[Congressional Record Volume 156, Number 58 (Thursday, April 22, 2010)]
[Senate]
[Pages S2566-S2573]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          CAREGIVERS AND VETERANS OMNIBUS HEALTH SERVICES ACT

  Mr. DORGAN. Madam President, I ask the Chair to lay before the Senate 
a message from the House with respect to S. 1963.
  The PRESIDING OFFICER. The Chair lays before the Senate a message 
from the House, which the clerk will report.
  The assistant legislative clerk read as follows:

                                S. 1963

       Resolved, That the bill from the Senate (S. 1963) entitled 
     ``An Act 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.'', do pass with an amendment.

  Mr. AKAKA. Mr. President, as chairman of the Committee on Veterans' 
Affairs, I am proud to urge our colleagues to support S. 1963, the 
proposed ``Caregivers and Veterans Omnibus Health Services Act of 
2010,'' as amended. This bill reflects a compromise agreement between 
the Committees on Veterans' Affairs of the Senate and the House of 
Representatives on health care and related provisions for veterans and 
their caregivers. The House passed this bill, by a vote of 419-0, on 
April 21, 2009.
  When this bill was passed by the Senate on November 19, 2009, it 
would have greatly expanded assistance for veterans and family members. 
The bill in its current form, after being reconciled with legislation 
in the other body, provides even more robust services, but is also 
significantly less expensive than when this legislation was originally 
approved unanimously by the Senate.
  The centerpiece of this bill is a new program of caregiver assistance 
for our most seriously wounded veterans. The Committee has heard over 
and over about family members who quit their jobs, go through their 
savings, and lose their health insurance as they stay home to care for 
their wounded family members from the current conflicts. For those 
family members who manage to keep their jobs, their employers, 
including many small businesses already struggling in these difficult 
economic times, lose money from absenteeism and declining productivity. 
The toll on the caregivers who try to do it all can be measured in 
higher rates of depression, and worse health status as they struggle to 
care for their seriously injured family members, an obligation that 
ultimately belongs to the Federal Government.
  The caregiver program that will be established by this compromise 
bill will help VA to fulfill its obligation to care for the Nation's 
wounded veterans by providing their caregivers with vital support 
services and a living stipend. These vital caregiver support services 
include training, education, counseling, mental health services, and 
respite care. This measure also provides health care to the family 
caregivers of injured veterans through CHAMPVA. These caregivers 
deserve our support and assistance and this new program will begin to 
meet that obligation.
  Another key part of the bill relates to women veterans. Women make up 
a significantly increasing portion of the overall veteran population. 
Thanks to the leadership of Senator Murray, this bill will increase 
funding for mental health services for women who have suffered military 
sexual trauma, and for medical services for newborn children. In 
addition, this bill requires VA to report on the barriers facing women 
veterans who seek health care at VA.
  With the help of Senator Tester, this bill also will improve veteran 
access to care in rural areas by authorizing VA to carry out 
demonstration projects for expanding care for veterans in rural areas 
through partnerships with other federal entities, such as the Centers 
for Medicare and Medicaid Services and the Indian Health Service. 
States which have an especially high number of veterans living in rural 
areas will benefit greatly from these programs.
  This bill also expands the scope of VA's Education Debt Reduction 
Program to include retention in addition to recruitment so that VA can 
address staff shortages in rural areas. Where VA has a shortage of 
qualified employees due to location or hard-to-recruit positions, this 
legislation would increase the total education debt reduction payments 
made by VA from $44,000 to $60,000.
  The bill also attacks another very difficult and painful problem--
that of homeless veterans. On any given night, the best estimate is 
that more than 107,000 veterans are homeless. We know that homelessness 
is often a consequence of multiple factors, including unstable family 
support, job loss, and health problems. This bill will create programs 
to help ease the burden of veteran homelessness and, in so doing, 
support Secretary Shinseki's efforts to end homelessness among 
veterans.
  Senator Durbin has helped keep attention on issues of overall quality 
management in VA, and resolving and preventing such problems as those 
identified at the Marion, IL, VA medical center, and other facilities. 
Provisions of this bill will make needed improvements in these areas.
  I am grateful to all who have worked diligently on this bipartisan 
bill--including the committee's ranking member, Senator Burr--and the 
veterans service organizations, who made this one of their priorities. 
We are particularly indebted to the Disabled American Veterans and the 
Wounded Warrior Project for being in the vanguard on advocating for 
family caregivers and for their unrelenting support for this 
legislation.
  Various other advocates have supported this bill as well, including 
the American Legion, the Veterans of Foreign Wars, the Paralyzed 
Veterans of America, the Nurses Organization of Veterans Affairs, the 
Brain Injury Association of America, the American Academy of 
Ophthalmology, the American Association of Colleges of Nursing, and 
many others.
  It has taken us several years to see this legislation through to what 
I hope will be final passage today. As we reach this final point in the 
legislative process, I take a moment to thank the members of the 
committee staff who worked so hard on this legislation, including 
former committee staffers who helped craft many of the provisions in 
this bill, Alexandra Sardegna, Aaron Sheldon, and Andrea Buck. I also 
thank current committee staff, Ryan Pettit, Preethi Raghavan, Nancy 
Hogan, and Lexi Simpson, and all the others who, in addition to their 
work on specific elements of the final agreement, have worked to bring 
this legislation to final passage.
  We have promised to care for veterans when they return from service 
to the Nation. The provisions in this bill will help us keep our 
promise by going beyond words and ceremony, and providing the care that 
veterans have earned through their sacrifices.
  I ask my colleagues to give this legislation their unanimous support.
  I ask unanimous consent that an explanatory statement developed 
jointly with our counterparts in the House to accompany this compromise 
bill be printed in the Record at the conclusion of my remarks.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

   Explanatory Statement Submitted by Senator Akaka, Chairman of the 
                 Senate Committee on Veterans' Affairs

  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

[[Page S2567]]

     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 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.

