
COMPENSATED WORK THERAPY PROGRAM.

Section 1151(a)(2) is amended--
(1) by inserting ``(A)'' after ``proximately caused''; and
(2) by inserting before the period at the end the
following: ``, or (B) by participation in a program (known as
a `compensated work therapy program') under section 1718 of
this title''.

SEC. 403. EXTENSION OF AUTHORITY TO ESTABLISH RESEARCH AND
EDUCATION CORPORATIONS.

Section 7368 is amended by striking ``December 31, 2000''
and inserting ``December 31, 2005''.

SEC. 404. DEPARTMENT OF VETERANS AFFAIRS FISHER HOUSES.

(a) Authority.--Subchapter I of chapter 17 of title 38,
United States Code, is amended by adding at the end the
following new section:

``Sec. 1708. Temporary lodging

[[Page H7954]]

proceeds from such charges shall be credited to the medical
care account and shall be available until expended for the
purposes of providing such lodging.
``(e) The Secretary shall prescribe regulations to carry
out this section. Such regulations shall include provisions--
``(1) limiting the duration of such lodging;
``(2) establishing standards and criteria under which
medical facilities may set charges for such lodging;
``(3) establishing criteria for persons considered to be
accompanying a veteran;
``(4) establishing criteria for the use of such premises;
and
``(5) any other limitations, conditions, and priorities
that the Secretary considers appropriate with respect to
temporary lodging under this section.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1707 the following new item:

``1708. Temporary lodging.''.

SEC. 405. EXTENSION OF ANNUAL REPORT OF COMMITTEE ON MENTALLY
ILL VETERANS.

Section 7321(d)(2) is amended by striking ``three'' and
inserting ``six''.

SEC. 406. EXCEPTION TO RECAPTURE RULE.

Section 8136 is amended--
(1) by inserting ``(a)'' at the beginning of the text of
the section; and
(2) by adding at the end the following new subsection:
``(b) The establishment and operation by the Secretary of
an outpatient clinic in facilities described in subsection
(a) shall not constitute grounds entitling the United States
to any recovery under that subsection.''.

SEC. 407. CHANGE TO ENHANCED USE LEASE CONGRESSIONAL
NOTIFICATION PERIOD.

Paragraph (2) of section 8163(c) is amended to read as
follows:
``(2) The Secretary may not enter into an enhanced use
lease until the end of the 90-day period beginning on the
date of the submission of notice under paragraph (1).''.

SEC. 408. TECHNICAL AND CONFORMING CHANGES.

(a) Requirement To Provide Care.--Section 1710A(a) is
amended by inserting ``(subject to section 1710(a)(4) of this
title)'' after ``Secretary''.
(b) Conforming Amendment.--Section 1710(a)(4) is amended by
striking ``requirement in'' and inserting ``requirements in
section 1710A(a) and''.

SEC. 409. APPOINTMENT OF VETERANS BENEFITS ADMINISTRATION
CLAIMS EXAMINERS (ALSO TITLED VETERANS SERVICE
REPRESENTATIVES) ON A FEE BASIS.

(a) Authority.--(1) Chapter 77 is amended by inserting
after section 7703 the following new section:

``Sec. 7705. Fee basis appointments of claims examiners

``(a) The Secretary, upon recommendation of the Under
Secretary for Benefits, may employ, without regard to civil
service or classification laws, rules, or regulations,
Veterans Claims Examiners (also titled Veterans Service
Representatives) on a fee basis.
``(b) Personnel employed under this section shall be paid
such rates of pay as the Secretary may prescribe.''.
(2) The table of sections at the beginning of such chapter
is amended by inserting after the item relating to section
7703 the following new item:

``7705. Fee basis appointments of claims examiners.''.
(b) Reports.--The Secretary of Veterans Affairs shall
submit to the Committees on Veterans' Affairs of the Senate
and House of Representatives two reports on the
implementation of section 7705 of title 38, United States
Code, as added by subsection (a). The first report shall be
submitted not later than December 31, 2001, and the second
report shall be submitted not later than December 31, 2002.

SEC. 410. RELEASE OF REVERSIONARY INTEREST OF THE UNITED
STATES IN CERTAIN REAL PROPERTY PREVIOUSLY
CONVEYED TO THE STATE OF TENNESSEE.

(a) Release of Interest.--The Secretary of Veterans Affairs
shall execute such legal instruments as necessary to release
the reversionary interest of the United States described in
subsection (b) in a certain parcel of real property conveyed
to the State of Tennessee pursuant to the Act entitled ``An
Act authorizing the transfer of certain property of the
Veterans' Administration (in Johnson City, Tennessee) to the
State of Tennessee'', approved June 6, 1953 (67 Stat. 54).
(b) Specified Reversionary Interest.--Subsection (a)
applies to the reversionary interest of the United States
required under section 2 of the Act referred to in subsection
(a), requiring use of the property conveyed pursuant to that
Act to be primarily for training of the National Guard and
for other military purposes.
(c) Conforming Amendment.--Section 2 of such Act is
repealed.

The SPEAKER pro tempore. The amendment printed in the bill is
adopted.
The text of H.R. 5109, as amended, is as follows:

H.R. 5109

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Department
of Veterans Affairs Health Care Personnel Act of 2000''.
(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--PERSONNEL MATTERS

Sec. 101. Annual national pay comparability adjustment for nurses
employed by Department of Veterans Affairs.
Sec. 102. Special pay for dentists.
Sec. 103. Exemption for pharmacists from ceiling on special salary
rates.
Sec. 104. Physician assistant adviser to Under Secretary for Health.
Sec. 105. Temporary full-time appointments of certain medical
personnel.
Sec. 106. Qualifications of social workers.
Sec. 107. Extension of voluntary separation incentive payments.

TITLE II--CONSTRUCTION AUTHORIZATION

Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of appropriations.

TITLE III--MILITARY SERVICE ISSUES

Sec. 301. Military service history.
Sec. 302. Study of post-traumatic stress disorder in Vietnam veterans.

TITLE IV--MEDICAL ADMINISTRATION

Sec. 401. Pilot program for coordination of hospital benefits.
Sec. 402. Benefits for persons disabled by participation in compensated
work therapy program.
Sec. 403. Extension of authority to establish research and education
corporations.
Sec. 404. Department of Veterans Affairs Fisher Houses.
Sec. 405. Extension of annual report of Committee on Mentally Ill
Veterans.
Sec. 406. Exception to recapture rule.
Sec. 407. Change to enhanced use lease congressional notification
period.
Sec. 408. Technical and conforming changes.
Sec. 409. Release of reversionary interest of the United States in
certain real property previously conveyed to the State of
Tennessee.

SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.

TITLE I--PERSONNEL MATTERS

SEC. 101. ANNUAL NATIONAL PAY COMPARABILITY ADJUSTMENT FOR
NURSES EMPLOYED BY DEPARTMENT OF VETERANS
AFFAIRS.

[[Page H7955]]

shall take effect on the first day of the first pay period
beginning after such action. The Secretary shall ensure that
the Under Secretary establishes a mechanism for the exercise
of the authority in the preceding sentence.
``(4) Each director of a Department health-care facility
shall provide to the Secretary, not later than July 31 each
year, a report on staffing for covered positions at that
facility. The report shall include the following:
``(A) Information on turnover rates and vacancy rates for
each grade in a covered position, including a comparison of
those rates with the rates for the preceding three years.
``(B) The director's findings concerning the review and
evaluation of the facility's staffing situation, including
whether there is, or is likely to be, in accordance with
criteria established by the Secretary, a significant pay-
related staffing problem at that facility for any grade of a
covered position and, if so, whether a wage survey was
conducted, or will be conducted with respect to that grade.
``(C) In any case in which the director conducts such a
wage survey during the period covered by the report,
information describing the survey and any actions taken or
not taken based on the survey, and the reasons for taking (or
not taking) such actions.
``(D) In any case in which the director, after finding that
there is, or is likely to be, in accordance with criteria
established by the Secretary, a significant pay-related
staffing problem at that facility for any grade of a covered
position, determines not to conduct a wage survey with
respect to that position, a statement of the reasons why the
director did not conduct such a survey.
``(5) Not later than September 30 of each year, the
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report on
staffing for covered positions at Department healthcare
facilities. Each such report shall include the following:
``(A) A summary and analysis of the information contained
in the most recent reports submitted by facility directors
under paragraph (4).
``(B) The information for each such facility specified in
paragraph (4).'';
(3) in subsection (f)--
(A) by striking ``February 1 of 1991, 1992, and 1993'' and
inserting ``March 1 of each year''; and
(B) by striking ``subsection (d)(1)(A)'' and inserting
``subsection (d)''; and
(4) by striking subsection (g) and redesignating subsection
(h) as subsection (g).
(b) Required Consultations With Nurses.--(1) Subchapter II
of chapter 73 is amended by adding at the end the following
new section:

``Sec. 7323. Required consultations with nurses

``The Under Secretary for Health shall ensure that--
``(1) the director of a geographic service area, in
formulating policy relating to the provision of patient care,
shall consult regularly with a senior nurse executive or
senior nurse executives; and
``(2) the director of a medical center shall, to the extent
feasible, include a registered nurse as a member of any
committee used at that medical center to provide
recommendations or decisions on medical center operations or
policy affecting clinical services, clinical outcomes,
budget, or resources.''.
(2) The table of sections at the beginning of such chapter
is amended by inserting after the item relating to section
7322 the following new item:

``7323. Required consultations with nurses.''.

SEC. 102. SPECIAL PAY FOR DENTISTS.

------------------------------------------------------------------------
Rate
``Length of Service -------------------------
Minimum Maximum
------------------------------------------------------------------------
1 year but less than 2 years.................. $1,000 $2,000
2 years but less than 4 years................. 4,000 5,000
4 years but less than 8 years................. 5,000 8,000
8 years but less than 12 years................ 8,000 12,000
12 years but less than 20 years............... 12,000 15,000
20 years or more.............................. 15,000 18,000.''.
------------------------------------------------------------------------

(2) The table in paragraph (4)(B) of that section is
amended to read as follows:

SEC. 103. EXEMPTION FOR PHARMACISTS FROM CEILING ON SPECIAL
SALARY RATES.

Section 7455(c)(1) is amended by inserting ``,
pharmacists,'' after ``anesthetists''.

