[Congressional Record Volume 147, Number 171 (Tuesday, December 11, 2001)]
[House]
[Pages H9217-H9225]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROGRAMS ENHANCEMENT ACT OF 
                                  2001

  Mr. SMITH of New Jersey. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 3447) to amend title 38, United States Code, to 
enhance the authority of the Secretary of Veterans Affairs to recruit 
and retain qualified nurses for the Veterans Health Administration, to 
provide an additional basis for establishing the inability of veterans 
to defray expenses of necessary medical care, to enhance certain health 
care programs of the Department of Veterans Affairs, and for other 
purposes.
  The Clerk read as follows:

                               H.R. 3447

       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 Programs Enhancement Act of 
     2001''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.

  TITLE I--ENHANCEMENT OF NURSE RECRUITMENT AND RETENTION AUTHORITIES

                  Subtitle A--Recruitment Authorities

Sec. 101. Enhancement of employee incentive scholarship program.
Sec. 102. Enhancement of education debt reduction program.
Sec. 103. Report on requests for waivers of pay reductions for 
              reemployed annuitants to fill nurse positions.

                   Subtitle B--Retention Authorities

Sec. 121. Additional pay for Saturday tours of duty for additional 
              health care professionals in the Veterans Health 
              Administration.
Sec. 122. Unused sick leave included in annuity computation of 
              registered nurses within the Veterans Health 
              Administration.
Sec. 123. Evaluation of Department of Veterans Affairs nurse managed 
              clinics.
Sec. 124. Staffing levels for operations of medical facilities.
Sec. 125. Annual report on use of authorities to enhance retention of 
              experienced nurses.
Sec. 126. Report on mandatory overtime for nurses and nursing 
              assistants in Department of Veterans Affairs facilities.

                     Subtitle C--Other Authorities

Sec. 131. Organizational responsibility of the Director of the Nursing 
              Service.
Sec. 132. Computation of annuity for part-time service performed by 
              certain health-care professionals before April 7, 1986.

[[Page H9218]]

Sec. 133. Modification of nurse locality pay authorities.

             Subtitle D--National Commission on VA Nursing

Sec. 141. Establishment of Commission.
Sec. 142. Duties of Commission.
Sec. 143. Reports.
Sec. 144. Powers.
Sec. 145. Personnel matters.
Sec. 146. Termination of Commission.

                        TITLE II--OTHER MATTERS

Sec. 201. Authority for Secretary of Veterans Affairs to provide 
              service dogs for veterans with certain disabilities.
Sec. 202. Management of health care for certain low-income veterans.
Sec. 203. Maintenance of capacity for specialized treatment and 
              rehabilitative needs of disabled veterans.
Sec. 204. Program for provision of chiropractic care and services to 
              veterans.
Sec. 205. Funds for field offices of the Office of Research Compliance 
              and Assurance.
Sec. 206. Major medical facility construction.
Sec. 207. Sense of Congress on special telephone services for veterans.
Sec. 208. Recodification of bereavement counseling authority and 
              certain other health-related authorities.
Sec. 209. Extension of expiring collections authorities.
Sec. 210. Personal emergency response system for veterans with service-
              connected disabilities.
Sec. 211. One-year extension of eligibility for health care of veterans 
              who served in Southwest Asia during the Persian Gulf War.

     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--ENHANCEMENT OF NURSE RECRUITMENT AND RETENTION AUTHORITIES

                  Subtitle A--Recruitment Authorities

     SEC. 101. ENHANCEMENT OF EMPLOYEE INCENTIVE SCHOLARSHIP 
                   PROGRAM.

       (a) Permanent Authority.--(1) Section 7676 is repealed.
       (2) The table of sections at the beginning of chapter 76 is 
     amended by striking the item relating to section 7676.
       (b) Minimum Period of Department Employment for 
     Eligibility.--Section 7672(b) is amended by striking ``2 
     years'' and inserting ``one year''.
       (c) Scholarship Amount.--Subsection (b) of section 7673 is 
     amended--
       (1) in paragraph (1), by striking ``for any 1 year'' and 
     inserting ``for the equivalent of one year of full-time 
     coursework''; and
       (2) by striking paragraph (2) and inserting the following 
     new paragraph (2):
       ``(2) in the case of a participant in the Program who is a 
     part-time student, shall bear the same ratio to the amount 
     that would be paid under paragraph (1) if the participant 
     were a full-time student in the course of education or 
     training being pursued by the participant as the coursework 
     carried by the participant to full-time coursework in that 
     course of education or training.''.
       (d) Limitation on Payment.--Subsection (c) of section 7673 
     is amended to read as follows:
       ``(c) Limitations on Period of Payment.--(1) The maximum 
     number of school years for which a scholarship may be paid 
     under subsection (a) to a participant in the Program shall be 
     six school years.
       ``(2) A participant in the Program may not receive a 
     scholarship under subsection (a) for more than the equivalent 
     of three years of full-time coursework.''.
       (e) Full-Time Coursework.--Section 7673 is further amended 
     by adding at the end the following new subsection:
       ``(e) Full-Time Coursework.--For purposes of this section, 
     full-time coursework shall consist of the following:
       ``(1) In the case of undergraduate coursework, 30 semester 
     hours per undergraduate school year.
       ``(2) In the case of graduate coursework, 18 semester hours 
     per graduate school year.''.
       (f) Annual Adjustment of Maximum Scholarship Amount.--
     Section 7631 is amended--
       (1) in subsection (a)(1), by striking ``and the maximum 
     Selected Reserve member stipend amount'' and inserting ``the 
     maximum Selected Reserve member stipend amount, the maximum 
     employee incentive scholarship amount,''; and
       (2) in subsection (b)--
       (A) by redesignating paragraph (4) as paragraph (6); and
       (B) by inserting after paragraph (3) the following new 
     paragraph (4):
       ``(4) The term `maximum employee incentive scholarship 
     amount' means the maximum amount of the scholarship payable 
     to a participant in the Department of Veterans Affairs 
     Employee Incentive Scholarship Program under subchapter VI of 
     this chapter, as specified in section 7673(b)(1) of this 
     title and as previously adjusted (if at all) in accordance 
     with this section.''.
       (g) Technical Amendments.--Section 7631(b) is further 
     amended by striking ``this subsection'' each place it appears 
     and inserting ``this section''.

     SEC. 102. ENHANCEMENT OF EDUCATION DEBT REDUCTION PROGRAM.

       (a) Permanent Authority.--(1) Section 7684 is repealed.
       (2) The table of sections at the beginning of chapter 76 is 
     amended by striking the item relating to section 7684.
       (b) Eligible Individuals.--Subsection (a)(1) of section 
     7682 is amended--
       (1) by striking ``under an appointment under section 
     7402(b) of this title in a position'' and inserting ``in a 
     position (as determined by the Secretary) providing direct-
     patient care services or services incident to direct-patient 
     care services''; and
       (2) by striking ``(as determined by the Secretary)'' and 
     inserting ``(as so determined)''.
       (c) Maximum Debt Reduction Amount.--Section 7683(d)(1) is 
     amended--
       (1) by striking ``for a year''; and
       (2) by striking ``exceed--'' and all that follows through 
     the end of the paragraph and inserting ``exceed $44,000 over 
     a total of five years of participation in the Program, of 
     which not more than $10,000 of such payments may be made in 
     each of the fourth and fifth years of participation in the 
     Program.''.
       (d) Annual Adjustment of Maximum Debt Reduction Payments 
     Amount.--(1) Section 7631, as amended by section 101(f) of 
     this Act, is further amended--
       (A) in subsection (a)(1), by inserting before the period at 
     the end of the first sentence the following: ``and the 
     maximum education debt reduction payments amount''; and
       (B) in subsection (b), by inserting after paragraph (4) the 
     following new paragraph (5):
       ``(5) The term `maximum education debt reduction payments 
     amount' means the maximum amount of education debt reduction 
     payments payable to a participant in the Department of 
     Veterans Affairs Education Debt Reduction Program under 
     subchapter VII of this chapter, as specified in section 
     7683(d)(1) of this title and as previously adjusted (if at 
     all) in accordance with this section.''.
       (2) Notwithstanding section 7631(a)(1) of title 38, United 
     States Code, as amended by paragraph (1), the Secretary of 
     Veterans Affairs shall not increase the maximum education 
     debt reduction payments amount under that section in calendar 
     year 2002.
       (e) Temporary Expansion of Individuals Eligible for 
     Participation in Program.--(1) Notwithstanding section 
     7682(c) of title 38, United States Code, the Secretary of 
     Veterans Affairs may treat a covered individual as being a 
     recently appointed employee in the Veterans Health 
     Administration under section 7682(a) of that title for 
     purposes of eligibility in the Education Debt Reduction 
     Program if the Secretary determines that the participation of 
     the individual in the Program under this subsection would 
     further the purposes of the Program.
       (2) For purposes of this subsection, a covered individual 
     is any individual otherwise described by section 7682(a) of 
     title 38, United States Code, as in effect on the day before 
     the date of the enactment of this Act, who--
       (A) was appointed as an employee in a position described in 
     paragraph (1) of that section, as so in effect, between 
     January 1, 1999, and December 31, 2001; and
       (B) is an employee in such position, or in another position 
     described in paragraph (1) of that section, as so in effect, 
     at the time of application for treatment as a covered 
     individual under this subsection.
       (3) The Secretary shall make determinations regarding the 
     exercise of the authority in this subsection on a case-by-
     case basis.
       (4) The Secretary may not exercise the authority in this 
     subsection after June 30, 2002. The expiration of the 
     authority in this subsection shall not affect the treatment 
     of an individual under this subsection before that date as a 
     covered individual for purposes of eligibility in the 
     Education Debt Reduction Program.
       (5) In this subsection, the term ``Education Debt Reduction 
     Program'' means the Department of Veterans Affairs Education 
     Debt Reduction Program under subchapter VII of chapter 76 of 
     title 38, United States Code.

