[104th Congress Public Law 262]
[From the U.S. Government Printing Office]
<DOC>
[DOCID: f:publ262.104]
[[Page 110 STAT. 3177]]
Public Law 104-262
104th Congress
An Act
To amend title 38, United States Code, to reform eligibility for health
care provided by the Department of Veterans Affairs, to authorize major
medical facility construction projects for the Department, to improve
administration of health care by the Department, and for other
purposes. <<NOTE: Oct. 9, 1996 - [H.R. 3118]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Veterans' Health
Care Eligibility Reform Act of 1996.>>
SECTION 1. <<NOTE: 38 USC 101 note.>> SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans' Health
Care Eligibility Reform Act of 1996''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
TITLE I--ELIGIBILITY REFORM
Sec. 101. Eligibility for hospital care and medical services.
Sec. 102. Revision in authorities for provision of priority health care
for certain veterans exposed to specified toxic substances.
Sec. 103. Prosthetics and preventive care.
Sec. 104. Management of health care.
Sec. 105. Authorization of appropriations.
Sec. 106. Assessment of implementation and operation.
TITLE II--CONSTRUCTION AUTHORIZATION
Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of major medical facility leases.
Sec. 203. Authorization of appropriations.
Sec. 204. Strategic planning.
Sec. 205. Revision to prospectus requirements.
Sec. 206. Construction authorization requirements.
Sec. 207. Terminology changes.
TITLE III--HEALTH CARE AND ADMINISTRATION
Subtitle A--Health Care Sharing and Administration
Sec. 301. Revision of authority to share medical facilities, equipment,
and information.
Sec. 302. Improved efficiency in health care resource management.
Sec. 303. Personnel furnishing shared resources.
Sec. 304. Waiting period for administrative reorganizations.
Sec. 305. Repeal of limitations on contracts for conversion of
performance of activities of Department health-care
facilities and revised annual reporting requirement.
Subtitle B--Care of Women Veterans
Sec. 321. Mammography quality standards.
Sec. 322. Patient privacy for women patients.
Sec. 323. Assessment of use by women veterans of Department health
services.
Sec. 324. Reporting requirements.
[[Page 110 STAT. 3178]]
Subtitle C--Readjustment Counseling and Mental Health Care
Sec. 331. Expansion of eligibility for readjustment counseling and
certain related counseling services.
Sec. 332. Reports relating to Vet Centers.
Sec. 333. Advisory Committee on the Readjustment of Veterans.
Sec. 334. Centers for mental illness research, education, and clinical
activities.
Sec. 335. Committee on Care of Severely Chronically Mentally Ill
Veterans.
Subtitle D--Other Provisions
Sec. 341. Hospice care study.
Sec. 342. Payment to States of per diem for veterans receiving adult day
health care.
Sec. 343. Research corporations.
Sec. 344. Veterans Health Administration headquarters.
Sec. 345. Disbursement agreements relating to medical residents and
interns.
Sec. 346. Authority to suspend special pay agreements for physicians and
dentists who enter residency training programs.
Sec. 347. Remunerated outside professional activities by Veterans Health
Administration personnel.
Sec. 348. Modification of restrictions on real property, Milwaukee
County,
Wisconsin.
Sec. 349. Modification of restrictions on real property, Cheyenne,
Wyoming.
Sec. 350. Name of Department of Veterans Affairs Medical Center, Johnson
City, Tennessee.
Sec. 351. Report on health care needs of veterans in east central
Florida.
Sec. 352. Evaluation of health status of spouses and children of Persian
Gulf War veterans.
SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.
Except as otherwise expressly provided, whenever in this Act an
amendment or repeal is expressed in terms of an amendment to or repeal
of a section or other provision, the reference shall be considered to be
made to a section or other provision of title 38, United States Code.
TITLE I--ELIGIBILITY REFORM
SEC. 101. ELIGIBILITY FOR HOSPITAL CARE AND MEDICAL SERVICES.
(a) New Criteria for Eligibility for Care.--Section 1710(a) is
amended to read as follows:
``(a)(1) The Secretary (subject to paragraph (4)) shall furnish
hospital care and medical services, and may furnish nursing home care,
which the Secretary determines to be needed--
``(A) to any veteran for a service-connected disability; and
``(B) to any veteran who has a service-connected disability
rated at 50 percent or more.
``(2) The Secretary (subject to paragraph (4)) shall furnish
hospital care and medical services, and may furnish nursing home care,
which the Secretary determines to be needed to any veteran--
``(A) who has a compensable service-connected disability
rated less than 50 percent;
``(B) whose discharge or release from active military,
naval, or air service was for a compensable disability that was
incurred or aggravated in the line of duty;
``(C) who is in receipt of, or who, but for a suspension
pursuant to section 1151 of this title (or both a suspension and
the receipt of retired pay), would be entitled to disability
compensation, but only to the extent that such veteran's
continuing eligibility for such care is provided for in the
judgment or settlement provided for in such section;
``(D) who is a former prisoner of war;
[[Page 110 STAT. 3179]]
``(E) who is a veteran of the Mexican border period or of
World War I;
``(F) who was exposed to a toxic substance, radiation, or
environmental hazard, as provided in subsection (e); or
``(G) who is unable to defray the expenses of necessary care
as determined under section 1722(a) of this title.
``(3) In the case of a veteran who is not described in paragraphs
(1) and (2), the Secretary may, to the extent resources and facilities
are available and subject to the provisions of subsections (f) and (g),
furnish hospital care, medical services, and nursing home care which the
Secretary determines to be needed.
``(4) The requirement in paragraphs (1) and (2) that the Secretary
furnish hospital care and medical services shall be effective in any
fiscal year only to the extent and in the amount provided in advance in
appropriations Acts for such purposes.''.
(b) Transfer of Provision.--Chapter 17 is amended--
(1) by redesignating subsection (g) of section 1710 as
subsection (h); and
(2) by transferring subsection (f) of section 1712 to
section 1710 and inserting such subsection so as to appear after
subsection (f), redesignating such subsection as subsection (g),
and amending such subsection by striking out ``section
1710(a)(2) of this title'' in paragraph (1) and inserting in
lieu thereof ``subsection (a)(3) of this section''.
(c) Repeal of Separate Outpatient Care Priorities.--(1) Section 1712
is amended--
(A) by striking out subsections (a) and (i);
(B) by redesignating subsections (b), (c), (d), (h) and (j),
as subsections (a), (b), (c), (d), and (e), respectively; and
(C) in subsection (b), as so redesignated, by striking out
``subsection (b) of this section'' and inserting in lieu thereof
``subsection (a)''.
(2)(A) The heading of such section is amended to read as follows:
``Sec. 1712. Dental care; drugs and medicines for certain disabled
veterans; vaccines''.
(B) The item relating to such section in the table of sections at
the beginning of chapter 17 is amended to read as follows:
``1712. Dental care; drugs and medicines for certain disabled veterans;
vaccines.''.
(d) Conforming Amendments to Chapter 17.--Chapter 17 is further
amended as follows:
(1) Section 1701(6)(B)(i) is amended--
(A) in subclause (I), by striking out ``section
1712(a)'' and inserting in lieu thereof ``paragraph (1)
or (2) of section 1710(a)''; and
(B) in subclause (II), by striking out ``section
1712(a)(5)(B)'' and inserting in lieu thereof
``paragraph (1), (2) or (3) of section 1710(a)''.
(2) Section 1710(c)(1) is amended by striking out ``section
1712(b)'' and inserting in lieu thereof ``section 1712(a)''.
(3) Section 1710(e)(1)(C) is amended by striking out
``hospital care and nursing home care under subsection (a)(1)(G)
of this section'' and inserting in lieu thereof ``hospital care,
medical services, and nursing home care under subsection
(a)(2)(F)''.
(4) Section 1710(f) is amended--
[[Page 110 STAT. 3180]]
(A) in paragraph (1), by striking out ``subsection
(a)(2)'' and inserting in lieu thereof ``subsection
(a)(3)''; and
(B) in paragraph (3)(E)--
(i) by striking out ``section 1712(a) of this
title'' and inserting in lieu thereof ``paragraph
(3) of subsection (a)''; and
(ii) by striking out ``section 1712(f) of this
title'' and inserting in lieu thereof ``subsection
(g)''; and
(C) in paragraph (3)(F), by striking out ``section
1712(f) of this title'' and inserting in lieu thereof
``subsection (g)''.
(5) Section 1712A is amended--
(A) in subsection (b)(1), by striking out ``under
the conditions specified in section 1712(a)(5)(B) of
this title''; and
(B) in subsection (e)(1), by striking out ``sections
1712(a)(1)(B) and 1703(a)(2)'' and inserting in lieu
thereof ``sections 1703(a)(2) and 1710(a)(1)(B)''.
(6) Section 1717(a) is amended--
(A) in paragraph (1), by striking out ``section
1712(a)'' and inserting in lieu thereof ``section
1710(a)''; and
(B) in paragraph (2)--
(i) in subparagraph (A), by striking out
``paragraph (1) of section 1712(a) of this title''
and inserting in lieu thereof ``section 1710(a)(1)
of this title, or for a disability described in
section 1710(a)(2)(C) of this title''; and
(ii) in subparagraph (B), by striking out
``section 1712'' and inserting in lieu thereof
``section 1710(a)(2)''.
(7) Section 1718(e) is amended by striking out ``section
1712(i)'' and inserting in lieu thereof ``section 1705''.
(8) Section 1720(f) is amended--
(A) in paragraph (1)(A)(ii), by striking out
``section 1712(a)(1)(B)'' and inserting in lieu thereof
``paragraph (1), (2), or (3) of section 1710(a)''; and
(B) by striking out paragraph (3).
(9) Section 1722 is amended--
(A) in subsection (a), by striking out ``section
1710(a)(1)(I)'' and inserting in lieu thereof ``section
1710(a)(2)(G)''; and
(B) in subsection (f)(3), by striking out ``or
1712(f)''.
(10) Section 1729(g)(3)(A) is amended by striking out
``under section 1710(f) of this title for hospital care or
nursing home care, under section 1712(f) of this title for
medical services,'' and inserting in lieu thereof ``under
subsection (f) or (g) of section 1710 of this title for hospital
care, medical services, or nursing home care''.
(e) Other Conforming and Technical Amendments.--
(1) Section 1525 is amended--
(A) in subsection (a), by striking out ``section
1712(h) of this title'' and all that follows through the
period at the end and inserting in lieu thereof
``section 1712(d) of this title.''; and
(B) in subsection (b), by striking out
``renumeration'' and inserting in lieu thereof
``remuneration''.
