[Congressional Record Volume 156, Number 57 (Wednesday, April 21, 2010)]
[House]
[Pages H2703-H2733]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CAREGIVERS AND VETERANS OMNIBUS HEALTH SERVICES ACT
Mr. FILNER. Mr. Speaker, I move to suspend the rules and pass the
bill (S. 1963) to amend title 38, United States Code, to provide
assistance to caregivers of veterans, to improve the provision of
health care to veterans, and for other purposes, as amended.
The Clerk read the title of the bill.
The text of the amendment is as follows:
Amendment:
Strike out all after the enacting clause and insert:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Caregivers
and Veterans Omnibus Health Services Act of 2010''.
(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--CAREGIVER SUPPORT
Sec. 101. Assistance and support services for caregivers.
Sec. 102. Medical care for family caregivers.
Sec. 103. Counseling and mental health services for caregivers.
Sec. 104. Lodging and subsistence for attendants.
TITLE II--WOMEN VETERANS HEALTH CARE MATTERS
Sec. 201. Study of barriers for women veterans to health care from the
Department of Veterans Affairs.
Sec. 202. Training and certification for mental health care providers
of the Department of Veterans Affairs on care for
veterans suffering from sexual trauma and post-traumatic
stress disorder.
Sec. 203. Pilot program on counseling in retreat settings for women
veterans newly separated from service in the Armed
Forces.
Sec. 204. Service on certain advisory committees of women recently
separated from service in the Armed Forces.
Sec. 205. Pilot program on assistance for child care for certain
veterans receiving health care.
Sec. 206. Care for newborn children of women veterans receiving
maternity care.
TITLE III--RURAL HEALTH IMPROVEMENTS
Sec. 301. Improvements to the Education Debt Reduction Program.
Sec. 302. Visual impairment and orientation and mobility professionals
education assistance program.
Sec. 303. Demonstration projects on alternatives for expanding care for
veterans in rural areas.
Sec. 304. Program on readjustment and mental health care services for
veterans who served in Operation Enduring Freedom and
Operation Iraqi Freedom.
Sec. 305. Travel reimbursement for veterans receiving treatment at
facilities of the Department of Veterans Affairs.
Sec. 306. Pilot program on incentives for physicians who assume
inpatient responsibilities at community hospitals in
health professional shortage areas.
Sec. 307. Grants for veterans service organizations for transportation
of highly rural veterans.
Sec. 308. Modification of eligibility for participation in pilot
program of enhanced contract care authority for health
care needs of certain veterans.
[[Page H2704]]
TITLE IV--MENTAL HEALTH CARE MATTERS
Sec. 401. Eligibility of members of the Armed Forces who serve in
Operation Enduring Freedom or Operation Iraqi Freedom for
counseling and services through Readjustment Counseling
Service.
Sec. 402. Restoration of authority of Readjustment Counseling Service
to provide referral and other assistance upon request to
former members of the Armed Forces not authorized
counseling.
Sec. 403. Study on suicides among veterans.
TITLE V--OTHER HEALTH CARE MATTERS
Sec. 501. Repeal of certain annual reporting requirements.
Sec. 502. Submittal date of annual report on Gulf War research.
Sec. 503. Payment for care furnished to CHAMPVA beneficiaries.
Sec. 504. Disclosure of patient treatment information from medical
records of patients lacking decisionmaking capacity.
Sec. 505. Enhancement of quality management.
Sec. 506. Pilot program on use of community-based organizations and
local and State government entities to ensure that
veterans receive care and benefits for which they are
eligible.
Sec. 507. Specialized residential care and rehabilitation for certain
veterans.
Sec. 508. Expanded study on the health impact of Project Shipboard
Hazard and Defense.
Sec. 509. Use of non-Department facilities for rehabilitation of
individuals with traumatic brain injury.
Sec. 510. Pilot program on provision of dental insurance plans to
veterans and survivors and dependents of veterans.
Sec. 511. Prohibition on collection of copayments from veterans who are
catastrophically disabled.
Sec. 512. Higher priority status for certain veterans who are medal of
honor recipients.
Sec. 513. Hospital care, medical services, and nursing home care for
certain Vietnam-era veterans exposed to herbicide and
veterans of the Persian Gulf War.
Sec. 514. Establishment of Director of Physician Assistant Services in
Veterans Health Administration.
Sec. 515. Committee on Care of Veterans with Traumatic Brain Injury.
Sec. 516. Increase in amount available to disabled veterans for
improvements and structural alterations furnished as part
of home health services.
Sec. 517. Extension of statutorily defined copayments for certain
veterans for hospital care and nursing home care.
Sec. 518. Extension of authority to recover cost of certain care and
services from disabled veterans with health-plan
contracts.
TITLE VI--DEPARTMENT PERSONNEL MATTERS
Sec. 601. Enhancement of authorities for retention of medical
professionals.
Sec. 602. Limitations on overtime duty, weekend duty, and alternative
work schedules for nurses.
Sec. 603. Reauthorization of health professionals educational
assistance scholarship program.
Sec. 604. Loan repayment program for clinical researchers from
disadvantaged backgrounds.
TITLE VII--HOMELESS VETERANS MATTERS
Sec. 701. Per diem grant payments to nonconforming entities.
TITLE VIII--NONPROFIT RESEARCH AND EDUCATION CORPORATIONS
Sec. 801. General authorities on establishment of corporations.
Sec. 802. Clarification of purposes of corporations.
Sec. 803. Modification of requirements for boards of directors of
corporations.
Sec. 804. Clarification of powers of corporations.
Sec. 805. Redesignation of section 7364A of title 38, United States
Code.
Sec. 806. Improved accountability and oversight of corporations.
TITLE IX--CONSTRUCTION AND NAMING MATTERS
Sec. 901. Authorization of medical facility projects.
Sec. 902. Designation of Merril Lundman Department of Veterans Affairs
Outpatient Clinic, Havre, Montana.
Sec. 903. Designation of William C. Tallent Department of Veterans
Affairs Outpatient Clinic, Knoxville, Tennessee.
Sec. 904. Designation of Max J. Beilke Department of Veterans Affairs
Outpatient Clinic, Alexandria, Minnesota.
TITLE X--OTHER MATTERS
Sec. 1001. Expansion of authority for Department of Veterans Affairs
police officers.
Sec. 1002. Uniform allowance for Department of Veterans Affairs police
officers.
Sec. 1003. Submission of reports to Congress by Secretary of Veterans
Affairs in electronic form.
Sec. 1004. Determination of budgetary effects for purposes of
compliance with Statutory Pay-As-You-Go-Act of 2010.
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--CAREGIVER SUPPORT
SEC. 101. ASSISTANCE AND SUPPORT SERVICES FOR CAREGIVERS.
(a) Assistance and Support Services.--
(1) In general.--Subchapter II of chapter 17 is amended by
adding at the end the following new section:
``Sec. 1720G. Assistance and support services for caregivers
``(a) Program of Comprehensive Assistance for Family
Caregivers.--(1)(A) The Secretary shall establish a program
of comprehensive assistance for family caregivers of eligible
veterans.
``(B) The Secretary shall only provide support under the
program required by subparagraph (A) to a family caregiver of
an eligible veteran if the Secretary determines it is in the
best interest of the eligible veteran to do so.
``(2) For purposes of this subsection, an eligible veteran
is any individual who--
``(A) is a veteran or member of the Armed Forces undergoing
medical discharge from the Armed Forces;
``(B) has a serious injury (including traumatic brain
injury, psychological trauma, or other mental disorder)
incurred or aggravated in the line of duty in the active
military, naval, or air service on or after September 11,
2001; and
``(C) is in need of personal care services because of--
``(i) an inability to perform one or more activities of
daily living;
``(ii) a need for supervision or protection based on
symptoms or residuals of neurological or other impairment or
injury; or
``(iii) such other matters as the Secretary considers
appropriate.
``(3)(A) As part of the program required by paragraph (1),
the Secretary shall provide to family caregivers of eligible
veterans the following assistance:
``(i) To each family caregiver who is approved as a
provider of personal care services for an eligible veteran
under paragraph (6)--
``(I) such instruction, preparation, and training as the
Secretary considers appropriate for the family caregiver to
provide personal care services to the eligible veteran;
``(II) ongoing technical support consisting of information
and assistance to address, in a timely manner, the routine,
emergency, and specialized caregiving needs of the family
caregiver in providing personal care services to the eligible
veteran;
``(III) counseling; and
``(IV) lodging and subsistence under section 111(e) of this
title.
``(ii) To each family caregiver who is designated as the
primary provider of personal care services for an eligible
veteran under paragraph (7)--
``(I) the assistance described in clause (i);
``(II) such mental health services as the Secretary
determines appropriate;
``(III) respite care of not less than 30 days annually,
including 24-hour per day care of the veteran commensurate
with the care provided by the family caregiver to permit
extended respite;
``(IV) medical care under section 1781 of this title; and
``(V) a monthly personal caregiver stipend.
``(B) Respite care provided under subparagraph (A)(ii)(III)
shall be medically and age-appropriate and include in-home
care.
``(C)(i) The amount of the monthly personal caregiver
stipend provided under subparagraph (A)(ii)(V) shall be
determined in accordance with a schedule established by the
Secretary that specifies stipends based upon the amount and
degree of personal care services provided.
``(ii) The Secretary shall ensure, to the extent
practicable, that the schedule required by clause (i)
specifies that the amount of the monthly personal caregiver
stipend provided to a primary provider of personal care
services for the provision of personal care services to an
eligible veteran is not less than the monthly amount a
commercial home health care entity would pay an individual in
the geographic area of the eligible veteran to provide
equivalent personal care services to the eligible veteran.
``(iii) If personal care services are not available from a
commercial home health entity in the geographic area of an
eligible veteran, the amount of the monthly personal
caregiver stipend payable under the schedule required by
clause (i) with respect to the eligible veteran shall be
determined by taking into consideration the costs of
commercial providers of personal care services in providing
personal care services in geographic areas other than the
geographic area of the eligible veteran with similar costs of
living.
[[Page H2705]]
``(4) An eligible veteran and a family member of the
eligible veteran seeking to participate in the program
required by paragraph (1) shall jointly submit to the
Secretary an application therefor in such form and in such
manner as the Secretary considers appropriate.
``(5) For each application submitted jointly by an eligible
veteran and family member, the Secretary shall evaluate--
``(A) the eligible veteran--
``(i) to identify the personal care services required by
the eligible veteran; and
``(ii) to determine whether such requirements could be
significantly or substantially satisfied through the
provision of personal care services from a family member; and
``(B) the family member to determine the amount of
instruction, preparation, and training, if any, the family
member requires to provide the personal care services
required by the eligible veteran--
``(i) as a provider of personal care services for the
eligible veteran; and
``(ii) as the primary provider of personal care services
for the eligible veteran.
``(6)(A) The Secretary shall provide each family member of
an eligible veteran who makes a joint application under
paragraph (4) the instruction, preparation, and training
determined to be required by such family member under
paragraph (5)(B).
``(B) Upon the successful completion by a family member of
an eligible veteran of instruction, preparation, and training
under subparagraph (A), the Secretary shall approve the
family member as a provider of personal care services for the
eligible veteran.
``(C) The Secretary shall, subject to regulations the
Secretary shall prescribe, provide for necessary travel,
lodging, and per diem expenses incurred by a family member of
an eligible veteran in undergoing instruction, preparation,
and training under subparagraph (A).
``(D) If the participation of a family member of an
eligible veteran in instruction, preparation, and training
under subparagraph (A) would interfere with the provision of
personal care services to the eligible veteran, the Secretary
shall, subject to regulations as the Secretary shall
prescribe and in consultation with the veteran, provide
respite care to the eligible veteran during the provision of
such instruction, preparation, and training to the family
member so that the family member can participate in such
instruction, preparation, and training without interfering
with the provision of such services to the eligible veteran.
``(7)(A) For each eligible veteran with at least one family
member who is described by subparagraph (B), the Secretary
shall designate one family member of such eligible veteran as
the primary provider of personal care services for such
eligible veteran.
``(B) A primary provider of personal care services
designated for an eligible veteran under subparagraph (A)
shall be selected from among family members of the eligible
veteran who--
``(i) are approved under paragraph (6) as a provider of
personal care services for the eligible veteran;
``(ii) elect to provide the personal care services to the
eligible veteran that the Secretary determines the eligible
veteran requires under paragraph (5)(A)(i);
``(iii) has the consent of the eligible veteran to be the
primary provider of personal care services for the eligible
veteran; and
``(iv) are considered by the Secretary as competent to be
the primary provider of personal care services for the
eligible veteran.
``(C) An eligible veteran receiving personal care services
from a family member designated as the primary provider of
personal care services for the eligible veteran under
subparagraph (A) may, in accordance with procedures the
Secretary shall establish for such purposes, revoke consent
with respect to such family member under subparagraph
(B)(iii).
``(D) If a family member designated as the primary provider
of personal care services for an eligible veteran under
subparagraph (A) subsequently fails to meet any requirement
set forth in subparagraph (B), the Secretary--
``(i) shall immediately revoke the family member's
designation under subparagraph (A); and
``(ii) may designate, in consultation with the eligible
veteran, a new primary provider of personal care services for
the eligible veteran under such subparagraph.
``(E) The Secretary shall take such actions as may be
necessary to ensure that the revocation of a designation
under subparagraph (A) with respect to an eligible veteran
does not interfere with the provision of personal care
services required by the eligible veteran.
``(8) If an eligible veteran lacks the capacity to make a
decision under this subsection, the Secretary may, in
accordance with regulations and policies of the Department
regarding appointment of guardians or the use of powers of
attorney, appoint a surrogate for the eligible veteran who
may make decisions and take action under this subsection on
behalf of the eligible veteran.
``(9)(A) The Secretary shall monitor the well-being of each
eligible veteran receiving personal care services under the
program required by paragraph (1).
``(B) The Secretary shall document each finding the
Secretary considers pertinent to the appropriate delivery of
personal care services to an eligible veteran under the
program.
``(C) The Secretary shall establish procedures to ensure
appropriate follow-up regarding findings described in
subparagraph (B). Such procedures may include the following:
``(i) Visiting an eligible veteran in the eligible
veteran's home to review directly the quality of personal
care services provided to the eligible veteran.
``(ii) Taking such corrective action with respect to the
findings of any review of the quality of personal care
services provided an eligible veteran as the Secretary
considers appropriate, which may include--
``(I) providing additional training to a family caregiver;
and
``(II) suspending or revoking the approval of a family
caregiver under paragraph (6) or the designation of a family
caregiver under paragraph (7).
``(10) The Secretary shall carry out outreach to inform
eligible veterans and family members of eligible veterans of
the program required by paragraph (1) and the benefits of
participating in the program.
``(b) Program of General Caregiver Support Services.--(1)
The Secretary shall establish a program of support services
for caregivers of covered veterans who are enrolled in the
health care system established under section 1705(a) of this
title (including caregivers who do not reside with such
veterans).
``(2) For purposes of this subsection, a covered veteran is
any individual who needs personal care services because of--
``(A) an inability to perform one or more activities of
daily living;
``(B) a need for supervision or protection based on
symptoms or residuals of neurological or other impairment or
injury; or
``(C) such other matters as the Secretary shall specify.
``(3)(A) The support services furnished to caregivers of
covered veterans under the program required by paragraph (1)
shall include the following:
``(i) Services regarding the administering of personal care
services, which, subject to subparagraph (B), shall include--
``(I) educational sessions made available both in person
and on an Internet website;
``(II) use of telehealth and other available technologies;
and
``(III) teaching techniques, strategies, and skills for
caring for a disabled veteran;
``(ii) Counseling and other services under section 1782 of
this title.
``(iii) Respite care under section 1720B of this title that
is medically and age appropriate for the veteran (including
24-hour per day in-home care).
``(iv) Information concerning the supportive services
available to caregivers under this subsection and other
public, private, and nonprofit agencies that offer support to
caregivers.
``(B) If the Secretary certifies to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives that funding available for a fiscal year is
insufficient to fund the provision of services specified in
one or more subclauses of subparagraph (A)(i), the Secretary
shall not be required under subparagraph (A) to provide the
services so specified in the certification during the period
beginning on the date that is 180 days after the date the
certification is received by the Committees and ending on the
last day of the fiscal year.
``(4) In providing information under paragraph (3)(A)(iv),
the Secretary shall collaborate with the Assistant Secretary
for Aging of the Department of Health and Human Services in
order to provide caregivers access to aging and disability
resource centers under the Administration on Aging of the
Department of Health and Human Services.
``(5) In carrying out the program required by paragraph
(1), the Secretary shall conduct outreach to inform covered
veterans and caregivers of covered veterans about the
program. The outreach shall include an emphasis on covered
veterans and caregivers of covered veterans living in rural
areas.
``(c) Construction.--(1) A decision by the Secretary under
this section affecting the furnishing of assistance or
support shall be considered a medical determination.
``(2) Nothing in this section shall be construed to
create--
``(A) an employment relationship between the Secretary and
an individual in receipt of assistance or support under this
section; or
``(B) any entitlement to any assistance or support provided
under this section.
``(d) Definitions.--In this section:
``(1) The term `caregiver', with respect to an eligible
veteran under subsection (a) or a covered veteran under
subsection (b), means an individual who provides personal
care services to the veteran.
``(2) The term `family caregiver', with respect to an
eligible veteran under subsection (a), means a family member
who is a caregiver of the veteran.
``(3) The term `family member', with respect to an eligible
veteran under subsection (a), means an individual who--
``(A) is a member of the family of the veteran, including--
``(i) a parent;
``(ii) a spouse;
``(iii) a child;
``(iv) a step-family member; and
``(v) an extended family member; or
``(B) lives with the veteran but is not a member of the
family of the veteran.
``(4) The term `personal care services', with respect to an
eligible veteran under subsection (a) or a covered veteran
under subsection (b), means services that provide the veteran
the following:
[[Page H2706]]
``(A) Assistance with one or more independent activities of
daily living.
``(B) Any other non-institutional extended care (as such
term is used in section 1701(6)(E) of this title).
``(e) Authorization of Appropriations.--There are
authorized to be appropriated to carry out the programs
required by subsections (a) and (b)--
``(1) $60,000,000 for fiscal year 2010; and
``(2) $1,542,000,000 for the period of fiscal years 2011
through 2015.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 17 is amended by inserting after the
item related to section 1720F the following new item:
``1720G. Assistance and support services for caregivers.''.
(3) Effective date.--
(A) In general.--The amendments made by this subsection
shall take effect on the date that is 270 days after the date
of the enactment of this Act.
(B) Implementation.--The Secretary of Veterans Affairs
shall commence the programs required by subsections (a) and
(b) of section 1720G of title 38, United States Code, as
added by paragraph (1) of this subsection, on the date on
which the amendments made by this subsection take effect.
(b) Implementation Plan and Report.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) develop a plan for the implementation of the program of
comprehensive assistance for family caregivers required by
section 1720G(a)(1) of title 38, United States Code, as added
by subsection (a)(1) of this section; and
(B) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on such plan.
(2) Consultation.--In developing the plan required by
paragraph (1)(A), the Secretary shall consult with the
following:
(A) Individuals described in section 1720G(a)(2) of title
38, United States Code, as added by subsection (a)(1) of this
section.
(B) Family members of such individuals who provide personal
care services to such individuals.
(C) The Secretary of Defense with respect to matters
concerning personal care services for members of the Armed
Forces undergoing medical discharge from the Armed Forces who
are eligible to benefit from personal care services furnished
under the program of comprehensive assistance required by
section 1720G(a)(1) of such title, as so added.
(D) Veterans service organizations, as recognized by the
Secretary for the representation of veterans under section
5902 of such title.
(E) National organizations that specialize in the provision
of assistance to individuals with the types of disabilities
that family caregivers will encounter while providing
personal care services under the program of comprehensive
assistance required by section 1720G(a)(1) of such title, as
so added.
(F) National organizations that specialize in provision of
assistance to family members of veterans who provide personal
care services to such veterans.
(G) Such other organizations with an interest in the
provision of care to veterans and assistance to family
caregivers as the Secretary considers appropriate.
(3) Report contents.--The report required by paragraph
(1)(B) shall contain the following:
(A) The plan required by paragraph (1)(A).
(B) A description of the individuals, caregivers, and
organizations consulted by the Secretary of Veterans Affairs
under paragraph (2).
(C) A description of such consultations.
(D) The recommendations of such individuals, caregivers,
and organizations, if any, that were not adopted and
incorporated into the plan required by paragraph (1)(A), and
the reasons the Secretary did not adopt such recommendations.
(c) Annual Evaluation Report.--
(1) In general.--Not later than two years after the date
described in subsection (a)(3)(A) and annually thereafter,
the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a comprehensive report on the
implementation of section 1720G of title 38, United States
Code, as added by subsection (a)(1).
(2) Contents.--The report required by paragraph (1) shall
include the following:
(A) With respect to the program of comprehensive assistance
for family caregivers required by subsection (a)(1) of such
section 1720G and the program of general caregiver support
services required by subsection (b)(1) of such section--
(i) the number of caregivers that received assistance under
such programs;
(ii) the cost to the Department of providing assistance
under such programs;
(iii) a description of the outcomes achieved by, and any
measurable benefits of, carrying out such programs;
(iv) an assessment of the effectiveness and the efficiency
of the implementation of such programs; and
(v) such recommendations, including recommendations for
legislative or administrative action, as the Secretary
considers appropriate in light of carrying out such programs.
(B) With respect to the program of comprehensive assistance
for family caregivers required by such subsection (a)(1)--
(i) a description of the outreach activities carried out by
the Secretary under such program; and
(ii) an assessment of the manner in which resources are
expended by the Secretary under such program, particularly
with respect to the provision of monthly personal caregiver
stipends under paragraph (3)(A)(ii)(v) of such subsection
(a).
(C) With respect to the provision of general caregiver
support services required by such subsection (b)(1)--
(i) a summary of the support services made available under
the program;
(ii) the number of caregivers who received support services
under the program;
(iii) the cost to the Department of providing each support
service provided under the program; and
(iv) such other information as the Secretary considers
appropriate.
(d) Report on Expansion of Family Caregiver Assistance.--
(1) In general.--Not later than two years after the date
described in subsection (a)(3)(A), the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the feasibility and advisability
of expanding the provision of assistance under section
1720G(a) of title 38, United States Code, as added by
subsection (a)(1), to family caregivers of veterans who have
a serious injury incurred or aggravated in the line of duty
in the active military, naval, or air service before
September 11, 2001.
(2) Recommendations.--The report required by paragraph (1)
shall include such recommendations as the Secretary considers
appropriate with respect to the expansion described in such
paragraph.
SEC. 102. MEDICAL CARE FOR FAMILY CAREGIVERS.
Section 1781(a) is amended--
(1) in paragraph (2), by striking ``and'' at the end;
(2) in paragraph (3), by inserting ``and'' at the end; and
(3) by inserting after paragraph (3), the following new
paragraph:
``(4) an individual designated as a primary provider of
personal care services under section 1720G(a)(7)(A) of this
title who is not entitled to care or services under a health-
plan contract (as defined in section 1725(f) of this
title),''.
SEC. 103. COUNSELING AND MENTAL HEALTH SERVICES FOR
CAREGIVERS.
(a) In General.--Section 1782(c) is amended--
(1) in paragraph (1), by striking ``; or'' and inserting a
semicolon;
(2) by redesignating paragraph (2) as paragraph (3); and
(3) by inserting after paragraph (1) the following new
paragraph (2):
``(2) a family caregiver of an eligible veteran or a
caregiver of a covered veteran (as those terms are defined in
section 1720G of this title); or''.
(b) Conforming Amendment.--The section heading of section
1782 is amended by adding at the end, the following: ``and
caregivers''.
(c) Clerical Amendment.--The table of sections at the
beginning of chapter 17 is amended by striking the item
relating to section 1782 and inserting the following new
item:
``1782. Counseling, training, and mental health services for immediate
family members and caregivers.''.
SEC. 104. LODGING AND SUBSISTENCE FOR ATTENDANTS.
Section 111(e) is amended--
(1) by striking ``When'' and inserting the following: ``(1)
Except as provided in paragraph (2), when''; and
(2) by adding at the end the following new paragraphs:
``(2)(A) Without regard to whether an eligible veteran
entitled to mileage under this section for travel to a
Department facility for the purpose of medical examination,
treatment, or care requires an attendant in order to perform
such travel, an attendant of such veteran described in
subparagraph (B) may be allowed expenses of travel (including
lodging and subsistence) upon the same basis as such veteran
during--
``(i) the period of time in which such veteran is traveling
to and from a Department facility for the purpose of medical
examination, treatment, or care; and
``(ii) the duration of the medical examination, treatment,
or care episode for such veteran.
``(B) An attendant of a veteran described in this
subparagraph is a provider of personal care services for such
veteran who is approved under paragraph (6) of section
1720G(a) of this title or designated under paragraph (7) of
such section 1720G(a).
``(C) The Secretary may prescribe regulations to carry out
this paragraph. Such regulations may include provisions--
``(i) to limit the number of attendants that may receive
expenses of travel under this paragraph for a single medical
examination, treatment, or care episode of an eligible
veteran; and
``(ii) to require such attendants to use certain travel
services.
``(D) In this subsection, the term `eligible veteran' has
the meaning given that term in section 1720G(a)(2) of this
title.''.
[[Page H2707]]
TITLE II--WOMEN VETERANS HEALTH CARE MATTERS
SEC. 201. STUDY OF BARRIERS FOR WOMEN VETERANS TO HEALTH CARE
FROM THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Study Required.--The Secretary of Veterans Affairs
shall conduct a comprehensive study of the barriers to the
provision of comprehensive health care by the Department of
Veterans Affairs encountered by women who are veterans. In
conducting the study, the Secretary shall--
(1) survey women veterans who seek or receive hospital care
or medical services provided by the Department of Veterans
Affairs as well as women veterans who do not seek or receive
such care or services;
(2) administer the survey to a representative sample of
women veterans from each Veterans Integrated Service Network;
and
(3) ensure that the sample of women veterans surveyed is of
sufficient size for the study results to be statistically
significant and is a larger sample than that of the study
referred to in subsection (b).
(b) Use of Previous Study.--In conducting the study
required by subsection (a), the Secretary shall build on the
work of the study of the Department of Veterans Affairs
titled ``National Survey of Women Veterans in Fiscal Year
2007-2008''.
(c) Elements of Study.--In conducting the study required by
subsection (a), the Secretary shall conduct research on the
effects of the following on the women veterans surveyed in
the study:
(1) The perceived stigma associated with seeking mental
health care services.
(2) The effect of driving distance or availability of other
forms of transportation to the nearest medical facility on
access to care.
(3) The availability of child care.
(4) The acceptability of integrated primary care, women's
health clinics, or both.
(5) The comprehension of eligibility requirements for, and
the scope of services available under, hospital care and
medical services.
(6) The perception of personal safety and comfort in
inpatient, outpatient, and behavioral health facilities.
(7) The gender sensitivity of health care providers and
staff to issues that particularly affect women.
(8) The effectiveness of outreach for health care services
available to women veterans.
(9) The location and operating hours of health care
facilities that provide services to women veterans.
(10) Such other significant barriers as the Secretary
considers appropriate.
(d) Discharge by Contract.--The Secretary shall enter into
a contract with a qualified independent entity or
organization to carry out the study and research required
under this section.
(e) Mandatory Review of Data by Certain Department
Divisions.--
(1) In general.--The Secretary shall ensure that the head
of each division of the Department of Veterans Affairs
specified in paragraph (2) reviews the results of the study
conducted under this section. The head of each such division
shall submit findings with respect to the study to the Under
Secretary for Health and to other pertinent program offices
within the Department of Veterans Affairs with
responsibilities relating to health care services for women
veterans.
(2) Specified divisions.--The divisions of the Department
of Veterans Affairs specified in this paragraph are the
following:
(A) The Center for Women Veterans established under section
318 of title 38, United States Code.
(B) The Advisory Committee on Women Veterans established
under section 542 of such title.
(f) Reports.--
(1) Report on implementation.--Not later than six months
after the date on which the Department of Veterans Affairs
publishes a final report on the study titled ``National
Survey of Women Veterans in Fiscal Year 2007-2008'', the
Secretary shall submit to Congress a report on the status of
the implementation of this section.
(2) Report on study.--Not later than 30 months after the
date on which the Department publishes such final report, the
Secretary shall submit to Congress a report on the study
required under this section. The report shall include
recommendations for such administrative and legislative
action as the Secretary considers appropriate. The report
shall also include the findings of the head of each division
of the Department specified under subsection (e)(2) and of
the Under Secretary for Health.
