[Congressional Record (Bound Edition), Volume 156 (2010), Part 5]
[House]
[Pages 5944-5976]
[From the U.S. Government Publishing Office, www.gpo.gov]




      CAREGIVERS AND VETERANS OMNIBUS HEALTH SERVICES ACT OF 2010

  Mr. FILNER. Mr. Speaker, I move to suspend the rules and pass the 
bill (S. 1963) to amend title 38, United States Code, to provide 
assistance to caregivers of veterans, to improve the provision of 
health care to veterans, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the amendment is as follows:

       Amendment:
       Strike out all after the enacting clause and insert:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Caregivers 
     and Veterans Omnibus Health Services Act of 2010''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

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

                       TITLE I--CAREGIVER SUPPORT

Sec. 101. Assistance and support services for caregivers.
Sec. 102. Medical care for family caregivers.
Sec. 103. Counseling and mental health services for caregivers.
Sec. 104. Lodging and subsistence for attendants.

              TITLE II--WOMEN VETERANS HEALTH CARE MATTERS

Sec. 201. Study of barriers for women veterans to health care from the 
              Department of Veterans Affairs.
Sec. 202. Training and certification for mental health care providers 
              of the Department of Veterans Affairs on care for 
              veterans suffering from sexual trauma and post-traumatic 
              stress disorder.
Sec. 203. Pilot program on counseling in retreat settings for women 
              veterans newly separated from service in the Armed 
              Forces.
Sec. 204. Service on certain advisory committees of women recently 
              separated from service in the Armed Forces.
Sec. 205. Pilot program on assistance for child care for certain 
              veterans receiving health care.
Sec. 206. Care for newborn children of women veterans receiving 
              maternity care.

                  TITLE III--RURAL HEALTH IMPROVEMENTS

Sec. 301. Improvements to the Education Debt Reduction Program.
Sec. 302. Visual impairment and orientation and mobility professionals 
              education assistance program.
Sec. 303. Demonstration projects on alternatives for expanding care for 
              veterans in rural areas.
Sec. 304. Program on readjustment and mental health care services for 
              veterans who served in Operation Enduring Freedom and 
              Operation Iraqi Freedom.
Sec. 305. Travel reimbursement for veterans receiving treatment at 
              facilities of the Department of Veterans Affairs.
Sec. 306. Pilot program on incentives for physicians who assume 
              inpatient responsibilities at community hospitals in 
              health professional shortage areas.
Sec. 307. Grants for veterans service organizations for transportation 
              of highly rural veterans.
Sec. 308. Modification of eligibility for participation in pilot 
              program of enhanced contract care authority for health 
              care needs of certain veterans.

                  TITLE IV--MENTAL HEALTH CARE MATTERS

Sec. 401. Eligibility of members of the Armed Forces who serve in 
              Operation Enduring Freedom or Operation Iraqi Freedom for 
              counseling and services through Readjustment Counseling 
              Service.

[[Page 5945]]

Sec. 402. Restoration of authority of Readjustment Counseling Service 
              to provide referral and other assistance upon request to 
              former members of the Armed Forces not authorized 
              counseling.
Sec. 403. Study on suicides among veterans.

                   TITLE V--OTHER HEALTH CARE MATTERS

Sec. 501. Repeal of certain annual reporting requirements.
Sec. 502. Submittal date of annual report on Gulf War research.
Sec. 503. Payment for care furnished to CHAMPVA beneficiaries.
Sec. 504. Disclosure of patient treatment information from medical 
              records of patients lacking decisionmaking capacity.
Sec. 505. Enhancement of quality management.
Sec. 506. Pilot program on use of community-based organizations and 
              local and State government entities to ensure that 
              veterans receive care and benefits for which they are 
              eligible.
Sec. 507. Specialized residential care and rehabilitation for certain 
              veterans.
Sec. 508. Expanded study on the health impact of Project Shipboard 
              Hazard and Defense.
Sec. 509. Use of non-Department facilities for rehabilitation of 
              individuals with traumatic brain injury.
Sec. 510. Pilot program on provision of dental insurance plans to 
              veterans and survivors and dependents of veterans.
Sec. 511. Prohibition on collection of copayments from veterans who are 
              catastrophically disabled.
Sec. 512. Higher priority status for certain veterans who are medal of 
              honor recipients.
Sec. 513. Hospital care, medical services, and nursing home care for 
              certain Vietnam-era veterans exposed to herbicide and 
              veterans of the Persian Gulf War.
Sec. 514. Establishment of Director of Physician Assistant Services in 
              Veterans Health Administration.
Sec. 515. Committee on Care of Veterans with Traumatic Brain Injury.
Sec. 516. Increase in amount available to disabled veterans for 
              improvements and structural alterations furnished as part 
              of home health services.
Sec. 517. Extension of statutorily defined copayments for certain 
              veterans for hospital care and nursing home care.
Sec. 518. Extension of authority to recover cost of certain care and 
              services from disabled veterans with health-plan 
              contracts.

                 TITLE VI--DEPARTMENT PERSONNEL MATTERS

Sec. 601. Enhancement of authorities for retention of medical 
              professionals.
Sec. 602. Limitations on overtime duty, weekend duty, and alternative 
              work schedules for nurses.
Sec. 603. Reauthorization of health professionals educational 
              assistance scholarship program.
Sec. 604. Loan repayment program for clinical researchers from 
              disadvantaged backgrounds.

                  TITLE VII--HOMELESS VETERANS MATTERS

Sec. 701. Per diem grant payments to nonconforming entities.

       TITLE VIII--NONPROFIT RESEARCH AND EDUCATION CORPORATIONS

Sec. 801. General authorities on establishment of corporations.
Sec. 802. Clarification of purposes of corporations.
Sec. 803. Modification of requirements for boards of directors of 
              corporations.
Sec. 804. Clarification of powers of corporations.
Sec. 805. Redesignation of section 7364A of title 38, United States 
              Code.
Sec. 806. Improved accountability and oversight of corporations.

               TITLE IX--CONSTRUCTION AND NAMING MATTERS

Sec. 901. Authorization of medical facility projects.
Sec. 902. Designation of Merril Lundman Department of Veterans Affairs 
              Outpatient Clinic, Havre, Montana.
Sec. 903. Designation of William C. Tallent Department of Veterans 
              Affairs Outpatient Clinic, Knoxville, Tennessee.
Sec. 904. Designation of Max J. Beilke Department of Veterans Affairs 
              Outpatient Clinic, Alexandria, Minnesota.

                         TITLE X--OTHER MATTERS

Sec. 1001. Expansion of authority for Department of Veterans Affairs 
              police officers.
Sec. 1002. Uniform allowance for Department of Veterans Affairs police 
              officers.
Sec. 1003. Submission of reports to Congress by Secretary of Veterans 
              Affairs in electronic form.
Sec. 1004. Determination of budgetary effects for purposes of 
              compliance with Statutory Pay-As-You-Go-Act of 2010.

     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--CAREGIVER SUPPORT

     SEC. 101. ASSISTANCE AND SUPPORT SERVICES FOR CAREGIVERS.

       (a) Assistance and Support Services.--
       (1) In general.--Subchapter II of chapter 17 is amended by 
     adding at the end the following new section:

     ``Sec. 1720G. Assistance and support services for caregivers

       ``(a) Program of Comprehensive Assistance for Family 
     Caregivers.--(1)(A) The Secretary shall establish a program 
     of comprehensive assistance for family caregivers of eligible 
     veterans.
       ``(B) The Secretary shall only provide support under the 
     program required by subparagraph (A) to a family caregiver of 
     an eligible veteran if the Secretary determines it is in the 
     best interest of the eligible veteran to do so.
       ``(2) For purposes of this subsection, an eligible veteran 
     is any individual who--
       ``(A) is a veteran or member of the Armed Forces undergoing 
     medical discharge from the Armed Forces;
       ``(B) has a serious injury (including traumatic brain 
     injury, psychological trauma, or other mental disorder) 
     incurred or aggravated in the line of duty in the active 
     military, naval, or air service on or after September 11, 
     2001; and
       ``(C) is in need of personal care services because of--
       ``(i) an inability to perform one or more activities of 
     daily living;
       ``(ii) a need for supervision or protection based on 
     symptoms or residuals of neurological or other impairment or 
     injury; or
       ``(iii) such other matters as the Secretary considers 
     appropriate.
       ``(3)(A) As part of the program required by paragraph (1), 
     the Secretary shall provide to family caregivers of eligible 
     veterans the following assistance:
       ``(i) To each family caregiver who is approved as a 
     provider of personal care services for an eligible veteran 
     under paragraph (6)--
       ``(I) such instruction, preparation, and training as the 
     Secretary considers appropriate for the family caregiver to 
     provide personal care services to the eligible veteran;
       ``(II) ongoing technical support consisting of information 
     and assistance to address, in a timely manner, the routine, 
     emergency, and specialized caregiving needs of the family 
     caregiver in providing personal care services to the eligible 
     veteran;
       ``(III) counseling; and
       ``(IV) lodging and subsistence under section 111(e) of this 
     title.
       ``(ii) To each family caregiver who is designated as the 
     primary provider of personal care services for an eligible 
     veteran under paragraph (7)--
       ``(I) the assistance described in clause (i);
       ``(II) such mental health services as the Secretary 
     determines appropriate;
       ``(III) respite care of not less than 30 days annually, 
     including 24-hour per day care of the veteran commensurate 
     with the care provided by the family caregiver to permit 
     extended respite;
       ``(IV) medical care under section 1781 of this title; and
       ``(V) a monthly personal caregiver stipend.
       ``(B) Respite care provided under subparagraph (A)(ii)(III) 
     shall be medically and age-appropriate and include in-home 
     care.
       ``(C)(i) The amount of the monthly personal caregiver 
     stipend provided under subparagraph (A)(ii)(V) shall be 
     determined in accordance with a schedule established by the 
     Secretary that specifies stipends based upon the amount and 
     degree of personal care services provided.
       ``(ii) The Secretary shall ensure, to the extent 
     practicable, that the schedule required by clause (i) 
     specifies that the amount of the monthly personal caregiver 
     stipend provided to a primary provider of personal care 
     services for the provision of personal care services to an 
     eligible veteran is not less than the monthly amount a 
     commercial home health care entity would pay an individual in 
     the geographic area of the eligible veteran to provide 
     equivalent personal care services to the eligible veteran.
       ``(iii) If personal care services are not available from a 
     commercial home health entity in the geographic area of an 
     eligible veteran, the amount of the monthly personal 
     caregiver stipend payable under the schedule required by 
     clause (i) with respect to the eligible veteran shall be 
     determined by taking into consideration the costs of 
     commercial providers of personal care services in providing 
     personal care services in geographic areas other than the 
     geographic area of the eligible veteran with similar costs of 
     living.

[[Page 5946]]

       ``(4) An eligible veteran and a family member of the 
     eligible veteran seeking to participate in the program 
     required by paragraph (1) shall jointly submit to the 
     Secretary an application therefor in such form and in such 
     manner as the Secretary considers appropriate.
       ``(5) For each application submitted jointly by an eligible 
     veteran and family member, the Secretary shall evaluate--
       ``(A) the eligible veteran--
       ``(i) to identify the personal care services required by 
     the eligible veteran; and
       ``(ii) to determine whether such requirements could be 
     significantly or substantially satisfied through the 
     provision of personal care services from a family member; and
       ``(B) the family member to determine the amount of 
     instruction, preparation, and training, if any, the family 
     member requires to provide the personal care services 
     required by the eligible veteran--
       ``(i) as a provider of personal care services for the 
     eligible veteran; and
       ``(ii) as the primary provider of personal care services 
     for the eligible veteran.
       ``(6)(A) The Secretary shall provide each family member of 
     an eligible veteran who makes a joint application under 
     paragraph (4) the instruction, preparation, and training 
     determined to be required by such family member under 
     paragraph (5)(B).
       ``(B) Upon the successful completion by a family member of 
     an eligible veteran of instruction, preparation, and training 
     under subparagraph (A), the Secretary shall approve the 
     family member as a provider of personal care services for the 
     eligible veteran.
       ``(C) The Secretary shall, subject to regulations the 
     Secretary shall prescribe, provide for necessary travel, 
     lodging, and per diem expenses incurred by a family member of 
     an eligible veteran in undergoing instruction, preparation, 
     and training under subparagraph (A).
       ``(D) If the participation of a family member of an 
     eligible veteran in instruction, preparation, and training 
     under subparagraph (A) would interfere with the provision of 
     personal care services to the eligible veteran, the Secretary 
     shall, subject to regulations as the Secretary shall 
     prescribe and in consultation with the veteran, provide 
     respite care to the eligible veteran during the provision of 
     such instruction, preparation, and training to the family 
     member so that the family member can participate in such 
     instruction, preparation, and training without interfering 
     with the provision of such services to the eligible veteran.
       ``(7)(A) For each eligible veteran with at least one family 
     member who is described by subparagraph (B), the Secretary 
     shall designate one family member of such eligible veteran as 
     the primary provider of personal care services for such 
     eligible veteran.
       ``(B) A primary provider of personal care services 
     designated for an eligible veteran under subparagraph (A) 
     shall be selected from among family members of the eligible 
     veteran who--
       ``(i) are approved under paragraph (6) as a provider of 
     personal care services for the eligible veteran;
       ``(ii) elect to provide the personal care services to the 
     eligible veteran that the Secretary determines the eligible 
     veteran requires under paragraph (5)(A)(i);
       ``(iii) has the consent of the eligible veteran to be the 
     primary provider of personal care services for the eligible 
     veteran; and
       ``(iv) are considered by the Secretary as competent to be 
     the primary provider of personal care services for the 
     eligible veteran.
       ``(C) An eligible veteran receiving personal care services 
     from a family member designated as the primary provider of 
     personal care services for the eligible veteran under 
     subparagraph (A) may, in accordance with procedures the 
     Secretary shall establish for such purposes, revoke consent 
     with respect to such family member under subparagraph 
     (B)(iii).
       ``(D) If a family member designated as the primary provider 
     of personal care services for an eligible veteran under 
     subparagraph (A) subsequently fails to meet any requirement 
     set forth in subparagraph (B), the Secretary--
       ``(i) shall immediately revoke the family member's 
     designation under subparagraph (A); and
       ``(ii) may designate, in consultation with the eligible 
     veteran, a new primary provider of personal care services for 
     the eligible veteran under such subparagraph.
       ``(E) The Secretary shall take such actions as may be 
     necessary to ensure that the revocation of a designation 
     under subparagraph (A) with respect to an eligible veteran 
     does not interfere with the provision of personal care 
     services required by the eligible veteran.
       ``(8) If an eligible veteran lacks the capacity to make a 
     decision under this subsection, the Secretary may, in 
     accordance with regulations and policies of the Department 
     regarding appointment of guardians or the use of powers of 
     attorney, appoint a surrogate for the eligible veteran who 
     may make decisions and take action under this subsection on 
     behalf of the eligible veteran.
       ``(9)(A) The Secretary shall monitor the well-being of each 
     eligible veteran receiving personal care services under the 
     program required by paragraph (1).
       ``(B) The Secretary shall document each finding the 
     Secretary considers pertinent to the appropriate delivery of 
     personal care services to an eligible veteran under the 
     program.
       ``(C) The Secretary shall establish procedures to ensure 
     appropriate follow-up regarding findings described in 
     subparagraph (B). Such procedures may include the following:
       ``(i) Visiting an eligible veteran in the eligible 
     veteran's home to review directly the quality of personal 
     care services provided to the eligible veteran.
       ``(ii) Taking such corrective action with respect to the 
     findings of any review of the quality of personal care 
     services provided an eligible veteran as the Secretary 
     considers appropriate, which may include--
       ``(I) providing additional training to a family caregiver; 
     and
       ``(II) suspending or revoking the approval of a family 
     caregiver under paragraph (6) or the designation of a family 
     caregiver under paragraph (7).
       ``(10) The Secretary shall carry out outreach to inform 
     eligible veterans and family members of eligible veterans of 
     the program required by paragraph (1) and the benefits of 
     participating in the program.
       ``(b) Program of General Caregiver Support Services.--(1) 
     The Secretary shall establish a program of support services 
     for caregivers of covered veterans who are enrolled in the 
     health care system established under section 1705(a) of this 
     title (including caregivers who do not reside with such 
     veterans).
       ``(2) For purposes of this subsection, a covered veteran is 
     any individual who needs personal care services because of--
       ``(A) an inability to perform one or more activities of 
     daily living;
       ``(B) a need for supervision or protection based on 
     symptoms or residuals of neurological or other impairment or 
     injury; or
       ``(C) such other matters as the Secretary shall specify.
       ``(3)(A) The support services furnished to caregivers of 
     covered veterans under the program required by paragraph (1) 
     shall include the following:
       ``(i) Services regarding the administering of personal care 
     services, which, subject to subparagraph (B), shall include--
       ``(I) educational sessions made available both in person 
     and on an Internet website;
       ``(II) use of telehealth and other available technologies; 
     and
       ``(III) teaching techniques, strategies, and skills for 
     caring for a disabled veteran;
       ``(ii) Counseling and other services under section 1782 of 
     this title.
       ``(iii) Respite care under section 1720B of this title that 
     is medically and age appropriate for the veteran (including 
     24-hour per day in-home care).
       ``(iv) Information concerning the supportive services 
     available to caregivers under this subsection and other 
     public, private, and nonprofit agencies that offer support to 
     caregivers.
       ``(B) If the Secretary certifies to the Committees on 
     Veterans' Affairs of the Senate and the House of 
     Representatives that funding available for a fiscal year is 
     insufficient to fund the provision of services specified in 
     one or more subclauses of subparagraph (A)(i), the Secretary 
     shall not be required under subparagraph (A) to provide the 
     services so specified in the certification during the period 
     beginning on the date that is 180 days after the date the 
     certification is received by the Committees and ending on the 
     last day of the fiscal year.
       ``(4) In providing information under paragraph (3)(A)(iv), 
     the Secretary shall collaborate with the Assistant Secretary 
     for Aging of the Department of Health and Human Services in 
     order to provide caregivers access to aging and disability 
     resource centers under the Administration on Aging of the 
     Department of Health and Human Services.
       ``(5) In carrying out the program required by paragraph 
     (1), the Secretary shall conduct outreach to inform covered 
     veterans and caregivers of covered veterans about the 
     program. The outreach shall include an emphasis on covered 
     veterans and caregivers of covered veterans living in rural 
     areas.
       ``(c) Construction.--(1) A decision by the Secretary under 
     this section affecting the furnishing of assistance or 
     support shall be considered a medical determination.
       ``(2) Nothing in this section shall be construed to 
     create--
       ``(A) an employment relationship between the Secretary and 
     an individual in receipt of assistance or support under this 
     section; or
       ``(B) any entitlement to any assistance or support provided 
     under this section.
       ``(d) Definitions.--In this section:
       ``(1) The term `caregiver', with respect to an eligible 
     veteran under subsection (a) or a covered veteran under 
     subsection (b), means an individual who provides personal 
     care services to the veteran.
       ``(2) The term `family caregiver', with respect to an 
     eligible veteran under subsection (a), means a family member 
     who is a caregiver of the veteran.
       ``(3) The term `family member', with respect to an eligible 
     veteran under subsection (a), means an individual who--
       ``(A) is a member of the family of the veteran, including--
       ``(i) a parent;

[[Page 5947]]

       ``(ii) a spouse;
       ``(iii) a child;
       ``(iv) a step-family member; and
       ``(v) an extended family member; or
       ``(B) lives with the veteran but is not a member of the 
     family of the veteran.
       ``(4) The term `personal care services', with respect to an 
     eligible veteran under subsection (a) or a covered veteran 
     under subsection (b), means services that provide the veteran 
     the following:
       ``(A) Assistance with one or more independent activities of 
     daily living.
       ``(B) Any other non-institutional extended care (as such 
     term is used in section 1701(6)(E) of this title).
       ``(e) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out the programs 
     required by subsections (a) and (b)--
       ``(1) $60,000,000 for fiscal year 2010; and
       ``(2) $1,542,000,000 for the period of fiscal years 2011 
     through 2015.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of chapter 17 is amended by inserting after the 
     item related to section 1720F the following new item:

``1720G. Assistance and support services for caregivers.''.

       (3) Effective date.--
       (A) In general.--The amendments made by this subsection 
     shall take effect on the date that is 270 days after the date 
     of the enactment of this Act.
       (B) Implementation.--The Secretary of Veterans Affairs 
     shall commence the programs required by subsections (a) and 
     (b) of section 1720G of title 38, United States Code, as 
     added by paragraph (1) of this subsection, on the date on 
     which the amendments made by this subsection take effect.
       (b) Implementation Plan and Report.--
       (1) In general.--Not later than 180 days after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall--
       (A) develop a plan for the implementation of the program of 
     comprehensive assistance for family caregivers required by 
     section 1720G(a)(1) of title 38, United States Code, as added 
     by subsection (a)(1) of this section; and
       (B) submit to the Committee on Veterans' Affairs of the 
     Senate and the Committee on Veterans' Affairs of the House of 
     Representatives a report on such plan.
       (2) Consultation.--In developing the plan required by 
     paragraph (1)(A), the Secretary shall consult with the 
     following:
       (A) Individuals described in section 1720G(a)(2) of title 
     38, United States Code, as added by subsection (a)(1) of this 
     section.
       (B) Family members of such individuals who provide personal 
     care services to such individuals.
       (C) The Secretary of Defense with respect to matters 
     concerning personal care services for members of the Armed 
     Forces undergoing medical discharge from the Armed Forces who 
     are eligible to benefit from personal care services furnished 
     under the program of comprehensive assistance required by 
     section 1720G(a)(1) of such title, as so added.
       (D) Veterans service organizations, as recognized by the 
     Secretary for the representation of veterans under section 
     5902 of such title.
       (E) National organizations that specialize in the provision 
     of assistance to individuals with the types of disabilities 
     that family caregivers will encounter while providing 
     personal care services under the program of comprehensive 
     assistance required by section 1720G(a)(1) of such title, as 
     so added.
       (F) National organizations that specialize in provision of 
     assistance to family members of veterans who provide personal 
     care services to such veterans.
       (G) Such other organizations with an interest in the 
     provision of care to veterans and assistance to family 
     caregivers as the Secretary considers appropriate.
       (3) Report contents.--The report required by paragraph 
     (1)(B) shall contain the following:
       (A) The plan required by paragraph (1)(A).
       (B) A description of the individuals, caregivers, and 
     organizations consulted by the Secretary of Veterans Affairs 
     under paragraph (2).
       (C) A description of such consultations.
       (D) The recommendations of such individuals, caregivers, 
     and organizations, if any, that were not adopted and 
     incorporated into the plan required by paragraph (1)(A), and 
     the reasons the Secretary did not adopt such recommendations.
       (c) Annual Evaluation Report.--
       (1) In general.--Not later than two years after the date 
     described in subsection (a)(3)(A) and annually thereafter, 
     the Secretary shall submit to the Committee on Veterans' 
     Affairs of the Senate and the Committee on Veterans' Affairs 
     of the House of Representatives a comprehensive report on the 
     implementation of section 1720G of title 38, United States 
     Code, as added by subsection (a)(1).
       (2) Contents.--The report required by paragraph (1) shall 
     include the following:
       (A) With respect to the program of comprehensive assistance 
     for family caregivers required by subsection (a)(1) of such 
     section 1720G and the program of general caregiver support 
     services required by subsection (b)(1) of such section--
       (i) the number of caregivers that received assistance under 
     such programs;
       (ii) the cost to the Department of providing assistance 
     under such programs;
       (iii) a description of the outcomes achieved by, and any 
     measurable benefits of, carrying out such programs;
       (iv) an assessment of the effectiveness and the efficiency 
     of the implementation of such programs; and
       (v) such recommendations, including recommendations for 
     legislative or administrative action, as the Secretary 
     considers appropriate in light of carrying out such programs.
       (B) With respect to the program of comprehensive assistance 
     for family caregivers required by such subsection (a)(1)--
       (i) a description of the outreach activities carried out by 
     the Secretary under such program; and
       (ii) an assessment of the manner in which resources are 
     expended by the Secretary under such program, particularly 
     with respect to the provision of monthly personal caregiver 
     stipends under paragraph (3)(A)(ii)(v) of such subsection 
     (a).
       (C) With respect to the provision of general caregiver 
     support services required by such subsection (b)(1)--
       (i) a summary of the support services made available under 
     the program;
       (ii) the number of caregivers who received support services 
     under the program;
       (iii) the cost to the Department of providing each support 
     service provided under the program; and
       (iv) such other information as the Secretary considers 
     appropriate.
       (d) Report on Expansion of Family Caregiver Assistance.--
       (1) In general.--Not later than two years after the date 
     described in subsection (a)(3)(A), the Secretary shall submit 
     to the Committee on Veterans' Affairs of the Senate and the 
     Committee on Veterans' Affairs of the House of 
     Representatives a report on the feasibility and advisability 
     of expanding the provision of assistance under section 
     1720G(a) of title 38, United States Code, as added by 
     subsection (a)(1), to family caregivers of veterans who have 
     a serious injury incurred or aggravated in the line of duty 
     in the active military, naval, or air service before 
     September 11, 2001.
       (2) Recommendations.--The report required by paragraph (1) 
     shall include such recommendations as the Secretary considers 
     appropriate with respect to the expansion described in such 
     paragraph.

     SEC. 102. MEDICAL CARE FOR FAMILY CAREGIVERS.

       Section 1781(a) is amended--
       (1) in paragraph (2), by striking ``and'' at the end;
       (2) in paragraph (3), by inserting ``and'' at the end; and
       (3) by inserting after paragraph (3), the following new 
     paragraph:
       ``(4) an individual designated as a primary provider of 
     personal care services under section 1720G(a)(7)(A) of this 
     title who is not entitled to care or services under a health-
     plan contract (as defined in section 1725(f) of this 
     title),''.

     SEC. 103. COUNSELING AND MENTAL HEALTH SERVICES FOR 
                   CAREGIVERS.

       (a) In General.--Section 1782(c) is amended--
       (1) in paragraph (1), by striking ``; or'' and inserting a 
     semicolon;
       (2) by redesignating paragraph (2) as paragraph (3); and
       (3) by inserting after paragraph (1) the following new 
     paragraph (2):
       ``(2) a family caregiver of an eligible veteran or a 
     caregiver of a covered veteran (as those terms are defined in 
     section 1720G of this title); or''.
       (b) Conforming Amendment.--The section heading of section 
     1782 is amended by adding at the end, the following: ``and 
     caregivers''.
       (c) Clerical Amendment.--The table of sections at the 
     beginning of chapter 17 is amended by striking the item 
     relating to section 1782 and inserting the following new 
     item:

``1782. Counseling, training, and mental health services for immediate 
              family members and caregivers.''.

     SEC. 104. LODGING AND SUBSISTENCE FOR ATTENDANTS.

       Section 111(e) is amended--
       (1) by striking ``When'' and inserting the following: ``(1) 
     Except as provided in paragraph (2), when''; and
       (2) by adding at the end the following new paragraphs:
       ``(2)(A) Without regard to whether an eligible veteran 
     entitled to mileage under this section for travel to a 
     Department facility for the purpose of medical examination, 
     treatment, or care requires an attendant in order to perform 
     such travel, an attendant of such veteran described in 
     subparagraph (B) may be allowed expenses of travel (including 
     lodging and subsistence) upon the same basis as such veteran 
     during--
       ``(i) the period of time in which such veteran is traveling 
     to and from a Department facility for the purpose of medical 
     examination, treatment, or care; and
       ``(ii) the duration of the medical examination, treatment, 
     or care episode for such veteran.
       ``(B) An attendant of a veteran described in this 
     subparagraph is a provider of personal

[[Page 5948]]

     care services for such veteran who is approved under 
     paragraph (6) of section 1720G(a) of this title or designated 
     under paragraph (7) of such section 1720G(a).
       ``(C) The Secretary may prescribe regulations to carry out 
     this paragraph. Such regulations may include provisions--
       ``(i) to limit the number of attendants that may receive 
     expenses of travel under this paragraph for a single medical 
     examination, treatment, or care episode of an eligible 
     veteran; and
       ``(ii) to require such attendants to use certain travel 
     services.
       ``(D) In this subsection, the term `eligible veteran' has 
     the meaning given that term in section 1720G(a)(2) of this 
     title.''.

              TITLE II--WOMEN VETERANS HEALTH CARE MATTERS

     SEC. 201. STUDY OF BARRIERS FOR WOMEN VETERANS TO HEALTH CARE 
                   FROM THE DEPARTMENT OF VETERANS AFFAIRS.

       (a) Study Required.--The Secretary of Veterans Affairs 
     shall conduct a comprehensive study of the barriers to the 
     provision of comprehensive health care by the Department of 
     Veterans Affairs encountered by women who are veterans. In 
     conducting the study, the Secretary shall--
       (1) survey women veterans who seek or receive hospital care 
     or medical services provided by the Department of Veterans 
     Affairs as well as women veterans who do not seek or receive 
     such care or services;
       (2) administer the survey to a representative sample of 
     women veterans from each Veterans Integrated Service Network; 
     and
       (3) ensure that the sample of women veterans surveyed is of 
     sufficient size for the study results to be statistically 
     significant and is a larger sample than that of the study 
     referred to in subsection (b).
       (b) Use of Previous Study.--In conducting the study 
     required by subsection (a), the Secretary shall build on the 
     work of the study of the Department of Veterans Affairs 
     titled ``National Survey of Women Veterans in Fiscal Year 
     2007-2008''.
       (c) Elements of Study.--In conducting the study required by 
     subsection (a), the Secretary shall conduct research on the 
     effects of the following on the women veterans surveyed in 
     the study:
       (1) The perceived stigma associated with seeking mental 
     health care services.
       (2) The effect of driving distance or availability of other 
     forms of transportation to the nearest medical facility on 
     access to care.
       (3) The availability of child care.
       (4) The acceptability of integrated primary care, women's 
     health clinics, or both.
       (5) The comprehension of eligibility requirements for, and 
     the scope of services available under, hospital care and 
     medical services.
       (6) The perception of personal safety and comfort in 
     inpatient, outpatient, and behavioral health facilities.
       (7) The gender sensitivity of health care providers and 
     staff to issues that particularly affect women.
       (8) The effectiveness of outreach for health care services 
     available to women veterans.
       (9) The location and operating hours of health care 
     facilities that provide services to women veterans.
       (10) Such other significant barriers as the Secretary 
     considers appropriate.
       (d) Discharge by Contract.--The Secretary shall enter into 
     a contract with a qualified independent entity or 
     organization to carry out the study and research required 
     under this section.
       (e) Mandatory Review of Data by Certain Department 
     Divisions.--
       (1) In general.--The Secretary shall ensure that the head 
     of each division of the Department of Veterans Affairs 
     specified in paragraph (2) reviews the results of the study 
     conducted under this section. The head of each such division 
     shall submit findings with respect to the study to the Under 
     Secretary for Health and to other pertinent program offices 
     within the Department of Veterans Affairs with 
     responsibilities relating to health care services for women 
     veterans.
       (2) Specified divisions.--The divisions of the Department 
     of Veterans Affairs specified in this paragraph are the 
     following:
       (A) The Center for Women Veterans established under section 
     318 of title 38, United States Code.
       (B) The Advisory Committee on Women Veterans established 
     under section 542 of such title.
       (f) Reports.--
       (1) Report on implementation.--Not later than six months 
     after the date on which the Department of Veterans Affairs 
     publishes a final report on the study titled ``National 
     Survey of Women Veterans in Fiscal Year 2007-2008'', the 
     Secretary shall submit to Congress a report on the status of 
     the implementation of this section.
       (2) Report on study.--Not later than 30 months after the 
     date on which the Department publishes such final report, the 
     Secretary shall submit to Congress a report on the study 
     required under this section. The report shall include 
     recommendations for such administrative and legislative 
     action as the Secretary considers appropriate. The report 
     shall also include the findings of the head of each division 
     of the Department specified under subsection (e)(2) and of 
     the Under Secretary for Health.
       (g) Authorization of Appropriations.--There is authorized 
     to be appropriated to the Secretary of Veterans Affairs 
     $4,000,000 to carry out this section.

     SEC. 202. TRAINING AND CERTIFICATION FOR MENTAL HEALTH CARE 
                   PROVIDERS OF THE DEPARTMENT OF VETERANS AFFAIRS 
                   ON CARE FOR VETERANS SUFFERING FROM SEXUAL 
                   TRAUMA AND POST-TRAUMATIC STRESS DISORDER.

