Persian Gulf War Veterans Health Care and Research Act of 1998

Summary: Persian Gulf War Veterans Health Care and Research Act of 1998 - Authorizes priority hospital care, medical services, and nursing home care for any illness for veterans who served on active duty:  (1) in a theater of combat operations during a period of war after the Vietnam era; or (2) in combat against a hostile force after the date of enactment of this Act.  Allows such priority notwithstanding that there is insufficient medical evidence to conclude that such condition is attributable to such service.  Extends through December 31, 2001, the authority for the provision of such services to other Persian Gulf War veterans.  Authorizes priority service for a period of five years after discharge or release. Requires a report from the Secretary of Veterans Affairs to the Congress on the experiences under the priority care. 
Elevates from level six to level four the priority assigned for purposes of enrollment for health care to veterans based on Persian Gulf War service, herbicide exposure during the Vietnam era, and exposure to ionizing radiation. 
Directs the Secretary to establish in the Veterans Health Administration (VHA) of the Department of Veterans Affairs a National Center for the Study of War-Related Illnesses to promote the clinical, research, and educational activities of the VHA with respect to war-related illnesses, including medically unexplained illnesses. 
Directs the Secretary to contract with the National Academy of Sciences (NAS) for the review of a methodology which could be used by the Department to determine the efficacy of treatments furnished to, and health outcomes of, Persian Gulf War veterans who have been treated for illnesses which may be associated with their service.  Requires an implementation report from the Secretary to the congressional veterans' committees. 
Authorizes the Secretaries of Veterans Affairs and Defense to contract with NAS to:  (1) develop a curriculum pertaining to the care and treatment of Persian Gulf War veterans who have ill-defined or undiagnosed illnesses for use in the continuing medical education of both general and specialty physicians providing care to such veterans; and (2) periodically review and provide recommendations regarding the research plans and strategies of the respective Departments relating to the health consequences of military service in the Persian Gulf theater of operations during the Persian Gulf War. 
Amends the Persian Gulf War Veterans' Health Status Act to direct Federal department or agency heads designated by the President to establish within their respective departments an advisory committee to advise on proposed research studies, plans, or strategies relating to the health consequences of military service in the Persian Gulf theater of operations.  Requires:  (1) related reports; and (2) the public availability of all research findings, including through the Internet World Wide Web. 
Designates the Department medical center in:  (1) Aspinwall, Pennsylvania, as the H. John Heinz III Department of Veterans Affairs Medical Center; and (2) Gainesville, Florida, as the Malcom Randall Department of Veterans Affairs Medical Center. 
Extends through April 1, 2001, reporting requirements of the Secretary concerning management of Department hospital care and medical services.  Requires the VHA's Under Secretary for Health to prescribe objective standards of job performance for Department employees having responsibility for allocating and managing Department hospital and medical resources. 
Extends through December 31, 2001, the authority to provide counseling and treatment to veterans to overcome sexual trauma. 
Authorizes the Secretary to carry out a major medical facility project for construction of a spinal cord injury center at the Department of Veterans Affairs Medical Center, Tampa, Florida, at a specified cost.  Authorizes appropriations for FY 1999 for such construction.  Allows the use of Construction, Major Projects, funding for fiscal years before 1999 for such project.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Persian Gulf War Veterans Health 
Care and Research Act of 1998''.

SEC. 2. HEALTH CARE FOR VETERANS OF WAR.