[[Page S2568]]

     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 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.

[[Page S2569]]

     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.
     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

[[Page S2570]]

     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 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.

[[Page S2571]]

       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 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 80-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).

[[Page S2572]]

       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 Merrill 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 
     ``Merrill 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.
     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 jointly entered into the Congressional 
     Record by the Chairmen of the Committees on the Budget of the 
     Senate and the House of Representatives.

  Mr. COBURN. Madam President, our Nation has been at war for nearly a 
decade now in Afghanistan and nearly as long in Iraq and we owe a huge 
debt of gratitude to the men and women who have fought on the front 
lines as well as to their families who have sacrificed so much.
  The Senate is considering S. 1963, the Caregivers and Veterans 
Omnibus Health Services Act of 2009. While I will support its passage, 
I believe this legislation represents a significant failure of Congress 
to uphold the responsibility entrusted to us by the citizens of this 
Nation and our obligation to military families and taxpayers.
  While there will be self-congratulating press releases from Members 
of Congress and some Veteran Service Organization lauding the bill's 
passage, I believe the shortcomings of this legislation--discriminating 
against most veterans and adding billions of dollars to our national 
debt--represent a failure of leadership and lack of responsibility.
  I had hoped that the House of Representatives would make some 
significant improvements to the legislation over the Senate. Sadly, 
they did not.
  The legislation that the Senate will consider still unfairly 
discriminates against severely disabled veterans from wars and combat 
prior to September 11, 2001.
  Many of these brave men and women have needed the assistance of 
caregivers for decades and have done so without help from the 
Department of Veterans Affairs. Many of these veterans were not the 
beneficiary of recent advancements in military medical care. The 
caregivers of these veterans will be left out of this benefits package.
  There are currently 35,000 veterans receiving aid and attendance 
benefits from the Department of Veterans Affairs, which is 
approximately the number of veterans in need of caregiver assistance. 
Out of this population, around 2,000 veterans received their injuries 
after September 11 and would qualify for extra caregiver assistance in 
this bill.
  Caregivers for almost 95 percent of severely disabled veterans from 
combat would not receive the level of caregiver assistance afforded to 
those veterans who were injured after September 11, 2001. When I 
offered an amendment that would provide equivalent caregiver benefits 
for all severely disabled veterans of all wars, the Senate summarily 
rejected that idea.
  Unfortunately the House of Representatives also ignored the danger 
that our massive debt poses to our Nation and did not eliminate or 
reduce any current programs in the Federal budget to pay for this 
legislation. The bill is not paid for by trimming any wasteful, 
duplicative, obsolete, or lower priority Federal programs.
  The Congressional Budget Office estimates that the bill will cost 
$3.6 billion over 5 years, which is slightly less than the version the 
Senate passed. The Senate also rejected my attempt to pay for this 
legislation out of the fraud, waste, and abuse of taxpayer dollars that 
we send each year to the United Nations.
  Instead the Congress has decided, as it always does, to pass the debt 
onto our children and grandchildren, rather than bear the cost and 
sacrifice today as our veterans have done.
  I fear that if we do not start paying for new spending then the 
sacrifice made by our veterans for future generations will have been in 
vain. At some point, the debt we are incurring today must be paid for 
and when that day comes, the promises we are making to veterans, 
caregivers, and others will no longer be affordable because Congress 
refused to be responsible by being fiscally responsible by trimming 
lower priority spending.
  When the Senate first considered this legislation last fall, some of 
the proponents of the Caregivers and Veterans Omnibus Health Services 
Act attempted to rebut my facts about our

[[Page S2573]]

growing national debt by saying that the bill does not actually 
appropriate any money for these programs.
  In a technical sense, they are correct. I suspect that these same 
proponents will issue statements celebrating its passage, which will 
disappoint any caregiver of a disabled veteran expecting the promised 
assistance soon.
  No caregiver will be helped unless the appropriations committee 
allocates the funding for this new program authorized in this bill.
  Until then, this bill is an empty promise to veterans and benefits no 
one except perhaps the career politicians who will claim credit for 
doing something to help veterans without really having to make any 
difficult choices.
  We owe an enormous sacrifice to our veterans who fought and died in 
our defense. This debt, which was incurred on a battlefield far from 
home, should be borne by this generation so that we ensure that the 
future they fought to secure for our children and grandchildren is not 
threatened by our own fiscal irresponsibility and shortsightedness.
  Congress has once again failed taxpayers, veterans, and their 
families today.
  Mr. DORGAN. I ask unanimous consent the Senate concur in the House 
amendment; that the motion to reconsider be laid upon the table with no 
intervening action or debate, and any statements relating to the bill 
be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________