[Senate Report 108-193]
[From the U.S. Government Publishing Office]
Calendar No. 383
108th Congress Report
SENATE
1st Session 108-193
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VETERANS HEALTH CARE AUTHORITIES EXTENSION AND IMPROVEMENT ACT OF 2003
_______
November 10, 2003.--Ordered to be printed
_______
Mr. Specter, from the Committee on Veterans' Affairs, submitted the
following
R E P O R T
[To accompany S. 1156]
The Committee on Veterans' Affairs (hereinafter, ``the
Committee''), to which was referred the bill (S. 1156), to
amend title 38, United States Code, to improve and enhance the
provision of long-term health care for veterans by the
Department of Veterans Affairs, to enhance and improve
authorities relating to the administration of personnel of the
Department of Veterans Affairs, and for other purposes, having
considered the same, reports favorably thereon with an
amendment in the nature of a committee substitute and an
amendment to the title, and recommends that the bill, as
amended, do pass.
Introduction
On May 23, 2003, Committee Chairman Arlen Specter
introduced S. 1156, the proposed ``Department of Veterans
Affairs Long-Term Care and Personnel Authorities Enhancement
Act of 2003.'' S. 1156, as introduced, would have extended VA's
authority to provide non-institutional long-term care services
to all enrolled veterans; modified and extended the requirement
that VA provide institutional nursing care to certain disabled
veterans; and authorized VA to enter into agreements with
appropriate private sector health care institutions for the
provision of long-term care services to veterans. In addition,
S. 1156 would have authorized major medical facility
construction projects; modified VA's authority to appoint
certain health care professionals in the VA's Veterans Health
Administration (hereinafter, ``VHA''); authorized the non-
competitive transfer of certain employees of VA's Veterans
Canteen Service for employment within VA; and made permanent
VA's authority to enter into contracts with private sector
organizations for the provision of disability ratings medical
examinations. Finally, the bill would have made retroactive the
changes relating to the retirement annuities of certain part-
time health-care professionals made in Title 38, United States
Code, by section 132 of Public Law 107-135.
On March 6, 2003, Committee Member John D. Rockefeller IV
introduced S. 548, a bill to improve mental health programs for
veterans, and for other purposes.
On March 13, 2003, Senator Rick Santorum and Chairman
Specter introduced S. 615, a bill to name the VA outpatient
clinic in Horsham, Pennsylvania, the ``Victor J. Saracini
Department of Veterans Affairs Outpatient Clinic.''
On May 23, 2003, Senator Richard Durbin introduced S. 1144,
a bill to name the VA Medical Center at 820 South Damen Avenue,
Chicago, Illinois, the ``Jesse Brown Department of Veterans
Affairs Medical Center.'' Committee Members Rockefeller, Jim
Bunning, and Patty Murray were later added as cosponsors.
On June 9, 2003, Chairman Specter introduced, at the
request of the Secretary of Veterans Affairs, S. 1213, a bill
to amend Title 38, United States Code, to improve benefits
afforded to Filipino veterans of World War II and survivors of
such veterans, and for other purposes.
On June 18, 2003, Committee Ranking Member Bob Graham
introduced S. 1283, a bill to require advance notification to
Congress regarding any action proposed to be taken by VA in
connection with the VA Capital Asset Realignment for Enhanced
Services (hereinafter, ``CARES'') initiative. Committee Members
Rockefeller and Murray were later added as cosponsors.
On June 19, 2003, Ranking Member Graham introduced S. 1289,
a bill to name the VA Medical Center in Minneapolis, Minnesota,
the ``Paul Wellstone Department of Veterans Affairs Medical
Center.'' Committee Members Rockefeller, Murray, Zell Miller,
and Ben Nelson were later added as cosponsors.
On June 26, 2003, Committee Member Kay Bailey Hutchison
introduced S. 1341, a bill to name the VA Medical Center in
Houston, Texas, the ``Michael E. DeBakey Department of Veterans
Affairs Medical Center.''
On September 2, 2003, Ranking Member Graham introduced S.
1572, a bill to authorize the expansion of VA's pilot program
on assisted living for veterans to include an additional health
care region.
Committee Hearings
On July 29, 2003, the Committee held a hearing to receive
testimony on, among other bills, S. 615, S. 1144, S. 1156, S.
1213, S. 1283, and S. 1289. Testimony was heard from: The
Honorable Tim S. McClain, VA's General Counsel; Ms. Cathleen C.
Wilembo, Deputy Director for Health Care, Veterans Affairs and
Rehabilitation Commission, The American Legion; Mr. Paul A.
Hayden, Deputy Director, National Legislative Service, Veterans
of Foreign Wars of the United States; Mr. Adrian M. Atizado,
Associate National Legislative Director, Disabled American
Veterans; Mr. Carl Blake, Associate Legislative Director,
Paralyzed Veterans of America; and Mr. Richard Jones, National
Legislative Director, AMVETS.
On September 11, 2003, the Committee held a hearing on VA's
CARES initiative. The Committee received testimony from
theHonorable Anthony J. Principi, Secretary of Veterans Affairs; Robert
H. Roswell, MD, VA's Under Secretary for Health; and Mr. Everett
Alvarez, Jr., Chairman, Capital Asset Realignment for Enhanced Services
Commission, U.S. Department of Veterans Affairs.
Committee Meeting
After carefully reviewing the testimony from the foregoing
hearings, the Committee met in open session on September 30,
2003, and voted by unanimous voice vote to report favorably S.
1156, as amended to include provisions derived from S. 548, S.
615, S. 1144, S. 1156 as introduced, S. 1213, S. 1283, S. 1289,
S. 1341, and S. 1572.
Summary of the Committee Bill as Reported
S. 1156, as reported (hereinafter, ``Committee bill''),
consists of four titles, summarized below.
TITLE I--EXTENSION OF CERTAIN HEALTH CARE AUTHORITIES
Title I contains freestanding provisions and amendments to
Title 38, United States Code, that would:
1. Extend for five years VA's authority to provide enrolled
veterans with a range of non-institutional extended care
services as set forth in Public Law 106-117, the ``Veterans
Millennium Health Care and Benefits Act,'' and extend through
2008 the same statute's mandate that VA provide institutional
nursing care services, as indicated, to severely service-
connected disabled veterans (section 101).
2. Authorize VA to enter into agreements with non-VA
providers of institutional nursing care or non-institutional
extended care in a manner similar to that which is permitted
under the Social Security Act (section 102).
3. Authorize the expansion of a pilot program for the
provision of assisted living services to veterans (section
103).
4. Increase from $15 million to $25 million annual funding
to be set aside for a program designed to expand and improve
services relating to the treatment of post-traumatic stress
disorder (hereinafter, ``PTSD'') and substance use disorders;
clarify that these funds are to be provided on an annual basis
for a three year period; require that not less than $10 million
be allocated by direct grants to programs that are identified
by VA's Mental Health Strategic Health Care Group and VA's
Committee on Care of Severely Chronically Mentally Ill
Veterans; require that not less than $5 million be allocated
for PTSD treatment programs; and require that not less than $5
million be allocated for substance use disorder treatment
programs (section 104).
TITLE II--CONSTRUCTION AUTHORITIES
Title II contains freestanding provisions and amendments to
Title 38, United States Code, that would:
1. Increase from $4,000,000 to $9,000,000 the threshold
amount which will result in a medical facility construction
project being classified a ``major'' construction project
(section 201).
2. Establish in the Treasury the ``Department of Veterans
Affairs Facilities Demolition Fund''; authorize that $25
million be appropriated to the fund; and authorize VA to use
amounts deposited into the fund for the purpose of demolishing
or removing dilapidated or hazardous VA structures (section
202).
3. Authorize VA to carry out major construction projects in
Lebanon, Pennsylvania and Beckley, West Virginia (section 211).
4. Authorize VA to enter into major medical facilities
leases in Denver, Colorado; Pensacola, Florida; Boston,
Massachusetts; and Charlotte, North Carolina (section 212).
5. Authorize $34.5 million in major construction funds and
$13.385 million in leasing authority to carry out the projects
and leases specified in sections 211 and 212 of the Committee
bill (section 213).
6. Name a VA Outpatient Clinic in Horsham, Pennsylvania the
``Victor J. Saracini Department of Veterans Affairs Outpatient
Clinic'' (section 221).
7. Name a VA Medical Center in Chicago, Illinois the
``Jesse Brown Department of Veterans Affairs Medical Center''
(section 222).
8. Name the VA Medical Center in Houston, Texas the
``Michael E. DeBakey Department of Veterans Affairs Medical
Center'' (section 223).
9. Name the VA Medical Center in Minneapolis, Minnesota the
``Paul Wellstone Department of Veterans Affairs Medical
Center'' (section 224).
TITLE III--PERSONNEL MATTERS
Title IIIuc contains freestanding provisions and amendments
to Title 38, United States Code, that would:
1. Modify VA authority to make appointments of certain
personnel in VHA (section 301).
2. Provide hourly-rate employees of VA's Veterans Canteen
Service with transfer rights to Title 5 positions in VA
(section 302).
3. Provide that the effective date of the amendment made by
section 132 of Public Law 107-135 shall be January 23, 2002;
and require that the Office of Personnel Management
(hereinafter, ``OPM'') recompute the annuities of affected
health care professionals who retired between April 7, 1986,
and January 23, 2002 (section 303).
TITLE IV--OTHER MATTERS
Title IV contains freestanding provisions and amendments to
Title 38, United States Code, that would:
1. Require VA to notify Congress of facility closings
proposed under the Capital Asset Realignment for Enhanced
Services initiative, and prohibit such closings from occurring
until the lapse of 60 days following the notification or 30
days of continuous session of Congress, whichever is longer
(section 401).
2. Authorize the Secretary to carry out major construction
projects in connection with the CARES initiative no sooner than
60 days following the submission of a report that lists all
major construction projects on which VA proposes to expend such
funds; require VA, when it develops that list, to develop it in
accordance with priorities specified in this section; authorize
VA to enter into multi-year contracts for the construction of
major medical facilities; and authorize VA to expend funds
appropriated for the CARES initiative and for ``major
construction'' to carry out the provisions of this section
(section 402).
3. Authorize a three-year extension of a program which
assists not-for-profit organizations and State and local
government agencies in providing housing assistance for
homeless veterans (section 411).
