[Congressional Record (Bound Edition), Volume 145 (1999), Part 15]
[House]
[Pages 21900-21916]
[From the U.S. Government Publishing Office, www.gpo.gov]



                  VETERANS' MILLENNIUM HEALTH CARE ACT

  Mr. STUMP. Mr. Speaker, I move to suspend the rules and pass the bill 
(H.R. 2116) to amend title 38, United States Code, to establish a 
program of extended care services for veterans and to make other 
improvements in health care programs of the Department of Veterans 
Affairs, as amended.
  The Clerk read as follows:

                               H.R. 2116

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS; REFERENCES TO 
                   TITLE 38, UNITED STATES CODE.

       (a) Short Title.--This Act may be cited as the ``Veterans' 
     Millennium Health Care Act''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

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

                        TITLE I--ACCESS TO CARE

Sec. 101. Extended care services.
Sec. 102. Reimbursement for emergency treatment.
Sec. 103. Eligibility for care of combat-injured veterans.
Sec. 104. Access to care for military retirees.
Sec. 105. Benefits for persons disabled by participation in compensated 
              work therapy program.
Sec. 106. Pilot program of medical care for certain dependents of 
              enrolled veterans.
Sec. 107. Enhanced services program at designated medical centers.
Sec. 108. Counseling and treatment for veterans who have experienced 
              sexual trauma.

                    TITLE II--PROGRAM ADMINISTRATION

Sec. 201. Medical care collections.
Sec. 202. Health Services Improvement Fund.
Sec. 203. Veterans Tobacco Trust Fund.
Sec. 204. Authority to accept funds for education and training.
Sec. 205. Extension and revision of certain authorities.
Sec. 206. State Home grant program.
Sec. 207. Expansion of enhanced-use lease authority.
Sec. 208. Ineligibility for employment by Veterans Health 
              Administration of health care professionals who have lost 
              license to practice in one jurisdiction while still 
              licensed in another jurisdiction.

                        TITLE III--MISCELLANEOUS

Sec. 301. Review of proposed changes to operation of medical 
              facilities.
Sec. 302. Patient services at Department facilities.
Sec. 303. Report on assisted living services.
Sec. 304. Chiropractic treatment.
Sec. 305. Designation of hospital bed replacement building at Ioannis 
              A. Lougaris Department of Veterans Affairs Medical 
              Center, Reno, Nevada.

             TITLE IV--CONSTRUCTION AND FACILITIES MATTERS

Sec. 401. Authorization of major medical facility projects.
Sec. 402. Authorization of major medical facility leases.
Sec. 403. Authorization of appropriations.
       (c) 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--ACCESS TO CARE

     SEC. 101. EXTENDED CARE SERVICES.

       (a) Requirement To Provide Extended Care Services.--(1) 
     Chapter 17 is amended by inserting after section 1710 the 
     following new section:

     ``Sec. 1710A. Extended care services

       ``(a) The Secretary (subject to section 1710(a)(4) of this 
     title and subsection (c) of this section) shall operate and 
     maintain a program to provide extended care services to 
     eligible veterans in accordance with this section. Such 
     services shall include the following:
       ``(1) Geriatric evaluation.
       ``(2) Nursing home care (A) in facilities operated by the 
     Secretary, and (B) in community-based facilities through 
     contracts under section 1720 of this title.
       ``(3) Domiciliary services under section 1710(b) of this 
     title.
       ``(4) Adult day health care under section 1720(f) of this 
     title.
       ``(5) Such other noninstitutional alternatives to nursing 
     home care, including those described in section 1720C of this 
     title, as the Secretary considers reasonable and appropriate.
       ``(6) Respite care under section 1720B of this title.
       ``(b)(1) In carrying out subsection (a), the Secretary 
     shall provide extended care services which the Secretary 
     determines are needed (A) to any veteran in need of such care 
     for a service-connected disability, and (B) to any veteran 
     who is in need of such care and who has a service-connected 
     disability rated at 50 percent or more.
       ``(2) The Secretary, in making placements for nursing home 
     care in Department facilities, shall give highest priority to 
     veterans (A) who are in need of such care for a service-
     connected disability, or (B) who have a service-connected 
     disability rated at 50 percent or more. The Secretary shall 
     ensure that a veteran described in this subsection who 
     continues to need nursing home care shall not after placement 
     in a Department nursing home be transferred from the facility 
     without the consent of the veteran, or, in the event the 
     veteran cannot provide informed consent, the representative 
     of the veteran.
       ``(c)(1) The Secretary, in carrying out subsection (a), 
     shall prescribe regulations governing the priorities for the 
     provision of nursing home care in Department facilities so as 
     to ensure that priority for such care is given (A) for 
     patient rehabilitation, (B) for clinically complex patient 
     populations, and (C) for patients for whom there are not 
     other suitable placement options.
       ``(2) The Secretary may not furnish extended care services 
     for a non-service-connected disability other than in the case 
     of a veteran who has a service-connected disability rated at 
     50 percent or more unless the veteran agrees to pay to the 
     United States a copayment for extended care services of more 
     than 21 days in any year.
       ``(d)(1) A veteran who is furnished extended care services 
     under this chapter and who is required under subsection 
     (c)(2) to pay an amount to the United States in order to be 
     furnished such services shall be liable to the United States 
     for that amount.
       ``(2) In implementing subsection (c)(2), the Secretary 
     shall develop a methodology for establishing the amount of 
     the copayment for which a veteran described in subsection (c) 
     is liable. That methodology shall provide for--
       ``(A) establishing a maximum monthly copayment (based on 
     all income and assets of the veteran and the spouse of such 
     veteran);
       ``(B) protecting the spouse of a veteran from financial 
     hardship by not counting all of the income and assets of the 
     veteran and spouse (in the case of a spouse who resides in 
     the community) as available for determining the copayment 
     obligation; and
       ``(C) allowing the veteran to retain a monthly personal 
     allowance.
       ``(e)(1) There is established in the Treasury of the United 
     States a revolving fund known as the Department of Veterans 
     Affairs Extended Care Fund (hereinafter in this section 
     referred to as the `fund'). Amounts in the fund shall be 
     available, without fiscal year limitation and without further 
     appropriation, exclusively for the purpose of providing 
     extended care services under subsection (a).
       ``(2) All amounts received by the Department under this 
     section shall be deposited in or credited to the fund.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after the item relating to section 
     1710 the following new item:

``1710A. Requirement to provide extended care.''.

       (b) Requirement To Increase Extended Care Services.--(1) 
     Not later than January

[[Page 21901]]

     1, 2000, the Secretary of Veterans Affairs shall develop and 
     begin to implement a plan for carrying out the recommendation 
     of the Federal Advisory Committee on the Future of Long-Term 
     Care to increase, above the level of extended care services 
     which were provided as of September 30, 1998--
       (A) the options and services for home and community-based 
     care for eligible veterans; and
       (B) the percentage of the Department of Veterans Affairs 
     medical care budget dedicated to such care.
       (2) The Secretary shall ensure that the staffing and level 
     of extended care services provided by the Secretary 
     nationally in facilities operated by the Secretary during any 
     fiscal year is not less than the level of such services 
     provided nationally in facilities operated by the Secretary 
     during fiscal year 1998.
       (c) Adult Day Health Care.--Section 1720(f)(1)(A) is 
     amended to read as follows:
       ``(f)(1)(A) The Secretary may furnish adult day health care 
     services to a veteran enrolled under section 1705(a) of this 
     title who would otherwise require nursing home care.''
       (d) Respite Care Program.--Section 1720B is amended--
       (1) in subsection (a), by striking ``eligible'' and 
     inserting ``enrolled'';
       (2) in subsection (b)--
       (A) by striking ``the term `respite care' means hospital or 
     nursing home care'' and inserting ``the term `respite care 
     services' means care and services'';
       (B) by striking ``is'' at the beginning of each of 
     paragraphs (1), (2), and (3) and inserting ``are''; and
       (C) by striking ``in a Department facility'' in paragraph 
     (2); and
       (3) by adding at the end the following new subsection:
       ``(c) In furnishing respite care services, the Secretary 
     may enter into contract arrangements.''.
       (e) Conforming Amendments.--Section 1710 is amended--
       (1) in subsection (a)(1), by striking ``may furnish nursing 
     home care,''; and
       (2) in subsection (a)(4), by inserting ``, and the 
     requirement in section 1710A of this title that the Secretary 
     provide a program of extended care services,'' after 
     ``medical services''.
       (f) State Homes.--Section 1741(a)(2) is amended by striking 
     ``adult day health care in a State home'' and inserting 
     ``extended care services described in any of paragraphs (4) 
     through (6) of section 1710A(a) of this title under a program 
     administered by a State home''.
       (g) Effective Date.--(1) Except as provided in paragraph 
     (2), the amendments made by this section shall take effect on 
     the date of the enactment of this Act.
       (2) Subsection (c)(2) of section 1710A(a) of title 38, 
     United States Code (as added by subsection (a)), shall take 
     effect on the effective date of regulations prescribed by the 
     Secretary of Veterans Affairs under subsections (c)(2) and 
     (d) of such section. The Secretary shall publish the 
     effective date of such regulations in the Federal Register.
       (3) The provisions of section 1710(f) of title 38, United 
     States Code, shall not apply to any day of nursing home care 
     on or after the effective date of regulations under paragraph 
     (2).

     SEC. 102. REIMBURSEMENT FOR EMERGENCY TREATMENT.

       (a) Authority To Provide Reimbursement.--Chapter 17 is 
     amended by inserting after section 1724 the following new 
     section:

     ``Sec. 1725. Reimbursement for emergency treatment

       ``(a) General Authority.--(1) Subject to subsections (c) 
     and (d), the Secretary may reimburse a veteran described in 
     subsection (b) for the reasonable value of emergency 
     treatment furnished the veteran in a non-Department facility.
       ``(2) In any case in which reimbursement is authorized 
     under subsection (a)(1), the Secretary, in the Secretary's 
     discretion, may, in lieu of reimbursing the veteran, make 
     payment of the reasonable value of the furnished emergency 
     treatment directly--
       ``(A) to a hospital or other health care provider that 
     furnished the treatment; or
       ``(B) to the person or organization that paid for such 
     treatment on behalf of such veteran.
       ``(b) Eligibility.--(1) A veteran referred to in subsection 
     (a)(1) is an individual who is an active Department health-
     care participant who is personally liable for emergency 
     treatment furnished the veteran in a non-Department facility.
       ``(2) A veteran is an active Department health-care 
     participant if the veteran--
       ``(A) is described in any of paragraphs (1) through (6) of 
     section 1705(a) of this title;
       ``(B) is enrolled in the health care system established 
     under such section; and
       ``(C) received care under this chapter within the 12-month 
     period preceding the furnishing of such emergency treatment.
       ``(3) A veteran is personally liable for emergency 
     treatment furnished the veteran in a non-Department facility 
     if the veteran--
       ``(A) is financially liable to the provider of emergency 
     treatment for that treatment;
       ``(B) has no entitlement to care or services under a 
     health-plan contract;
       ``(C) has no other contractual or legal recourse against a 
     third party that would, in whole or in part, extinguish such 
     liability to the provider; and
       ``(D) is not eligible for reimbursement for medical care or 
     services under section 1728 of this title.
       ``(c) Limitations on Reimbursement.--(1) The Secretary, in 
     accordance with regulations prescribed by the Secretary, 
     shall--
       ``(A) establish the maximum amount payable under subsection 
     (a);
       ``(B) delineate the circumstances under which such payments 
     may be made, to include such requirements on requesting 
     reimbursement as the Secretary shall establish; and
       ``(C) provide that in no event may a payment under that 
     subsection include any amount for which the veteran is not 
     personally liable.
       ``(2) Subject to paragraph (1), the Secretary may provide 
     reimbursement under this section only after the veteran or 
     the provider of emergency treatment has exhausted without 
     success all claims and remedies reasonably available to the 
     veteran or provider against a third party for payment of such 
     treatment.
       ``(3) Payment by the Secretary under this section, on 
     behalf of a veteran described in subsection (b), to a 
     provider of emergency treatment, shall, unless rejected and 
     refunded by the provider within 30 days of receipt, 
     extinguish any liability on the part of the veteran for that 
     treatment. Neither the absence of a contract or agreement 
     between the Secretary and the provider nor any provision of a 
     contract, agreement, or assignment to the contrary shall 
     operate to modify, limit, or negate the requirement in the 
     preceding sentence.
       ``(d) Independent Right of Recovery.--(1) In accordance 
     with regulations prescribed by the Secretary, the United 
     States shall have the independent right to recover any amount 
     paid under this section when, and to the extent that, a third 
     party subsequently makes a payment for the same emergency 
     treatment.
       ``(2) Any amount paid by the United States to the veteran 
     (or the veteran's personal representative, successor, 
     dependents, or survivors) or to any other person or 
     organization paying for such treatment shall constitute a 
     lien in favor of the United States against any recovery the 
     payee subsequently receives from a third party for the same 
     treatment.
       ``(3) Any amount paid by the United States to the provider 
     that furnished the veteran's emergency treatment shall 
     constitute a lien against any subsequent amount the provider 
     receives from a third party for the same emergency treatment 
     for which the United States made payment.
       ``(4) The veteran (or the veteran's personal 
     representative, successor, dependents, or survivors) shall 
     ensure that the Secretary is promptly notified of any payment 
     received from any third party for emergency treatment 
     furnished to the veteran. The veteran (or the veteran's 
     personal representative, successor, dependents, or survivors) 
     shall immediately forward all documents relating to such 
     payment, cooperate with the Secretary in the investigation of 
     such payment, and assist the Secretary in enforcing the 
     United States right to recover any payment made under 
     subsection (c)(3).
       ``(e) Waiver.--The Secretary, in the Secretary's 
     discretion, may waive recovery of a payment made to a veteran 
     under this section that is otherwise required by subsection 
     (d)(1) when the Secretary determines that such waiver would 
     be in the best interest of the United States, as defined by 
     regulations prescribed by the Secretary.
       ``(f) Definitions.--For purposes of this section:
       ``(1) The term `emergency treatment' means medical care or 
     services furnished, in the judgment of the Secretary--
       ``(A) when Department or other Federal facilities are not 
     feasibly available and an attempt to use them beforehand 
     would not be reasonable;
       ``(B) when such care or services are rendered in a medical 
     emergency of such nature that delay would be hazardous to 
     life or health; and
       ``(C) until such time as the veteran can be transferred 
     safely to a Department facility or other Federal facility.
       ``(2) The term `health-plan contract' includes any of the 
     following:
       ``(A) An insurance policy or contract, medical or hospital 
     service agreement, membership or subscription contract, or 
     similar arrangement under which health services for 
     individuals are provided or the expenses of such services are 
     paid.
       ``(B) An insurance program described in section 1811 of the 
     Social Security Act (42 U.S.C. 1395c) or established by 
     section 1831 of such Act (42 U.S.C. 1395j).
       ``(C) A State plan for medical assistance approved under 
     title XIX of such Act (42 U.S.C. 1396 et seq.).
       ``(D) A workers' compensation law or plan described in 
     section 1729(a)(2)(A) of this title.
       ``(E) A law of a State or political subdivision described 
     in section 1729(a)(2)(B) of this title.
       ``(3) The term `third party' means any of the following:
       ``(A) A Federal entity.
       ``(B) A State or political subdivision of a State.

[[Page 21902]]

       ``(C) An employer or an employer's insurance carrier.
       ``(D) An automobile accident reparations insurance carrier.
       ``(E) A person or entity obligated to provide, or to pay 
     the expenses of, health services under a health-plan 
     contract.''.
       (b) Conforming Amendments.--(1) Section 1729A(b) is 
     amended--
       (A) by redesignating paragraph (6) as paragraph (7); and
       (B) by inserting after paragraph (5) the following new 
     paragraph:
       ``(6) Section 1725 of this title.''.
       (2) The table of sections at the beginning of chapter 17 is 
     amended by inserting after the item relating to section 1724 
     the following new item:

``1725. Reimbursement for emergency treatment.''.

       (c) Effective Date.--The amendments made by this section 
     shall take effect 180 days after the date of the enactment of 
     this Act.
       (d) Implementation Reports.--The Secretary of Veterans 
     Affairs shall include with the budget justification materials 
     submitted to Congress in support of the Department of 
     Veterans Affairs budget for fiscal year 2002 and for fiscal 
     year 2003 a report on the implementation of section 1725 of 
     title 38, United States Code, as added by subsection (a). 
     Each such report shall include information on the experience 
     of the Department under that section and the costs incurred, 
     and expected to be incurred, under that section.