    (a) Authority To Provide Priority Care.--Section 1710(e) of title 
38, United States Code, is amended--
            (1) by adding at the end of paragraph (1) the following new 
        subparagraph:
    ``(D) Subject to paragraphs (2) and (3), a veteran who served on 
active duty in a theater of combat operations (as determined by the 
Secretary in consultation with the Secretary of Defense) during a 
period of war after the Vietnam era, or in combat against a hostile 
force during a period of hostilities (as defined in section 
1712A(a)(2)(B) of this title) after the date of the enactment of this 
subparagraph, is eligible for hospital care, medical services, and 
nursing home care under subsection (a)(2)(F) for any illness, 
notwithstanding that there is insufficient medical evidence to conclude 
that such condition is attributable to such service.'';
            (2) in paragraph (2)(B), by inserting ``or (1)(D)'' after 
        ``paragraph (1)(C)'';
            (3) in paragraph (3)--
                    (A) by striking out ``and'' at the end of 
                subparagraph (A);
                    (B) by striking out ``December 31, 1998.'' in 
                subparagraph (B) and inserting in lieu thereof 
                ``December 31, 2001; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(C) in the case of care for a veteran described in 
        paragraph (1)(D), after a period of five years beginning on the 
        date of the veteran's discharge or release from active 
        military, naval, or air service.''; and
            (4) by adding at the end the following new paragraph:
    ``(5) When the Secretary first provides care for veterans using the 
authority provided in paragraph (1)(D), the Secretary shall submit to 
Congress a report on the experience under that authority. The report 
shall cover the period of the first three years during which that 
authority is used and shall be submitted not later than nine months 
after the end of that three-year period. The Secretary shall include in 
the report any recommendations of the Secretary for extension of that 
authority.''.
    (b) Enrollment Priority.--Section 1705(a)(4) of such title is 
amended--
            (1) by striking out ``and'' after ``permanently 
        housebound'' and inserting in lieu thereof a comma; and
            (2) by inserting ``, and veterans described in subparagraph 
        (F) of section 1710(a)(2) of this title'' after ``disabled''.

 SEC. 3. NATIONAL CENTER FOR THE STUDY OF WAR-RELATED ILLNESSES.

    (a) In General.--(1) Chapter 73 of title 38, United States Code, is 
amended by inserting after section 7322 the following new section:
``Sec. 7323. National Center for the Study of War-Related Illnesses
    ``(a) Establishment.--The Secretary, acting through the Under 
Secretary for Health, shall establish and operate in the Veterans 
Health Administration a National Center for the Study of War-Related 
Illnesses (hereinafter in this section referred to as the `Center'). 
The Center shall, as appropriate, coordinate its activities with those 
of the National Center on Post-Traumatic-Stress Disorder established 
pursuant to section 110(c) of the Veterans' Health Care Act of 1984 
(Public Law 98-528).
    ``(b) Purposes.--The purposes of the Center shall be to promote 
improvement of clinical, research, and educational activities of the 
Veterans Health Administration with respect to war-related illnesses, 
including medically unexplained illnesses.
    ``(c) Functions.--In carrying out the purposes of the Center, the 
Under Secretary shall ensure that the Center--
            ``(1) promotes the training of health care and related 
        personnel in, and research into, the causes, mechanisms, and 
        treatment of war-related illnesses;
            ``(2) serves as a resource center for, and promotes and 
        seeks to coordinate the exchange of information regarding, 
        research and training activities carried out by the Department, 
        the Department of Defense, and other Federal and non-Federal 
        entities; and
            ``(3) coordinates with the Department of Defense and other 
        interested Federal departments and agencies in the conduct of 
        research, training, and treatment and the dissemination of 
        information pertaining to war-related illnesses.
    ``(d) Staff.--The Under Secretary shall ensure that the staff of 
the Center has an appropriate range and breadth of expertise so as to 
enable the Center to bring an interdisciplinary approach to the study 
and treatment of war-related illnesses.
    ``(e) Coordination Between Departments.--(1) In order to ensure 
needed coordination between the Department and the Department of 
Defense in carrying out the mission of the Center, the officials 
identified in subparagraphs (A) and (B) of section 8111(b)(2) of this 
title shall--
            ``(A) meet regularly to review pertinent policies, 
        procedures, and practices of their respective departments 
        relating to such coordination and to identify actions that 
        could be taken to change policies, procedures, and practices to 
        improve such coordination; and
            ``(B) take all appropriate steps to carry out those actions 
        identified under paragraph (1).
    ``(2) The Secretary and the Secretary of Defense shall submit to 
the appropriate committees of Congress an annual joint report, not 
later than April 1 each year, on the activities under paragraph (1) 
during the preceding year.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 7322 the 
following new item:

``7323. National Center for the Study of War-Related Illnesses.''.
    (b) Effective Date.--The National Center for the Study of War-
Related Illnesses required to be established by section 7323 of title 
38, United States Code, as added by subsection (a), shall be 
established not later than October 1, 1999.

SEC. 4. ASSESSMENT OF EFFECTIVENESS OF CARE OF PERSIAN GULF WAR 
              VETERANS.