SEC. 104. PHYSICIAN ASSISTANT ADVISER TO UNDER SECRETARY FOR
HEALTH.

SEC. 105. TEMPORARY FULL-TIME APPOINTMENTS OF CERTAIN MEDICAL
PERSONNEL.

SEC. 106. QUALIFICATIONS OF SOCIAL WORKERS.

Section 7402(b)(9) is amended by striking ``a person must''
and all that follows and inserting ``a person must--
``(A) hold a master's degree in social work from a college
or university approved by the Secretary; and

[[Page H7956]]

``(B) be licensed or certified to independently practice
social work in a State, except that the Secretary may waive
the requirement of licensure or certification for an
individual social worker for a reasonable period of time
recommended by the Under Secretary for Health.''.

SEC. 107. EXTENSION OF VOLUNTARY SEPARATION INCENTIVE
PAYMENTS.

TITLE II--CONSTRUCTION AUTHORIZATION

SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

SEC. 202. AUTHORIZATION OF APPROPRIATIONS.

(a) In General.--There are authorized to be appropriated to
the Secretary of Veterans Affairs for fiscal years 2001 and
2002 for the Construction, Major Projects, account,
$101,900,000 for the projects authorized in section 101(a).
(b) Limitation.--The projects authorized in section 101(a)
may only be carried out using--
(1) funds appropriated for fiscal year 2001 or 2002
pursuant to the authorization of appropriations in subsection
(a);
(2) funds appropriated for Construction, Major Projects for
a fiscal year before fiscal year 2001 that remain available
for obligation; and
(3) funds appropriated for Construction, Major Projects for
fiscal year 2001 or 2002 for a category of activity not
specific to a project.

TITLE III--MILITARY SERVICE ISSUES

SEC. 301. MILITARY SERVICE HISTORY.

SEC. 302. STUDY OF POST-TRAUMATIC STRESS DISORDER IN VIETNAM
VETERANS.

(a) Study on Post-Traumatic Stress Disorder.--Not later
than 10 months after the date of the enactment of this Act,
the Secretary of Veterans Affairs shall enter into a contract
with an appropriate entity to carry out a study on post-
traumatic stress disorder.
(b) Follow-Up Study.--The contract under subsection (a)
shall provide for a follow-up study to the study conducted in
accordance with section 102 of the Veterans Health Care
Amendments of 1983 (Public Law 98-160). Such follow-up study
shall use the data base and sample of the previous study.
(c) Information To Be Included.--The study conducted
pursuant to this section shall be designed to yield
information on--
(1) the long-term course of post-traumatic stress disorder;
(2) any long-term medical consequences of post-traumatic
stress disorder;
(3) whether particular subgroups of veterans are at greater
risk of chronic or more severe problems with such disorder;
and
(4) the services used by veterans who have post-traumatic
stress disorder and the effect of those services on the
course of the disorder.
(d) Report.--The Secretary shall submit to the Committees
of Veterans' Affairs of the Senate and House of
Representatives a report on the results of the study under
this section. The report shall be submitted no later than
October 1, 2004.

TITLE IV--MEDICAL ADMINISTRATION

SEC. 401. PILOT PROGRAM FOR COORDINATION OF HOSPITAL
BENEFITS.

(a) In General.--Chapter 17 is amended by inserting after
section 1725 the following new section:

``Sec. 1725A. Coordination of hospital benefits: pilot
program

``(a) The Secretary may carry out a pilot program in not
more than four geographic areas of the United States to
improve access to, and coordination of, inpatient care of
eligible veterans. Under the pilot program, the Secretary,
subject to subsection (b), may pay certain costs described in
subsection (b) for which an eligible veteran would otherwise
be personally liable. The authority to carry out the pilot
program shall expire on September 30, 2005.
``(b) In carrying out the program described in subsection
(a), the Secretary may pay the costs authorized under this
section for hospital care and medical services furnished on
an inpatient basis in a non-Department hospital to an
eligible veteran participating in the program. Such payment
may cover the costs for applicable plan deductibles and
coinsurance and the reasonable costs of such inpatient care
and medical services not covered by any applicable health-
care plan of the veteran, but only to the extent such care
and services are of the kind authorized under this chapter.
The Secretary shall limit the care and services for which
payment may be made under the program to general medical and
surgical services and shall require that such services may be
provided only upon preauthorization by the Secretary.
``(c)(1) A veteran described in paragraph (1) or (2) of
section 1710(a) of this title is eligible to participate in
the pilot program if the veteran--
``(A) is enrolled to receive medical services from an
outpatient clinic operated by the Secretary which is (i)
within reasonable proximity to the principal residence of the
veteran, and (ii) located within the geographic area in which
the Secretary is carrying out the program described in
subsection (a);
``(B) has received care under this chapter within the 24-
month period preceding the veteran's application for
enrollment in the pilot program;
``(C) as determined by the Secretary before the
hospitalization of the veteran (i) requires such hospital
care and services for a non-service-connected condition, and
(ii) could not receive such services from a clinic operated
by the Secretary; and
``(D) elects to receive such care under a health-care plan
(other than under this title) under which the veteran is
entitled to receive such care.
``(2) Nothing in this section shall be construed to reduce
the authority of the Secretary to contract with non-
Department facilities for care of a service-connected
disability of a veteran.
``(3) Notwithstanding subparagraph (D) of paragraph (1),
the Secretary shall ensure that not less than 15 percent of
the veterans participating in the program are veterans who do
not have a health-care plan.
``(d) As part of the program under this section, the
Secretary shall, through provision of case-management,
coordinate the care being furnished directly by the Secretary
and care furnished under the program in non-Department
hospitals to veterans participating in the program.
``(e)(1) In designating geographic areas in which to
establish the program under subsection (a), the Secretary
shall ensure that--
``(A) the areas designated are geographically dispersed;
``(B) at least 70 percent of the veterans who reside in a
designated area reside at least two hours driving distance
from the closest medical center operated by the Secretary
which provides medical and surgical hospital care; and
``(C) the establishment of the program in any such area
would not result in jeopardizing the critical mass of
patients needed to maintain a Department medical center that
serves that area.
``(2) Notwithstanding paragraph (1)(B), the Secretary may
designate for participation in the program at least one area
which is in proximity to a Department medical center which,
as a result of a change in mission of that center, does not
provide hospital care.
``(f)(1) Not later than September 30, 2002, the Secretary
shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the
experience in implementing the pilot program under subsection
(a).
``(2) Not later than September 30, 2004, the Secretary
shall submit to those committees a report on the experience
in operating the pilot program during the first two full
fiscal years during which the pilot program is conducted.
That report shall include--
``(A) a comparison of the costs incurred by the Secretary
under the program and the cost experience for the calendar
year preceding establishment of the program at each site at
which the program is operated;
``(B) an assessment of the satisfaction of the participants
in the program; and
``(C) an analysis of the effect of the program on access
and quality of care for veterans.
``(g) The total amount expended for the pilot program in
any fiscal year (including amounts for administrative costs)
may not exceed $50,000,000.
``(h) For purposes of this section, the term `health-care
plan' has the meaning given that term in section 1725(f)(3)
of this title.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1725 the following new item:

``1725A. Coordination of hospital benefits: pilot program.''.

SEC. 402. BENEFITS FOR PERSONS DISABLED BY PARTICIPATION IN
COMPENSATED WORK THERAPY PROGRAM.

Section 1151(a)(2) is amended--
(1) by inserting ``(A)'' after ``proximately caused''; and

[[Page H7957]]

(2) by inserting before the period at the end the
following: ``, or (B) by participation in a program (known as
a `compensated work therapy program') under section 1718 of
this title''.

SEC. 403. EXTENSION OF AUTHORITY TO ESTABLISH RESEARCH AND
EDUCATION CORPORATIONS.

Section 7368 is amended by striking ``December 31, 2000''
and inserting ``December 31, 2005''.

SEC. 404. DEPARTMENT OF VETERANS AFFAIRS FISHER HOUSES.

(a) Authority.--Subchapter I of chapter 17 of title 38,
United States Code, is amended by adding at the end the
following new section:

``Sec. 1708. Temporary lodging

``(a) The Secretary may furnish persons described in
subsection (b) with temporary lodging in a Fisher house or
other appropriate facility in connection with the
examination, treatment, or care of a veteran under this
chapter or, as provided for under subsection (e)(5), in
connection with benefits administered under this title.
``(b) Persons to whom the Secretary may provide lodging
under subsection (a) are the following:
``(1) A veteran who must travel a significant distance to
receive care or services under this title.
``(2) A member of the family of a veteran and others who
accompany a veteran and provide the equivalent of familial
support for such veteran.
``(c) In this section, the term `Fisher house' means a
housing facility that--
``(1) is located at, or in proximity to, a Department
medical facility;
``(2) is available for residential use on a temporary basis
by patients of that facility and others described in
subsection (b)(2); and
``(3) is constructed by, and donated to the Secretary by,
the Zachary and Elizabeth M. Fisher Armed Services
Foundation.
``(d) The Secretary may establish charges for providing
lodging under this section. The proceeds from such charges
shall be credited to the medical care account and shall be
available until expended for the purposes of providing such
lodging.
``(e) The Secretary shall prescribe regulations to carry
out this section. Such regulations shall include provisions--
``(1) limiting the duration of such lodging;
``(2) establishing standards and criteria under which
medical facilities may set charges for such lodging;
``(3) establishing criteria for persons considered to be
accompanying a veteran;
``(4) establishing criteria for the use of such premises;
and
``(5) any other limitations, conditions, and priorities
that the Secretary considers appropriate with respect to
temporary lodging under this section.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1707 the following new item:

``1708. Temporary lodging.''.

SEC. 405. EXTENSION OF ANNUAL REPORT OF COMMITTEE ON MENTALLY
ILL VETERANS.

Section 7321(d)(2) is amended by striking ``three'' and
inserting ``six''.

SEC. 406. EXCEPTION TO RECAPTURE RULE.

SEC. 407. CHANGE TO ENHANCED USE LEASE CONGRESSIONAL
NOTIFICATION PERIOD.

SEC. 408. TECHNICAL AND CONFORMING CHANGES.

