Union Calendar No. 216

104TH CONGRESS

1ST SESSION H. R. 2814

[Report No. 104–443]

A BILL

To authorize major medical facility projects and

other purposes.of Veterans Affairs for fiscal year 1996, and formajor medical facility leases for the Department

DECEMBER 22, 1995

Committed to the Committee of the Whole House on the

State of the Union and ordered to be printed
IB

Union Calendar No. 216

104TH CONGRESS

1ST SESSION H. R. 2814

[Report No. 104–443]

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.

IN THE HOUSE OF REPRESENTATIVES

DECEMBER 20, 1995

Mr. STUMP (for himself, Mr. MONTGOMERY, Mr. HUTCHINSON, and Mr. EDWARDS) introduced the following bill; which was referred to the Committee on Veterans’ Affairs

DECEMBER 22, 1995

Committed to the Committee of the Whole House on the State of the Union

and ordered to be printed

A BILL

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.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 TITLE I—CONSTRUCTION

2 AUTHORIZATION

3 SEC. 101. AUTHORIZATION OF MAJOR MEDICAL FACILITY

4 PROJECTS.

5 (a) AUTHORIZED PROJECTS.—The Secretary of Vet6 erans Affairs may carry out the following major medical

7 facility projects, with each project to be carried out in the

8 amount specified for that project:

9 (1) Construction of an outpatient clinic in

10 Brevard County, Florida, in the amount of

11 $25,000,000.

12 (2) Construction of an outpatient clinic at

13 Travis Air Force Base in Fairfield, California, in the

14 amount of $25,000,000.

15 (3) Renovation of nursing home facilities at the

16 Department of Veterans Affairs medical center in

17 Lebanon, Pennsylvania, in the amount of

18 $9,000,000.

19 (4) Environmental improvements at the Depart20 ment of Veterans Affairs medical center in Marion,

21 Illinois, in the amount of $11,500,000.

22 (5) Replacement of psychiatric beds at the De23 partment of Veterans Affairs medical center in Mar24 ion, Indiana, in the amount of $17,300,000.
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1 (6) Renovation of psychiatric wards at the De2 partment of Veterans Affairs medical center in

3 Perry Point, Maryland, in the amount of

4 $15,100,000.

5 (7) Environmental enhancement at the Depart6 ment of Veterans Affairs medical center in Salis7 bury, North Carolina, in the amount of

8 $17,200,000.

9 (8) Construction of an ambulatory care addition

10 at the Department of Veterans Affairs medical cen11 ter in Asheville, North Carolina, in the amount of

12 $28,500,000.

13 (9) Construction of an ambulatory care addition

14 at the Department of Veterans Affairs medical cen15 ter in Temple, Texas, in the amount of $9,800,000.

16 (10) Construction of an ambulatory care addi17 tion at the Department of Veterans Affairs medical

18 center in Tucson, Arizona, in the amount of

19 $35,500,000.

20 (11) Seismic corrections at the Department of

21 Veterans Affairs medical center in Palo Alto, Cali22 fornia, in the amount of $36,800,000.

23 (12) Seismic corrections at the Department of

24 Veterans Affairs medical center in Long Beach,

25 California, in the amount of $20,200,000.
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1 (b) LIMITATION CONCERNING OUTPATIENT CLINIC

2 PROJECTS.—In the case of either of the projects for a new

3 outpatient clinic authorized in paragraphs (1) and (2) of

4 subsection (a)—

5 (1) the Secretary of Veterans Affairs may not

6 obligate any funds for that project until the Sec7 retary determines, and certifies to the Committees

8 on Veterans’ Affairs of the Senate and House of

9 Representatives, the amount required for the

10 project; and

11 (2) the amount obligated for the project may

12 not exceed the amount certified under paragraph (1)

13 with respect to that project.

14 SEC. 102. AUTHORIZATION OF MAJOR MEDICAL FACILITY

15 LEASES.

16 The Secretary of Veterans Affairs may enter into

17 leases for medical facilities as follows:

18 (1) Lease of a satellite outpatient clinic in Fort

19 Myers, Florida, in the amount of $1,736,000.

20 (2) Lease of a National Footwear Center in

21 New York, New York, in the amount of $1,054,000.

22 SEC. 103. AUTHORIZATION OF APPROPRIATIONS.

23 (a) IN GENERAL.—There are authorized to be appro24 priated to the Secretary of Veterans Affairs for fiscal year

25 1996—
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1 (1) for the Construction, Major Projects, ac2 count, $250,900,000 for the projects authorized in

3 section 101;

4 (2) for the Construction, Major Projects, ac5 count $28,000,000, for construction of an ambula6 tory care addition at the Department of Veterans

7 Affairs medical center in Boston, Massachusetts, as

8 authorized by section 201(b)(1)(A) of the Veterans

9 Health Programs Extension Act of 1994 (Public

10 Law 103–452; 108 Stat. 4787); and

11 (3) for the Medical Care account, $2,790,000

12 for the leases authorized in section 102.