(2) Section 2104(b) is amended--
[[Page 110 STAT. 3181]]
(A) in the first sentence, by striking out ``section
1712(a)'' and inserting in lieu thereof ``section
1717(a)(2)''; and
(B) in the second sentence, by striking out
``section 1712(a)'' and inserting in lieu thereof
``section 1717(a)(2)''.
(3) Section 5317(c)(3) is amended by striking out ``sections
1710(a)(1)(I), 1710(a)(2), 1710(b), and 1712(a)(2)(B)'' and
inserting in lieu thereof ``subsections (a)(2)(G), (a)(3), and
(b) of section 1710''.
(4) Section 8110(a)(2) is amended by striking out ``section
1712'' and inserting in lieu thereof ``section 1710(a)''.
(5) Section 8111A(b)(2)(A) is amended by striking out
``subsection (f) of section 1712'' and inserting in lieu thereof
``subsection (a) of section 1710''.
SEC. 102. REVISION IN AUTHORITIES FOR PROVISION OF PRIORITY HEALTH CARE
FOR CERTAIN VETERANS EXPOSED TO SPECIFIED TOXIC SUBSTANCES.
(a) Authorized Inpatient Care.--Section 1710(e) is
amended--
(1) in paragraph (1), by striking out subparagraphs (A) and
(B) and inserting in lieu thereof the following:
``(A) A Vietnam-era herbicide-exposed veteran is eligible (subject
to paragraph (2)) for hospital care, medical services, and nursing home
care under subsection (a)(2)(F) for any disability, notwithstanding that
there is insufficient medical evidence to conclude that such disability
may be associated with such exposure.
``(B) A radiation-exposed veteran is eligible for hospital care,
medical services, and nursing home care under subsection (a)(2)(F) for
any disease suffered by the veteran that is--
``(i) a disease listed in section 1112(c)(2) of this title;
or
``(ii) any other disease for which the Secretary, based on
the advice of the Advisory Committee on Environmental Hazards,
determines that there is credible evidence of a positive
association between occurrence of the disease in humans and
exposure to ionizing radiation.''; and
(2) by striking out paragraphs (2) and (3) and inserting in
lieu thereof the following:
``(2)(A) In the case of a veteran described in paragraph (1)(A),
hospital care, medical services, and nursing home care may not be
provided under subsection (a)(2)(F) with respect to--
``(i) a disability that is found, in accordance with
guidelines issued by the Under Secretary for Health, to have
resulted from a cause other than an exposure described in
paragraph (4)(A)(ii); or
``(ii) a disease for which the National Academy of Sciences,
in a report issued in accordance with section 2 of the Agent
Orange Act of 1991, has determined that there is limited or
suggestive evidence of the lack of a positive association
between occurrence of the disease in humans and exposure to a
herbicide agent.
``(B) In the case of a veteran described in paragraph (1)(C),
hospital care, medical services, and nursing home care may not be
provided under subsection (a)(2)(F) with respect to a disability that is
found, in accordance with guidelines issued by the Under Secretary for
Health, to have resulted from a cause other than an exposure described
in that paragraph.
[[Page 110 STAT. 3182]]
``(3) Hospital care, medical services, and nursing home care may not
be provided under or by virtue of subsection (a)(2)(F)--
``(A) in the case of care for a veteran described in
paragraph (1)(A), after December 31, 2002; and
``(B) in the case of care for a veteran described in
paragraph (1)(C), after December 31, 1998.
``(4) For purposes of this subsection--
``(A) The term `Vietnam-era herbicide-exposed veteran' means
a veteran (i) who served on active duty in the Republic of
Vietnam during the Vietnam era, and (ii) who the Secretary finds
may have been exposed during such service to dioxin or was
exposed during such service to a toxic substance found in a
herbicide or defoliant used for military purposes during such
era.
``(B) The term `radiation-exposed veteran' has the meaning
given that term in section 1112(c)(3) of this title.''.
(b) Savings <<NOTE: 38 USC 1710 note.>> Provisions.--The provisions
of sections 1710(e) and 1712(a) of title 38, United States Code, as in
effect on the day before the date of the enactment of this Act, shall
continue to apply on and after such date with respect to the furnishing
of hospital care, nursing home care, and medical services for any
veteran who was furnished such care or services before such date of
enactment on the basis of presumed exposure to a substance or radiation
under the authority of those provisions, but only for treatment for a
disability for which such care or services were furnished before such
date.
SEC. 103. PROSTHETICS AND PREVENTIVE CARE.
(a) Eligibility.--Section 1701(6)(A)(i) is amended--
(1) by striking out ``(in the case of a person otherwise
receiving care or services under this chapter)'' and ``(except
under the conditions described in section 1712(a)(5)(A) of this
title),'';
(2) by inserting ``(in the case of a person otherwise
receiving care or services under this chapter)'' before
``wheelchairs,''; and
(3) by inserting ``except that the Secretary may not furnish
sensori-neural aids other than in accordance with guidelines
which the Secretary shall prescribe,'' after ``reasonable and
necessary,''.
(b) Regulations.--Not <<NOTE: 38 USC 1701 note.>> later than 30 days
after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall prescribe the guidelines required by the amendments made
by subsection (a) and shall furnish a copy of those guidelines to the
Committees on Veterans' Affairs of the Senate and House of
Representatives.
SEC. 104. MANAGEMENT OF HEALTH CARE.
(a) In General.--(1) Chapter 17 is amended by inserting after
section 1704 the following new sections:
``Sec. 1705. Management of health care: patient enrollment
system
``(a) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary, in
accordance with regulations the Secretary shall prescribe, shall
establish and operate a system of annual patient enrollment. The
Secretary shall manage the enrollment of veterans in accordance with the
following priorities, in the order listed:
[[Page 110 STAT. 3183]]
``(1) Veterans with service-connected disabilities rated 50
percent or greater.
``(2) Veterans with service-connected disabilities rated 30
percent or 40 percent.
``(3) Veterans who are former prisoners of war, veterans
with service-connected disabilities rated 10 percent or 20
percent, and veterans described in subparagraphs (B) and (C) of
section 1710(a)(2) of this title.
``(4) Veterans who are in receipt of increased pension based
on a need of regular aid and attendance or by reason of being
permanently housebound and other veterans who are
catastrophically disabled.
``(5) Veterans not covered by paragraphs (1) through (4) who
are unable to defray the expenses of necessary care as
determined under section 1722(a) of this title.
``(6) All other veterans eligible for hospital care, medical
services, and nursing home care under section 1710(a)(2) of this
title.
``(7) Veterans described in section 1710(a)(3) of this
title.
``(b) In the design of an enrollment system under subsection (a),
the Secretary--
``(1) shall ensure that the system will be managed in a
manner to ensure that the provision of care to enrollees is
timely and acceptable in quality;
``(2) may establish additional priorities within each
priority group specified in subsection (a), as the Secretary
determines necessary; and
``(3) may provide for exceptions to the specified priorities
where dictated by compelling medical reasons.
``(c)(1) Effective on October 1, 1998, the Secretary may not provide
hospital care or medical services to a veteran under paragraph (2) or
(3) of section 1710(a) of this title unless the veteran enrolls in the
system of patient enrollment established by the Secretary under
subsection (a).
``(2) The Secretary shall provide hospital care and medical services
under section 1710(a)(1) of this title, and under subparagraph (B) of
section 1710(a)(2) of this title, for the 12-month period following such
veteran's discharge or release from service, to any veteran referred to
in such sections for a disability specified in the applicable
subparagraph of such section, notwithstanding the failure of the veteran
to enroll in the system of patient enrollment referred to in subsection
(a) of this section.
``Sec. 1706. Management of health care: other requirements
``(a) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary shall, to
the extent feasible, design, establish and manage health care programs
in such a manner as to promote cost-effective delivery of health care
services in the most clinically appropriate setting.
``(b)(1) In managing the provision of hospital care and medical
services under such section, the Secretary shall ensure that the
Department maintains its capacity to provide for the specialized
treatment and rehabilitative needs of disabled veterans (including
veterans with spinal cord dysfunction, blindness, amputations, and
mental illness) within distinct programs or facilities of the Department
that are dedicated to the specialized needs of those veterans in a
manner that (A) affords those veterans reasonable access
[[Page 110 STAT. 3184]]
to care and services for those specialized needs, and (B) ensures that
overall capacity of the Department to provide such services is not
reduced below the capacity of the Department, nationwide, to provide
those services, as of the date of the enactment of this section. The
Secretary shall carry out this paragraph in consultation with the
Advisory Committee on Prosthetics and Special Disabilities Programs and
the Committee on Care of Severely Chronically Mentally Ill Veterans.
``(2) <<NOTE: Reports.>> Not later than April 1, 1997, April 1,
1998, and April 1, 1999, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a report on
the Secretary's compliance, by facility and by service-network, with the
requirements of this subsection.''.
(2) The table of sections at the beginning of chapter 17 is amended
by inserting after the item relating to section 1704 the following new
items:
``1705. Management of health care: patient enrollment system.
``1706. Management of health care: other requirements.''.
(b) Conforming Amendments to Section 1703.--Section 1703(a) is
amended--
(1) in the matter preceding paragraph (1), by striking out
``or 1712'';
(2) in paragraph (2)--
(A) by striking out ``1712(a)(1)(B)'' in
subparagraph (A) and inserting in lieu thereof
``1710(a)(1)(B)'';
(B) by striking out subparagraph (B) and inserting
in lieu thereof the following:
``(B) a veteran who (i) has been furnished hospital
care, nursing home care, domiciliary care, or medical
services, and (ii) requires medical services to complete
treatment incident to such care or services; or''; and
(C) by striking ``section 1712(a)(3) (other than a
veteran who is a former prisoner of war) of this title''
in subparagraph (C) and inserting in lieu thereof
``section 1710(a)(2)(E) of this title, or a veteran who
is in receipt of increased pension, or additional
compensation or allowances based on the need of regular
aid and attendance or by reason of being permanently
housebound (or who, but for the receipt of retired pay,
would be in receipt of such pension, compensation, or
allowance),''; and
(3) in paragraph (7), by striking out ``1712(b)(1)(F)'' and
inserting in lieu thereof ``1712(a)(1)(F)''.
SEC. 105. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated for the Department of
Veterans Affairs for the Medical Care account, for the purposes
specified for that account in Public Law 103-327 (108 Stat. 2300),
including the cost of providing hospital care and medical services under
the amendments made by section 101 of this title, not to exceed
$17,250,000,000 for fiscal year 1997 and not to exceed $17,900,000,000
for fiscal year 1998.
SEC. 106. <<NOTE: 38 USC 1705 note.>> ASSESSMENT OF IMPLEMENTATION AND
OPERATION.