(g) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs
$4,000,000 to carry out this section.
SEC. 202. TRAINING AND CERTIFICATION FOR MENTAL HEALTH CARE
PROVIDERS OF THE DEPARTMENT OF VETERANS AFFAIRS
ON CARE FOR VETERANS SUFFERING FROM SEXUAL
TRAUMA AND POST-TRAUMATIC STRESS DISORDER.
Section 1720D is amended--
(1) by redesignating subsection (d) as subsection (f); and
(2) by inserting after subsection (c) the following new
subsections:
``(d)(1) The Secretary shall carry out a program to provide
graduate medical education, training, certification, and
continuing medical education for mental health professionals
who provide counseling, care, and services under subsection
(a).
``(2) In carrying out the program required by paragraph
(1), the Secretary shall ensure that--
``(A) all mental health professionals described in such
paragraph have been trained in a consistent manner; and
``(B) training described in such paragraph includes
principles of evidence-based treatment and care for sexual
trauma and post-traumatic stress disorder.
``(e) Each year, the Secretary shall submit to Congress an
annual report on the counseling, care, and services provided
to veterans pursuant to this section. Each report shall
include data for the year covered by the report with respect
to each of the following:
``(1) The number of mental health professionals, graduate
medical education trainees, and primary care providers who
have been certified under the program required by subsection
(d) and the amount and nature of continuing medical education
provided under such program to such professionals, trainees,
and providers who are so certified.
``(2) The number of women veterans who received counseling
and care and services under subsection (a) from professionals
and providers who received training under subsection (d).
``(3) The number of graduate medical education, training,
certification, and continuing medical education courses
provided by reason of subsection (d).
``(4) The number of trained full-time equivalent employees
required in each facility of the Department to meet the needs
of veterans requiring treatment and care for sexual trauma
and post-traumatic stress disorder.
``(5) Such recommendations for improvements in the
treatment of women veterans with sexual trauma and post-
traumatic stress disorder as the Secretary considers
appropriate.
``(6) Such other information as the Secretary considers
appropriate.''.
SEC. 203. PILOT PROGRAM ON COUNSELING IN RETREAT SETTINGS FOR
WOMEN VETERANS NEWLY SEPARATED FROM SERVICE IN
THE ARMED FORCES.
(a) Pilot Program Required.--
(1) In general.--Commencing not later than 180 days after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall carry out, through the Readjustment
Counseling Service of the Veterans Health Administration, a
pilot program to evaluate the feasibility and advisability of
providing reintegration and readjustment services described
in subsection (b) in group retreat settings to women veterans
who are recently separated from service in the Armed Forces
after a prolonged deployment.
(2) Participation at election of veteran.--The
participation of a veteran in the pilot program under this
section shall be at the election of the veteran.
(b) Covered Services.--The services provided to a woman
veteran under the pilot program shall include the following:
(1) Information on reintegration into the veteran's family,
employment, and community.
(2) Financial counseling.
(3) Occupational counseling.
(4) Information and counseling on stress reduction.
(5) Information and counseling on conflict resolution.
(6) Such other information and counseling as the Secretary
considers appropriate to assist a woman veteran under the
pilot program in reintegration into the veteran's family,
employment, and community.
(c) Locations.--The Secretary shall carry out the pilot
program at not fewer than three locations selected by the
Secretary for purposes of the pilot program.
(d) Duration.--The pilot program shall be carried out
during the two-year period beginning on the date of the
commencement of the pilot program.
(e) Report.--Not later than 180 days after the completion
of the pilot program, the Secretary shall submit to Congress
a report on the pilot program. The report shall contain the
findings and conclusions of the Secretary as a result of the
pilot program, and shall include such recommendations for the
continuation or expansion of the pilot program as the
Secretary considers appropriate.
(f) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs for
each of fiscal years 2010 and 2011, $2,000,000 to carry out
the pilot program.
SEC. 204. SERVICE ON CERTAIN ADVISORY COMMITTEES OF WOMEN
RECENTLY SEPARATED FROM SERVICE IN THE ARMED
FORCES.
(a) Advisory Committee on Women Veterans.--Section
542(a)(2)(A) is amended--
(1) in clause (ii), by striking ``and'' at the end;
(2) in clause (iii), by striking the period at the end and
inserting ``; and''; and
(3) by inserting after clause (iii) the following new
clause:
``(iv) women veterans who are recently separated from
service in the Armed Forces.''.
(b) Advisory Committee on Minority Veterans.--Section
544(a)(2)(A) is amended--
(1) in clause (iii), by striking ``and'' at the end;
(2) in clause (iv), by striking the period at the end and
inserting ``; and''; and
(3) by inserting after clause (iv) the following new
clause:
[[Page H2708]]
``(v) women veterans who are minority group members and are
recently separated from service in the Armed Forces.''.
(c) Applicability.--The amendments made by this section
shall apply to appointments made on or after the date of the
enactment of this Act.
SEC. 205. PILOT PROGRAM ON ASSISTANCE FOR CHILD CARE FOR
CERTAIN VETERANS RECEIVING HEALTH CARE.
(a) Pilot Program Required.--The Secretary of Veterans
Affairs shall carry out a pilot program to assess the
feasibility and advisability of providing, subject to
subsection (b), assistance to qualified veterans described in
subsection (c) to obtain child care so that such veterans can
receive health care services described in subsection (c).
(b) Limitation on Period of Payments.--Assistance may only
be provided to a qualified veteran under the pilot program
for receipt of child care during the period that the
qualified veteran--
(1) receives the types of health care services described in
subsection (c) at a facility of the Department; and
(2) requires travel to and return from such facility for
the receipt of such health care services.
(c) Qualified Veterans.--For purposes of this section, a
qualified veteran is a veteran who is--
(1) the primary caretaker of a child or children; and
(2)(A) receiving from the Department--
(i) regular mental health care services;
(ii) intensive mental health care services; or
(iii) such other intensive health care services that the
Secretary determines that provision of assistance to the
veteran to obtain child care would improve access to such
health care services by the veteran; or
(B) in need of regular or intensive mental health care
services from the Department, and but for lack of child care
services, would receive such health care services from the
Department.
(d) Locations.--The Secretary shall carry out the pilot
program in no fewer than three Veterans Integrated Service
Networks selected by the Secretary for purposes of the pilot
program.
(e) Duration.--The pilot program shall be carried out
during the two-year period beginning on the date of the
commencement of the pilot program.
(f) Forms of Child Care Assistance.--
(1) In general.--Child care assistance under this section
may include the following:
(A) Stipends for the payment of child care offered by
licensed child care centers (either directly or through a
voucher program) which shall be, to the extent practicable,
modeled after the Department of Veterans Affairs Child Care
Subsidy Program established pursuant to section 630 of the
Treasury and General Government Appropriations Act, 2002
(Public Law 107-67; 115 Stat. 552).
(B) Direct provision of child care at an on-site facility
of the Department of Veterans Affairs.
(C) Payments to private child care agencies.
(D) Collaboration with facilities or programs of other
Federal departments or agencies.
(E) Such other forms of assistance as the Secretary
considers appropriate.
(2) Amounts of stipends.--In the case that child care
assistance under this section is provided as a stipend under
paragraph (1)(A), such stipend shall cover the full cost of
such child care.
(g) Report.--Not later than six months after the completion
of the pilot program, the Secretary shall submit to Congress
a report on the pilot program. The report shall include the
findings and conclusions of the Secretary as a result of the
pilot program, and shall include such recommendations for the
continuation or expansion of the pilot program as the
Secretary considers appropriate.
(h) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs to
carry out the pilot program $1,500,000 for each of fiscal
years 2010 and 2011.
SEC. 206. CARE FOR NEWBORN CHILDREN OF WOMEN VETERANS
RECEIVING MATERNITY CARE.
(a) In General.--Subchapter VIII of chapter 17 is amended
by adding at the end the following new section:
``Sec. 1786. Care for newborn children of women veterans
receiving maternity care
``(a) In General.--The Secretary may furnish health care
services described in subsection (b) to a newborn child of a
woman veteran who is receiving maternity care furnished by
the Department for not more than seven days after the birth
of the child if the veteran delivered the child in--
``(1) a facility of the Department; or
``(2) another facility pursuant to a Department contract
for services relating to such delivery.
``(b) Covered Health Care Services.--Health care services
described in this subsection are all post-delivery care
services, including routine care services, that a newborn
child requires.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 17 is amended by inserting after the
item relating to section 1785 the following new item:
``1786. Care for newborn children of women veterans receiving maternity
care.''.
TITLE III--RURAL HEALTH IMPROVEMENTS
SEC. 301. IMPROVEMENTS TO THE EDUCATION DEBT REDUCTION
PROGRAM.
(a) Inclusion of Employee Retention as Purpose of
Program.--Section 7681(a)(2) is amended by inserting ``and
retention'' after ``recruitment'' the first time it appears.
(b) Expansion of Eligibility.--Section 7682 is amended--
(1) in subsection (a)(1), by striking ``a recently
appointed'' and inserting ``an''; and
(2) by striking subsection (c).
(c) Increase in Maximum Annual Amount of Payments.--
Paragraph (1) of subsection (d) of section 7683 is amended--
(1) by striking ``$44,000'' and inserting ``$60,000''; and
(2) by striking ``$10,000'' and inserting ``$12,000''.
(d) Exception to Limitation on Amount for Certain
Participants.--Such subsection is further amended by adding
at the end the following new paragraph:
``(3)(A) The Secretary may waive the limitations under
paragraphs (1) and (2) in the case of a participant described
in subparagraph (B). In the case of such a waiver, the total
amount of education debt repayments payable to that
participant is the total amount of the principal and the
interest on the participant's loans referred to in subsection
(a).
``(B) A participant described in this subparagraph is a
participant in the Program who the Secretary determines
serves in a position for which there is a shortage of
qualified employees by reason of either the location or the
requirements of the position.''.
SEC. 302. VISUAL IMPAIRMENT AND ORIENTATION AND MOBILITY
PROFESSIONALS EDUCATION ASSISTANCE PROGRAM.
(a) Establishment of Program.--Part V is amended by
inserting after chapter 74 the following new chapter:
``CHAPTER 75--VISUAL IMPAIRMENT AND ORIENTATION AND MOBILITY
PROFESSIONALS EDUCATIONAL ASSISTANCE PROGRAM
``Sec.
``7501. Establishment of scholarship program; purpose.
``7502. Application and acceptance.
``7503. Amount of assistance; duration.
``7504. Agreement.
``7505. Repayment for failure to satisfy requirements of agreement.
``Sec. 7501. Establishment of scholarship program; purpose
``(a) Establishment.--Subject to the availability of
appropriations, the Secretary shall establish and carry out a
scholarship program to provide financial assistance in
accordance with this chapter to individuals who--
``(1) are accepted for enrollment or currently enrolled in
a program of study leading to a degree or certificate in
visual impairment or orientation and mobility, or a dual
degree or certification in both such areas, at an accredited
(as determined by the Secretary) educational institution that
is in a State; and
``(2) enter into an agreement with the Secretary as
described in section 7504 of this title.
``(b) Purpose.--The purpose of the scholarship program is
to increase the supply of qualified blind rehabilitation
specialists for the Department and the Nation.
``(c) Outreach.--The Secretary shall publicize the
scholarship program to educational institutions throughout
the United States, with an emphasis on disseminating
information to such institutions with high numbers of
Hispanic students and to Historically Black Colleges and
Universities.
``Sec. 7502. Application and acceptance
``(a) Application.--(1) To apply and participate in the
scholarship program under this chapter, an individual shall
submit to the Secretary an application for such participation
together with an agreement described in section 7504 of this
title under which the participant agrees to serve a period of
obligated service in the Department as provided in the
agreement in return for payment of educational assistance as
provided in the agreement.
``(2) In distributing application forms and agreement forms
to individuals desiring to participate in the scholarship
program, the Secretary shall include with such forms the
following:
``(A) A fair summary of the rights and liabilities of an
individual whose application is approved (and whose agreement
is accepted) by the Secretary.
``(B) A full description of the terms and conditions that
apply to participation in the scholarship program and service
in the Department.
``(b) Approval.--(1) Upon the Secretary's approval of an
individual's participation in the scholarship program, the
Secretary shall, in writing, promptly notify the individual
of that acceptance.
``(2) An individual becomes a participant in the
scholarship program upon such approval by the Secretary.
``Sec. 7503. Amount of assistance; duration
``(a) Amount of Assistance.--The amount of the financial
assistance provided an individual under the scholarship
program under this chapter shall be the amount determined by
the Secretary as being necessary to pay the tuition and fees
of the individual. In the case of an individual enrolled in a
program of study leading to a dual degree or certification in
both the areas of study described in section 7501(a)(1) of
this title, the tuition and
[[Page H2709]]
fees shall not exceed the amounts necessary for the minimum
number of credit hours to achieve such dual degree or
certification.
``(b) Relationship to Other Assistance.--Financial
assistance may be provided to an individual under the
scholarship program to supplement other educational
assistance to the extent that the total amount of educational
assistance received by the individual during an academic year
does not exceed the total tuition and fees for such academic
year.
``(c) Maximum Amount of Assistance.--(1) The total amount
of assistance provided under the scholarship program for an
academic year to an individual who is a full-time student may
not exceed $15,000.
``(2) In the case of an individual who is a part-time
student, the total amount of assistance provided under the
scholarship program 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 program of study being
pursued by the individual as the coursework carried by the
individual to full-time coursework in that program of study.
``(3) The total amount of assistance provided to an
individual under the scholarship program may not exceed
$45,000.
``(d) Maximum Duration of Assistance.--Financial assistance
may not be provided to an individual under the scholarship
program for more than six academic years.
``Sec. 7504. Agreement
``An agreement between the Secretary and a participant in
the scholarship program under this chapter shall be in
writing, shall be signed by the participant, and shall
include--
``(1) the Secretary's agreement to provide the participant
with financial assistance as authorized under this chapter;
``(2) the participant's agreement--
``(A) to accept such financial assistance;
``(B) to maintain enrollment and attendance in the program
of study described in section 7501(a)(1) of this title;
``(C) while enrolled in such program, to maintain an
acceptable level of academic standing (as determined by the
educational institution offering such program under
regulations prescribed by the Secretary); and
``(D) after completion of the program, to serve as a full-
time employee in the Department for a period of three years,
to be served within the first six years after the participant
has completed such program and received a degree or
certificate described in section 7501(a)(1) of this title;
and
``(3) any other terms and conditions that the Secretary
considers appropriate for carrying out this chapter.
``Sec. 7505. Repayment for failure to satisfy requirements of
agreement
``(a) In General.--An individual who receives educational
assistance under the scholarship program under this chapter
shall repay to the Secretary an amount equal to the unearned
portion of such assistance if the individual fails to satisfy
the requirements of the agreement entered into under section
7504 of this title, except in circumstances authorized by the
Secretary.
``(b) Amount of Repayment.--The Secretary shall establish,
by regulations, procedures for determining the amount of the
repayment required under this section and the circumstances
under which an exception to the required repayment may be
granted.
``(c) Waiver or Suspension of Compliance.--The Secretary
shall prescribe regulations providing for the waiver or
suspension of any obligation of an individual for service or
payment under this chapter (or an agreement under this
chapter) whenever--
``(1) noncompliance by the individual is due to
circumstances beyond the control of the individual; or
``(2) the Secretary determines that the waiver or
suspension of compliance is in the best interest of the
United States.
``(d) Obligation as Debt to United States.--An obligation
to repay the Secretary under this section is, for all
purposes, a debt owed the United States. A discharge in
bankruptcy under title 11 does not discharge a person from
such debt if the discharge order is entered less than five
years after the date of the termination of the agreement or
contract on which the debt is based.''.
(b) Clerical Amendments.--The tables of chapters at the
beginning of title 38, and of part V, are each amended by
inserting after the item relating to chapter 74 the following
new item:
``75. Visual Impairment and Orientation and Mobility Professionals
Educational Assistance Program..........................7501''.....
(c) Implementation.--The Secretary of Veterans Affairs
shall implement chapter 75 of title 38, United States Code,
as added by subsection (a), not later than six months after
the date of the enactment of this Act.
SEC. 303. DEMONSTRATION PROJECTS ON ALTERNATIVES FOR
EXPANDING CARE FOR VETERANS IN RURAL AREAS.
(a) In General.--The Secretary of Veterans Affairs may,
through the Director of the Office of Rural Health, carry out
demonstration projects to examine the feasibility and
advisability of alternatives for expanding care for veterans
in rural areas, which may include the following:
(1) Establishing a partnership between the Department of
Veterans Affairs and the Centers for Medicare and Medicaid
Services of the Department of Health and Human Services to
coordinate care for veterans in rural areas at critical
access hospitals (as designated or certified under section
1820 of the Social Security Act (42 U.S.C. 1395i-4)).
(2) Establishing a partnership between the Department of
Veterans Affairs and the Department of Health and Human
Services to coordinate care for veterans in rural areas at
community health centers.
(3) Expanding coordination between the Department of
Veterans Affairs and the Indian Health Service to expand care
for Indian veterans.
(b) Geographic Distribution.--The Secretary shall ensure
that the demonstration projects carried out under subsection
(a) are located at facilities that are geographically
distributed throughout the United States.
(c) Report.--Not later than two years after the date of the
enactment of this Act, the Secretary shall submit a report on
the results of the demonstration projects carried out under
subsection (a) to--
(1) the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate; and
(2) the Committee on Veterans' Affairs and the Committee on
Appropriations of the House of Representatives.
(d) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $5,000,000 for
fiscal year 2010 and each fiscal year thereafter.
SEC. 304. PROGRAM ON READJUSTMENT AND MENTAL HEALTH CARE
SERVICES FOR VETERANS WHO SERVED IN OPERATION
ENDURING FREEDOM AND OPERATION IRAQI FREEDOM.
(a) Program Required.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall establish a program to provide--
(1) to veterans of Operation Enduring Freedom and Operation
Iraqi Freedom, particularly veterans who served in such
operations while in the National Guard and the Reserves--
(A) peer outreach services;
(B) peer support services;
(C) readjustment counseling and services described in
section 1712A of title 38, United States Code; and
(D) mental health services; and
(2) to members of the immediate family of veterans
described in paragraph (1), during the three-year period
beginning on the date of the return of such veterans from
deployment in Operation Enduring Freedom or Operation Iraqi
Freedom, education, support, counseling, and mental health
services to assist in--
(A) the readjustment of such veterans to civilian life;
(B) in the case such veterans have an injury or illness
incurred during such deployment, the recovery of such
veterans from such injury or illness; and
(C) the readjustment of the family following the return of
such veterans.
(b) Contracts With Community Mental Health Centers and
Other Qualified Entities.--In carrying out the program
required by subsection (a), the Secretary may contract with
community mental health centers and other qualified entities
to provide the services required by such subsection only in
areas the Secretary determines are not adequately served by
other health care facilities or vet centers of the Department
of Veterans Affairs. Such contracts shall require each
contracting community health center or entity--
(1) to the extent practicable, to use telehealth services
for the delivery of services required by subsection (a);
(2) to the extent practicable, to employ veterans trained
under subsection (c) in the provision of services covered by
that subsection;
(3) to participate in the training program conducted in
accordance with subsection (d);
(4) to comply with applicable protocols of the Department
before incurring any liability on behalf of the Department
for the provision of services required by subsection (a);
(5) for each veteran for whom a community mental health
center or other qualified entity provides mental health
services under such contract, to provide the Department with
such clinical summary information as the Secretary shall
require;
(6) to submit annual reports to the Secretary containing,
with respect to the program required by subsection (a) and
for the last full calendar year ending before the submittal
of such report--
(A) the number of the veterans served, veterans diagnosed,
and courses of treatment provided to veterans as part of the
program required by subsection (a); and
(B) demographic information for such services, diagnoses,
and courses of treatment; and
(7) to meet such other requirements as the Secretary shall
require.
(c) Training of Veterans for Provision of Peer-outreach and
Peer-support Services.--In carrying out the program required
by subsection (a), the Secretary shall contract with a
national not-for-profit mental health organization to carry
out a national program of training for veterans described in
subsection (a) to provide the services described in
subparagraphs (A) and (B) of paragraph (1) of such
subsection.
(d) Training of Clinicians for Provision of Services.--The
Secretary shall conduct a training program for clinicians of
community mental health centers or entities that have
contracts with the Secretary under subsection (b) to ensure
that such clinicians can
[[Page H2710]]
provide the services required by subsection (a) in a manner
that--
(1) recognizes factors that are unique to the experience of
veterans who served on active duty in Operation Enduring
Freedom or Operation Iraqi Freedom (including their combat
and military training experiences); and
(2) uses best practices and technologies.
(e) Vet Center Defined.--In this section, the term ``vet
center'' means a center for readjustment counseling and
related mental health services for veterans under section
1712A of title 38, United States Code.
SEC. 305. TRAVEL REIMBURSEMENT FOR VETERANS RECEIVING
TREATMENT AT FACILITIES OF THE DEPARTMENT OF
VETERANS AFFAIRS.
(a) Enhancement of Allowance Based Upon Mileage Traveled.--
Section 111 is amended--
(1) in subsection (a), by striking ``traveled,'' and
inserting ``(at a rate of 41.5 cents per mile),''; and
(2) by amending subsection (g) to read as follows:
``(g)(1) Beginning one year after the date of the enactment
of the Caregivers and Veterans Omnibus Health Services Act of
2010, the Secretary may adjust the mileage rate described in
subsection (a) to be equal to the mileage reimbursement rate
for the use of privately owned vehicles by Government
employees on official business (when a Government vehicle is
available), as prescribed by the Administrator of General
Services under section 5707(b) of title 5.
``(2) If an adjustment in the mileage rate under paragraph
(1) results in a lower mileage rate than the mileage rate
otherwise specified in subsection (a), the Secretary shall,
not later than 60 days before the date of the implementation
of the mileage rate as so adjusted, submit to Congress a
written report setting forth the adjustment in the mileage
rate under this subsection, together with a justification for
the decision to make the adjustment in the mileage rate under
this subsection.''.
(b) Coverage of Cost of Transportation by Air.--Subsection
(a) of section 111, as amended by subsection (a)(1), is
further amended by inserting after the first sentence the
following new sentence: ``Actual necessary expense of travel
includes the reasonable costs of airfare if travel by air is
the only practical way to reach a Department facility.''.
(c) Elimination of Limitation Based on Maximum Annual Rate
of Pension.--Subsection (b)(1)(D)(i) of such section is
amended by inserting ``who is not traveling by air and''
before ``whose annual''.
(d) Determination of Practicality.--Subsection (b) of such
section is amended by adding at the end the following new
paragraph:
``(4) In determining for purposes of subsection (a) whether
travel by air is the only practical way for a veteran to
reach a Department facility, the Secretary shall consider the
medical condition of the veteran and any other impediments to
the use of ground transportation by the veteran.''.
(e) No Expansion of Eligibility for Beneficiary Travel.--
The amendments made by subsections (b) and (d) of this
section may not be construed as expanding or otherwise
modifying eligibility for payments or allowances for
beneficiary travel under section 111 of title 38, United
States Code, as in effect on the day before the date of the
enactment of this Act.
(f) Clarification of Relation to Public Transportation in
Veterans Health Administration Handbook.--Not later than 30
days after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall revise the Veterans
Health Administration Handbook to clarify that an allowance
for travel based on mileage paid under section 111(a) of
title 38, United States Code, may exceed the cost of such
travel by public transportation regardless of medical
necessity.
SEC. 306. PILOT PROGRAM ON INCENTIVES FOR PHYSICIANS WHO
ASSUME INPATIENT RESPONSIBILITIES AT COMMUNITY
HOSPITALS IN HEALTH PROFESSIONAL SHORTAGE
AREAS.
(a) Pilot Program Required.--The Secretary of Veterans
Affairs shall carry out a pilot program to assess the
feasability and advisability of each of the following:
(1) The provision of financial incentives to eligible
physicians who obtain and maintain inpatient privileges at
community hospitals in health professional shortage areas in
order to facilitate the provision by such physicians of
primary care and mental health services to veterans at such
hospitals.
(2) The collection of payments from third-party providers
for care provided by eligible physicians to nonveterans while
discharging inpatient responsibilities at community hospitals
in the course of exercising the privileges described in
paragraph (1).
(b) Eligible Physicians.--For purposes of this section, an
eligible physician is a primary care or mental health
physician employed by the Department of Veterans Affairs on a
full-time basis.
(c) Duration of Program.--The pilot program shall be
carried out during the three-year period beginning on the
date of the commencement of the pilot program.
(d) Locations.--
(1) In general.--The pilot program shall be carried out at
not less than five community hospitals in each of not less
than two Veterans Integrated Services Networks. The hospitals
shall be selected by the Secretary using the results of the
survey required under subsection (e).
(2) Qualifying community hospitals.--A community hospital
may be selected by the Secretary as a location for the pilot
program if--
(A) the hospital is located in a health professional
shortage area; and
(B) the number of eligible physicians willing to assume
inpatient responsibilities at the hospital (as determined
using the result of the survey) is sufficient for purposes of
the pilot program.
(e) Survey of Physician Interest in Participation.--
(1) In general.--Not later than 120 days after the date of
the enactment of this Act, the Secretary shall conduct a
survey of eligible physicians to determine the extent of the
interest of such physicians in participating in the pilot
program.
(2) Elements.--The survey shall disclose the type, amount,
and nature of the financial incentives to be provided under
subsection (h) to physicians participating in the pilot
program.
(f) Physician Participation.--
(1) In general.--The Secretary shall select physicians for
participation in the pilot program from among eligible
physicians who--
(A) express interest in participating in the pilot program
in the survey conducted under subsection (e);
(B) are in good standing with the Department; and
(C) primarily have clinical responsibilities with the
Department.
(2) Voluntary participation.--Participation in the pilot
program shall be voluntary. Nothing in this section shall be
construed to require a physician working for the Department
to assume inpatient responsibilities at a community hospital
unless otherwise required as a term or condition of
employment with the Department.
(g) Assumption of Inpatient Physician Responsibilities.--
(1) In general.--Each eligible physician selected for
participation in the pilot program shall assume and maintain
inpatient responsibilities, including inpatient
responsibilities with respect to nonveterans, at one or more
community hospitals selected by the Secretary for
participation in the pilot program under subsection (d).
(2) Coverage under federal tort claims act.--If an eligible
physician participating in the pilot program carries out on-
call responsibilities at a community hospital where
privileges to practice at such hospital are conditioned upon
the provision of services to individuals who are not veterans
while the physician is on call for such hospital, the
provision of such services by the physician shall be
considered an action within the scope of the physician's
office or employment for purposes of chapter 171 of title 28,
United States Code (commonly referred to as the ``Federal
Tort Claims Act'').
(h) Compensation.--
(1) In general.--The Secretary shall provide each eligible
physician participating in the pilot program with such
compensation (including pay and other appropriate
compensation) as the Secretary considers appropriate to
compensate such physician for the discharge of any inpatient
responsibilities by such physician at a community hospital
for which such physician would not otherwise be compensated
by the Department as a full-time employee of the Department.
(2) Written agreement.--The amount of any compensation to
be provided a physician under the pilot program shall be
specified in a written agreement entered into by the
Secretary and the physician for purposes of the pilot
program.
(3) Treatment of compensation.--The Secretary shall consult
with the Director of the Office of Personnel Management on
the inclusion of a provision in the written agreement
required under paragraph (2) that describes the treatment
under Federal law of any compensation provided a physician
under the pilot program, including treatment for purposes of
retirement under the civil service laws.
(i) Collections From Third Parties.--In carrying out the
pilot program for the purpose described in subsection (a)(2),
the Secretary shall implement a variety and range of
requirements and mechanisms for the collection from third-
party payors of amounts to reimburse the Department for
health care services provided to nonveterans under the pilot
program by eligible physicians discharging inpatient
responsibilities under the pilot program.
(j) Report.--Not later than one year after the date of the
enactment of this Act and annually thereafter, the Secretary
shall submit to Congress a report on the pilot program,
including the following:
(1) The findings of the Secretary with respect to the pilot
program.
(2) The number of veterans and nonveterans provided
inpatient care by physicians participating in the pilot
program.
(3) The amounts payable and collected under subsection (i).
(k) Definitions.--In this section:
(1) Health professional shortage area.--The term ``health
professional shortage area'' has the meaning given the term
in section 332(a) of the Public Health Service Act (42 U.S.C.
