[Congressional Record (Bound Edition), Volume 146 (2000), Part 13]
[House]
[Pages 18801-18818]
[From the U.S. Government Publishing Office, www.gpo.gov]



    DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PERSONNEL ACT OF 2000

  Ms. PRYCE of Ohio. Mr. Speaker, by direction of the Committee on 
Rules, I call up House Resolution 585 and ask for its immediate 
consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 585

       Resolved, That upon the adoption of this resolution it 
     shall be in order without intervention of any point of order 
     to consider in the House the bill (H.R. 5109) to amend title 
     38, United States Code, to improve the personnel system of 
     the Veterans Health Administration, and for other purposes. 
     The bill shall be considered as read for amendment. The 
     amendment recommended by the Committee on Veterans' Affairs 
     now printed in the bill shall be considered as adopted. The 
     previous question shall be considered as ordered on the bill, 
     as amended, and on any further amendment thereto to final 
     passage without intervening motion except: (1) one hour of 
     debate on the bill, as amended, equally divided and 
     controlled by the chairman and ranking minority member of the 
     Committee on Veterans' Affairs; (2) the further amendment 
     printed in the report of the Committee on Rules accompanying 
     this resolution, if offered by Representative Stump of 
     Arizona, Representative Evans of Illinois, or a designee, 
     which shall be in order without intervention of any point of 
     order or demand for division of the question, shall be 
     considered as read, and shall be separately debatable for 10 
     minutes equally divided and controlled by the proponent and 
     an opponent; and (3) one motion to recommit with or without 
     instructions.

  The SPEAKER pro tempore. The gentlewoman from Ohio (Ms. Pryce) is 
recognized for 1 hour.
  Ms. PRYCE of Ohio. Mr. Speaker, for the purpose of debate only, I 
yield the customary 30 minutes to the ranking member of the Committee 
on Rules, the gentleman from Massachusetts (Mr. Moakley), pending which 
I yield myself such time as I may consume. During consideration of this 
resolution, all time yielded is for the purpose of debate only.
  Mr. Speaker, House Resolution 585 is a modified closed rule providing 
for consideration of H.R. 5109, the Department of Veterans Affairs 
Health Care Personnel Act. This legislation is the culmination of work 
done by the House Committee on Veterans' Affairs over the past year to 
determine what can be done to improve the VA health care system. We all 
recognize the great sacrifices made by those who have bravely served 
their country in the armed services. Providing quality health care to 
these great Americans and their families is one of the most important 
ways that we can extend our gratitude. After numerous hearings, 
meetings and oversight conducted by the Committee on Veterans' Affairs, 
this legislation was developed to address a range of VA health issues.
  The House will have 1 hour to engage in general debate on the bill 
which will be equally divided between the chairman and ranking minority 
member of the Committee on Veterans' Affairs. Under the rule, the 
amendment recommended by the Committee on Veterans' Affairs, now 
printed in the bill, shall be considered as adopted. All points of 
order against the bill, as

[[Page 18802]]

amended, and against its consideration are waived. The rule makes in 
order one bipartisan amendment which is printed in the Committee on 
Rules report which shall be considered as read and not subject to 
amendment. All points of order against this amendment are waived.
  Finally, the rule provides for the customary motion to recommit, with 
or without instructions.
  Mr. Speaker, we all have heard from our constituents about the 
problems that riddle the VA health system. I would venture to guess 
that all of us share a desire to improve this system to ensure that our 
Nation's veterans get the quality care that they so rightly deserve. 
Making sure our veterans are treated right starts with treating the 
personnel in the VA health system right. That is why much of H.R. 5109 
focuses on the providers of health care in the VA system.
  Under this legislation, pay for VA nurses will become more equitable 
and a guaranteed national comparability pay increase on par with that 
received by other Federal workers will improve morale among nurses 
which in turn will enhance recruitment and retention of these valued 
employees. In addition, these nurses, who often spend more time with 
individual patients and who are more intimately familiar with their 
care, will be given a greater role in policy and decision-making at the 
VA. Dentists will also see their pay rise, as will VA pharmacists under 
the provisions of this legislation.
  In addition to ensuring that the personnel in the VA system receive 
adequate compensation, H.R. 5109 responds to the unique health care 
needs of veterans by requiring the VA to incorporate a military history 
into medical examinations. Treating the medical conditions that arise 
out of military service is at the foundation of the VA system. If such 
conditions are left undiagnosed and/or untreated, the long-term 
consequences can be very, very severe. This legislation requires that 
during a veteran's initial clinical examination, the VA inquire about 
and document a veteran's military service and any exposures during 
their service that may contribute to their health status.
  Along these same lines, H.R. 5109 seeks to build on the knowledge 
that has grown out of the survey that began in 1984 regarding post-
traumatic stress disorder. This legislation calls for a follow-up study 
to determine, among other things, what the long range course of PTSD 
is, which veterans are least likely to recover from the disorder, and 
how it contributes to subsequent health conditions, such as 
cardiovascular disease.
  Another concern that many of us have heard about from our veterans 
back home is that VA health facilities are inconvenient because they 
are so often so far away. Too often we learn of a sick individual who 
has to endure the hardship of traveling hours to get to where he or she 
needs to be, that is, the VA center. More and more, doctors can treat 
patients on an outpatient basis, but if a veteran is traveling 2 or 3 
hours to get to an outpatient clinic, he or she may have to spend the 
night, particularly if follow-up care is required the next day, as it 
so often is.
  The legislation we will vote on today improves the situation for 
veterans by providing clear authority to the VA to provide overnight 
accommodations at or near a VA facility.
  Another provision of this legislation offers greater convenience to 
veterans by establishing a pilot program that will allow veterans with 
Medicare or other health coverage to coordinate their benefits and seek 
care in a community hospital rather than a VA facility that may be 
hundreds of miles away. The VA would coordinate the care to ensure that 
the patient does not incur additional out-of-pocket costs, and VA 
approval would be required to ensure that the VA is still responsible 
for delivering the specialized care that so many veterans require.
  Mr. Speaker, these and other improvements to the VA health care 
system are worthy of bipartisan support. The rule before us was 
reported by the Committee on Rules by a voice vote. I urge its swift 
adoption by the House so that we may move forward with this legislation 
which is so very important to our veterans.
  I urge a yes vote on the rule and the Department of Veterans Affairs 
Health Care Personnel Act.
  Mr. Speaker, I reserve the balance of my time.
  Mr. MOAKLEY. Mr. Speaker, I thank my dear friend, the gentlewoman 
from Ohio (Ms. Pryce), for yielding me the customary half hour, and I 
yield myself such time as I may consume.
  Mr. Speaker, this veterans health care bill is bipartisan, and it 
deserves all of our complete support. Many parts of our country have 
far fewer veterans hospitals than they actually need; and veterans who 
live in those areas, particularly older veterans, have a very difficult 
time obtaining any kind of health care. This bill, bottom line, will 
enable veterans who live more than 2 hours away from a veterans 
facility to see a non-VA doctor and have the costs absorbed by the 
Veterans' Administration.

                              {time}  1200

  This will make it much easier for the elderly veterans to get their 
health care, and it will help make sure that our country keeps its 
promise to provide health care to our fighting men and women.
  Mr. Speaker, this also will help fix some of the problems with pay 
for nurses, dentists, and pharmacists; and it will stem what could be a 
disastrous departure from the government work for these health care 
professionals.
  Mr. Speaker, the bill would also help build new veterans hospitals in 
California, Virginia, Florida, and Tennessee, because we find as the 
veterans get older, they go to warmer climates; and, therefore, there 
is an inordinate amount of veterans settling in some of our southern 
States.
  Mr. Speaker, I thank the gentleman from Arizona (Mr. Stump), my 
colleague, who has done a great job on this, and the gentleman from 
Illinois (Mr. Evans), my colleague, for his excellent work. They have 
improved the health care for American veterans, and this bill as well 
as the rule deserve our full support.
  Mr. Speaker, I reserve the balance of my time.
  Ms. PRYCE of Ohio. Mr. Speaker, I yield such time as he might consume 
to the gentleman from Florida (Mr. Goss), my distinguished colleague 
and the vice chairman of the Committee on Rules.
  Mr. GOSS. Mr. Speaker, I rise in strong support of this rule and the 
underlying legislation. I thank the gentlewoman from Ohio (Ms. Pryce), 
my good friend for not only her leadership but yielding me this time. I 
appreciate very much the observations of the gentleman from 
Massachusetts (Mr. Moakley), who well understands the plight of our 
veterans.
  Mr. Speaker, my home State of Florida has about 1.7 million veterans, 
that is a lot of veterans, and it serves as home to thousands more 
during our busy winter season, which is about to start. Given what we 
are told about the price of heating oil this year, I expect we are 
going to have an awful lot of visitors to Florida.
  Given the age and special needs of the population, many of these men 
and women require extensive medical attention. The lack of timely, 
quality health care for our veterans has reached a crisis point across 
our Nation, as the gentlewoman from Ohio (Ms. Pryce) has pointed out, 
but the problem is even more acute in southwest Florida.
  Sadly, the need far exceeds our resources in southwest Florida, and 
it is not because we have not been trying. Veterans routinely wait 
months, sometimes over a year, just to get an appointment for something 
as simple as vision care or hearing care, and to make matters worse, 
many are forced to drive hundreds of miles to a VA facility in order to 
receive the medical attention they require when high-quality private 
facilities are located right around the corner from their homes.
  This is sort of an unacceptable way to treat those who have served 
our country so honorably when we needed them so much.
  H.R. 5109 begins to address this injustice by establishing a program 
to allow

[[Page 18803]]

vets in remote areas to receive care at non-VA facilities at the VA 
expense. This program would not only relieve the stress of a long drive 
on an ailing veteran, but it would also introduce more choice into the 
current VA health system.
  Veterans in rural areas would finally have a choice between the 
traditional VA care and the utilization of private medical facilities. 
Introducing free market values into the VA medical system in my view 
will likely improve the quality of medical attention received by our 
Nation's veterans, and they deserve the best.
  It is time we enable our veterans to have this right to choose, and I 
think this bill gets us going on that road. It is also about time we 
treat veterans the same, no matter where they live. They certainly 
earned that. I think the veterans in southwest Florida should not be 
discriminated against just because so many of them have found out that 
southwest Florida is a great place to live and have moved there.
  Mr. Speaker, it seems to me the facilities ought to follow the 
veterans. I strongly encourage my colleagues to support the rule, I 
think it is noncontroversial, and the bill. And I want to congratulate 
the gentleman from Arizona (Chairman Stump) and all of the other people 
who have participated in bringing this forward for their leadership and 
commitment to veterans.
  When we talked at the testimony at the Committee on Rules last 
evening, the gentleman from Arizona (Chairman Stump) indicated his 
clear awareness of this problem and his sympathy for our problems in 
Fort Myers and for that I am grateful.
  Mr. MOAKLEY. Mr. Speaker, I yield back the balance of my time.
  Ms. PRYCE of Ohio. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I hope all of my colleagues will join me in supporting 
this fair rule, which will allow the House to debate a bipartisan bill 
that will improve the health care for our Nation's veterans. I also 
want to congratulate the gentleman from Arizona (Chairman Stump) for 
his fine work on this effort.
  These individuals who have been willing to make great sacrifices to 
serve their country through their military service deserve not only our 
respect, but our deepest gratitude.
  Mr. Speaker, the legislation before us would demonstrate to our 
veterans that we are sincere in our desire to repay them for the 
sacrifice, in part by ensuring their access to high quality health care 
through the VA system.
  The Department of Veterans Affairs Health Care Personnel Act is a 
thoughtful bipartisan effort to make some of the changes necessary to 
improve VA care.
  Mr. Speaker, I urge my colleagues to support the bill and this very 
fair rule.
  Mr. Speaker, I yield back the balance of my time, and I move the 
previous question on the resolution.
  The previous question was ordered.
  The resolution was agreed to.
  A motion to reconsider was laid on the table.
  Mr. STUMP. Mr. Speaker, pursuant to the provisions of House 
Resolution 585, I call up the bill (H.R. 5109) to amend title 38, 
United States Code, to improve the personnel system of the Veterans 
Health Administration, and for other purposes, and ask for its 
immediate consideration in the House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore (Mr. Ryan of Wisconsin). Pursuant to House 
Resolution 585, the bill is considered read for amendment.
  The text of H.R. 5109 is as follows:

                               H.R. 5109

       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.

       (a) Short Title.--This Act may be cited as the ``Department 
     of Veterans Affairs Health Care Personnel Act of 2000''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.

                       TITLE I--PERSONNEL MATTERS

Sec. 101. Revised authority for pay adjustments for nurses employed by 
              the Department of Veterans Affairs.
Sec. 102. Special pay for dentists.
Sec. 103. Exemption for pharmacists from ceiling on special salary 
              rates.
Sec. 104. Physician assistant advisers to Under Secretary for Health.
Sec. 105. Temporary full-time appointments of certain medical 
              personnel.
Sec. 106. Qualifications of social workers.
Sec. 107. Extension of temporary early retirement authority.

                  TITLE II--CONSTRUCTION AUTHORIZATION

Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of appropriations.

                   TITLE III--MILITARY SERVICE ISSUES

Sec. 301. Military service history.
Sec. 302. Study of post-traumatic stress disorder in Vietnam veterans.

                    TITLE IV--MEDICAL ADMINISTRATION

Sec. 401. Pilot program for coordination of hospital benefits.
Sec. 402. Benefits for persons disabled by participation in compensated 
              work therapy program.
Sec. 403. Extension of authority to establish research and education 
              corporations.
Sec. 404. Department of Veterans Affair Fisher Houses.
Sec. 405. Extension of annual report of Committee on Mentally Ill 
              Veterans.
Sec. 406. Exception of recapture rule.
Sec. 407. Change to enhanced use lease congressional notification 
              period.
Sec. 408. Technical and conforming changes.
Sec. 409. Appointment of Veterans Benefits Administration claims 
              examiners (also titled Veterans Service Representatives) 
              on a fee basis.
Sec. 410. Release of reversionary interest of the United States in 
              certain real property previously conveyed to the State of 
              Tennessee.

     SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.

       Except as otherwise expressly provided, whenever in this 
     Act an amendment or repeal is expressed in terms of an 
     amendment to, or repeal of, a section or other provision, the 
     reference shall be considered to be made to a section or 
     other provision of title 38, United States Code.

                       TITLE I--PERSONNEL MATTERS

     SEC. 101. ANNUAL NATIONAL PAY COMPARABILITY ADJUSTMENT FOR 
                   NURSES EMPLOYED BY DEPARTMENT OF VETERANS 
                   AFFAIRS.

