[Congressional Record (Bound Edition), Volume 147 (2001), Part 20]
[Extensions of Remarks]
[Pages 28023-28026]
[From the U.S. Government Publishing Office, www.gpo.gov]


[[Page 28023]]

DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROGRAMS ENHANCEMENT ACT OF 
                                  2001

                                 ______
                                 

                               speech of

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                       Tuesday, December 11, 2001

  Mr. SMITH of New Jersey. Mr. Speaker, the ``Department of Veterans 
Affairs Health Care Programs Enhancement Act of 2001'' reflects a 
compromise agreement that the Senate and House of Representatives 
Committees on Veterans' Affairs reached on certain provisions of a 
number of bills considered by the House and Senate during the 107th 
Congress, including: H.R. 2792, a bill to make service dogs available 
to disabled veterans and to make various other improvements in health 
care benefits provided by the Department of Veterans Affairs, and for 
other purposes, by the House Committee on Veterans' Affairs on October 
16, 2001, and passed by the House on October 23, 2001 [hereinafter, 
``House Bill'']; S. 1188, a bill to enhance the authority of the 
Secretary of Veterans' Affairs to recruit and retain qualified nurses 
for the Veterans Health Administration, and for other purposes, 
reported by the Senate Committee on Veterans' Affairs on October 10, 
2001, as proposed to be amended by a manager's amendment [hereinafter, 
``Senate Bill'']; S. 1576, a bill to amend section 1710 of title 38, 
United States Code, to extend the eligibility for health care of 
veterans who served in Southwest Asia during the Persian Gulf War; and, 
S. 1598, a bill to amend section 1706 of title 38, United States Code, 
to enhance the management of the provision by the Department of 
Veterans Affairs of specialized treatment and rehabilitation for 
disabled veterans, and for other purposes, introduced on October 21, 
2001.
  The House and Senate Committees on Veterans' Affairs have prepared 
the following explanation of the compromise bill, H.R. 3447 
(hereinafter referred to as the ``Compromise Agreement''). Differences 
between the provisions contained in the Compromise Agreement and the 
related provisions in the bills listed above are noted in this 
document, except for clerical corrections and conforming changes made 
necessary by the Compromise Agreement, and minor drafting, technical, 
and clarifying changes.

  TITLE I--ENHANCEMENT OF NURSE RECRUITMENT AND RETENTION AUTHORITIES

               Subtitle A--Nurse Recruitment Authorities

     Current Law
       Several VA programs under existing law are designed to aid 
     the Department in recruiting qualified health care 
     professionals in fields where scarcity and high demand 
     produce competition with the private sector. The Department 
     is authorized to operate the Employee Incentive Scholarship 
     Program (hereafter EISP) under section 7671 of title 38, 
     United States Code. Under the EISP, VA may award scholarship 
     funds, up to $10,000 per year per participant in full-time 
     study, for up to 3 years. These scholarships require eligible 
     participants to reciprocate with periods of obligated service 
     to the Department. Currently, enrollment in the scholarship 
     program is limited to employees with 2 or more antecedent 
     years of VA employment. Statutory authority for this program 
     terminates December 31, 2001.
       The Department is authorized to operate the Education Debt 
     Reduction Program (hereafter EDRP) under section 7681 of 
     title 38, United States Code. Under the EDRP, the Department 
     may repay education-related loans incurred by recently hired 
     VA clinical professionals in high demand positions. Statutory 
     authority for this program, a program not yet implemented by 
     the Department, terminates on December 31, 2001. If 
     implemented, the program would authorize VA to repay $6,000, 
     $8,000, and $10,000 per year, respectively, over a 3-year 
     period, in combined principal and interest on educational 
     loans obtained by scarce VA professionals.
       Under sections 8344 and 8468 of title 5, United States 
     Code, the Department is authorized to request waivers of the 
     pay reduction otherwise required by law for re-employed 
     Federal annuitants who are recruited to the Department in 
     order to meet staffing needs in scarce health care 
     specialties.
     Senate Bill
       Section 111 would permanently authorize the EISP; reduce 
     the minimum period of employment for eligibility in the 
     program from 2 years to 1 year; remove the award limit for 
     education pursued during a particular school year by a 
     participant, as long as the participant had not exceeded the 
     overall limitation of the equivalent of 3 years of full-time 
     education; and, extend authority to increase the award 
     amounts based on Federal national comparability increases in 
     pay.
       Section 112 would permanently authorize the EDRP; expand 
     the list of eligible occupations furnishing direct patient 
     care services and services incident to such care to veterans; 
     extend the number of years to 5 that a Departmental employee 
     may participate in the EDRP, and increase the gross award 
     limit to any participant to $44,000, with the award payments 
     for the fourth and fifth years to a participant limited to 
     $10,000 in each; and provide limited authority (until June 
     30, 2002) for the Secretary to waive the eligibility 
     requirement limiting EDRP participation to recently appointed 
     employees on a case-by-case basis for individuals appointed 
     on or after January 1, 1999, through December 30, 2001.
       Section 113 would require the Department to report to 
     Congress its use of the authority in title 5, United States 
     Code, to request waivers of pay reduction normally required 
     from re-employed Federal annuitants, when such requests are 
     used to meet its nurse staffing requirements.
     House Bill
       The House bill has no comparable provisions.
     Compromise Agreement
       Sections 101, 102, and 103 follow the Senate language.