254e(a)).
(2) Inpatient responsibilities.--The term ``inpatient
responsibilities'' means on-call responsibilities customarily
required of a physician by a community hospital as a
condition of granting privileges to the physician to practice
in the hospital.
[[Page H2711]]
SEC. 307. GRANTS FOR VETERANS SERVICE ORGANIZATIONS FOR
TRANSPORTATION OF HIGHLY RURAL VETERANS.
(a) Grants Authorized.--
(1) In general.--The Secretary of Veterans Affairs shall
establish a grant program to provide innovative
transportation options to veterans in highly rural areas.
(2) Eligible recipients.--The following may be awarded a
grant under this section:
(A) State veterans service agencies.
(B) Veterans service organizations.
(3) Use of funds.--A State veterans service agency or
veterans service organization awarded a grant under this
section may use the grant amount to--
(A) assist veterans in highly rural areas to travel to
Department of Veterans Affairs medical centers; and
(B) otherwise assist in providing transportation in
connection with the provision of medical care to veterans in
highly rural areas.
(4) Maximum amount.--The amount of a grant under this
section may not exceed $50,000.
(5) No matching requirement.--The recipient of a grant
under this section shall not be required to provide matching
funds as a condition for receiving such grant.
(b) Regulations.--The Secretary shall prescribe regulations
for--
(1) evaluating grant applications under this section; and
(2) otherwise administering the program established by this
section.
(c) Definitions.--In this section:
(1) Highly rural.--The term ``highly rural'', in the case
of an area, means that the area consists of a county or
counties having a population of less than seven persons per
square mile.
(2) Veterans service organization.--The term ``veterans
service organization'' means any organization recognized by
the Secretary of Veterans Affairs for the representation of
veterans under section 5902 of title 38, United States Code.
(d) Authorization of Appropriations.--There is authorized
to be appropriated $3,000,000 for each of fiscal years 2010
through 2014 to carry out this section.
SEC. 308. MODIFICATION OF ELIGIBILITY FOR PARTICIPATION IN
PILOT PROGRAM OF ENHANCED CONTRACT CARE
AUTHORITY FOR HEALTH CARE NEEDS OF CERTAIN
VETERANS.
Subsection (b) of section 403 of the Veterans' Mental
Health and other Care Improvements Act of 2008 (Public Law
110-387; 122 Stat. 4125; 38 U.S.C. 1703 note) is amended to
read as follows:
``(b) Covered Veterans.--For purposes of the pilot program
under this section, a covered veteran is any veteran who--
``(1) is--
``(A) enrolled in the system of patient enrollment
established under section 1705(a) of title 38, United States
Code, as of the date of the commencement of the pilot program
under subsection (a)(2); or
``(B) eligible for health care under section 1710(e)(3) of
such title; and
``(2) resides in a location that is--
``(A) more than 60 minutes driving distance from the
nearest Department health care facility providing primary
care services, if the veteran is seeking such services;
``(B) more than 120 minutes driving distance from the
nearest Department health care facility providing acute
hospital care, if the veteran is seeking such care; or
``(C) more than 240 minutes driving distance from the
nearest Department health care facility providing tertiary
care, if the veteran is seeking such care.''.
TITLE IV--MENTAL HEALTH CARE MATTERS
SEC. 401. ELIGIBILITY OF MEMBERS OF THE ARMED FORCES WHO
SERVE IN OPERATION ENDURING FREEDOM OR
OPERATION IRAQI FREEDOM FOR COUNSELING AND
SERVICES THROUGH READJUSTMENT COUNSELING
SERVICE.
(a) In General.--Any member of the Armed Forces, including
a member of the National Guard or Reserve, who serves on
active duty in the Armed Forces in Operation Enduring Freedom
or Operation Iraqi Freedom is eligible for readjustment
counseling and related mental health services under section
1712A of title 38, United States Code, through the
Readjustment Counseling Service of the Veterans Health
Administration.
(b) No Requirement for Current Active Duty Service.--A
member of the Armed Forces who meets the requirements for
eligibility for counseling and services under subsection (a)
is entitled to counseling and services under that subsection
regardless of whether or not the member is currently on
active duty in the Armed Forces at the time of receipt of
counseling and services under that subsection.
(c) Regulations.--The eligibility of members of the Armed
Forces for counseling and services under subsection (a) shall
be subject to such regulations as the Secretary of Defense
and the Secretary of Veterans Affairs shall jointly prescribe
for purposes of this section.
(d) Subject to Availability of Appropriations.--The
provision of counseling and services under subsection (a)
shall be subject to the availability of appropriations for
such purpose.
SEC. 402. RESTORATION OF AUTHORITY OF READJUSTMENT COUNSELING
SERVICE TO PROVIDE REFERRAL AND OTHER
ASSISTANCE UPON REQUEST TO FORMER MEMBERS OF
THE ARMED FORCES NOT AUTHORIZED COUNSELING.
Section 1712A is amended--
(1) by redesignating subsections (c) through (f) as
subsections (d) through (g), respectively; and
(2) by inserting after subsection (b) the following new
subsection (c):
``(c) Upon receipt of a request for counseling under this
section from any individual who has been discharged or
released from active military, naval, or air service but who
is not otherwise eligible for such counseling, the Secretary
shall--
``(1) provide referral services to assist such individual,
to the maximum extent practicable, in obtaining mental health
care and services from sources outside the Department; and
``(2) if pertinent, advise such individual of such
individual's rights to apply to the appropriate military,
naval, or air service, and to the Department, for review of
such individual's discharge or release from such service.''.
SEC. 403. STUDY ON SUICIDES AMONG VETERANS.
(a) Study Required.--The Secretary of Veterans Affairs
shall conduct a study to determine the number of veterans who
died by suicide between January 1, 1999, and the date of the
enactment of this Act.
(b) Coordination.--In carrying out the study under
subsection (a) the Secretary of Veterans Affairs shall
coordinate with--
(1) the Secretary of Defense;
(2) veterans service organizations;
(3) the Centers for Disease Control and Prevention; and
(4) State public health offices and veterans agencies.
(c) Report to Congress.--The Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the study required under
subsection (a) and the findings of the Secretary.
(d) Veterans Service Organization Defined.--In this
section, the term ``veterans service organization'' means any
organization recognized by the Secretary for the
representation of veterans under section 5902 of title 38,
United States Code.
TITLE V--OTHER HEALTH CARE MATTERS
SEC. 501. REPEAL OF CERTAIN ANNUAL REPORTING REQUIREMENTS.
(a) Nurse Pay Report.--Section 7451 is amended--
(1) by striking subsection (f); and
(2) by redesignating subsection (g) as subsection (f).
(b) Long-term Planning Report.--
(1) In general.--Section 8107 is repealed.
(2) Conforming amendment.--The table of sections at the
beginning of chapter 81 is amended by striking the item
relating to section 8107.
SEC. 502. SUBMITTAL DATE OF ANNUAL REPORT ON GULF WAR
RESEARCH.
Section 707(c)(1) of the Persian Gulf War Veterans' Health
Status Act (title VII of Public Law 102-585; 38 U.S.C. 527
note) is amended by striking ``Not later than March 1 of each
year'' and inserting ``Not later than July 1, 2010, and July
1 of each of the five following years''.
SEC. 503. PAYMENT FOR CARE FURNISHED TO CHAMPVA
BENEFICIARIES.
Section 1781 is amended by adding at the end the following
new subsection:
``(e) Payment by the Secretary under this section on behalf
of a covered beneficiary for medical care shall constitute
payment in full and extinguish any liability on the part of
the beneficiary for that care.''.
SEC. 504. DISCLOSURE OF PATIENT TREATMENT INFORMATION FROM
MEDICAL RECORDS OF PATIENTS LACKING
DECISIONMAKING CAPACITY.
Section 7332(b)(2) is amended by adding at the end the
following new subparagraph:
``(F)(i) To a representative of a patient who lacks
decision-making capacity, when a practitioner deems the
content of the given record necessary for that representative
to make an informed decision regarding the patient's
treatment.
``(ii) In this subparagraph, the term `representative'
means an individual, organization, or other body authorized
under section 7331 of this title and its implementing
regulations to give informed consent on behalf of a patient
who lacks decision-making capacity.''.
SEC. 505. ENHANCEMENT OF QUALITY MANAGEMENT.
(a) Enhancement of Quality Management Through Quality
Management Officers.--
(1) In general.--Subchapter II of chapter 73 is amended by
inserting after section 7311 the following new section:
``Sec. 7311A. Quality management officers
``(a) National Quality Management Officer.--(1) The Under
Secretary for Health shall designate an official of the
Veterans Health Administration to act as the principal
quality management officer for the quality-assurance program
required by section 7311 of this title. The official so
designated may be known as the `National Quality Management
Officer of the Veterans Health Administration' (in this
section referred to as the `National Quality Management
Officer').
``(2) The National Quality Management Officer shall report
directly to the Under Secretary for Health in the discharge
of responsibilities and duties of the Officer under this
section.
[[Page H2712]]
``(3) The National Quality Management Officer shall be the
official within the Veterans Health Administration who is
principally responsible for the quality-assurance program
referred to in paragraph (1). In carrying out that
responsibility, the Officer shall be responsible for the
following:
``(A) Establishing and enforcing the requirements of the
program referred to in paragraph (1).
``(B) Developing an aggregate quality metric from existing
data sources, such as the Inpatient Evaluation Center of the
Department, the National Surgical Quality Improvement
Program, and the External Peer Review Program of the Veterans
Health Administration, that could be used to assess reliably
the quality of care provided at individual Department medical
centers and associated community based outpatient clinics.
``(C) Ensuring that existing measures of quality, including
measures from the Inpatient Evaluation Center, the National
Surgical Quality Improvement Program, System-Wide Ongoing
Assessment and Review reports of the Department, and Combined
Assessment Program reviews of the Office of Inspector General
of the Department, are monitored routinely and analyzed in a
manner that ensures the timely detection of quality of care
issues.
``(D) Encouraging research and development in the area of
quality metrics for the purposes of improving how the
Department measures quality in individual facilities.
``(E) Carrying out such other responsibilities and duties
relating to quality management in the Veterans Health
Administration as the Under Secretary for Health shall
specify.
``(4) The requirements under paragraph (3) shall include
requirements regarding the following:
``(A) A confidential system for the submittal of reports by
Veterans Health Administration personnel regarding quality
management at Department facilities.
``(B) Mechanisms for the peer review of the actions of
individuals appointed in the Veterans Health Administration
in the position of physician.
``(b) Quality Management Officers for VISNs.--(1) The
Regional Director of each Veterans Integrated Services
Network shall appoint an official of the Network to act as
the quality management officer of the Network.
``(2) The quality management officer for a Veterans
Integrated Services Network shall report to the Regional
Director of the Veterans Integrated Services Network, and to
the National Quality Management Officer, regarding the
discharge of the responsibilities and duties of the officer
under this section.
``(3) The quality management officer for a Veterans
Integrated Services Network shall--
``(A) direct the quality management office in the Network;
and
``(B) coordinate, monitor, and oversee the quality
management programs and activities of the Administration
medical facilities in the Network in order to ensure the
thorough and uniform discharge of quality management
requirements under such programs and activities throughout
such facilities.
``(c) Quality Management Officers for Medical Facilities.--
(1) The director of each Veterans Health Administration
medical facility shall appoint a quality management officer
for that facility.
``(2) The quality management officer for a facility shall
report directly to the director of the facility, and to the
quality management officer of the Veterans Integrated
Services Network in which the facility is located, regarding
the discharge of the responsibilities and duties of the
quality management officer under this section.
``(3) The quality management officer for a facility shall
be responsible for designing, disseminating, and implementing
quality management programs and activities for the facility
that meet the requirements established by the National
Quality Management Officer under subsection (a).
``(d) Authorization of Appropriations.--(1) Except as
provided in paragraph (2), there are authorized to be
appropriated such sums as may be necessary to carry out this
section.
``(2) There is authorized to be appropriated to carry out
the provisions of subparagraphs (B), (C), and (D) of
subsection (a)(3), $25,000,000 for the two-year period of
fiscal years beginning after the date of the enactment of
this section.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 73 is amended by inserting after the
item relating to section 7311 the following new item:
``7311A. Quality management officers.''.
(b) Reports on Quality Concerns Under Quality-assurance
Program.--Section 7311(b) is amended by adding at the end the
following new paragraph:
``(4) As part of the quality-assurance program, the Under
Secretary for Health shall establish mechanisms through which
employees of Veterans Health Administration facilities may
submit reports, on a confidential basis, on matters relating
to quality of care in Veterans Health Administration
facilities to the quality management officers of such
facilities under section 7311A(c) of this title. The
mechanisms shall provide for the prompt and thorough review
of any reports so submitted by the receiving officials.''.
(c) Review of Current Health Care Quality Safeguards.--
(1) In general.--The Secretary of Veterans Affairs shall
conduct a comprehensive review of all current policies and
protocols of the Department of Veterans Affairs for
maintaining health care quality and patient safety at
Department medical facilities. The review shall include a
review and assessment of the National Surgical Quality
Improvement Program, including an assessment of--
(A) the efficacy of the quality indicators under the
program;
(B) the efficacy of the data collection methods under the
program;
(C) the efficacy of the frequency with which regular data
analyses are performed under the program; and
(D) the extent to which the resources allocated to the
program are adequate to fulfill the stated function of the
program.
(2) Report.--Not later than 60 days after the date of the
enactment of this Act, the Secretary shall submit to Congress
a report on the review conducted under paragraph (1),
including the findings of the Secretary as a result of the
review and such recommendations as the Secretary considers
appropriate in light of the review.
SEC. 506. PILOT PROGRAM ON USE OF COMMUNITY-BASED
ORGANIZATIONS AND LOCAL AND STATE GOVERNMENT
ENTITIES TO ENSURE THAT VETERANS RECEIVE CARE
AND BENEFITS FOR WHICH THEY ARE ELIGIBLE.
(a) Pilot Program Required.--The Secretary of Veterans
Affairs shall carry out a pilot program to assess the
feasibility and advisability of using community-based
organizations and local and State government entities--
(1) to increase the coordination of community, local,
State, and Federal providers of health care and benefits for
veterans to assist veterans who are transitioning from
military service to civilian life in such transition;
(2) to increase the availability of high quality medical
and mental health services to veterans transitioning from
military service to civilian life;
(3) to provide assistance to families of veterans who are
transitioning from military service to civilian life to help
such families adjust to such transition; and
(4) to provide outreach to veterans and their families to
inform them about the availability of benefits and connect
them with appropriate care and benefit programs.
(b) Duration of Program.--The pilot program shall be
carried out during the two-year period beginning on the date
that is 180 days after the date of the enactment of this Act.
(c) Program Locations.--
(1) In general.--The pilot program shall be carried out at
five locations selected by the Secretary for purposes of the
pilot program.
(2) Considerations.--In selecting locations for the pilot
program, the Secretary shall consider the advisability of
selecting locations in--
(A) rural areas;
(B) areas with populations that have a high proportion of
minority group representation;
(C) areas with populations that have a high proportion of
individuals who have limited access to health care; and
(D) areas that are not in close proximity to an active duty
military installation.
(d) Grants.--The Secretary shall carry out the pilot
program through the award of grants to community-based
organizations and local and State government entities.
(e) Selection of Grant Recipients.--
(1) In general.--A community-based organization or local or
State government entity seeking a grant under the pilot
program shall submit to the Secretary an application therefor
in such form and in such manner as the Secretary considers
appropriate.
(2) Elements.--Each application submitted under paragraph
(1) shall include the following:
(A) A description of the consultations, if any, with the
Department of Veterans Affairs in the development of the
proposal under the application.
(B) A plan to coordinate activities under the pilot
program, to the greatest extent possible, with the local,
State, and Federal providers of services for veterans to
reduce duplication of services and to enhance the effect of
such services.
(f) Use of Grant Funds.--The Secretary shall prescribe
appropriate uses of grant funds received under the pilot
program.
(g) Report on Program.--
(1) In general.--Not later than 180 days after the
completion of the pilot program, the Secretary shall submit
to Congress a report on the pilot program.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) The findings and conclusions of the Secretary with
respect to the pilot program.
(B) An assessment of the benefits to veterans of the pilot
program.
(C) The recommendations of the Secretary as to the
advisability of continuing the pilot program.
SEC. 507. SPECIALIZED RESIDENTIAL CARE AND REHABILITATION FOR
CERTAIN VETERANS.
Section 1720 is amended by adding at the end the following
new subsection:
``(g) The Secretary may contract with appropriate entities
to provide specialized residential care and rehabilitation
services to a veteran of Operation Enduring Freedom or
Operation Iraqi Freedom who the Secretary determines suffers
from a traumatic brain
[[Page H2713]]
injury, has an accumulation of deficits in activities of
daily living and instrumental activities of daily living, and
because of these deficits, would otherwise require admission
to a nursing home even though such care would generally
exceed the veteran's nursing needs.''.
SEC. 508. EXPANDED STUDY ON THE HEALTH IMPACT OF PROJECT
SHIPBOARD HAZARD AND DEFENSE.
(a) In General.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall enter into a contract with the Institute of Medicine of
the National Academies to conduct an expanded study on the
health impact of Project Shipboard Hazard and Defense
(Project SHAD).
(b) Covered Veterans.--The study required by subsection (a)
shall include, to the extent practicable, all veterans who
participated in Project Shipboard Hazard and Defense.
(c) Use of Existing Studies.--The study required by
subsection (a) may use results from the study covered in the
report titled ``Long-Term Health Effects of Participation in
Project SHAD'' of the Institute of Medicine of the National
Academies.
SEC. 509. USE OF NON-DEPARTMENT FACILITIES FOR REHABILITATION
OF INDIVIDUALS WITH TRAUMATIC BRAIN INJURY.
Section 1710E is amended--
(1) by redesignating subsection (b) as subsection (c);
(2) by inserting after subsection (a) the following new
subsection (b):
``(b) Covered Individuals.--The care and services provided
under subsection (a) shall be made available to an
individual--
``(1) who is described in section 1710C(a) of this title;
and
``(2)(A) to whom the Secretary is unable to provide such
treatment or services at the frequency or for the duration
prescribed in such plan; or
``(B) for whom the Secretary determines that it is optimal
with respect to the recovery and rehabilitation for such
individual.''; and
(3) by adding at the end the following new subsection:
``(d) Standards.--The Secretary may not provide treatment
or services as described in subsection (a) at a non-
Department facility under such subsection unless such
facility maintains standards for the provision of such
treatment or services established by an independent, peer-
reviewed organization that accredits specialized
rehabilitation programs for adults with traumatic brain
injury.''.
SEC. 510. PILOT PROGRAM ON PROVISION OF DENTAL INSURANCE
PLANS TO VETERANS AND SURVIVORS AND DEPENDENTS
OF VETERANS.
(a) Pilot Program Required.--The Secretary of Veterans
Affairs shall carry out a pilot program to assess the
feasibility and advisability of providing a dental insurance
plan to veterans and survivors and dependents of veterans
described in subsection (b).
(b) Covered Veterans and Survivors and Dependents.--The
veterans and survivors and dependents of veterans described
in this subsection are as follows:
(1) Any veteran who is enrolled in the system of annual
patient enrollment under section 1705 of title 38, United
States Code.
(2) Any survivor or dependent of a veteran who is eligible
for medical care under section 1781 of such title.
(c) Duration of Program.--The pilot program shall be
carried out during the three-year period beginning on the
date that is 270 days after the date of the enactment of this
Act.
(d) Locations.--The pilot program shall be carried out in
such Veterans Integrated Services Networks as the Secretary
considers appropriate for purposes of the pilot program.
(e) Administration.--The Secretary shall contract with a
dental insurer to administer the dental insurance plan
provided under the pilot program.
(f) Benefits.--The dental insurance plan under the pilot
program shall provide such benefits for dental care and
treatment as the Secretary considers appropriate for the
dental insurance plan, including diagnostic services,
preventative services, endodontics and other restorative
services, surgical services, and emergency services.
(g) Enrollment.--
(1) Voluntary.--Enrollment in the dental insurance plan
under the pilot program shall be voluntary.
(2) Minimum period.--Enrollment in the dental insurance
plan shall be for such minimum period as the Secretary shall
prescribe for purposes of this section.
(h) Premiums.--
(1) In general.--Premiums for coverage under the dental
insurance plan under the pilot program shall be in such
amount or amounts as the Secretary shall prescribe to cover
all costs associated with the pilot program.
(2) Annual adjustment.--The Secretary shall adjust the
premiums payable under the pilot program for coverage under
the dental insurance plan on an annual basis. Each individual
covered by the dental insurance plan at the time of such an
adjustment shall be notified of the amount and effective date
of such adjustment.
(3) Responsibility for payment.--Each individual covered by
the dental insurance plan shall pay the entire premium for
coverage under the dental insurance plan, in addition to the
full cost of any copayments.
(i) Voluntary Disenrollment.--
(1) In general.--With respect to enrollment in the dental
insurance plan under the pilot program, the Secretary shall--
(A) permit the voluntary disenrollment of an individual in
the dental insurance plan if the disenrollment occurs during
the 30-day period beginning on the date of the enrollment of
the individual in the dental insurance plan; and
(B) permit the voluntary disenrollment of an individual in
the dental insurance plan for such circumstances as the
Secretary shall prescribe for purposes of this subsection,
but only to the extent such disenrollment does not jeopardize
the fiscal integrity of the dental insurance plan.
(2) Allowable circumstances.--The circumstances prescribed
under paragraph (1)(B) shall include the following:
(A) If an individual enrolled in the dental insurance plan
relocates to a location outside the jurisdiction of the
dental insurance plan that prevents use of the benefits under
the dental insurance plan.
(B) If an individual enrolled in the dental insurance plan
is prevented by a serious medical condition from being able
to obtain benefits under the dental insurance plan.
(C) Such other circumstances as the Secretary shall
prescribe for purposes of this subsection.
(3) Establishment of procedures.--The Secretary shall
establish procedures for determinations on the permissibility
of voluntary disenrollments under paragraph (1)(B). Such
procedures shall ensure timely determinations on the
permissibility of such disenrollments.
(j) Relationship to Dental Care Provided by Secretary.--
Nothing in this section shall affect the responsibility of
the Secretary to provide dental care under section 1712 of
title 38, United States Code, and the participation of an
individual in the dental insurance plan under the pilot
program shall not affect the individual's entitlement to
outpatient dental services and treatment, and related dental
appliances, under that section.
(k) Regulations.--The dental insurance plan under the pilot
program shall be administered under such regulations as the
Secretary shall prescribe.
SEC. 511. PROHIBITION ON COLLECTION OF COPAYMENTS FROM
VETERANS WHO ARE CATASTROPHICALLY DISABLED.
(a) In General.--Subchapter III of chapter 17 is amended by
adding at the end the following new section:
``Sec. 1730A. Prohibition on collection of copayments from
catastrophically disabled veterans
``Notwithstanding subsections (f) and (g) of section 1710
and section 1722A(a) of this title or any other provision of
law, the Secretary may not require a veteran who is
catastrophically disabled, as defined by the Secretary, to
make any copayment for the receipt of hospital care or
medical services under the laws administered by the
Secretary.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 17 is amended by inserting after the
item relating to section 1730 the following new item:
``1730A. Prohibition on collection of copayments from catastrophically
disabled veterans.''.
SEC. 512. HIGHER PRIORITY STATUS FOR CERTAIN VETERANS WHO ARE
MEDAL OF HONOR RECIPIENTS.
Section 1705(a)(3) is amended by inserting ``veterans who
were awarded the medal of honor under section 3741, 6241, or
8741 of title 10 or section 491 of title 14,'' after ``the
Purple Heart,''.
SEC. 513. HOSPITAL CARE, MEDICAL SERVICES, AND NURSING HOME
CARE FOR CERTAIN VIETNAM-ERA VETERANS EXPOSED
TO HERBICIDE AND VETERANS OF THE PERSIAN GULF
WAR.
Section 1710(e) is amended--
(1) in paragraph (3)--
(A) by striking ``subsection (a)(2)(F)--'' and all that
follows through ``(C) in the case'' and inserting
``subsection (a)(2)(F) in the case''; and
(B) by redesignating clauses (i) and (ii) of the former
subparagraph (C) as subparagraphs (A) and (B) of such
paragraph (3) and by realigning the margin of such new
subparagraphs two ems to the left; and
(2) in paragraph (1)(C)--
(A) by striking ``paragraphs (2) and (3)'' and inserting
``paragraph (2)''; and
(B) by inserting after ``on active duty'' the following:
``between August 2, 1990, and November 11, 1998,''.
SEC. 514. ESTABLISHMENT OF DIRECTOR OF PHYSICIAN ASSISTANT
SERVICES IN VETERANS HEALTH ADMINISTRATION.
(a) In General.--Section 7306(a) is amended by striking
paragraph (9) and inserting the following new paragraph (9):
``(9) The Director of Physician Assistant Services, who
shall--
``(A) serve in a full-time capacity at the Central Office
of the Department;
``(B) be a qualified physician assistant; and
``(C) be responsible and report directly to the Chief
Patient Care Services Officer of the Veterans Health
Administration on all matters relating to the education and
training, employment, appropriate use, and optimal
participation of physician assistants within the programs and
initiatives of the Administration.''.
(b) Deadline for Implementation.--The Secretary of Veterans
Affairs shall ensure that an individual is serving as the
Director
[[Page H2714]]
of Physician Assistant Services under paragraph (9) of
section 7306(a) of title 38, United States Code, as amended
by subsection (a), by not later than 120 days after the date
of the enactment of this Act.
SEC. 515. COMMITTEE ON CARE OF VETERANS WITH TRAUMATIC BRAIN
INJURY.
(a) Establishment of Committee.--Subchapter II of chapter
73 is amended by inserting after section 7321 the following
new section:
``Sec. 7321A. Committee on Care of Veterans with Traumatic
Brain Injury
``(a) Establishment.--The Secretary shall establish in the
Veterans Health Administration a committee to be known as the
`Committee on Care of Veterans with Traumatic Brain Injury'.
The Under Secretary for Health shall appoint employees of the
Department with expertise in the care of veterans with
traumatic brain injury to serve on the committee.
``(b) Responsibilities of Committee.--The committee shall
assess, and carry out a continuing assessment of, the
capability of the Veterans Health Administration to meet
effectively the treatment and rehabilitation needs of
veterans with traumatic brain injury. In carrying out that
responsibility, the committee shall--
``(1) evaluate the care provided to such veterans through
the Veterans Health Administration;
``(2) identify systemwide problems in caring for such
veterans in facilities of the Veterans Health Administration;
``(3) identify specific facilities within the Veterans
Health Administration at which program enrichment is needed
to improve treatment and rehabilitation of such veterans; and
``(4) identify model programs which the committee considers
to have been successful in the treatment and rehabilitation
of such veterans and which should be implemented more widely
in or through facilities of the Veterans Health
Administration.
``(c) Advice and Recommendations.--The committee shall--
``(1) advise the Under Secretary regarding the development
of policies for the care and rehabilitation of veterans with
traumatic brain injury; and
``(2) make recommendations to the Under Secretary--
``(A) for improving programs of care of such veterans at
specific facilities and throughout the Veterans Health
Administration;
``(B) for establishing special programs of education and
training relevant to the care of such veterans for employees
of the Veterans Health Administration;
``(C) regarding research needs and priorities relevant to
the care of such veterans; and
``(D) regarding the appropriate allocation of resources for
all such activities.
``(d) Annual Report.--Not later than June 1, 2010, and each
year thereafter, the Secretary shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on
the implementation of this section. Each such report shall
include the following for the calendar year preceding the
year in which the report is submitted:
``(1) A list of the members of the committee.
``(2) The assessment of the Under Secretary for Health,
after review of the findings of the committee, regarding the
capability of the Veterans Health Administration, on a
systemwide and facility-by-facility basis, to meet
effectively the treatment and rehabilitation needs of
veterans with traumatic brain injury.
``(3) The plans of the committee for further assessments.
``(4) The findings and recommendations made by the
committee to the Under Secretary for Health and the views of
the Under Secretary on such findings and recommendations.
``(5) A description of the steps taken, plans made (and a
timetable for the execution of such plans), and resources to
be applied toward improving the capability of the Veterans
Health Administration to meet effectively the treatment and
rehabilitation needs of veterans with traumatic brain
injury.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 73 is amended by inserting after the
item relating to section 7321 the following new item:
``7321A. Committee on Care of Veterans with Traumatic Brain Injury.''.
