[Congressional Record (Bound Edition), Volume 145 (1999), Part 20]
[House]
[Pages 29818-29828]
[From the U.S. Government Publishing Office, www.gpo.gov]




  CONFERENCE REPORT ON H.R. 2116, VETERANS MILLENNIUM HEALTH CARE AND 
                              BENEFITS ACT

  Mr. STUMP. Mr. Speaker, I move to suspend the rules and agree to the 
conference report on 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.
  The Clerk read the title of the bill.
  (For conference report and statement, see prior proceedings of the 
House of today.)
  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Arizona (Mr. Stump) and the gentleman from Illinois (Mr. Evans) 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 to revise and extend their remarks and include 
extraneous material on the conference report 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, the Veterans Millennium Health Care and Benefits Act is 
the most comprehensive legislation to be acted on in behalf of 
America's veterans in decades. H.R. 2116 includes landmark legislation 
mandating access to VA nursing home care for severely disabled veterans 
and requiring the VA to provide more veterans with alternatives to 
nursing home care. This legislation also authorizes the VA to pay for 
emergency care service for veterans who do not have insurance or access 
to Medicare. Additionally, we are elevating the health care priority 
for veterans who receive the Purple Heart and providing greater access 
to VA health care for military retirees.

                              {time}  1715

  The Veterans Millennium Health Care and Benefit Act also includes 
many benefits, including providing special borrowing authority to the 
American Battle Monuments Commission to assure that groundbreaking on 
the national World War II Memorial can take place on Veterans' Day next 
year; making it easier for surviving spouses and children of ex-POWs to 
qualify for compensation and naming this provision for Mr. Bill Rolen 
of the American Ex-POWs, who passed away this past September; improving 
the Montgomery GI Bill benefits for officers who began military service 
as enlisted personnel and veterans preparing to take entrance 
examinations; and requiring the VA to begin planning for six new 
additional cemeteries in recognition of the demographic realities 
facing our veterans population; and, adding a rare form of lung cancer 
to the conditions presumed in law to be service connected due to 
exposure of ionizing radiation.
  Mr. Speaker, I urge my colleagues to support this conference report, 
and I reserve the balance of my time.
  Mr. EVANS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I want to thank the chairman of our committee and salute 
him for his outstanding leadership. This conference agreement is due in

[[Page 29819]]

large part to the commitment and determination of the gentleman from 
Arizona (Mr. Stump), the chairman of the Committee on Veterans' 
Affairs, to address the needs of our Nation's veterans. I also want to 
thank the other House conferees from both sides of the aisle who worked 
hard together. Every Member of the House can proudly support this 
agreement. It strongly reaffirms our commitment to America's veterans.
  I also want to acknowledge the commitment of the other conferees from 
the other body to craft this conference agreement. Their cooperation 
was essential.
  Mr. Speaker, there are a number of provisions in the conference 
agreement which are particularly noteworthy. I will describe only a few 
at this time.
  Mr. Speaker, this conference agreement responds to the long-term care 
needs of our veterans. This bill mandates that the VA provide nursing 
home care to enrolled veterans rated 70 percent or more service-
connected disabled, and to veterans with a service-connected disability 
in need of institutional long-term care for that service-connected 
disability.
  Noninstitutional long-term care as part of the basic benefits package 
as well for VA enrollees. As the author of emergency care legislation, 
I am particularly pleased that the VA is authorized to provide 
reimbursement for emergency care not provided in VA facilities to 
certain enrolled veterans.
  As the author of the House legislation requiring the VA to adopt, in 
consultation with chiropractic providers, a formal policy on 
chiropractic treatment in the VA, I am very pleased that this 
requirement is included in H.R. 2116.
  I am also pleased that the agreement authorizes the VA Sexual Trauma 
Counseling Program and the VA's Federal Advisory Committee on Minority 
Veterans. The conference agreement also contains two important 
provisions that fortify important, but expensive, programs for 
vulnerable veterans with severe chronic mental illnesses.
  Mr. Speaker, the conference agreement also reauthorizes the Homeless 
Veterans Reintegration Project for 4 more years. In addition, the 
amount authorized annually for this vital program is increased 
incrementally from $10 million to $20 million per year by fiscal year 
2002.
  This measure also directs the Secretary of Veterans Affairs to 
establish six areas of the country most in need of cemetery space to 
serve American veterans and their families. I am certain our committee 
will be vigilant in its oversight of the Department's compliance with 
the requirements of this provision.
  The Secretary is also required to contract for an independent study 
on improvements to veterans' burial benefits. I want to thank the 
gentlewoman from Florida (Ms. Brown) for her outstanding leadership on 
this issue.
  As the author of the House legislation to establish a rigorous 
quality assurance program within the VA, I am pleased that the 
conference agreement mandates a quality review program in the Veterans' 
Benefits Administration that meets appropriate governmental standards 
for independence and internal control. Our veterans deserve no less.
  Mr. Speaker, this is a conference agreement that we can all be proud 
of, and I urge my colleagues to support it.
  Mr. Speaker, I rise in support of the Veterans Millennium Benefits 
Act of 1999. H.R. 2116, as agreed to by the conferees, makes 
significant improvements to the benefits and services provided to 
America's veterans.
  I want to thank the Chairman of the Committee, Bob Stump for his 
outstanding leadership. The conference agreement before the House today 
is due in large measure to Bob Stump's commitment and determination to 
address the needs of our Nation's veterans. I also want to thank the 
other House conferees from both sides of the aisle. Everyone worked 
well together to produce a conference agreement which every Member of 
the House can proudly support. It is strong reaffirmation of our 
commitment to America's veterans.


                         extended care services

  Defining a direction for VA long-term care is imperative. In my view, 
the solution must define a clear policy that would preserve and 
strengthen VA's nursing home program and prompt VA's expansion of the 
use of non-institutional alternatives to long-term care without forcing 
unreasonable new costs on VA. This struggle to define appropriate 
coverage for individuals who need long-term care is confronting our 
whole health care system right now.
  I believe VA's future, in large measure, depends on its ability to 
address the special needs of veterans. Inasmuch as it fails to address 
veterans' long-term care needs, particularly for the highest priority 
veterans, I believe its future is jeopardized. One of the primary 
reasons I became an original cosponsor and architect of the Veterans' 
Millennium Health Care Act was to address the evolution of VA's nursing 
home programs. My staff has collected data from VA medical centers 
across the country that indicates VA's role in long-term care is 
diminishing substantially. There is no longer any guarantee to life 
placement for many veterans as VA shifts its nursing homes to 
restorative, rehabilitative and palliative care. Veterans assuredly 
have a need for all of these types of care, but neither these subacute 
services, nor non-institutional care is always able to substitute for 
nursing home care needed for the most impaired veterans.
  The good news is that this conference agreement will define a 
direction for VA in managing long-term care--an important, but 
expensive part of the health care continuum. The legislation initially 
approved by the House guaranteed extended care and non-institutional 
care to the system's highest priority users. The goal of the other body 
was to create a guaranteed package of non-institutional long-term care 
for all VA enrollees. This agreement ensures institutional and non-
institutional care for veterans with service-connected conditions for 
their service-connected condition and veterans with service-connected 
disabilities rated greater than 70%. It also establishes authority for 
VA to provide non-institutional care to all enrolled veterans.
  In addition, VA will be required to maintain the level of in-house 
extended care services it offered in 1998, while expanding non-
institutional care. The extended care provisions also authorize several 
pilot projects--one based on the successful and cost-effective Program 
for All-Inclusive Care for the Elderly (PACE) that offers an integrated 
and comprehensive array of medical and social services to help the 
frail elderly remain as independent as possible. Another pilot will 
examine the appropriate use of assisted living for veterans served by 
VA.
  These benefits reassert the importance of long-term care in the 
continuum of care VA offers to veterans. It also provides a substantial 
benefit to veterans which VA can accommodate. While setting a new 
course for long-term care, we have done so in fiscally responsible 
manner that will not inflict an unfunded mandate on VA.


                           emergency services

  The conference agreement on H.R. 2116 contains authority to reimburse 
hospitals for enrolled veterans' emergency care. Today, too many 
veterans face frustration and failure when they seek VA reimbursement 
for their emergency care provided by a non-VA provider. By emphasizing 
its role as a primary care provider, I believe many veterans have 
logically assumed VA would be responsible for their emergency care 
costs. Furthermore, an Executive Order in November 1997 provided all 
federal agencies conform to the President's Patient Bill of Rights. VA 
did not provide most veterans reimbursement for treatment received from 
a non-VA provider in a medical emergency. Veterans' experiences in 
seeking reimbursement from VA for emergency care, even when 
``referred'' to a community provider by VA and refused transfer to VA, 
indicate that this is a significant problem for many VA users. 
Emergency care is a potentially catastrophic ``hole'' in the safety net 
veterans believe they have with VA health care.
  The conference agreement authorizes VA to reimburse providers for 
emergency care provided to any enrolled veteran who has used VA care 
within the last two years. It uses a ``prudent lay person'' standard, 
as the recently approved Patient Bill of Rights did, to determine what 
constitutes a medical emergency. I thank the Senator from West Virginia 
for agreeing to support legislation offered by the Senate Minority 
Leader, a companion to the emergency care legislation I authored and 
introduced in the House. I am also pleased that, in achieving a 
productive compromise on the legislation I offered in this and the last 
session of Congress,

[[Page 29820]]

this measure is now an even more fiscally responsible proposal that 
will allow VA to better manage this important new benefit to veterans.


                   sexual trauma counseling services

  The Ranking Democratic Member of the Health Subcommittee, Congressman 
Luis Gutierrez, has worked diligently to ensure VA's sexual trauma 
counseling services are preserved and strengthened. The conference 
agreement provides that VA must offer a sexual trauma program. This is 
an important change from current law that makes the program 
discretionary. While the conference agreement does not include a House 
provision to authorize reservists to receive program services, a study 
is required to determine the needs for these services within the 
reservist population. With a strengthened provision on outreach, this 
agreement insures sexual trauma counseling and treatment programs are a 
stronger part of VA's core services.


