[Senate Report 105-344]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 597
105th Congress                                                   Report
                                 SENATE

 2d Session                                                     105-344
_______________________________________________________________________


 
    AMENDING TITLE 38, UNITED STATES CODE, TO AUTHORIZE ADDITIONAL 
   EDUCATIONAL ASSISTANCE FOR CERTAIN DEPARTMENT OF VETERANS AFFAIRS 
 HEALTH PROFESSIONALS, TO AUTHORIZE MEDICAL FACILITY CONSTRUCTION AND 
           LEASES FOR THE DEPARTMENT, AND FOR OTHER PURPOSES

                                _______
                                

               September 22, 1998.--Ordered to be printed

_______________________________________________________________________


  Mr. Specter, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 1822]

    The Committee on Veterans' Affairs, to which was referred 
the bill (S. 1822) to authorize the provision of care to 
veterans treated with nasopharyngeal radium irradiation, having 
considered the same, reports favorably thereon with an 
amendment in the form of a substitute and an amendment to the 
title, and recommends that the bill as amended do pass.

                          Committee Amendments

    The amendments are as follows:
    Strike out all after the enacting clause as follows:

    [That except as otherwise expressly provided, whenever in this Act 
an amendment is expressed in terms of an amendment to 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.
    [Sec. 2. (a) The Secretary may examine, and include in the 
Department's Ionizing Radiation Registry Program, any veteran who 
received nasopharyngeal radium irradiation treatments while serving in 
the active military, naval, or air service.
    [(b) Section 1710 is amended--
    [(1) in subsection (a)(2)(F), by inserting ``or who received 
nasopharyngeal radium irradiation treatments,'' after ``environmental 
hazard,''; and
    [(2) in subsection (e)(1)(B) by inserting ``, or a veteran who 
received nasopharyngeal radium irradiation treatments while serving in 
the active military, naval, or air service,'' after ``radiation-exposed 
veteran''.]

    Insert in lieu thereof the following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Veterans' Health 
Care Improvements Act of 1998''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.

          TITLE I--HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE

Sec. 101. Short title.
Sec. 102. Scholarship program for Department of Veterans Affairs 
employees receiving education or training in the health professions.
Sec. 103. Education debt reduction program for Veterans Health 
Administration health professionals.
Sec. 104. Repeal of prohibition on payment of tuition loans.
Sec. 105. Outreach.
Sec. 106. Conforming amendments.

                  TITLE II--CONSTRUCTION AUTHORIZATION

Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of major medical facility leases.
Sec. 203. Authorization of appropriations.
Sec. 204. Increase in threshold for major medical facility leases for 
purposes of Congressional authorization.
Sec. 205. Master plan regarding use of Department of Veterans Affairs 
lands at West Los Angeles Medical Center, California.
Sec. 206. Name of Department of Veterans Affairs medical center, 
Aspinwall, Pennsylvania.

                  TITLE III--MISCELLANEOUS PROVISIONS

Sec. 301. Health care for veterans who received nasopharyngeal radium 
irradiation treatment.
Sec. 302. Extension of eligibility of former members of Selected 
Reserve for housing loans.
Sec. 303. Reestablishment of authority to retain certain excess pension 
amounts for facility expenses.
Sec. 304. Reestablishment of requirement for reports on exercise of 
authorities for payment of competitive pay for nurses and other health-
care personnel.

          TITLE I--HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE

SEC. 101. SHORT TITLE.

    This title may be cited as the ``Department of Veterans Affairs 
Primary Care Providers Incentive Act of 1998''.

SEC. 102. SCHOLARSHIP PROGRAM FOR DEPARTMENT OF VETERANS AFFAIRS 
                    EMPLOYEES RECEIVING EDUCATION OR TRAINING IN THE 
                    HEALTH PROFESSIONS.

    (a) Program Authority.--(1) Chapter 76 of title 38, United States 
Code, is amended by adding at the end the following new subchapter:

        ``SUBCHAPTER VI--EMPLOYEE INCENTIVE SCHOLARSHIP PROGRAM

``Sec. 7671. Authority for program

    ``As part of the Educational Assistance Program, the Secretary 
shall carry out a scholarship program under this subchapter. The 
program shall be known as the Department of Veterans Affairs Employee 
Incentive Scholarship Program (hereinafter in this subchapter referred 
to as the `Program').

``Sec. 7672. Eligibility; agreement

    ``(a) Eligibility.--To be eligible to participate in the Program, 
an individual--
          ``(1) must be an eligible Department employee who is accepted 
        for enrollment or enrolled (as described in section 7602 of 
        this title) as a full-time or part-time student in a field of 
        education or training described in subsection (c); and
          ``(2) must demonstrate financial need, as determined under 
        regulations prescribed by the Secretary.
    ``(b) Eligible Department Employees.--For purposes of subsection 
(a), an eligible Department employee is any employee of the Department 
who, as of the date on which the employee submits an application for 
participation in the Program, has been continuously employed by the 
Department for not less than two years.
    ``(c) Qualifying Fields of Education or Training.--A scholarship 
may be awarded under the Program only for education and training in a 
field leading to appointment or retention in a position under section 
7401 of this title.
    ``(d) Preference in Award of Scholarships.--(1) Notwithstanding 
section 7603(d) of this title and subject to paragraph (2), in 
selecting participants in the Program, the Secretary shall give 
preference to the following applicants, in the order specified:
          ``(A) Applicants who are or will be pursuing a course of 
        education or training in a field relating to the provision of 
        primary care health services, as designated by the Secretary.
          ``(B) Applicants who are employed at Department health-care 
        facilities located in rural areas or at which there is an 
        inadequate supply of individuals qualified to hold a position 
        under section 7401 of this title, as so designated.
    ``(2) In the case of a pool of applicants covered by subparagraph 
(A) or (B) of paragraph (1), the Secretary shall give preference in the 
award of scholarships to the members of the pool who have the greatest 
financial need.
    ``(3) The Secretary shall maintain, and update periodically, a list 
setting forth--
          ``(A) the fields of education or training covered by 
        subparagraph (A) of paragraph (1); and
          ``(B) the facilities covered by subparagraph (B) of that 
        paragraph.
    ``(e) Agreement.--(1) An agreement between the Secretary and a 
participant in the Program shall (in addition to the requirements set 
forth in section 7604 of this title) include the following:
          ``(A) The Secretary's agreement to provide the participant 
        with a scholarship under the Program for a specified number 
        (from one to three) of school years during which the 
        participant pursues a course of education or training described 
        in subsection (c) that meets the requirements set forth in 
        section 7602(a) of this title.
          ``(B) The participant's agreement to serve as a full-time 
        employee in the Veterans Health Administration for a period of 
        time (hereinafter in this subchapter referred to as the `period 
        of obligated service') of one calendar year for each school 
        year or part thereof for which the participant was provided a 
        scholarship under the Program, but for not less than two years.
          ``(C) The participant's agreement to serve under subparagraph 
        (B) in a Department facility selected by the Secretary.
    ``(2) In a case in which an extension is granted under section 
7673(c)(2) of this title, the number of years for which a scholarship 
may be provided under the Program shall be the number of school years 
provided for as a result of the extension.
    ``(3) In the case of a participant who is a part-time student--
          ``(A) the period of obligated service shall be reduced in 
        accordance with the proportion that the number of credit hours 
        carried by such participant in any such school year bears to 
        the number of credit hours required to be carried by a full-
        time student in the course of training being pursued by the 
        participant, but in no event to less than one year; and
          ``(B) the agreement shall include the participant's agreement 
        to maintain employment, while enrolled in such course of 
        education or training, as a Department employee permanently 
        assigned to a Department health-care facility.

``Sec. 7673. Scholarship

    ``(a) Scholarship.--A scholarship provided to a participant in the 
Program for a school year shall consist of payment of the tuition of 
the participant for that school year and payment of other reasonable 
educational expenses (including fees, books, and laboratory expenses) 
for that school year.
    ``(b) Amounts.--The total amount of the scholarship payable under 
subsection (a)--
          ``(1) in the case of a participant in the Program who is a 
        full-time student, may not exceed $10,000 for any one year; and
          ``(2) in the case of a participant in the Program who is a 
        part-time student, shall be the amount specified in paragraph 
        (1) reduced in accordance with the proportion that the number 
        of credit hours carried by the participant in that school year 
        bears to the number of credit hours required to be carried by a 
        full-time student in the course of education or training being 
        pursued by the participant.
    ``(c) Limitation on Years of Payment.--(1) Subject to paragraph 
(2), a participant in the Program may not receive a scholarship under 
subsection (a) for more than three school years.
    ``(2) The Secretary may extend the number of school years for which 
a scholarship may be awarded to a participant in the Program who is a 
part-time student to a maximum of six school years if the Secretary 
determines that the extension would be in the best interest of the 
United States.
    ``(d) Payment of Educational Expenses by Educational 
Institutions.--The Secretary may arrange with an educational 
institution in which a participant in the Program is enrolled for the 
payment of the educational expenses described in subsection (a). Such 
payments may be made without regard to subsections (a) and (b) of 
section 3324 of title 31.

``Sec. 7674. Status of certain participants

    ``(a) Status.--A participant in the Program described in subsection 
(b) shall not, by reason of such participation--
          ``(1) be considered an employee of the Federal Government; or
          ``(2) be counted against any personnel ceiling affecting the 
        Veterans Health Administration.
    ``(b) Covered Participants.--Subsection (a) applies in the case of 
any participant in the Program who is a student on a full-time basis 
and is not performing service for the Department.

``Sec. 7675. Obligated service

    ``(a) In General.--Each participant in the Program shall provide 
service as a full-time employee of the Department for the period of 
obligated service provided in the agreement of the participant entered 
into under section 7603 of this title. Such service shall be provided 
in the full-time clinical practice of such participant's profession or 
in another health-care position in an assignment or location determined 
by the Secretary.
    ``(b) Determination of Service Commencement Date.--(1) Not later 
than 60 days before a participant's service commencement date, the 
Secretary shall notify the participant of that service commencement 
date. That date is the date for the beginning of the participant's 
period of obligated service.
    ``(2) As soon as possible after a participant's service 
commencement date, the Secretary shall--
          ``(A) in the case of a participant who is not a full-time 
        employee in the Veterans Health Administration, appoint the 
        participant as such an employee; and
          ``(B) in the case of a participant who is an employee in the 
        Veterans Health Administration but is not serving in a position 
        for which the participant's course of education or training 
        prepared the participant, assign the participant to such a 
        position.
    ``(3)(A) In the case of a participant receiving a degree from a 
school of medicine, osteopathy, dentistry, optometry, or podiatry, the 
participant's service commencement date is the date upon which the 
participant becomes licensed to practice medicine, osteopathy, 
dentistry, optometry, or podiatry, as the case may be, in a State.
    ``(B) In the case of a participant receiving a degree from a school 
of nursing, the participant's service commencement date is the later 
of--
          ``(i) the participant's course completion date; or
          ``(ii) the date upon which the participant becomes licensed 
        as a registered nurse in a State.
    ``(C) In the case of a participant not covered by subparagraph (A) 
or (B), the participant's service commencement date is the later of--
          ``(i) the participant's course completion date; or
          ``(ii) the date the participant meets any applicable 
        licensure or certification requirements.
    ``(4) The Secretary shall by regulation prescribe the service 
commencement date for participants who were part-time students. Such 
regulations shall prescribe terms as similar as practicable to the 
terms set forth in paragraph (3).
    ``(c) Commencement of Obligated Service.--(1) Except as provided in 
paragraph (2), a participant in the Program shall be considered to have 
begun serving the participant's period of obligated service--
          ``(A) on the date, after the participant's course completion 
        date, on which the participant (in accordance with subsection 
        (b)) is appointed as a full-time employee in the Veterans 
        Health Administration; or
          ``(B) if the participant is a full-time employee in the 
        Veterans Health Administration on such course completion date, 
        on the date thereafter on which the participant is assigned to 
        a position for which the participant's course of training 
        prepared the participant.
    ``(2) A participant in the Program who on the participant's course 
completion date is a full-time employee in the Veterans Health 
Administration serving in a capacity for which the participant's course 
of training prepared the participant shall be considered to have begun 
serving the participant's period of obligated service on such course 
completion date.
    ``(d) Course Completion Date Defined.--In this section, the term 
`course completion date' means the date on which a participant in the 
Program completes the participant's course of education or training 
under the Program.