4. Authorize a four-year extension of a program that
mandates that VA evaluate the health status of spouses and
children of Persian Gulf War veterans (section 412).
5. Authorize VA to provide to U.S.-resident World War II
veterans of the Commonwealth Army of the Philippines and so-
called ``new Philippine Scouts'' medical services on the same
basis as those services are provided to veterans of the Armed
Forces of the United States (section 421).
6. Repeal the requirement that certain officials in VA's
Office of the Under Secretary for Health be appointed for terms
of four years (section 422).
Background and Discussion
TITLE I--EXTENSION OF CERTAIN HEALTH CARE AUTHORITIES
Section 101. Extension and modification of certain health care
authorities
By the enactment of Public Law 106-117, the Veterans
Millennium Health Care and Benefits Act'' (hereinafter,
``Millennium Act'') in 1999, the Congress directed that VA
establish a comprehensive program to provide non-institutional
extended care services for veterans enrolled for VA care.
Further, it directed by enactment of the Millennium Act that VA
provide institutional nursing care to veterans in need of such
care for service-connected disabilities and to veterans who
have sustained service-connected disabilities rated at 70
percent or more and who are in need of institutional long-term
care to treat any condition. These provisions are scheduled to
expire on December 31, 2003.
In January 2003, VA reported to Congress on its experience
in providing both non-institutional extended care services and
nursing home care as required by the Millennium Act. Some of
the information reported by VA is encouraging; some is not. On
the positive side, VA reports that over 90 percent of VA
medical centers now provide outpatient-based long-term care. VA
reported, further, that the proportion of VA long-term care
patients treated in an outpatient-based care setting has
increased from 57 percent (in 1998) to 64 percent (in 2001).
These data suggest that growth in non-institutional care
programs is allowing more veterans to receive necessary
extended care services while remaining in a home setting.
Additionally, the Committee is encouraged that the number of
patients treated in VA long-term care settings grew by 6.7
percent from 1998 thru 2001 and that during the same period
geriatric evaluation and management programs grew by over 50
percent.
VA's January 2003 report, however, also sets forth a number
of discouraging revelations. VA reports that ``only small
changes in VA long-term care occur[ed] immediately after
enactment of Public Law 106-117'' and ``overall costs are
basically equal to what one would expect in the absence of the
Act through fiscal year 2001.'' In fact, the report notes that,
since enactment of the Millennium Act, the percentage of VA's
overall health care budget spent on long-term care has declined
from just over--to slightly under--7.5 percent. Findings such
as these suggest that VA has done too little to provide added
extended care services for an aging veterans' population
despite Congress' clear direction that it do so.
In response, in part, to the insufficient progress being
made to expand VA long-term care services, Chairman Specter
introduced legislation, S. 1156, a bill which, as introduced,
would have lowered to 50 percent the threshold of service-
connected disability that would give rise to qualification for
mandatory institutional extended care services. However,
testimony rendered by VA General Counsel Tim S. McClain to the
Committee on July 29, 2003, raised serious concerns about the
costs and consequences of such a change. Mr. McClain stated:
We estimate that the change from 70 percent to 50
percent would cost $2.5 billion over 5 years * * *
[and] the provisions could have serious unintended
consequences including slowing the rate of growth of
non-institutional long-term care and reducing the
availability of services for non-mandatory categories
of veterans. * * *
In light of that testimony, and because the current backlog
of patients waiting 6 months or more for primary care services
still stands at approximately 100,000 veterans, the Committee
bill extends the expiration dates of both long-term care
authorities for an additional five years, until December 31,
2008, but it does not lower the threshold for eligibility for
mandatory institutional care. Even so, the Committee is
committed to expanding the range of long-term care services
available to veterans. The Committee expects that VA will
respond to that commitment despite the Committee's
determination to defer for now the issue of modifying the
mandatory care threshold.
Sec. 102. Enhanced agreement authority for provision of nursing home
care and adult day health care in non-Department of Veterans
Affairs facilities
Under current law, VA is authorized to enter into
contractual arrangements with private providers of extended
care services to serve the needs of veterans. Federal reporting
requirements relating to the demographics of contractor
employees and applicants are required tobe submitted to the
Department of Labor under these contractual arrangements. The Committee
has learned that, due to these reporting requirements, many small
providers of extended care services are unable, or they are unwilling,
to admit VA patients. Many such providers have apparently concluded
that reimbursement from VA for caring for one or two veterans is not
worth the cost of compiling and reporting the data required by general
Federal contract law.
The Social Security Act allows the Centers for Medicare and
Medicaid Services (hereinafter, ``CMS'') to enter into provider
agreements for the provision of care to both Medicare and
Medicaid beneficiaries. Such agreements require that
contractors comply with Federal laws concerning hiring
practices. But they do not require that providers prepare
reports of such compliance. Nor do they subject providers to
annual audits like most Federal contracts do. Not surprisingly,
CMS is more successful than VA in inducing smaller providers to
provide care to its beneficiaries.
Section 102 of the Committee bill places VA contractors in
a similar position as CMS contractors with respect to Federal
reporting requirements. By this action, the Committee seeks to
encourage VA to bring care closer to veterans' homes and
community support structures by contracting with small
community-based providers. Even so, however, the Committee
fully anticipates and expects that VA will require compliance
with all applicable Federal laws concerning employment and
hiring practices.
Sec. 103. Expansion of pilot program in the Department of Veterans
Affairs to provide assisted living for veterans
Currently, 35 percent of veterans--some 8.75 million
veterans--are 65 years of age or older. Of these, approximately
640,000 are over 85 years old. VA estimates that the numbers of
this ``most-in-need'' segment of the veterans' population will
more than double, to approximately 1.3 million veterans, by
2012.
These facts lead the Committee to conclude that VA must
concentrate on the development of a national policy on the
provision of assisted living services for veterans. The
assisted living pilot program authorized by section 103(b) of
Public Law 106-117 was designed to allow VA to assess veterans'
needs for assisted living care, to determine the cost of
providing such care, and to explore the best setting in which
to provide such care. The success of this initial program--
which is still under way in Veterans Integrated Service Network
20--and the strong emphasis the CARES Draft National Plan has
placed on assisted-living services, have led the Committee to
conclude that another pilot is both warranted, and needed, to
allow VA to compile more data and to study this issue further.
By immediately adding an additional site and building on
the achievements of the first pilot, VA will be provided with
the further information it requires to formulate a national
plan. The Committee's expectation is that, eventually, the
entire nation will benefit from this important program.
Sec. 104. Improvement of program for provision of specialized mental
health services to veterans
VA has a unique responsibility to meet the special
requirements of veterans who need spinal cord injury care,
prosthetic devices, blind rehabilitation services, and PTSD
therapy services. VA's specialized programs to serve these
``special need'' veterans, however, have been under budgetary
pressure due to VA's shift in health care focus from inpatient-
based care to outpatient-based services and the introduction of
a new resource allocation system.
In 1996, Congress recognized that specialized services
might face such funding pressure, and it took steps to counter
the potential erosion of these programs. The Veterans' Health
Care Eligibility Reform Act of 1996, Public Law 104-262,
mandated that VA maintain its capacity to treat the ``special
need'' disabled veterans at then-current levels, and required
VA to report to Congress annually on the maintenance of these
specialized services. Further, in December 2001, Congress
reinforced its direction that ``special need'' services be
maintained by enacting the Department of Veterans Affairs
Health Care Programs Enhancement Act, Public Law 107-135. That
statute described the manner in which VA is to maintain such
capacity and, in addition, specified that $15 million in VA
medical care funding would be set aside solely to assist
medical facilities in improving care for veterans with
substance use disorders and PTSD. That set-aside provision is
scheduled to expire at the end of fiscal year 2003.
The Committee believes that VA has made improvements in
substance use disorder treatment and PTSD care--in large part
because of this funding set-aside provision. It seeks to
sustain that progress. Accordingly, section 104 of the
Committee bill would ``protect'' this set-aside funding for
three additional years. Additionally, it would increase the
total amount of funding identified specifically for treatment
of substance use disorders and PTSD from $15 million to $25
million. The Committee expects that this extension and increase
in funding levels will allow VA to continue the trend of
improving these vital services for veterans.
TITLE II--CONSTRUCTION AND FACILITIES MATTERS
Subtitle A--Construction Authorities
Sec. 201. Increase in threshold for major medical facility projects
Under current law, VA medical facility construction
projects with a projected total cost of less than $4 million
are classified as ``minor'' projects. Those with costs
projected to exceed $4 million are ``major'' construction
projects and, as such, they are subject to the statutory
requirement that they be individually authorized and funded by
Congress. See 38 U.S.C. Sec. 8104. While minor projects are not
subject to this stricture, all VA construction projects,
including ``minor'' projects, are subjected to internal VA
review and are approved and ranked by VHA's Capital Asset
Board, VA's Strategic Management Council and VA's Deputy
Secretary. Among the factors considered in this approval and
ranking process are projected need, projected costs, projected
impact on CARES activities, projectedimpact on medical care
quality and access, and projected impact on medical appointment waiting
times.
Recent VA requests for the authorization and funding of
major medical facility construction projects have shown that
major facility projects rarely cost less than $10 million.
Indeed, VA's Fiscal Year 2004 budget submission listed 22
``major'' projects that are authorized, funded and, in many
cases, now under construction. Only two of these 22 projects
had projected costs of less than $10 million.
In light of this, the Committee believes that the original
intent of the law--that VA not undertake major medical facility
construction projects without the approval of Congress--would
be advanced by a modification of the major project threshold
amount to $9 million. Section 201 of the Committee bill
contains language raising the major construction threshold to
reflect that view.
Sec. 202. Demolition of obsolete, dilapidated and hazardous structures
on Department of Veterans Affairs property
There are many buildings on VA property, e.g., former staff
living quarters and even farming structures, that lie vacant
and, in many cases, are semi-derelict. In August 1999, the U.S.
General Accounting Office (hereinafter, ``GAO'') reported that
VA lacks an incentive to dispose of such structures because VA
construction funds may, by law, only be spent to build, alter
or acquire facilities, not to tear down unneeded and unused
ones.