                          Specialized Services

  The Veterans Millennium Benefits Act incorporates two measures--one 
approved by each body. To strengthen VA's paramount special emphasis 
programs, particularly for seriously chronically mentally ill veterans. 
The conference agreement on H.R. 2116 requires VA to report on bed 
closures that affect inpatient substance abuse treatment programs, 
post-traumatic stress disorder programs or other programs for the 
seriously chronically mentally ill. A report on bed closures is also 
required for rehabilitation beds. The report requirement is intended to 
encourage careful consideration by VA facility directors of the 
importance of continuing treatment( regardless of setting) for 
vulnerable veterans, not, as some have suggested, to deter bed closures 
entirely.
  The other provision would establish a grant program to allow VA to 
provide at least $15 million to programs for treatment of post-
traumatic stress disorder and substance abuse programs. Restrained 
budgets have taken a serious toll on these programs that offer care to 
a very vulnerable population. These two initiatives are intended to 
restore these very important services that have been diminished due to 
fiscal constraints.


                           State Home Grants

  The VA funds state home grants to construct nursing homes and 
domiciliaries. This is a beneficial relationship between VA and states 
that almost every state has embraced. As the State Homes increase, so 
to does veterans' access to long-term care. This is recognized as a 
benefit by all.
  For some time, however, grant requests from the states to construct 
new beds have overwhelmed the ability of the Congress to fund them. As 
a result, the backlog of grant requests for homes from states that long 
ago made the commitment to serve veterans through State Homes has grown 
tremendously. In addition, some State Homes have fallen into disrepair 
over the more than 35-year history of this VA program.
  I view the agreement of the conferees as a ``good Government'' 
proposal. It will allow VA to take care of State Homes that have long 
cared for veterans and allow VA to give greater priority to states that 
still have a substantial need for State Home beds. Our veterans will be 
better served by State Homes because of the conference agreement.


                      Enhanced-Use Lease Authority

  Recently, GAO claimed VA was ``wasting a million dollars a day'' on 
its overbuilt infrastructure. While I do not fully support this view, 
it does document the challenge VA has in managing its vast array of 
capital assets. One tool VA has found useful to maintain properties not 
now needed for patient care or other uses is enhanced-use leases. These 
leases allow VA to continue to hold the title to properties, without 
having the expense of maintaining them, while they are used for 
productive purposes by non-VA entities.
  To make these leases more attractive to those who might consider 
their use, the conference agreement increases the number of years that 
developers have use of property from 35 to 75 years. This will allow 
those who want to make significant investments in property to 
capitalize on them throughout the useful life of most construction 
projects.


                         chiropractic treatment

  I am pleased the conference agreement includes a provision requiring 
VA to establish a policy on chiropractic care for veterans. While this 
requirement does not specify the nature of the policy to be established 
by VA, VA is directed to consult chiropractors in developing this new 
policy. For too long, VA has lacked a formal policy on chiropractors 
and the care that they provide in VA. VA should review the medical 
literature and consider those studies that have shown chiropractic care 
for lower back pain is at least as effective as ``traditional'' medical 
treatment. While chiropractic care is not explicitly restricted in the 
VA, VA institutional barriers create restrictions for chiropractors who 
want to practice in VA.
  It is clear that more Americans, as well as mainstream medicine, are 
embracing certain complementary and alternative therapies. Chiropractic 
care, which has established a licensure process in every state, is a 
choice many Americans, including veterans, want. I am glad VA will 
develop this policy and hopeful it will see the wisdom of offering 
veterans this choice.


 dependency and indemnity compensation for surviving spouses of former 
                            prisoners of war

  As an original co-sponsor of H.R. 784, to amend and liberalize the 
requirements for Dependence and Indemnity Compensation (DIC) for the 
surviving spouses of veterans who were Prisoners of War (POW), I 
strongly support section 501 of the conference agreement. Section 501 
of the conference agreement which follows legislation approved by the 
other body will fully meet the objectives of H.R. 784 to liberalize the 
requirements for DIC eligibility. I am also pleased that the bill 
recognizes the tireless efforts of the late John William ``Bill'' 
Rolen, a former POW who devoted many years of his life to advocating 
for the needs of his fellow POWs and their families. Bill was a 
tireless advocate for our Nation's Ex-POW's and it is only fitting that 
the last piece of legislation he urged the Congress to adopt be named 
for him.
  Section 502 of the conference agreement follows H.R. 708, a measure I 
authored. This provision restores eligibility for CHAMP-VA medical 
care, education benefits and home loan assistance to remarried 
surviving spouses who lost eligibility for these benefits upon 
remarriage and whose subsequent marriage has ended. During the 105th 
Congress, legislation was enacted allowing for reinstatement of 
eligibility for dependency and indemnity compensation (DIC) cash 
benefits after termination of the remarriage. The present measure 
completes the restoration of eligibility for all VA benefits lost by a 
surviving spouse of a service-connected veteran upon remarriage if the 
subsequent marriage is ended.
  As an original co-sponsor of H.R. 690, I am pleased that at long last 
bronchiolo-aleveolar carcinoma has been added to the list of radiogenic 
diseases which are presumed to be service-connected for our Nation's 
Atomic veterans. Unfortunately, other medical conditions which are 
clearly radiogenic such as lung cancer still require proof by a dose 
reconstruction procedure which the Institute of Medicine acknowledged 
is inadequate in its October 20, 1999 report. I am disappointed that 
many of our Atomic veterans continue to be denied compensation for 
their exposures while efforts are underway to compensate exposed 
civilians.


                         world war ii memorial

  Both bodies approved legislation which would speed construction of 
the World War II Memorial, and the compromise measure includes the 
House language related to this issue.
  Public Law 103-32 authorized the building of a national World War II 
Memorial. This legislation assigned responsibility for designing and 
constructing the memorial to the American Battle Monuments Commission 
(ABMC), an independent federal agency created in 1923. The ABMC 
administers, operates and maintains military cemeteries and memorials 
in 15 countries around the world. The Commission is also responsible 
for the establishment of other memorials in the U.S., when directed by 
Congress.
  Under the compromise measure, the ABMC is given authority to borrow 
funds from the U.S. Treasury for a brief period. Under existing law, 
groundbreaking for the WWII Memorial may not occur until the ABMC, the 
Memorial's sponsor, has either received cash donations equal to the 
estimated cost of the Memorial or has sufficient borrowing authority to 
assure that the Memorial will be completed. ABMC projects that it will 
not receive sufficient cash donations until the year 2002 and that 
construction of the Memorial will take three years. The borrowing 
authority provided under title VI of the conference agreement will 
enable the ABMC to begin construction next year. ABMC projects that it 
will need no more than $11 million in borrowing authority and

[[Page 29821]]

that borrowed funds will be repaid within three years. It is important 
that construction on this memorial begin as soon as possible because 
World War II veterans are dying at the rate of 31,000 per month.


            Establishment of Additional National Cemeteries

  Approval of legislation by both bodies to expand the national 
cemetery system clearly demonstrates Congressional concern regarding 
this issue. Section 211 of H.R. 2280 directed the Secretary of Veterans 
Affairs to establish a national cemetery in each of the four areas of 
the United States most in need of cemetery space to serve veterans and 
their families. S. 695 directed the Secretary to establish a national 
cemetery in five specific locations. The compromise measure generally 
follows the House-approved language and requires the Secretary to 
establish national cemeteries in the six areas of the United States 
most in need. The Secretary, when determining those six sites, shall 
take into consideration the under-served areas listed in Senate Report 
106-113--Miami, Florida; Pittsburg, Pennsylvania; Detroit, Michigan; 
Sacramento, California; Atlanta, Georgia, and Oklahoma City, Oklahoma. 
These are the six areas listed in the 1987 and 1994 VA reports to 
Congress regarding the national cemetery system that remain unserved.
  VA statistics show that the demand for burial benefits will increase 
sharply in the near future, with interments increasing 42 percent from 
1995 to 2010. Unless new national cemeteries are established soon, VA 
will not be able to meet the need for burial services for veterans in 
serveral metropolitan areas of the country, and too many veterans will 
lack access to the final--and for many, the only--veterans benefit they 
will receive from our grateful Nation.
  When the House Committee on Veterans Affairs finally agree last year 
to enact legislation requested by the VA to enhance the State Cemetery 
Grants Program, it was only after the Department assured the Committee 
that the new State program would continue to supplement the national 
cemetery system--not replace it. However, the Administration's FY 2000 
budget for VA failed to include a request for the funding required to 
initiate any of the needed new national cemeteries. I strongly urge the 
Administration to include the funding necessary to establish the six 
new cemeteries required under this provision in its FY 2001 budget.