(a) Assessment Systems.--The Secretary of Veterans Affairs shall
establish information systems to assess the experience of the Department
of Veterans Affairs in implementing sections 101, 103, and 104,
including the amendments made by those sections,
[[Page 110 STAT. 3185]]
during fiscal year 1997. The Secretary shall establish those information
systems in time to include assessments under such systems in the report
required under subsection (b).
(b) Report.--Not later than March 1, 1998, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and House of
Representatives a report reflecting the experience of the Department
during fiscal year 1997 on--
(1) the effect of implementation of, and provision and
management of care under, sections 101, 103, and 104 (including
the amendments made by those sections) on demand for health care
services from the Department of Veterans Affairs by veterans
described in paragraphs (1), (2), and (3) of section 1710(a) of
title 38, United States Code, as amended by section 101;
(2) any differing patterns of demand on the part of such
veterans relating to such factors as relative distance from
Department facilities and prior experience, or lack of
experience, as recipients of care from the Department;
(3) the extent to which the Department has met such demand
for care; and
(4) changes in health-care delivery patterns in Department
facilities and the fiscal impact of such changes.
(c) Matters To Be Included.--The report under subsection (b) shall
include detailed information with respect to fiscal year 1997 regarding
the following:
(1) The number of veterans enrolled for care at each
Department medical facility and, of such veterans, the number
enrolled at each such facility who had not received care from
the Department during the preceding three fiscal years.
(2) With respect to the veterans who had not received care
from the Department during the three preceding fiscal years, the
total cost of providing care to such veterans, shown in total
and separately (A) by level of care, and (B) by reference to
whether care was furnished in Department facilities or under
contract arrangements.
(3) With respect to the number of veterans described in
paragraphs (1), (2), and (3) of section 1710(a) of title 38,
United States Code, as amended by section 101, who applied for
health care from the Department during fiscal year 1997--
(A) the number who applied for care (shown in total
and separately by facility);
(B) the number who were denied enrollment (shown in
total and separately by facility); and
(C) the number who were denied care which was
considered to be medically necessary but not of an
emergency nature (shown in total and separately by
facility).
(4) The numbers and characteristics of, and the type and
extent of health care furnished to, veterans enrolled for care
(shown in total and separately by facility).
(5) The numbers and characteristics of, and the type and
extent of health care furnished to, veterans not enrolled for
care (shown separately by reference to each class of
eligibility, both in total and separately by facility).
(6) The specific fiscal impact (shown in total and by
geographic health-care delivery areas) of changes in delivery
patterns instituted under the amendments made by this title.
[[Page 110 STAT. 3186]]
TITLE II--CONSTRUCTION AUTHORIZATION
SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.
(a) Ambulatory Care Addition Projects.--The Secretary of Veterans
Affairs may carry out the following ambulatory care addition major
medical facility projects, with each project to be carried out in the
amount specified for that project:
(1) Construction of an ambulatory care facility and
renovation of ``E'' wing, Tripler Army Hospital, Honolulu,
Hawaii, $43,000,000.
(2) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Brockton, Massachusetts,
$13,500,000.
(3) Addition of ambulatory care facilities for outpatient
improvements at the Department of Veterans Affairs medical
center in Shreveport, Louisiana, $25,000,000.
(4) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Lyons, New Jersey,
$21,100,000.
(5) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Tomah, Wisconsin,
$12,700,000.
(6) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Asheville, North Carolina,
$26,300,000.
(7) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Temple, Texas, $9,800,000.
(8) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Tucson, Arizona,
$35,500,000.
(9) Construction of an ambulatory care facility at the
Department of Veterans Affairs medical center in Leavenworth,
Kansas, $27,750,000.
(b) Environmental Improvement Projects.--The Secretary may carry out
the following environmental improvement major medical facility projects,
with each project to be carried out in the amount specified for that
project:
(1) Environmental improvements for the renovation of
nursing home facilities at the Department of Veterans Affairs
medical center in Lebanon, Pennsylvania, $9,500,000.
(2) Environmental improvements at the Department of
Veterans Affairs medical center in Marion, Illinois,
$11,500,000.
(3) Environmental improvements for ward renovation for
patient privacy at the Department of Veterans Affairs medical
center in Omaha, Nebraska, $7,700,000.
(4) Environmental improvements at the Department of
Veterans Affairs medical center in Pittsburgh, Pennsylvania,
$17,400,000.
(5) Environmental improvements for the renovation of
various buildings at the Department of Veterans Affairs medical
center in Waco, Texas, $26,000,000.
(6) Environmental improvements for the replacement of
psychiatric beds at the Department of Veterans Affairs medical
center in Marion, Indiana, $17,300,000.
[[Page 110 STAT. 3187]]
(7) Environmental improvements for the renovation of
psychiatric wards at the Department of Veterans Affairs medical
center in Perry Point, Maryland, $15,100,000.
(8) Environmental enhancement at the Department of Veterans
Affairs medical center in Salisbury, North Carolina,
$18,200,000.
(c) Seismic Correction Project.--The Secretary may carry out seismic
corrections to Building Number 324 at the Department of Veterans Affairs
medical center in Palo Alto, California, in the amount of $20,800,000.
(d) Project Authorization When Partial Funding
Provided.--If the amount of funds appropriated for fiscal year 1997 or
1998 for design and partial construction of a major medical facility
project that is authorized in this section is less than the amount
required to complete the construction of that project as authorized and
if the Secretary obligates funds for such construction, such project
shall be deemed to be fully authorized. Any such authorization shall
cease to have effect at the close of fiscal year 2001.
SEC. 202. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.
The Secretary of Veterans Affairs may enter into leases for medical
facilities as follows:
(1) Lease of a satellite outpatient clinic in Allentown,
Pennsylvania, in an amount not to exceed $2,159,000.
(2) Lease of a satellite outpatient clinic in Beaumont,
Texas, in an amount not to exceed $1,940,000.
(3) Lease of a satellite outpatient clinic in Boston,
Massachusetts, in an amount not to exceed $2,358,000.
(4) Lease of a parking facility in Cleveland, Ohio, in an
amount not to exceed $1,300,000.
(5) Lease of a satellite outpatient clinic and Veterans
Benefits Administration field office in San Antonio, Texas, in
an amount not to exceed $2,256,000.
(6) Lease of a satellite outpatient clinic in Toledo, Ohio,
in an amount not to exceed $2,223,000.
SEC. 203. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There are authorized to be appropriated to the
Secretary of Veterans Affairs for fiscal year 1997 and fiscal year
1998--
(1) for the Construction, Major Projects, account, a total
of $358,150,000 for the projects authorized in section 201; and
(2) for the Medical Care account, a total of $12,236,000 for
the leases authorized in section 202.
(b) Limitation.--The projects authorized in section 201 may only be
carried out using--
(1) funds appropriated for fiscal year 1997 or fiscal year
1998 consistent with the authorization of appropriations in
subsection (a);
(2) funds appropriated for Construction, Major Projects for
a fiscal year before fiscal year 1997 that remain available for
obligation; and
(3) funds appropriated for Construction, Major Projects for
fiscal year 1997 or fiscal year 1998 for a category of activity
not specific to a project.
[[Page 110 STAT. 3188]]
SEC. 204. STRATEGIC PLANNING.
Section 8107 is amended--
(1) by redesignating subsection (b) as subsection (c);
(2) by striking out subsection (a) and inserting in lieu
thereof the following new subsections:
``(a) <<NOTE: Reports.>> In order to promote effective planning for
the efficient provision of care to eligible veterans, the Secretary,
based on the analysis and recommendations of the Under Secretary for
Health, shall submit to each committee an annual report regarding long-
range health planning of the Department. The report shall be submitted
each year not later than the date on which the budget for the next
fiscal year is submitted to the Congress under section 1105 of title 31.
``(b) Each report under subsection (a) shall include the following:
``(1) A five-year strategic plan for the provision of care
under chapter 17 of this title to eligible veterans through
coordinated networks of medical facilities operating within
prescribed geographic service-delivery areas, such plan to
include provision of services for the specialized treatment and
rehabilitative needs of disabled veterans (including veterans
with spinal cord dysfunction, blindness, amputations, and mental
illness) through distinct programs or facilities of the
Department dedicated to the specialized needs of those veterans.
``(2) A description of how planning for the networks will be
coordinated.
``(3) A profile regarding each such network of medical
facilities which identifies--
``(A) the mission of each existing or proposed
medical facility in the network;
``(B) any planned change in the mission for any such
facility and the rationale for such planned change;
``(C) the population of veterans to be served by the
network and anticipated changes over a five-year period
and a ten-year period, respectively, in that population
and in the health-care needs of that population;
``(D) information relevant to assessing progress
toward the goal of achieving relative equivalency in the
level of resources per patient distributed to each
network, such information to include the plans for and
progress toward lowering the cost of care-delivery in
the network (by means such as changes in the mix in the
network of physicians, nurses, physician assistants, and
advance practice nurses);
``(E) the capacity of non-Federal facilities in the
network to provide acute, long-term, and specialized
treatment and rehabilitative services (described in
section 7305 of this title), and determinations
regarding the extent to which services to be provided in
each service-delivery area and each facility in such
area should be provided directly through facilities of
the Department or through contract or other
arrangements, including arrangements authorized under
sections 8111 and 8153 of this title; and
``(F) a five-year plan for construction,
replacement, or alteration projects in support of the
approved mission of each facility in the network and a
description of how those projects will improve access to
care, or quality of care, for patients served in the
network.
``(4) A status report for each facility on progress toward--
[[Page 110 STAT. 3189]]
``(A) instituting planned mission changes identified
under paragraph (3)(B);
``(B) implementing principles of managed care of
eligible veterans; and
``(C) developing and instituting cost-effective
alternatives to provision of institutional care.''; and
(3) by adding at the end the following new subsection:
``(d)(1) <<NOTE: Reports.>> The Secretary shall submit to each
committee, not later than January 31 of each year, a report showing the
current priorities of the Department for proposed major medical
construction projects. Each such report shall identify the 20 projects,
from within all the projects in the Department's inventory of proposed
projects, that have the highest priority and, for those 20 projects, the
relative priority and rank scoring of each such project and the
projected cost of such project (including the projected operating costs,
including both recurring and nonrecurring costs). The 20 projects shall
be compiled, and their relative rankings shall be shown, by category of
project (including the categories of ambulatory care projects, nursing
home care projects, and such other categories as the Secretary
determines).
``(2) The Secretary shall include in each report, for each project
listed, a description of the specific factors that account for the
relative ranking of that project in relation to other projects within
the same category.