13 (b) LIMITATION.—The projects authorized in section

14 101, and the project referred to in subsection (a)(2), may

15 only be carried out using—

16 (1) funds appropriated for fiscal year 1996 pur17 suant to the authorization of appropriations in sub18 section (a);

19 (2) funds appropriated for Construction, Major

20 Projects for a fiscal year before fiscal year 1996 that

21 remain available for obligation; and

22 (3) funds appropriated for Construction, Major

23 Projects for fiscal year 1996 for a category of activ24 ity not specific to a project.
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1 SEC. 104. REPORT ON HEALTH CARE NEEDS OF VETERANS

2 IN EAST CENTRAL FLORIDA.

3 (a) REPORT REQUIRED.—Not later than March 1,

4 1996, the Secretary of Veterans Affairs shall submit to

5 the Committees on Veterans’ Affairs of the Senate and

6 House of Representatives a report on the health care

7 needs of veterans in east central Florida. In preparing the

8 report, the Secretary shall consider the needs of such vet9 erans for psychiatric and long-term care. The Secretary

10 shall include in the report the Secretary’s views, based on

11 the Secretary’s determination of such needs, as to the best

12 means of meeting such needs using the amounts appro13 priated pursuant to the authorization of appropriations in

14 this Act and Public Law 103–452 for projects to meet

15 the health care needs of such veterans. The Secretary

16 may, subject to the availability of appropriations for such

17 purpose, use an independent contractor to assist in the

18 determination of such health care needs.

19 (b) LIMITATION.—The Secretary may not obligate

20 any funds, other than for design work, for the conversion

21 of the former Orlando Naval Training Center Hospital in

22 Orlando, Florida (now under the jurisdiction of the Sec23 retary of Veterans Affairs), to a nursing home care unit

24 until 15 days after the date on which the report required

25 by subsection (a) is submitted.
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1 TITLE II—STRATEGIC PLANNING

2 FOR HEALTH CARE RESOURCES

3 SEC. 201. STRATEGIC PLANNING.

4 Section 8107 of title 38, United States Code, is

5 amended—

6 (1) by redesignating subsection (b) as sub7 section (c);

8 (2) by striking out subsection (a) and inserting

9 in lieu thereof the following new subsections:

10 ‘‘(a) In order to promote effective planning for the

11 efficient provision of care to eligible veterans, the Sec12 retary, based on the analysis and recommendations of the

13 Under Secretary for Health, shall submit to each commit14 tee, not later than January 31 of each year, a report re15 garding long-range health planning of the Department.

16 ‘‘(b) Each report under subsection (a) shall include

17 the following:

18 ‘‘(1) A five-year strategic plan for the provision

19 of care under chapter 17 of this title to eligible vet20 erans through coordinated networks of medical fa21 cilities operating within prescribed geographic serv22 ice-delivery areas, such plan to include provision of

23 services for the specialized treatment and rehabilita24 tive needs of disabled veterans (including veterans

25 with spinal cord dysfunction, blindness, amputations,
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1 and mental illness) through distinct programs or fa2 cilities of the Department dedicated to the special3 ized needs of those veterans.

4 ‘‘(2) A description of how planning for the net5 works will be coordinated.

6 ‘‘(3) A profile regarding each such network of

7 medical facilities which identifies—

8 ‘‘(A) the mission of each existing or pro9 posed medical facility in the network;

10 ‘‘(B) any planned change in the mission

11 for any such facility and the rationale for such

12 planned change;

13 ‘‘(C) the population of veterans to be

14 served by the network and anticipated changes

15 over a five-year period and a ten-year period,

16 respectively, in that population and in the

17 health-care needs of that population;

18 ‘‘(D) information relevant to assessing

19 progress toward the goal of achieving relative

20 equivalency in the level of resources per patient

21 distributed to each network, such information

22 to include the plans for and progress toward

23 lowering the cost of care-delivery in the network

24 (by means such as changes in the mix in the
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1 network of physicians, nurses, physician assist2 ants, and advance practice nurses);

3 ‘‘(E) the capacity of non-Federal facilities

4 in the network to provide acute, long-term, and

5 specialized treatment and rehabilitative services

6 (described in section 7305 of this title), and de7 terminations regarding the extent to which

8 services to be provided in each service-delivery

9 area and each facility in such area should be

10 provided directly through facilities of the De11 partment or through contract or other arrange12 ments, including arrangements authorized

13 under sections 8111 and 8153 of this title; and

14 ‘‘(F) a five-year plan for construction, re15 placement, or alteration projects in support of

16 the approved mission of each facility in the net17 work and a description of how those projects

18 will improve access to care, or quality of care,

19 for patients served in the network.