  Use of Flat Grave Markers at Santa Fe National Cemetery, New Mexico

  The compromise agreement of a provision, derived from S. 695, which 
authorizes the Secretary of Veterans Affairs to provide for flat grave 
markers at the Sante Fe National Cemetery, New Mexico. Although I 
supported accepting this Senate provision, I want to make it clear that 
I continue to strongly believe that upright grave markets should be the 
standard for the national cemetery system. It is only under very 
unusual circumstances that flat markers should be approved, and I would 
not support any effort to eliminate the requirement under current law 
that requires upright grave markers.


              Study on Improvements to National Cemeteries

  The conference agreement includes a provision, based on section 212 
of H.R. 2280, to require the Secretary of Veterans Affairs to contract 
for a study of national cemeteries. The study is to include an 
assessment of--
  1. One-time repairs required at each national cemetery,
  2. The feasibility of making appearance of national cemeteries as 
attractive as the finest cemeteries in the world,
  3. The number of additional cemeteries that will be required for the 
interment of veterans who die after 2010, and
  The report must also identify, by five-year period beginning with 
2010 and ending with 2030--
  1. The number of additional national cemeteries required during each 
five-year period, and
  2. The areas in the U.S. with the greatest concentration of veterans 
whose burial needs are not served by national cemeteries or State 
veterans' cemeteries.
  Additionally, the report will include information regarding the 
advantages and disadvantages of using of flat grave markers and upright 
grave markers in national cemeteries as well as a report on the current 
conditions of flat marker sections at all national cemeteries. I want 
to repeat, however, my earlier-stated commitment to requiring, with 
only occasional exceptions, the use of upright markers in national 
cemeteries.
  Section 212(b)(1)(D) of H.R. 2280 required that an independent study 
on improvements to veterans' cemeteries required under section 212 
include a study of improvements to burial benefits under chapter 23 of 
title 38, United States Code. This study was to include a proposal to 
increase the amount of the benefit for plot allowances under section 
2303(b) of title 38, to better serve veterans and their families. I am 
very pleased that the compromise agreement includes a provision based 
on this section.
  Under the compromise agreement, Subtitle C of Title VI requires the 
Secretary of Veterans Affairs, not later than 60 days after the date of 
enactment of this Act, to contract for an independent study on 
improvements to veterans' burial benefits. The matters to be studied 
under this section include:
  1. An assessment of the adequacy and effectiveness of the burial 
benefits provided under chapter 23 of title 38, United States Code, in 
meeting the burial needs of veterans and their families.
  2. Options to better serve the burial needs of veterans and their 
families, including modifications to burial benefit amounts and 
eligibility, including the estimated cost for each modification.
  3. Expansion of the authority of the Secretary to provide burial 
benefits for burials in private-sector cemeteries and to make grants to 
private-sector cemeteries.
  This provision further requires the contractor to submit the report 
to the Secretary no later than 120 days after the contract is 
completed. No later than 60 days following receipt of the report, the 
Secretary is required to transmit the report, together with any 
comments regarding the report the Secretary considers appropriate, to 
the House and Senate Committees on Veterans Affairs.
  For many veterans, the only benefits they receive related to their 
military service are those provided at their death. I believe it to be 
a matter of national honor that the level of burial benefits provided 
adequately meet the needs of veterans and their families. This report 
will help us ascertain what changes and improvements need to be made in 
order to achieve this goal.


availability of montgomery gi bill benefits for preparatory courses for 
               college and graduate school entrance exams

  S. 1402 included a provision which would enable veterans to use their 
benefits under the Montgomery GI Bill (chapter 30, title 38, United 
States Code) to pay for the costs of (a) preparatory courses for tests 
that are required or utilized for admission to an institution of higher 
education, such as the Scholastic Aptitude Test (SAT) and (b) a 
preparatory course for a test that is required or utilized for 
admission to a graduate school, such as the Graduate Record Exam (GRE). 
Many colleges and graduate schools rely heavily on the results of these 
tests when assessing individuals seeking admission to their schools, 
and veterans should have the opportunity to take the preparatory 
courses designed to increase test scores. Accordingly, I am very 
pleased that this provision is included in the conference agreement.


         montgomery gi bill enhancements approved by the senate

  S. 1402, the All-Volunteer Force Educational Assistance Programs 
Improvements Act of 1999, would increase benefits and expand 
educational opportunities under the Montgomery GI Bill (MGIB) and also 
increase rates of survivors and dependents educational assistance. 
Unfortunately, the Senate did not also provide the off-sets required 
under the Budget Act to pay for their GI Bill amendments. Although I 
welcome the Senate's interest in veterans' education programs, without 
offsetting savings the House would not take up for consideration a 
conference agreement that included the Senate-approved MGIB amendments.
  Because GI Bill enhancement's are long overdue. I introduced H.R. 
1071, the Montgomery GI Bill Improvements Act of 1999, earlier this 
year. I strongly agree with the assertion in the recent report of the 
Congressional Commission on Servicemembers and Veterans Transition 
Assistance that ``. . . an opportunity to obtain the best education for 
which they qualify is the most valuable benefit our Nation can offer 
the men and women whose military service preserves our liberty.''
  I believe that if the Montgomery GI Bill is to fulfill its purposes 
as a meaningful readjustment benefit and as an effective recruitment 
incentive for our Armed Forces, it must be significantly improved. 
Accordingly, H.R. 1071 would establish a two-tiered program.
  Tier I would enhance the GI Bill in the following ways for those who 
enlist or reenlist for a minimum of four years--
  Pay the full costs of tuition, fees, books and supplies.
  Provide a subsistence allowance of $800/month (indexed for inflation) 
for 36 months.
  Eliminate the $1,200 basic pay reduction required under current law.
  Permit payment for approved specialized courses offered by entities 
other than educational institutions.

[[Page 29822]]

  Tier II would enhance the GI Bill in the following ways for those who 
enlist for fewer than 4 years--
  Increase the current basic benefit from $536/month to $900/month.
  Eliminate the $1,200 basic pay reduction.
  Permit trainees to receive accelerated lump-sum benefits.
  Permit payment for approved specialized courses offered by entities 
other than educational institutions.
  It is my hope that next year Congress will adopt a budget resolution 
that will enable us to enact H.R. 1071 and significantly improve the 
Montgomery GI Bill.


  continuing eligibility for Educational assistance of members of the 
            armed forces attending officers training school

  I am very pleased that included in the compromise measure is a 
provision derived from S. 1402 that would allow servicemembers to 
retain their eligibility under the Montgomery GI Bill (MGIB) if they 
are discharged during their initial enlistment period to receive a 
commission as an officer.
  The Committee recently learned that an enlisted servicemember who 
completes Officer Training School (OTS) or Officer Candidate School 
(OCS) is discharged upon completion of this school in order to accept 
an immediate commission as an officer. If the discharge occurs before 
the servicemember completes his or her minimum period of active duty 
required to establish MGIB eligibility, the servicemember becomes 
ineligible for education benefits. The Subcommittee on Benefits held 
hearings on October 28, 1999 on a draft bill to allow the two periods 
of active duty to be considered as one, thereby permitting these 
individuals to maintain their MGIB eligibility. Similar language is 
included in the compromise agreement.
  It was not the intent of Congress that certain young men and women 
selected to attend OTS or OCS to be forced to make a choice between 
being commissioned and maintaining their GI Bill eligibility. This 
provision will correct this unintentional inequity in law.


  report on veterans' education and vocational training by the states

  The compromise agreement includes a provision, derived from S. 1402, 
that would require the Secretary of Veterans Affairs to provide a 
report to the House and Senate Committees on Veterans Affairs listing 
veterans' education and vocational training benefits provided by the 
States. This report would include benefits provided, by reason of 
service in the Armed Forces, to active duty servicemembers, veterans, 
and members of the Selected Reserve. I believe the information included 
in this document will be very helpful to veterans, and I urge the VA to 
update this initial report annually.


  Extension of Authority for Housing Loans for certain Members of the 
                            Selected Reserve

  Prior to 1992, only individuals who served on active duty qualified 
for VA housing loan benefits. Public Law 102-547, however, included a 
pilot program which granted loan eligibility, through October 1999, to 
persons who had at least six years of honorable service in the Selected 
Reserve. Under a provision of P.L. 105-368, eligibility was extended 
through September 30, 2003.
  Earlier this year, it was pointed out to me by the executive director 
of the Enlisted Association of the National Guard of the United States 
(EANGUS) that, although they greatly appreciated the extension enacted 
last year, the limitation on the availability of the program hampered 
their efforts to use this benefit as an incentive to recruit 
individuals who would agree to six-year enlistments. In response to 
this very legitimate concern, I introduced H.R. 1603, which would have 
made this eligibility permanent. The provisions of H.R. 1603 were 
included in H.R. 2280 and were approved by the House.
  Although the other body was unwilling to agree to providing permanent 
eligibility for VA housing loans for certain Selected Reservists, I am 
pleased the conference agreement extends this eligibility through 
September 30, 2007.