       (a) Revised Pay Adjustment Procedures.--Section 7451 is 
     amended--
       (1) in subsection (d)--
       (A) in paragraph (1)--
       (i) by striking ``The rates'' and inserting ``Subject to 
     subsection (e), the rates''; and
       (ii) in subparagraph (A), by inserting ``and to be by the 
     same percentage'' after ``to have the same effective date'';
       (B) in paragraph (2), by striking ``Such'' in the second 
     sentence and inserting ``Except as provided in paragraph 
     (1)(A), such'';
       (C) in paragraph (3)(B)--
       (i) by inserting after the first sentence the following new 
     sentence: ``To the extent practicable, the director shall use 
     third-party industry wage surveys to meet the requirements of 
     the preceding sentence.'';
       (ii) by inserting before the penultimate sentence the 
     following new sentence: ``To the extent practicable, all 
     surveys conducted pursuant to this subparagraph or 
     subparagraph (A) shall include the collection of salary 
     midpoints, actual salaries, lowest and highest salaries, 
     average salaries, bonuses, incentive pays, differential pays, 
     actual beginning rates of pay and such other information 
     needed to meet the purpose of this section.''; and
       (iii) in the penultimate sentence, by inserting ``or 
     published'' after ``completed'';
       (D) by striking clause (iii) of paragraph (3)(C);
       (2) by striking subsection (e) and inserting the following:
       ``(e)(1) An adjustment in a rate of basic pay under 
     subsection (d) may not reduce the rate of basic pay 
     applicable to any grade of a covered position.
       ``(2) The director of a Department health-care facility, in 
     determining whether to carry out a wage survey under 
     subsection (d)(3) with respect to rates of basic pay for a 
     grade of a covered position, may not consider as a factor in 
     such determination the absence of a current recruitment or 
     retention problem for personnel in that grade of that 
     position. The director shall make such a determination based 
     upon whether, in accordance with criteria established by the 
     Secretary, there is a significant pay-related staffing 
     problem at that facility in any grade for a position. If the 
     director determines that there is such a problem, or that 
     such a problem is likely to exist in the near future, the 
     Director shall provide for a wage survey in accordance with 
     paragraph (3) of subsection (d).
       ``(3) The Under Secretary for Health may, to the extent 
     necessary to carry out the purposes of subsection (d), modify 
     any determination made by the director of a Department 
     health-care facility with respect to adjusting the rates of 
     basic pay applicable to covered positions. Upon such action 
     by the

[[Page 18804]]

     Under Secretary, any adjustment shall take effect on the 
     first day of the first pay period beginning after such 
     action. The Secretary shall ensure that the Under Secretary 
     establishes a mechanism for the exercise of the authority in 
     the preceding sentence.
       ``(4) Each director of a Department health-care facility 
     shall provide to the Secretary, not later than July 31 each 
     year, a report on staffing for covered positions at that 
     facility. The report shall include the following:
       ``(A) Information on turnover rates and vacancy rates for 
     each grade in a covered position, including a comparison of 
     those rates with the rates for the preceding three years.
       ``(B) The director's findings concerning the review and 
     evaluation of the facility's staffing situation, including 
     whether there is, or is likely to be, in accordance with 
     criteria established by the Secretary, a significant pay-
     related staffing problem at that facility for any grade of a 
     covered position and, if so, whether a wage survey was 
     conducted, or will be conducted with respect to that grade.
       ``(C) In any case in which the director conducts such a 
     wage survey during the period covered by the report, 
     information describing the survey and any actions taken or 
     not taken based on the survey, and the reasons for taking (or 
     not taking) such actions.
       ``(D) In any case in which the director, after finding that 
     there is, or is likely to be, in accordance with criteria 
     established by the Secretary, a significant pay-related 
     staffing problem at that facility for any grade of a covered 
     position, determines not to conduct a wage survey with 
     respect to that position, a statement of the reasons why the 
     director did not conduct such a survey.
       ``(5) Not later than September 30 of each year, the 
     Secretary shall submit to the Committees on Veterans' Affairs 
     of the Senate and House of Representatives a report on 
     staffing for covered positions at Department healthcare 
     facilities. Each such report shall include the following:
       ``(A) A summary and analysis of the information contained 
     in the most recent reports submitted by facility directors 
     under paragraph (4).
       ``(B) The information for each such facility specified in 
     paragraph (4).'';
       (3) in subsection (f)--
       (A) by striking ``February 1 of 1991, 1992, and 1993'' and 
     inserting ``March 1 of each year''; and
       (B) by striking ``subsection (d)(1)(A)'' and inserting 
     ``subsection (d)''; and
       (4) by striking subsection (g) and redesignating subsection 
     (h) as subsection (g).
       (b) Required Consultations With Nurses.--(1) Subchapter II 
     of chapter 73 is amended by adding at the end the following 
     new section:

     ``Sec. 7323. Required consultations with nurses

       ``The Under Secretary for Health shall ensure that--
       ``(1) the director of a geographic service area, in 
     formulating policy relating to the provision of patient care, 
     shall consult regularly with a senior nurse executive or 
     senior nurse executives; and
       ``(2) the director of a medical center shall, to the extent 
     feasible, include a registered nurse as a member of any 
     committee used at that medical center to provide 
     recommendations or decisions on medical center operations or 
     policy affecting clinical services, clinical outcomes, 
     budget, or resources.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after the item relating to section 
     7322 the following new item:

``7323. Required consultations with nurses.''.

     SEC. 102. SPECIAL PAY FOR DENTISTS.

       (a) Full-Time Status Pay.--Paragraph (1) of section 7435(b) 
     is amended by striking ``$3,500'' and inserting ``$9,000''.
       (b) Special Pay for Post-Graduate Training.--Such section 
     is amended by adding at the end the following new paragraph:
       ``(8) For a dentist who has successfully completed a post-
     graduate year of hospital-based training in a program 
     accredited by the American Dental Association, an annual rate 
     of $2,000 for each of the first two years of service after 
     successful completion of that training.''.
       (c) Tenure Pay.--The table in paragraph (2)(A) of that 
     section is amended to read as follows:


------------------------------------------------------------------------
                                                          Rate
              ``Length of Service              -------------------------
                                                  Minimum      Maximum
------------------------------------------------------------------------
1 year but less than 2 years..................       $1,000       $2,000
2 years but less than 3 years.................        4,000        5,000
4 years but less than 7 years.................        5,000        8,000
8 years but less than 11 years................        8,000       12,000
12 years but less than 19 years...............       12,000       15,000
20 years or more..............................       15,000   18,000.''.
------------------------------------------------------------------------

       (d) Scarce Specialty Pay.--Paragraph (3)(A) of that section 
     is amended by striking ``$20,000'' and inserting ``$30,000''.
       (e) Geographic Pay.--Paragraph (6) of that section is 
     amended by striking ``$5,000'' and inserting ``$12,000''.
       (f) Responsibility Pay.--(1) The table in paragraph (4)(A) 
     is amended to read as follows:


------------------------------------------------------------------------
                                                          Rate
                  ``Position                   -------------------------
                                                  Minimum      Maximum
------------------------------------------------------------------------
Chief of Staff or in an Executive Grade.......      $14,500      $25,000
Director Grade................................            0       25,000
Service Chief (or in a comparable position as         4,500   15,000.''.
 determined by the Secretary).................
------------------------------------------------------------------------

       (2) The table in paragraph (4)(B) is amended to read as 
     follows:

------------------------------------------------------------------------
                         ``Position                              Rate
------------------------------------------------------------------------
Deputy Service Director....................................      $20,000
Service Director...........................................       25,000
Deputy Assistant Under Secretary for Health................       27,500
Assistant Under Secretary for Health (or in a comparable      30,000.''.
 position as determined by the Secretary)..................
------------------------------------------------------------------------

       (g) Crediting of Increased Tenure Pay for Civil Service 
     Retirement.--Section 7438(b) is amended--
       (1) by redesignating paragraph (5) as paragraph (6); and
       (2) by inserting after paragraph (4) the following new 
     paragraph:
       ``(5) Notwithstanding paragraphs (1) and (2), a dentist 
     employed as a dentist in the Veterans Health Administration 
     on the effective date of section 102 of the Department of 
     Veterans Affairs Health Care Personnel Act of 2000 shall be 
     entitled to have special pay paid to the dentist under 
     section 7435(b)(2)(A) of this title (referred to as `tenure 
     pay') considered basic pay for the purposes of chapter 83 or 
     84, as appropriate, of title 5 only as follows:
       ``(A) In an amount equal to the amount that would have been 
     so considered under such section on the day before such 
     effective date based on the rates of special pay the dentist 
     was entitled to receive under that section on the day before 
     such effective date.
       ``(B) With respect to any amount of special pay received 
     under that section in excess of the amount such dentist was 
     entitled to receive under such section on the day before such 
     effective date, in an amount equal to 25 percent of such 
     excess amount for each two years that the physician or 
     dentist has completed as a physician or dentist in the 
     Veterans Health Administration after such effective date.''.
       (h) Effective Date.--The amendments made by this section 
     shall apply with respect to agreements entered into by 
     dentists under subchapter III of chapter 74 of title 38, 
     United States Code, on or after the later of--
       (1) the date of the enactment of this Act; and
       (2) October 1, 2000.
       (i) Transition.--(1) In the case of an agreement entered 
     into by a dentist under subchapter III of chapter 74 of title 
     38, United States Code, before the date of the enactment of 
     this Act that expires after the effective date specified in 
     subsection (h), the Secretary of Veterans Affairs and the 
     dentist concerned may agree to terminate that agreement as of 
     that effective date in order to permit a new agreement in 
     accordance with section 7435 of such title, as amended by 
     this section, to take effect as of that effective date.
       (2) In the case of an agreement entered into under such 
     subchapter before the date of the enactment of this Act that 
     expires during the period beginning on the date of the 
     enactment of this Act and ending on the effective date 
     specified in subsection (h)(2), an extension or renewal of 
     that agreement may not extend beyond that effective date.
       (3) In the case of a dentist who begins employment with the 
     Department of Veterans Affairs during the period beginning on 
     the date of the enactment of this Act and ending on the 
     effective date specified in subsection (h)(2) who is eligible 
     for an agreement under subchapter III of chapter 74 of title 
     38, United States Code, any such agreement may not extend 
     beyond that effective date.

     SEC. 103. EXEMPTION FOR PHARMACISTS FROM CEILING ON SPECIAL 
                   SALARY RATES.

       Section 7455(c)(1) is amended by inserting ``, 
     pharmacists,'' after ``anesthetists''.

     SEC. 104. PHYSICIAN ASSISTANT ADVISER TO UNDER SECRETARY FOR 
                   HEALTH.

       Section 7306(f) is amended--
       (1) by striking ``and'' at the end of paragraph (1);
       (2) by striking the period at the end of paragraph (2) and 
     inserting ``; and''; and
       (3) by adding at the end the following new paragraph:
       ``(3) a physician assistant with appropriate experience 
     (who may have a permanent duty station at a Department 
     medical care facility in reasonable proximity to Washington, 
     DC) advises the Under Secretary on all matters relating to 
     the utilization and employment of physician assistants in the 
     Administration.''.

     SEC. 105. TEMPORARY FULL-TIME APPOINTMENTS OF CERTAIN MEDICAL 
                   PERSONNEL.

       (a) Physician Assistants Awaiting Certification or 
     Licensure.--Paragraph (2) of section 7405(c) is amended to 
     read as follows:
       ``(2) A temporary full-time appointment may not be made for 
     a period in excess of two years in the case of a person who--
       ``(A) has successfully completed--
       ``(i) a full course of nursing in a recognized school of 
     nursing, approved by the Secretary; or
       ``(ii) a full course of training for any category of 
     personnel described in paragraph (3) of section 7401 of this 
     title, or as a physician assistant, in a recognized education 
     or training institution approved by the Secretary; and
       ``(B) is pending registration or licensure in a State or 
     certification by a national board recognized by the 
     Secretary.''.

[[Page 18805]]

       (b) Medical Support Personnel.--That section is further 
     amended--
       (1) by redesignating paragraph (3) as paragraph (4); and
       (2) by inserting after paragraph (2) the following new 
     paragraph (3):
       ``(3)(A) Temporary full-time appointments of persons in 
     positions referred to in subsection (a)(1)(D) shall not 
     exceed three years.
       ``(B) Temporary full-time appointments under this paragraph 
     may be renewed for one or more additional periods not in 
     excess of three years each.''.

     SEC. 106. QUALIFICATIONS OF SOCIAL WORKERS.

       Section 7402(9) is amended by striking ``a person must'' 
     and all that follows and inserting ``a person must--
       ``(1) hold a master's degree in social work from a college 
     or university approved by the Secretary; and
       ``(2) be licensed or certified to independently practice 
     social work in a State, except that the Secretary may waive 
     the requirement of licensure or certification for an 
     individual social worker for a reasonable period of time 
     recommended by the Under Secretary for Health.''.

     SEC. 107. EXTENSION OF TEMPORARY EARLY RETIREMENT AUTHORITY.

       The Department of Veterans Affairs Employment Reduction 
     Assistance Act of 1999 (title XI of Public Law 106-117; 5 
     U.S.C. 5597 note) is amended as follows:
       (1) Section 1102(c) is amended to read as follows:
       ``(c) Limitation.--The plan under subsection (a) shall be 
     limited to 8,110 positions within the Department.''.
       (2) Section 1105(a) is amended by striking ``26 percent'' 
     and inserting ``15 percent''.
       (3) Section 1109(a) is amended by striking ``December 31, 
     2000'' and inserting ``December 31, 2002''.

                  TITLE II--CONSTRUCTION AUTHORIZATION

     SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

       (a) Fiscal Year 2001 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) Construction of a psychogeriatric care building at the 
     Department of Veterans Affairs MedicalCenter, Palo Alto, 
     California, in an amount not to exceed $26,600,000.
       (2) Construction of a utility plant and electrical vault at 
     the Department of Veterans Affairs Medical Center, Miami, 
     Florida, in an amount not to exceed $23,600,000.
       (3) Seismic corrections, clinical consolidation, and other 
     improvements at the Department of Veterans Affairs Medical 
     Center, Long Beach, California, in an amount not to exceed 
     $51,700,000.
       (b) Additional Fiscal Year 2000 Project.--The Secretary is 
     authorized to carry out a project for the renovation of 
     psychiatric nursing units at the Department of Veterans 
     Affairs Medical Center, Murfreesboro, Tennessee, in an amount 
     not to exceed $14,000,000.

     SEC. 202. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There are authorized to be appropriated to 
     the Secretary of Veterans Affairs for fiscal years 2001 and 
     2002 for the Construction, Major Projects, account, 
     $101,900,000 for the projects authorized in section 101(a).
       (b) Limitation.--The projects authorized in section 101(a) 
     may only be carried out using--
       (1) funds appropriated for fiscal year 2001 or 2002 
     pursuant to the authorization of appropriations in subsection 
     (a);
       (2) funds appropriated for Construction, Major Projects for 
     a fiscal year before fiscal year 2001 that remain available 
     for obligation; and
       (3) funds appropriated for Construction, Major Projects for 
     fiscal year 2001 or 2002 for a category of activity not 
     specific to a project.

                   TITLE III--MILITARY SERVICE ISSUES

     SEC. 301. MILITARY SERVICE HISTORY.

       (a) Military Histories.--The Secretary of Veterans Affairs, 
     in carrying out the responsibilities of the Secretary under 
     chapter 17 of title 38, United States Code, shall ensure 
     that--
       (1) during at least one clinical evaluation of a patient in 
     a facility of the Department, a protocol is used to identify 
     pertinent military experiences and exposures of the patient 
     that may contribute to the health status of the patient; and
       (2) pertinent information relating to the military history 
     of the patient is included in the Department's medical 
     records of the patient.
       (b) Report.--Not later than nine months after the date of 
     the enactment of this Act, the Secretary shall submit to the 
     Committees on Veterans' Affairs of the Senate and House of 
     Representatives a report on the feasibility and desirability 
     of using a computer-based system in conducting clinical 
     evaluations referred to in subsection (a)(1).

     SEC. 302. STUDY OF POST-TRAUMATIC STRESS DISORDER IN VIETNAM 
                   VETERANS.

       (a) Study on Post-Traumatic Stress Disorder.--Not later 
     than 10 months after the date of the enactment of this Act, 
     the Secretary of Veterans Affairs shall enter into a contract 
     with an appropriate entity to carry out a study on post-
     traumatic stress disorder.
       (b) Follow-Up Study.--The contract under subsection (a) 
     shall provide for a follow-up study to the study conducted in 
     accordance with section 102 of the Veterans Health Care 
     Amendments of 1983 (Public Law 98-160). Such follow-up study 
     shall use the data base and sample of the previous study.
       (c) Information To Be Included.--The study conducted 
     pursuant to this section shall be designed to yield 
     information on--
       (1) the long-term course of post-traumatic stress disorder;
       (2) any long-term medical consequences of post-traumatic 
     stress disorder;
       (3) whether particular subgroups of veterans are at greater 
     risk of chronic or more severe problems with such disorder; 
     and
       (4) the services used by veterans who have post-traumatic 
     stress disorder and the effect of those services on the 
     course of the disorder.
       (d) Report.--The Secretary shall submit to the Committees 
     of Veterans Affairs of the Senate and House of 
     Representatives a report on the results of the study under 
     this section. The report shall be submitted no later than 
     October 1, 2004.

                    TITLE IV--MEDICAL ADMINISTRATION

     SEC. 401. PILOT PROGRAM FOR COORDINATION OF HOSPITAL 
                   BENEFITS.