(a) Requirement To Provide Care.--Section 1710A(a) is
amended by inserting ``(subject to section 1710(a)(4) of this
title)'' after ``Secretary'' the first place it appears.
(b) Conforming Amendment.--Section 1710(a)(4) is amended by
striking ``requirement in'' and inserting ``requirements in
section 1710A(a) and''.

SEC. 409. RELEASE OF REVERSIONARY INTEREST OF THE UNITED
STATES IN CERTAIN REAL PROPERTY PREVIOUSLY
CONVEYED TO THE STATE OF TENNESSEE.

The SPEAKER pro tempore. After 1 hour of debate on the bill, as
amended, it shall be in order to consider a further amendment printed
in the House report 106-875 if offered by the gentleman from Arizona
(Mr. Stump) or the gentleman from Illinois (Mr. Evans), or a designee,
which shall be considered read, and shall be debatable for 10 minutes,
equally divided and controlled by the proponent and an opponent.
The gentleman from Arizona (Mr. Stump) and the gentleman from
Illinois (Mr. Evans) each will control 30 minutes of debate on the
bill.
The Chair recognizes the gentleman from Arizona (Mr. Stump).
Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, H.R. 5109 addresses a number of key personnel management
systems needs in the VA health care system.
It authorizes regular pay raises for the VA nurses and gives the VA
the authority to increase salaries for VA dentists.
It also proposes an innovative four-site health care pilot program so
that veterans, who are enrolled with VA for health care, can be
referred to a community hospital if the VA hospital is too far away.
Mr. Chairman, I reserve the balance of my time.
Mr. EVANS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I also want to thank the gentleman from Arizona
(Chairman Stump) and the gentleman from Florida (Mr. Stearns) and the
gentleman from Illinois (Mr. Gutierrez), the ranking member of the
Subcommittee on Health, for working with me on an important pay
provision contained in the legislation now before the House, H.R. 5109.
As many of my colleagues know, my mother was a nurse, a fact of which
I am very proud. I understand well the pressures nurses face as the
backbone of our health care system. I understand, too, that nurses have
had to shoulder even more responsibility as health care delivery is
being transformed. From my perspective, it was grossly unfair to
maintain a pay system under our jurisdiction that allowed hospital
directors to balance the budget on the backs of VA nurses.
This bill comes at a time when competition for skilled health care
personnel is fierce. Besides nurses, the bill addresses pay inequities
for dentists. It provides physician assistants long-sought
representation within VA headquarters along with better training
opportunities. It will help the VA retain social workers, pharmacists
and medical support personnel, to retain them as well.
This legislation also supports a pilot project that the gentleman
from Arizona (Chairman Stump) just talked about. It will allow the VA
to manage VA's health care system in their own communities. The concept
of this pilot brought to my attention by two health care professionals,
the gentlewoman from California (Mrs. Capps) and the gentleman from
Florida (Mr. Weldon) is simple, the VA will preapprove certain veterans
who are distant from VA medical centers, but who rely on VA outpatient
clinics to receive certain general medical and surgical hospital in-
patient services in their own communities.
Mr. Speaker, far from being the end of the VA health care system as
we know now it, this is a project that is consistent with VA's goals to
bring veterans' health care into our communities.
The gentleman from Arizona (Chairman Stump) is offering a strong
bill, and I urge my colleagues to support it.
Mr. Speaker, I include for the Record the letter from the American
Federation of Government Employees:

American Federation of

Government Employees, AFL-CIO

September 21, 2000.
Hon. Bob Stump,
Chairman, House Veterans' Affairs Committee, Cannon House
Office Building, Washington, DC.
Hon. Cliff Stearns,
Chairman, Subcommittee on Health, House Veterans' Affairs
Committee, Cannon House Office Building, Washington, DC
20515.
Hon. Lane Evans,
Ranking Member, House Veterans' Affairs Committee, Cannon
House Office Building, Washington, DC.
Dear Chairman Stump, Chairman Stearns and Ranking Member
Evans: On behalf of the American Federation of Government
Employees (AFGE), AFL-CIO and the 600,000 federal workers
AFGE, represents, including roughly 125,000 Department of
Veterans' Affairs (DVA) employees, I thank you for your
efforts to guarantee DVA registered nurses

[[Page H7958]]

an annual pay raise and to improve the pay for dentists and
pharmacists who work at the DVA.
H.R. 5109 will guarantee DVA nurses the same annual
nationwide pay increase provided to General Schedule
employees. The fundamental change in the DVA nurse pay system
is similar to the change proposed in H.R. 1216, the AFGE
authored legislation which was introduced by Representative
Steve LaTourette (R-OH). It is our understanding that H.R.
5109 will ensure that no DVA nurse will again be denied an
annual pay raise or receive a negative pay adjustment.
Such changes to the current DVA nurse pay system are
consistent with the AFGE testimony given before Chairman
Steams' subcommittee on April 12th. At the hearing AFGE
called for a guaranteed annual pay raise for DVA nurses to
create a floor for nurses' pay. AFGE also urged that the
Secretary be given the authority to increase nurses' pay
above this floor when needed. H.R. 5109 incorporates these
core principles.
AFGE opposes the section in H.R. 5109 titled,
``Coordination of Hospital Benefits Program,'' which would
create a pilot voucher-like program in four geographic areas.
The section would authorize DVA to cover a veteran's costs of
inpatient care at non-DVA facilities. DVA would become the
secondary insurance for any out-of-pocket expenses of
veterans with insurance, including Medicare, when veterans
seek inpatient services in private sector hospitals.
Section 401 establishes an entirely new eligibility
category for veterans' health care based not on the veteran's
status or need, but purely on the veteran's geographic
location, and to a great extent, the veteran's own health
insurance. Accordingly, Section 401 will create a disparity
between the health care available to veterans who chose to
use DVA health care facilities and those, primarily with
their own insurance, who have previously chosen not to use
DVA facilities.
Section 401 will also set a precedent for sending veterans
to non-DVA providers for inpatient services that are paid by
veterans' own insurance. DVA would not subsidize care outside
of the DVA system, lose both the direct and appropriated
dollars and any third-party reimbursements. If this precedent
is set and expanded, DVA health care facilities would only
become local referral centers without the resources to
sustain the full range of care, including the specialized
services such as spinal cord injury care and substance abuse
treatment, for which it is well known.
Under Section 401, DVA would not really have control to
manage the veteran's case once referred because it would be a
secondary payer, not the provider of care.
AFGE is for increased access in veterans' care but not at
the cost of unraveling the DVA operated health care system.
Veterans deserve and need a unique health care system devoted
and dedicated to treating their unique medical needs. Picking
up the co-payments for veterans who have insurance will
ultimately transform DVA from a health care system designed
and focused on veterans medical care into an insurance
company. This proposal claims to give a few veterans improved
``access'' but will do so at the cost of maintaining a fully
staffed and functioning DVA health care system. We urge you
to omit this section from the final conference bill.
Thank you for considering AFGE's views on these important
matters. AFGE appreciates that you have incorporated the core
principles of the AFGE authored nurse pay legislation into
H.R. 5109.
Sincerely,
Bobby L. Harnage, Sr.,
National President.

Mr. Speaker, I reserve the balance of my time.
Mr. STUMP. Mr. Speaker, I yield 9 minutes to the gentleman from
Florida (Mr. Stearns) the chairman of the Subcommittee on Health.
Mr. STEARNS. Mr. Speaker, I thank my colleague from Arizona (Mr.
Stump) for yielding the time to me.
Mr. Speaker, I want to again, like others, recognize the superb
leadership of the gentleman from Arizona and also to recognize the
gentleman from Illinois (Mr. Gutierrez), the ranking member of the
Subcommittee on Health, and, of course, recognize the gentleman from
Illinois (Mr. Evans), the ranking member of the Committee on Veterans'
Affairs, for all of their efforts in the development of this bill.
Mr. Speaker, this is a good bill for veterans, and it is a good bill
to pass today. It contains provisions that are workable, useful and
innovative. It is a winning combination for the veterans we serve and
for the Department of Veterans Affairs who we are charged with to take
care of our veterans.
After a number of hearings we had on the subcommittee dealing with
site visits and other data collection, I introduced this bill with
bipartisan support, H.R. 5109, the Department of Veterans Affairs
Health Care Personnel Act of the Year 2000. It has 20 cosponsors from
the Democrat side and many from the Republican side. It is bipartisan.
Mr. Speaker, let me just quickly review for my colleagues some of the
key provisions of our bill. Mr. Speaker, about 10 years ago, Congress
created an innovative pay system for the nurses in the VA system with
the locality-based mechanism to produce pay raises that were intended
to address labor market needs and to keep our veterans' nurses
competitive. The idea was that each veteran hospital could act on its
own self-interest and remain competitive locally.
It was intended to be a good reform, and this system initially gave
the VA nurses a big pay raise. Mr. Speaker, VA's recruitment and
retention problem for nurses effectively disappeared for a while with
this reform. But the old saying ``that was then and this is now'' is
true today.
My subcommittee gave special focus during this Congress to the pay
situation of VA nurses, because a lot of them were leaving our system,
what we found was disappointing. We have learned that many VA nurses
had not received any pay increases in their pay since the initial one
from our 1990 legislation. While those first pay increases were, in
many cases, substantial, in the course of time, with inflation and
other Federal employee groups moving ahead, what happened is they fell
behind. So once again VA found itself in a competitive disadvantage,
and some VA nurses were looking for employment options elsewhere.
In my judgment, as chairman of the Subcommittee on Health, it was a
loss that we could not afford; therefore, our bill guarantees VA nurses
the statutory national comparability pay raises given to all the other
Federal employees, Mr. Speaker.
I am not declaring reform to be my enemy. I want to make the earlier
legislation work that we passed in the 101st Congress. In addition to
the guaranteed national pay raise for nurses, the subcommittee crafted
necessary adjustments to the locality survey mechanism to ensure that
data are available when needed and to specify that certain steps be
taken when they are necessary that lead to appropriate salary rate
increases for our VA nurses.
I believe this is the right solution. It is a compromise with our
colleagues on the other side of the aisle but in the end that is what
is best.
Mr. Speaker, the bill also addresses a recommendation of VA's
Quadrennial Pay Report concerning the veterans' dentists, bringing
their pay into better balance with average compensation of hospital-
based dentists in the private sector. This is the first change in 10
years in VA dentists special pay.
Mr. Speaker, I want to thank my colleague, the gentleman from
California (Mr. Filner), for bringing his voice to this important issue
and for continuing to prod us forward on behalf of the VA dentists.
Our bill also authorizes major medical facility constructions in Palo
Alto and Long Beach, California; Miami, Florida with a commensurate
authorization of appropriations money for this construction. Southern
and western States such as these, Mr. Speaker, are areas where we
continue to see rising VA patient-care work loads and demand for
modern, accessible and safe facilities for veterans. These projects
will help ease these burdens.