                           Quality Assurance

  The Quality Assurance provisions of section 801 of the bill are 
designed to assure that the Veterans Benefits Administration's (VBA) 
internal quality assurance activities meet the recognized appropriate 
governmental standards for independence. This will require the 
establishment within VBA of a quality assurance program which comports 
with generally accepted government standards for performance audits.
  For years our Nation's veterans who filed a claim with the Department 
of Veterans Affairs (VA) for benefits associated with their military 
service, particularly service-connected disability compensation, have 
been forced to contend with a VA claims adjudication process which has 
been both too slow and too inaccurate. Recent information suggests that 
after waiting years for a decision, one out of three veterans may find 
that the rating decision made by VA was wrong. Untimely and inaccurate 
decision-making by the VA, and particularly the Veterans Benefits 
Administration (VBA), have been twin problems which have plagued 
veterans, veterans service organizations and Members of Congress who 
assist their veteran constituents.
  While experience clearly indicated otherwise, between 1993 and 1997, 
VBA reported that the quality of its work was nearly error free as 
measured by VBA. Quality standards had been relaxed to the point that 
VA was reporting an accuracy rate of 97%. To his credit, the Under 
Secretary of Veterans Benefits, Mr. Joe Thompson instituted, on a trial 
basis, a new system for measuring the quality of the claims 
adjudication work performed by VBA. This new quality measure, the 
Strategic Technical Accuracy Review (STAR) was tested and used 
operationally in 1998.
  STAR use has been focused on claims submitted by veterans which 
require the VA to rate the claim, make a determination as to whether a 
medical disability is service-connected or non-service-connected and 
determine the degree of disability manifest. Using the STAR 
methodology, the accuracy of various actions taken during the 
adjudication process are used to determine if the case was correctly or 
incorrectly decided. A case is either all right or all wrong. Using 
STAR, the accuracy rate was 64%--fewer than two out of three claims 
were correctly decided.
  While STAR provided a more realistic assessment of the quality of VA 
claims adjudication, STAR does not currently meet generally accepted 
governmental standards for independence and separation of duties. 
Reviews of regional office decisions are made by persons who are also 
decision makers reporting to managers whose evaluations are enhanced if 
quality results are shown. There is not sufficient staff whose primary 
focus is improving the quality of claims adjudication at the regional 
office level. In order to pinpoint errors, it is important to be able 
to identify regional offices which have specific high or low accuracy 
rates and to ascertain the reasons for discrepancies between regional 
offices.
  One measure of quality, the percentage of decisions appealed to the 
Board of Veterans Appeals (the Board) which are either reversed or 
remanded back to the regional offices for further work, is particularly 
disturbing. During fiscal year 1998, 17.2% of the appealed decisions 
were reversed outright by the Board. An additional 41.2% of the appeals 
were remanded for further action by the regional offices. Another 
measure of accuracy is the integrity of data relied upon by the VBA. 
During 1998, the VA Inspector General issued a report finding that data 
entered into the VBA computer system was being manipulated to make it 
appear that claims were processed more efficiently than was actually 
occurring.
  Problems are not confined to the Compensation and Pension Service. In 
reviewing VA's compliance with statutory financial requirements, the 
General Accounting Office (GAO) noted that VA's home loan program was 
unable to perform routine accounting functions and had lost control 
over a number of loans which were transferred to an outside loan 
company for continued loan servicing. VA was not able to obtain an 
unqualified audit opinion as a result of these deficiencies. On 
February 24, 1999, VA's Inspector General reported that the $400 
million vocational rehabilitation program was placed at high risk after 
the Qualify Assurance Program for that service was discontinued in 
1995.
  Because of the fundamental importance of accurate and effective 
claims processing and adjudication by VA regional offices, and the need 
for effective oversight of Regional Office claims processing and 
adjudication by the VBA, I requested GAO to review VBA's quality 
assurance policies and practices. On March 1, 1999, GAO issued a report 
which determined that further improvement was needed in claims-
processing accuracy. In particular, GAO determined that VBA's quality 
assurance activities did not meet the standards for independence and 
internal control. These standards are contained in the Comptroller 
General of the United States, United States General Accounting 
publication Government Auditing Standards (1994 Revision).
  Section 801 of the bill is designed to give VBA sufficient 
flexibility to design the program in a manner so as to achieve its 
objective of improving the quality of claims adjudication. I have been 
informally advised by the General Accounting Office that under VBA's 
present structure, placement of the functions within the jurisdiction 
of the Deputy Under Secretary for Management would provide sufficient 
independence to meet the relevant standards.
  In fiscal year 2000, the GAO will pay over $22 billion in monetary 
benefits to veterans. I

[[Page 29823]]

expect that the careful development and implementation of a program of 
quality assurance, which meets generally accepted governmental auditing 
standards for program performance audits, will provide impartial and 
independent oversight of the quality of claims adjudication decisions 
and will improve the confidence of veterans in a system which is 
designed to recognize the sacrifices our Nation's veterans have made.
  With the establishment of independent oversight of the qualify of 
claims adjudication decisions, the number of claims which are remanded 
because of the poor quality of claims adjudication will be reduced. 
With better initial decisions and fewer remands for re-adjudication, 
veterans will receive a quicker and a more accurate response.
  The conference agreement changes the way decisions concerning claims 
for compensation and pension, education, vocational rehabilitation and 
counseling, home loan and insurance benefits will be reviewed and 
evaluated. Employees who are independent of decisions makers will be 
devoted to identifying problems in the decision-making process. By 
identifying the kinds of errors made by VA personnel, VBA managers will 
be able to take appropriate action. I expect that remand rates will be 
significantly reduced and veterans will find that VA makes the right 
decision the first time the claim is presented. As the author of the 
language, I am pleased the conference agreement contains these 
provisions.
  We can not expect any real improvement in the timeliness of claims 
adjudication unless the barriers to quality decision making are 
identified and addressed in a systemic fashion. Our nation's veterans 
deserve to have their claims for VA benefits decided right the first 
time. By enacting this provision, Congress has put the VA claims 
adjudication process on the right track. Our veterans deserve no less.


                advisory committee on minority veterans

  The Advisory Committee on Minority Veterans has offered concrete 
recommendations for the last five years to the Secretary on the special 
challenges of minority veterans who seek care and benefits from VA. 
Unlike many other Federal Advisory Committees, the authority for the 
Advisory Committee on Minority Veterans is temporary. H.R. 2116 as 
agreed to by the conference extends the authority for this Committee 
through 2003. I will continue to work to ensure that the authority for 
the Committee is offered parity with other Federal Advisory Committees 
and extended indefinitely.