       (a) In General.--Chapter 17 is amended by inserting after 
     section 1725 the following new section:

     Sec. 1725A. Coordination of hospital benefits: pilot program

       ``(a) The Secretary may carry out a pilot program in not 
     more than four geographic areas of the United States to 
     improve access to, and coordination of, inpatient care of 
     eligible veterans. Under the pilot program, the Secretary, 
     subject to subsection (b), may pay certain costs described in 
     subsection (b) for which an eligible veteran would otherwise 
     be personally liable. The authority to carry out the pilot 
     program shall expire on September 30, 2005.
       ``(b) In carrying out the program described in subsection 
     (a), the Secretary may pay the costs authorized under this 
     section for hospital care and medical services furnished on 
     an inpatient basis in a non-Department hospital to an 
     eligible veteran participating in the program. Such payment 
     may cover the costs for applicable plan deductibles and 
     coinsurance and the reasonable costs of such inpatient care 
     and medical services not covered by any applicable health-
     care plan of the veteran, but only to the extent such care 
     and services are of the kind authorized under this chapter. 
     The Secretary shall limit the care and services for which 
     payment may be made under the program to general medical and 
     surgical services and shall require that such services may be 
     provided only upon preauthorization by the Secretary.
       ``(c)(1) A veteran described in paragraph (1) or (2) of 
     section 1710(a) of this title is eligible to participate in 
     the pilot program if the veteran--
       ``(A) is enrolled to receive medical services from an 
     outpatient clinic operated by the Secretary whichis (i) 
     within reasonable proximity to the principal residence of the 
     veteran, and (ii) located within the geographic area in which 
     the Secretary is carrying out the program described in 
     subsection (a);
       ``(B) has received care under this chapter within the 24-
     month period preceding the veteran's application for 
     enrollment in the pilot program;
       ``(C) as determined by the Secretary before the 
     hospitalization of the veteran (i) requires such hospital 
     care and services for a non-service-connected condition, and 
     (ii) could not receive such services from a clinic operated 
     by the Secretary; and
       ``(D) elects to receive such care under a health-care plan 
     (other than under this title) under which the veteran is 
     entitled to receive such care.
       ``(2) Nothing in this section shall be construed to reduce 
     the authority of the Secretary to contract with non-
     Department facilities for care of a service-connected 
     disability of a veteran.
       ``(3) Notwithstanding subparagraph (C) of paragraph (1), 
     the Secretary shall ensure that not less than 15 percent of 
     the veterans participating in the program are veterans who do 
     not have a health-care plan.
       ``(d) As part of the program under this section, the 
     Secretary shall, through provision of case-management, 
     coordinate the care being furnished directly by the Secretary 
     and care furnished under the program in non-Department 
     hospitals to veterans participating in the program.
       ``(e)(1) In designating geographic areas in which to 
     establish the program under subsection (a), the Secretary 
     shall ensure that--
       ``(A) the areas designated are geographically dispersed;
       ``(B) at least 70 percent of the veterans who reside in a 
     designated area reside at least two hours driving distance 
     from the closest medical center operated by the Secretary 
     which provides medical and surgical hospital care; and
       ``(C) the establishment of the program in any such area 
     would not result in jeopardizing the critical mass of 
     patients needed to maintain a Department medical center that 
     serves that area.
       ``(2) Notwithstanding paragraph (1)(B), the Secretary may 
     designate for participation in

[[Page 18806]]

     the program at least one area which is in proximity to a 
     Department medical center which, as a result of a change in 
     mission of that center, does not provide hospital care.
       ``(f)(1) Not later than September 30, 2002, the Secretary 
     shall submit to the Committees on Veterans' Affairs of the 
     Senate and House of Representatives a report on the 
     experience in implementing the pilot program under subsection 
     (a).
       ``(2) Not later than September 30, 2004, the Secretary 
     shall submit to those committees a report on the experience 
     in operating the pilot program during the first two full 
     fiscal years during which the pilot program is conducted. 
     That report shall include--
       ``(A) a comparison of the costs incurred by the Secretary 
     under the program and the cost experience for the calendar 
     year preceding establishment of the program at each site at 
     which the program is operated;
       ``(B) an assessment of the satisfaction of the participants 
     in the program; and
       ``(C) an analysis of the effect of the program on access 
     and quality of care for veterans.
       ``(g) The total amount expended for the pilot program in 
     any fiscal year (including amounts for administrative costs) 
     may not exceed $50,000,000.
       ``(h) For purposes of this section:
       ``(1) The term `health-care plan' has the meaning given 
     that term in section 1725(f)(3) 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 1725 the following new item:

``1725A. Coordination of hospital benefits: pilot program.''.

     SEC. 402. 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. 403. EXTENSION OF AUTHORITY TO ESTABLISH RESEARCH AND 
                   EDUCATION CORPORATIONS.

       Section 7368 is amended by striking ``December 31, 2000'' 
     and inserting ``December 31, 2005''.

     SEC. 404. DEPARTMENT OF VETERANS AFFAIRS FISHER HOUSES.

       (a) Authority.--Subchapter I of chapter 17 of title 38, 
     United States Code, is amended by adding at the end the 
     following new section:

     ``Sec. 1708. Temporary lodging

       ``(a) The Secretary may furnish persons described in 
     subsection (b) with temporary lodging in a Fisher house or 
     other appropriate facility in connection with the 
     examination, treatment, or care of a veteran under this 
     chapter or, as provided for under subsection (e)(5), in 
     connection with benefits administered under this title.
       ``(b) Person to whom the Secretary may provide lodging 
     under subsection (a) are the following:
       ``(1) A veteran who must travel a significant distance to 
     receive care or services under this title.
       ``(2) A member of the family of a veteran and others who 
     accompany a veteran and provide the equivalent of familial 
     support for such veteran.
       ``(c) In this section, the term `Fisher house' means a 
     housing facility that--
       ``(1) is located at, or in proximity to, a Department 
     medical facility;
       ``(2) is available for residential use on a temporary basis 
     by patients of that facility and others described in 
     subsection (b)(2); and
       ``(3) is constructed by, and donated to the Secretary by, 
     the Zachary and Elizabeth M. Fisher Armed Services 
     Foundation.
       ``(d) The Secretary may establish charges for providing 
     lodging under this section. The proceeds from suchcharges 
     shall be credited to the medical care account and shall be 
     available until expended for the purposes of providing such 
     lodging.
       ``(e) The Secretary shall prescribe regulations to carry 
     out this section. Such regulations shall include provisions--
       ``(1) limiting the duration of such lodging;
       ``(2) establishing standards and criteria under which 
     medical facilities may set charges for such lodging;
       ``(3) establishing criteria for persons considered to be 
     accompanying a veteran;
       ``(4) establishing criteria for the use of such premises; 
     and
       ``(5) any other limitations, conditions, and priorities 
     that the Secretary considers appropriate with respect to 
     temporary lodging under this section.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of such chapter is amended by inserting after the 
     item relating to section 1707 the following new item:

``1708. Temporary lodging.''.

     SEC. 405. EXTENSION OF ANNUAL REPORT OF COMMITTEE ON MENTALLY 
                   ILL VETERANS.

       Section 7321(d)(2) is amended by striking ``three'' and 
     inserting ``six''.

     SEC. 406. EXCEPTION TO RECAPTURE RULE.

       Section 8136 is amended--
       (1) by inserting ``(a)'' at the beginning of the text of 
     the section; and
       (2) by adding at the end the following new subsection:
       ``(b) The establishment and operation by the Secretary of 
     an outpatient clinic in facilities described in subsection 
     (a) shall not constitute grounds entitling the United States 
     to any recovery under that subsection.''.

     SEC. 407. CHANGE TO ENHANCED USE LEASE CONGRESSIONAL 
                   NOTIFICATION PERIOD.

       Paragraph (2) of section 8163(c) is amended to read as 
     follows:
       ``(2) The Secretary may not enter into an enhanced use 
     lease until the end of the 90-day period beginning on the 
     date of the submission of notice under paragraph (1).''.

     SEC. 408. TECHNICAL AND CONFORMING CHANGES.

       (a) Requirement To Provide Care.--Section 1710A(a) is 
     amended by inserting ``(subject to section 1710(a)(4) of this 
     title)'' after ``Secretary''.
       (b) Conforming Amendment.--Section 1710(a)(4) is amended by 
     striking ``requirement in'' and inserting ``requirements in 
     section 1710A(a) and''.

     SEC. 409. APPOINTMENT OF VETERANS BENEFITS ADMINISTRATION 
                   CLAIMS EXAMINERS (ALSO TITLED VETERANS SERVICE 
                   REPRESENTATIVES) ON A FEE BASIS.

       (a) Authority.--(1) Chapter 77 is amended by inserting 
     after section 7703 the following new section:

     ``Sec. 7705. Fee basis appointments of claims examiners

       ``(a) The Secretary, upon recommendation of the Under 
     Secretary for Benefits, may employ, without regard to civil 
     service or classification laws, rules, or regulations, 
     Veterans Claims Examiners (also titled Veterans Service 
     Representatives) on a fee basis.
       ``(b) Personnel employed under this section shall be paid 
     such rates of pay as the Secretary may prescribe.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after the item relating to section 
     7703 the following new item:

``7705. Fee basis appointments of claims examiners.''.
       (b) Reports.--The Secretary of Veterans Affairs shall 
     submit to the Committees on Veterans' Affairs of the Senate 
     and House of Representatives two reports on the 
     implementation of section 7705 of title 38, United States 
     Code, as added by subsection (a). The first report shall be 
     submitted not later than December 31, 2001, and the second 
     report shall be submitted not later than December 31, 2002.

     SEC. 410. RELEASE OF REVERSIONARY INTEREST OF THE UNITED 
                   STATES IN CERTAIN REAL PROPERTY PREVIOUSLY 
                   CONVEYED TO THE STATE OF TENNESSEE.

       (a) Release of Interest.--The Secretary of Veterans Affairs 
     shall execute such legal instruments as necessary to release 
     the reversionary interest of the United States described in 
     subsection (b) in a certain parcel of real property conveyed 
     to the State of Tennessee pursuant to the Act entitled ``An 
     Act authorizing the transfer of certain property of the 
     Veterans' Administration (in Johnson City, Tennessee) to the 
     State of Tennessee'', approved June 6, 1953 (67 Stat. 54).
       (b) Specified Reversionary Interest.--Subsection (a) 
     applies to the reversionary interest of the United States 
     required under section 2 of the Act referred to in subsection 
     (a), requiring use of the property conveyed pursuant to that 
     Act to be primarily for training of the National Guard and 
     for other military purposes.
       (c) Conforming Amendment.--Section 2 of such Act is 
     repealed.

  The SPEAKER pro tempore. The amendment printed in the bill is 
adopted.
  The text of H.R. 5109, as amended, is as follows:

                               H.R. 5109

       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.

       (a) Short Title.--This Act may be cited as the ``Department 
     of Veterans Affairs Health Care Personnel Act of 2000''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.

                       TITLE I--PERSONNEL MATTERS

Sec. 101. Annual national pay comparability adjustment for nurses 
              employed by Department of Veterans Affairs.
Sec. 102. Special pay for dentists.
Sec. 103. Exemption for pharmacists from ceiling on special salary 
              rates.
Sec. 104. Physician assistant adviser to Under Secretary for Health.
Sec. 105. Temporary full-time appointments of certain medical 
              personnel.
Sec. 106. Qualifications of social workers.
Sec. 107. Extension of voluntary separation incentive payments.

                  TITLE II--CONSTRUCTION AUTHORIZATION

Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of appropriations.

[[Page 18807]]

                   TITLE III--MILITARY SERVICE ISSUES

Sec. 301. Military service history.
Sec. 302. Study of post-traumatic stress disorder in Vietnam veterans.

                    TITLE IV--MEDICAL ADMINISTRATION

Sec. 401. Pilot program for coordination of hospital benefits.
Sec. 402. Benefits for persons disabled by participation in compensated 
              work therapy program.
Sec. 403. Extension of authority to establish research and education 
              corporations.
Sec. 404. Department of Veterans Affairs Fisher Houses.
Sec. 405. Extension of annual report of Committee on Mentally Ill 
              Veterans.
Sec. 406. Exception to recapture rule.
Sec. 407. Change to enhanced use lease congressional notification 
              period.
Sec. 408. Technical and conforming changes.
Sec. 409. Release of reversionary interest of the United States in 
              certain real property previously conveyed to the State of 
              Tennessee.

     SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.

       Except as otherwise expressly provided, whenever in this 
     Act an amendment or repeal is expressed in terms of an 
     amendment to, or repeal of, a section or other provision, the 
     reference shall be considered to be made to a section or 
     other provision of title 38, United States Code.

                       TITLE I--PERSONNEL MATTERS

     SEC. 101. ANNUAL NATIONAL PAY COMPARABILITY ADJUSTMENT FOR 
                   NURSES EMPLOYED BY DEPARTMENT OF VETERANS 
                   AFFAIRS.

       (a) Revised Pay Adjustment Procedures.--Section 7451 is 
     amended--
       (1) in subsection (d)--
       (A) in paragraph (1)--
       (i) by striking ``The rates'' and inserting ``Subject to 
     subsection (e), the rates''; and
       (ii) in subparagraph (A), by inserting ``and to be by the 
     same percentage'' after ``to have the same effective date'';
       (B) in paragraph (2), by striking ``Such'' in the second 
     sentence and inserting ``Except as provided in paragraph 
     (1)(A), such'';
       (C) in paragraph (3)(B)--
       (i) by inserting after the first sentence the following new 
     sentence: ``To the extent practicable, the director shall use 
     third-party industry wage surveys to meet the requirements of 
     the preceding sentence.'';
       (ii) by inserting before the penultimate sentence the 
     following new sentence: ``To the extent practicable, all 
     surveys conducted pursuant to this subparagraph or 
     subparagraph (A) shall include the collection of salary 
     midpoints, actual salaries, lowest and highest salaries, 
     average salaries, bonuses, incentive pays, differential pays, 
     actual beginning rates of pay and such other information 
     needed to meet the purpose of this section.''; and
       (iii) in the penultimate sentence, by inserting ``or 
     published'' after ``completed'';
       (D) by striking clause (iii) of paragraph (3)(C);
       (2) by striking subsection (e) and inserting the following:
       ``(e)(1) An adjustment in a rate of basic pay under 
     subsection (d) may not reduce the rate of basic pay 
     applicable to any grade of a covered position.
       ``(2) The director of a Department health-care facility, in 
     determining whether to carry out a wage survey under 
     subsection (d)(3) with respect to rates of basic pay for a 
     grade of a covered position, may not consider as a factor in 
     such determination the absence of a current recruitment or 
     retention problem for personnel in that grade of that 
     position. The director shall make such a determination based 
     upon whether, in accordance with criteria established by the 
     Secretary, there is a significant pay-related staffing 
     problem at that facility in any grade for a position. If the 
     director determines that there is such a problem, or that 
     such a problem is likely to exist in the near future, the 
     Director shall provide for a wage survey in accordance with 
     paragraph (3) of subsection (d).
       ``(3) The Under Secretary for Health may, to the extent 
     necessary to carry out the purposes of subsection (d), modify 
     any determination made by the director of a Department 
     health-care facility with respect to adjusting the rates of 
     basic pay applicable to covered positions. Upon such action 
     by the Under Secretary, any adjustment shall take effect on 
     the first day of the first pay period beginning after such 
     action. The Secretary shall ensure that the Under Secretary 
     establishes a mechanism for the exercise of the authority in 
     the preceding sentence.
       ``(4) Each director of a Department health-care facility 
     shall provide to the Secretary, not later than July 31 each 
     year, a report on staffing for covered positions at that 
     facility. The report shall include the following:
       ``(A) Information on turnover rates and vacancy rates for 
     each grade in a covered position, including a comparison of 
     those rates with the rates for the preceding three years.
       ``(B) The director's findings concerning the review and 
     evaluation of the facility's staffing situation, including 
     whether there is, or is likely to be, in accordance with 
     criteria established by the Secretary, a significant pay-
     related staffing problem at that facility for any grade of a 
     covered position and, if so, whether a wage survey was 
     conducted, or will be conducted with respect to that grade.
       ``(C) In any case in which the director conducts such a 
     wage survey during the period covered by the report, 
     information describing the survey and any actions taken or 
     not taken based on the survey, and the reasons for taking (or 
     not taking) such actions.
       ``(D) In any case in which the director, after finding that 
     there is, or is likely to be, in accordance with criteria 
     established by the Secretary, a significant pay-related 
     staffing problem at that facility for any grade of a covered 
     position, determines not to conduct a wage survey with 
     respect to that position, a statement of the reasons why the 
     director did not conduct such a survey.
       ``(5) Not later than September 30 of each year, the 
     Secretary shall submit to the Committees on Veterans' Affairs 
     of the Senate and House of Representatives a report on 
     staffing for covered positions at Department healthcare 
     facilities. Each such report shall include the following:
       ``(A) A summary and analysis of the information contained 
     in the most recent reports submitted by facility directors 
     under paragraph (4).
       ``(B) The information for each such facility specified in 
     paragraph (4).'';
       (3) in subsection (f)--
       (A) by striking ``February 1 of 1991, 1992, and 1993'' and 
     inserting ``March 1 of each year''; and
       (B) by striking ``subsection (d)(1)(A)'' and inserting 
     ``subsection (d)''; and
       (4) by striking subsection (g) and redesignating subsection 
     (h) as subsection (g).
       (b) Required Consultations With Nurses.--(1) Subchapter II 
     of chapter 73 is amended by adding at the end the following 
     new section:

     ``Sec. 7323. Required consultations with nurses

       ``The Under Secretary for Health shall ensure that--
       ``(1) the director of a geographic service area, in 
     formulating policy relating to the provision of patient care, 
     shall consult regularly with a senior nurse executive or 
     senior nurse executives; and
       ``(2) the director of a medical center shall, to the extent 
     feasible, include a registered nurse as a member of any 
     committee used at that medical center to provide 
     recommendations or decisions on medical center operations or 
     policy affecting clinical services, clinical outcomes, 
     budget, or resources.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after the item relating to section 
     7322 the following new item:

``7323. Required consultations with nurses.''.