``Sec. 7676. Breach of agreement: liability

    ``(a) Liquidated Damages.--A participant in the Program (other than 
a participant described in subsection (b)) who fails to accept payment, 
or instructs the educational institution in which the participant is 
enrolled not to accept payment, in whole or in part, of a scholarship 
under the agreement entered into under section 7603 of this title shall 
be liable to the United States for liquidated damages in the amount of 
$1,500. Such liability is in addition to any period of obligated 
service or other obligation or liability under the agreement.
    ``(b) Liability During Course of Education or Training.--(1) Except 
as provided in subsection (d), a participant in the Program shall be 
liable to the United States for the amount which has been paid to or on 
behalf of the participant under the agreement if any of the following 
occurs:
          ``(A) The participant fails to maintain an acceptable level 
        of academic standing in the educational institution in which 
        the participant is enrolled (as determined by the educational 
        institution under regulations prescribed by the Secretary).
          ``(B) The participant is dismissed from such educational 
        institution for disciplinary reasons.
          ``(C) The participant voluntarily terminates the course of 
        education or training in such educational institution before 
        the completion of such course of education or training.
          ``(D) The participant fails to become licensed to practice 
        medicine, osteopathy, dentistry, podiatry, or optometry in a 
        State, fails to become licensed as a registered nurse in a 
        State, or fails to meet any applicable licensure requirement in 
        the case of any other health-care personnel who provide either 
        direct patient-care services or services incident to direct 
        patient-care services, during a period of time determined under 
        regulations prescribed by the Secretary.
          ``(E) In the case of a participant who is a part-time 
        student, the participant fails to maintain employment, while 
        enrolled in the course of training being pursued by the 
        participant, as a Department employee.
    ``(2) Liability under this subsection is in lieu of any service 
obligation arising under a participant's agreement.
    ``(c) Liability During Period of Obligated Service.--(1) Except as 
provided in subsection (d), if a participant in the Program breaches 
the agreement by failing for any reason to complete such participant's 
period of obligated service, the United States shall be entitled to 
recover from the participant an amount determined in accordance with 
the following formula:


    ``(2) In such formula:
          ``(A) `A' is the amount the United States is entitled to 
        recover.
          ``(B) `F' is the sum of--
                  ``(i) the amounts paid under this subchapter to or on 
                behalf of the participant; and
                  ``(ii) the interest on such amounts which would be 
                payable if at the time the amounts were paid they were 
                loans bearing interest at the maximum legal prevailing 
                rate, as determined by the Treasurer of the United 
                States.
          ``(C) `t' is the total number of months in the participant's 
        period of obligated service, including any additional period of 
        obligated service in accordance with section 7673(c)(2) of this 
        title.
          ``(D) `s' is the number of months of such period served by 
        the participant in accordance with section 7673 of this title.
    ``(d) Limitation on Liability for Reductions-in-Force.--Liability 
shall not arise under subsection (b)(1)(E) or (c) in the case of a 
participant otherwise covered by the subsection concerned if the 
participant fails to maintain employment as a Department employee due 
to a reduction-in-force.
    ``(e) Period for Payment of Damages.--Any amount of damages which 
the United States is entitled to recover under this section shall be 
paid to the United States within the one-year period beginning on the 
date of the breach of the agreement.

``Sec. 7677. Expiration of program

    ``The Secretary may not furnish scholarships to individuals who 
commence participation in the Program after December 31, 2001.''.
    (2) The table of sections at the beginning of chapter 76 of title 
38, United States Code, is amended by adding at the end the following:

        ``SUBCHAPTER VI--EMPLOYEE INCENTIVE SCHOLARSHIP PROGRAM

``7671. Authority for program.
``7672. Eligibility; agreement.
``7673. Scholarship.
``7674. Status of certain participants.
``7675. Obligated service.
``7676. Breach of agreement: liability.
``7677. Expiration of program.''.

    (b) Regulations.--The Secretary of Veterans Affairs may treat 
regulations prescribed subchapter II of chapter 76 of title 38, United 
States Code, as regulations required under subchapter VI of that 
chapter, as added by subsection (a), but only to the extent that the 
regulations prescribed under such subchapter II are not inconsistent 
with the provisions of such subchapter VI.

SEC. 103. EDUCATION DEBT REDUCTION PROGRAM FOR VETERANS HEALTH 
                    ADMINISTRATION HEALTH PROFESSIONALS.

    (a) Program Authority.--Chapter 76 of title 38, United States Code 
(as amended by section 102), is further amended by adding after 
subchapter VI the following new subchapter:

           ``SUBCHAPTER VII--EDUCATION DEBT REDUCTION PROGRAM

``Sec. 7681. Authority for program

    ``(a) In General.--(1) As part of the Educational Assistance 
Program, the Secretary may carry out an education debt reduction 
program under this subchapter. The program shall be known as the 
Department of Veterans Affairs Primary Care Workers Education Debt 
Reduction Program (hereinafter in this subchapter referred to as the 
`Education Debt Reduction Program').
    ``(2) The purpose of the Education Debt Reduction Program is to 
assist personnel serving in health-care positions in the Veterans 
Health Administration in reducing the amount of debt incurred by such 
personnel in completing programs of education or training that 
qualified such personnel for such service.
    ``(b) Relationship to Educational Assistance Program.--Education 
debt reduction payments under the Education Debt Reduction Program 
shall be in addition to other assistance available to individuals under 
the Educational Assistance Program.

``Sec. 7682. Eligibility

    ``(a) Eligibility.--An individual eligible to participate in the 
Education Debt Reduction Program is any individual who--
          ``(1) is serving in a position in the Veterans Health 
        Administration under an appointment under section 7402(b) of 
        this title; and
          ``(2) owes any amount of principal or interest under a loan 
        the proceeds of which were used by or on behalf of the 
        individual to pay costs relating to a course of education or 
        training which led to a degree that qualified the individual 
        for a position referred to in paragraph (1).
    ``(b) Covered Costs.--For purposes of subsection (a)(2), costs 
relating to a course of education or training include--
          ``(1) tuition expenses;
          ``(2) all other reasonable educational expenses, including 
        expenses for fees, books, and laboratory expenses; and
          ``(3) reasonable living expenses.

``Sec. 7683. Preference

    ``(a) Preference.--Notwithstanding section 7603(d) of this title, 
in selecting individuals for education debt reduction payments under 
the Education Debt Reduction Program, the Secretary shall give 
preference to the following (in the order specified):
          ``(1) Individuals recently appointed by the Secretary to 
        positions under section 7401 of this title in fields relating 
        to primary care health services, as designated by the 
        Secretary.
          ``(2) Individuals recently appointed by the Secretary to 
        positions under such section in areas in which the recruitment 
        or retention of an adequate supply of qualified health-care 
        personnel is difficult, as so designated.
          ``(3) Any other individuals serving in appointments to 
        positions described in paragraphs (1) and (2).
    ``(b) Recently Appointed Individuals.--An individual shall be 
treated as recently appointed to a position for purposes of subsection 
(a) if the individual was appointed to the position not more than 6 
months before the date of treatment for such purposes.

``Sec. 7684. Education debt reduction

    ``(a) In General.--Education debt reduction payments under the 
Education Debt Reduction Program shall consist of payments to 
individuals selected to participate in the program of amounts to 
reimburse such individuals for payments by such individuals of 
principal and interest on loans described in section 7682(a)(2) of this 
title.
    ``(b) Frequency of Payment.--(1) The Secretary may make education 
debt reduction payments to any given participant in the Education Debt 
Reduction Program on a monthly or annual basis, at the election of the 
Secretary.
    ``(2) The Secretary shall make such payments at the end of the 
period elected by the Secretary under paragraph (1).
    ``(c) Performance Requirement.--The Secretary may make education 
debt reduction payments to a participant in the Education Debt 
Reduction Program for a period only if the Secretary determines that 
the individual maintained an acceptable level of performance in the 
position or positions served by the participant during the period.
    ``(d) Maximum Annual Amount.--(1) Subject to paragraph (2), the 
total amount of education debt reduction payments made to a participant 
for a year under the Education Debt Reduction Program shall be--
          ``(A) $6,000 for the first year of the participant's 
        participation in such Program;
          ``(B) $8,000 for the second year of the participant's 
        participation in such Program; and
          ``(C) $10,000 for the third year of the participant's 
        participation in such Program.
    ``(2) The total amount payable to a participant in such Program for 
any year may not exceed the amount of the principle and interest on 
loans referred to in subsection (a) that is paid by the individual 
during such year.

``Sec. 7685. Expiration of program

    ``The Secretary may not make education debt reduction payments to 
individuals who commence participation in the Education Debt Reduction 
Program after December 31, 2001.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 76 of title 38, United States Code (as amended by section 
102(b)), is further amended by adding at the end the following:

           ``SUBCHAPTER VII--EDUCATION DEBT REDUCTION PROGRAM

``7681. Authority for program.
``7682. Eligibility.
``7683. Preference.
``7684. Education debt reduction.
``7685. Expiration of program.''.

SEC. 104. REPEAL OF PROHIBITION ON PAYMENT OF TUITION LOANS.

    Section 523(b) of the Veterans Health Care Act of 1992 (Public Law 
102-585; 106 Stat. 4959; 38 U.S.C. 7601 note) is repealed.

SEC. 105. OUTREACH.

    The Secretary of Veterans Affairs shall take appropriate actions to 
notify employees of the Department of Veterans Affairs of the benefits 
available under the Department of Veterans Affairs Employee Incentive 
Scholarship Program under subchapter VI of chapter 76 of title 38, 
United States Code (as added by section 102), and under the Department 
of Veterans Affairs Primary Care Workers Education Debt Reduction 
Program under subchapter VII of that chapter (as added by section 103).

SEC. 106. CONFORMING AMENDMENTS.

    Chapter 76 of title 38, United States Code (as amended by this 
title), is further amended as follows:
          (1) In section 7601(a)--
                  (A) by striking out ``and'' at the end of paragraph 
                (2);
                  (B) by striking out the period at the end of 
                paragraph (3) and inserting in lieu thereof a 
                semicolon; and
                  (C) by adding at the end the following:
          ``(4) the employee incentive scholarship program provided for 
        in subchapter VI of this chapter; and''; and
          ``(5) the education debt reduction program provided for in 
        subchapter VII of this chapter.''.
          (2) In section 7602--
                  (A) in subsection (a)(1)--
                          (i) by striking out ``subchapter I or II'' 
                        and inserting in lieu thereof ``subchapter II, 
                        III, or VI'';
                          (ii) by striking out ``or for which'' and 
                        inserting in lieu thereof ``, for which''; and
                          (iii) by inserting before the period at the 
                        end the following: ``, or for which a 
                        scholarship may be awarded under subchapter VI 
                        of this chapter, as the case may be''; and
                  (B) in subsection (b), by striking out ``subchapter I 
                or II'' and inserting in lieu thereof ``subchapter II, 
                III, or VI''.
          (3) In section 7603--
                  (A) in subsection (a)--
                          (i) by striking out ``To apply to participate 
                        in the Educational Assistance Program,'' and 
                        inserting in lieu thereof ``(1) To apply to 
                        participate in the Educational Assistance 
                        Program under subsection II, III, V, or VI of 
                        this chapter,''; and
                          (ii) by adding at the end the following:
    ``(2) To apply to participate in the Educational Assistance Program 
under subchapter VII of this chapter, an individual shall submit to the 
Secretary an application for such participation.''; and
                  (B) in subsection (b)(1), by inserting ``(if 
                required)'' before the period at the end.
          (4) In section 7604, by striking out ``subchapter II, III, or 
        V'' each place it appears in paragraphs (1)(A), (2)(D), and (5) 
        and inserting in lieu thereof ``subchapter II, III, V, or VI''.
          (5) In section 7632--
                  (A) in paragraph (1)--
                          (i) by striking out ``and the Tuition 
                        Reimbursement Program'' and inserting in lieu 
                        thereof ``, the Tuition Reimbursement Program, 
                        the Employee Incentive Scholarship Program, and 
                        the Education Debt Reduction Program''; and
                          (ii) by inserting ``(if any)'' after ``number 
                        of students'';
                  (B) in paragraph (2), by inserting ``(if any)'' after 
                ``education institutions''; and
                  (C) in paragraph (4)--
                          (i) by striking ``and per participant'' and 
                        inserting in lieu thereof ``, per 
                        participant''; and
                          (ii) by inserting ``, per participant in the 
                        Employee Incentive Scholarship Program, and per 
                        participant in the Education Debt Reduction 
                        Program'' before the period at the end.
          (6) In section 7636, by striking ``or a stipend'' and 
        inserting ``a stipend, or education debt reduction''.