``(3) In a case in which the relative ranking of a proposed project
has changed since the last report under this subsection was submitted,
the Secretary shall also include in the report a description of the
reasons for the change in the ranking, including an explanation of any
change in the scoring of the project under the Department's scoring
system for proposed major medical construction projects.''.
SEC. 205. REVISION TO PROSPECTUS REQUIREMENTS.
(a) Additional Information.--Section 8104(b) is amended--
(1) by striking out the matter preceding paragraph (1) and
inserting in lieu thereof the following:
``(b) Whenever the President or the Secretary submit to the Congress
a request for the funding of a major medical facility project (as
defined in subsection (a)(3)(A)) or a major medical facility lease (as
defined in subsection (a)(3)(B)), the Secretary shall submit to each
committee, on the same day, a prospectus of the proposed medical
facility. Any such prospectus shall include the following:'';
(2) in paragraph (1)--
(A) by striking out ``a detailed'' and inserting in
lieu thereof ``A detailed''; and
(B) by striking out the semicolon at the end and
inserting in lieu thereof a period;
(3) in paragraph (2)--
(A) by striking out ``an estimate'' and inserting in
lieu thereof ``An estimate''; and
(B) by striking out ``; and'' and inserting in lieu
thereof a period;
(4) in paragraph (3), by striking out ``an estimate'' and
inserting in lieu thereof ``An estimate''; and
(5) by adding at the end the following new paragraphs:
``(4) Demographic data applicable to such facility,
including information on projected changes in the population of
veterans
[[Page 110 STAT. 3190]]
to be served by the facility over a five-year period and a ten-
year period.
``(5) Current and projected workload and utilization data
regarding the facility.
``(6) Current and projected operating costs of the facility,
including both recurring and non-recurring costs.
``(7) The priority score assigned to the project or lease
under the Department's prioritization methodology and, if the
project or lease is being proposed for funding before a project
or lease with a higher score, a specific explanation of the
factors other than the priority score that were considered and
the basis on which the project or lease is proposed for funding
ahead of projects or leases with higher priority scores.
``(8) In the case of a prospectus proposing the construction
of a new or replacement medical facility, a description of each
alternative to construction of the facility that was
considered.''.
(b) Applicability.--The <<NOTE: 38 USC 8104 note.>> amendments made
by subsection (a) shall apply with respect to any prospectus submitted
by the Secretary of Veterans Affairs after the date of the enactment of
this Act.
SEC. 206. CONSTRUCTION AUTHORIZATION REQUIREMENTS.
(a) Definition of Major Medical Facility Project.--Paragraph (3)(A)
of section 8104(a) is amended by striking out ``$3,000,000'' and
inserting in lieu thereof ``$4,000,000''.
(b) Applicability of Construction Authorization Requirement.--(1)
Subsection (b) of section 301 of the Veterans' Medical Programs
Amendments of 1992 (Public Law 102-405; 106 Stat. 1984) <<NOTE: 38 USC
8104 note.>> is repealed.
(2) The amendments made by subsection (a) of such section shall
apply with respect to any major medical facility project or any major
medical facility lease of the Department of Veterans Affairs, regardless
of when funds are first appropriated for that project or lease, except
that in the case of a project for which funds were first appropriated
before October 9, 1992, such amendments shall not apply with respect to
amounts appropriated for that project for a fiscal year before fiscal
year 1998.
(c) Limitation on Obligations for Advance Planning.--Section 8104 is
amended by adding at the end the following new subsection:
``(f) The Secretary may not obligate funds in an amount in excess of
$500,000 from the Advance Planning Fund of the Department toward design
or development of a major medical facility project (as defined in
subsection (a)(3)(A)) until--
``(1) <<NOTE: Reports.>> the Secretary submits to the
committees a report on the proposed obligation; and
``(2) a period of 30 days has passed after the date on which
the report is received by the committees.''.
SEC. 207. TERMINOLOGY CHANGES.
(a) Definition of ``Construct''.--Section 8101(2) is amended--
(1) by striking out ``working drawings'' and inserting in
lieu thereof ``construction documents''; and
(2) by striking out ``preliminary plans'' and inserting in
lieu thereof ``design development''.
(b) Parking Facilities.--Section 8109(h)(3)(B) is amended by
striking out ``working drawings'' and inserting in lieu thereof
``construction documents''.
[[Page 110 STAT. 3191]]
TITLE III--HEALTH CARE AND ADMINISTRATION
Subtitle A--Health Care Sharing and Administration
SEC. 301. REVISION OF AUTHORITY TO SHARE MEDICAL FACILITIES, EQUIPMENT,
AND INFORMATION.
(a) Statement of Purpose.--The text of section 8151 is
amended to read as follows:
``It is the purpose of this subchapter to strengthen the medical
programs at Department facilities and improve the quality of health care
provided veterans under this title by authorizing the Secretary to enter
into agreements with health-care providers in order to share health-care
resources with, and receive health-care resources from, such providers
while ensuring no diminution of services to veterans.''.
(b) Definitions.--Section 8152 is amended--
(1) by striking out paragraphs (1), (2), and (3) and
inserting in lieu thereof the following new paragraphs (1) and
(2):
``(1) The term `health-care resource' includes hospital care
and medical services (as those terms are defined in section 1701
of this title), any other health-care service, and any health-
care support or administrative resource.
``(2) The term `health-care providers' includes health-care
plans and insurers and any organizations, institutions, or other
entities or individuals who furnish health-care resources.'';
and
(2) by redesignating paragraph (4) as paragraph (3).
(c) Authority To Secure Health-Care Resources.--Section 8153 is
amended as follows:
(1) Subsection (a) is amended--
(A) in paragraph (1)--
(i) by striking out ``certain specialized
medical resources'' and inserting in lieu thereof
``health-care resources'';
(ii) by striking out ``other medical
resources'' and inserting in lieu thereof ``other
health-care resources''; and
(iii) by striking out ``of--'' and all that
follows through ``section 1742(a) of this title''
and inserting in lieu thereof ``of health-care
resources between Department health-care
facilities and any health-care provider, or other
entity or individual'';
(B) in paragraph (2), by striking out ``only'' and
all that follows through ``are not'' and inserting in
lieu thereof ``if such resources are not, or would not
be,''; and
(C) by adding at the end the following:
``(3)(A) If the health-care resource required is a commercial
service, the use of medical equipment or space, or research, and is to
be acquired from an institution affiliated with the Department in
accordance with section 7302 of this title, including medical practice
groups and other entities associated with affiliated institutions, blood
banks, organ banks, or research centers, the Secretary may make
arrangements for acquisition of the resource without
[[Page 110 STAT. 3192]]
regard to any law or regulation that would otherwise require the use of
competitive procedures for acquiring the resource.
``(B)(i) If the health-care resource required is a commercial
service or the use of medical equipment or space, and is not to be
acquired from an entity described in subparagraph (A), any procurement
of the resource may be conducted without regard to any law or regulation
that would otherwise require the use of competitive procedures for
procuring the resource, but only if the procurement is conducted in
accordance with the simplified procedures prescribed pursuant to clause
(ii).
``(ii) The Secretary, in consultation with the Administrator for
Federal Procurement Policy, may prescribe simplified procedures for the
procurement of health-care resources under this subparagraph. The
Secretary shall publish such procedures for public comment in accordance
with section 22 of the Office of Federal Procurement Policy Act (41
U.S.C. 418b). Such procedures shall permit all responsible sources to
submit a bid, proposal, or quotation (as appropriate) for the resources
to be procured and provide for the consideration by the Department of
bids, proposals, or quotations so submitted.
``(iii) Pending publication of the procedures under clause (ii), the
Secretary shall (except as provided under subparagraph (A)) procure
health-care resources referred to in clause (i) in accordance with all
procurement laws and regulations.
``(C) Any procurement of health-care resources other than those
covered by subparagraph (A) or (B) shall be conducted in accordance with
all procurement laws and regulations.
``(D) For any procurement to be conducted on a sole source basis
other than a procurement covered by subparagraph (A), a written
justification shall be prepared that includes the information and is
approved at the levels prescribed in section 303(f) of the Federal
Property and Administrative Services Act of 1949 (41 U.S.C. 253(f)).
``(E) As used in this paragraph, the term `commercial service' means
a service that is offered and sold competitively in the commercial
marketplace, is performed under standard commercial terms and
conditions, and is procured using firm-fixed price contracts.''.
(2) Subsection (b) is amended by striking out ``reciprocal
reimbursement'' in the first sentence and all that follows
through the period at the end of that sentence and inserting in
lieu thereof ``payment to the Department in accordance with
procedures that provide appropriate flexibility to negotiate
payment which is in the best interest of the Government.''.
(3) Subsection (d) is amended by striking out ``preclude
such payment, in accordance with--'' and all that follows
through ``to such facility therefor'' and inserting in lieu
thereof ``preclude such payment to such facility for such care
or services''.
(4) Such section is further amended--
(A) by redesignating subsection (e) as subsection
(g); and
(B) by inserting after subsection (d) the following
new subsections:
``(e) The Secretary may make an arrangement that authorizes the
furnishing of services by the Secretary under this section to
individuals who are not veterans only if the Secretary determines--
[[Page 110 STAT. 3193]]
``(1) that veterans will receive priority under such an
arrangement; and
``(2) that such an arrangement--
``(A) is necessary to maintain an acceptable level
and quality of service to veterans at that facility; or
``(B) will result in the improvement of services to
eligible veterans at that facility.
``(f) Any amount received by the Secretary from a non-Federal entity
as payment for services provided by the Secretary during a prior fiscal
year under an agreement entered into under this section may be obligated
by the Secretary during the fiscal year in which the Secretary receives
the payment.''.
(d) Clerical Amendments.--(1) The heading of section 8153 is amended
to read as follows:
``Sec. 8153. Sharing of health-care resources''.
(2) The item relating to section 8153 in the table of sections at
the beginning of chapter 81 is amended to read as follows:
``8153. Sharing of health-care resources.''.
SEC. 302. IMPROVED EFFICIENCY IN HEALTH CARE RESOURCE MANAGEMENT.
(a) Temporary Expansion of Authority for Sharing Agreements.--
Section 201 of the Veterans Health Care Act of 1992 (Public Law 102-585;
38 U.S.C. 8111 note) is amended--
(1) by inserting ``(a) Authority.--'' before ``The Secretary
of Veterans Affairs''; and
(2) by adding at the end thereof the following new
subsection:
``(b) Use of Funds.--Any amount received by the Secretary from a
non-Federal entity as payment for services provided by the Secretary
during a prior fiscal year under an agreement entered into under this
section may be obligated by the Secretary during the fiscal year in
which the Secretary receives the payment.''.
(b) Repeal of Sunset Provision.--(1) Section 204 of such Act (38
U.S.C. 8111 note) is repealed.