       Section 1720D is amended--
       (1) by redesignating subsection (d) as subsection (f); and
       (2) by inserting after subsection (c) the following new 
     subsections:
       ``(d)(1) The Secretary shall carry out a program to provide 
     graduate medical education, training, certification, and 
     continuing medical education for mental health professionals 
     who provide counseling, care, and services under subsection 
     (a).
       ``(2) In carrying out the program required by paragraph 
     (1), the Secretary shall ensure that--
       ``(A) all mental health professionals described in such 
     paragraph have been trained in a consistent manner; and
       ``(B) training described in such paragraph includes 
     principles of evidence-based treatment and care for sexual 
     trauma and post-traumatic stress disorder.
       ``(e) Each year, the Secretary shall submit to Congress an 
     annual report on the counseling, care, and services provided 
     to veterans pursuant to this section. Each report shall 
     include data for the year covered by the report with respect 
     to each of the following:
       ``(1) The number of mental health professionals, graduate 
     medical education trainees, and primary care providers who 
     have been certified under the program required by subsection 
     (d) and the amount and nature of continuing medical education 
     provided under such program to such professionals, trainees, 
     and providers who are so certified.
       ``(2) The number of women veterans who received counseling 
     and care and services under subsection (a) from professionals 
     and providers who received training under subsection (d).
       ``(3) The number of graduate medical education, training, 
     certification, and continuing medical education courses 
     provided by reason of subsection (d).
       ``(4) The number of trained full-time equivalent employees 
     required in each facility of the Department to meet the needs 
     of veterans requiring treatment and care for sexual trauma 
     and post-traumatic stress disorder.
       ``(5) Such recommendations for improvements in the 
     treatment of women veterans with sexual trauma and post-
     traumatic stress disorder as the Secretary considers 
     appropriate.
       ``(6) Such other information as the Secretary considers 
     appropriate.''.

     SEC. 203. PILOT PROGRAM ON COUNSELING IN RETREAT SETTINGS FOR 
                   WOMEN VETERANS NEWLY SEPARATED FROM SERVICE IN 
                   THE ARMED FORCES.

       (a) Pilot Program Required.--
       (1) In general.--Commencing not later than 180 days after 
     the date of the enactment of this Act, the Secretary of 
     Veterans Affairs shall carry out, through the Readjustment 
     Counseling Service of the Veterans Health Administration, a 
     pilot program to evaluate the feasibility and advisability of 
     providing reintegration and readjustment services described 
     in subsection (b) in group retreat settings to women veterans 
     who are recently separated from service in the Armed Forces 
     after a prolonged deployment.
       (2) Participation at election of veteran.--The 
     participation of a veteran in the pilot program under this 
     section shall be at the election of the veteran.
       (b) Covered Services.--The services provided to a woman 
     veteran under the pilot program shall include the following:
       (1) Information on reintegration into the veteran's family, 
     employment, and community.
       (2) Financial counseling.
       (3) Occupational counseling.
       (4) Information and counseling on stress reduction.
       (5) Information and counseling on conflict resolution.
       (6) Such other information and counseling as the Secretary 
     considers appropriate to assist a woman veteran under the 
     pilot program in reintegration into the veteran's family, 
     employment, and community.
       (c) Locations.--The Secretary shall carry out the pilot 
     program at not fewer than three locations selected by the 
     Secretary for purposes of the pilot program.
       (d) Duration.--The pilot program shall be carried out 
     during the two-year period beginning on the date of the 
     commencement of the pilot program.
       (e) Report.--Not later than 180 days after the completion 
     of the pilot program, the Secretary shall submit to Congress 
     a report on the pilot program. The report shall contain the 
     findings and conclusions of the Secretary as a result of the 
     pilot program, and shall include such recommendations for the 
     continuation or expansion of the pilot program as the 
     Secretary considers appropriate.
       (f) Authorization of Appropriations.--There is authorized 
     to be appropriated to the

[[Page 5949]]

     Secretary of Veterans Affairs for each of fiscal years 2010 
     and 2011, $2,000,000 to carry out the pilot program.

     SEC. 204. SERVICE ON CERTAIN ADVISORY COMMITTEES OF WOMEN 
                   RECENTLY SEPARATED FROM SERVICE IN THE ARMED 
                   FORCES.

       (a) Advisory Committee on Women Veterans.--Section 
     542(a)(2)(A) is amended--
       (1) in clause (ii), by striking ``and'' at the end;
       (2) in clause (iii), by striking the period at the end and 
     inserting ``; and''; and
       (3) by inserting after clause (iii) the following new 
     clause:
       ``(iv) women veterans who are recently separated from 
     service in the Armed Forces.''.
       (b) Advisory Committee on Minority Veterans.--Section 
     544(a)(2)(A) is amended--
       (1) in clause (iii), by striking ``and'' at the end;
       (2) in clause (iv), by striking the period at the end and 
     inserting ``; and''; and
       (3) by inserting after clause (iv) the following new 
     clause:
       ``(v) women veterans who are minority group members and are 
     recently separated from service in the Armed Forces.''.
       (c) Applicability.--The amendments made by this section 
     shall apply to appointments made on or after the date of the 
     enactment of this Act.

     SEC. 205. PILOT PROGRAM ON ASSISTANCE FOR CHILD CARE FOR 
                   CERTAIN VETERANS RECEIVING HEALTH CARE.

       (a) Pilot Program Required.--The Secretary of Veterans 
     Affairs shall carry out a pilot program to assess the 
     feasibility and advisability of providing, subject to 
     subsection (b), assistance to qualified veterans described in 
     subsection (c) to obtain child care so that such veterans can 
     receive health care services described in subsection (c).
       (b) Limitation on Period of Payments.--Assistance may only 
     be provided to a qualified veteran under the pilot program 
     for receipt of child care during the period that the 
     qualified veteran--
       (1) receives the types of health care services described in 
     subsection (c) at a facility of the Department; and
       (2) requires travel to and return from such facility for 
     the receipt of such health care services.
       (c) Qualified Veterans.--For purposes of this section, a 
     qualified veteran is a veteran who is--
       (1) the primary caretaker of a child or children; and
       (2)(A) receiving from the Department--
       (i) regular mental health care services;
       (ii) intensive mental health care services; or
       (iii) such other intensive health care services that the 
     Secretary determines that provision of assistance to the 
     veteran to obtain child care would improve access to such 
     health care services by the veteran; or
       (B) in need of regular or intensive mental health care 
     services from the Department, and but for lack of child care 
     services, would receive such health care services from the 
     Department.
       (d) Locations.--The Secretary shall carry out the pilot 
     program in no fewer than three Veterans Integrated Service 
     Networks selected by the Secretary for purposes of the pilot 
     program.
       (e) Duration.--The pilot program shall be carried out 
     during the two-year period beginning on the date of the 
     commencement of the pilot program.
       (f) Forms of Child Care Assistance.--
       (1) In general.--Child care assistance under this section 
     may include the following:
       (A) Stipends for the payment of child care offered by 
     licensed child care centers (either directly or through a 
     voucher program) which shall be, to the extent practicable, 
     modeled after the Department of Veterans Affairs Child Care 
     Subsidy Program established pursuant to section 630 of the 
     Treasury and General Government Appropriations Act, 2002 
     (Public Law 107-67; 115 Stat. 552).
       (B) Direct provision of child care at an on-site facility 
     of the Department of Veterans Affairs.
       (C) Payments to private child care agencies.
       (D) Collaboration with facilities or programs of other 
     Federal departments or agencies.
       (E) Such other forms of assistance as the Secretary 
     considers appropriate.
       (2) Amounts of stipends.--In the case that child care 
     assistance under this section is provided as a stipend under 
     paragraph (1)(A), such stipend shall cover the full cost of 
     such child care.
       (g) Report.--Not later than six months after the completion 
     of the pilot program, the Secretary shall submit to Congress 
     a report on the pilot program. The report shall include the 
     findings and conclusions of the Secretary as a result of the 
     pilot program, and shall include such recommendations for the 
     continuation or expansion of the pilot program as the 
     Secretary considers appropriate.
       (h) Authorization of Appropriations.--There is authorized 
     to be appropriated to the Secretary of Veterans Affairs to 
     carry out the pilot program $1,500,000 for each of fiscal 
     years 2010 and 2011.

     SEC. 206. CARE FOR NEWBORN CHILDREN OF WOMEN VETERANS 
                   RECEIVING MATERNITY CARE.

       (a) In General.--Subchapter VIII of chapter 17 is amended 
     by adding at the end the following new section:

     ``Sec. 1786. Care for newborn children of women veterans 
       receiving maternity care

       ``(a) In General.--The Secretary may furnish health care 
     services described in subsection (b) to a newborn child of a 
     woman veteran who is receiving maternity care furnished by 
     the Department for not more than seven days after the birth 
     of the child if the veteran delivered the child in--
       ``(1) a facility of the Department; or
       ``(2) another facility pursuant to a Department contract 
     for services relating to such delivery.
       ``(b) Covered Health Care Services.--Health care services 
     described in this subsection are all post-delivery care 
     services, including routine care services, that a newborn 
     child requires.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 17 is amended by inserting after the 
     item relating to section 1785 the following new item:

``1786. Care for newborn children of women veterans receiving maternity 
              care.''.

                  TITLE III--RURAL HEALTH IMPROVEMENTS

     SEC. 301. IMPROVEMENTS TO THE EDUCATION DEBT REDUCTION 
                   PROGRAM.

       (a) Inclusion of Employee Retention as Purpose of 
     Program.--Section 7681(a)(2) is amended by inserting ``and 
     retention'' after ``recruitment'' the first time it appears.
       (b) Expansion of Eligibility.--Section 7682 is amended--
       (1) in subsection (a)(1), by striking ``a recently 
     appointed'' and inserting ``an''; and
       (2) by striking subsection (c).
       (c) Increase in Maximum Annual Amount of Payments.--
     Paragraph (1) of subsection (d) of section 7683 is amended--
       (1) by striking ``$44,000'' and inserting ``$60,000''; and
       (2) by striking ``$10,000'' and inserting ``$12,000''.
       (d) Exception to Limitation on Amount for Certain 
     Participants.--Such subsection is further amended by adding 
     at the end the following new paragraph:
       ``(3)(A) The Secretary may waive the limitations under 
     paragraphs (1) and (2) in the case of a participant described 
     in subparagraph (B). In the case of such a waiver, the total 
     amount of education debt repayments payable to that 
     participant is the total amount of the principal and the 
     interest on the participant's loans referred to in subsection 
     (a).
       ``(B) A participant described in this subparagraph is a 
     participant in the Program who the Secretary determines 
     serves in a position for which there is a shortage of 
     qualified employees by reason of either the location or the 
     requirements of the position.''.

     SEC. 302. VISUAL IMPAIRMENT AND ORIENTATION AND MOBILITY 
                   PROFESSIONALS EDUCATION ASSISTANCE PROGRAM.

       (a) Establishment of Program.--Part V is amended by 
     inserting after chapter 74 the following new chapter:

     ``CHAPTER 75--VISUAL IMPAIRMENT AND ORIENTATION AND MOBILITY 
              PROFESSIONALS EDUCATIONAL ASSISTANCE PROGRAM

``Sec.
``7501. Establishment of scholarship program; purpose.
``7502. Application and acceptance.
``7503. Amount of assistance; duration.
``7504. Agreement.
``7505. Repayment for failure to satisfy requirements of agreement.

     ``Sec. 7501. Establishment of scholarship program; purpose

       ``(a) Establishment.--Subject to the availability of 
     appropriations, the Secretary shall establish and carry out a 
     scholarship program to provide financial assistance in 
     accordance with this chapter to individuals who--
       ``(1) are accepted for enrollment or currently enrolled in 
     a program of study leading to a degree or certificate in 
     visual impairment or orientation and mobility, or a dual 
     degree or certification in both such areas, at an accredited 
     (as determined by the Secretary) educational institution that 
     is in a State; and
       ``(2) enter into an agreement with the Secretary as 
     described in section 7504 of this title.
       ``(b) Purpose.--The purpose of the scholarship program is 
     to increase the supply of qualified blind rehabilitation 
     specialists for the Department and the Nation.
       ``(c) Outreach.--The Secretary shall publicize the 
     scholarship program to educational institutions throughout 
     the United States, with an emphasis on disseminating 
     information to such institutions with high numbers of 
     Hispanic students and to Historically Black Colleges and 
     Universities.

     ``Sec. 7502. Application and acceptance

       ``(a) Application.--(1) To apply and participate in the 
     scholarship program under this chapter, an individual shall 
     submit to the Secretary an application for such participation 
     together with an agreement described in section 7504 of this 
     title under which the participant agrees to serve a period of 
     obligated service in the Department

[[Page 5950]]

     as provided in the agreement in return for payment of 
     educational assistance as provided in the agreement.
       ``(2) In distributing application forms and agreement forms 
     to individuals desiring to participate in the scholarship 
     program, the Secretary shall include with such forms the 
     following:
       ``(A) A fair summary of the rights and liabilities of an 
     individual whose application is approved (and whose agreement 
     is accepted) by the Secretary.
       ``(B) A full description of the terms and conditions that 
     apply to participation in the scholarship program and service 
     in the Department.
       ``(b) Approval.--(1) Upon the Secretary's approval of an 
     individual's participation in the scholarship program, the 
     Secretary shall, in writing, promptly notify the individual 
     of that acceptance.
       ``(2) An individual becomes a participant in the 
     scholarship program upon such approval by the Secretary.

     ``Sec. 7503. Amount of assistance; duration

       ``(a) Amount of Assistance.--The amount of the financial 
     assistance provided an individual under the scholarship 
     program under this chapter shall be the amount determined by 
     the Secretary as being necessary to pay the tuition and fees 
     of the individual. In the case of an individual enrolled in a 
     program of study leading to a dual degree or certification in 
     both the areas of study described in section 7501(a)(1) of 
     this title, the tuition and fees shall not exceed the amounts 
     necessary for the minimum number of credit hours to achieve 
     such dual degree or certification.
       ``(b) Relationship to Other Assistance.--Financial 
     assistance may be provided to an individual under the 
     scholarship program to supplement other educational 
     assistance to the extent that the total amount of educational 
     assistance received by the individual during an academic year 
     does not exceed the total tuition and fees for such academic 
     year.
       ``(c) Maximum Amount of Assistance.--(1) The total amount 
     of assistance provided under the scholarship program for an 
     academic year to an individual who is a full-time student may 
     not exceed $15,000.
       ``(2) In the case of an individual who is a part-time 
     student, the total amount of assistance provided under the 
     scholarship program shall bear the same ratio to the amount 
     that would be paid under paragraph (1) if the participant 
     were a full-time student in the program of study being 
     pursued by the individual as the coursework carried by the 
     individual to full-time coursework in that program of study.
       ``(3) The total amount of assistance provided to an 
     individual under the scholarship program may not exceed 
     $45,000.
       ``(d) Maximum Duration of Assistance.--Financial assistance 
     may not be provided to an individual under the scholarship 
     program for more than six academic years.

     ``Sec. 7504. Agreement

       ``An agreement between the Secretary and a participant in 
     the scholarship program under this chapter shall be in 
     writing, shall be signed by the participant, and shall 
     include--
       ``(1) the Secretary's agreement to provide the participant 
     with financial assistance as authorized under this chapter;
       ``(2) the participant's agreement--
       ``(A) to accept such financial assistance;
       ``(B) to maintain enrollment and attendance in the program 
     of study described in section 7501(a)(1) of this title;
       ``(C) while enrolled in such program, to maintain an 
     acceptable level of academic standing (as determined by the 
     educational institution offering such program under 
     regulations prescribed by the Secretary); and
       ``(D) after completion of the program, to serve as a full-
     time employee in the Department for a period of three years, 
     to be served within the first six years after the participant 
     has completed such program and received a degree or 
     certificate described in section 7501(a)(1) of this title; 
     and
       ``(3) any other terms and conditions that the Secretary 
     considers appropriate for carrying out this chapter.

     ``Sec. 7505. Repayment for failure to satisfy requirements of 
       agreement

       ``(a) In General.--An individual who receives educational 
     assistance under the scholarship program under this chapter 
     shall repay to the Secretary an amount equal to the unearned 
     portion of such assistance if the individual fails to satisfy 
     the requirements of the agreement entered into under section 
     7504 of this title, except in circumstances authorized by the 
     Secretary.
       ``(b) Amount of Repayment.--The Secretary shall establish, 
     by regulations, procedures for determining the amount of the 
     repayment required under this section and the circumstances 
     under which an exception to the required repayment may be 
     granted.
       ``(c) Waiver or Suspension of Compliance.--The Secretary 
     shall prescribe regulations providing for the waiver or 
     suspension of any obligation of an individual for service or 
     payment under this chapter (or an agreement under this 
     chapter) whenever--
       ``(1) noncompliance by the individual is due to 
     circumstances beyond the control of the individual; or
       ``(2) the Secretary determines that the waiver or 
     suspension of compliance is in the best interest of the 
     United States.
       ``(d) Obligation as Debt to United States.--An obligation 
     to repay the Secretary under this section is, for all 
     purposes, a debt owed the United States. A discharge in 
     bankruptcy under title 11 does not discharge a person from 
     such debt if the discharge order is entered less than five 
     years after the date of the termination of the agreement or 
     contract on which the debt is based.''.
       (b) Clerical Amendments.--The tables of chapters at the 
     beginning of title 38, and of part V, are each amended by 
     inserting after the item relating to chapter 74 the following 
     new item:

``75. Visual Impairment and Orientation and Mobility Professionals 
    Educational Assistance Program..........................7501''.....

       (c) Implementation.--The Secretary of Veterans Affairs 
     shall implement chapter 75 of title 38, United States Code, 
     as added by subsection (a), not later than six months after 
     the date of the enactment of this Act.

     SEC. 303. DEMONSTRATION PROJECTS ON ALTERNATIVES FOR 
                   EXPANDING CARE FOR VETERANS IN RURAL AREAS.

       (a) In General.--The Secretary of Veterans Affairs may, 
     through the Director of the Office of Rural Health, carry out 
     demonstration projects to examine the feasibility and 
     advisability of alternatives for expanding care for veterans 
     in rural areas, which may include the following:
       (1) Establishing a partnership between the Department of 
     Veterans Affairs and the Centers for Medicare and Medicaid 
     Services of the Department of Health and Human Services to 
     coordinate care for veterans in rural areas at critical 
     access hospitals (as designated or certified under section 
     1820 of the Social Security Act (42 U.S.C. 1395i-4)).
       (2) Establishing a partnership between the Department of 
     Veterans Affairs and the Department of Health and Human 
     Services to coordinate care for veterans in rural areas at 
     community health centers.
       (3) Expanding coordination between the Department of 
     Veterans Affairs and the Indian Health Service to expand care 
     for Indian veterans.
       (b) Geographic Distribution.--The Secretary shall ensure 
     that the demonstration projects carried out under subsection 
     (a) are located at facilities that are geographically 
     distributed throughout the United States.
       (c) Report.--Not later than two years after the date of the 
     enactment of this Act, the Secretary shall submit a report on 
     the results of the demonstration projects carried out under 
     subsection (a) to--
       (1) the Committee on Veterans' Affairs and the Committee on 
     Appropriations of the Senate; and
       (2) the Committee on Veterans' Affairs and the Committee on 
     Appropriations of the House of Representatives.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $5,000,000 for 
     fiscal year 2010 and each fiscal year thereafter.

     SEC. 304. PROGRAM ON READJUSTMENT AND MENTAL HEALTH CARE 
                   SERVICES FOR VETERANS WHO SERVED IN OPERATION 
                   ENDURING FREEDOM AND OPERATION IRAQI FREEDOM.

       (a) Program Required.--Not later than 180 days after the 
     date of the enactment of this Act, the Secretary of Veterans 
     Affairs shall establish a program to provide--
       (1) to veterans of Operation Enduring Freedom and Operation 
     Iraqi Freedom, particularly veterans who served in such 
     operations while in the National Guard and the Reserves--
       (A) peer outreach services;
       (B) peer support services;
       (C) readjustment counseling and services described in 
     section 1712A of title 38, United States Code; and
       (D) mental health services; and
       (2) to members of the immediate family of veterans 
     described in paragraph (1), during the three-year period 
     beginning on the date of the return of such veterans from 
     deployment in Operation Enduring Freedom or Operation Iraqi 
     Freedom, education, support, counseling, and mental health 
     services to assist in--
       (A) the readjustment of such veterans to civilian life;
       (B) in the case such veterans have an injury or illness 
     incurred during such deployment, the recovery of such 
     veterans from such injury or illness; and
       (C) the readjustment of the family following the return of 
     such veterans.
       (b) Contracts With Community Mental Health Centers and 
     Other Qualified Entities.--In carrying out the program 
     required by subsection (a), the Secretary may contract with 
     community mental health centers and other qualified entities 
     to provide the services required by such subsection only in 
     areas the Secretary determines are not adequately served by 
     other health care facilities or vet centers of the Department 
     of Veterans Affairs. Such contracts shall require each 
     contracting community health center or entity--
       (1) to the extent practicable, to use telehealth services 
     for the delivery of services required by subsection (a);
       (2) to the extent practicable, to employ veterans trained 
     under subsection (c) in the

[[Page 5951]]

     provision of services covered by that subsection;
       (3) to participate in the training program conducted in 
     accordance with subsection (d);
       (4) to comply with applicable protocols of the Department 
     before incurring any liability on behalf of the Department 
     for the provision of services required by subsection (a);
       (5) for each veteran for whom a community mental health 
     center or other qualified entity provides mental health 
     services under such contract, to provide the Department with 
     such clinical summary information as the Secretary shall 
     require;
       (6) to submit annual reports to the Secretary containing, 
     with respect to the program required by subsection (a) and 
     for the last full calendar year ending before the submittal 
     of such report--
       (A) the number of the veterans served, veterans diagnosed, 
     and courses of treatment provided to veterans as part of the 
     program required by subsection (a); and
       (B) demographic information for such services, diagnoses, 
     and courses of treatment; and
       (7) to meet such other requirements as the Secretary shall 
     require.
       (c) Training of Veterans for Provision of Peer-outreach and 
     Peer-support Services.--In carrying out the program required 
     by subsection (a), the Secretary shall contract with a 
     national not-for-profit mental health organization to carry 
     out a national program of training for veterans described in 
     subsection (a) to provide the services described in 
     subparagraphs (A) and (B) of paragraph (1) of such 
     subsection.
       (d) Training of Clinicians for Provision of Services.--The 
     Secretary shall conduct a training program for clinicians of 
     community mental health centers or entities that have 
     contracts with the Secretary under subsection (b) to ensure 
     that such clinicians can provide the services required by 
     subsection (a) in a manner that--
       (1) recognizes factors that are unique to the experience of 
     veterans who served on active duty in Operation Enduring 
     Freedom or Operation Iraqi Freedom (including their combat 
     and military training experiences); and
       (2) uses best practices and technologies.
       (e) Vet Center Defined.--In this section, the term ``vet 
     center'' means a center for readjustment counseling and 
     related mental health services for veterans under section 
     1712A of title 38, United States Code.

     SEC. 305. TRAVEL REIMBURSEMENT FOR VETERANS RECEIVING 
                   TREATMENT AT FACILITIES OF THE DEPARTMENT OF 
                   VETERANS AFFAIRS.

       (a) Enhancement of Allowance Based Upon Mileage Traveled.--
     Section 111 is amended--
       (1) in subsection (a), by striking ``traveled,'' and 
     inserting ``(at a rate of 41.5 cents per mile),''; and
       (2) by amending subsection (g) to read as follows:
       ``(g)(1) Beginning one year after the date of the enactment 
     of the Caregivers and Veterans Omnibus Health Services Act of 
     2010, the Secretary may adjust the mileage rate described in 
     subsection (a) to be equal to the mileage reimbursement rate 
     for the use of privately owned vehicles by Government 
     employees on official business (when a Government vehicle is 
     available), as prescribed by the Administrator of General 
     Services under section 5707(b) of title 5.
       ``(2) If an adjustment in the mileage rate under paragraph 
     (1) results in a lower mileage rate than the mileage rate 
     otherwise specified in subsection (a), the Secretary shall, 
     not later than 60 days before the date of the implementation 
     of the mileage rate as so adjusted, submit to Congress a 
     written report setting forth the adjustment in the mileage 
     rate under this subsection, together with a justification for 
     the decision to make the adjustment in the mileage rate under 
     this subsection.''.
       (b) Coverage of Cost of Transportation by Air.--Subsection 
     (a) of section 111, as amended by subsection (a)(1), is 
     further amended by inserting after the first sentence the 
     following new sentence: ``Actual necessary expense of travel 
     includes the reasonable costs of airfare if travel by air is 
     the only practical way to reach a Department facility.''.
       (c) Elimination of Limitation Based on Maximum Annual Rate 
     of Pension.--Subsection (b)(1)(D)(i) of such section is 
     amended by inserting ``who is not traveling by air and'' 
     before ``whose annual''.
       (d) Determination of Practicality.--Subsection (b) of such 
     section is amended by adding at the end the following new 
     paragraph:
       ``(4) In determining for purposes of subsection (a) whether 
     travel by air is the only practical way for a veteran to 
     reach a Department facility, the Secretary shall consider the 
     medical condition of the veteran and any other impediments to 
     the use of ground transportation by the veteran.''.
       (e) No Expansion of Eligibility for Beneficiary Travel.--
     The amendments made by subsections (b) and (d) of this 
     section may not be construed as expanding or otherwise 
     modifying eligibility for payments or allowances for 
     beneficiary travel under section 111 of title 38, United 
     States Code, as in effect on the day before the date of the 
     enactment of this Act.
       (f) Clarification of Relation to Public Transportation in 
     Veterans Health Administration Handbook.--Not later than 30 
     days after the date of the enactment of this Act, the 
     Secretary of Veterans Affairs shall revise the Veterans 
     Health Administration Handbook to clarify that an allowance 
     for travel based on mileage paid under section 111(a) of 
     title 38, United States Code, may exceed the cost of such 
     travel by public transportation regardless of medical 
     necessity.

     SEC. 306. PILOT PROGRAM ON INCENTIVES FOR PHYSICIANS WHO 
                   ASSUME INPATIENT RESPONSIBILITIES AT COMMUNITY 
                   HOSPITALS IN HEALTH PROFESSIONAL SHORTAGE 
                   AREAS.

       (a) Pilot Program Required.--The Secretary of Veterans 
     Affairs shall carry out a pilot program to assess the 
     feasability and advisability of each of the following:
       (1) The provision of financial incentives to eligible 
     physicians who obtain and maintain inpatient privileges at 
     community hospitals in health professional shortage areas in 
     order to facilitate the provision by such physicians of 
     primary care and mental health services to veterans at such 
     hospitals.
       (2) The collection of payments from third-party providers 
     for care provided by eligible physicians to nonveterans while 
     discharging inpatient responsibilities at community hospitals 
     in the course of exercising the privileges described in 
     paragraph (1).
       (b) Eligible Physicians.--For purposes of this section, an 
     eligible physician is a primary care or mental health 
     physician employed by the Department of Veterans Affairs on a 
     full-time basis.
       (c) Duration of Program.--The pilot program shall be 
     carried out during the three-year period beginning on the 
     date of the commencement of the pilot program.
       (d) Locations.--
       (1) In general.--The pilot program shall be carried out at 
     not less than five community hospitals in each of not less 
     than two Veterans Integrated Services Networks. The hospitals 
     shall be selected by the Secretary using the results of the 
     survey required under subsection (e).
       (2) Qualifying community hospitals.--A community hospital 
     may be selected by the Secretary as a location for the pilot 
     program if--
       (A) the hospital is located in a health professional 
     shortage area; and
       (B) the number of eligible physicians willing to assume 
     inpatient responsibilities at the hospital (as determined 
     using the result of the survey) is sufficient for purposes of 
     the pilot program.
       (e) Survey of Physician Interest in Participation.--
       (1) In general.--Not later than 120 days after the date of 
     the enactment of this Act, the Secretary shall conduct a 
     survey of eligible physicians to determine the extent of the 
     interest of such physicians in participating in the pilot 
     program.
       (2) Elements.--The survey shall disclose the type, amount, 
     and nature of the financial incentives to be provided under 
     subsection (h) to physicians participating in the pilot 
     program.
       (f) Physician Participation.--
       (1) In general.--The Secretary shall select physicians for 
     participation in the pilot program from among eligible 
     physicians who--
       (A) express interest in participating in the pilot program 
     in the survey conducted under subsection (e);
       (B) are in good standing with the Department; and
       (C) primarily have clinical responsibilities with the 
     Department.
       (2) Voluntary participation.--Participation in the pilot 
     program shall be voluntary. Nothing in this section shall be 
     construed to require a physician working for the Department 
     to assume inpatient responsibilities at a community hospital 
     unless otherwise required as a term or condition of 
     employment with the Department.
       (g) Assumption of Inpatient Physician Responsibilities.--
       (1) In general.--Each eligible physician selected for 
     participation in the pilot program shall assume and maintain 
     inpatient responsibilities, including inpatient 
     responsibilities with respect to nonveterans, at one or more 
     community hospitals selected by the Secretary for 
     participation in the pilot program under subsection (d).
       (2) Coverage under federal tort claims act.--If an eligible 
     physician participating in the pilot program carries out on-
     call responsibilities at a community hospital where 
     privileges to practice at such hospital are conditioned upon 
     the provision of services to individuals who are not veterans 
     while the physician is on call for such hospital, the 
     provision of such services by the physician shall be 
     considered an action within the scope of the physician's 
     office or employment for purposes of chapter 171 of title 28, 
     United States Code (commonly referred to as the ``Federal 
     Tort Claims Act'').
       (h) Compensation.--
       (1) In general.--The Secretary shall provide each eligible 
     physician participating in the pilot program with such 
     compensation (including pay and other appropriate 
     compensation) as the Secretary considers appropriate to 
     compensate such physician for the discharge of any inpatient 
     responsibilities by such physician at a community hospital 
     for which such physician would not otherwise be

[[Page 5952]]

     compensated by the Department as a full-time employee of the 
     Department.
       (2) Written agreement.--The amount of any compensation to 
     be provided a physician under the pilot program shall be 
     specified in a written agreement entered into by the 
     Secretary and the physician for purposes of the pilot 
     program.
       (3) Treatment of compensation.--The Secretary shall consult 
     with the Director of the Office of Personnel Management on 
     the inclusion of a provision in the written agreement 
     required under paragraph (2) that describes the treatment 
     under Federal law of any compensation provided a physician 
     under the pilot program, including treatment for purposes of 
     retirement under the civil service laws.
       (i) Collections From Third Parties.--In carrying out the 
     pilot program for the purpose described in subsection (a)(2), 
     the Secretary shall implement a variety and range of 
     requirements and mechanisms for the collection from third-
     party payors of amounts to reimburse the Department for 
     health care services provided to nonveterans under the pilot 
     program by eligible physicians discharging inpatient 
     responsibilities under the pilot program.
       (j) Report.--Not later than one year after the date of the 
     enactment of this Act and annually thereafter, the Secretary 
     shall submit to Congress a report on the pilot program, 
     including the following:
       (1) The findings of the Secretary with respect to the pilot 
     program.
       (2) The number of veterans and nonveterans provided 
     inpatient care by physicians participating in the pilot 
     program.
       (3) The amounts payable and collected under subsection (i).
       (k) Definitions.--In this section:
       (1) Health professional shortage area.--The term ``health 
     professional shortage area'' has the meaning given the term 
     in section 332(a) of the Public Health Service Act (42 U.S.C. 
     254e(a)).
       (2) Inpatient responsibilities.--The term ``inpatient 
     responsibilities'' means on-call responsibilities customarily 
     required of a physician by a community hospital as a 
     condition of granting privileges to the physician to practice 
     in the hospital.

     SEC. 307. GRANTS FOR VETERANS SERVICE ORGANIZATIONS FOR 
                   TRANSPORTATION OF HIGHLY RURAL VETERANS.