     SEC. 102. SPECIAL PAY FOR DENTISTS.

       (a) Full-Time Status Pay.--Paragraph (1) of section 7435(b) 
     is amended by striking ``$3,500'' and inserting ``$9,000''.
       (b) Special Pay for Post-Graduate Training.--Such section 
     is amended by adding at the end the following new paragraph:
       ``(8) For a dentist who has successfully completed a post-
     graduate year of hospital-based training in a program 
     accredited by the American Dental Association, an annual rate 
     of $2,000 for each of the first two years of service after 
     successful completion of that training.''.
       (c) Tenure Pay.--The table in paragraph (2)(A) of that 
     section is amended to read as follows:


------------------------------------------------------------------------
                                                          Rate
              ``Length of Service              -------------------------
                                                  Minimum      Maximum
------------------------------------------------------------------------
1 year but less than 2 years..................       $1,000       $2,000
2 years but less than 4 years.................        4,000        5,000
4 years but less than 8 years.................        5,000        8,000
8 years but less than 12 years................        8,000       12,000
12 years but less than 20 years...............       12,000       15,000
20 years or more..............................       15,000   18,000.''.
------------------------------------------------------------------------

       (d) Scarce Specialty Pay.--Paragraph (3)(A) of that section 
     is amended by striking ``$20,000'' and inserting ``$30,000''.
       (e) Geographic Pay.--Paragraph (6) of that section is 
     amended by striking ``$5,000'' and inserting ``$12,000''.
       (f) Responsibility Pay.--(1) The table in paragraph (4)(A) 
     of that section is amended to read as follows:


------------------------------------------------------------------------
                                                          Rate
                  ``Position                   -------------------------
                                                  Minimum      Maximum
------------------------------------------------------------------------
Chief of Staff or in an Executive Grade.......      $14,500      $25,000
Director Grade................................            0       25,000
Service Chief (or in a comparable position as         4,500   15,000.''.
 determined by the Secretary).................
------------------------------------------------------------------------

       (2) The table in paragraph (4)(B) of that section is 
     amended to read as follows:

------------------------------------------------------------------------
                         ``Position                              Rate
------------------------------------------------------------------------
Deputy Service Director....................................      $20,000
Service Director...........................................       25,000
Deputy Assistant Under Secretary for Health................       27,500
Assistant Under Secretary for Health (or in a comparable      30,000.''.
 position as determined by the Secretary)..................
------------------------------------------------------------------------

       (g) Crediting of Increased Tenure Pay for Civil Service 
     Retirement.--Section 7438(b) is amended--
       (1) by redesignating paragraph (5) as paragraph (6); and
       (2) by inserting after paragraph (4) the following new 
     paragraph:
       ``(5) Notwithstanding paragraphs (1) and (2), a dentist 
     employed as a dentist in the Veterans Health Administration 
     on the effective date of section 102 of the Department of 
     Veterans Affairs Health Care Personnel Act of 2000 shall be 
     entitled to have special pay paid to the dentist under 
     section 7435(b)(2)(A) of this title (referred to as `tenure 
     pay') considered basic pay for the purposes of chapter 83 or 
     84, as appropriate, of title 5 only as follows:

[[Page 18808]]

       ``(A) In an amount equal to the amount that would have been 
     so considered under such section on the day before such 
     effective date based on the rates of special pay the dentist 
     was entitled to receive under that section on the day before 
     such effective date.
       ``(B) With respect to any amount of special pay received 
     under that section in excess of the amount such dentist was 
     entitled to receive under such section on the day before such 
     effective date, in an amount equal to 25 percent of such 
     excess amount for each two years that the physician or 
     dentist has completed as a physician or dentist in the 
     Veterans Health Administration after such effective date.''.
       (h) Effective Date.--The amendments made by this section 
     shall apply with respect to agreements entered into by 
     dentists under subchapter III of chapter 74 of title 38, 
     United States Code, on or after the later of--
       (1) the date of the enactment of this Act; and
       (2) October 1, 2000.
       (i) Transition.--(1) In the case of an agreement entered 
     into by a dentist under subchapter III of chapter 74 of title 
     38, United States Code, before the date of the enactment of 
     this Act that expires after the effective date specified in 
     subsection (h), the Secretary of Veterans Affairs and the 
     dentist concerned may agree to terminate that agreement as of 
     that effective date in order to permit a new agreement in 
     accordance with section 7435 of such title, as amended by 
     this section, to take effect as of that effective date.
       (2) In the case of an agreement entered into under such 
     subchapter before the date of the enactment of this Act that 
     expires during the period beginning on the date of the 
     enactment of this Act and ending on the effective date 
     specified in subsection (h)(2), an extension or renewal of 
     that agreement may not extend beyond that effective date.
       (3) In the case of a dentist who begins employment with the 
     Department of Veterans Affairs during the period beginning on 
     the date of the enactment of this Act and ending on the 
     effective date specified in subsection (h)(2) who is eligible 
     for an agreement under subchapter III of chapter 74 of title 
     38, United States Code, any such agreement may not extend 
     beyond that effective date.

     SEC. 103. EXEMPTION FOR PHARMACISTS FROM CEILING ON SPECIAL 
                   SALARY RATES.

       Section 7455(c)(1) is amended by inserting ``, 
     pharmacists,'' after ``anesthetists''.

     SEC. 104. PHYSICIAN ASSISTANT ADVISER TO UNDER SECRETARY FOR 
                   HEALTH.

       Section 7306(f) is amended--
       (1) by striking ``and'' at the end of paragraph (1);
       (2) by striking the period at the end of paragraph (2) and 
     inserting ``; and''; and
       (3) by adding at the end the following new paragraph:
       ``(3) a physician assistant with appropriate experience 
     (who may have a permanent duty station at a Department 
     medical care facility in reasonable proximity to Washington, 
     DC) advises the Under Secretary on all matters relating to 
     the utilization and employment of physician assistants in the 
     Administration.''.

     SEC. 105. TEMPORARY FULL-TIME APPOINTMENTS OF CERTAIN MEDICAL 
                   PERSONNEL.

       (a) Physician Assistants Awaiting Certification or 
     Licensure.--Paragraph (2) of section 7405(c) is amended to 
     read as follows:
       ``(2) A temporary full-time appointment may not be made for 
     a period in excess of two years in the case of a person who--
       ``(A) has successfully completed--
       ``(i) a full course of nursing in a recognized school of 
     nursing, approved by the Secretary; or
       ``(ii) a full course of training for any category of 
     personnel described in paragraph (3) of section 7401 of this 
     title, or as a physician assistant, in a recognized education 
     or training institution approved by the Secretary; and
       ``(B) is pending registration or licensure in a State or 
     certification by a national board recognized by the 
     Secretary.''.
       (b) Medical Support Personnel.--That section is further 
     amended--
       (1) by redesignating paragraph (3) as paragraph (4); and
       (2) by inserting after paragraph (2) the following new 
     paragraph (3):
       ``(3)(A) Temporary full-time appointments of persons in 
     positions referred to in subsection (a)(1)(D) shall not 
     exceed three years.
       ``(B) Temporary full-time appointments under this paragraph 
     may be renewed for one or more additional periods not in 
     excess of three years each.''.

     SEC. 106. QUALIFICATIONS OF SOCIAL WORKERS.

       Section 7402(b)(9) is amended by striking ``a person must'' 
     and all that follows and inserting ``a person must--
       ``(A) hold a master's degree in social work from a college 
     or university approved by the Secretary; and
       ``(B) be licensed or certified to independently practice 
     social work in a State, except that the Secretary may waive 
     the requirement of licensure or certification for an 
     individual social worker for a reasonable period of time 
     recommended by the Under Secretary for Health.''.

     SEC. 107. EXTENSION OF VOLUNTARY SEPARATION INCENTIVE 
                   PAYMENTS.

       The Department of Veterans Affairs Employment Reduction 
     Assistance Act of 1999 (title XI of Public Law 106-117; 5 
     U.S.C. 5597 note) is amended as follows:
       (1) Section 1102(c) is amended to read as follows:
       ``(c) Limitation.--The plan under subsection (a) shall be 
     limited to 8,110 positions within the Department.''.
       (2) Section 1105(a) is amended by striking ``26 percent'' 
     and inserting ``15 percent''.
       (3) Section 1109(a) is amended by striking ``December 31, 
     2000'' and inserting ``December 31, 2002''.

                  TITLE II--CONSTRUCTION AUTHORIZATION

     SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

       (a) Fiscal Year 2001 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) Construction of a psychogeriatric care building at the 
     Department of Veterans Affairs Medical Center, Palo Alto, 
     California, in an amount not to exceed $26,600,000.
       (2) Construction of a utility plant and electrical vault at 
     the Department of Veterans Affairs Medical Center, Miami, 
     Florida, in an amount not to exceed $23,600,000.
       (3) Seismic corrections, clinical consolidation, and other 
     improvements at the Department of Veterans Affairs Medical 
     Center, Long Beach, California, in an amount not to exceed 
     $51,700,000.
       (b) Additional Fiscal Year 2000 Project.--The Secretary is 
     authorized to carry out a project for the renovation of 
     psychiatric nursing units at the Department of Veterans 
     Affairs Medical Center, Murfreesboro, Tennessee, in an amount 
     not to exceed $14,000,000.

     SEC. 202. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There are authorized to be appropriated to 
     the Secretary of Veterans Affairs for fiscal years 2001 and 
     2002 for the Construction, Major Projects, account, 
     $101,900,000 for the projects authorized in section 101(a).
       (b) Limitation.--The projects authorized in section 101(a) 
     may only be carried out using--
       (1) funds appropriated for fiscal year 2001 or 2002 
     pursuant to the authorization of appropriations in subsection 
     (a);
       (2) funds appropriated for Construction, Major Projects for 
     a fiscal year before fiscal year 2001 that remain available 
     for obligation; and
       (3) funds appropriated for Construction, Major Projects for 
     fiscal year 2001 or 2002 for a category of activity not 
     specific to a project.

                   TITLE III--MILITARY SERVICE ISSUES

     SEC. 301. MILITARY SERVICE HISTORY.

       (a) Military Histories.--The Secretary of Veterans Affairs, 
     in carrying out the responsibilities of the Secretary under 
     chapter 17 of title 38, United States Code, shall ensure 
     that--
       (1) during at least one clinical evaluation of a patient in 
     a facility of the Department, a protocol is used to identify 
     pertinent military experiences and exposures of the patient 
     that may contribute to the health status of the patient; and
       (2) pertinent information relating to the military history 
     of the patient is included in the Department's medical 
     records of the patient.
       (b) Report.--Not later than nine months after the date of 
     the enactment of this Act, the Secretary shall submit to the 
     Committees on Veterans' Affairs of the Senate and House of 
     Representatives a report on the feasibility and desirability 
     of using a computer-based system in conducting clinical 
     evaluations referred to in subsection (a)(1).

     SEC. 302. STUDY OF POST-TRAUMATIC STRESS DISORDER IN VIETNAM 
                   VETERANS.

       (a) Study on Post-Traumatic Stress Disorder.--Not later 
     than 10 months after the date of the enactment of this Act, 
     the Secretary of Veterans Affairs shall enter into a contract 
     with an appropriate entity to carry out a study on post-
     traumatic stress disorder.
       (b) Follow-Up Study.--The contract under subsection (a) 
     shall provide for a follow-up study to the study conducted in 
     accordance with section 102 of the Veterans Health Care 
     Amendments of 1983 (Public Law 98-160). Such follow-up study 
     shall use the data base and sample of the previous study.
       (c) Information To Be Included.--The study conducted 
     pursuant to this section shall be designed to yield 
     information on--
       (1) the long-term course of post-traumatic stress disorder;
       (2) any long-term medical consequences of post-traumatic 
     stress disorder;
       (3) whether particular subgroups of veterans are at greater 
     risk of chronic or more severe problems with such disorder; 
     and
       (4) the services used by veterans who have post-traumatic 
     stress disorder and the effect of those services on the 
     course of the disorder.
       (d) Report.--The Secretary shall submit to the Committees 
     of Veterans' Affairs of the Senate and House of 
     Representatives a report on the results of the study under 
     this section. The report shall be submitted no later than 
     October 1, 2004.

                    TITLE IV--MEDICAL ADMINISTRATION

     SEC. 401. PILOT PROGRAM FOR COORDINATION OF HOSPITAL 
                   BENEFITS.

       (a) In General.--Chapter 17 is amended by inserting after 
     section 1725 the following new section:

     ``Sec. 1725A. Coordination of hospital benefits: pilot 
       program

       ``(a) The Secretary may carry out a pilot program in not 
     more than four geographic areas of the United States to 
     improve access to, and coordination of, inpatient care of 
     eligible veterans. Under the pilot program, the Secretary, 
     subject to subsection (b), may pay certain costs described in 
     subsection (b) for which an eligible veteran would otherwise 
     be personally liable.

[[Page 18809]]

     The authority to carry out the pilot program shall expire on 
     September 30, 2005.
       ``(b) In carrying out the program described in subsection 
     (a), the Secretary may pay the costs authorized under this 
     section for hospital care and medical services furnished on 
     an inpatient basis in a non-Department hospital to an 
     eligible veteran participating in the program. Such payment 
     may cover the costs for applicable plan deductibles and 
     coinsurance and the reasonable costs of such inpatient care 
     and medical services not covered by any applicable health-
     care plan of the veteran, but only to the extent such care 
     and services are of the kind authorized under this chapter. 
     The Secretary shall limit the care and services for which 
     payment may be made under the program to general medical and 
     surgical services and shall require that such services may be 
     provided only upon preauthorization by the Secretary.
       ``(c)(1) A veteran described in paragraph (1) or (2) of 
     section 1710(a) of this title is eligible to participate in 
     the pilot program if the veteran--
       ``(A) is enrolled to receive medical services from an 
     outpatient clinic operated by the Secretary which is (i) 
     within reasonable proximity to the principal residence of the 
     veteran, and (ii) located within the geographic area in which 
     the Secretary is carrying out the program described in 
     subsection (a);
       ``(B) has received care under this chapter within the 24-
     month period preceding the veteran's application for 
     enrollment in the pilot program;
       ``(C) as determined by the Secretary before the 
     hospitalization of the veteran (i) requires such hospital 
     care and services for a non-service-connected condition, and 
     (ii) could not receive such services from a clinic operated 
     by the Secretary; and
       ``(D) elects to receive such care under a health-care plan 
     (other than under this title) under which the veteran is 
     entitled to receive such care.
       ``(2) Nothing in this section shall be construed to reduce 
     the authority of the Secretary to contract with non-
     Department facilities for care of a service-connected 
     disability of a veteran.
       ``(3) Notwithstanding subparagraph (D) of paragraph (1), 
     the Secretary shall ensure that not less than 15 percent of 
     the veterans participating in the program are veterans who do 
     not have a health-care plan.
       ``(d) As part of the program under this section, the 
     Secretary shall, through provision of case-management, 
     coordinate the care being furnished directly by the Secretary 
     and care furnished under the program in non-Department 
     hospitals to veterans participating in the program.
       ``(e)(1) In designating geographic areas in which to 
     establish the program under subsection (a), the Secretary 
     shall ensure that--
       ``(A) the areas designated are geographically dispersed;
       ``(B) at least 70 percent of the veterans who reside in a 
     designated area reside at least two hours driving distance 
     from the closest medical center operated by the Secretary 
     which provides medical and surgical hospital care; and
       ``(C) the establishment of the program in any such area 
     would not result in jeopardizing the critical mass of 
     patients needed to maintain a Department medical center that 
     serves that area.
       ``(2) Notwithstanding paragraph (1)(B), the Secretary may 
     designate for participation in the program at least one area 
     which is in proximity to a Department medical center which, 
     as a result of a change in mission of that center, does not 
     provide hospital care.
       ``(f)(1) Not later than September 30, 2002, the Secretary 
     shall submit to the Committees on Veterans' Affairs of the 
     Senate and House of Representatives a report on the 
     experience in implementing the pilot program under subsection 
     (a).
       ``(2) Not later than September 30, 2004, the Secretary 
     shall submit to those committees a report on the experience 
     in operating the pilot program during the first two full 
     fiscal years during which the pilot program is conducted. 
     That report shall include--
       ``(A) a comparison of the costs incurred by the Secretary 
     under the program and the cost experience for the calendar 
     year preceding establishment of the program at each site at 
     which the program is operated;
       ``(B) an assessment of the satisfaction of the participants 
     in the program; and
       ``(C) an analysis of the effect of the program on access 
     and quality of care for veterans.
       ``(g) The total amount expended for the pilot program in 
     any fiscal year (including amounts for administrative costs) 
     may not exceed $50,000,000.
       ``(h) For purposes of this section, the term `health-care 
     plan' has the meaning given that term in section 1725(f)(3) 
     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 1725 the following new item:

``1725A. Coordination of hospital benefits: pilot program.''.