     SEC. 103. REPORT ON REQUESTS FOR WAIVERS OF PAY REDUCTIONS 
                   FOR REEMPLOYED ANNUITANTS TO FILL NURSE 
                   POSITIONS.

       (a) Report.--Not later than March 28 of each of 2002 and 
     2003, the Secretary of Veterans Affairs shall submit to the 
     Committees on Veterans' Affairs of the Senate and the House 
     of Representatives and to the National Commission on VA 
     Nursing established under subtitle D a report describing each 
     request of the Secretary, during the fiscal year preceding 
     such report, to the Director of the Office of Personnel 
     Management for the following:
       (1) A waiver under subsection (i)(1)(A) of section 8344 of 
     title 5, United States Code, of the provisions of such 
     section in order to meet requirements of the Department of 
     Veterans Affairs for appointments to nurse positions in the 
     Veterans Health Administration.
       (2) A waiver under subsection (f)(1)(A) of section 8468 of 
     title 5, United States Code, of the provisions of such 
     section in order to meet requirements of the Department for 
     appointments to such positions.
       (3) A grant of authority under subsection (i)(1)(B) of 
     section 8344 of title 5, United States Code, for the waiver 
     of the provisions of such section in order to meet 
     requirements of the Department for appointments to such 
     positions.

[[Page H9219]]

       (4) A grant of authority under subsection (f)(1)(B) of 
     section 8468 of title 5, United States Code, for the waiver 
     of the provisions of such section in order to meet 
     requirements of the Department for appointments to such 
     positions.
       (b) Information on Responses to Requests.--The report under 
     subsection (a) shall specify for each request covered by the 
     report--
       (1) the response of the Director to such request; and
       (2) if such request was granted, whether or not the waiver 
     or authority, as the case may be, assisted the Secretary in 
     meeting requirements of the Department for appointments to 
     nurse positions in the Veterans Health Administration.

                   Subtitle B--Retention Authorities

     SEC. 121. ADDITIONAL PAY FOR SATURDAY TOURS OF DUTY FOR 
                   ADDITIONAL HEALTH CARE PROFESSIONALS IN THE 
                   VETERANS HEALTH ADMINISTRATION.

       (a) In General.--Section 7454(b) is amended--
       (1) by inserting ``(1)'' after ``(b)''; and
       (2) by adding at the end the following new paragraph:
       ``(2) Health care professionals employed in positions 
     referred to in paragraph (1) shall be entitled to additional 
     pay on the same basis as provided for nurses in section 
     7453(c) of this title.''.
       (b) Applicability.--The amendments made by subsection (a) 
     shall apply with respect to pay periods beginning on or after 
     the date of the enactment of this Act.

     SEC. 122. UNUSED SICK LEAVE INCLUDED IN ANNUITY COMPUTATION 
                   OF REGISTERED NURSES WITHIN THE VETERANS HEALTH 
                   ADMINISTRATION.

       (a) Annuity Computation.--Section 8415 of title 5, United 
     States Code, is amended by adding at the end the following 
     new subsection:
       ``(i) In computing an annuity under this subchapter, the 
     total service of an employee who retires from the position of 
     a registered nurse with the Veterans Health Administration on 
     an immediate annuity, or dies while employed in that position 
     leaving any survivor entitled to an annuity, includes the 
     days of unused sick leave to the credit of that employee 
     under a formal leave system, except that such days shall not 
     be counted in determining average pay or annuity eligibility 
     under this subchapter.''.
       (b) Deposit Not Required.--Section 8422(d) of such title is 
     amended--
       (1) by inserting ``(1)'' before ``Under such regulations''; 
     and
       (2) by adding at the end the following:
       ``(2) Deposit may not be required for days of unused sick 
     leave credited under section 8415(i).''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect 60 days after the date of the enactment of 
     this Act and shall apply to individuals who separate from 
     service on or after that effective date.

     SEC. 123. EVALUATION OF DEPARTMENT OF VETERANS AFFAIRS NURSE 
                   MANAGED CLINICS.

       (a) Evaluation.--The Secretary of Veterans Affairs shall 
     carry out an evaluation of the efficacy of the nurse managed 
     health care clinics of the Department of Veterans Affairs. 
     The Secretary shall complete the evaluation not later than 18 
     months after the date of the enactment of this Act.
       (b) Clinics To Be Evaluated.--(1) In carrying out the 
     evaluation under subsection (a), the Secretary shall consider 
     nurse managed health care clinics, including primary care 
     clinics and geriatric care clinics, located in three 
     different geographic service areas of the Department.
       (2) If there are not nurse managed health care clinics 
     located in three different geographic service areas as of the 
     commencement of the evaluation, the Secretary shall--
       (A) establish nurse managed health care clinics in 
     additional geographic service areas such that there are nurse 
     managed health care clinics in three different geographic 
     service areas for purposes of the evaluation; and
       (B) include such clinics, as so established, in the 
     evaluation.
       (c) Matters To Be Evaluated.--In carrying out the 
     evaluation under subsection (a), the Secretary shall address 
     the following:
       (1) Patient satisfaction.
       (2) Provider experiences.
       (3) Cost of care.
       (4) Access to care, including waiting time for care.
       (5) The functional status of patients receiving care.
       (6) Any other matters the Secretary considers appropriate.
       (d) Report.--Not later than 18 months after the date of the 
     enactment of this Act, the Secretary shall submit to the 
     Committees on Veterans' Affairs of the Senate and the House 
     of Representatives a report on the evaluation carried out 
     under subsection (a). The report shall address the matters 
     specified in subsection (c) and include any other 
     information, and any recommendations, that the Secretary 
     considers appropriate. The Secretary shall provide a copy of 
     the report to the National Commission on VA Nursing 
     established under subtitle D.

     SEC. 124. STAFFING LEVELS FOR OPERATIONS OF MEDICAL 
                   FACILITIES.

       (a) In General.--Section 8110(a) is amended--
       (1) in paragraph (1), by inserting after ``complete care of 
     patients,'' in the fifth sentence the following: ``and in a 
     manner consistent with the policies of the Secretary on 
     overtime,''; and
       (2) in paragraph (2)--
       (A) by inserting ``, including the staffing required to 
     maintain such capacities,'' after ``all Department medical 
     facilities'';
       (B) by striking ``and to minimize'' and inserting ``, to 
     minimize''; and
       (C) by inserting before the period the following: ``, and 
     to ensure that eligible veterans are provided such care and 
     services in an appropriate manner''.
       (b) Nationwide Policy on Staffing.--Paragraph (3) of that 
     section is amended--
       (1) in subparagraph (A), by inserting ``the adequacy of 
     staff levels for compliance with the policy established under 
     subparagraph (C),'' after ``regarding''; and
       (2) by inserting after subparagraph (B) the following new 
     subparagraph:
       ``(C) The Secretary shall, in consultation with the Under 
     Secretary for Health, establish a nationwide policy on the 
     staffing of Department medical facilities in order to ensure 
     that such facilities have adequate staff for the provision to 
     veterans of appropriate, high-quality care and services. The 
     policy shall take into account the staffing levels and 
     mixture of staff skills required for the range of care and 
     services provided veterans in Department facilities.''.

     SEC. 125. ANNUAL REPORT ON USE OF AUTHORITIES TO ENHANCE 
                   RETENTION OF EXPERIENCED NURSES.