       (a) Grants Authorized.--
       (1) In general.--The Secretary of Veterans Affairs shall 
     establish a grant program to provide innovative 
     transportation options to veterans in highly rural areas.
       (2) Eligible recipients.--The following may be awarded a 
     grant under this section:
       (A) State veterans service agencies.
       (B) Veterans service organizations.
       (3) Use of funds.--A State veterans service agency or 
     veterans service organization awarded a grant under this 
     section may use the grant amount to--
       (A) assist veterans in highly rural areas to travel to 
     Department of Veterans Affairs medical centers; and
       (B) otherwise assist in providing transportation in 
     connection with the provision of medical care to veterans in 
     highly rural areas.
       (4) Maximum amount.--The amount of a grant under this 
     section may not exceed $50,000.
       (5) No matching requirement.--The recipient of a grant 
     under this section shall not be required to provide matching 
     funds as a condition for receiving such grant.
       (b) Regulations.--The Secretary shall prescribe regulations 
     for--
       (1) evaluating grant applications under this section; and
       (2) otherwise administering the program established by this 
     section.
       (c) Definitions.--In this section:
       (1) Highly rural.--The term ``highly rural'', in the case 
     of an area, means that the area consists of a county or 
     counties having a population of less than seven persons per 
     square mile.
       (2) Veterans service organization.--The term ``veterans 
     service organization'' means any organization recognized by 
     the Secretary of Veterans Affairs for the representation of 
     veterans under section 5902 of title 38, United States Code.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated $3,000,000 for each of fiscal years 2010 
     through 2014 to carry out this section.

     SEC. 308. MODIFICATION OF ELIGIBILITY FOR PARTICIPATION IN 
                   PILOT PROGRAM OF ENHANCED CONTRACT CARE 
                   AUTHORITY FOR HEALTH CARE NEEDS OF CERTAIN 
                   VETERANS.

       Subsection (b) of section 403 of the Veterans' Mental 
     Health and other Care Improvements Act of 2008 (Public Law 
     110-387; 122 Stat. 4125; 38 U.S.C. 1703 note) is amended to 
     read as follows:
       ``(b) Covered Veterans.--For purposes of the pilot program 
     under this section, a covered veteran is any veteran who--
       ``(1) is--
       ``(A) enrolled in the system of patient enrollment 
     established under section 1705(a) of title 38, United States 
     Code, as of the date of the commencement of the pilot program 
     under subsection (a)(2); or
       ``(B) eligible for health care under section 1710(e)(3) of 
     such title; and
       ``(2) resides in a location that is--
       ``(A) more than 60 minutes driving distance from the 
     nearest Department health care facility providing primary 
     care services, if the veteran is seeking such services;
       ``(B) more than 120 minutes driving distance from the 
     nearest Department health care facility providing acute 
     hospital care, if the veteran is seeking such care; or
       ``(C) more than 240 minutes driving distance from the 
     nearest Department health care facility providing tertiary 
     care, if the veteran is seeking such care.''.

                  TITLE IV--MENTAL HEALTH CARE MATTERS

     SEC. 401. ELIGIBILITY OF MEMBERS OF THE ARMED FORCES WHO 
                   SERVE IN OPERATION ENDURING FREEDOM OR 
                   OPERATION IRAQI FREEDOM FOR COUNSELING AND 
                   SERVICES THROUGH READJUSTMENT COUNSELING 
                   SERVICE.

       (a) In General.--Any member of the Armed Forces, including 
     a member of the National Guard or Reserve, who serves on 
     active duty in the Armed Forces in Operation Enduring Freedom 
     or Operation Iraqi Freedom is eligible for readjustment 
     counseling and related mental health services under section 
     1712A of title 38, United States Code, through the 
     Readjustment Counseling Service of the Veterans Health 
     Administration.
       (b) No Requirement for Current Active Duty Service.--A 
     member of the Armed Forces who meets the requirements for 
     eligibility for counseling and services under subsection (a) 
     is entitled to counseling and services under that subsection 
     regardless of whether or not the member is currently on 
     active duty in the Armed Forces at the time of receipt of 
     counseling and services under that subsection.
       (c) Regulations.--The eligibility of members of the Armed 
     Forces for counseling and services under subsection (a) shall 
     be subject to such regulations as the Secretary of Defense 
     and the Secretary of Veterans Affairs shall jointly prescribe 
     for purposes of this section.
       (d) Subject to Availability of Appropriations.--The 
     provision of counseling and services under subsection (a) 
     shall be subject to the availability of appropriations for 
     such purpose.

     SEC. 402. RESTORATION OF AUTHORITY OF READJUSTMENT COUNSELING 
                   SERVICE TO PROVIDE REFERRAL AND OTHER 
                   ASSISTANCE UPON REQUEST TO FORMER MEMBERS OF 
                   THE ARMED FORCES NOT AUTHORIZED COUNSELING.

       Section 1712A is amended--
       (1) by redesignating subsections (c) through (f) as 
     subsections (d) through (g), respectively; and
       (2) by inserting after subsection (b) the following new 
     subsection (c):
       ``(c) Upon receipt of a request for counseling under this 
     section from any individual who has been discharged or 
     released from active military, naval, or air service but who 
     is not otherwise eligible for such counseling, the Secretary 
     shall--
       ``(1) provide referral services to assist such individual, 
     to the maximum extent practicable, in obtaining mental health 
     care and services from sources outside the Department; and
       ``(2) if pertinent, advise such individual of such 
     individual's rights to apply to the appropriate military, 
     naval, or air service, and to the Department, for review of 
     such individual's discharge or release from such service.''.

     SEC. 403. STUDY ON SUICIDES AMONG VETERANS.

       (a) Study Required.--The Secretary of Veterans Affairs 
     shall conduct a study to determine the number of veterans who 
     died by suicide between January 1, 1999, and the date of the 
     enactment of this Act.
       (b) Coordination.--In carrying out the study under 
     subsection (a) the Secretary of Veterans Affairs shall 
     coordinate with--
       (1) the Secretary of Defense;
       (2) veterans service organizations;
       (3) the Centers for Disease Control and Prevention; and
       (4) State public health offices and veterans agencies.
       (c) Report to Congress.--The Secretary of Veterans Affairs 
     shall submit to the Committee on Veterans' Affairs of the 
     Senate and the Committee on Veterans' Affairs of the House of 
     Representatives a report on the study required under 
     subsection (a) and the findings of the Secretary.
       (d) Veterans Service Organization Defined.--In this 
     section, the term ``veterans service organization'' means any 
     organization recognized by the Secretary for the 
     representation of veterans under section 5902 of title 38, 
     United States Code.

                   TITLE V--OTHER HEALTH CARE MATTERS

     SEC. 501. REPEAL OF CERTAIN ANNUAL REPORTING REQUIREMENTS.

       (a) Nurse Pay Report.--Section 7451 is amended--
       (1) by striking subsection (f); and
       (2) by redesignating subsection (g) as subsection (f).
       (b) Long-term Planning Report.--
       (1) In general.--Section 8107 is repealed.
       (2) Conforming amendment.--The table of sections at the 
     beginning of chapter 81 is amended by striking the item 
     relating to section 8107.

[[Page 5953]]



     SEC. 502. SUBMITTAL DATE OF ANNUAL REPORT ON GULF WAR 
                   RESEARCH.

       Section 707(c)(1) of the Persian Gulf War Veterans' Health 
     Status Act (title VII of Public Law 102-585; 38 U.S.C. 527 
     note) is amended by striking ``Not later than March 1 of each 
     year'' and inserting ``Not later than July 1, 2010, and July 
     1 of each of the five following years''.

     SEC. 503. PAYMENT FOR CARE FURNISHED TO CHAMPVA 
                   BENEFICIARIES.

       Section 1781 is amended by adding at the end the following 
     new subsection:
       ``(e) Payment by the Secretary under this section on behalf 
     of a covered beneficiary for medical care shall constitute 
     payment in full and extinguish any liability on the part of 
     the beneficiary for that care.''.

     SEC. 504. DISCLOSURE OF PATIENT TREATMENT INFORMATION FROM 
                   MEDICAL RECORDS OF PATIENTS LACKING 
                   DECISIONMAKING CAPACITY.

       Section 7332(b)(2) is amended by adding at the end the 
     following new subparagraph:
       ``(F)(i) To a representative of a patient who lacks 
     decision-making capacity, when a practitioner deems the 
     content of the given record necessary for that representative 
     to make an informed decision regarding the patient's 
     treatment.
       ``(ii) In this subparagraph, the term `representative' 
     means an individual, organization, or other body authorized 
     under section 7331 of this title and its implementing 
     regulations to give informed consent on behalf of a patient 
     who lacks decision-making capacity.''.

     SEC. 505. ENHANCEMENT OF QUALITY MANAGEMENT.

       (a) Enhancement of Quality Management Through Quality 
     Management Officers.--
       (1) In general.--Subchapter II of chapter 73 is amended by 
     inserting after section 7311 the following new section:

     ``Sec. 7311A. Quality management officers

       ``(a) National Quality Management Officer.--(1) The Under 
     Secretary for Health shall designate an official of the 
     Veterans Health Administration to act as the principal 
     quality management officer for the quality-assurance program 
     required by section 7311 of this title. The official so 
     designated may be known as the `National Quality Management 
     Officer of the Veterans Health Administration' (in this 
     section referred to as the `National Quality Management 
     Officer').
       ``(2) The National Quality Management Officer shall report 
     directly to the Under Secretary for Health in the discharge 
     of responsibilities and duties of the Officer under this 
     section.
       ``(3) The National Quality Management Officer shall be the 
     official within the Veterans Health Administration who is 
     principally responsible for the quality-assurance program 
     referred to in paragraph (1). In carrying out that 
     responsibility, the Officer shall be responsible for the 
     following:
       ``(A) Establishing and enforcing the requirements of the 
     program referred to in paragraph (1).
       ``(B) Developing an aggregate quality metric from existing 
     data sources, such as the Inpatient Evaluation Center of the 
     Department, the National Surgical Quality Improvement 
     Program, and the External Peer Review Program of the Veterans 
     Health Administration, that could be used to assess reliably 
     the quality of care provided at individual Department medical 
     centers and associated community based outpatient clinics.
       ``(C) Ensuring that existing measures of quality, including 
     measures from the Inpatient Evaluation Center, the National 
     Surgical Quality Improvement Program, System-Wide Ongoing 
     Assessment and Review reports of the Department, and Combined 
     Assessment Program reviews of the Office of Inspector General 
     of the Department, are monitored routinely and analyzed in a 
     manner that ensures the timely detection of quality of care 
     issues.
       ``(D) Encouraging research and development in the area of 
     quality metrics for the purposes of improving how the 
     Department measures quality in individual facilities.
       ``(E) Carrying out such other responsibilities and duties 
     relating to quality management in the Veterans Health 
     Administration as the Under Secretary for Health shall 
     specify.
       ``(4) The requirements under paragraph (3) shall include 
     requirements regarding the following:
       ``(A) A confidential system for the submittal of reports by 
     Veterans Health Administration personnel regarding quality 
     management at Department facilities.
       ``(B) Mechanisms for the peer review of the actions of 
     individuals appointed in the Veterans Health Administration 
     in the position of physician.
       ``(b) Quality Management Officers for VISNs.--(1) The 
     Regional Director of each Veterans Integrated Services 
     Network shall appoint an official of the Network to act as 
     the quality management officer of the Network.
       ``(2) The quality management officer for a Veterans 
     Integrated Services Network shall report to the Regional 
     Director of the Veterans Integrated Services Network, and to 
     the National Quality Management Officer, regarding the 
     discharge of the responsibilities and duties of the officer 
     under this section.
       ``(3) The quality management officer for a Veterans 
     Integrated Services Network shall--
       ``(A) direct the quality management office in the Network; 
     and
       ``(B) coordinate, monitor, and oversee the quality 
     management programs and activities of the Administration 
     medical facilities in the Network in order to ensure the 
     thorough and uniform discharge of quality management 
     requirements under such programs and activities throughout 
     such facilities.
       ``(c) Quality Management Officers for Medical Facilities.--
     (1) The director of each Veterans Health Administration 
     medical facility shall appoint a quality management officer 
     for that facility.
       ``(2) The quality management officer for a facility shall 
     report directly to the director of the facility, and to the 
     quality management officer of the Veterans Integrated 
     Services Network in which the facility is located, regarding 
     the discharge of the responsibilities and duties of the 
     quality management officer under this section.
       ``(3) The quality management officer for a facility shall 
     be responsible for designing, disseminating, and implementing 
     quality management programs and activities for the facility 
     that meet the requirements established by the National 
     Quality Management Officer under subsection (a).
       ``(d) Authorization of Appropriations.--(1) Except as 
     provided in paragraph (2), there are authorized to be 
     appropriated such sums as may be necessary to carry out this 
     section.
       ``(2) There is authorized to be appropriated to carry out 
     the provisions of subparagraphs (B), (C), and (D) of 
     subsection (a)(3), $25,000,000 for the two-year period of 
     fiscal years beginning after the date of the enactment of 
     this section.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of chapter 73 is amended by inserting after the 
     item relating to section 7311 the following new item:

``7311A. Quality management officers.''.

       (b) Reports on Quality Concerns Under Quality-assurance 
     Program.--Section 7311(b) is amended by adding at the end the 
     following new paragraph:
       ``(4) As part of the quality-assurance program, the Under 
     Secretary for Health shall establish mechanisms through which 
     employees of Veterans Health Administration facilities may 
     submit reports, on a confidential basis, on matters relating 
     to quality of care in Veterans Health Administration 
     facilities to the quality management officers of such 
     facilities under section 7311A(c) of this title. The 
     mechanisms shall provide for the prompt and thorough review 
     of any reports so submitted by the receiving officials.''.
       (c) Review of Current Health Care Quality Safeguards.--
       (1) In general.--The Secretary of Veterans Affairs shall 
     conduct a comprehensive review of all current policies and 
     protocols of the Department of Veterans Affairs for 
     maintaining health care quality and patient safety at 
     Department medical facilities. The review shall include a 
     review and assessment of the National Surgical Quality 
     Improvement Program, including an assessment of--
       (A) the efficacy of the quality indicators under the 
     program;
       (B) the efficacy of the data collection methods under the 
     program;
       (C) the efficacy of the frequency with which regular data 
     analyses are performed under the program; and
       (D) the extent to which the resources allocated to the 
     program are adequate to fulfill the stated function of the 
     program.
       (2) Report.--Not later than 60 days after the date of the 
     enactment of this Act, the Secretary shall submit to Congress 
     a report on the review conducted under paragraph (1), 
     including the findings of the Secretary as a result of the 
     review and such recommendations as the Secretary considers 
     appropriate in light of the review.

     SEC. 506. PILOT PROGRAM ON USE OF COMMUNITY-BASED 
                   ORGANIZATIONS AND LOCAL AND STATE GOVERNMENT 
                   ENTITIES TO ENSURE THAT VETERANS RECEIVE CARE 
                   AND BENEFITS FOR WHICH THEY ARE ELIGIBLE.

       (a) Pilot Program Required.--The Secretary of Veterans 
     Affairs shall carry out a pilot program to assess the 
     feasibility and advisability of using community-based 
     organizations and local and State government entities--
       (1) to increase the coordination of community, local, 
     State, and Federal providers of health care and benefits for 
     veterans to assist veterans who are transitioning from 
     military service to civilian life in such transition;
       (2) to increase the availability of high quality medical 
     and mental health services to veterans transitioning from 
     military service to civilian life;
       (3) to provide assistance to families of veterans who are 
     transitioning from military service to civilian life to help 
     such families adjust to such transition; and
       (4) to provide outreach to veterans and their families to 
     inform them about the availability of benefits and connect 
     them with appropriate care and benefit programs.

[[Page 5954]]

       (b) Duration of Program.--The pilot program shall be 
     carried out during the two-year period beginning on the date 
     that is 180 days after the date of the enactment of this Act.
       (c) Program Locations.--
       (1) In general.--The pilot program shall be carried out at 
     five locations selected by the Secretary for purposes of the 
     pilot program.
       (2) Considerations.--In selecting locations for the pilot 
     program, the Secretary shall consider the advisability of 
     selecting locations in--
       (A) rural areas;
       (B) areas with populations that have a high proportion of 
     minority group representation;
       (C) areas with populations that have a high proportion of 
     individuals who have limited access to health care; and
       (D) areas that are not in close proximity to an active duty 
     military installation.
       (d) Grants.--The Secretary shall carry out the pilot 
     program through the award of grants to community-based 
     organizations and local and State government entities.
       (e) Selection of Grant Recipients.--
       (1) In general.--A community-based organization or local or 
     State government entity seeking a grant under the pilot 
     program shall submit to the Secretary an application therefor 
     in such form and in such manner as the Secretary considers 
     appropriate.
       (2) Elements.--Each application submitted under paragraph 
     (1) shall include the following:
       (A) A description of the consultations, if any, with the 
     Department of Veterans Affairs in the development of the 
     proposal under the application.
       (B) A plan to coordinate activities under the pilot 
     program, to the greatest extent possible, with the local, 
     State, and Federal providers of services for veterans to 
     reduce duplication of services and to enhance the effect of 
     such services.
       (f) Use of Grant Funds.--The Secretary shall prescribe 
     appropriate uses of grant funds received under the pilot 
     program.
       (g) Report on Program.--
       (1) In general.--Not later than 180 days after the 
     completion of the pilot program, the Secretary shall submit 
     to Congress a report on the pilot program.
       (2) Elements.--The report required by paragraph (1) shall 
     include the following:
       (A) The findings and conclusions of the Secretary with 
     respect to the pilot program.
       (B) An assessment of the benefits to veterans of the pilot 
     program.
       (C) The recommendations of the Secretary as to the 
     advisability of continuing the pilot program.

     SEC. 507. SPECIALIZED RESIDENTIAL CARE AND REHABILITATION FOR 
                   CERTAIN VETERANS.

       Section 1720 is amended by adding at the end the following 
     new subsection:
       ``(g) The Secretary may contract with appropriate entities 
     to provide specialized residential care and rehabilitation 
     services to a veteran of Operation Enduring Freedom or 
     Operation Iraqi Freedom who the Secretary determines suffers 
     from a traumatic brain injury, has an accumulation of 
     deficits in activities of daily living and instrumental 
     activities of daily living, and because of these deficits, 
     would otherwise require admission to a nursing home even 
     though such care would generally exceed the veteran's nursing 
     needs.''.

     SEC. 508. EXPANDED STUDY ON THE HEALTH IMPACT OF PROJECT 
                   SHIPBOARD HAZARD AND DEFENSE.

       (a) In General.--Not later than 90 days after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall enter into a contract with the Institute of Medicine of 
     the National Academies to conduct an expanded study on the 
     health impact of Project Shipboard Hazard and Defense 
     (Project SHAD).
       (b) Covered Veterans.--The study required by subsection (a) 
     shall include, to the extent practicable, all veterans who 
     participated in Project Shipboard Hazard and Defense.
       (c) Use of Existing Studies.--The study required by 
     subsection (a) may use results from the study covered in the 
     report titled ``Long-Term Health Effects of Participation in 
     Project SHAD'' of the Institute of Medicine of the National 
     Academies.

     SEC. 509. USE OF NON-DEPARTMENT FACILITIES FOR REHABILITATION 
                   OF INDIVIDUALS WITH TRAUMATIC BRAIN INJURY.

       Section 1710E is amended--
       (1) by redesignating subsection (b) as subsection (c);
       (2) by inserting after subsection (a) the following new 
     subsection (b):
       ``(b) Covered Individuals.--The care and services provided 
     under subsection (a) shall be made available to an 
     individual--
       ``(1) who is described in section 1710C(a) of this title; 
     and
       ``(2)(A) to whom the Secretary is unable to provide such 
     treatment or services at the frequency or for the duration 
     prescribed in such plan; or
       ``(B) for whom the Secretary determines that it is optimal 
     with respect to the recovery and rehabilitation for such 
     individual.''; and
       (3) by adding at the end the following new subsection:
       ``(d) Standards.--The Secretary may not provide treatment 
     or services as described in subsection (a) at a non-
     Department facility under such subsection unless such 
     facility maintains standards for the provision of such 
     treatment or services established by an independent, peer-
     reviewed organization that accredits specialized 
     rehabilitation programs for adults with traumatic brain 
     injury.''.

     SEC. 510. PILOT PROGRAM ON PROVISION OF DENTAL INSURANCE 
                   PLANS TO VETERANS AND SURVIVORS AND DEPENDENTS 
                   OF VETERANS.

       (a) Pilot Program Required.--The Secretary of Veterans 
     Affairs shall carry out a pilot program to assess the 
     feasibility and advisability of providing a dental insurance 
     plan to veterans and survivors and dependents of veterans 
     described in subsection (b).
       (b) Covered Veterans and Survivors and Dependents.--The 
     veterans and survivors and dependents of veterans described 
     in this subsection are as follows:
       (1) Any veteran who is enrolled in the system of annual 
     patient enrollment under section 1705 of title 38, United 
     States Code.
       (2) Any survivor or dependent of a veteran who is eligible 
     for medical care under section 1781 of such title.
       (c) Duration of Program.--The pilot program shall be 
     carried out during the three-year period beginning on the 
     date that is 270 days after the date of the enactment of this 
     Act.
       (d) Locations.--The pilot program shall be carried out in 
     such Veterans Integrated Services Networks as the Secretary 
     considers appropriate for purposes of the pilot program.
       (e) Administration.--The Secretary shall contract with a 
     dental insurer to administer the dental insurance plan 
     provided under the pilot program.
       (f) Benefits.--The dental insurance plan under the pilot 
     program shall provide such benefits for dental care and 
     treatment as the Secretary considers appropriate for the 
     dental insurance plan, including diagnostic services, 
     preventative services, endodontics and other restorative 
     services, surgical services, and emergency services.
       (g) Enrollment.--
       (1) Voluntary.--Enrollment in the dental insurance plan 
     under the pilot program shall be voluntary.
       (2) Minimum period.--Enrollment in the dental insurance 
     plan shall be for such minimum period as the Secretary shall 
     prescribe for purposes of this section.
       (h) Premiums.--
       (1) In general.--Premiums for coverage under the dental 
     insurance plan under the pilot program shall be in such 
     amount or amounts as the Secretary shall prescribe to cover 
     all costs associated with the pilot program.
       (2) Annual adjustment.--The Secretary shall adjust the 
     premiums payable under the pilot program for coverage under 
     the dental insurance plan on an annual basis. Each individual 
     covered by the dental insurance plan at the time of such an 
     adjustment shall be notified of the amount and effective date 
     of such adjustment.
       (3) Responsibility for payment.--Each individual covered by 
     the dental insurance plan shall pay the entire premium for 
     coverage under the dental insurance plan, in addition to the 
     full cost of any copayments.
       (i) Voluntary Disenrollment.--
       (1) In general.--With respect to enrollment in the dental 
     insurance plan under the pilot program, the Secretary shall--
       (A) permit the voluntary disenrollment of an individual in 
     the dental insurance plan if the disenrollment occurs during 
     the 30-day period beginning on the date of the enrollment of 
     the individual in the dental insurance plan; and
       (B) permit the voluntary disenrollment of an individual in 
     the dental insurance plan for such circumstances as the 
     Secretary shall prescribe for purposes of this subsection, 
     but only to the extent such disenrollment does not jeopardize 
     the fiscal integrity of the dental insurance plan.
       (2) Allowable circumstances.--The circumstances prescribed 
     under paragraph (1)(B) shall include the following:
       (A) If an individual enrolled in the dental insurance plan 
     relocates to a location outside the jurisdiction of the 
     dental insurance plan that prevents use of the benefits under 
     the dental insurance plan.
       (B) If an individual enrolled in the dental insurance plan 
     is prevented by a serious medical condition from being able 
     to obtain benefits under the dental insurance plan.
       (C) Such other circumstances as the Secretary shall 
     prescribe for purposes of this subsection.
       (3) Establishment of procedures.--The Secretary shall 
     establish procedures for determinations on the permissibility 
     of voluntary disenrollments under paragraph (1)(B). Such 
     procedures shall ensure timely determinations on the 
     permissibility of such disenrollments.
       (j) Relationship to Dental Care Provided by Secretary.--
     Nothing in this section shall affect the responsibility of 
     the Secretary to provide dental care under section 1712 of 
     title 38, United States Code, and the participation of an 
     individual in the dental insurance plan under the pilot 
     program shall not affect the individual's entitlement to 
     outpatient dental services and treatment,

[[Page 5955]]

     and related dental appliances, under that section.
       (k) Regulations.--The dental insurance plan under the pilot 
     program shall be administered under such regulations as the 
     Secretary shall prescribe.

     SEC. 511. PROHIBITION ON COLLECTION OF COPAYMENTS FROM 
                   VETERANS WHO ARE CATASTROPHICALLY DISABLED.

       (a) In General.--Subchapter III of chapter 17 is amended by 
     adding at the end the following new section:

     ``Sec. 1730A. Prohibition on collection of copayments from 
       catastrophically disabled veterans

       ``Notwithstanding subsections (f) and (g) of section 1710 
     and section 1722A(a) of this title or any other provision of 
     law, the Secretary may not require a veteran who is 
     catastrophically disabled, as defined by the Secretary, to 
     make any copayment for the receipt of hospital care or 
     medical services under the laws administered by the 
     Secretary.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 17 is amended by inserting after the 
     item relating to section 1730 the following new item:

``1730A. Prohibition on collection of copayments from catastrophically 
              disabled veterans.''.

     SEC. 512. HIGHER PRIORITY STATUS FOR CERTAIN VETERANS WHO ARE 
                   MEDAL OF HONOR RECIPIENTS.

       Section 1705(a)(3) is amended by inserting ``veterans who 
     were awarded the medal of honor under section 3741, 6241, or 
     8741 of title 10 or section 491 of title 14,'' after ``the 
     Purple Heart,''.

     SEC. 513. HOSPITAL CARE, MEDICAL SERVICES, AND NURSING HOME 
                   CARE FOR CERTAIN VIETNAM-ERA VETERANS EXPOSED 
                   TO HERBICIDE AND VETERANS OF THE PERSIAN GULF 
                   WAR.

       Section 1710(e) is amended--
       (1) in paragraph (3)--
       (A) by striking ``subsection (a)(2)(F)--'' and all that 
     follows through ``(C) in the case'' and inserting 
     ``subsection (a)(2)(F) in the case''; and
       (B) by redesignating clauses (i) and (ii) of the former 
     subparagraph (C) as subparagraphs (A) and (B) of such 
     paragraph (3) and by realigning the margin of such new 
     subparagraphs two ems to the left; and
       (2) in paragraph (1)(C)--
       (A) by striking ``paragraphs (2) and (3)'' and inserting 
     ``paragraph (2)''; and
       (B) by inserting after ``on active duty'' the following: 
     ``between August 2, 1990, and November 11, 1998,''.

     SEC. 514. ESTABLISHMENT OF DIRECTOR OF PHYSICIAN ASSISTANT 
                   SERVICES IN VETERANS HEALTH ADMINISTRATION.

       (a) In General.--Section 7306(a) is amended by striking 
     paragraph (9) and inserting the following new paragraph (9):
       ``(9) The Director of Physician Assistant Services, who 
     shall--
       ``(A) serve in a full-time capacity at the Central Office 
     of the Department;
       ``(B) be a qualified physician assistant; and
       ``(C) be responsible and report directly to the Chief 
     Patient Care Services Officer of the Veterans Health 
     Administration on all matters relating to the education and 
     training, employment, appropriate use, and optimal 
     participation of physician assistants within the programs and 
     initiatives of the Administration.''.
       (b) Deadline for Implementation.--The Secretary of Veterans 
     Affairs shall ensure that an individual is serving as the 
     Director of Physician Assistant Services under paragraph (9) 
     of section 7306(a) of title 38, United States Code, as 
     amended by subsection (a), by not later than 120 days after 
     the date of the enactment of this Act.

     SEC. 515. COMMITTEE ON CARE OF VETERANS WITH TRAUMATIC BRAIN 
                   INJURY.

       (a) Establishment of Committee.--Subchapter II of chapter 
     73 is amended by inserting after section 7321 the following 
     new section:

     ``Sec. 7321A. Committee on Care of Veterans with Traumatic 
       Brain Injury

       ``(a) Establishment.--The Secretary shall establish in the 
     Veterans Health Administration a committee to be known as the 
     `Committee on Care of Veterans with Traumatic Brain Injury'. 
     The Under Secretary for Health shall appoint employees of the 
     Department with expertise in the care of veterans with 
     traumatic brain injury to serve on the committee.
       ``(b) Responsibilities of Committee.--The committee shall 
     assess, and carry out a continuing assessment of, the 
     capability of the Veterans Health Administration to meet 
     effectively the treatment and rehabilitation needs of 
     veterans with traumatic brain injury. In carrying out that 
     responsibility, the committee shall--
       ``(1) evaluate the care provided to such veterans through 
     the Veterans Health Administration;
       ``(2) identify systemwide problems in caring for such 
     veterans in facilities of the Veterans Health Administration;
       ``(3) identify specific facilities within the Veterans 
     Health Administration at which program enrichment is needed 
     to improve treatment and rehabilitation of such veterans; and
       ``(4) identify model programs which the committee considers 
     to have been successful in the treatment and rehabilitation 
     of such veterans and which should be implemented more widely 
     in or through facilities of the Veterans Health 
     Administration.
       ``(c) Advice and Recommendations.--The committee shall--
       ``(1) advise the Under Secretary regarding the development 
     of policies for the care and rehabilitation of veterans with 
     traumatic brain injury; and
       ``(2) make recommendations to the Under Secretary--
       ``(A) for improving programs of care of such veterans at 
     specific facilities and throughout the Veterans Health 
     Administration;
       ``(B) for establishing special programs of education and 
     training relevant to the care of such veterans for employees 
     of the Veterans Health Administration;
       ``(C) regarding research needs and priorities relevant to 
     the care of such veterans; and
       ``(D) regarding the appropriate allocation of resources for 
     all such activities.
       ``(d) Annual Report.--Not later than June 1, 2010, and each 
     year thereafter, the Secretary shall submit to the Committee 
     on Veterans' Affairs of the Senate and the Committee on 
     Veterans' Affairs of the House of Representatives a report on 
     the implementation of this section. Each such report shall 
     include the following for the calendar year preceding the 
     year in which the report is submitted:
       ``(1) A list of the members of the committee.
       ``(2) The assessment of the Under Secretary for Health, 
     after review of the findings of the committee, regarding the 
     capability of the Veterans Health Administration, on a 
     systemwide and facility-by-facility basis, to meet 
     effectively the treatment and rehabilitation needs of 
     veterans with traumatic brain injury.
       ``(3) The plans of the committee for further assessments.
       ``(4) The findings and recommendations made by the 
     committee to the Under Secretary for Health and the views of 
     the Under Secretary on such findings and recommendations.
       ``(5) A description of the steps taken, plans made (and a 
     timetable for the execution of such plans), and resources to 
     be applied toward improving the capability of the Veterans 
     Health Administration to meet effectively the treatment and 
     rehabilitation needs of veterans with traumatic brain 
     injury.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 73 is amended by inserting after the 
     item relating to section 7321 the following new item:

``7321A. Committee on Care of Veterans with Traumatic Brain Injury.''.

     SEC. 516. INCREASE IN AMOUNT AVAILABLE TO DISABLED VETERANS 
                   FOR IMPROVEMENTS AND STRUCTURAL ALTERATIONS 
                   FURNISHED AS PART OF HOME HEALTH SERVICES.

       (a) Increase.--Section 1717(a)(2) is amended by striking 
     subparagraphs (A) and (B) and inserting the following:
       ``(A) in the case of medical services furnished under 
     section 1710(a)(1) of this title, or for a disability 
     described in section 1710(a)(2)(C) of this title--
       ``(i) in the case of a veteran who first applies for 
     benefits under this paragraph before the date of the 
     Caregivers and Veterans Omnibus Health Services Act of 2010, 
     $4,100; or
       ``(ii) in the case of a veteran who first applies for 
     benefits under this paragraph on or after the date of the 
     Caregivers and Veterans Omnibus Health Services Act of 2010, 
     $6,800; and
       ``(B) in the case of medical services furnished under any 
     other provision of section 1710(a) of this title--
       ``(i) in the case of a veteran who first applies for 
     benefits under this paragraph before the date of the 
     Caregivers and Veterans Omnibus Health Services Act of 2010, 
     $1,200; or
       ``(ii) in the case of a veteran who first applies for 
     benefits under this paragraph on or after the date of the 
     Caregivers and Veterans Omnibus Health Services Act of 2010, 
     $2,000.''.
       (b) Construction.--A veteran who exhausts such veteran's 
     eligibility for benefits under section 1717(a)(2) of such 
     title before the date of the enactment of this Act, is not 
     entitled to additional benefits under such section by reason 
     of the amendments made by subsection (a).