               homeless veterans' reintegration programs

  I am very pleased that the conference agreement reauthorized the 
Homeless Veterans' Reintegration Programs (HVRP). Under the compromise 
agreement, this program would be extended for four years through fiscal 
year 2003. The authorized funding levels for the program would be $10 
million in FY 2000, $15 million in FY 2001, $20 million in FY 2002, and 
$20 million in FY 2003. Although section 302 of H.R. 2280 would have 
extended this program for five years at authorized funding levels of 
$10 million for FY 2000, $15 million for FY 2001, $20 million for FY 
2002, $25 million for FY 2003, and $30 million for FY 2004, the 
compromise is a good one. It will enable the community-based 
organizations across the country that are funded by this program to 
continue their very effective work helping homeless veterans reenter 
the workforce.
  Mr. Speaker, I reserve the balance of my time.
  Mr. STUMP. Mr. Speaker, I yield 6 minutes to the gentleman from 
Florida (Mr. Stearns), the chairman of our Subcommittee on Health.
  Mr. STEARNS. Mr. Speaker, I thank the gentleman for yielding me this 
time. I commend his leadership in pushing this bill forward. I commend 
the gentleman from Illinois (Mr. Evans) and the gentleman from Illinois 
(Mr. Gutierrez), my ranking member. I also want to commend the staff, 
the senior member, Ralph Immon and Carl Commenator, who is chief of 
staff for the gentleman from Arizona (Mr. Stump), for all of the 
diligence that they did; and many of us know a lot of these bills do 
not get put together until the staff is implementing them and does the 
details.
  I think it is altogether fitting this afternoon, as we honored 
America's veterans and fallen heroes last week, that we make this 
historic bill come to the House and get passage. I think it will be a 
day that we look back on and note that Congress took two historic steps 
during this first session of the 106th Congress. One, of course, was 
passing an additional $1.7 billion for veterans' medical care; and 
second, I believe, will be the adoption of this bill. It is a bold new 
step for our veterans for the next millennium, and I am very pleased 
that we were able to get bipartisan support. It covers a broad spectrum 
of veterans' benefits, some of the most significant provisions 
affecting the VA health care system, and I am proud to have introduced 
this bill.
  In working with the other body in conference, we set aside a few 
contentious issues, adopted a number of Senate provisions, and 
strengthened some of our own. At its core, however, I say to my 
colleagues, the conference report achieves a broad goal underlying the 
millennium health care bill that we voted on overwhelmingly here not 
too long ago. Most important, the bill provides a blueprint, as I 
mentioned earlier, for the next millennium.
  Like the original House-passed measure, the conference report has 
four central themes: one, to give the VA much needed direction for 
meeting veterans' long-term care; two, to expand veterans' access to 
care; three, to close gaps in current eligibility law; and, four, to 
make needed reforms that will further improve the VA health care 
system.
  This important legislation tackles some of the major challenges that 
we face with the VA health care system, and foremost among these are 
the long-term care of our aging veterans. The challenge has gone 
unanswered for too long. And of singular importance, this legislation 
would put a halt to the steady erosion we have seen in the VA long-term 
care program.
  It would establish for the first time that the VA must maintain and 
operate long-term care programs. It would require that the VA provide 
needed nursing home care to veterans who are 70 percent or more 
service-connected disabled and veterans who need such care for service-
connected conditions. It would also provide for the VA to furnish 
alternatives to institutional care to veterans who are enrolled for VA 
care. Through these and other provisions, it would provide greater 
assurance that veterans who rely on VA for care would have access to 
needed services.
  The conferees devoted a great deal of time to the issue of long-term 
care because it is of such importance to our aging veterans population. 
These are very important provisions to our veterans, and we will 
certainly monitor their impact in the months and years ahead.
  There are a couple of things, Mr. Speaker, that I am a little 
disappointed about; and one is that we did not contain the question of 
the obsolete, unused VA hospitals. We had set a particular criteria, 
limits and safeguards. This was not adopted. Veterans and VA employees 
would have been better served by the protections we proposed. But they 
were not part of the bill, and that is for another time.
  The measure we take up today, however, helps address the VA's 
infrastructure challenge. In essence, the VA has an extensive facility 
infrastructure, and with it, the burden of maintaining thousands of 
buildings and extensive acreage at more than 180 sites across the 
country. While the conference report does not specifically address the 
inevitable need for the VA to deal with these obsolete facilities so 
that the money spent on them could be used to take care of our 
veterans, it gives the VA an important tool to improve the management 
of its capital assets, and I think that is important. It does so by 
providing VA facility managers considerably more flexibility and 
incentives to negotiate long-term leases under which unused or under-
used VA properties may be developed. Given the capital resources at the 
VA's disposal, long-term care leasing could be used extensively. 
Importantly, veterans will be the ultimate beneficiaries of these 
projects.
  The VA health care system has improved significantly, I believe, in 
the last 4 years; and this comprehensive bill will continue the VA on 
the course of providing veterans better access to needed care. I am 
proud, and I believe this bill breaks brand-new ground in such areas as 
long-term care.
  Mr. Speaker, there are many other provisions in this bill. Let me 
just touch on one. For example, the bill

[[Page 29824]]

arms the VA for the first time with the means to cover uninsured 
veterans who cannot reach a VA facility in a medical emergency. It 
provides assurance that a combat-injured veteran who has not previously 
sought VA compensation can get priority health care. It offers military 
retirees improved access to VA care. It extends and expands VA's grant 
program to assist in combating homelessness among veterans. It 
continues VA sexual trauma counseling program, it reforms the VA 
program of grants to the States to assist in the construction and 
renovation of States' veterans' homes; and lastly, it provides for new 
revenues which would help place the VA health care system on a sounder 
footing.
  So for all of these reasons, I strongly urge my colleagues to vote 
for this and adopt the conference report.
  Mr. Speaker, I rise in support of the conference report.
  It is altogether fitting that after honoring America's fallen heroes 
last week at Veterans' Day ceremonies across the country, we bring a 
historic veterans' bill to the floor today.
  I believe we will one day look back, and note that the Congress took 
two historic actions on behalf of America's veterans this session. 
First, it rejected an Administration budget plan which would have 
crippled the VA health care system. Instead, we added a record $1.7 
billion for veterans' medical care. Second, we adopted this conference 
report.
  While the report covers a broad spectrum of veterans' benefits, some 
of its more significant provisions affect the VA health care system, 
and have their genesis in the Veterans Millennium Health Care Act, H.R. 
2116, which I am proud to have introduced.
  In working with the other body in conference, we set aside a few 
contentious issues and adopted a number of Senate provisions while 
strengthening some of our own. At its core, however, the conference 
report achieves the broad goals underlying the Veterans' Millennium 
Health Care Act. Most important, this bill provides a blueprint to help 
position VA for the future.
  Like the original House-passed measure, the conference report has 
four central themes: (1) to give VA much-needed direction for meeting 
veterans' long-term care needs; (2) to expand veterans' access to care; 
(3) to close gaps in current eligibility law; and (4) to make needed 
reforms that will further improve the VA for health care system.
  This important legislation tackles some of the major challenges 
facing the VA health care system. Foremost among VA's challenges are 
the long-term care needs of aging veterans. That challenge has gone 
unanswered for too long. Of singular importance, this legislation would 
put a halt to the steady erosion we have seen in VA long term care 
programs. Moreover, it would establish a framework for expanding access 
to needed long-term care services. And it could provide greater 
assurance than under current law that veterans who rely on VA for care 
would gain access to needed services. At the same time, we have 
approached this difficult issue with sensitivity to its costs, and will 
be monitoring its impact. To illustrate, in our conference with the 
Senate we substantially modified a provision in S. 1076 which would 
have required VA to provide an extensive array of services 
(specifically identified services constituting alternatives to 
institutional care) to veterans enrolled for VA care. Among the changes 
to that provision which were adopted by the conferees was language 
which makes it clear that, in the case of a veteran who has eligibility 
for such a service (home health care, for example) under another 
Federal program, VA has no obligation to furnish that service. The 
expectation, instead, is that VA would refer, or otherwise arrange for 
that veteran to obtain those services as beneficiary of that other 
program.
  The original House-passed bill confronted the challenge posed by a 
General Accounting Office audit which found that VA may spend billions 
of dollars in the next five years to operate unneeded buildings. In 
testimony before my Subcommittee, 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 VA has discussed hospital 
closures (and has a closure proposal under review at this time). In 
some locations, changing the mission of a VA facility would certainly 
make sense. The point is that VA has the authority to take such a step 
and has already used in an number of instances.
  I am disappointed that the conference report does not contain a 
House-passed provision which focused directly on the question of 
obsolete, underused VA hospitals. That bill would have set some 
important limits and safeguards on the process VA employs in realigning 
its facilities. Veterans and VA employees would have been well served 
by the protections proposed in that bill--protections which are not 
provided under current law. In sum, that provision was not aimed at 
diminishing the services furnished America's veterans, but at improving 
them.
  The measure we take up today does, however, help address the VA's 
infrastructure challenge. In essence, VA has an extensive facility 
infrastructure, and with it the burden of maintaining thousands of 
buildings and acreage across the country. It maintains some 4700 
buildings at more than 180 major sites. More than 40 percent of those 
structure are more than 50 years old; almost 200 of them were built 
before 1900. Many of its facilities were designed to provide care in a 
very different manner than the way care is provided today. While VA has 
made renovations to its older hospitals to keep them operational and 
safe, many are functionally obsolete.
  While the conference report does not specifically address the closure 
of obsolete facilities or direct VA to confront its infrastructure 
challenge, it provides VA an important tool to improve the management 
of its capital assets. It does so by giving VA considerably more 
flexibility, and incentive, to employ what has to date been a little 
used authority known as ``enhanced use leasing.'' Under authority 
created in Public Law 102-86, VA may enter into long-term (up to 35 
years) leases under which VA could permit private development of VA 
property for uses that are not inconsistent with VA's mission, so long 
as the overall objective of the lease enhances a VA mission. Enhanced 
use leasing offers VA an opportunity to benefit from unused or 
underused capital assets. VA has employed this authority to develop 
such new uses as child care centers, parking facilities, and energy 
generation projects.
  Given the capital resources at VA's disposal, long-term leasing could 
be used even more extensively to improve VA's health-delivery mission. 
To that end, this measure would expand VA's enhanced use leasing 
authority. It would give VA the latitude to enter into such a lease--
not simply to enhance VA property with an activity that contribute to 
the VA mission--but to realize the broader goal of improving services 
to veterans in the area. So this leasing authority could be used to 
generate revenue from unneeded VA assets and apply such revenue to 
improve VA care. To foster that objective, the enabling legislation 
would be further amended to provide greater incentives for facility 
management to use this valuable tool. To that end, the measure provides 
that consideration under such a lease is to be retained locally and 
used to improve services. It would also expand the maximum lease term 
from the current 35 years to 75 years, thus overcoming a limitation 
which can be a formidable barrier to needed financing.
  It is noteworthy that VA has in some instances entered into enhanced 
use leases in which the lessee has obtained financing for the 
development of facilities through the municipal bond market. The 
availability of this source of low-cost financing for facilities 
developed on VA-controlled lands under enhanced-use leases has resulted 
in significant savings and revenues for VA, furthering its ability to 
serve veterans. The availability of municipal bond market financing has 
also encouraged VA to enter into mutually advantageous arrangements 
with state and local entities which, in turn, has fostered ventures 
which not only advance VA's mission but benefit local government 
entities and local communities. Accordingly, the Secretary is 
encouraged to pursue this type of financing for its enhanced-use 
lessees. Moreover, any facility, structure or improvement that is 
subject to an enhanced use lease should be considered a public project 
owned by and under the general control of the Department of Veterans' 
Affairs if such facility, structure or improvement was developed, 
constructed, operated, or maintained pursuant to an enhanced-use lease.
  In sum, the VA health care system has certainly improved 
significantly in the last four years. This comprehensive bill would 
continue VA on the course of improving veterans' access to needed care. 
I'm proud that this bill breaks new ground for our veterans in the 
areas of long term care, emergency care coverage, military retirees' 
care, and placing the VA health care system on a sounder footing.
  We have worked closely with veterans' organizations in developing 
this legislation; they have recognized the important advances the bill 
would establish. I particularly want to thank the many veterans 
organizations--representing millions of veterans--who supported and 
worked for this legislation. We and they have not achieved all our 
objectives, but we have taken a major step toward the new millennium in 
honoring our commitment to veterans.