                  TITLE II--CONSTRUCTION AUTHORIZATION

SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

    The Secretary of Veterans Affairs may carry out the following major 
medical facility projects, with each project to be carried out in the 
amount specified for that project:
          (1) Clinical consolidations and seismic corrections at the 
        Department of Veterans Affairs medical center in Long Beach, 
        California, in an amount not to exceed $23,200,000.
          (2) Seismic corrections at the Department of Veterans Affairs 
        medical center in San Juan, Puerto Rico, in an amount not to 
        exceed $50,000,000.
          (3) Nursing home care unit renovations in Lebanon, 
        Pennsylvania, in an amount not to exceed $9,500,000.
          (4) Construction of a parking structure at the Department of 
        Veterans Affairs medical center in Denver, Colorado, in an 
        amount not to exceed $13,000,000, to be derived only from funds 
        appropriated for the Parking Revolving Fund for a fiscal year 
        before fiscal year 1999 that remain available for obligation.
          (5) Outpatient clinic projects at Auburn, California, and 
        Merced California, as part of the Northern California 
        Healthcare Systems Project, in an amount not to exceed 
        $3,000,000, to be derived only from funds appropriated for 
        Construction, Major Projects, for a fiscal year before fiscal 
        year 1999 that remain available for obligation.

SEC. 202. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

    The Secretary of Veterans Affairs may enter into leases for medical 
facilities as follows:
          (1) Lease of a satellite outpatient clinic in Baton Rouge, 
        Louisiana, in an amount not to exceed $1,792,500.
          (2) Lease of a satellite outpatient clinic in Daytona Beach, 
        Florida, in an amount not to exceed $2,573,300.
          (3) Lease of a satellite outpatient clinic in Oakland Park, 
        Florida, in an amount not to exceed $4,008,600.

SEC. 203. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to the 
Secretary of Veterans Affairs for fiscal year 1999--
          (1) for the Construction, Major Projects account, $82,700,000 
        for the projects authorized in paragraphs (1), (2), and (3) of 
        section 201; and
          (2) for the Medical Care account, $8,374,400 for the leases 
        authorized in section 202.
    (b) Limitation.--The projects authorized in section 201 may only be 
carried out using--
          (1) funds appropriated for fiscal year 1999 pursuant to the 
        authorization of appropriations in subsection (a);
          (2) funds appropriated for Construction, Major Projects for a 
        fiscal year before fiscal year 1999 that remain available for 
        obligation;
          (3) funds appropriated for the Parking Revolving Fund for a 
        fiscal year before fiscal year 1999 that remain available for 
        obligation; and
          (4) funds appropriated for Construction, Major Projects for 
        fiscal year 1999 for a category of activity not specific to a 
        project.

SEC. 204. INCREASE IN THRESHOLD FOR MAJOR MEDICAL FACILITY LEASES FOR 
                    PURPOSES OF CONGRESSIONAL AUTHORIZATION.

    Section 8104(a)(3)(B) of title 38, United States Code, is amended 
by striking out ``$300,000'' and inserting in lieu thereof 
``$600,000''.

SEC. 205. MASTER PLAN REGARDING USE OF DEPARTMENT OF VETERANS AFFAIRS 
                    LANDS AT WEST LOS ANGELES MEDICAL CENTER, 
                    CALIFORNIA.

    (a) Report.--The Secretary of Veterans Affairs shall submit to 
Congress a report on the master plan of the Department of Veterans 
Affairs relating to the use of Department lands at the West Los Angeles 
Department of Veterans Affairs Medical Center, California.
    (b) Report Elements.--The report under subsection (a) shall set 
forth the following:
          (1) The master plan referred to in that subsection, if such 
        plan currently exists.
          (2) A current assessment of the master plan.
          (3) Any proposals of the Department for a veterans park on 
        the lands referred to in subsection (a), and an assessment of 
        such proposals.
          (4) Any proposals to use a portion of such lands as dedicated 
        green space, and an assessment of such proposals.
    (c) Alternative Element.--If the master plan referred to in 
subsection (a) does not exist as of the date of enactment of this Act, 
the Secretary shall set forth in the report under that subsection, in 
lieu of the elements required under paragraphs (1) and (2) of 
subsection (b), a plan for the development of a master plan for the use 
of the lands referred to in subsection (a) over the next 25 years and 
over the next 50 years.

SEC. 206. NAME OF DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER, 
                    ASPINWALL, PENNSYLVANIA.

    The Department of Veterans Affairs medical center in Aspinwall, 
Pennsylvania, shall be known and designated as the ``H. John Heinz III 
Department of Veterans Affairs Medical Center''. Any reference to such 
medical center in any law, regulation, map, document, record, or other 
paper of the United States shall be considered to be a reference to the 
H. John Heinz III Department of Veterans Affairs Medical Center.

                  TITLE III--MISCELLANEOUS PROVISIONS

SEC. 301. HEALTH CARE FOR VETERANS WHO RECEIVED NASOPHARYNGEAL RADIUM 
                    IRRADIATION TREATMENT.

    (a) Authority To Provide Care.--Section 1710 of title 38, United 
States Code, is amended--
          (1) in subsection (a)(2)(F), by inserting ``or who received 
        nasopharyngeal radium irradiation treatments,'' after ``or 
        other conditions,''; and
          (2) in subsection (e)(1)(B), by inserting ``, or a veteran 
        who received nasopharyngeal radium irradiation treatments while 
        serving in the active military, naval, or air service,'' after 
        ``radiation-exposed veteran''.
    (b) Inclusion in Ionizing Radiation Registry Program.--The 
Secretary of Veterans Affairs may examine and include in the Ionizing 
Radiation Registry Program of the Department of Veterans Affairs any 
veteran who received nasopharyngeal radium irradiation treatments while 
serving in the active military, naval, or air service.

SEC. 302. EXTENSION OF ELIGIBILITY OF FORMER MEMBERS OF SELECTED 
                    RESERVE FOR HOUSING LOANS.

    Section 3702(a)(2)(E) of title 38, United States Code, is amended 
by striking out ``October 27, 1999'' and inserting in lieu thereof 
``December 31, 2004''.

SEC. 303. REESTABLISHMENT OF AUTHORITY TO RETAIN CERTAIN EXCESS PENSION 
                    AMOUNTS FOR FACILITY EXPENSES.

    Section 5503(a)(1)(B) of title 38, United States Code, is amended 
in the second sentence by striking out ``September 30, 1997'' and 
inserting in lieu thereof ``September 30, 2003''.

SEC. 304. REESTABLISHMENT OF REQUIREMENT FOR REPORTS ON EXERCISE OF 
                    AUTHORITIES FOR PAYMENT OF COMPETITIVE PAY FOR 
                    NURSES AND OTHER HEALTH-CARE PERSONNEL.

    Section 7451(g) of title 38, United States Code, is amended by 
striking out ``December 1 of 1991, 1992, and 1993'' and inserting in 
lieu thereof ``December 1 of 1999, 2000, and 2001''.

    Amend the title so as to read:

    ``A Bill to amend title 38, United States Code, to authorize 
additional educational assistance for certain Department of Veterans 
Affairs health professionals, to authorize medical facility 
construction and leases for the Department, and for other purposes.''.

                              Introduction

    On March 23, 1998, the Chairman of the Committee, Senator 
Arlen Specter, introduced S. 1822 with the cosponsorship of the 
RankingMinority Member of the Committee, Senator John D. 
Rockefeller IV, Committee Member Strom Thurmond, Committee Member James 
M. Jeffords, Committee Member Frank H. Murkowski, Committee Member 
Daniel K. Akaka, Committee Member Paul Wellstone, Senator Joseph I. 
Lieberman, and Committee Member Patty Murray. As introduced, S. 1822 
would have authorized the provision of medical care by the Department 
of Veterans Affairs (VA), on a priority basis, to veterans who, while 
in service, had been treated with nasopharyngeal radium irradiation.
    On April 30, 1998, Committee Member Bob Graham introduced 
S. 2012 with the cosponsorship of Senator Connie Mack. As 
introduced, S. 2012 would have named the VA medical center in 
Gainesville, Florida, the ``Malcolm Randall Department of 
Veterans Affairs Medical Center.''
    On May 22, 1998, Senator Rockefeller introduced S. 2115 
with the cosponsorship of Senator Barbara A. Mikulski. As 
introduced, S. 2115 would have established scholarship and 
education loan debt reduction programs in order to facilitate 
the employment of primary care and other health care 
professionals by VA.
    On June 17, 1998, Senator Akaka introduced S. 2181. As 
introduced, S. 2181 would have made permanent the eligibility 
of certain current and former members of the Selected Reserve 
to participate in VA housing loan benefits programs.
    On April 21, 1998, the Committee held a hearing to receive 
testimony on pending legislation, including S. 1822. Testimony 
was received from: the Honorable Kenneth W. Kizer, M.D., 
M.P.H., Under Secretary for Health, Department of Veterans 
Affairs; the Honorable Joseph Thompson, Under Secretary for 
Benefits, Department of Veterans Affairs; Ms. Joan Ma Pierre, 
Director for Electronics and Systems, Defense Special Weapons 
Agency, U.S. Department of Defense; Captain Richard L. 
LaFontaine, USN, U.S. Navy Bureau of Medicine and Surgery; 
Rosalie Bertell, Ph.D., International Institute of Concern for 
Public Health, Toronto, Canada; Mr. William J. Brady, Health 
Physicist; Otto Raabe, Ph.D., University of California, Davis; 
Richard B. Setlow, Ph.D., Brookhaven National Laboratory; Steve 
Wing, Ph.D., University of North Carolina; Mr. Tidoro A. 
Garcia; Mr. James J. Garrity; and Mr. Albert G. Parrish.

                           Committee Meeting

    After carefully reviewing the testimony from the foregoing 
hearing, the Committee met in open session on July 28, 1998, 
and voted unanimously to report S. 1822 with an amendment in 
the nature of a substitute that includes provisions from S. 
1822, as introduced; S. 2012; S. 2115; S. 2181, as amended; an 
original provision authorizing VA major medical facility 
construction projects and major medical facility leases; an 
original provision increasing from $300,000 to $600,000 per 
year the threshhold lease payment which will trigger the 
requirement that a major medical facility lease be authorized 
by statute; an original provision directing that VA provide to 
Congress a master plan regarding the use of lands at the VA 
medical center in West Los Angeles, California; an original 
provision naming a VA medical center in Aspinwall, 
Pennsylvania, the ``H. John Heinz III VA Medical Center''; an 
original provision reestablishing VA authority to retain, 
rather than requiring that VA remit to the Treasury, benefits 
formerly received by pension-eligible veterans receiving 
nursing home care by VA; and an original provision 
reestablishing a requirement that VA report to the Congress 
regarding competitive pay for registered nurses and certain 
other health care professionals.

                     Summary of S. 1822 as Reported

    S. 1822 as reported (hereinafter referred to as the 
``Committee bill'') consists of three titles, summarized below, 
that would establish a scholarship program and an education 
loan debt reduction program to facilitate the employment of 
primary care and other health care professionals by VA; 
authorize VA major medical facility construction projects and 
major medical facility leases; increase the threshhold lease 
payment (from $300,000 to $600,000 per year) which will trigger 
the requirement that a major medical facility lease be 
authorized by statute; require that VA provide to Congress a 
master plan regarding the use of lands at the VA medical center 
in West Los Angeles, California; name VA medical centers in 
Aspinwall, Pennsylvania, and Gainesville, Florida, the ``H. 
John Heinz III VA Medical Center'' and the ``Malcolm Randall VA 
Medical Center'' respectively; authorize the provision of 
medical care by VA, on a priority basis, to veterans who, while 
in service, had been treated with nasopharyngeal radium 
irradiation; extend until December 31, 2004, the eligibility of 
former members of the Selected Reserve to participate in VA 
housing loan benefits programs; reestablish, until September 
30, 2003, an expired provision of law authorizing VA to retain, 
rather than remit to the Treasury, benefits formerly received 
by pension-eligible veterans receiving nursing home care by VA; 
and extend through fiscal year 2001 an expired requirement that 
VA report to the Congress concerning competitive pay for 
registered nurses and certain other health care professionals.