     SEC. 402. 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. 403. EXTENSION OF AUTHORITY TO ESTABLISH RESEARCH AND 
                   EDUCATION CORPORATIONS.

       Section 7368 is amended by striking ``December 31, 2000'' 
     and inserting ``December 31, 2005''.

     SEC. 404. DEPARTMENT OF VETERANS AFFAIRS FISHER HOUSES.

       (a) Authority.--Subchapter I of chapter 17 of title 38, 
     United States Code, is amended by adding at the end the 
     following new section:

     ``Sec. 1708. Temporary lodging

       ``(a) The Secretary may furnish persons described in 
     subsection (b) with temporary lodging in a Fisher house or 
     other appropriate facility in connection with the 
     examination, treatment, or care of a veteran under this 
     chapter or, as provided for under subsection (e)(5), in 
     connection with benefits administered under this title.
       ``(b) Persons to whom the Secretary may provide lodging 
     under subsection (a) are the following:
       ``(1) A veteran who must travel a significant distance to 
     receive care or services under this title.
       ``(2) A member of the family of a veteran and others who 
     accompany a veteran and provide the equivalent of familial 
     support for such veteran.
       ``(c) In this section, the term `Fisher house' means a 
     housing facility that--
       ``(1) is located at, or in proximity to, a Department 
     medical facility;
       ``(2) is available for residential use on a temporary basis 
     by patients of that facility and others described in 
     subsection (b)(2); and
       ``(3) is constructed by, and donated to the Secretary by, 
     the Zachary and Elizabeth M. Fisher Armed Services 
     Foundation.
       ``(d) The Secretary may establish charges for providing 
     lodging under this section. The proceeds from such charges 
     shall be credited to the medical care account and shall be 
     available until expended for the purposes of providing such 
     lodging.
       ``(e) The Secretary shall prescribe regulations to carry 
     out this section. Such regulations shall include provisions--
       ``(1) limiting the duration of such lodging;
       ``(2) establishing standards and criteria under which 
     medical facilities may set charges for such lodging;
       ``(3) establishing criteria for persons considered to be 
     accompanying a veteran;
       ``(4) establishing criteria for the use of such premises; 
     and
       ``(5) any other limitations, conditions, and priorities 
     that the Secretary considers appropriate with respect to 
     temporary lodging under this section.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of such chapter is amended by inserting after the 
     item relating to section 1707 the following new item:

``1708. Temporary lodging.''.

     SEC. 405. EXTENSION OF ANNUAL REPORT OF COMMITTEE ON MENTALLY 
                   ILL VETERANS.

       Section 7321(d)(2) is amended by striking ``three'' and 
     inserting ``six''.

     SEC. 406. EXCEPTION TO RECAPTURE RULE.

       Section 8136 is amended--
       (1) by inserting ``(a)'' at the beginning of the text of 
     the section; and
       (2) by adding at the end the following new subsection:
       ``(b) The establishment and operation by the Secretary of 
     an outpatient clinic in facilities described in subsection 
     (a) shall not constitute grounds entitling the United States 
     to any recovery under that subsection.''.

     SEC. 407. CHANGE TO ENHANCED USE LEASE CONGRESSIONAL 
                   NOTIFICATION PERIOD.

       Paragraph (2) of section 8163(c) is amended to read as 
     follows:
       ``(2) The Secretary may not enter into an enhanced use 
     lease until the end of the 90-day period beginning on the 
     date of the submission of notice under paragraph (1).''.

     SEC. 408. TECHNICAL AND CONFORMING CHANGES.

       (a) Requirement To Provide Care.--Section 1710A(a) is 
     amended by inserting ``(subject to section 1710(a)(4) of this 
     title)'' after ``Secretary'' the first place it appears.
       (b) Conforming Amendment.--Section 1710(a)(4) is amended by 
     striking ``requirement in'' and inserting ``requirements in 
     section 1710A(a) and''.

     SEC. 409. RELEASE OF REVERSIONARY INTEREST OF THE UNITED 
                   STATES IN CERTAIN REAL PROPERTY PREVIOUSLY 
                   CONVEYED TO THE STATE OF TENNESSEE.

       (a) Release of Interest.--The Secretary of Veterans Affairs 
     shall execute such legal instruments as necessary to release 
     the reversionary interest of the United States described in 
     subsection (b) in a certain parcel of real property conveyed 
     to the State of Tennessee pursuant to the Act entitled ``An 
     Act authorizing the transfer of certain property of the 
     Veterans' Administration (in Johnson City, Tennessee) to the 
     State of Tennessee'', approved June 6, 1953 (67 Stat. 54).
       (b) Specified Reversionary Interest.--Subsection (a) 
     applies to the reversionary interest of the United States 
     required under section 2 of the Act referred to in subsection 
     (a), requiring use of the property conveyed pursuant to that 
     Act to be primarily for training of the National Guard and 
     for other military purposes.
       (c) Conforming Amendment.--Section 2 of such Act is 
     repealed.

  The SPEAKER pro tempore. After 1 hour of debate on the bill, as 
amended, it shall be in order to consider a further amendment printed 
in the House

[[Page 18810]]

report 106-875 if offered by the gentleman from Arizona (Mr. Stump) or 
the gentleman from Illinois (Mr. Evans), or a designee, which shall be 
considered read, and shall be debatable for 10 minutes, equally divided 
and controlled by the proponent and an opponent.
  The gentleman from Arizona (Mr. Stump) and the gentleman from 
Illinois (Mr. Evans) each will control 30 minutes of debate on the 
bill.
  The Chair recognizes the gentleman from Arizona (Mr.  Stump).
  Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, H.R. 5109 addresses a number of key personnel management 
systems needs in the VA health care system.
  It authorizes regular pay raises for the VA nurses and gives the VA 
the authority to increase salaries for VA dentists.
  It also proposes an innovative four-site health care pilot program so 
that veterans, who are enrolled with VA for health care, can be 
referred to a community hospital if the VA hospital is too far away.
  Mr. Chairman, I reserve the balance of my time.
  Mr. EVANS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I also want to thank the gentleman from Arizona 
(Chairman Stump) and the gentleman from Florida (Mr. Stearns) and the 
gentleman from Illinois (Mr.  Gutierrez), the ranking member of the 
Subcommittee on Health, for working with me on an important pay 
provision contained in the legislation now before the House, H.R. 5109.
  As many of my colleagues know, my mother was a nurse, a fact of which 
I am very proud. I understand well the pressures nurses face as the 
backbone of our health care system. I understand, too, that nurses have 
had to shoulder even more responsibility as health care delivery is 
being transformed. From my perspective, it was grossly unfair to 
maintain a pay system under our jurisdiction that allowed hospital 
directors to balance the budget on the backs of VA nurses.
  This bill comes at a time when competition for skilled health care 
personnel is fierce. Besides nurses, the bill addresses pay inequities 
for dentists. It provides physician assistants long-sought 
representation within VA headquarters along with better training 
opportunities. It will help the VA retain social workers, pharmacists 
and medical support personnel, to retain them as well.
  This legislation also supports a pilot project that the gentleman 
from Arizona (Chairman Stump) just talked about. It will allow the VA 
to manage VA's health care system in their own communities. The concept 
of this pilot brought to my attention by two health care professionals, 
the gentlewoman from California (Mrs. Capps) and the gentleman from 
Florida (Mr. Weldon) is simple, the VA will preapprove certain veterans 
who are distant from VA medical centers, but who rely on VA outpatient 
clinics to receive certain general medical and surgical hospital in-
patient services in their own communities.
  Mr. Speaker, far from being the end of the VA health care system as 
we know now it, this is a project that is consistent with VA's goals to 
bring veterans' health care into our communities.
  The gentleman from Arizona (Chairman Stump) is offering a strong 
bill, and I urge my colleagues to support it.
  Mr. Speaker, I include for the Record the letter from the American 
Federation of Government Employees:

                                            American Federation of


                                 Government Employees, AFL-CIO

                                               September 21, 2000.
     Hon. Bob Stump,
     Chairman, House Veterans' Affairs Committee, Cannon House 
         Office Building, Washington, DC.
     Hon. Cliff Stearns,
     Chairman, Subcommittee on Health, House Veterans' Affairs 
         Committee, Cannon House Office Building, Washington, DC 
         20515.
     Hon. Lane Evans,
     Ranking Member, House Veterans' Affairs Committee, Cannon 
         House Office Building, Washington, DC.
       Dear Chairman Stump, Chairman Stearns and Ranking Member 
     Evans: On behalf of the American Federation of Government 
     Employees (AFGE), AFL-CIO and the 600,000 federal workers 
     AFGE, represents, including roughly 125,000 Department of 
     Veterans' Affairs (DVA) employees, I thank you for your 
     efforts to guarantee DVA registered nurses an annual pay 
     raise and to improve the pay for dentists and pharmacists who 
     work at the DVA.
       H.R. 5109 will guarantee DVA nurses the same annual 
     nationwide pay increase provided to General Schedule 
     employees. The fundamental change in the DVA nurse pay system 
     is similar to the change proposed in H.R. 1216, the AFGE 
     authored legislation which was introduced by Representative 
     Steve LaTourette (R-OH). It is our understanding that H.R. 
     5109 will ensure that no DVA nurse will again be denied an 
     annual pay raise or receive a negative pay adjustment.
       Such changes to the current DVA nurse pay system are 
     consistent with the AFGE testimony given before Chairman 
     Steams' subcommittee on April 12th. At the hearing AFGE 
     called for a guaranteed annual pay raise for DVA nurses to 
     create a floor for nurses' pay. AFGE also urged that the 
     Secretary be given the authority to increase nurses' pay 
     above this floor when needed. H.R. 5109 incorporates these 
     core principles.
       AFGE opposes the section in H.R. 5109 titled, 
     ``Coordination of Hospital Benefits Program,'' which would 
     create a pilot voucher-like program in four geographic areas. 
     The section would authorize DVA to cover a veteran's costs of 
     inpatient care at non-DVA facilities. DVA would become the 
     secondary insurance for any out-of-pocket expenses of 
     veterans with insurance, including Medicare, when veterans 
     seek inpatient services in private sector hospitals.
       Section 401 establishes an entirely new eligibility 
     category for veterans' health care based not on the veteran's 
     status or need, but purely on the veteran's geographic 
     location, and to a great extent, the veteran's own health 
     insurance. Accordingly, Section 401 will create a disparity 
     between the health care available to veterans who chose to 
     use DVA health care facilities and those, primarily with 
     their own insurance, who have previously chosen not to use 
     DVA facilities.
       Section 401 will also set a precedent for sending veterans 
     to non-DVA providers for inpatient services that are paid by 
     veterans' own insurance. DVA would not subsidize care outside 
     of the DVA system, lose both the direct and appropriated 
     dollars and any third-party reimbursements. If this precedent 
     is set and expanded, DVA health care facilities would only 
     become local referral centers without the resources to 
     sustain the full range of care, including the specialized 
     services such as spinal cord injury care and substance abuse 
     treatment, for which it is well known.
       Under Section 401, DVA would not really have control to 
     manage the veteran's case once referred because it would be a 
     secondary payer, not the provider of care.
       AFGE is for increased access in veterans' care but not at 
     the cost of unraveling the DVA operated health care system. 
     Veterans deserve and need a unique health care system devoted 
     and dedicated to treating their unique medical needs. Picking 
     up the co-payments for veterans who have insurance will 
     ultimately transform DVA from a health care system designed 
     and focused on veterans medical care into an insurance 
     company. This proposal claims to give a few veterans improved 
     ``access'' but will do so at the cost of maintaining a fully 
     staffed and functioning DVA health care system. We urge you 
     to omit this section from the final conference bill.
       Thank you for considering AFGE's views on these important 
     matters. AFGE appreciates that you have incorporated the core 
     principles of the AFGE authored nurse pay legislation into 
     H.R. 5109.
           Sincerely,
                                            Bobby L. Harnage, Sr.,
                                               National President.

  Mr. Speaker, I reserve the balance of my time.
  Mr. STUMP. Mr. Speaker, I yield 9 minutes to the gentleman from 
Florida (Mr. Stearns) the chairman of the Subcommittee on Health.
  Mr. STEARNS. Mr. Speaker, I thank my colleague from Arizona (Mr. 
Stump) for yielding the time to me.
  Mr. Speaker, I want to again, like others, recognize the superb 
leadership of the gentleman from Arizona and also to recognize the 
gentleman from Illinois (Mr. Gutierrez), the ranking member of the 
Subcommittee on Health, and, of course, recognize the gentleman from 
Illinois (Mr. Evans), the ranking member of the Committee on Veterans' 
Affairs, for all of their efforts in the development of this bill.
  Mr. Speaker, this is a good bill for veterans, and it is a good bill 
to pass today. It contains provisions that are workable, useful and 
innovative. It is a winning combination for the veterans we serve and 
for the Department of Veterans Affairs who we are charged with to take 
care of our veterans.

[[Page 18811]]

  After a number of hearings we had on the subcommittee dealing with 
site visits and other data collection, I introduced this bill with 
bipartisan support, H.R. 5109, the Department of Veterans Affairs 
Health Care Personnel Act of the Year 2000. It has 20 cosponsors from 
the Democrat side and many from the Republican side. It is bipartisan.
  Mr. Speaker, let me just quickly review for my colleagues some of the 
key provisions of our bill. Mr. Speaker, about 10 years ago, Congress 
created an innovative pay system for the nurses in the VA system with 
the locality-based mechanism to produce pay raises that were intended 
to address labor market needs and to keep our veterans' nurses 
competitive. The idea was that each veteran hospital could act on its 
own self-interest and remain competitive locally.
  It was intended to be a good reform, and this system initially gave 
the VA nurses a big pay raise. Mr. Speaker, VA's recruitment and 
retention problem for nurses effectively disappeared for a while with 
this reform. But the old saying ``that was then and this is now'' is 
true today.
  My subcommittee gave special focus during this Congress to the pay 
situation of VA nurses, because a lot of them were leaving our system, 
what we found was disappointing. We have learned that many VA nurses 
had not received any pay increases in their pay since the initial one 
from our 1990 legislation. While those first pay increases were, in 
many cases, substantial, in the course of time, with inflation and 
other Federal employee groups moving ahead, what happened is they fell 
behind. So once again VA found itself in a competitive disadvantage, 
and some VA nurses were looking for employment options elsewhere.
  In my judgment, as chairman of the Subcommittee on Health, it was a 
loss that we could not afford; therefore, our bill guarantees VA nurses 
the statutory national comparability pay raises given to all the other 
Federal employees, Mr. Speaker.
  I am not declaring reform to be my enemy. I want to make the earlier 
legislation work that we passed in the 101st Congress. In addition to 
the guaranteed national pay raise for nurses, the subcommittee crafted 
necessary adjustments to the locality survey mechanism to ensure that 
data are available when needed and to specify that certain steps be 
taken when they are necessary that lead to appropriate salary rate 
increases for our VA nurses.
  I believe this is the right solution. It is a compromise with our 
colleagues on the other side of the aisle but in the end that is what 
is best.
  Mr. Speaker, the bill also addresses a recommendation of VA's 
Quadrennial Pay Report concerning the veterans' dentists, bringing 
their pay into better balance with average compensation of hospital-
based dentists in the private sector. This is the first change in 10 
years in VA dentists special pay.
  Mr. Speaker, I want to thank my colleague, the gentleman from 
California (Mr. Filner), for bringing his voice to this important issue 
and for continuing to prod us forward on behalf of the VA dentists.
  Our bill also authorizes major medical facility constructions in Palo 
Alto and Long Beach, California; Miami, Florida with a commensurate 
authorization of appropriations money for this construction. Southern 
and western States such as these, Mr. Speaker, are areas where we 
continue to see rising VA patient-care work loads and demand for 
modern, accessible and safe facilities for veterans. These projects 
will help ease these burdens.