(2) <<NOTE: 38 USC 8111 note.>> Any services provided pursuant to
agreements entered into under section 201 of such Act (38 U.S.C. 8111
note) during the period beginning on October 1, 1996, and ending on the
date of the enactment of this Act are hereby ratified.
(c) Cost Recovery.--Title II of such Act is further amended by
adding at the end the following new section:
``SEC. <<NOTE: 38 USC 8111 note.>> 207. AUTHORITY TO BILL HEALTH-PLAN
CONTRACTS.
``(a) Right To Recover.--In the case of a primary beneficiary (as
described in section 201(a)(2)(B)) who has coverage under a health-plan
contract, as defined in section 1729(i)(1)(A) of title 38, United States
Code, and who is furnished care or services by a Department medical
facility pursuant to this title, the United States shall have the right
to recover or collect charges for such care or services from such
health-plan contract to the extent that the beneficiary (or the provider
of the care or services) would be eligible to receive payment for such
care or services from such health-plan contract if the care or services
had not been furnished by a department or agency of the United States.
Any funds received from such health-plan contract shall be credited to
funds that have been allotted to the facility that furnished the care or
services.
[[Page 110 STAT. 3194]]
``(b) Enforcement.--The right of the United States to recover under
such a beneficiary's health-plan contract shall be enforceable in the
same manner as that provided by subsections (a)(3), (b), (c)(1), (d),
(f), (h), and (i) of section 1729 of title 38, United States Code.''.
SEC. 303. PERSONNEL FURNISHING SHARED RESOURCES.
Section 712(b)(2) is amended--
(1) by striking out ``the sum of--'' and inserting in lieu
thereof ``the sum of the following:'';
(2) by capitalizing the first letter of the first word of
each of subparagraphs (A) and (B);
(3) by striking out ``; and'' at the end of subparagraph (A)
and inserting in lieu thereof a period; and
(4) by adding at the end the following new subparagraph:
``(C) The number of such positions in the Department
during that fiscal year held by persons involved in
providing health-care resources under section 8111 or
8153 of this title or under section 201 of the Veterans
Health Care Act of 1992 (Public Law 102-585; 106 Stat.
4949; 38 U.S.C. 8111 note).''.
SEC. 304. WAITING PERIOD FOR ADMINISTRATIVE REORGANIZATIONS.
Section 510(b) is amended--
(1) in the second sentence, by striking out ``a 90-day
period of continuous session of Congress following the date of
the submission of the report'' and inserting in lieu thereof ``a
45-day period following the date of the submission of the
report, not less than 30 days of which shall be days during
which Congress shall have been in continuous session''; and
(2) in the third sentence, by striking out ``such 90-day
period'' and inserting in lieu thereof ``any period of
continuity of session''.
SEC. 305. REPEAL OF LIMITATIONS ON CONTRACTS FOR CONVERSION OF
PERFORMANCE OF ACTIVITIES OF DEPARTMENT HEALTH-CARE
FACILITIES AND REVISED ANNUAL REPORTING REQUIREMENT.
Subsection (c) of section 8110 is amended to read as follows:
``(c) The Secretary shall include in the materials submitted to
Congress each year in support of the budget of the Department for the
next fiscal year a report on activities and proposals involving
contracting for performance by contractor personnel of work previously
performed by Department employees. The report shall--
``(1) identify those specific activities that are currently
performed at a Department facility by more than 10 Department
employees which the Secretary proposes to study for possible
contracting involving conversion from performance by Department
employees to performance by employees of a contractor; and
``(2) identify those specific activities that have been
contracted for performance by contractor employees during the
prior fiscal year (shown by location, subject, scope of
contracts, and savings) and shall describe the effect of such
contracts on the quality of delivery of health services during
such year.''.
[[Page 110 STAT. 3195]]
Subtitle B--Care of Women Veterans
SEC. 321. MAMMOGRAPHY QUALITY STANDARDS.
(a) In General.--(1) Subchapter II of chapter 73 is amended by
adding after section 7318 the following new section:
``Sec. 7319. Mammography quality standards
``(a) A mammogram may not be performed at a Department facility
unless that facility is accredited for that purpose by a private
nonprofit organization designated by the Secretary. An organization
designated by the Secretary under this subsection shall meet the
standards for accrediting bodies established under subsection (e) of
section 354 of the Public Health Service Act (42 U.S.C. 263b).
``(b) The Secretary, in consultation with the Secretary of Health
and Human Services, shall prescribe quality assurance and quality
control standards relating to the performance and interpretation of
mammograms and use of mammogram equipment and facilities of the
Department of Veterans Affairs consistent with the requirements of
section 354(f)(1) of the Public Health Service Act. Such standards shall
be no less stringent than the standards prescribed by the Secretary of
Health and Human Services under section 354(f) of the Public Health
Service Act.
``(c)(1) The Secretary, to ensure compliance with the standards
prescribed under subsection (b), shall provide for an annual inspection
of the equipment and facilities used by and in Department health care
facilities for the performance of mammograms. Such inspections shall be
carried out in a manner consistent with the inspection of certified
facilities by the Secretary of Health and Human Services under section
354(g) of the Public Health Service Act.
``(2) The Secretary may not provide for an inspection under
paragraph (1) to be performed by a State agency.
``(d) The Secretary shall ensure that mammograms performed for the
Department under contract with any non-Department facility or provider
conform to the quality standards prescribed by the Secretary of Health
and Human Services under section 354 of the Public Health Service Act.
``(e) For the purposes of this section, the term `mammogram' has the
meaning given such term in paragraph (5) of section 354(a) of the Public
Health Service Act.''.
(2) The table of sections at the beginning of such chapter is
amended by inserting after the item relating to section 7318 the
following new item:
``7319. Mammography quality standards.''.
(b) Deadline <<NOTE: 38 USC 7319 note.>> for Prescribing
Standards.--The Secretary of Veterans Affairs shall prescribe standards
under subsection (b) of section 7319 of title 38, United States Code, as
added by subsection (a), not later than the end of the 120-day period
beginning on the date of the enactment of this Act.
(c) Implementation <<NOTE: 38 USC 7319 note.>> Report.--The
Secretary shall submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the Secretary's
implementation of section 7319 of title 38, United States Code, as added
by subsection (a). The report shall be submitted not later than 120 days
after the date of the enactment of this Act.
[[Page 110 STAT. 3196]]
SEC. 322. <<NOTE: 38 USC 1710 note.>> PATIENT PRIVACY FOR WOMEN
PATIENTS.
(a) Identification of Deficiencies.--The Secretary of Veterans
Affairs shall conduct a survey of each medical center under the
jurisdiction of the Secretary to identify deficiencies relating to
patient privacy afforded to women patients in the clinical areas at each
such center which may interfere with appropriate treatment of such
patients.
(b) Correction of Deficiencies.--The Secretary shall ensure that
plans and, where appropriate, interim steps to correct the deficiencies
identified in the survey conducted under subsection (a) are developed
and are incorporated into the Department's construction planning
processes and, in cases in which it is cost-effective to do so, are
given a high priority.
(c) Reports to Congress.--The Secretary shall compile an annual
inventory, by medical center, of deficiencies identified under
subsection (a) and of plans and, where appropriate, interim steps, to
correct such deficiencies. The Secretary shall submit to the Committees
on Veterans' Affairs of the Senate and House of Representatives, not
later than October 1, 1997, and not later than October 1 each year
thereafter through 1999 a report on such deficiencies. The Secretary
shall include in such report the inventory compiled by the Secretary,
the proposed corrective plans, and the status of such plans.
SEC. 323. <<NOTE: 38 USC 318 note.>> ASSESSMENT OF USE BY WOMEN VETERANS
OF DEPARTMENT HEALTH SERVICES.
(a) Reports to Under Secretary for Health.--The Center for Women
Veterans of the Department of Veterans Affairs (established under
section 509 of Public Law 103-446), in consultation with the Advisory
Committee on Women Veterans, shall assess the use by women veterans of
health services through the Department of Veterans Affairs, including
counseling for sexual trauma and mental health services. The Center
shall submit to the Under Secretary for Health of the Department of
Veterans Affairs a report not later than April 1, 1997, and April 1 of
each of the two following years, on--
(1) the extent to which women veterans described in
paragraphs (1) and (2) of section 1710(a) of title 38, United
States Code, fail to seek, or face barriers in seeking, health
services through the Department, and the reasons therefor; and
(2) recommendations, if indicated, for encouraging greater
use of such services, including (if appropriate) public service
announcements and other outreach efforts.
(b) Reports to Congressional Committees.--Not later than July 1,
1997, and July 1 of each of the two following years, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans' Affairs of
the Senate and House of Representatives a report containing--
(1) the most recent report of the Center for Women Veterans
under subsection (a);
(2) the views of the Under Secretary for Health on such
report's findings and recommendations; and
(3) a description of the steps being taken by the Secretary
to remedy any problems described in the report.
[[Page 110 STAT. 3197]]
SEC. 324. REPORTING REQUIREMENTS.
(a) Extension of Annual Report Requirement.--Section 107(a) of the
Veterans Health Care Act of 1992 (Public Law 102-585; 106 Stat.
4947) <<NOTE: 38 USC 1710 note.>> is amended by striking out ``Not
later than January 1, 1993, January 1, 1994, and January 1, 1995'' and
inserting in lieu thereof ``Not later than January 1 of 1993 and each
year thereafter through 1998''.
(b) Report on Health Care and Research.--Section 107(b) of such Act
is amended--
(1) in paragraph (2)(A), by inserting ``(including
information on the number of inpatient stays and the number of
outpatient visits through which such services were provided)''
after ``facility''; and
(2) by adding at the end the following new paragraph:
``(5) A description of the actions taken by the Secretary to
foster and encourage the expansion of such research.''.
Subtitle C--Readjustment Counseling and Mental Health Care
SEC. 331. EXPANSION OF ELIGIBILITY FOR READJUSTMENT COUNSELING AND
CERTAIN RELATED COUNSELING SERVICES.
(a) Expansion of Eligibility.--Subsection (a) of section 1712A is
amended to read as follows:
``(a)(1)(A) Upon the request of any veteran referred to in
subparagraph (B), the Secretary shall furnish counseling to the veteran
to assist the veteran in readjusting to civilian life. Such counseling
may include a general mental and psychological assessment of the veteran
to ascertain whether such veteran has mental or psychological problems
associated with readjustment to civilian life.
``(B) Subparagraph (A) applies to the following veterans:
``(i) Any veteran who served on active duty--
``(I) in a theater of combat operations (as
determined by the Secretary in consultation with the
Secretary of Defense) during the Vietnam era; or
``(II) after May 7, l975, in an area at a time
during which hostilities occurred in that area.