     SEC. 517. EXTENSION OF STATUTORILY DEFINED COPAYMENTS FOR 
                   CERTAIN VETERANS FOR HOSPITAL CARE AND NURSING 
                   HOME CARE.

       Subparagraph (B) of section 1710(f)(2) is amended to read 
     as follows:
       ``(B) before September 30, 2012, an amount equal to $10 for 
     every day the veteran receives hospital care and $5 for every 
     day the veteran receives nursing home care.''.

     SEC. 518. EXTENSION OF AUTHORITY TO RECOVER COST OF CERTAIN 
                   CARE AND SERVICES FROM DISABLED VETERANS WITH 
                   HEALTH-PLAN CONTRACTS.

       Subparagraph (E) of section 1729(a)(2) is amended to read 
     as follows:
       ``(E) for which care and services are furnished before 
     October 1, 2012, under this chapter to a veteran who--
       ``(i) has a service-connected disability; and

[[Page 5956]]

       ``(ii) is entitled to care (or payment of the expenses of 
     care) under a health-plan contract.''.

                 TITLE VI--DEPARTMENT PERSONNEL MATTERS

     SEC. 601. ENHANCEMENT OF AUTHORITIES FOR RETENTION OF MEDICAL 
                   PROFESSIONALS.

       (a) Secretarial Authority To Extend Title 38 Status to 
     Additional Positions.--
       (1) In general.--Paragraph (3) of section 7401 is amended 
     by striking ``and blind rehabilitation outpatient 
     specialists.'' and inserting the following: ``blind 
     rehabilitation outpatient specialists, and such other classes 
     of health care occupations as the Secretary considers 
     necessary for the recruitment and retention needs of the 
     Department subject to the following requirements:
       ``(A) Such other classes of health care occupations--
       ``(i) are not occupations relating to administrative, 
     clerical, or physical plant maintenance and protective 
     services;
       ``(ii) that would otherwise receive basic pay in accordance 
     with the General Schedule under section 5332 of title 5;
       ``(iii) provide, as determined by the Secretary, direct 
     patient care services or services incident to direct patient 
     services; and
       ``(iv) would not otherwise be available to provide medical 
     care or treatment for veterans.
       ``(B) Not later than 45 days before the Secretary appoints 
     any personnel for a class of health care occupations that is 
     not specifically listed in this paragraph, the Secretary 
     shall submit to the Committee on Veterans' Affairs of the 
     Senate, the Committee on Veterans' Affairs of the House of 
     Representatives, and the Office of Management and Budget 
     notice of such appointment.
       ``(C) Before submitting notice under subparagraph (B), the 
     Secretary shall solicit comments from any labor organization 
     representing employees in such class and include such 
     comments in such notice.''.
       (2) Appointment of nurse assistants.--Such paragraph is 
     further amended by inserting ``nurse assistants,'' after 
     ``licensed practical or vocational nurses,''.
       (b) Probationary Periods for Registered Nurses.--Section 
     7403(b) is amended--
       (1) in paragraph (1), by striking ``Appointments'' and 
     inserting ``Except as otherwise provided in this subsection, 
     appointments'';
       (2) by redesignating paragraph (2) as paragraph (4); and
       (3) by inserting after paragraph (1) the following new 
     paragraphs:
       ``(2) With respect to the appointment of a registered nurse 
     under this chapter, paragraph (1) shall apply with respect to 
     such appointment regardless of whether such appointment is on 
     a full-time basis or a part-time basis.
       ``(3) An appointment described in subsection (a) on a part-
     time basis of a person who has previously served on a full-
     time basis for the probationary period for the position 
     concerned shall be without a probationary period.''.
       (c) Prohibition on Temporary Part-time Registered Nurse 
     Appointments in Excess of Two Years.--Section 7405 is amended 
     by adding at the end the following new subsection:
       ``(g)(1) Except as provided in paragraph (3), employment of 
     a registered nurse on a temporary part-time basis under 
     subsection (a)(1) shall be for a probationary period of two 
     years.
       ``(2) Except as provided in paragraph (3), upon completion 
     by a registered nurse of the probationary period described in 
     paragraph (1)--
       ``(A) the employment of such nurse shall--
       ``(i) no longer be considered temporary; and
       ``(ii) be considered an appointment described in section 
     7403(a) of this title; and
       ``(B) the nurse shall be considered to have served the 
     probationary period required by section 7403(b).
       ``(3) This subsection shall not apply to appointments made 
     on a term limited basis of less than or equal to three years 
     of--
       ``(A) nurses with a part-time appointment resulting from an 
     academic affiliation or teaching position in a nursing 
     academy of the Department;
       ``(B) nurses appointed as a result of a specific research 
     proposal or grant; or
       ``(C) nurses who are not citizens of the United States and 
     appointed under section 7407(a) of this title.''.
       (d) Rate of Basic Pay for Appointees to the Office of the 
     Under Secretary for Health Set to Rate of Basic Pay for 
     Senior Executive Service Positions.--
       (1) In general.--Section 7404(a) is amended--
       (A) by striking ``The annual'' and inserting ``(1) The 
     annual'';
       (B) by striking ``The pay'' and inserting the following:
       ``(2) The pay'';
       (C) by striking ``under the preceding sentence'' and 
     inserting ``under paragraph (1)''; and
       (D) by adding at the end the following new paragraph:
       ``(3)(A) The rate of basic pay for a position to which an 
     Executive order applies under paragraph (1) and is not 
     described by paragraph (2) shall be set in accordance with 
     section 5382 of title 5 as if such position were a Senior 
     Executive Service position (as such term is defined in 
     section 3132(a) of title 5).
       ``(B) A rate of basic pay for a position may not be set 
     under subparagraph (A) in excess of--
       ``(i) in the case the position is not described in clause 
     (ii), the rate of basic pay payable for level III of the 
     Executive Schedule; or
       ``(ii) in the case that the position is covered by a 
     performance appraisal system that meets the certification 
     criteria established by regulation under section 5307(d) of 
     title 5, the rate of basic pay payable for level II of the 
     Executive Schedule.
       ``(C) Notwithstanding the provisions of subsection (d) of 
     section 5307 of title 5, the Secretary may make any 
     certification under that subsection instead of the Office of 
     Personnel Management and without concurrence of the Office of 
     Management and Budget.''.
       (2) Effective date.--The amendments made by paragraph (1) 
     shall take effect on the first day of the first pay period 
     beginning after the day that is 180 days after the date of 
     the enactment of this Act.
       (e) Special Incentive Pay for Department Pharmacist 
     Executives.--Section 7410 is amended--
       (1) by striking ``The Secretary may'' and inserting the 
     following:
       ``(a) In General.--The Secretary may''; and
       (2) by adding at the end the following new subsection:
       ``(b) Special Incentive Pay for Department Pharmacist 
     Executives.--(1) In order to recruit and retain highly 
     qualified Department pharmacist executives, the Secretary may 
     authorize the Under Secretary for Health to pay special 
     incentive pay of not more than $40,000 per year to an 
     individual of the Veterans Health Administration who is a 
     pharmacist executive.
       ``(2) In determining whether and how much special pay to 
     provide to such individual, the Under Secretary shall 
     consider the following:
       ``(A) The grade and step of the position of the individual.
       ``(B) The scope and complexity of the position of the 
     individual.
       ``(C) The personal qualifications of the individual.
       ``(D) The characteristics of the labor market concerned.
       ``(E) Such other factors as the Secretary considers 
     appropriate.
       ``(3) Special incentive pay under paragraph (1) for an 
     individual is in addition to all other pay (including basic 
     pay) and allowances to which the individual is entitled.
       ``(4) Except as provided in paragraph (5), special 
     incentive pay under paragraph (1) for an individual shall be 
     considered basic pay for all purposes, including retirement 
     benefits under chapters 83 and 84 of title 5, and other 
     benefits.
       ``(5) Special incentive pay under paragraph (1) for an 
     individual shall not be considered basic pay for purposes of 
     adverse actions under subchapter V of this chapter.
       ``(6) Special incentive pay under paragraph (1) may not be 
     awarded to an individual in an amount that would result in an 
     aggregate amount of pay (including bonuses and awards) 
     received by such individual in a year under this title that 
     is greater than the annual pay of the President.''.
       (f) Pay for Physicians and Dentists.--
       (1) Non-foreign cost of living adjustment allowance.--
     Section 7431(b) is amended by adding at the end the following 
     new paragraph:
       ``(5) The non-foreign cost of living adjustment allowance 
     authorized under section 5941 of title 5 for physicians and 
     dentists whose pay is set under this section shall be 
     determined as a percentage of base pay only.''.
       (2) Market pay determinations for physicians and dentists 
     in administrative or executive leadership positions.--Section 
     7431(c)(4)(B)(i) is amended by adding at the end the 
     following: ``The Secretary may exempt physicians and dentists 
     occupying administrative or executive leadership positions 
     from the requirements of the previous sentence.''.
       (3) Exception to prohibition on reduction of market pay.--
     Section 7431(c)(7) is amended by striking ``concerned.'' and 
     inserting ``concerned, unless there is a change in board 
     certification or reduction of privileges.''.
       (g) Adjustment of Pay Cap for Nurses.--Section 7451(c)(2) 
     is amended by striking ``level V'' and inserting ``level 
     IV''.
       (h) Exemption for Certified Registered Nurse Anesthetists 
     From Limitation on Authorized Competitive Pay.--Section 
     7451(c)(2) is further amended by adding at the end the 
     following new sentence: ``The maximum rate of basic pay for a 
     grade for the position of certified registered nurse 
     anesthetist pursuant to an adjustment under subsection (d) 
     may exceed the maximum rate otherwise provided in the 
     preceding sentence.''.
       (i) Increased Limitation on Special Pay for Nurse 
     Executives.--Section 7452(g)(2) is amended by striking 
     ``$25,000'' and inserting ``$100,000''.
       (j) Locality Pay Scale Computations.--
       (1) Education, training, and support for facility directors 
     in wage surveys.--Section 7451(d)(3) is amended by adding at 
     the end the following new subparagraph:

[[Page 5957]]

       ``(F) The Under Secretary for Health shall provide 
     appropriate education, training, and support to directors of 
     Department health care facilities in the conduct and use of 
     surveys, including the use of third-party surveys, under this 
     paragraph.''.
       (2) Information on methodology used in wage surveys.--
     Section 7451(e)(4) is amended--
       (A) by redesignating subparagraph (D) as subparagraph (E); 
     and
       (B) by inserting after subparagraph (C) the following new 
     subparagraph (D):
       ``(D) In any case in which the director conducts such a 
     wage survey during the period covered by the report and makes 
     adjustment in rates of basic pay applicable to one or more 
     covered positions at the facility, information on the 
     methodology used in making such adjustment or adjustments.''.
       (3) Disclosure of information to persons in covered 
     positions.--Section 7451(e), as amended by paragraph (2) of 
     this subsection, is further amended by adding at the end the 
     following new paragraph:
       ``(6)(A) Upon the request of an individual described in 
     subparagraph (B) for a report provided under paragraph (4) 
     with respect to a Department health-care facility, the Under 
     Secretary for Health or the director of such facility shall 
     provide to the individual the most current report for such 
     facility provided under such paragraph.
       ``(B) An individual described in this subparagraph is--
       ``(i) an individual in a covered position at a Department 
     health-care facility; or
       ``(ii) a representative of the labor organization 
     representing that individual who is designated by that 
     individual to make the request.''.
       (k) Eligibility of Part-Time Nurses for Additional Nurse 
     Pay.--
       (1) In general.--Section 7453 is amended--
       (A) in subsection (a), by striking ``a nurse'' and 
     inserting ``a full-time nurse or part-time nurse'';
       (B) in subsection (b)--
       (i) in the first sentence--

       (I) by striking ``on a tour of duty'';
       (II) by striking ``service on such tour'' and inserting 
     ``such service''; and
       (III) by striking ``of such tour'' and inserting ``of such 
     service''; and

       (ii) in the second sentence, by striking ``of such tour'' 
     and inserting ``of such service'';
       (C) in subsection (c)--
       (i) by striking ``on a tour of duty''; and
       (ii) by striking ``service on such tour'' and inserting 
     ``such service''; and
       (D) in subsection (e)--
       (i) in paragraph (1), by striking ``eight hours in a day'' 
     and inserting ``eight consecutive hours''; and
       (ii) in paragraph (5)(A), by striking ``tour of duty'' and 
     inserting ``period of service''.
       (2) Exclusion of application of additional nurse pay 
     provisions to certain additional employees.--Paragraph (3) of 
     section 7454(b) is amended to read as follows:
       ``(3) Employees appointed under section 7408 of this title 
     performing service on a tour of duty, any part of which is 
     within the period commencing at midnight Friday and ending at 
     midnight Sunday, shall receive additional pay in addition to 
     the rate of basic pay provided such employees for each hour 
     of service on such tour at a rate equal to 25 percent of such 
     employee's hourly rate of basic pay.''.
       (l) Enhanced Authority To Increase Rates of Basic Pay To 
     Obtain or Retain Services of Certain Persons.--Section 
     7455(c) is amended to read as follows:
       ``(c)(1) Subject to paragraph (2), the amount of any 
     increase under subsection (a) in the minimum rate for any 
     grade may not (except in the case of nurse anesthetists, 
     licensed practical nurses, licensed vocational nurses, 
     nursing positions otherwise covered by title 5, pharmacists, 
     and licensed physical therapists) exceed the maximum rate of 
     basic pay (excluding any locality-based comparability payment 
     under section 5304 of title 5 or similar provision of law) 
     for the grade or level by more than 30 percent.
       ``(2) No rate may be established under this section in 
     excess of the rate of basic pay payable for level IV of the 
     Executive Schedule.''.

     SEC. 602. LIMITATIONS ON OVERTIME DUTY, WEEKEND DUTY, AND 
                   ALTERNATIVE WORK SCHEDULES FOR NURSES.

       (a) Overtime Duty.--
       (1) In general.--Subchapter IV of chapter 74 is amended by 
     adding at the end the following new section:

     ``Sec. 7459. Nursing staff: special rules for overtime duty

       ``(a) Limitation.--Except as provided in subsection (c), 
     the Secretary may not require nursing staff to work more than 
     40 hours (or 24 hours if such staff is covered under section 
     7456 of this title) in an administrative work week or more 
     than eight consecutive hours (or 12 hours if such staff is 
     covered under section 7456 or 7456A of this title).
       ``(b) Voluntary Overtime.--(1) Nursing staff may on a 
     voluntary basis elect to work hours otherwise prohibited by 
     subsection (a).
       ``(2) The refusal of nursing staff to work hours prohibited 
     by subsection (a) shall not be grounds--
       ``(A) to discriminate (within the meaning of section 704(a) 
     of the Civil Rights Act of 1964 (42 U.S.C. 2000e-3(a))) 
     against the staff;
       ``(B) to dismiss or discharge the staff; or
       ``(C) for any other adverse personnel action against the 
     staff.
       ``(c) Overtime Under Emergency Circumstances.--(1) Subject 
     to paragraph (2), the Secretary may require nursing staff to 
     work hours otherwise prohibited by subsection (a) if--
       ``(A) the work is a consequence of an emergency that could 
     not have been reasonably anticipated;
       ``(B) the emergency is non-recurring and is not caused by 
     or aggravated by the inattention of the Secretary or lack of 
     reasonable contingency planning by the Secretary;
       ``(C) the Secretary has exhausted all good faith, 
     reasonable attempts to obtain voluntary workers;
       ``(D) the nurse staff have critical skills and expertise 
     that are required for the work; and
       ``(E) the work involves work for which the standard of care 
     for a patient assignment requires continuity of care through 
     completion of a case, treatment, or procedure.
       ``(2) Nursing staff may not be required to work hours under 
     this subsection after the requirement for a direct role by 
     the staff in responding to medical needs resulting from the 
     emergency ends.
       ``(d) Nursing Staff Defined.--In this section, the term 
     `nursing staff' includes the following:
       ``(1) A registered nurse.
       ``(2) A licensed practical or vocational nurse.
       ``(3) A nurse assistant appointed under this chapter or 
     title 5.
       ``(4) Any other nurse position designated by the Secretary 
     for purposes of this section.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of chapter 74 is amended by inserting after the 
     item relating to section 7458 the following new item:

``7459. Nursing staff: special rules for overtime duty.''.

       (b) Weekend Duty.--Section 7456 is amended--
       (1) by striking subsection (c); and
       (2) by redesignating subsection (d) as subsection (c).
       (c) Alternate Work Schedules.--
       (1) In general.--Section 7456A(b)(1)(A) is amended by 
     striking ``three regularly scheduled'' and all that follows 
     through the period at the end and inserting ``six regularly 
     scheduled 12-hour tours of duty within a 14-day period shall 
     be considered for all purposes to have worked a full 80-hour 
     pay period.''.
       (2) Conforming amendments.--Section 7456A(b) is amended--
       (A) in the subsection heading, by striking ``36/40'' and 
     inserting ``72/80'';
       (B) in paragraph (2)(A), by striking ``40-hour basic work 
     week'' and inserting ``80-hour pay period''; and
       (C) in paragraph (3), by striking ``regularly''.

     SEC. 603. REAUTHORIZATION OF HEALTH PROFESSIONALS EDUCATIONAL 
                   ASSISTANCE SCHOLARSHIP PROGRAM.

       (a) In General.--Section 7618 is amended by striking 
     ``December 31, 1998'' and inserting ``December 31, 2014''.
       (b) Expansion of Eligibility Requirements.--Section 
     7612(b)(2) is amended by striking ``(under section'' and all 
     that follows through ``or vocational nurse.'' and inserting 
     the following: ``as an appointee under paragraph (1) or (3) 
     of section 7401 of this title.''.
       (c) Additional Program Requirements.--Subchapter II of 
     chapter 76, as amended by subsections (a) and (b), is further 
     amended--
       (1) by redesignating section 7618 as section 7619; and
       (2) by inserting after section 7617 the following new 
     section:

     ``Sec. 7618. Additional program requirements

       ``(a) Program Modification.--Notwithstanding any provision 
     of this subchapter, the Secretary shall carry out this 
     subchapter after the date of the enactment of this section by 
     modifying the Scholarship Program in such a manner that the 
     program and hiring processes are designed to fully employ 
     Scholarship Program graduates as soon as possible, if not 
     immediately, upon graduation and completion of necessary 
     certifications, and to actively assist and monitor graduates 
     to ensure certifications are obtained in a minimal amount of 
     time following graduation.
       ``(b) Clinical Tours.--The Secretary shall require 
     participants in the Scholarship Program to perform clinical 
     tours in assignments or locations determined by the Secretary 
     while the participants are enrolled in the course of 
     education or training for which the scholarship is provided.
       ``(c) Mentors.--The Secretary shall ensure that at the 
     commencement of the period of obligated service of a 
     participant in the Scholarship Program, the participant is 
     assigned to a mentor who is employed in the same facility 
     where the participant performs such service.''.
       (d) Clerical Amendment.--The table of sections at the 
     beginning of chapter 76 is amended by striking the item 
     relating to section 7618 and inserting the following new 
     items:

``7618. Additional program requirements.
``7619. Expiration of program.''.

[[Page 5958]]



     SEC. 604. LOAN REPAYMENT PROGRAM FOR CLINICAL RESEARCHERS 
                   FROM DISADVANTAGED BACKGROUNDS.

       (a) In General.--The Secretary of Veterans Affairs may, in 
     consultation with the Secretary of Health and Human Services, 
     use the authorities available in section 487E of the Public 
     Health Service Act (42 U.S.C. 288-5) for the repayment of the 
     principal and interest of educational loans of appropriately 
     qualified health professionals who are from disadvantaged 
     backgrounds in order to secure clinical research by such 
     professionals for the Veterans Health Administration.
       (b) Limitations.--The exercise by the Secretary of Veterans 
     Affairs of the authorities referred to in subsection (a) 
     shall be subject to the conditions and limitations specified 
     in paragraphs (2) and (3) of section 487E(a) of the Public 
     Health Service Act (42 U.S.C. 288-5(a)(2) and (3)).
       (c) Funding.--Amounts for the repayment of principal and 
     interest of educational loans under this section shall be 
     derived from amounts available to the Secretary of Veterans 
     Affairs for the Veterans Health Administration for Medical 
     Services.

                  TITLE VII--HOMELESS VETERANS MATTERS

     SEC. 701. PER DIEM GRANT PAYMENTS TO NONCONFORMING ENTITIES.

       Section 2012 is amended by adding at the end the following 
     new subsection:
       ``(d) Per Diem Payments to Nonconforming Entities.--(1) The 
     Secretary may make funds available for per diem payments 
     under this section to the following grant recipients or 
     eligible entities:
       ``(A) Grant recipients or eligible entities that--
       ``(i) meet each of the transitional and supportive services 
     criteria prescribed by the Secretary pursuant to subsection 
     (a)(1); and
       ``(ii) furnish services to homeless individuals, of which 
     less than 75 percent are veterans.
       ``(B) Grant recipients or eligible entities that--
       ``(i) meet at least one, but not all, of the transitional 
     and supportive services criteria prescribed by the Secretary 
     pursuant to subsection (a)(1); and
       ``(ii) furnish services to homeless individuals, of which 
     not less than 75 percent are veterans.
       ``(C) Grant recipients or eligible entities that--
       ``(i) meet at least one, but not all, of the transitional 
     and supportive services criteria prescribed by the Secretary 
     pursuant to subsection (a)(1); and
       ``(ii) furnish services to homeless individuals, of which 
     less than 75 percent are veterans.
       ``(2) Notwithstanding subsection (a)(2), in providing per 
     diem payments under this subsection, the Secretary shall 
     determine the rate of such per diem payments in accordance 
     with the following order of priority:
       ``(A) Grant recipients or eligible entities described by 
     paragraph (1)(A).
       ``(B) Grant recipients or eligible entities described by 
     paragraph (1)(B).
       ``(C) Grant recipients or eligible entities described by 
     paragraph (1)(C).
       ``(3) For purposes of this subsection, an eligible entity 
     is a nonprofit entity and may be an entity that is ineligible 
     to receive a grant under section 2011 of this title, but whom 
     the Secretary determines carries out the purposes described 
     in that section.''.

       TITLE VIII--NONPROFIT RESEARCH AND EDUCATION CORPORATIONS

     SEC. 801. GENERAL AUTHORITIES ON ESTABLISHMENT OF 
                   CORPORATIONS.

       (a) Authorization of Multi-medical Center Research 
     Corporations.--
       (1) In general.--Section 7361 is amended--
       (A) by redesignating subsection (b) as subsection (e); and
       (B) by inserting after subsection (a) the following new 
     subsection (b):
       ``(b)(1) Subject to paragraph (2), a corporation 
     established under this subchapter may facilitate the conduct 
     of research, education, or both at more than one medical 
     center. Such a corporation shall be known as a `multi-medical 
     center research corporation'.
       ``(2) The board of directors of a multi-medical center 
     research corporation under this subsection shall include the 
     official at each Department medical center concerned who is, 
     or who carries out the responsibilities of, the medical 
     center director of such center as specified in section 
     7363(a)(1)(A)(i) of this title.
       ``(3) In facilitating the conduct of research, education, 
     or both at more than one Department medical center under this 
     subchapter, a multi-medical center research corporation may 
     administer receipts and expenditures relating to such 
     research, education, or both, as applicable, performed at the 
     Department medical centers concerned.''.
       (2) Expansion of existing corporations to multi-medical 
     center research corporations.--Such section is further 
     amended by adding at the end the following new subsection:
       ``(f) A corporation established under this subchapter may 
     act as a multi-medical center research corporation under this 
     subchapter in accordance with subsection (b) if--
       ``(1) the board of directors of the corporation approves a 
     resolution permitting facilitation by the corporation of the 
     conduct of research, education, or both at the other 
     Department medical center or medical centers concerned; and
       ``(2) the Secretary approves the resolution of the 
     corporation under paragraph (1).''.
       (b) Restatement and Modification of Authorities on 
     Applicability of State Law.--
       (1) In general.--Section 7361 as amended by subsection (a) 
     of this section, is further amended by inserting after 
     subsection (b) the following new subsection (c):
       ``(c) Any corporation established under this subchapter 
     shall be established in accordance with the nonprofit 
     corporation laws of the State in which the applicable 
     Department medical center is located and shall, to the extent 
     not inconsistent with any Federal law, be subject to the laws 
     of such State. In the case of any multi-medical center 
     research corporation that facilitates the conduct of 
     research, education, or both at Department medical centers 
     located in different States, the corporation shall be 
     established in accordance with the nonprofit corporation laws 
     of the State in which one of such Department medical centers 
     is located.''.
       (2) Conforming amendment.--Section 7365 is repealed.
       (c) Clarification of Status of Corporations.--Section 7361, 
     as amended by this section, is further amended--
       (1) in subsection (a), by striking the second sentence; and
       (2) by inserting after subsection (c) the following new 
     subsection (d):
       ``(d)(1) Except as otherwise provided in this subchapter or 
     under regulations prescribed by the Secretary, any 
     corporation established under this subchapter, and its 
     officers, directors, and employees, shall be required to 
     comply only with those Federal laws, regulations, and 
     executive orders and directives that apply generally to 
     private nonprofit corporations.
       ``(2) A corporation under this subchapter is not--
       ``(A) owned or controlled by the United States; or
       ``(B) an agency or instrumentality of the United States.''.
       (d) Reinstatement of Requirement for 501(c)(3) Status of 
     Corporations.--Subsection (e) of section 7361, as 
     redesignated by subsection (a)(1), is further amended by 
     inserting ``section 501(c)(3) of'' after ``exempt from 
     taxation under''.

     SEC. 802. CLARIFICATION OF PURPOSES OF CORPORATIONS.

       (a) Clarification of Purposes.--Subsection (a) of section 
     7362 is amended in the first sentence--
       (1) by striking ``Any corporation'' and all that follows 
     through ``facilitate'' and inserting ``A corporation 
     established under this subchapter shall be established to 
     provide a flexible funding mechanism for the conduct of 
     approved research and education at one or more Department 
     medical centers and to facilitate functions related to the 
     conduct of''; and
       (2) by inserting before the period at the end the 
     following: ``or centers''.
       (b) Modification of Defined Term Relating to Education and 
     Training.--Subsection (b) of such section is amended in the 
     matter preceding paragraph (1) by striking ``the term 
     `education and training''' and inserting ``the term 
     `education' includes education and training and''.
       (c) Repeal of Role of Corporations With Respect to 
     Fellowships.--Paragraph (1) of subsection (b) of such section 
     is amended by striking the flush matter following 
     subparagraph (C).
       (d) Availability of Education for Families of Veteran 
     Patients.--Paragraph (2) of subsection (b) of such section is 
     amended by striking ``to patients and to the families'' and 
     inserting ``and includes education and training for patients 
     and families''.

     SEC. 803. MODIFICATION OF REQUIREMENTS FOR BOARDS OF 
                   DIRECTORS OF CORPORATIONS.

       (a) Requirements for Department Board Members.--Paragraph 
     (1) of section 7363(a) is amended to read as follows:
       ``(1) with respect to the Department medical center--
       ``(A)(i) the director (or directors of each Department 
     medical center, in the case of a multi-medical center 
     research corporation);
       ``(ii) the chief of staff; and
       ``(iii) as appropriate for the activities of such 
     corporation, the associate chief of staff for research and 
     the associate chief of staff for education; or
       ``(B) in the case of a Department medical center at which 
     one or more of the positions referred to in subparagraph (A) 
     do not exist, the official or officials who are responsible 
     for carrying out the responsibilities of such position or 
     positions at the Department medical center; and''.
       (b) Requirements for Non-department Board Members.--
     Paragraph (2) of such section is amended--
       (1) by inserting ``not less than two'' before ``members''; 
     and
       (2) by striking ``and who'' and all that follows through 
     the period at the end and inserting ``and who have 
     backgrounds, or business, legal, financial, medical, or 
     scientific

[[Page 5959]]

     expertise, of benefit to the operations of the 
     corporation.''.
       (c) Conflicts of Interest.--Subsection (c) of section 7363 
     is amended by striking ``, employed by, or have any other 
     financial relationship with'' and inserting ``or employed 
     by''.

     SEC. 804. CLARIFICATION OF POWERS OF CORPORATIONS.

       (a) In General.--Section 7364 is amended to read as 
     follows:

     ``Sec. 7364. General powers

       ``(a) In General.--(1) A corporation established under this 
     subchapter may, solely to carry out the purposes of this 
     subchapter--
       ``(A) accept, administer, retain, and spend funds derived 
     from gifts, contributions, grants, fees, reimbursements, and 
     bequests from individuals and public and private entities;
       ``(B) enter into contracts and agreements with individuals 
     and public and private entities;
       ``(C) subject to paragraph (2), set fees for education and 
     training facilitated under section 7362 of this title, and 
     receive, retain, administer, and spend funds in furtherance 
     of such education and training;
       ``(D) reimburse amounts to the applicable appropriation 
     account of the Department for the Office of General Counsel 
     for any expenses of that Office in providing legal services 
     attributable to research and education agreements under this 
     subchapter; and
       ``(E) employ such employees as the corporation considers 
     necessary for such purposes and fix the compensation of such 
     employees.
       ``(2) Fees charged pursuant to paragraph (1)(C) for 
     education and training described in that paragraph to 
     individuals who are officers or employees of the Department 
     may not be paid for by any funds appropriated to the 
     Department.
       ``(3) Amounts reimbursed to the Office of General Counsel 
     under paragraph (1)(D) shall be available for use by the 
     Office of the General Counsel only for staff and training, 
     and related travel, for the provision of legal services 
     described in that paragraph and shall remain available for 
     such use without fiscal year limitation.
       ``(b) Transfer and Administration of Funds.--(1) Except as 
     provided in paragraph (2), any funds received by the 
     Secretary for the conduct of research or education at a 
     Department medical center or centers, other than funds 
     appropriated to the Department, may be transferred to and 
     administered by a corporation established under this 
     subchapter for such purposes.
       ``(2) A Department medical center may reimburse the 
     corporation for all or a portion of the pay, benefits, or 
     both of an employee of the corporation who is assigned to the 
     Department medical center if the assignment is carried out 
     pursuant to subchapter VI of chapter 33 of title 5.
       ``(3) A Department medical center may retain and use funds 
     provided to it by a corporation established under this 
     subchapter. Such funds shall be credited to the applicable 
     appropriation account of the Department and shall be 
     available, without fiscal year limitation, for the purposes 
     of that account.
       ``(c) Research Projects.--Except for reasonable and usual 
     preliminary costs for project planning before its approval, a 
     corporation established under this subchapter may not spend 
     funds for a research project unless the project is approved 
     in accordance with procedures prescribed by the Under 
     Secretary for Health for research carried out with Department 
     funds. Such procedures shall include a scientific review 
     process.
       ``(d) Education Activities.--Except for reasonable and 
     usual preliminary costs for activity planning before its 
     approval, a corporation established under this subchapter may 
     not spend funds for an education activity unless the activity 
     is approved in accordance with procedures prescribed by the 
     Under Secretary for Health.
       ``(e) Policies and Procedures.--The Under Secretary for 
     Health may prescribe policies and procedures to guide the 
     spending of funds by corporations established under this 
     subchapter that are consistent with the purpose of such 
     corporations as flexible funding mechanisms and with Federal 
     and State laws and regulations, and executive orders, 
     circulars, and directives that apply generally to the receipt 
     and expenditure of funds by nonprofit organizations exempt 
     from taxation under section 501(c)(3) of the Internal Revenue 
     Code of 1986.''.
       (b) Conforming Amendment.--Section 7362(a), as amended by 
     section 802(a)(1) of this Act, is further amended by striking 
     the last sentence.

     SEC. 805. REDESIGNATION OF SECTION 7364A OF TITLE 38, UNITED 
                   STATES CODE.

       (a) Redesignation.--Section 7364A is redesignated as 
     section 7365.
       (b) Clerical Amendments.--The table of sections at the 
     beginning of chapter 73 is amended--
       (1) by striking the item relating to section 7364A; and
       (2) by striking the item relating to section 7365 and 
     inserting the following new item:

``7365. Coverage of employees under certain Federal tort claims 
              laws.''.