                              {time}  1215

  This House is making the right choice by authorizing these projects 
now.
  My friend, the gentleman from Illinois (Mr. Evans), as the ranking 
member of the full committee, recently raised the profile of the need 
for Congress to reauthorize the landmark 1988 study of post-traumatic 
stress disorder in Vietnam veterans. Our bill authorizes this important 
study again.
  The bill also requires VA to record military service history when VA 
physicians and other caregivers take a veteran's health history. This 
will aid any veteran who files a VA claim for disability, especially 
given our new appreciation that military and combat exposure may, may 
be associated with onset of disease later in life. I want to commend 
the veterans, the Vietnam veterans of America, for bringing this 
proposal to us. It is valuable. It is a valuable contribution to this 
bill.
  Lastly, Mr. Speaker, our bill contains a very good approach, crafted 
by my good friend and colleague, the gentleman from Florida (Mr. 
Weldon). The gentleman from Florida (Mr. Weldon) has no VA hospital in 
his district; nor do I. We believe that in such a situation, when a 
veteran who is under VA care in a VA community-based clinic remote from 
a VA hospital, needs brief inpatient hospitalization, that he or she 
should be able to obtain this vital service closer to home. It is not 
any different for a veteran in this regard than it is for a nonveteran.
  Can anyone in this Chamber say he or she would relish the thought of 
leaving their family and friends and traveling hundreds of miles for a 
hospital admission at a distant hospital while bypassing community 
hospitals closer to home?
  While working with our colleagues across the aisle, our bill sets up 
a pilot program involving not more than four small VA clinic service 
areas. Within these areas, enrolled veterans in need of uncomplicated 
general hospital admissions would be referred to community hospitals 
rather than being sent to distant VA facilities. VA would serve as a 
coordinator of benefits to ensure that costs are covered by available 
private and public coverage held by most veterans who use the VA. VA 
will ensure that the care is delivered efficiently and with due regard 
to these veterans' needs.
  On discharge from these short hospital stays, these veterans would 
continue under VA care just as before. It is a voluntary program, Mr. 
Speaker, a time-limited test, capped for expenditures, intended to test 
the premise of providing a more convenient alternative to veterans than 
traveling hundred of miles to seek inpatient care in large, urban VA 
hospitals.
  Mr. Speaker, a previous small scale experiment similar to this 
proposal in one VA clinic was a smashing success, with a 98 percent 
patient satisfaction rate and was found to have saved between 15 and 28 
percent of the costs that would have been paid by taxpayers had these 
patients traveled to a faraway veterans hospital for their admissions.
  Importantly, the VA facility in Florida suffered no impact on their 
patient care workloads because of this local experiment. So, Mr. 
Speaker, this is a good idea.
  Mr. Speaker, this is a synopsis of our key provisions of H.R. 5109. I 
ask all of my colleagues to support this bill.
  I would like to point out that we have a number of organizations that 
have supported this. The American Legion, the Veterans of Foreign Wars 
of the United States, Vietnam Veterans of America, the Nursing 
Organization of Veterans Affairs, the American Dental Association and 
the largest union, the American Federation of Government Employees, 
among others, have all supported this legislation. So I hope my 
colleagues will vote for passage of this in a strong way so that we can 
enact this in the 106th Congress and go forward to help our veterans.
  Mr. EVANS. Mr. Speaker, I yield 5 minutes to the gentleman from 
California (Mr. Filner).
  Mr. FILNER. Mr. Speaker, I thank the gentleman from Illinois (Mr. 
Evans) for yielding me the time.
  Mr. Speaker, I rise in strong support of H.R. 5109. I want to thank 
the chairman, the gentleman from Arizona (Mr. Stamp); the ranking 
member, the gentleman from Illinois (Mr. Evans); the gentleman from 
Florida (Mr. Stearns), the chairman of the Subcommittee on Health; and 
the gentleman from Illinois (Mr. Gutierrez), the ranking member of that 
subcommittee, for developing a true bipartisan proposal to address some 
of the pay inequities that were brought to the attention of our 
Committee on Veterans' Affairs.

[[Page 18812]]

  In response to some of these concerns, I introduced last fall H.R. 
2660, which I entitled Put Your Money Where Your Mouth Is, the VA 
Dentist Equity Act, in response to a variety of concerns of VA 
dentists. This spring, the gentleman from Florida (Mr. Stearns) 
conducted a hearing of the Subcommittee on Health where we heard 
stirring testimony from dentists who have devoted their careers to the 
Department of Veterans Affairs. Members representing the National 
Association of VA Physicians and Dentists, the American Dental 
Association, the American Association of Oral and Maxillofacial 
Surgeons raised concerns about the precipitous decline in recent years 
in the number of dentists practicing in the VA, and raised concerns 
about VA's ability to recruit new dentists into the system now and in 
the future. These concerns are based on the facts that the dental 
workforce in VA is rapidly declining. Only 4 years ago, the VA had more 
than 900 dentists. Now we have less than 800, and in individual sites 
the changes have been even more pronounced.
  In testimony to the subcommittee, the National Association of VA 
Physicians and Dentists discussed general practice dentists at one 
facility in the Northeast dropping from 8 to only 2 positions. Now we 
know that almost 70 percent of VA dentists are eligible for retirement 
in the next 3 years and that VA dentists are paid less than defense 
dentists, dentists in academia or dentists in private practice. In 
fact, they make almost one-third less than dentists working in these 
settings.
  So I am very glad that H.R. 5109 includes many of the provisions that 
were in my earlier bill and will include the recruitment and retention 
of VA dentists. I want to say for our legislative record that although 
there is a range of salaries that are printed for dentists that will 
give them some equity with regard to physicians, we hear concerns in 
specific medical centers that the top of that range for dentists is 
never fully utilized.
  I think it is fair to say that our committee expects that the full 
range, especially the top range, when eligible, of the salary schedules 
that are in H.R. 5109, be utilized by individual medical centers.
  Now I do have one disappointment in this bill, that despite a strong 
sentiment in the full Committee on Veterans' Affairs to move a 
chiropractic health care benefit amendment in this bill, we are 
apparently unable to reach an agreement to introduce direct access, 
full scope of practice chiropractic care into the VA health care system 
in this year. Chiropractic is the fastest growing and second largest 
primary health care profession. Chiropractors are a highly trained and 
licensed professional health care workforce. It is time to put VA 
health care on a par with other government health care programs and 
recognize chiropractic as a vital component of our health care system. 
In fact, we said that a year ago in our millennium health care bill.
  These are technical corrections to that bill. A year ago, we asked 
the VA to develop a chiropractic plan within 90 days to give 
chiropractic services to our veterans. The VA did not do this. I met 
with the Assistant Secretary for health after the 90 days were up, with 
various representatives of the National Chiropractic Associations. We 
stressed to the Assistant Secretary how important it was to act on 
this; and we got, frankly, bureaucratic inertia, bureaucratic 
resistance, and literally very little was done by a year later when we 
have the corrections for VA on the millennium health care bill.
  I know this is not a simple issue, and I know the gentleman from 
Florida (Mr. Stearns) is as vitally concerned about this as I am; and 
he has promised, as I understand, to have hearings on this issue within 
our coming sessions, and I hope that we put a chiropractic health care 
provision that is meaningful at the top of our committee's agenda next 
year so that our veterans can have direct access to this important 
benefit as quickly as possible.
  I certainly will be working toward that goal. I look forward to 
working with members of the committee. The gentleman from Illinois (Mr. 
Evans) has been a strong proponent of chiropractic care. The gentleman 
from Indiana (Mr. Buyer) on our committee has also put in a provision 
in the defense authorization bill that moves the Defense Department 
more toward this. I hope that the Committee on Veterans' Affairs 
working with our members and the VA health care division will cooperate 
as we move to our full benefits to our veterans.
  I thank the chairman of the Subcommittee on Health for this wonderful 
bill.
  Mr. STUMP. Mr. Speaker, I yield 2 minutes to the gentleman from 
Indiana (Mr. Buyer), a member of the committee.
  Mr. BUYER. Mr. Speaker, I rise in strong support of the Department of 
Veterans Affairs Health Care Personnel Act of 2000. This is great news 
for VA employees, especially VA nurses and dentists. More importantly, 
it is great news for veterans who receive VA medical care.
  The bill will help the Department of Veterans Affairs recruit and 
retain qualified health care professionals as well as help ensure that 
VA hospitals are more fully staffed to meet their demanding health care 
needs. I know that in my own congressional district, the Fifth District 
of Indiana, VA employees have repeatedly raised the issue of pay parity 
so that they receive compatible pay, pay increases and special rates of 
pay to that of other Federal employees. I agree that it is only fair.
  Last year, the Marion VA Chapter, the American Federation of 
Government Employees Local 1020 contacted my office seeking the pay 
parity for VA nurses. In addition, the Local 1020 asked the committee 
for relief in helping them to better address manning and staffing 
levels that were creating patient and employee safety issues due to 
lack of adequate nursing staff. To that end, I want to thank the 
Committee on Veterans' Affairs chairman, the gentleman from Arizona 
(Mr. Stump), and the subcommittee chairman, the gentleman from Alabama 
(Mr. Everett), for their decision to hold field hearings in June at the 
Marion VA.
  The committee's findings were indeed a revelation. It became quite 
clear to me and to the Department of Veterans Affairs that the Marion 
and Fort Wayne facilities had severe nurses shortfalls. It was evident 
that to ensure the highest quality of care for our veterans, an effort 
to meet these shortfalls would be required.
  In fact, 68 positions were then immediately identified as needed to 
be filled. $6.5 million was placed into the budget's shortfall of this 
year alone, and I thank the gentleman from Arizona (Mr. Stump) for that 
effort.
  In addition, the director of the Northern Indiana Health Care System 
requested a staffing survey which identified the need for another 20 
positions, so now we are up to 88 positions.
  Last week, prior to the Committee on Veterans' Affairs reporting this 
bill to the House floor, Local 1020 indicated their support for H.R. 
5109 and reiterated the need for nurse pay parity.
  I will throw out there to the gentleman from Florida (Mr. Stearns) 
what I have been told by the nursing profession that 50 percent of the 
nurses are expected to retire in the next 15 years. When we look at our 
education institutions in our country and we maximize them to 100 
percent at the present rate of graduation, we fall very short of what 
the need and requirements are in front of us. So given the whole supply 
and demand, this bill, while we are singing its praises, is really one 
of those leaps forward; and we still have work yet to do.
  Mr. EVANS. Mr. Speaker, I yield 5 minutes to the gentlewoman from 
California (Mrs. Capps).
  Mrs. CAPPS. Mr. Speaker, I thank the gentleman from Illinois (Mr. 
Evans) for yielding me time.
  Mr. Speaker, I am pleased to rise in strong support of H.R. 5109, the 
Department of Veterans Affairs Health Care Personnel Act.
  I want to take this opportunity to thank the gentleman from Arizona 
(Mr. Stump) and the ranking member, the gentleman from Illinois (Mr. 
Evans) for all their hard work on this

[[Page 18813]]

legislation. Their unflagging commitment to our Nation's veterans is 
truly laudable. This bill will significantly improve veterans' access 
to health care. It will also provide much-needed raises for VA nurses 
and other health care professionals. As a nurse, I am particularly 
proud that this legislation will secure pay raises for 30,000 VA 
nurses. These registered nurses care for sick veterans day in and day 
out, and they deserve raises on a par with other Federal employees.
  H.R. 5109 will also allow for greater nurse participation in policy 
and decision-making at the Veterans Administration health centers, and 
it would revise the pay rates for VA dentists and pharmacists. These 
are measures which will address the difficulties the VA has experienced 
in recruiting and retaining nurses and other health care personnel.
  Now I want to highlight a particular provision that is included in 
this bill, and it is one that my colleague, the gentleman from Florida 
(Mr. Weldon) and I have worked very hard to secure. I am very pleased 
that the Veterans Service Improvement Act is part of this bill, and I 
want to thank the gentleman from Cape Canaveral for his outstanding 
leadership on this issue. This is an important bipartisan provision 
which will authorize multiple pilot projects to allow the VA to 
contract with local hospitals to provide care for veterans.
  Now what does this mean for vets?

                              {time}  1230

  Right now, for example, the veterans in my district on the central 
coast of California have to drive all the way to Los Angeles or to 
Fresno for hospital care under the VA. That means for my veterans 
driving 2\1/2\ to 5 hours just to check into a hospital. This is a 
definite hardship for aging veterans and for their families, the 
transportation involved and the sometimes inconvenience and real 
hardship that it puts families under.
  With this pilot project, veterans could check in with their local VA 
clinic and then get referred to a nearby hospital. This would allow 
vets to receive care close by to their friends and their family.
  The legislation also allows for the coordination of benefits. For 
example, veterans who use Medicare for care at a local hospital are 
currently paying a 20 percent copayment; and under these pilot 
projects, that copayment would be partially or totally covered by the 
Veterans' Administration. This is a benefit all veterans deserve, 
particularly those who are ill or disabled.
  This proposal is designed to expand the successful VA pilot program 
operated in Florida last year. As we have heard, over 1,000 veterans 
chose to participate in this program, and 98 percent of them said they 
would recommend it to other vets. In addition, the preliminary results 
show that this program provided a significant cost savings to the VA, 
and that is a benefit which we should not ignore.
  Mr. Speaker, H.R. 5109 gives veterans more health care choices and 
provides more convenient options for their care. The veterans service 
improvement act is a pilot project; and I want to stress that as a 
pilot project, it will be carefully studied to see what the results 
are. It is not intended to undermine the Veterans' Administration 
specialized hospital care in any way. Rather, I believe it could 
demonstrate to augment it.
  So, Mr. Speaker, I am pleased that this important legislation will 
pass through the House today, and I hope to see it signed into law very 
soon. The brave men and women who have sacrificed so much for our 
country deserve nothing less.
  Mr. STUMP. Mr. Speaker, I yield 3 minutes to the gentleman from New 
Jersey (Mr. Smith), the vice chairman of the committee.
  Mr. SMITH of New Jersey. Mr. Speaker, I rise in very strong support 
of H.R. 5109, a bill affecting very positively health care personnel 
and formulating a pilot system for coordination of services between the 
VA and non-VA health care facilities.
  I would like to thank at the outset the gentleman from Arizona (Mr. 
Stump), the good and very able and very distinguished chairman of the 
full committee, for his leadership on this. He is indefatigable in his 
efforts to help and enhance veterans benefits. I have been on this 
committee for 20 years, and it has always been a real joy to watch him 
in action; and I want to thank him for his leadership. Also I want to 
thank the gentleman from Florida (Mr. Stearns), the chairman of the 
subcommittee, who has done yeoman's work on this legislation and the 
Millennium Act and other important bills; and the gentleman from 
Illinois (Mr. Evans), my good friend, for his good bipartisanship and 
very strong commitment to our veterans and for his work on this bill as 
well.
  In summary, the bill not only updates pay to nurses, but adjusts the 
mechanism for making nurses' pay more responsive to today's market 
realities, increases rates of special pay to dentists, increases the 
salary rates to our pharmacists, and designates a physician's assistant 
to serve as a consultant to the Undersecretary of Veterans' 
Administration.
  As a cutting edge initiative, it establishes pilot programs to allow 
veterans dependent upon medical services to be seen in facilities in 
much greater proximity to the veteran's home. We all know, as my good 
friend just said a moment ago, very often, the very long trips that 
members of our veterans' communities have to make to get to a hospital, 
I hear about it over and over again in my own district, and then there 
is always that legendary wait once you get there to get that service 
sometimes becomes a disincentive for our veterans to utilize the 
system. So, it is very important that we see if this experiment works 
and if it does, then perhaps roll it out even more.
  Again, I want to congratulate my colleagues on an excellent, 
outstanding bill that should get the unanimous support of my 
colleagues.
  I rise today in support of H.R. 5109 a veterans bill affecting 
Healthcare Personel formulating a pilot system for coordination of 
services between VA and Non-VA Healthcare facilities.
  In summary, this bill not only updates pay to nurses but adjusts the 
mechanism for making nurses pay more responsive to today's market 
realities, increases rate of special pay to dentists, increases salary 
rates to pharmacist, and designates a physicians assistant to serve as 
a consultant to the Under Secretary of Veterans Administration. As a 
cutting edge initiative, it establishes pilot programs to allow 
veterans dependant upon medical services to be seen in facilities of 
much greater proximity to the veteran's home.
  There is a general agreement that there is a nation-wide nursing 
shortage. In addition, the VA has experienced significant nurse 
retention problems. Appropriate and timely pay increases must be 
provided as part of a satisfactory work environment. This bill 
addresses this concern in several ways. First, it authorizes national 
comparability pay raise for VA nurses on par with that of other federal 
employees. Second, it makes optional annual locality survey process for 
VA nurse pay. Third, it eliminates facility directors as the sole 
discretionary authority to make pay increases and introduces an 
automatic mechanism. This will stimulate more timely raises for nurses 
at VA hospitals. These provisions added together, are designed to make 
the VA more responsive to the economic needs of nurses and will 
increase their retention.


                    pay for dentists and pharmacists

  The bill revises and increases the rates of special pay which is 
provided to dentists employed by the Veterans Health Administration and 
is long over due. It eliminates the salary cap on pharmacists.


                   physician assistant as consultant

  The VA employs some 1,200 PA's as the nation's largest employer of 
PA's in the past 30 years. But amazingly the VA does not have a PA 
representative to advise the Administration on the optimal usage of 
PA's. This bill designates a Physician's Assistant to serve as a 
consultant to the Under Secretary which will greatly improve 
understanding and utilization of the PA's by the Veterans 
Administration.