SEC. 516. INCREASE IN AMOUNT AVAILABLE TO DISABLED VETERANS
FOR IMPROVEMENTS AND STRUCTURAL ALTERATIONS
FURNISHED AS PART OF HOME HEALTH SERVICES.
(a) Increase.--Section 1717(a)(2) is amended by striking
subparagraphs (A) and (B) and inserting the following:
``(A) in the case of medical services furnished under
section 1710(a)(1) of this title, or for a disability
described in section 1710(a)(2)(C) of this title--
``(i) in the case of a veteran who first applies for
benefits under this paragraph before the date of the
Caregivers and Veterans Omnibus Health Services Act of 2010,
$4,100; or
``(ii) in the case of a veteran who first applies for
benefits under this paragraph on or after the date of the
Caregivers and Veterans Omnibus Health Services Act of 2010,
$6,800; and
``(B) in the case of medical services furnished under any
other provision of section 1710(a) of this title--
``(i) in the case of a veteran who first applies for
benefits under this paragraph before the date of the
Caregivers and Veterans Omnibus Health Services Act of 2010,
$1,200; or
``(ii) in the case of a veteran who first applies for
benefits under this paragraph on or after the date of the
Caregivers and Veterans Omnibus Health Services Act of 2010,
$2,000.''.
(b) Construction.--A veteran who exhausts such veteran's
eligibility for benefits under section 1717(a)(2) of such
title before the date of the enactment of this Act, is not
entitled to additional benefits under such section by
reason of the amendments made by subsection (a).
SEC. 517. EXTENSION OF STATUTORILY DEFINED COPAYMENTS FOR
CERTAIN VETERANS FOR HOSPITAL CARE AND NURSING
HOME CARE.
Subparagraph (B) of section 1710(f)(2) is amended to read
as follows:
``(B) before September 30, 2012, an amount equal to $10 for
every day the veteran receives hospital care and $5 for every
day the veteran receives nursing home care.''.
SEC. 518. EXTENSION OF AUTHORITY TO RECOVER COST OF CERTAIN
CARE AND SERVICES FROM DISABLED VETERANS WITH
HEALTH-PLAN CONTRACTS.
Subparagraph (E) of section 1729(a)(2) is amended to read
as follows:
``(E) for which care and services are furnished before
October 1, 2012, under this chapter to a veteran who--
``(i) has a service-connected disability; and
``(ii) is entitled to care (or payment of the expenses of
care) under a health-plan contract.''.
TITLE VI--DEPARTMENT PERSONNEL MATTERS
SEC. 601. ENHANCEMENT OF AUTHORITIES FOR RETENTION OF MEDICAL
PROFESSIONALS.
(a) Secretarial Authority To Extend Title 38 Status to
Additional Positions.--
(1) In general.--Paragraph (3) of section 7401 is amended
by striking ``and blind rehabilitation outpatient
specialists.'' and inserting the following: ``blind
rehabilitation outpatient specialists, and such other classes
of health care occupations as the Secretary considers
necessary for the recruitment and retention needs of the
Department subject to the following requirements:
``(A) Such other classes of health care occupations--
``(i) are not occupations relating to administrative,
clerical, or physical plant maintenance and protective
services;
``(ii) that would otherwise receive basic pay in accordance
with the General Schedule under section 5332 of title 5;
``(iii) provide, as determined by the Secretary, direct
patient care services or services incident to direct patient
services; and
``(iv) would not otherwise be available to provide medical
care or treatment for veterans.
``(B) Not later than 45 days before the Secretary appoints
any personnel for a class of health care occupations that is
not specifically listed in this paragraph, the Secretary
shall submit to the Committee on Veterans' Affairs of the
Senate, the Committee on Veterans' Affairs of the House of
Representatives, and the Office of Management and Budget
notice of such appointment.
``(C) Before submitting notice under subparagraph (B), the
Secretary shall solicit comments from any labor organization
representing employees in such class and include such
comments in such notice.''.
(2) Appointment of nurse assistants.--Such paragraph is
further amended by inserting ``nurse assistants,'' after
``licensed practical or vocational nurses,''.
(b) Probationary Periods for Registered Nurses.--Section
7403(b) is amended--
(1) in paragraph (1), by striking ``Appointments'' and
inserting ``Except as otherwise provided in this subsection,
appointments'';
(2) by redesignating paragraph (2) as paragraph (4); and
(3) by inserting after paragraph (1) the following new
paragraphs:
``(2) With respect to the appointment of a registered nurse
under this chapter, paragraph (1) shall apply with respect to
such appointment regardless of whether such appointment is on
a full-time basis or a part-time basis.
``(3) An appointment described in subsection (a) on a part-
time basis of a person who has previously served on a full-
time basis for the probationary period for the position
concerned shall be without a probationary period.''.
(c) Prohibition on Temporary Part-time Registered Nurse
Appointments in Excess of Two Years.--Section 7405 is amended
by adding at the end the following new subsection:
``(g)(1) Except as provided in paragraph (3), employment of
a registered nurse on a temporary part-time basis under
subsection (a)(1) shall be for a probationary period of two
years.
``(2) Except as provided in paragraph (3), upon completion
by a registered nurse of the probationary period described in
paragraph (1)--
``(A) the employment of such nurse shall--
``(i) no longer be considered temporary; and
``(ii) be considered an appointment described in section
7403(a) of this title; and
[[Page H2715]]
``(B) the nurse shall be considered to have served the
probationary period required by section 7403(b).
``(3) This subsection shall not apply to appointments made
on a term limited basis of less than or equal to three years
of--
``(A) nurses with a part-time appointment resulting from an
academic affiliation or teaching position in a nursing
academy of the Department;
``(B) nurses appointed as a result of a specific research
proposal or grant; or
``(C) nurses who are not citizens of the United States and
appointed under section 7407(a) of this title.''.
(d) Rate of Basic Pay for Appointees to the Office of the
Under Secretary for Health Set to Rate of Basic Pay for
Senior Executive Service Positions.--
(1) In general.--Section 7404(a) is amended--
(A) by striking ``The annual'' and inserting ``(1) The
annual'';
(B) by striking ``The pay'' and inserting the following:
``(2) The pay'';
(C) by striking ``under the preceding sentence'' and
inserting ``under paragraph (1)''; and
(D) by adding at the end the following new paragraph:
``(3)(A) The rate of basic pay for a position to which an
Executive order applies under paragraph (1) and is not
described by paragraph (2) shall be set in accordance with
section 5382 of title 5 as if such position were a Senior
Executive Service position (as such term is defined in
section 3132(a) of title 5).
``(B) A rate of basic pay for a position may not be set
under subparagraph (A) in excess of--
``(i) in the case the position is not described in clause
(ii), the rate of basic pay payable for level III of the
Executive Schedule; or
``(ii) in the case that the position is covered by a
performance appraisal system that meets the certification
criteria established by regulation under section 5307(d) of
title 5, the rate of basic pay payable for level II of the
Executive Schedule.
``(C) Notwithstanding the provisions of subsection (d) of
section 5307 of title 5, the Secretary may make any
certification under that subsection instead of the Office of
Personnel Management and without concurrence of the Office of
Management and Budget.''.
(2) Effective date.--The amendments made by paragraph (1)
shall take effect on the first day of the first pay period
beginning after the day that is 180 days after the date of
the enactment of this Act.
(e) Special Incentive Pay for Department Pharmacist
Executives.--Section 7410 is amended--
(1) by striking ``The Secretary may'' and inserting the
following:
``(a) In General.--The Secretary may''; and
(2) by adding at the end the following new subsection:
``(b) Special Incentive Pay for Department Pharmacist
Executives.--(1) In order to recruit and retain highly
qualified Department pharmacist executives, the Secretary may
authorize the Under Secretary for Health to pay special
incentive pay of not more than $40,000 per year to an
individual of the Veterans Health Administration who is a
pharmacist executive.
``(2) In determining whether and how much special pay to
provide to such individual, the Under Secretary shall
consider the following:
``(A) The grade and step of the position of the individual.
``(B) The scope and complexity of the position of the
individual.
``(C) The personal qualifications of the individual.
``(D) The characteristics of the labor market concerned.
``(E) Such other factors as the Secretary considers
appropriate.
``(3) Special incentive pay under paragraph (1) for an
individual is in addition to all other pay (including basic
pay) and allowances to which the individual is entitled.
``(4) Except as provided in paragraph (5), special
incentive pay under paragraph (1) for an individual shall be
considered basic pay for all purposes, including retirement
benefits under chapters 83 and 84 of title 5, and other
benefits.
``(5) Special incentive pay under paragraph (1) for an
individual shall not be considered basic pay for purposes of
adverse actions under subchapter V of this chapter.
``(6) Special incentive pay under paragraph (1) may not be
awarded to an individual in an amount that would result in an
aggregate amount of pay (including bonuses and awards)
received by such individual in a year under this title that
is greater than the annual pay of the President.''.
(f) Pay for Physicians and Dentists.--
(1) Non-foreign cost of living adjustment allowance.--
Section 7431(b) is amended by adding at the end the following
new paragraph:
``(5) The non-foreign cost of living adjustment allowance
authorized under section 5941 of title 5 for physicians and
dentists whose pay is set under this section shall be
determined as a percentage of base pay only.''.
(2) Market pay determinations for physicians and dentists
in administrative or executive leadership positions.--Section
7431(c)(4)(B)(i) is amended by adding at the end the
following: ``The Secretary may exempt physicians and dentists
occupying administrative or executive leadership positions
from the requirements of the previous sentence.''.
(3) Exception to prohibition on reduction of market pay.--
Section 7431(c)(7) is amended by striking ``concerned.'' and
inserting ``concerned, unless there is a change in board
certification or reduction of privileges.''.
(g) Adjustment of Pay Cap for Nurses.--Section 7451(c)(2)
is amended by striking ``level V'' and inserting ``level
IV''.
(h) Exemption for Certified Registered Nurse Anesthetists
From Limitation on Authorized Competitive Pay.--Section
7451(c)(2) is further amended by adding at the end the
following new sentence: ``The maximum rate of basic pay for a
grade for the position of certified registered nurse
anesthetist pursuant to an adjustment under subsection (d)
may exceed the maximum rate otherwise provided in the
preceding sentence.''.
(i) Increased Limitation on Special Pay for Nurse
Executives.--Section 7452(g)(2) is amended by striking
``$25,000'' and inserting ``$100,000''.
(j) Locality Pay Scale Computations.--
(1) Education, training, and support for facility directors
in wage surveys.--Section 7451(d)(3) is amended by adding at
the end the following new subparagraph:
``(F) The Under Secretary for Health shall provide
appropriate education, training, and support to directors of
Department health care facilities in the conduct and use of
surveys, including the use of third-party surveys, under this
paragraph.''.
(2) Information on methodology used in wage surveys.--
Section 7451(e)(4) is amended--
(A) by redesignating subparagraph (D) as subparagraph (E);
and
(B) by inserting after subparagraph (C) the following new
subparagraph (D):
``(D) In any case in which the director conducts such a
wage survey during the period covered by the report and makes
adjustment in rates of basic pay applicable to one or more
covered positions at the facility, information on the
methodology used in making such adjustment or adjustments.''.
(3) Disclosure of information to persons in covered
positions.--Section 7451(e), as amended by paragraph (2) of
this subsection, is further amended by adding at the end the
following new paragraph:
``(6)(A) Upon the request of an individual described in
subparagraph (B) for a report provided under paragraph (4)
with respect to a Department health-care facility, the Under
Secretary for Health or the director of such facility shall
provide to the individual the most current report for such
facility provided under such paragraph.
``(B) An individual described in this subparagraph is--
``(i) an individual in a covered position at a Department
health-care facility; or
``(ii) a representative of the labor organization
representing that individual who is designated by that
individual to make the request.''.
(k) Eligibility of Part-Time Nurses for Additional Nurse
Pay.--
(1) In general.--Section 7453 is amended--
(A) in subsection (a), by striking ``a nurse'' and
inserting ``a full-time nurse or part-time nurse'';
(B) in subsection (b)--
(i) in the first sentence--
(I) by striking ``on a tour of duty'';
(II) by striking ``service on such tour'' and inserting
``such service''; and
(III) by striking ``of such tour'' and inserting ``of such
service''; and
(ii) in the second sentence, by striking ``of such tour''
and inserting ``of such service'';
(C) in subsection (c)--
(i) by striking ``on a tour of duty''; and
(ii) by striking ``service on such tour'' and inserting
``such service''; and
(D) in subsection (e)--
(i) in paragraph (1), by striking ``eight hours in a day''
and inserting ``eight consecutive hours''; and
(ii) in paragraph (5)(A), by striking ``tour of duty'' and
inserting ``period of service''.
(2) Exclusion of application of additional nurse pay
provisions to certain additional employees.--Paragraph (3) of
section 7454(b) is amended to read as follows:
``(3) Employees appointed under section 7408 of this title
performing service on a tour of duty, any part of which is
within the period commencing at midnight Friday and ending at
midnight Sunday, shall receive additional pay in addition to
the rate of basic pay provided such employees for each hour
of service on such tour at a rate equal to 25 percent of such
employee's hourly rate of basic pay.''.
(l) Enhanced Authority To Increase Rates of Basic Pay To
Obtain or Retain Services of Certain Persons.--Section
7455(c) is amended to read as follows:
``(c)(1) Subject to paragraph (2), the amount of any
increase under subsection (a) in the minimum rate for any
grade may not (except in the case of nurse anesthetists,
licensed practical nurses, licensed vocational nurses,
nursing positions otherwise covered by title 5, pharmacists,
and licensed physical therapists) exceed the maximum rate of
basic pay (excluding any locality-based comparability payment
under section 5304 of title 5 or similar provision of law)
for the grade or level by more than 30 percent.
``(2) No rate may be established under this section in
excess of the rate of basic pay payable for level IV of the
Executive Schedule.''.
[[Page H2716]]
SEC. 602. LIMITATIONS ON OVERTIME DUTY, WEEKEND DUTY, AND
ALTERNATIVE WORK SCHEDULES FOR NURSES.
(a) Overtime Duty.--
(1) In general.--Subchapter IV of chapter 74 is amended by
adding at the end the following new section:
``Sec. 7459. Nursing staff: special rules for overtime duty
``(a) Limitation.--Except as provided in subsection (c),
the Secretary may not require nursing staff to work more than
40 hours (or 24 hours if such staff is covered under section
7456 of this title) in an administrative work week or more
than eight consecutive hours (or 12 hours if such staff is
covered under section 7456 or 7456A of this title).
``(b) Voluntary Overtime.--(1) Nursing staff may on a
voluntary basis elect to work hours otherwise prohibited by
subsection (a).
``(2) The refusal of nursing staff to work hours prohibited
by subsection (a) shall not be grounds--
``(A) to discriminate (within the meaning of section 704(a)
of the Civil Rights Act of 1964 (42 U.S.C. 2000e-3(a)))
against the staff;
``(B) to dismiss or discharge the staff; or
``(C) for any other adverse personnel action against the
staff.
``(c) Overtime Under Emergency Circumstances.--(1) Subject
to paragraph (2), the Secretary may require nursing staff to
work hours otherwise prohibited by subsection (a) if--
``(A) the work is a consequence of an emergency that could
not have been reasonably anticipated;
``(B) the emergency is non-recurring and is not caused by
or aggravated by the inattention of the Secretary or lack of
reasonable contingency planning by the Secretary;
``(C) the Secretary has exhausted all good faith,
reasonable attempts to obtain voluntary workers;
``(D) the nurse staff have critical skills and expertise
that are required for the work; and
``(E) the work involves work for which the standard of care
for a patient assignment requires continuity of care through
completion of a case, treatment, or procedure.
``(2) Nursing staff may not be required to work hours under
this subsection after the requirement for a direct role by
the staff in responding to medical needs resulting from the
emergency ends.
``(d) Nursing Staff Defined.--In this section, the term
`nursing staff' includes the following:
``(1) A registered nurse.
``(2) A licensed practical or vocational nurse.
``(3) A nurse assistant appointed under this chapter or
title 5.
``(4) Any other nurse position designated by the Secretary
for purposes of this section.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 74 is amended by inserting after the
item relating to section 7458 the following new item:
``7459. Nursing staff: special rules for overtime duty.''.
(b) Weekend Duty.--Section 7456 is amended--
(1) by striking subsection (c); and
(2) by redesignating subsection (d) as subsection (c).
(c) Alternate Work Schedules.--
(1) In general.--Section 7456A(b)(1)(A) is amended by
striking ``three regularly scheduled'' and all that follows
through the period at the end and inserting ``six regularly
scheduled 12-hour tours of duty within a 14-day period shall
be considered for all purposes to have worked a full 80-hour
pay period.''.
(2) Conforming amendments.--Section 7456A(b) is amended--
(A) in the subsection heading, by striking ``36/40'' and
inserting ``72/80'';
(B) in paragraph (2)(A), by striking ``40-hour basic work
week'' and inserting ``80-hour pay period''; and
(C) in paragraph (3), by striking ``regularly''.
SEC. 603. REAUTHORIZATION OF HEALTH PROFESSIONALS EDUCATIONAL
ASSISTANCE SCHOLARSHIP PROGRAM.
(a) In General.--Section 7618 is amended by striking
``December 31, 1998'' and inserting ``December 31, 2014''.
(b) Expansion of Eligibility Requirements.--Section
7612(b)(2) is amended by striking ``(under section'' and all
that follows through ``or vocational nurse.'' and inserting
the following: ``as an appointee under paragraph (1) or (3)
of section 7401 of this title.''.
(c) Additional Program Requirements.--Subchapter II of
chapter 76, as amended by subsections (a) and (b), is further
amended--
(1) by redesignating section 7618 as section 7619; and
(2) by inserting after section 7617 the following new
section:
``Sec. 7618. Additional program requirements
``(a) Program Modification.--Notwithstanding any provision
of this subchapter, the Secretary shall carry out this
subchapter after the date of the enactment of this section by
modifying the Scholarship Program in such a manner that the
program and hiring processes are designed to fully employ
Scholarship Program graduates as soon as possible, if not
immediately, upon graduation and completion of necessary
certifications, and to actively assist and monitor graduates
to ensure certifications are obtained in a minimal amount of
time following graduation.
``(b) Clinical Tours.--The Secretary shall require
participants in the Scholarship Program to perform clinical
tours in assignments or locations determined by the Secretary
while the participants are enrolled in the course of
education or training for which the scholarship is provided.
``(c) Mentors.--The Secretary shall ensure that at the
commencement of the period of obligated service of a
participant in the Scholarship Program, the participant is
assigned to a mentor who is employed in the same facility
where the participant performs such service.''.
(d) Clerical Amendment.--The table of sections at the
beginning of chapter 76 is amended by striking the item
relating to section 7618 and inserting the following new
items:
``7618. Additional program requirements.
``7619. Expiration of program.''.
SEC. 604. LOAN REPAYMENT PROGRAM FOR CLINICAL RESEARCHERS
FROM DISADVANTAGED BACKGROUNDS.
(a) In General.--The Secretary of Veterans Affairs may, in
consultation with the Secretary of Health and Human Services,
use the authorities available in section 487E of the Public
Health Service Act (42 U.S.C. 288-5) for the repayment of the
principal and interest of educational loans of appropriately
qualified health professionals who are from disadvantaged
backgrounds in order to secure clinical research by such
professionals for the Veterans Health Administration.
(b) Limitations.--The exercise by the Secretary of Veterans
Affairs of the authorities referred to in subsection (a)
shall be subject to the conditions and limitations specified
in paragraphs (2) and (3) of section 487E(a) of the Public
Health Service Act (42 U.S.C. 288-5(a)(2) and (3)).
(c) Funding.--Amounts for the repayment of principal and
interest of educational loans under this section shall be
derived from amounts available to the Secretary of Veterans
Affairs for the Veterans Health Administration for Medical
Services.
TITLE VII--HOMELESS VETERANS MATTERS
SEC. 701. PER DIEM GRANT PAYMENTS TO NONCONFORMING ENTITIES.
Section 2012 is amended by adding at the end the following
new subsection:
``(d) Per Diem Payments to Nonconforming Entities.--(1) The
Secretary may make funds available for per diem payments
under this section to the following grant recipients or
eligible entities:
``(A) Grant recipients or eligible entities that--
``(i) meet each of the transitional and supportive services
criteria prescribed by the Secretary pursuant to subsection
(a)(1); and
``(ii) furnish services to homeless individuals, of which
less than 75 percent are veterans.
``(B) Grant recipients or eligible entities that--
``(i) meet at least one, but not all, of the transitional
and supportive services criteria prescribed by the Secretary
pursuant to subsection (a)(1); and
``(ii) furnish services to homeless individuals, of which
not less than 75 percent are veterans.
``(C) Grant recipients or eligible entities that--
``(i) meet at least one, but not all, of the transitional
and supportive services criteria prescribed by the Secretary
pursuant to subsection (a)(1); and
``(ii) furnish services to homeless individuals, of which
less than 75 percent are veterans.
``(2) Notwithstanding subsection (a)(2), in providing per
diem payments under this subsection, the Secretary shall
determine the rate of such per diem payments in accordance
with the following order of priority:
``(A) Grant recipients or eligible entities described by
paragraph (1)(A).
``(B) Grant recipients or eligible entities described by
paragraph (1)(B).
``(C) Grant recipients or eligible entities described by
paragraph (1)(C).
``(3) For purposes of this subsection, an eligible entity
is a nonprofit entity and may be an entity that is ineligible
to receive a grant under section 2011 of this title, but whom
the Secretary determines carries out the purposes described
in that section.''.
TITLE VIII--NONPROFIT RESEARCH AND EDUCATION CORPORATIONS
SEC. 801. GENERAL AUTHORITIES ON ESTABLISHMENT OF
CORPORATIONS.
(a) Authorization of Multi-medical Center Research
Corporations.--
(1) In general.--Section 7361 is amended--
(A) by redesignating subsection (b) as subsection (e); and
(B) by inserting after subsection (a) the following new
subsection (b):
``(b)(1) Subject to paragraph (2), a corporation
established under this subchapter may facilitate the conduct
of research, education, or both at more than one medical
center. Such a corporation shall be known as a `multi-medical
center research corporation'.
``(2) The board of directors of a multi-medical center
research corporation under this subsection shall include the
official at each Department medical center concerned who is,
or who carries out the responsibilities of, the medical
center director of such center as specified in section
7363(a)(1)(A)(i) of this title.
``(3) In facilitating the conduct of research, education,
or both at more than one Department medical center under this
subchapter, a multi-medical center research corporation
[[Page H2717]]
may administer receipts and expenditures relating to such
research, education, or both, as applicable, performed at the
Department medical centers concerned.''.
(2) Expansion of existing corporations to multi-medical
center research corporations.--Such section is further
amended by adding at the end the following new subsection:
``(f) A corporation established under this subchapter may
act as a multi-medical center research corporation under this
subchapter in accordance with subsection (b) if--
``(1) the board of directors of the corporation approves a
resolution permitting facilitation by the corporation of the
conduct of research, education, or both at the other
Department medical center or medical centers concerned; and
``(2) the Secretary approves the resolution of the
corporation under paragraph (1).''.
(b) Restatement and Modification of Authorities on
Applicability of State Law.--
(1) In general.--Section 7361 as amended by subsection (a)
of this section, is further amended by inserting after
subsection (b) the following new subsection (c):
``(c) Any corporation established under this subchapter
shall be established in accordance with the nonprofit
corporation laws of the State in which the applicable
Department medical center is located and shall, to the extent
not inconsistent with any Federal law, be subject to the laws
of such State. In the case of any multi-medical center
research corporation that facilitates the conduct of
research, education, or both at Department medical centers
located in different States, the corporation shall be
established in accordance with the nonprofit corporation laws
of the State in which one of such Department medical centers
is located.''.
(2) Conforming amendment.--Section 7365 is repealed.
(c) Clarification of Status of Corporations.--Section 7361,
as amended by this section, is further amended--
(1) in subsection (a), by striking the second sentence; and
(2) by inserting after subsection (c) the following new
subsection (d):
``(d)(1) Except as otherwise provided in this subchapter or
under regulations prescribed by the Secretary, any
corporation established under this subchapter, and its
officers, directors, and employees, shall be required to
comply only with those Federal laws, regulations, and
executive orders and directives that apply generally to
private nonprofit corporations.
``(2) A corporation under this subchapter is not--
``(A) owned or controlled by the United States; or
``(B) an agency or instrumentality of the United States.''.
(d) Reinstatement of Requirement for 501(c)(3) Status of
Corporations.--Subsection (e) of section 7361, as
redesignated by subsection (a)(1), is further amended by
inserting ``section 501(c)(3) of'' after ``exempt from
taxation under''.
SEC. 802. CLARIFICATION OF PURPOSES OF CORPORATIONS.
(a) Clarification of Purposes.--Subsection (a) of section
7362 is amended in the first sentence--
(1) by striking ``Any corporation'' and all that follows
through ``facilitate'' and inserting ``A corporation
established under this subchapter shall be established to
provide a flexible funding mechanism for the conduct of
approved research and education at one or more Department
medical centers and to facilitate functions related to the
conduct of''; and
(2) by inserting before the period at the end the
following: ``or centers''.
(b) Modification of Defined Term Relating to Education and
Training.--Subsection (b) of such section is amended in the
matter preceding paragraph (1) by striking ``the term
`education and training' '' and inserting ``the term
`education' includes education and training and''.
(c) Repeal of Role of Corporations With Respect to
Fellowships.--Paragraph (1) of subsection (b) of such section
is amended by striking the flush matter following
subparagraph (C).
(d) Availability of Education for Families of Veteran
Patients.--Paragraph (2) of subsection (b) of such section is
amended by striking ``to patients and to the families'' and
inserting ``and includes education and training for patients
and families''.
SEC. 803. MODIFICATION OF REQUIREMENTS FOR BOARDS OF
DIRECTORS OF CORPORATIONS.
(a) Requirements for Department Board Members.--Paragraph
(1) of section 7363(a) is amended to read as follows:
``(1) with respect to the Department medical center--
``(A)(i) the director (or directors of each Department
medical center, in the case of a multi-medical center
research corporation);
``(ii) the chief of staff; and
``(iii) as appropriate for the activities of such
corporation, the associate chief of staff for research and
the associate chief of staff for education; or
``(B) in the case of a Department medical center at which
one or more of the positions referred to in subparagraph (A)
do not exist, the official or officials who are responsible
for carrying out the responsibilities of such position or
positions at the Department medical center; and''.
(b) Requirements for Non-department Board Members.--
Paragraph (2) of such section is amended--
(1) by inserting ``not less than two'' before ``members'';
and
(2) by striking ``and who'' and all that follows through
the period at the end and inserting ``and who have
backgrounds, or business, legal, financial, medical, or
scientific expertise, of benefit to the operations of the
corporation.''.
(c) Conflicts of Interest.--Subsection (c) of section 7363
is amended by striking ``, employed by, or have any other
financial relationship with'' and inserting ``or employed
by''.
SEC. 804. CLARIFICATION OF POWERS OF CORPORATIONS.
(a) In General.--Section 7364 is amended to read as
follows:
``Sec. 7364. General powers
``(a) In General.--(1) A corporation established under this
subchapter may, solely to carry out the purposes of this
subchapter--
``(A) accept, administer, retain, and spend funds derived
from gifts, contributions, grants, fees, reimbursements, and
bequests from individuals and public and private entities;
``(B) enter into contracts and agreements with individuals
and public and private entities;
``(C) subject to paragraph (2), set fees for education and
training facilitated under section 7362 of this title, and
receive, retain, administer, and spend funds in furtherance
of such education and training;
``(D) reimburse amounts to the applicable appropriation
account of the Department for the Office of General Counsel
for any expenses of that Office in providing legal services
attributable to research and education agreements under this
subchapter; and
``(E) employ such employees as the corporation considers
necessary for such purposes and fix the compensation of such
employees.
``(2) Fees charged pursuant to paragraph (1)(C) for
education and training described in that paragraph to
individuals who are officers or employees of the Department
may not be paid for by any funds appropriated to the
Department.
``(3) Amounts reimbursed to the Office of General Counsel
under paragraph (1)(D) shall be available for use by the
Office of the General Counsel only for staff and training,
and related travel, for the provision of legal services
described in that paragraph and shall remain available for
such use without fiscal year limitation.
``(b) Transfer and Administration of Funds.--(1) Except as
provided in paragraph (2), any funds received by the
Secretary for the conduct of research or education at a
Department medical center or centers, other than funds
appropriated to the Department, may be transferred to and
administered by a corporation established under this
subchapter for such purposes.