     SEC. 103. ELIGIBILITY FOR CARE OF COMBAT-INJURED VETERANS.

       (a) Priority of Care.--Chapter 17 is amended --
       (1) in section 1710(a)(2)(D), by inserting ``or who was 
     injured in combat'' after ``former prisoner of war''; and
       (2) in section 1705(a)(3), by inserting ``or who were 
     injured in combat'' after ``former prisoners of war''.
       (b) Definition of Injured in Combat.--Section 1701 is 
     amended by adding at the end the following new paragraph:
       ``(10) The term `injured in combat' means wounded in action 
     as the result of an act of an enemy of the United States or 
     otherwise wounded in action by weapon fire while directly 
     engaged in armed conflict (other than as the result of 
     willful misconduct by the wounded individual).''.

     SEC. 104. ACCESS TO CARE FOR MILITARY RETIREES.

       (a) Improved Access.--(1) Section 1710(a)(2) is amended--
       (A) by striking ``or'' at the end of subparagraph (F);
       (B) by striking the period at the end of subparagraph (G) 
     and inserting ``; or''; and
       (C) by adding at the end the following new subparagraph:
       ``(H) who has retired from active military, naval, or air 
     service in the Army, Navy, Air Force, or Marine Corps, is 
     eligible for care under the TRICARE program established by 
     the Secretary of Defense, and is not otherwise described in 
     paragraph (1) or in this paragraph.''.
       (2) Section 1705(a) is amended--
       (A) by redesignating paragraph (7) as paragraph (8);
       (B) by inserting after paragraph (6) the following new 
     paragraph (7):
       ``(7) Veterans who are eligible for hospital care, medical 
     services, and nursing home care under section 1710(a)(2)(H) 
     of this title.''; and
       (C) in paragraph (6), by inserting ``(other than 
     subparagraph (H) of such section)'' before the period at the 
     end.
       (b) Interagency Agreement.--(1) The Secretary of Defense 
     shall enter into an agreement (characterized as a memorandum 
     of understanding or otherwise) with the Secretary of Veterans 
     Affairs with respect to the provision of medical care by the 
     Secretary of Veterans Affairs to eligible military retirees 
     in accordance with the amendments made by subsection (a). 
     That agreement shall include provisions for reimbursement of 
     the Secretary of Veterans Affairs by the Secretary of Defense 
     for medical care provided by the Secretary of Veterans 
     Affairs to an eligible military retiree and may include such 
     other provisions with respect to the terms and conditions of 
     such care as may be agreed upon by the two Secretaries.
       (2) Reimbursement under that agreement shall be in 
     accordance with rates agreed upon by the Secretary of Defense 
     and the Secretary of Veterans Affairs. Such reimbursement may 
     be made by the Secretary of Defense or by the appropriate 
     TRICARE Managed Care Support contractor, as determined in 
     accordance with that agreement.
       (3) In entering into the agreement under paragraph (1), 
     particularly with respect to determination of the rates of 
     reimbursement under paragraph (2), the Secretary of Defense 
     shall consult with TRICARE Managed Care Support contractors.
       (4) The Secretary of Veterans Affairs may not enter into an 
     agreement under paragraph (1) for the provision of care in 
     accordance with the amendments made by subsection (a) with 
     respect to any geographic service area, or a part of any such 
     area, of the Veterans Health Administration unless--
       (A) in the judgment of that Secretary, the Department of 
     Veterans Affairs will recover the costs of providing such 
     care to eligible military retirees; and
       (B) that Secretary has certified and documented, with 
     respect to any geographic service area in which the Secretary 
     proposes to provide care in accordance with the amendments 
     made by subsection (a), that such geographic service area, or 
     designated part of any such area, has adequate capacity 
     (consistent with the requirements in section 1705(b)(1) of 
     title 38, United States Code, that care to enrollees shall be 
     timely and acceptable in quality) to provide such care.
       (5) The agreement under paragraph (1) shall be entered into 
     by the Secretaries not later than nine months after the date 
     of the enactment of this Act. If the Secretaries are unable 
     to reach agreement, they shall jointly report, by that date 
     or within 30 days thereafter, to the Committees on Armed 
     Services and the Committees on Veterans' Affairs of the 
     Senate and House of Representatives on the reasons for their 
     inability to reach an agreement and their mutually agreed 
     plan for removing any impediments to final agreement.
       (c) Depositing of Reimbursements.--Amounts received by the 
     Secretary of Veterans Affairs under the agreement under 
     subsection (b) shall be deposited in the Department of 
     Veterans Affairs Health Services Improvement Fund established 
     under section 1729B of title 38, United States Code, as added 
     by section 202.
       (d) Phased Implementation.--(1) The Secretary of Defense 
     shall include in each TRICARE contract entered into after the 
     date of the enactment of this Act provisions to implement the 
     agreement under subsection (b).
       (2) The amendments made by subsection (a) and the 
     provisions of the agreement under subsection (b)(2) shall 
     apply to the furnishing of medical care by the Secretary of 
     Veterans Affairs in any area of the United States only if 
     that area is covered by a TRICARE contract that was entered 
     into after the date of the enactment of this Act.
       (e) Eligible Military Retirees.--For purposes of subsection 
     (b), an eligible military retiree is a member of the Army, 
     Navy, Air Force, or Marine Corps who--
       (1) has retired from active military, naval, or air 
     service;
       (2) is eligible for care under the TRICARE program 
     established by the Secretary of Defense;
       (3) has enrolled for care under section 1705 of title 38, 
     United States Code; and
       (4) is not described in paragraph (1) or (2) of section 
     1710(a) of such title (other than subparagraph (H) of such 
     paragraph (2)), as amended by subsection (a).

     SEC. 105. BENEFITS FOR PERSONS DISABLED BY PARTICIPATION IN 
                   COMPENSATED WORK THERAPY PROGRAM.

       Section 1151(a)(2) is amended--
       (1) by inserting ``(A)'' after ``proximately caused''; and
       (2) by inserting before the period at the end the 
     following: ``, or (B) by participation in a program (known as 
     a `compensated work therapy program') under section 1718 of 
     this title''.

     SEC. 106. PILOT PROGRAM OF MEDICAL CARE FOR CERTAIN 
                   DEPENDENTS OF ENROLLED VETERANS.

       (a) In General.--(1) Chapter 17 is amended by inserting 
     after section 1713 the following new section:

     ``Sec. 1713A. Medical care for certain dependents of enrolled 
       veterans: pilot program

       ``(a) The Secretary may, during the program period, carry 
     out a pilot program to provide primary health care services 
     for eligible dependents of veterans in accordance with this 
     section.
       ``(b) For purposes of this section:
       ``(1) The term `program period' means the period beginning 
     on the first day of the first month beginning more than 180 
     days after the date of the enactment of this section and 
     ending three years after that day.
       ``(2) The term `eligible dependent' means an individual 
     who--
       ``(A) is the spouse or child of a veteran who is enrolled 
     in the system of patient enrollment established by the 
     Secretary under section 1705 of this title; and
       ``(B) is determined by the Secretary to have the ability to 
     pay for such care or services either directly or through 
     reimbursement or indemnification from a third party.
       ``(c) The Secretary may furnish health care services to an 
     eligible dependent under this section only if the dependent 
     (or, in the case of a minor, the parent or guardian of the 
     dependent) agrees--
       ``(1) to pay to the United States an amount representing 
     the reasonable charges for the care or services furnished (as 
     determined by the Secretary); and
       ``(2) to cooperate with and provide the Secretary an 
     appropriate assignment of benefits, authorization to release 
     medical records, and any other executed documents, 
     information, or evidence reasonably needed by the Secretary 
     to recover the Department's charges for the care or services 
     furnished by the Secretary.
       ``(d)(1) The health care services provided under the pilot 
     program under this section may consist of such primary 
     hospital care services and such primary medical services as 
     may be authorized by the Secretary. The Secretary may furnish 
     those services directly through a Department medical facility 
     or, subject to paragraphs (2) and (3), pursuant to a contract 
     or other agreement with

[[Page 21903]]

     a non-Department facility (including a health-care provider, 
     as defined in section 8152(2) of this title).
       ``(2) The Secretary may enter into a contract or agreement 
     to furnish primary health care services under this section in 
     a non-Department facility on the same basis as provided under 
     subsections (a) and (b) of section 1703 of this title or may 
     include such care in an existing or new agreement under 
     section 8153 of this title when the Secretary determines it 
     to be in the best interest of the prevailing standards of the 
     Department medical care program.
       ``(3) Primary health care services may not be authorized to 
     be furnished under this section at any medical facility if 
     the furnishing of those services would result in the denial 
     of, or a delay in providing, access to care for any enrolled 
     veteran at that facility.
       ``(e)(1) In the case of an eligible dependent who is 
     furnished primary health care services under this section and 
     who has coverage under a health-plan contract, as defined in 
     section 1729(i)(1) of this title, the United States shall 
     have the right to recover or collect the reasonable charges 
     for such care or services from such health-plan contract to 
     the extent that the individual or the provider of the care or 
     services would be eligible to receive payment for such care 
     or services from such health-plan contract if the care or 
     services had not been furnished by a department or agency of 
     the United States.
       ``(2) The right of the United States to recover under 
     paragraph (1) shall be enforceable with respect to an 
     eligible dependent in the same manner as applies under 
     subsections (a)(3), (b), (c)(1), (c)(2), (d), (f), (h), and 
     (i) of section 1729 of this title with respect to a veteran.
       ``(f)(1) Subject to paragraphs (2) and (3), the pilot 
     program under this section shall be carried out during the 
     program period in not more than four veterans integrated 
     service networks, as designated by the Secretary. In 
     designating networks under the preceding sentence, the 
     Secretary shall favor designation of networks that are suited 
     to serve dependents of veterans because of--
       ``(A) the capability of one or more medical facilities 
     within the network to furnish primary health care services to 
     eligible dependents while assuring that veterans continue to 
     receive priority for care and services;
       ``(B) the demonstrated success of such medical facilities 
     in billings and collections;
       ``(C) support for initiating such a pilot program among 
     veterans in the network; and
       ``(D) such other criteria as the Secretary considers 
     appropriate.
       ``(2) In implementing the pilot program, the Secretary may 
     not provide health care services for dependents who are 
     children--
       ``(A) in more than one of the participating networks during 
     the first year of the program period; and
       ``(B) in more than two of the participating networks during 
     the second year of the program period.
       ``(3) In implementing the pilot program, the Secretary 
     shall give priority to facilities which operate women 
     veterans' clinics.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after the item relating to section 
     1713 the following new item:

``1713A. Medical care for certain dependents and enrolled veterans: 
              pilot program.''.

       (b) GAO Review and Recommendations.--(1) Beginning six 
     months after the commencement of the pilot program, the 
     Comptroller General, in consultation with the Under Secretary 
     for Health of the Department of Veterans Affairs, shall 
     monitor the conduct of the pilot program.
       (2) Not later than 14 months after the commencement of the 
     pilot program, the Comptroller General shall submit to the 
     Secretary of Veterans Affairs a report setting forth the 
     Comptroller General's findings and recommendations with 
     respect to the first 12 months of operation of the pilot 
     program.
       (3)(A) The report under paragraph (2) shall include the 
     findings of the Comptroller General regarding--
       (i) whether the collection of reasonable charges for the 
     care or services provided reasonably covers the costs of 
     providing such care and services; and
       (ii) whether the Secretary, in carrying out the program, is 
     in compliance with the limitation in subsection (d)(3) of 
     section 1713A of title 38, United States Code, as added by 
     subsection (a).
       (B) The report shall include the recommendations of the 
     Comptroller General regarding any remedial steps that the 
     Secretary should take in the conduct of the program or in the 
     billing and collection of charges under the program.
       (4) The Secretary, in consultation with, and following 
     receipt of the report of, the Comptroller General, shall take 
     such steps as may be needed to ensure that any 
     recommendations of the Comptroller General in the report 
     under paragraph (2) with respect to billings and collections, 
     and with respect to compliance with the limitation in 
     subsection (d)(3) of such section, are carried out.
       (5) For purposes of this subsection, the term 
     ``commencement of the pilot program'' means the date on which 
     the Secretary of Veterans Affairs begins to furnish services 
     to eligible dependents under the pilot program under section 
     1713A of title 38, United States Code, as added by subsection 
     (a).

     SEC. 107. ENHANCED SERVICES PROGRAM AT DESIGNATED MEDICAL 
                   CENTERS.

       (a) Findings.--Congress makes the following findings:
       (1) Historically, health care facilities under the 
     jurisdiction of the Department of Veterans Affairs have not 
     consistently been located in proximity to veteran population 
     concentrations.
       (2) Hospital occupancy rates at numbers of Department 
     medical centers are at levels substantially below a level 
     needed for efficient operation and optimal quality of care.
       (3) The costs of maintaining highly inefficient medical 
     centers, which were designed and constructed decades ago to 
     standards no longer considered acceptable, substantially 
     diminish the availability of resources which could be devoted 
     to the provision of needed direct care services.
       (4) Freeing resources currently devoted to highly 
     inefficient provision of hospital care could, through 
     contracting for acute hospital care and establishing new 
     facilities for provision of outpatient care, yield improved 
     access and service to veterans.
       (b) Enhanced Services Program at Designated Medical 
     Centers.--The Secretary of Veterans Affairs, in carrying out 
     the responsibilities of the Secretary to furnish hospital 
     care and medical services through network-based planning, 
     shall establish an enhanced service program at Department 
     medical centers (hereinafter in this section referred to as 
     ``designated centers'') that are designated by the Secretary 
     for the purposes of this section. Medical centers shall be 
     designated to improve access, and quality of service 
     provided, to veterans served by those medical centers. The 
     Secretary may designate a medical center for the program only 
     if the Secretary determines, on the basis of a market and 
     data analysis (which shall include a study of the cost-
     effectiveness of the care provided at such center), that the 
     medical center--
       (1) can, in whole or in part, no longer be operated in a 
     manner that provides hospital or other care efficiently and 
     at optimal quality because of such factors as--
       (A) the current and projected need for hospital or other 
     care capacity at such center;
       (B) the extent to which the facility is functionally 
     obsolete; and
       (C) the cost of operation and maintenance of the physical 
     plant; and
       (2) is located in proximity (A) to one or more community 
     hospitals which have the capacity to provide primary and 
     secondary hospital care of appropriate quality to veterans 
     under contract arrangements with the Secretary which the 
     Secretary determines are advantageous to the Department, or 
     (B) to another Department medical center which is capable of 
     absorbing some or all of the patient workload of such medical 
     center.
       (c) Medical Center Plan.--The Secretary shall, with respect 
     to each designated center, develop a plan aimed at improving 
     the accessibility and quality of service provided to 
     veterans. Each plan shall be developed in accordance with the 
     requirements for strategic network-based planning described 
     in section 8107 of title 38, United States Code. In the plan 
     for a designated center, the Secretary shall describe a 
     program which, if implemented, would allow the Secretary to 
     do any of the following:
       (1) Provide for a Department facility described in 
     subsection (b)(2)(B) to absorb some or all of the patient 
     workload of the designated center.
       (2) Contract, under such arrangements as the Secretary 
     determines appropriate, for needed primary and secondary 
     hospital care for veterans--
       (A) who reside in the catchment area of each designated 
     center;
       (B) who are described in paragraphs (1) through (6) of 
     section 1705(a) of title 38, United States Code; and
       (C) whom the Secretary has enrolled for care pursuant to 
     section 1705 of title 38, United States Code.
       (3) Cease to provide hospital care, or hospital care and 
     other medical services, at such center.
       (4) If practicable, lease, under subchapter V of chapter 81 
     of title 38, United States Code, land and improvements which 
     had been dedicated to providing care described in paragraph 
     (3).
       (5) Establish, through reallocation of operational funds 
     and through appropriate lease arrangements or renovations, 
     facilities for--
       (A) delivery of outpatient care; and
       (B) services which would obviate a need for nursing home 
     care or other long-term institutional care.
       (d) Employee Protections.--(1) In entering into any 
     contract or lease under subsection (c), the Secretary shall 
     attempt to ensure that employees of the Secretary who would 
     be displaced under this section be given priority in hiring 
     by such contractor, lessee, or other entity.
       (2) In carrying out subsection (c)(5), the Secretary shall 
     give preference to providing services through employee-based 
     delivery models.
       (e) Required Consultation.--In developing a plan under 
     subsection (c), the Secretary shall obtain the views of 
     veterans organizations, exclusive employee representatives,