Section 202 of the Committee bill authorizes the
appropriation of $25 million for a VA Facilities Demolition
Fund. It further authorizes VA to use amounts deposited into
the fund for the purpose of demolishing or removing dilapidated
or hazardous structures from VA property. Such properties are,
at best, eyesores. Worse, they are potential hazards.
Subtitle B--Construction Authorizations
Sec 211. Authorization of major medical facility projects
As noted above, VA may not obligate or expend funds on any
``major medical facility project'' unless that project has been
specifically authorized by law.
Section 211 of the Committee bill authorizes two projects
that Congress had previously approved, but which have not yet
been funded. First, the Committee bill authorizes $20 million
to construct a nursing care facility at the Beckley, West
Virginia VA Medical Center. Second, the Committee bill extends
the $14.5 million authorization now in place for the
construction of a nursing home project at the Lebanon,
Pennsylvania VA Medical Center. These projects continue to have
merit for the reasons cited in previous legislative reports.
Sec. 212. Authorization of major medical facility leases
VA may not obligate or expend funds on any major medical
facility lease unless that lease has been specifically
authorized by law. Id. A ``major medical facility lease'' is
one that involves the annual expenditure of $600,000 or more in
rent.
In its Fiscal Year 2004 budget request, VA requested
authority to enter into the following leases: (1) The
relocation and expansion of a health administration center in
Denver, Colorado ($4.08 million); (2) an outpatient clinic
extension in Pensacola, Florida ($3.8 million); (3) an
outpatient clinic extension in Boston, Massachusetts ($2.879
million); and (4) a Satellite Outpatient Clinic in Charlotte,
North Carolina ($2.626 million). Each of these proposed leases
is, in the judgment of the Committee, necessary to improve
health care for all veterans. Accordingly, section 212 of the
Committee bill would authorize each of them.
The Committee is aware that many communities and
organizations have made efforts to provide VA with space to
lease for the provision of health care services to veterans.
Many of these proposals--such as one offered for services in
Elko, Nevada--are potentially of great importance to the local
health care and veterans' communities. The Committee urges VA
to work with such organizations where possible to bring care
closer to veterans.
Sec. 213. Authorization of appropriations
Section 8104(a)(2) of title 38, U.S. Code, requires
statutory authorization of all major medical facility projects
and major medical facility leases prior to appropriation of
funds. In its Fiscal Year 2004 budget request, VA requested the
authorization of $98.5 million for major medical facility
projects and $10.759 million for major medical facility leases
in 2004.
Section 213 of the Committee bill authorizes appropriations
for major VA medical facility projects and major VA medical
facility leases for fiscal year 2004. Specifically, section 213
authorizes a total of $34.5 million for the major medical
facility projects specified in section 211 of the Committee
bill, and $13.385 million for leases specified in section 212
of the Committee bill. The Committee believes these major
medical facility projects and leases are in the interest of
improving health care for all veterans.
Subtitle C--Designation of Facilities
Sec. 221. Designation of Department of Veterans Affairs Outpatient
Clinic, Horsham, Pennsylvania
Victor J. Saracini was a decorated United States Navy
officer. He ended his naval career in the Naval Reserve at
Naval Air Station Willow Grove, Pennsylvania. During his
civilian career as a United Airlines pilot, Mr. Saracini was
captain of United Airlines Flight 175, one of the four
commercial jets hijacked by terrorists on September 11, 2001.
Flight 175 was flown into the South Tower of the World Trade
Center in New York City, killing all people onboard including
Captain Saracini.
The Committee believes that naming the VA outpatient clinic
in Horsham, Pennsylvania would be an appropriate tribute to a
devoted aviator and veteran. Section 221 of the Committee bill
would so name the VA Outpatient Clinic in Horsham, Pennsylvania
the ``Victor J. Saracini Department of Veterans Affairs
Outpatient Clinic.''
Sec. 222. Designation of Department of Veterans Affairs Health Care
Facility, Chicago, Illinois
The Honorable Jesse Brown was disabled by enemy fire in
1965 while serving as a United States Marine in Vietnam. He
later served in the Disabled American Veterans, rising to the
office of Executive Director. Subsequently, he was appointed
Secretary of Veterans Affairs by President Bill Clinton in
January 1993. He served with distinction in that position until
July 1997. Secretary Brown died on August 15, 2002.
The Committee believes that naming a VA Medical Center in
Chicago, Illinois--Secretary Brown's home town--would be an
appropriate tribute to the Secretary's service. Section 222 of
the Committee bill would so name the VA Medical Center at 820
South Damen Avenue, Chicago, Illinois, the ``Jesse Brown
Department of Veterans Affairs Medical Center.''
Sec. 223. Designation of Department of Veterans Affairs Medical Center,
Houston, Texas
Dr. Michael E. DeBakey is one of the world's foremost heart
surgeons. During World War II, he served as a Colonel on the
staff of the U.S. Army Surgeon General and conducted studies
that led to the development of mobile army surgical hospital
(``MASH'') units. He is a recipient of the U.S. Army Legion of
Merit Award, and he is credited with assisting in the
establishment of the system of treating military personnel
returning from war which eventually evolved into VA's modern
Veterans Health Administration.
The Committee believes that naming the VA Medical Center in
Houston, Texas would be an appropriate tribute to Dr. DeBakey's
longstanding commitment to the health care of veterans. Section
223 of the Committee bill would so name the VA Medical Center
in Houston, Texas the ``Michael E. DeBakey Department of
Veterans Affairs Medical Center.''
Sec. 224. Designation of Department of Veterans Affairs Medical Center,
Minneapolis, Minnesota
The late Paul Wellstone of Minnesota served as a
distinguished member of the Senate Committee on Veterans'
Affairs, and was the principal author of the Hmong Veterans'
Naturalization Act and the Heather French Homeless Veterans
Assistance Act. During his life, Senator Wellstone was honored
by the Military Order of the Purple Heart, the Disabled
American Veterans, the Minnesota chapter of the Paralyzed
Veterans of America, the Minnesota Department of the Veterans
of Foreign Wars, and the Vietnam Veterans of America for his
commitment to veterans' issues. On October 25, 2002, Senator
Paul Wellstone died in a tragic plane crash.
The Committee believes that naming the VA Medical Center in
Minneapolis, Minnesota would be an appropriate tribute to
Senator Wellstone. Section 224 of the Committee bill would so
name the VA Medical Center in Minneapolis, Minnesota as the
``Paul Wellstone Department of Veterans Affairs Medical
Center.''
TITLE III--PERSONNEL MATTERS
Sec. 301. Modification of authority on appointment of personnel in the
Veterans Health Administration
Under current law, VHA employs its hospital and clinical
staff under three separate legal authorities; the authority
under which a particular staff member is employed is a function
of the duties the employee in question performs. Critical
``hands-on'' clinical staff--physicians, dentists, and
registered nurses--are employed under legal authorities unique
to VHA contained in chapter 74 of title 38, U.S. Code. As
distinguished from these ``Title 38'' employees, other VA
staff--so-called ``Title 5'' employees--are employed under
traditional civil service legal authorities specified in Title
5 of United States Code. A third group of VA staff, discussed
below, is employed under a system known as ``hybrid Title 38''
status.
VHA's Title 38 employees work within a ``rank-in-person''
system; each clinician's pay grade, and his or her pay scale
within each grade, are determined by comparing the individual's
professional qualifications against published VA standards.
Under the Title 38 employment system, VA has considerable
hiring flexibility--it can hire professional employees
directly--to assure that necessary health care staffing levels
are always maintained. Further, VHA has flexibility to
remunerate Title 38 employees at levels that are consistent
with such staff's professional qualifications, thereby
enhancing VA's ability to retain highly-trained staff.
Promotions under the Title 38 system are awarded by review
panels comprised principally of clinical peers having similar
credentials and experience.
Title 5, or traditional civil service employment is, by
contrast, a ``rank-in-position'' system that is administered
according to standards specified by the Office of Personnel
Management. Positions within the Title 5 employment system are
graded according to classification standards, and employee pay
is determined based on the position classification, not on the
individual qualifications of the person occupying the position.
As distinguished from Title 38 hiring, VHA management cannot
fill Title 5 positions by direct hiring. Rather, management is
provided a ``certificate'' of eligible candidates by OPM (or by
a VA Delegated Examining Unit) which administers competitive
examinations to candidates seeking employment. VHA managers may
choose from among the top three candidates on the certificate.
The Title 5 hiring process is time-consuming; it typically
takes a minimum of several weeks, and often as long as several
months, to fill a position. Title 5 employees are afforded many
protections and benefits not extended to Title 38 employees,
including grievance procedures, Reduction-in-Force protections,
annual pay increases based on increases in the consumer price
index, and leave time accrued according to length of service.
Finally, VA employs limited clinical staff--e.g., clinical
and counseling psychologists, respiratory and physical
therapists, etc.--under so-called ``hybrid Title 38'' status.
VA's ``hybrid'' system was developed to merge the best
characteristics of the Title 38 and Title 5hiring and
compensation schemes. Candidates for employment under hybrid Title 38
status can be hired quickly, and they may receive special pay rates and
promotions based on individual qualifications and peer review. However,
hybrid Title 38 employees also enjoy grievance protections and annual
leave accrual rights, and other benefits and protections, afforded to
``conventional'' Title 5 employees.
Section 301 of the Committee bill would place three
clinical professions--certain psychologists not already within
the ``hybrid'' system, social workers, and kinesiologists--who
are now hired under Title 5 authority into hybrid Title 38
status. As discussed above, these professionals would then be
subject to hybrid rules concerning hiring authority and peer
review-based promotion. But they would also retain many of the
protections enjoyed by staff employed under Title 5, United
States Code. The Committee believes that it is in the interest
of veterans and the VA health care system to hire and promote
clinicians in these professions on the basis of individual
qualifications and performance. However, the Committee also
recognizes that many clinicians in these professions have
worked for, and enjoy, the greater protections and employment
security afforded under their current Title 5 status, and they
ought to retain the bulk of such benefits.
