[Congressional Record Volume 149, Number 78 (Friday, May 23, 2003)]
[Senate]
[Pages S7154-S7155]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SPECTER:
  S. 1156. A bill to amend title 38, United States Code, to improve and 
enhance the provision of long-term health care for veterans by the 
Department of Veterans Affairs, to enhance and improve authorities 
relating to the administration of personnel of the Department of 
Veterans Affairs, and for other purposes; to the Committee on Veterans' 
Affairs.
  Mr. SPECTER. Mr. President, I have sought recognition to explain 
briefly the provisions of the ``Department of Veterans Affairs Long-
Term Care and Personnel Authorities Enhancement Act of 2003,'' a bill 
that I have introduced today.
  Title I of the bill would extend through calendar year 2008 
authorities that now specify that the Department of Veterans Affairs, 
VA, will provide to veterans enrolled for VA medical care outpatient-
based long-term care services, such as Adult Day Health Care, Home 
Health Aide assistance, Non-Institutional Respite Care, and Home-based 
Primary Care. These services provide alternatives to institutional care 
and, in many cases, they obviate the need for institutional care by 
allowing veterans to remain in their own homes with care-giving 
assistance provided by VA.
  In addition, this bill would lower, from 70 percent to 50 percent, 
the threshold level of service-connected disability that would qualify 
a veteran for highest-priority for institutional care should he or she 
need it. VA currently provides highest-priority access to hospital and 
outpatient clinic-based care to veterans who have suffered a service-
connected disability rated by VA as 50 percent disabling or higher. 
Highest-priority access to inpatient-based long-term care services, 
however, is only granted by law to veterans who are 70 percent or more 
disabled, unless such care is needed specifically to treat a less-
disabling service-connected disability. When this provision of law was 
enacted in 1999, Congress set the threshold for priority access to 
nursing home care at 70 percent, rather than at 50 percent, due 
primarily to concerns that a lower threshold--which was actively 
considered--might cause VA to be faced with an unforeseen level of 
demand that could not be met. Since then, however, VA has reported that 
``there was only a small increase in the numbers of veterans 70 percent 
service-connected or greater who were estimated to need nursing home 
care but who actually received that care from VA.'' In light of that, I 
see no compelling reason to continue distinguishing between nursing 
home care and all other types of care that are made available to 50 
percent or higher service-connected veterans on a highest-priority 
basis. This bill would provide, in effect, that hospital care, 
outpatient clinic-based care, and nursing home care will equally be 
made available to all such enrolled veterans.
  Title I of the bill would also make technical changes to VA authority 
to contract for nursing home and adult day health care services by 
allowing VA to enter into agreements with providers under standards 
similar to those allowed by Medicare. According to VA, these changes 
will allow a greater number of smaller community-based providers to 
contract with VA by reducing the regulatory burdens placed upon them as 
a condition to contracting eligibility.
  Title II of the bill authorizes major construction for long-term care 
facilities in Beckley, WV and Lebanon, PA. Each of these states has a 
substantial elderly population and each is need of expansion to their 
VA long-term care programs.
  Title III of the bill would change current law to allow VA to more 
easily hire and retain certain clinical staff members. Under current 
law, VA hires many clinical professionals, such as physicians and 
nurses, under streamlined authorities set forth in title 38 of U.S. 
Code. But other key clinical professionals, such as clinical social 
workers, psychologists, and pharmacists, may only be hired through the 
standard ``civil service'' authorities specified in Title 5, U.S. Code. 
Further, members of such professions may only be paid and promoted in 
accordance with the standard civil service General Schedule, GS, pay 
scale. The process of hiring staff under these procedures is arduous 
and lengthy, consuming three months or more and placing VA at great 
competitive disadvantage in securing the services of best qualified 
candidates. This bill would convert many of these positions into 
``hybrid Title 38'' status and permit VA greatly increased hiring and 
promotion flexibility, and compensation at special, locally-based, pay 
scales. Such clinicians, however, would retain their standard civil 
service grievance, vacation, and discipline protections.
  Title III of the bill also contains provisions to correct a long-
standing inequity relating to retirement benefits for certain part-time 
VA nurses; to expand a successful pilot program allowing for contract-
physician disability compensation medical examinations; and to afford 
certain wage-grade canteen workers an opportunity to compete favorably 
for VA employment.
  I urge my colleagues to support this legislation.
  Mr. President, I ask unanimous consent that the text of this bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1156

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Department of Veterans 
     Affairs Long-Term Care and Personnel Authorities Enhancement 
     Act of 2003''.