                Subtitle B--Nurse Retention Authorities

     Current Law
       Section 7453(c) of title 38, United States Code, guarantees 
     premium pay (at 25 percent over the basic pay rate) to VA 
     registered nurses who work regularly scheduled tours of duty 
     during Saturdays and Sundays. However, licensed vocational 
     nurses and certain health care support personnel, whose 
     employment status is grounded in employment authorities in 
     title 5 and title 38, United States Code, are eligible for 
     premium pay on regularly scheduled tours of duty that include 
     Sundays. Saturday premium pay for these employees is a 
     discretionary decision at individual medical facilities.
       At retirement, VA registered nurses enrolled in the Civil 
     Service Retirement System receive annuity credit for unused 
     sick leave. This credit is unavailable, however, for 
     registered nurses who retire under the Federal Employee 
     Retirement System.
     Senate Bill
       Section 121 would mandate that VA provide Saturday premium 
     pay to employees specified in Section 7454(b).
       Section 122 would extend authority for the Department to 
     provide VA nurses enrolled in the Federal Employee Retirement 
     System the equivalent sick-leave credit in their retirement 
     annuity calculations that is provided to other VA nurses who 
     are enrolled in the Civil Service Retirement System.
       Section 123 would require the Department to evaluate nurse-
     managed clinics, including those providing primary and 
     geriatric care to veterans. Several nurse-managed clinics are 
     in operation throughout the VA health care system, with a 
     preponderance of clinics operating in the Upper Midwest 
     Health Care Network. The evaluation would include information 
     on patient satisfaction, provider experiences, cost, access 
     and other matters. The Secretary would be required to report 
     results from this evaluation to the Committees on Veterans' 
     Affairs 18 months after enactment.
       Section 124 would require the Department to develop a 
     nationwide clinical staffing standards policy to ensure that 
     veterans are provided with safe and high quality care. 
     Section 8110 of title 38, United States Code, sets forth the 
     manner in which medical facilities shall be operated, but 
     does not include reference to staffing levels for such 
     operation.
       Section 125 would require the Secretary to submit annual 
     reports on exceptions approved by the Secretary to VA's nurse 
     qualification standards. Such reports would include the 
     number of waivers requested and granted to permit promotion 
     of nurses who do not have baccalaureate degrees in nursing, 
     and other pertinent information.
       Section 126 would require the Department to report 
     facility-specific use of mandatory overtime for professional 
     nursing staff and nursing assistants during 2001. The 
     Department has no nationwide policy on the use of mandatory 
     overtime. This report would be required within 180 days of 
     enactment. The report would include information on the amount 
     of mandatory overtime paid by VA health care facilities, 
     mechanisms employed to monitor overtime use, assessment of 
     any ill effects on patient care, and recommendations on 
     preventing or minimizing its use.
     House Bill
       The House bill has no comparable provisions.
     Compromise Agreement
       Sections 121, 122, 123, 124, 125, and 126 are identical to 
     the provisions in the Senate bill.
       The Committees are concerned about VA's current national 
     policy requiring VA nurses to achieve baccalaureate degrees 
     as one means of quality assurance. VA has issued directive 
     5012.1, a directive that requires VA's registered nurses to 
     obtain baccalaureate degrees in nursing as a precondition to 
     advancement beyond entry level, and to do so by 2005. This 
     policy is effective immediately for newly employed nurses.
       At a time of looming crisis in achieving adequacy of basic 
     clinical staffing of VA facilities, the Committees express 
     concern over whether such a policy guiding nurse