Sec. 302. Coverage of employees of Veterans' Canteen Service under
additional employment laws
Hourly-rate employees of VA's Veterans Canteen Service
(hereinafter, ``VCS'') are Federal employees under authority of
38 U.S.C. Sec. 7802. However, while they are hired through a
merit system and they are provided many of the same benefits as
other Federal employees--e.g., workers compensation, health,
and retirement benefits, and veterans' preference rights--there
are benefits to which they are not entitled. For example, VCS
hourly-rate employees do not have the same rights to transfer
to positions within VA that VCS managers have. As a
consequence, when an hourly food service employee in a VCS
canteen applies for a similar position in VA food service
operations, he or she is not treated as a transferring VA
employee (or, in technical terms, as an ``internal competitive
service candidate''). His or her years of service and
experience in a VCS position are irrelevant to VA hiring; in
practical terms, the VCS employee cannot transfer to a job
within VA without first going through civil service competition
despite a history of service within a VA health care facility.
In 1979, OPM approved an interchange agreement that permits
eased movement between VA and VCS--but only for management-
level employees. VA has repeatedly sought (in 1984, 1987 and in
1998) to establish a similar interchange agreement for VCS
hourly employees, but OPM has declined to approve these VA
proposals. The Committee disagrees with OPM's judgment on this
issue. It believes that principles of equity dictate that VCS
hourly-rate employees be afforded the same transfer rights as
their managerial counterparts. Section 302 of the Committee
bill so specifies.
Sec. 303. Effective date of modification of treatment for retirement
annuity purposes of part-time service of certain Department of
Veterans Affairs health-care professionals
In 1985, Congress enacted Public Law 99-272, the
Consolidated Omnibus Budget Reconciliation Act of 1985
(hereinafter, ``COBRA''). That law granted to all part-time
Federal employees full-time annuity credits for part-time work.
Previously, the government had prorated part-time work for
Title 38 employees.
The following year, VA requested legislation to exclude all
part-time Title 38 employees from the 1985 COBRA retirement
change. VA's request was based on the premise that part-time VA
physicians earn significant outside salaries, and that the
granting to them of full-time annuity credit for part-time work
would have disproportionately enriched them. Congress granted
VA's request and incorporated the requested change into Public
Law 99-509, the 1986 Omnibus Budget Reconciliation Act.
In 2001, it was recognized that the 1986 legislation
affected all part-time Title 38 employees--including VA nurses.
VA nurses, unlike VA physicians, do not engage in lucrative
outside practices. In recognition of that fact, Congress
enacted section 132 of Public Law 107-135, ``The Department of
Veterans Affairs Health Care Programs Enhancement Act of 2001''
in an attempt to ``undo'' the 1986 exclusion of nurses from the
COBRA liberalization of retirement benefits so that, once
again, VA nurses would get full-time credit for part-time work
for purposes of computing retirement annuities. OPM, however,
interpreted the changes contained in Public Law 107-135 as
applying only to nurses who retired after the enactment date.
As a consequence, similarly situated VA nurses receive
different retirement annuities based not on their terms of
service, but based purely on the date on which they retired.
Section 303 of the Committee bill would rectify this
unintended situation by requiring OPM to recalculate the
annuities for these retired health care professionals using a
system that awards full-time credit for part-time service.
TITLE IV--OTHER MATTERS
Subtitle A--Capital Asset Realignment for Enhanced Services Initiative
Sec. 401. Advance notification of capital asset realignment initiatives
VA's Capital Assets Realignment for Enhanced Services
initiative is a nine-step process that was initiated in late
2000. The purpose of CARES is to evaluate the projected health
care needs of veterans over the next twenty years and to
realign VA's infrastructure to better meet those needs. To
simplify the procedures which have taken place to date--and
which the Committee anticipates will give rise to CARES
recommendations in late 2003--VA's Under Secretary for Health
has issued a preliminary CARES report (hereinafter, the ``Draft
National Plan''), see 68 Fed. Reg. 50224 et seq. (August 20,
2003). That plan relies heavily--but not exclusively--
onrecommendations which the Directors of 20 of VA's veterans integrated
service networks had submitted to the Under Secretary earlier in the
year. The Draft National Plan, the contents of which are discussed
below, is now being reviewed by a Commission appointed by the Secretary
of Veterans Affairs (hereinafter, ``CARES Commission'') which, as of
the date of this report, is in the midst of conducting a series of
public hearings throughout the Nation in advance of its issuance of
recommendations to the Secretary. The preliminary stages of the CARES
process--preliminary in the sense that VA will only have identified
actions it proposes to take--will culminate with the issuance of a
Final CARES Report by the Secretary in, if he is able to adhere to a
time line that he has set, December 2003.
The Draft National Plan, among other things, recommends the
closing of seven VA health care facilities, and recommends
major mission changes at over 30 other VA facilities. The sites
slated to be closed are in the following locations:
Canandaigua, New York; Pittsburgh, Pennsylvania (Highland Drive
Division); Lexington, Kentucky (Leestown Division); Cleveland,
Ohio (Brecksville Unit); Gulfport, Mississippi; Waco, Texas;
and Livermore, California. Patients currently provided services
at these VA sites will still be provided care, but at other
nearby sites. In many cases, e.g., in Pittsburgh, new capacity
at alternative nearby sites will have to be built before those
sites may be closed.
VA proposals to close sites now providing services to
veterans will, if they are adopted, affect hundreds of
thousands of veterans. Accordingly, section 401 of the
Committee bill provides for a 60-day notice and wait period
before the VA would be authorized to take such actions. The
Committee intends to continue vigorous oversight of the
identification of sites where VA proposes to close VA medical
facilities under CARES, and the implementation of such
proposals.
Sec. 402. Authorization of major construction projects in connection
with capital asset realignment initiative
The Draft National Plan proposes to do more than close VA
facilities. It also recommends that new major medical
facilities be built in Las Vegas, Nevada and East Central
Florida. In addition, the CARES Commission has held hearings on
proposals to build a replacement hospital in Denver, Colorado.
Further, the Draft National Plan anticipates significant
infrastructure upgrades at numerous sites including, as noted
above, at or near locations where VA proposes to close
facilities. Finally, the Draft National Plan suggests that VA
open new Community Based Outpatient Clinics (hereinafter,
``CBOCs'') in over 100 communities not currently served by a
VA-operated health care facility.
The Committee supports VA efforts to modernize existing VA
facilities, to place major medical facilities in locales where
they are needed, and to expand veterans' access to CBOCs so
that they might receive care close to their homes and families.
And it supports VA's movement toward these objectives with all
deliberate speed. At this point, however, the Committee does
not authorize specific major construction projects, except
those specified in subtitle B of title II of the Committee
bill, since VA has not yet finalized its CARES proposals. Yet
the Committee does want VA to be able to proceed without
inordinate delay once the Secretary issues the Final CARES
Report. Accordingly, section 402 of the Committee bill
authorizes major construction projects as may be contained in
the Secretary's Final CARES Report. That authority, however,
would be contingent upon the Secretary submitting to the
Congress a report that lists the projects on which VA proposes
to expend construction funds under authority of this section.
And it would be contingent, further, upon the Secretary
specifying projects that conform to the priorities specified in
section 402 and described below.
It is likely that the Final CARES Report will identify far
more needed construction projects than can be started
simultaneously. Thus, once the Final CARES Report is issued, it
will still be necessary to prioritize projects. The non-
specific authorization specified in section 402--qualified as
it is to require VA reporting and VA ranking of projects in
accordance with Congressionally-mandated priorities--is
intended to assure that VA priorities conform to the
Committee's judgment on such matters. The Committee believes VA
must proceed first on projects involving the construction or
renovation of facilities that the Final CARES Report states are
necessary in order to facilitate the closure of existing
healthcare sites. For example, VA's Draft National Plan
proposes to close the Highland Drive VA Medical Center in
Pittsburgh, Pennsylvania. But that facility is currently in
use; its closure would require significant construction at two
other VA sites in Pittsburgh--at University Drive and in
Aspinwall--so that patients served, and care modalities
provided, at Highland Drive may be provided at those sites.
Similar considerations apply to Draft National Plan proposals
at Montrose and Canandaigua, New York; at Leestown, Kentucky;
at Livermore, California; and at Waco, Texas. If these Draft
recommendations ripen to proposed actions under the Final CARES
Report, it would be the Committee's expectation that such
projects have first priority to construction funds. Further, if
other projects of this nature not included in the Draft
National Plan--e.g., a proposed replacement hospital in Denver,
Colorado--are specified in the Final CARES Report, the
Committee would also expect that those projects have first
priority. For it is abundantly clear that many veterans do not
believe that CARES will result in the building of new and
modern facilities; they believe CARES is only about closing
``surplus'' hospitals. By listing the completion of replacement
or enhancement projects in places in which a major facility is
slated for closure as the highest construction priority, the
Committee intends to convey the following message to both VA
and America's veterans: CARES will modernize and enhance care;
it will not cut care.
Second, the Committee is aware that the Draft National Plan
recommends that two new tertiary care hospitals (in East
Central Florida and in Las Vegas, Nevada) be built. The
Committee believes that the construction of such facilities
will advance the CARES objective of providing modern medical
care in modern 21st Century facilities, close to where the
veterans reside. These two sites are among the fastest growing
areas of the country. Accordingly,construction at these
locations would be accorded a high priority under the standards
specified in the Committee bill if, indeed, these sites are identified
in the Final CARES Report.
Additionally, the Committee lists the construction of new
CBOCs, and projects necessary to make facilities attractive for
``enhanced-use leases,'' as important priorities to which VA
should devote post-CARES construction funding.
The non-specific construction authorization contained in
section 402--and the Committee's willingness to grant to this
Secretary project authority not heretofore delegated--do not
signal complete approval by the Committee, or the Congress, of
all VA proposals that are identified in the Draft National
Plan. Indeed, the Committee anticipates changes in that plan;
were that not the case, the Committee would now proceed to
authorize the projects recommended by the Draft National Plan
that, in the Committee's judgment, have merit. For this year,
however, the Committee is willing to afford this Secretary
considerable authority subject, as noted, to his adherence to
Committee priorities and reporting requirements. The Committee
anticipates hearings and informal interactions between VA and
Congress to assure full oversight--and opportunity to object--
prior to the obligation of funds.
Subtitle B--Extension of Other Authorities
Sec. 411. Three-year extension of housing assistance for homeless
veterans
VA currently furnishes assistance to homeless veterans
through two major mechanisms: by providing services directly
and by assisting community-based not-for-profit entities, and
State or local governmental agencies, that furnish services to
homeless veterans. One of the legal authorities under which VA
provides assistance to community-based and governmental
service-providers is scheduled to expire on December 31, 2003.