           TITLE I--EXTENSION AND ENHANCEMENT OF AUTHORITIES

     SEC. 101. EXTENSION AND MODIFICATION OF CERTAIN HEALTH CARE 
                   AUTHORITIES.

       (a) Treatment of Noninstitutional Extended Care Services as 
     Medical Services.--Section 1701(a)(10)(A) of title 38, United 
     States Code, is amended by striking ``December 31, 2003'' and 
     inserting ``December 31, 2008''.
       (b) Required Nursing Home Care.--(1) Subsection (a) of 
     section 1710A of such title is amended by striking ``70 
     percent'' and inserting ``50 percent''.
       (2) Subsection (c) of such section is amended by striking 
     ``December 31, 2003'' and inserting ``December 31, 2008''.

     SEC. 102. ENHANCED AGREEMENT AUTHORITY FOR PROVISION OF 
                   NURSING HOME CARE AND ADULT DAY HEALTH CARE IN 
                   NON-DEPARTMENT OF VETERANS AFFAIRS FACILITIES.

       Section 1720 of title 38, United States Code, is amended--
       (1) in subsection (c)--
       (A) by designating the existing text as paragraph (2); and
       (B) by inserting before paragraph (2), as so designated, 
     the following new paragraph (1):
       ``(1) In furnishing nursing home care or adult day health 
     care under this section, the Secretary may enter into 
     agreements for furnishing such care utilizing such 
     authorities relating to agreements for the provision of 
     services under section 1866 of the Social Security Act (42 
     U.S.C. 1395cc) that the Secretary considers appropriate.''; 
     and
       (2) in subsection (f)(1)(B), by inserting ``or agreement'' 
     after ``contract'' each place it appears.

                  TITLE II--CONSTRUCTION AUTHORIZATION

     SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

       The Secretary of Veterans Affairs may carry out the 
     following major medical facility projects, with each project 
     to be carried out in an amount not to exceed the amount 
     specified for that project:
       (1) Construction of a long-term care facility in Lebanon, 
     Pennsylvania, $14,500,000.
       (2) Construction of a long-term care facility in Beckley, 
     West Virginia, $20,000,000.

     SEC. 202. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There are authorized to be appropriated 
     for the Secretary of Veterans Affairs for fiscal year 2004 
     for the Construction, Major Projects, account, a total of 
     $34,500,000 for the projects authorized in paragraphs (1) and 
     (2) of section 201.
       (b) Limitation.--The projects authorized in section 201 may 
     only be carried out using--
       (1) funds appropriated for fiscal year 2004 pursuant to the 
     authorization of appropriations in subsection (a);
       (2) funds appropriated for Construction, Major Projects, 
     for a fiscal year before fiscal year 2004 that remain 
     available for obligation; and
       (3) funds appropriated for Construction, Major Projects, 
     for fiscal year 2004 for a category of activity not specific 
     to a project.

                          TITLE III--PERSONNEL

     SEC. 301. MODIFICATION OF AUTHORITIES ON APPOINTMENTS OF 
                   PERSONNEL IN THE VETERANS HEALTH 
                   ADMINISTRATION.

       (a) Positions Treatable as Hybrid Status Positions.--
     Section 7401 of title 38, United States Code, is amended--
       (1) in paragraph (2), by striking ``Psychologists'' and all 
     that follows through ``other scientific'' and inserting 
     ``Other scientific''; and

[[Page S7155]]

       (2) by striking paragraph (3) and inserting the following 
     new paragraph (3):
       ``(3) Audiologists, speech pathologists, and audiologist-
     speech pathologists, biomedical engineers, certified or 
     registered respiratory therapists, dietitians, licensed 
     physical therapists, licensed practical or vocational nurses, 
     medical instrument technicians, medical records 
     administrators or specialists, medical records technicians, 
     medical technologists, nuclear medicine technologists, 
     occupational therapists, occupational therapy assistants, 
     orthotist-prosthetists, pharmacists, pharmacy technicians, 
     physical therapy assistants, prosthetic representatives, 
     psychologists, diagnostic radiologic technicians, therapeutic 
     radiologic technicians, social workers, and personnel in such 
     other positions as the Secretary designates (subject to 
     section 7403(f)(4) of this title) for purposes of this 
     paragraph as necessary for the medical care of veterans.''.
       (b) Report on Proposal To Designate Additional Positions as 
     Hybrid Status Positions.--Section 7403(f) of such title is 
     amended by adding at the end the following new paragraph:
       ``(4) Not later than 45 days before the date on which the 
     Secretary proposes to designate a position as a position 
     necessary for the medical care of veterans for which 
     appointment may be made under section 7401(3) of this title, 
     the Secretary shall submit to the Committees on Veterans' 
     Affairs of the Senate and the House of Representatives a 
     report on the proposed designation.''.
       (c) Temporary, Part-Time, and Without Compensation 
     Appointments.--Section 7405 of such title is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by striking subparagraphs (B) and (C) 
     and inserting the following new subparagraphs:
       ``(B) Positions listed in section 7401(3) of this title.
       ``(C) Librarians.''; and
       (B) in paragraph (2), by striking subparagraph (B) and 
     inserting the following new subparagraph (B):
       ``(B) Positions listed in section 7401(3) of this title.''; 
     and
       (2) in subsection (c)(1), by striking ``section 7401(1)'' 
     and inserting ``paragraphs (1) and (3) of section 7401''.
       (d) Authority for Additional Pay for Certain Health Care 
     Professionals.--Section 7454(b)(1) of such title is amended 
     by striking ``certified or registered'' and all that follows 
     through ``occupational therapists,'' and inserting 
     ``individuals in positions listed in section 7401(3) of this 
     title,''.