          Title I--Health Professionals Educational Assistance

    Title I contains amendments to title 38, United States 
Code, that would:
          1. Establish a Department of Veterans Affairs 
        Employee Incentive Scholarship Program; provide that 
        health care professionals who have been continuously 
        employed by VA for a period of not less than 2 years, 
        and who demonstrate financial need, will be eligible 
        for incentive scholarships; provide that preferences be 
        given to providers of primary care services, to 
        employees in rural or other areas where there is an 
        inadequate supply of health care professionals, and to 
        persons having the greatest financial need; require 
        that scholarship recipients agree to serve as VA health 
        care professionals for a period of obligated service at 
        the completion of VA-supported training; and specify 
        that scholarship benefits will consist of tuition 
        payments and reasonable educational expenses (not to 
        exceed $10,000 per year) for a period not to exceed 3 
        academic years (section 102).
          2. Establish a Department of Veterans Affairs Primary 
        Care Workers Education Debt Reduction Program; provide 
        that health care professionals employed by VA would be 
        eligible for debt reduction program participation, with 
        preferences given to recently appointed primary care 
        service providers and to recently appointed health care 
        professionals serving in areas where there is an 
        inadequate supply of health care professionals; and 
        specify that benefits would consist of reimbursement of 
        actual educational debt payments, on a monthly or 
        annual basis, in an amount not to exceed $6,000 to 
        $10,000 per year (section 103).
          3. Repeal a prohibition on payments to VA health care 
        professionals for repayment of tuition loans (section 
        104).
          4. Direct VA outreach efforts and make appropriate 
        conforming amendments (sections 105 and 106).

                  Title II--Construction Authorization

    Title II contains freestanding provisions and amendments to 
title 38, United States Code, that would:
          1. Authorize major medical facility construction 
        projects in Long Beach, California; San Juan, Puerto 
        Rico; Lebanon, Pennsylvania; Denver, Colorado; Auburn, 
        California; and Merced, California (section 201).
          2. Authorize major medical facility leases in Baton 
        Rouge, Louisiana; Daytona Beach, Florida; and Oakland 
        Park, Florida (section 202).
          3. Authorize appropriations for major medical 
        facility construction projects and major medical 
        facility leases for fiscal year 1999 (section 203).
          4. Increase the threshhold lease payment (from 
        $300,000 to $600,000 per year) which would trigger the 
        requirement that a major medical facility lease be 
        authorized by statute (section 204).
          5. Require that VA provide to Congress a master plan 
        regarding the use of lands at the VA medical center in 
        West Los Angeles, California (section 205).
          6. Name the VA medical center in Aspinwall, 
        Pennsylvania, the ``H. John Heinz III Department of 
        Veterans Affairs Medical Center'' (section 206).
          7. Name the VA medical center in Gainesville, 
        Florida, the ``Malcolm Randall Department of Veterans 
        Affairs Medical Center'' (section 207).

                  Title III--Miscellaneous Provisions

    Title III contains amendments to title 38, United States 
Code, that would:
          1. Authorize VA to provide health care services, on a 
        priority basis, to veterans who, while in service, had 
        been treated with nasopharyngeal radium irradiation 
        (section 301).
          2. Extend until December 31, 2004, the eligibility of 
        former members of the Selected Reserve to participate 
        in VA housing loan benefits programs (section 302).
          3. Reestablish until September 30, 2003, an expired 
        provision of law authorizing VA to retain, rather than 
        remit to the Treasury, benefits formerly received by 
        pension-eligible veterans receiving nursing home care 
        by VA (section 303).
          4. Reestablish through fiscal year 2001 an expired 
        requirement that VA report to the Congress concerning 
        competitive pay for registered nurses and certain other 
        health care professionals (section 304).

                               Discussion

          title i--health professionals educational assistance

    Title I of the Committee bill, which is derived from S. 
2115, would establish as part of VA's Educational Assistance 
Program an Employee Incentive Scholarship Program and a Primary 
Care Workers Education Debt Reduction Program in order to 
facilitate the recruitment and retention of primary health care 
service providers by VA.

Background

    Under current law, VA administers three programs as part of 
its Health Professional Educational Assistance Program: a 
Health Professional Scholarship Program; a Nurse Education 
Tuition Reimbursement Program; and a stipend program for 
members of the Selected Reserves.
    Under the Health Professional Scholarship Program, VA 
provides educational assistance to program participants in the 
form of full tuition payments, and the payment of reasonable 
educational expenses and a stipend. In return, program 
participants must agree to serve as VA-appointed health care 
professionals for a period of obligated service. The period of 
obligated service is equal to the number of years of training 
supported by VA. Students pursuing degrees in medicine, 
dentistry, podiatry, optometry, nursing (including licensed 
practical nursing and vocational nursing), psychology, and 
respiratory and physical therapy are eligible for program 
participation; persons enrolled in physician assistant and 
expanded function dental auxiliary programs are also eligible.
    VA's Nurse Education Tuition Reimbursement Program provides 
tuition reimbursement support to full-time VA employees 
pursuing nursing degrees. In exchange for such support, program 
participants must agree to continue to serve as full-time VA 
employees for a period of 1 year after completion of the course 
of study.
    VA supports former members of the Selected Reserves who 
seek training in the health professions by providing stipends 
of $400 per month in exchange for their agreement to serve as 
VA employees for a period of obligated service. (Such 
individuals are otherwise eligible for educational assistance 
benefits administered by the Department of Defense under 
chapter 106 of title 10, United States Code; indeed, 
eligibility for such benefits is a statutory prerequisite for 
eligibility for VA stipend assistance.)
    No funds have been appropriated for VA's Health 
Professional Educational Assistance Programs since fiscal year 
1995.

Committee bill

    Section 102. Scholarship Program for Department of Veterans 
Affairs Employees Receiving Education or Training in the Health 
Professions.--Section 102 of the Committee bill would establish 
a Department of Veterans Affairs Employee Incentive Scholarship 
Program. That program would provide educational assistance in 
the form of tuition payments and the payment of reasonable 
educational expenses (not to exceed $10,000 per year) to VA 
employees who seek to pursue training in the health 
professions. VA employees who had served for a period of not 
less than 2 years and who demonstrate financial need would be 
eligible for assistance for a period not to exceed 3 academic 
years and, as is the case with all participants in VA's Health 
Professional Educational Assistance Program, program 
participants would be required to agree to serve a period of 
obligated service after completion of a VA-supported course of 
study.
    Preference would be given to employee applicants seeking 
training in primary care services and to employees serving in 
rural or other areas where there is an inadequate supply of 
health care professionals. Eligible primary care services would 
include, but not be limited to, nurse practitioners, physician 
assistants, occupational therapists, physical therapists, and 
respiratory therapists.
    While VA's health care system is, in fact, ``downsizing,'' 
VA's need for primary care providers, particularly non-
physician primary care providers, continues to be unmet. The VA 
Employee Incentive Scholarship Program would assist in meeting 
that need while, at the same time, assisting VA in retaining a 
skilled workforce by improving employee morale and by providing 
opportunities and incentives for VA employees to upgrade their 
skills.
    Section 103. Education Debt Reduction Program for Veterans 
Health Administration Health Professionals.--Section 103 of the 
Committee bill would establish a Department of Veterans Affairs 
Primary Care Workers Education Debt Reduction Program. That 
program would provide educational assistance in the form of 
student loan repayment assistance to VA health care 
professionals. Participation preference would be given to 
recently appointed primary care service providers and to 
recently appointed health care professionals serving in areas 
where there is an inadequate supply of health care 
professionals. In specifying such preferences, the Committee 
intends that the Primary Care Workers Education Debt Reduction 
Program would serve as a tool to recruit needed primary care 
providers, particularly non-physician primary care providers.
    The Committee notes that the assistance programs created by 
sections 102 and 103 of the Committee bill are not intended to 
assist VA nursing staff in meeting educational standards newly 
required of VA nursing staff. Financial assistance to help 
nurses meet these requirements should, in the Committee's view, 
be made available through alternate means.
    Section 104. Repeal of Prohibition on Payment of Tuition 
Loans.--Section 104 of the Committee bill would repeal a 
provision in current law which prohibits educational assistance 
in the form of tuition loan repayment assistance. Such a repeal 
is necessary to put into effect the policies of section 103 of 
the Committee bill.
    Section 105. Outreach.--Section 105 of the Committee bill 
would direct that VA undertake outreach efforts to notify VA 
employees ofbenefits offered under the VA Employee Incentive 
Scholarship Program and the VA Primary Care Workers Education Debt 
Reduction Program.

                  Title II--Construction Authorization

    Title II of the Committee bill contains various 
freestanding provisions and amendments to title 38, United 
States Code, relating to real property administration, as 
outlined below.
    Section 201. Authorization of Major Medical Facility 
Projects.--VA may not expend funds on a ``major medical 
facility project'' without prior statutory authorization. 38 
U.S.C. Sec. 8104(a)(2). A ``major medical facility project'' is 
a construction project that will ``involv[e] the total 
expenditure of more than $4,000,000.'' 38 U.S.C. 
Sec. 8104(a)(3).
    By letter dated May 12, 1998, VA requested authorization to 
proceed with the following major medical facility projects in 
the amounts specified: a seismic corrections project at the VA 
medical center in San Juan, Puerto Rico, $50 million; a 
clinical improvements and seismic corrections project at the VA 
medical center in Long Beach, California, $23.2 million; 
outpatient clinic projects at Auburn and Merced, California, $3 
million; and a parking structure at the VA medical center in 
Denver, Colorado, $13 million.
    Section 201 of the Committee bill would authorize each of 
the requested projects and, in addition, would authorize the 
appropriation of $9.5 million for construction of an extended 
care unit at the VA medical center in Lebanon, Pennsylvania.
    Section 202. Authorization of Major Medical Facility 
Leases.--VA may not expend funds on a ``major medical facility 
lease'' without prior statutory authorization. 38 U.S.C. 
Sec. 8104(a)(2). A ``major medical facility lease'' is one that 
will have an average annual rental of more than $300,000. 38 
U.S.C. Sec. 8104(a)(3).
    By letter dated May 12, 1998, VA requested authorization to 
lease space for satellite outpatient clinics at the following 
locations in the annual rental amounts specified: Oakland Park, 
Florida, $4.0 million; Daytona Beach, Florida, $2.6 million; 
and Baton Rouge, Louisiana, $1.8 million.
    Section 202 of the Committee bill would authorize each of 
the requested major medical facility leases.
    Section 203. Authorization of Appropriations.--Section 203 
of the Committee bill would authorize appropriations for fiscal 
year 1999 for major medical facility projects in the amount of 
$73.2 million, and would authorize for fiscal year 1999 
appropriations for major medical facility leases in the amount 
of $8.374 million. By letter dated May 12, 1998, VA requested 
authorizations in those amounts.
    Section 204. Increase in Threshold for Major Medical 
Facility Leases for Purposes of Congressional Authorization.--
As noted above, VA may not expend funds on a ``major medical 
facility lease''--that is, one that will have an average annual 
rental of more than $300,000--without prior statutory 
authorization. By letter dated May 12, 1998, VA requested that 
the $300,000 annual rent threshold amount be raised to $1 
million.
    Section 204 of the Committee bill would raise the threshold 
amount to $600,000 per year.
    Section 205. Master Plan Regarding Use of Department of 
Veterans Affairs Lands at the West Los Angeles Medical Center, 
California.--A civic organization in Los Angeles, California, 
has proposed that certain acreage on the grounds of the West 
Los Angeles VA Medical Center be preserved as a park to 
memorialize deceased veterans. VA has previously been directed 
to develop a master plan specifying its long-term plans for the 
development of the West Los Angeles VA Medical Center property.
    Section 205 of the Committee bill would direct VA to 
furnish to the Congress a report on the previously mandated 
master plan. VA would be required to furnish with that report 
the previously mandated master plan (and develop such a plan if 
one has not yet been prepared), a current assessment of that 
plan, and proposals VA may have developed for use of land as a 
veterans memorial park or as dedicated green space.
    Section 206. Name of Department of Veterans Affairs Medical 
Center, Aspinwall, Pennsylvania.--Section 206 of the Committee 
bill would name the VA medical center in Aspinwall, 
Pennsylvania, the ``H. John Heinz III Department of Veterans 
Affairs Medical Center'' in honor of Senator H. John Heinz III 
of Pennsylvania. Senator Heinz was killed in a tragic aviation 
accident on April 4, 1991.
    Section 207. Name of Department of Veterans Affairs Medical 
Center, Gainesville, Florida.--Section 207 of the Committee 
bill, which is derived from S. 2012, would name the VA medical 
center in Gainesville, Florida, the ``Malcolm Randall 
Department of Veterans Affairs Medical Center'' in honor of the 
medical center's recently retired director.