``(ii) Any veteran (other than a veteran covered by clause
(i)) who served on active duty during the Vietnam era who seeks
or is furnished such counseling before January 1, 2000.
``(2)(A) Upon the request of any veteran (other than a veteran
covered by paragraph (1)) who served in the active military, naval, or
air service in a theater of combat operations (as so determined) during
a period of war, or in any other area during a period in which
hostilities (as defined in subparagraph (B)) occurred in such area, the
Secretary may furnish counseling to the veteran to assist the veteran in
readjusting to civilian life.
``(B) For the purposes of subparagraph (A), the term `hostilities'
means an armed conflict in which the members of the Armed Forces are
subjected to danger comparable to the danger to which members of the
Armed Forces have been subjected in combat with enemy armed forces
during a period of war, as determined by the Secretary in consultation
with the Secretary of Defense.''.
[[Page 110 STAT. 3198]]
(b) Repeal of Referral Provisions.--Subsection (c) of such section
is repealed.
SEC. 332. REPORTS RELATING TO VET CENTERS.
(a) Report on Collocation of Vet Centers and Department Outpatient
Clinics.--(1) Not later than six months after the date of the enactment
of this Act, the Secretary of Veterans Affairs shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a report on the feasibility and desirability of
providing for the collocation of Vet Centers and outpatient clinics
(including rural mobile clinics) of the Department of Veterans Affairs
as current leases for such centers and clinics expire.
(2) The report shall include an assessment of the following:
(A) The results of any collocation of Vet Centers and
outpatient clinics carried out by the Secretary before the date
of the enactment of this Act, including the effects of such
collocation on the quality of care provided at such centers and
clinics.
(B) The effect of such collocation on the capacity of such
centers and clinics to carry out their primary mission.
(C) The extent to which such collocation will impair the
operational independence or administrative integrity of such
centers and clinics.
(D) The feasibility of combining the services provided by
such centers and clinics in the course of such collocation.
(E) The advisability of the collocation of centers and
clinics of significantly different size.
(F) The effect of the locations (including urban and rural
locations) of the centers and clinics on the feasibility and
desirability of such collocation.
(G) The amount of any costs savings to be achieved by the
Department as a result of such collocation.
(H) Any other matter that the Secretary considers
appropriate.
(b) Report on Provision of Limited Health Care Services at
Readjustment Counseling Centers.--(1) Not later than six months after
the date of the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committees on Veterans' Affairs of the Senate and
House of Representatives a report on the feasibility and desirability of
providing a limited battery of health care services (including
ambulatory services and health care screening services) to veterans at
Department of Veterans Affairs readjustment counseling centers.
(2) The report shall include a discussion of the following:
(A) The effect on the advisability of providing health care
services at readjustment counseling centers of the geographic
location of such centers, including the urban location and rural
location of such centers and the proximity of such centers to
Department of Veterans Affairs medical facilities.
(B) The effect on the advisability of providing such
services at such centers of the type and level of services to be
provided, and the demographic characteristics (including age,
socio-economic status, ethnicity, and sex) of veterans likely to
be provided the services.
(C) The effect of providing such services at such centers on
the readjustment counseling center program in general and on the
efficiency and autonomy of the clinical and administra
[[Page 110 STAT. 3199]]
tive operations of the readjustment counseling centers in
particular.
(D) Any other matter that the Secretary considers
appropriate.
(c) Rule of Construction.--Nothing in this section is intended to
preclude the Secretary, during the period before the submission of the
reports under this section, from providing limited health care services
at Vet Centers.
SEC. 333. ADVISORY COMMITTEE ON THE READJUSTMENT OF
VETERANS.
(a) In General.--(1) Subchapter III of chapter 5 is amended by
inserting after section 544 the following new section:
``Sec. 545. Advisory Committee on the Readjustment of Veterans
``(a)(1) There is in the Department the Advisory Committee on the
Readjustment of Veterans (hereafter in this section referred to as the
`Committee').
``(2) The Committee shall consist of not more than 18 members
appointed by the Secretary from among individuals who--
``(A) have demonstrated significant civic or professional
achievement; and
``(B) have experience with the provision of veterans
benefits and services by the Department.
``(3) The Secretary shall seek to ensure that members appointed to
the Committee include individuals from a wide variety of geographic
areas and ethnic backgrounds, individuals from veterans service
organizations, individuals with combat experience, and women.
``(4) The Secretary shall determine the terms of service and pay and
allowances of the members of the Committee, except that a term of
service may not exceed two years. The Secretary may reappoint any member
for additional terms of service.
``(b)(1) The Secretary shall, on a regular basis, consult with and
seek the advice of the Committee with respect to the provision by the
Department of benefits and services to veterans in order to assist
veterans in the readjustment to civilian life.
``(2)(A) In providing advice to the Secretary under this subsection,
the Committee shall--
``(i) assemble and review information relating to the needs
of veterans in readjusting to civilian life;
``(ii) provide information relating to the nature and
character of psychological problems arising from service in the
Armed Forces;
``(iii) provide an on-going assessment of the effectiveness
of the policies, organizational structures, and services of the
Department in assisting veterans in readjusting to civilian
life; and
``(iv) provide on-going advice on the most appropriate means
of responding to the readjustment needs of veterans in the
future.
``(B) In carrying out its duties under subparagraph (A), the
Committee shall take into special account the needs of veterans who have
served in a theater of combat operations.
``(c)(1) <<NOTE: Reports.>> Not later than March 31 of each year,
the Committee shall submit to the Secretary a report on the programs and
activities
[[Page 110 STAT. 3200]]
of the Department that relate to the readjustment of veterans to
civilian life. Each such report shall include--
``(A) an assessment of the needs of veterans with respect to
readjustment to civilian life;
``(B) a review of the programs and activities of the
Department designed to meet such needs; and
``(C) such recommendations (including recommendations for
administrative and legislative action) as the Committee
considers appropriate.
``(2) Not later than 90 days after the receipt of a report under
paragraph (1), the Secretary shall transmit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a copy of
the report, together with any comments and recommendations concerning
the report that the Secretary considers appropriate.
``(3) The Committee may also submit to the Secretary such other
reports and recommendations as the Committee considers appropriate.
``(4) The Secretary shall submit with each annual report submitted
to the Congress pursuant to section 529 of this title a summary of all
reports and recommendations of the Committee submitted to the Secretary
since the previous annual report of the Secretary submitted pursuant to
that section.
``(d)(1) Except as provided in paragraph (2), the provisions of the
Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the
activities of the Committee under this section.
``(2) Section 14 of such Act shall not apply to the Committee.''.
(2) The table of sections at the beginning of chapter 5 is amended
by inserting after the item relating to section 544 the following new
item:
``545. Advisory Committee on the Readjustment of Veterans.''.
(b) Original <<NOTE: 38 USC 545 note.>> Members.--(1)
Notwithstanding subsection (a)(2) of section 545 of title 38, United
States Code (as added by subsection (a)), the members of the Advisory
Committee on the Readjustment of Vietnam and Other War Veterans on the
date of the enactment of this Act shall be the original members of the
advisory committee recognized under such section.
(2) The original members shall so serve until the Secretary of
Veterans Affairs carries out appointments under such subsection (a)(2).
The Secretary of Veterans Affairs shall carry out such appointments as
soon after such date as is practicable. The Secretary may make such
appointments from among such original members.
SEC. 334. CENTERS FOR MENTAL ILLNESS RESEARCH, EDUCATION, AND CLINICAL
ACTIVITIES.
(a) In General.--(1) Subchapter II of chapter 73 is amended by
adding after section 7319, as added by section 321(a)(1), the following
new section:
``Sec. 7320. Centers for mental illness research, education, and
clinical activities
``(a) The purpose of this section is to provide for the improvement
of the provision of health-care services and related counseling services
to eligible veterans suffering from mental illness (especially mental
illness related to service-related conditions) through--
``(1) the conduct of research (including research on
improving mental health service facilities of the Department and
[[Page 110 STAT. 3201]]
on improving the delivery of mental health services by the
Department);
``(2) the education and training of health care personnel of
the Department; and
``(3) the development of improved models and systems for the
furnishing of mental health services by the Department.
``(b)(1) The Secretary shall establish and operate centers for
mental illness research, education, and clinical activities. Such
centers shall be established and operated by collaborating Department
facilities as provided in subsection (c)(1). Each such center shall
function as a center for--
``(A) research on mental health services;
``(B) the use by the Department of specific models for
furnishing services to treat serious mental illness;
``(C) education and training of health-care professionals of
the Department; and
``(D) the development and implementation of innovative
clinical activities and systems of care with respect to the
delivery of such services by the Department.
``(2) The Secretary shall, upon the recommendation of the Under
Secretary for Health, designate the centers under this section. In
making such designations, the Secretary shall ensure that the centers
designated are located in various geographic regions of the United
States. The Secretary may designate a center under this section only
if--
``(A) the proposal submitted for the designation of the
center meets the requirements of subsection (c);
``(B) the Secretary makes the finding described in
subsection (d); and
``(C) the peer review panel established under subsection (e)
makes the determination specified in subsection (e)(3) with
respect to that proposal.
``(3) Not more than five centers may be designated under this
section.
``(4) The authority of the Secretary to establish and operate
centers under this section is subject to the appropriation of funds for
that purpose.
``(c) A proposal submitted for the designation of a center under
this section shall--
``(1) provide for close collaboration in the establishment
and operation of the center, and for the provision of care and
the conduct of research and education at the center, by a
Department facility or facilities in the same geographic area
which have a mission centered on care of the mentally ill and a
Department facility in that area which has a mission of
providing tertiary medical care;
``(2) provide that no less than 50 percent of the funds
appropriated for the center for support of clinical care,
research, and education will be provided to the collaborating
facility or facilities that have a mission centered on care of
the mentally ill; and
``(3) provide for a governance arrangement between the
collaborating Department facilities which ensures that the
center will be established and operated in a manner aimed at
improving the quality of mental health care at the collaborating
facility or facilities which have a mission centered on care of
the mentally ill.
[[Page 110 STAT. 3202]]
``(d) The finding referred to in subsection (b)(2)(B) with respect
to a proposal for designation of a site as a location of a center under
this section is a finding by the Secretary, upon the recommendation of
the Under Secretary for Health, that the facilities submitting the
proposal have developed (or may reasonably be anticipated to develop)
each of the following:
``(1) An arrangement with an accredited medical school that
provides education and training in psychiatry and with which one
or more of the participating Department facilities is affiliated
under which medical residents receive education and training in
psychiatry through regular rotation through the participating
Department facilities so as to provide such residents with
training in the diagnosis and treatment of mental illness.