       (a) Annual Report.--(1) Subchapter II of chapter 73 is 
     amended by adding at the end the following new section:

     ``Sec. 7324. Annual report on use of authorities to enhance 
       retention of experienced nurses

       ``(a) Annual Report.--Not later than January 31 each year, 
     the Secretary, acting through the Under Secretary for Health, 
     shall submit to Congress a report on the use during the 
     preceding year of authorities for purposes of retaining 
     experienced nurses in the Veterans Health Administration, as 
     follows:
       ``(1) The authorities under chapter 76 of this title.
       ``(2) The authority under VA Directive 5102.1, relating to 
     the Department of Veterans Affairs nurse qualification 
     standard, dated November 10, 1999, or any successor 
     directive.
       ``(3) Any other authorities available to the Secretary for 
     those purposes.
       ``(b) Report Elements.--Each report under subsection (a) 
     shall specify for the period covered by such report, for each 
     Department medical facility and for each geographic service 
     area of the Department, the following:
       ``(1) The number of waivers requested under the authority 
     referred to in subsection (a)(2), and the number of waivers 
     granted under that authority, to promote to the Nurse II 
     grade or Nurse III grade under the Nurse Schedule under 
     section 7404(b)(1) of this title any nurse who has not 
     completed a baccalaureate degree in nursing in a recognized 
     school of nursing, set forth by age, race, and years of 
     experience of the individuals subject to such waiver requests 
     and waivers, as the case may be.
       ``(2) The programs carried out to facilitate the use of 
     nursing education programs by experienced nurses, including 
     programs for flexible scheduling, scholarships, salary 
     replacement pay, and on-site classes.''.
       (2) The table of sections at the beginning of chapter 73 is 
     amended by inserting after the item relating to section 7323 
     the following new item:

``7324. Annual report on use of authorities to enhance retention of 
              experienced nurses.''.

       (b) Initial Report.--The initial report required under 
     section 7324 of title 38, United States Code, as added by 
     subsection (a), shall be submitted to the National Commission 
     on VA Nursing established under subtitle D as well as to 
     Congress.

     SEC. 126. REPORT ON MANDATORY OVERTIME FOR NURSES AND NURSING 
                   ASSISTANTS IN DEPARTMENT OF VETERANS AFFAIRS 
                   FACILITIES.

       (a) Report.--Not later than 180 days after the date of the 
     enactment of this Act, the Secretary of Veterans Affairs 
     shall submit to the Committees on Veterans' Affairs of the 
     Senate and the House of Representatives and to the National 
     Commission on VA Nursing established under subtitle D a 
     report on the mandatory overtime required of licensed nurses 
     and nursing assistants providing direct patient care at 
     Department of Veterans Affairs medical facilities during 
     2001.
       (b) Mandatory Overtime.--For purposes of the report under 
     subsection (a), mandatory overtime shall consist of any 
     period in which a nurse or nursing assistant is mandated or 
     otherwise required, whether directly or indirectly, to work 
     or be in on-duty status in excess of--
       (1) a scheduled workshift or duty period;
       (2) 12 hours in any 24-hour period; or
       (3) 80 hours in any period of 14 consecutive days.
       (c) Elements.--The report under subsection (a) shall 
     include the following:
       (1) A description of the amount of mandatory overtime 
     described in that subsection at each Department medical 
     facility during the period covered by the report.
       (2) A description of the mechanisms employed by the 
     Secretary to monitor overtime of the nurses and nursing 
     assistants referred to in that subsection.
       (3) An assessment of the effects of the mandatory overtime 
     of such nurses and nursing

[[Page H9220]]

     assistants on patient care, including any reported 
     association with medical errors.
       (4) Recommendations regarding mechanisms for preventing 
     mandatory overtime in other than emergency situations by such 
     nurses and nursing assistants.
       (5) Any other matters that the Secretary considers 
     appropriate.

                     Subtitle C--Other Authorities

     SEC. 131. ORGANIZATIONAL RESPONSIBILITY OF THE DIRECTOR OF 
                   THE NURSING SERVICE.

       Section 7306(a)(5) is amended by inserting ``, and report 
     directly to,'' after ``responsible to''.

     SEC. 132. COMPUTATION OF ANNUITY FOR PART-TIME SERVICE 
                   PERFORMED BY CERTAIN HEALTH-CARE PROFESSIONALS 
                   BEFORE APRIL 7, 1986.

       Section 7426 is amended by adding at the end the following 
     new subsection:
       ``(c) The provisions of subsection (b) shall not apply to 
     the part-time service before April 7, 1986, of a registered 
     nurse, physician assistant, or expanded-function dental 
     auxiliary. In computing the annuity under the applicable 
     provision of law specified in that subsection of an 
     individual covered by the preceding sentence, the service 
     described in that sentence shall be credited as full-time 
     service.''.

     SEC. 133. MODIFICATION OF NURSE LOCALITY PAY AUTHORITIES.

       Section 7451 is amended--
       (1) in subsection (d)(3)--
       (A) in subparagraph (A), by striking ``beginning rates of'' 
     each place it appears;
       (B) in subparagraph (B), by striking ``beginning rates of'' 
     the first place it appears; and
       (C) in subparagraph (C)(i), by striking ``beginning rates 
     of'' each place it appears;
       (2) in subsection (d)(4)--
       (A) by striking ``or at any other time that an adjustment 
     in rates of pay is scheduled to take place under this 
     subsection'' in the first sentence; and
       (B) by striking the second sentence; and
       (3) in subsection (e)(4)--
       (A) in subparagraph (A), by striking ``grade in a'';
       (B) in subparagraph (B)--
       (i) by striking ``grade of a''; and
       (ii) by striking ``that grade'' and inserting ``that 
     position''; and
       (C) in subparagraph (D), by striking ``grade of a''.

             Subtitle D--National Commission on VA Nursing

     SEC. 141. ESTABLISHMENT OF COMMISSION.

       (a) Establishment.--There is hereby established in the 
     Department of Veterans Affairs a commission to be known as 
     the ``National Commission on VA Nursing'' (hereinafter in 
     this subtitle referred to as the ``Commission'').
       (b) Composition.--The Commission shall be composed of 12 
     members appointed by the Secretary of Veterans Affairs as 
     follows:
       (1) At least two shall be recognized representatives of 
     employees (including nurses) of the Department of Veterans 
     Affairs.
       (2) At least one shall be a representative of professional 
     associations of nurses of the Department or similar 
     organizations affiliated with the Department's health care 
     practitioners.
       (3) At least one shall be a nurse from a nursing school 
     affiliated with the Department of Veterans Affairs.
       (4) At least two shall be representatives of veterans.
       (5) At least one shall be an economist.
       (6) The remainder shall be appointed in such manner as the 
     Secretary considers appropriate.
       (c) Chair of Commission.--The Secretary of Veterans Affairs 
     shall designate one of the members of the Commission to chair 
     the Commission.
       (d) Period of Appointment; Vacancies.--Members shall be 
     appointed for the life of the Commission. Any vacancy in the 
     Commission shall be filled in the same manner as the original 
     appointment.
       (e) Initial Organization Requirements.--All appointments to 
     the Commission shall be made not later than 60 days after the 
     date of the enactment of this Act. The Commission shall 
     convene its first meeting not later than 60 days after the 
     date as of which all members of the Commission have been 
     appointed.

     SEC. 142. DUTIES OF COMMISSION.

       (a) Assessment.--The Commission shall--
       (1) consider legislative and organizational policy changes 
     to enhance the recruitment and retention of nurses and other 
     nursing personnel by the Department of Veterans Affairs; and
       (2) assess the future of the nursing profession within the 
     Department.
       (b) Recommendations.--The Commission shall recommend 
     legislative and organizational policy changes to enhance the 
     recruitment and retention of nurses and other nursing 
     personnel in the Department.

     SEC. 143. REPORTS.

       (a) Commission Report.--The Commission shall, not later 
     than two years after the date of its first meeting, submit to 
     Congress and the Secretary of Veterans Affairs a report on 
     the Commission's findings and recommendations.
       (b) Secretary of Veterans Affairs Report.--Not later than 
     60 days after the date of the Commission's report under 
     subsection (a), the Secretary shall submit to Congress a 
     report--
       (1) providing the Secretary's views on the Commission's 
     findings and recommendations; and
       (2) explaining what actions, if any, the Secretary intends 
     to take to implement the recommendations of the Commission 
     and the Secretary's reasons for doing so.

     SEC. 144. POWERS.

       (a) Hearings.--The Commission or, at its direction, any 
     panel or member of the Commission, may, for the purpose of 
     carrying out the provisions of this subtitle, hold hearings 
     and take testimony to the extent that the Commission or any 
     member considers advisable.
       (b) Information.--The Commission may secure directly from 
     any Federal department or agency information that the 
     Commission considers necessary to enable the Commission to 
     carry out its responsibilities under this subtitle.

     SEC. 145. PERSONNEL MATTERS.

       (a) Pay of Members.--Members of the Commission shall serve 
     without pay by reason of their work on the Commission.
       (b) Travel Expenses.--The members of the Commission shall 
     be allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Commission.
       (c) Staff.--(1) The Secretary may, without regard to the 
     provisions of title 5, United States Code, governing 
     appointments in the competitive service, appoint a staff 
     director and such additional personnel as may be necessary to 
     enable the Commission to perform its duties.
       (2) The Secretary may fix the pay of the staff director and 
     other personnel appointed under paragraph (1) without regard 
     to the provisions of chapter 51 and subchapter III of chapter 
     53 of title 5, United States Code, relating to classification 
     of positions and General Schedule pay rates, except that the 
     rate of pay fixed under this paragraph for the staff director 
     may not exceed the rate payable for level V of the Executive 
     Schedule under section 5316 of such title and the rate of pay 
     for other personnel may not exceed the maximum rate payable 
     for grade GS-15 of the General Schedule.
       (d) Detail of Government Employees.--Upon request of the 
     Secretary, the head of any Federal department or agency may 
     detail, on a nonreimbursable basis, any personnel of that 
     department or agency to the Commission to assist it in 
     carrying out its duties.