{time} 1215

This House is making the right choice by authorizing these projects
now.
My friend, the gentleman from Illinois (Mr. Evans), as the ranking
member of the full committee, recently raised the profile of the need
for Congress to reauthorize the landmark 1988 study of post-traumatic
stress disorder in Vietnam veterans. Our bill authorizes this important
study again.
The bill also requires VA to record military service history when VA
physicians and other caregivers take a veteran's health history. This
will aid any veteran who files a VA claim for disability, especially
given our new appreciation that military and combat exposure may, may
be associated with onset of disease later in life. I want to commend
the veterans, the Vietnam veterans of America, for bringing this
proposal to us. It is valuable. It is a valuable contribution to this
bill.
Lastly, Mr. Speaker, our bill contains a very good approach, crafted
by my good friend and colleague, the gentleman from Florida (Mr.
Weldon). The gentleman from Florida (Mr.

[[Page H7959]]

Weldon) has no VA hospital in his district; nor do I. We believe that
in such a situation, when a veteran who is under VA care in a VA
community-based clinic remote from a VA hospital, needs brief inpatient
hospitalization, that he or she should be able to obtain this vital
service closer to home. It is not any different for a veteran in this
regard than it is for a nonveteran.
Can anyone in this Chamber say he or she would relish the thought of
leaving their family and friends and traveling hundreds of miles for a
hospital admission at a distant hospital while bypassing community
hospitals closer to home?
While working with our colleagues across the aisle, our bill sets up
a pilot program involving not more than four small VA clinic service
areas. Within these areas, enrolled veterans in need of uncomplicated
general hospital admissions would be referred to community hospitals
rather than being sent to distant VA facilities. VA would serve as a
coordinator of benefits to ensure that costs are covered by available
private and public coverage held by most veterans who use the VA. VA
will ensure that the care is delivered efficiently and with due regard
to these veterans' needs.
On discharge from these short hospital stays, these veterans would
continue under VA care just as before. It is a voluntary program, Mr.
Speaker, a time-limited test, capped for expenditures, intended to test
the premise of providing a more convenient alternative to veterans than
traveling hundred of miles to seek inpatient care in large, urban VA
hospitals.
Mr. Speaker, a previous small scale experiment similar to this
proposal in one VA clinic was a smashing success, with a 98 percent
patient satisfaction rate and was found to have saved between 15 and 28
percent of the costs that would have been paid by taxpayers had these
patients traveled to a faraway veterans hospital for their admissions.
Importantly, the VA facility in Florida suffered no impact on their
patient care workloads because of this local experiment. So, Mr.
Speaker, this is a good idea.
Mr. Speaker, this is a synopsis of our key provisions of H.R. 5109. I
ask all of my colleagues to support this bill.
I would like to point out that we have a number of organizations that
have supported this. The American Legion, the Veterans of Foreign Wars
of the United States, Vietnam Veterans of America, the Nursing
Organization of Veterans Affairs, the American Dental Association and
the largest union, the American Federation of Government Employees,
among others, have all supported this legislation. So I hope my
colleagues will vote for passage of this in a strong way so that we can
enact this in the 106th Congress and go forward to help our veterans.
Mr. EVANS. Mr. Speaker, I yield 5 minutes to the gentleman from
California (Mr. Filner).
Mr. FILNER. Mr. Speaker, I thank the gentleman from Illinois (Mr.
Evans) for yielding me the time.
Mr. Speaker, I rise in strong support of H.R. 5109. I want to thank
the chairman, the gentleman from Arizona (Mr. Stamp); the ranking
member, the gentleman from Illinois (Mr. Evans); the gentleman from
Florida (Mr. Stearns), the chairman of the Subcommittee on Health; and
the gentleman from Illinois (Mr. Gutierrez), the ranking member of that
subcommittee, for developing a true bipartisan proposal to address some
of the pay inequities that were brought to the attention of our
Committee on Veterans' Affairs.
In response to some of these concerns, I introduced last fall H.R.
2660, which I entitled Put Your Money Where Your Mouth Is, the VA
Dentist Equity Act, in response to a variety of concerns of VA
dentists. This spring, the gentleman from Florida (Mr. Stearns)
conducted a hearing of the Subcommittee on Health where we heard
stirring testimony from dentists who have devoted their careers to the
Department of Veterans Affairs. Members representing the National
Association of VA Physicians and Dentists, the American Dental
Association, the American Association of Oral and Maxillofacial
Surgeons raised concerns about the precipitous decline in recent years
in the number of dentists practicing in the VA, and raised concerns
about VA's ability to recruit new dentists into the system now and in
the future. These concerns are based on the facts that the dental
workforce in VA is rapidly declining. Only 4 years ago, the VA had more
than 900 dentists. Now we have less than 800, and in individual sites
the changes have been even more pronounced.
In testimony to the subcommittee, the National Association of VA
Physicians and Dentists discussed general practice dentists at one
facility in the Northeast dropping from 8 to only 2 positions. Now we
know that almost 70 percent of VA dentists are eligible for retirement
in the next 3 years and that VA dentists are paid less than defense
dentists, dentists in academia or dentists in private practice. In
fact, they make almost one-third less than dentists working in these
settings.
So I am very glad that H.R. 5109 includes many of the provisions that
were in my earlier bill and will include the recruitment and retention
of VA dentists. I want to say for our legislative record that although
there is a range of salaries that are printed for dentists that will
give them some equity with regard to physicians, we hear concerns in
specific medical centers that the top of that range for dentists is
never fully utilized.
I think it is fair to say that our committee expects that the full
range, especially the top range, when eligible, of the salary schedules
that are in H.R. 5109, be utilized by individual medical centers.
Now I do have one disappointment in this bill, that despite a strong
sentiment in the full Committee on Veterans' Affairs to move a
chiropractic health care benefit amendment in this bill, we are
apparently unable to reach an agreement to introduce direct access,
full scope of practice chiropractic care into the VA health care system
in this year. Chiropractic is the fastest growing and second largest
primary health care profession. Chiropractors are a highly trained and
licensed professional health care workforce. It is time to put VA
health care on a par with other government health care programs and
recognize chiropractic as a vital component of our health care system.
In fact, we said that a year ago in our millennium health care bill.
These are technical corrections to that bill. A year ago, we asked
the VA to develop a chiropractic plan within 90 days to give
chiropractic services to our veterans. The VA did not do this. I met
with the Assistant Secretary for health after the 90 days were up, with
various representatives of the National Chiropractic Associations. We
stressed to the Assistant Secretary how important it was to act on
this; and we got, frankly, bureaucratic inertia, bureaucratic
resistance, and literally very little was done by a year later when we
have the corrections for VA on the millennium health care bill.
I know this is not a simple issue, and I know the gentleman from
Florida (Mr. Stearns) is as vitally concerned about this as I am; and
he has promised, as I understand, to have hearings on this issue within
our coming sessions, and I hope that we put a chiropractic health care
provision that is meaningful at the top of our committee's agenda next
year so that our veterans can have direct access to this important
benefit as quickly as possible.
I certainly will be working toward that goal. I look forward to
working with members of the committee. The gentleman from Illinois (Mr.
Evans) has been a strong proponent of chiropractic care. The gentleman
from Indiana (Mr. Buyer) on our committee has also put in a provision
in the defense authorization bill that moves the Defense Department
more toward this. I hope that the Committee on Veterans' Affairs
working with our members and the VA health care division will cooperate
as we move to our full benefits to our veterans.
I thank the chairman of the Subcommittee on Health for this wonderful
bill.
Mr. STUMP. Mr. Speaker, I yield 2 minutes to the gentleman from
Indiana (Mr. Buyer), a member of the committee.
Mr. BUYER. Mr. Speaker, I rise in strong support of the Department of
Veterans Affairs Health Care Personnel Act of 2000. This is great news
for VA employees, especially VA nurses and dentists. More importantly,
it is great

[[Page H7960]]

