[Congressional Record Volume 149, Number 90 (Wednesday, June 18, 2003)]
[Senate]
[Pages S8135-S8136]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAHAM of Florida:
  S. 1283. A bill to require advance notification of Congress regarding 
any action proposed to be taken by the Secretary of Veterans Affairs in 
the implementation of the Capital Asset Realignment for Enhanced 
Services initiative of the Department of Veterans Affairs, and for 
other purposes; to the Committee on Veterans' Affairs.
  Mr. GRAHAM of Florida. Madam President, the Department of Veterans 
Affairs, VA, is in the midst of determining how best to serve the 
millions of veterans who turn to the VA health care system for their 
care. This process--known as CARES or Capital Asset Realignment for 
Enhanced Services--will likely bring significant change to the VA 
system. Recommendations stemming from this process could lead to 
billions of dollars in new facilities construction, on the one hand, 
and possible closure of facilities and thousands of beds, on the other. 
Despite the magnitude of these possible changes, Congress has virtually 
no formal role in the process.
  I introduce legislation today that would allow for Congressional 
review of the CARES recommendations that the Secretary of VA will begin 
to implement at the end of this year.
  The CARES initiative has been ongoing since the Fall of 2002, tasking 
VA facilities with developing recommendations based on a review of 
population data; the conduct of market analyses of veterans' health 
care needs; the identification of planning initiatives for each market 
area; and most important, the significant involvement of stakeholders, 
including myriad public meetings. These so-called planning initiatives 
are ultimately slated to be passed on to the Secretary, who will then 
make the final decisions.
  While an independent review led by a national CARES Commission is 
already planned, in addition to public hearings--which I fully 
support--I must reiterate that Congress has little, if any, role in the 
CARES effort outside of construction authorization and appropriation 
activities. Yet, all states and most health care facilities will be 
affected by the results. The legislation I introduce today would give 
Congress a 60-day period to review the CARES recommendations submitted 
by the Secretary of Veterans Affairs. During that time, VA would be 
prohibited from moving forward with any bed or facility closures.
  This oversight is absolutely essential--particularly in light of 
recent events. Just last month, all VA health care networks submitted 
their plans to VA headquarters. These plans were developed following 
substantial analysis and thorough stakeholder involvement. While 
abiding by the criteria and process set forth by VA, facilities made 
their recommendations to the Under Secretary for Health. In a surprise 
move and an apparent manipulation of the process, VA instructed the 
network directors to re-evaluate the plans they had already submitted 
for 20 different VA facilities. They were told to ``evaluate a strategy 
to convert from a 24-hour operation to an 8 hour a day operation. This 
includes any inpatient care, including long term care.''
  One of these hospitals is in Lake City, in my home State of Florida. 
Network 8, which has responsibility for Lake City, had previously 
recommended that no long-term care beds be deactivated at this 
facility, yet they were told to go back to the drawing board to develop 
a strategy to close nursing home beds there.
  Another facility tasked with re-examining their plan is Bedford, 
Massachusetts. In their network's plan, submitted to the Under 
Secretary, officials stated that they had in fact considered 
``alternatives to consolidate Long Term Care, LTC, including the 
Alzheimer's and SCI Units, and Psychiatry inpatient beds from the 
Bedford to Brockton facilities'' yet, ``as final projections are not 
available for LTC inpatient beds and earlier projections indicated a 
substantial increase in LTC beds, it was determined to utilize current 
capacities.'' Despite these assessments to the contrary, VA has asked

[[Page S8136]]

that they instead plan to convert these facilities to outpatient 
operations only.
  Yet one more example of this apparent manipulation involves another 
facility now slated for bed closures, the Leavenworth VA Medical Center 
in Kansas. The network plan concluded that ``[r]ealignment of workload 
from Leavenworth to Kansas City would exceed current capacity. . . . 
Elimination of inpatient and outpatient primary care capabilities at 
Leavenworth would seriously undermine continuity of care for the 
remaining long-term care patients, reduce timely access to care, hinder 
its ability to provide ongoing support to the DoD facility located at 
Ft. Leavenworth . . . '' . Again, analysis conducted at the regional 
level resulted in a recommendation that VA is now directing be 
reconsidered.
  The VA facility in Knoxville, IA, is being targeted for significant 
changes as well. The current proposal is to move all of the beds from 
Knoxville to Des Moines. The Knoxville facility has more than 226 long-
term care beds, 40 domiciliary beds, and 34 inpatient psychiatric beds. 
We need to take a look at this proposal and the many others that will 
affect veterans all across the country.
  Other facilities asked to re-evaluate are: Batavia, Lyons, St. 
Albans, Montrose, Pittsburgh at Highland Drive, Augusta, Dublin, 
Lexington, Brecksville, Gulfport, Marlin/Waco, Vancouver, Livermore, 
and Hot Springs.
  While VA intends to present a five-year capital plan to Congress, 
there is nothing that requires VA to inform Members about possible 
reductions, closures, and other decisions that would have a deleterious 
effect on VA health care services and our veterans. This is 
unacceptable. Congress' role should not be limited to merely funding 
the implementation of these decisions; rather, we should be involved in 
a process that could result in the significant loss of inpatient, long-
term care, and domiciliary capacity at VA health care facilities 
nationwide. We can rectify this problem very easily, however, by 
enacting the legislation I propose today.
  In an internal VA memo, Secretary Principi stated that ``the CARES 
process may be one of the most important activities undertaken by VA 
this decade. The outcome of this process will construct the foundation 
for, and set the course of, our health care system for the first half 
of the 21st century.'' In light of the great impact of this initiative 
on VA health care services, as well as recent actions that threaten the 
integrity of the process, it is imperative that Congress be granted a 
mere 60 days to review VA's proposals. I urge my colleagues to join me 
in this effort to secure the future of health care for our nation's 
veterans.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1283

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

     SECTION 1. ADVANCE NOTIFICATION OF A DEPARTMENT OF VETERANS 
                   AFFAIRS CAPITAL ASSET REALIGNMENT INITIATIVE.

       (a) Requirement for Advance Notification.--Before taking 
     any action proposed under the Capital Asset Realignment for 
     Enhanced Services initiative of the Department of Veterans 
     Affairs, the Secretary of Veterans Affairs shall submit to 
     Congress a written notification of the intent to take such 
     action.
       (b) Limitation.--The Secretary of Veterans Affairs may not 
     take any proposed action described in subsection (a) until 
     the later of--
       (1) the expiration of the 60-day period beginning on the 
     date on which the Secretary submits to Congress the 
     notification of the proposed action required under subsection 
     (a); or
       (2) the expiration of a period of 30 days of continuous 
     session of Congress beginning on such date of notification 
     or, if either House of Congress is not in session on such 
     date, the first day after such date that both Houses of 
     Congress are in session.
       (c) Continuous Session of Congress.--For the purposes of 
     subsection (b)--
       (1) the continuity of session of Congress is broken only by 
     an adjournment of Congress sine die; and
       (2) the days on which either House is not in session 
     because of an adjournment of more than three days to a day 
     certain are excluded in the computation of any period of time 
     in which Congress is in continuous session.
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