[[Page 28024]]

     qualifications may work against VA's interests and 
     responsibilities to protect the safety of its patients by 
     creating unintended shortages of scarce health personnel. The 
     Committees urge the Secretary to consider the implications of 
     continuing such a policy in the face of future shortages of 
     nursing personnel. The American Association of Community 
     Colleges has reported that, each year, more than 60 percent 
     of new US registered nurses are produced in two-year 
     associate degree programs. The Department's current 
     qualification standard for registered nurses may dissuade 
     these fully licensed health care professionals from 
     considering VA employment.

                     Subtitle C--Other Authorities

     Current Law
       Section 7306(a)(5) of title 38, United States Code, 
     requires that the Office of the Under Secretary for Health 
     include a Director of Nursing Service, responsible to the 
     Under Secretary for Health.
       Section 7426 of title 38, United States Code, provides 
     retirement rights for, among others, nurses, physician 
     assistants and expanded-function dental auxiliaries with 
     part-time appointments. These employees' retirement annuities 
     are calculated in a way that produces an unfair loss of 
     annuity for them compared to other Federal employees. 
     Congress has made a number of efforts since 1980 to provide 
     equity for this group, many members of whom are now retired. 
     These individuals, appointed to their part-time VA positions 
     prior to April 6, 1986, under the employment authority of 
     title 38, United States Code, have been penalized with lower 
     annuities by subsequent Acts of Congress that addressed 
     retirement annuity calculation rules for other part-time 
     Federal employees appointed under the authority of title 5, 
     United States Code.
       Section 7251 of title 38, United States Code, authorizes 
     the directors of VA health care facilities to request 
     adjustments to the minimum rates of basic pay for nurses 
     based on local variations in the labor market.
     Senate Bill
       Section 131 would amend section 7306(a)(5) of title 38, 
     United States Code, to elevate the office of the VA Nurse 
     Executive by requiring that official to report directly to 
     the VA Under Secretary for Health.
       Section 132 would amend section 7426 of title 38, United 
     States Code, to exempt registered nurses, physician 
     assistants, and expanded-function dental auxiliaries from the 
     requirement that part-time service performed prior to April 
     7, 1986, be prorated when calculating retirement annuities.
       Section 133 would modify the nurse locality-pay authorities 
     and reporting requirements. The section would clarify and 
     simplify a VA medical center's use of Bureau of Labor 
     Statistics (BLS) information to facilitate locality-pay 
     decisions for VA nurses. Additionally, section 133 would 
     clarify the Committees' intent on steps VA facilities would 
     take when certain BLS data were unavailable, thus serving as 
     a trigger for the use of third-party survey information, and 
     thereby reducing current restrictions on the use of such 
     surveys.
     House Bill
       The House bill contains no comparable provisions.
     Compromise Agreement
       Sections 131, 132, and 133 follow the Senate bill.