news for veterans who receive VA medical care.
The bill will help the Department of Veterans Affairs recruit and
retain qualified health care professionals as well as help ensure that
VA hospitals are more fully staffed to meet their demanding health care
needs. I know that in my own congressional district, the Fifth District
of Indiana, VA employees have repeatedly raised the issue of pay parity
so that they receive compatible pay, pay increases and special rates of
pay to that of other Federal employees. I agree that it is only fair.
Last year, the Marion VA Chapter, the American Federation of
Government Employees Local 1020 contacted my office seeking the pay
parity for VA nurses. In addition, the Local 1020 asked the committee
for relief in helping them to better address manning and staffing
levels that were creating patient and employee safety issues due to
lack of adequate nursing staff. To that end, I want to thank the
Committee on Veterans' Affairs chairman, the gentleman from Arizona
(Mr. Stump), and the subcommittee chairman, the gentleman from Alabama
(Mr. Everett), for their decision to hold field hearings in June at the
Marion VA.
The committee's findings were indeed a revelation. It became quite
clear to me and to the Department of Veterans Affairs that the Marion
and Fort Wayne facilities had severe nurses shortfalls. It was evident
that to ensure the highest quality of care for our veterans, an effort
to meet these shortfalls would be required.
In fact, 68 positions were then immediately identified as needed to
be filled. $6.5 million was placed into the budget's shortfall of this
year alone, and I thank the gentleman from Arizona (Mr. Stump) for that
effort.
In addition, the director of the Northern Indiana Health Care System
requested a staffing survey which identified the need for another 20
positions, so now we are up to 88 positions.
Last week, prior to the Committee on Veterans' Affairs reporting this
bill to the House floor, Local 1020 indicated their support for H.R.
5109 and reiterated the need for nurse pay parity.
I will throw out there to the gentleman from Florida (Mr. Stearns)
what I have been told by the nursing profession that 50 percent of the
nurses are expected to retire in the next 15 years. When we look at our
education institutions in our country and we maximize them to 100
percent at the present rate of graduation, we fall very short of what
the need and requirements are in front of us. So given the whole supply
and demand, this bill, while we are singing its praises, is really one
of those leaps forward; and we still have work yet to do.
Mr. EVANS. Mr. Speaker, I yield 5 minutes to the gentlewoman from
California (Mrs. Capps).
Mrs. CAPPS. Mr. Speaker, I thank the gentleman from Illinois (Mr.
Evans) for yielding me time.
Mr. Speaker, I am pleased to rise in strong support of H.R. 5109, the
Department of Veterans Affairs Health Care Personnel Act.
I want to take this opportunity to thank the gentleman from Arizona
(Mr. Stump) and the ranking member, the gentleman from Illinois (Mr.
Evans) for all their hard work on this legislation. Their unflagging
commitment to our Nation's veterans is truly laudable. This bill will
significantly improve veterans' access to health care. It will also
provide much-needed raises for VA nurses and other health care
professionals. As a nurse, I am particularly proud that this
legislation will secure pay raises for 30,000 VA nurses. These
registered nurses care for sick veterans day in and day out, and they
deserve raises on a par with other Federal employees.
H.R. 5109 will also allow for greater nurse participation in policy
and decision-making at the Veterans Administration health centers, and
it would revise the pay rates for VA dentists and pharmacists. These
are measures which will address the difficulties the VA has experienced
in recruiting and retaining nurses and other health care personnel.
Now I want to highlight a particular provision that is included in
this bill, and it is one that my colleague, the gentleman from Florida
(Mr. Weldon) and I have worked very hard to secure. I am very pleased
that the Veterans Service Improvement Act is part of this bill, and I
want to thank the gentleman from Cape Canaveral for his outstanding
leadership on this issue. This is an important bipartisan provision
which will authorize multiple pilot projects to allow the VA to
contract with local hospitals to provide care for veterans.
Now what does this mean for vets?

{time} 1230

Right now, for example, the veterans in my district on the central
coast of California have to drive all the way to Los Angeles or to
Fresno for hospital care under the VA. That means for my veterans
driving 2\1/2\ to 5 hours just to check into a hospital. This is a
definite hardship for aging veterans and for their families, the
transportation involved and the sometimes inconvenience and real
hardship that it puts families under.
With this pilot project, veterans could check in with their local VA
clinic and then get referred to a nearby hospital. This would allow
vets to receive care close by to their friends and their family.
The legislation also allows for the coordination of benefits. For
example, veterans who use Medicare for care at a local hospital are
currently paying a 20 percent copayment; and under these pilot
projects, that copayment would be partially or totally covered by the
Veterans' Administration. This is a benefit all veterans deserve,
particularly those who are ill or disabled.
This proposal is designed to expand the successful VA pilot program
operated in Florida last year. As we have heard, over 1,000 veterans
chose to participate in this program, and 98 percent of them said they
would recommend it to other vets. In addition, the preliminary results
show that this program provided a significant cost savings to the VA,
and that is a benefit which we should not ignore.
Mr. Speaker, H.R. 5109 gives veterans more health care choices and
provides more convenient options for their care. The veterans service
improvement act is a pilot project; and I want to stress that as a
pilot project, it will be carefully studied to see what the results
are. It is not intended to undermine the Veterans' Administration
specialized hospital care in any way. Rather, I believe it could
demonstrate to augment it.
So, Mr. Speaker, I am pleased that this important legislation will
pass through the House today, and I hope to see it signed into law very
soon. The brave men and women who have sacrificed so much for our
country deserve nothing less.
Mr. STUMP. Mr. Speaker, I yield 3 minutes to the gentleman from New
Jersey (Mr. Smith), the vice chairman of the committee.
(Mr. SMITH of New Jersey asked and was given permission to revise and
extend his remarks.)
Mr. SMITH of New Jersey. Mr. Speaker, I rise in very strong support
of H.R. 5109, a bill affecting very positively health care personnel
and formulating a pilot system for coordination of services between the
VA and non-VA health care facilities.
I would like to thank at the outset the gentleman from Arizona (Mr.
Stump), the good and very able and very distinguished chairman of the
full committee, for his leadership on this. He is indefatigable in his
efforts to help and enhance veterans benefits. I have been on this
committee for 20 years, and it has always been a real joy to watch him
in action; and I want to thank him for his leadership. Also I want to
thank the gentleman from Florida (Mr. Stearns), the chairman of the
subcommittee, who has done yeoman's work on this legislation and the
Millennium Act and other important bills; and the gentleman from
Illinois (Mr. Evans), my good friend, for his good bipartisanship and
very strong commitment to our veterans and for his work on this bill as
well.
In summary, the bill not only updates pay to nurses, but adjusts the
mechanism for making nurses' pay more responsive to today's market
realities, increases rates of special pay to dentists, increases the
salary rates to our pharmacists, and designates a physician's assistant
to serve as a consultant to the Undersecretary of Veterans'
Administration.
As a cutting edge initiative, it establishes pilot programs to allow
veterans

[[Page H7961]]

dependent upon medical services to be seen in facilities in much
greater proximity to the veteran's home. We all know, as my good friend
just said a moment ago, very often, the very long trips that members of
our veterans' communities have to make to get to a hospital, I hear
about it over and over again in my own district, and then there is
always that legendary wait once you get there to get that service
sometimes becomes a disincentive for our veterans to utilize the
system. So, it is very important that we see if this experiment works
and if it does, then perhaps roll it out even more.
Again, I want to congratulate my colleagues on an excellent,
outstanding bill that should get the unanimous support of my
colleagues.
I rise today in support of H.R. 5109 a veterans bill affecting
Healthcare Personel formulating a pilot system for coordination of
services between VA and Non-VA Healthcare facilities.
In summary, this bill not only updates pay to nurses but adjusts the
mechanism for making nurses pay more responsive to today's market
realities, increases rate of special pay to dentists, increases salary
rates to pharmacist, and designates a physicians assistant to serve as
a consultant to the Under Secretary of Veterans Administration. As a
cutting edge initiative, it establishes pilot programs to allow
veterans dependant upon medical services to be seen in facilities of
much greater proximity to the veteran's home.
There is a general agreement that there is a nation-wide nursing
shortage. In addition, the VA has experienced significant nurse
retention problems. Appropriate and timely pay increases must be
provided as part of a satisfactory work environment. This bill
addresses this concern in several ways. First, it authorizes national
comparability pay raise for VA nurses on par with that of other federal
employees. Second, it makes optional annual locality survey process for
VA nurse pay. Third, it eliminates facility directors as the sole
discretionary authority to make pay increases and introduces an
automatic mechanism. This will stimulate more timely raises for nurses
at VA hospitals. These provisions added together, are designed to make
the VA more responsive to the economic needs of nurses and will
increase their retention.

pay for dentists and pharmacists

The bill revises and increases the rates of special pay which is
provided to dentists employed by the Veterans Health Administration and
is long over due. It eliminates the salary cap on pharmacists.

physician assistant as consultant

The VA employs some 1,200 PA's as the nation's largest employer of
PA's in the past 30 years. But amazingly the VA does not have a PA
representative to advise the Administration on the optimal usage of
PA's. This bill designates a Physician's Assistant to serve as a
consultant to the Under Secretary which will greatly improve
understanding and utilization of the PA's by the Veterans
Administration.

pilot program on coordinating benefits

There appear to be many veterans in all areas of the country who
while in need of medical services, must travel a good distance for
care. In some cases this is 100 miles or more round trip. This is
accomplished often at considerable inconvenience to the patient and to
the family of the loved one who must provide transportation to and from
VA hospitals. Add that to the legendary wait. This bill sets up a 4
site pilot program coordinating healthcare benefits between VA and non-
VA health care facilities. Following up on a previously successful
program in Florida, this pilot program will see if coordinated and
contracted care would be satisfactory to the veteran and a cost saving
gain to the Veterans Administration.
Let me emphasize that this is a program which is totally voluntary.
No veteran who feels uncomfortable participating in the program is
forced to do so. This is not intended to replace the parent program
which has served veterans so well in the past.
Mr. EVANS. Mr. Speaker, I yield 3 minutes to the gentlewoman from
California (Ms. Millender-McDonald).
Ms. MILLENDER-MCDONALD. Mr. Speaker, let me first thank the chairman
and the ranking member for their leadership on this great piece of
legislation.
I rise today in strong support of the Department of Veterans Affairs
Health Care Personnel Act. As a representative of the 37th
Congressional District in California, I represent parts of the Long
Beach area, so I am particularly supportive of this bill, since it will
help many of my constituents.
There are approximately 24.4 million veterans in America, 552,800 of
whom are in Los Angeles alone, and 28,900 of whom live in the 37th
Congressional District. The number of veterans has declined over the
years, but the average age of America's veterans has increased. The
median age of veterans is 58 years, and 36 percent are over 65 years of
age. This means the services provided at veterans' health care
facilities throughout the country are even more important to our
veterans, now more than ever before.
Mr. Speaker, this legislation authorizes important construction
projects primarily at VA medical facilities to help veterans who have
reached an age where the need for safe, accessible medical care is
critical. In particular, it authorizes the construction of the VA
Medical Center in Long Beach which is located on major fault lines that
have yielded earthquakes which have caused severe damage to the area
over the years. This construction project will correct life safety and
functional space deficiencies and ensure that veterans receive the
health care they need in a safe environment.
The Department of Veterans Affairs Health Care Personnel Act also
improves the pay of nurses, dentists and other health care
professionals employed by the Department of Veterans Affairs which
ensures that those who serve our veterans are adequately compensated.
In addition, it establishes a pilot project that will allow four
sites to provide inpatient hospital care to veterans in their own
communities. The bill also contains a provision that would increase the
availability of accommodations at VA medical facilities for veterans
and their families who need to travel great distances and stay
overnight when obtaining VA medical services.
Mr. Speaker, all of these measures will significantly impact the
lives of veterans and their families; and, therefore, Mr. Speaker, I
urge my colleagues to join me in voting for the Department of Veterans
Affairs Health Care Personnel Act. It is a great piece of legislation.
Mr. STUMP. Mr. Speaker, I yield 3 minutes to the gentlewoman from New
York (Mrs. Kelly).
Mrs. KELLY. Mr. Speaker, I rise today in support of H.R. 5109, the
Department of Veterans Affairs Health Care Personnel Act of 2000, with
one reservation. It is a good bill. The committee has worked hard on
it, and my colleagues should be commended for it.
Mr. Speaker, H.R. 5109 corrects a real problem with the pay increases
of VA nurses. While the current system of salary adjustments for VA
nurses does not allow salary decreases, the current system does allow
for the salary to be frozen for a number of years. With inflation, this
is tantamount to a cut in salary, with VA nurses having to spend more
of their salary each year on the increasing cost of living. This
includes the yearly increases that Federal employees must pay on their
health care premiums.
In the lower New York area, we have one of the highest costs of
living in the Nation. The struggle of our dedicated nurses to raise a
family and save for the future is a daily challenge. At the very least,
we have to ensure that all VA personnel salary is adjusted for
inflation, and this good legislation corrects a grave injustice that
has denied nurses pay raises that virtually all Federal workers are
given on a yearly basis. This portion of the legislation has my strong
support.
Unfortunately, section 401 of the legislation concerns me and
colleagues I have spoken with, and that is the section that is
entitled, Coordination of Hospitals Benefits Program. It would create a
pilot voucher-like program in four geographic areas. The section would
authorize the VA to cover a veteran's cost of inpatient care at non-VA
facilities. The VA would thus become a secondary insurance for any out-
of-pocket expenses of veterans with insurance, including Medicare, when
veterans seek inpatient services in private sector hospitals.
It is a good idea, but right now the VA can and does contract with
non-VA hospitals to treat veterans for their service-connected
conditions. The premise of this pilot gives veterans a financial
incentive to go to non-VA facilities for their inpatient care. It
establishes an entirely new eligibility category for veterans care
based not on the veteran's status or need, but purely on the veteran's
geographic location, and to a great extent, the veteran's