``(2) An arrangement with an accredited graduate program of
psychology under which students receive education and training
in clinical, counseling, or professional psychology through
regular rotation through the participating Department facilities
so as to provide such students with training in the diagnosis
and treatment of mental illness.
``(3) An arrangement under which nursing, social work,
counseling, or allied health personnel receive training and
education in mental health care through regular rotation through
the participating Department facilities.
``(4) The ability to attract scientists who have
demonstrated achievement in research--
``(A) into the evaluation of innovative approaches
to the design of mental health services; or
``(B) into the causes, prevention, and treatment of
mental illness.
``(5) The capability to evaluate effectively the activities
of the center, including activities relating to the evaluation
of specific efforts to improve the quality and effectiveness of
mental health services provided by the Department at or through
individual facilities.
``(e)(1) In order to provide advice to assist the Secretary and the
Under Secretary for Health to carry out their responsibilities under
this section, the official within the central office of the
Veterans Health Administration responsible for mental health and
behavioral sciences matters shall establish a peer review panel to
assess the scientific and clinical merit of proposals that are submitted
to the Secretary for the designation of centers under this section.
``(2) The panel shall consist of experts in the fields of mental
health research, education and training, and clinical care. Members of
the panel shall serve as consultants to the Department.
``(3) The panel shall review each proposal submitted to the panel by
the official referred to in paragraph (1) and shall submit to that
official its views on the relative scientific and clinical merit of each
such proposal. The panel shall specifically determine with respect to
each such proposal whether that proposal is among those proposals which
have met the highest competitive standards of scientific and clinical
merit.
``(4) The panel shall not be subject to the Federal Advisory
Committee Act (5 U.S.C. App.).
``(f) Clinical and scientific investigation activities at each
center established under this section--
[[Page 110 STAT. 3203]]
``(1) may compete for the award of funding from amounts
appropriated for the Department of Veterans Affairs medical and
prosthetics research account; and
``(2) shall receive priority in the award of funding from
such account insofar as funds are awarded to projects and
activities relating to mental illness.
``(g) The Under Secretary for Health shall ensure that at least
three centers designated under this section emphasize research into
means of improving the quality of care for veterans suffering from
mental illness through the development of community-based alternatives
to institutional treatment for such illness.
``(h) The Under Secretary for Health shall ensure that information
produced by the research, education and training, and clinical
activities of centers established under this section that may be useful
for other activities of the Veterans Health Administration is
disseminated throughout the Veterans Health Administration. Such
dissemination shall be made through publications, through programs of
continuing medical and related education provided through regional
medical education centers under subchapter VI of chapter 74 of this
title, and through other means. Such programs of continuing medical
education shall receive priority in the award of funding.
``(i) The official within the central office of the Veterans Health
Administration responsible for mental health and behavioral sciences
matters shall be responsible for supervising the operation of the
centers established pursuant to this section and shall provide for
ongoing evaluation of the centers and their compliance with the
requirements of this section.
``(j)(1) <<NOTE: Appropriation authorization.>> There are authorized
to be appropriated to the Department of Veterans Affairs for the basic
support of the research and education and training activities of centers
established pursuant to this section amounts as follows:
``(A) $3,125,000 for fiscal year 1998.
``(B) $6,250,000 for each of fiscal years 1999 through 2001.
``(2) In addition to funds appropriated for a fiscal year pursuant
to the authorization of appropriations in paragraph (1), the Under
Secretary for Health shall allocate to such centers from other funds
appropriated for that fiscal year generally for the Department of
Veterans Affairs medical care account and the Department of Veterans
Affairs medical and prosthetics research account such amounts as the
Under Secretary for Health determines appropriate to carry out the
purposes of this section.''.
(2) The table of sections at the beginning of chapter 73 is amended
by inserting after the item relating to section 7319, as added by
section 321(a)(2), the following new item:
``7320. Centers for mental illness research, education, and clinical
activities.''.
(b) Annual <<NOTE: 38 USC 7320 note.>> Reports.--Not later than
February 1 of each of 1999, 2000, 2001, and 2002, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans' Affairs of
the Senate and House of Representatives a report on the status and
activities during the previous fiscal year of the centers for mental
illness research, education, and clinical activities established
pursuant to section 7320 of title 38, United States Code (as added by
subsection (a)). Each such report shall include the following:
(1) A description of the activities carried out at each
center and the funding provided for such activities.
[[Page 110 STAT. 3204]]
(2) A description of the advances made at each of the
participating facilities of the center in research, education
and training, and clinical activities relating to mental illness
in veterans.
(3) A description of the actions taken by the Under
Secretary for Health pursuant to subsection (h) of that section
(as so added) to disseminate information derived from such
activities throughout the Veterans Health Administration.
(4) The Secretary's evaluations of the effectiveness of the
centers in fulfilling the purposes of the centers.
(c) Implementation.--The <<NOTE: 38 USC 7320 note.>> Secretary of
Veterans Affairs shall designate at least one center under section 7320
of title 38, United States Code, not later than January 1, 1998.
SEC. 335. COMMITTEE ON CARE OF SEVERELY CHRONICALLY
MENTALLY ILL VETERANS.
(a) Establishment.--Subchapter II of chapter 73 is amended by adding
after section 7320, as added by section 334(a)(1), the following new
section:
``Sec. 7321. Committee on Care of Severely Chronically Mentally Ill
Veterans
``(a) The Secretary, acting through the Under Secretary for Health,
shall establish in the Veterans Health Administration a Committee on
Care of Severely Chronically Mentally Ill Veterans. The Under Secretary
shall appoint employees of the Department with expertise in the care of
the chronically mentally ill to serve on the committee.
``(b) The committee shall assess, and carry out a continuing
assessment of, the capability of the Veterans Health Administration to
meet effectively the treatment and rehabilitation needs of mentally ill
veterans whose mental illness is severe and chronic and who are eligible
for health care furnished by the Department, including the needs of such
veterans who are women. In carrying out that responsibility, the
committee shall--
``(1) evaluate the care provided to such veterans through
the Veterans Health Administration;
``(2) identify systemwide problems in caring for such
veterans in facilities of the Veterans Health Administration;
``(3) identify specific facilities within the Veterans
Health Administration at which program enrichment is needed to
improve treatment and rehabilitation of such veterans; and
``(4) identify model programs which the committee considers
to have been successful in the treatment and rehabilitation of
such veterans and which should be implemented more widely in or
through facilities of the Veterans Health Administration.
``(c) The committee shall--
``(1) advise the Under Secretary regarding the development
of policies for the care and rehabilitation of severely
chronically mentally ill veterans; and
``(2) make recommendations to the Under Secretary--
``(A) for improving programs of care of such
veterans at specific facilities and throughout the
Veterans Health Administration;
``(B) for establishing special programs of education
and training relevant to the care of such veterans for
employees of the Veterans Health Administration;
[[Page 110 STAT. 3205]]
``(C) regarding research needs and priorities
relevant to the care of such veterans; and
``(D) regarding the appropriate allocation of
resources for all such activities.
``(d)(1) Not later than April 1, 1997, the Secretary shall submit to
the Committees on Veterans' Affairs of the Senate and House of
Representatives a report on the implementation of this section. The
report shall include the following:
``(A) A list of the members of the committee.
``(B) The assessment of the Under Secretary for Health,
after review of the initial findings of the committee, regarding
the capability of the Veterans Health Administration, on a
systemwide and facility-by-facility basis, to meet effectively
the treatment and rehabilitation needs of severely chronically
mentally ill veterans who are eligible for Department care.
``(C) The plans of the committee for further assessments.
``(D) The findings and recommendations made by the committee
to the Under Secretary for Health and the views of the Under
Secretary on such findings and recommendations.
``(E) A description of the steps taken, plans made (and a
timetable for their execution), and resources to be applied
toward improving the capability of the Veterans Health
Administration to meet effectively the treatment and
rehabilitation needs of severely chronically mentally ill
veterans who are eligible for Department care.
``(2) <<NOTE: Reports.>> Not later than February 1, 1998, and
February 1 of each of the three following years, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and House of
Representatives a report containing information updating the reports
submitted under this subsection before the submission of such report.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 73 is amended by inserting after the item relating to section
7320, as added by section 334(a)(2), the following new item:
``7321. Committee on Care of Severely Chronically Mentally Ill
Veterans.''.
Subtitle D--Other Provisions
SEC. 341. <<NOTE: 38 USC 1710 note.>> HOSPICE CARE STUDY.
(a) Study Required.--The Secretary of Veterans Affairs shall conduct
a research study to determine the desirability of the Secretary
furnishing hospice care to terminally ill veterans and to evaluate the
most cost-effective and efficient way to do so. The Secretary shall
carry out the study using resources and personnel of the Department.
(b) Conduct of Study.--In carrying out the study required by
subsection (a), the Secretary shall--
(1) evaluate the programs, and the program models, through
which the Secretary furnishes hospice care services within or
through facilities of the Department of Veterans Affairs and the
programs and program models through which non-Department
facilities provide such services;
(2) assess the satisfaction of patients, and family members
of patients, in each of the program models covered by paragraph
(1);
[[Page 110 STAT. 3206]]
(3) compare the costs (or range of costs) of providing care
through each of the program models covered by paragraph (1); and
(4) identify any barriers to providing, procuring, or
coordinating hospice services through any of the program models
covered by paragraph (1).
(c) Program Models.--For purposes of subsection (b)(1), the
Secretary shall evaluate a variety of types of models for delivery of
hospice care, including the following:
(1) Direct furnishing of full hospice care by the Secretary.
(2) Direct furnishing of some hospice services by the
Secretary.
(3) Contracting by the Secretary for the furnishing of
hospice care, with a commitment that the Secretary will provide
any further required hospital care for the patient.
(4) Contracting for all required care to be furnished
outside the Department.
(5) Referral of the patient for hospice care without a
contract.
(d) Report.--Not later than April 1, 1998, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and House of
Representatives a report on the research study. The report shall set
forth the Secretary's findings and recommendations. The Secretary shall
include in the report information on the extent to which the Secretary
advises veterans concerning their eligibility for hospice care and
information on the number of veterans (as of the time of the report) who
are in each model of hospice care described in subsection (c) and the
average cost per patient of hospice care for each such model.
SEC. 342. PAYMENT TO STATES OF PER DIEM FOR VETERANS
RECEIVING ADULT DAY HEALTH CARE.