    (a) Assessment by National Academy of Sciences.--Not later than 
November 1, 1998, the Secretary of Veterans Affairs shall enter into a 
contract with the National Academy of Sciences for the conduct of a 
review of a methodology which could be used by the Department of 
Veterans Affairs for determining the efficacy of treatments furnished 
to, and health outcomes (to include functional status) of, Persian Gulf 
War veterans who have been treated for illnesses which may be 
associated with their service in the Persian Gulf War.
    (b) Action on Report.--Not later than 180 days after receiving the 
final report of the National Academy of Sciences under subsection (a), 
the Secretary shall--
            (1) if scientifically feasible, develop an appropriate 
        mechanism to monitor and study the effectiveness of treatments 
        furnished to, and health outcomes of, Persian Gulf War veterans 
        who suffer from diagnosed and undiagnosed illnesses which may 
        be associated with their service in the Persian Gulf War; and
            (2) submit to the Committees on Veterans' Affairs of the 
        Senate and House of Representatives a report on the 
        implementation of this subsection.

SEC. 5. CONTRACT FOR INDEPENDENT RECOMMENDATIONS ON RESEARCH AND FOR 
              DEVELOPMENT OF CURRICULUM ON CARE OF PERSIAN GULF WAR 
              VETERANS.

    Section 706 of the Persian Gulf War Veterans' Health Status Act 
(title VII of Public Law 102-585; 38 U.S.C. 527 note) is amended by 
adding at the end thereof the following new subsection:
    ``(d) Research Review and Development of Medical Education 
Curriculum.--(1) In order to further understanding of the health 
consequences of military service in the Persian Gulf theater of 
operations and of new research findings with implications for improving 
the provision of care for veterans of such service, the Secretary of 
Veterans Affairs and the Secretary of Defense shall seek to enter into 
an agreement with the National Academy of Sciences under which the 
Institute of Medicine of the Academy would--
            ``(A) develop a curriculum pertaining to the care and 
        treatment of veterans of such service who have ill-defined or 
        undiagnosed illnesses for use in the continuing medical 
        education of both general and specialty physicians who provide 
        care for such veterans; and
            ``(B) periodically review and provide recommendations 
        regarding the research plans and research strategies of the 
        Departments relating to the health consequences of military 
        service in the Persian Gulf theater of operations during the 
        Persian Gulf War, including recommendations that the Academy 
        considers appropriate for additional scientific studies to 
        resolve areas of continuing scientific uncertainty relating to 
        the health consequences of any aspects of such military 
        service.
    ``(2) Not later than 6 months after the Institute of Medicine 
provides the Secretaries the curriculum developed under paragraph (1), 
the Secretaries shall provide for the conduct of continuing education 
programs using the curriculum developed under paragraph (1). Such 
programs shall include instruction which seeks to emphasize use of 
appropriate protocols of diagnosis, referral, and treatment of such 
veterans.''.

SEC. 6. REVISION TO PROCESS FOR DETERMINING PRIORITIES FOR HEALTH-
              RELATED RESEARCH ON THE PERSIAN GULF WAR.

    Section 707 of the Persian Gulf War Veterans' Health Status Act 
(title VII of Public Law 102-585; 38 U.S.C. 527 note) is amended by 
striking out subsection (b) and inserting in lieu thereof the 
following:
    ``(b) Public Advisory Committee.--Not later than January 1, 1999, 
the head of the department or agency designated under subsection (a) 
shall establish an advisory committee consisting of members of the 
general public, to include Persian Gulf War veterans and 
representatives of such veterans, to provide advice to the head of that 
department or agency on proposed research studies, research plans, or 
research strategies relating to the health consequences of military 
service in the Persian Gulf theater of operations during the Persian 
Gulf War. The department or agency head shall consult with such 
advisory committee on a regular basis.
    ``(c) Reports.--(1) Not later than March 1 of each year, the head 
of the department or agency designated under subsection (a) shall 
submit to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report on--
            ``(A) the status and results of all such research 
        activities undertaken by the executive branch during the 
        previous year;
            ``(B) research priorities identified during that year; and
            ``(C) recommendations of the public advisory committee 
        established under subsection (b) that were not adopted during 
        that year and the reasons for not adopting each such 
        recommendation.
    ``(2)(A) Not later than 120 days after submission of the 
epidemiological research study conducted by the Department of Veterans 
Affairs entitled `VA National Survey of Persian Gulf Veterans--Phase 
III', the head of the department or agency designated under subsection 
(a) shall submit to the congressional committees specified in paragraph 
(1) a report on the findings under that study.
    ``(B) With respect to any findings of that study which identify 
scientific evidence of a greater relative risk of illness or illnesses 
in family members of veterans who served in the Persian Gulf War 
theater of operations than in family members of veterans who did not so 
serve, the head of the department or agency designated under subsection 
(a) shall seek to ensure that appropriate research studies are designed 
to follow up on such findings.
    ``(d) Public Availability of Research Findings.--The head of the 
department or agency designated under subsection (a) shall ensure that 
the findings of all research conducted by or for the executive branch 
relating to the health consequences of military service in the Persian 
Gulf theater of operations during the Persian Gulf War (including 
information pertinent to improving provision of care for veterans of 
such service) are made available to the public through peer-reviewed 
medical journals, the Internet World Wide Web, and other appropriate 
media.''.