[[Page 21904]]

     and other interested parties and provide for such 
     organizations and parties to participate in the development 
     of the plan.
       (f) Submission of Plan to Congress.--The Secretary may not 
     implement a plan described in subsection (c) with respect to 
     a medical center unless the Secretary has first submitted a 
     report containing a detailed plan and justification to the 
     appropriate committees of Congress. No action to carry out 
     such plan may be taken after the submission of such report 
     until the end of a 45-day period following the date of the 
     submission of the report, not less than 30 days of which 
     shall be days during which Congress shall have been in 
     continuous session. For purposes of the preceding sentence, 
     continuity of a session of Congress is broken only by 
     adjournment sine die, and there shall be excluded from the 
     computation of any period of continuity of session any day 
     during which either House of Congress is not in session 
     during an adjournment of more than three days to a day 
     certain.
       (g) Implementation of Plan.--In carrying out the plan 
     described in subsection (c), or a modification to that plan 
     following the submission of such plan to the appropriate 
     committees of Congress, the Secretary--
       (1) may, without regard to any limitation under section 
     1703 of title 38, United States Code, contract for hospital 
     care for veterans who are--
       (A) described in paragraphs (1) through (6) of section 
     1705(a) of title 38, United States Code; and
       (B) enrolled under subsection (a) of such section 1705;
       (2) may enter into any contract under section 8153 of title 
     38, United States Code;
       (3) shall, in exercising the authority of the Secretary 
     under this section to contract for hospital care, provide for 
     ongoing oversight and management, by employees of the 
     Department, of the hospital care furnished such veterans; and
       (4) shall, in the case of a designated center which ceases 
     to provide services under the program--
       (A) ensure a reallocation of funds as provided in 
     subsection (h); and
       (B) provide reemployment assistance to employees.
       (h) Funds Allocation.--In carrying out subsection (g)(4), 
     the Secretary shall ensure that not less than 90 percent of 
     the funds that would have been made available to a designated 
     center to support the provision of services, but for such 
     mission change, shall be made available to the appropriate 
     health care region of the Veterans Health Administration to 
     ensure that the implementation of the plan under subsection 
     (g) will result in demonstrable improvement in the 
     accessibility, and quality of service provided, to veterans 
     in the catchment area of such center.
       (i) Specialized Services.--The provisions of this section 
     do not diminish the obligations of the Secretary under 
     section 1706(b) of title 38, United States Code.
       (j) Report.--Not later than 12 months after implementation 
     of any plan under subsection (b), the Secretary shall submit 
     to Congress a report on the implementation of the enhanced 
     service program.
       (k) Residual Authority.--Nothing in this section may be 
     construed to diminish the authority of the Secretary to--
       (1) consolidate, eliminate, abolish, or redistribute the 
     functions or missions of facilities in the Department;
       (2) revise the functions or missions of any such facility 
     or activity; or
       (3) create new facilities or activities in the Department.

     SEC. 108. COUNSELING AND TREATMENT FOR VETERANS WHO HAVE 
                   EXPERIENCED SEXUAL TRAUMA.

       (a) Extension of Period of Program.--Subsection (a) of 
     section 1720D is amended--
       (1) in paragraph (1), by striking ``December 31, 2001'' and 
     inserting ``December 31, 2002''; and
       (2) in paragraph (3), by striking ``December 31, 2001'' and 
     inserting ``December 31, 2002''.
       (b) Mandatory Nature of Program.--(1) Subsection (a)(1) of 
     such section is further amended by striking ``may provide 
     counseling to a veteran who the Secretary determines requires 
     such counseling'' and inserting ``shall operate a program 
     under which the Secretary provides counseling and appropriate 
     care and services to veterans who the Secretary determines 
     require such counseling and care and services''.
       (2) Subsection (a) of such section is further amended--
       (A) by striking paragraph (2); and
       (B) by redesignating paragraph (3) (as amended by 
     subsection (a)(2)) as paragraph (2).
       (c) Outreach Efforts.--Subsection (c) of such section is 
     amended--
       (1) by inserting ``and treatment'' in the first sentence 
     and in paragraph (2) after ``counseling'';
       (2) by striking ``and'' at the end of paragraph (1);
       (3) by redesignating paragraph (2) as paragraph (3); and
       (4) by inserting after paragraph (1) the following new 
     paragraph (2):
       ``(2) shall ensure that information about the counseling 
     and treatment available to veterans under this section--
       ``(A) is revised and updated as appropriate;
       ``(B) is made available and visibly posted at appropriate 
     facilities of the Department; and
       ``(C) is made available through appropriate public 
     information services; and''.
       (d) Report on Implementation of Outreach Activities.--Not 
     later than six months after the date of the enactment of this 
     Act, the Secretary of Veterans Affairs shall submit to the 
     Committees on Veterans' Affairs of the Senate and House of 
     Representatives a report on the Secretary's implementation of 
     paragraph (2) of section 1720D(c) of title 38, United States 
     Code, as added by subsection (c). Such report shall include 
     examples of the documents and other means of communication 
     developed for compliance with that paragraph.
       (e) Study of Expanding Eligibility for Counseling and 
     Treatment.--(1) The Secretary of Veterans Affairs, in 
     consultation with the Secretary of Defense, shall conduct a 
     study to determine--
       (A) the extent to which former members of the reserve 
     components of the Armed Forces experienced physical assault 
     of a sexual nature or battery of a sexual nature while 
     serving on active duty for training;
       (B) the extent to which such former members have sought 
     counseling from the Department of Veterans Affairs relating 
     to those incidents; and
       (C) the additional resources that, in the judgment of the 
     Secretary, would be required to meet the projected need of 
     those former members for such counseling.
       (2) Not later than 16 months after the date of the 
     enactment of this Act, the Secretary of Veterans Affairs 
     shall submit to the Committees on Veterans' Affairs of the 
     Senate and House of Representatives a report on the results 
     of the study conducted under paragraph (1).
       (f) Oversight of Outreach Activities.--Not later than 14 
     months after the date of the enactment of this Act, the 
     Secretary of Veterans Affairs and the Secretary of Defense 
     shall submit to the appropriate congressional committees a 
     joint report describing in detail the collaborative efforts 
     of the Department of Veterans Affairs and the Department of 
     Defense to ensure that members of the Armed Forces, upon 
     separation from active military, naval, or air service, are 
     provided appropriate and current information about programs 
     of the Department of Veterans Affairs to provide counseling 
     and treatment for sexual trauma that may have been 
     experienced by those members while in the active military, 
     naval, or air service, including information about 
     eligibility requirements for, and procedures for applying 
     for, such counseling and treatment. The report shall include 
     proposed recommendations from both the Secretary of Veterans 
     Affairs and the Secretary of Defense for the improvement of 
     their collaborative efforts to provide such information.
       (g) Report on Implementation of Sexual Trauma Treatment 
     Program.--Not later than 14 months after the date of the 
     enactment of this Act, the Secretary of Veterans Affairs 
     shall submit to the Committees on Veterans' Affairs of the 
     Senate and House of Representatives a report on the use made 
     of the authority provided under section 1720D of title 38, 
     United States Code, as amended by this section. The report 
     shall include the following with respect to activities under 
     that section since the enactment of this Act:
       (1) The number of veterans who have received counseling 
     under that section.
       (2) The number of veterans who have been referred to non-
     Department mental health facilities and providers in 
     connection with sexual trauma counseling and treatment.

                    TITLE II--PROGRAM ADMINISTRATION

     SEC. 201. MEDICAL CARE COLLECTIONS.

       (a) Limited Authority To Set Copayments.--(1) Section 1722A 
     is amended--
       (A) by redesignating subsections (b) and (c) as subsections 
     (c) and (d), respectively;
       (B) by inserting after subsection (a) the following new 
     subsection (b):
       ``(b) The Secretary, pursuant to regulations which the 
     Secretary shall prescribe, may--
       ``(1) increase the copayment amount in effect under 
     subsection (a);
       ``(2) establish a maximum annual pharmaceutical copayment 
     amount under subsection (a) for veterans who have multiple 
     outpatient prescriptions; and
       ``(3) require a veteran, other than a veteran described in 
     subsection (a)(3), to pay to the United States a reasonable 
     copayment for sensori-neural aids, electronic equipment, and 
     any other costly item or equipment furnished the veteran for 
     a nonservice-connected condition, other than a wheelchair or 
     artificial limb.''; and
       (C) in subsection (c), as redesignated by subparagraph 
     (A)--
       (i) by striking ``this section'' and inserting ``subsection 
     (a)''; and
       (ii) by adding at the end the following new sentence: 
     ``Amounts collected through use of the authority under 
     subsection (b) shall be deposited in Department of Veterans 
     Affairs Health Services Improvement Fund.''.
       (2)(A) The heading of such section is amended to read as 
     follows:

[[Page 21905]]



     ``Sec. 1722A. Copayments for medications and certain costly 
       items and equipment''.

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

``1722A. Copayments for medications and certain costly items and 
              equipment.''.

       (b) Outpatient Treatment of Category C Veterans.--(1) 
     Section 1710(g) is amended--
       (A) in paragraph (1), by striking ``the amount under 
     paragraph (2) of this subsection'' and inserting ``in the 
     case of each outpatient visit the applicable amount or 
     amounts established by the Secretary by regulation''; and
       (B) in paragraph (2), by striking all after ``for an 
     amount'' and inserting ``which the Secretary shall establish 
     by regulation.''.

     SEC. 202. HEALTH SERVICES IMPROVEMENT FUND.

       (a) Establishment of Fund.--Chapter 17 is amended by 
     inserting after section 1729A the following new section:

     ``Sec. 1729B. Health Services Improvement Fund

       ``(a) There is established in the Treasury of the United 
     States a fund to be known as the `Department of Veterans 
     Affairs Health Services Improvement Fund'.
       ``(b) Amounts received or collected after the date of the 
     enactment of this section under any of the following 
     provisions of law shall be deposited in the fund:
       ``(1) Section 1713A of this title.
       ``(2) Section 1722A(b) of this title.
       ``(3) Section 8165(a) of this title.
       ``(4) Section 104(c) of the Veterans' Millennium Health 
     Care Act.
       ``(c) Amounts in the fund are hereby available, without 
     fiscal year limitation, to the Secretary for the purposes 
     stated in subparagraphs (A) and (B) of section 1729A(c)(1) of 
     this title.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of such chapter is amended by inserting after the 
     item relating to section 1729A the following new item:

``1729B. Health Services Improvement Fund.''.

     SEC. 203. VETERANS TOBACCO TRUST FUND.

       (a) Findings.--Congress finds the following:
       (1) Smoking related illnesses, including cancer, heart 
     disease, and emphysema, are highly prevalent among the more 
     than 3,000,000 veterans who use the Department of Veterans 
     Affairs health care system annually.
       (2) The Department of Veterans Affairs estimates that it 
     spent $3,600,000,000 in 1997 to treat smoking-related 
     illnesses and that over the next five years it will spend 
     $20,000,000,000 on such care.
       (3) Congress established the Department of Veterans Affairs 
     in furtherance of its constitutional power to provide for the 
     national defense in order to provide benefits and services to 
     veterans of the uniformed services.
       (4) There is in the Department of Veterans Affairs a health 
     care system which has as its primary function to provide a 
     complete medical and hospital service for the medical care 
     and treatment of such veterans as can be served through 
     available appropriations.
       (5) The Federal Government, including the Department of 
     Veterans Affairs, has lacked the means to prevent the onset 
     of smoking-related illnesses among veterans and has had no 
     authority to deny needed treatment to any veteran on the 
     basis that an illness is or might be smoking-related.
       (6) With some 20 percent of its health care budget absorbed 
     in treating smoking-related illnesses, the Department of 
     Veterans Affairs health care system has lacked resources to 
     provide needed nursing home care, home care, community-based 
     ambulatory care, and other services to tens of thousands of 
     other veterans.
       (7) The network of academically affiliated medical centers 
     of the Department of Veterans Affairs provides a unique 
     system within which outstanding medical research is conducted 
     and which has the potential to expand significantly ongoing 
     research on tobacco-related illnesses.
       (b) Establishment of Trust Fund.--(1) Chapter 17 is amended 
     by inserting after section 1729B, as added by section 202(a), 
     the following new section:

     ``Sec. 1729C. Veterans Tobacco Trust Fund

       ``(a) There is established in the Treasury of the United 
     States a trust fund to be known as the `Veterans Tobacco 
     Trust Fund', consisting of such amounts as may be 
     appropriated, credited, or donated to the trust fund.
       ``(b) If the United States pursues recovery (other than a 
     recovery authorized under this title) from a party or parties 
     specifically for health care costs incurred or to be incurred 
     by the United States that are attributable to tobacco-related 
     illnesses, there shall be credited to the trust fund from the 
     amount of any such recovery by the United States, without 
     further appropriation, the amount that bears the same ratio 
     to the amount recovered as the amount of the Department's 
     costs for health care attributable to tobacco-related 
     illnesses for which recovery is sought bears to the total 
     amount sought by the United States.
       ``(c) After September 30, 2004, amounts in the trust fund 
     shall be available, without fiscal year limitation, to the 
     Secretary for the following purposes:
       ``(1) Furnishing medical care and services under this 
     chapter, to be available during any fiscal year for the same 
     purposes and subject to the same limitations (other than with 
     respect to the period of availability for obligation) as 
     apply to amounts appropriated from the general fund of the 
     Treasury for that fiscal year for medical care.
       ``(2) Conducting medical research, rehabilitation research, 
     and health systems research, with particular emphasis on 
     research relating to prevention and treatment of, and 
     rehabilitation from, tobacco addiction and diseases 
     associated with tobacco use.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after the item relating to section 
     1729B, as added by section 202(b), the following new item:

``1729C. Veterans Tobacco Trust Fund.''.

     SEC. 204. AUTHORITY TO ACCEPT FUNDS FOR EDUCATION AND 
                   TRAINING.

       (a) Establishment of Nonprofit Corporations at Medical 
     Centers.--Section 7361(a) is amended--
       (1) by inserting ``and education'' after ``research''; and
       (2) by adding at the end the following: ``Such a 
     corporation may be established to facilitate either research 
     or education or both research and education.''.
       (b) Purpose of Corporations.--Section 7362 is amended--
       (1) in the first sentence, by inserting ``and education and 
     training as described in sections 7302, 7471, 8154, and 
     1701(6)(B) of this title'' after ``of this title''; and
       (2) in the second sentence--
       (A) by inserting ``or education'' after ``research''; and
       (B) by striking ``that purpose'' and inserting ``these 
     purposes''.
       (c) Board of Directors.--Section 7363(a) is amended--
       (1) in subsection (a)(1), by striking all after ``medical 
     center, and'' and inserting ``as appropriate, the assistant 
     chief of staff for research for the medical center and the 
     associate chief of staff for education for the medical 
     center, or, in the case of a facility at which such positions 
     do not exist, those officials who are responsible for 
     carrying out the responsibilities of the medical center 
     director, chief of staff, and, as appropriate, the assistant 
     chief of staff for research and the assistant chief for 
     education; and'';
       (2) in subsection (a)(2), by inserting ``or education, as 
     appropriate'' after ``research''; and
       (3) in subsection (c), by inserting ``or education'' after 
     ``research''.
       (d) Approval of Expenditures.--Section 7364 is amended by 
     adding at the end the following new subsection:
       ``(c)(1) 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.
       ``(2) The Under Secretary for Health shall prescribe 
     policies and procedures to guide the expenditure of funds by 
     corporations under paragraph (1) consistent with the purpose 
     of such corporations as flexible funding mechanisms.''.

     SEC. 205. EXTENSION AND REVISION OF CERTAIN AUTHORITIES.

       (a) Readjustment Counseling Program.--Section 
     1712A(a)(1)(B)(ii) is amended by striking ``2000'' and 
     inserting ``2003''.
       (b) Committee on Mentally Ill Veterans.--Section 7321(d)(2) 
     is amended by striking ``three'' and inserting ``five''.
       (c) Committee on Post-Traumatic Stress Disorder.--Section 
     110 of Public Law 98-528 (38 U.S.C. 1712A note) is amended--
       (1) in subsection (e)(1), by striking ``March 1, 1985'' and 
     inserting ``March 1, 2000''; and
       (2) in subsection (e)(2), by striking ``February 1, 1986'' 
     and inserting ``February 1, 2001''.
       (d) Extension of Authority To Make Grants.--Section 3(a)(2) 
     of the Homeless Veterans Comprehensive Service Programs Act 
     of 1992 (38 U.S.C. 7721 note) is amended by striking 
     ``September 30, 1999'' and inserting ``September 30, 2002''.
       (e) Authority To Make Grants for Homeless Veterans.--
     Section 3(b)(2) of the Homeless Veterans Comprehensive 
     Service Programs Act of 1992 (38 U.S.C. 7721 note) is amended 
     by striking ``and no more than 20 programs which incorporate 
     the procurement of vans as described in paragraph (1)''.