             Subtitle D--National Commission on VA Nursing

     Current Law
       None.
     House Bill
       Section 301 would establish a 12-member National Commission 
     on VA Nursing. The Secretary would appoint eleven members, 
     and the Nurse Executive of the Department would serve as the 
     twelfth, ex officio, member. Members would include three 
     recognized representatives of employees of the Department; 
     three representatives of professional associations of nurses 
     or similar organizations affiliated with the Department's 
     health care practitioners; two representatives of trade 
     associations representing the nursing profession; two would 
     be nurses from nursing schools affiliated with the 
     Department; and one member would represent veterans. The 
     Secretary would designate one member to serve as Chair of the 
     Commission.
       Section 302 would authorize the Commission to assess 
     legislative and organizational policy changes to enhance the 
     recruitment and retention of nurses by the Department and the 
     future of the nursing profession within the Department. This 
     section would also provide for Commission recommendations on 
     legislation and policy changes to enhance recruitment and 
     retention of nurses by the Department.
       Section 303 would require the Commission to submit to 
     Congress and the Secretary a report on its findings and 
     conclusions. The report would be due not later than 2 years 
     after the date of the first meeting of the Commission. The 
     Secretary would be required to promptly consider the 
     Commission's report and submit to Congress the Department's 
     views on the Commission's findings and conclusions, including 
     actions, if any, that the Department would take to implement 
     the recommendations.
       Sections 304 and 305 would delineate the powers afforded to 
     the Commission, including powers to conduct hearings and 
     meetings, take testimony and obtain information from external 
     sources, employ staff, authorize rates of pay, detail other 
     Federal employees to the Commission staff, and address other 
     administrative matters.
       Section 306 would terminate the Commission 90 days after 
     the date of the submission of its report to Congress.
     Senate Bill
       The Senate bill has no comparable provisions.
     Compromise Agreement
       Sections 141, 142, 143, 144, 145 and 146 follow the House 
     bill, with certain modifications to the membership of the 
     Commission.
       The Committees expect the National Commission on VA Nursing 
     to concern itself with the full spectrum of occupations 
     involved in nursing care of veterans in the Veterans Health 
     Administration, with specific reference to registered 
     professional and licensed vocational nurses, clinical nurse 
     specialists, nurse practitioners, nurse managers and 
     executives, nursing assistants, and other technical and 
     ancillary personnel of the Department involved in direct 
     health care delivery to the nation's veterans. In addition to 
     statutory requirements, the Committees expect the Secretary 
     to appoint members to the Commission to reflect the wide 
     variety of occupations and disciplines that constitute the 
     nursing profession within the Department.

                        TITLE II--OTHER MATTERS


                       PROVISION OF SERVICE DOGS

     Current Law
       None.
     House Bill
       Section 101 would amend section 1714 of title 38, United 
     States Code, to authorize the Department to provide service 
     dogs to veterans suffering from spinal cord injury or 
     dysfunction, other diseases causing physical immobility, or 
     hearing loss (or other types of disabilities susceptible to 
     improvement or enhanced functioning) for which use of service 
     dogs is likely to improve or enhance their ability to perform 
     activities of daily living or other skills of independent 
     living. Under the provision, a veteran would be required to 
     be enrolled in VA care under section 1705 of title 38, United 
     States Code, as a prerequisite to eligibility. Service dogs 
     would be provided in accordance with existing priorities for 
     VA health care enrollment.
     Senate Bill
       Section 201 would authorize the Secretary to provide 
     service dogs to service-connected veterans with hearing 
     impairments and with spinal cord injuries.
     Compromise Agreement
       Section 201 follows the House provision.
       Any travel expenses of the veteran in adjusting to the 
     service dog would be reimbursable on the same basis as such 
     expenses are reimbursed under Section 111, title 38, United 
     States Code, for blind veterans adjusting to a guide dog.


       MANAGEMENT OF HEALTH CARE FOR CERTAIN LOW-INCOME VETERANS

     Current Law
       Section 1722(a) of title 38, United States Code, places 
     veterans whose incomes are below a specified level--in 
     calendar year 2001, $23,688 for an individual without 
     dependents--within the definition of a person who is ``unable 
     to defray'' the cost of health care. The section includes two 
     other such indicators of inability to defray: evidence of 
     eligibility for Medicaid, and receipt of VA nonservice-
     connected pension. Veterans in these circumstances are 
     adjudged equally unable to defray the costs of health care; 
     as such, they are eligible to receive comprehensive VA health 
     care without agreeing to make co-payments required from 
     veterans whose incomes are higher. Under current law, a 
     single-income threshold (with adjustments only for 
     dependents) is the standard used.
     House Bill
       Section 103 would amend section 1722(a) of title 38, United 
     States Code, to establish geographically adjusted income 
     thresholds for determining a non-service-connected veteran's 
     priority for VA care, and therefore, whether the veteran must 
     agree to make co-payments in order to receive VA care. The 
     section's purpose would be to address local variations in 
     cost of care, cost-of-living or other variables that, beyond 
     gross income, impinge on a veteran's relative economic status 
     and ability to defray the cost of care.
       In section 103, low-income limits administered by the 
     Department of Housing and Urban Development (HUD) for its 
     subsidized housing programs would establish an adjusted 
     poverty-income threshold to be used in the ability-to-defray 
     determination. The actual threshold for determining an 
     individual veteran's ability to pay would be the greater of 
     the current-law income threshold in section 1722 of title 38, 
     United States Code, or the local low-income limits set by 
     HUD.
       Section 103 also would include a 5-year limitation on the 
     effects of adoption of the HUD low-income limits policy on 
     system resource allocation within the Veterans Health 
     Administration. Such allocations would not be increased or 
     decreased during the period by more than 5 percent due to 
     this provision.