     SEC. 146. TERMINATION OF COMMISSION.

       The Commission shall terminate 90 days after the date of 
     the submission of its report under section 143(a).

                        TITLE II--OTHER MATTERS

     SEC. 201. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO 
                   PROVIDE SERVICE DOGS FOR VETERANS WITH CERTAIN 
                   DISABILITIES.

       (a) Authority.--Section 1714 is amended--
       (1) in subsection (b)--
       (A) by striking ``seeing-eye or'' the first place it 
     appears;
       (B) by striking ``who are entitled to disability 
     compensation'' and inserting ``who are enrolled under section 
     1705 of this title'';
       (C) by striking ``, and may pay'' and all that follows 
     through ``such seeing-eye or guide dogs''; and
       (D) by striking ``handicap'' and inserting ``disability''; 
     and
       (2) by adding at the end the following new subsections:
       ``(c) The Secretary may, in accordance with the priority 
     specified in section 1705 of this title, provide--
       ``(1) service dogs trained for the aid of the hearing 
     impaired to veterans who are hearing impaired and are 
     enrolled under section 1705 of this title; and
       ``(2) service dogs trained for the aid of persons with 
     spinal cord injury or dysfunction or other chronic impairment 
     that substantially limits mobility to veterans with such 
     injury, dysfunction, or impairment who are enrolled under 
     section 1705 of this title.
       ``(d) In the case of a veteran provided a dog under 
     subsection (b) or (c), the Secretary may pay travel and 
     incidental expenses for that veteran under the terms and 
     conditions set forth in section 111 of this title to and from 
     the veteran's home for expenses incurred in becoming adjusted 
     to the dog.''.
       (b) Clerical Amendments.--(1) The heading for such section 
     is amended to read as follows:

     ``Sec. 1714. Fitting and training in use of prosthetic 
       appliances; guide dogs; service dogs''.

       (2) The item relating to such section in the table of 
     sections at the beginning of chapter 17 is amended to read as 
     follows:

``1714. Fitting and training in use of prosthetic appliances; guide 
              dogs; service dogs.''.

     SEC. 202. MANAGEMENT OF HEALTH CARE FOR CERTAIN LOW-INCOME 
                   VETERANS.

       (a) Priority of Enrollment in Patient Enrollment System.--
     Section 1705(a) is amended by striking paragraph (7) and 
     inserting the following new paragraphs:
       ``(7) Veterans described in section 1710(a)(3) of this 
     title who are eligible for treatment as a low-income family 
     under section 3(b) of the United States Housing Act of 1937 
     (42 U.S.C. 1437a(b)) for the area in which such veterans 
     reside, regardless of whether such veterans are treated as 
     single person families under paragraph (3)(A) of such section 
     3(b) or as families under paragraph (3)(B) of such section 
     3(b).
       ``(8) Veterans described in section 1710(a)(3) of this 
     title who are not covered by paragraph (7).''.

[[Page H9221]]

       (b) Reduced Copayments for Care.--Subsection (f) of section 
     1710 is amended--
       (1) in paragraph (1), by inserting ``or (4)'' after 
     ``paragraph (2)'';
       (2) by redesignating paragraph (4) as paragraph (5); and
       (3) by inserting after paragraph (3) the following new 
     paragraph (4):
       ``(4) In the case of a veteran covered by this subsection 
     who is also described by section 1705(a)(7) of this title, 
     the amount for which the veteran shall be liable to the 
     United States for hospital care under this subsection shall 
     be an amount equal to 20 percent of the total amount for 
     which the veteran would otherwise be liable for such care 
     under subparagraphs (2)(B) and (3)(A) but for this 
     paragraph.''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on October 1, 2002.

     SEC. 203. MAINTENANCE OF CAPACITY FOR SPECIALIZED TREATMENT 
                   AND REHABILITATIVE NEEDS OF DISABLED VETERANS.

       (a) Maintenance of Capacity on a Geographic Service Area 
     Basis.--Section 1706(b) is amended--
       (1) in paragraph (1)--
       (A) in the first sentence, by inserting ``(and each 
     geographic service area of the Veterans Health 
     Administration)'' after ``ensure that the Department''; and
       (B) in clause (B), by inserting ``(and each geographic 
     service area of the Veterans Health Administration)'' after 
     ``overall capacity of the Department'';
       (2) by redesignating paragraphs (2) and (3) as paragraphs 
     (5) and (6), respectively; and
       (3) by inserting after paragraph (1) the following new 
     paragraphs;
       ``(2) For purposes of paragraph (1), the capacity of the 
     Department (and each geographic service area of the Veterans 
     Health Administration) to provide for the specialized 
     treatment and rehabilitative needs of disabled veterans 
     (including veterans with spinal cord dysfunction, traumatic 
     brain injury, blindness, prosthetics and sensory aids, and 
     mental illness) within distinct programs or facilities shall 
     be measured for seriously mentally ill veterans as follows 
     (with all such data to be provided by geographic service area 
     and totaled nationally):
       ``(A) For mental health intensive community-based care, the 
     number of discrete intensive care teams constituted to 
     provide such intensive services to seriously mentally ill 
     veterans and the number of veterans provided such care.
       ``(B) For opioid substitution programs, the number of 
     patients treated annually and the amounts expended.
       ``(C) For dual-diagnosis patients, the number treated 
     annually and the amounts expended.
       ``(D) For substance-use disorder programs--
       ``(i) the number of beds (whether hospital, nursing home, 
     or other designated beds) employed and the average bed 
     occupancy of such beds;
       ``(ii) the percentage of unique patients admitted directly 
     to outpatient care during the fiscal year who had two or more 
     additional visits to specialized outpatient care within 30 
     days of their first visit, with a comparison from 1996 until 
     the date of the report;
       ``(iii) the percentage of unique inpatients with substance-
     use disorder diagnoses treated during the fiscal year who had 
     one or more specialized clinic visits within three days of 
     their index discharge, with a comparison from 1996 until the 
     date of the report;
       ``(iv) the percentage of unique outpatients seen in a 
     facility or geographic service area during the fiscal year 
     who had one or more specialized clinic visits, with a 
     comparison from 1996 until the date of the report; and
       ``(v) the rate of recidivism of patients at each 
     specialized clinic in each geographic service area of the 
     Veterans Health Administration.
       ``(E) For mental health programs, the number and type of 
     staff that are available at each facility to provide 
     specialized mental health treatment, including satellite 
     clinics, outpatient programs, and community-based outpatient 
     clinics, with a comparison from 1996 to the date of the 
     report.
       ``(F) The number of such clinics providing mental health 
     care, the number and type of mental health staff at each such 
     clinic, and the type of mental health programs at each such 
     clinic.
       ``(G) The total amounts expended for mental health during 
     the fiscal year.
       ``(3) For purposes of paragraph (1), the capacity of the 
     Department (and each geographic service area of the Veterans 
     Health Administration) to provide for the specialized 
     treatment and rehabilitative needs of disabled veterans 
     within distinct programs or facilities shall be measured for 
     veterans with spinal cord dysfunction, traumatic brain 
     injury, blindness, or prosthetics and sensory aids as follows 
     (with all such data to be provided by geographic service area 
     and totaled nationally):
       ``(A) For spinal cord injury and dysfunction specialized 
     centers and for blind rehabilitation specialized centers, the 
     number of staffed beds and the number of full-time equivalent 
     employees assigned to provide care at such centers.
       ``(B) For prosthetics and sensory aids, the annual amount 
     expended.
       ``(C) For traumatic brain injury, the number of patients 
     treated annually and the amounts expended.
       ``(4) In carrying out paragraph (1), the Secretary may not 
     use patient outcome data as a substitute for, or the 
     equivalent of, compliance with the requirement under that 
     paragraph for maintenance of capacity.''.
       (b) Extension of Annual Report Requirement.--Paragraph (5) 
     of such section, as so redesignated, is amended--
       (1) by inserting ``(A)'' before ``Not later than'';
       (2) by striking ``April 1, 1999, April 1, 2000, and April 
     1, 2001'' and inserting ``April 1 of each year through 
     2004'';
       (3) by adding at the end of subparagraph (A), as designated 
     by paragraph (1), the following new sentence: ``Each such 
     report shall include information on recidivism rates 
     associated with substance-use disorder treatment.''; and
       (4) by adding at the end of such paragraph the following 
     new subparagraphs:
       ``(B) In preparing each report under subparagraph (A), the 
     Secretary shall use standardized data and data definitions.
       ``(C) Each report under subparagraph (A) shall be audited 
     by the Inspector General of the Department, who shall submit 
     to Congress a certification as to the accuracy of each such 
     report.''.