See 38 U.S.C. Sec. 2041(c). Specifically, this expiring
provision authorizes VA to enter into agreements with the
above-mentioned providers for the sale, lease, or donation of
real property acquired by VA as a result of a default of a loan
made, insured, or guaranteed by VA. The Committee believes such
providers are invaluable in addressing the needs of homeless
veterans.
Section 411 of the Committee bill would extend VA authority
to enter into such agreements for three additional years to
December 31, 2006.
Sec. 412. Four-year extension evaluation of health status of spouses
and children of Persian Gulf war veterans
Section 107(b) of the Persian Gulf War Veterans' Benefits
Act, title I of Public Law 103-446, directs that VA monitor and
study the health status of the spouses and children of Persian
Gulf War veterans. It also specifies that VA develop standard
protocols and guidelines for providing diagnostic testing of
these spouses and children to ensure the uniform development of
medical data. Finally, the statute requires that VA enter its
study results into a Persian Gulf War Veterans Health Registry.
These mandates are scheduled to expire on December 31, 2003.
Section 412 of the Committee bill would extend these
mandates for an additional four years, to December 31, 2007.
Subtitle C--Other Matters
Sec. 421. Modification of eligibility of Filipino veterans for health
care in the United States
Section 107 of title 38, U.S. Code, specifies that World
War II service by Filipinos in the organized military forces of
the Commonwealth of the Philippines (the so-called Philippine
Commonwealth Army) shall be considered to be active service in
U.S. forces for purposes of eligibility for veterans benefits,
but only as provided by law. Similarly, that statute specifies
that service as a so-called new Philippine Scout will be
considered to be active service in U.S. forces for purposes of
veterans benefits, but only as specified by law.
Under section 1734 of title 38, U.S. Code, Commonwealth
Army veterans who are citizens or lawful residents of the
United States are eligible to receive VA medical care benefits,
but only if the Commonwealth Army veteran in question is
disabled and receiving compensation benefits under chapter 11
of title 38, U.S. Code (as limited by section 107). Similarly,
New Philippine Scouts who are disabled and receiving
compensation benefits under chapter 11 (as limited by section
107) and who are citizens or lawful residents of the United
States are eligible to receive VA medical care benefits, but
they may only be provided treatment for their service-connected
disabilities.
By letter dated May 12, 2003, VA Secretary Anthony J.
Principi proposed legislation (S. 1213) on behalf of the
Administration to modify the above-summarized limitations,
stating as follows:
The proposal would extend to new Philippine Scouts
who reside legally in the United States the same
eligibility for medical care * * * that currently
exists for Commonwealth Army veterans, while
eliminating the receipt-of-compensation requirement for
these veterans and scouts.
Section 421 of the Committee bill would extend to new
Philippine Scouts who reside legally in the United States the
same eligibility for medical care services, including care for
non-service-connected disabilities, that are currently afforded
to Commonwealth Army veterans. And it would eliminate for both
groups of Filipino veterans the requirement that they be
receiving compensation in order to be eligible for VA-provided
medical care services.
Sec. 422. Repeal of limits on terms of certain officials in the Office
of the Under Secretary for Health
Under current law, the Office of the VA Under Secretary for
Health shall include a number of positions subordinate to the
Under Secretary including a Deputy Under Secretary, an
Associate Deputy Under Secretary, several Assistant Deputy
Under Secretaries and Directors of various enumerated clinical
services, e.g., Dental Services, Nursing Services, Podiatric
Services, etc. By statute, the appointees to these subordinate
positions are appointed for four year terms, and they may be
removed from such positions only for cause. See 38 U.S.C.
Sec. 7306(d). This is true whether the incumbent Under
Secretary who appointed them ``turns over'' or not.
The clinicians appointed to these key positions are
directly responsible to the Under Secretary. In the view of the
Committee, the Under Secretary must have a positive working
relationship with these professionals, and the Under Secretary
must personally value their respective judgments. A statutory
mandate that, in effect, requires the Under Secretary to retain
his or her predecessor's staff is, in the judgment of the
Committee, contrary to these purposes. Further, it interferes
more than the Committee deems necessary or advisable with the
prerogative of a very senior VA official to assemble the team
of advisors that he or she believes will best assist in the
execution of his or her responsibilities. Accordingly, section
422 of the Committee bill eliminates the terms for appointments
to positions in the Office of the Under Secretary for Health.
The Committee stresses that it is not of the view that a newly-
appointed Under Secretary must--or should--replace all
incumbents of such positions. To the contrary, the interests of
the Under Secretary, and veterans, are generally served by
maintaining continuity at senior management levels.
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
(hereinafter, ``CBO''), estimates that enactment of the
Committee bill would increase direct spending for veterans
programs by $4 million in 2004, $28 million over the 2004-2008
period, and $62 million over the 2004-2013 period. In addition,
CBO estimates that enactment of the Committee bill would
increase direct spending outlays by $71 million in 2004, and
$51 million over the 2004-2008 period, assuming appropriation
of the estimated amounts. Enactment of the Committee 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, October 27, 2003.
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. 1156, the
Veterans' Health Care Authorities Extension and Improvement Act
of 2003.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sam
Papenfuss.
Sincerely,
Douglas Holtz-Eakin,
Director.
Enclosure.
Veterans Health Care Authorities Extension and Improvement Act of 2003
Summary: S. 1156 would extend an authorization that the
Department of Veterans Affairs (VA) provide nursing home care
to certain veterans. In addition, the bill would:
Affect annuities for certain part-time
employees of VA,
Provide new health care benefits to some
Filipino veterans,
Require that VA provide more mental health
care to veterans than it currently does,
Establish a pilot program to provide
assisted living services to veterans,
Authorize appropriations for major
construction,
Create and authorize appropriations for a
new fund to pay for the demolition and removal of
obsolete, dilapidated and hazardous structures on VA
property,
Change the names of four health care
facilities operated by VA, and
Authorize VA to lease three medical
facilities.
CBO estimates that enacting this bill would increase direct
spending by $4 million in 2004, $28 million over the 2004-2008
period,and $62 million over the 2004-2013 period. Additionally,
S. 1156 would modify provisions governing discretionary spending for
veterans' health care and construction programs, which CBO estimates
would result in outlays of $71 million in 2004 and $451 million over
the 2004-2008 period, assuming appropriation of the estimated amounts.
S. 1156 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary impact of S. 1156 is shown in Table 1. The costs of
this legislation fall within budget functions 600 (income
security) and 700 (veterans benefits and services).
TABLE 1.--ESTIMATED BUDGETARY IMPACT OF S. 1156
[By fiscal year, in millions of dollars]
----------------------------------------------------------------------------------------------------------------
2004 2005 2006 2007 2008
----------------------------------------------------------------------------------------------------------------
CHANGES IN DIRECT SPENDING
Estimated Budget Authority......................................... 4 6 6 6 6
Estimated Outlays.................................................. 4 6 6 6 6
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level...................................... 135 100 101 64 61
Estimated Outlays.................................................. 71 114 120 80 66
----------------------------------------------------------------------------------------------------------------
Basis of estimate: This estimate assumes that S. 1156 will
be enacted by the end of calendar year 2003 and that the
necessary amounts for implementing the bill will be
appropriated for each year.
Direct spending
The Department of Veterans Affairs Health Care Programs
Enhancement Act of 2001 (Public Law 107-135), enacted on
January 23, 2002, made changes to the way retirement benefits
are determined for federal retirees who performed part-time
service as registered nurses, physician's assistants, and
certain dental technicians at VA prior to April 7, 1986, and
retired on or after the enactment date of that legislation.
That legislation treated pre-April 7, 1986, part-time service
as full-time service for the purposes of calculating retirement
annuities.
S. 1156 would extend these changes to the types of workers
covered by Public Law 107-135, but who retired between April 6,
1986, and January 23, 2002, by treating their pre-April 7,
1986, part-time service as full-time service for the purpose of
calculating retirement annuities. Retirement benefits for these
workers currently are set according to a formula that prorates
all part-time service performed in these positions. For most
other federal workers, including those covered by Public Law
107-135, part-time service performed prior to April 7, 1986, is
treated as full-time service when calculating retirement
annuities. In most cases, the changes result in higher
retirement benefits.
Information about retirees who would be covered by S. 1156
is limited, but based on data provided by the Office of
Personnel Management, CBO estimates that about 1,500 current
retirees would have their benefits increased by the bill. CBO
estimates that the new formula would increase benefits for
affected retirees by 13 percent to 22 percent, depending on how
much part-time service was performed prior to April 7, 1986. As
a result, CBO estimates that enacting S. 1156 would increase
direct spending by $4 million in 2004, $28 million over the
2004-2008 period, and $62 million over the 2004-2013 period
(see Table 2).
TABLE 2.--ESTIMATED CHANGES IN DIRECT SPENDING UNDER S. 1156
[By fiscal year, in millions of dollars]
----------------------------------------------------------------------------------------------------------------
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
----------------------------------------------------------------------------------------------------------------
CHANGES IN DIRECT SPENDING
Estimated Budget Authority................ 4 6 6 6 6 6 7 7 7 7
Estimated Outlays......................... 4 6 6 6 6 6 7 7 7 7
----------------------------------------------------------------------------------------------------------------
Spending Subject to Appropriation
As shown in Table 3, CBO estimates that implementing S.
1156 would increase discretionary spending for veterans' health
care programs and major construction by $71 million in 2004 and
$451 million over the 2004-2008 period, assuming that
appropriations are provided in the authorized and estimated
amounts. Individual provisions that would affect discretionary
spending are described below.
Veterans Medical Care. Federal spending for all veterans
medical care totals more than $25 billion a year. Several
sections of the bill would affect medical care for veterans. In
total, CBO estimates that implementing these provisions would
cost $64 million in 2004 and $370 million over the 2004-2008
period.