[[Page 28025]]

     The provision would take effect on October 1, 2002.
     Senate Bill
       Section 202 would amend section 1722 of title 38, United 
     States Code, to include the HUD income index in determining 
     eligibility for treatment as a low-income family based upon 
     the veteran's permanent residence. The current national 
     threshold would remain in place as the base figure if the HUD 
     formula determines the low-income rate for a particular area 
     is actually less than that amount. The effective date of this 
     change would be January 1, 2002, and would apply to all means 
     tests after December 31, 2001, using data from the HUD index 
     at the time the means test is given.
     Compromise Agreement
       Section 202 retains the current-law income threshold, but 
     would significantly reduce co-payments from veterans near the 
     threshold of poverty for acute VA hospital inpatient care. 
     The HUD low-income limits would be used to establish a family 
     income determination within the priority 7 group. Those 
     veterans with family incomes above the HUD income limits for 
     their primary residences would pay the co-payments as 
     otherwise required by law. Veterans whose family incomes fall 
     between the current income threshold level under section 
     1722, title 38, United States Code, and the HUD income limits 
     level for the standard metropolitan statistical area of their 
     primary residences, would be required to pay co-payments for 
     inpatient care that are reduced by 80 percent from co-
     payments required of veterans with higher incomes. The 
     effective date for this change would be October 1, 2002.


 MAINTENANCE OF CAPACITY FOR SPECIALIZED TREATMENT AND REHABILITATIVE 
                       NEEDS OF DISABLED VETERANS

     Current Law
       Section 1706 of title 38, United States Code, requires VA 
     to maintain nationwide capacity to provide for specialized 
     treatment and rehabilitative needs of disabled veterans, 
     including those with amputations, spinal cord injury or 
     dysfunction, traumatic brain injury, and severe, chronic, 
     disabling mental illnesses. To validate VA's compliance with 
     capacity maintenance, section 1706 includes a requirement for 
     an annual report to Congress. The reporting requirement 
     expired on April 1, 2001.
     House Bill
       Section 102 would modify the mandate for VA to maintain 
     capacity in specialized medical programs for veterans by 
     requiring the Department and each of its Veterans Integrated 
     Service Networks to maintain capacity in certain specialized 
     health care programs for veterans (those with serious mental 
     illness, substance-use disorders, spinal cord injuries and 
     dysfunction, the brain injured and blinded, and those who 
     need prosthetics and sensory aids); and, would extend the 
     capacity reporting requirement for 3 years.
     Senate Bill
       S. 1598 similarly would modify current law with regard to 
     VA's capacity for specialized services, but would require 
     that medical centers maintain capacity, in addition to 
     geographic service areas; require that VA utilize uniform 
     standards in the documentation of patient care workload used 
     to construct reports under the authority; require the 
     Inspector General on an annual basis to audit each geographic 
     service area and each medical center in the Veterans Health 
     Administration to ensure compliance with capacity 
     limitations; and, prohibit VA from substituting health care 
     outcome data to satisfy the requirement for maintenance of 
     capacity.
     Compromise Agreement
       Section 203 is derived substantially from the House bill, 
     with addition of provisions from the Senate bill, including a 
     requirement that VA utilize uniform standards in the 
     documentation of workload; a clarification that ``mental 
     illness'' be defined to include post-traumatic stress 
     disorder (PTSD), substance-use disorder, and seriously and 
     chronically mentally ill services; a prohibition from 
     substituting outcome data to satisfy the requirement to 
     maintain capacity; and, a requirement that the IG audit and 
     certify to Congress as to the accuracy of VA's required 
     reports.