     SEC. 204. PROGRAM FOR PROVISION OF CHIROPRACTIC CARE AND 
                   SERVICES TO VETERANS.

       (a) Requirement for Program.--Subject to the provisions of 
     this section, the Secretary of Veterans Affairs shall carry 
     out a program to provide chiropractic care and services to 
     veterans through Department of Veterans Affairs medical 
     centers and clinics.
       (b) Eligible Veterans.--Veterans eligible to receive 
     chiropractic care and services under the program are veterans 
     who are enrolled in the system of patient enrollment under 
     section 1705 of title 38, United States Code.
       (c) Location of Program.--The program shall be carried out 
     at sites designated by the Secretary for purposes of the 
     program. The Secretary shall designate at least one site for 
     such program in each geographic service area of the Veterans 
     Health Administration. The sites so designated shall be 
     medical centers and clinics located in urban areas and in 
     rural areas.
       (d) Care and Services Available.--The chiropractic care and 
     services available under the program shall include a variety 
     of chiropractic care and services for neuro-musculoskeletal 
     conditions, including subluxation complex.
       (e) Other Administrative Matters.--(1) The Secretary shall 
     carry out the program through personal service contracts and 
     by appointment of licensed chiropractors in Department 
     medical centers and clinics.
       (2) As part of the program, the Secretary shall provide 
     training and materials relating to chiropractic care and 
     services to Department health care providers assigned to 
     primary care teams for the purpose of familiarizing such 
     providers with the benefits of chiropractic care and 
     services.
       (f) Regulations.--The Secretary shall prescribe regulations 
     to carry out this section.
       (g) Chiropractic Advisory Committee.--(1) The Secretary 
     shall establish an advisory committee to provide direct 
     assistance and advice to the Secretary in the development and 
     implementation of the chiropractic health program.
       (2) The membership of the advisory committee shall include 
     members of the chiropractic care profession and such other 
     members as the Secretary considers appropriate.
       (3) Matters on which the advisory committee shall assist 
     and advise the Secretary shall include the following:
       (A) Protocols governing referral to chiropractors.
       (B) Protocols governing direct access to chiropractic care.
       (C) Protocols governing scope of practice of chiropractic 
     practitioners.
       (D) Definition of services to be provided.
       (E) Such other matters the Secretary determines to be 
     appropriate.
       (4) The advisory committee shall cease to exist on December 
     31, 2004.

     SEC. 205. FUNDS FOR FIELD OFFICES OF THE OFFICE OF RESEARCH 
                   COMPLIANCE AND ASSURANCE.

       (a) In General.--Section 7303 is amended by adding at the 
     end the following new subsection:
       ``(e) Amounts for the activities of the field offices of 
     the Office of Research Compliance and Assurance of the 
     Department shall be derived from amounts appropriated for the 
     Veterans Health Administration for Medical Care (rather than 
     from amounts appropriated for the Veterans Health 
     Administration for Medical and Prosthetic Research).''.
       (b) Applicability to Fiscal Year 2002.--In order to carry 
     out subsection (e) of section 7303 of title 38, United States 
     Code, as added by subsection (a), for fiscal year 2002, the 
     Secretary of Veterans Affairs shall transfer such sums as 
     necessary for that purpose from amounts appropriated for the 
     Veterans Health Administration for Medical and Prosthetic 
     Research for fiscal year 2002 to amounts appropriated for the 
     Veterans Health Administration for Medical Care for that 
     fiscal year.

     SEC. 206. MAJOR MEDICAL FACILITY CONSTRUCTION.

       (a) Project Authorized.--The Secretary of Veterans Affairs 
     may carry out a major medical facility project for the 
     renovation from electrical fire of the Department of Veterans 
     Affairs Medical Center, Miami, Florida, in an amount not to 
     exceed $28,300,000.
       (b) Authorization of Appropriations.--There is authorized 
     to be appropriated to the

[[Page H9222]]

     Secretary of Veterans Affairs for the Construction, Major 
     Projects Account, for fiscal year 2002, $28,300,000 for the 
     project authorized by subsection (a).
       (c) Limitation.--The project authorized by subsection (a) 
     may only be carried out using--
       (1) funds appropriated for fiscal year 2002 pursuant to the 
     authorization of appropriations in subsection (b);
       (2) funds appropriated for Construction, Major Projects, 
     for a fiscal year before fiscal year 2002 that remain 
     available for obligation; and
       (3) funds appropriated for Construction, Major Projects, 
     for fiscal year 2002 for a category of activity not specific 
     to a project.

     SEC. 207. SENSE OF CONGRESS ON SPECIAL TELEPHONE SERVICES FOR 
                   VETERANS.

       It is the sense of Congress that the Secretary of Veterans 
     Affairs should conduct an assessment of all special telephone 
     services for veterans (such as help lines and hotlines) that 
     are provided by the Department of Veterans Affairs and that 
     any such assessment, if conducted, should include assessment 
     of the geographical coverage, availability, utilization, 
     effectiveness, management, coordination, staffing, and cost 
     of those services and should include a survey of veterans to 
     measure their satisfaction with current special telephone 
     services and the demand for additional services.

     SEC. 208. RECODIFICATION OF BEREAVEMENT COUNSELING AUTHORITY 
                   AND CERTAIN OTHER HEALTH-RELATED AUTHORITIES.

       (a) Statutory Reorganization.--Subchapter I of chapter 17 
     is amended--
       (1) in section 1701(6)--
       (A) by striking subparagraph (B) and the sentence following 
     that subparagraph;
       (B) by striking ``services--'' in the matter preceding 
     subparagraph (A) and inserting ``services, the following:''; 
     and
       (C) by striking subparagraph (A) and inserting the 
     following:
       ``(A) Surgical services.
       ``(B) Dental services and appliances as described in 
     sections 1710 and 1712 of this title.
       ``(C) Optometric and podiatric services.
       ``(D) Preventive health services.
       ``(E) In the case of a person otherwise receiving care or 
     services under this chapter--
       ``(i) wheelchairs, artificial limbs, trusses, and similar 
     appliances;
       ``(ii) special clothing made necessary by the wearing of 
     prosthetic appliances; and
       ``(iii) such other supplies or services as the Secretary 
     determines to be reasonable and necessary.
       ``(F) Travel and incidental expenses pursuant to section 
     111 of this title.''; and
       (2) in section 1707--
       (A) by inserting ``(a)'' at the beginning of the text of 
     the section; and
       (B) by adding at the end the following:
       ``(b) The Secretary may furnish sensori-neural aids only in 
     accordance with guidelines prescribed by the Secretary.''.
       (b) Consolidation of Provisions Relating to Persons Other 
     Than Veterans.--Such chapter is further amended by adding at 
     the end the following new subchapter:

     ``SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS

     ``Sec. 1782. Counseling, training, and mental health services 
       for immediate family members

       ``(a) Counseling for Family Members of Veterans Receiving 
     Service-Connected Treatment.--In the case of a veteran who is 
     receiving treatment for a service-connected disability 
     pursuant to paragraph (1) or (2) of section 1710(a) of this 
     title, the Secretary shall provide to individuals described 
     in subsection (c) such consultation, professional counseling, 
     training, and mental health services as are necessary in 
     connection with that treatment.
       ``(b) Counseling for Family Members of Veterans Receiving 
     Non-Service-Connected Treatment.--In the case of a veteran 
     who is eligible to receive treatment for a non-service-
     connected disability under the conditions described in 
     paragraph (1), (2), or (3) of section 1710(a) of this title, 
     the Secretary may, in the discretion of the Secretary, 
     provide to individuals described in subsection (c) such 
     consultation, professional counseling, training, and mental 
     health services as are necessary in connection with that 
     treatment if--
       ``(1) those services were initiated during the veteran's 
     hospitalization; and
       ``(2) the continued provision of those services on an 
     outpatient basis is essential to permit the discharge of the 
     veteran from the hospital.
       ``(c) Eligible Individuals.--Individuals who may be 
     provided services under this subsection are--
       ``(1) the members of the immediate family or the legal 
     guardian of a veteran; or
       ``(2) the individual in whose household such veteran 
     certifies an intention to live.
       ``(d) Travel and Transportation Authorized.--Services 
     provided under subsections (a) and (b) may include, under the 
     terms and conditions set forth in section 111 of this title, 
     travel and incidental expenses of individuals described in 
     subsection (c) in the case of any of the following:
       ``(1) A veteran who is receiving care for a service-
     connected disability.
       ``(2) A dependent or survivor receiving care under the last 
     sentence of section 1783(b) of this title.