TABLE 3.--ESTIMATED SPENDING SUBJECT TO APPROPRIATION FOR S. 1156
[By fiscal year, in millions of dollars]
----------------------------------------------------------------------------------------------------------------
2003 2004 2005 2006 2007 2008
----------------------------------------------------------------------------------------------------------------
VETERANS MEDICAL CARE
Baseline Spending Under Current Law:
Estimated Authorization Level \1\..................... 25,279 26,153 26,987 27,890 28,824 29,452
Estimated Outlays..................................... 25,677 26,179 26,783 27,655 28,583 29,271
Proposed Changes:
Estimated Authorization Level......................... 0 71 95 96 59 56
Estimated Outlays..................................... 0 64 93 96 61 56
Spending Under S. 1156:
Estimated Authorization Level......................... 25,279 26,224 27,082 27,986 28,883 29,508
Estimated Outlays..................................... 25,677 26,243 26,876 27,751 28,644 29,327
CONSTRUCTION AND LEASING
Spending Under Current Law:
Estimated Authorization Level \1\..................... 99 101 103 105 107 110
Estimated Outlays..................................... 174 155 130 112 106 105
Proposed Changes:
Estimated Authorization Level......................... 0 64 5 5 5 5
Estimated Outlays..................................... 0 7 21 24 19 10
Spending Under S. 1156:
Estimated Authorization Level......................... 99 165 108 110 112 115
Estimated Outlays..................................... 174 162 151 136 125 115
SUMMARY OF CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level............................. 0 135 100 101 64 61
Estimated Outlays......................................... 0 71 114 120 80 66
----------------------------------------------------------------------------------------------------------------
\1\ The 2003 level is the estimated net amount appropriated for that year. No full-year appropriation has yet
been provided for fiscal year 2004. The current-law amounts for the 2004-2008 period assume that
appropriations remain at the 2003 level with adjustments for anticipated inflation.
Long-Term Care. Section 101 would extend a requirement in
current law that VA provide nursing home care to veterans that
have a disability rating of 70 percent or greater. Under
current law, this requirement expires on December 31, 2003.
This provision would extend the requirement through December
31, 2008. According to VA, the department currently spends more
than $2 billion for nursing home care. VA provided nursing home
care to veterans with disability ratings of 70 percent or
greater before the requirement in current law was enacted.
According to VA, since enactment of this requirement in 1999,
the number of veterans with disability ratings of 70 percent or
greater receiving nursing home care from VA increased from
about 1,800 to 2,300 at a cost of about $56 million in 2002.
CBO assumes that 75 percent of that increase resulted from the
current requirement to provide such care. Adjusting for
inflation, CBO estimates that extending this requirement would
cost $34 million in 2004, and $254 million over the 2004-2008
period, assuming appropriation of the estimated amounts. Costs
are slightly lower in 2004 because the extension would only
affect the last nine months of fiscal year 2004.
Mental Health Programs. Section 104 would require VA to
spend an additional $25 million a year on mental health care
over the 2004-2006 period, above the level spent in 2003 ($583
million). Under current law, VA is required to spend $15
million more each year than what they otherwise would have
spent on post-traumatic stress disorder and substance use
disorders; there is no expiration date associated with this
requirement. Under section 104, VA would be required to spend
$25 million more than specified under current law over the
2004-2006 period, but would then not be required to spend any
additional amounts after 2006. Thus, CBO estimates that
implementing this section would cost $23 million in 2004, cost
$73 million over the 2004-2006 period, and save $27 million
over the 2007-2008 period, assuming appropriation of the
required amounts.
Health Care for Filipino Veterans. Under current law, only
certain Filipino veterans who served during World War II are
eligible for health care benefits from VA. Under section 421 of
the bill, any individual who is a veteran of the Philippine
Commonwealth Army or a former New Philippine Scout living
legally in the United States would be eligible for health care
benefits provided by VA. Using information from VA, CBO
estimates that in 2004 about 9,500 Filipino veterans would
qualify for this new benefit and that they would beclassified
as Category 5 veterans, based on income and other factors. Based on
average enrollment and use rates for Category 5 veterans, CBO estimates
that about 35 percent of these veterans would use VA health care
benefits in 2004 at an estimated cost of $5,100 per person. After
adjusting for mortality, CBO expects that the number of eligible
Filipino veterans using VA health care benefits would grow to 2,900 in
2005 as more of these veterans become aware of the benefit, and then
gradually decline to about 1,900 by 2008. Accordingly, CBO estimates
that implementing this section would cost $7 million in 2004 and $61
million over the 2004-2008 period, assuming appropriation of the
estimated amounts.
Assisted Living Pilot Program. Section 103 would allow VA
to establish another pilot program to help veterans obtain
assisted living services for a period of three years. VA
currently administers one pilot program to provide these
services and, according to VA, expects to spend a total of
about $9 million for this program. Assuming that costs for the
new program are similar, CBO estimates that implementing this
section would cost less than $500,000 in 2004 and $9 million
over the 2004-2008 period.
Construction and Leasing. S. 1156 contains several sections
that would authorize appropriations for major construction
projects, the leasing of facilities in three cities, and
establish a new fund that would pay for the demolition and
removal of obsolete, dilapidated and hazardous structures on VA
property. CBO estimates that implementing these sections would
cost $7 million in 2004 and $81 million over the 2004-2008
period, assuming appropriation of the authorized amounts.
Section 213 would authorize the appropriation of $34.5
million for the construction of two long-term care facilities.
The long-term care facilities would be located in Lebanon,
Pennsylvania, and Beckley, West Virginia. Section 201 would
create the Department of Veterans Affairs Facilities Demolition
Fund for the purpose of removing obsolete, dilapidated, and
hazardous buildings and structures on VA property and would
authorize the appropriation of $25 million in 2004 to be
deposited into that fund. CBO estimates that implementing these
two sections would cost $3 million in 2004 and $57 million over
the 2004-2008 period, assuming appropriation of the authorized
amounts.
Section 213 also would authorize VA to lease three medical
facilities for lease payments that together could not exceed $5
million a year. The three medical facilities would be located
in Denver, Colorado; Pensacola, Florida; and Boston,
Massachusetts. While the bill does not specify the length of
the leases, according to VA, it expects to lease these
facilities for up to 20 years. The actual length of each lease
will depend on the results of an ongoing process that VA is
using to determine its future construction and leasing needs.
Based on information from VA, CBO believes these leases would
meet the criteria for an operating lease. CBO estimates that
implementing these leases would cost $4 million in 2004 and $24
million over the 2004-2008 period, assuming appropriation of
the authorized amounts.
S. 1156 also would raise the threshold for projects to be
financed out of the appropriation for construction of major
medical facilities from $4 million to $9 million. (Thus, under
the bill, projects costing up to $9 million would be considered
minor construction.)
Naming Provisions. S. 1156 also contains four provisions
that would change the names of health care facilities operated
by VA. Section 221 would name the VA outpatient clinic in
Horsham, Pennsylvania, as the ``Victor J. Saracini Department
of Veterans Affairs Outpatient Clinic.'' Section 222 would name
the VA health care facility located at 820 South Damen Avenue
in Chicago, Illinois, as the ``Jesse Brown Department of
Veterans Affairs Medical Center.'' Section 223 would name the
VA Medical Center in Houston, Texas, as the ``Michael E.
DeBakey Department of Veterans Affairs Medical Center.''
Finally, section 224 would name the VA medical center in
Minneapolis, Minnesota, as the ``Paul Wellstone Department of
Veterans Affairs Medical Center.'' All four sections would
require that any reference to such medical center or outpatient
clinic in any law, regulation, map, document, record, or other
paper of the United States be considered to be a reference to
the medical center or clinic by the new name. CBO estimates
that implementing those provisions would have a negligible
cost, subject to the availability of appropriated funds.
Intergovernmental and private-sector impact: S. 1156
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Previous CBO estimates: On June 30, 2003, CBO transmitted a
cost estimate of H.R. 2357, the Veterans Health Care
Improvement Act of 2003, as ordered reported by the House
Committee on Veterans' Affairs on June 26, 2003. Section 2 of
H.R. 2357, which would authorize the provision of health care
to certain Filipino veterans, is similar to section 421 of S.
1156 and CBO's estimated cost is the same for both provisions.
On May 13, 2003, CBO transmitted a cost estimate of H.R.
1908, a bill to name the health care facility of the Department
of Veterans Affairs located at 820 South Damen Avenue in
Chicago, Illinois, as the ``Jesse Brown Department of Veterans
Affairs Medical Center,'' as introduced on May 1, 2003. On May
19, 2003, CBO also transmitted an estimate of H.R. 1562, the
Veterans Health Care Cost Recovery Act of 2003, as ordered
reported by the House Committee on Veterans' Affairs on May 15,
2003. H.R. 1908 and section 4 in H.R. 1562 are both the same as
section 222 in S. 1156.
Estimate prepared by: Federal Costs: Sam Papenfuss and
Geoffrey Gerhardt. Impact on State, Local, and Tribal
Governments: Melissa Merrell. Impact on the Private Sector:
Daniel G. Frisk.
Estimate approved by: Peter H. Fontaine, 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 that
would be incurred in carrying out the Committee bill. The
Committee finds that the Committee bill would not entail any
regulation of individuals or businesses or result in any 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 September 30, 2003, meeting. On that
date, the Committee, by unanimous voice vote, ordered H.R.
1156, a bill to amend title 38, United States Code, to improve
and enhance the provision of long-term health care to veterans
by the Department of Veterans Affairs, to enhance and improve
authorities relating to the Administration of personnel of the
Department of Veterans Affairs, and for other purposes, as
amended, reported favorably to the Senate.
Agency Report
On July 29, 2003, VA General Counsel, the Honorable Tim S.
McClain, appeared before the Committee on Veterans' Affairs and
submitted testimony on, among other things, S. 615, S. 1144, S.
1156, S. 1213, S. 1283, and S. 1289. Excerpts from this
statement are reprinted below:
Statement of Tim S. McClain, General Counsel, Department of Veterans
Affairs
Good afternoon Mr. Chairman and Members of the Committee. I
am pleased to be here to present the Administration's views on
six bills that pertain primarily to the veterans health-care
system.
S. 1156
Mr. Chairman, I will begin by addressing S. 1156, your
omnibus health-care bill. It includes provisions pertaining to
long-term health care in VA, personnel matters, authorization
for construction of two major medical facilities, and permanent
authorization of the Veterans Benefits Administration to obtain
disability examinations on a contract basis.