``(2) A Department medical center may reimburse the
corporation for all or a portion of the pay, benefits, or
both of an employee of the corporation who is assigned to the
Department medical center if the assignment is carried out
pursuant to subchapter VI of chapter 33 of title 5.
``(3) A Department medical center may retain and use funds
provided to it by a corporation established under this
subchapter. Such funds shall be credited to the applicable
appropriation account of the Department and shall be
available, without fiscal year limitation, for the purposes
of that account.
``(c) Research Projects.--Except for reasonable and usual
preliminary costs for project planning before its approval, a
corporation established under this subchapter may not spend
funds for a research project unless the project is approved
in accordance with procedures prescribed by the Under
Secretary for Health for research carried out with Department
funds. Such procedures shall include a scientific review
process.
``(d) Education Activities.--Except for reasonable and
usual preliminary costs for activity planning before its
approval, a corporation established under this subchapter may
not spend funds for an education activity unless the activity
is approved in accordance with procedures prescribed by the
Under Secretary for Health.
``(e) Policies and Procedures.--The Under Secretary for
Health may prescribe policies and procedures to guide the
spending of funds by corporations established under this
subchapter that are consistent with the purpose of such
corporations as flexible funding mechanisms and with Federal
and State laws and regulations, and executive orders,
circulars, and directives that apply generally to the receipt
and expenditure of funds by nonprofit organizations exempt
from taxation under section 501(c)(3) of the Internal Revenue
Code of 1986.''.
(b) Conforming Amendment.--Section 7362(a), as amended by
section 802(a)(1) of this Act, is further amended by striking
the last sentence.
SEC. 805. REDESIGNATION OF SECTION 7364A OF TITLE 38, UNITED
STATES CODE.
(a) Redesignation.--Section 7364A is redesignated as
section 7365.
(b) Clerical Amendments.--The table of sections at the
beginning of chapter 73 is amended--
(1) by striking the item relating to section 7364A; and
(2) by striking the item relating to section 7365 and
inserting the following new item:
``7365. Coverage of employees under certain Federal tort claims
laws.''.
[[Page H2718]]
SEC. 806. IMPROVED ACCOUNTABILITY AND OVERSIGHT OF
CORPORATIONS.
(a) Additional Information in Annual Reports.--Subsection
(b) of section 7366 is amended to read as follows:
``(b)(1) Each corporation shall submit to the Secretary
each year a report providing a detailed statement of the
operations, activities, and accomplishments of the
corporation during that year.
``(2)(A) A corporation with revenues in excess of $500,000
for any year shall obtain an audit of the corporation for
that year.
``(B) A corporation with annual revenues between $100,000
and $500,000 shall obtain an audit of the corporation at
least once every three years.
``(C) Any audit under this paragraph shall be performed by
an independent auditor.
``(3) The corporation shall include in each report to the
Secretary under paragraph (1) the following:
``(A) The most recent audit of the corporation under
paragraph (2).
``(B) The most recent Internal Revenue Service Form 990
`Return of Organization Exempt from Income Tax' or equivalent
and the applicable schedules under such form.''.
(b) Conflict of Interest Policies.--Subsection (c) of such
section is amended to read as follows:
``(c) Each director, officer, and employee of a corporation
established under this subchapter shall be subject to a
conflict of interest policy adopted by that corporation.''.
(c) Establishment of Appropriate Payee Reporting
Threshold.--Subsection (d)(3)(C) of such section is amended
by striking ``$35,000'' and inserting ``$50,000''.
TITLE IX--CONSTRUCTION AND NAMING MATTERS
SEC. 901. AUTHORIZATION OF MEDICAL FACILITY PROJECTS.
(a) Authorization of Fiscal Year 2010 Major Medical
Facility Projects.--The Secretary of Veterans Affairs may
carry out the following major medical facility projects in
fiscal year 2010, with each project to be carried out in the
amount specified for such project:
(1) Construction (including acquisition of land) for the
realignment of services and closure projects at the
Department of Veterans Affairs Medical Center in Livermore,
California, in an amount not to exceed $55,430,000.
(2) Construction (including acquisition of land) for a new
medical facility at the Department of Veterans Affairs
Medical Center in Louisville, Kentucky, in an amount not to
exceed $75,000,000.
(3) Construction (including acquisition of land) for a
clinical expansion for a Mental Health Facility at the
Department of Veterans Affairs Medical Center in Dallas,
Texas, in an amount not to exceed $15,640,000.
(4) Construction (including acquisition of land) for a
replacement bed tower and clinical expansion at the
Department of Veterans Affairs Medical Center in St. Louis,
Missouri, in an amount not to exceed $43,340,000.
(b) Extension of Authorization for Major Medical Facility
Construction Projects Previously Authorized.--The Secretary
of Veterans Affairs may carry out the following major medical
facility projects in fiscal year 2010, as follows with each
project to be carried out in the amount specified for such
project:
(1) Replacement of the existing Department of Veterans
Affairs Medical Center in Denver, Colorado, in an amount not
to exceed $800,000,000.
(2) Construction of Outpatient and Inpatient Improvements
in Bay Pines, Florida, in an amount not to exceed
$194,400,000.
(c) Authorization of Appropriations.--
(1) Authorization of appropriations for construction.--
There is authorized to be appropriated to the Secretary of
Veterans Affairs for fiscal year 2010, or the year in which
funds are appropriated, for the Construction, Major Projects
account--
(A) $189,410,000 for the projects authorized in subsection
(a); and
(B) $994,400,000 for the projects authorized in subsection
(b).
(2) Limitation.--The projects authorized in subsections (a)
and (b) may only be carried out using--
(A) funds appropriated for fiscal year 2010 pursuant to the
authorization of appropriations in paragraph (1);
(B) funds available for Construction, Major Projects for a
fiscal year before fiscal year 2010 that remain available for
obligation;
(C) funds available for Construction, Major Projects for a
fiscal year after fiscal year 2010 that remain available for
obligation;
(D) funds appropriated for Construction, Major Projects for
fiscal year 2010 for a category of activity not specific to a
project;
(E) funds appropriated for Construction, Major Projects for
a fiscal year before 2010 for a category of activity not
specific to a project; and
(F) funds appropriated for Construction, Major Projects for
a fiscal year after 2010 for a category of activity not
specific to a project.
SEC. 902. DESIGNATION OF MERRIL LUNDMAN DEPARTMENT OF
VETERANS AFFAIRS OUTPATIENT CLINIC, HAVRE,
MONTANA.
(a) Designation.--The Department of Veterans Affairs
outpatient clinic in Havre, Montana, shall after the date of
the enactment of this Act be known and designated as the
``Merril Lundman Department of Veterans Affairs Outpatient
Clinic''.
(b) References.--Any reference in any law, regulation, map,
document, record, or other paper of the United States to the
outpatient clinic referred to in subsection (a) shall be
considered to be a reference to the Merril Lundman Department
of Veterans Affairs Outpatient Clinic.
SEC. 903. DESIGNATION OF WILLIAM C. TALLENT DEPARTMENT OF
VETERANS AFFAIRS OUTPATIENT CLINIC, KNOXVILLE,
TENNESSEE.
(a) Designation.--The Department of Veterans Affairs
Outpatient Clinic in Knoxville, Tennessee, shall after the
date of the enactment of this Act be known and designated as
the ``William C. Tallent Department of Veterans Affairs
Outpatient Clinic''.
(b) References.--Any reference in any law, regulation, map,
document, record, or other paper of the United States to the
outpatient clinic referred to in subsection (a) shall be
considered to be a reference to the William C. Tallent
Department of Veterans Affairs Outpatient Clinic.
SEC. 904. DESIGNATION OF MAX J. BEILKE DEPARTMENT OF VETERANS
AFFAIRS OUTPATIENT CLINIC, ALEXANDRIA,
MINNESOTA.
(a) Designation.--The Department of Veterans Affairs
outpatient clinic in Alexandria, Minnesota, shall after the
date of the enactment of this Act be known and designated as
the ``Max J. Beilke Department of Veterans Affairs Outpatient
Clinic''.
(b) References.--Any reference in any law, regulation, map,
document, record, or other paper of the United States to the
outpatient clinic referred to in subsection (a) shall be
considered to be a reference to the Max J. Beilke Department
of Veterans Affairs Outpatient Clinic.
TITLE X--OTHER MATTERS
SEC. 1001. EXPANSION OF AUTHORITY FOR DEPARTMENT OF VETERANS
AFFAIRS POLICE OFFICERS.
Section 902 is amended--
(1) in subsection (a)--
(A) by amending paragraph (1) to read as follows:
``(1) Employees of the Department who are Department police
officers shall, with respect to acts occurring on Department
property--
``(A) enforce Federal laws;
``(B) enforce the rules prescribed under section 901 of
this title;
``(C) enforce traffic and motor vehicle laws of a State or
local government (by issuance of a citation for violation of
such laws) within the jurisdiction of which such Department
property is located as authorized by an express grant of
authority under applicable State or local law;
``(D) carry the appropriate Department-issued weapons,
including firearms, while off Department property in an
official capacity or while in an official travel status;
``(E) conduct investigations, on and off Department
property, of offenses that may have been committed on
property under the original jurisdiction of Department,
consistent with agreements or other consultation with
affected Federal, State, or local law enforcement agencies;
and
``(F) carry out, as needed and appropriate, the duties
described in subparagraphs (A) through (E) when engaged in
duties authorized by other Federal statutes.'';
(B) by striking paragraph (2) and redesignating paragraph
(3) as paragraph (2); and
(C) in paragraph (2), as redesignated by subparagraph (B)
of this paragraph, by inserting ``, and on any arrest warrant
issued by competent judicial authority'' before the period;
and
(2) by amending subsection (c) to read as follows:
``(c) The powers granted to Department police officers
designated under this section shall be exercised in
accordance with guidelines approved by the Secretary and the
Attorney General.''.
SEC. 1002. UNIFORM ALLOWANCE FOR DEPARTMENT OF VETERANS
AFFAIRS POLICE OFFICERS.
Section 903 is amended--
(1) by striking subsection (b) and inserting the following
new subsection (b):
``(b)(1) The amount of the allowance that the Secretary may
pay under this section is the lesser of--
``(A) the amount currently allowed as prescribed by the
Office of Personnel Management; or
``(B) estimated costs or actual costs as determined by
periodic surveys conducted by the Department.
``(2) During any fiscal year no officer shall receive more
for the purchase of a uniform described in subsection (a)
than the amount established under this subsection.''; and
(2) by striking subsection (c) and inserting the following
new subsection (c):
``(c) The allowance established under subsection (b) shall
be paid at the beginning of a Department police officer's
employment for those appointed on or after October 1, 2010.
In the case of any other Department police officer, an
allowance in the amount established under subsection (b)
shall be paid upon the request of the officer.''.
SEC. 1003. SUBMISSION OF REPORTS TO CONGRESS BY SECRETARY OF
VETERANS AFFAIRS IN ELECTRONIC FORM.
(a) In General.--Chapter 1 is amended by adding at the end
the following new section:
[[Page H2719]]
``Sec. 118. Submission of reports to Congress in electronic
form
``(a) In General.--Whenever the Secretary or any other
official of the Department is required by law to submit to
Congress (or any committee of either chamber of Congress) a
report, the Secretary or other official shall submit to
Congress (or such committee) a copy of the report in an
electronic format.
``(b) Treatment.--The submission of a copy of a report in
accordance with this section shall be treated as meeting any
requirement of law to submit such report to Congress (or any
committee of either chamber of Congress).
``(c) Report Defined.--For purposes of this section, the
term `report' includes any certification, notification, or
other communication in writing.''.
(b) Technical and Clerical Amendments.--The table of
sections at the beginning of chapter 1 is amended--
(1) by striking the item relating to section 117; and
(2) by adding at the end the following new items:
``117. Advance appropriations for certain medical care accounts.
``118. Reports to Congress: submission in electronic form.''.
SEC. 1004. DETERMINATION OF BUDGETARY EFFECTS FOR PURPOSES OF
COMPLIANCE WITH STATUTORY PAY-AS-YOU-GO-ACT OF
2010.
The budgetary effects of this Act, for the purpose of
complying with the Statutory Pay-As-You-Go-Act of 2010, shall
be determined by reference to the latest statement titled
``Budgetary Effects of PAYGO Legislation'' for this Act,
submitted for printing in the Congressional Record by the
Chairman of the House Budget Committee, provided that such
statement has been submitted prior to the vote on passage.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
California (Mr. Filner) and the gentleman from Indiana (Mr. Buyer) each
will control 20 minutes.
The Chair recognizes the gentleman from California.
General Leave
Mr. FILNER. I ask unanimous consent that all Members may have 5
legislative days in which to revise and extend their remarks and
include extraneous materials on S. 1963, as amended.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
Mr. FILNER. I yield myself 4 minutes.
Mr. Speaker, when I became chairman of the Committee on Veterans'
Affairs 3 years ago, the VA was strained to the breaking point by years
of chronic underfunding. We were a country at war; yet, the Department
of Veterans Affairs remained unprepared to care for the hundreds of
thousands of new veterans returning from Iraq and Afghanistan.
It is simply our duty as a Nation, no matter where we stand on the
war, to put our men and women in harm's way under the care of our
Nation when they return. Under the Democratic leadership, Congress has
provided almost a 60 percent increase for VA medical care funding over
the last 3 years, adding over $20 billion to the VA budget baseline.
S. 1963 demonstrates America's commitment to the dedicated
servicemembers who have served in uniform and puts front and center the
health care needs of veterans and their families. It is our pledge to
them that we have not forgotten the sacrifices they have made in
defense of this country. So in this bill, we help caregivers of injured
veterans, women veterans, rural veterans, homeless veterans, and
veterans with mental health issues.
S. 1963 provides immediate support to the mothers, fathers, husbands,
and wives caring for warriors from the current conflicts as well as
from previous conflicts. Today we have the opportunity to recognize
their tremendous sacrifice and share their heavy burden.
The bill also expands and improves VA services for the 1.8 million
women veterans currently receiving VA health care and goes a step
further by anticipating the expected increase of women warriors over
the next 5 years. This bill seeks to build a VA health care system
respectful of the unique medical needs of women veterans.
S. 1963 also advances America's commitment to end veterans'
homelessness. Hundreds of thousands of veterans are at risk of
homelessness because of poverty and the lack of support from family and
friends. An increasing number of veterans of operations in Afghanistan
and Iraq are falling into this category, and we must be vigilant in
providing support to this population.
We expand the number of places where homeless vets may receive
supportive services; and for our veterans struggling without a roof
over their heads, this small change in the law will make a big
difference in their lives.
The bill also includes key provisions to improve health care provided
to our rural veterans by authorizing stronger partnerships with
community providers and the Department of Health and Human Services.
These collaborations will allow VA to offer health care options to
servicemembers living far from the nearest medical facility.
In addition, we address the troubling reality of posttraumatic stress
disorder and troubling incidents of suicide amongst the veterans'
population. The bill requires a much-needed and long-awaited study on
veteran suicide and requires the VA to provide counseling referrals for
former members of the Armed Forces who are not otherwise eligible for
readjustment counseling.
S. 1963 provides higher priority status for Medal of Honor
recipients, establishes a director of physician assistant services, and
creates a committee on care of veterans with traumatic brain injury. It
requires the VA to provide health care for herbicide-exposed Vietnam
veterans and veterans of the Persian Gulf War who have insufficient
medical evidence to establish a service-connected disability, and it
prohibits the VA from collecting copayments from veterans who are
catastrophically disabled.
This bill, Mr. Speaker, demands our immediate attention. We owe our
veterans a great debt of gratitude, and this bill represents an
understanding that the sacrifices of our veterans are shared amongst
all Americans.
I urge all of my colleagues to support passage of S. 1963, as
amended, and reserve the balance of my time.
Explanatory Statement Submitted by Mr. Filner, Chairman of the House
Committee on Veterans' Affairs, Regarding the Amendment of the House of
Representatives to S. 1963
Caregivers and Veterans Omnibus Health Services Act of 2010
S. 1963, as amended, the ``Caregivers and Veterans Omnibus
Health Services Act of 2010,'' reflects the Compromise
Agreement between the Committees on Veterans' Affairs of the
Senate and the House of Representatives (the Committees) on
health care and related provisions for veterans and their
caregivers. The provisions in the Compromise Agreement are
derived from a number of bills that were introduced and
considered by the House and Senate during the 111th Congress.
These bills include S. 1963, a bill to provide assistance to
caregivers of veterans, to improve the provision of health
care to veterans, and for other purposes, which passed the
Senate on November 19, 2009 (Senate bill); and H.R. 3155, a
bill to provide certain caregivers of veterans with training,
support, and medical care, and for other purposes, which
passed the House on July 27, 2009 (House bill).
In addition, the Compromise Agreement includes provisions
derived from the following bills which were passed by the
House: H.R. 402, a bill to designate the Department of
Veterans Affairs Outpatient Clinic in Knoxville, Tennessee,
as the ``William C. Tallent Department of Veterans Affairs
Outpatient Clinic,'' passed by the House on July 14, 2009;
H.R. 1211, a bill to expand and improve health care services
available to women veterans, especially those serving in
Operation Enduring Freedom and Operation Iraqi Freedom, from
the Department of Veterans Affairs, and for other purposes,
passed by the House on June 23, 2009; H.R. 1293, a bill to
provide for an increase in the amount payable by the
Secretary of Veterans Affairs to veterans for improvements
and structural alterations furnished as part of home health
services, passed by the House on July 28, 2009; H.R. 2770, a
bill to modify and update provisions of law relating to
nonprofit research and education corporations, and for other
purposes, passed by the House on July 27, 2009; H.R. 3157, a
bill to name the Department of Veterans Affairs outpatient
clinic in Alexandria, Minnesota, as the ``Max J. Beilke
Department of Veterans Affairs Outpatient Clinic,'' passed by
the House on November 3, 2009; H.R. 3219, a bill to make
certain improvements in the laws administered by the
Secretary of Veterans Affairs relating to insurance and
health care, and for other purposes, passed by the House on
July 27, 2009; and H.R. 3949, a bill to make certain
improvements in the laws relating to benefits administered by
the Secretary of Veterans Affairs, and for other purposes,
passed by the House on November 3, 2009.
The Compromise Agreement also includes provisions derived
from the following House bills, which were introduced and
referred to the Subcommittee on Health of the House Committee
on Veterans' Affairs: H.R. 919, to enhance the capacity of
the Department of Veterans Affairs to recruit and retain
nurses and other critical health care professionals, and for
other purposes, which was introduced on February 9, 2009;
H.R. 3796, to improve per
[[Page H2720]]
diem grant payments for organizations assisting homeless
veterans, which was introduced on October 13, 2009; and H.R.
4166, to make certain improvements in the laws administered
by the Secretary of Veterans Affairs relating to educational
assistance for health professionals, and for other purposes,
which was introduced on December 1, 2009, and was
concurrently referred to the Committee on Energy and
Commerce.
The House and Senate Committees on Veterans' Affairs have
prepared the following explanation of the Compromise
Agreement. Differences between the provisions contained in
the Compromise Agreement and the related provisions in the
bills listed above are noted in this document, except for
clerical corrections and conforming changes, and minor
drafting, technical, and clarifying changes.
Title I--Caregiver Support
Assistance and Support Services for Family Caregivers
(section 101)
The Senate bill contains a provision (section 102) that
would create a new program to help caregivers of eligible
veterans who, together with the veteran, submit a joint
application requesting services under the new program.
Eligible veterans are defined as those who have a serious
injury, including traumatic brain injury, psychological
trauma, or other mental disorder, incurred or aggravated
while on active duty on or after September 11, 2001. Within
two years of program implementation, the Department of
Veterans Affairs (VA) would be required to submit a report on
the feasibility and advisability of extending the program to
veterans of earlier periods of service. Severely injured
veterans are defined as those who need personal care services
because they are unable to perform one or more independent
activities of daily living, require supervision as a result
of neurological or other impairments, or need personal care
services because of other matters specified by the VA. For
accepted caregiver applicants, VA would be required to
provide respite care as well as pay for travel, lodging and
per-diem expenses while the caregiver of an eligible veteran
is undergoing necessary training and education to provide
personal care services. Once a caregiver completes training
and is designated as the primary personal care attendant,
this individual would receive ongoing assistance including
direct technical support, counseling and mental health
services, respite care of no less than 30 days annually,
health care through the Civilian Health and Medical Program
of the Department of Veterans Affairs (CHAMPVA), and a
monthly financial stipend. The provision in the Senate bill
would require VA to carry out oversight of the caregiver by
utilizing the services of home health agencies. A home health
agency would be required to visit the home of a veteran not
less often than once every six months and report its findings
to VA. Based on the findings, VA would have the final
authority to revoke a caregiver's designation as a primary
personal care attendant. The provision also would require an
implementation and evaluation report, and provide for an
effective date 270 days after the date of the enactment of
this Act.
The House bill contains comparable provisions (section 2
and section 4) with some key differences. The provisions in
the House bill would provide educational sessions, access to
a list of comprehensive caregiver support services available
at the county level, information and outreach, respite care,
and counseling and mental health services to family and non-
family caregivers of veterans of any era. For family
caregivers of eligible veterans who served in Operation
Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF),
the House bill would require VA to provide a monthly
financial stipend, health care service through CHAMPVA,
and lodging and subsistence to the caregiver when the
caregiver accompanies the veteran on medical care visits.
Eligible OEF or OIF veterans are defined as those who have
a service-connected disability or illness that is severe;
in need of caregiver services without which the veteran
would be hospitalized, or placed in nursing home care or
other residential institutional care; and are unable to
carry out activities (including instrumental activities)
of daily living.
The Compromise Agreement contains the Senate provision
modified to no longer require VA to enter into relationships
with home health agencies to make home visits every six
months. In addition, the Compromise Agreement follows the
House bill in creating a separate program of general family
caregiver support services for family and non-family
caregivers of veterans of any era. Such support services
would include training and education, counseling and mental
health services, respite care, and information on the support
services available to caregivers through other public,
private, and nonprofit agencies. In the event that sufficient
funding is not available to provide training and education
services, the Secretary would be given the authority to
suspend the provision of such services. The Secretary would
be required to certify to the Committees that there is
insufficient funding 180 days before suspending the provision
of these services. This certification and the resulting
suspension of services would expire at the end of the fiscal
year concerned.
The overall caregiver support program for caregivers of
eligible OEF or OIF veterans would authorize VA to provide
training and supportive services to family members and
certain others who wish to care for a disabled veteran in the
home and to allow veterans to receive the most appropriate
level of care. The newly authorized supportive services would
include training and certification, a living stipend, and
health care--including mental health counseling,
transportation benefits, and respite.
The Compromise Agreement also includes an authorization for
appropriations that is below the estimate furnished by the
Congressional Budget Office. The lower authorization level is
based on information contained in a publication (Economic
Impact on Caregivers of the Seriously Wounded, Ill, and
Injured, April 2009) of the Center for Naval Analyses (CNA).
This study estimated that, annually, 720 post-September 11,
2001 veterans require comprehensive caregiver services. The
Compromise Agreement limits the caregiver program only to
``seriously injured or very seriously injured'' veterans who
were injured or aggravated an injury in the line of duty on
or after September 11, 2001. CNA found that the average
requirement for such caregiver services is 18 months, and
that only 43 percent of veterans require caregiver services
over the long-term. CNA also found that, on average, veterans
need only 21 hours of caregiver services per week. Only 233
family caregivers were referred by VA for training and
certification through existing home health agencies in FY
2008. This represented five percent of all home care
referrals. In FY 2009, only 168 family caregivers were
referred to home care agencies for training and
certification.
Medical Care for Family Caregivers (section 102)
The Senate bill contains a provision (section 102) that
would provide health care through the CHAMPVA program for
individuals designated as the primary care attendant for
eligible OEF or OIF veterans and who have no other insurance
coverage.
The House bill contains a comparable provision (section 5),
with a difference in the target population. Under the House
bill, the target population would include all family
caregivers of eligible OEF or OIF veterans, defined as those
who have a service-connected disability or illness that is
severe; are in need of caregiver services without which
hospitalization, nursing home care, or other residential
institutional care would be required; and, are unable to
carry out activities (including instrumental activities) of
daily living.
The Compromise Agreement contains the Senate provision.
Counseling and Mental Health Services for Family Caregivers
(section 103)
The Senate bill contains a provision (section 102) that
would provide counseling and mental health services for
family caregivers of OEF or OIF veterans.
The House bill contains a comparable provision (section 3),
except that counseling and mental health services would be
available to caregivers of veterans of any era.
The Compromise Agreement contains the House provision.
Lodging and Subsistence for Attendants (section 104)
The Senate bill contains a provision (section 103) that
would allow VA to pay for the lodging and subsistence costs
incurred by any attendant who accompanies an eligible OEF or
OIF veteran seeking VA health care.
The House bill contains a comparable provision (section 6),
with a difference in the target population. Under the House
bill, the target population would include all family
caregivers of eligible OEF or OIF veterans, defined as those
who have a service-connected disability or illness that is
severe; are in need of caregiver services without which
hospitalization, nursing home care, or other residential
institutional care would be required; and, are unable to
carry out activities (including instrumental activities) of
daily living.
The Compromise Agreement contains the Senate provision.
Title II--Women Veterans Health Care Matters
Study of Barriers for Women Veterans to Health Care from the
Department of Veterans Affairs (section 201)
The Senate bill contains a provision (section 201) that
would require VA to report, by June 1, 2010, on barriers
facing women veterans who seek health care at VA, especially
women veterans of OEF or OIF.
H.R. 1211 contains a comparable provision (section 101)
that would require a similar study of health care barriers
for women veterans. The House provision also would define the
parameters of the research study sample; direct VA to build
on the work of an existing study entitled ``National Survey
of Women Veterans in Fiscal Year 2007-2008;'' mandate VA to
share the barriers study data with the Center for Women
Veterans and the Advisory Committee on Women Veterans; and
authorize appropriations of $4 million to conduct the study.
VA would be required to submit to Congress a report on the
implementation of this section within six months of the
publication of the ``National Survey of Women Veterans in
Fiscal Year 2007-2008'', and the final report within 30
months of publication.
The Compromise Agreement contains the House provision.
Training and Certification for Mental Health Care Providers
of the Department of Veterans Affairs on Care for
Veterans Suffering from Sexual Trauma and Post-Traumatic
Stress Disorder (section 202)
The Senate bill contains a provision (section 204) that
would require VA to implement a program for education,
training, certification, and continuing medical education
[[Page H2721]]
for mental health professionals, which would include
principles of evidence-based treatment and care for sexual
trauma. VA would also be required to submit an annual report
on the counseling, care, and services provided to veterans
suffering from sexual trauma, and to establish education,
training, certification, and staffing standards for personnel
providing treatment for veterans with sexual trauma.
H.R. 1211 contains a similar provision (section 202),
except it included no provision requiring VA to establish
education, training, certification, and staffing standards
for the mental health professionals caring for veterans with
sexual trauma.
The Compromise Agreement contains the House provision.
Pilot Program on Counseling in Retreat Settings for Women
Veterans Newly Separated from Service in the Armed Forces
(section 203)
The Senate bill contains a provision (section 205) that
would require VA to establish, at a minimum of five
locations, a two-year pilot program in which women veterans
newly separated from the Armed Forces would receive
reintegration and readjustment services in a group retreat
setting. The provision also would require a report detailing
the pilot program findings and providing recommendations on
whether VA should continue or expand the pilot program.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision but
specifies that the program be carried out at a minimum of
three, not five, locations.
Service on Certain Advisory Committees of Women Recently
Separated from Service in the Armed Forces (section 204)
The Senate bill contains a provision (section 207) that
would amend the membership of the Advisory Committee on Women
Veterans and the Advisory Committee on Minority Veterans to
require that such committees include women recently separated
from the Armed Forces and women who are minority group
members and are recently separated from the Armed Forces,
respectively.
H.R. 1211 contains a similar provision (section 204) except
that it would allow either men or women who are members of a
minority group to serve on the Advisory Committee on Minority
Veterans.
The Compromise Agreement contains the Senate provision.