              Title III--Miscellaneous Benefits Provisions

    Title III of the Committee bill contains various amendments 
to title 38, United States Code, as outlined below.
    Section 301. Health Care for Veterans Who Received 
Nasopharyngeal Radium Irradiation Treatment.--All veterans are 
eligible for VA-provided health care services, but certain 
veterans have priority access to care on a non-fee basis. Under 
current law, a veteran who was ``exposed to a toxic substance, 
radiation, or environmental hazard''while in service has 
priority access for treatment of diseases associated with such an 
exposure. 38 U.S.C. Sec. 1710(a)(2)(F).
    Nasopharyngeal radium irradiation is a treatment modality 
which was medically accepted in the 1940's through the early 
1960's, and which involved the insertion of a radium-tipped rod 
up a patient's nose. That treatment, which was commonly 
furnished to aviators and submariners to relieve inner ear 
maladies associated with pressure changes, is now believed to 
be associated with certain head and neck cancers.
    Section 301 of the Committee bill would add a new class of 
veteran to the grouping of section 1710(a)(2)(F) veterans who 
have priority access to VA health care: veterans who, in 
service, were treated with nasopharyngeal radium irradiation.
    Section 302. Extension of Eligibility of Former Members of 
Selected Reserve for Housing Loans.--VA provides housing loan 
benefits to persons who meet eligibility criteria specified by 
statute. See 38 U.S.C. Sec. 3702. Public Law 102-547 provided 
that, for the period of October 28, 1992, through October 27, 
1999, the following persons would be eligible for such 
benefits: persons who have served in the Selected Reserves for 
a period of at least 6 years and who continue to serve in the 
Selected Reserves; persons who, after having served in the 
Selected Reserves for at least 6 years, have been honorably 
discharged, been placed on the retired list, or been 
transferred to the Standby Reserve or the Ready Reserve; and 
persons who are discharged or released from Selected Reserves 
because of a service-connected disability prior to serving 6 
years. 38 U.S.C. Sec. 3702(a)(2)(E).
    Section 302 of the Committee bill, which is derived from S. 
2181, would extend the above-summarized Selected Reserves 
eligibility for VA housing loan benefits until December 31, 
2004.
    Section 303. Reestablishment of Authority to Retain Certain 
Excess Pension Amounts for Facility Expenses.--Under current 
law, a veteran who served during a period of war and who is 
permanently and totally disabled due to a non-service-connected 
cause is eligible for pension. Pension benefits are comprised 
of monthly payments in the amount necessary to bring the 
disabled veteran's total annual income, including retirement 
and Social Security benefits, to a level set by statute, e.g., 
in the case of a veteran with no dependents, $8665 per year.
    Pension-eligible veterans, however, who have no dependents 
and who have been receiving VA nursing home care for more than 
a 3- month period are not eligible to receive pension in excess 
of $90 per month. 38 U.S.C. Sec. 5503(a)(1)(B). Through 
September 30, 1997, pension benefits above the $90 limit 
(``excess'' pension benefits) were deposited into a revolving 
fund account maintained at the VA medical facility providing 
nursing home care to assist in defraying the operating expenses 
of that facility. Id. As of October 1, 1997, however, authority 
to retain excess pension benefits expired and, as a 
consequence, such funds now revert to the Treasury.
    Section 303 of the Committee bill would reestablish VA 
authority to retain, rather than remit to the Treasury, excess 
pension benefits formerly received by pension-eligible veterans 
receiving VA nursing home care. Such authority would, under 
section 303, expire on September 30, 2003.
    Section 304. Reestablishment of Requirement for Reports on 
Exercise of Authorities for Payment of Competitive Pay for 
Nurses and Other Health Care Professionals.--For the period 
1991-1993, VA was required to submit to Congress reports 
concerning certain nurse and other health care professional pay 
issues. See 38 U.S.C. Sec. 7451(g). Generally, VA was required 
to report on its utilization of special pay provisions, set 
forth in 38 U.S.C. chapter 74, subchapter IV, which authorize 
VA to increase pay levels over rates of basic pay otherwise 
applicable to ensure VA competitiveness in the marketplace for 
nurses and other health care professionals. Specifically, VA 
was required to report on its use of the special pay 
authorities provided by law; its plans to utilize such 
authorities in the year succeeding the report; VA health 
professional pay rates, by facility and position; data 
concerning the numbers of VA health professional employees who 
had left VA employment; data concerning position vacancies; and 
other information.
    Section 304 of the Committee bill would reestablish the 
requirement that VA report to the Congress as specified in 38 
U.S.C. Sec. 7451(g). Such reports would be due on December 31, 
1999, 2000, and 2001.

                             Cost Estimate

    In compliance with paragraph 11(a) of rule XXVI of the 
Standing Rules of the Senate, the Committee, based on 
information supplied by the Congressional Budget Office (CBO), 
estimates that direct spending resulting from the enactment of 
the Committee bill, as compared to costs under current law and 
as scored against the current CBO baseline for the first 5 
years following enactment, would increase by $4 million over 
the period fiscal years 1999 through 2003. The bill would not 
affect the budgets of State, local, or tribal governments.
    The cost estimate provided by CBO, setting forth a detailed 
breakdown of costs, follows:

                                     U.S. Congress,
                               Congressional Budget Office,
                                Washington, DC, September 14, 1998.
Hon. Arlen Specter,
Chairman, Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office (CBO) 
has prepared the enclosed cost estimate for S. 1822, the 
Veterans' Health Care Improvements Act of 1998.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Shawn Bishop.
            Sincerely,
                                         June E. O'Neill, Director.
    Enclosure.

S. 1822--Veterans' Health Care Improvements Act of 1998

    Summary: S. 1822 would authorize appropriations for major 
construction projects and leases at medical facilities of the 
Department of Veterans Affairs (VA), authorize additional 
educational assistance for certain VA employees, and make other 
changes to permanent law. CBO estimates that S. 1822 would 
result in additional discretionary outlays totaling $14 million 
in 1999 and $117 million over the 1999-2003 period, assuming 
appropriation of the necessary amounts. In addition, the bill 
would increase direct spending by $4 million over the five-year 
period. Because the bill would affect direct spending, pay-as-
you-go procedures would apply.
    The bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would not affect the budgets of state, local, or tribal 
governments.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 1822 over the 1999-2003 period is shown 
in Table 1. The costs of this legislation would fall within 
budget function 700 (veterans affairs).

     TABLE 1. BUDGETARY IMPACT OF S. 1822, AS ORDERED REPORTED BY THE SENATE COMMITTEE ON VETERANS' AFFAIRS
----------------------------------------------------------------------------------------------------------------
                                                                  By fiscal year, in millions of dollars--
                                                           -----------------------------------------------------
                                                              1998     1999     2000     2001     2002     2003
----------------------------------------------------------------------------------------------------------------
                                                 DIRECT SPENDING
Estimated budget authority................................        0        4       -1       -1       -1        3
Estimated outlays.........................................        0        4       -1       -1       -1        3
                                        SPENDING SUBJECT TO APPROPRIATION
Estimated authorization level.............................        0      101       10       10        0        0
Estimated outlays.........................................        0       14       22       36       28       17
----------------------------------------------------------------------------------------------------------------

    Direct spending: Direct spending costs would stem from 
payments from the account that funds veterans' pensions to a VA 
revolving fund and from an extension of housing benefits for 
reservists.
    Pensions: Section 303 would authorize payments from the 
veterans' pensions account (a mandatory account) to the Medical 
Facilities Revolving Fund, which could spend the receipts. The 
amounts transferred would be the difference between the 
standard monthly pension payments for some veterans receiving 
nursing home care from the VA and the $90 monthly payment they 
receive under provisions scheduled to expire in 2002. The VA 
would use the transfer to the revolving fund to defray 
operating expenses at the facility providing the veteran's 
care. CBO estimates that this section would increase spending 
by about $2 million annually, except that costs would total an 
estimated $4 million in 1999 because the transfer associated 
with 1998 pension payments would probably occur in 1999. (See 
Table 2.)

  TABLE 2. DIRECT SPENDING EFFECTS OF S. 1822, AS ORDERED REPORTED BY THE SENATE COMMITTEE ON VETERANS' AFFAIRS
                                    [By fiscal year, in millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                              1998     1999     2000     2001     2002     2003
----------------------------------------------------------------------------------------------------------------
                                               VETERANS' PENSIONS
Spending under current law for veterans' pensions:
    Estimated Budget Authority............................    3,045    3,055    3,114    3,140    3,185    3,710
    Estimated Outlays.....................................    3,037    3,047    3,107    3,138    3,182    3,706
Proposed changes:
    Estimated budget authority............................        0        4        2        2        2        0
    Estimated outlays.....................................        0        4        2        2        2        0
Spending under S. 1822 for veterans' pensions:
    Estimated budget authority............................    3,045    3,059    3,116    3,142    3,187    3,710
    Estimated outlays.....................................    3,037    3,051    3,109    3,140    3,184    3,706
                                              VETERANS' HOME LOANS
Spending under current law for veterans' home loans:
    Estimated budget authority............................      617      112      117      118      118      289
    Estimated Outlays.....................................      617      112      117      118      118      289
Proposed changes:
    Estimated budget authority............................        0        0       -3       -3       -3        3
    Estimated outlays.....................................        0        0       -3       -3       -3        3
Spending under S. 1822 for veterans' home loans:
    Estimated budget authority............................      617      112      114      115      115      292
    Estimated outlays.....................................      617      112      114      115      115      292
                                             TOTAL PROPOSED CHANGES
Proposed changes:
    Estimated budget authority............................        0        4       -1       -1       -1        3
    Estimated outlays.....................................        0        4       -1       -1       -1        3
----------------------------------------------------------------------------------------------------------------

    Home loans for reservists: Section 302 would extend the 
home loan benefits for reservists through December 31, 2004. 
Under current law, those benefits expire on October 27, 1999. 
CBO estimates that this provision would increase VA loan 
guarantees by roughly 7,000 each year. Because origination fees 
would more than offset the subsidy cost of additional loan 
guarantees, CBO estimates that the provision would lower net 
spending by about $3 million annually through 2002. In 2003 and 
2004, however, this provision would cost $3 million a year 
because certain fees will expire under current law. In 2005, 
when this provision would expire, CBO estimates the program 
would cost about $1 million.
    Spending subject to appropriation: The bill contains 
several provisions that would affect spending subject to 
appropriation (see Table 3). CBO assumes appropriation of the 
authorized amounts by the beginning of each fiscal year. Outlay 
estimates are based on historical spending patterns.