     SEC. 206. STATE HOME GRANT PROGRAM.

       (a) General Regulations.--Section 8134 is amended--
       (1) by redesignating subsection (b) as subsection (c);
       (2) by striking the matter in subsection (a) preceding 
     paragraph (2) and inserting the following:
       ``(a)(1) The Secretary shall prescribe regulations for the 
     purposes of this subchapter.
       ``(2) In those regulations, the Secretary shall prescribe 
     for each State the number of nursing home and domiciliary 
     beds for which assistance under this subchapter may be 
     furnished. Such regulations shall be based on projected 
     demand for such care 10 years after the date of the enactment 
     of the Veterans' Millennium Health Care Act by veterans who 
     at such time are 65 years of age or older and who reside in 
     that State. In determining such projected demand, the 
     Secretary shall take into account travel distances for 
     veterans and their families.

[[Page 21906]]

       ``(3)(A) In those regulations, the Secretary shall 
     establish criteria under which the Secretary shall determine, 
     with respect to an application for assistance under this 
     subchapter for a project described in subparagraph (B) which 
     is from a State that has a need for additional beds as 
     determined under subsections (a)(2) and (d)(1), whether the 
     need for such beds is most aptly characterized as great, 
     significant, or limited. Such criteria shall take into 
     account the availability of beds already operated by the 
     Secretary and other providers which appropriately serve the 
     needs which the State proposes to meet with its application.
       ``(B) This paragraph applies to a project for the 
     construction or acquisition of a new State home facility, to 
     a project to increase the number of beds available at a State 
     home facility, and a project to replace beds at a State home 
     facility.
       ``(4) The Secretary shall review and, as necessary, revise 
     regulations prescribed under paragraphs (2) and (3) not less 
     often than every four years.
       ``(b) The Secretary shall prescribe the following by 
     regulation:'';
       (3) by redesignating paragraphs (2) and (3) of subsection 
     (b), as designated by paragraph (2), as paragraphs (1) and 
     (2);
       (4) in subsection (c), as redesignated by paragraph (1), by 
     striking ``subsection (a)(3)'' and inserting ``subsection 
     (b)(2)''; and
       (5) by adding at the end the following new subsection:
       ``(d)(1) In prescribing regulations to carry out this 
     subchapter, the Secretary shall provide that in the case of a 
     State that seeks assistance under this subchapter for a 
     project described in subsection (a)(3)(B), the determination 
     of the unmet need for beds for State homes in that State 
     shall be reduced by the number of beds in all previous 
     applications submitted by that State under this subchapter, 
     including beds which have not been recognized by the 
     Secretary under section 1741 of this title.
       ``(2)(A) Financial assistance under this subchapter for a 
     renovation project may only be provided for a project for 
     which the total cost of construction is in excess of $400,000 
     (as adjusted from time to time in such regulations to reflect 
     changes in costs of construction).
       ``(B) For purposes of this paragraph, a renovation project 
     is a project to remodel or alter existing buildings for which 
     financial assistance under this subchapter may be provided 
     and does not include maintenance and repair work which is the 
     responsibility of the State.''.
       (b) Applications With Respect to Projects.--Section 8135 is 
     amended--
       (1) in subsection (a)--
       (A) by striking ``set forth--'' in the matter preceding 
     paragraph (1) and inserting ``set forth the following:'';
       (B) by capitalizing the first letter of the first word in 
     each of paragraphs (1) through (9);
       (C) by striking the comma at the end of each of paragraphs 
     (1) through (7) and inserting a period; and
       (D) by striking ``, and'' at the end of paragraph (8) and 
     inserting a period;
       (2) by redesignating subsections (b), (c), (d), and (e) as 
     subsections (c), (d), (e), and (f), respectively;
       (3) by inserting after subsection (a) the following new 
     subsection (b):
       ``(b)(1) Any State seeking to receive assistance under this 
     subchapter for a project that would involve construction or 
     acquisition of either nursing home or domiciliary facilities 
     shall include with its application under subsection (a) the 
     following:
       ``(A) Documentation (i) that the site for the project is in 
     reasonable proximity to a sufficient concentration and 
     population of veterans who are 65 years of age and older, and 
     (ii) that there is a reasonable basis to conclude that the 
     facilities when complete will be fully occupied.
       ``(B) A financial plan for the first three years of 
     operation of such facilities.
       ``(C) A five-year capital plan for the State home program 
     for that State.
       ``(2) Failure to provide adequate documentation under 
     paragraph (1)(A) or to provide an adequate financial plan 
     under paragraph (1)(B) shall be a basis for disapproving the 
     application.''; and
       (4) in subsection (c), as redesignated by paragraph (2)--
       (A) in paragraph (1), by striking ``for a grant under 
     subsection (a) of this section'' in the matter preceding 
     subparagraph (A) and inserting ``under subsection (a) for 
     financial assistance under this subchapter'';
       (B) in paragraph (2)--
       (i) by striking ``the construction or acquisition of'' in 
     subparagraph (A); and
       (ii) by striking subparagraphs (B), (C), and (D) and 
     inserting the following:
       ``(B) An application from a State for a project at an 
     existing facility to remedy a condition or conditions that 
     have been cited by an accrediting institution, by the 
     Secretary, or by a local licensing or approving body of the 
     State as being threatening to the lives or safety of the 
     patients in the facility.
       ``(C) An application from a State that has not previously 
     applied for award of a grant under this subchapter for 
     construction or acquisition of a State nursing home.
       ``(D) An application for construction or acquisition of a 
     nursing home or domiciliary from a State that the Secretary 
     determines, in accordance with regulations under this 
     subchapter, has a great need for the beds to be established 
     at such home or facility.
       ``(E) An application from a State for renovations to a 
     State home facility other than renovations described in 
     subparagraph (B).
       ``(F) An application for construction or acquisition of a 
     nursing home or domiciliary from a State that the Secretary 
     determines, in accordance with regulations under this 
     subchapter, has a significant need for the beds to be 
     established at such home or facility.
       ``(G) An application that meets other criteria as the 
     Secretary determines appropriate and has established in 
     regulations.
       ``(H) An application for construction or acquisition of a 
     nursing home or domiciliary from a State that the Secretary 
     determines, in accordance with regulations under this 
     subchapter, has a limited need for the beds to be established 
     at such home or facility.''; and
       (C) in paragraph (3), by striking subparagraph (A) and 
     inserting the following:
       ``(A) may not accord any priority to a project for the 
     construction or acquisition of a hospital; and''.
       (c) Transition.--The provisions of sections 8134 and 8135 
     of title 38, United States Code, as in effect on June 1, 
     1999, shall continue in effect after such date with respect 
     to applications described in section 8135(b)(2)(A) of such 
     title, as in effect on that date, that are identified on the 
     list that (1) is described in section 8135(b)(4) of such 
     title, as in effect on that date, and (2) was established by 
     the Secretary of Veterans Affairs on October 29, 1998.
       (d) Effective Date for Initial Regulations.--The Secretary 
     of Veterans Affairs shall prescribe the initial regulations 
     under subsection (a) of section 8134 of title 38, United 
     States Code, as added by subsection (a), not later than April 
     30, 2000.

     SEC. 207. EXPANSION OF ENHANCED-USE LEASE AUTHORITY.

       (a) Authority.--Section 8162(a)(2) is amended--
       (1) by striking ``only if the Secretary'' and inserting 
     ``only if--
       ``(A) the Secretary'';
       (2) by redesignating subparagraphs (A), (B), and (C) as 
     clauses (i), (ii), and (iii), respectively, and realigning 
     those clauses so as to be four ems from the left margin;
       (3) by striking the period at the end of clause (iii), as 
     so redesignated, and inserting ``; or''; and
       (4) by adding at the end the following:
       ``(B) the Secretary determines that the implementation of a 
     business plan proposed by the Under Secretary for Health for 
     applying the consideration under such a lease to the 
     provision of medical care and services would result in a 
     demonstrable improvement of services to eligible veterans in 
     the geographic service-delivery area within which the 
     property is located.''.
       (b) Term of Enhanced-Use Lease.--Section 8162(b) is 
     amended--
       (1) in paragraph (2), by striking ``may not exceed--'' and 
     all that follows and inserting ``may not exceed 75 years.''; 
     and
       (2) by striking paragraph (4) and inserting the following:
       ``(4) The terms of an enhanced-use lease may provide for 
     the Secretary to--
       ``(A) obtain facilities, space, or services on the leased 
     property; and
       ``(B) use minor construction funds for capital contribution 
     payments.''.
       (c) Designation of Property Proposed To Be Leased.--(1) 
     Subsection (b) of section 8163 is amended--
       (A) by striking ``include--'' and inserting ``include the 
     following:'';
       (B) by capitalizing the first letter of the first word of 
     each of paragraphs (1), (2), (3), (4), and (5);
       (C) by striking the semicolon at the end of paragraphs (1), 
     (2), and (3) and inserting a period; and
       (D) by striking subparagraphs (A), (B), and (C) of 
     paragraph (4) and inserting the following:
       ``(A) would--
       ``(i) contribute in a cost-effective manner to the mission 
     of the Department;
       ``(ii) not be inconsistent with the mission of the 
     Department;
       ``(iii) not adversely affect the mission of the Department; 
     and
       ``(iv) affect services to veterans; or
       ``(B) would result in a demonstrable improvement of 
     services to eligible veterans in the geographic service-
     delivery area within which the property is located.''.
       (2) Subparagraph (E) of subsection (c)(1) of that section 
     is amended by striking clauses (i), (ii), and (iii) and 
     inserting the following:
       ``(i) would--
       ``(I) contribute in a cost-effective manner to the mission 
     of the Department;
       ``(II) not be inconsistent with the mission of the 
     Department;
       ``(III) not adversely affect the mission of the Department; 
     and
       ``(IV) affect services to veterans; or
       ``(ii) would result in a demonstrable improvement of 
     services to eligible veterans in the geographic service-
     delivery area within which the property is located.''.
       (d) Use of Proceeds.--Section 8165(a) is amended--

[[Page 21907]]

       (1) by striking paragraph (1) and inserting the following:
       ``(a)(1) Funds received by the Department under an 
     enhanced-use lease and remaining after any deduction from 
     those funds under subsection (b) shall be deposited in the 
     Department of Veterans Affairs Health Services Improvement 
     Fund established under section 1729B of this title. The 
     Secretary shall make available to the designated health care 
     region of the Veterans Health Administration within which the 
     leased property is located not less than 75 percent of the 
     amount deposited in the fund attributable to that lease.''; 
     and
       (2) by adding at the end the following new paragraph:
       ``(3) For the purposes of paragraph (1), the term 
     `designated health care region of the Veterans Health 
     Administration' means a geographic area designated by the 
     Secretary for the purposes of the management of, and 
     allocation of resources for, health care services provided by 
     the Veterans Health Administration.''.
       (e) Repeal of Termination Provision.--(1) Section 8169 is 
     repealed.
       (2) The table of sections at the beginning of chapter 81 is 
     amended by striking the item relating to section 8169.
       (f) Repeal of Obsolete Provisions.--Section 8162 is 
     amended--
       (1) by striking the last sentence of subsection (a)(1); and
       (2) by striking subsection (c).

     SEC. 208. INELIGIBILITY FOR EMPLOYMENT BY VETERANS HEALTH 
                   ADMINISTRATION OF HEALTH CARE PROFESSIONALS WHO 
                   HAVE LOST LICENSE TO PRACTICE IN ONE 
                   JURISDICTION WHILE STILL LICENSED IN ANOTHER 
                   JURISDICTION.

       Section 7402 is amended by adding at the end the following 
     new subsection:
       ``(f) A person may not be employed in a position under 
     subsection (b) (other than under paragraph (4) of that 
     subsection) if--
       ``(1) the person is or has been licensed, registered, or 
     certified (as applicable to such position) in more than one 
     State; and
       ``(2) either--
       ``(A) any of those States has terminated such license, 
     registration, or certification for cause; or
       ``(B) the person has voluntarily relinquished such license, 
     registration, or certification in any of those States after 
     being notified in writing by that State of potential 
     termination for cause.''.

                        TITLE III--MISCELLANEOUS

     SEC. 301. REVIEW OF PROPOSED CHANGES TO OPERATION OF MEDICAL 
                   FACILITIES.

       Section 8110 is amended by adding at the end the following 
     new subsections:
       ``(d) The Secretary may not in any fiscal year close more 
     than 50 percent of the beds within a bed section (of 20 or 
     more beds) of a Department medical center unless the 
     Secretary first submits to the Committees on Veterans' 
     Affairs of the Senate and the House of Representatives a 
     report providing a justification for the closure. No action 
     to carry out such closure may be taken after the submission 
     of such report until the end of the 21-day period beginning 
     on the date of the submission of the report.
       ``(e) The Secretary shall submit to the Committees on 
     Veterans' Affairs of the Senate and the House of 
     Representatives, not later than January 20 of each year, a 
     report documenting by network for the preceding fiscal year 
     the following:
       ``(1) The number of medical service and surgical service 
     beds, respectively, that were closed during that fiscal year 
     and, for each such closure, a description of the changes in 
     delivery of services that allowed such closure to occur.
       ``(2) The number of nursing home beds that were the subject 
     of a mission change during that fiscal year and the nature of 
     each such mission change.
       ``(f) For purposes of this section:
       ``(1) The term `closure', with respect to beds in a medical 
     center, means ceasing to provide staffing for, and to 
     operate, those beds. Such term includes converting the 
     provision of such bed care from care in a Department facility 
     to care under contract arrangements.
       ``(2) The term `bed section', with respect to a medical 
     center, means psychiatric beds (including beds for treatment 
     of substance abuse and post-traumatic stress disorder), 
     intermediate, neurology, and rehabilitation medicine beds, 
     extended care (other than nursing home) beds, and domiciliary 
     beds.
       ``(3) The term `justification', with respect to closure of 
     beds, means a written report that includes the following:
       ``(A) An explanation of the reasons for the determination 
     that the closure is appropriate and advisable.
       ``(B) A description of the changes in the functions to be 
     carried out and the means by which such care and services 
     would continue to be provided to eligible veterans.
       ``(C) A description of the anticipated effects of the 
     closure on veterans and on their access to care.''.

     SEC. 302. PATIENT SERVICES AT DEPARTMENT FACILITIES.

       (a) Scope of Services.--Section 7803 is amended--
       (1) in subsection (a)--
       (A) by striking ``(a)'' before ``The canteens''; and
       (B) by striking ``in this subsection;'' and all that 
     follows through ``the premises'' and inserting ``in this 
     section''; and
       (2) by striking subsection (b).
       (b) Technical Amendments.--(1) Paragraphs (1) and (11) of 
     section 7802 are each amended by striking ``hospitals and 
     homes'' and inserting ``medical facilities''.
       (2) Section 7803, as amended by subsection (a), is 
     amended--
       (A) by striking ``hospitals and homes'' each place it 
     appears and inserting ``medical facilities''; and
       (B) by striking ``hospital or home'' and inserting 
     ``medical facility''.

     SEC. 303. REPORT ON ASSISTED LIVING SERVICES.

       Not later than April 1, 2000, the Secretary of Veterans 
     Affairs shall submit to the Committees on Veterans Affairs of 
     the Senate and House of Representatives a report on the 
     feasibility of establishing a pilot program to assist 
     veterans in receiving needed assisted living services. The 
     Secretary shall include in such report recommendations on--
       (1) the services and staffing that should be provided to a 
     veteran receiving assisted living services under such a pilot 
     program;
       (2) the appropriate design of such a pilot program; and
       (3) the issues that such a pilot program should be designed 
     to address.

     SEC. 304. CHIROPRACTIC TREATMENT.

       (a) Establishment of Program.--Within 120 days after the 
     date of the enactment of this Act, the Under Secretary for 
     Health of the Department of Veterans Affairs, after 
     consultation with chiropractors, shall establish a policy for 
     the Veterans Health Administration regarding the role of 
     chiropractic treatment in the care of veterans under chapter 
     17 of title 38, United States Code.
       (b) Definitions.--For purposes of this section:
       (1) The term ``chiropractic treatment'' means the manual 
     manipulation of the spine performed by a chiropractor for the 
     treatment of such musculo-skeletal conditions as the 
     Secretary considers appropriate.
       (2) The term ``chiropractor'' means an individual who--
       (A) is licensed to practice chiropractic in the State in 
     which the individual performs chiropractic services; and
       (B) holds the degree of doctor of chiropractic from a 
     chiropractic college accredited by the Council on 
     Chiropractic Education.