[[Page 29825]]

  Mr. Speaker, I urge Members to join with the many veterans groups and 
support this important bill.
  Mr. EVANS. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Filner).
  Mr. FILNER. Mr. Speaker, I too rise in full support of the conference 
agreement on long-term veterans' health care, and I thank the gentleman 
from Florida (Mr. Stearns), chairman of the Subcommittee on Health of 
the Committee on Veterans Affairs for leading us in a bipartisan bill 
that we could all support. As the gentleman said, this bill improves 
and enhances virtually every major program administered by the 
Department of Veterans' Affairs.
  As the ranking Democrat on the Subcommittee on Benefits, there are 
two provisions I particularly want to mention. Legislation I sponsored 
in the 105th Congress restored eligibility for dependency and indemnity 
compensation to former DIC recipients who had lost eligibility for this 
benefit when they remarried. My provision in Public Law 150-178 
restored DIC benefits if a subsequent marriage ended. I am very pleased 
that section 502 of this agreement expands that legislation and will 
restore CHAMPVA medical coverage, educational assistance, and housing 
loan benefits to this group of surviving spouses.
  Additionally, I am very pleased that section 901 of this bill 
reauthorizes and increases funding for the Homeless Veterans 
Reintegration Program.
  I am very satisfied with the compromise in the bill that gradually 
increases funding to $20 million per year that will enable the 
Department of Labor's Veterans' Employment and Training Service to 
effectively administer the program, and the increased funding level 
will give thousands of homeless veterans the assistance they need to 
reenter employment.
  Finally, I want to commend the conferees for including the House-
passed provision which enables veterans to receive chiropractic care 
through the health care system. Chiropractic is the most widespread of 
the complementary and alternative approaches to medicine in the United 
States. Each year, nearly 27 million patients seek the services of 
doctors of chiropractic, receiving safe and effective and appropriate 
care from highly trained State-licensed providers. The research record 
continues to validate the use of chiropractic for a wide range of 
conditions.
  In practically all areas of the Federal health care system, Congress 
has recognized this rule of chiropractic care by providing 
beneficiaries with access to services. The VA has chosen not to make 
chiropractic routinely available to veterans, thereby limiting their 
choice and their ability to be an active participant in their own 
health care.
  This agreement ensures that the VA will develop, with licensed 
doctors of chiropractic, a policy that will provide veterans with 
access to this care. It ensures that veterans, like patients in every 
other health care system, will have the ability to make health care 
choices that best address their needs. It affords veterans the best of 
both worlds by integrating conventional medicine with complementary 
medicine, so I am pleased to support this provision of the bill.
  Mr. Speaker, H.R. 2116 is an excellent agreement that will enhance 
the lives of millions of veterans and their families. I urge my 
colleagues to vote in favor of this measure.
  Mr. STUMP. Mr. Speaker, I yield 3 minutes to the gentleman from 
Florida (Mr. Bilirakis), a member of the committee.

                              {time}  1730

  Mr. BILIRAKIS. Mr. Speaker, I thank the gentleman for yielding time 
to me.
  Mr. Speaker, I rise, too, in strong support of H.R. 2116, the 
Veterans' Millennium Health Care Act.
  In addition to making comprehensive reforms to the veterans health 
care system, which others have and will describe, this legislation 
includes provisions to assist the surviving spouses of certain former 
prisoners of war.
  These provisions, Mr. Speaker, are similar to legislation that I 
introduced earlier this year. Specifically, the provisions included in 
H.R. 2116 will allow certain spouses of former POWs to qualify for 
survivor benefits. These women might not otherwise be eligible for such 
benefits under current law.
  The Dependency and Indemnity Compensation, the DIC program, provides 
monthly benefits to the survivors of veterans who die of service-
connected conditions. Under current law, DIC payments may also be 
authorized for the survivors of veterans whose deaths were not the 
result of a service-connected disability.
  In this case, the spouse only qualifies for DIC benefits if the 
former POW is rated totally disabled for a period of 10 years or more 
immediately preceding his death.
  There are approximately 20 presumptive service-connected conditions 
for former POWs who were detained or interned for at least 30 days. 
Unfortunately, some of these presumptions have been in effect for less 
than 10 years. This means that a spouse of a former POW may not qualify 
for DIC benefits if the veteran dies of a non-service-connected 
condition before meeting the 10-year time requirement.
  Even if a presumption has been in effect for 10 or more years, many 
ex-POWs will not have been rated as totally disabled for the minimum 
period of time required before their deaths. This may occur for a 
variety of reasons. For example, the POW may not have filed a 
disability claim as soon as the presumption was enacted, or it may have 
taken a while for his claim to be adjudicated. Alternatively, the POW 
could have a lower disability rating that worsened over time.
  This issue was first brought to my attention by a very close friend 
of mine, Mr. Wayne Hitchcock of Dunedin, Florida. Wayne is the past 
national commander of the American Ex-Prisoners of War, and is now 
seriously ill and in the hospital. I credit this portion of H.R. 2116 
to ex-POWs Wayne Hitchcock and recently deceased Bill Rolen.
  After talking to Wayne, I introduced the bill to waive the 10-year 
time requirement for the surviving spouses of former POWs. The bill was 
incorporated into a larger benefits bill which passed the House in 
June. The provisions that have been included in H.R. 2116 are slightly 
modified. They will allow the surviving spouse of a former POW to 
receive DIC compensation if the veteran is rated totally disabled for 1 
year prior to his death.
  We all know, Mr. Speaker, that military service does not take place 
in a vacuum. Many POWs experience unimaginable horrors. Today many 
continue to experience prolonged battles with various illnesses and 
other disabilities. Consequently, their spouses have spent years caring 
for them after their release from prisoner of war camps. These women 
deserve DIC benefits. I urge my colleagues to support this legislation.
  Mr. EVANS. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Texas (Mr. Green).
  Mr. GREEN of Texas. Mr. Speaker, I rise today concerning H.R. 2116, 
the Veterans' Millennium Health Care Act.
  As my colleagues are aware, I have been a strong supporter of 
veterans since my election to this House. However, this bill, hastily 
added to the schedule today, could be unfair and detrimental to 
veterans in the State of Texas.
  Section 206 of this bill would reorder the priorities under which 
state veterans' homes currently receive VA state home construction 
grants. Under the current priority scheme, Texas would likely receive 
grants for seven State Veteran Home projects. Our projects hold spots 
3-9 on the VA list that was published on November 3 of this year. 
Section 206 could reduce the number of State Veterans' Homes Texas 
would receive.
  Texas has the third largest veterans' population in the nation, and 
that population is aging. Until last year, we had never received any 
funding for these grants. We received grants for four last year, and 
while those funds have helped, the need for additional homes is still 
great.
  I understand that the new priority scheme would prioritize funding 
for upgrading existing facilities where there are safety concerns. This 
is a difficult balance to strike, but what stands out to me is that 
this process is already underway and the State of Texas has already 
made plans for these homes. Now we want to change that process in 
midstream and this legislation would make no accommodation for that.