     TABLE 3. DISCRETIONARY SPENDING EFFECTS OF S. 1822, AS ORDERED REPORTED BY THE SENATE VETERANS' AFFAIRS
                                                    COMMITTEE
                                    [By fiscal year, in millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                              1998     1999     2000     2001     2002     2003
----------------------------------------------------------------------------------------------------------------
                                               MAJOR CONSTRUCTION
Spending under current law:
    Authorization level \1\...............................      209        0        0        0        0        0
    Estimated outlays.....................................      328      287      209      121       51        9
Proposed changes:
    Authorization level...................................        0       83        0        0        0        0
    Estimated outlays.....................................        0      (2)       13       26       24       15
Spending under S. 1822:
    Authorization level \2\...............................      209       83        0        0        0        0
    Estimated outlays.....................................      328      288      222      147       75       24
                                                  MEDICAL CARE
Spending under current law:
    Estimated authorization level 1,3.....................   17,739   17,739   17,739   17,739   17,739   17,739
    Estimated outlays.....................................   17,615   18,122   17,763   17,739   17,739   17,739
Proposed changes:
    Major medical leases:
        Estimated authorization level.....................        0        8        0        0        0        0
        Estimated outlays.................................        0        8        1        0        0        0
    Educational assistance programs:
        Estimated authorization level.....................        0       10       10       10        0        0
        Estimated outlays.................................        0        6        8       10        4        2
    Nasopharyngeal irradiation:
        Estimated authorization level.....................        0    (\2\)    (\2\)    (\2\)    (\2\)    (\2\)
        Estimated outlays.................................        0    (\2\)    (\2\)    (\2\)    (\2\)    (\2\)
    Subtotal--Proposed changes:
        Estimated authorization level.....................        0       18       10       10        0        0
        Estimated outlays.................................        0       14        9       10        4        2
Spending under S. 1822:
    Estimated authorization level 1,3.....................   17,739   17,757   17,749   17,749   17,739   17,739
    Estimated outlays.....................................   17,615   18,136   17,772   17,749   17,743   17,741
                                             TOTAL PROPOSED CHANGES
Proposed changes:
    Estimated authorization level.........................        0      101       10       10        0        0
    Estimated outlays.....................................        0       14       22       36       28       17
----------------------------------------------------------------------------------------------------------------
\1\ The 1998 level is the amount appropriated for that year.
\2\ Costs of less than $500,000.
\3\ The current law amounts for 1999-2003 assume that appropriations remain at the 1998 level. If they are
  adjusted for inflation, the base amounts would rise by about $600 million a year, but the estimated changes
  would remain as shown.
Note.--Details may not add to totals because of rounding.

    Major construction and leases: Section 203 would authorize 
appropriations of $82.7 million to complete several projects 
that are specified in the bill. The bill would also authorize 
appropriations of $8.4 million for leasing agreements for three 
satellite outpatient clinics. In addition, the bill would 
authorize other projects that would not require new 
appropriations. First, the bill would authorize VA to spend $13 
million to construct a parking structure at the medical center 
in Denver, Colorado. For this project, VA would be required to 
use $13 million from balances in the Parking Revolving Fund. 
Second, the bill would authorize VA to use $3 million in 
unobligated balances to build ambulatory care facilities. The 
funding would be derived from amounts appropriated for fiscal 
years beginning before 1999 and that remain available for 
obligation. CBO estimates that these authorizations of spending 
from existing balances would have no budgetary impact because 
the annual spending for the newly authorized projects would not 
differ significantly from spending that would occur under 
current law.
    Educational assistance programs: Sections 102 and 103 would 
create two additional educational assistance programs for 
certain employees of VA. One would provide scholarships up to 
$10,000 a year for three years to employees pursuing medical 
education or training in certain fields, and the other would 
reimburse employees for health-related educational loans up to 
a specified amount, depending on how many years the employee 
participated in the program. The programs would be available to 
employees who would be accepted into them by December 31, 2001.
    CBO estimates that outlays for those programs would be $6 
million in 1999 and $30 million over the 1999-2003 period, 
assuming appropriation of the necessary funds. Even though the 
VA would not be able to select new employees after 2001, it 
might have commitments to the employees accepted into the 
programs by then. This estimate assumes the annual cost of both 
programs would equal the amount provided in S. 2168, the 1999 
appropriations bill for the VA, as passed by the Senate on July 
17, 1998. However, S. 1822 does not specify funding or limit 
the size of the programs; therefore, the annual cost could be 
higher after 1999, particularly if the VA uses its entire 
appropriation to cover one year of assistance for participating 
employees and then adds new cohorts in the following years. For 
this estimate, CBO assumes that the VA would structure the 
programs so that it covers the total multiyear cost of its 
commitments with the appropriation in any given year.
    Veterans treated with nasopharyngeal radium therapy: 
Section 301 would grant priority access to hospital, medical, 
and nursing home care to veterans who were given nasopharyngeal 
radium irradiation treatments while on active duty. Those 
veterans would be placed in the same priority category as 
veterans exposed to nuclear radiation. Under current law, 
veterans exposed to nuclear radiation may receive priority care 
for certain diseases specified in law or by the VA, namely for 
cancers and leukemia.
    According to data presented at a workshop sponsored by the 
Centers for Disease Control, 8,000 to 20,000 veterans were 
treated with nasopharyngeal radium irradiation. CBO assumes 
that 14,000 veterans were exposed and that because most 
exposures occurred during or shortly after World War II, about 
6,000 are alive today. Based on epidemiologic data from the 
National Cancer Institute and the likelihood that some of these 
veterans already qualify for benefits, CBO estimates that about 
200 veterans would become eligible for health care from the VA. 
Finally, data from the 1992 Survey of Veterans suggests that 
very few of these veterans would seek care from the VA because 
their incomes and eligibility for Medicare coverage would lead 
them to other sources of care. Thus, CBO estimates that section 
301 would cost less than $500,000 annually.
    Pay-as-you-go considerations: The Balanced Budget and 
Emergency Deficit Control Act sets up pay-as-you-go procedures 
for legislation affecting direct spending or receipts. The net 
changes in outlays and governmental receipts that are subject 
to pay-as-you-go procedures are shown in the following table. 
For the purposes of enforcing pay-as-you-go procedures, only 
the effects in the current year, the budget year, and the 
succeeding four years are counted.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                         By fiscal year, in millions of dollars--
                                                                 ---------------------------------------------------------------------------------------
                                                                   1998    1999    2000    2001    2002    2003    2004    2005    2006    2007    2008
--------------------------------------------------------------------------------------------------------------------------------------------------------
Changes in outlays..............................................       0       4      -1      -1      -1       3       3       1       0       0       0
Changes in receipts.............................................                                      Not applicable
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Intergovernmental and private-sector impact: The bill 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would not affect the budgets of state, 
local, or tribal governments.
    Previous CBO estimate: On July 14, 1998, CBO prepared an 
estimate for H.R. 4110 as ordered reported by the House 
Committee on Veterans' Affairs. Section 302 of S. 1822 and 
section 402 of H.R. 4110 would extend home loan benefits for 
reservists and have similar costs, except that the provision in 
S. 1822 would expire in 2005. Section 303 of S. 1822 and 
section 406 of H.R. 4110 are similar provisions and have the 
same estimated budgetary impact.
    On April 2, 1998, CBO prepared a cost estimate for H.R. 
3603 as ordered reported by the House Committee on Veterans' 
Affairs. That bill would authorize appropriations of $214 
million for construction and leases of medical facilities.
    Estimate prepared by: Federal costs: Shawn Bishop (health), 
Sunita D'Monte (housing) and Charles Riemann (pensions); Impact 
on State, local, and tribal governments: Marc Nicole; Impact on 
the private sector: Rachel Schmidt.
    Estimate approved by: Robert A. Sunshine, Deputy Assistant 
Director for Budget Analysis.

                      Regulatory Impact Statement

    In compliance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the Committee on Veterans' 
Affairs has made an evaluation of the regulatory impact which 
would be incurred in carrying out the Committee bill. The 
Committee finds that the Committee bill would not entail any 
significant regulation of individuals or businesses or result 
in any significant impact on the personal privacy of any 
individuals, and that the paperwork resulting from enactment 
would be minimal.

                 Tabulation of Votes Cast in Committee

    In compliance with paragraph 7 of rule XXVI of the Standing 
Rules of the Senate, the following is a tabulation of votes 
cast in person or by proxy by members of the Committee on 
Veterans' Affairs at its July 28, 1998, meeting. On that date, 
the Committee, by unanimous voice vote, ordered S. 1822, as 
amended, reported favorably to the Senate.

                             Agency Report

    On April 21, 1998, Kenneth W. Kizer, M.D., M.P.H., Under 
Secretary for Health, and Joseph Thompson, Under Secretary for 
Benefits, Department of Veterans' Affairs, submitted testimony 
on, among other things, S. 1822. An excerpt from that testimony 
is reprinted below:

      Statement of Department of Veterans' Affairs, April 21, 1998

    Mr. Chairman, and Members of the Committee, we are pleased 
to be here this morning to discuss a number of issues 
concerning radiation-exposed, or ``atomic'' veterans. Your 
invitation letter of April 10, 1998, indicated that today's 
hearing would focus on the following items or issues: (1) S. 
1385, a bill to amend title 38, United States Code, to expand 
the number of diseases presumed to be service connected with 
respect to radiation-exposed veterans, introduced by Senator 
Wellstone; (2) S. 1822, a bill to amend title 38, United States 
Code, to authorize provision of care to veterans treated with 
nasopharyngeal radium irradiation, introduced by the Chairman 
at VA's request; (3) current ``dose reconstruction'' policies 
that govern claims for service connection of radiation-related 
disabilities; and (4) the Federal government's response to the 
needs of atomic veterans.

           *       *       *       *       *       *       *

S. 1822
    Finally, Mr. Chairman, we would like to discuss S. 1822, 
which would authorize provision of health care to veterans 
treated with nasopharyngeal radium irradiation. We would like 
to thank you, Mr. Chairman, and Senator Rockefeller and other 
Members of the Committee who cosponsored this VA proposal.
    S. 1822 would authorize participation in VA's ionizing 
radiation program by veterans who were treated with 
nasopharyngeal radium irradiation many years ago. During the 
1940s and 1950s, the military administered nasopharyngeal 
radium treatments to thousands of submariners and air crew 
members to prevent ear injury during the severe pressure 
changes they encountered on the job. Scientific study now 
suggests that treated individuals may be at increased risk for 
development of head and neck malignancies. It is also possible 
that the treatment may cause other types of diseases and 
disorders.
    With the current state of knowledge regarding the possible 
consequences of nasopharyngeal radium treatment, it is 
appropriate for VA to provide needed health care for cancers 
and other diseases and disorders that might be associated with 
such exposure to radiation. Accordingly, our bill would 
authorize treatment for the same diseases and disorders that 
the law currently authorizes for veterans who may have been 
exposed to ionizing radiation during weapons testing or during 
the occupation of Japan following World War II. It would also 
authorize VA to examine any veteran treated with radium 
irradiation and include any findings in the Department's 
radiation registry.
    Mr. Chairman, that concludes VA's testimony.

          Changes in Existing Law Made by S. 1822, as Reported

    In compliance with paragraph 12 of Rule XXVI of the 
Standing Rules of the Senate, changes in existing law made by 
the Committee bill, as reported, are shown as follows (existing 
law proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

TITLE 38, UNITED STATES CODE

           *       *       *       *       *       *       *


PART II--GENERAL BENEFITS

           *       *       *       *       *       *       *


CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

           *       *       *       *       *       *       *


SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL 
                               TREATMENT

Sec. 1710. Eligibility for hospital, nursing home, and domiciliary care

    (a)(1) * * *

           *       *       *       *       *       *       *

    (2) The Secretary (subject to paragraph (4)) shall furnish 
hospital care and medical services, and may furnish nursing 
home care, which the Secretary determines to be needed to any 
veteran--
          (A) * * *

           *       *       *       *       *       *       *

          (F) who was exposed to a toxic substance, radiation, 
        or other conditions, or who received nasopharyngeal 
        radium irradiation treatments, as provided in 
        subsection (e); or

           *       *       *       *       *       *       *

    (e)(1)(A) * * *
    (B) A radiation-exposed veteran, or a veteran who received 
nasopharyngeal radium irradiation treatments while serving in 
the active military, naval, or air service, is eligible for 
hospital care, medical services, and nursing home care under 
subsection (a)(2)(F) for any disease suffered by the veteran 
that is--

           *       *       *       *       *       *       *


PART III--READJUSTMENT AND RELATED BENEFITS

           *       *       *       *       *       *       *


              CHAPTER 37--HOUSING AND SMALL BUSINESS LOANS

SUBCHAPTER I--GENERAL

           *       *       *       *       *       *       *


Sec. 3702. Basic entitlement

    (a)(1) * * *

           *       *       *       *       *       *       *

    (2) The veterans referred to in the first sentence of 
paragraph (1) of this subsection are the following:
                  (A) * * *

           *       *       *       *       *       *       *

                  (E) For the period beginning on October 28, 
                1992, and ending on [October 27, 1999] December 
                31, 2004, each veteran described in section 
                3701(b)(5) of this title.