     SEC. 305. DESIGNATION OF HOSPITAL BED REPLACEMENT BUILDING AT 
                   IOANNIS A. LOUGARIS DEPARTMENT OF VETERANS 
                   AFFAIRS MEDICAL CENTER, RENO, NEVADA.

       The hospital bed replacement building under construction at 
     the Ioannis A. Lougaris Department of Veterans Affairs 
     Medical Center in Reno, Nevada, is hereby designated as the 
     ``Jack Streeter Building''. Any reference to that building in 
     any law, regulation, map, document, record, or other paper of 
     the United States shall be considered to be a reference to 
     the Jack Streeter Building.

             TITLE IV--CONSTRUCTION AND FACILITIES MATTERS

     SEC. 401. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

       The Secretary of Veterans Affairs may carry out the 
     following major medical facility projects, with each project 
     to be carried out in the amount specified for that project:
       (1) Renovation to provide a domiciliary at Orlando, 
     Florida, in a total amount not to exceed $2,400,000, to be 
     derived only from funds appropriated for Construction, Major 
     Projects, for a fiscal year before fiscal year 2000 that 
     remain available for obligation.
       (2) Surgical addition at the Kansas City, Missouri, 
     Department of Veterans Affairs medical center, in an amount 
     not to exceed $13,000,000.

     SEC. 402. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

       The Secretary of Veterans Affairs may enter into leases for 
     medical facilities as follows:
       (1) Lease of an outpatient clinic, Lubbock, Texas, in an 
     amount not to exceed $1,112,000.
       (2) Lease of a research building, San Diego, California, in 
     an amount not to exceed $1,066,500.

      SEC. 403. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There are authorized to be appropriated to 
     the Secretary of Veterans Affairs for fiscal year 2000 and 
     for fiscal year 2001--
       (1) for the Construction, Major Projects, account 
     $13,000,000 for the project authorized in section 401(2); and
       (2) for the Medical Care account, $2,178,500 for the leases 
     authorized in section 402.
       (b) Limitation.--The project authorized in section 401(2) 
     may only be carried out using--
       (1) funds appropriated for fiscal year 2000 or fiscal year 
     2001 pursuant to the authorization of appropriations in 
     subsection (a);
       (2) funds appropriated for Construction, Major Projects, 
     for a fiscal year before fiscal year 2000 that remain 
     available for obligation; and
       (3) funds appropriated for Construction, Major Projects, 
     for fiscal year 2000 for a category of activity not specific 
     to a project.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Arizona (Mr. Stump) and the gentleman

[[Page 21908]]

from Texas (Mr. Reyes) each will control 20 minutes.
  The Chair recognizes the gentleman from Arizona (Mr. Stump).


                             General Leave

  Mr. STUMP. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days within which to revise and extend their remarks 
and include extraneous material on H.R. 2116.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Arizona?
  There was no objection.
  Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, H.R. 2116, the Veterans' Millennium Health Care Act, is 
an important bill that is strongly supported by veterans and their 
service organizations.
  This bill would improve access to long-term health care for our most 
severely disabled veterans. It would authorize the VA to pay reasonable 
emergency care costs for service-connected disabled veterans who have 
no health insurance or other medical coverage. It would impose new 
requirements that the VA must follow to further consolidate or realign 
facilities. It also increases the health care priority provided for 
combat-injured veterans and for military retirees choosing to use the 
VA health services. It would expand VA's flexibility to generate new 
revenue and spend it on health care for veterans.
  H.R. 2116 also extends the VA's authority to make existing grants to 
homeless veterans.
  I urge my colleagues to support the legislation on H.R. 2116, as 
amended.
  Mr. Speaker, I reserve the balance of my time.
  Mr. REYES. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the gentleman from Illinois (Mr. Evans), the ranking 
Democratic member of the Committee on Veterans' Affairs, has been 
unavoidably detained, so I will be managing the bill on his behalf this 
afternoon.
  Mr. Speaker, I rise today in support of the Veterans Millennium 
Health Care Act, H.R. 2116. I thank the gentleman from Arizona 
(Chairman Stump); the gentleman from Illinois (Mr. Evans); the ranking 
member, the gentleman from Florida (Chairman Stearns); and the 
gentleman from Illinois (Mr. Gutierrez), the ranking Democratic member 
of the Subcommittee on Health for their fine work on this measure and 
their support in incorporating certain provisions.
  The gentleman from Illinois (Mr. Evans) has long supported in this 
important bill the issues that are very important and vital for our 
veterans.
  This is an ambitious, but realistic bill. It recognizes recent 
disturbing trends in funding for veterans health care, notwithstanding 
the committee's support of significant funding increases.

                              {time}  1415

  This bill will better assure Congress that the VA is continuing to 
meet vital needs for long-term care services for our veterans. It gives 
Congress better assurance that the Veterans' Administration will plan 
effectively for ways to continue treating veterans, regardless of the 
health care setting.
  It will also allow high-priority veterans, who regularly use the VA 
system, to receive reimbursement for emergency care services. The 
millennium plan establishes a good baseline for meeting veterans' needs 
for long-term health care. It provides that veterans with the highest 
priority for care, those with health care conditions due to military 
service, receive all of the long-term care that they actually need.
  This measure also contains a report-and-wait requirement. This 
responds to the concerns that VA is dismantling its inpatient programs 
without adequately planning to fulfill veterans' needs in outpatient or 
community settings.
  This measure also further allows the Veterans' Administration to 
reimburse certain enrolled veterans for medical emergency expenditures. 
Veterans who rely on the Veterans' Administration for their health care 
have been financially devastated by medical emergencies which require 
them to seek care from the closest available health care facility. 
Veterans have been told by the VA staff to go to the closest health 
care facility for emergency care; but once the bills come, the VA has 
refused repeatedly to reimburse these veterans. The VA should not 
abandon these veterans when they have a health care emergency.
  This millennium bill will also require the Veterans' Administration 
to work with chiropractors to develop a policy that will allow veterans 
better access to chiropractic services within the Veterans' 
Administration. It is abundantly clear that the VA is not operating in 
a world of unlimited resources. I believe that this bill has many 
positive gains for veterans while not imposing unreasonable new costs 
onto an already fiscally strapped system. I endorse this ambitious 
bipartisan legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STUMP. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Florida (Mr. Stearns), the chairman of our Subcommittee 
on Health.
  Mr. STEARNS. Mr. Speaker, I thank the distinguished chairman of the 
Committee on Veterans' Affairs, and I rise in support of H.R. 2116, as 
amended.
  Mr. Speaker, I believe we will one day look back and note on 
September 21, 1999, that the House took two historic actions on behalf 
of our American veterans. First, it added $1.7 billion for veterans' 
medical care; and, second, it adopted the Veterans' Millennium Health 
Care Act, H.R. 2116.
  This important legislation tackles some of the major challenges 
facing the VA health care system. In doing so, Mr. Speaker, it offers a 
blueprint to help position the Veterans Administration for the future. 
Overall, the bill has four central themes: first, to give VA much 
needed direction for meeting veterans' long-term care needs; second, it 
expands veterans' access to health care; third, it closes gaps in 
current eligibility law; and, fourth, it makes needed reforms that will 
further improve the VA health care system.
  Foremost among vast challenges are the long-term care needs of aging 
veterans. That challenge has gone unanswered, Mr. Speaker, for too 
long. This legislation would put a halt to the steady erosion we have 
seen in the VA long-term care program, and it would establish a 
framework for expanding access to needed long-term care services.
  The bill tackles the challenge posed by the General Accounting Office 
audit which found that VA may spend billions of dollars in the next 5 
years to operate unneeded buildings. In testimony before my 
subcommittee, the GAO stated that one of every four VA medical care 
dollars is spent in maintaining buildings rather than caring for 
patients.
  It is no secret that the VA is discussing hospital closures and, in 
some locations, in some locations, that may be appropriate. The point 
is that the VA has closure authority today and, my colleagues, has 
already used it. We should not let tight budgets drive such decisions, 
however. This bill, instead, requires that decisions on hospital 
missions must be based on comprehensive studies and planning. The 
process must include veterans' organizations and the employee groups.
  In short, the bill puts in place numerous safeguards to help and 
protect veterans. Most important, it would specifically provide that 
the VA cannot simply stop operating a hospital and walk away from its 
responsibility to those veterans. It must ``reinvest'' savings in a 
new, improved treatment facility or improved services in the area.
  This is a very reasonable approach. The VA health care system has 
certainly improved significantly in the last 4 years. This 
comprehensive bill, my colleagues, continues the VA on the course 
towards improving veterans' access to needed care. I am proud that this 
bill breaks new ground. It is a bold step forward for our veterans in 
the area of long-term care, emergency care coverage, military retirees' 
care, and placing the VA health care system on a sounder footing.
  Now, we have worked closely with veterans' organizations in 
developing

[[Page 21909]]

this legislation. It was not done in a vacuum. And they have recognized 
the important advances this bill would establish. It is important that 
the two largest veterans' organizations, representing millions of 
veterans, the American Legion and Veterans of Foreign Wars, have 
endorsed this bill. Many other organizations also support the bill, 
including AMVETS, the Vietnam Veterans of America, the Non-Commissioned 
Officers Association, the Military Order of the Purple Heart, the 
Retired Enlisted Association and, Mr. Speaker, the 26 organizations 
making up the Military Coalition.
  So I urge my colleagues to join with me and others here in passing 
this bill and supporting it on the House floor.
  Mr. REYES. Mr. Speaker, I yield 6 minutes to the gentleman from Maine 
(Mr. Baldacci).
  Mr. BALDACCI. Mr. Speaker, I wish to thank my colleague, the 
gentleman from Texas (Mr. Reyes), for managing the bill, and for the 
committee and their work on both sides of the aisle on this very 
important subject matter. I also wish to echo the statements by the 
gentleman from Florida (Mr. Stearns) in regards to the fact of the 
appropriation being $1.7 billion for veterans' health care.
  I wish to address, Mr. Speaker, the Millennium Health Care Act; and I 
rise in support of the provisions, most of the provisions in the bill, 
but there is a section of the bill which I would like to be able to 
address today, and that is section 206 of the bill. I hope to be able 
to work with the chairman and the ranking member and the committee as 
they go to conference to further ensure that rural areas and rural 
health care needs are addressed.
  I think that the amendment that was put forward by the gentleman from 
Vermont (Mr. Sanders), that was unanimously approved by a voice vote in 
regards to the VA-HUD appropriations, which states that the House 
supports improvements in health care services for veterans in rural 
areas, was very important. I think we all agree this is an important 
priority, and I think it extends to the long-term residential care and 
nursing home care as well as other forms of health care.
  The needs of veterans in my State cannot be reasonably met by setting 
up a single facility in one area of the State. The second district of 
Maine, which I represent, is the largest physical district east of the 
Mississippi. I represent 32 rural health clinics in my district, a very 
sparsely populated 22 million acres of land, and with a large 
population of veterans versus the whole State-wide population of 1.2 
million, a veteran population of 154,000 people.
  So the rural aspects of my State and the challenges that those 
represent impact upon the access to health care. The difficulties of 
veterans and families in traveling long distances to facilities are 
compounded by varied terrain and, often, inclement weather.
  Just this past weekend I was in Lubec, Maine, which is the 
easternmost point in the United States, where the sunrises in Sunrise 
County, and it required landing far away and taking a cutter across the 
bay and taking further transportation to get to Lubec in order to be 
able to put on a benefit for a restoration in the community. I would 
hate to think that the requirements that were being forced upon 
veterans in Downeast Maine would cause them those same kind of 
requirements.
  One of the things that always interests me in every veterans' 
ceremony I go to in every community in the second district is the 
length and breadth of the town's honor roll which recognizes the 
veterans in that community that have not only been part of the military 
service but usually have been enlisted and have felt the responsibility 
to serve of their own volition to continue to ensure the freedoms for 
all Americans. And the length of that list in some very small towns is 
remarkable.
  We always talk about Joshua Chamberlain and the 20th Maine; but there 
are many other veterans, up until even Gary Gordon, who is from 
Lincoln, Maine, who is a Congressional Medal of Honor winner who risked 
and lost his life in trying to save others. But they are all throughout 
Maine in their willingness to become part of the military service in 
this country to preserve the freedoms and foundation which we all 
enjoy.
  Mr. Speaker, I hate to think that we put obstacles in their way, in 
their families' way, in terms of getting the care, and health care, 
that we really owe them as a country and a Nation.
  The issue in terms of section 206, in establishing the new priorities 
and criteria and how it impacts on rural health care and the 
availability of that care, I seek to work with Members on both sides of 
the aisle. Maine currently has preapproval for four projects that will 
be placed on the priority list by the end of October. These four 
projects are to add beds to existing homes. The current occupancy rate 
at our existing homes is 94.5 percent. This is far above the national 
average and demonstrates the great need for this care in my State.
  I hope that we will be able to assure States that have made the 
commitment to put up the matching funds for these projects, that the 
promise for those crucial Federal dollars will be met. I am concerned 
that this legislation does not adequately protect the hard work that 
States have done to get their projects listed and that many will be 
forced to start all over again. I am also concerned about the criteria 
used for new construction and its push toward renovation.
  Washington County, Downeast Maine, is looking for a residential care 
facility. There is no structure there now. Recognizing there are others 
who wish to speak, Mr. Speaker, I would just like to be able to offer 
for the Record some of the facts that have been presented in terms of 
occupancy rates and meeting that level and other information that is 
being presented by the State of Maine.
  In closing, I would just like to again thank the chairman and the 
ranking members of the committee for their dedication that they have 
exhibited in addressing the long-term care issues, and I look forward 
to working with them on this as we try to serve our veterans throughout 
the country.
  The information I just alluded to, Mr. Speaker, is as follows:

                                                                               MAINE VETERANS' HOMES DAILY CENSUS
                                                                                        [Sept. 16, 1999]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                             Veteran vs. non-veteran status                                             Payor source
              Facility                  Total   ------------------------------------------------------------------------------------------------------------------------------------  Occupancy
                                         beds     Veteran    Percent    Non-vet    Percent     Total     Private    Percent    Medicaid   Percent    Medicare   Percent     Total     (percent)
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Augusta.............................        120         81       71.7         32       28.3        113         38       33.6         67       59.3          8        7.1        113         94.2
Bangor..............................        120         78       67.8         37       32.2        115         17       14.8         83       72.2         15       13.0        115         95.8
Caribou.............................         40         28       75.7          9       24.3         37          3        8.1         34       91.8          0        0.0         37         92.5
Scarborough.........................        120         91       62.0         20       18.0        111         31       27.9         73       65.8          7        6.3        111         92.5
So. Paris...........................         90         63       72.4         24       27.6         87         19       21.8         66       75.9          2        2.3         87         96.7
    NF..............................         62         41       68.3         18       31.7         50         17       28.3         41       68.3          2        3.3         80         95.8
    Res. Care.......................         28         22       31.8          5       18.5         27          2        7.4         25       92.5          0        0.0         27         95.4
      Totals........................        490        341       73.7        122       26.3        463        108       23.3        323       69.8         32        6.9        463         94.5
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

  Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume to 
assure the gentleman from Maine, representing a district of 50,000-some 
square miles, I will be more than happy to work with him on rural 
health care issues, and especially on the State Veterans Home Program. 
This is probably one of the most efficient and one of the best programs 
we have in the VA, and we look forward to working with him on any 
problems he may have.

[[Page 21910]]

  Mr. Speaker, I yield such time as he may consume to the gentleman 
from Virginia (Mr. Bliley), the chairman of our Committee on Commerce.
  Mr. BLILEY. Mr. Speaker, I thank the chairman of the committee, the 
gentleman from Arizona (Mr. Stump), for yielding me this time, and I 
applaud him for bringing this bill to the floor. I also want to thank 
the gentleman from Florida (Mr. Stearns) for his efforts on this bill.
  Today, Mr. Speaker, I rise in support of the Veterans' Millennium 
Health Care Act of 1999. The gentleman from Florida (Mr. Stearns) was 
kind enough to include as a provision of this legislation my bill, H.R. 
430, the Combat Veterans Medical Equity Act. Due to a broad base of 
support, my bill gained 177 cosponsors and was endorsed by the Military 
Order of the Purple Heart.
  Most people are unaware that under current law combat wounded 
veterans do not always qualify for medical care at VA facilities.