     SEC. 806. IMPROVED ACCOUNTABILITY AND OVERSIGHT OF 
                   CORPORATIONS.

       (a) Additional Information in Annual Reports.--Subsection 
     (b) of section 7366 is amended to read as follows:
       ``(b)(1) Each corporation shall submit to the Secretary 
     each year a report providing a detailed statement of the 
     operations, activities, and accomplishments of the 
     corporation during that year.
       ``(2)(A) A corporation with revenues in excess of $500,000 
     for any year shall obtain an audit of the corporation for 
     that year.
       ``(B) A corporation with annual revenues between $100,000 
     and $500,000 shall obtain an audit of the corporation at 
     least once every three years.
       ``(C) Any audit under this paragraph shall be performed by 
     an independent auditor.
       ``(3) The corporation shall include in each report to the 
     Secretary under paragraph (1) the following:
       ``(A) The most recent audit of the corporation under 
     paragraph (2).
       ``(B) The most recent Internal Revenue Service Form 990 
     `Return of Organization Exempt from Income Tax' or equivalent 
     and the applicable schedules under such form.''.
       (b) Conflict of Interest Policies.--Subsection (c) of such 
     section is amended to read as follows:
       ``(c) Each director, officer, and employee of a corporation 
     established under this subchapter shall be subject to a 
     conflict of interest policy adopted by that corporation.''.
       (c) Establishment of Appropriate Payee Reporting 
     Threshold.--Subsection (d)(3)(C) of such section is amended 
     by striking ``$35,000'' and inserting ``$50,000''.

               TITLE IX--CONSTRUCTION AND NAMING MATTERS

     SEC. 901. AUTHORIZATION OF MEDICAL FACILITY PROJECTS.

       (a) Authorization of Fiscal Year 2010 Major Medical 
     Facility Projects.--The Secretary of Veterans Affairs may 
     carry out the following major medical facility projects in 
     fiscal year 2010, with each project to be carried out in the 
     amount specified for such project:
       (1) Construction (including acquisition of land) for the 
     realignment of services and closure projects at the 
     Department of Veterans Affairs Medical Center in Livermore, 
     California, in an amount not to exceed $55,430,000.
       (2) Construction (including acquisition of land) for a new 
     medical facility at the Department of Veterans Affairs 
     Medical Center in Louisville, Kentucky, in an amount not to 
     exceed $75,000,000.
       (3) Construction (including acquisition of land) for a 
     clinical expansion for a Mental Health Facility at the 
     Department of Veterans Affairs Medical Center in Dallas, 
     Texas, in an amount not to exceed $15,640,000.
       (4) Construction (including acquisition of land) for a 
     replacement bed tower and clinical expansion at the 
     Department of Veterans Affairs Medical Center in St. Louis, 
     Missouri, in an amount not to exceed $43,340,000.
       (b) Extension of Authorization for Major Medical Facility 
     Construction Projects Previously Authorized.--The Secretary 
     of Veterans Affairs may carry out the following major medical 
     facility projects in fiscal year 2010, as follows with each 
     project to be carried out in the amount specified for such 
     project:
       (1) Replacement of the existing Department of Veterans 
     Affairs Medical Center in Denver, Colorado, in an amount not 
     to exceed $800,000,000.
       (2) Construction of Outpatient and Inpatient Improvements 
     in Bay Pines, Florida, in an amount not to exceed 
     $194,400,000.
       (c) Authorization of Appropriations.--
       (1) Authorization of appropriations for construction.--
     There is authorized to be appropriated to the Secretary of 
     Veterans Affairs for fiscal year 2010, or the year in which 
     funds are appropriated, for the Construction, Major Projects 
     account--
       (A) $189,410,000 for the projects authorized in subsection 
     (a); and
       (B) $994,400,000 for the projects authorized in subsection 
     (b).
       (2) Limitation.--The projects authorized in subsections (a) 
     and (b) may only be carried out using--
       (A) funds appropriated for fiscal year 2010 pursuant to the 
     authorization of appropriations in paragraph (1);
       (B) funds available for Construction, Major Projects for a 
     fiscal year before fiscal year 2010 that remain available for 
     obligation;
       (C) funds available for Construction, Major Projects for a 
     fiscal year after fiscal year 2010 that remain available for 
     obligation;
       (D) funds appropriated for Construction, Major Projects for 
     fiscal year 2010 for a category of activity not specific to a 
     project;
       (E) funds appropriated for Construction, Major Projects for 
     a fiscal year before 2010 for a category of activity not 
     specific to a project; and
       (F) funds appropriated for Construction, Major Projects for 
     a fiscal year after 2010 for a category of activity not 
     specific to a project.

     SEC. 902. DESIGNATION OF MERRIL LUNDMAN DEPARTMENT OF 
                   VETERANS AFFAIRS OUTPATIENT CLINIC, HAVRE, 
                   MONTANA.

       (a) Designation.--The Department of Veterans Affairs 
     outpatient clinic in Havre, Montana, shall after the date of 
     the enactment of this Act be known and designated as

[[Page 5960]]

     the ``Merril Lundman Department of Veterans Affairs 
     Outpatient Clinic''.
       (b) References.--Any reference in any law, regulation, map, 
     document, record, or other paper of the United States to the 
     outpatient clinic referred to in subsection (a) shall be 
     considered to be a reference to the Merril Lundman Department 
     of Veterans Affairs Outpatient Clinic.

     SEC. 903. DESIGNATION OF WILLIAM C. TALLENT DEPARTMENT OF 
                   VETERANS AFFAIRS OUTPATIENT CLINIC, KNOXVILLE, 
                   TENNESSEE.

       (a) Designation.--The Department of Veterans Affairs 
     Outpatient Clinic in Knoxville, Tennessee, shall after the 
     date of the enactment of this Act be known and designated as 
     the ``William C. Tallent Department of Veterans Affairs 
     Outpatient Clinic''.
       (b) References.--Any reference in any law, regulation, map, 
     document, record, or other paper of the United States to the 
     outpatient clinic referred to in subsection (a) shall be 
     considered to be a reference to the William C. Tallent 
     Department of Veterans Affairs Outpatient Clinic.

     SEC. 904. DESIGNATION OF MAX J. BEILKE DEPARTMENT OF VETERANS 
                   AFFAIRS OUTPATIENT CLINIC, ALEXANDRIA, 
                   MINNESOTA.

       (a) Designation.--The Department of Veterans Affairs 
     outpatient clinic in Alexandria, Minnesota, shall after the 
     date of the enactment of this Act be known and designated as 
     the ``Max J. Beilke Department of Veterans Affairs Outpatient 
     Clinic''.
       (b) References.--Any reference in any law, regulation, map, 
     document, record, or other paper of the United States to the 
     outpatient clinic referred to in subsection (a) shall be 
     considered to be a reference to the Max J. Beilke Department 
     of Veterans Affairs Outpatient Clinic.

                         TITLE X--OTHER MATTERS

     SEC. 1001. EXPANSION OF AUTHORITY FOR DEPARTMENT OF VETERANS 
                   AFFAIRS POLICE OFFICERS.

       Section 902 is amended--
       (1) in subsection (a)--
       (A) by amending paragraph (1) to read as follows:
       ``(1) Employees of the Department who are Department police 
     officers shall, with respect to acts occurring on Department 
     property--
       ``(A) enforce Federal laws;
       ``(B) enforce the rules prescribed under section 901 of 
     this title;
       ``(C) enforce traffic and motor vehicle laws of a State or 
     local government (by issuance of a citation for violation of 
     such laws) within the jurisdiction of which such Department 
     property is located as authorized by an express grant of 
     authority under applicable State or local law;
       ``(D) carry the appropriate Department-issued weapons, 
     including firearms, while off Department property in an 
     official capacity or while in an official travel status;
       ``(E) conduct investigations, on and off Department 
     property, of offenses that may have been committed on 
     property under the original jurisdiction of Department, 
     consistent with agreements or other consultation with 
     affected Federal, State, or local law enforcement agencies; 
     and
       ``(F) carry out, as needed and appropriate, the duties 
     described in subparagraphs (A) through (E) when engaged in 
     duties authorized by other Federal statutes.'';
       (B) by striking paragraph (2) and redesignating paragraph 
     (3) as paragraph (2); and
       (C) in paragraph (2), as redesignated by subparagraph (B) 
     of this paragraph, by inserting ``, and on any arrest warrant 
     issued by competent judicial authority'' before the period; 
     and
       (2) by amending subsection (c) to read as follows:
       ``(c) The powers granted to Department police officers 
     designated under this section shall be exercised in 
     accordance with guidelines approved by the Secretary and the 
     Attorney General.''.

     SEC. 1002. UNIFORM ALLOWANCE FOR DEPARTMENT OF VETERANS 
                   AFFAIRS POLICE OFFICERS.

       Section 903 is amended--
       (1) by striking subsection (b) and inserting the following 
     new subsection (b):
       ``(b)(1) The amount of the allowance that the Secretary may 
     pay under this section is the lesser of--
       ``(A) the amount currently allowed as prescribed by the 
     Office of Personnel Management; or
       ``(B) estimated costs or actual costs as determined by 
     periodic surveys conducted by the Department.
       ``(2) During any fiscal year no officer shall receive more 
     for the purchase of a uniform described in subsection (a) 
     than the amount established under this subsection.''; and
       (2) by striking subsection (c) and inserting the following 
     new subsection (c):
       ``(c) The allowance established under subsection (b) shall 
     be paid at the beginning of a Department police officer's 
     employment for those appointed on or after October 1, 2010. 
     In the case of any other Department police officer, an 
     allowance in the amount established under subsection (b) 
     shall be paid upon the request of the officer.''.

     SEC. 1003. SUBMISSION OF REPORTS TO CONGRESS BY SECRETARY OF 
                   VETERANS AFFAIRS IN ELECTRONIC FORM.

       (a) In General.--Chapter 1 is amended by adding at the end 
     the following new section:

     ``Sec. 118. Submission of reports to Congress in electronic 
       form

       ``(a) In General.--Whenever the Secretary or any other 
     official of the Department is required by law to submit to 
     Congress (or any committee of either chamber of Congress) a 
     report, the Secretary or other official shall submit to 
     Congress (or such committee) a copy of the report in an 
     electronic format.
       ``(b) Treatment.--The submission of a copy of a report in 
     accordance with this section shall be treated as meeting any 
     requirement of law to submit such report to Congress (or any 
     committee of either chamber of Congress).
       ``(c) Report Defined.--For purposes of this section, the 
     term `report' includes any certification, notification, or 
     other communication in writing.''.
       (b) Technical and Clerical Amendments.--The table of 
     sections at the beginning of chapter 1 is amended--
       (1) by striking the item relating to section 117; and
       (2) by adding at the end the following new items:

``117. Advance appropriations for certain medical care accounts.
``118. Reports to Congress: submission in electronic form.''.

     SEC. 1004. DETERMINATION OF BUDGETARY EFFECTS FOR PURPOSES OF 
                   COMPLIANCE WITH STATUTORY PAY-AS-YOU-GO-ACT OF 
                   2010.

       The budgetary effects of this Act, for the purpose of 
     complying with the Statutory Pay-As-You-Go-Act of 2010, shall 
     be determined by reference to the latest statement titled 
     ``Budgetary Effects of PAYGO Legislation'' for this Act, 
     submitted for printing in the Congressional Record by the 
     Chairman of the House Budget Committee, provided that such 
     statement has been submitted prior to the vote on passage.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Filner) and the gentleman from Indiana (Mr. Buyer) each 
will control 20 minutes.
  The Chair recognizes the gentleman from California.


                             General Leave

  Mr. FILNER. I ask unanimous consent that all Members may have 5 
legislative days in which to revise and extend their remarks and 
include extraneous materials on S. 1963, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. FILNER. I yield myself 4 minutes.
  Mr. Speaker, when I became chairman of the Committee on Veterans' 
Affairs 3 years ago, the VA was strained to the breaking point by years 
of chronic underfunding. We were a country at war; yet, the Department 
of Veterans Affairs remained unprepared to care for the hundreds of 
thousands of new veterans returning from Iraq and Afghanistan.
  It is simply our duty as a Nation, no matter where we stand on the 
war, to put our men and women in harm's way under the care of our 
Nation when they return. Under the Democratic leadership, Congress has 
provided almost a 60 percent increase for VA medical care funding over 
the last 3 years, adding over $20 billion to the VA budget baseline.
  S. 1963 demonstrates America's commitment to the dedicated 
servicemembers who have served in uniform and puts front and center the 
health care needs of veterans and their families. It is our pledge to 
them that we have not forgotten the sacrifices they have made in 
defense of this country. So in this bill, we help caregivers of injured 
veterans, women veterans, rural veterans, homeless veterans, and 
veterans with mental health issues.
  S. 1963 provides immediate support to the mothers, fathers, husbands, 
and wives caring for warriors from the current conflicts as well as 
from previous conflicts. Today we have the opportunity to recognize 
their tremendous sacrifice and share their heavy burden.
  The bill also expands and improves VA services for the 1.8 million 
women veterans currently receiving VA health care and goes a step 
further by anticipating the expected increase of women warriors over 
the next 5 years. This bill seeks to build a VA health care system 
respectful of the unique medical needs of women veterans.

[[Page 5961]]

  S. 1963 also advances America's commitment to end veterans' 
homelessness. Hundreds of thousands of veterans are at risk of 
homelessness because of poverty and the lack of support from family and 
friends. An increasing number of veterans of operations in Afghanistan 
and Iraq are falling into this category, and we must be vigilant in 
providing support to this population.
  We expand the number of places where homeless vets may receive 
supportive services; and for our veterans struggling without a roof 
over their heads, this small change in the law will make a big 
difference in their lives.
  The bill also includes key provisions to improve health care provided 
to our rural veterans by authorizing stronger partnerships with 
community providers and the Department of Health and Human Services. 
These collaborations will allow VA to offer health care options to 
servicemembers living far from the nearest medical facility.
  In addition, we address the troubling reality of posttraumatic stress 
disorder and troubling incidents of suicide amongst the veterans' 
population. The bill requires a much-needed and long-awaited study on 
veteran suicide and requires the VA to provide counseling referrals for 
former members of the Armed Forces who are not otherwise eligible for 
readjustment counseling.
  S. 1963 provides higher priority status for Medal of Honor 
recipients, establishes a director of physician assistant services, and 
creates a committee on care of veterans with traumatic brain injury. It 
requires the VA to provide health care for herbicide-exposed Vietnam 
veterans and veterans of the Persian Gulf War who have insufficient 
medical evidence to establish a service-connected disability, and it 
prohibits the VA from collecting copayments from veterans who are 
catastrophically disabled.
  This bill, Mr. Speaker, demands our immediate attention. We owe our 
veterans a great debt of gratitude, and this bill represents an 
understanding that the sacrifices of our veterans are shared amongst 
all Americans.
  I urge all of my colleagues to support passage of S. 1963, as 
amended, and reserve the balance of my time.

 Explanatory Statement Submitted by Mr. Filner, Chairman of the House 
Committee on Veterans' Affairs, Regarding the Amendment of the House of 
                       Representatives to S. 1963

      Caregivers and Veterans Omnibus Health Services Act of 2010

       S. 1963, as amended, the ``Caregivers and Veterans Omnibus 
     Health Services Act of 2010,'' reflects the Compromise 
     Agreement between the Committees on Veterans' Affairs of the 
     Senate and the House of Representatives (the Committees) on 
     health care and related provisions for veterans and their 
     caregivers. The provisions in the Compromise Agreement are 
     derived from a number of bills that were introduced and 
     considered by the House and Senate during the 111th Congress. 
     These bills include S. 1963, a bill to provide assistance to 
     caregivers of veterans, to improve the provision of health 
     care to veterans, and for other purposes, which passed the 
     Senate on November 19, 2009 (Senate bill); and H.R. 3155, a 
     bill to provide certain caregivers of veterans with training, 
     support, and medical care, and for other purposes, which 
     passed the House on July 27, 2009 (House bill).
       In addition, the Compromise Agreement includes provisions 
     derived from the following bills which were passed by the 
     House: H.R. 402, a bill to designate the Department of 
     Veterans Affairs Outpatient Clinic in Knoxville, Tennessee, 
     as the ``William C. Tallent Department of Veterans Affairs 
     Outpatient Clinic,'' passed by the House on July 14, 2009; 
     H.R. 1211, a bill to expand and improve health care services 
     available to women veterans, especially those serving in 
     Operation Enduring Freedom and Operation Iraqi Freedom, from 
     the Department of Veterans Affairs, and for other purposes, 
     passed by the House on June 23, 2009; H.R. 1293, a bill to 
     provide for an increase in the amount payable by the 
     Secretary of Veterans Affairs to veterans for improvements 
     and structural alterations furnished as part of home health 
     services, passed by the House on July 28, 2009; H.R. 2770, a 
     bill to modify and update provisions of law relating to 
     nonprofit research and education corporations, and for other 
     purposes, passed by the House on July 27, 2009; H.R. 3157, a 
     bill to name the Department of Veterans Affairs outpatient 
     clinic in Alexandria, Minnesota, as the ``Max J. Beilke 
     Department of Veterans Affairs Outpatient Clinic,'' passed by 
     the House on November 3, 2009; H.R. 3219, a bill to make 
     certain improvements in the laws administered by the 
     Secretary of Veterans Affairs relating to insurance and 
     health care, and for other purposes, passed by the House on 
     July 27, 2009; and H.R. 3949, a bill to make certain 
     improvements in the laws relating to benefits administered by 
     the Secretary of Veterans Affairs, and for other purposes, 
     passed by the House on November 3, 2009.
       The Compromise Agreement also includes provisions derived 
     from the following House bills, which were introduced and 
     referred to the Subcommittee on Health of the House Committee 
     on Veterans' Affairs: H.R. 919, to enhance the capacity of 
     the Department of Veterans Affairs to recruit and retain 
     nurses and other critical health care professionals, and for 
     other purposes, which was introduced on February 9, 2009; 
     H.R. 3796, to improve per diem grant payments for 
     organizations assisting homeless veterans, which was 
     introduced on October 13, 2009; and H.R. 4166, to make 
     certain improvements in the laws administered by the 
     Secretary of Veterans Affairs relating to educational 
     assistance for health professionals, and for other purposes, 
     which was introduced on December 1, 2009, and was 
     concurrently referred to the Committee on Energy and 
     Commerce.
       The House and Senate Committees on Veterans' Affairs have 
     prepared the following explanation of the Compromise 
     Agreement. Differences between the provisions contained in 
     the Compromise Agreement and the related provisions in the 
     bills listed above are noted in this document, except for 
     clerical corrections and conforming changes, and minor 
     drafting, technical, and clarifying changes.


                       Title I--Caregiver Support

     Assistance and Support Services for Family Caregivers 
         (section 101)
       The Senate bill contains a provision (section 102) that 
     would create a new program to help caregivers of eligible 
     veterans who, together with the veteran, submit a joint 
     application requesting services under the new program. 
     Eligible veterans are defined as those who have a serious 
     injury, including traumatic brain injury, psychological 
     trauma, or other mental disorder, incurred or aggravated 
     while on active duty on or after September 11, 2001. Within 
     two years of program implementation, the Department of 
     Veterans Affairs (VA) would be required to submit a report on 
     the feasibility and advisability of extending the program to 
     veterans of earlier periods of service. Severely injured 
     veterans are defined as those who need personal care services 
     because they are unable to perform one or more independent 
     activities of daily living, require supervision as a result 
     of neurological or other impairments, or need personal care 
     services because of other matters specified by the VA. For 
     accepted caregiver applicants, VA would be required to 
     provide respite care as well as pay for travel, lodging and 
     per-diem expenses while the caregiver of an eligible veteran 
     is undergoing necessary training and education to provide 
     personal care services. Once a caregiver completes training 
     and is designated as the primary personal care attendant, 
     this individual would receive ongoing assistance including 
     direct technical support, counseling and mental health 
     services, respite care of no less than 30 days annually, 
     health care through the Civilian Health and Medical Program 
     of the Department of Veterans Affairs (CHAMPVA), and a 
     monthly financial stipend. The provision in the Senate bill 
     would require VA to carry out oversight of the caregiver by 
     utilizing the services of home health agencies. A home health 
     agency would be required to visit the home of a veteran not 
     less often than once every six months and report its findings 
     to VA. Based on the findings, VA would have the final 
     authority to revoke a caregiver's designation as a primary 
     personal care attendant. The provision also would require an 
     implementation and evaluation report, and provide for an 
     effective date 270 days after the date of the enactment of 
     this Act.
       The House bill contains comparable provisions (section 2 
     and section 4) with some key differences. The provisions in 
     the House bill would provide educational sessions, access to 
     a list of comprehensive caregiver support services available 
     at the county level, information and outreach, respite care, 
     and counseling and mental health services to family and non-
     family caregivers of veterans of any era. For family 
     caregivers of eligible veterans who served in Operation 
     Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF), the 
     House bill would require VA to provide a monthly financial 
     stipend, health care service through CHAMPVA, and lodging and 
     subsistence to the caregiver when the caregiver accompanies 
     the veteran on medical care visits. Eligible OEF or OIF 
     veterans are defined as those who have a service-connected 
     disability or illness that is severe; in need of caregiver 
     services without which the veteran would be hospitalized, or 
     placed in nursing home care or other residential 
     institutional care; and are unable to carry out activities 
     (including instrumental activities) of daily living.
       The Compromise Agreement contains the Senate provision 
     modified to no longer require VA to enter into relationships 
     with home health agencies to make home visits every six 
     months. In addition, the Compromise Agreement follows the 
     House bill in creating a separate program of general family 
     caregiver support services for family and

[[Page 5962]]

     non-family caregivers of veterans of any era. Such support 
     services would include training and education, counseling and 
     mental health services, respite care, and information on the 
     support services available to caregivers through other 
     public, private, and nonprofit agencies. In the event that 
     sufficient funding is not available to provide training and 
     education services, the Secretary would be given the 
     authority to suspend the provision of such services. The 
     Secretary would be required to certify to the Committees that 
     there is insufficient funding 180 days before suspending the 
     provision of these services. This certification and the 
     resulting suspension of services would expire at the end of 
     the fiscal year concerned.
       The overall caregiver support program for caregivers of 
     eligible OEF or OIF veterans would authorize VA to provide 
     training and supportive services to family members and 
     certain others who wish to care for a disabled veteran in the 
     home and to allow veterans to receive the most appropriate 
     level of care. The newly authorized supportive services would 
     include training and certification, a living stipend, and 
     health care--including mental health counseling, 
     transportation benefits, and respite.
       The Compromise Agreement also includes an authorization for 
     appropriations that is below the estimate furnished by the 
     Congressional Budget Office. The lower authorization level is 
     based on information contained in a publication (Economic 
     Impact on Caregivers of the Seriously Wounded, Ill, and 
     Injured, April 2009) of the Center for Naval Analyses (CNA). 
     This study estimated that, annually, 720 post-September 11, 
     2001 veterans require comprehensive caregiver services. The 
     Compromise Agreement limits the caregiver program only to 
     ``seriously injured or very seriously injured'' veterans who 
     were injured or aggravated an injury in the line of duty on 
     or after September 11, 2001. CNA found that the average 
     requirement for such caregiver services is 18 months, and 
     that only 43 percent of veterans require caregiver services 
     over the long-term. CNA also found that, on average, veterans 
     need only 21 hours of caregiver services per week. Only 233 
     family caregivers were referred by VA for training and 
     certification through existing home health agencies in FY 
     2008. This represented five percent of all home care 
     referrals. In FY 2009, only 168 family caregivers were 
     referred to home care agencies for training and 
     certification.
     Medical Care for Family Caregivers (section 102)
       The Senate bill contains a provision (section 102) that 
     would provide health care through the CHAMPVA program for 
     individuals designated as the primary care attendant for 
     eligible OEF or OIF veterans and who have no other insurance 
     coverage.
       The House bill contains a comparable provision (section 5), 
     with a difference in the target population. Under the House 
     bill, the target population would include all family 
     caregivers of eligible OEF or OIF veterans, defined as those 
     who have a service-connected disability or illness that is 
     severe; are in need of caregiver services without which 
     hospitalization, nursing home care, or other residential 
     institutional care would be required; and, are unable to 
     carry out activities (including instrumental activities) of 
     daily living.
       The Compromise Agreement contains the Senate provision.
     Counseling and Mental Health Services for Family Caregivers 
         (section 103)
       The Senate bill contains a provision (section 102) that 
     would provide counseling and mental health services for 
     family caregivers of OEF or OIF veterans.
       The House bill contains a comparable provision (section 3), 
     except that counseling and mental health services would be 
     available to caregivers of veterans of any era.
       The Compromise Agreement contains the House provision.
     Lodging and Subsistence for Attendants (section 104)
       The Senate bill contains a provision (section 103) that 
     would allow VA to pay for the lodging and subsistence costs 
     incurred by any attendant who accompanies an eligible OEF or 
     OIF veteran seeking VA health care.
       The House bill contains a comparable provision (section 6), 
     with a difference in the target population. Under the House 
     bill, the target population would include all family 
     caregivers of eligible OEF or OIF veterans, defined as those 
     who have a service-connected disability or illness that is 
     severe; are in need of caregiver services without which 
     hospitalization, nursing home care, or other residential 
     institutional care would be required; and, are unable to 
     carry out activities (including instrumental activities) of 
     daily living.
       The Compromise Agreement contains the Senate provision.


              Title II--Women Veterans Health Care Matters

     Study of Barriers for Women Veterans to Health Care from the 
         Department of Veterans Affairs (section 201)
       The Senate bill contains a provision (section 201) that 
     would require VA to report, by June 1, 2010, on barriers 
     facing women veterans who seek health care at VA, especially 
     women veterans of OEF or OIF.
       H.R. 1211 contains a comparable provision (section 101) 
     that would require a similar study of health care barriers 
     for women veterans. The House provision also would define the 
     parameters of the research study sample; direct VA to build 
     on the work of an existing study entitled ``National Survey 
     of Women Veterans in Fiscal Year 2007-2008;'' mandate VA to 
     share the barriers study data with the Center for Women 
     Veterans and the Advisory Committee on Women Veterans; and 
     authorize appropriations of $4 million to conduct the study. 
     VA would be required to submit to Congress a report on the 
     implementation of this section within six months of the 
     publication of the ``National Survey of Women Veterans in 
     Fiscal Year 2007-2008'', and the final report within 30 
     months of publication.
       The Compromise Agreement contains the House provision.
     Training and Certification for Mental Health Care Providers 
         of the Department of Veterans Affairs on Care for 
         Veterans Suffering from Sexual Trauma and Post-Traumatic 
         Stress Disorder (section 202)
       The Senate bill contains a provision (section 204) that 
     would require VA to implement a program for education, 
     training, certification, and continuing medical education for 
     mental health professionals, which would include principles 
     of evidence-based treatment and care for sexual trauma. VA 
     would also be required to submit an annual report on the 
     counseling, care, and services provided to veterans suffering 
     from sexual trauma, and to establish education, training, 
     certification, and staffing standards for personnel providing 
     treatment for veterans with sexual trauma.
       H.R. 1211 contains a similar provision (section 202), 
     except it included no provision requiring VA to establish 
     education, training, certification, and staffing standards 
     for the mental health professionals caring for veterans with 
     sexual trauma.
       The Compromise Agreement contains the House provision.
     Pilot Program on Counseling in Retreat Settings for Women 
         Veterans Newly Separated from Service in the Armed Forces 
         (section 203)
       The Senate bill contains a provision (section 205) that 
     would require VA to establish, at a minimum of five 
     locations, a two-year pilot program in which women veterans 
     newly separated from the Armed Forces would receive 
     reintegration and readjustment services in a group retreat 
     setting. The provision also would require a report detailing 
     the pilot program findings and providing recommendations on 
     whether VA should continue or expand the pilot program.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision but 
     specifies that the program be carried out at a minimum of 
     three, not five, locations.
     Service on Certain Advisory Committees of Women Recently 
         Separated from Service in the Armed Forces (section 204)
       The Senate bill contains a provision (section 207) that 
     would amend the membership of the Advisory Committee on Women 
     Veterans and the Advisory Committee on Minority Veterans to 
     require that such committees include women recently separated 
     from the Armed Forces and women who are minority group 
     members and are recently separated from the Armed Forces, 
     respectively.
       H.R. 1211 contains a similar provision (section 204) except 
     that it would allow either men or women who are members of a 
     minority group to serve on the Advisory Committee on Minority 
     Veterans.
       The Compromise Agreement contains the Senate provision.
     Pilot Program on Subsidies for Child Care for Certain 
         Veterans Receiving Health Care (section 205)
       The Senate bill contains a provision (section 208) that 
     would require VA to establish a pilot program through which 
     child care subsidies would be provided to women veterans 
     receiving regular and intensive mental health care and 
     intensive health care services. The pilot program would be 
     carried out in no fewer than three Veterans Integrated 
     Service Networks (VISNs) for a duration of two years and, at 
     its conclusion, there would be a requirement for a report to 
     be submitted within six months detailing findings related to 
     the program and recommendations on its continuation or 
     extension. The provision also would direct VA, to the extent 
     practicable, to model the pilot program after an existing VA 
     Child Care Subsidy Program.
       H.R. 1211 contains a comparable provision (section 203), 
     but it does not stipulate that the child care program shall 
     be executed through stipends. Rather, stipends are one option 
     among several listed, including partnership with private 
     agencies, collaboration with facilities or program of other 
     Federal departments or agencies, and the arrangement of 
     after-school care.
       The Compromise Agreement contains the Senate provision, 
     with a modification to clarify that the child care subsidy 
     payments shall cover the full cost of child care services. In 
     addition, the provision expands the definition of veterans 
     who qualify for the child care subsidy to women veterans who 
     are in need of regular or intensive mental health care 
     services but who do not seek such care due to lack of child 
     care services. Finally, the Compromise Agreement follows the 
     House provision by allowing for other

[[Page 5963]]

     forms of child care assistance. In addition to stipends, 
     child care services may be provided through the direct 
     provision of child care at an on-site VA facility, payments 
     to private child care agencies, collaboration with facilities 
     or programs of other Federal departments or agencies, and 
     other forms as deemed appropriate by the Secretary.
     Care for Newborn Children of Women Veterans Receiving 
         Maternity Care (section 206)
       The Senate bill contains a provision (section 209) that 
     would authorize VA to provide post-delivery health care 
     services to a newborn child of a woman veteran receiving 
     maternity care from VA if the child was delivered in a VA 
     facility or a non-VA facility pursuant to a VA contract for 
     delivery. Such care would be authorized for up to seven days.
       H.R. 1211 contains a comparable provision (section 201), 
     but would allow VA to provide care for a set seven-day period 
     for newborn children of women veterans receiving maternity 
     care.
       The Compromise Agreement contains the Senate provision.


