To authorize major medical facility projects and major medical facility leases for the Department of Veterans Affairs for fiscal year 1996, and for other purposes.

TITLE I--CONSTRUCTION AUTHORIZATION  

SEC. 101. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

    (a) Authorized Projects.--The Secretary of Veterans Affairs may 
carry out the following major medical facility projects, with each 
project to be carried out in the amount specified for that project:
            (1) Construction of an outpatient clinic in Brevard County, 
        Florida, in the amount of $25,000,000.
            (2) Construction of an outpatient clinic at Travis Air 
        Force Base in Fairfield, California, in the amount of 
        $25,000,000.
            (3) Renovation of nursing home facilities at the Department 
        of Veterans Affairs medical center in Lebanon, Pennsylvania, in 
        the amount of $9,000,000.
            (4) Environmental improvements at the Department of 
        Veterans Affairs medical center in Marion, Illinois, in the 
        amount of $11,500,000.
            (5) Replacement of psychiatric beds at the Department of 
        Veterans Affairs medical center in Marion, Indiana, in the 
        amount of $17,300,000.
            (6) Renovation of psychiatric wards at the Department of 
        Veterans Affairs medical center in Perry Point, Maryland, in 
        the amount of $15,100,000.
            (7) Environmental enhancement at the Department of Veterans 
        Affairs medical center in Salisbury, North Carolina, in the 
        amount of $17,200,000.
            (8) Construction of an ambulatory care addition at the 
        Department of Veterans Affairs medical center in Asheville, 
        North Carolina, in the amount of $28,500,000.
            (9) Construction of an ambulatory care addition at the 
        Department of Veterans Affairs medical center in Temple, Texas, 
        in the amount of $9,800,000.
            (10) Construction of an ambulatory care addition at the 
        Department of Veterans Affairs medical center in Tucson, 
        Arizona, in the amount of $35,500,000.
            (11) Seismic corrections at the Department of Veterans 
        Affairs medical center in Palo Alto, California, in the amount 
        of $36,800,000.
            (12) Seismic corrections at the Department of Veterans 
        Affairs medical center in Long Beach, California, in the amount 
        of $20,200,000.
    (b) Limitation Concerning Outpatient Clinic Projects.--In the case 
of either of the projects for a new outpatient clinic authorized in 
paragraphs (1) and (2) of subsection (a)--
            (1) the Secretary of Veterans Affairs may not obligate any 
        funds for that project until the Secretary determines, and 
        certifies to the Committees on Veterans' Affairs of the Senate 
        and House of Representatives, the amount required for the 
        project; and
            (2) the amount obligated for the project may not exceed the 
        amount certified under paragraph (1) with respect to that 
        project.

SEC. 102. 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 Fort Myers, 
        Florida, in the amount of $1,736,000.
            (2) Lease of a National Footwear Center in New York, New 
        York, in the amount of $1,054,000.

SEC. 103. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to the 
Secretary of Veterans Affairs for fiscal year 1996--
            (1) for the Construction, Major Projects, account, 
        $250,900,000 for the projects authorized in section 101;
            (2) for the Construction, Major Projects, account 
        $28,000,000, for construction of an ambulatory care addition at 
        the Department of Veterans Affairs medical center in Boston, 
Massachusetts, as authorized by section 201(b)(1)(A) of the Veterans 
Health Programs Extension Act of 1994 (Public Law 103-452; 108 Stat. 
4787); and
            (3) for the Medical Care account, $2,790,000 for the leases 
        authorized in section 102.
    (b) Limitation.--The projects authorized in section 101, and the 
project referred to in subsection (a)(2), may only be carried out 
using--
            (1) funds appropriated for fiscal year 1996 pursuant to the 
        authorization of appropriations in subsection (a);
            (2) funds appropriated for Construction, Major Projects for 
        a fiscal year before fiscal year 1996 that remain available for 
        obligation; and
            (3) funds appropriated for Construction, Major Projects for 
        fiscal year 1996 for a category of activity not specific to a 
        project.

SEC. 104. REPORT ON HEALTH CARE NEEDS OF VETERANS IN EAST CENTRAL 
              FLORIDA.

    (a) Report Required.--Not later than March 1, 1996, 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 15 days after the date on which the report required by 
subsection (a) is submitted.

         TITLE II--STRATEGIC PLANNING FOR HEALTH CARE RESOURCES

SEC. 201. STRATEGIC PLANNING.

    Section 8107 of title 38, United States Code, 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) 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, not later than January 31 of each year, a 
report regarding long-range health planning of the Department.
    ``(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--
                    ``(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) 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. 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. 202. REVISION TO PROSPECTUS REQUIREMENTS.

    (a) Additional Information.--Section 8104(b) of title 38, United 
States Code, is amended--
            (1) by striking out ``shall include--'' and inserting in 
        lieu thereof ``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 the project, including 
        information on projected changes in the population of veterans 
        to be served by the project over a five-year period and a ten-
        year period.
            ``(5) Current and projected workload and utilization data.
            ``(6) Current and projected operating costs of the 
        facility, to include both recurring and non-recurring costs.
            ``(7) The priority score assigned to the project under the 
        Department's prioritization methodology and, if the project is 
        being proposed for funding ahead of a project with a higher 
        score, a specific explanation of the factors other than the 
        priority that were considered and the basis on which the 
        project is proposed for funding ahead of projects with higher 
        priority scores.
            ``(8) A listing of each alternative to construction of the 
        facility that has been considered.''.
    (b) Applicability.--The 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. 203. CONSTRUCTION AUTHORIZATION REQUIREMENTS.