                              {time}  1430

  This bill would change the law to ensure combat wounded veterans 
receive automatic access to treatment at VA facilities. It sets the 
enrollment priority for combat-injured veterans for medical service at 
level three, the same level as former prisoners of war, and veterans 
with service-connected disabilities rated between 10 and 20 percent.
  We, as a Nation, owe a debt of gratitude to all of our veterans who 
have been awarded the Purple Heart for injuries suffered in service to 
our country. I would like to thank the gentleman from Florida (Chairman 
Stearns) for including my legislation, the Combat Veterans Equity Act 
in this important legislation.
  I also would like to congratulate the Military Order of the Purple 
Heart for their hard work and advocacy on behalf of our Nation's 
combat-wounded veterans.
  The Veterans Millennium Health Care Act of 1999 is long overdue. I am 
proud to support this bill for our Nation's veterans, and I urge a 
``yes'' vote.
  Mr. REYES. Mr. Speaker, how much time do I have remaining?
  The SPEAKER pro tempore (Mr. Calvert). The gentleman from Texas (Mr. 
Reyes) has 11 minutes remaining.
  Mr. REYES. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
Indiana (Ms. Carson).
  Ms. CARSON. Mr. Speaker, I thank very much the gentleman from Texas 
(Mr. Reyes) and the gentleman from Florida (Mr. Stearns) and the 
gentleman from Arizona (Mr. Stump), et al, for allowing me to say just 
a few words on behalf of the Veterans Millennium Health Care Act, H.R. 
2116.
  I would anticipate that every Member of this House would be 
enthusiastically supportive of the Veterans Millennium Health Care Act 
in that they have veterans in all 50 States of the United States.
  I applaud the bipartisan effort that led to the creation and movement 
of this innovative legislation. I want to specifically point out the 
section that deals with sexual harassment and domestic violence that is 
incorporated in H.R. 2116.
  In the wake of several allegations of sexual harassment in the Armed 
Services, H.R. 2116 would reauthorize until December 31, 2002, a VA 
program that provides counseling and medical treatment to veterans who 
were sexually abused or raped while serving in the military. It is 
estimated that 35 to 50 percent of all female veterans have reported at 
least one incident of sexual harassment while serving in the military.
  I enthusiastically encourage and urge each Member of this august body 
to vote in favor of the Veterans Millennium Health Care Act.
  Mr. Speaker, I rise today in support of the Veterans Millennium 
Health Care Act, H.R. 2116, and encourage all of my colleagues to add 
their support for this measure that will take veterans health care into 
the 21st century.
  I applaud the bipartisan effort that led to the creation and movement 
of this innovative legislation.
  This bill tackles some of the most pressing issues facing the VA, 
including the VA long-term care challenge, and provides a blueprint to 
help position VA for the future.
  This bill opens the door to an expansion of long-term care, to 
greater access to outpatient care and to improve benefits including 
emergency care coverage. The measure improves access to care through 
facility realignment, eligibility enhancement for military retirees and 
veterans injured in combat, and ensures that the VA offers nursing home 
care to the highest priority veterans.
  One provision of this bill would require the VA to maintain long-term 
care programs and increase both home and community-based long-term care 
and respite care. The VA also would be required to provide long-term 
care for 50-percent service-connected veterans, and veterans needing 
care for a specific service-related condition. Another provision would 
require other veterans receiving long-term care to make co-payments, 
based on ability to pay. The revenues from co-payments would support 
expanded long-term benefits.
  This bill would set conditions under which the VA could close an 
obsolete, inefficient hospital and reinvest savings in new outpatient 
clinics and other improved services for the veterans affected. It also 
extends VA's authority to make grants to assist homeless veterans, and 
reform the criteria for awarding grants for building and remodeling 
State veterans' homes.
  The measure also would extend the length of time the VA could lease 
facilities, space or land to private companies from 35 years to 75 
years. This extension would raise the incentive to foster private-
public relationships between the VA and local hospitals, nursing homes 
and clinics, allowing VA to contract out under-utilized property.
  The eligibility provisions include specific authority for VA care of 
veterans who were awarded the Purple Heart for injuries sustained in 
combat, and authority for VA care of TRICARE-eligible military retirees 
not otherwise eligible for priority VA care. Under this provision, DOD 
would reimburse VA for such care at rates to be negotiated by the 
Departments.
  Another measure authorizes VA to establish and make payments for 
emergency care of service-connected and low-income veterans who have no 
health insurance or other medical coverage and rely on VA care.
  H.R. 2116 also would generate revenues by authorizing VA to increase 
copayments on prescription drugs and establish copayments on hearing 
aids and other costly items provided for nonservice-connected 
conditions. Such new revenues would be earmarked to find VA medical 
care.
  In the wake of several allegations of sexual harassment in the armed 
services, H.R. 2116 would reauthorize, until December 31, 2002, a VA 
program that provides counseling and medical treatment to veterans who 
were sexually abused or raped while serving in the military. It is 
estimated that 35 percent to 50 percent of all female veterans have 
reported at least one incident of sexual harassment while serving in 
the military.
  These initiatives cover the broad spectrum of programs long sought by 
veterans and would ensure that this Nation is responsive to those who 
have served in armed conflicts for almost a century. Further it would 
send a powerful signal to those now serving that their extraordinary 
sacrifices are appreciated and that the health care they have earned 
through years of dedicated service will be available when or if they 
need it.
  Caring for America's veterans is an ongoing cost of war. As a nation, 
if we fail in this obligation, how can we justify sending more and more 
young service members into harm's way? How might we expect our children 
and grandchildren to volunteer for military service in the future, if 
we are not prepared to keep promises to disabled veterans today?
  Additionally, our failure to appropriately fund the VA will mean that 
veterans may not receive the health care they need and the level of 
service they deserve. Appropriate funding is vital to keeping the 
promise that was made to our veterans when they joined the Armed Forces 
and made their promise to serve their country. Only with this funding 
can we begin to meet the long-term care needs of our aging veterans. We 
owe more to the men and women who served our Nation in battle.
  H.R. 2116 is a good bill with very important provisions that have 
been endorsed by major veterans groups. It passed by an overwhelmingly 
majority in the full Committee on Veterans Affairs. I urge all my 
colleagues to support this legislation.
  Mr. STUMP. Mr. Speaker, I yield 2 minutes to the gentleman from 
Colorado (Mr. Hefley).
  Mr. HEFLEY. Mr. Speaker, I want to commend the gentleman from Arizona 
(Mr. Stump) on bringing this bill to the

[[Page 21911]]

floor of the House. This is one of the really serious issues, veterans 
and retirees' health care both. We are dealing with veterans' health 
care here, but both are very, very important.
  As I go around to these various military bases, and I am sure my 
colleagues have the same experience, one of the things that the young 
recruits express concern about is that recruits before them were 
promised certain health care benefits that they do not feel they are 
getting today.
  I think the bill that my colleague is proposing today goes a long way 
towards meeting that concern or, at least, takes giant steps in that 
direction. I think it will help in recruitment, it will help in 
retention.
  It is an extremely important thing that we ask people to go and lay 
their necks on the line for America and, by golly, we need to take care 
of their health care needs; and I think my colleague goes a long way 
towards that. I thank the gentleman for yielding me the time and for 
bringing this bill to the floor.
  Mr. REYES. Mr. Speaker, it is my pleasure to yield 4 minutes to the 
gentleman from Texas (Mr. Doggett).
  Mr. DOGGETT. Mr. Speaker, there are many ways that we can express our 
gratitude to those who answered their Nation's call and have made such 
great sacrifices for their country, sacrifices that protect our country 
and our people and ensure that we embody the highest aspirations of 
human endeavor to allow each individual to conduct a life with freedom 
and with dignity.
  I rise in support of this legislation, which not only extends long-
term care services but also attempts to extend an additional degree of 
dignity to our veterans that comes with home- and community-based 
health care options that are recommended in this bill.
  The legislation recognizes that even though the Veterans 
Administration operates the largest health care system in the United 
States, there are still many communities that desperately lack 
resources for our veterans.
  Central Texas, which I represent, is experiencing a rapid growth in 
the number of veterans that are retiring there; and many of these folks 
are entitled to medical services that just simply are not available 
nearby at our local Veterans Outpatient Clinic or at other local health 
care facilities.
  If a woman in Travis County, for example, needs a mammogram, she has 
to drive 60 to 70 miles to get one. Despite all the orthopedic doctors 
in Austin, Texas, veterans must make the same long drive past those 
clinics and to a VA Hospital because none of the services are available 
locally.
  So I am pleased that the committee is exploring new ways for the 
Veterans Administration to spread its resources. For instance, the bill 
allows the Veterans Administration to enter into long-term leases to 
improve services.
  The veterans health care system is facing considerable budget 
pressures as it attempts to deal with an aging veterans population and 
escalating pharmaceutical costs. But while we must maintain fiscal 
discipline, it is important that our veterans who defended our freedom 
do not bear a disproportionate share of the burden.
  Mr. Speaker, in August, the New York Times reported on an audit of 
the Veterans Health Administration by the General Accounting Office, 
the investigating arm of Congress, under the headings ``Audit of VA 
Health Care Finds Millions Are Wasted,'' and says ``Money That Could 
Improve Treatment Goes to Operate Unneeded Buildings.'' That report 
noted that the Veterans Administration ``Spends more than $1 million a 
day to operate unneeded hospital buildings, where a dwindling number of 
veterans receive care in under-populated wards,'' and that of the 
``more than $17 billion that the Veterans Administration receives each 
year to provide health care to veterans, it spends about one-fourth of 
the money caring for 4,700 buildings around the country.''
  The Austin American-Statesman editorialized similarly ``Veterans 
Hospitals Monuments to Waste.'' The General Accounting Office itself 
noted that the Veterans Health Administration ``could enhance veterans' 
health care benefits if it reduced the level of resources spent on 
underused, inefficient, or obsolete buildings and reinvested these 
savings, instead, to provide health care more efficiently in future 
facilities at existing locations or new locations closer to where 
veterans live.''
  That is certainly what we need in Central Texas. And the advice seems 
pretty reasonable. It reminds me of the baseball legend Wee Willie 
Keeler who, when asked the secret to hitting, replied ``hit it where 
they ain't.'' Well, I believe the Veterans Administration needs to 
provide more services where our veterans are rather than simply 
maintaining under-utilized buildings and making people come to them.
  I believe that today's legislation represents a modest step in that 
direction.
  We should pledge ourselves to the fulfillment of our obligations to 
those who have suffered in the defense of our country. To do less would 
be to sell short the very principles we profess to value so highly as a 
nation.
  Mr. REYES. Mr. Speaker, I yield myself such time as I may consume.
  As a Nation, Mr. Speaker, we are seeing a growing population of older 
veterans whose health care needs are increasingly complex and, in some 
cases, serious. Moreover, these veterans are entering a system which is 
in transition, moving toward a greater outpatient and community-based 
treatment.
  At the same time, the VA is suffering under straining and 
insufficient budgets, this bill is vital as it restores security and 
confidence in veterans' health care in this changing environment. 
Therefore, as a member of the Committee on Veterans Health Affairs, I 
am proud that this bill focuses on important priorities, including 
long-term services and reimbursement for emergency care services to our 
veterans.
  In addition, I am pleased that this bill requires input and planning 
as the Veterans Administration attempts to restructure and modernize 
its facilities so that the VA will continue to treat veterans 
regardless of their health care provider.
  In addition, I am proud of the provisions which strengthen long-term 
care. We have seen reduced levels of long-term care as veterans are 
prematurely discharged from long-term care facilities. Inadequate time 
in long-term care is a short-sighted method of trying to care for 
larger numbers of aging veterans.
  This bill attacks this problem by assuring that veterans with health 
care conditions due to military service can obtain long-term care for 
as long as they need it.
  Also, I am pleased that that bill makes sure that veterans are 
reimbursed for emergency care no matter where they get that treatment. 
Veterans and their families deserve to know that they can obtain 
emergency care and not later be financially strapped or devastated 
because the VA refuses to reimburse them.
  This bill rectifies this situation, following the request of the VA 
and the President's Patients' Bill of Rights. It also allows VA to 
reimburse any high priority enrolled veterans for medical emergencies.
  In summary, this millennium bill is the most comprehensive health 
care bill for veterans in the past 5 years. It provides a framework 
that better ensures that the views of veterans, employees, and 
veterans' advocates are taken into account and that the VA finds the 
best way to care for our Nation's veterans.
  Health care for our veterans should not be compromised. With this 
bill, we are taking important steps to ensure that we meet our needs 
and our obligations to these proud Americans who have sacrificed so 
much for our country.
  I, therefore, am pleased and proud to support this bill, and I ask 
all my colleagues to join in passing this important legislation.
  Mr. Speaker, I yield back the balance of my time.
  Mr. STUMP. Mr. Speaker, I would like to thank the gentleman from 
Illinois (Mr. Evans), ranking member of the full committee; as well as 
the chairman of the Health Subcommittee, the gentleman from Florida 
(Mr. Stearns); and also the gentleman from Texas (Mr. Reyes) for all 
their hard work in bringing this bill to the floor.

[[Page 21912]]