Pilot Program on Subsidies for Child Care for Certain
Veterans Receiving Health Care (section 205)
The Senate bill contains a provision (section 208) that
would require VA to establish a pilot program through which
child care subsidies would be provided to women veterans
receiving regular and intensive mental health care and
intensive health care services. The pilot program would be
carried out in no fewer than three Veterans Integrated
Service Networks (VISNs) for a duration of two years and, at
its conclusion, there would be a requirement for a report to
be submitted within six months detailing findings related to
the program and recommendations on its continuation or
extension. The provision also would direct VA, to the extent
practicable, to model the pilot program after an existing VA
Child Care Subsidy Program.
H.R. 1211 contains a comparable provision (section 203),
but it does not stipulate that the child care program shall
be executed through stipends. Rather, stipends are one option
among several listed, including partnership with private
agencies, collaboration with facilities or program of other
Federal departments or agencies, and the arrangement of
after-school care.
The Compromise Agreement contains the Senate provision,
with a modification to clarify that the child care subsidy
payments shall cover the full cost of child care services. In
addition, the provision expands the definition of veterans
who qualify for the child care subsidy to women veterans who
are in need of regular or intensive mental health care
services but who do not seek such care due to lack of child
care services. Finally, the Compromise Agreement follows the
House provision by allowing for other forms of child care
assistance. In addition to stipends, child care services may
be provided through the direct provision of child care at an
on-site VA facility, payments to private child care
agencies, collaboration with facilities or programs of
other Federal departments or agencies, and other forms as
deemed appropriate by the Secretary.
Care for Newborn Children of Women Veterans Receiving
Maternity Care (section 206)
The Senate bill contains a provision (section 209) that
would authorize VA to provide post-delivery health care
services to a newborn child of a woman veteran receiving
maternity care from VA if the child was delivered in a VA
facility or a non-VA facility pursuant to a VA contract for
delivery. Such care would be authorized for up to seven days.
H.R. 1211 contains a comparable provision (section 201),
but would allow VA to provide care for a set seven-day period
for newborn children of women veterans receiving maternity
care.
The Compromise Agreement contains the Senate provision.
Title III--Rural Health Improvements
Improvements to the Education Debt Reduction Program (section
301)
The Senate bill contains a provision (section 301) that
would eliminate the cap in current law on the total amount of
education debt reduction payments that can be made over five
years so as to permit payments equal to the total amount of
principal and interest owed on eligible loans.
H.R. 4166 contains a provision (section 3), that would
expand the purpose of the Education Debt Reduction Program
(EDRP), set forth in subchapter VII of chapter 76 of title
38, United States Code, to include retention in addition to
recruitment, as well as to modify and expand the eligibility
requirements for participation in the program. In addition,
the provision would increase the total education debt
reduction payments made by VA from $44,000 to $60,000 and
raise the cap on payments to be made during the fourth and
fifth years of the program from $10,000 to $12,000. The
provision would also provide VA with the flexibility to waive
the limitations of the EDRP and pay the full principal and
interest owed by participants who fill hard-to-recruit
positions at VA.
The Compromise Agreement contains the House provision.
Visual Impairment and Orientation and Mobility Professionals
Education Assistance Program (section 302)
The Senate bill contains a provision (section 302) that
would require VA to establish a scholarship program for
students accepted or enrolled in a program of study leading
to certification or a degree in the areas of visual
impairment or orientation and mobility. The student would be
required to agree to maintain an acceptable level of academic
standing as well as join VA as a full-time employee for three
years following their completion of the program. VA would be
required to disseminate information on the scholarship
program throughout educational institutions, with a special
emphasis on those with a high number of Hispanic students and
Historically Black Colleges and Universities.
H.R. 3949 contains the same provision (section 302).
The Compromise Agreement contains this provision.
Demonstration Projects on Alternatives for Expanding Care for
Veterans in Rural Areas (section 303)
The Senate bill contains a provision (section 305) that
would authorize VA to carry out demonstration projects to
expand care to veterans in rural areas through the
Department's Office of Rural Health. Projects could include
VA establishing a partnership with the Centers for Medicare
and Medicaid Services to coordinate care for veterans in
rural areas at critical access hospitals, developing a
partnership with the Department of Health and Human Services
to coordinate care for veterans in rural areas at community
health centers, and the expanding coordination with the
Indian Health Service to enhance care for Native American
veterans.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Program on Readjustment and Mental Health Care Services for
Veterans who Served in Operation Enduring Freedom and
Operation Iraqi Freedom (section 304)
The Senate bill contains a provision (section 306) that
would require VA to establish a program providing OEF and OIF
veterans with mental health services, readjustment counseling
and services, and peer outreach and support. The program
would also provide the immediate families of these veterans
with education, support, counseling, and mental health
services. In areas not adequately served by VA facilities, VA
would be authorized to contract with community mental health
centers and other qualified entities for the provision of
such services, as well as provide training to clinicians and
contract with a national non-profit mental health
organization to train veterans participating in the peer
outreach and support program. The provision would require an
initial implementation report within 45 days after enactment
of the legislation. Additionally, the Secretary would be
required to submit a status report within one year of
enactment of the legislation detailing the number of veterans
participating in the program as well as an evaluation of the
services being provided under the program.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision, but
does not include the reporting requirement and authorizes
rather than requires VA to contract with community mental
health centers and other qualified entities in areas not
adequately served by VA facilities.
Travel Reimbursement for Veterans Receiving Treatment at
Facilities of the Department of Veterans Affairs (section
305)
The Senate bill contains a provision (section 308) that
would authorize VA to increase the mileage reimbursement rate
under section 111 of title 38, United States Code, to 41.5
cents per mile, and, a year after the enactment of this
legislation, allow the Secretary to adjust the newly
specified mileage rate to be equal to the rate paid to
Government employees who use privately owned vehicles on
official business. If such an adjustment would result in a
lower mileage rate, the Secretary would be required to submit
to Congress a justification for the lowered rate. The
provision also would allow the Secretary to reimburse
veterans for the reasonable cost of airfare when that is the
only practical way to reach a VA facility.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
[[Page H2722]]
Pilot Program on Incentives for Physicians Who Assume
Inpatient Responsibilities at Community Hospitals in
Health Professional Shortage Areas (section 306)
The Senate bill contains a provision (section 313) that
would require VA to establish a pilot program under which VA
physicians caring for veterans admitted to community
hospitals would receive financial incentives, of an amount
deemed appropriate by the Secretary, if they maintain
inpatient privileges at community hospitals in health
professional shortage areas. Participation in the pilot
program would be voluntary. VA would be required to carry out
the pilot program for three years, in not less than five
community hospitals in each of not fewer than two VISNs. In
addition, VA would be authorized to collect third party
payments for care provided by VA physicians to nonveterans
while carrying out their responsibilities at the community
hospital where they are privileged.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Grants for Veterans Service Organizations for Transportation
of Highly Rural Veterans (section 307)
The Senate bill contains a provision (section 315) that
would require VA to establish a grant program to provide
innovative transportation options to veterans in highly rural
areas. Eligible grant recipients would include state veterans
service agencies and veterans service organizations, and
grant awards would not exceed $50,000.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Modifications of Eligibility for Participation in Pilot
Program of Enhanced Contract Care Authority for Health
Care Needs of Certain Veterans (section 308)
The Senate bill contains a provision (section 316) that
would clarify the definition of eligible veterans who are
covered under a pilot program of enhanced contract care
authority for rural veterans, created by section 403(b) of
the Veterans' Mental Health and Other Care Improvements Act
of 2008 (P.L. 110-387, 122 Stat. 4110). Eligible veterans
would be defined to include those living more than 60 minutes
driving distance from the nearest VA facility providing
primary care services, living more than 120 minutes driving
distance from the nearest VA facility providing acute
hospital care, and living more than 240 minutes driving
distance from the nearest VA facility providing tertiary
care.
H.R. 3219 contains the same provision (section 206).
The Compromise Agreement contains this provision.
Title IV--Mental Health Care Matters
Eligibility of Members of the Armed Forces Who Served in
Operation Enduring Freedom or Operation Iraqi Freedom for
Counseling and Services Through Readjustment Counseling
Services (section 401)
The Senate bill contains a provision (section 401) that
would allow any member of the Armed Forces, including members
of the National Guard or Reserve, who served in OEF or OIF to
be eligible for readjustment counseling services at VA
Readjustment Counseling Centers, also known as Vet Centers.
The provision of such services would be limited by the
availability of appropriations so that this new provision
would not adversely affect services provided to the veterans
that Vet Centers are currently serving.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Restoration of Authority of Readjustment Counseling Service
to Provide Referral and Other Assistance upon Request to
Former Members of the Armed Forces Not Authorized
Counseling (section 402)
The Senate bill contains a provision (section 402) that
would require VA to help former members of the Armed Forces
who have been discharged or released from active duty, but
who are not otherwise eligible for readjustment
counseling. VA would be authorized to help these
individuals by providing them with referrals to obtain
counseling and services from sources outside of VA, or by
advising such individuals of their right to apply for a
review of their release or discharge through the
appropriate military branch of service.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Study on Suicides among Veterans (section 403)
The Senate bill contains a provision (section 403) that
would require VA to conduct a study to determine the number
of veterans who committed suicide between January 1, 1999 and
the enactment of the legislation. To conduct this study, VA
would be required to coordinate with the Secretary of
Defense, veterans' service organizations, the Centers for
Disease Control and Prevention, and state public health
offices and veterans agencies.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Title V--Other Health Care Matters
Repeal of Certain Annual Reporting Requirements (section 501)
The Senate bill contains a provision (section 501) that
would eliminate the reporting requirements, set forth in
sections 7451 and 8107 of title 38, United States Code, on
pay adjustments for registered nurses. These reporting
requirements date to a time when VA facility directors had
the discretion to offer annual General Schedule (GS)
comparability increases to nurses. Current law requires VA to
provide GS comparability increases to nurses so that that pay
adjustment report is no longer necessary. The provision would
also eliminate the reporting requirement on VA's long-range
health care planning which included the operations and
construction plans for medical facilities. The information
contained in this report is already submitted in other
reports and plans, in particular the Department's annual
budget request.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Submittal Date of Annual Report on Gulf War Research (section
502)
The Senate bill contains a provision (section 502) that
would amend the due date of the Annual Gulf War Research
Report from March 1 to July 1 of each of the five years with
the first report due in 2010.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Payment for Care Furnished to CHAMPVA Beneficiaries (section
503)
The Senate bill contains a provision (section 503) that
would clarify that payments made by VA to providers who
provide medical care to a beneficiary covered under CHAMPVA
shall constitute payment in full, thereby removing any
liability on the part of the beneficiary.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Disclosure of Patient Treatment Information from Medical
Records of Patients Lacking Decision-making Capacity
(section 504)
The Senate bill contains a provision (section 504) that
would authorize VA health care practitioners to disclose
relevant portions of VA medical records to surrogate
decision-makers who are authorized to make decisions on
behalf of patients lacking decision-making capacity. The
provision would only allow such disclosures where the
information is clinically relevant to the decision that the
surrogate is being asked to make.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Enhancement of Quality Management (section 505)
The Senate bill contains a provision (section 506) that
would create a National Quality Management Officer to act as
the principal officer responsible for the Veteran Health
Administration's quality assurance program. The
provision would require each VISN and medical facility to
appoint a quality management officer, as well as require VA
to carry out a review of policies and procedures for
maintaining health care quality and patient safety.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Pilot Program on Use of Community-Based Organizations and
Local and State Government Entities To Ensure That
Veterans Receive Care and Benefits for Which They are
Eligible (section 506)
The Senate bill contains a provision (section 508) that
would require VA to create a pilot program to study the use
of community organizations and local and State government
entities in providing care and benefits to veterans. The
grantees would be selected for their ability to increase
outreach, enhance the coordination of community, local,
state, and Federal providers of health care, and expand the
availability of care and services to transitioning
servicemembers and their families. The two-year pilot program
would be required to be implemented in five locations and, in
making the site selections, the Secretary would be required
to give special consideration to rural areas, areas with high
proportions of minority groups, areas with high proportions
of individuals who have limited access to health care, and
areas that are not in close proximity to an active duty
military station.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision, but
would give VA 180 days to implement the pilot program.
Specialized Residential Care and Rehabilitation for Certain
Veterans (section 507)
The Senate bill contains a provision (section 509) that
would authorize VA to contract for specialized residential
care and rehabilitation services for certain veterans.
Eligible veterans would be those who served in OEF or OIF,
suffer from a traumatic brain injury (TBI), and possess an
accumulation of deficits in activities of daily living and
instrumental activities of daily living that would otherwise
require admission to a nursing home.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Expanded Study on the Health Impact of Project Shipboard
Hazard and Defense (section 508)
The Senate bill contains a provision (section 510) that
would require VA to contract with the Institute of Medicine
(IOM) to study the health impact of veterans' participation
in Project Shipboard Hazard and Defense (SHAD). The study
would be intended
[[Page H2723]]
to cover, to the extent practicable, all veterans who
participated in Project SHAD and may utilize results from the
study included in IOM's report on ``Long-Term Health Effects
of Participation in Project SHAD.''
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Use of Non-Department Facilities for Rehabilitation of
Individuals with Traumatic Brain Injury (section 509)
The Senate bill contains a provision (section 511) that
would clarify when non-VA facilities may be utilized to
provide treatment and rehabilitative services for veterans
and members of the Armed Forces with TBI. Specifically, the
provision would allow non-VA facilities to be used when VA
cannot provide treatment or services at the frequency or
duration required by the individual plan of the veteran or
servicemember with TBI. The provision also would allow the
use of non-VA facilities if VA determines that it is optimal
for the recovery and rehabilitation of the veteran or
servicemember. Such non-VA facility would be required to
maintain standards that have been established by an
independent, peer-reviewed organization that accredits
specialized rehabilitation programs for adults with TBI.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Pilot Program on Provision of Dental Insurance Plans to
Veterans and Survivors and Dependents of Veterans
(section 510)
The Senate bill contains a provision (section 513) that
would require VA to carry out a three-year pilot program to
provide specified dental services through a contract with a
dental insurer. Additionally, the provision would provide
that the pilot program should take place in at least two but
no more than four VISNs and that enrollment would be
voluntary. The program would provide diagnostic services,
preventive services, endodontic and other restorative
services, surgical services, emergency services, and such
other services as VA considers appropriate.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision,
modified to provide that the pilot program may take place in
any number of VISNs the Secretary deems appropriate. The
purpose of providing the Secretary with this authority is to
ensure the capability, should it be required, to maximize the
number of voluntary enrollees insured under the dental
program so as to reduce premium expenditures.
Prohibition on Collection of Copayments from Veterans who are
Catastrophically Disabled (section 511)
The Senate bill contains a provision (section 515) that
would add a new section 1730A in title 38, United States
Code, to prohibit VA from collecting copayments from
catastrophically disabled veterans for medical services
rendered, including prescription drug and nursing home care
copayments.
H.R. 3219 contains the same provision (section 203).
The Compromise Agreement contains this provision.
Higher Priority Status for Certain Veterans who are Medal of
Honor Recipients (section 512)
H.R. 3519 contains a provision (section 201) that would
amend section 1705 of title 38, United States Code, to place
Medal of Honor recipients in priority group 3 for the
purposes of receiving health care through VA. This would
situate Medal of Honor recipients in a priority group with
former prisoners of war and Purple Heart recipients.
The Senate bill contains no comparable provision.
The Compromise Agreement contains the House provision.
Hospital Care, Medical Services, and Nursing Home Care for
Certain Vietnam-Era Veterans Exposed to Herbicide and
Veterans of the Persian Gulf War (section 513)
H.R. 3219 contains a provision (section 202) that would
amend section 1710 of title 38, United States Code, to
provide permanent authorization for the special treatment
authority of Vietnam-era veterans exposed to an herbicide and
Gulf-War era veterans who have insufficient medical evidence
to establish a service-connected disability.
The Senate bill contains no comparable provision.
The Compromise Agreement contains the House provision.
Establishment of Director of Physician Assistant Services in
Veterans Health Administration (section 514)
H.R. 3219 contains a provision (section 204) that would
create the position of Director of Physician Assistant
Services in VA central office who would report directly to
the Under Secretary for Health on all matters related to
education, training, employment, and proper utilization of
physician assistants.
The Senate bill contains no comparable provision.
The Compromise Agreement contains the House provision,
modified to require the Director of Physician Assistant
Services to report directly to the Chief of the Office of
Patient Services instead of to the Under Secretary for
Health.
Committee on Care of Veterans with Traumatic Brain Injury
(section 515)
H.R. 3219 contains a provision (section 205) that would
require VA to establish a Committee on Care of Veterans with
Traumatic Brain Injury. This Committee would be required to
evaluate VA's capacity to meet the treatment and
rehabilitative needs of veterans with TBI, as well as make
recommendations and advise the Under Secretary for Health on
matters relating to this condition. Additionally, VA would be
required to submit to the Committees on Veterans' Affairs of
the Senate and the House of Representatives an annual report
on the Committee's findings and recommendations and the
Department's response.
The Senate bill contains no comparable provision.
The Compromise Agreement contains the House provision.
Increase in Amount Available to Disabled Veterans for
Improvements and Structural Alterations Furnished as Part
of Home Health Services (section 516)
H.R. 1293 contains a provision that would increase, from
$4,100 to $6,800, the amount authorized to be paid to
veterans who have service-connected disabilities rated 50
percent or more disabling for home improvements and
structural alterations. The provision would also increase
from $1,200 to $2,000, the amount authorized to be paid to
veterans with service-connected disabilities rated less than
50 percent disabling.
The Senate bill contains no comparable provision.
The Compromise Agreement contains the House provision.
Extension of Statutorily Defined Copayments for Certain
Veterans for Hospital Care and Nursing Home Care (section
517)
Under current law, VA has the authority to provide hospital
and nursing home care on a space available basis to veterans
who do not otherwise qualify for such care. VA is authorized
to collect from such a veteran an amount equal to $10 for
every day that a veteran receives hospital care, and $5 for
every day a veteran receives nursing home care. This
authority expires on September 30, 2010.
Neither the House nor Senate bills contain a provision to
extend this authority.
The Compromise Agreement contains a provision which would
extend the statutorily defined copayments for certain
veterans for hospital care and nursing home care to September
30, 2012.
Extension of Authority to Recover Cost of Certain Care and
Services from Disabled Veterans with Health-Plan
Contracts (section 518)
Under current law, VA is authorized to recover the costs
associated with medical care provided to a veteran for a non-
service-connected disability if, among other eligibility
criteria, the veteran receives such care before October 1,
2010, the veteran has a service-connected disability, and the
veteran is entitled to benefits for health care under a
health-plan contract.
Neither the House nor Senate bills contain a provision to
extend this authority.
The Compromise Agreement contains a provision which would
extend the authority to recover the cost of such care and
services from disabled veterans with health-plan contracts to
October 1, 2012.
Title VI--Department Personnel Matters
Enhancement of Authorities for Retention of Medical
Professionals (section 601)
The Senate bill contains provisions (section 601) intended
to improve VA's ability to recruit and retain health
professionals. First, VA would be given the authority to
apply the title 38 hybrid employment system to additional
health care occupations to meet the recruitment and retention
needs of VA. Next, the probationary period for full-time and
part-time registered nurses would be set at two years; part-
time registered nurses who served previously on a full-time
basis would not be subject to a probationary period. In
addition, VA would be authorized to waive the salary offset
where the salary of an employee rehired after retirement from
the Veterans Health Administration is reduced according to
the amount of their annuity under a federal government
retirement system.
Section 601 also would provide for a number of new or
expanded pay authorities, including setting the pay for all
senior executives in the Office of the Under Secretary for
Health at Level II or Level III of the Executive Schedule;
authorizing recruitment and retention special incentive pay
for pharmacist executives of up to $40,000; amending the pay
provisions of physicians and dentists by clarifying the
determination of the non-foreign cost of living adjustment,
exempting physicians and dentists in executive leadership
positions from compensation panels, and allowing for a
reduction in market pay for changes in board certification or
a reduction of privileges; modifying the pay cap for
registered nurses and other covered positions to Level IV of
the Executive Schedule; allowing the pay for certified
registered nurse anesthetists to exceed the pay caps for
registered nurses; increasing the limitation on special pay
for nurse executives from $25,000 to $100,000; adding
licensed practical nurses, licensed vocational nurses, and
nursing positions covered by title 5 to the list of
occupations that are exempt from the limitations on increases
in rates of basic pay; and expanding the eligibility for
additional premium pay to part-time nurses. Finally, section
601 would improve VA's locality pay system by requiring VA to
provide education, training, and support to the directors of
VA health care facilities on the use of locality pay system
surveys.
H.R. 919 contains a comparable provision (section 2) which
would not, in contrast to
[[Page H2724]]
the Senate bill, restrict VA from applying hybrid title 38
status to positions that are administrative, clerical or
physical plant maintenance and protective services, would
otherwise be included under the authority of section 5332 of
title 5, United States Code; do not provide direct patient
care services, or would otherwise be available to provide
medical care and treatment for veterans. The House provision
also would not place restrictions on the categories of part-
time nurses for whom the probationary period would be waived.
The House section contains an additional provision which
would provide comparability pay up to $100,000 per year to
all individuals appointed by the Under Secretary for Health
under the authority of section 7306 of title 38, United
States Code, who are not physicians or dentists and who would
be compensated at a higher rate in the private sector.
The Compromise Agreement contains the Senate provision,
modified to eliminate the provision of the Senate bill that
would provide VA with the authority to waive salary offsets
for retirees who are reemployed in the Veterans Health
Administration.
Limitations on Overtime Duty, Weekend Duty, and Alternative
Work Schedules for Nurses (section 602)
The Senate bill contains a provision (section 602) that
would prohibit VA from requiring nurses to work more than 40
hours in an administrative work week or more than 8 hours
consecutively, except under unanticipated emergency
conditions in which the nurses' skills are necessary and good
faith efforts to find voluntary replacements have failed. The
provision also would strike subsection 7456(c) of title 38,
United States Code, which provides that nurses on approved
sick or annual leave during a 12-hour work shift shall be
charged at a rate of five hours of leave per three hours of
absence. Finally, for recruitment and retention purposes, VA
would be authorized to consider a nurse who has worked 6
regularly scheduled 12-hour work shifts within a 14-day
period to have worked a full eighty-hour pay period.
H.R. 919 contains the same provision (section 3).
The Compromise Agreement contains this provision.
Reauthorization of Health Professionals Educational
Assistance Scholarship Program (section 603)
H.R. 919 contains a provision (section 4) that would
reinstate the Health Professionals Educational Assistance
Scholarship Program. Section 2 of H.R. 4166 contains a
similar provision which would also direct VA to fully employ
program graduates as soon as possible following their
graduation, require graduates to perform clinical rotations
in assignments or locations determined by VA, and assign a
mentor to graduates in the same facility in which they are
serving.
The Senate bill contains a similar provision but did not
include the requirement to fully employ graduates as soon as
possible.
The Compromise Agreement contains the provision from
section 2 of H.R. 4166.
Loan Repayment Program for Clinical Researchers from
Disadvantaged Backgrounds (section 604)
H.R. 919 (section 4) and H.R. 4166 (section 4) contain
identical provisions that would allow VA to utilize the
authorities available in the Public Health Service Act for
the repayment of the principal and interest of educational
loans of health professionals from disadvantaged
backgrounds in order to employ such professionals in the
Veterans Health Administration to conduct clinical
research.
The Senate bill contains the same provision (section 603).
The Compromise Agreement contains this provision.
Title VII--Homeless Veterans Matters
Per Diem Grant Payments (section 701)
H.R. 3796 contains a provision that would authorize VA to
make per diem payments to organizations assisting homeless
veterans in an amount equal to the greater of the daily cost
of care or $60 per bed, per day. The provision would also
require VA to ensure that 25 percent of the funds available
for per diem payments are distributed to organizations that
meet some but not all of the criteria for the receipt of per
diem payments. These would include (in order of priority)
organizations that meet each of the transitional and
supportive services criteria and serve a population that is
less than 75 percent veterans; organizations that meet at
least one but not all of the transitional and supportive
services criteria, but have a population that is at least 75
percent veterans; or organizations that meet at least one but
not all of the transitional and supportive services criteria
and serve a population that is less than 75 percent veterans.
The Senate bill contains no comparable provision.
The Compromise Agreement contains the House provision, but
does not require the minimum amount of $60 per bed, per day
for the Grant and Per Diem program. In addition, VA would be
authorized but not required to award the per diem grants to
non-profit organizations meeting some but not all of the
criteria for the receipt of such payments.
Title VIII--Nonprofit Research and Education Corporations
General Authorities on Establishment of Corporations (section
801)
H.R. 2770 contains a provision (section 2) that would
authorize Nonprofit Research and Education Corporations
(NPCs) to merge, thereby creating multi-medical center
research corporations.
The Senate bill contains the same provision (section 801).
The Compromise Agreement contains this provision.
Clarification of Purposes of Corporations (section 802)
H.R. 2770 contains a provision (section 3) that would
clarify the purpose of NPCs to include specific reference to
their role as funding mechanisms for approved research and
education, in addition to their role in facilitating research
and education.
The Senate bill contains the same provision (section 802).
The Compromise Agreement contains this provision.
Modification of Requirements for Boards of Directors of
Corporations (section 803)
The Senate bill contains a provision (section 803) that
would require that a minimum of two members of the Board of
Directors of an NPC be other-than-federal employees.
Additionally, the provision would allow for the appointment
of individuals with expertise in legal, financial, or
business matters. The provision also would conform the law
relating to NPCs to other federal conflict of interest
regulations by removing the requirement that members of the
NPC boards have no financial relationship with any entity
that is a source of funding for research or education by VA.
H.R. 2770 contains a comparable provision (section 4), but
provides that the executive director of the corporation may
be a VA employee.
The Compromise Agreement contains the House provision, with
a modification which removes the provision allowing VA
employees to serve as executive directors.
Clarification of Powers of Corporations (section 804)
H.R. 2770 contains a provision (section 5) that would
clarify the NPCs' authority to accept, administer, and
transfer funds for various purposes. NPCs would be allowed to
enter into contracts and set fees for the education and
training facilitated through the corporation.
The Senate bill contains the same provision (section 804).
The Compromise Agreement contains this provision.
Redesignation of Section 7364A of Title 38, United States
Code (section 805)
H.R. 2770 contains a provision (section 6) that would
provide clerical amendments associated with implementing this
legislation concerning Nonprofit Research and Education
Corporations.
The Senate bill contains the same provision (section 805).
The Compromise Agreement contains this provision.
Improved Accountability and Oversight of Corporations
(section 806)
The Senate bill contains a provision (section 806) that
would strengthen VA's oversight of NPCs by requiring those
NPCs with revenues of over $10,000 to obtain an independent
audit once every three years, or with revenues of over
$300,000 to obtain such an audit each year, and to submit
certain Internal Revenue Service forms.
H.R. 2770 contains a comparable provision (section 7), but
would instead raise to $100,000 the threshold for requiring
three-year audits and to $500,000 the revenue threshold that
would require yearly audits. The provision also would revise
conflict of interest policies to apply to the policies
adopted by the corporation.
The Compromise Agreement contains the House provision.
Title IX--Construction and Naming Matters
Authorization of Medical Facility Projects (section 901)
The Senate bill contains a provision (section 901) that
would authorize funds for the following major medical
facility projects in FY 2010: Livermore, California; Walla
Walla, Washington; Louisville, Kentucky; Dallas, Texas; St.
Louis, Missouri; Denver, Colorado and Bay Pines, Florida.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision, but
strikes the authorization for the construction project in
Walla Walla, Washington, since authorization for this
construction project was provided in Public Law 111-98,
enacted on November 11, 2009.
Designation of Merril Lundman Department of Veterans Affairs
Outpatient Clinic, Havre, Montana (section 902)
The Senate bill contains a provision (section 903) that
would name VA outpatient clinic in Havre, Montana, as the
``Merril Lundman Department of Veterans Affairs Outpatient
Clinic.''
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Designation of William C. Tallent Department of Veterans
Affairs Outpatient Clinic, Knoxville, Tennessee (section
903)
In the House, H.R. 402 contains a provision that would name
the VA outpatient clinic in Knoxville, Tennessee as the
``William C. Tallent Department of Veterans Affairs
Outpatient Clinic.''
The Senate bill contains no comparable provision.
The Compromise Agreement contains the House provision.
[[Page H2725]]
Designation of Max J. Beilke Department of Veterans Affairs
Outpatient Clinic, Alexandria, Minnesota (section 904)
In the House, H.R. 3157 contains a provision that would
name the VA outpatient clinic in Alexandria, Minnesota as the
``Max J. Beilke Department of Veterans Affairs Outpatient
Clinic.''
The Senate bill contains no comparable provision.