                  Title III--Rural Health Improvements

     Improvements to the Education Debt Reduction Program (section 
         301)
       The Senate bill contains a provision (section 301) that 
     would eliminate the cap in current law on the total amount of 
     education debt reduction payments that can be made over five 
     years so as to permit payments equal to the total amount of 
     principal and interest owed on eligible loans.
       H.R. 4166 contains a provision (section 3), that would 
     expand the purpose of the Education Debt Reduction Program 
     (EDRP), set forth in subchapter VII of chapter 76 of title 
     38, United States Code, to include retention in addition to 
     recruitment, as well as to modify and expand the eligibility 
     requirements for participation in the program. In addition, 
     the provision would increase the total education debt 
     reduction payments made by VA from $44,000 to $60,000 and 
     raise the cap on payments to be made during the fourth and 
     fifth years of the program from $10,000 to $12,000. The 
     provision would also provide VA with the flexibility to waive 
     the limitations of the EDRP and pay the full principal and 
     interest owed by participants who fill hard-to-recruit 
     positions at VA.
       The Compromise Agreement contains the House provision.
     Visual Impairment and Orientation and Mobility Professionals 
         Education Assistance Program (section 302)
       The Senate bill contains a provision (section 302) that 
     would require VA to establish a scholarship program for 
     students accepted or enrolled in a program of study leading 
     to certification or a degree in the areas of visual 
     impairment or orientation and mobility. The student would be 
     required to agree to maintain an acceptable level of academic 
     standing as well as join VA as a full-time employee for three 
     years following their completion of the program. VA would be 
     required to disseminate information on the scholarship 
     program throughout educational institutions, with a special 
     emphasis on those with a high number of Hispanic students and 
     Historically Black Colleges and Universities.
       H.R. 3949 contains the same provision (section 302).
       The Compromise Agreement contains this provision.
     Demonstration Projects on Alternatives for Expanding Care for 
         Veterans in Rural Areas (section 303)
       The Senate bill contains a provision (section 305) that 
     would authorize VA to carry out demonstration projects to 
     expand care to veterans in rural areas through the 
     Department's Office of Rural Health. Projects could include 
     VA establishing a partnership with the Centers for Medicare 
     and Medicaid Services to coordinate care for veterans in 
     rural areas at critical access hospitals, developing a 
     partnership with the Department of Health and Human Services 
     to coordinate care for veterans in rural areas at community 
     health centers, and the expanding coordination with the 
     Indian Health Service to enhance care for Native American 
     veterans.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Program on Readjustment and Mental Health Care Services for 
         Veterans who Served in Operation Enduring Freedom and 
         Operation Iraqi Freedom (section 304)
       The Senate bill contains a provision (section 306) that 
     would require VA to establish a program providing OEF and OIF 
     veterans with mental health services, readjustment counseling 
     and services, and peer outreach and support. The program 
     would also provide the immediate families of these veterans 
     with education, support, counseling, and mental health 
     services. In areas not adequately served by VA facilities, VA 
     would be authorized to contract with community mental health 
     centers and other qualified entities for the provision of 
     such services, as well as provide training to clinicians and 
     contract with a national non-profit mental health 
     organization to train veterans participating in the peer 
     outreach and support program. The provision would require an 
     initial implementation report within 45 days after enactment 
     of the legislation. Additionally, the Secretary would be 
     required to submit a status report within one year of 
     enactment of the legislation detailing the number of veterans 
     participating in the program as well as an evaluation of the 
     services being provided under the program.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision, but 
     does not include the reporting requirement and authorizes 
     rather than requires VA to contract with community mental 
     health centers and other qualified entities in areas not 
     adequately served by VA facilities.
     Travel Reimbursement for Veterans Receiving Treatment at 
         Facilities of the Department of Veterans Affairs (section 
         305)
       The Senate bill contains a provision (section 308) that 
     would authorize VA to increase the mileage reimbursement rate 
     under section 111 of title 38, United States Code, to 41.5 
     cents per mile, and, a year after the enactment of this 
     legislation, allow the Secretary to adjust the newly 
     specified mileage rate to be equal to the rate paid to 
     Government employees who use privately owned vehicles on 
     official business. If such an adjustment would result in a 
     lower mileage rate, the Secretary would be required to submit 
     to Congress a justification for the lowered rate. The 
     provision also would allow the Secretary to reimburse 
     veterans for the reasonable cost of airfare when that is the 
     only practical way to reach a VA facility.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Pilot Program on Incentives for Physicians Who Assume 
         Inpatient Responsibilities at Community Hospitals in 
         Health Professional Shortage Areas (section 306)
       The Senate bill contains a provision (section 313) that 
     would require VA to establish a pilot program under which VA 
     physicians caring for veterans admitted to community 
     hospitals would receive financial incentives, of an amount 
     deemed appropriate by the Secretary, if they maintain 
     inpatient privileges at community hospitals in health 
     professional shortage areas. Participation in the pilot 
     program would be voluntary. VA would be required to carry out 
     the pilot program for three years, in not less than five 
     community hospitals in each of not fewer than two VISNs. In 
     addition, VA would be authorized to collect third party 
     payments for care provided by VA physicians to nonveterans 
     while carrying out their responsibilities at the community 
     hospital where they are privileged.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Grants for Veterans Service Organizations for Transportation 
         of Highly Rural Veterans (section 307)
       The Senate bill contains a provision (section 315) that 
     would require VA to establish a grant program to provide 
     innovative transportation options to veterans in highly rural 
     areas. Eligible grant recipients would include state veterans 
     service agencies and veterans service organizations, and 
     grant awards would not exceed $50,000.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Modifications of Eligibility for Participation in Pilot 
         Program of Enhanced Contract Care Authority for Health 
         Care Needs of Certain Veterans (section 308)
       The Senate bill contains a provision (section 316) that 
     would clarify the definition of eligible veterans who are 
     covered under a pilot program of enhanced contract care 
     authority for rural veterans, created by section 403(b) of 
     the Veterans' Mental Health and Other Care Improvements Act 
     of 2008 (P.L. 110-387, 122 Stat. 4110). Eligible veterans 
     would be defined to include those living more than 60 minutes 
     driving distance from the nearest VA facility providing 
     primary care services, living more than 120 minutes driving 
     distance from the nearest VA facility providing acute 
     hospital care, and living more than 240 minutes driving 
     distance from the nearest VA facility providing tertiary 
     care.
       H.R. 3219 contains the same provision (section 206).
       The Compromise Agreement contains this provision.


                  Title IV--Mental Health Care Matters

     Eligibility of Members of the Armed Forces Who Served in 
         Operation Enduring Freedom or Operation Iraqi Freedom for 
         Counseling and Services Through Readjustment Counseling 
         Services (section 401)
       The Senate bill contains a provision (section 401) that 
     would allow any member of the Armed Forces, including members 
     of the National Guard or Reserve, who served in OEF or OIF to 
     be eligible for readjustment counseling services at VA 
     Readjustment Counseling Centers, also known as Vet Centers. 
     The provision of such services would be limited by the 
     availability of appropriations so that this new provision 
     would not adversely affect services provided to the veterans 
     that Vet Centers are currently serving.

[[Page 5964]]

       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Restoration of Authority of Readjustment Counseling Service 
         to Provide Referral and Other Assistance upon Request to 
         Former Members of the Armed Forces Not Authorized 
         Counseling (section 402)
       The Senate bill contains a provision (section 402) that 
     would require VA to help former members of the Armed Forces 
     who have been discharged or released from active duty, but 
     who are not otherwise eligible for readjustment counseling. 
     VA would be authorized to help these individuals by providing 
     them with referrals to obtain counseling and services from 
     sources outside of VA, or by advising such individuals of 
     their right to apply for a review of their release or 
     discharge through the appropriate military branch of service.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Study on Suicides among Veterans (section 403)
       The Senate bill contains a provision (section 403) that 
     would require VA to conduct a study to determine the number 
     of veterans who committed suicide between January 1, 1999 and 
     the enactment of the legislation. To conduct this study, VA 
     would be required to coordinate with the Secretary of 
     Defense, veterans' service organizations, the Centers for 
     Disease Control and Prevention, and state public health 
     offices and veterans agencies.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.


                   Title V--Other Health Care Matters

     Repeal of Certain Annual Reporting Requirements (section 501)
       The Senate bill contains a provision (section 501) that 
     would eliminate the reporting requirements, set forth in 
     sections 7451 and 8107 of title 38, United States Code, on 
     pay adjustments for registered nurses. These reporting 
     requirements date to a time when VA facility directors had 
     the discretion to offer annual General Schedule (GS) 
     comparability increases to nurses. Current law requires VA to 
     provide GS comparability increases to nurses so that that pay 
     adjustment report is no longer necessary. The provision would 
     also eliminate the reporting requirement on VA's long-range 
     health care planning which included the operations and 
     construction plans for medical facilities. The information 
     contained in this report is already submitted in other 
     reports and plans, in particular the Department's annual 
     budget request.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Submittal Date of Annual Report on Gulf War Research (section 
         502)
       The Senate bill contains a provision (section 502) that 
     would amend the due date of the Annual Gulf War Research 
     Report from March 1 to July 1 of each of the five years with 
     the first report due in 2010.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Payment for Care Furnished to CHAMPVA Beneficiaries (section 
         503)
       The Senate bill contains a provision (section 503) that 
     would clarify that payments made by VA to providers who 
     provide medical care to a beneficiary covered under CHAMPVA 
     shall constitute payment in full, thereby removing any 
     liability on the part of the beneficiary.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Disclosure of Patient Treatment Information from Medical 
         Records of Patients Lacking Decision-making Capacity 
         (section 504)
       The Senate bill contains a provision (section 504) that 
     would authorize VA health care practitioners to disclose 
     relevant portions of VA medical records to surrogate 
     decision-makers who are authorized to make decisions on 
     behalf of patients lacking decision-making capacity. The 
     provision would only allow such disclosures where the 
     information is clinically relevant to the decision that the 
     surrogate is being asked to make.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Enhancement of Quality Management (section 505)
       The Senate bill contains a provision (section 506) that 
     would create a National Quality Management Officer to act as 
     the principal officer responsible for the Veteran Health 
     Administration's quality assurance program. The 
     provision would require each VISN and medical facility to 
     appoint a quality management officer, as well as require VA 
     to carry out a review of policies and procedures for 
     maintaining health care quality and patient safety.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Pilot Program on Use of Community-Based Organizations and 
         Local and State Government Entities To Ensure That 
         Veterans Receive Care and Benefits for Which They are 
         Eligible (section 506)
       The Senate bill contains a provision (section 508) that 
     would require VA to create a pilot program to study the use 
     of community organizations and local and State government 
     entities in providing care and benefits to veterans. The 
     grantees would be selected for their ability to increase 
     outreach, enhance the coordination of community, local, 
     state, and Federal providers of health care, and expand the 
     availability of care and services to transitioning 
     servicemembers and their families. The two-year pilot program 
     would be required to be implemented in five locations and, in 
     making the site selections, the Secretary would be required 
     to give special consideration to rural areas, areas with high 
     proportions of minority groups, areas with high proportions 
     of individuals who have limited access to health care, and 
     areas that are not in close proximity to an active duty 
     military station.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision, but 
     would give VA 180 days to implement the pilot program.
     Specialized Residential Care and Rehabilitation for Certain 
         Veterans (section 507)
       The Senate bill contains a provision (section 509) that 
     would authorize VA to contract for specialized residential 
     care and rehabilitation services for certain veterans. 
     Eligible veterans would be those who served in OEF or OIF, 
     suffer from a traumatic brain injury (TBI), and possess an 
     accumulation of deficits in activities of daily living and 
     instrumental activities of daily living that would otherwise 
     require admission to a nursing home.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Expanded Study on the Health Impact of Project Shipboard 
         Hazard and Defense (section 508)
       The Senate bill contains a provision (section 510) that 
     would require VA to contract with the Institute of Medicine 
     (IOM) to study the health impact of veterans' participation 
     in Project Shipboard Hazard and Defense (SHAD). The study 
     would be intended to cover, to the extent practicable, all 
     veterans who participated in Project SHAD and may utilize 
     results from the study included in IOM's report on ``Long-
     Term Health Effects of Participation in Project SHAD.''
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Use of Non-Department Facilities for Rehabilitation of 
         Individuals with Traumatic Brain Injury (section 509)
       The Senate bill contains a provision (section 511) that 
     would clarify when non-VA facilities may be utilized to 
     provide treatment and rehabilitative services for veterans 
     and members of the Armed Forces with TBI. Specifically, the 
     provision would allow non-VA facilities to be used when VA 
     cannot provide treatment or services at the frequency or 
     duration required by the individual plan of the veteran or 
     servicemember with TBI. The provision also would allow the 
     use of non-VA facilities if VA determines that it is optimal 
     for the recovery and rehabilitation of the veteran or 
     servicemember. Such non-VA facility would be required to 
     maintain standards that have been established by an 
     independent, peer-reviewed organization that accredits 
     specialized rehabilitation programs for adults with TBI.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Pilot Program on Provision of Dental Insurance Plans to 
         Veterans and Survivors and Dependents of Veterans 
         (section 510)
       The Senate bill contains a provision (section 513) that 
     would require VA to carry out a three-year pilot program to 
     provide specified dental services through a contract with a 
     dental insurer. Additionally, the provision would provide 
     that the pilot program should take place in at least two but 
     no more than four VISNs and that enrollment would be 
     voluntary. The program would provide diagnostic services, 
     preventive services, endodontic and other restorative 
     services, surgical services, emergency services, and such 
     other services as VA considers appropriate.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision, 
     modified to provide that the pilot program may take place in 
     any number of VISNs the Secretary deems appropriate. The 
     purpose of providing the Secretary with this authority is to 
     ensure the capability, should it be required, to maximize the 
     number of voluntary enrollees insured under the dental 
     program so as to reduce premium expenditures.
     Prohibition on Collection of Copayments from Veterans who are 
         Catastrophically Disabled (section 511)
       The Senate bill contains a provision (section 515) that 
     would add a new section 1730A in title 38, United States 
     Code, to prohibit VA from collecting copayments from 
     catastrophically disabled veterans for medical services 
     rendered, including prescription drug and nursing home care 
     copayments.
       H.R. 3219 contains the same provision (section 203).
       The Compromise Agreement contains this provision.

[[Page 5965]]


     Higher Priority Status for Certain Veterans who are Medal of 
         Honor Recipients (section 512)
       H.R. 3519 contains a provision (section 201) that would 
     amend section 1705 of title 38, United States Code, to place 
     Medal of Honor recipients in priority group 3 for the 
     purposes of receiving health care through VA. This would 
     situate Medal of Honor recipients in a priority group with 
     former prisoners of war and Purple Heart recipients.
       The Senate bill contains no comparable provision.
       The Compromise Agreement contains the House provision.
     Hospital Care, Medical Services, and Nursing Home Care for 
         Certain Vietnam-Era Veterans Exposed to Herbicide and 
         Veterans of the Persian Gulf War (section 513)
       H.R. 3219 contains a provision (section 202) that would 
     amend section 1710 of title 38, United States Code, to 
     provide permanent authorization for the special treatment 
     authority of Vietnam-era veterans exposed to an herbicide and 
     Gulf-War era veterans who have insufficient medical evidence 
     to establish a service-connected disability.
       The Senate bill contains no comparable provision.
       The Compromise Agreement contains the House provision.
     Establishment of Director of Physician Assistant Services in 
         Veterans Health Administration (section 514)
       H.R. 3219 contains a provision (section 204) that would 
     create the position of Director of Physician Assistant 
     Services in VA central office who would report directly to 
     the Under Secretary for Health on all matters related to 
     education, training, employment, and proper utilization of 
     physician assistants.
       The Senate bill contains no comparable provision.
       The Compromise Agreement contains the House provision, 
     modified to require the Director of Physician Assistant 
     Services to report directly to the Chief of the Office of 
     Patient Services instead of to the Under Secretary for 
     Health.
     Committee on Care of Veterans with Traumatic Brain Injury 
         (section 515)
       H.R. 3219 contains a provision (section 205) that would 
     require VA to establish a Committee on Care of Veterans with 
     Traumatic Brain Injury. This Committee would be required to 
     evaluate VA's capacity to meet the treatment and 
     rehabilitative needs of veterans with TBI, as well as make 
     recommendations and advise the Under Secretary for Health on 
     matters relating to this condition. Additionally, VA would be 
     required to submit to the Committees on Veterans' Affairs of 
     the Senate and the House of Representatives an annual report 
     on the Committee's findings and recommendations and the 
     Department's response.
       The Senate bill contains no comparable provision.
       The Compromise Agreement contains the House provision.
     Increase in Amount Available to Disabled Veterans for 
         Improvements and Structural Alterations Furnished as Part 
         of Home Health Services (section 516)
       H.R. 1293 contains a provision that would increase, from 
     $4,100 to $6,800, the amount authorized to be paid to 
     veterans who have service-connected disabilities rated 50 
     percent or more disabling for home improvements and 
     structural alterations. The provision would also increase 
     from $1,200 to $2,000, the amount authorized to be paid to 
     veterans with service-connected disabilities rated less than 
     50 percent disabling.
       The Senate bill contains no comparable provision.
       The Compromise Agreement contains the House provision.
     Extension of Statutorily Defined Copayments for Certain 
         Veterans for Hospital Care and Nursing Home Care (section 
         517)
       Under current law, VA has the authority to provide hospital 
     and nursing home care on a space available basis to veterans 
     who do not otherwise qualify for such care. VA is authorized 
     to collect from such a veteran an amount equal to $10 for 
     every day that a veteran receives hospital care, and $5 for 
     every day a veteran receives nursing home care. This 
     authority expires on September 30, 2010.
       Neither the House nor Senate bills contain a provision to 
     extend this authority.
       The Compromise Agreement contains a provision which would 
     extend the statutorily defined copayments for certain 
     veterans for hospital care and nursing home care to September 
     30, 2012.
     Extension of Authority to Recover Cost of Certain Care and 
         Services from Disabled Veterans with Health-Plan 
         Contracts (section 518)
       Under current law, VA is authorized to recover the costs 
     associated with medical care provided to a veteran for a non-
     service-connected disability if, among other eligibility 
     criteria, the veteran receives such care before October 1, 
     2010, the veteran has a service-connected disability, and the 
     veteran is entitled to benefits for health care under a 
     health-plan contract.
       Neither the House nor Senate bills contain a provision to 
     extend this authority.
       The Compromise Agreement contains a provision which would 
     extend the authority to recover the cost of such care and 
     services from disabled veterans with health-plan contracts to 
     October 1, 2012.


                 Title VI--Department Personnel Matters

     Enhancement of Authorities for Retention of Medical 
         Professionals (section 601)
       The Senate bill contains provisions (section 601) intended 
     to improve VA's ability to recruit and retain health 
     professionals. First, VA would be given the authority to 
     apply the title 38 hybrid employment system to additional 
     health care occupations to meet the recruitment and retention 
     needs of VA. Next, the probationary period for full-time and 
     part-time registered nurses would be set at two years; part-
     time registered nurses who served previously on a full-time 
     basis would not be subject to a probationary period. In 
     addition, VA would be authorized to waive the salary offset 
     where the salary of an employee rehired after retirement from 
     the Veterans Health Administration is reduced according to 
     the amount of their annuity under a federal government 
     retirement system.
       Section 601 also would provide for a number of new or 
     expanded pay authorities, including setting the pay for all 
     senior executives in the Office of the Under Secretary for 
     Health at Level II or Level III of the Executive Schedule; 
     authorizing recruitment and retention special incentive pay 
     for pharmacist executives of up to $40,000; amending the pay 
     provisions of physicians and dentists by clarifying the 
     determination of the non-foreign cost of living adjustment, 
     exempting physicians and dentists in executive leadership 
     positions from compensation panels, and allowing for a 
     reduction in market pay for changes in board certification or 
     a reduction of privileges; modifying the pay cap for 
     registered nurses and other covered positions to Level IV of 
     the Executive Schedule; allowing the pay for certified 
     registered nurse anesthetists to exceed the pay caps for 
     registered nurses; increasing the limitation on special pay 
     for nurse executives from $25,000 to $100,000; adding 
     licensed practical nurses, licensed vocational nurses, and 
     nursing positions covered by title 5 to the list of 
     occupations that are exempt from the limitations on increases 
     in rates of basic pay; and expanding the eligibility for 
     additional premium pay to part-time nurses. Finally, section 
     601 would improve VA's locality pay system by requiring VA to 
     provide education, training, and support to the directors of 
     VA health care facilities on the use of locality pay system 
     surveys.
       H.R. 919 contains a comparable provision (section 2) which 
     would not, in contrast to the Senate bill, restrict VA from 
     applying hybrid title 38 status to positions that are 
     administrative, clerical or physical plant maintenance and 
     protective services, would otherwise be included under the 
     authority of section 5332 of title 5, United States Code; do 
     not provide direct patient care services, or would otherwise 
     be available to provide medical care and treatment for 
     veterans. The House provision also would not place 
     restrictions on the categories of part-time nurses for whom 
     the probationary period would be waived. The House section 
     contains an additional provision which would provide 
     comparability pay up to $100,000 per year to all individuals 
     appointed by the Under Secretary for Health under the 
     authority of section 7306 of title 38, United States Code, 
     who are not physicians or dentists and who would be 
     compensated at a higher rate in the private sector.
       The Compromise Agreement contains the Senate provision, 
     modified to eliminate the provision of the Senate bill that 
     would provide VA with the authority to waive salary offsets 
     for retirees who are reemployed in the Veterans Health 
     Administration.
     Limitations on Overtime Duty, Weekend Duty, and Alternative 
         Work Schedules for Nurses (section 602)
       The Senate bill contains a provision (section 602) that 
     would prohibit VA from requiring nurses to work more than 40 
     hours in an administrative work week or more than 8 hours 
     consecutively, except under unanticipated emergency 
     conditions in which the nurses' skills are necessary and good 
     faith efforts to find voluntary replacements have failed. The 
     provision also would strike subsection 7456(c) of title 38, 
     United States Code, which provides that nurses on approved 
     sick or annual leave during a 12-hour work shift shall be 
     charged at a rate of five hours of leave per three hours of 
     absence. Finally, for recruitment and retention purposes, VA 
     would be authorized to consider a nurse who has worked 6 
     regularly scheduled 12-hour work shifts within a 14-day 
     period to have worked a full eighty-hour pay period.
       H.R. 919 contains the same provision (section 3).
       The Compromise Agreement contains this provision.
     Reauthorization of Health Professionals Educational 
         Assistance Scholarship Program (section 603)
       H.R. 919 contains a provision (section 4) that would 
     reinstate the Health Professionals Educational Assistance 
     Scholarship Program. Section 2 of H.R. 4166 contains a 
     similar provision which would also direct VA to fully employ 
     program graduates as soon as possible following their 
     graduation, require graduates to perform clinical rotations 
     in assignments or locations determined by

[[Page 5966]]

     VA, and assign a mentor to graduates in the same facility in 
     which they are serving.
       The Senate bill contains a similar provision but did not 
     include the requirement to fully employ graduates as soon as 
     possible.
       The Compromise Agreement contains the provision from 
     section 2 of H.R. 4166.
     Loan Repayment Program for Clinical Researchers from 
         Disadvantaged Backgrounds (section 604)
       H.R. 919 (section 4) and H.R. 4166 (section 4) contain 
     identical provisions that would allow VA to utilize the 
     authorities available in the Public Health Service Act for 
     the repayment of the principal and interest of educational 
     loans of health professionals from disadvantaged backgrounds 
     in order to employ such professionals in the Veterans Health 
     Administration to conduct clinical research.
       The Senate bill contains the same provision (section 603).
       The Compromise Agreement contains this provision.


                  Title VII--Homeless Veterans Matters

     Per Diem Grant Payments (section 701)
       H.R. 3796 contains a provision that would authorize VA to 
     make per diem payments to organizations assisting homeless 
     veterans in an amount equal to the greater of the daily cost 
     of care or $60 per bed, per day. The provision would also 
     require VA to ensure that 25 percent of the funds available 
     for per diem payments are distributed to organizations that 
     meet some but not all of the criteria for the receipt of per 
     diem payments. These would include (in order of priority) 
     organizations that meet each of the transitional and 
     supportive services criteria and serve a population that is 
     less than 75 percent veterans; organizations that meet at 
     least one but not all of the transitional and supportive 
     services criteria, but have a population that is at least 75 
     percent veterans; or organizations that meet at least one but 
     not all of the transitional and supportive services criteria 
     and serve a population that is less than 75 percent veterans.
       The Senate bill contains no comparable provision.
       The Compromise Agreement contains the House provision, but 
     does not require the minimum amount of $60 per bed, per day 
     for the Grant and Per Diem program. In addition, VA would be 
     authorized but not required to award the per diem grants to 
     non-profit organizations meeting some but not all of the 
     criteria for the receipt of such payments.


       Title VIII--Nonprofit Research and Education Corporations

     General Authorities on Establishment of Corporations (section 
         801)
       H.R. 2770 contains a provision (section 2) that would 
     authorize Nonprofit Research and Education Corporations 
     (NPCs) to merge, thereby creating multi-medical center 
     research corporations.
       The Senate bill contains the same provision (section 801).
       The Compromise Agreement contains this provision.
     Clarification of Purposes of Corporations (section 802)
       H.R. 2770 contains a provision (section 3) that would 
     clarify the purpose of NPCs to include specific reference to 
     their role as funding mechanisms for approved research and 
     education, in addition to their role in facilitating research 
     and education.
       The Senate bill contains the same provision (section 802).
       The Compromise Agreement contains this provision.
     Modification of Requirements for Boards of Directors of 
         Corporations (section 803)
       The Senate bill contains a provision (section 803) that 
     would require that a minimum of two members of the Board of 
     Directors of an NPC be other-than-federal employees. 
     Additionally, the provision would allow for the appointment 
     of individuals with expertise in legal, financial, or 
     business matters. The provision also would conform the law 
     relating to NPCs to other federal conflict of interest 
     regulations by removing the requirement that members of the 
     NPC boards have no financial relationship with any entity 
     that is a source of funding for research or education by VA.
       H.R. 2770 contains a comparable provision (section 4), but 
     provides that the executive director of the corporation may 
     be a VA employee.
       The Compromise Agreement contains the House provision, with 
     a modification which removes the provision allowing VA 
     employees to serve as executive directors.
     Clarification of Powers of Corporations (section 804)
       H.R. 2770 contains a provision (section 5) that would 
     clarify the NPCs' authority to accept, administer, and 
     transfer funds for various purposes. NPCs would be allowed to 
     enter into contracts and set fees for the education and 
     training facilitated through the corporation.
       The Senate bill contains the same provision (section 804).
       The Compromise Agreement contains this provision.
     Redesignation of Section 7364A of Title 38, United States 
         Code (section 805)
       H.R. 2770 contains a provision (section 6) that would 
     provide clerical amendments associated with implementing this 
     legislation concerning Nonprofit Research and Education 
     Corporations.
       The Senate bill contains the same provision (section 805).
       The Compromise Agreement contains this provision.
     Improved Accountability and Oversight of Corporations 
         (section 806)
       The Senate bill contains a provision (section 806) that 
     would strengthen VA's oversight of NPCs by requiring those 
     NPCs with revenues of over $10,000 to obtain an independent 
     audit once every three years, or with revenues of over 
     $300,000 to obtain such an audit each year, and to submit 
     certain Internal Revenue Service forms.
       H.R. 2770 contains a comparable provision (section 7), but 
     would instead raise to $100,000 the threshold for requiring 
     three-year audits and to $500,000 the revenue threshold that 
     would require yearly audits. The provision also would revise 
     conflict of interest policies to apply to the policies 
     adopted by the corporation.
       The Compromise Agreement contains the House provision.


               Title IX--Construction and Naming Matters

     Authorization of Medical Facility Projects (section 901)
       The Senate bill contains a provision (section 901) that 
     would authorize funds for the following major medical 
     facility projects in FY 2010: Livermore, California; Walla 
     Walla, Washington; Louisville, Kentucky; Dallas, Texas; St. 
     Louis, Missouri; Denver, Colorado and Bay Pines, Florida.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision, but 
     strikes the authorization for the construction project in 
     Walla Walla, Washington, since authorization for this 
     construction project was provided in Public Law 111-98, 
     enacted on November 11, 2009.
     Designation of Merril Lundman Department of Veterans Affairs 
         Outpatient Clinic, Havre, Montana (section 902)
       The Senate bill contains a provision (section 903) that 
     would name VA outpatient clinic in Havre, Montana, as the 
     ``Merril Lundman Department of Veterans Affairs Outpatient 
     Clinic.''
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Designation of William C. Tallent Department of Veterans 
         Affairs Outpatient Clinic, Knoxville, Tennessee (section 
         903)
       In the House, H.R. 402 contains a provision that would name 
     the VA outpatient clinic in Knoxville, Tennessee as the 
     ``William C. Tallent Department of Veterans Affairs 
     Outpatient Clinic.''
       The Senate bill contains no comparable provision.
       The Compromise Agreement contains the House provision.
     Designation of Max J. Beilke Department of Veterans Affairs 
         Outpatient Clinic, Alexandria, Minnesota (section 904)
       In the House, H.R. 3157 contains a provision that would 
     name the VA outpatient clinic in Alexandria, Minnesota as the 
     ``Max J. Beilke Department of Veterans Affairs Outpatient 
     Clinic.''
       The Senate bill contains no comparable provision.
       The Compromise Agreement contains the House provision.


                         Title X--Other Matters

     Expansion of Authority for Department of Veterans Affairs 
         Police Officers (section 1001)
       The Senate bill contains a provision (section 1001) that 
     would provide additional authorities to VA uniformed police 
     officers, including the authority to carry a VA-issued weapon 
     in an official capacity when off VA property and in official 
     travel status, the authority to conduct investigations on and 
     off VA property of offenses that may have been committed on 
     VA property, expanded authority to enforce local and State 
     traffic regulations when such authority has been granted by 
     local or State law, and to make arrests based upon an arrest 
     warrant issued by any competent judicial authority.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Uniform Allowance for Department of Veterans Affairs Police 
         Officers (section 1002)
       The Senate bill contains a provision (section 1002) that 
     would modify VA's authority to pay an allowance to VA police 
     officers for purchasing uniforms. The provision would provide 
     a uniform allowance in an amount which is the lesser of the 
     amount prescribed by the Office of Personnel Management or 
     the actual or estimated cost as determined by periodic 
     surveys conducted by VA.
       There was no comparable House provision.
       The Compromise Agreement contains the Senate provision.
     Submission of Reports to Congress by Secretary of Veterans 
         Affairs in Electronic Form (section 1003)
       Under current law, there is no requirement for VA to submit 
     Congressionally mandated reports in an electronic form.
       Neither the House nor Senate bills contained a provision to 
     change this procedure.

[[Page 5967]]

       The Compromise Agreement contains a provision which would 
     create a new section 118 in title 38, United States Code, 
     which would require VA to submit reports to Congress, or any 
     Committee thereof, in electronic format. Reports would be 
     defined to include any certification, notification, or other 
     communication in writing.
     Determination of Budgetary Effects for Purposes of Compliance 
         with Statutory Pay-As-You-Go-Act of 2010 (section 1004)
       Neither the Senate nor House bills contain a provision 
     relating to compliance with the Statutory Pay-As-You-Go-Act 
     of 2010, Title I of P.L. 111-139, 124 Stat. 8.
       The Compromise Agreement contains a procedural provision to 
     require the determination of the budgetary effects of 
     provisions contained in the Compromise Agreement to be based 
     upon the statement entered into the Congressional Record by 
     the Chairman of the Committee on the Budget of the House of 
     Representatives.