[[Page H7962]]

own health insurance. It could create real problems.
First, it creates a disparity between health care available to
veterans who choose to use the VA health care facilities and those
primarily with their own insurance who have previously chosen not to
use VA facilities. Second, it sets a precedent for sending veterans to
non-VA providers for inpatient services that are paid by veterans'
insurance. The VA would now subsidize care outside the system, losing
both the direct and appropriated dollars on any third-party
reimbursements. This worries me.
If this precedent is set and expanded, the VA health care facilities
would only become local referral centers without the resources to
sustain a full range of care, including the acute beds and specialized
services such as spinal cord injury care and substance abuse treatment
for which it is well known. The VA would not really have the control to
manage a veteran's case once referred because it would be a secondary
payer, not the provider of care.
It is my hope this section could be removed or greatly modified
before the legislation comes back to the House.
Mr. EVANS. Mr. Speaker, I yield the balance of my time to the
gentleman from Arizona (Mr. Stump), the chairman of the committee.
Mr. STUMP. Mr. Speaker, I thank the gentleman for yielding us this
time, and I yield 3 minutes to the gentleman from Ohio (Mr.
LaTourette).
(Mr. LaTOURETTE asked and was given permission to revise and extend
his remarks.)
Mr. LaTOURETTE. Mr. Speaker, I rise today in support of H.R. 5109.
Mr. Speaker, today is a great day and a wonderful day for the 39,000
VA nurses who care for our Nation's ailing veterans, and I want to
thank the gentleman from Arizona (Mr. Stump), the gentleman from
Florida (Mr. Stearns), the gentleman from Illinois (Mr. Evans), and the
gentleman from Illinois (Mr. Gutierrez) for making this day possible.
In May of last year, I joined with a number of colleagues to
introduce legislation called the VA Nurse Appreciation Act. The premise
of the legislation was simple, to guarantee that VA nurses get the same
annual raise as virtually every other Federal worker; no more, no less,
just pay parity. It seems impossible to fathom, but for much of the
last decade, VA nurses across the country have been getting short
shrift when it comes to Federal pay raises.
When the Nurse Pay Act was passed about a decade ago, it did exactly
what it was supposed to do. It allowed the VA to dramatically increase
nurse pay so that salaries were comparable with the private sector.
That law, so well intended and fully supported by the Congress,
eliminated a dire nursing shortage and restored stability to VA
hospitals across the country.
Sadly, when budgets became tight, VA medical center directors began
using the broad discretion of the law provided in a way that the
Congress never intended. Local pay surveys designed to document the
need for higher raises than the GS increases were suddenly turned into
a tool to withhold raises or award absurdly low raises.
Mr. Speaker, it is no walk in the park being a nurse at a Veterans'
Administration facility. The hours are long, the job is stressful, and
the veterans can be very sick with a whole host of medical conditions
not normally seen in other hospitals. But the women and men who have
devoted their careers to caring for our Nation's heroes are a dedicated
lot. Despite years of meager annual raises or no raise at all, these
39,000 VA nurses did not turn their backs on our veterans or even think
of withholding care.
Mr. Speaker, we are now enjoying the greatest economic prosperity in
a generation and unheralded budget surpluses; yet we still have VA
nurses out there who received no annual pay raise for 2, 3, 4, or, in
some cases, 5 consecutive years. It is a miracle that more nurses have
not abandoned the VA.
This legislation, H.R. 5109, is a wonderful step in correcting that
inequity, and I again commend the chairman of the committee and the
ranking member, the chairman of the subcommittee and the ranking member
of the subcommittee. I am most appreciative of their interest in the
issue and their willingness to correct this injustice. Special thanks
are also due to the AFGE, which has worked tirelessly to make this day
possible, together with the ANA and NOVA.
This change in law cannot come soon enough either. All evidence
points to a looming and critical shortage of nurses. Right now the
average VA nurse is 47 years old, about 5 years older than the national
average. We do not attract new nurses with a promise of no annual
increase.
Mr. Speaker, this has been a long, hard fight. This is a good bill
with many wonderful provisions. I again want to thank the gentleman
from Arizona (Mr. Stump) and the gentleman from Florida (Mr. Stearns)
for correcting an inequity. I urge my colleagues to support the bill.
Mr. STUMP. Mr. Speaker, I yield 4 minutes to the gentleman from
California (Mr. Horn).
(Mr. HORN asked and was given permission to revise and extend his
remarks.)
Mr. HORN. Mr. Speaker, I rise today in strong support of H.R. 5109. I
praise the gentleman from Arizona (Mr. Stump) and his colleagues in
both parties who have brought this fine piece of legislation to the
House, the Veterans Affairs Health Care Personnel Act of 2000.

{time} 1245

Not only will this bill improve pay and help retain qualified nurses
at the VA medical facilities, a provision that will significantly help
nurses at the VA Medical Center Long Beach in my district and one that
I have long been a supporter of in this House, it also authorizes $51.7
million for seismic corrections at the VA Medical Center Long Beach.
Providing a broad range of inpatient, outpatient and home care
services for veterans throughout Southern California, the VA Medical
Center Long Beach has long been recognized for the integral role it
plays in Southern California's health care system. The Long Beach
Center has also achieved national prominence in the field of spinal
cord injury and the rehabilitation of paraplegic and quadriplegic
patients.
Ranked second on the VA priority list, this project is essential to
provide a safe environment for the 35,000 veteran patients served at
the Long Beach VA and the 2,300 employees that work there. The four
buildings included in this project house direct patient care functions
and support activities that are crucial to meeting the organization's
mission and goals.
These buildings are all seismically deficient and in need of
upgrading. The United States Geological Survey studies have shown that
the fault lines in the Southern California region run directly through
the medical center. These major fault lines have yielded earthquakes of
significant magnitude and caused severe damage over the years,
compromising the patient care mission of the Long Beach Veterans
Administration Medical Center.
The demolition of these seismically compromised and deteriorating
buildings with the replacement of one newly constructed building with
modern and efficient space is crucial in order to provide safety for
patients, visitors and staff. It is also the most cost-effective
option.
This bill is a fitting tribute to those who have served our Nation
with courage and commitment and is the next step in fulfilling our
continuing obligation to our Nation's veterans.
I urge all Members of this House to support this very important
legislation.
Mr. STUMP. Mr. Speaker, I yield such time as he may consume to the
gentleman from Florida (Mr. Weldon).
Mr. WELDON of Florida. Mr. Speaker, I want to thank the gentleman
from Arizona (Chairman Stump) for his courage and commitment in moving
this bill forward. I want to particularly commend him for including the
language in section 401 that deals with the establishment of a new
pilot program that will allow the coordination of payments of benefits.
This was the thrust of legislation, H.R. 4575, introduced earlier by
the gentlewoman from California (Mrs. Capps) and myself. She has the
same challenge I have, a lot of veterans in her congressional district
that are served only by a clinic and not a full-service hospital. Her
assistance has been critical in moving this initiative forward.