SEC. 7. DESIGNATION OF DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER IN 
              ASPINWALL, PENNSYLVANIA.

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

SEC. 8. DESIGNATION OF DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER IN 
              GAINESVILLE, FLORIDA.

    The Department of Veterans Affairs medical center in Gainesville, 
Florida, is hereby designated as the ``Malcom Randall Department of 
Veterans Affairs Medical Center''. Any reference to that medical center 
in any law, regulation, map, document, record, or other paper of the 
United States shall be considered to be a reference to the ``Malcom 
Randall Department of Veterans Affairs Medical Center''.

SEC. 9. MANAGEMENT OF SPECIALIZED TREATMENT AND REHABILITATIVE 
              PROGRAMS.

    (a) Standards of Job Performance.--Section 1706(b) of title 38, 
United States Code, is amended--
            (1) in paragraph (2), by striking out ``April 1, 1997, 
        April 1, 1998, and April 1, 1999'', and inserting in lieu 
        thereof ``April 1, 1999, April 1, 2000, and April 1, 2001''; 
        and
            (2) by adding at the end the following new paragraph:
    ``(3)(A) To ensure compliance with paragraph (1), the Under 
Secretary for Health shall prescribe objective standards of job 
performance for employees in positions described in subparagraph (B) 
with respect to the job performance of those employees in carrying out 
the requirements of paragraph (1). Those job performance standards 
shall include measures of workload, allocation of resources, and 
quality-of-care indicators.
    ``(B) Positions described in this subparagraph are positions in the 
Veterans Health Administration that have responsibility for allocating 
and managing resources applicable to the requirements of paragraph (1).
    ``(C) The Under Secretary shall develop the job performance 
standards under subparagraph (A) in consultation with the Advisory 
Committee on Prosthetics and Special Disabilities Programs and the 
Committee on Care of Severely Chronically Mentally Ill Veterans.''.
    (b) Effective Date.--The standards of job performance required by 
paragraph (3) of section 1706(b) of title 38, United States Code, as 
added by subsection (a), shall be prescribed not later than January 1, 
1999.

SEC. 10. EXTENSION OF AUTHORITY TO COUNSEL AND TREAT VETERANS FOR 
              SEXUAL TRAUMA.

    Section 1720D(a) of title 38, United States Code, is amended by 
striking out ``December 31, 1998'' in paragraphs (1) and (3) and 
inserting in lieu thereof ``December 31, 2001''.

SEC. 11. AUTHORIZATION OF CONSTRUCTION OF A SPINAL CORD INJURY CENTER 
              AT THE TAMPA, FLORIDA, VAMC.

    (a) Authorization.--The Secretary of Veterans Affairs may carry out 
a major medical facility project for construction of a spinal cord 
injury center at the Department of Veterans Affairs Medical Center, 
Tampa, Florida, in an amount not to exceed $46,300,000.
    (b) Funding.--There are authorized to be appropriated to the 
Secretary of Veterans Affairs for fiscal year 1999 for the 
Construction, Major Projects, account $20,000,000 to be available for 
the project authorized in subsection (a).
    (c) Source of Funds.--The project authorized in subsection (a) may 
be carried out using --
            (A) funds appropriated pursuant to the authorization of 
        appropriations in subsection (b);
            (B) funds appropriated for Construction, Major Projects, 
        for a fiscal year before fiscal year 1999 that remain available 
        for obligation; and
            (C) funds appropriated for Construction, Major Projects, 
        for a fiscal year before fiscal year 1999 for a category of 
        activity not specific to a project.

            Passed the House of Representatives August 3, 1998.

            Attest:

                                                ROBIN H. CARLE,

                                                                 Clerk.