    (a) Definition of Major Medical Facility Project.--Paragraph (3)(A) 
of section 8104(a) of title 38, United States Code, is amended by 
inserting before the period at the end the following: ``, and, in the 
case of a project which is principally for the alteration of a medical 
facility to provide additional space for provision of ambulatory care, 
such term means a project involving a total expenditure of more than 
$5,000,000''.
    (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) 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 1997.
    (c) Limitation on Obligations for Advance Planning.--Section 8104 
of title 38, United States Code, 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 until--
            ``(1) 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. 204. TERMINOLOGY CHANGES.

    (a) Definition of ``Construct''.--Section 8101(2) of title 38, 
United States Code, 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) of such title is 
amended by striking out ``working drawings'' and inserting in lieu 
thereof ``construction documents''.

SEC. 205. VETERANS HEALTH ADMINISTRATION HEADQUARTERS.

    (a) Repeal of Statutory Specification of Organizational Services.--
The text of section 7305 of title 38, United States Code, is amended to 
read as follows:
    ``(a) The Veterans Health Administration shall include the Office 
of the Under Secretary for Health and such professional and auxiliary 
services as the Secretary may find to be necessary to carry out the 
functions of the Administration.
    ``(b) In organizing, and appointing persons to positions in, the 
Office, the Under Secretary shall ensure that the Office is staffed so 
as to provide the Under Secretary with appropriate expertise, including 
expertise in--
            ``(1) unique programs operated by the Administration to 
        provide for the specialized treatment and rehabilitation of 
        disabled veterans (including blind rehabilitation, spinal cord 
        dysfunction, mental illness, and geriatrics and long-term 
        care); and
            ``(2) appropriate clinical care disciplines.''.
    (b) Office of the Under Secretary.--Section 7306 of such title is 
amended--
            (1) in subsection (a)--
                    (A) by striking out ``and who shall be a qualified 
                doctor of medicine'' in paragraph (2);
                    (B) by striking out paragraphs (5), (6), and (7); 
                and
                    (C) by redesignating the succeeding two paragraphs 
                as paragraphs (5) and (6), respectively; and
            (2) in subsection (b)--
                    (A) by striking out ``subsection (a)(3)'' and all 
                that follows through ``two may be'' and inserting in 
                lieu thereof ``subsection (a)(3), not more than two may 
                be'';
                    (B) by striking out the semicolon after ``dental 
                medicines'' and inserting in lieu thereof a period; and
                    (C) by striking out paragraphs (2) and (3).
HR 2814----2

Summary: TABLE OF CONTENTS: Title I: Construction Authorization Title II: Strategic Planning for Health Care Resources Title I: Construction Authorization - Authorizes the Secretary of Veterans Affairs to carry out specified major medical facility projects, in specified amounts, in Florida, California, Pennsylvania, Illinois, Indiana, Maryland, North Carolina, Texas, and Arizona. Provides an obligation limitation with respect to two outpatient clinic projects. Authorizes the Secretary to enter into leases for two medical facilities in Florida and New York, in specified amounts. Authorizes appropriations to the Secretary for FY 1996 for two Construction, Major Projects, accounts and for the Medical Care account, in specified amounts, with a limitation. Directs the Secretary to report to the Senate and House Veterans' Affairs Committees on the health care needs of veterans in east central Florida. Prohibits the obligation of funds for the conversion of the former Orlando Naval Training Center Hospital in Orlando, Florida, until such report is submitted. Title II: Strategic Planning for Health Care Resources - Directs the Secretary, based on an analysis and recommendations of the Under Secretary for Health, to submit to the veterans' committees an annual report regarding long-range health planning of the Department of Veterans Affairs. Directs the Secretary to report annually to such committees showing the current Department priorities for proposed major medical construction projects. Specifies additional information required to be included in a prospectus submitted by the Secretary to the veterans' committees in connection with proposed medical facilities. States that the definition of major medical facility project shall include a project involving a total expenditure of more than $5 million in the case of a project which is principally for the alteration of a medical facility in order to provide additional space for the provision of ambulatory care. Repeals a provision of the Veterans' Medical Programs Amendments of 1992 which makes inapplicable to projects for which funds were appropriated prior to the enactment of such Act a prohibition on the appropriation, obligation, or expenditure of funds for any major medical facility project unless funds for such project have been specifically authorized by law. Prohibits the Secretary from obligating funds in excess of $500,000 from the Advance Planning Fund of the Department toward design or development of a major medical facility project until the Secretary submits a report to the veterans' committees on the proposed obligation and 30 days have passed since the receipt of such report. Requires the Veterans Health Administration (VHA) to include such professional and auxiliary services as the Secretary finds necessary to carry out VHA functions. Requires the Under Secretary for Health to ensure that his office is staffed so as to provide appropriate expertise. Amends Federal provisions concerning the Office of the Under Secretary to: (1) repeal the requirement that the Associate Deputy Under Secretary for Health be a qualified doctor of medicine. (2) no longer require such Office to include a Director of Nursing Service, Pharmacy Service, Dietetic Service, Podiatric Service, and Optometric Service. And (3) no longer require one Assistant Under Secretary for Health to be a qualified doctor of dental surgery or dental medicine and another to be a qualified physician trained in geriatrics.