PROGRAM FOR THE PROVISION OF CHIROPRACTIC CARE AND SERVICES TO VETERANS

     Current Law
       Public Law 106-117 requires the VA to establish a Veterans 
     Health Administration-wide policy regarding chiropractic 
     care. Veterans Health Administration Directive 2000-014, 
     dated May 5, 2000, established such a policy.
     House Bill
       Title II would establish a national VA chiropractic 
     services program, implemented over a 5-year period; authorize 
     VA to employ chiropractors as federal employees and obtain 
     chiropractic services through contracts; establish an 
     advisory committee on chiropractic care; authorize 
     chiropractors to function as VA primary care providers; 
     authorize the appointment of a director of chiropractic 
     service reporting to the Secretary with the same authority as 
     other service directors in the VA health care system; and 
     provide for training and materials relating to chiropractic 
     services to Department health care providers.
     Senate Bill
       Section 204 of the Senate Bill would establish a VA 
     chiropractic services program in VA health care facilities 
     and clinics in not less than 25 states. The chiropractic care 
     and services would be for neuro-musculoskeletal conditions, 
     including subluxation complex. The VA would carry out the 
     program through personal service contracts and appointments 
     of licensed chiropractors. Training and materials would be 
     provided to VA health care providers for the purpose of 
     familiarizing them with the benefits of chiropractic care and 
     services.
     Compromise Agreement
       Section 204 would follow the Senate bill but would replace 
     its reference to 25 states with a reference to VA's 22 
     Veterans Integrated Service Networks (referred to as 
     ``geographic service areas'' in the section). Also, the 
     agreement would include an advisory committee to assist the 
     Secretary of Veterans Affairs in implementation of the 
     chiropractic program. Under the agreement, the advisory 
     committee would expire 3 years from enactment.


   FUNDS FOR FIELD OFFICES OF THE OFFICE OF RESEARCH COMPLIANCE AND 
                            ASSURANCE (ORCA)

     Current Law
       The Under Secretary for Health has provided funding for 
     ORCA field offices from funds appropriated for Medical and 
     Prosthetic Research.
     Senate Bill
       Since field offices of ORCA directly protect patient 
     safety, section 205 would authorize VA to fund them from the 
     Medical Care appropriation.
     House Bill
       The House bill has no comparable provision.
     Compromise Agreement
       Section 205 follows the Senate bill.
       The Committees are concerned about the need for ORCA to 
     maintain independence from the Office of Research and 
     Development. The Committees have concluded, on the strength 
     of hearings and reports on potential conflicts of interest, 
     that funding for ORCA field offices should be statutorily 
     separated from the Medical and Prosthetic Research 
     Appropriation and associated with the Medical Care 
     Appropriation. ORCA advises the Under Secretary for Health on 
     matters affecting the integrity of research, the safety of 
     human-subjects research and research personnel, and the 
     welfare of laboratory animals used in VA biomedical research 
     and development. ORCA field offices investigate allegations 
     of research impropriety, lack of compliance with rules for 
     protection of research participants and scientific 
     misconduct. The ORCA chief officer reports to the Under 
     Secretary for Health.


                  MAJOR MEDICAL FACILITY CONSTRUCTION

     Current Law
       None.
     Senate Bill
       Fiscal year 2002 appropriations are available for an 
     emergency repair project at the VA Medical Center, Miami, 
     Florida. Section 205 of the Senate Bill authorizes $28.3 
     million for this project, in accordance with section 8104 of 
     title 38, United States Code.
     House Bill
       The House bill has no comparable provision.
     Compromise Agreement
       Section 206 follows the Senate bill.


      SENSE OF CONGRESS ON SPECIAL TELEPHONE SERVICES FOR VETERANS

     Current Law
       None.
     House Bill
       Section 104 would require the Secretary to assess special 
     telephone services for veterans (such as help lines and 
     ``hotlines'') provided by the Department. The assessment 
     would include the geographic coverage, availability, 
     utilization, effectiveness, management, coordination, 
     staffing, and cost of those services. It would require the 
     assessment to include a survey of veterans to measure 
     satisfaction with current special telephone services, as well 
     as the demand for additional services. The Secretary would be 
     required to submit a report to Congress on the assessment 
     within 1 year of enactment.
     Senate Bill
       The Senate bill contains no comparable provision.
     Compromise Agreement
       Section 207 contains a Sense of the Congress Resolution on 
     the Department's need to assess and report on special 
     telephone services for veterans.