     SEC. 302. COVERAGE OF EMPLOYEES OF VETERANS' CANTEEN SERVICE 
                   UNDER ADDITIONAL EMPLOYMENT LAWS.

       Section 7802(5) is amended by inserting before the 
     semicolon the following: ``. Employees and personnel under 
     this clause may be considered for appointment in Department 
     positions in the competitive service in the same manner that 
     Department employees in the competitive service are 
     considered for transfer to such positions. An employee or 
     individual appointed as personnel under this clause who is 
     appointed to a Department position under the authority of the 
     preceding sentence shall be treated as having a career 
     appointment in such position once such employee or individual 
     meets the three-year requirement for career tenure (with any 
     previous period of employment or appointment in the Service 
     being counted toward satisfaction of such requirement)''.

     SEC. 303. EFFECTIVE DATE OF MODIFICATION OF TREATMENT FOR 
                   RETIREMENT ANNUITY PURPOSES OF CERTAIN PART-
                   TIME SERVICE OF CERTAIN DEPARTMENT OF VETERANS 
                   AFFAIRS HEALTH-CARE PROFESSIONALS.

       (a) Effective Date.--The effective date of the amendment 
     made by section 132 of the Department of Veterans Affairs 
     Health Care Programs Enhancement Act of 2001 (Public Law 107-
     135; 115 Stat. 2454) shall be as follows:
       (1) January 23, 2002, in the case of health care 
     professionals referred to in subsection (c) of section 7426 
     of title 38, United States Code (as so amended), who retire 
     on or after that date.
       (2) The date of the enactment of this Act, in the case of 
     health care professionals referred to in such subsection (c) 
     who retired before January 23, 2002, but after April 7, 1986.
       (b) Recomputation of Annuity.--The Office of Personnel 
     Management shall recompute the annuity of each health-care 
     professional described in the first sentence of subsection 
     (c) of section 7426 of title 38, United States Code (as so 
     amended), who retired before January 23, 2002, but after 
     April 7, 1986, in order to take into account the amendment 
     made by section 132 of the Department of Veterans Affairs 
     Health Care Programs Enhancement Act of 2001. Such 
     recomputation shall be effective only with respect to 
     annuities paid after the date of the enactment of this Act, 
     and shall apply beginning the first day of the first month 
     beginning after the date of the enactment of this Act.

     SEC. 304. PERMANENT AUTHORITY FOR USE OF CONTRACT PHYSICIANS 
                   FOR DISABILITY EXAMINATIONS.

       (a) Permanent Authority.--Section 504 of the Veterans' 
     Benefits Improvements Act of 1996 (Public Law 104-275; 110 
     Stat. 3341; 38 U.S.C. 5101 note) is amended--
       (1) in subsection (a), by striking ``may conduct a pilot 
     program'' and all that follows through ``may be made by'' and 
     inserting ``may carry out examinations with respect to the 
     medical disability of applicants for benefits under the laws 
     administered by the Secretary through''; and
       (2) in subsection (c), by striking ``the pilot program 
     under''.
       (b) Repeal of Limitation and Obsolete Authority.--That 
     section is further amended--
       (1) by striking subsections (b) and (d); and
       (2) by redesignating subsection (c), as amended by 
     subsection (a) of this section, as subsection (b).
       (c) Conforming Amendment.--The heading for that section is 
     amended to read as follows:

     ``SEC. 504. AUTHORITY FOR USE OF CONTRACT PHYSICIANS FOR 
                   DISABILITY EXAMINATIONS.''.

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