[[Page H7963]]

I also want to thank the gentleman from Florida (Mr. McCollum) and
the gentleman from Florida (Mr. Stearns) who have worked with me on
this issue for 4 years, and, of course, the gentleman from Illinois
(Mr. Evans), ranking member, who has been very gracious.
He had a very lengthy meeting with me and the gentlewoman from
California (Mrs. Capps) earlier in August to try to work with us on
moving forward on this issue.
I also want to mention the gentleman from Illinois (Mr. Gutierrez)
who has offered his support for this provision and, of course, the
Republican and Democratic staff on the committee who have worked very,
very hard.
My experience on this issue comes from my background, not only as a
veteran, the son of a World War II combat-wounded Purple Heart veteran,
but as well as a physician who did part of his training in a VA
hospital; and, indeed, I continue to volunteer some of my time at the
Veterans Health Care Clinic in my congressional district. So I think I
can come to this debate with a little bit of perspective.
The veterans want three things. They want access, access, access.
They want access to quality care. They want access to specialty care.
They want access to care that is close to home. They do not want to be
told to pack their bags, to travel across the State, or, worse, to
travel to another State to get their health care.
Now, we have operated a pilot program in my congressional district
for the last several years. More than 1,000 veterans have received care
under this program. Did they like it? Ninety-eight percent said they
liked it a lot and would recommend it to a friend. Did it cost more
money? No. Actually, it saved the Veterans Administration 15 to 20
percent over cost being provided in a veterans hospital.
When it was stopped by the Veterans Administration in September of
last year, the veterans in my congressional district demanded that it
be restarted, and it was in July of this year. However, the Veterans
Administration excluded veterans over 65 because they are covered by
Medicare.
Now, I would like to read a letter that was sent to me by the wife of
a veteran, Mrs. Gay Tatro. She wrote: ``My husband was probably one of
the first'' veterans ``in the County admitted to the hospital on the
Pilot Program in May 1998 and one of the last in September 1999. Both
times, plus a couple of hospitalizations in between, he would have been
sent to Tampa.'' Now, Tampa is clean across the State. It is a 3-hour
drive from my congressional district.
She goes on to say: ``This would have created a substantial hardship
both financially and emotionally. In this last hospitalization, the
doctors were talking about amputating part of his foot. To have to go
to Tampa and deal with this type of trauma by himself would have been
unthinkable. The alternative: I would have to stay out of work plus pay
for accommodations in Tampa to be near him.''
Section 401 of this bill establishes a new pilot program that would
allow the coordination of benefits. It would allow it to be established
in three additional sites. There are many underserved areas in this
country. Brownsville, Texas; Santa Barbara, California and many others
where veterans have to travel hours.
Now, there have been some people, including some we have heard today,
who have raised some concerns about this provision of the bill. They
seem to center on two things. The first one is that it moves the
Veterans Administration away from the business of providing care to one
of ensuring care.
To the veterans in my congressional district and those in other
underserved areas, I can tell my colleagues they do not care. They want
to get quality health care close to home, and these kinds of debates
are irrelevant to them. They are certainly irrelevant to the Tatros.
They want quality health care close to home.
The other issue that they bring up is that resources could be drained
from existing facilities that are currently providing care. This
reminds me of, in many ways, FDR's old speech: ``The only thing you
have to fear is fear itself.'' I cannot imagine a situation where the
chairman, the ranking member would allow services to be drained to
provide for care for those veterans and underserved areas, drained from
one area to another. The issue here is making sure our veterans get the
quality health care they need.
What is clear is the status quo is unacceptable. The status quo is a
two-tiered system, Mr. Speaker, a system where we have two kinds of
veterans, those who live close to a facility and those who live far
away and have to travel.
What we are trying to do in this provision is address the needs of
those so they do not have to travel; and for those who live close to a
facility, to turn to those veterans who live far away and say, no, no,
no, we do not want to provide health care to you close to home, because
it might affect my health care where I get my care close to the
hospital is unacceptable.
This is the richest country in the world. This is the most powerful
country in the world. We can take care of both groups, and this bill
provides for that.
I encourage all my colleagues to not succumb to the arguments of the
theoretical or to succumb to the arguments of fear, but support this
provision, support this legislation.
Mr. Speaker, I am very, very happy to yield to the gentleman from
Florida (Mr. Stearns).
Mr. STEARNS. Mr. Speaker, I just want to commend the gentleman from
Florida (Mr. Weldon) for what he is doing and point out to my
colleagues this program maximum is a $50 million pilot program. This is
on a $49 billion budget for veterans, which is the second largest
appropriations of money. The only one larger is the Department of
Defense. So this might be, I do not know if the fractions are right,
but this is one-one thousandths of a percent that is going for a very
small program to demonstrate, to see if it is feasible.
So I think that this is a very modest approach, and I commend the
gentleman from Florida (Mr. Weldon) for what he is doing. I certainly
think, as one of his constituents pointed out, this is worth this small
effort to try to serve veterans.
Mr. WELDON of Florida. Mr. Speaker, I would just like to point out
that this provision is endorsed by the VFW and the American Legion. I
believe it is the right thing for us to do for our veterans. We can
provide quality health care to all of our veterans, and that is what we
are trying to do.

General Leave

Mr. STUMP. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days within which to revise and extend their remarks
and include extraneous materials on H.R. 5109, as amended.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Arizona?
There was no objection.
Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume.
(Mr. STUMP asked and was given permission to revise and extend his
remarks.)
Mr. STUMP. Mr. Speaker, I want to thank the House leadership on both
sides of this aisle for allowing us to move this bill so quickly today.
I want to especially thank the gentleman from Illinois (Mr. Evans) for
all the hard work and cooperation that he has given us and, once again,
thank him for the time he has generously yielded to our side.
I want to express my appreciation to the gentleman from Florida (Mr.
Stearns), the chairman of the Subcommittee on Health, for all his hard
work, as well as the gentleman from Illinois (Mr. Gutierrez), ranking
member, also the gentleman from Florida (Mr. Weldon) for all the work
he has done, the gentleman from Ohio (Mr. LaTourette) and the gentleman
from California (Mr. Horn) for their dedication in serving their
veterans.
I have no further requests for time. I urge all Members to support
the bill.
Mr. JONES of North Carolina. Mr. Speaker, I rise in strong support of
the legislation offered the Chairman and Ranking Members of the
Veterans Affairs Committee. I do not have to remind the Members of this
body that our Nation would not have the prosperity we enjoy if it had
not been for the millions of men and women who signed up to serve in
our nation's armed forces. Their willingness to offer their lives in
the defense of our Nation is the very reason that we enjoy the freedoms
we have today. We owe them a debt of gratitude and

[[Page H7964]]

the legislation before us today is one more innovative way to ensure
that we fulfill that obligation.
I support the legislation for several reasons:
First, I think the proposal to allow rural veterans access to health
through local facilities could dramatically increase access for those
veterans who must travel great distances to receive care.
Second, this legislation recognizes that we must also ensure that we
have the most capable people providing the care that those veterans
have earned.
Third, the bill has the potential to greatly improve the quality of
care our veterans receive by better integrating the providers of that
care into the policy making process.
As our veterans' population continues to age, we must always look
outside the box of existing policies to further improve the care and
support we provide. H.R. 5109 meets that goal and is a bill that needs
to be signed into law. I urge my colleagues to work with me to improve
the quality and access to health care for our Nation's veterans and
pass the Department of Veterans Affairs Health Care Personnel Act of
2000.
Mrs. McCARTHY of New York. Mr. Speaker, I rise today in strong
support of the VA Health Care Personnel Act. This important piece of
legislation improves veterans' access to health care and raises the
salaries of VA nurses and dentists. It's incredibly unfair that VA
nurses are paid less to do the same work as their counterparts in
private hospitals. Under this legislation, VA nurses are guaranteed
annual national pay raises based on pay inequities, instead of nursing
recruitment or retention. This bill also increases the amount of pay to
VA dentists who specialized or take on added responsibilities to help
meet the dental needs of our veterans.
On Long Island, the cost-of-living is well-above the rest of the
country. However, VA nurses travel to understaffed VA hospitals and
care for our veterans at a salary that is unacceptable. As a former
nurse, I understand the commitment and professionalism demanded by this
profession. Unfortunately, VA nurses continue to work at salary level
that does not reflect their commitment to caring for our veterans.
Lastly, this legislation extends a pilot program to four as yet unnamed
geographic areas where Medicare-eligible veterans can go to non-VA
hospitals, at VA expense, if there are no convenient VA hospitals
nearby.
Under the new program, the VA would cover some of the costs of care
at non-VA hospitals for participating veterans whose private or
Medicare plans would pay for most of the share. Too many veterans are
forced to drive several hours to a VA hospital if there is a problem.
This pilot program examines the benefits of allowing Medicare-eligible
veterans to receive treatment at their local hospital. This bill puts
veterans one step closer to the care and benefits they deserve. I urge
my colleagues to support this legislation.
Mr. GILMAN. Mr. Speaker, I rise today in strong support of H.R. 5109,
the Department of Veterans Affairs Health Care Personnel Act of 2000. I
urge my colleagues to join in supporting this timely, appropriate
legislation.
H.R. 5109 is designed to improve the quality and availability of
health care provided by the Department of Veterans Affairs medical
facilities. It was drafted to respond to a number of concerns raised by
VA personnel and veterans alike. I want to commend Chairman Stump and
the other members of the Veterans Committee for their dedication to
this issue, for both listening to our veterans and VA employees, and
for following up on their concerns.
Over the past 2 years, I have heard from many VA nurses and
pharmacists that their working conditions and their pay levels have
contributed to a serious retention problem for these two professions.
H.R. 5109 addresses this problem by making changes to the salary review
system so that facility directors will have to conduct annual reviews
of their nursing turnover and vacancy rates to determine if raises are
warranted. It also stipulates that nursing personnel are to participate
in this process. Moreover, it clarifies that the absence of a retention
problem is not to be a basis for failing to provide a pay increase, and
it prohibits ``negative pay adjustments.''
Regarding specialists, H.R. 5109 increases the rates of special pay
for VA dentists, and adds pharmacists to the occupations that are
exempt from a statutory cap on special salary rates.
This legislation also requires that, when conducting an initial
clinical evaluation of a veteran, the VA identify and document
pertinent military experiences and exposures which may contribute to
the health status of the patient.
Finally, H.R. 5109 authorizes a pilot program involving coordination
of hospital benefits. Under the program, veterans with Medicare or
other coverage who use a nearby VA clinic for care, but reside far from
the nearest VA medical facility, could make a choice to receive care at
a community hospital as a Medicare or other health plan beneficiary
when the VA finds that they need hospital care. The VA clinic would
still coordinate the care, and to ensure that the patient does not
incur additional out-of-pocket costs. The bill provides that VA would
cover co-payments required by an individual veteran's health plan.
This component of the bill is welcome news for those veterans who
reside in rural areas. I look forward to monitoring its progress, and
hope it will be expanded in future years.
Mr. Speaker, H.R. 5109 makes a number of much needed adjustments to
provide our veterans with better health care. For this reason, I
strongly encourage our colleagues to join in supporting its passage.
Mr. RODRIGUEZ. Mr. Speaker, I commend the efforts of the VA Committee
and staff in developing the VA employee pay and VA health care
improvements in this bill. There are many positive elements in this
bill dealing with personnel issues and I am happy to support them. VA
nurses, dentists, physicians assistants, pharmacists, and social
workers play a critical role in the VA health care system. The
amendment to improve chiropractic service in the VA is also necessary
in order to expand the availability of important chiropractic services.
This legislation addresses ever-changing professions within the VA
health care system by improving the salaries and working conditions of
its employees.
I am especially pleased with the sections on mental illness.
Authorizing another study on post-traumatic stress disorder is long
overdue. We have some quality people working on PTSD at the VA and this
provision would bolster that important work. I also welcome the
extension of the Annual Report of the Committee on Mentally Ill
Veterans. We must continue to recognize the special nature of mental
illness in our Nation's veterans and continuing the input from the
committee is necessary for that to occur.
I represent an area with underserved veterans. Many veterans have to
travel more than 200 miles to the nearest VA facility. While I continue
to advocate expanding the brick and mortar VA system where there is a
genuine need, I support the pilot project at coordinating health care
in under-served areas. By limiting the project to four sites and
capping the costs, we have an opportunity to see the viability of this
service without jeopardizing the VA as a unique hospital system. The VA
is not an insurance company, and nothing we do in this bill should show
an intent to re-invent the VA as such. I look forward to working with
my colleagues in the Senate at enacting the provisions of this
legislation this year.
Mr. McGOVERN. Mr. Speaker, I rise today in support of H.R. 5109, the
Department of Veterans Affairs Health Care Personnel Act of 2000. H.R.
5109 is important because it guarantees that nurses, dentists and
pharmacists will receive pay raises that will improve their quality of
life. Nurses at VA hospitals are underpaid and deserve to be paid at
the same rate as those nurses at local, non-governmental hospitals.
It's unconscionable that our veterans should be treated by nurses that
are being paid less than their fellow nurses at other facilities. H.R.
5109 will fix that problem and properly pay these important people.
H.R. 5109 also recognizes the hard work of dentists at these VA
facilities. Dentists who specialize, take on added responsibilities, or
who are stationed at certain facilities will receive increased pay and
also expands retirement benefits for VA dentists. Another provision
exempts VA pharmacists from ceilings on special salary rates. Overall,
H.R. 5109 will improve the quality of life of VA nurses, dentists and
pharmacists. However, I am concerned about the provision that allows
some patients to be treated at non-VA hospital facilities. While I
recognize this provision creates a pilot program in four areas and has
specific requirements for eligibility for participation, I am concerned
that this type of program could lead to the closing of VA hospitals.
Last year, this Congress voted on H.R. 2116, the Veterans' Millennium
Health Care Act. A provision in that bill would have established the
process by which the Veterans Administration could close VA hospitals,
profoundly damaging veterans' access to good quality health care in the
Northeast. Fortunately, the final version of H.R. 2116 did not include
this provision and VA hospitals were not endangered. I believe H.R.
5109 was drafted with the best intentions and that this bill is
designed to improve the quality of life of VA employees and,
consequently, the veterans who receive care at VA facilities. I also
believe this provision was written with the intention of providing the
best care possible to veterans. My concern is that, ultimately, this
provision will force veterans from VA hospitals to private care.
I will vote for H.R. 5109 because, overall, this bill is a good bill.
However, I ask the sponsor and the members of the Committee on Veterans
Affairs to clarify the provision that creates the pilot program to
ensure that it does not decrease the level of care at or, ultimately,
close VA hospitals in the Northeast or across this country.