     ``Sec. 1783. Bereavement counseling

       ``(a) Deaths of Veterans.--In the case of an individual who 
     was a recipient of services under section 1782 of this title 
     at the time of the death of the veteran, the Secretary may 
     provide bereavement counseling to that individual in the case 
     of a death--
       ``(1) that was unexpected; or
       ``(2) that occurred while the veteran was participating in 
     a hospice program (or a similar program) conducted by the 
     Secretary.
       ``(b) Deaths In Active Service.--The Secretary may provide 
     bereavement counseling to an individual who is a member of 
     the immediate family of a member of the Armed Forces who dies 
     in the active military, naval, or air service in the line of 
     duty and under circumstances not due to the person's own 
     misconduct.
       ``(c) Bereavement Counseling Defined.--For purposes of this 
     section, the term `bereavement counseling' means such 
     counseling services, for a limited period, as the Secretary 
     determines to be reasonable and necessary to assist an 
     individual with the emotional and psychological stress 
     accompanying the death of another individual.

     ``Sec. 1784. Humanitarian care

       ``The Secretary may furnish hospital care or medical 
     services as a humanitarian service in emergency cases, but 
     the Secretary shall charge for such care and services at 
     rates prescribed by the Secretary.''.
       (c) Transfer of CHAMPVA Section.--Section 1713 is--
       (1) transferred to subchapter VIII of chapter 17 of title 
     38, United States Code, as added by subsection (b), and 
     inserted after the subchapter heading;
       (2) redesignated as section 1781; and
       (3) amended by adding at the end of subsection (b) the 
     following new sentence: ``A dependent or survivor receiving 
     care under the preceding sentence shall be eligible for the 
     same medical services as a veteran, including services under 
     sections 1782 and 1783 of this title.''.
       (d) Repeal of Recodified Authority.--Section 1711 is 
     amended by striking subsection (b).
       (e) Cross Reference Amendments.--Title 38, United States 
     Code, is further amended as follows:
       (1) Section 103(d)(5)(B) is amended by striking ``1713'' 
     and inserting ``1781''.
       (2) Sections 1701(5) is amended by striking ``1713(b)'' in 
     subparagraphs (B) and (C)(i) and inserting ``1781(b)''.
       (3) Section 1712A(b) is amended--
       (A) in the last sentence of paragraph (1), by striking 
     ``section 1711(b)'' and inserting ``section 1784''; and
       (A) in paragraph (2), by striking ``section 1701(6)(B)'' 
     and inserting ``sections 1782 and 1783''.
       (4) Section 1729(f) is amended by striking ``section 
     1711(b)'' and inserting ``section 1784''.
       (5) Section 1729A(b) is amended--
       (A) by redesignating paragraph (7) as paragraph (8); and
       (B) by inserting after paragraph (6) the following new 
     paragraph (7):
       ``(7) Section 1784 of this title.''.
       (6) Section 8111(g) is amended--
       (A) in paragraph (4), by inserting ``services under 
     sections 1782 and 1783 of this title'' after ``of this 
     title,''; and
       (B) in paragraph (5), by striking ``section 1711(b) or 
     1713'' and inserting ``section 1782, 1783, or 1784''.
       (7) Section 8111A(a)(2) is amended by inserting ``, and the 
     term `medical services' includes services under sections 1782 
     and 1783 of this title'' before the period at the end.
       (8) Section 8152(1) is amended by inserting ``services 
     under sections 1782 and 1783 of this title,'' after ``of this 
     title),''.
       (9) Sections 8502(b), 8520(a), and 8521 are amended by 
     striking ``the last sentence of section 1713(b)'' and 
     inserting ``the penultimate sentence of section 1781(b)''.
       (f) Clerical Amendments.--
       (1) The table of sections at the beginning of such chapter 
     is amended--
       (A) by striking the item relating to section 1707 and 
     inserting the following:

``1707. Limitations.'';

       (B) by striking the item relating to section 1713; and
       (C) by adding at the end the following:

     ``subchapter viii--health care of persons other than veterans

``1781. Medical care for survivors and dependents of certain veterans.
``1782. Counseling, training, and mental health services for immediate 
              family members.
``1783. Bereavement counseling.
``1784. Humanitarian care.''.

       (2) The heading for section 1707 is amended to read as 
     follows:

     ``Sec. 1707. Limitations''.

     SEC. 209. EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES.

       (a) Health Care Copayments.--Section 1710(f)(2)(B) is 
     amended by striking ``September 30, 2002'' and inserting 
     ``September 30, 2007''.
       (b) Medical Care Cost Recovery.--Section 1729(a)(2)(E) is 
     amended by striking ``October 1, 2002'' and inserting 
     ``October 1, 2007''.

     SEC. 210. PERSONAL EMERGENCY RESPONSE SYSTEM FOR VETERANS 
                   WITH SERVICE-CONNECTED DISABILITIES.

       (a) Evaluation and Study.--The Secretary of Veterans 
     Affairs shall carry out an evaluation and study of the 
     feasibility and desirability of providing a personal 
     emergency response system to veterans who have service-

[[Page H9223]]

     connected disabilities. The evaluation and study shall be 
     commenced not later than 60 days after the date of the 
     enactment of this Act.
       (b) Report.--Not later than 180 days 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 evaluation and study under 
     subsection (a). The Secretary shall include in the report the 
     Secretary's findings resulting from the evaluation and study 
     and the Secretary's conclusion as to whether the Department 
     of Veterans Affairs should provide a personal emergency 
     response system to veterans with service-connected 
     disabilities.
       (c) Authority To Provide System.--If the Secretary 
     concludes in the report under subsection (b) that a personal 
     emergency response system should be provided by the 
     Department of Veterans Affairs to veterans with service-
     connected disabilities--
       (1) the Secretary may provide such a system, without 
     charge, to any veteran with a service-connected disability 
     who is enrolled under section 1705 of title 38, United States 
     Code, and who submits an application for such a system under 
     subsection (d); and
       (2) the Secretary may contract with one or more vendors to 
     furnish such a system.
       (d) Application.--A personal emergency response system may 
     be provided to a veteran under subsection (c)(1) only upon 
     the submission by the veteran of an application for the 
     system. Any such application shall be in such form and manner 
     as the Secretary may require.
       (e) Definition.--For purposes of this section, the term 
     ``personal emergency response system'' means a device--
       (1) that can be activated by an individual who is 
     experiencing a medical emergency to notify appropriate 
     emergency medical personnel that the individual is 
     experiencing a medical emergency; and
       (2) that provides the individual's location through a 
     Global Positioning System indicator.

     SEC. 211. ONE-YEAR EXTENSION OF ELIGIBILITY FOR HEALTH CARE 
                   OF VETERANS WHO SERVED IN SOUTHWEST ASIA DURING 
                   THE PERSIAN GULF WAR.