Long-term care provisions
In 1999, the Congress made significant changes in our long-
term-care programs through enactment of what we commonly refer
to as ``The Millennium Act.'' Among other things, that law
directed that VA ``shall'' furnish nursing home care to any
veteran needing such care for a service-connected disability
and to any veteran with a service-connected disability rated at
least 70 percent. It also directed that VA include various non-
institutional extended care services in the medical benefits
package. At the time of enactment, the impact both provisions
would have on VA was uncertain, and Congress chose to limit
their applicability to the four-year period ending December
31st of this year. Section 101 of your bill would extend the
provisions for an additional five years through December 31,
2008. That section would also extend the requirement that we
furnish needed nursing home care to all veterans with service-
connected disabilities rated 50 or 60 percent.
The Department's view is that it would be premature at this
time to extend the two Millennium Act provisions for five
years. As you know, we provided the Congress with a report on
implementation of the Millennium Act in March. We are
continuing to gather information and will provide the Congress
with an additional report later this year. That report, and
other actuarial analyses, will provide data that will aid VHA
leaders and Congressional policymakers in determining
appropriate longer-term directions for development of VA long-
term care services. Accordingly, we recommend only a one-year
extension at this time.
We are also concerned about extending so-called
``mandatory'' nursing home eligibility to all veterans with
service-connected disabilities rated at least 50 percent. We
estimate that the change from 70 percent to 50 percent would
cost $2.5 billion over 5 years and has not been planned for in
the budget process. As a result, the provision could have
serious unintended consequences including slowing the rate of
growth of non-institutional long-term care services and
reducing the availability of services for non-mandatory
categories of veterans because of competing priorities for
limited resources. We recommend that the Committee defer any
such change in law until further data about VA's experience
under the Millennium Act are available to better inform its
decision. We also believe State homes should be included in the
options available to these severely disabled service-connected
veterans. State-home care should be made available to these
veterans without out-of-pocket cost. We would like to work with
the Committee to develop the necessary legislation.
Section 102 of your bill would amend existing law to
clarify that we have authority to provide veterans with nursing
home care and adult day health care in private community
nursing homes and other facilities using agreements for
reimbursement similar to those used under the Medicare Program.
That approach would differ from our current practice of
providing such care only through actual contracts with the
nursing homes or providers of adult day health care. To
implement the authority, the Department would have to
promulgate regulations to establish a program to directly
reimburse the community facilities on behalf of veterans for
the care furnished. The regulations would include all of the
parameters for the program, including amounts VA would pay for
various types of care, and the standards that facilities would
have to meet to receive VA reimbursement. In many respects, the
parameters for the program could mirror those now used in the
Medicare Program. We do not object to section 102 as an
alternative approach to assist us in meeting the needs of
veterans for nursing home care and adult day health care in
non-Department facilities.
Construction authorization
Section 201 of the bill would authorize construction of a
long-term care facility in Lebanon, Pennsylvania, in an amount
not exceeding $14,500,000 and a long-term care facility in
Beckley, West Virginia, in an amount not to exceed $20,000,000.
We would point out that the cost for the project in Beckley is
now estimated to be $20,800,000. We generally support these
projects in concept and we will be considering them in the
context of future budget preparations.
Mr. Chairman, the President's fiscal year 2004 budget
included a request for authorization for a major construction
project at Chicago (West Side), Illinois for a new inpatient
tower; outpatient clinic leases in Boston, Massachusetts and
Pensacola, Florida; and a lease for the Health Administration
Center in Denver, Colorado. In addition we requested an
authorization for an outpatient lease in Charlotte, North
Carolina that received an appropriation in FY 2002. We ask that
you act favorably on those requests, as well as those seismic
projects that were listed in the President's FY 2003 budget.
The facilities at Palo Alto, San Francisco, and West Los
Angeles remain as a critical risk to the safety of patients and
staff in the case of seismic events and those projects remain a
high priority for the Department. We are confident that the
CARES studies will validate the continued need for these major
facilities. In addition, we request authorization for a health
care facility in Las Vegas to replace the existing clinic that
we were required to vacate on July 1st because of structural
inadequacies in the building. It is important that the
Department be provided this authorization so we will be able to
move forward next year.
Personnel provisions
S. 1156 also contains four separate sections that address
personnel matters. The first provision, section 301, would
amend existing law to add a significant number of mission-
critical, scarce, skilled health care positions, such as
dietitians, medical technologists, and medical records
administrators/specialists to the current list of title-38
hybrid positions. We support the goals of increased flexibility
in staffing these positions because of today's fierce
competition for qualified candidates (particularly those who
possess skills acquired in primary care settings), market-wide
shortages in these health care occupations, and VA's aging
health care work force. We are currently considering a similar
proposal to increase flexibility in staffing these positions,
and the Office of Personnel Management recently issued interim
final regulations greatly expanding availability of direct hire
authority for critical need or shortage situations. We are
examining whether or not we need legislation given these brand
new regulations, and will work with Congress to reconcile if we
do.
In the past, we have not been able to quickly and
efficiently recruit candidates. Our inability to consistently
make timely job offers is a chief reason why the Department is
experiencing hiring difficulties. These difficulties can
adversely affect access to care for many of our veterans.
Second, the delays cause many qualified candidates to forego
consideration of VA employment. With multiple job opportunities
in hand, they turn to the private sector where the hiring
process is more responsive.
Section 302 of the bill would amend the law establishing
the Veterans Canteen Service (VCS) to permit persons employed
by VCS to be considered for competitive service appointments in
the Department in the same manner that Department employees in
the competitive service are considered for transfers to
competitive service positions. Currently, VCS Management
Program employees may be appointed to positions in the
competitive service under an interchange agreement between the
Department and the Office of Personnel Management (OPM).
Section 302 would authorize a similar interchange agreement for
non-managerial VCS employees. It would authorize all VCS
employees to transfer into a competitive service position. Time
served in the Canteen Service would count toward the 3-year
service requirement for career civil service status.
The Administration does not support section 302 because it
believes that establishing eligibility for the non-competitive
conversions of VCS hourly employees into competitive service
positions would provide an unfair advantage over excepted
service employees from other Departments and agencies seeking
appointment to competitive service positions at VA.
Section 303 of the bill would retroactively apply recently
legislated changes to the method of computing retirement
annuities for certain VA health-care personnel who are already
retired. The Department of Veterans Affairs Health Care
Programs Enhancement Act of 2001 prospectively changed the way
part-time service performed before April 7, 1986, by certain VA
health-care personnel is credited for annuity purposes. Section
303 would extend this change to individuals who retired before
the effective date of enactment. Traditionally, retirement
benefit changes have been applicable only to individuals
retiring after enactment of the change. This change would
recreate a very expensive precedent for government-wide
application of the principle of retroactivity in retirement
cases involving part-time service. Consequently, the
Administration strongly opposes this provision, as it would
impact retirement fund outlays and have a PAYGO cost not
contemplated in the President's Budget
* * * * *
S. 1213
S. 1213, a bill entitled the ``Filipino Veterans'' Benefits
Act of 2003,'' is the Administration's bill that you introduced
on our behalf. I want to express my sincere appreciation to you
for introducing the measure. As you know, section 2 of the bill
would extend health care benefits to Filipino veterans residing
legally in the United States who served in the Commonwealth
Army and new Philippine Scouts. I urge that you act on the bill
as expeditiously as possible so we can meet the needs of these
very deserving Filipino veterans.
s. 615, s. 1289 and s. 1144
S. 615 would designate the outpatient clinic located in
Horsham, Pennsylvania, as the ``Victor J. Saracini Department
of Veterans Affairs Outpatient Clinic''. S. 1289 would
designate the Minneapolis VA Medical Center as the Paul
Wellstone Department of Veterans Affairs Medical Center. S.
1144 would designate the facility in Chicago now known as the
West Side VA Medical Center as the ``Jesse Brown Department of
Veterans Affairs Medical Center''. While we ordinarily defer to
the views of Congress on the naming of Federal properties, in
the case of former Senator Wellstone and former Secretary Jesse
Brown we make an exception. Enactment of S. 1144 and S. 1289
would be an altogether fitting tribute to these two truly
courageous and steadfast advocates for America's veterans.
s. 1283
S. 1283 would impose new Congressional notice-and-wait
requirements on VA before we could take any action to implement
our Capital Asset Realignment for Enhances Services (CARES)
decisions. The bill would prohibit VA from taking a proposed
action for 60 days following submission of advance written
notice of the action to Congress, or before 30 days during a
continuous session of Congress.
Mr. Chairman, we must object to enactment of this bill. As
drafted, the bill is overly broad, unnecessary, and would
significantly impede our completion of the CARES process. By
stating that VA must provide prior notice of ``any action,''
apparently including even minor actions, the measure would
effectively prevent completing the CARES process in anything
like a timely manner. I can assure you we will provide Congress
and this Committee with our CARES plan well in advance of
undertaking significant actions to implement it. Congress will
have considerable lead-time to consider our proposed actions
before they are undertaken.
I would also point out that we are already subject to
various existing notice-and-wait requirements that serve the
same purpose as that intended by this legislation. We currently
provide such advance notice under section 510 of title 38
whenever we undertake a significant reorganization of any
office or facility. Congress must also approve in advance any
significant construction project, and we provide Congress with
advance notice of any proposed enhanced-use leases. The
additional requirements this bill would impose are therefore
unnecessary.
* * * * *
That concludes my prepared statement. I would be pleased to
answer any questions you may have.
Changes in Existing Law Made by the Committee Bill, 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
* * * * * * *
Sec. 1701. Definitions
* * * * * * *
(1) * * *
* * * * * * *
(10) (A) During the period beginning on November 30,
1999, and ending on [December 31, 2003] December 31,
2008, the term ``medical services'' includes
noninstitutional extended care services.
* * * * * * *
Sec. 1710A. Required nursing home care
(a) * * *
* * * * * * *
(c) The provisions of subsection (a) shall terminate on
[December 31, 2003], December 31, 2008.
* * * * * * *
Sec. 1720. Transfers for nursing home care; adult day health care
(a) * * *
* * * * * * *
(c) (1) In furnishing nursing home care, adult day health
care, or other extended care services under this section, the
Secretary may enter into agreements for furnishing such care or
services utilizing such authorities relating to agreements for
the provision of services under section 1866 of the Social
Security Act (42 U.S.C. 1395cc) as the Secretary considers
appropriate.