(a) Payment of Per Diem for Veterans Receiving Adult Day Care.--
Section 1741 is amended--
(1) by inserting ``(1)'' after ``(a)'';
(2) by redesignating paragraphs (1) and (2) as subparagraphs
(A) and (B), respectively; and
(3) by adding at the end the following new paragraph (2):
``(2) The Secretary may pay each State per diem at a rate determined
by the Secretary for each veteran receiving adult day health care in a
State home, if such veteran is eligible for such care under laws
administered by the Secretary.''.
(b) Assistance to States for Construction of Adult Day Care
Facilities.--(1) Section 8131(3) is amended by inserting ``adult day
health,'' before ``or hospital care''.
(2) Section 8132 is amended by inserting ``adult day health,''
before ``or hospital care''.
(3) Section 8135(b) is amended--
(A) in paragraph (2)(C), by inserting ``or adult day health
care facilities'' after ``domiciliary beds''; and
(B) in paragraph (3)(A), by inserting ``or construction
(other than new construction) of adult day health care
buildings'' before the semicolon.
[[Page 110 STAT. 3207]]
SEC. 343. RESEARCH CORPORATIONS.
(a) Renewal of Authority.--Section 7368 is amended by striking out
``December 31, 1992'' and inserting in lieu thereof ``December 31,
2000''.
(b) Clarification of Tax-Exempt Status.--Sections 7361(b) and
7363(c) are amended by striking out ``section 501(c)(3) of''.
(c) Periodic Audits.--Subsection (b) of section 7366 is amended by
striking out ``The corporation'' in the second sentence and all that
follows through ``shall include that report'' and inserting in lieu
thereof the following: ``A corporation with revenues in excess of
$300,000 for any year shall obtain an audit of the corporation for that
year. A corporation with annual revenues between $10,000 and $300,000
shall obtain an independent audit of the corporation at least once every
three years. Any audit under the preceding sentences shall be performed
by an independent auditor. The corporation shall include the most recent
such audit''.
(d) Compliance With Conflict of Interest Laws and Regulations.--
Subsection (c)(2) of section 7366 is amended by striking out ``an annual
statement signed by the director or employee certifying that the
director or'' and inserting in lieu thereof ``a statement signed by the
executive director of the corporation certifying that each director
and''.
(e) Revised Reporting Requirement.--Subsection (d) of section 7366
is amended to read as follows:
``(d) The Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives an annual report on
the corporations established under this subchapter. The report shall set
forth the following information:
``(1) The location of each corporation.
``(2) The amount received by each corporation during the
previous year, including--
``(A) the total amount received;
``(B) the amount received from governmental
entities;
``(C) the amount received from all other sources;
and
``(D) if the amount received from a source referred
to in subparagraph (C) exceeded $25,000, information
that identifies the source.
``(3) The amount expended by each corporation during the
year, including--
``(A) the amount expended for salary for research
staff and for salary for support staff;
``(B) the amount expended for direct support of
research; and
``(C) if the amount expended with respect to any
payee exceeded $35,000, information that identifies the
payee.''.
SEC. 344. VETERANS HEALTH ADMINISTRATION HEADQUARTERS.
Section 7306 is amended by adding at the end the following new
subsection:
``(f) 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
[[Page 110 STAT. 3208]]
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. 345. DISBURSEMENT AGREEMENTS RELATING TO MEDICAL
RESIDENTS AND INTERNS.
Section 7406(c) is amended--
(1) by striking out ``Department hospital'' each place it
appears and inserting in lieu thereof ``Department facility
furnishing hospital care or medical services'';
(2) by striking out ``participating hospital'' in paragraph
(4)(C) and inserting in lieu thereof ``participating facility'';
and
(3) by striking out ``hospital'' both places it appears in
paragraph (5) and inserting in lieu thereof ``facility''.
SEC. 346. AUTHORITY TO SUSPEND SPECIAL PAY AGREEMENTS FOR PHYSICIANS AND
DENTISTS WHO ENTER RESIDENCY TRAINING PROGRAMS.
Section 7432(b)(2) is amended--
(1) by inserting ``(A)'' after ``(2)''; and
(2) by adding at the end the following:
``(B) The Secretary may suspend a special pay agreement entered into
under this section in the case of a physician or dentist who, having
entered into the special pay agreement, enters a residency training
program. Any such suspension shall terminate when the physician or
dentist completes, withdraws from, or is no longer a participant in the
program. During the period of such a suspension, the physician or
dentist is not subject to the provisions of paragraph (1).''.
SEC. 347. REMUNERATED OUTSIDE PROFESSIONAL ACTIVITIES BY
VETERANS HEALTH ADMINISTRATION PERSONNEL.
(a) Authority.--Subsection (b) of section 7423 is amended--
(1) by striking out paragraph (1); and
(2) by redesignating paragraphs (2) through (6) as
paragraphs (1) through (5), respectively.
(b) Conforming Amendment.--Subsection (c) of such section is amended
in the matter preceding paragraph (1) by striking out ``subsection
(b)(6)'' and inserting in lieu thereof ``subsection (b)(5)''.
SEC. 348. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY, MILWAUKEE
COUNTY, WISCONSIN.
(a) Modification of Reversionary Interest.--The Secretary of
Veterans Affairs is authorized to execute such instruments as may be
necessary to modify the conditions under which the land described in
subsection (b) will revert to the United States in order--
(1) to permit Milwaukee County, Wisconsin, to grant all or
part of such land to another party with a condition on such
grant that the grantee use such land only for civic and
recreational purposes; and
[[Page 110 STAT. 3209]]
(2) to provide that the conditions under which title to all
or any part of such land reverts to the United States are stated
so that any such reversion would occur at the option of the
United States.
(b) Description <<NOTE: Wisconsin.>> of Land.--The land covered by
this section is the tract of 28 acres of land, more or less, conveyed to
Milwaukee County, Wisconsin, pursuant to the Act entitled ``An Act
authorizing the Administrator of Veterans' Affairs to convey certain
property to Milwaukee County, Wisconsin'', approved August 27, 1954 (68
Stat. 866).
(c) General Authorities.--The Secretary may carry out this section
subject to such terms and conditions (including reservations of rights
for the United States) as the Secretary considers necessary to protect
the interests of the United States. In carrying out this section, the
Secretary may eliminate any existing covenant or restriction with
respect to the tract of land described in subsection (b) which the
Secretary determines to be no longer necessary to protect the interests
of the United States.
SEC. 349. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY, CHEYENNE,
WYOMING.
(a) Modification of Reversionary Interest.--The Secretary of
Veterans Affairs is authorized to execute such instruments as may be
necessary to modify the conditions under which the land described in
subsection (b) will revert to the United States in order to permit the
City of Cheyenne, Wyoming, to grant all or part of such land to the
First Cheyenne Federal Credit Union (formerly known as the Cheyenne VAF
Federal Credit Union) with a condition on such grant that the First
Cheyenne Federal Credit Union use such land only for the purpose of
constructing a building to house its operations.
(b) Description of Land.--The land covered by this section is the
tract of 27 acres of land, more or less, conveyed to the City of
Cheyenne, Wyoming, pursuant to the Act entitled ``An Act authorizing the
Administrator of Veterans' Affairs to convey certain property to the
City of Cheyenne, Wyoming'', approved November 8, 1965 (79 Stat. 1304).
(c) Terms of Reversionary Interest.--In carrying out this section,
the Secretary may cause the statement of the conditions under which
title to all or any part of the land described in subsection (b) reverts
to the United States to be revised so that any such reversion would
occur at the option of the United States.
(d) General Authorities.--The Secretary may carry out this section
subject to such terms and conditions (including reservations of rights
for the United States) as the Secretary considers necessary to protect
the interests of the United States. In carrying out this section, the
Secretary may eliminate any existing covenant or restriction with
respect to the tract of land described in subsection (b) which the
Secretary determines to be no longer necessary to protect the interests
of the United States.
SEC. 350. NAME OF DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER, JOHNSON
CITY, TENNESSEE.
(a) Name.--The Mountain Home Department of Veterans Affairs Medical
Center in Johnson City, Tennessee, shall after the date of the enactment
of this Act be known and designated as the ``James H. Quillen Department
of Veterans Affairs Medical Center''. Any reference to such medical
center in any law,
[[Page 110 STAT. 3210]]
regulation, map, document, record, or other paper of the United States
shall be considered to be a reference to the James H. Quillen Department
of Veterans Affairs Medical Center.
(b) Effective Date.--Subsection (a) shall take effect at noon on
January 3, 1997.
SEC. 351. REPORT ON HEALTH CARE NEEDS OF VETERANS IN EAST CENTRAL
FLORIDA.
(a) Report Required.--Not later than 60 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit to
the Committees on Veterans' Affairs of the Senate and House of
Representatives a report on the health care needs of veterans in east
central Florida. In preparing the report, the Secretary shall consider
the needs of such veterans for psychiatric and long-term care. The
Secretary shall include in the report the Secretary's views, based on
the Secretary's determination of such needs, as to the best means of
meeting such needs using the amounts appropriated pursuant to the
authorization of appropriations in this Act and Public Law 103-452 for
projects to meet the health care needs of such veterans. The Secretary
may, subject to the availability of appropriations for such purpose, use
an independent contractor to assist in the determination of such health
care needs.
(b) Limitation.--The Secretary may not obligate any funds, other
than for design work, for the conversion of the former Orlando Naval
Training Center Hospital in Orlando, Florida (now under the jurisdiction
of the Secretary of Veterans Affairs), to a nursing home care unit until
45 days after the date on which the report required by subsection (a) is
submitted.
SEC. 352. EVALUATION OF HEALTH STATUS OF SPOUSES AND
CHILDREN OF PERSIAN GULF WAR VETERANS.
(a) Extension of Authority.--Subsection (b) of section 107 of the
Persian Gulf War Veterans' Benefits Act (title I of Public Law 103-446;
108 Stat. 4652; 38 U.S.C. 1117 note) is amended by striking out
``September 30, 1996'' and inserting in lieu thereof ``December 31,
1998''.
[[Page 110 STAT. 3211]]
(b) Ratification <<NOTE: 38 USC 1117 note.>> of Actions.--Any
diagnostic testing and medical examinations undertaken by the Secretary
of Veterans Affairs for the purpose of the study required by subsection
(a) of such section during the period beginning on October 1, 1996, and
ending on the date of the enactment of this Act is hereby ratified.
Approved October 9, 1996.
LEGISLATIVE HISTORY--H.R. 3118 (S. 1359):
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HOUSE REPORTS: No. 104-690 (Comm. on Veterans' Affairs).
SENATE REPORTS: No. 104-372 accompanying S. 1359 (Comm. on Veterans'
Affairs).
CONGRESSIONAL RECORD, Vol. 142 (1996):
July 30, considered and passed House.
Sept. 28, considered and passed Senate, amended. House
concurred in Senate amendments.
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