The Compromise Agreement contains the House provision.
Title X--Other Matters
Expansion of Authority for Department of Veterans Affairs
Police Officers (section 1001)
The Senate bill contains a provision (section 1001) that
would provide additional authorities to VA uniformed police
officers, including the authority to carry a VA-issued weapon
in an official capacity when off VA property and in official
travel status, the authority to conduct investigations on and
off VA property of offenses that may have been committed on
VA property, expanded authority to enforce local and State
traffic regulations when such authority has been granted by
local or State law, and to make arrests based upon an arrest
warrant issued by any competent judicial authority.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Uniform Allowance for Department of Veterans Affairs Police
Officers (section 1002)
The Senate bill contains a provision (section 1002) that
would modify VA's authority to pay an allowance to VA police
officers for purchasing uniforms. The provision would provide
a uniform allowance in an amount which is the lesser of the
amount prescribed by the Office of Personnel Management or
the actual or estimated cost as determined by periodic
surveys conducted by VA.
There was no comparable House provision.
The Compromise Agreement contains the Senate provision.
Submission of Reports to Congress by Secretary of Veterans
Affairs in Electronic Form (section 1003)
Under current law, there is no requirement for VA to submit
Congressionally mandated reports in an electronic form.
Neither the House nor Senate bills contained a provision to
change this procedure.
The Compromise Agreement contains a provision which would
create a new section 118 in title 38, United States Code,
which would require VA to submit reports to Congress, or any
Committee thereof, in electronic format. Reports would be
defined to include any certification, notification, or other
communication in writing.
Determination of Budgetary Effects for Purposes of Compliance
with Statutory Pay-As-You-Go-Act of 2010 (section 1004)
Neither the Senate nor House bills contain a provision
relating to compliance with the Statutory Pay-As-You-Go-Act
of 2010, Title I of P.L. 111-139, 124 Stat. 8.
The Compromise Agreement contains a procedural provision to
require the determination of the budgetary effects of
provisions contained in the Compromise Agreement to be based
upon the statement entered into the Congressional Record by
the Chairman of the Committee on the Budget of the House of
Representatives.
Mr. BUYER. I yield myself such time as I may consume.
I rise in support of S. 1963, as amended, the Caregivers and Veterans
Omnibus Health Services Act of 2010.
This bill represents a bipartisan effort on behalf of the House and
Senate, and I express my thanks to Chairman Filner, Chairman Akaka, and
Ranking Member Burr for their leadership. I'd also like to thank
Chairman Michaud and Ranking Member Brown of the Subcommittee on Health
for their efforts in bringing this legislation forward.
Reflecting the spirit of compromise and cooperation, S. 1963 is
composed of a number of bills from both sides of the aisle. It would
provide increased access to care, better outreach and support for
wounded veterans, rural veterans, and homeless veterans, and also
includes enhancements and provisions of mental health care and
readjustment counseling for recent veterans of Iraq and Afghanistan.
I would like to thank my good friend and colleague from Kansas, Jerry
Moran, for his bill, H.R. 3103, that was included to help VA move
forward with a pilot program to enhance contract care authority for
highly rural veterans. This pilot, which was enacted in the last
Congress, was Mr. Moran's initiative.
I'd also like to thank my friend John Duncan from Tennessee for
introducing his bill, H.R. 402, which is included in this legislation.
H.R. 402 would name the Veterans Affairs Outpatient Clinic in
Knoxville, Tennessee, the William C. Tallent Veterans Outpatient
Clinic. This gentleman honorably served in World War II and maintained
a lifelong service to veterans.
S. 1963 would also establish a new, all-encompassing system of
support for family caregivers. As we all know, some veterans of Iraq
and Afghanistan have been severely wounded and will require a great
deal of care for the rest of their lives. In previous wars, these
veterans would probably not have survived their wounds, but significant
improvements in battlefield medicine, the medicine logistics chain and
the follow-up treatment have improved the survival rates for the most
severely wounded combatants.
Family caregivers are more often than not at the core of what
sustains the treatment and recovery of a severely wounded or injured
soldier. Their commitment is strong and heartfelt; yet, it can be
enormously challenging in a long recovery. There are many struggles
that families face when assuming this role, including job absences,
lost income, travel and relocation costs, child care concerns,
exhaustion, and emotional and psychological stress. Many,
understandably, become overwhelmed and eventually experience burnout.
So there is a real problem, and the question is how to best address it.
I am concerned, however, about a provision in this bill that would
establish an unprecedented stipend for certain family caregivers. I
would have preferred to build upon and expand an existing successful
Department of Veterans Affairs VA program known as Aid and Attendance.
The Aid and Attendance program is paid directly to veterans so they can
obtain the needed service in their own homes. The extent and types of
services could be expanded, and last summer I proposed to do so in H.R.
3407, the Severely Injured Veterans' Benefits Act of 2009. It would
provide a 50 percent increase in compensation for catastrophically
injured veterans who are in need of assistance for daily personal
needs, such as bathing and eating. It gives the veteran the choice of
how to obtain services tailored to their unique needs and
circumstances.
It is unclear how the caregiver stipend program in this bill will
operate and how it will work in conjunction with the present Aid and
Attendance or whether it replaces some of the current services.
Additionally, Mr. Speaker, we lack a Congressional Budget Office
estimate of this compromised agreement. It appears that the Democrat
majority has not been obtaining CBO cost estimates for discretionary
bills, and we still don't have the official views of the administration
on the compromised legislation. I am aware of their concerns. I
requested the administration to address them in writing on March 18,
2010, and they were due on April 7. Although we have not yet read them,
it is my understanding they are still in the concurrence process.
Based on legislative hearing testimony from last year, I believe the
VA has concerns about the caregiver stipend as well as some of the
other personnel provisions included in the bill. Dr. Cross, who is the
principal deputy undersecretary for health, testified before the Senate
Veterans Affairs Committee. This is in reference to the caregiver
provisions. He stated, The VA does not support section 209. Currently
we are able to contract for caregiver services with home health and
similar public and private agencies. The contractor trains and pays
them and affords them liability protection and oversees the quality of
care. This remains the preferable arrangement as it does not divert VA
from its primary mission of treating veterans and training clinicians.
Moreover, it does not put VA in the position of having to tell family
members how, at risk of losing their caregiver compensation, they have
to care for their loved ones.
Mr. Speaker, it is unfortunate that the administration's concern
regarding the caregiver stipend provision in this bill was not worked
out because the bill, as a whole, does many good things for veterans. I
hope this issue gets resolved with the administration, and I am pleased
that legislation that I had sponsored, H.R. 1293, the Disabled Veterans
Home Improvement and Structural Alteration Grant Increase Act of 2009,
is in this bill. This would increase the amount VA is authorized to pay
under its home health services to make modifications to a veteran's
home to enable the veteran to be cared for in their home rather than in
a hospital or institutional setting.
[[Page H2726]]
We should always be reminded that while veterans may spend only a
short time in uniform, the wounds they carry home with them can last a
lifetime and profoundly impact their daily lives.
I reserve my time.
Mr. FILNER. Mr. Speaker, the chairman of our Health Subcommittee, Mr.
Michaud, and ranking member, Mr. Brown of South Carolina, were the
chief hard workers on this bill. We thank them all.
I yield 3\1/2\ minutes to Chairman Michaud.
{time} 1045
Mr. MICHAUD. Thank you very much, Mr. Speaker, and thank you, Mr.
Chairman. I also want to thank Ranking Member Buyer for all his hard
work on this bill before us today, as well as my colleague, Mr. Brown,
for working in a bipartisan manner throughout the years on veterans
affairs issues.
I rise today in strong support on S. 1963, the Caregivers and
Veterans Omnibus Health Services Act. This landmark bill reflects a
strong commitment to family caregivers, who are often underappreciated
in their efforts to care for our wounded servicemembers. We must
recognize that family caregivers in Maine and throughout our country
often put their lives on hold to care for our injured veterans, and
their duties take a heavy toll on them financially, emotionally, and
physically.
Our brave men and women who serve our country have come to rely on
our spouses, parents, siblings, and close friends to be there with
them. We owe it to these devoted caregivers to offer them the support
they need.
That's why this bill creates a robust, supportive services program
for caregivers. This includes counseling services and respite care to
help relieve the heavy emotional and physical stress of caregivers.
The bill also attempts to alleviate the financial difficulties facing
eligible caregivers by providing a monthly financial stipend, as well
as access to health care through the CHAMPVA program. The bill also
recognizes the importance of caregivers being by veterans' sides during
every step of their medical treatment. The bill authorizes the VA to
pay lodging and other costs incurred by caregivers for accompanying
veterans during medical appointments.
In addition to addressing the needs of caregivers, this bill helps
the VA deliver high quality health care for our rural veterans. The
bill improves the VA ability to recruit and retain qualified medical
personnel. It addresses the barriers of long trips to medical
appointments by providing reimbursement for air travel.
The bill also creates a more robust health care infrastructure in our
rural areas. It does this by supporting collaboration with other
Federal providers and fostering the VA's ability to contract with
community providers.
I urge my colleagues to support this critical bill that supports
caregivers and expands health care for our rural veterans.
Mr. BUYER. I reserve the balance of my time.
Mr. FILNER. Mr. Speaker, before I yield to our Speaker, I just want
to say with gratitude, on the part of our Nation's veterans, in her
3\1/2\ years as Speaker and her years before that as minority leader,
Ms. Pelosi focused like a laser on the needs of our veterans. We would
not be here with this landmark bill were it not for our Speaker.
I yield 1 minute to the Speaker of the House, the gentlewoman from
California (Ms. Pelosi).
Ms. PELOSI. I thank the gentleman for yielding, I thank him for his
leadership, and I am very pleased today that we have bipartisan support
for this important legislation to benefit our veterans.
I, too, join my colleagues in rising to honor the sacrifice and
service of the bravest among us, the men and women of our Armed Forces.
In the name of our safety, they lay their lives on the line. In the
name of our security, they fight our enemies far from home. In the name
of our values, they serve as our Nation's greatest ambassadors, as
champions of America's families.
Each and every day our soldiers, sailors, airmen and marines earn the
respect of a grateful Nation. And as long as those in uniform continue
the battle abroad, we must do everything in our power to support them
here at home.
I would like to thank all Members of Congress on both sides of the
aisle who worked so hard to strengthen this bill and bring it to the
floor today. Again, I want to commend Bob Filner, the chairman of the
Committee on Veterans' Affairs, Chairman Mike Michaud of the Health
Subcommittee of the Committee on Veterans' Affairs, and Chairwoman
Stephanie Herseth Sandlin of the Economic Opportunity Subcommittee of
the Committee on Veterans' Affairs.
I also want to recognize the hard work and commitment to those who
have worn our Nation's uniform by three key freshmen Members of
Congress, Congressman Tom Perriello, Congresswoman Debbie Halvorson,
and Congressman Harry Teague.
In both Houses, this has been a bipartisan effort, and I commend
Ranking Member Buyer for his leadership. I know that everything is not
in this bill. There is an endless list of everything we want to do for
our veterans, but we are very proud of Senator Burr and the role that
he has played in the Senate and all of the Members here. Thank you, Mr.
Buyer.
The Caregivers and Veterans Omnibus Health Services Act is a landmark
moment in the ongoing effort to give back to our veterans and their
families. It's a tribute to their service. In the words of the
Paralyzed Veterans of America, it will ``provide valuable benefit for
veterans and their families, benefits they need, have earned and so
richly deserve.''
This legislation will support family members and others who care for
the disabled, ill or injured veterans. This is very important to
families, military families. Our wounded soldiers and their families
have made a serious sacrifice for our country, and this bill will bring
them some relief. It will expand mental health services and health care
access for veterans in rural areas and prohibit copays for our most
severely wounded warriors.
Thank you, Chairwoman Herseth Sandlin, as this bill marks a step
forward for the 1.8 million women in uniform, removing existing
barriers to female veterans seeking medical care. In a sweeping change
long overdue and with strong bipartisan support, we will provide care
for newborns in the first time in history. Thank you, Congressman Henry
Brown, for your leadership as well, my friend.
Today's vote is one in a series of actions taken by this Congress to
give back to America's veterans. Our signature achievement remains our
new GI Bill, providing those who serve with a full, 4-year college
education. This is also transferable to a family member, and also a new
improvement that we made was if a serviceman or woman dies in combat,
that this opportunity is provided for their children or another family
member.
Late last year, again in a bipartisan way, we celebrated the passage
of the Veterans Health Care Budget Reform and Transparency Act,
ensuring that the VA has timely and predictable funding and our
veterans receive the high quality care they have earned. Working to
make sure that our economic recovery truly benefits all Americans, the
American Recovery and Reinvestment Act offered a tax credit for hiring
veterans and a $250 payment to disabled veterans.
Just this past month we passed the TRICARE Affirmation Act, stating
explicitly that our health care reform legislation will not impact the
excellent health coverage our veterans and servicemembers already
receive. In the last 3 years, we have given our troops a pay raise,
helped restore military readiness and bolstered support for our
military families. Today we strengthen the benefits our men and women
in uniform receive.
Mr. Speaker, in the course of our meetings with the veterans service
organizations and with the families of our men and women in uniform and
our veterans, we hear directly from them what their needs are and try
to establish their priorities and to make it a priority in allocating
the resources of our country. In the course of those conversations, we
have heard from the families that in the survey they took of their own
membership of Blue Star Families, that 94 percent of them thought that
most Americans did not have a clear understanding of their needs.
[[Page H2727]]
We promised them that in all we do here we will remove doubt in
anyone's mind among our military families that we understand their
needs, especially if they present them in a prioritized way and will
make them our priority in the Congress. In every action we strive to
live up to that commitment.
Just as the military on the battlefield has said, on the battlefield
we will leave no soldier behind. So too when they come home, we will
leave no veteran behind.
As the leaders of the American Legion have stated, this legislation
offers bold solutions to major challenges facing servicemembers,
veterans and their families on behalf of every American who wears the
uniform.
I urge my colleagues to vote ``yes'' on this bill.
Mr. BUYER. Mr. Speaker, I yield myself such time as I may consume.
I would like to thank the Speaker for her kind remarks and her
support of the bill. Also, I ask for your support, we have a problem we
have to get worked out, and that deals with the widows, orphans, and
the Spina Bifida Program was left out of the health care bill that we
recently passed to ensure that it's defined as minimum essential
benefit.
Madam Speaker, I hope for your support for this. The issue has been
addressed in the Senate. The Senate passed it, the bill is at the desk,
but it has to originate in the House, so I ask for your support on
this.
Ms. PELOSI. Thank you, Mr. Buyer. The chairman has this legislation,
as you may be aware, and it is going to Ways and Means and we will be
taking it up soon, but we will look forward to working with you and
will bring it together in a bipartisan way in the spirit that we owe
our veterans. They are all Americans and so are we.
Mr. BUYER. Thank you, I appreciate that.
Ms. PELOSI. Thank you, Mr. Buyer, and thank you, Mr. Brown, for your
leadership as well.
Mr. BUYER. I now yield 3 minutes to the gentleman from South Carolina
(Mr. Brown).
Mr. BROWN of South Carolina. I thank the gentleman from Indiana for
yielding me this time.
I rise today to express my strong support for S. 1963, the Caregivers
and Veterans Omnibus Health Services Act of 2009. Chairman Filner and
Chairman Michaud, along with Ranking Member Buyer and I have brought
this legislation forward in order to continue the great progress made
by the VA toward providing the kind of health care veterans deserve,
and I am proud to support it today.
I think it's pretty evident, as the Speaker alluded to earlier, that
in the Committee on Veterans' Affairs, which I have had the privilege
to serve now 10 years, we always leave our bipartisanship at the door
when we enter that committee, and I am grateful that Mr. Filner also
continued in that same spirit when he became the chairman.
At a time when our soldiers are overseas keeping us safe here at
home, the VA is faced with a number of unique challenges. It must
respond to the signature wounds of the wars in Iraq and Afghanistan, to
soldiers returning home who live far from VA facilities, to the ever-
increasing number of women veterans, and to the families of veterans
who cannot care for themselves, but it must also remain responsive to
those whom it already serves. I believe this bill would accomplish
this.
When soldiers return home from war, unable to care for themselves,
their families often face difficult burdens. To help them help the
veterans, this bill would establish a comprehensive assistance program
for caregivers, making caregivers eligible to receive education and
training and technical support, counseling, lodging and subsistence.
To serve the rural veterans, who may live a long distance from VA
facilities, this bill would make the VA more flexible while increasing
reach-out efforts. The VA would be allowed to partner with Medicare,
Medicaid, the Department of Health and Human Services and the Indian
Health Service in demonstration projects that could expand care.
Finally, two of the most common wounds of war in Iraq and Afghanistan
have been post-traumatic stress disorder and traumatic brain injury. By
expanding eligibility for readjustment counseling at Vet Centers to any
members of the Armed Forces who have served in OIF/OEF and establishing
the Committee on Care for Veterans with TBI, the VA will become more
responsive to those who are transitioning back to civilian life.
In closing, I want to thank Chairman Filner and Ranking Member Buyer
of the Veterans' Affairs Committee, and Chairman Michaud of the Health
Subcommittee, for their leadership in bringing this bill forward.
I urge my colleagues to stand up for America's true heroes and help
continue to make the VA world class care even better.
Mr. FILNER. Mr. Speaker, I yield 2 minutes to Ms. Herseth Sandlin of
South Dakota, the chair of our Economic Opportunity Subcommittee and
the prime mover behind the section of this bill dealing with our women
veterans.
Ms. HERSETH SANDLIN. I thank the gentleman from California for
yielding.
I rise today in strong support of S. 1963, the Caregivers and
Veterans Omnibus Health Services Act of 2010. I want to thank our full
committee chairman, Mr. Filner; our ranking member, Mr. Buyer; and
Health Subcommittee Chairman Michaud and Ranking Member Brown for their
leadership, for their strong support of this legislation, which
contains many important provisions related to caregiver support and
rural health care for veterans. It also includes legislation I
introduced, the Women Veterans Health Care Improvement Act.
This act will provide significant enhancements to the health care
available for women veterans. Today women make up approximately 8
percent of veterans in the United States, and that percentage will
continue to rise as more and more women answer the call to serve their
country. With an increasing number of women seeking access to care
within the VA, the challenge of providing adequate health care services
for women veterans is one the VA must master, and I am confident that
it can.
{time} 1100
This legislation addresses this challenge by taking several important
steps to ensure adequate attention is given to women veterans and their
health care programs so that women can access the quality primary
health care and the specialized services they deserve and have earned.
Among its provisions, this bill improves the VA's sexual trauma and
post-traumatic stress disorder programs for women by requiring the
Secretary of the VA to ensure that all mental health professionals have
been properly and consistently trained in the best methods and
practices so women veterans feel secure in seeking treatment.
Childcare is another crucial issue for women veterans--and for male
veterans as well--and the bill before us today tackles current barriers
to care by authorizing a childcare pilot program and requiring the VA
to carry out this program in at least three veteran service networks.
We anticipate that this is going to help veterans keep their
appointments.
The legislation also requires the VA to provide 7 days of medical
care for newborn children of women veterans, representing an important
policy update in the VA. Currently, the VA has no provision to provide
care for these infants, yet 86 percent of Operation Enduring Freedom
and Operation Iraqi Freedom women veterans are under the age of 40.
Accordingly, I urge all of my colleagues on both sides of the aisle
to support this important legislation.
Mr. BUYER. Mr. Speaker, at this time, I yield 2 minutes to Ms. Ginny
Brown-Waite of Florida.
Ms. GINNY BROWN-WAITE of Florida. I thank the gentleman.
Mr. Speaker, I rise today in support of S. 1963, the Caregivers and
Veterans Omnibus Health Services Act of 2009.
As Members of Congress, we do have a responsibility to provide the
best support we can to our Nation's veterans. With provisions for
caregiver support, rural health improvement and mental health benefits,
there are many reasons why I support this legislation. I could speak at
length about these important and necessary benefits. However, in the
interest of time, I would like to highlight just one: health care for
women veterans.
[[Page H2728]]
While more and more women are joining the military, the VA's health
care services for women veterans have not kept pace. Although
approximately 14 percent of our troops are female, as a female veteran
recently said in an interview with Good Housekeeping magazine, it is as
if women are ``Martians, abnormalities descending on the VA health
system.'' In fact, of the country's 153 VA medical centers, only about
half even have a gynecologist on staff. This is despite the fact that
between 23 and 29 percent of all female veterans seeking medical care
through the VA have reported experiencing sexual assault. Is it any
surprise, then, that the number of female veterans being treated for
post-traumatic stress disorder rose from 1 to 19 percent in only 4
years?
For this reason, my colleague, Representative Herseth Sandlin, and I
introduced H.R. 1211, the Women Veterans Health Care Improvement Act.
Although the Senate has not acted on our legislation, I am happy to see
some of the key provisions, like studying the barriers preventing women
veterans from receiving VA health care and developing a plan to improve
that care for women veterans both immediately and in the long term,
that actually made it into this bill.
Mr. FILNER. Mr. Speaker, the freshman members of our committee have
added a new level of commitment and enthusiasm and have played a major
part in this bill. I would like to yield 1\1/2\ minutes to one of those
great freshmen, Mrs. Halvorson of Illinois.
Mrs. HALVORSON. Mr. Speaker, I rise today for those veterans who
can't. I rise today for the catastrophically injured veterans who have
to battle their injuries and their rising health care costs. I rise
today for those caregivers who dedicate their lives to supporting our
wounded warriors and our military families. I rise today to support S.
1963 and the two provisions in the bill that I was proud to author.
The first provision, H.R. 1335, would relieve the burden of costly
copayments from catastrophically disabled veterans who receive medical
or nursing home care from the VA. This was the first piece of
legislation that I introduced when I came to Congress because I knew
that there are men and women who have served honorably that need our
help. These are brave men and women who have sacrificed so much so that
we can enjoy the freedoms that we have every day. These are men and
women who struggle through their routines in life that we take for
granted, and they should not have to struggle to make their copays.
Passing this measure into law would be a great way to show our
support for our wounded warriors and to show that we are truly
dedicated to making their lives better.
However, it is not just our injured veterans who need our help. Every
day in districts across the country caregivers provide essential
services to our veterans. When my stepson, Jay, was injured in
Afghanistan and recuperating at Walter Reed, I spoke to so many of
these families who just began their second battle, the battle to
rehabilitate. That is why I worked to include in this bill H.R. 2898,
the Wounded Warrior Caregiver Assistance Act, to provide support
services to those taking care of our wounded warriors. Just as it is
our duty to care for a disabled soldier, passing this provision would
help care for those who work tirelessly every day to look after our
injured veterans.
I urge my colleagues to join me in honoring those who have sacrificed
for us by supporting this legislation.
Mr. BUYER. Mr. Speaker, I continue to reserve and defer to the
chairman.
Mr. FILNER. Mr. Speaker, I yield 1\1/2\ minutes to another one of our
great freshmen, Mr. Perriello from Virginia.
Mr. PERRIELLO. Mr. Speaker, today is a good day for America's
veterans and their families. I rise in support of S. 1963, the
Caregivers and Veterans Omnibus Health Services Act of 2009, landmark
legislation that makes good on our national commitment to our veterans
and their families, including those in our rural communities. I also
want to thank the chairs and the ranking members for putting our
veterans ahead of our partisan divides.
Taking care of our veterans includes taking care of those who care
for them when they are unable to care for themselves. Today, more than
ever, revolutionary advances in military medicine have significantly
increased servicemembers' chances of surviving a catastrophic injury
sustained in combat, but in many cases surviving a catastrophic injury
is only the first step in the battle. Recovering from such injuries
requires a long-term commitment not only from the veteran, but also
from those who love and care for them.
Once an injured veteran returns home from treatment at a DOD or VA
facility, it is often a spouse, mother, father, or other loving family
member who steps up to the challenge of providing ongoing care. And
while this care is provided out of a sense of love, compassion, and
devotion, it oftentimes shifts into a full-time commitment requiring
the caregiver to make significant personal decisions regarding
professional goals, commitments, and obligations.
To help better support family caregivers, I introduced H.R. 2734, the
Health Care for Family Caregivers Act of 2009, a bill that will help
provide much-needed assistance to those family caregivers facing the
difficult decisions related to caring for a veteran confronting a
catastrophic injury. I am pleased that this bill has included this, and
I encourage its support.
Mr. FILNER. Mr. Speaker, Mr. Teague from New Mexico authored an
important provision in the bill, and I would yield to him 1\1/2\
minutes to explain that provision.
Mr. TEAGUE. Mr. Speaker, I rise today in support of S. 1963, which
includes H.R. 2738, my bill to reimburse caregivers of disabled
veterans for travel expenses to medical appointments. For those Members
of Congress that represent vast rural districts with large veteran
populations like mine, we know that this assistance has been needed for
far too long.
Mr. Speaker, veterans throughout my district often volunteer their
time to drive fellow veterans to medical appointments even though the
drive can last over 3 or 4 hours. That means that veterans in Silver
City must leave their homes at three in the morning to make a trip to
the only VA hospital in our State. It means that many of my
constituents must dedicate entire days to travel from their homes in
Jal or Deming or Santa Rosa to a medical visit that may only take a few
minutes.
This also means that the family of Airman Michael Malarsie, an airman
from Bosque Farms who was blinded by an IED, would have to take time
off work to travel to a VA medical center; and as the law currently
stands, they must pay for that trip out of pocket whether they can
afford it or not.
Mr. Speaker, that is just plain wrong. But we can right that wrong
today by passing this bill and providing our wounded warriors and
families with the help that they have earned and need. It is the very
least that we can do to repay the debt that we as a Nation owe to our
veterans and their courageous families.
Mr. FILNER. Mr. Speaker, another valued member of our committee, Mr.
Ciro Rodriguez of Texas, authored an important provision in this bill,
and I would recognize him for 1\1/2\ minutes.
Mr. RODRIGUEZ. Mr. Speaker, our veterans deserve more. The proper
care of our veterans is our most fervent duty to uphold. This bill
permits us to advance this support even more with needed programs that
will not only cover our veterans, but will also extend caregiver
support to their families.
This bill makes marked improvements in rural health programs such as
the partnering with the Department of Health and Human Services to
expand care in rural areas. It also gives the Department of Veterans
Affairs the flexibility it needs to contract mental health services in
rural areas where there are no adequate VA facilities.
This bill also addresses the need for coordination between the
Departments and the key stakeholders in the study to find solutions to
the alarming suicide rates among our veterans and active duty forces
and gives more resources to the Department of Veterans Affairs to
address key areas such as veteran homelessness and women's health, and
strengthens their quality assurance and other programs.
Additionally, this bill reestablishes the previous highly successful
Health Professionals Education Assistance Scholarship Program in the
Department of Veterans Affairs. Earlier this
[[Page H2729]]
year, I introduced H.R. 4166, a bill to bring back this successful
program. I am glad that this bill includes my legislation.
We also need to recognize our soldiers and thank them for their
service. We owe it to each and every one of our wounded warriors and
all veterans to ensure their care and medical needs are properly taken
care of. Their selfless sacrifices for our Nation's freedom and the
sacrifices endured by their families warrant the passage of this bill.
Mr. FILNER. Mr. Speaker, how much time does each side have remaining?
The SPEAKER pro tempore. Four minutes.
Mr. FILNER. Mr. Speaker, one of the great provisions of this bill is
an incentive program to get doctors in certain specialties into the VA.
The author of that scholarship program is Ms. Jackson Lee of Texas, and
I would recognize her for 1 minute.
Ms. JACKSON LEE of Texas. Mr. Chairman, I am particularly grateful
for your leadership and that of the ranking member. Thank you for
guiding me on this legislation.
I rise to support S. 1963, the Caregivers and Veterans Omnibus Health
Services Act, for the work it is doing on caregivers and dealing with
suicide and unfortunate tragedies that occur among our military.
This morning I was with the United States Air Force and their Air
Force Cares program. I am pleased that this legislation included H.R.
228, the Blind Veterans of America, an organization chartered by
Congress in 1958, which has been for nearly 50 years the only veterans
service organization exclusively dedicated to serving America's blind
and visually impaired veterans.
There are approximately 160,000 legally blind veterans in the United
States, but only approximately 35,000 are currently enrolled in the
Veterans Health Administration services. It is estimated that there are
1 million low-vision veterans in the United States, and incidences of
blindness among the approximate total veteran population of 26 million
are expected to increase by about 40 percent over the next few years.