       Section 1710(e)(3)(B) is amended by striking ``December 31, 
     2001'' and inserting ``December 31, 2002''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Smith) and the gentleman from Illinois (Mr. Evans) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey (Mr. Smith).
  Mr. SMITH of New Jersey. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I rise in strong support of H.R. 3447, the Department of 
Veterans Affairs Health Care Programs Enhancement Act of 2001. Although 
this bill was only recently introduced, it is the product of many 
months of work by both bodies. It is derived from the following bills: 
H.R. 2792 which passed the House on October 23; S. 1160; S. 1188; and 
S. 1221. The bill would accomplish improvements in health care and 
related services for our Nation's veterans.
  The distinguished chairman of the Subcommittee on Health the 
gentleman from Kansas (Mr. Moran) deserves special recognition for his 
original authorship of major components of this bill. I salute his 
leadership in formulating it for final House consideration in the first 
session of the 107th Congress. I also appreciate the hard work of our 
colleagues on the Senate Committee on Veterans' Affairs who have 
contributed major portions of this legislation as well.
  Mr. Speaker, this bill would enhance nurse recruitment and staffing 
in the Department of Veterans Affairs health care system and improve VA 
health care for veterans. The bill would also authorize significant new 
veterans health care benefits, including VA chiropractic care for 
disabled veterans on a nationwide basis. This legislation would provide 
greater accountability in the conduct of VA health care programs and 
would give substantial relief from copayments now required of poor 
veterans in urban areas.
  Mr. Speaker, all of these changes are good for veterans and they are 
good for the Nation. I anticipate that, after House passage, this bill 
will be taken up immediately by the Senate and passed without further 
amendment. It represents an agreement between the two Committees on 
Veterans' Affairs on these matters; and while it is a compromise on 
several House-authored provisions, we recommend it as sound, 
progressive policy.
  Mr. Speaker, I want to thank our full committee ranking member the 
gentleman from Illinois (Mr. Evans) for his close cooperation on this 
bipartisan bill. He is a valued partner as we work together to keep our 
great country's commitments to those men and women who have defended 
our precious freedoms. The gentleman from California (Mr. Filner), the 
ranking member of our Subcommittee on Health, has also worked hard on 
this bill, in particular for the new chiropractic care services for our 
veterans. I thank him for his contributions as well.
  The leadership on both sides of the aisle have facilitated the 
clearance for consideration of this bill, which the committee also 
deeply appreciates. I want to especially thank the majority leader, the 
gentleman from Texas (Mr. Armey), for facilitating that as well. We 
were able to work through this process in remarkably short order 
because our House leadership continues to make veterans issues a 
priority.
  Mr. Speaker, I urge all of my colleagues to support this measure. It 
has broad backing and sends the right message: Congress will be 
attentive to the people's business and stand by those courageous men 
and women who have answered the call to arms.
  Mr. Speaker, I reserve the balance of my time.
  Mr. EVANS. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. EVANS asked and was given permission to revise and extend his 
remarks, and include extraneous material.)
  Mr. EVANS. Mr. Speaker, I rise in support of this legislation. I want 
to thank the chairman again, the gentleman from New Jersey, who has 
been a long and undeterred advocate for this legislation. I want to 
thank the gentleman from Kansas (Mr. Moran) and the gentleman from 
California (Mr. Filner), the chairman and ranking member of the 
Subcommittee on Health, for their continuing work on the complex issues 
in this bill. I want to particularly recognize the abiding interest of 
the gentlewoman from California (Mrs. Capps) in ensuring better access 
to health care services for our veterans. At her urging, we have 
included a comprehensive study of telephone services available through 
the Department.
  I also want to express my appreciation to members of the committee 
staff on both sides of the aisle for their persistence in reaching a 
good compromise on this bill.
  For many years, I have strongly advocated the provision of 
chiropractic care as an alternative source of health care for veterans. 
Medicare, most State Medicaid programs, and the Department of Defense 
have developed means of reimbursing or even, in the latter case, hiring 
chiropractors to meet their beneficiaries' needs. VA, unfortunately, 
has been slower to adopt chiropractic care. As a result, the 
legislation requires VA to have a permanent, national chiropractic 
program; and I trust VA will now ensure that veterans are better able 
to access these important services.
  The chairman mentioned the nurses that are the backbone of any health 
care system. We also listed them. I want to thank the gentleman from 
New Mexico (Mr. Udall) for introducing H.R. 3017, which contains many 
of the nurse recruitment and retention provisions that have been 
included in this bill.
  This bill recognizes that income alone is not a fair measure of a 
veteran's standard of living because of geographic cost-of-living 
differences, which can be significant. Veterans in the Chicago area, 
for example, may not be able to stretch their dollars as far as 
veterans in lower-cost areas. I am pleased that, in recognition of 
these differing costs of living, this bill will reduce the burden of 
acute hospital inpatient copayments for some veterans.
  In a report I requested from the GAO last year, they said that VA 
could not confirm that these important but expensive programs for 
veterans with longer term service-connected conditions were not being 
eroded under fiscal pressure to treat more veterans at a lower cost per 
patient. I am pleased that this bill also provides a strong reporting 
requirement for specialized programs for disabled veterans.
  Following the trend to place care in community and outpatient 
settings, the committee has been greatly concerned with the 
availability of VA health care services for seriously mentally ill 
veterans. Veterans' advocates, advocates of mentally ill people and 
even internal working groups have continually validated these concerns. 
The

[[Page H9224]]

legislation will allow the Congress to monitor these important programs 
and intervene if measures indicate that would be necessary.
  Mr. Speaker, I am proud to support this legislation. I believe in the 
long run we will be able to ensure an improved health care system for 
our Nation's veterans.
  This important measure provides a number of changes in current law 
that will allow VA to remain competitive in recruiting and retaining 
its nurse workforce. Critically, this measure retains and strengthens 
reporting requirements on the specialized programs for veterans with 
disabilities, many of which VA has perfected since the days following 
World War II. It will provide some relief in meeting VA copayment 
requirements for acute hospital inpatient care to veterans with 
marginal incomes. It will also address a significant deficit in the 
VA's care continuum by developing a permanent program for chiropractic 
care within the Department of Veterans Affairs.
  I believe this bill moves VA in the right direction to meet new and 
evolving challenges and I am proud to have participated in its 
development. I want to thank my Committee Chairman, the gentleman from 
New Jersey, Chris Smith, who has been a strong and undeterred advocate 
of this legislation. I want to thank Jerry Moran and Bob Filner, the 
Chairman and Ranking Member of the Health Subcommittee, for continuing 
to work on the complex range of issues this bill addresses. I also want 
to thank Congresswoman Lois Capps for her abiding interest in ensuring 
better access to health care services for veterans. At her urging, we 
have included a comprehensive study of telephone services available 
through the Department. I also want to express my appreciation to 
members of the Committee staff from both sides of the aisle for their 
persistence in reaching a good compromise on this bill.
  For many years, I have strongly advocated the provision of 
chiropractic as an alternative source of health care for veterans. 
Chiropractors are capable of promoting wellness and preventing illness 
without relying upon pharmaceutical drugs or surgical interventions. 
For the millions of Americans who choose to use chiropractors--often 
paying for their services ``out-of-pocket''--the benefits of 
chiropractic care are clear. Gradually, the federal government has 
recognized the importance of the care chiropractors provide in the 
health care continuum--Medicare, most state Medicaid programs, and the 
Department of Defense have developed means or reimbursing or even, in 
the latter case, hiring chiropractors to meet their beneficiaries' 
needs. Many private insurers also reimburse care from chiropractors.
  VA has been much slower to adopt chiropractic. Under the Veterans 
Millennium Health Care and Benefits Act, VA was directed to develop a 
policy on chiropractic care. Unfortunately, it appeared that the VA 
circled the wagons and resorted to practices that have actually reduced 
veterans' use of chiropractic in the last year. I called on VA and 
representatives of chiropractic providers to discuss opportunities for 
VA to develop a policy on chiropractic care as the Millennium Act had 
directed it to do. After several interactions with chiropractor 
representatives this summer, VA ultimately told me that if I and the 
other Members that participated in this dialogue wanted VA to increase 
or enhance its use of chiropractors in VA, we would have to mandate VA 
to do it. We have now developed an approach that requires VA to have a 
permanent, national chiropractic program, and I trust VA will now 
ensure that veterans are better able to access these important 
services.
  This bill adjusts copayments for veterans with marginal incomes. In 
so doing, it recognizes that income alone is not a fair measure of a 
veteran's standard of living because of the often significant 
differences in geographic costs-of-living. Veterans in the Chicago 
area, for example, may not be able to stretch their dollars as far as 
veterans in lower cost areas. I am pleased that, in recognition of 
these differing ``costs of living'', this bill will reduce the burden 
of acute hospital inpatient copayments for some veterans.
  The Department of Veterans Affairs Health Care Programs Enhancement 
Act of 2001 will allow VA to remain a competitive employer during the 
current scarcity of nurses in the labor market. I want to thank my 
friend Tom Udall for introducing H.R. 3017, which contains many of the 
nurse recruitment and retention provisions that have been included in 
this bill.
  Nurses are the backbone of any health care system and their role is 
no less critical within VA. Yet, it is easy to see why this profession 
is once again facing a crisis in developing and maintaining its 
workforce. My mother was a nurse so I well understand the demands and 
pressures of this vocation--hours are long and often unpredictable. The 
work takes a psychic and physical toll. In recent years, nurses 
complain of having more of their time devoted to administrative 
activities than to working with their patients--often the most 
satisfying part of their job. H.R. 3447 will help address some of the 
reasons this profession is facing its current challenges by having 
experts offer solutions to some of the issues that confront the 
profession, by providing more flexible educational tools as incentives 
for its current and future workforce, and by ensuring that the 
Department is reviewing safe staffing patterns and practices to support 
its dedicated workforce.
  I am pleased that this bill also provides a strong reporting 
requirement for specialized programs for disabled veterans. Some of 
these programs were developed in direct response to the needs of 
veterans returning from war with combat-incurred disabilities, such as 
spinal cord injuries, blindness, or post-traumatic stress disorder, and 
have become unique chronic care programs in a health care world that 
generally seems to prefer dealing with acute illnesses. In a report I 
requested from the General Accounting Office last year, GAO said that 
VA could not assure that these important, but expensive, programs for 
veterans with longer-term service-connected conditions were not being 
eroded under fiscal pressure to treat more veterans at a lower cost per 
patient.
  Following a new trend to place care in community and outpatient 
settings, this Committee has also been greatly concerned with the 
availability of VA services for seriously mentally ill veterans--
veterans' advocates, advocates of mentally ill people and even internal 
working groups have continually validated these concerns. This 
legislation will allow Congress to monitor these important programs and 
intervene if measures indicate that would be necessary.
  Mr. Speaker, I am proud to support this legislation. I believe that 
in so doing we will ensure an improved health care system for our 
nation's veterans.