[[Page H7965]]

Mr. STUMP. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Ryan of Wisconsin). Pursuant to House
Resolution 585, the previous question is ordered on the bill, as
amended.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. STUMP. Mr. Speaker, I object to the vote on the ground that a
quorum is not present and make the point of order that a quorum is not
present.
The SPEAKER pro tempore. Evidently a quorum is not present.
The Sergeant at Arms will notify absent Members.
The vote was taken by electronic device, and there were--yeas 411,
nays 0, not voting 22, as follows:

[Roll No. 486]

YEAS--411

Abercrombie
Ackerman
Aderholt
Allen
Andrews
Archer
Armey
Baca
Bachus
Baird
Baker
Baldacci
Baldwin
Ballenger
Barcia
Barr
Barrett (NE)
Barrett (WI)
Bartlett
Barton
Bass
Becerra
Bentsen
Bereuter
Berkley
Berman
Berry
Biggert
Bilbray
Bilirakis
Bishop
Blagojevich
Bliley
Blumenauer
Blunt
Boehlert
Boehner
Bonilla
Bonior
Bono
Borski
Boswell
Boucher
Boyd
Brady (PA)
Brady (TX)
Brown (FL)
Brown (OH)
Bryant
Burr
Buyer
Callahan
Calvert
Camp
Canady
Cannon
Capps
Capuano
Cardin
Carson
Castle
Chabot
Chambliss
Chenoweth-Hage
Clayton
Clement
Clyburn
Coble
Coburn
Collins
Combest
Condit
Conyers
Cook
Cooksey
Costello
Cox
Coyne
Cramer
Crane
Crowley
Cubin
Cummings
Cunningham
Davis (FL)
Davis (IL)
Davis (VA)
Deal
DeFazio
DeGette
Delahunt
DeLauro
DeLay
DeMint
Dickey
Dicks
Dingell
Dixon
Doggett
Doolittle
Doyle
Dreier
Duncan
Dunn
Edwards
Ehlers
Ehrlich
Emerson
Engel
English
Eshoo
Etheridge
Evans
Everett
Ewing
Farr
Fattah
Filner
Fletcher
Foley
Forbes
Ford
Fossella
Fowler
Frank (MA)
Franks (NJ)
Frelinghuysen
Gallegly
Ganske
Gejdenson
Gekas
Gephardt
Gibbons
Gilchrest
Gillmor
Gilman
Gonzalez
Goode
Goodlatte
Goodling
Gordon
Goss
Granger
Green (TX)
Green (WI)
Greenwood
Gutierrez
Gutknecht
Hall (OH)
Hall (TX)
Hansen
Hastings (WA)
Hayes
Hayworth
Hefley
Herger
Hill (IN)
Hill (MT)
Hilleary
Hilliard
Hinchey
Hinojosa
Hobson
Hoeffel
Hoekstra
Holden
Holt
Hooley
Horn
Hostettler
Houghton
Hoyer
Hulshof
Hunter
Hyde
Inslee
Isakson
Istook
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Jenkins
John
Johnson (CT)
Johnson, E. B.
Johnson, Sam
Jones (NC)
Jones (OH)
Kanjorski
Kaptur
Kasich
Kelly
Kennedy
Kildee
Kilpatrick
Kind (WI)
King (NY)
Kingston
Kleczka
Knollenberg
Kolbe
Kucinich
Kuykendall
LaFalce
LaHood
Lampson
Lantos
Largent
Larson
Latham
LaTourette
Leach
Lee
Levin
Lewis (CA)
Lewis (GA)
Lewis (KY)
Linder
Lipinski
LoBiondo
Lofgren
Lowey
Lucas (KY)
Lucas (OK)
Luther
Maloney (CT)
Maloney (NY)
Manzullo
Markey
Martinez
Mascara
Matsui
McCarthy (MO)
McCarthy (NY)
McCrery
McDermott
McGovern
McHugh
McIntyre
McKeon
McKinney
McNulty
Meehan
Meek (FL)
Meeks (NY)
Menendez
Mica
Millender-McDonald
Miller (FL)
Miller, Gary
Miller, George
Minge
Mink
Moakley
Mollohan
Moore
Moran (KS)
Moran (VA)
Morella
Murtha
Myrick
Nadler
Napolitano
Neal
Nethercutt
Ney
Northup
Norwood
Nussle
Oberstar
Obey
Olver
Ortiz
Ose
Owens
Oxley
Packard
Pallone
Pascrell
Pastor
Paul
Payne
Pease
Pelosi
Peterson (MN)
Peterson (PA)
Petri
Phelps
Pickering
Pickett
Pitts
Pombo
Pomeroy
Porter
Portman
Price (NC)
Pryce (OH)
Quinn
Radanovich
Rahall
Ramstad
Rangel
Regula
Reynolds
Riley
Rivers
Rodriguez
Roemer
Rogan
Rogers
Rohrabacher
Rothman
Roukema
Roybal-Allard
Royce
Rush
Ryan (WI)
Ryun (KS)
Sabo
Salmon
Sanchez
Sanders
Sandlin
Sanford
Sawyer
Saxton
Scarborough
Schaffer
Schakowsky
Scott
Sensenbrenner
Serrano
Sessions
Shadegg
Shaw
Shays
Sherman
Sherwood
Shimkus
Shows
Shuster
Simpson
Sisisky
Skeen
Skelton
Slaughter
Smith (MI)
Smith (NJ)
Smith (TX)
Smith (WA)
Snyder
Souder
Spence
Spratt
Stabenow
Stark
Stearns
Stenholm
Strickland
Stump
Stupak
Sununu
Sweeney
Talent
Tancredo
Tanner
Tauscher
Tauzin
Taylor (MS)
Taylor (NC)
Terry
Thomas
Thompson (CA)
Thompson (MS)
Thornberry
Thune
Thurman
Tiahrt
Tierney
Toomey
Towns
Traficant
Turner
Udall (CO)
Udall (NM)
Upton
Velazquez
Visclosky
Vitter
Walden
Walsh
Wamp
Waters
Watkins
Watt (NC)
Watts (OK)
Weiner
Weldon (FL)
Weldon (PA)
Weller
Weygand
Whitfield
Wicker
Wilson
Wise
Wolf
Woolsey
Wu
Wynn
Young (AK)
Young (FL)

NOT VOTING--22

Burton
Campbell
Clay
Danner
Deutsch
Diaz-Balart
Dooley
Frost
Graham
Hastings (FL)
Hutchinson
Klink
Lazio
McCollum
McInnis
McIntosh
Metcalf
Reyes
Ros-Lehtinen
Vento
Waxman
Wexler

{time} 1321

Mrs. NAPOLITANO changed her vote from ``nay'' to ``yea.''
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
Stated for:
Mr. DEUTSCH. Mr. Speaker, I was unavoidably absent from the Chamber
today during rollcall vote No. 486, the vote on final passage of H.R.
5109, the Department of Veterans Affairs Health Care Personnel Act. Had
I been present, I would have voted ``yea'' on rollcall vote No. 486.
Mr. DIAZ-BALART. Mr. Speaker, on rollcall No. 486, the Department of
Veterans Affairs Health Care Personnel Act, I was unavoidably detained.
Had I been present, I would have voted ``aye.''

____________________