                 pilot program on coordinating benefits

  There appear to be many veterans in all areas of the country who 
while in need of medical services, must travel a good distance for 
care. In some cases this is 100 miles or more round trip. This is 
accomplished often at considerable inconvenience to the patient and to 
the family of the loved one who must provide transportation to and from 
VA hospitals. Add that to the legendary wait. This bill sets

[[Page 18814]]

up a 4 site pilot program coordinating healthcare benefits between VA 
and non-VA health care facilities. Following up on a previously 
successful program in Florida, this pilot program will see if 
coordinated and contracted care would be satisfactory to the veteran 
and a cost saving gain to the Veterans Administration.
  Let me emphasize that this is a program which is totally voluntary. 
No veteran who feels uncomfortable participating in the program is 
forced to do so. This is not intended to replace the parent program 
which has served veterans so well in the past.
  Mr. EVANS. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
California (Ms. Millender-McDonald).
  Ms. MILLENDER-MCDONALD. Mr. Speaker, let me first thank the chairman 
and the ranking member for their leadership on this great piece of 
legislation.
  I rise today in strong support of the Department of Veterans Affairs 
Health Care Personnel Act. As a representative of the 37th 
Congressional District in California, I represent parts of the Long 
Beach area, so I am particularly supportive of this bill, since it will 
help many of my constituents.
  There are approximately 24.4 million veterans in America, 552,800 of 
whom are in Los Angeles alone, and 28,900 of whom live in the 37th 
Congressional District. The number of veterans has declined over the 
years, but the average age of America's veterans has increased. The 
median age of veterans is 58 years, and 36 percent are over 65 years of 
age. This means the services provided at veterans' health care 
facilities throughout the country are even more important to our 
veterans, now more than ever before.
  Mr. Speaker, this legislation authorizes important construction 
projects primarily at VA medical facilities to help veterans who have 
reached an age where the need for safe, accessible medical care is 
critical. In particular, it authorizes the construction of the VA 
Medical Center in Long Beach which is located on major fault lines that 
have yielded earthquakes which have caused severe damage to the area 
over the years. This construction project will correct life safety and 
functional space deficiencies and ensure that veterans receive the 
health care they need in a safe environment.
  The Department of Veterans Affairs Health Care Personnel Act also 
improves the pay of nurses, dentists and other health care 
professionals employed by the Department of Veterans Affairs which 
ensures that those who serve our veterans are adequately compensated.
  In addition, it establishes a pilot project that will allow four 
sites to provide inpatient hospital care to veterans in their own 
communities. The bill also contains a provision that would increase the 
availability of accommodations at VA medical facilities for veterans 
and their families who need to travel great distances and stay 
overnight when obtaining VA medical services.
  Mr. Speaker, all of these measures will significantly impact the 
lives of veterans and their families; and, therefore, Mr. Speaker, I 
urge my colleagues to join me in voting for the Department of Veterans 
Affairs Health Care Personnel Act. It is a great piece of legislation.
  Mr. STUMP. Mr. Speaker, I yield 3 minutes to the gentlewoman from New 
York (Mrs. Kelly).
  Mrs. KELLY. Mr. Speaker, I rise today in support of H.R. 5109, the 
Department of Veterans Affairs Health Care Personnel Act of 2000, with 
one reservation. It is a good bill. The committee has worked hard on 
it, and my colleagues should be commended for it.
  Mr. Speaker, H.R. 5109 corrects a real problem with the pay increases 
of VA nurses. While the current system of salary adjustments for VA 
nurses does not allow salary decreases, the current system does allow 
for the salary to be frozen for a number of years. With inflation, this 
is tantamount to a cut in salary, with VA nurses having to spend more 
of their salary each year on the increasing cost of living. This 
includes the yearly increases that Federal employees must pay on their 
health care premiums.
  In the lower New York area, we have one of the highest costs of 
living in the Nation. The struggle of our dedicated nurses to raise a 
family and save for the future is a daily challenge. At the very least, 
we have to ensure that all VA personnel salary is adjusted for 
inflation, and this good legislation corrects a grave injustice that 
has denied nurses pay raises that virtually all Federal workers are 
given on a yearly basis. This portion of the legislation has my strong 
support.
  Unfortunately, section 401 of the legislation concerns me and 
colleagues I have spoken with, and that is the section that is 
entitled, Coordination of Hospitals Benefits Program. It would create a 
pilot voucher-like program in four geographic areas. The section would 
authorize the VA to cover a veteran's cost of inpatient care at non-VA 
facilities. The VA would thus become a secondary insurance for any out-
of-pocket expenses of veterans with insurance, including Medicare, when 
veterans seek inpatient services in private sector hospitals.
  It is a good idea, but right now the VA can and does contract with 
non-VA hospitals to treat veterans for their service-connected 
conditions. The premise of this pilot gives veterans a financial 
incentive to go to non-VA facilities for their inpatient care. It 
establishes an entirely new eligibility category for veterans care 
based not on the veteran's status or need, but purely on the veteran's 
geographic location, and to a great extent, the veteran's own health 
insurance. It could create real problems.
  First, it creates a disparity between health care available to 
veterans who choose to use the VA health care facilities and those 
primarily with their own insurance who have previously chosen not to 
use VA facilities. Second, it sets a precedent for sending veterans to 
non-VA providers for inpatient services that are paid by veterans' 
insurance. The VA would now subsidize care outside the system, losing 
both the direct and appropriated dollars on any third-party 
reimbursements. This worries me.
  If this precedent is set and expanded, the VA health care facilities 
would only become local referral centers without the resources to 
sustain a full range of care, including the acute beds and specialized 
services such as spinal cord injury care and substance abuse treatment 
for which it is well known. The VA would not really have the control to 
manage a veteran's case once referred because it would be a secondary 
payer, not the provider of care.
  It is my hope this section could be removed or greatly modified 
before the legislation comes back to the House.
  Mr. EVANS. Mr. Speaker, I yield the balance of my time to the 
gentleman from Arizona (Mr. Stump), the chairman of the committee.
  Mr. STUMP. Mr. Speaker, I thank the gentleman for yielding us this 
time, and I yield 3 minutes to the gentleman from Ohio (Mr. 
LaTourette).
  Mr. LaTOURETTE.  Mr. Speaker, I rise today in support of H.R. 5109.
  Mr. Speaker, today is a great day and a wonderful day for the 39,000 
VA nurses who care for our Nation's ailing veterans, and I want to 
thank the gentleman from Arizona (Mr. Stump), the gentleman from 
Florida (Mr. Stearns), the gentleman from Illinois (Mr. Evans), and the 
gentleman from Illinois (Mr. Gutierrez) for making this day possible.
  In May of last year, I joined with a number of colleagues to 
introduce legislation called the VA Nurse Appreciation Act. The premise 
of the legislation was simple, to guarantee that VA nurses get the same 
annual raise as virtually every other Federal worker; no more, no less, 
just pay parity. It seems impossible to fathom, but for much of the 
last decade, VA nurses across the country have been getting short 
shrift when it comes to Federal pay raises.
  When the Nurse Pay Act was passed about a decade ago, it did exactly 
what it was supposed to do. It allowed the VA to dramatically increase 
nurse pay so that salaries were comparable with the private sector. 
That law, so well intended and fully supported by the Congress, 
eliminated a dire nursing shortage and restored stability to VA 
hospitals across the country.

[[Page 18815]]

  Sadly, when budgets became tight, VA medical center directors began 
using the broad discretion of the law provided in a way that the 
Congress never intended. Local pay surveys designed to document the 
need for higher raises than the GS increases were suddenly turned into 
a tool to withhold raises or award absurdly low raises.
  Mr. Speaker, it is no walk in the park being a nurse at a Veterans' 
Administration facility. The hours are long, the job is stressful, and 
the veterans can be very sick with a whole host of medical conditions 
not normally seen in other hospitals. But the women and men who have 
devoted their careers to caring for our Nation's heroes are a dedicated 
lot. Despite years of meager annual raises or no raise at all, these 
39,000 VA nurses did not turn their backs on our veterans or even think 
of withholding care.
  Mr. Speaker, we are now enjoying the greatest economic prosperity in 
a generation and unheralded budget surpluses; yet we still have VA 
nurses out there who received no annual pay raise for 2, 3, 4, or, in 
some cases, 5 consecutive years. It is a miracle that more nurses have 
not abandoned the VA.
  This legislation, H.R. 5109, is a wonderful step in correcting that 
inequity, and I again commend the chairman of the committee and the 
ranking member, the chairman of the subcommittee and the ranking member 
of the subcommittee. I am most appreciative of their interest in the 
issue and their willingness to correct this injustice. Special thanks 
are also due to the AFGE, which has worked tirelessly to make this day 
possible, together with the ANA and NOVA.
  This change in law cannot come soon enough either. All evidence 
points to a looming and critical shortage of nurses. Right now the 
average VA nurse is 47 years old, about 5 years older than the national 
average. We do not attract new nurses with a promise of no annual 
increase.
  Mr. Speaker, this has been a long, hard fight. This is a good bill 
with many wonderful provisions. I again want to thank the gentleman 
from Arizona (Mr. Stump) and the gentleman from Florida (Mr. Stearns) 
for correcting an inequity. I urge my colleagues to support the bill.
  Mr. STUMP. Mr. Speaker, I yield 4 minutes to the gentleman from 
California (Mr. Horn).
  Mr. HORN. Mr. Speaker, I rise today in strong support of H.R. 5109. I 
praise the gentleman from Arizona (Mr. Stump) and his colleagues in 
both parties who have brought this fine piece of legislation to the 
House, the Veterans Affairs Health Care Personnel Act of 2000.

                              {time}  1245

  Not only will this bill improve pay and help retain qualified nurses 
at the VA medical facilities, a provision that will significantly help 
nurses at the VA Medical Center Long Beach in my district and one that 
I have long been a supporter of in this House, it also authorizes $51.7 
million for seismic corrections at the VA Medical Center Long Beach.
  Providing a broad range of inpatient, outpatient and home care 
services for veterans throughout Southern California, the VA Medical 
Center Long Beach has long been recognized for the integral role it 
plays in Southern California's health care system. The Long Beach 
Center has also achieved national prominence in the field of spinal 
cord injury and the rehabilitation of paraplegic and quadriplegic 
patients.
  Ranked second on the VA priority list, this project is essential to 
provide a safe environment for the 35,000 veteran patients served at 
the Long Beach VA and the 2,300 employees that work there. The four 
buildings included in this project house direct patient care functions 
and support activities that are crucial to meeting the organization's 
mission and goals.
  These buildings are all seismically deficient and in need of 
upgrading. The United States Geological Survey studies have shown that 
the fault lines in the Southern California region run directly through 
the medical center. These major fault lines have yielded earthquakes of 
significant magnitude and caused severe damage over the years, 
compromising the patient care mission of the Long Beach Veterans 
Administration Medical Center.
  The demolition of these seismically compromised and deteriorating 
buildings with the replacement of one newly constructed building with 
modern and efficient space is crucial in order to provide safety for 
patients, visitors and staff. It is also the most cost-effective 
option.
  This bill is a fitting tribute to those who have served our Nation 
with courage and commitment and is the next step in fulfilling our 
continuing obligation to our Nation's veterans.
  I urge all Members of this House to support this very important 
legislation.
  Mr. STUMP. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Florida (Mr. Weldon).
  Mr. WELDON of Florida. Mr. Speaker, I want to thank the gentleman 
from Arizona (Chairman Stump) for his courage and commitment in moving 
this bill forward. I want to particularly commend him for including the 
language in section 401 that deals with the establishment of a new 
pilot program that will allow the coordination of payments of benefits.
  This was the thrust of legislation, H.R. 4575, introduced earlier by 
the gentlewoman from California (Mrs. Capps) and myself. She has the 
same challenge I have, a lot of veterans in her congressional district 
that are served only by a clinic and not a full-service hospital. Her 
assistance has been critical in moving this initiative forward.
  I also want to thank the gentleman from Florida (Mr. McCollum) and 
the gentleman from Florida (Mr. Stearns) who have worked with me on 
this issue for 4 years, and, of course, the gentleman from Illinois 
(Mr. Evans), ranking member, who has been very gracious.
  He had a very lengthy meeting with me and the gentlewoman from 
California (Mrs. Capps) earlier in August to try to work with us on 
moving forward on this issue.
  I also want to mention the gentleman from Illinois (Mr. Gutierrez) 
who has offered his support for this provision and, of course, the 
Republican and Democratic staff on the committee who have worked very, 
very hard.
  My experience on this issue comes from my background, not only as a 
veteran, the son of a World War II combat-wounded Purple Heart veteran, 
but as well as a physician who did part of his training in a VA 
hospital; and, indeed, I continue to volunteer some of my time at the 
Veterans Health Care Clinic in my congressional district. So I think I 
can come to this debate with a little bit of perspective.
  The veterans want three things. They want access, access, access. 
They want access to quality care. They want access to specialty care. 
They want access to care that is close to home. They do not want to be 
told to pack their bags, to travel across the State, or, worse, to 
travel to another State to get their health care.
  Now, we have operated a pilot program in my congressional district 
for the last several years. More than 1,000 veterans have received care 
under this program. Did they like it? Ninety-eight percent said they 
liked it a lot and would recommend it to a friend. Did it cost more 
money? No. Actually, it saved the Veterans Administration 15 to 20 
percent over cost being provided in a veterans hospital.
  When it was stopped by the Veterans Administration in September of 
last year, the veterans in my congressional district demanded that it 
be restarted, and it was in July of this year. However, the Veterans 
Administration excluded veterans over 65 because they are covered by 
Medicare.
  Now, I would like to read a letter that was sent to me by the wife of 
a veteran, Mrs. Gay Tatro. She wrote: ``My husband was probably one of 
the first veterans in the County admitted to the hospital on the Pilot 
Program in May 1998 and one of the last in September 1999. Both times, 
plus a couple of hospitalizations in between, he would have been sent 
to Tampa.'' Now, Tampa is clean across the State. It is a

[[Page 18816]]

3-hour drive from my congressional district.
  She goes on to say: ``This would have created a substantial hardship 
both financially and emotionally. In this last hospitalization, the 
doctors were talking about amputating part of his foot. To have to go 
to Tampa and deal with this type of trauma by himself would have been 
unthinkable. The alternative: I would have to stay out of work plus pay 
for accommodations in Tampa to be near him.''
  Section 401 of this bill establishes a new pilot program that would 
allow the coordination of benefits. It would allow it to be established 
in three additional sites. There are many underserved areas in this 
country. Brownsville, Texas; Santa Barbara, California and many others 
where veterans have to travel hours.
  Now, there have been some people, including some we have heard today, 
who have raised some concerns about this provision of the bill. They 
seem to center on two things. The first one is that it moves the 
Veterans Administration away from the business of providing care to one 
of ensuring care.
  To the veterans in my congressional district and those in other 
underserved areas, I can tell my colleagues they do not care. They want 
to get quality health care close to home, and these kinds of debates 
are irrelevant to them. They are certainly irrelevant to the Tatros. 
They want quality health care close to home.
  The other issue that they bring up is that resources could be drained 
from existing facilities that are currently providing care. This 
reminds me of, in many ways, FDR's old speech: ``The only thing you 
have to fear is fear itself.'' I cannot imagine a situation where the 
chairman, the ranking member would allow services to be drained to 
provide for care for those veterans and underserved areas, drained from 
one area to another. The issue here is making sure our veterans get the 
quality health care they need.
  What is clear is the status quo is unacceptable. The status quo is a 
two-tiered system, Mr. Speaker, a system where we have two kinds of 
veterans, those who live close to a facility and those who live far 
away and have to travel.
  What we are trying to do in this provision is address the needs of 
those so they do not have to travel; and for those who live close to a 
facility, to turn to those veterans who live far away and say, no, no, 
no, we do not want to provide health care to you close to home, because 
it might affect my health care where I get my care close to the 
hospital is unacceptable.
  This is the richest country in the world. This is the most powerful 
country in the world. We can take care of both groups, and this bill 
provides for that.
  I encourage all my colleagues to not succumb to the arguments of the 
theoretical or to succumb to the arguments of fear, but support this 
provision, support this legislation.
  Mr. Speaker, I am very, very happy to yield to the gentleman from 
Florida (Mr. Stearns).
  Mr. STEARNS. Mr. Speaker, I just want to commend the gentleman from 
Florida (Mr. Weldon) for what he is doing and point out to my 
colleagues this program maximum is a $50 million pilot program. This is 
on a $49 billion budget for veterans, which is the second largest 
appropriations of money. The only one larger is the Department of 
Defense. So this might be, I do not know if the fractions are right, 
but this is one-one thousandths of a percent that is going for a very 
small program to demonstrate, to see if it is feasible.
  So I think that this is a very modest approach, and I commend the 
gentleman from Florida (Mr. Weldon) for what he is doing. I certainly 
think, as one of his constituents pointed out, this is worth this small 
effort to try to serve veterans.
  Mr. WELDON of Florida. Mr. Speaker, I would just like to point out 
that this provision is endorsed by the VFW and the American Legion. I 
believe it is the right thing for us to do for our veterans. We can 
provide quality health care to all of our veterans, and that is what we 
are trying to do.