[[Page 29826]]

  Nobody wants to vote against veterans health care, so I would urge my 
colleagues to delay this legislation so that we can reach an agreement 
that would treat all of our nation's veterans fairly.
  Mr. EVANS. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
Florida (Ms. Brown).
  Ms. BROWN of Florida. Mr. Speaker, it is a pleasure to come to the 
floor today to support the conference report for the Veterans Millenium 
Health Care Act. This was the first conference involving Members in 
many years, in fact, 25. We have only had three conferences in 25 
years, so I wanted to thank my colleagues and the committee staff for 
all of their hard work in putting this compromise bill together.
  The Veterans Millenium Health Care Act will positively serve veterans 
in my State of Florida and throughout the Nation. This bill, although 
not perfect, will offer additional medical and long-term care options 
for a rapidly aging veterans population, extend vital programs like 
VA's sexual trauma program, the health evaluation programs for Gulf War 
veterans, and VA homeless veterans assistance programs; in addition, 
education benefits and housing loan guarantees, and requiring the 
Secretary of Veterans Affairs to obligate funds for the establishment 
of six additional national cemeteries for veterans, and to conduct an 
independent study on burial benefits.
  I have personally worked very hard in support of additional cemetery 
spaces for our veterans. My State of Florida, which has the oldest 
veteran population in the Nation, is in desperate need of additional 
burial space. Today, of the four national cemeteries in Florida, only 
two remain fully open to the veterans population. For those who served 
this country with pride and dignity, VA will now be obligated to 
provide an opportunity to be buried in a national cemetery near their 
home, an opportunity that is not available to many of our veterans.
  Standing on the threshold of a new century, it is our obligation as 
Members of Congress to again affirm America's solid commitment to her 
veterans, past, present, and future, and to their families, and to 
provide the appropriate health care and service promised them. The 
Department of Veterans Affairs will fully carry out its responsibility 
to that end.
  Mr. STUMP. Mr. Speaker, I yield 4 minutes to the gentleman from 
Arizona (Mr. Hayworth), a member of the committee.
  Mr. HAYWORTH. Mr. Speaker, I thank the gentleman, the chairman of our 
committee and the dean of our delegation from Arizona for yielding time 
to me.
  Mr. Speaker, last Thursday, the 11th day of the 11th month of the 
11th hour, I joined with veterans in Apache Junction, Arizona, and then 
later that day in Payson, Arizona, to commemorate their contributions 
to our national security on Veterans Day.
  It is in their honor, and indeed, Mr. Speaker, in honor of all who 
have worn the uniform of our country in peacetime and in war, that I am 
pleased to rise today in support of H.R. 2116, the bipartisan Veterans' 
Millenium Health Care Act.
  Mr. Speaker, veterans' benefits are truly earned opportunities. I am 
very pleased we are able to approach this new century with 
comprehensive new legislation. This bill makes a number of needed 
improvements to programs serving veterans, two of which I would like to 
briefly highlight.
  As the gentleman from Arizona (Chairman Stump) indicated, the bill 
would authorize the American Battle Monuments Commission to begin 
construction of the World War II monument here in the District of 
Columbia.
  Mr. Speaker, the World War II generation, as NBC nightly news 
managing editor and anchor Tom Brokaw has written, is in fact the 
greatest generation. What greater gift can one generation, in this 
case, our World War II generation, give to the generations that follow 
than freedom? And, what more enduring thanks can America give our World 
War II veterans than to build their memorial, and build it now?
  H.R. 2116 also aggressively authorizes appropriations to the 
Department of Labor for the homeless veterans reintegration program. 
Mr. Speaker, as we approach a new century, on any given evening it is 
estimated that more than 275,000 veterans, the equivalent of 17 
infantry divisions, will sleep in doorways, in boxes, and on grates in 
our cities, and in barns, in lean-tos, and on the ground in our towns.
  Mr. Speaker, our millenium bill aims to help many of these men and 
women find jobs by authorizing a 4-year increase in Labor Department 
funding for this competitively-bid nationwide community-based 
employment program. I know of no group that wants to break the cycle of 
homelessness more than America's sons and daughters who have worn the 
uniform of this country.
  Finally, Mr. Speaker, I would note that despite the strong efforts of 
the gentleman from Arizona (Chairman Stump), the ranking member, the 
gentleman from Illinois (Mr. Evans), and the efforts of our own 
subcommittee chaired by the gentleman from New York (Mr. Quinn), the 
House version for the current G.I. bill and the role it hopefully will 
play in resolving veterans' transition and military recruitment issues 
in the next century is not part of this legislation, but Mr. Speaker, 
it will be a top subcommittee priority next year.
  Mr. Speaker, H.R. 2116 is the result of bipartisan hard work, for 
which I thank the Members on both sides of the aisle, and specifically, 
the members of our Subcommittee on Benefits.
  Mr. Speaker, I urge my colleagues to support this millenium bill 
because it accords veterans opportunities that they have earned; 
nothing more and nothing less. I thank the chairman of the full 
committee for his longstanding leadership on behalf of our Nation's 
veterans, and I thank the ranking minority member for his continued 
commitment and support, as well.
  Mr. Speaker, in closing, I would celebrate the bipartisan nature of 
this bill, and join with the gentleman from Arizona (Chairman Stump) 
and the ranking member, the gentleman from Illinois (Mr. Evans) in 
congratulating Ms. Jill Cochran, longtime Democratic member staff 
director for the Subcommittee on Benefits, on her upcoming retirement 
after a quarter century, 25 years of dedicated service to our veterans 
affairs committee.
  Mr. Speaker, Jill has made a wonderful contribution. I know my 
colleagues in this body extend their kindest wishes as she embarks on 
the next phase of her journey in life.
  Mr. EVANS. Mr. Speaker, I yield 3 minutes to the gentleman from Texas 
(Mr. Rodriguez).
  Mr. RODRIGUEZ. Mr. Speaker, I thank the gentleman from Illinois (Mr. 
Evans), the ranking minority member, for yielding time to me, and I 
thank him for his efforts in this area.
  Mr. Speaker, there is no doubt that there is a critical need 
throughout the United States when it comes to our veterans, our 
homeless veterans that are in need of housing. In Texas in particular, 
I know that we have been working real hard and got the first initial 
four. It was one of the first States that did not have any additional 
homes.
  I want to take this opportunity and ask the subcommittee chairman, 
the gentleman from Florida (Mr. Stearns) to engage in a colloquy, if he 
would.
  One of the things that I wanted to ask, because I know one of the 
things as we move into next year, we have allocated $90 million. I feel 
real strongly that there is a need for additional resources. We know we 
have a long list.
  It is my understanding that one of the new priorities that we have 
indicated and that we have reranked is based on need, and it is based 
on identifying the importance of that need in those specific States. I 
just want to get a clarification from the gentleman from that 
perspective. In addition to that, I want to get some feedback also from 
the gentleman in terms of hopefully a drive or push as we move into the 
year 2000, 2001, and on for stressing the importance of additional 
resources in this specific area.
  Mr. STEARNS. Mr. Speaker, will the gentleman yield?
  Mr. RODRIGUEZ. I yield to the gentleman from Florida.

[[Page 29827]]


  Mr. STEARNS. Mr. Speaker, I thank the gentleman for yielding to me.
  Mr. Speaker, I think the gentleman is talking about the home 
construction program. I certainly think the subcommittee would look 
favorably next year when we review the budget for the State home 
construction program, and to look for a recommendation for sufficient 
funds to meet the needs of States like the gentleman's, Texas, and of 
course States like mine, Florida, the Sunbelt, where we have these 
continued needs for facilities.
  We have an influx of veterans, more so than other places. For that, 
homes for veterans, that whole construction project will be looked 
favorably upon for more money. I assure the Member we will try and take 
that up in the spring.
  Mr. RODRIGUEZ. In this particular process, we were ranked at a 
certain level. It is my understanding that that ranking will not 
necessarily change, but in terms of redefining that ranking based on 
need.
  In addition to grandfathering in some of the 99 projects, those 
States that had additional homes, for example, it was my understanding 
that Florida is also very similar to Texas, where the gentleman has not 
moved either like Texas in terms of trying to get those homes as much 
as other States have.
  If that occurs, then, that means that or my understanding is that we 
are going to prioritize the 99 projects of some of the old existing 
homes versus new existing homes, is that correct?
  Mr. STEARNS. I think that would be a good approximation of what we 
will be looking at in terms of the gentleman's State, my State. In 
fact, I have received letters from other Members from their States, 
too. So looking at the balance of all this relatively, I assure the 
gentleman we will look at it in the spring.
  Mr. RODRIGUEZ. I thank the gentleman very much.
  Mr. STUMP. Mr. Speaker, I am pleased to yield 3 minutes to the 
gentleman from New Jersey (Mr. Smith), vice-chairman of the Committee 
on Veterans' Affairs.
  Mr. SMITH of New Jersey. Mr. Speaker, I thank the chairman of the 
full committee, my good friend, the gentleman from Arizona (Mr. Stump), 
the gentleman from Florida (Mr. Stearns), the chairman of the 
subcommittee, the gentleman from Illinois (Mr. Evans), and all who have 
done so much on this important piece of legislation.
  Mr. Speaker, this is a great day for our veterans. This legislation 
is comprehensive. Its name certainly is indicative of what it is, a 
very forward-thinking bill, the Veterans Millennium Health Care Act. 
This legislation positions us for the challenges ahead.
  I just want to thank the gentleman from Florida (Mr. Stearns) and the 
gentleman from Arizona (Mr. Stump) for including two provisions that I 
have been working on, one for over 10 years.
  One of the widows of a former serviceman, a Navy officer in my state, 
for years had been denied, denied compensation for his very, very 
untimely death. He suffered from a very rare disease, a lung cancer 
that usually is the result of plutonium exposure.
  He was one of those who was on the U.S.S. McKinley during an atomic 
test--code named operation wigwam. The Record shows that Tom McCarthy 
was bathed in an atomic aerosol that more than likely contained 
plutonium, and then suffered the onset of cancer and a premature death. 
Bronchiolo alveolar carcinoma, the malady Tom was infected with is a 
nonsmoking disease that is usually induced by exposure to plutonium.
  Unfortunately, his widow, Joan McCarthy, was denied year after year 
after year when she would put in claims to the VA. That is a profound 
injustice that my provision sets right. This legislation finally, 
belatedly recognizes that her claim is legitimate, authentic, and ought 
to be paid. It seems to me, this is the very least our action can do. 
As a matter of fact, we owe Joan an apology for our collective 
indifference for her loss.
  Again, I want to thank the chairman, the gentleman from Arizona (Mr. 
Stump) throughout two decades, and Mr. Montgomery when he was here was 
always very supportive of this legislation when he was chairman. We 
have finally succeeded in righting, to some extent, a terrible wrong 
which will now help this widow and other widows who have suffered.
  I also want to thank the chairman, the gentleman from Arizona (Mr. 
Stump) and the gentleman from Florida (Mr. Stearns) for their support 
of the respite care provisions.