  Mrs. CHRISTENSEN. Mr. Speaker, I rise today in support of the 
Veterans Millennium Health Care Act and I compliment my colleagues Mr. 
Sutmp and Mr. Evans for bringing this bill to the floor today.
  Mr. Speaker, we can all agree that we have not done right by our 
Veterans. Over and over we have told our young men and women that if 
they answered their country's call to serve, we would provide for their 
health for the rest of their lives. But, sadly, this has not been done. 
We have instead, continued to reduce spending for veterans services and 
at the same time narrowly classify the eligibility for veterans to 
receive this limited services.
  It is because of this why I am pleased to support the Veterans 
Millennium Health Care Act because it begins to reverse this unfair 
treatment towards veterans and responds to some of their pressing 
needs.
  Some of the bills key provisions include the requirement that the VA 
increase both home and community-based long term care particularly for 
veterans who are 50% service-connected and veterans needing care for a 
service-related condition. This provision is particularly important to 
the veterans in my Congressional District who have to travel, at their 
own expense, to the neighboring island of Puerto Rico for their care.
  I am likewise very pleased that the bill would also authorize the VA 
to pay reasonable emergency care cost for service-connected, low-income 
and other high priority veterans who have no health insurance of other 
medical coverage, authorize an increase in the copayment on 
prescription drugs and extend the VA's authority to make grants to 
assist homeless veterans.
  Mr. Speaker, in my previous life as a Family Physician, I counted 
many of our local veterans as my patients. I got to know many of them 
very well and came to understand the disappointment that feel about 
their apparently reneging on the promises that were made to them when 
they enlisted. It is time that we begin to do right by our veterans and 
H.R. 2116 is a good beginning.
  I urge my colleagues to support this important bill.
  Mr. GILMAN. Mr. Speaker, I reluctantly rise in opposition to H.R. 
2116, the Veterans Millennium Health Care Act.
  I say reluctantly because the majority of H.R. 2116 contains 
provisions that expand services to veterans and provide many vitally 
needed benefits. These include: requiring the VA to provide long term 
care to veterans with service connected disabilities of 50% or greater, 
lifting the six month limit on VA adult day health care, providing 
Purple Heart recipients with the same priority as POWs in regards to 
health care, expanding services for homeless veterans, grants higher 
priority access to VA medical services for military retirees, extends 
authority for the VA to provide counseling for sexual trauma victims, 
and expands VA's authority to lease unneeded property.
  My primary objection to this legislation is with regard to section 
107, which sets out conditions under which VA medical facilities can be 
closed and veterans sent to local hospitals for care.
  VA medical facilities represent a unique resource. There are many who 
would argue that their maintenance costs could be best used in other 
areas, and for this reason they should be closed if they are being 
underutilized. I do not agree with that assessment.
  If these facilities are being underutilized, as the critics would 
claim, it is through no fault of the veteran. There has been a 
concentrated drive underway in recent years in the VA to increase the 
amount of health care provided on an outpatient basis. This is 
commendable, and necessary to hold down costs, as everyone knows 
outpatient care is often more efficient and cheaper to provide that 
traditional inpatient care.
  However, this drive towards efficiency has left far too many of our 
veterans in its wake. Not all veterans can be best treated in an 
outpatient setting. The ironic fact is that those who are most in need 
of traditional inpatient care: the elderly, the immobile, the 
paralyzed, the mentally ill, the homeless and the substance abuser, are 
the individuals who could best use the existing ``underutilized'' 
facilities that many are eager to close.
  My congressional district has a large percentage of elderly veterans, 
as does most of the northeast. There is an increasing demand for long 
term care for the elderly in New York, which the VA cannot presently 
address. Likewise, New York City has a very large population of 
homeless veterans who continually fall between the cracks in the 
current system.
  Rather than these proposals to close existing VA medical facilities 
that have seen their traditional inpatient population decrease over 
time, we need to explore what other needs these facilities could be 
used for.
  As I noted, these facilities are a unique resource. Once they are 
closed down and sold off, they are gone forever. The Government will 
never be able to procure a similar piece of real estate for an 
affordable price should the need arise in the future.
  We should not squander the irreplaceable resource found in our VA 
medical centers while so many veterans are not having their needs fully 
addressed.
  As I stated earlier, there is much in this bill that is sorely needed 
and worthy of our support. However, as a Member from the VA VISN that 
has suffered the deepest cuts in its health care budget, I cannot bring 
myself to vote for a bill that would further reduce their VA medical 
options.
  In the interim, I will continue to work with the distinguished 
chairman of the House Veterans Committee (Mr. Stump), to ensure that 
adequate funds are diverted from the VA emergency reserve to VISN #3 
for FY'00. Moreover, both Chairman Stump and I will request the VA to 
revisit its VERA formulas used to determine funding levels for 
northeastern VISNS, particularly those in New York which have been the 
hardest hit under VERA.
  In closing, I want to thank our distinguished Veteran's Committee 
Chairman for his agreement to designate lower New York as a 
demonstration site should Medicare subvention legislation pass the 
Congress, as well as for his working with me to ensure that the VA 
explores the possibility of turning unused space at VISN #3 medical 
facilities into long term nursing home care units for veterans through 
the expanded use of the enhanced lease authority.
  Mr. SMITH of New Jersey. Mr. Speaker, the Veterans' Millennium Health 
Care Act addresses the future of VA health care in the 21st century. 
The legislative package which we are considering today is an ambitious 
and very necessary undertaking. It forces the VA to step up to the 
challenges posed by the aging of our society. It will also ensure that 
the VA's long term care services reflect the health needs of America's 
veterans. It puts important checks and balances in place so that 
critical VA decisions regarding health care delivery are made with the 
input of veterans, health care staffers, and Congress.
  The Veterans' Millennium Health Care Act includes the following key 
components: it requires the VA to provide long term care to veterans 
who are either 50% service connected or in need of such care for a 
service connected condition; it requires the VA to operate and maintain 
long term care programs including geriatric evaluation, nursing home 
care, domiciliary care, adult day health care, and respite care; and it 
restores the ability of Purple Heart recipients to automatically use VA 
health care facilities.
  One component of this package is especially important to me: respite 
care. Earlier this year, I introduced H.R. 1762, legislation which 
expands the definition of respite care within the VA's health care 
system. For the first time, this legislation allows the VA to contract 
with home care professionals to provide care for our aging veteran 
population, as well as provide care services through non-VA facilities 
when appropriate. Currently, veterans and their care givers who are in 
need of respite care must travel to the closest VA nursing home--even 
if it is just for temporary relief--when a bed becomes available. By 
providing respite care in the home, the VA will relieve a veteran's 
spouse or adult child of such duties as preparing meals, doing laundry, 
or changing bed linens.
  The current policy places a tremendous burden on the care giver, be 
it a spouse, an adult child, family member, or friend. The closest VA 
nursing home or state facility may be hours away. My legislation 
instead allows the VA to either send someone to the veterans' home to 
relieve the caregiver or to make arrangements and pay for other short-
term options.
  H.R. 1762 has been endorsed by the American Legion, the VFW, Eastern 
Paralyzed Veterans of America, Vietnam Veterans of America, and the 
Disabled Paralyzed Veterans Association. All of these groups know that 
if it were not for the loving care being provided by spouses and adult 
children, the VA long term care system would be in dire straits. I 
cannot underscore how crucial it is for our veterans that we provide 
assistance for these caregivers and enable them to continue their good 
works.
  Providing caregivers with the occasional day off so that they might 
attend to their own lives for a few hours or days will significantly 
improve the lives of our veterans and unquestionably save the VA money 
in the long run. Most Americans want to remain in their own homes for 
as long as possible. Expanding the VA's ability to use respite care as 
well as other long term care services reflects the flexibility that 
America's seniors demand and have come to expect.

[[Page 21913]]

  A few years ago, I got a first-hand education about the need for 
respite care when I watched my parents suffer from cancer. My wife, 
Marie, provided my mother with around the clock care--so our family 
knows how emotionally consuming it can be. This is why I am a 
passionate believer in expanding the VA's ability to provide respite 
care. This provision of the bill is much needed by our Nation's 
veterans and their care givers.
  As a Co-Chair of the Congressional Alzheimer's Disease Task Force, I 
know that unless we begin building the framework for dealing with long-
term care issues in our VA system, a demographic tidal wave--the aging 
of our veterans--will crash into the system and cause serious damage. 
The VA should lead the way.
  For example, persons aged 85 and above are the fastest growing age 
category in the country, and half of those persons will contract 
Alzheimer's disease. Cases of Alzheimer's are expected to more than 
quadruple from 4 million to 18 million by the year 2050. We need to 
take measures to accommodate families caring for Alzheimer's patients, 
and the respite care provisions in the Millennium Health Care Act are 
the right policy at the right time.
  In a California statewide survey taken by the Family Caregiver 
Alliance, 58% of the caregivers showed signs of clinical depression. 
When asked, they responded that their two greatest needs were emotional 
support and respite care. On average, they are providing 10.5 hours of 
care per day. According to the Caregiver Assistance Network, family and 
volunteer caregivers provide 85% of all home care given in the United 
States. These husbands and wives, sons and daughters, are willing to 
make the sacrifices necessary to ensure that their loved one--who have 
served our Nation in the Armed Forces--are able to remain at home in 
their time of need.
  Besides Alzheimer's, many of our veterans suffer from the aftermath 
of a stroke, Parkinson's disease, and other adult onset brain-impairing 
diseases and disorders. By contracting out for respite care services, 
the VA will make a real difference in the day to day quality of life 
for a veteran and his or her family member.
  Another important provision in the Veterans Millennium Health Care 
Act is that the bill puts in ``speed bumps'' for the VA as it examines 
its physical facilities and their future use as we enter the next 
century. Last month, House Veterans' Affairs Committee staff along with 
my veterans aide traveled to New Jersey to see first hand how our state 
and the VA network which it is part of, is dealing with the President's 
budget cuts. They were pleased to find out that there is a strong level 
of commitment and dedication among the staff in spite of much belt 
tightening that has resulted under the Veterans Equitable Resource 
Allocation (VERA) formula. And yet, VA officials told Committee staff 
that future cuts will cut into the bone. As a result, veterans in New 
Jersey and throughout the Northeast have been concerned about closure 
of hospitals, nursing homes, and clinics. I know that at the Brick 
Clinic located within my Congressional district, we have successfully 
fought to restore specialty services for our veterans. To not do so 
would force them to travel an hour and a half in the car to the VA's 
facility in East Orange. This is unacceptable and we were able to 
successfully persuade the VA to rethink their health care strategy for 
Central New Jersey.
  Recognizing veterans' concerns about their facilities, H.R. 2116 puts 
in place several mechanisms that will prevent the VA from an arbitrary 
closure or realignment of a facility. For instance, under H.R. 2116, 
the VA must conduct a study before it can even consider changing a 
hospital's mission. Any realignment plan put forth must include the 
participation of federal employees and veterans. Furthermore, VA 
employees will be given preference in future hiring. Any savings from a 
mission change must be retained within the local area and reinvested in 
new services for veterans, insuring improved access to care. Finally, 
and most importantly, Congress will be given a minimum of 45 days to 
review any VA recommendations on potential changes.
  This provision, and the overall Millennium Health Care Act, does come 
with a price tage--but it is one that our veterans both need and 
deserve. Enhancing eligibility for veterans on a variety of levels 
requires that both Congress and the President find the necessary funds 
for long term care and eligibility expansion. Earlier this month, the 
House approved a $1.7 billion increase for veteran's health care.
  I urge all of my colleagues to join me in voting for passage of this 
bill which is integral to the health and well being of America's 
veterans.
  Mr. FILNER. Mr. Speaker, I rise in support of the Veterans' 
Millennium Health Care Act. This bill improves the VA health care 
system in many ways. For example, it will extend long term care and 
emergency care services, provide sexual trauma counseling, expand care 
and treatment for veterans who have been recognized by the award of the 
Purple Heart.
  In addition, I am especially pleased that this legislation ensures 
that the Veterans Administration (VA) will work with licensed doctors 
of chiropractic care to develop a policy to provide veterans with 
access to chiropractic services. Even though chiropractic is the most 
widespread of the complementary approaches to medicine in the United 
States, serving roughly 27 million patients--and even though Congress 
has recognized chiropractic care in other areas of the federal health 
care system (Medicare, Medicaid, and federal workers compensation), VA 
has chosen not to make chiropractic routinely available to veterans. 
This bill changes that.
  As a Member representing a portion of San Diego County, I am also 
pleased that H.R. 2116 includes a biomedical research facility for the 
VA San Diego Healthcare System to accommodate current and pending 
research programs on diabetes, immunology, hypertension, Parkinson's 
Disease, AIDS, and memory.
  I encourage my colleagues to support and vote in favor of the 
Veterans' Millennium Health Care Act.
  Mrs. KELLY. Mr. Speaker, I rise today in opposition to H.R. 2116, the 
Veterans Millennium Health Care Act, in its present form. This is a 
position I take after a great deal of deliberation and review of the 
effects of some of the provisions in this legislation.
  I want to begin by recognizing the many positive initiatives 
contained in this legislation that will truly benefit our veterans 
population, such as the requirement for long term care for veterans 
with 50 percent or greater service connected disability. This issue is 
one of my highest priorities in Congress and is the reason I introduced 
H.R. 1432, the Veterans Long Term Care Availability Act, which 
requires, essentially, the very same thing. Additionally, the 
provisions that provide coverage for emergency care services to 
veterans, priority care for Purple Heart recipients and expansion of 
the enhanced use lease authority available to VA facilities with extra 
unused space are all good initiatives that I wholeheartedly support.
  Unfortunately, these good provisions are coupled with two problematic 
provisions that we should be given the opportunity to offer amendments 
to correct. By suspending the rules to pass this bill we are unable to 
offer amendments to correct some of the bill's problems. For instance, 
Section 107 of this legislation, entitled ``Enhanced services program 
at designated medical centers,'' sounds like a good program. In 
reality, however, this section stipulates the conditions under which a 
VA hospital can be closed. This is a very important process before us 
now that entails a great deal of controversy that should be debated on 
its merits. I have to question why we would want to put into place a 
procedure for closing VA hospitals in a time when we are facing 
unprecedented growth of the health care needs of veterans. One of the 
stipulations of this section is that Congress gets 30 in session days 
to review the VA's findings. I believe this period should be longer. We 
all know that Congress was intentionally created to be a very 
deliberative body. If we are going to have an opportunity to review 
such a report we will need more than 30 days to do so.
  Additionally, Section 201 entitled ``Medical care collections,'' 
would enable the VA to raise co-payments that veterans would be 
required to pay on their prescription drug benefits. Veterans I have 
spoken to in my area are frustrated enough with the current co-payments 
they are required to pay. The typical veteran from New York is poorer, 
sicker and older than the rest of the nation. The current prescription 
drug benefits that veterans have are one of the few benefits that 
genuinely helps them. If we need more money we should appropriate it, 
not charge veterans.
  Finally, the question that comes to my mind is the cost of this 
legislation. CBO testified before the House Veterans Affairs Committee 
that this bill would cost $1.4 billion a year to implement. Where are 
we going to get this money. The last thing Congress should do is pass 
costly mandates upon the VA without passing appropriate funding. If we 
fail to pass appropriate proper funding, the VA will be forced to cut 
back or end other services in order to comply with these new mandates. 
This year the House has passed a VA-HUD Appropriations Act that 
increases VA spending by $1.7 billion. This level is currently in 
question and I wonder if we will be able to achieve it. With the 
funding requirements this bill would incur, where is the money going to 
come from? Do we have a commitment to provide a $1.4 billion increase 
next Congress? This is one of the questions that must be answered

[[Page 21914]]

before we pass such a large bill. We cannot afford to short change 
veterans.
  Finally, the supporters of this bill speak of the many endorsements 
H.R. 2116 has received from national veterans groups. I have contacted 
these groups and found that many of them agree with my concerns. Let me 
quote from a letter from Richard Esau, Jr., the National Commander of 
the Military Order of the Purple Heart.

       H.R. 2116 was ``the topic'' of conversation at our 
     Convention. We concur completely with your evaluation of this 
     bill. Yes, we need long term care for veterans with service 
     connected disability of 50 percent or greater. Yes, we need 
     VA provided emergency care services and most assuredly we 
     need priority care for Purple Heart recipients and military 
     retirees. If a percentage of these funds is to be recovered 
     via the Federal tobacco lawsuit, so be it. I can't ever 
     remember a C-ration package that didn't have a cigarette pack 
     in it.
       Congresswoman, we couldn't agree more with your concerns 
     about the bill's procedures for closing VA hospitals. You 
     have only to look at the State of Maine to see how the 
     laissez faire attitude of federal bureaucrats is working a 
     hardship on thousands of veterans who soon will have to 
     travel from their homes (some on the Canadian border) to 
     Boston, Massachusetts for treatment. Further, we wouldn't 
     want the VA Secretary to have the authority to increase 
     prescription co-payments for veterans with service connected 
     disabilities of less than 50 percent. Too often, the VA 
     Secretary is a political animal who has never had a shot 
     fired at him in anger. This type of Secretary just doesn't 
     seem to understand how important medicines are to older vets 
     and what a slap in the face it is to require them to pay more 
     rather than less for this service. Do other Members of 
     Congress realize a plurality of these veterans are on fixed 
     incomes?
       I personally would like to see your bill, H.R. 1432, taken 
     out of committee and debated on the floor of the House. I am, 
     however, a realist who knows that ``half a loaf'' is better 
     than none. Therefore, along with my fellow patriots, I 
     support passage of H.R. 2116 and ask you, Sue Kelly, to 
     continue your watchdog activities to ensure vets have their 
     medicines at reasonable prices and needed ``old'' VA 
     facilities stay open.