           *       *       *       *       *       *       *


PART IV--GENERAL ADMINISTRATIVE PROVISIONS

           *       *       *       *       *       *       *


CHAPTER 55--MINORS, INCOMPETENTS, AND OTHER WARDS

           *       *       *       *       *       *       *


Sec. 5503. Hospitalized veterans and estates of incompetent 
                    institutionalized veterans

    (a)(1)(A) * * *
    (B) Except as provided in subparagraph (D) of this 
paragraph, where any veteran having neither spouse nor child is 
being furnished nursing home care by the Department, no pension 
in excess of $90 per month shall be paid to or for the veteran 
for any period after the end of the third full calendar month 
following the month of admission for such care. Effective 
through [September 30, 1997] September 30, 2003, any amount in 
excess of $90 per month to which the veteran would be entitled 
but for the application of the preceding sentence shall be 
deposited in a revolving fund at the Department medical 
facility which furnished the veteran nursing care, and such 
amount shall be available for obligation without fiscal year 
limitation to help defray operating expenses of that facility.

           *       *       *       *       *       *       *


PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

           *       *       *       *       *       *       *


         CHAPTER 74--VETERANS HEALTH ADMINISTRATION--PERSONNEL

     SUBCHAPTER IV--PAY FOR NURSES AND OTHER HEALTH-CARE PERSONNEL

Sec. 7451. Nurses and other health-care personnel: competitive pay

    (a)(1) * * *

           *       *       *       *       *       *       *

    (g) Not later than [December 1 of 1991, 1992, and 1993] 
December 1 of 1999, 2000, and 2001, the Secretary shall submit 
to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report regarding the exercise of the 
authorities provided in this section for the preceding fiscal 
year. Each such report shall include the following:
          (1) * * *

           *       *       *       *       *       *       *


    CHAPTER 76--HEALTH PROFESSIONALS EDUCATIONAL ASSISTANCE PROGRAM

                         SUBCHAPTER I--GENERAL

Sec.
7601. * * *
     * * * * * * *

          SUBCHAPTER VI--EMPLOYEE INCENTIVE SCHOLARSHIP PROGRAM

7671. Authority for program.
7672. Eligibility; agreement.
7673. Scholarship.
7674. Status of certain participants.
7675. Obligated service.
7676. Breach of agreement: liability.
7677. Expiration of program.

            SUBCHAPTER VII--EDUCATION DEBT REDUCTION PROGRAM

7681. Authority for program.
7682. Eligibility.
7683. Preference.
7684. Education debt reduction.
7685. Expiration of program.

                         SUBCHAPTER I--GENERAL

Sec. 7601. Establishment of program; purpose

    (a) There is hereby established a program to be known as 
the Department of Veterans Affairs Health Professionals 
Educational Assistance Program (hereinafter in this chapter 
referred to as the ``Educational Assistance Program''). The 
program consists of--
          (1) * * *
          (2) the tuition reimbursement program provided for in 
        subchapter III of this chapter; [and]
          (3) the Selected Reserve member stipend program 
        provided for under subchapter V of this chapter[.];
          (4) the employee incentive scholarship program 
        provided for in subchapter VI of this chapter; and
          (5) the education debt reduction program provided for 
        in subchapter VII of this chapter.
    (b) * * *

Sec. 7602. Eligibility

    (a)(1) To be eligible to participate in the Educational 
Assistance Program under [subchapter I or II] subchapter II, 
III, or VI of this chapter, an individual must be accepted for 
enrollment or be currently enrolled as a student at a 
qualifying educational institution in a course of education or 
training that is approved by the Secretary and that leads 
toward completion of a degree in a field of education or 
training for which a scholarship may be awarded under 
subchapter II of this chapter [or for which], for which tuition 
reimbursement may be provided under subchapter III of this 
chapter, or for which a scholarship may be awarded under 
subchapter VI of this chapter, as the case may be.
    (2) * * *
    (b) An individual is not eligible to apply to participate 
in the Educational Assistance Program under [subchapter I or 
II] subchapter II, III, or VI of this chapter if the individual 
is obligated under any other Federal program to perform service 
after completion of the course of education or training of such 
individual referred to in subsection (a) of this section.

Sec. 7603. Application and acceptance

    (a) [To apply to participate in the Educational Assistance 
Program,] (1) To apply to participate in the Educational 
Assistance Program under subsection II, III, V, or VI of this 
chapter, an individualshall submit to the Secretary an 
application for such participation together with an agreement described 
in section 7604 of this title under which the participant agrees to 
serve a period of obligated service in the Veterans Health 
Administration as provided in the agreement in return for payment of 
educational assistance as provided in the agreement.
    (2) To apply to participate in the Educational Assistance 
Program under subchapter VII of this chapter, an individual 
shall submit to the Secretary an application for such 
participation.
    (b)(1) An individual becomes a participant in the 
Educational Assistance Program upon the Secretary's approval of 
the individual's application and the Secretary's acceptance of 
the agreement (if required).

           *       *       *       *       *       *       *


Sec. 7604. Terms of agreement

    An agreement between the Secretary and a participant in the 
Educational Assistance Program shall be in writing, shall be 
signed by the participant, and shall include the following 
provisions:
          (1) The Secretary's agreement--
                  (A) to provide the participant with 
                educational assistance as authorized in 
                [subchapter II, III, or V] subchapter II, III, 
                V, or VI of this chapter and specified in the 
                agreement; and
                  (B) * * *
          (2) The participant's agreement--
                  (A) * * *

           *       *       *       *       *       *       *

                  (D) after completion of the course of 
                training, to serve as a full-time employee in 
                the Veterans Health Administration as specified 
                in the agreement in accordance with [subchapter 
                II, III, or V] subchapter II, III, V, or VI of 
                this chapter.

           *       *       *       *       *       *       *

          (5) Such other terms as are required to be included 
        in the agreement under [subchapter II, III, or V] 
        subchapter II, III, V, or VI of this chapter or as the 
        Secretary may require consistent with the provisions of 
        this chapter.

           *       *       *       *       *       *       *


SUBCHAPTER IV--ADMINISTRATIVE MATTERS

           *       *       *       *       *       *       *


Sec. 7632. Annual report

    Not later than March 1 of each year, the Secretary shall 
submit to Congress a report on the Educational Assistance 
Program. Each such report shall include the following 
information:
          (1) The number of students receiving educational 
        assistance under the Educational Assistance Program, 
        showing the numbers of students receiving assistance 
        under the Scholarship Program [and the Tuition 
        Reimbursement Program], the Tuition Reimbursement 
        Program, the Employee Incentive Scholarship Program, 
        and the Education Debt Reduction Program separately, 
        and the number of students (if any) enrolled in each 
        type of health profession training under each program.
          (2) The education institutions (if any) providing 
        such training to students in each program.
          (3) * * *
          (4) The average amounts of educational assistance 
        provided per participant in the Scholarship Program 
        [and per participant], per participant in the Tuition 
        Reimbursement Program, per participant in the Employee 
        Incentive Scholarship Program, and per participant in 
        the Education Debt Reduction Program.

           *       *       *       *       *       *       *


Sec. 7636. Exemption of educational assistance payments from taxation

    Notwithstanding any other law, any payment to, or on behalf 
of a participant in the Educational Assistance Program, for 
tuition, education expenses, [or a stipend] a stipend, or 
education debt reduction under this chapter shall be exempt 
from taxation.

           *       *       *       *       *       *       *


         SUBCHAPTER VI--EMPLOYEE INCENTIVE SCHOLARSHIP PROGRAM

Sec. 7671. Authority for program

    As part of the Educational Assistance Program, the 
Secretary shall carry out a scholarship program under this 
subchapter. The program shall be known as the Department of 
Veterans Affairs Employee Incentive Scholarship Program 
(hereinafter in this subchapter referred to as the 
``Program'').

Sec. 7672. Eligibility; agreement

    (a) Eligibility.--To be eligible to participate in the 
Program, an individual--
          (1) must be an eligible Department employee who is 
        accepted for enrollment or enrolled (as described in 
        section 7602 of this title) as a full-time or part-time 
        student in a field of education or training described 
        in subsection (c); and
          (2) must demonstrate financial need, as determined 
        under regulations prescribed by the Secretary.
    (b) Eligible Department Employees.--For purposes of 
subsection (a), an eligible Department employee is any employee 
of the Department who, as of the date on which the employee 
submits an application for participation in the Program, has 
been continuously employed by the Department for not less than 
two years.
    (c) Qualifying Fields of Education or Training.--A 
scholarship may be awarded under the Program only for education 
and training in a field leading to appointment or retention in 
a position under section 7401 of this title.
    (d) Preference in Award of Scholarships.--(1) 
Notwithstanding section 7603(d) of this title and subject to 
paragraph (2), in selecting participants in the Program, the 
Secretary shall give preference to the following applicants, in 
the order specified:
          (A) Applicants who are or will be pursuing a course 
        of education or training in a field relating to the 
        provision of primary care health services, as 
        designated by the Secretary.
          (B) Applicants who are employed at Department health-
        care facilities located in rural areas or at which 
        there is an inadequate supply of individuals qualified 
        to hold a position under section 7401 of this title, as 
        so designated.
    (2) In the case of a pool of applicants covered by 
subparagraph (A) or (B) of paragraph (1), the Secretary shall 
give preference in the award of scholarships to the members of 
the pool who have the greatest financial need.
    (3) The Secretary shall maintain, and update periodically, 
a list setting forth--
          (A) the fields of education or training covered by 
        subparagraph (A) of paragraph (1); and
          (B) the facilities covered by subparagraph (B) of 
        that paragraph.
    (e) Agreement.--(1) An agreement between the Secretary and 
a participant in the Program shall (in addition to the 
requirements set forth in section 7604 of this title) include 
the following:
          (A) The Secretary's agreement to provide the 
        participant with a scholarship under the Program for a 
        specified number (from one to three) of school years 
        during which the participant pursues a course of 
        education or training described in subsection (c) that 
        meets the requirements set forth in section 7602(a) of 
        this title.
          (B) The participant's agreement to serve as a full-
        time employee in the Veterans Health Administration for 
        a period of time (hereinafter in this subchapter 
        referred to as the ``period of obligated service'') of 
        one calendar year for each school year or part thereof 
        for which the participant was provided a scholarship 
        under the Program, but for not less than two years.
          (C) The participant's agreement to serve under 
        subparagraph (B) in a Department facility selected by 
        the Secretary.
    (2) In a case in which an extension is granted under 
section 7673(c)(2) of this title, the number of years for which 
a scholarship may be provided under the Program shall be the 
number of school years provided for as a result of the 
extension.
    (3) In the case of a participant who is a part-time 
student--
          (A) the period of obligated service shall be reduced 
        in accordance with the proportion that the number of 
        credit hours carried by such participant in any such 
        school year bears to the number of credit hours 
        required to be carried by a full-time student in the 
        course of training being pursued by the participant, 
        but in no event to less than one year; and
          (B) the agreement shall include the participant's 
        agreement to maintain employment, while enrolled in 
        such course of education or training, as a Department 
        employee permanently assigned to a Department health-
        care facility.

Sec. 7673. Scholarship

    (a) Scholarship.--A scholarship provided to a participant 
in the Program for a school year shall consist of payment of 
the tuition of the participant for that school year and payment 
of other reasonable educational expenses (including fees, 
books, and laboratory expenses) for that school year.
    (b) Amounts.--The total amount of the scholarship payable 
under subsection (a)--
          (1) in the case of a participant in the Program who 
        is a full-time student, may not exceed $10,000 for any 
        one year; and
          (2) in the case of a participant in the Program who 
        is a part-time student, shall be the amount specified 
        in paragraph (1) reduced in accordance with the 
        proportion that the number of credit hours carried by 
        the participant in that school year bears to the number 
        of credit hours required to be carried by a full-time 
        student in the course of education or training being 
        pursued by the participant.
    (c) Limitation on Years of Payment.--(1) Subject to 
paragraph (2), a participant in the Program may not receive a 
scholarship under subsection (a) for more than three school 
years.
    (2) The Secretary may extend the number of school years for 
which a scholarship may be awarded to a participant in the 
Program who is a part-time student to a maximum of six school 
years if the Secretary determines that the extension would be 
in the best interest of the United States.
    (d) Payment of Educational Expenses by Educational 
Institutions.--The Secretary may arrange with an educational 
institution in which a participant in the Program is enrolled 
for the payment of the educational expenses described in 
subsection (a). Such payments may be made without regard to 
subsections (a) and (b) of section 3324 of title 31.