                              {time}  1745

  Respite care is one of those very often unrecognized needs. The 
caregivers who spend on average about 10\1/2\ hours a day helping 
disabled loved ones, usually their family members. And in this case we 
are talking about veterans, many of whom are World War II veterans. My 
legislation, which is now a provision and tax bill, will provide 
contract care, the ability, the authority for the VA to contract so 
that that respite care can be given. Under current law, in order to 
receive respite care benefits, the caregiver has to put the loved one 
into a VA or State nursing home. That is so onerous and unworkable that 
in 1998, only 232 cases of respite care was provided by the VA; and we 
know that the need exceeds that. This new VA authority vests the VA 
with the ability to contract out for respite care.
  Mr. Speaker, I again want to thank all of those who were involved in 
writing this legislation. Our staff has been extraordinarily effective. 
We had a very challenging conference with the Senate. But, thankfully, 
there was a meeting of the minds. Prudent compromises were agreed to. 
So I salute the gentleman from Arizona (Mr. Stump) and the gentleman 
from Florida (Mr. Stearns) for their extraordinary leadership. They are 
great friends of the veteran. This is an outstanding bill. I urge 
support for it.
  Mr. EVANS. Mr. Speaker, I yield 1 minute to the gentleman from Texas 
(Mr. Reyes).
  Mr. REYES. Mr. Speaker, I thank the gentleman from Illinois (Mr. 
Evans) for yielding me this time. I also want to thank the gentleman 
from Arizona (Chairman Stump) and the gentleman from Illinois (Mr. 
Evans), ranking member, for all the hard work and support that they 
have given our Nation's veterans.
  I, too, as the gentleman from Texas was concerned, am concerned about 
the reprioritization of the veterans' nursing homes. I appreciate the 
hard work and the reassurances from the gentleman from Florida 
(Chairman Stearns) that he will work with us to make sure that these 
homes are prioritized and we get an opportunity to provide these kinds 
of facilities for our veterans in States like Texas.
  Mr. Speaker, one of the biggest challenges that I see our committee 
having to deal with is the challenge of addressing the migration of the 
veterans to the Sunbelt States like Florida, Texas, and Arizona. As we 
work through this process in the coming year, in the next fiscal year, 
I hope that all of us are able to provide for all the Nations' 
veterans.
  Mr. EVANS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Mississippi (Mr. Shows).
  Mr. SHOWS. Mr. Speaker, this legislation is a step in the right 
direction. I am encouraged to see this legislation, the Veteran's 
Millennium Health Care Act. I would like to congratulate the gentleman 
from Florida (Mr. Stearns) for bringing forward this comprehensive and 
ambitious legislation, as well as the gentleman from Arizona (Mr. 
Stump) and the gentleman from Illinois (Mr. Evans).
  Mr. Speaker, I have 46,000 veterans in my district alone. With a 
growing and older veterans population in the South, it is particularly 
important to address long-term care. The Sonny Montgomery Medical 
Center is in my district. This facility serves a veterans population of 
130,000 veterans in 50 central Mississippi counties and six Louisiana 
parishes. With an ever-growing veterans population, legislation and 
resources are needed to ensure that long-term care, including nursing 
home care, assisted living, is required, not just desired.

[[Page 29828]]

  This legislation will create a 4-year plan requiring the Veterans 
Affairs Department to provide institutional care to veterans with 
service-connected disabilities of 70 percent or greater. This is needed 
legislation. I am proud to be able to vote for this ambitious 
legislation.
  Mr. EVANS. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I want to thank the gentleman from New York (Mr. Quinn) 
and the gentleman from California (Mr. Filner), the chairman and 
ranking member of the Subcommittee on Benefits, for their hard work on 
this bill. I would like to express my appreciation to the gentleman 
from Florida (Mr. Stearns), the chairman of the Subcommittee on Health, 
for introducing the health care provisions in the Millennium Health 
Care Act, as well as the gentleman from Illinois (Mr. Gutierrez), the 
subcommittee's ranking member.
  Mr. Speaker, as always the gentleman from Illinois (Mr. Evans) the 
ranking member of the full committee, has worked in the committee's 
traditional bipartisan fashion on this important legislation. I thank 
the gentleman for his effort and for his efforts on all the legislation 
that we have had this year.
  The House and Senate VA committees came to this agreement over the 
past week, and I want to express my appreciation to both Senators 
Specter and Rockefeller, the chairman and ranking member of the VA 
committee on the Senate side, for their cooperative spirit in which 
they approach all issues considered in conference.
  The staff of the House Committee on Veterans' Affairs and the Senate 
VA committee should be commended for their cooperation demonstrated 
during our final legislative deliberations of this year. One particular 
staff member needs to be singled out and I would like to pay tribute to 
Jill T. Cochran on the occasion of her retirement. Jill leaves after 25 
years of service, and we commend her for her service to the House on 
behalf of our Nation's veterans. We wish Jill all the very best.
  Mr. BLILEY. Mr. Speaker, today I rise in support of the Veterans 
Millennium Health Care Act of 1999 Conference Report. Included in this 
Conference Report is my bill H.R. 430, the Combat Veterans Medical 
Equity Act. Due to the broad base of support, my bill gained 177 
cosponsors and was endorsed by the Military Order of the Purple Heart, 
Catholic War Veterans, The Non Commissioned Officers Association of the 
United States of America, Veterans of Foreign Wars, Legion of Valor, 
American Veterans Committee and the Jewish War Veterans.
  Most people are unaware that under current law, combat wounded 
veterans do not always qualify for medical care at VA facilities. This 
bill will 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 Prisoner of 
Wars and veterans with service connected disabilities rated between 10 
and 20 percent.
  We as a nation owe a debt of gratitude to all our veterans who have 
been awarded the Purple Heart for injuries suffered in service to our 
country. I would like to thank Chairman Stump and Chairman Specter for 
including my legislation, the Combat Veterans Medical Equity Act, in 
this important legislation. I would also like to congratulate the 
Military Order of the Purple Heart for their hard work and advocacy on 
behalf of our nations 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. PORTMAN. Mr. Speaker, the conference report on H.R. 2116, the 
Veterans Millennium Health Care Act of 1999, is important legislation 
designed to lay the ground work for veterans health care into the next 
century.
  Overall, I support many of the provisions of H.R. 2116 that provide 
needed modifications to the VA health care system, and I will vote for 
the bill. However, I do have serious concerns about one element of the 
bill which will unfairly delay funding for a proposed nursing home 
facility that is desperately needed to serve veterans in southern Ohio. 
I say unfairly because under current law, the proposed facility in 
Georgetown, Ohio is well on track to receive final approval by VA for 
FY 2000 funds to pay the federal share of the project. The problem is 
that all parties involved--the VA, the State of Ohio, local government 
officials, and concerned veterans groups--have acted in good faith and 
followed the rules under the application process. Unfortunately, H.R. 
2116 changes those rules in the middle of the game, preventing 
Georgetown from receiving the federal funds in FY 2000 as planned.
  Ohio has a serious shortfall of more than 4,000 VA nursing home beds. 
In fact, the only VA nursing home serving Ohio is in Sandusky--a 4 or 5 
hour drive from southern Ohio--and 160 veterans are on the waiting 
list. Since only 8 of the home's 650 residents are from southern Ohio, 
it is clear why the Georgetown facility is vital to the veterans in our 
part of the state.
  The State of Ohio recognizes the urgency of this situation and has 
committed $4.5 million for 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. 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. The VA agrees that the 
Georgetown facility is important to veterans in Ohio, and the Secretary 
has placed the project on the Department's priority one list to receive 
the federal share of funding at $7.8 million.
  During consideration of the House-passed version of H.R. 2116 in 
September, I voiced my concerns that the bill would delay the 
Georgetown project for several years. Chairman Stump, Chairman Stearns 
and ranking members Evans and Gutierrez agree that it is important to 
move ahead with the project, and they worked with the Senate to include 
language that will have the effect of placing the Georgetown facility 
first on the list for federal funding in FY 2001. While I would prefer 
that the project be funded in FY 2000, I do want to thank the Chairmen, 
the ranking members and the Senate for listening to the concerns of the 
veterans in Ohio and seeing that this project remains a priority. I 
will continue to work with them, Secretary West as well as state and 
local officials in Ohio to ensure that the Georgetown facility becomes 
a reality without any further delay,
  STUMP. Mr. Speaker, I have no further requests for time, and I yield 
back the balance of my time.
  The SPEAKER pro tempore (Mr. Barr of Georgia). The question is on the 
motion offered by the gentleman from Arizona (Mr. Stump) that the House 
suspend the rules and agree to the conference report on the bill, H.R. 
2116.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the conference report was agreed 
to.
  A motion to reconsider was laid on the table.

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