SUMMARY--H.R. 3447--DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROGRAMS 
                        ENHANCEMENT ACT OF 2001

       H.R. 3447 would:
       1. Enhance eligibility and benefits for the Employee 
     Incentive Scholarship and Education Debt Reduction Programs 
     by enabling VA nurses to pursue advanced degrees while 
     continuing to care for veterans, in order to improve 
     recruitment and retention of nurses within the VA health care 
     system.
       2. Mandate that VA provide Saturday premium pay to title 5/
     title 38 hybrid employees. Such hybrid-authority employees 
     include licensed vocational nurses, pharmacists, certified or 
     registered respiratory therapists, physical therapists, and 
     occupational therapists.
       3. Require VA to develop a nationwide policy on staffing 
     standards to ensure that veterans are provided with safe and 
     high quality care, taking into consideration the numbers and 
     skill mix required of staff in specific health care settings. 
     Require a report on the use of mandatory overtime by licensed 
     nursing staff and nursing assistants in each VA health care 
     facility; include in report a description of the amount of 
     mandatory overtime used by facilities.
       4. Change reporting responsibility of the Director of the 
     Nursing Service to report to the Under Secretary for Health.
       5. Recompute annuities for part-time service performed by 
     certain health care professionals before April 7, 1986.
       6. Establish a 12-member National Commission on VA Nursing 
     that would assess legislative and organizational policy 
     changes to enhance the recruitment and retention of nurses by 
     the Department and the future of the nursing profession 
     within the Department, and recommend legislative and 
     organizational policy changes to enhance the recruitment and 
     retention of nursing personnel in the Department.
       7. Authorize service dogs to be provided by VA to a veteran 
     suffering from spinal cord injuries or dysfunction, other 
     diseases causing physical immobility, hearing loss or other 
     types of disabilities susceptible to improvement or enhanced 
     functioning in activities of daily living through employment 
     of a service dog.
       8. Modify VA's system of determining nonservice-connected 
     veterans' ``ability to pay'' for VA health care services by 
     introducing (as an upper income bound contrasted with current 
     income limits) the ``Low Income Housing Limits'' employed by 
     the Department of Housing and Urban Development (HUD), used 
     by HUD to determine family income thresholds for housing 
     assistance. This index is adjusted for all Standard 
     Metropolitan Statistical Areas (SMSAs), and is updated 
     periodically by HUD to reflect economic changes within the 
     SMSAs. Would retain current-law means test national 
     income threshold, but reduce co-payments by 80 percent for 
     near-poor veterans who require acute VA hospital inpatient 
     care.
       9. Strengthen the mandate for VA to maintain capacity in 
     specialized medical programs for veterans by requiring VA and 
     each of its Veterans Integrated Service Networks to maintain 
     the national capacity in certain specialized health care 
     programs for veterans (those with serious mental illness, 
     including substance use disorders, and spinal cord, brain 
     injured and blinded veterans; veterans who need prosthetics 
     and sensory aids); and extend capacity reporting requirement 
     for 3 years.
       10. Establish a program of chiropractic services in each 
     Veterans Integrated Service

[[Page H9225]]

     Network and require VA to provide training and educational 
     materials on chiropractic services to VA health care 
     providers. Authorize VA to employ chiropractors as federal 
     employees and obtain chiropractic services through contracts; 
     create a VA advisory committee on chiropractic health care.
       11. Require the Office of Research Compliance and 
     Assurance, which conducts oversight and compliance reviews of 
     VA research and development, be funded by the Medical Care 
     appropriation, rather than the Medical and Prosthetic 
     Research appropriation.
       12. Authorize $28,300,000 for major medical facility 
     construction project at the Miami, Florida VA Medical Center.
       13. Require Secretary of Veterans Affairs to assess all 
     special telephone services made available to veterans, such 
     as ``help lines'' and ``hotlines.'' Assessment would include 
     geographical coverage, availability, utilization, 
     effectiveness, management, coordination, staffing, cost, and 
     a survey of veterans to measure effectiveness of these 
     telephone services and future needs. A report to Congress 
     would be required within 1 year of enactment.
       14. Extend expiring authorities for VA to collect proceeds 
     from veterans' health insurance policies for care provided 
     for non-service connected care.
       15. Provide authority for the Secretary to study, and then 
     if determined feasible, obtain personal emergency-
     notification and response systems for service-disabled 
     veterans.
       16. Extend VA's authority to provide health care for those 
     who served in the Persian Gulf until December 31, 2002.

  Mr. FILNER. Mr. Speaker, I rise in support of the ``Department of 
Veterans Affairs Health Care Programs Enhancement Act of 2001''. I want 
to thank Chairman Christopher Smith, Ranking Member Lane Evans and 
Chairman Jerry Moran of the Health Subcommittee for addressing some of 
the concerns I raised about earlier versions of the bill. We now have a 
bill to which I am pleased to lend my support.
  Mr. Speaker, as a long-time advocate of chiropractic and a user of 
its services, I am, perhaps, most gratified that we have agreed to a 
comprehensive proposal to create a permanent chiropractic program 
within the Department of Veterans Affairs. This legislation will 
require VA to establish a national chiropractic program that will make 
chiropractic services available in each geographic service area. VA has 
rebuffed Congress and the chiropractic profession time and time again 
in an attempt to bring better access to chiropractic services under the 
VA's umbrella. We asked VA to develop a policy under the Veterans 
Millennium Health Care and Benefits Act, but leaving the policy 
development in VA's hands, veterans' access to chiropractic services 
has worsened. We simply cannot allow VA to keep barring the door to 
chiropractic care.
  Today is a fresh start for chiropractic care in VA. While I prefer 
the chiropractic care version this House approved in H.R. 2792, as 
amended, the provision in the bill before us today ensures that 
chiropractic care will be available in every VA network. To ensure that 
this program's implementation is smooth, the conference agreement 
establishes a chiropractic advisory committee that will provide VA the 
expertise and advocacy needed to address the issues involved in hiring 
chiropractors and ensuring that chiropractors are able to participate 
in its workforce using their skills and training to their fullest 
potential. I believe that this bill offers the fundamentals from which 
VA can begin to develop a sound chiropractic program. Eventually, I 
believe it will be necessary for VA to establish a director of 
chiropractic service and for Congress to specify, in law, an 
established number of sites for chiropractic care. Still, for the first 
time, this law will ensure that veterans have a real opportunity to 
access this important part of the health care continuum.
  In our Subcommittee hearing this Fall, we heard from many of the 
veterans' service organizations and animal trainers on the invaluable 
assistance provided by service dogs to severely disabled people. I am 
pleased that this bill retains this provision.
  We have strengthened the requirements for VA to report to Congress on 
programs that serve some of our most vulnerable veterans. We have 
focused these reporting requirements on VA's mental health programs. I 
believe this will give Congress a much clearer idea about what types of 
valuable specialized services are eroding. I am also pleased that these 
reports will make geographic service areas accountable for maintaining 
programs under their authority. For too long, we have heard VA's 
central office indicate that they are helpless over controlling the 
activities of their field managers. Making the networks accountable for 
the maintenance of specialized programs to serve disabled veterans puts 
the responsibility where the authority lies.
  Mr. Speaker, I believe thousands of veterans will benefit from a 
provision in this bill, strongly advocated by Chairman Smith, that 
adjusts VA copayments for acute hospital inpatient care to the cost-of-
living veterans experience in different areas of the country. Salaries, 
food, and housing costs vary greatly across this Nation. This 
legislation permits VA to use a widely employed index of geographic 
variances in cost of living--one already used by the Department of 
Housing and Urban Development to assess a family's ability to afford 
housing--to gauge veterans' ability to pay for health care services. 
This legislation ensures that veterans, who are eligible for low-income 
housing in a given geographic location, but who are not considered 
medically indigent under the national Department of Veterans Affairs 
means-test, are given a break on the acute inpatient hospital 
copayments they would otherwise have to make.
  I want to extend a special thanks to Congresswoman Lois Capps for 
introducing H.R. 1435. This bill raised the Committee's awareness of 
the need for a round-the-clock telephone crisis and referral service. 
We intend to have the VA investigate its current resources and 
recommend a strategy for enhancing its current capabilities.
  This measure contains a charter for a new Commission on VA Nursing. 
As we know, the nursing profession, inside and outside of VA has 
changed and VA must be prepared to be an ``employer of choice'' in the 
future. This Commission can give expert advise on where VA must 
position itself now and in the future to attract the best nurses 
available to treat our veterans. In addition, it contains provisions 
from S. 1188, and its companion introduced in the House by Tom Udall, 
H.R. 3017. These provisions will provide additional opportunities for 
VA to recruit and retain nurses--an invaluable component of its health 
care staff.
  The Health Care Programs Enhancement Act is a strong measure and I 
urge my colleagues to support the bill.
  Mr. EVANS. Mr. Speaker, I yield back the balance of my time.

                              {time}  2310

  Mr. SMITH of New Jersey. Mr. Speaker, I have no further requests for 
time, and I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Terry). The question is on the motion 
offered by the gentleman from New Jersey (Mr. Smith) that the House 
suspend the rules and pass the bill, H.R. 3447.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

                          ____________________