  As we see from this letter, veterans are ready to take the good 
portions of this bill along with the bad portions of this legislation. 
We should pass the best bill possible, not a good and bad bill. We 
should allow for a full and open debate of these provisions and take 
H.R. 2116 off the suspension list and allow amendments. It is only 
through the full open democratic process that we can ensure that all 
sides are properly represented. If this bill fails tonight when the 
full House votes, I pledge to do everything in my power to ensure that 
this bill is given the proper time for full House consideration of all 
germane amendments.
  I am joined in opposition by members who want only the best for our 
veterans and the Eastern Paralyzed Veterans Association. I urge members 
on both sides of the aisle to carefully consider these issues before 
casting their vote on this all too important legislation.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise in support of H.R. 
2116. This bill makes a number of important changes to veterans' health 
care programs.
  The bill directs that the VA operate and maintain a national program 
of extended care services, including geriatric evaluations, nursing 
home care, adult day health care, domiciliary care and respite. The 
measure requires the VA to develop and begin to implement by January 1, 
2000 a plan for carrying out the recommendation of the Federal Advisory 
Committee on the Future of Long Term Care. The VA was directed to 
increase home and community based care options as well as the 
percentage of the medical care budget dedicated to such care. The bill 
mandates the VA to provide needed extended care services in the case of 
veterans who are 50% service connected or in the need of such care for 
a service connected condition; and provide such veterans highest 
priority for placement in VA nursing homes.
  Although the calendar year indicates that we honor these men and 
women on Memorial Day and Veteran Day, I believe that we should pause 
everyday to thank them for their sacrifice. The collective experience 
of our 25 million living veterans encompasses the turbulence and 
progress America has experienced throughout the twentieth century. This 
nation's veterans have written much of the history of the last hundred 
years. They have served this nation without reservation or hesitation 
during its darker moments.
  Their unwavering devotion to duty and country has brought this nation 
through two World Wars and numerous costly struggles against 
aggression. From World War I to the Gulf War, America's veterans have 
been leading this nation against those who have threatened the values 
and interests of our nation.
  Only today are the accomplishments and sacrifices of our veterans 
being fully appreciated by historians and the public. These genuine 
heroes have often been ignored and denied their proper place in 
America's melting pot. We need to remember that America owes these men 
and women the best it can offer because they have given us the best 
they could when America was in need.
  Mr. Speaker, I am fortunate to have The Houston Department of 
Veterans Affairs Medical Center located in my congressional district. 
Having just celebrated fifty years of service to the veterans in the 
Houston community. Some 1,646,700 veterans live in the State of Texas 
alone. The Houston VA Medical Center expects to receive and serve over 
50,000 veterans in this year alone. I expect this measure to improve 
the quality of life for all our veterans who so proudly served our 
nation.
  Mr. Speaker, this bill is important not only because it provides for 
the needs of our veterans today but because it sends an important 
signal to the men and women serving our nation in places like Bosnia, 
Kosovo, Germany, Korea, Japan and other far off places around the 
world. That message is simple, that when you serve our nation we will 
answer the plea of President Lincoln ``to care for him who shall have 
borne the battle.''
  I urge my colleagues to vote yes on H.R. 2116 and care for the men 
and women who have borne the battle.
  Mr. PORTMAN. Mr. Speaker, I rise to support H.R. 2116, the Veterans' 
Millennium Health Care Act of 1999, which is designed to address the 
long-term health care needs of veterans of the 21st century.
  However, I want to express my seniors concerns with a provision of 
the bill that may unfairly impact a vital nursing home facility 
proposed to serve veterans in southern Ohio. Specifically, I am 
concerned with Section 206, the State Home Grant Program, which would 
only allows projects to be funded in FY 2000 that are on the VA's 
approved list as of October 29, 1998. The effect of this could be to 
prevent the federal matching funds next year for a facility in 
Georgetown, Ohio in Brown County. Ohio's application for the Brown 
County facility was submitted to VA earlier this summer.
  Ohio has a shortfall of more than 4,000 VA nursing home beds and is 
vastly underserved. In fact, the only VA nursing facility Ohio is 
located in Sandusky in the northern part of the state, and there are 
160 veterans on the waiting list for admission. Of the Sandusky VA 
facility's 650 residents, only 8 are from southern Ohio. As a result of 
this shortfall and the need to better serve veterans in southern Ohio, 
the state committed $4.5 million for the Brown County project as its 
share of the construction money in Ohio's FY 2000 budget. The state has 
also committed $500,000 for various administrative expenses to see the 
project to completion for a total of $5 million in state funds. The 
federal share needed for the facility is $7.8 million.
  The State of Ohio's financial commitment to the Brown County facility 
was signed into law by the Governor on June 30, 1999. Ohio's 
application was submitted to VA on July 22, a month ahead of VA's 
August 15 deadline for receiving FY 2000 funding applications. As you 
know, the House recently approved $90 million for the State Homes 
Construction Grant program in the FY 2000 VA, HUD, Independent Agencies 
bill--a $50 million increase over the President's request which I had 
worked for in the Appropriations Committee and supported. I am told 
that a similar amount is expected to be included in the Senate bill. It 
is my understanding that Ohio's application should be sufficiently high 
in priority that the VA, HUD Independent Agencies appropriation would 
provide the federal funds needed for the Brown County facility in FY 
2000. Unfortunately, I am advised by the State of Ohio officials and 
the VA, that the October 29, 1998 cutoff date in H.R. 2116 will 
automatically make Ohio's application ineligible for funding next year.
  Ohio has acted in good faith to provide the needed $5 million state 
match and has spent an additional $154,000 to prepare the application, 
which was submitted well within the timetable for FY 2000 funding under 
VA's current guidelines. I want to add that Brown County has spent 
$186,000 of its own funds for land acquisition, an environmental impact 
study and for other expenses, so there has been a considerable state 
and local investment in this project.
  Of course, the VA still must approve the Brown County application 
based on its merits. However, it is unfair to change the rules in the 
middle of this year's application process and preclude Brown County's 
facility from being funded in FY 2000 as would happen under the current 
language of H.R. 2116. It is my hope that an equitable solution to this 
unfortunate situation can be worked out in conference, and I look 
forward to working with Chairman Stump, Chairman Stearns, ranking 
members

[[Page 21915]]

Evans and Gutierrez and the Senate to ensure that the veterans in 
southern Ohio are treated fairly in this process.
  Mr. STUPAK. Mr. Speaker, I speak today in support of H.R. 2116, the 
Veterans Millennium Health Care Act. I would like to commend Chairman 
Stump and Ranking Member Evans on their hard work on this bill, and 
their work on behalf of America's veterans.
  I have a small VA medical facility in my district, Iron Mountain 
Veterans Medical Center. Under existing law, VA could arbitrarily close 
this facility, and have come close to doing so in the past. H.R. 2116 
would provide protections not available under current law. It would 
require VA to involve veterans' service organizations, employee unions, 
and other interested parties. It would require VA to submit the plan 
and justification to Congress and allow a waiting period of 45 days. 
These provisions provide for far greater protection than under current 
law, and allow for the community and individual input which is lacking 
in current proceedings.
  Other notable provisions in H.R. 2116 address issues which have been 
neglected for too long. Long-term care is expanded; VA's authority to 
make grants to assist homeless veterans is extended; the criteria for 
awarding grants to building and remodeling state veteran's homes has 
been reformed; VA is directed to cover emergency costs for uninsured 
veterans; it provides for sexual trauma counseling; provides for 
chiropractic care; it will give the VA access to a portion, if funds 
are recovered from tobacco companies, to compromise for its costs of 
tobacco-related illnesses; and it establishes a new health care 
enrollment category for non-disabled military retirees eligible for 
Tricare which essentially guarantees these military retirees health 
care.
  The innovative provisions in this bill which make it so responsive to 
those veterans who have served our country so well is deserving of our 
support, and I urge my colleagues to vote for the Veterans Millennium 
Health Care Act.
  Mr. RODRIGUEZ. Mr. Speaker, I rise in support of the Veterans 
Millennium Health Care Act of 1999. I commend the efforts of the 
Chairman and Ranking Member of the VA Committee, along with the 
Chairman and Ranking Member of the Health Subcommittee and their staff, 
of developing this needed piece of legislation.
  This health care bill offers many positive improvements, including 
the expansion of care for long-term nursing, mental health services, 
emergency and other needed care. It represents a comprehensive and 
necessary change to keep our VA health care facilities and services in 
tune with the needs of veterans and the changing health care industry. 
I urge the Senate to act quickly in passing this bill so we can have it 
enacted into law this year.
  A more fundamental problem we face lies in the funding of such 
programs, especially for the discretionary health care budget. We can 
authorize all we want for VA health care. But based on the budget caps 
set by the House leadership, veterans will be lucky just to avoid 
having cutbacks in fiscal year 2001 and could face much more drastic 
cuts in future years. We all want HR 2116, and authorizing bills like 
it, to expand health care and benefits to veterans and their families. 
But we must be prepared to bite the bullet and give adequate funding 
for all veterans services.
  Mr. SMITH of Texas. Mr. Speaker, I strongly support H.R. 2116, the 
Veterans Millennium Health Care Act.
  Health care as we know it is changing. New technology allows for 
better treatment, better diagnosis and greater opportunities than ever 
before.
  But as we approach the 21st century, the Veterans Administration must 
also change to address the needs of our veterans. This bill 
accomplishes that objective.
  Mr. Speaker, my district contains one of the highest concentrations 
of veterans in the country. I have held town meetings across my 
district to listen to their concerns. The veterans I represent have 
advocated many of the provisions contained in this bill.
  From requiring the VA to enlist the help of veterans organizations in 
developing enhanced service plans, to allowing the VA to contract for 
needed hospital care, the provisions contained in H.R. 2116 will 
benefit the VA for years to come.
  Mr. KOLBE. Mr. Speaker, I welcome this legislation to meet the health 
care needs of our veterans and rise to express my support for the 
Veterans' Millennium Health Care Act. This is the kind of act that will 
help restore accountability and credibility to the government's 
reputation with regard to keeping our promise to take care of our 
nation's veterans.
  In Tucson, we eagerly await the ground breaking of the Tucson VA 
Medical Center's new outpatient facility. This legislation complements 
that effort to insure the policy as well as the infrastructure is in 
place to provide appropriate care for Southern Arizona veterans. 
Outpatient care delivers more care to greater number at a lower cost. I 
am pleased to see outpatient care further supported in this bill. With 
the World War II generation and their sons and daughters entering the 
later half of their lives, these improvements to long term care is 
timely and needed.
  This represents Congress responding to real needs of the people. The 
broad support within the House of Representatives shows that we put the 
people we serve first and we are using the best of our collective 
experience to implement the most responsible policies. Again, I thank 
the members of the Committee and fellow Arizona member Bob Stump for is 
diligent efforts and leadership in serving our veterans.
  Mr. BUYER. Mr. Speaker, I rise in strong support of the Veterans' 
Millennium Health Care Act. This bill will directly address the 
veterans' concerns regarding the availability of long-term care, 
improving access to VA health care, and provide many military retirees 
access to a VA Health Care system that, in the past, has been closed to 
them.
  In addition, this bill finally addresses the issue of allowing VA to 
reimburse service-connected veterans and low income veterans for 
emergency care that they may have received at a non-VA facility. 
Equally important, the Veterans' Millennium Health Care Act provides VA 
the authority to generate much needed revenues by establishing 
copayments on hearing aids and other extremely high cost items for 
nonservice-connected conditions, and allow VA to earmark these revenues 
specifically for medical care.
  Lastly, this bill provides veterans and their families a voice in the 
future of their health care system by requiring the VA to consult with 
the veterans community about the realignment of any VA facilities. Mr. 
Speaker, this bill is good for VA, and more importantly good for 
veterans.
  Mr. EVANS. Mr. Speaker, I rise in support of H.R. 2116, as amended, 
the Veterans' Millennium Health Care Act. Before I comment on some of 
the specific provisions of this bill, I want to thank Chairman Stump, 
Chairman Stearns, and the Ranking Democratic Member of the Health 
Subcommittee, Mr. Gutierrez, for working with me to incorporate certain 
provisions I have long-supported in this important bill.
  This is an ambitious bill, but it is a bill that works in a realistic 
context. It takes cognizance of some disturbing trends we have seen in 
funding for veterans' health care, notwithstanding the Committee's 
support of significant funding increases. It is a bill that will better 
assure Congress that VA is continuing to meet veterans' vital needs for 
long-term care services. It is a bill that gives Congress better 
assurance that VA will plan effectively for ways to continue to treat 
veterans regardless of the health care setting. Finally, it is a bill 
that will allow veterans who regularly use the VA system to receive 
reimbursement for emergency care services.
  The bill also contains a ``report and wait'' requirement which 
responds to a concern I raised that VA is dismantling its inpatient 
programs without adequate planning to fulfill veterans' needs for these 
programs in outpatient or community settings. The provision follows 
other efforts Congress has put in place to ensure that important 
services and programs remain available to veterans as it restructures 
under what may be an austere budget.
  Since decentralizing its management, VA has closed acute inpatient 
beds at a pace that I believe has taken many by surprise. The hardest 
hit have been the beds for psychiatric, rehabilitation, and other 
services of a ``longer term'' nature. Unfortunately there are some 
indications that, instead of planning effectively to continue to meet 
the needs of these vulnerable patients on an outpatient basis, their 
care is slipping through the cracks.
  Long-term care remains an area of concern as VA continues to tighten 
its belt. Last month, I presented findings from a report done at my 
request to assess recent changes in VA's long-term care delivery 
efforts to veterans. My staff surveyed VA's Chiefs of Staff to see how 
VA was responding to veterans' growing need for long-term care. Survey 
findings indicated that there were substantial erosions in the long-
term care program--VA may be treating more veterans, but it is 
discharging them after much shorter stays that may not satisfy their 
need for ongoing care. The Report concluded with several 
recommendations to improve VA Long-Term Care that the Millennium Plan 
addresses. The findings and recommendations of this report were 
instrumental in shaping this legislative plan for addressing long-term 
care in VA.
  The Millennium Plan establishes a good baseline for meeting veterans' 
needs for long-

[[Page 21916]]

term care. We believed it was best to guarantee that veterans with the 
highest priority for care--those with health care conditions due to 
military service--receive all of the long-term care they need.
  The bill also requires VA to maintain its long-term care program and 
enhance the services it provides in the home and community. VA is under 
enormous financial pressure and long-term care is expensive. The survey 
identified some disturbing changes in VA's long-term care program that 
obviously stemmed from financial pressure. it is time to give VA clear 
direction about whom we expect VA to treat and what services we will 
require it to offer.
  I have had a long-standing interest in emergency care reimbursement. 
I introduced two bills in the last Congress and this year I introduced 
H.R. 135, the ``Veterans Emergency Health Care Act''. H.R. 135 allows 
VA to reimburse enrolled veterans for expenditures made during medical 
emergencies. Veterans who rely on VA for their health care have been 
financially devastated by an emergency health care episode. Veterans 
who try to reach VA during a health care crisis have been told by VA 
staff to go to the closest health care facility for treatment, but once 
the bills came, the VA refused to reimburse them. It seems 
unconscionable that VA would abandon these veterans during their 
greatest health care crises, but I know it happens.
  I also know VA wants to fix this problem. Asked to identify 
legislation it needs to comply with the President's ``Patient Bill of 
Rights'', VA indicated it would need authorization to reimburse 
emergency health care for the veterans it enrolled. The President 
ordered federal agencies to comply with the bill, yet a proposal 
contained in the President's budget only partially addressed VA's 
request for this authority. The Millennium Bill goes farther by 
allowing VA to reimburse any high-priority enrolled veteran for 
emergency care services.
  I have also advocated allowing more veterans to choose chiropractic 
care in VA. Last year I introduced a bill to establish a chiropractic 
service in VA which was supported by the American Chiropractic 
Association and the International Chiropractors Association. The 
Millennium Bill will require that VA work with chiropractors on a 
policy that will allow veterans' better access to their service within 
VA. Veterans deserve the opportunity to choose chiropractic care.
  The Millennium Bill contains provisions that will authorize VA to 
increase copayments for drugs, neurosensory devices and certain other 
prosthetics, and extended care. I believe the Committee must offer 
leadership in addressing some of these difficult issues head on. I want 
to make sure that VA can maintain services for veterans that rely on it 
for their health care--the best way we can do this is by requiring some 
veterans to contribute more to their health care. VA's costs for 
pharmaceuticals have doubled over the last ten years; allowing more 
veterans to acquire hearing aids and eyeglasses from VA has also put a 
tremendous strain on VA's ability to acquire prosthetics. We need to 
ask some veterans to chip in for these benefits which are not provided 
by most health care insurers--it's still a significant benefit for 
veterans.
  The bill addresses facility realignment which has been an 
understandable concern for some. Mr. Speaker, it is important to 
realize that VA currently has the authority to realign its medical 
resources, including closing hospitals. Since the VA has allowed so 
much of its decision making to take place in its 22 networks, Congress' 
ability to ensure that VA is going through a fair process in 
determining the need for facility closures has diminished considerably. 
In this bill, we provide VA with a framework that better ensures that 
the views of veterans, employees and other interested parties are taken 
into account and that VA finds the least disruptive means of continuing 
to care for the veterans it serves. While I do not view this 
legislation as supportive of such closures, I do not believe it will 
lead to a more constructive process for planning for major 
restructuring.
  It is abundantly clear that VA is not operating in a world of 
unlimited resources. I believe this bill has many positive gains for 
veterans while not imposing unreasonable new costs onto an already 
fiscally strapped system. I endorse this ambitious bipartisan 
legislation.
  Mr. UDALL of New Mexico. Mr. Speaker, I rise today to voice my 
support for the Veterans' Millenium Health Care Act, a bill which I 
have cosponsored.
  As we enter the dawn of a new millenium, we are faced with a nation 
of aging veterans. These men and women, who protected our national 
security, now need us to ensure their long-term health care security.
  This bill quite literally changes the face of the current VA hospital 
system. Under this Act, veterans' health care will shift from one where 
veterans must go to a designated center to one that will become more 
accessible to veterans through outpatient clinics, long-term care and 
community care centers. This is the prescription for medical care that 
northern New Mexico veterans have been waiting for.
  With only one major VA center in New Mexico, hundreds of miles from 
where my constituents live, veterans are dependent on the limited care 
provided by rural health care centers. This bill will ensure these 
rural health care clinics have the resources available to give our 
veterans the full medical treatment they require.
  This is a commonsense bill that provides veterans in rural 
communities the same type of treatment that veterans in other 
communities already receive and I urge my colleagues to pass it 
immediately.
  Mr. STUMP. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Arizona (Mr. Stump) that the House suspend the rules and 
pass the bill, H.R. 2116, as amended.
  The question was taken.
  Mrs. KELLY. 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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