                             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 materials on H.R. 5109, as amended.
  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, I want to thank the House leadership on both sides of 
this aisle for allowing us to move this bill so quickly today. I want 
to especially thank the gentleman from Illinois (Mr. Evans) for all the 
hard work and cooperation that he has given us and, once again, thank 
him for the time he has generously yielded to our side.
  I want to express my appreciation to the gentleman from Florida (Mr. 
Stearns), the chairman of the Subcommittee on Health, for all his hard 
work, as well as the gentleman from Illinois (Mr. Gutierrez), ranking 
member, also the gentleman from Florida (Mr. Weldon) for all the work 
he has done, the gentleman from Ohio (Mr. LaTourette) and the gentleman 
from California (Mr. Horn) for their dedication in serving their 
veterans.
  I have no further requests for time. I urge all Members to support 
the bill.
  Mr. JONES of North Carolina. Mr. Speaker, I rise in strong support of 
the legislation offered the Chairman and Ranking Members of the 
Veterans Affairs Committee. I do not have to remind the Members of this 
body that our Nation would not have the prosperity we enjoy if it had 
not been for the millions of men and women who signed up to serve in 
our nation's armed forces. Their willingness to offer their lives in 
the defense of our Nation is the very reason that we enjoy the freedoms 
we have today. We owe them a debt of gratitude and the legislation 
before us today is one more innovative way to ensure that we fulfill 
that obligation.
  I support the legislation for several reasons:
  First, I think the proposal to allow rural veterans access to health 
through local facilities could dramatically increase access for those 
veterans who must travel great distances to receive care.
  Second, this legislation recognizes that we must also ensure that we 
have the most capable people providing the care that those veterans 
have earned.
  Third, the bill has the potential to greatly improve the quality of 
care our veterans receive by better integrating the providers of that 
care into the policy making process.
  As our veterans' population continues to age, we must always look 
outside the box of existing policies to further improve the care and 
support we provide. H.R. 5109 meets that goal and is a bill that needs 
to be signed into law. I urge my colleagues to work with me to improve 
the quality and access to health care for our Nation's veterans and 
pass the Department of Veterans Affairs Health Care Personnel Act of 
2000.
  Mrs. McCARTHY of New York. Mr. Speaker, I rise today in strong 
support of the VA Health Care Personnel Act. This important piece of 
legislation improves veterans' access to health care and raises the 
salaries of VA nurses and dentists. It's incredibly unfair that VA 
nurses are paid less to do the same work as their counterparts in 
private hospitals. Under this legislation, VA nurses are guaranteed 
annual national pay raises based on pay inequities, instead of nursing 
recruitment or retention. This bill also increases the amount of pay to 
VA dentists who specialized or take on added responsibilities to help 
meet the dental needs of our veterans.
  On Long Island, the cost-of-living is well-above the rest of the 
country. However, VA nurses travel to understaffed VA hospitals and 
care for our veterans at a salary that is unacceptable. As a former 
nurse, I understand the commitment and professionalism demanded by this 
profession. Unfortunately, VA nurses continue to work at salary level 
that does not reflect their commitment to caring for our veterans. 
Lastly, this legislation extends a pilot program to four as yet unnamed 
geographic areas where Medicare-eligible veterans can go to non-VA 
hospitals, at VA expense, if there are no convenient VA hospitals 
nearby.
  Under the new program, the VA would cover some of the costs of care 
at non-VA hospitals for participating veterans whose private or 
Medicare plans would pay for most of the share. Too many veterans are 
forced to drive several hours to a VA hospital if there is a problem. 
This pilot program examines the benefits of allowing Medicare-eligible 
veterans to receive treatment at their local hospital.

[[Page 18817]]

This bill puts veterans one step closer to the care and benefits they 
deserve. I urge my colleagues to support this legislation.
  Mr. GILMAN. Mr. Speaker, I rise today in strong support of H.R. 5109, 
the Department of Veterans Affairs Health Care Personnel Act of 2000. I 
urge my colleagues to join in supporting this timely, appropriate 
legislation.
  H.R. 5109 is designed to improve the quality and availability of 
health care provided by the Department of Veterans Affairs medical 
facilities. It was drafted to respond to a number of concerns raised by 
VA personnel and veterans alike. I want to commend Chairman Stump and 
the other members of the Veterans Committee for their dedication to 
this issue, for both listening to our veterans and VA employees, and 
for following up on their concerns.
  Over the past 2 years, I have heard from many VA nurses and 
pharmacists that their working conditions and their pay levels have 
contributed to a serious retention problem for these two professions. 
H.R. 5109 addresses this problem by making changes to the salary review 
system so that facility directors will have to conduct annual reviews 
of their nursing turnover and vacancy rates to determine if raises are 
warranted. It also stipulates that nursing personnel are to participate 
in this process. Moreover, it clarifies that the absence of a retention 
problem is not to be a basis for failing to provide a pay increase, and 
it prohibits ``negative pay adjustments.''
  Regarding specialists, H.R. 5109 increases the rates of special pay 
for VA dentists, and adds pharmacists to the occupations that are 
exempt from a statutory cap on special salary rates.
  This legislation also requires that, when conducting an initial 
clinical evaluation of a veteran, the VA identify and document 
pertinent military experiences and exposures which may contribute to 
the health status of the patient.
  Finally, H.R. 5109 authorizes a pilot program involving coordination 
of hospital benefits. Under the program, veterans with Medicare or 
other coverage who use a nearby VA clinic for care, but reside far from 
the nearest VA medical facility, could make a choice to receive care at 
a community hospital as a Medicare or other health plan beneficiary 
when the VA finds that they need hospital care. The VA clinic would 
still coordinate the care, and to ensure that the patient does not 
incur additional out-of-pocket costs. The bill provides that VA would 
cover co-payments required by an individual veteran's health plan.
  This component of the bill is welcome news for those veterans who 
reside in rural areas. I look forward to monitoring its progress, and 
hope it will be expanded in future years.
  Mr. Speaker, H.R. 5109 makes a number of much needed adjustments to 
provide our veterans with better health care. For this reason, I 
strongly encourage our colleagues to join in supporting its passage.
  Mr. RODRIGUEZ. Mr. Speaker, I commend the efforts of the VA Committee 
and staff in developing the VA employee pay and VA health care 
improvements in this bill. There are many positive elements in this 
bill dealing with personnel issues and I am happy to support them. VA 
nurses, dentists, physicians assistants, pharmacists, and social 
workers play a critical role in the VA health care system. The 
amendment to improve chiropractic service in the VA is also necessary 
in order to expand the availability of important chiropractic services. 
This legislation addresses ever-changing professions within the VA 
health care system by improving the salaries and working conditions of 
its employees.
  I am especially pleased with the sections on mental illness. 
Authorizing another study on post-traumatic stress disorder is long 
overdue. We have some quality people working on PTSD at the VA and this 
provision would bolster that important work. I also welcome the 
extension of the Annual Report of the Committee on Mentally Ill 
Veterans. We must continue to recognize the special nature of mental 
illness in our Nation's veterans and continuing the input from the 
committee is necessary for that to occur.
  I represent an area with underserved veterans. Many veterans have to 
travel more than 200 miles to the nearest VA facility. While I continue 
to advocate expanding the brick and mortar VA system where there is a 
genuine need, I support the pilot project at coordinating health care 
in under-served areas. By limiting the project to four sites and 
capping the costs, we have an opportunity to see the viability of this 
service without jeopardizing the VA as a unique hospital system. The VA 
is not an insurance company, and nothing we do in this bill should show 
an intent to re-invent the VA as such. I look forward to working with 
my colleagues in the Senate at enacting the provisions of this 
legislation this year.
  Mr. McGOVERN. Mr. Speaker, I rise today in support of H.R. 5109, the 
Department of Veterans Affairs Health Care Personnel Act of 2000. H.R. 
5109 is important because it guarantees that nurses, dentists and 
pharmacists will receive pay raises that will improve their quality of 
life. Nurses at VA hospitals are underpaid and deserve to be paid at 
the same rate as those nurses at local, non-governmental hospitals. 
It's unconscionable that our veterans should be treated by nurses that 
are being paid less than their fellow nurses at other facilities. H.R. 
5109 will fix that problem and properly pay these important people.
  H.R. 5109 also recognizes the hard work of dentists at these VA 
facilities. Dentists who specialize, take on added responsibilities, or 
who are stationed at certain facilities will receive increased pay and 
also expands retirement benefits for VA dentists. Another provision 
exempts VA pharmacists from ceilings on special salary rates. Overall, 
H.R. 5109 will improve the quality of life of VA nurses, dentists and 
pharmacists. However, I am concerned about the provision that allows 
some patients to be treated at non-VA hospital facilities. While I 
recognize this provision creates a pilot program in four areas and has 
specific requirements for eligibility for participation, I am concerned 
that this type of program could lead to the closing of VA hospitals.
  Last year, this Congress voted on H.R. 2116, the Veterans' Millennium 
Health Care Act. A provision in that bill would have established the 
process by which the Veterans Administration could close VA hospitals, 
profoundly damaging veterans' access to good quality health care in the 
Northeast. Fortunately, the final version of H.R. 2116 did not include 
this provision and VA hospitals were not endangered. I believe H.R. 
5109 was drafted with the best intentions and that this bill is 
designed to improve the quality of life of VA employees and, 
consequently, the veterans who receive care at VA facilities. I also 
believe this provision was written with the intention of providing the 
best care possible to veterans. My concern is that, ultimately, this 
provision will force veterans from VA hospitals to private care.
  I will vote for H.R. 5109 because, overall, this bill is a good bill. 
However, I ask the sponsor and the members of the Committee on Veterans 
Affairs to clarify the provision that creates the pilot program to 
ensure that it does not decrease the level of care at or, ultimately, 
close VA hospitals in the Northeast or across this country.
  Mr. STUMP. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Ryan of Wisconsin). Pursuant to House 
Resolution 585, the previous question is ordered on the bill, as 
amended.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. STUMP. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Evidently a quorum is not present.
  The Sergeant at Arms will notify absent Members.
  The vote was taken by electronic device, and there were--yeas 411, 
nays 0, not voting 22, as follows:

                             [Roll No. 486]

                               YEAS--411

     Abercrombie
     Ackerman
     Aderholt
     Allen
     Andrews
     Archer
     Armey
     Baca
     Bachus
     Baird
     Baker
     Baldacci
     Baldwin
     Ballenger
     Barcia
     Barr
     Barrett (NE)
     Barrett (WI)
     Bartlett
     Barton
     Bass
     Becerra
     Bentsen
     Bereuter
     Berkley
     Berman
     Berry
     Biggert
     Bilbray
     Bilirakis
     Bishop
     Blagojevich
     Bliley
     Blumenauer
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bonior
     Bono
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brady (TX)
     Brown (FL)
     Brown (OH)
     Bryant
     Burr
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cannon
     Capps
     Capuano
     Cardin
     Carson
     Castle
     Chabot
     Chambliss
     Chenoweth-Hage
     Clayton
     Clement
     Clyburn
     Coble
     Coburn
     Collins
     Combest
     Condit
     Conyers
     Cook
     Cooksey
     Costello
     Cox
     Coyne
     Cramer
     Crane
     Crowley
     Cubin
     Cummings
     Cunningham
     Davis (FL)
     Davis (IL)
     Davis (VA)
     Deal
     DeFazio
     DeGette
     Delahunt
     DeLauro
     DeLay
     DeMint
     Dickey
     Dicks
     Dingell
     Dixon
     Doggett

[[Page 18818]]


     Doolittle
     Doyle
     Dreier
     Duncan
     Dunn
     Edwards
     Ehlers
     Ehrlich
     Emerson
     Engel
     English
     Eshoo
     Etheridge
     Evans
     Everett
     Ewing
     Farr
     Fattah
     Filner
     Fletcher
     Foley
     Forbes
     Ford
     Fossella
     Fowler
     Frank (MA)
     Franks (NJ)
     Frelinghuysen
     Gallegly
     Ganske
     Gejdenson
     Gekas
     Gephardt
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gonzalez
     Goode
     Goodlatte
     Goodling
     Gordon
     Goss
     Granger
     Green (TX)
     Green (WI)
     Greenwood
     Gutierrez
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hansen
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (IN)
     Hill (MT)
     Hilleary
     Hilliard
     Hinchey
     Hinojosa
     Hobson
     Hoeffel
     Hoekstra
     Holden
     Holt
     Hooley
     Horn
     Hostettler
     Houghton
     Hoyer
     Hulshof
     Hunter
     Hyde
     Inslee
     Isakson
     Istook
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Jenkins
     John
     Johnson (CT)
     Johnson, E.B.
     Johnson, Sam
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kasich
     Kelly
     Kennedy
     Kildee
     Kilpatrick
     Kind (WI)
     King (NY)
     Kingston
     Kleczka
     Knollenberg
     Kolbe
     Kucinich
     Kuykendall
     LaFalce
     LaHood
     Lampson
     Lantos
     Largent
     Larson
     Latham
     LaTourette
     Leach
     Lee
     Levin
     Lewis (CA)
     Lewis (GA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Lofgren
     Lowey
     Lucas (KY)
     Lucas (OK)
     Luther
     Maloney (CT)
     Maloney (NY)
     Manzullo
     Markey
     Martinez
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McCrery
     McDermott
     McGovern
     McHugh
     McIntyre
     McKeon
     McKinney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Mica
     Millender-McDonald
     Miller (FL)
     Miller, Gary
     Miller, George
     Minge
     Mink
     Moakley
     Mollohan
     Moore
     Moran (KS)
     Moran (VA)
     Morella
     Murtha
     Myrick
     Nadler
     Napolitano
     Neal
     Nethercutt
     Ney
     Northup
     Norwood
     Nussle
     Oberstar
     Obey
     Olver
     Ortiz
     Ose
     Owens
     Oxley
     Packard
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pease
     Pelosi
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pickett
     Pitts
     Pombo
     Pomeroy
     Porter
     Portman
     Price (NC)
     Pryce (OH)
     Quinn
     Radanovich
     Rahall
     Ramstad
     Rangel
     Regula
     Reynolds
     Riley
     Rivers
     Rodriguez
     Roemer
     Rogan
     Rogers
     Rohrabacher
     Rothman
     Roukema
     Roybal-Allard
     Royce
     Rush
     Ryan (WI)
     Ryun (KS)
     Sabo
     Salmon
     Sanchez
     Sanders
     Sandlin
     Sanford
     Sawyer
     Saxton
     Scarborough
     Schaffer
     Schakowsky
     Scott
     Sensenbrenner
     Serrano
     Sessions
     Shadegg
     Shaw
     Shays
     Sherman
     Sherwood
     Shimkus
     Shows
     Shuster
     Simpson
     Sisisky
     Skeen
     Skelton
     Slaughter
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Snyder
     Souder
     Spence
     Spratt
     Stabenow
     Stark
     Stearns
     Stenholm
     Strickland
     Stump
     Stupak
     Sununu
     Sweeney
     Talent
     Tancredo
     Tanner
     Tauscher
     Tauzin
     Taylor (MS)
     Taylor (NC)
     Terry
     Thomas
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Thune
     Thurman
     Tiahrt
     Tierney
     Toomey
     Towns
     Traficant
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Velazquez
     Visclosky
     Vitter
     Walden
     Walsh
     Wamp
     Waters
     Watkins
     Watt (NC)
     Watts (OK)
     Weiner
     Weldon (FL)
     Weldon (PA)
     Weller
     Weygand
     Whitfield
     Wicker
     Wilson
     Wise
     Wolf
     Woolsey
     Wu
     Wynn
     Young (AK)
     Young (FL)

                             NOT VOTING--22

     Burton
     Campbell
     Clay
     Danner
     Deutsch
     Diaz-Balart
     Dooley
     Frost
     Graham
     Hastings (FL)
     Hutchinson
     Klink
     Lazio
     McCollum
     McInnis
     McIntosh
     Metcalf
     Reyes
     Ros-Lehtinen
     Vento
     Waxman
     Wexler

                              {time}  1321

  Mrs. NAPOLITANO changed her vote from ``nay'' to ``yea.''
  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Mr. DEUTSCH. Mr. Speaker, I was unavoidably absent from the Chamber 
today during rollcall vote No. 486, the vote on final passage of H.R. 
5109, the Department of Veterans Affairs Health Care Personnel Act. Had 
I been present, I would have voted ``yea'' on rollcall vote No. 486.
  Mr. DIAZ-BALART. Mr. Speaker, on rollcall No. 486, the Department of 
Veterans Affairs Health Care Personnel Act, I was unavoidably detained. 
Had I been present, I would have voted ``aye.''

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