  Mr. BUYER. I yield myself such time as I may consume.
  I rise in support of S. 1963, as amended, the Caregivers and Veterans 
Omnibus Health Services Act of 2010.
  This bill represents a bipartisan effort on behalf of the House and 
Senate, and I express my thanks to Chairman Filner, Chairman Akaka, and 
Ranking Member Burr for their leadership. I'd also like to thank 
Chairman Michaud and Ranking Member Brown of the Subcommittee on Health 
for their efforts in bringing this legislation forward.
  Reflecting the spirit of compromise and cooperation, S. 1963 is 
composed of a number of bills from both sides of the aisle. It would 
provide increased access to care, better outreach and support for 
wounded veterans, rural veterans, and homeless veterans, and also 
includes enhancements and provisions of mental health care and 
readjustment counseling for recent veterans of Iraq and Afghanistan.
  I would like to thank my good friend and colleague from Kansas, Jerry 
Moran, for his bill, H.R. 3103, that was included to help VA move 
forward with a pilot program to enhance contract care authority for 
highly rural veterans. This pilot, which was enacted in the last 
Congress, was Mr. Moran's initiative.
  I'd also like to thank my friend John Duncan from Tennessee for 
introducing his bill, H.R. 402, which is included in this legislation. 
H.R. 402 would name the Veterans Affairs Outpatient Clinic in 
Knoxville, Tennessee, the William C. Tallent Veterans Outpatient 
Clinic. This gentleman honorably served in World War II and maintained 
a lifelong service to veterans.
  S. 1963 would also establish a new, all-encompassing system of 
support for family caregivers. As we all know, some veterans of Iraq 
and Afghanistan have been severely wounded and will require a great 
deal of care for the rest of their lives. In previous wars, these 
veterans would probably not have survived their wounds, but significant 
improvements in battlefield medicine, the medicine logistics chain and 
the follow-up treatment have improved the survival rates for the most 
severely wounded combatants.
  Family caregivers are more often than not at the core of what 
sustains the treatment and recovery of a severely wounded or injured 
soldier. Their commitment is strong and heartfelt; yet, it can be 
enormously challenging in a long recovery. There are many struggles 
that families face when assuming this role, including job absences, 
lost income, travel and relocation costs, child care concerns, 
exhaustion, and emotional and psychological stress. Many, 
understandably, become overwhelmed and eventually experience burnout. 
So there is a real problem, and the question is how to best address it.
  I am concerned, however, about a provision in this bill that would 
establish an unprecedented stipend for certain family caregivers. I 
would have preferred to build upon and expand an existing successful 
Department of Veterans Affairs VA program known as Aid and Attendance. 
The Aid and Attendance program is paid directly to veterans so they can 
obtain the needed service in their own homes. The extent and types of 
services could be expanded, and last summer I proposed to do so in H.R. 
3407, the Severely Injured Veterans' Benefits Act of 2009. It would 
provide a 50 percent increase in compensation for catastrophically 
injured veterans who are in need of assistance for daily personal 
needs, such as bathing and eating. It gives the veteran the choice of 
how to obtain services tailored to their unique needs and 
circumstances.
  It is unclear how the caregiver stipend program in this bill will 
operate and how it will work in conjunction with the present Aid and 
Attendance or whether it replaces some of the current services.
  Additionally, Mr. Speaker, we lack a Congressional Budget Office 
estimate of this compromised agreement. It appears that the Democrat 
majority has not been obtaining CBO cost estimates for discretionary 
bills, and we still don't have the official views of the administration 
on the compromised legislation. I am aware of their concerns. I 
requested the administration to address them in writing on March 18, 
2010, and they were due on April 7. Although we have not yet read them, 
it is my understanding they are still in the concurrence process.
  Based on legislative hearing testimony from last year, I believe the 
VA has concerns about the caregiver stipend as well as some of the 
other personnel provisions included in the bill. Dr. Cross, who is the 
principal deputy undersecretary for health, testified before the Senate 
Veterans Affairs Committee. This is in reference to the caregiver 
provisions. He stated, The VA does not support section 209. Currently 
we are able to contract for caregiver services with home health and 
similar public and private agencies. The contractor trains and pays 
them and affords them liability protection and oversees the quality of 
care. This remains the preferable arrangement as it does not divert VA 
from its primary mission of treating veterans and training clinicians. 
Moreover, it does not put VA in the position of having to tell family 
members how, at risk of losing their caregiver compensation, they have 
to care for their loved ones.
  Mr. Speaker, it is unfortunate that the administration's concern 
regarding the caregiver stipend provision in this bill was not worked 
out because the bill, as a whole, does many good things for veterans. I 
hope this issue gets resolved with the administration, and I am pleased 
that legislation that I had sponsored, H.R. 1293, the Disabled Veterans 
Home Improvement and Structural Alteration Grant Increase Act of 2009, 
is in this bill. This would increase the amount VA is authorized to pay 
under its home health services to make modifications to a veteran's 
home to enable the veteran to be cared for in their home rather than in 
a hospital or institutional setting.
  We should always be reminded that while veterans may spend only a 
short time in uniform, the wounds they carry home with them can last a 
lifetime and profoundly impact their daily lives.
  I reserve my time.
  Mr. FILNER. Mr. Speaker, the chairman of our Health Subcommittee, Mr. 
Michaud, and ranking member, Mr. Brown of South Carolina, were the 
chief hard workers on this bill. We thank them all.
  I yield 3\1/2\ minutes to Chairman Michaud.

                              {time}  1045

  Mr. MICHAUD. Thank you very much, Mr. Speaker, and thank you, Mr. 
Chairman. I also want to thank Ranking Member Buyer for all his hard 
work on this bill before us today, as well as my colleague, Mr. Brown, 
for working in a bipartisan manner throughout the years on veterans 
affairs issues.
  I rise today in strong support on S. 1963, the Caregivers and 
Veterans Omnibus Health Services Act. This landmark bill reflects a 
strong commitment to family caregivers, who are often underappreciated 
in their efforts to care for our wounded servicemembers. We must 
recognize that family caregivers in Maine and throughout our country 
often put their lives on hold to care for our injured veterans, and 
their duties take a heavy toll on them financially, emotionally, and 
physically.
  Our brave men and women who serve our country have come to rely on 
our

[[Page 5968]]

spouses, parents, siblings, and close friends to be there with them. We 
owe it to these devoted caregivers to offer them the support they need.
  That's why this bill creates a robust, supportive services program 
for caregivers. This includes counseling services and respite care to 
help relieve the heavy emotional and physical stress of caregivers.
  The bill also attempts to alleviate the financial difficulties facing 
eligible caregivers by providing a monthly financial stipend, as well 
as access to health care through the CHAMPVA program. The bill also 
recognizes the importance of caregivers being by veterans' sides during 
every step of their medical treatment. The bill authorizes the VA to 
pay lodging and other costs incurred by caregivers for accompanying 
veterans during medical appointments.
  In addition to addressing the needs of caregivers, this bill helps 
the VA deliver high quality health care for our rural veterans. The 
bill improves the VA ability to recruit and retain qualified medical 
personnel. It addresses the barriers of long trips to medical 
appointments by providing reimbursement for air travel.
  The bill also creates a more robust health care infrastructure in our 
rural areas. It does this by supporting collaboration with other 
Federal providers and fostering the VA's ability to contract with 
community providers.
  I urge my colleagues to support this critical bill that supports 
caregivers and expands health care for our rural veterans.
  Mr. BUYER. I reserve the balance of my time.
  Mr. FILNER. Mr. Speaker, before I yield to our Speaker, I just want 
to say with gratitude, on the part of our Nation's veterans, in her 
3\1/2\ years as Speaker and her years before that as minority leader, 
Ms. Pelosi focused like a laser on the needs of our veterans. We would 
not be here with this landmark bill were it not for our Speaker.
  I yield 1 minute to the Speaker of the House, the gentlewoman from 
California (Ms. Pelosi).
  Ms. PELOSI. I thank the gentleman for yielding, I thank him for his 
leadership, and I am very pleased today that we have bipartisan support 
for this important legislation to benefit our veterans.
  I, too, join my colleagues in rising to honor the sacrifice and 
service of the bravest among us, the men and women of our Armed Forces. 
In the name of our safety, they lay their lives on the line. In the 
name of our security, they fight our enemies far from home. In the name 
of our values, they serve as our Nation's greatest ambassadors, as 
champions of America's families.
  Each and every day our soldiers, sailors, airmen and marines earn the 
respect of a grateful Nation. And as long as those in uniform continue 
the battle abroad, we must do everything in our power to support them 
here at home.
  I would like to thank all Members of Congress on both sides of the 
aisle who worked so hard to strengthen this bill and bring it to the 
floor today. Again, I want to commend Bob Filner, the chairman of the 
Committee on Veterans' Affairs, Chairman Mike Michaud of the Health 
Subcommittee of the Committee on Veterans' Affairs, and Chairwoman 
Stephanie Herseth Sandlin of the Economic Opportunity Subcommittee of 
the Committee on Veterans' Affairs.
  I also want to recognize the hard work and commitment to those who 
have worn our Nation's uniform by three key freshmen Members of 
Congress, Congressman Tom Perriello, Congresswoman Debbie Halvorson, 
and Congressman Harry Teague.
  In both Houses, this has been a bipartisan effort, and I commend 
Ranking Member Buyer for his leadership. I know that everything is not 
in this bill. There is an endless list of everything we want to do for 
our veterans, but we are very proud of Senator Burr and the role that 
he has played in the Senate and all of the Members here. Thank you, Mr. 
Buyer.
  The Caregivers and Veterans Omnibus Health Services Act is a landmark 
moment in the ongoing effort to give back to our veterans and their 
families. It's a tribute to their service. In the words of the 
Paralyzed Veterans of America, it will ``provide valuable benefit for 
veterans and their families, benefits they need, have earned and so 
richly deserve.''
  This legislation will support family members and others who care for 
the disabled, ill or injured veterans. This is very important to 
families, military families. Our wounded soldiers and their families 
have made a serious sacrifice for our country, and this bill will bring 
them some relief. It will expand mental health services and health care 
access for veterans in rural areas and prohibit copays for our most 
severely wounded warriors.
  Thank you, Chairwoman Herseth Sandlin, as this bill marks a step 
forward for the 1.8 million women in uniform, removing existing 
barriers to female veterans seeking medical care. In a sweeping change 
long overdue and with strong bipartisan support, we will provide care 
for newborns in the first time in history. Thank you, Congressman Henry 
Brown, for your leadership as well, my friend.
  Today's vote is one in a series of actions taken by this Congress to 
give back to America's veterans. Our signature achievement remains our 
new GI Bill, providing those who serve with a full, 4-year college 
education. This is also transferable to a family member, and also a new 
improvement that we made was if a serviceman or woman dies in combat, 
that this opportunity is provided for their children or another family 
member.
  Late last year, again in a bipartisan way, we celebrated the passage 
of the Veterans Health Care Budget Reform and Transparency Act, 
ensuring that the VA has timely and predictable funding and our 
veterans receive the high quality care they have earned. Working to 
make sure that our economic recovery truly benefits all Americans, the 
American Recovery and Reinvestment Act offered a tax credit for hiring 
veterans and a $250 payment to disabled veterans.
  Just this past month we passed the TRICARE Affirmation Act, stating 
explicitly that our health care reform legislation will not impact the 
excellent health coverage our veterans and servicemembers already 
receive. In the last 3 years, we have given our troops a pay raise, 
helped restore military readiness and bolstered support for our 
military families. Today we strengthen the benefits our men and women 
in uniform receive.
  Mr. Speaker, in the course of our meetings with the veterans service 
organizations and with the families of our men and women in uniform and 
our veterans, we hear directly from them what their needs are and try 
to establish their priorities and to make it a priority in allocating 
the resources of our country. In the course of those conversations, we 
have heard from the families that in the survey they took of their own 
membership of Blue Star Families, that 94 percent of them thought that 
most Americans did not have a clear understanding of their needs.
  We promised them that in all we do here we will remove doubt in 
anyone's mind among our military families that we understand their 
needs, especially if they present them in a prioritized way and will 
make them our priority in the Congress. In every action we strive to 
live up to that commitment.
  Just as the military on the battlefield has said, on the battlefield 
we will leave no soldier behind. So too when they come home, we will 
leave no veteran behind.
  As the leaders of the American Legion have stated, this legislation 
offers bold solutions to major challenges facing servicemembers, 
veterans and their families on behalf of every American who wears the 
uniform.
  I urge my colleagues to vote ``yes'' on this bill.
  Mr. BUYER. Mr. Speaker, I yield myself such time as I may consume.
  I would like to thank the Speaker for her kind remarks and her 
support of the bill. Also, I ask for your support, we have a problem we 
have to get worked out, and that deals with the widows, orphans, and 
the Spina Bifida Program was left out of the health care

[[Page 5969]]

bill that we recently passed to ensure that it's defined as minimum 
essential benefit.
  Madam Speaker, I hope for your support for this. The issue has been 
addressed in the Senate. The Senate passed it, the bill is at the desk, 
but it has to originate in the House, so I ask for your support on 
this.
  Ms. PELOSI. Thank you, Mr. Buyer. The chairman has this legislation, 
as you may be aware, and it is going to Ways and Means and we will be 
taking it up soon, but we will look forward to working with you and 
will bring it together in a bipartisan way in the spirit that we owe 
our veterans. They are all Americans and so are we.
  Mr. BUYER. Thank you, I appreciate that.
  Ms. PELOSI. Thank you, Mr. Buyer, and thank you, Mr. Brown, for your 
leadership as well.
  Mr. BUYER. I now yield 3 minutes to the gentleman from South Carolina 
(Mr. Brown).
  Mr. BROWN of South Carolina. I thank the gentleman from Indiana for 
yielding me this time.
  I rise today to express my strong support for S. 1963, the Caregivers 
and Veterans Omnibus Health Services Act of 2009. Chairman Filner and 
Chairman Michaud, along with Ranking Member Buyer and I have brought 
this legislation forward in order to continue the great progress made 
by the VA toward providing the kind of health care veterans deserve, 
and I am proud to support it today.
  I think it's pretty evident, as the Speaker alluded to earlier, that 
in the Committee on Veterans' Affairs, which I have had the privilege 
to serve now 10 years, we always leave our bipartisanship at the door 
when we enter that committee, and I am grateful that Mr. Filner also 
continued in that same spirit when he became the chairman.
  At a time when our soldiers are overseas keeping us safe here at 
home, the VA is faced with a number of unique challenges. It must 
respond to the signature wounds of the wars in Iraq and Afghanistan, to 
soldiers returning home who live far from VA facilities, to the ever-
increasing number of women veterans, and to the families of veterans 
who cannot care for themselves, but it must also remain responsive to 
those whom it already serves. I believe this bill would accomplish 
this.
  When soldiers return home from war, unable to care for themselves, 
their families often face difficult burdens. To help them help the 
veterans, this bill would establish a comprehensive assistance program 
for caregivers, making caregivers eligible to receive education and 
training and technical support, counseling, lodging and subsistence.
  To serve the rural veterans, who may live a long distance from VA 
facilities, this bill would make the VA more flexible while increasing 
reach-out efforts. The VA would be allowed to partner with Medicare, 
Medicaid, the Department of Health and Human Services and the Indian 
Health Service in demonstration projects that could expand care.
  Finally, two of the most common wounds of war in Iraq and Afghanistan 
have been post-traumatic stress disorder and traumatic brain injury. By 
expanding eligibility for readjustment counseling at Vet Centers to any 
members of the Armed Forces who have served in OIF/OEF and establishing 
the Committee on Care for Veterans with TBI, the VA will become more 
responsive to those who are transitioning back to civilian life.
  In closing, I want to thank Chairman Filner and Ranking Member Buyer 
of the Veterans' Affairs Committee, and Chairman Michaud of the Health 
Subcommittee, for their leadership in bringing this bill forward.
  I urge my colleagues to stand up for America's true heroes and help 
continue to make the VA world class care even better.
  Mr. FILNER. Mr. Speaker, I yield 2 minutes to Ms. Herseth Sandlin of 
South Dakota, the chair of our Economic Opportunity Subcommittee and 
the prime mover behind the section of this bill dealing with our women 
veterans.
  Ms. HERSETH SANDLIN. I thank the gentleman from California for 
yielding.
  I rise today in strong support of S. 1963, the Caregivers and 
Veterans Omnibus Health Services Act of 2010. I want to thank our full 
committee chairman, Mr. Filner; our ranking member, Mr. Buyer; and 
Health Subcommittee Chairman Michaud and Ranking Member Brown for their 
leadership, for their strong support of this legislation, which 
contains many important provisions related to caregiver support and 
rural health care for veterans. It also includes legislation I 
introduced, the Women Veterans Health Care Improvement Act.
  This act will provide significant enhancements to the health care 
available for women veterans. Today women make up approximately 8 
percent of veterans in the United States, and that percentage will 
continue to rise as more and more women answer the call to serve their 
country. With an increasing number of women seeking access to care 
within the VA, the challenge of providing adequate health care services 
for women veterans is one the VA must master, and I am confident that 
it can.

                              {time}  1100

  This legislation addresses this challenge by taking several important 
steps to ensure adequate attention is given to women veterans and their 
health care programs so that women can access the quality primary 
health care and the specialized services they deserve and have earned.
  Among its provisions, this bill improves the VA's sexual trauma and 
post-traumatic stress disorder programs for women by requiring the 
Secretary of the VA to ensure that all mental health professionals have 
been properly and consistently trained in the best methods and 
practices so women veterans feel secure in seeking treatment.
  Childcare is another crucial issue for women veterans--and for male 
veterans as well--and the bill before us today tackles current barriers 
to care by authorizing a childcare pilot program and requiring the VA 
to carry out this program in at least three veteran service networks. 
We anticipate that this is going to help veterans keep their 
appointments.
  The legislation also requires the VA to provide 7 days of medical 
care for newborn children of women veterans, representing an important 
policy update in the VA. Currently, the VA has no provision to provide 
care for these infants, yet 86 percent of Operation Enduring Freedom 
and Operation Iraqi Freedom women veterans are under the age of 40.
  Accordingly, I urge all of my colleagues on both sides of the aisle 
to support this important legislation.
  Mr. BUYER. Mr. Speaker, at this time, I yield 2 minutes to Ms. Ginny 
Brown-Waite of Florida.
  Ms. GINNY BROWN-WAITE of Florida. I thank the gentleman.
  Mr. Speaker, I rise today in support of S. 1963, the Caregivers and 
Veterans Omnibus Health Services Act of 2009.
  As Members of Congress, we do have a responsibility to provide the 
best support we can to our Nation's veterans. With provisions for 
caregiver support, rural health improvement and mental health benefits, 
there are many reasons why I support this legislation. I could speak at 
length about these important and necessary benefits. However, in the 
interest of time, I would like to highlight just one: health care for 
women veterans.
  While more and more women are joining the military, the VA's health 
care services for women veterans have not kept pace. Although 
approximately 14 percent of our troops are female, as a female veteran 
recently said in an interview with Good Housekeeping magazine, it is as 
if women are ``Martians, abnormalities descending on the VA health 
system.'' In fact, of the country's 153 VA medical centers, only about 
half even have a gynecologist on staff. This is despite the fact that 
between 23 and 29 percent of all female veterans seeking medical care 
through the VA have reported experiencing sexual assault. Is it any 
surprise, then, that the number of female veterans being treated for 
post-traumatic stress

[[Page 5970]]

disorder rose from 1 to 19 percent in only 4 years?
  For this reason, my colleague, Representative Herseth Sandlin, and I 
introduced H.R. 1211, the Women Veterans Health Care Improvement Act. 
Although the Senate has not acted on our legislation, I am happy to see 
some of the key provisions, like studying the barriers preventing women 
veterans from receiving VA health care and developing a plan to improve 
that care for women veterans both immediately and in the long term, 
that actually made it into this bill.
  Mr. FILNER. Mr. Speaker, the freshman members of our committee have 
added a new level of commitment and enthusiasm and have played a major 
part in this bill. I would like to yield 1\1/2\ minutes to one of those 
great freshmen, Mrs. Halvorson of Illinois.
  Mrs. HALVORSON. Mr. Speaker, I rise today for those veterans who 
can't. I rise today for the catastrophically injured veterans who have 
to battle their injuries and their rising health care costs. I rise 
today for those caregivers who dedicate their lives to supporting our 
wounded warriors and our military families. I rise today to support S. 
1963 and the two provisions in the bill that I was proud to author.
  The first provision, H.R. 1335, would relieve the burden of costly 
copayments from catastrophically disabled veterans who receive medical 
or nursing home care from the VA. This was the first piece of 
legislation that I introduced when I came to Congress because I knew 
that there are men and women who have served honorably that need our 
help. These are brave men and women who have sacrificed so much so that 
we can enjoy the freedoms that we have every day. These are men and 
women who struggle through their routines in life that we take for 
granted, and they should not have to struggle to make their copays.
  Passing this measure into law would be a great way to show our 
support for our wounded warriors and to show that we are truly 
dedicated to making their lives better.
  However, it is not just our injured veterans who need our help. Every 
day in districts across the country caregivers provide essential 
services to our veterans. When my stepson, Jay, was injured in 
Afghanistan and recuperating at Walter Reed, I spoke to so many of 
these families who just began their second battle, the battle to 
rehabilitate. That is why I worked to include in this bill H.R. 2898, 
the Wounded Warrior Caregiver Assistance Act, to provide support 
services to those taking care of our wounded warriors. Just as it is 
our duty to care for a disabled soldier, passing this provision would 
help care for those who work tirelessly every day to look after our 
injured veterans.
  I urge my colleagues to join me in honoring those who have sacrificed 
for us by supporting this legislation.
  Mr. BUYER. Mr. Speaker, I continue to reserve and defer to the 
chairman.
  Mr. FILNER. Mr. Speaker, I yield 1\1/2\ minutes to another one of our 
great freshmen, Mr. Perriello from Virginia.
  Mr. PERRIELLO. Mr. Speaker, today is a good day for America's 
veterans and their families. I rise in support of S. 1963, the 
Caregivers and Veterans Omnibus Health Services Act of 2009, landmark 
legislation that makes good on our national commitment to our veterans 
and their families, including those in our rural communities. I also 
want to thank the chairs and the ranking members for putting our 
veterans ahead of our partisan divides.
  Taking care of our veterans includes taking care of those who care 
for them when they are unable to care for themselves. Today, more than 
ever, revolutionary advances in military medicine have significantly 
increased servicemembers' chances of surviving a catastrophic injury 
sustained in combat, but in many cases surviving a catastrophic injury 
is only the first step in the battle. Recovering from such injuries 
requires a long-term commitment not only from the veteran, but also 
from those who love and care for them.
  Once an injured veteran returns home from treatment at a DOD or VA 
facility, it is often a spouse, mother, father, or other loving family 
member who steps up to the challenge of providing ongoing care. And 
while this care is provided out of a sense of love, compassion, and 
devotion, it oftentimes shifts into a full-time commitment requiring 
the caregiver to make significant personal decisions regarding 
professional goals, commitments, and obligations.
  To help better support family caregivers, I introduced H.R. 2734, the 
Health Care for Family Caregivers Act of 2009, a bill that will help 
provide much-needed assistance to those family caregivers facing the 
difficult decisions related to caring for a veteran confronting a 
catastrophic injury. I am pleased that this bill has included this, and 
I encourage its support.
  Mr. FILNER. Mr. Speaker, Mr. Teague from New Mexico authored an 
important provision in the bill, and I would yield to him 1\1/2\ 
minutes to explain that provision.
  Mr. TEAGUE. Mr. Speaker, I rise today in support of S. 1963, which 
includes H.R. 2738, my bill to reimburse caregivers of disabled 
veterans for travel expenses to medical appointments. For those Members 
of Congress that represent vast rural districts with large veteran 
populations like mine, we know that this assistance has been needed for 
far too long.
  Mr. Speaker, veterans throughout my district often volunteer their 
time to drive fellow veterans to medical appointments even though the 
drive can last over 3 or 4 hours. That means that veterans in Silver 
City must leave their homes at three in the morning to make a trip to 
the only VA hospital in our State. It means that many of my 
constituents must dedicate entire days to travel from their homes in 
Jal or Deming or Santa Rosa to a medical visit that may only take a few 
minutes.
  This also means that the family of Airman Michael Malarsie, an airman 
from Bosque Farms who was blinded by an IED, would have to take time 
off work to travel to a VA medical center; and as the law currently 
stands, they must pay for that trip out of pocket whether they can 
afford it or not.
  Mr. Speaker, that is just plain wrong. But we can right that wrong 
today by passing this bill and providing our wounded warriors and 
families with the help that they have earned and need. It is the very 
least that we can do to repay the debt that we as a Nation owe to our 
veterans and their courageous families.
  Mr. FILNER. Mr. Speaker, another valued member of our committee, Mr. 
Ciro Rodriguez of Texas, authored an important provision in this bill, 
and I would recognize him for 1\1/2\ minutes.
  Mr. RODRIGUEZ. Mr. Speaker, our veterans deserve more. The proper 
care of our veterans is our most fervent duty to uphold. This bill 
permits us to advance this support even more with needed programs that 
will not only cover our veterans, but will also extend caregiver 
support to their families.
  This bill makes marked improvements in rural health programs such as 
the partnering with the Department of Health and Human Services to 
expand care in rural areas. It also gives the Department of Veterans 
Affairs the flexibility it needs to contract mental health services in 
rural areas where there are no adequate VA facilities.
  This bill also addresses the need for coordination between the 
Departments and the key stakeholders in the study to find solutions to 
the alarming suicide rates among our veterans and active duty forces 
and gives more resources to the Department of Veterans Affairs to 
address key areas such as veteran homelessness and women's health, and 
strengthens their quality assurance and other programs.
  Additionally, this bill reestablishes the previous highly successful 
Health Professionals Education Assistance Scholarship Program in the 
Department of Veterans Affairs. Earlier this year, I introduced H.R. 
4166, a bill to bring back this successful program. I am glad that this 
bill includes my legislation.
  We also need to recognize our soldiers and thank them for their 
service. We owe it to each and every one of our wounded warriors and 
all veterans to

[[Page 5971]]

ensure their care and medical needs are properly taken care of. Their 
selfless sacrifices for our Nation's freedom and the sacrifices endured 
by their families warrant the passage of this bill.
  Mr. FILNER. Mr. Speaker, how much time does each side have remaining?
  The SPEAKER pro tempore. Four minutes.
  Mr. FILNER. Mr. Speaker, one of the great provisions of this bill is 
an incentive program to get doctors in certain specialties into the VA. 
The author of that scholarship program is Ms. Jackson Lee of Texas, and 
I would recognize her for 1 minute.
  Ms. JACKSON LEE of Texas. Mr. Chairman, I am particularly grateful 
for your leadership and that of the ranking member. Thank you for 
guiding me on this legislation.
  I rise to support S. 1963, the Caregivers and Veterans Omnibus Health 
Services Act, for the work it is doing on caregivers and dealing with 
suicide and unfortunate tragedies that occur among our military.
  This morning I was with the United States Air Force and their Air 
Force Cares program. I am pleased that this legislation included H.R. 
228, the Blind Veterans of America, an organization chartered by 
Congress in 1958, which has been for nearly 50 years the only veterans 
service organization exclusively dedicated to serving America's blind 
and visually impaired veterans.
  There are approximately 160,000 legally blind veterans in the United 
States, but only approximately 35,000 are currently enrolled in the 
Veterans Health Administration services. It is estimated that there are 
1 million low-vision veterans in the United States, and incidences of 
blindness among the approximate total veteran population of 26 million 
are expected to increase by about 40 percent over the next few years. 
This is because the most prevalent cause of blindness and low vision 
are age-related. This bill provides scholarships for training 
individuals, and I ask my colleagues to support it. And thank you for 
including H.R. 228.
  I rise in support of S. 1963--to provide needed support to caregivers 
of our nation's veterans, to improve the full spectrum of healthcare 
and access provided to those we honor and recognize as our country's 
present and past warriors and defenders.
  There are few if any higher obligations of the Congress, the 
President, and the American people than keeping faith with the men and 
women who have worn the uniform in service to our country.
  I applaud the work of the all those who have worked on this bill and 
who are charged with legislative, oversight and investigative 
jurisdiction over education of veterans, employment and training of 
veterans, vocational rehabilitation, veterans' housing programs, and 
readjustment of servicemembers to civilian life.
  S. 1963 addresses many of the important needs of our veterans 
relating to services for women's health care, rural health care, 
homelessness, employment, health, and education.


                       WOMEN VETERANS HEALTH CARE

  The bill will expand and improve VA health care services for the 1.8 
million women who have bravely served their country. It requires the VA 
to:
  Conduct a study of barriers to women veterans seeking health care,
  Educate and train mental health professionals caring for veterans 
with sexual trauma;
  Implement a reintegration and readjustment pilot program;
  Establish a child care pilot program for women receiving regular and 
intensive mental health care and intensive health care services, or who 
are in need of such services but do not seek care due to the lack of 
child care services;
  Provide up to 7 days of post-delivery health care to a newborn child 
of a women veteran.


                       RURAL HEALTH IMPROVEMENTS

  Improves health care for veterans living in rural areas, including by 
expanding transportation for veterans to local VA hospitals and clinics 
through VA grants to local Veterans Service Organizations.


                           MENTAL HEALTH CARE

  Provides access to counseling and other mental health centers to any 
member of the Armed Forces (including members of the National Guard and 
Reserves, who served during Operation Iraqi Freedom and Operation 
Enduring Freedom but who are no longer on active duty) and Requires the 
VA to conduct a veterans' suicide study.


                        OTHER HEALTH CARE ISSUES

  Prohibits the VA from collecting copayments from veterans who are 
catastrophically disabled.
  Creates a pilot program, which would provide specified dental 
services to veterans, survivors, and dependents of veterans through a 
dental insurer.
  Requires the VA to provide hospital care, medical services, and 
nursing home care for certain Vietnam-era veterans exposed to herbicide 
and Gulf War era veterans who have insufficient medical evidence to 
establish a service-connected disability.
  Provides higher priority status for certain veterans who are Medal of 
Honor recipients.


                           HOMELESS VETERANS

  Expands the organizations offering transitional housing and other 
support for homeless veterans that can receive grants or per diems from 
the VA, which is particularly important to veterans in rural areas.
  I am extremely pleased to help answer the needs of America's veterans 
and am pleased that H.R. 228, a bill I introduced to establish a 
scholarship program for students learning to care for veterans with 
visual impairments is included in Title III, Section 302 of S. 1963. As 
we work to strengthen our efforts nationally to provide better care for 
veterans we can not afford to leave any issue unexamined or 
unaddressed. We must especially ensure that veterans have the access to 
the quality healthcare that they deserve.
  The Blind Veterans of America, an organization chartered by Congress 
in 1958, and which has been for nearly 50 the only veterans service 
organization exclusively dedicated to serving America's blind and 
visually impaired veterans.
  Mr. Speaker, there are approximately 160,000 legally blind veterans 
in the United States, but approximately only 35,000 are currently 
enrolled in Veterans Health Administration services.
  In addition, it is estimated that there are over 1 million low-vision 
veterans in the United States, and incidences of blindness among the 
approximate total veteran population of 26 million are expected to 
increase by about 40% over the next few years. This is because the most 
prevalent causes of legal blindness and low vision are age-related, and 
the average age of the veteran population is increasing; the current 
average age is about 80 years old.
  Members of the Armed Forces are important to our nation and we show 
them our appreciation by taking care of them even after they have 
completed their service. But the fact is that there are not enough 
blind rehabilitation specialists to serve all legally blind and low-
vision veterans in the United States.
  Blind rehabilitation training helps give these veterans awareness of 
and functioning in their surroundings and enables them to retain their 
independence and dignity. Veterans without these services may find it 
difficult to be self-sufficient, relying on others to perform certain 
skills or even simple tasks on their behalf.
   Mr. Speaker, Public Law 104-262, the Eligibility Reform Act 1996, 
requires the Department of Veterans Affairs to maintain its capacity to 
provide specialized rehabilitative services to disabled veterans, but 
it cannot do so when there are not enough specialists to address these 
needs. That is why we must work harder to provide for the needs of our 
men and women who have served this Nation so valiantly.
  We should all take a day to reflect on the sacrifices U.S. veterans 
and servicemembers have made, and are still making, for their country. 
However, to truly honor and pay tribute to these special Americans 
requires our commitment for the other 364 days of the year.
  Veterans continue to have many unanswered needs, and we should 
continue to fight for the rights of our most patriotic Americans. I am 
a strong believer in the fact that veterans have kept their promise to 
serve our nation; they have willingly risked their lives to protect the 
country we all love. We must now ensure that we keep our promises to 
our veterans because the way a nation treats those who have stood in 
harms way to defend it, risking life, limb and psychological injury is 
extremely telling.
  Members of the Armed Forces are important to our nation, and we show 
them our appreciation by passing this all encompassing healthcare 
legislation which directly impacts the Nation's ability to take care of 
servicemembers after they have completed their service.
  There are 25.9 million veterans in the United States who have 
protected this country in military conflicts as early as WWI. The wars 
in Iraq and Afghanistan are however producing a new wave of veterans. 
Of 1.4 million who have served, more than 205,000 have sought to obtain 
health care this year. In part this is good news. Thanks to medical and 
technological advances, the survival and recovery rate is several times 
higher than in previous conflicts. However there are still many

[[Page 5972]]

 inequities and system failures that mitigate veterans' getting proper 
and timely care.
  Consequently, equipping veterans to navigate civilian life, often 
with severe mental and physical illnesses, has to be a national 
priority. Yet the Veterans Affairs Department, which provides millions 
of injured veterans with payments and care, has had issues responding 
to the inundation. Additionally, the Veterans' Disability Benefits 
Commission (VDBC) has reported that the VA falls woefully short in 
providing timely and fair disability payments, as well as adequate 
mental health care. The report cited an average delay of nearly six 
months in handing out payments. This legislation directly responds to 
these and many other pertinent issues which will allow us to meet the 
needs of all of our veterans, their families and caregivers.
  Mr. FILNER. Mr. Speaker, this bill adds an important position to the 
Department of Veterans Affairs. The author of that legislation is Mr. 
Hare of Illinois. He was on our committee; I wish we had him back. I 
yield him 1 minute.
  Mr. HARE. Mr. Speaker, this Congress, under the leadership of Speaker 
Pelosi and Chairman Filner, has honored our veterans by dramatically 
increasing funding for VA health care and making it more timely, 
efficient, and predictable, hiring additional benefits claims 
processors and improving VA facilities. The bill before us builds on 
our earlier victories to improve the quality of health care for our 
Nation's veterans.
  Mr. Speaker, I am particularly pleased that this veterans package 
includes a bill I introduced with Congressman Jerry Moran to elevate 
the Department of Veterans Affairs physician assistant adviser to a 
full-time director. My bill would give 2,000 physician assistants 
employed at the VA who manage care for one-quarter of all primary care 
patients a fair and long-overdue voice within the VA.
  With the director of physician assistant services, we can ensure that 
the PA workforce will continue to be an integral component within the 
VA health system and PAs are able to provide the best possible care to 
our veterans, especially those in underserved rural areas.
  Mr. Speaker, I urge all of my colleagues to vote for S. 1963.
  Mr. FILNER. Mr. Speaker, the gentlelady from Texas (Ms. Eddie Bernice 
Johnson), added an important provision with regard to retention and 
recruitment of the kind of professionals we need in the VA. I would 
yield to her 1 minute and thank her for her efforts.
  Ms. EDDIE BERNICE JOHNSON of Texas. Let me thank the chairman and the 
ranking member for this bill, and I rise in strong support of the bill, 
the Caregivers and Veterans Omnibus Health Services Act.
  It is our duty to ensure that our veterans who so courageously serve 
our country receive the medical support they deserve.