Sec. 7674. Status of certain participants

    (a) Status.--A participant in the Program described in 
subsection (b) shall not, by reason of such participation----
          (1) be considered an employee of the Federal 
        Government; or
          (2) be counted against any personnel ceiling 
        affecting the Veterans Health Administration.
    (b) Covered Participants.--Subsection (a) applies in the 
case of any participant in the Program who is a student on a 
full-time basis and is not performing service for the 
Department.

Sec. 7675. Obligated service

    (a) In General.--Each participant in the Program shall 
provide service as a full-time employee of the Department for 
the period of obligated service provided in the agreement of 
the participant entered into under section 7603 of this title. 
Such service shall be provided in the full-time clinical 
practice of such participant's profession or in another health-
care position in an assignment or location determined by the 
Secretary.
    (b) Determination of Service Commencement Date.--(1) Not 
later than 60 days before a participant's service commencement 
date, the Secretary shall notify the participant of that 
service commencement date. That date is the date for the 
beginning of the participant's period of obligated service.
    (2) As soon as possible after a participant's service 
commencement date, the Secretary shall----
          (A) in the case of a participant who is not a full-
        time employee in the Veterans Health Administration, 
        appoint the participant as such an employee; and
          (B) in the case of a participant who is an employee 
        in the Veterans Health Administration but is not 
        serving in a position for which the participant's 
        course of education or training prepared the 
        participant, assign the participant to such a position.
    (3)(A) In the case of a participant receiving a degree from 
a school of medicine, osteopathy, dentistry, optometry, or 
podiatry, the participant's service commencement date is the 
date upon which the participant becomes licensed to practice 
medicine, osteopathy, dentistry, optometry, or podiatry, as the 
case may be, in a State.
    (B) In the case of a participant receiving a degree from a 
school of nursing, the participant's service commencement date 
is the later of----
          (i) the participant's course completion date; or
          (ii) the date upon which the participant becomes 
        licensed as a registered nurse in a State.
    (C) In the case of a participant not covered by 
subparagraph (A) or (B), the participant's service commencement 
date is the later of----
          (i) the participant's course completion date; or
          (ii) the date the participant meets any applicable 
        licensure or certification requirements.
    (4) The Secretary shall by regulation prescribe the service 
commencement date for participants who were part-time students. 
Such regulations shall prescribe terms as similar as 
practicable to the terms set forth in paragraph (3).
    (c) Commencement of Obligated Service.--(1) Except as 
provided in paragraph (2), a participant in the Program shall 
be considered to have begun serving the participant's period of 
obligated service----
          (A) on the date, after the participant's course 
        completion date, on which the participant (in 
        accordance with subsection (b)) is appointed as a full-
        time employee in the Veterans Health Administration; or
          (B) if the participant is a full-time employee in the 
        Veterans Health Administration on such course 
        completion date, on the date thereafter on which the 
        participant is assigned to a position for which the 
        participant's course of training prepared the 
        participant.
    (2) A participant in the Program who on the participant's 
course completion date is a full-time employee in the Veterans 
Health Administration serving in a capacity for which the 
participant's course of training prepared the participant shall 
be considered to have begun serving the participant's period of 
obligated service on such course completion date.
    (d) Course Completion Date Defined.--In this section, the 
term ``course completion date'' means the date on which a 
participant in the Program completes the participant's course 
of education or training under the Program.

Sec. 7676. Breach of agreement: liability

    (a) Liquidated Damages.--A participant in the Program 
(other than a participant described in subsection (b)) who 
fails to accept payment, or instructs the educational 
institution in which the participant is enrolled not to accept 
payment, in whole or in part, of a scholarship under the 
agreement entered into under section 7603 of this title shall 
be liable to the United States for liquidated damages in the 
amount of $1,500. Such liability is in addition to any period 
of obligated service or other obligation or liability under the 
agreement.
    (b) Liability During Course of Education or Training.--(1) 
Except as provided in subsection (d), a participant in the 
Program shall be liable to the United States for the amount 
which has been paid to or on behalf of the participant under 
the agreement if any of the following occurs:
          (A) The participant fails to maintain an acceptable 
        level of academic standing in the educational 
        institution in which the participant is enrolled (as 
        determined by the educational institution under 
        regulations prescribed by the Secretary).
          (B) The participant is dismissed from such 
        educational institution for disciplinary reasons.
          (C) The participant voluntarily terminates the course 
        of education or training in such educational 
        institution before the completion of such course of 
        education or training.
          (D) The participant fails to become licensed to 
        practice medicine, osteopathy, dentistry, podiatry, or 
        optometry in a State, fails to become licensed as a 
        registered nurse in a State, or fails to meet any 
        applicable licensure requirement in the case of any 
        other health-care personnel who provide either direct 
        patient-care services or services incident to direct 
        patient-care services, during a period of time 
        determined under regulations prescribed by the 
        Secretary.
          (E) In the case of a participant who is a part-time 
        student, the participant fails to maintain employment, 
        while enrolled in the course of training being pursued 
        by the participant, as a Department employee.
    (2) Liability under this subsection is in lieu of any 
service obligation arising under a participant's agreement.
    (c) Liability During Period of Obligated Service.--(1) 
Except as provided in subsection (d), if a participant in the 
Program breaches the agreement by failing for any reason to 
complete such participant's period of obligated service, the 
United States shall be entitled to recover from the participant 
an amount determined in accordance with the following formula:


    (2) In such formula:
          (A) ``A'' is the amount the United States is entitled 
        to recover.
          (B) ``F'' is the sum of--
                  (i) the amounts paid under this subchapter to 
                or on behalf of the participant; and
                  (ii) the interest on such amounts which would 
                be payable if at the time the amounts were paid 
                they were loans bearing interest at the maximum 
                legal prevailing rate, as determined by the 
                Treasurer of the United States.
          (C) ``t'' is the total number of months in the 
        participant's period of obligated service, including 
        any additional period of obligated service in 
        accordance with section 7673(c)(2) of this title.
          (D) ``s'' is the number of months of such period 
        served by the participant in accordance with section 
        7673 of this title.
    (d) Limitation on Liability for Reductions-in-Force.--
Liability shall not arise under subsection (b)(1)(E) or (c) in 
the case of a participant otherwise covered by the subsection 
concerned if the participant fails to maintain employment as a 
Department employee due to a reduction-in-force.
    (e) Period for Payment of Damages.--Any amount of damages 
which the United States is entitled to recover under this 
section shall be paid to the United States within the one-year 
period beginning on the date of the breach of the agreement.

Sec. 7677. Expiration of program

    The Secretary may not furnish scholarships to individuals 
who commence participation in the Program after December 31, 
2001.

            SUBCHAPTER VII--EDUCATION DEBT REDUCTION PROGRAM

Sec. 7681. Authority for program

    (a) In General.--(1) As part of the Educational Assistance 
Program, the Secretary may carry out an education debt 
reduction program under this subchapter. The program shall be 
known as the Department of Veterans Affairs Primary Care 
Workers Education Debt Reduction Program (hereinafter in this 
subchapter referred to as the ``Education Debt Reduction 
Program'').
    (2) The purpose of the Education Debt Reduction Program is 
to assist personnel serving in health-care positions in the 
Veterans Health Administration in reducing the amount of debt 
incurred by suchpersonnel in completing programs of education 
or training that qualified such personnel for such service.
    (b) Relationship to Educational Assistance Program.--
Education debt reduction payments under the Education Debt 
Reduction Program shall be in addition to other assistance 
available to individuals under the Educational Assistance 
Program.

Sec. 7682. Eligibility

    (a) Eligibility.--An individual eligible to participate in 
the Education Debt Reduction Program is any individual who--
          (1) is serving in a position in the Veterans Health 
        Administration under an appointment under section 
        7402(b) of this title; and
          (2) owes any amount of principal or interest under a 
        loan the proceeds of which were used by or on behalf of 
        the individual to pay costs relating to a course of 
        education or training which led to a degree that 
        qualified the individual for a position referred to in 
        paragraph (1).
    (b) Covered Costs.--For purposes of subsection (a)(2), 
costs relating to a course of education or training include--
                  (1) tuition expenses;
                  (2) all other reasonable educational 
                expenses, including expenses for fees, books, 
                and laboratory expenses; and
                  (3) reasonable living expenses.

Sec. 7683. Preference

    (a) Preference.--Notwithstanding section 7603(d) of this 
title, in selecting individuals for education debt reduction 
payments under the Education Debt Reduction Program, the 
Secretary shall give preference to the following (in the order 
specified):
          (1) Individuals recently appointed by the Secretary 
        to positions under section 7401 of this title in fields 
        relating to primary care health services, as designated 
        by the Secretary.
          (2) Individuals recently appointed by the Secretary 
        to positions under such section in areas in which the 
        recruitment or retention of an adequate supply of 
        qualified health-care personnel is difficult, as so 
        designated.
          (3) Any other individuals serving in appointments to 
        positions described in paragraphs (1) and (2).
    (b) Recently Appointed Individuals.--An individual shall be 
treated as recently appointed to a position for purposes of 
subsection (a) if the individual was appointed to the position 
not more than 6 months before the date of treatment for such 
purposes.

Sec. 7684. Education debt reduction

    (a) In General.--Education debt reduction payments under 
the Education Debt Reduction Program shall consist of payments 
to individuals selected to participate in the program of 
amounts to reimburse such individuals for payments by such 
individuals of principal and interest on loans described in 
section 7682(a)(2) of this title.
    (b) Frequency of Payment.--(1) The Secretary may make 
education debt reduction payments to any given participant in 
the Education Debt Reduction Program on a monthly or annual 
basis, at the election of the Secretary.
    (2) The Secretary shall make such payments at the end of 
the period elected by the Secretary under paragraph (1).
    (c) Performance Requirement.--The Secretary may make 
education debt reduction payments to a participant in the 
Education Debt Reduction Program for a period only if the 
Secretary determines that the individual maintained an 
acceptable level of performance in the position or positions 
served by the participant during the period.
    (d) Maximum Annual Amount.--(1) Subject to paragraph (2), 
the total amount of education debt reduction payments made to a 
participant for a year under the Education Debt Reduction 
Program shall be--
          (A) $6,000 for the first year of the participant's 
        participation in such Program;
          (B) $8,000 for the second year of the participant's 
        participation in such Program; and
          (C) $10,000 for the third year of the participant's 
        participation in such Program.
    (2) The total amount payable to a participant in such 
Program for any year may not exceed the amount of the principle 
and interest on loans referred to in subsection (a) that is 
paid by the individual during such year.

Sec. 7685. Expiration of program

    The Secretary may not make education debt reduction 
payments to individuals who commence participation in the 
Education Debt Reduction Program after December 31, 2001.

           *       *       *       *       *       *       *


            PART VI--ACQUISITION AND DISPOSITION OF PROPERTY

   CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY 
    FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL 
PROPERTY

           *       *       *       *       *       *       *


SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES

           *       *       *       *       *       *       *


Sec. 8104. Congressional approval of certain medical facility 
                    acquisitions

    (a)(1) * * *

           *       *       *       *       *       *       *

    (3) For the purpose of this subsection:
          (A) * * *
          (B) The term ``major medical facility lease'' means a 
        lease for space for use as a new medical facility at an 
        average annual rental of more than [$300,000] $600,000.

           *       *       *       *       *       *       *

                              ----------                              


VETERANS HEALTH CARE ACT OF 1992

           *       *       *       *       *       *       *


TITLE V--GENERAL HEALTH CARE AND ADMINISTRATION

           *       *       *       *       *       *       *


Subtitle C--Health Care Administration and Personnel

           *       *       *       *       *       *       *


SEC. 523. EXTENSION OF AUTHORITY TO WAIVE CERTAIN LIMITATIONS 
                    APPLICABLE TO RECEIPT OF RETIREMENT PAY BY NURSES.

    (a) * * *
    [(b) Health Professionals.--Notwithstanding any other 
provision of law, the Secretary of Veterans Affairs may not 
provide payments to health-care professional employees of the 
Department of Veterans Affairs for payment of tuition loans.]