 RECODIFICATION OF BEREAVEMENT COUNSELING AUTHORITY AND CERTAIN OTHER 
                       HEALTH-RELATED AUTHORITIES

     Current Law
       Chapter 17 of title 38, United States Code, contains 
     various legal authorities under which VA provides services to 
     non-veterans. These provisions, that authorize bereavement 
     and mental health counseling, care for

[[Page 28026]]

     research subjects, care for dependents and survivors of 
     permanently and totally disabled veterans, and emergency 
     humanitarian care, are intermingled with authorities for the 
     care of veterans in various sections of chapter 17.
     House Bill
       Section 105 of the House bill would in a new subchapter 
     consolidate and reorganize without substantive change all of 
     the legal authorities under which VA provides services to 
     non-veterans. It would reorganize section 1701 of title 38, 
     United States Code, by transferring one provision (pertaining 
     to sensori-neural aids) to section 1707.
       Section 105 would create a new Subchapter VIII in Chapter 
     17 of title 38, United States Code, to incorporate provisions 
     concerning bereavement-counseling services for family members 
     of certain veterans and active duty personnel. A new section 
     1782 would provide counseling, training, and mental health 
     services for immediate family members.
       Section 105 would place in the new subchapter the current 
     dependent health care authorities known as ``Civilian Health 
     and Medical Programs--Veterans Affairs'' (CHAMPVA), 
     transferred from current section 1713 to the new section 
     1781. A new provision would specify that a dependent or 
     survivor receiving such VA-sponsored care would be eligible 
     for bereavement and other counseling and training and mental 
     health services otherwise available to family members under 
     the subchapter.
       The existing authority to provide hospital care or medical 
     services as a humanitarian service in emergency cases would 
     be moved to this new subchapter from its current location in 
     section 1711(b).
       Section 105 would also make various technical changes to 
     accommodate the subchapter reorganization. These changes 
     would recodify the existing provisions, and consolidate and 
     clarify the existing statutory authority to provide care to 
     non-veterans.
     Senate Bill
       The Senate bill has no comparable provisions.
     Compromise Agreement
       Section 208 follows the House bill.


             EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES

     Current Law
       Section 1710(f)(2)(B) of title 38, United States Code, 
     authorizes VA until September 30, 2002, to collect nursing 
     home, hospital, and outpatient co-payments from certain 
     veterans. Section 1729(a)(2)(E) of title 38, United States 
     Code, authorizes VA until October 1, 2002, to collect third-
     party payments for the treatment of the nonservice-connected 
     disabilities of veterans with service-connected disabilities.
     House Bill
       Section 106 would extend until 2007 VA's authority to 
     collect means test co-payments and to collect third-party 
     payments.
     Senate Bill
       The Senate bill contains no comparable provision.
     Compromise Agreement
       Section 209 follows the House bill.


PERSONAL EMERGENCY RESPONSE SYSTEM FOR VETERANS WITH SERVICE-CONNECTED 
                              DISABILITIES

     Current Law
       None.
     House Bill
       Section 107 of the House bill would require the Secretary 
     to carry out an evaluation and study of the feasibility and 
     desirability of providing a specialized personal emergency 
     response system for veterans with service-connected 
     disabilities. It would require a report to Congress on the 
     results of this evaluation.
     Senate Bill
       The Senate bill contains no comparable provision.
     Compromise Agreement
       Section 210 follows the House bill.


               HEALTH CARE FOR PERSIAN GULF WAR VETERANS

     Current Law
       Section 1710 of title 38, United States Code, defines 
     eligible veterans for whom the Secretary is required to 
     furnish hospital, nursing home, and domiciliary care. Section 
     1710(e)(1)(C) of title 38 authorizes the Secretary to provide 
     health care services on a priority basis to veterans who 
     served in the Southwest Asia Theater of operations during the 
     Persian Gulf War. Section 1710(e)(3)(B) of title 38 specifies 
     that this eligibility expires on December 31, 2001.
     Senate Bill
       The Senate Bill would amend section 1710 of title 38, 
     United States Code, to extend health care eligibility for 
     veterans who served in Southwest Asia during the Gulf War, to 
     December 31, 2011.
     House Bill
       The House Bill contains no comparable provision.
     Compromise Agreement
       Section 211 follows the Senate bill but extends the health 
     care eligibility to December 31, 2002.

     

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