                              {time}  1115

  My professional career as a nurse was spent in the veterans' system. 
I visited at a hospital after they had four suicides from the 
psychiatric unit, and one of the problems they had was 
noncompetitiveness with nurses' salaries, so I have introduced a bill 
to attempt to correct that. This bill has been incorporated, and I am 
pleased that it has been. The Senate companion bill is also included. 
It increases the pay limitations for VA nurses from level V to level IV 
of the executive schedule to address pay disparities, and also to 
increase special pay for nurse executives.
  It is my pleasure to present this because I know firsthand what it is 
like to try to recruit good nurses.
  I rise in strong support of S. 1963, the Caregivers and Veterans 
Omnibus Health Services Act.
  I would like to thank Chairman Filner and the Committee on Veterans' 
Affairs for their work on this legislation.
  It is our duty to ensure that our veterans, who have so courageously 
served our country, receive the medical support they deserve.
  The VA system must be able to successfully compete for the best 
health care providers in the United States.
  I am also pleased that provisions in my bill, H.R. 919 and its Senate 
companion bill, are included in this legislation.
  This bill will increase the pay limitations for VA nurses from Level 
V to Level IV of the Executive Schedule to address pay disparity, and 
also increase Special Pay for Nurse Executives.
  As a result, the VA will be able to recruit and retain highly 
qualified Nurse Executives and raise their standing to be on par with 
other executive personnel.
  Part-time nurses will now also be eligible for Title 38 status and 
additional nurse pay.
  As a non-practicing Registered Nurse, I am pleased with these 
improvements for nurses who are on the front lines of care.
  Overall, this legislation will recognize and treat our VA nurses, 
physicians, dentists, and pharmacist executives as the true 
professionals they are.
  I am pleased to support this bill and urge my colleagues to do the 
same.
  Mr. BUYER. I yield myself such time as I may consume.
  Mr. Speaker, in an exchange I just had in a colloquy with Speaker 
Pelosi with regard to her commitment to correct an error in the 
President's health package, I would like to place that commitment in 
some context.
  Since late July of last year, when the debate on the President's 
health care package started, I tried on multiple occasions to ensure 
that the care our Nation's veterans and their families received from 
the Department would be considered minimum essential coverage. I did 
that during the markup in the Subcommittee on Health, in the Energy and 
Commerce Committee, and in the full committee. My efforts included 
trying to obtain jurisdiction for the Veterans' Affairs Committee on 
H.R. 3200 back in August of last year.
  In November, during the floor debate on H.R. 3962, I again sought to 
obtain protections for our Nation's veterans and their families. At 
that time, not only I but Chairman Filner received assurances in 
writing from the chairman of the House Ways and Means Committee, from 
the chairman of the House Energy and Commerce Committee, and from the 
Energy and Labor Committee that veterans and their families would, in 
fact, be protected.
  I think this will be helpful to us, Mr. Filner, as your bill 
proceeds.
  Most recently, in March, I and Ranking Member Buck McKeon of the 
House Armed Services Committee offered an amendment to H.R. 3590, which 
would ensure that benefits offered under TRICARE and the Department of 
Veterans Affairs programs would be considered minimum essential 
coverage. However, our amendment was not allowed then under the rule, 
and I made that appeal to the Rules Committee.
  This amendment was then introduced in a form of legislation, H.R. 
4894, which then was referred to the Energy and Commerce Committee.
  I raised the issue again, because in that recently passed Senate 
health bill, it did not include some of the veterans' programs in the 
definition of ``minimum essential coverage.'' Unfortunately, the bill 
did not mention the ``other veterans' programs'' under chapter 17. It 
mentioned veterans' programs but not the other veterans' programs under 
chapter 17 of title 38, which includes widows, orphans, and dependents 
covered by the Civilian Health and Medical Program of the VA, known as 
CHAMPVA. It also did not mention chapter 18, which includes the spina 
bifida program for the children of Korea and Vietnam veterans who have 
spina bifida as a result of their parents' exposure to Agent Orange.
  I brought up that issue. When Chairman Skelton recognized that the 
Senate health bill mentioned TRICARE for Life but did not mention 
TRICARE, he immediately brought a bill to the floor, and it was 
considered. I tried to amend that bill. I tried to get it withdrawn. At 
that time, I received a commitment from the chairman of the House Ways 
and Means Committee that he would work with us to get that corrected. I 
even raised the issue during the markup of the President's health bill, 
itself, on the floor. I know the VFW was very concerned, along with the 
American Legion.
  Yet, as I raised these concerns that this bill had a large error, I 
was marginalized. I was marginalized by some in the House who said, Oh, 
those issues are not real. Even the White House issued a press release, 
along with the Secretary of Veterans Affairs, which read that it was 
unfounded. Well, it is founded. It is a problem that we have to fix. 
Senator Akaka passed a bill to protect the veterans. It passed

[[Page 5973]]

on unanimous consent. It is currently at the Speaker's desk. However, 
the parliamentarian has ruled that it is a revenue bill. Otherwise, I 
would immediately call it forward.
  So what has happened? A little magic dust again.
  I appreciate, with regard to this issue, that the chairman has 
recognized that there is an error which needs to be corrected. I am 
deeply appreciative. So is the Speaker. She has just exercised her 
commitment to correct the error in the bill.
  Chairman Filner has taken the language of the Akaka bill and has 
introduced his own bill. It has been referred now to the Ways and Means 
Committee. I have written a letter as a follow-up. From the colloquy I 
had with Chairman Levin of the House Ways and Means Committee, I have 
asked him to expedite Mr. Filner's bill and to have it brought to the 
floor so that we can correct this error in the President's health bill 
and so that we may cover the widows, the orphans, the spina bifida 
program, and CHAMPVA, all of which were excluded from the definition of 
``minimum essential coverage.'' That will correct the error, and I 
think that needs to be done. I had hoped that Mr. Filner's bill would 
have been included in the bill we are presently considering. That would 
have cleaned this up now, but that didn't occur.
  So I've taken every opportunity to try to correct this error, but for 
whatever reason, it just hasn't gotten done. It needs to be done. I 
think it was an error in the drafting. No one intended for widows, for 
orphans, and for the beneficiaries of the spina bifida program to be 
left out. I believe it was unintentional, but it is a real issue, and 
we need to correct it. Hopefully, we are going to do that.
  I want to thank the chairman for his leadership to correct that 
error, and I want to thank the staff on both sides of the aisle for all 
of their efforts in the bill.
  I would ask my colleagues to pass the bill that is before us, and I 
yield back the balance of my time.
  Mr. FILNER. I yield myself the balance of my time, and I want to 
return the debate to the bill under consideration.
  Mr. Speaker, this is a landmark bill. Finally, it gives some help to 
the caregivers of wounded warriors--family members who have to, 
perhaps, give up their jobs and spend almost full time with their loved 
ones. There is the issue of women veterans, which is a rising 
percentage in what was always a male institution, and we have to change 
the culture there in the VA. We help our homeless veterans. We help 
those who are in rural areas, and we provide more money for mental 
health care for all of our Nation's veterans. This is an important 
bill, and I urge unanimous approval.
  Ms. GIFFORDS. Mr. Speaker, I rise today in support of the Caregivers 
and Veterans Omnibus Health Services Act. This bill will provide a 
number of additional benefits to our servicemembers and their families 
and I am pleased that the Chairman and the Ranking Member were able to 
get it to the floor.
  I am particularly pleased that language from two of my behavioral 
healthcare bills, H.R. 2698 and 2699, were included in the final 
version of this landmark bill.
  My language will provide increased access to Vet Centers for our 
Guardsmen and Reservists, ensuring they are never again turned away for 
the behavioral health care they need and deserve.
  My language also authorizes the Vet Centers to provide veterans and 
servicemembers with referrals for behavioral health care so they can 
see their own doctor in their own community when they need it.
  These two items will help remove some of the stigma from behavioral 
health issues and specifically grant access to care for those who need 
it the most.
  When our men and women in uniform come home from war, it is our 
responsibility to ensure they receive the care they need and deserve.
  My language and this bill provide them and their families with the 
care and peace of mind they have earned and we owe to them.
  I strongly urge passage of this bill.
  Mr. QUIGLEY. Mr. Speaker, I rise today in support of the house 
amendments to S. 1963, the Caregivers and Veterans Omnibus Health 
Services Act.
  Today we are taking action to begin to address the needs of not only 
those who serve, but their families as well.
  All too often we see families and friends altering their lives to 
care for those who served our country and then return home wounded or 
disabled.
  Many caregivers have lost their jobs and benefits, and have had to 
dip into their hard-earned savings just to provide the care our wounded 
warriors so desperately need.
  S. 1963 will begin to ensure that disabled veterans and their 
families will have the resources and support, both technical and 
financial, needed to provide care.
  We can never fully repay our veterans and their families for their 
service and the personal sacrifices they continue to make.
  The passage of this bill is a start--and will go a long way to ensure 
they receive the benefits they need, deserve, and have courageously 
earned.
  Ms. SLAUGHTER. Mr. Speaker, over the past year, I have become 
increasingly concerned about veterans access to benefits, care and job 
training. We must encourage soldiers completing their active duty 
service to sign up with the U.S. Department of Veterans Affairs. This 
is a critical message we must reiterate to all our returning service 
men and women.
  As the heroes of our country, we believe our veterans and their 
families deserve the very best benefits to ensure peace of mind. With 
this in mind, Congress has provided more than 185,000 servicemembers 
and veterans with $500 for every month they were forced to serve under 
stop-loss orders since 2001. In addition, we've created new claims 
processors to make sure our veterans earn their benefits in a timely 
manner. We built new transition centers for wounded warriors, more 
military child care centers, and better barracks and military family 
housing. With veterans' families in mind, Congress has increased 
support for veteran caregivers. And lastly, those disabled veterans can 
rest assured that their benefits will keep pace with the cost of living 
and their needs.
  Today I rise in support of S. 1963, the Caregivers and Veterans 
Omnibus Health Services Act. This landmark legislation will provide 
support to family and others who care for disabled, ill, or injured 
veterans; will enhance health services for the 1.8 million women 
veterans, including care for newborns for the first time in history; to 
expand mental health services for veterans and health care access for 
veterans in rural areas; and to prohibit copayments for veterans who 
are catastrophically disabled.
  To help meet the many hardships and sacrifices associated with 
lengthy recovery and rehabilitation from severe injuries of veterans, 
S. 1963 will provide support services to family and other caregivers of 
veterans, including education on how to be a better caregiver, 
counseling and mental health services, and respite care for family and 
other caregivers of all veterans. It also provides health care and a 
stipend for caregivers living with severely wounded veterans of Iraq 
and Afghanistan.
  This support is vital for the wounded veterans of Iraq and 
Afghanistan and their families, as about 20 percent of active duty, 15 
percent of reserve and 25 percent of retired and separated members have 
a family member or friend who has been forced to leave a job to care 
for the veteran full-time, according to the Dole/Shalala report.
  The bill also expands and improves VA health care services for the 
women who have bravely served their country, working to remove existing 
barriers to women veterans seeking health care, providing up to seven 
days of care of newborn children of women veterans for the first time 
in history, and enhancing treatment for sexual trauma for women at the 
VA.
  I urge my colleagues to vote ``yes'' in favor of this historic 
legislation for the sake of our heroes and their families. Our veterans 
deserve our gratitude and support at the very least.
  Mr. SALAZAR. Mr. Speaker, I rise today to support S. 1963 the 
Caregivers and Veterans Omnibus Health Services Act of 2009.
  As a veteran, I am proud to lend my support to this landmark bill.
  With its provisions for women, homeless and rural veterans, S. 1963 
addresses many critical sectors of the veteran's community.
  Mr. Speaker, Colorado is home to over 427,000 veterans, 70,000 of 
which live in my district.
  These veterans and their families face many of the same issues as 
their urban counterparts but must also deal with unique issues of 
accessibility and availability of resources.
  This historic bill contains provisions that will be of particular 
importance to America's rural veterans.
  I am encouraged that the bill specifically looks to improve health 
care for veterans living

[[Page 5974]]

in rural areas and will provide financial assistance to help transport 
veterans to local VA hospitals and clinics.
  S. 1963 will create a demonstration project to examine the 
feasibility and advisability of alternatives for expanding care for 
veterans in rural areas in addition to establishing goals for the 
recruitment of personnel in rural areas.
  I encourage my colleagues on both sides of the aisle to support this 
legislation.
  Mr. SKELTON. Mr. Speaker, let me share my support for the House 
Amendment to S. 1963, the Caregivers and Veterans Omnibus Health 
Services Act. This is a good bill for our nation's veterans and those 
who care for them, and I am thankful for all the hard work that has 
gone in to this legislation.
  Missouri's Fourth Congressional District, which I have the honor to 
represent, is a rural district consisting of small towns, farms, and 
patriotic Americans, so I am particularly pleased with the provisions 
of the bill that focus on the needs of rural veterans. Veterans of all 
of our nation's conflicts, from World War II to today, call the Fourth 
District home, but the advantages of living in rural Missouri often 
come with long drives to the closest VA hospital or clinic. This 
legislation takes a number of steps to improve access to care for rural 
veterans, including increasing the mileage reimbursement rate for 
traveling to a VA health facility and partnering with veterans service 
organizations to provide transportation options for veterans living in 
rural areas. These moves would help address some of the concerns I 
often hear from veterans.
  I am also pleased with the provisions of the legislation that impact 
the caregivers of our veterans. Oftentimes, the day-to-day care of a 
seriously injured or ill veteran is provided by a spouse, a child or a 
parent. These individuals give of themselves gladly, but many are 
forced to take time off of work or school, or to leave their jobs or 
their pursuit of higher education altogether. And many caregivers do 
not have the experience or training to provide the most effective care 
for their loved one. The bill before us today expands training and 
education for caregivers, provides access to them for counseling and 
mental health services, and for those caring for veterans of Operation 
Iraqi Freedom and Operation Enduring Freedom, provides a monthly 
stipend and health care through the CHAMPVA program. These caregivers 
are providing an important service for our veterans and this 
legislation gives proper consideration for their needs.
  Mr. FALEOMAVAEGA. Mr. Speaker, I rise in strong support of the 
``Caregivers and Veterans Omnibus Health Services Act of 2009.'' I want 
to thank Chairman Bob Filner and my colleagues in the U.S. House 
Committee on Veterans' Affairs for their support and for bringing this 
bill before the House for consideration. I also want to commend the 
chief cosponsor of this bill and Chairman of the US Senate Committee on 
Veterans' Affairs, my good friend from the State of Hawaii, Senator 
Akaka, for continuing to look out for the interest and the needs of 
those that have served in the armed forces of this great nation.
  The bill before us today reaffirms our commitment to provide for the 
needs and to share the sacrifice borne by our veterans. Among other 
things, it will: provide immediate support for veteran caregivers; 
improve health care access for women veterans; improve rural health 
care delivery; and increase access to mental health support for 
servicemembers and veterans.
  Mr. Speaker, I am very pleased that Congress recognizes the needs of 
the families and those that are taking care of our veterans. Today, 
more servicemembers are surviving the wounds of war than those injured 
in previous conflicts. For example, the ratio of wounded per fatality 
averaged approximately 1.7 in the first two World Wars compared to 3.1 
in the Korea and Vietnam wars. This number jumped to 7.1 during 
Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), 
mainly due to improved body armor and superior battlefield medicine 
techniques.
  As a result of this improvement, there is a growing need to provide 
continuing care to those injured and wounded from recent conflicts once 
they reach veterans status. Providing support and resources to 
caregivers and attendants that take care of our wounded and injured 
veterans is of a major concern.
  The bill before us today makes it easier for a veteran to be 
accompanied by a family member when traveling to and from a treatment 
facility. In addition to mileage, lodging and subsistence will be 
provided for, especially for those veterans that want to stay close to 
their families. A caregiver support program is also created where 
caregivers of veterans of all eras would receive supportive services 
such as caregiver training and education, counseling and mental health 
services, and respite care. More significantly, our veterans would 
receive better treatment and quality of care.
  I urge my colleagues to vote in support of this important piece of 
legislation.
  Mrs. McCARTHY of New York. Today, the House will consider an 
important bill--the Caregivers and Veterans Omnibus Health Services 
Act. This legislation will provide much-needed support for our veterans 
and their families.
  According to the Dole/Shalala report, 20 percent of active duty, 15 
percent of reserve, and 25 percent of retired and separated members of 
the military have a family member of friend who has been forced to 
leave a job to care for the veteran full-time. This places an 
incredible burden on many, many families across our country.
  Today's bill offers an important array of support services for 
veterans and their caregivers such as: training and education, 
counseling and mental health services, lodging and subsistence payments 
for the caregiver when accompanying the veteran on medical care visits, 
and monthly financial stipends for caregivers. This bill takes 
important steps towards supporting those individuals who care for our 
veterans.
  The bill also makes important investments in health care for women 
veterans. Over 1.8 million women have served our country and for too 
long many of their health care needs have gone unaddressed. This bill 
builds on the previous efforts of our Congress to correct that 
inequity.
  S. 1963 expands and improves Veterans Administration health care for 
women by requiring the VA to conduct a study of barriers to women 
veterans seeking health care, educate and train mental health 
professionals caring for female veterans with sexual trauma, implement 
a reintegration and readjustment pilot program aimed a helping women 
veterans, establish a child care pilot program, and provide post-
delivery health care to a new born child of a woman veteran.
  I support this legislation and our Majority's efforts to support 
those men and women who have risked their lives for our country.
  Mr. ETHERIDGE. Mr. Speaker, I rise in support of S. 1963, the 
Caregivers and Veterans Omnibus Health Services Act. This legislation 
keeps the promises made to our troops, wounded warriors, and veterans. 
It is simply our duty as a Nation, when we put our men and women in 
harm's way, to care for them when they return home.
  S. 1963 will provide support to families and those who care for 
disabled or injured veterans. This bill helps ease the many hardships 
and sacrifices that many families face during lengthy recovery and 
rehabilitation of severe injuries of their loved one. S. 1963 will 
provide support services to family members and other caregivers of 
veterans, including education on how to be a better caregiver, 
counseling and mental health services. The bill also provides health 
care and a stipend for caregivers living with severely wounded veterans 
of the Iraq and Afghanistan wars.
  As a veteran myself, I strongly support making sure Congress honors 
its commitments to our veterans. Our support system should work for all 
those who sacrifice for our country and this bill improves health care 
for the women who have bravely served their country. It also improves 
mental health as an important part of overall health for our veterans.
  Finally, this bill recognizes that more and more of our soldiers are 
women, and it removes existing barriers to women veterans seeking 
health care. Our military health care needs to provide everyone who has 
served our nation receives the services he or she needs. In particular, 
the legislation enables female veterans to receive up to seven days of 
care for newborn children and enhances sexual trauma treatment for 
women at the VA.
  It is time to change the way we care for veterans by providing better 
support and training for those that care for them. The sacrifice of our 
veterans is appreciated by all Americans. S. 1963 represents compassion 
for those who served our country, and support for those who now serve 
them.
  Mr. Speaker, this bill takes care of those who are keeping America 
safe. I urge my colleagues to join me in support of S. 1963, to fulfill 
our continued obligations to our nation's military.
  Mr. STARK. Mr. Speaker, the service men and women serving overseas 
have born the brunt of the cost of the wars in Iraq and Afghanistan. 
The Caregivers and Veterans Omnibus Health Services Act ensures that 
when they return, they will obtain the quality treatment and health 
care they deserve.
  This legislation addresses many of our veterans' most urgent needs. 
Record numbers of service men and women returning home are suffering 
from posttraumatic stress, and this bill ensures that mental health 
services are more accessible. The bill ensures that women

[[Page 5975]]

don't get second-class health care by expanding coverage for women's 
health, including care for newborns. The bill also eliminates health 
care copayments for veterans who are catastrophically disabled.
  Many politicians use the slogan ``support the troops'' when they mean 
``support this war.'' This bill actually supports our troops--by 
providing them the care and support services they need when they return 
home. I urge my colleagues to support this bill.
  Mr. CONYERS. Mr. Speaker, I rise in strong support of S. 1963, the 
``Caregivers and Veterans Omnibus Health Services Act of 2009.'' As a 
Korean War veteran, I understand the various challenges that veterans 
face when returning home. This bill takes a significant step forward in 
terms of improving the overall access to quality, affordable health 
care for our nation's veterans and provides much needed assistance to 
the devoted families across this nation that provide housing, food, and 
full-time care for wounded veterans.
  Under S. 1963, veterans who are catastrophically disabled would no 
longer be required to pay copayments for their medical care. As we all 
know, in America, the sicker you are, the more you must pay in out-of-
pocket costs. Passage of this bill means veterans and their caretakers 
will be able to live with less financial stress.
  This bill also increases funding to expand VA clinics in rural areas 
where VA programs currently do not exist. Veterans living in rural 
areas must often travel hundreds of miles in order to receive care at a 
Veterans hospital--a crushing burden for veterans who need frequent 
health care services, and must pay for expensive travel due to 
increasing transportation costs.
  The bill will also help address the many hardships and sacrifices 
associated with the lengthy recovery and rehabilitation associated with 
severe injuries. In particular, the bill improves access to counseling 
and mental health services. S. 1963 also provides health care and a 
stipend for caregivers living with severely wounded veterans of the 
wars Iraq and Afghanistan. This stipend should help reduce the enormous 
financial pressures on caregivers who are providing food, clothing, 
transportation, and housing to their wounded loved ones during one of 
the worst economic downturns since the Great Depression.
  Again, I thank the Democratic leadership for introducing this 
important bill, which will go a long way in improving the lives of 
scores of veterans and their caregivers for years to come. I encourage 
my colleagues to support the bill.
  Mr. BACA. Mr. Speaker, I rise today in strong support of S. 1963, the 
Caregivers and Veterans Omnibus Health Services Act of 2009.
  The United States of America has a moral obligation to provide for 
all the brave men and women whose courageous service allows all of us 
to live the lives we do.
  This service comes not without a price, and America must provide for 
these service members and their families during deployment and post-
deployment.
  Our disabled, ill and injured veterans need the assistance and care 
they deserve for their sacrifice.
  S. 1963 will expand mental health services for veterans; enhance 
health services for 1.8 million women veterans--which for the first 
time includes care for newborns.
  This is a landmark legislation that builds upon the last three years 
of significant accomplishments for veterans, troops and military 
families.
  S. 1963 will allow for a caregiver of a veteran to receive training, 
counseling, lodging and subsistence payments when accompanying a 
veteran on medical care visits.
  We must ensure that those who care for our veterans are properly 
equipped and trained to do so.
  In addition, we will prohibit the VA from collecting copayments from 
veterans who are catastrophically disabled.
  I am proud to vote for S. 1963, on behalf of all the service members, 
veterans and their families in my District. I urge my colleagues to 
support this bill.
  Mr. DINGELL. Mr. Speaker, I rise today to proudly support the House 
Amendments to S. 1963, the Caregivers and Veterans Omnibus Health 
Services Act; legislation that recognizes and aims to meet the needs of 
our veterans who have bravely served in Iraq and Afghanistan after 9/
11. My colleagues will remember that this legislation was held up in 
the Senate due to one senator's objection that the bill was not paid 
for. However, our warriors have already paid a very high price through 
their sacrifices and selfless devotion to our national security, and 
they should be repaid with excellent care when they return to civilian 
life. Fortunately, this legislation builds on the Democratic Congress' 
record of supporting our veterans through new and innovative programs, 
fixing some of the existing problems in the VA, and increasing funding 
for the VA budget.
  The legislation we are voting on today is a comprehensive approach to 
caring for our veterans. Specifically, it provides robust support for 
those who care for our wounded warriors, addresses the needs women 
veterans, expands services to rural veterans and for mental health 
care, and closes a loophole for disabled veterans health care.
  Specifically, the House amendments to S. 1963 provides services, 
training, and reimbursements for the caregivers of veterans who return 
from war with serious injuries. It will strengthen support for 
caregivers of all veterans and will provide reimbursements for lodging 
and healthcare to caregivers of Afghanistan and Iraq War veterans 
through the Civilian Health and Medical Program of the Department of 
Veterans Affairs.
  In addition, the legislation expands health care services for our 1.8 
million women veterans including provisions mandating a study of the 
barriers to women veterans seeking health care, education and training 
for mental health professionals caring for veterans with sexual trauma, 
a reintegration and readjustment pilot program, establishment of a 
child care pilot program for women receiving regular and intensive 
mental health care and intensive health care services, and post-
delivery health care for new born children.
  This comprehensive bill also improves health care for our veterans 
living in rural areas, including by expanding transportation for 
veterans to local VA hospitals and clinics through VA grants to local 
Veterans Service Organizations and provides increased access to 
counseling and other mental health centers to any member of the Armed 
Forces.
  Other provisions in this legislation include prohibiting the VA from 
collecting copayments from veterans who are catastrophically disabled; 
creating a pilot program to provide specified dental services to 
veterans, survivors, and dependents of veterans through a dental 
insurer; providing hospital care, medical services, and nursing home 
care for certain Vietnam-era veterans exposed to herbicide and Gulf-War 
era veterans who have insufficient medical evidence to establish a 
service-connected disability; and expanding the organizations offering 
transitional housing and other support for homeless veterans that can 
receive grants or per diems from the VA, which is particularly 
important to veterans in rural areas.
  Mr. Speaker, I urge my colleagues to join me in supporting this 
legislation and for the Senate to swiftly act so that this legislation 
can become law and our veterans can begin to benefit from the important 
programs this comprehensive bill implements.
  Mrs. CAPPS. Mr. Speaker, it is with great pride that I rise today to 
express my support for the Caregivers and Veterans Omnibus Health 
Services Act (S. 1963). This important piece of legislation is a 
tremendous step forward for our nation's bravest men and women, and the 
dedicated caregivers who support them.
  This landmark legislation will strengthen health care services for 
our nation's veterans by expanding services for women veterans, 
providing resources to caregivers of wounded veterans, improving health 
care for veterans living in rural areas, providing greater access to 
mental health services, and expanding assistance to homeless veterans. 
Importantly, the legislation has received strong endorsements from 
numerous veterans groups, including the VFW, American Legion, Disabled 
American Veterans, AMVETS, the Wounded Warrior Project, and Paralyzed 
Veterans of America.
  Among its many critical provisions, I am particularly proud of the 
expansion of VA services offered to the 1.8 million women who have 
courageously served their country, including child care for women 
receiving intensive mental and physical health care services, and post-
delivery health care for newborns. In addition, the expansion of mental 
health benefits, greater support for caregivers, and help for homeless 
vets will improve the lives of millions of brave men and women and 
their families.
  This important legislation exemplifies the Democrat-led 111th 
Congress' unwavering commitment to our veterans and their families. 
Tremendous advances in battlefield medicine have increased the survival 
rate of wounded soldiers in Iraq and Afghanistan and made it even more 
important that we constantly work to improve veterans' health care and 
its many support services.
  As a nurse, I've seen first-hand the devastating consequences of 
inadequate health care for our nation's veterans. America has a sacred 
obligation to ensure these brave men and women receive the highest 
quality care

[[Page 5976]]

and today that commitment extends to those dedicated individuals who 
care for our wounded warriors.
  Mr. ADLER of New Jersey. Mr. Speaker, I rise in support of S. 1963, 
the Caregivers and Veterans Omnibus Health Services Act.
  The Caregivers and Veterans Omnibus Health Services Act is a 
comprehensive piece of legislation aimed at augmenting the support 
services available to family caregivers of wounded veterans, improving 
VA services to women veterans, preventing veteran homelessness, and 
increasing mental health care access to veterans.
  This historic bill achieves so many necessary and important goals. 
First, it provides immediate support for veteran caregivers by creating 
a program to offer caregiver training, access to mental health 
counseling, and 24-hour respite care in the veteran's home. Family 
caregivers sacrifice so much of their own lives in order to care for 
our nation's heroes. It is so important that we give them every 
supportive service they need so they do not become overwhelmed by the 
daily realities of caring for a wounded veteran.
  Second, this bill seeks to build a VA health care system respectful 
of the unique medical needs of women veterans. For the first time, VA 
will be authorized to provide health care for newborn infants of women 
veterans. Our women veterans deserve private health care that is 
respectful of their unique medical needs.
  This bill also seeks to expand VA services that are designed to end 
veteran homelessness. It is unacceptable that the brave men and women 
who fought in service to our country would go without a place to rest 
their heads at night. I applaud these efforts to augment Secretary 
Shinseki's plan to end veteran homelessness in the next 5 years.
  The Caregivers and Veterans Omnibus Health Services Act deserves our 
undivided support. I urge my colleagues to vote in favor of S. 1963.
  Ms. RICHARDSON. Mr. Speaker, I rise today in support of S. 1963, the 
``Caregivers and Veterans Omnibus Health Services Act of 2009,'' which 
will finally give our brave men and women in uniform the benefits they 
deserve and provide their families and caregivers with the support that 
they need. Too many of our veterans return home--many of them wounded 
or disabled--after risking their lives on our behalf and do not receive 
adequate health care or benefits. Too many families fall into debt as 
they assume the responsibility of caring for a loved one who has 
returned from Iraq or Afghanistan. This bill will right these 
injustices.
  I thank Chairman Filner for his leadership in bringing this bill to 
the floor. I also thank the sponsor of this legislation, Senator Akaka, 
for working hard to ensure that our Nation's dedication to its veterans 
matches their selfless devotion to this country.
  Mr. Speaker, representing a district that is home to over 24,000 
veterans and the VA Medical Center of Long Beach, I understand the work 
that must be done to uphold our Nation's obligation to its veterans. 
Unfortunately, for years the health care services provided for our 
Nation's veterans have been inadequate. Veterans' families have been 
especially over-burdened by this failure. When wounded or disabled 
veterans return home from overseas, family members often become their 
primary caregivers. However willing these individuals may be to care 
for their loved one, the truth is that family members often lack the 
resources or skills needed to provide the care that our veterans 
deserve. S. 1963 will provide training and financial assistance to 
family caregivers, so that veterans' families can afford to provide 
them with quality care.
  In addition, S. 1963 will improve health care for female veterans. 
For too long, female veterans have lacked access to comprehensive 
health care. We cannot stand for this kind of discrimination. S. 1963 
will break down this barrier and give female veterans access to health 
professionals specializing in the specific health care needs of women. 
Among many other things, the bill will provide counseling and care to 
female veterans suffering from sexual trauma.
  This bill will also provide an array of new health services for 
veterans, ensuring that every veteran has access to the care that he or 
she deserves. The bill will expand care for veterans in rural areas, 
because where veterans live should never determine the quality of care 
that they receive. It will improve mental health support for veterans, 
because we must respond to traumatic experiences that our men and women 
in uniform are braving in Iraq and Afghanistan. Finally, this 
legislation will help homeless veterans find housing, because it is 
simply unacceptable for our veterans to risk their lives for our 
country and return home to live on the streets.
  Mr. Speaker, our men and women in uniform have assumed the 
responsibility of protecting us and the values that we cherish as 
American citizens; we, then, have a responsibility to them. We must 
provide them with support they need to live healthy and financially 
stable lives upon returning home. This bill will do just that. I 
strongly urge my colleagues to join me in supporting S. 1963.
  Mr. FILNER. I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Filner) that the House suspend the rules 
and pass the bill, S. 1963, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. FILNER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

                          ____________________