This is because the most prevalent cause of blindness and low vision
are age-related. This bill provides scholarships for training
individuals, and I ask my colleagues to support it. And thank you for
including H.R. 228.
I rise in support of S. 1963--to provide needed support to caregivers
of our nation's veterans, to improve the full spectrum of healthcare
and access provided to those we honor and recognize as our country's
present and past warriors and defenders.
There are few if any higher obligations of the Congress, the
President, and the American people than keeping faith with the men and
women who have worn the uniform in service to our country.
I applaud the work of the all those who have worked on this bill and
who are charged with legislative, oversight and investigative
jurisdiction over education of veterans, employment and training of
veterans, vocational rehabilitation, veterans' housing programs, and
readjustment of servicemembers to civilian life.
S. 1963 addresses many of the important needs of our veterans
relating to services for women's health care, rural health care,
homelessness, employment, health, and education.
WOMEN VETERANS HEALTH CARE
The bill will expand and improve VA health care services for the 1.8
million women who have bravely served their country. It requires the VA
to:
Conduct a study of barriers to women veterans seeking health care,
Educate and train mental health professionals caring for veterans
with sexual trauma;
Implement a reintegration and readjustment pilot program;
Establish a child care pilot program for women receiving regular and
intensive mental health care and intensive health care services, or who
are in need of such services but do not seek care due to the lack of
child care services;
Provide up to 7 days of post-delivery health care to a newborn child
of a women veteran.
RURAL HEALTH IMPROVEMENTS
Improves health care for veterans living in rural areas, including by
expanding transportation for veterans to local VA hospitals and clinics
through VA grants to local Veterans Service Organizations.
MENTAL HEALTH CARE
Provides access to counseling and other mental health centers to any
member of the Armed Forces (including members of the National Guard and
Reserves, who served during Operation Iraqi Freedom and Operation
Enduring Freedom but who are no longer on active duty) and Requires the
VA to conduct a veterans' suicide study.
OTHER HEALTH CARE ISSUES
Prohibits the VA from collecting copayments from veterans who are
catastrophically disabled.
Creates a pilot program, which would provide specified dental
services to veterans, survivors, and dependents of veterans through a
dental insurer.
Requires the VA to provide hospital care, medical services, and
nursing home care for certain Vietnam-era veterans exposed to herbicide
and Gulf War era veterans who have insufficient medical evidence to
establish a service-connected disability.
Provides higher priority status for certain veterans who are Medal of
Honor recipients.
HOMELESS VETERANS
Expands the organizations offering transitional housing and other
support for homeless veterans that can receive grants or per diems from
the VA, which is particularly important to veterans in rural areas.
I am extremely pleased to help answer the needs of America's veterans
and am pleased that H.R. 228, a bill I introduced to establish a
scholarship program for students learning to care for veterans with
visual impairments is included in Title III, Section 302 of S. 1963. As
we work to strengthen our efforts nationally to provide better care for
veterans we can not afford to leave any issue unexamined or
unaddressed. We must especially ensure that veterans have the access to
the quality healthcare that they deserve.
The Blind Veterans of America, an organization chartered by Congress
in 1958, and which has been for nearly 50 the only veterans service
organization exclusively dedicated to serving America's blind and
visually impaired veterans.
Mr. Speaker, there are approximately 160,000 legally blind veterans
in the United States, but approximately only 35,000 are currently
enrolled in Veterans Health Administration services.
In addition, it is estimated that there are over 1 million low-vision
veterans in the United States, and incidences of blindness among the
approximate total veteran population of 26 million are expected to
increase by about 40% over the next few years. This is because the most
prevalent causes of legal blindness and low vision are age-related, and
the average age of the veteran population is increasing; the current
average age is about 80 years old.
Members of the Armed Forces are important to our nation and we show
them our appreciation by taking care of them even after they have
completed their service. But the fact is that there are not enough
blind rehabilitation specialists to serve all legally blind and low-
vision veterans in the United States.
Blind rehabilitation training helps give these veterans awareness of
and functioning in their surroundings and enables them to retain their
independence and dignity. Veterans without these services may find it
difficult to be self-sufficient, relying on others to perform certain
skills or even simple tasks on their behalf.
Mr. Speaker, Public Law 104-262, the Eligibility Reform Act 1996,
requires the Department of Veterans Affairs to maintain its capacity to
provide specialized rehabilitative services to disabled veterans, but
it cannot do so when there are not enough specialists to address these
needs. That is why we must work harder to provide for the needs of our
men and women who have served this Nation so valiantly.
We should all take a day to reflect on the sacrifices U.S. veterans
and servicemembers have made, and are still making, for their country.
However, to truly honor and pay tribute to these special Americans
requires our commitment for the other 364 days of the year.
Veterans continue to have many unanswered needs, and we should
continue to fight for the rights of our most patriotic Americans. I am
a strong believer in the fact that veterans have kept their promise to
serve our nation; they have willingly risked their lives to protect the
country we all love. We must now ensure that we keep our promises to
our veterans because the way a nation treats those who have stood in
harms way to defend it, risking life, limb and psychological injury is
extremely telling.
Members of the Armed Forces are important to our nation, and we show
them our appreciation by passing this all encompassing healthcare
legislation which directly impacts the Nation's ability to take care of
servicemembers after they have completed their service.
There are 25.9 million veterans in the United States who have
protected this country in military conflicts as early as WWI. The wars
in Iraq and Afghanistan are however producing a new wave of veterans.
Of 1.4 million who have served, more than 205,000 have sought to obtain
health care this year. In part this is good news. Thanks to medical and
technological advances, the survival and recovery rate is several times
higher than in previous conflicts. However there are still many
[[Page H2730]]
inequities and system failures that mitigate veterans' getting proper
and timely care.
Consequently, equipping veterans to navigate civilian life, often
with severe mental and physical illnesses, has to be a national
priority. Yet the Veterans Affairs Department, which provides millions
of injured veterans with payments and care, has had issues responding
to the inundation. Additionally, the Veterans' Disability Benefits
Commission (VDBC) has reported that the VA falls woefully short in
providing timely and fair disability payments, as well as adequate
mental health care. The report cited an average delay of nearly six
months in handing out payments. This legislation directly responds to
these and many other pertinent issues which will allow us to meet the
needs of all of our veterans, their families and caregivers.
Mr. FILNER. Mr. Speaker, this bill adds an important position to the
Department of Veterans Affairs. The author of that legislation is Mr.
Hare of Illinois. He was on our committee; I wish we had him back. I
yield him 1 minute.
Mr. HARE. Mr. Speaker, this Congress, under the leadership of Speaker
Pelosi and Chairman Filner, has honored our veterans by dramatically
increasing funding for VA health care and making it more timely,
efficient, and predictable, hiring additional benefits claims
processors and improving VA facilities. The bill before us builds on
our earlier victories to improve the quality of health care for our
Nation's veterans.
Mr. Speaker, I am particularly pleased that this veterans package
includes a bill I introduced with Congressman Jerry Moran to elevate
the Department of Veterans Affairs physician assistant adviser to a
full-time director. My bill would give 2,000 physician assistants
employed at the VA who manage care for one-quarter of all primary care
patients a fair and long-overdue voice within the VA.
With the director of physician assistant services, we can ensure that
the PA workforce will continue to be an integral component within the
VA health system and PAs are able to provide the best possible care to
our veterans, especially those in underserved rural areas.
Mr. Speaker, I urge all of my colleagues to vote for S. 1963.
Mr. FILNER. Mr. Speaker, the gentlelady from Texas (Ms. Eddie Bernice
Johnson), added an important provision with regard to retention and
recruitment of the kind of professionals we need in the VA. I would
yield to her 1 minute and thank her for her efforts.
Ms. EDDIE BERNICE JOHNSON of Texas. Let me thank the chairman and the
ranking member for this bill, and I rise in strong support of the bill,
the Caregivers and Veterans Omnibus Health Services Act.
It is our duty to ensure that our veterans who so courageously serve
our country receive the medical support they deserve.
{time} 1115
My professional career as a nurse was spent in the veterans' system.
I visited at a hospital after they had four suicides from the
psychiatric unit, and one of the problems they had was
noncompetitiveness with nurses' salaries, so I have introduced a bill
to attempt to correct that. This bill has been incorporated, and I am
pleased that it has been. The Senate companion bill is also included.
It increases the pay limitations for VA nurses from level V to level IV
of the executive schedule to address pay disparities, and also to
increase special pay for nurse executives.
It is my pleasure to present this because I know firsthand what it is
like to try to recruit good nurses.
I rise in strong support of S. 1963, the Caregivers and Veterans
Omnibus Health Services Act.
I would like to thank Chairman Filner and the Committee on Veterans'
Affairs for their work on this legislation.
It is our duty to ensure that our veterans, who have so courageously
served our country, receive the medical support they deserve.
The VA system must be able to successfully compete for the best
health care providers in the United States.
I am also pleased that provisions in my bill, H.R. 919 and its Senate
companion bill, are included in this legislation.
This bill will increase the pay limitations for VA nurses from Level
V to Level IV of the Executive Schedule to address pay disparity, and
also increase Special Pay for Nurse Executives.
As a result, the VA will be able to recruit and retain highly
qualified Nurse Executives and raise their standing to be on par with
other executive personnel.
Part-time nurses will now also be eligible for Title 38 status and
additional nurse pay.
As a non-practicing Registered Nurse, I am pleased with these
improvements for nurses who are on the front lines of care.
Overall, this legislation will recognize and treat our VA nurses,
physicians, dentists, and pharmacist executives as the true
professionals they are.
I am pleased to support this bill and urge my colleagues to do the
same.
Mr. BUYER. I yield myself such time as I may consume.
Mr. Speaker, in an exchange I just had in a colloquy with Speaker
Pelosi with regard to her commitment to correct an error in the
President's health package, I would like to place that commitment in
some context.
Since late July of last year, when the debate on the President's
health care package started, I tried on multiple occasions to ensure
that the care our Nation's veterans and their families received from
the Department would be considered minimum essential coverage. I did
that during the markup in the Subcommittee on Health, in the Energy and
Commerce Committee, and in the full committee. My efforts included
trying to obtain jurisdiction for the Veterans' Affairs Committee on
H.R. 3200 back in August of last year.
In November, during the floor debate on H.R. 3962, I again sought to
obtain protections for our Nation's veterans and their families. At
that time, not only I but Chairman Filner received assurances in
writing from the chairman of the House Ways and Means Committee, from
the chairman of the House Energy and Commerce Committee, and from the
Energy and Labor Committee that veterans and their families would, in
fact, be protected.
I think this will be helpful to us, Mr. Filner, as your bill
proceeds.
Most recently, in March, I and Ranking Member Buck McKeon of the
House Armed Services Committee offered an amendment to H.R. 3590, which
would ensure that benefits offered under TRICARE and the Department of
Veterans Affairs programs would be considered minimum essential
coverage. However, our amendment was not allowed then under the rule,
and I made that appeal to the Rules Committee.
This amendment was then introduced in a form of legislation, H.R.
4894, which then was referred to the Energy and Commerce Committee.
I raised the issue again, because in that recently passed Senate
health bill, it did not include some of the veterans' programs in the
definition of ``minimum essential coverage.'' Unfortunately, the bill
did not mention the ``other veterans' programs'' under chapter 17. It
mentioned veterans' programs but not the other veterans' programs under
chapter 17 of title 38, which includes widows, orphans, and dependents
covered by the Civilian Health and Medical Program of the VA, known as
CHAMPVA. It also did not mention chapter 18, which includes the spina
bifida program for the children of Korea and Vietnam veterans who have
spina bifida as a result of their parents' exposure to Agent Orange.
I brought up that issue. When Chairman Skelton recognized that the
Senate health bill mentioned TRICARE for Life but did not mention
TRICARE, he immediately brought a bill to the floor, and it was
considered. I tried to amend that bill. I tried to get it withdrawn. At
that time, I received a commitment from the chairman of the House Ways
and Means Committee that he would work with us to get that corrected. I
even raised the issue during the markup of the President's health bill,
itself, on the floor. I know the VFW was very concerned, along with the
American Legion.
Yet, as I raised these concerns that this bill had a large error, I
was marginalized. I was marginalized by some in the House who said, Oh,
those issues are not real. Even the White House issued a press release,
along with the Secretary of Veterans Affairs, which read that it was
unfounded. Well, it is founded. It is a problem that we have to fix.
Senator Akaka passed a bill to protect the veterans. It passed on
unanimous consent. It is currently at the Speaker's desk. However, the
parliamentarian has ruled that it is a revenue bill. Otherwise, I would
immediately call it forward.
So what has happened? A little magic dust again.
[[Page H2731]]
I appreciate, with regard to this issue, that the chairman has
recognized that there is an error which needs to be corrected. I am
deeply appreciative. So is the Speaker. She has just exercised her
commitment to correct the error in the bill.
Chairman Filner has taken the language of the Akaka bill and has
introduced his own bill. It has been referred now to the Ways and Means
Committee. I have written a letter as a follow-up. From the colloquy I
had with Chairman Levin of the House Ways and Means Committee, I have
asked him to expedite Mr. Filner's bill and to have it brought to the
floor so that we can correct this error in the President's health bill
and so that we may cover the widows, the orphans, the spina bifida
program, and CHAMPVA, all of which were excluded from the definition of
``minimum essential coverage.'' That will correct the error, and I
think that needs to be done. I had hoped that Mr. Filner's bill would
have been included in the bill we are presently considering. That would
have cleaned this up now, but that didn't occur.
So I've taken every opportunity to try to correct this error, but for
whatever reason, it just hasn't gotten done. It needs to be done. I
think it was an error in the drafting. No one intended for widows, for
orphans, and for the beneficiaries of the spina bifida program to be
left out. I believe it was unintentional, but it is a real issue, and
we need to correct it. Hopefully, we are going to do that.
I want to thank the chairman for his leadership to correct that
error, and I want to thank the staff on both sides of the aisle for all
of their efforts in the bill.
I would ask my colleagues to pass the bill that is before us, and I
yield back the balance of my time.
Mr. FILNER. I yield myself the balance of my time, and I want to
return the debate to the bill under consideration.
Mr. Speaker, this is a landmark bill. Finally, it gives some help to
the caregivers of wounded warriors--family members who have to,
perhaps, give up their jobs and spend almost full time with their loved
ones. There is the issue of women veterans, which is a rising
percentage in what was always a male institution, and we have to change
the culture there in the VA. We help our homeless veterans. We help
those who are in rural areas, and we provide more money for mental
health care for all of our Nation's veterans. This is an important
bill, and I urge unanimous approval.
Ms. GIFFORDS. Mr. Speaker, I rise today in support of the Caregivers
and Veterans Omnibus Health Services Act. This bill will provide a
number of additional benefits to our servicemembers and their families
and I am pleased that the Chairman and the Ranking Member were able to
get it to the floor.
I am particularly pleased that language from two of my behavioral
healthcare bills, H.R. 2698 and 2699, were included in the final
version of this landmark bill.
My language will provide increased access to Vet Centers for our
Guardsmen and Reservists, ensuring they are never again turned away for
the behavioral health care they need and deserve.
My language also authorizes the Vet Centers to provide veterans and
servicemembers with referrals for behavioral health care so they can
see their own doctor in their own community when they need it.
These two items will help remove some of the stigma from behavioral
health issues and specifically grant access to care for those who need
it the most.
When our men and women in uniform come home from war, it is our
responsibility to ensure they receive the care they need and deserve.
My language and this bill provide them and their families with the
care and peace of mind they have earned and we owe to them.
I strongly urge passage of this bill.
Mr. QUIGLEY. Mr. Speaker, I rise today in support of the house
amendments to S. 1963, the Caregivers and Veterans Omnibus Health
Services Act.
Today we are taking action to begin to address the needs of not only
those who serve, but their families as well.
All too often we see families and friends altering their lives to
care for those who served our country and then return home wounded or
disabled.
Many caregivers have lost their jobs and benefits, and have had to
dip into their hard-earned savings just to provide the care our wounded
warriors so desperately need.
S. 1963 will begin to ensure that disabled veterans and their
families will have the resources and support, both technical and
financial, needed to provide care.
We can never fully repay our veterans and their families for their
service and the personal sacrifices they continue to make.
The passage of this bill is a start--and will go a long way to ensure
they receive the benefits they need, deserve, and have courageously
earned.
Ms. SLAUGHTER. Mr. Speaker, over the past year, I have become
increasingly concerned about veterans access to benefits, care and job
training. We must encourage soldiers completing their active duty
service to sign up with the U.S. Department of Veterans Affairs. This
is a critical message we must reiterate to all our returning service
men and women.
As the heroes of our country, we believe our veterans and their
families deserve the very best benefits to ensure peace of mind. With
this in mind, Congress has provided more than 185,000 servicemembers
and veterans with $500 for every month they were forced to serve under
stop-loss orders since 2001. In addition, we've created new claims
processors to make sure our veterans earn their benefits in a timely
manner. We built new transition centers for wounded warriors, more
military child care centers, and better barracks and military family
housing. With veterans' families in mind, Congress has increased
support for veteran caregivers. And lastly, those disabled veterans can
rest assured that their benefits will keep pace with the cost of living
and their needs.
Today I rise in support of S. 1963, the Caregivers and Veterans
Omnibus Health Services Act. This landmark legislation will provide
support to family and others who care for disabled, ill, or injured
veterans; will enhance health services for the 1.8 million women
veterans, including care for newborns for the first time in history; to
expand mental health services for veterans and health care access for
veterans in rural areas; and to prohibit copayments for veterans who
are catastrophically disabled.
To help meet the many hardships and sacrifices associated with
lengthy recovery and rehabilitation from severe injuries of veterans,
S. 1963 will provide support services to family and other caregivers of
veterans, including education on how to be a better caregiver,
counseling and mental health services, and respite care for family and
other caregivers of all veterans. It also provides health care and a
stipend for caregivers living with severely wounded veterans of Iraq
and Afghanistan.
This support is vital for the wounded veterans of Iraq and
Afghanistan and their families, as about 20 percent of active duty, 15
percent of reserve and 25 percent of retired and separated members have
a family member or friend who has been forced to leave a job to care
for the veteran full-time, according to the Dole/Shalala report.
The bill also expands and improves VA health care services for the
women who have bravely served their country, working to remove existing
barriers to women veterans seeking health care, providing up to seven
days of care of newborn children of women veterans for the first time
in history, and enhancing treatment for sexual trauma for women at the
VA.
I urge my colleagues to vote ``yes'' in favor of this historic
legislation for the sake of our heroes and their families. Our veterans
deserve our gratitude and support at the very least.
Mr. SALAZAR. Mr. Speaker, I rise today to support S. 1963 the
Caregivers and Veterans Omnibus Health Services Act of 2009.
As a veteran, I am proud to lend my support to this landmark bill.
With its provisions for women, homeless and rural veterans, S. 1963
addresses many critical sectors of the veteran's community.
Mr. Speaker, Colorado is home to over 427,000 veterans, 70,000 of
which live in my district.
These veterans and their families face many of the same issues as
their urban counterparts but must also deal with unique issues of
accessibility and availability of resources.
This historic bill contains provisions that will be of particular
importance to America's rural veterans.
I am encouraged that the bill specifically looks to improve health
care for veterans living in rural areas and will provide financial
assistance to help transport veterans to local VA hospitals and
clinics.
S. 1963 will create a demonstration project to examine the
feasibility and advisability of alternatives for expanding care for
veterans in rural areas in addition to establishing goals for the
recruitment of personnel in rural areas.
I encourage my colleagues on both sides of the aisle to support this
legislation.
Mr. SKELTON. Mr. Speaker, let me share my support for the House
Amendment to S. 1963, the Caregivers and Veterans Omnibus Health
Services Act. This is a good bill for our nation's veterans and those
who care for them, and I am thankful for all the hard work that has
gone in to this legislation.
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Missouri's Fourth Congressional District, which I have the honor to
represent, is a rural district consisting of small towns, farms, and
patriotic Americans, so I am particularly pleased with the provisions
of the bill that focus on the needs of rural veterans. Veterans of all
of our nation's conflicts, from World War II to today, call the Fourth
District home, but the advantages of living in rural Missouri often
come with long drives to the closest VA hospital or clinic. This
legislation takes a number of steps to improve access to care for rural
veterans, including increasing the mileage reimbursement rate for
traveling to a VA health facility and partnering with veterans service
organizations to provide transportation options for veterans living in
rural areas. These moves would help address some of the concerns I
often hear from veterans.
I am also pleased with the provisions of the legislation that impact
the caregivers of our veterans. Oftentimes, the day-to-day care of a
seriously injured or ill veteran is provided by a spouse, a child or a
parent. These individuals give of themselves gladly, but many are
forced to take time off of work or school, or to leave their jobs or
their pursuit of higher education altogether. And many caregivers do
not have the experience or training to provide the most effective care
for their loved one. The bill before us today expands training and
education for caregivers, provides access to them for counseling and
mental health services, and for those caring for veterans of Operation
Iraqi Freedom and Operation Enduring Freedom, provides a monthly
stipend and health care through the CHAMPVA program. These caregivers
are providing an important service for our veterans and this
legislation gives proper consideration for their needs.
Mr. FALEOMAVAEGA. Mr. Speaker, I rise in strong support of the
``Caregivers and Veterans Omnibus Health Services Act of 2009.'' I want
to thank Chairman Bob Filner and my colleagues in the U.S. House
Committee on Veterans' Affairs for their support and for bringing this
bill before the House for consideration. I also want to commend the
chief cosponsor of this bill and Chairman of the US Senate Committee on
Veterans' Affairs, my good friend from the State of Hawaii, Senator
Akaka, for continuing to look out for the interest and the needs of
those that have served in the armed forces of this great nation.
The bill before us today reaffirms our commitment to provide for the
needs and to share the sacrifice borne by our veterans. Among other
things, it will: provide immediate support for veteran caregivers;
improve health care access for women veterans; improve rural health
care delivery; and increase access to mental health support for
servicemembers and veterans.
Mr. Speaker, I am very pleased that Congress recognizes the needs of
the families and those that are taking care of our veterans. Today,
more servicemembers are surviving the wounds of war than those injured
in previous conflicts. For example, the ratio of wounded per fatality
averaged approximately 1.7 in the first two World Wars compared to 3.1
in the Korea and Vietnam wars. This number jumped to 7.1 during
Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF),
mainly due to improved body armor and superior battlefield medicine
techniques.
As a result of this improvement, there is a growing need to provide
continuing care to those injured and wounded from recent conflicts once
they reach veterans status. Providing support and resources to
caregivers and attendants that take care of our wounded and injured
veterans is of a major concern.
The bill before us today makes it easier for a veteran to be
accompanied by a family member when traveling to and from a treatment
facility. In addition to mileage, lodging and subsistence will be
provided for, especially for those veterans that want to stay close to
their families. A caregiver support program is also created where
caregivers of veterans of all eras would receive supportive services
such as caregiver training and education, counseling and mental health
services, and respite care. More significantly, our veterans would
receive better treatment and quality of care.
I urge my colleagues to vote in support of this important piece of
legislation.
Mrs. McCARTHY of New York. Today, the House will consider an
important bill--the Caregivers and Veterans Omnibus Health Services
Act. This legislation will provide much-needed support for our veterans
and their families.
According to the Dole/Shalala report, 20 percent of active duty, 15
percent of reserve, and 25 percent of retired and separated members of
the military have a family member of friend who has been forced to
leave a job to care for the veteran full-time. This places an
incredible burden on many, many families across our country.
Today's bill offers an important array of support services for
veterans and their caregivers such as: training and education,
counseling and mental health services, lodging and subsistence payments
for the caregiver when accompanying the veteran on medical care visits,
and monthly financial stipends for caregivers. This bill takes
important steps towards supporting those individuals who care for our
veterans.
The bill also makes important investments in health care for women
veterans. Over 1.8 million women have served our country and for too
long many of their health care needs have gone unaddressed. This bill
builds on the previous efforts of our Congress to correct that
inequity.
S. 1963 expands and improves Veterans Administration health care for
women by requiring the VA to conduct a study of barriers to women
veterans seeking health care, educate and train mental health
professionals caring for female veterans with sexual trauma, implement
a reintegration and readjustment pilot program aimed a helping women
veterans, establish a child care pilot program, and provide post-
delivery health care to a new born child of a woman veteran.
I support this legislation and our Majority's efforts to support
those men and women who have risked their lives for our country.
Mr. ETHERIDGE. Mr. Speaker, I rise in support of S. 1963, the
Caregivers and Veterans Omnibus Health Services Act. This legislation
keeps the promises made to our troops, wounded warriors, and veterans.
It is simply our duty as a Nation, when we put our men and women in
harm's way, to care for them when they return home.
S. 1963 will provide support to families and those who care for
disabled or injured veterans. This bill helps ease the many hardships
and sacrifices that many families face during lengthy recovery and
rehabilitation of severe injuries of their loved one. S. 1963 will
provide support services to family members and other caregivers of
veterans, including education on how to be a better caregiver,
counseling and mental health services. The bill also provides health
care and a stipend for caregivers living with severely wounded veterans
of the Iraq and Afghanistan wars.
As a veteran myself, I strongly support making sure Congress honors
its commitments to our veterans. Our support system should work for all
those who sacrifice for our country and this bill improves health care
for the women who have bravely served their country. It also improves
mental health as an important part of overall health for our veterans.
Finally, this bill recognizes that more and more of our soldiers are
women, and it removes existing barriers to women veterans seeking
health care. Our military health care needs to provide everyone who has
served our nation receives the services he or she needs. In particular,
the legislation enables female veterans to receive up to seven days of
care for newborn children and enhances sexual trauma treatment for
women at the VA.
It is time to change the way we care for veterans by providing better
support and training for those that care for them. The sacrifice of our
veterans is appreciated by all Americans. S. 1963 represents compassion
for those who served our country, and support for those who now serve
them.
Mr. Speaker, this bill takes care of those who are keeping America
safe. I urge my colleagues to join me in support of S. 1963, to fulfill
our continued obligations to our nation's military.
Mr. STARK. Mr. Speaker, the service men and women serving overseas
have born the brunt of the cost of the wars in Iraq and Afghanistan.
The Caregivers and Veterans Omnibus Health Services Act ensures that
when they return, they will obtain the quality treatment and health
care they deserve.
This legislation addresses many of our veterans' most urgent needs.
Record numbers of service men and women returning home are suffering
from posttraumatic stress, and this bill ensures that mental health
services are more accessible. The bill ensures that women don't get
second-class health care by expanding coverage for women's health,
including care for newborns. The bill also eliminates health care
copayments for veterans who are catastrophically disabled.
Many politicians use the slogan ``support the troops'' when they mean
``support this war.'' This bill actually supports our troops--by
providing them the care and support services they need when they return
home. I urge my colleagues to support this bill.
Mr. CONYERS. Mr. Speaker, I rise in strong support of S. 1963, the
``Caregivers and Veterans Omnibus Health Services Act of 2009.'' As a
Korean War veteran, I understand the various challenges that veterans
face when returning home. This bill takes a significant step forward in
terms of improving the overall access to quality, affordable health
care for our nation's veterans and provides much needed assistance to
the devoted families across this nation that provide housing, food, and
full-time care for wounded veterans.
Under S. 1963, veterans who are catastrophically disabled would no
longer be required to pay copayments for their medical
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care. As we all know, in America, the sicker you are, the more you must
pay in out-of-pocket costs. Passage of this bill means veterans and
their caretakers will be able to live with less financial stress.
This bill also increases funding to expand VA clinics in rural areas
where VA programs currently do not exist. Veterans living in rural
areas must often travel hundreds of miles in order to receive care at a
Veterans hospital--a crushing burden for veterans who need frequent
health care services, and must pay for expensive travel due to
increasing transportation costs.
The bill will also help address the many hardships and sacrifices
associated with the lengthy recovery and rehabilitation associated with
severe injuries. In particular, the bill improves access to counseling
and mental health services. S. 1963 also provides health care and a
stipend for caregivers living with severely wounded veterans of the
wars Iraq and Afghanistan. This stipend should help reduce the enormous
financial pressures on caregivers who are providing food, clothing,
transportation, and housing to their wounded loved ones during one of
the worst economic downturns since the Great Depression.
Again, I thank the Democratic leadership for introducing this
important bill, which will go a long way in improving the lives of
scores of veterans and their caregivers for years to come. I encourage
my colleagues to support the bill.
Mr. FILNER. I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from California (Mr. Filner) that the House suspend the rules
and pass the bill, S. 1963, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. FILNER. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the
Chair's prior announcement, further proceedings on this motion will be
postponed.
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