(2) In applying the provisions of section 2(b)(1) of the
Service Contract Act of 1965 (41 U.S.C. 351(b)(1)) with respect
to any contract entered into under this section to provide
nursing home care of veterans, the payment of wages not less
than those specified in section 6(b) of the Fair Labor
Standards Act of 1938 (29 U.S.C. 206(b)) shall be deemed to
constitute compliance with such provisions.
* * * * * * *
(f)(1) * * *
* * * * * * *
(B) The Secretary may provide in-kind assistance
(through the services of Department employees and the
sharing of other Department resources) to a facility
furnishing care to veterans under subparagraph (A) of
this paragraph. Any such in-kind assistance shall be
provided under a contract or agreement between the
Secretary and the facility concerned. The Secretary may
provide such assistance only for use solely in the
furnishing of adult day health care and only if, under
such contract or agreement, the Department receives
reimbursement for the full cost of such assistance,
including the cost of services and supplies and normal
depreciation and amortization of equipment. Such
reimbursement may be made by reduction in the charges
to the United States or by payment to the United
States. Any funds received through such reimbursement
shall be credited to funds allotted to the Department
facility that provided the assistance.
* * * * * * *
Sec. 1734. Hospital and nursing home care and medical services in the
United States
(a) The Secretary shall, within the limits of Department
facilities, [may] furnish hospital and nursing home care and
medical services to [Commonwealth Army veterans and new
Philippine Scouts for the treatment of the service-connected
disabilities of such veterans and scouts.] an individual
described in subsection (b) in the same manner as provided for
under section 1710 of this title.
(b) An individual [who is in receipt of benefits under
subchapter II or IV of chapter 11 of this title [38 USCS
Sec. Sec. 1110 et seq. or 1131 et seq.] paid by reason of
service] described in [section 107(a) of this title] this
subsection is any individual who is residing in the United
States and [who] is a citizen of, or an alien lawfully admitted
for permanent residence in, the United States [shall be
eligible for hospital and nursing home care and medical
services in the same manner as a veteran, and the disease or
disability for which such benefits are paid shall be considered
to be a service-connected disability for purposes of this
chapter [38 USCS Sec. Sec. 1701 et seq.].] as follows:
(1) A Commonwealth Army veteran
(2) A new Philippine Scout.
* * * * * * *
Sec. 2041. Housing assistance for homeless veterans
(a) * * *
* * * * * * *
(c) The Secretary may not enter into agreements under
subsection (a) after [December 31, 2003] December 31, 2006.
* * * * * * *
Sec. 7306. Office of the Under Secretary for Health
(a) * * *
* * * * * * *
[(d)--Except as provided in subsection (e)--
[(1) any appointment under this section shall be for
a period of four years, with reappointment permissible
for successive like periods,
[(2) any such appointment or reappointment may be
extended by the Secretary for a period not in excess of
three years, and
[(3) any person so appointed or reappointed or whose
appointmentor reappointment is extended shall be
subject to removal by the Secretary for cause.]
[(e)](d)(1) The Secretary may designate a member of the
Chaplain Service of the Department as Director, Chaplain
Service, for a period of two years, subject to removal by the
Secretary for cause. Redesignation under this subsection may be
made for successive like periods or for any period not
exceeding two years.
(2) A person designated as Director, Chaplain Service,
shall at the end of such person's period of service as Director
revert to the position, grade, and status which such person
held immediately before being designated Director, Chaplain
Service, and all service as Director, Chaplain Service, shall
be creditable as service in the former position.
[(f)](e) In organizing the Office and appointing persons to
positions in the Office, the Under Secretary shall ensure
that--
(1) the Office is staffed so as to provide the Under
Secretary, through a designated clinician in the
appropriate discipline in each instance, with expertise
and direct policy guidance on--
(A) unique programs operated by the
Administration to provide for the specialized
treatment and rehabilitation of disabled
veterans (including blind rehabilitation, care
of spinal cord dysfunction, mental illness, and
long-term care); and
(B) the programs established under section
1712A of this title; and
(2) with respect to the programs established under
section 1712A of this title, a clinician with
appropriate expertise in those programs is responsible
to the Under Secretary for the management of those
programs.
* * * * * * *
Sec. 7401. Appointments in Veterans Health Administration
* * * * * * *
(1) * * *
(2) [Psychologists (other than those described in
paragraph (3)), dietitians,] Dietitians, and other
scientific and professional personnel, such as
microbiologists, chemists, biostatisticians, and
medical and dental technologists.
(3) Clinical or counseling psychologists who hold
diplomas as diplomates in psychology from an
accrediting authority approved by the Secretary, other
psychologists, certified or registered respiratory
therapists, licensed physical therapists, licensed
practical or vocational nurses, pharmacists, [and]
occupational therapists, kinesiologists, and social
workers.
* * * * * * *
Sec. 7802. Duties of Secretary with respect to Service
The Secretary shall--
(1) * * *
* * * * * * *
(5) employ such persons as are necessary for the
establishment, maintenance, and operation of the
Service, and pay the salaries, wages, and expenses of
all such employees from the funds of the Service.
Personnel necessary for the transaction of the business
of the Service at canteens, warehouses, and storage
depots shall be appointed, compensated from funds of
the Service, and removed by the Secretary without
regard to the provisions of title 5 governing
appointments in the competitive service and chapter 51,
and subchapter III of chapter 53 of title 5 [5 USCS
Sec. Sec. 5101 et seq., 5331 et seq.]. Those employees
are subject to the provisions of title 5 relating to a
preference eligible described in section 2108(3) of
title 5, subchapter I of chapter 81 of title 5 [5 USCS
Sec. Sec. 8101 et seq.], and subchapter III of chapter
83 of title 5 [5 USCS Sec. Sec. 8331 et seq.].
Employees and personnel under this clause may be
considered for appointment in Department positions in
the competitive service in the same manner that
Department employees in the competitive service are
considered for transfer to such positions. An employee
or individual appointed as personnel under this clause
who is appointed to a Department position under the
authority of the preceding sentence shall be treated as
having a career appointment in such position once such
employee or individual meets the three-year requirement
for career tenure (with any previous period of
employment or appointment in the Service being counted
toward satisfaction of such requirement);
* * * * * * *
Sec. 8104. Congressional approval of certain medical facility
acquisitions
(a)(1) * * *
* * * * * * *
(3) For the purpose of this subsection:
(A) The term ``major medical facility project'' means
a project for the construction, alteration, or
acquisition of a medical facility involving a total
expenditure of more than [$4,000] $9,000,000, but such
term does not include an acquisition by exchange.
* * * * * * *
VETERANS MILLENNIUM HEALTH CARE AND BENEFITS ACT
SEC. 103. PILOT PROGRAM RELATING TO ASSISTED LIVING
(a) * * *
(b) [Location] Locations of Pilot Program.--
(1) The pilot program shall be carried out in a
designated health care region of the Department
selected by the Secretary for purposes of this section.
(2)(A) In the addition to the health care region of
the Department selected for the pilot program under
paragraph (1), the Secretary may also carry out the
pilot program in not more than one additional
designated health care region of the Department
selected by the Secretary for purposes of this section.
(B) Notwithstanding subsection (f), the authority of
the Secretary to provide services under the pilot
program in a health care region of the Department
selected under subparagraph (A) shall cease on the date
that is three years after the commencement of the
provision of services under the pilot program in the
health care region.
* * * * * * *
SEC. 116. SPECIALIZED MENTAL HEALTH SERVICES
(a) * * *
* * * * * * *
(c) Funding.--
(1) In carrying out the program described in
subsection (a), the Secretary shall identify, from
funds available to the Department for medical care, an
amount of not less than [$15,000,000] $25,000,000 in
each of fiscal years 2004, 2005, and 2006 to be
available to carry out the program and to be allocated
to facilities of the Department pursuant to subsection
(d).
(2) In identifying available amounts pursuant to
paragraph (1), the Secretary shall ensure that, after
the allocation of those funds under subsection (d), the
total expenditure for programs relating to (A) the
treatment of post-traumatic stress disorder, and (B)
substance use disorders is not less than [$15,000,000]
$25,000,000 in excess of the baseline amount.
(3) (A) For purposes of paragraph (2), the baseline
amount is the amount of the total expenditures on such
programs for the most recent fiscal year for which
final expenditure amounts are known, adjusted to
reflect any subsequent increase in applicable costs to
deliver such services in the Veterans Health
Administration, as determined by the Committee on Care
of Severely Chronically Mentally Ill Veterans.
(B) For purposes of this paragraph, in fiscal years
2004, 2005, and 2006, the fiscal year utilized to
determine the baseline amount shall be fiscal year
2003.
(d) Allocation of funds to Department facilities. [The
Secretary] (1) In each of fiscal years 2004, 2005, and 2006,
the Secretary shall allocate funds identified pursuant to
subsection (c)(1) to individual medical facilities of the
Department as the Secretary determines appropriate based upon
proposals submitted by those facilities for the use of those
funds for improvements to specialized mental health services.
(2) In allocating funds to facilities in a fiscal year
under paragraph (1), the Secretary shall ensure that--
(A) not less than $10,000,000 is allocated by direct
grants to programs that are identified by the Mental
Health Strategic Health Care Group and the Committee on
Care of Severely Chronically Mentally Ill Veterans;
(B) not less than $5,000,000 is allocated for
programs on post-traumatic stress disorder; and
(C) not less than $5,000,000 is allocated for
programs on substance abuse disorder.
(3) The Secretary shall provide that the funds to be
allocated under this section during each of fiscal years 2004,
2005, and 2006 are funds for a special purpose program for
which funds are not allocated through the Veterans Equitable
Resource Allocation system.
* * * * * * *
PERSIAN GULF WAR VETERANS' BENEFIT ACT
TITLE I--PERSIAN GULF WAR VETERANS
SEC. 107. EVALUATION OF HEALTH STATUS OF SPOUSES AND CHILDREN OF
PERSIAN GULF WAR VETERANS.
(a) * * *
* * * * * * *
(b) Duration of Program. The program shall be carried out
during the period beginning on November 1, 1994, and ending on
[December 31, 2003] December 31, 2007.
* * * * * * *