20 ‘‘(4) A status report for each facility on

21 progress toward—

22 ‘‘(A) instituting planned mission changes

23 identified under paragraph (3)(B);

24 ‘‘(B) implementing principles of managed

25 care of eligible veterans; and
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1 ‘‘(C) developing and instituting cost-effec2 tive alternatives to provision of institutional

3 care.’’; and

4 (3) by adding at the end the following new sub5 section:

6 ‘‘(d)(1) The Secretary shall submit to each commit7 tee, not later than January 31 of each year, a report show8 ing the current priorities of the Department for proposed

9 major medical construction projects. Each such report

10 shall identify the 20 projects, from within all the projects

11 in the Department’s inventory of proposed projects, that

12 have the highest priority and, for those 20 projects, the

13 relative priority and rank scoring of each such project.

14 The 20 projects shall be compiled, and their relative

15 rankings shall be shown, by category of project (including

16 the categories of ambulatory care projects, nursing home

17 care projects, and such other categories as the Secretary

18 determines).

19 ‘‘(2) The Secretary shall include in each report, for

20 each project listed, a description of the specific factors

21 that account for the relative ranking of that project in re22 lation to other projects within the same category.

23 ‘‘(3) In a case in which the relative ranking of a pro24 posed project has changed since the last report under this

25 subsection was submitted, the Secretary shall also include
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1 in the report a description of the reasons for the change

2 in the ranking, including an explanation of any change in

3 the scoring of the project under the Department’s scoring

4 system for proposed major medical construction

5 projects.’’.

6 SEC. 202. REVISION TO PROSPECTUS REQUIREMENTS.

7 (a) ADDITIONAL INFORMATION.—Section 8104(b) of

8 title 38, United States Code, is amended—

9 (1) by striking out ‘‘shall include—’’ and insert10 ing in lieu thereof ‘‘shall include the following:’’;

11 (2) in paragraph (1)—

12 (A) by striking out ‘‘a detailed’’ and insert13 ing in lieu thereof ‘‘A detailed’’; and

14 (B) by striking out the semicolon at the

15 end and inserting in lieu thereof a period;

16 (3) in paragraph (2)—

17 (A) by striking out ‘‘an estimate’’ and in18 serting in lieu thereof ‘‘An estimate’’; and

19 (B) by striking out ‘‘; and’’ and inserting

20 in lieu thereof a period;

21 (4) in paragraph (3), by striking out ‘‘an esti22 mate’’ and inserting in lieu thereof ‘‘An estimate’’;

23 and

24 (5) by adding at the end the following new

25 paragraphs:
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1 ‘‘(4) Demographic data applicable to the

2 project, including information on projected changes

3 in the population of veterans to be served by the

4 project over a five-year period and a ten-year period.

5 ‘‘(5) Current and projected workload and utili6 zation data.

7 ‘‘(6) Current and projected operating costs of

8 the facility, to include both recurring and non-recur9 ring costs.

10 ‘‘(7) The priority score assigned to the project

11 under the Department’s prioritization methodology

12 and, if the project is being proposed for funding

13 ahead of a project with a higher score, a specific ex14 planation of the factors other than the priority that

15 were considered and the basis on which the project

16 is proposed for funding ahead of projects with high17 er priority scores.

18 ‘‘(8) A listing of each alternative to construc19 tion of the facility that has been considered.’’.

20 (b) APPLICABILITY.—The amendments made by sub21 section (a) shall apply with respect to any prospectus sub22 mitted by the Secretary of Veterans Affairs after the date

23 of the enactment of this Act.
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1 SEC. 203. CONSTRUCTION AUTHORIZATION REQUIRE2 MENTS.

3 (a) DEFINITION OF MAJOR MEDICAL FACILITY

4 PROJECT.—Paragraph (3)(A) of section 8104(a) of title

5 38, United States Code, is amended by inserting before

6 the period at the end the following: ‘‘, and, in the case

7 of a project which is principally for the alteration of a

8 medical facility to provide additional space for provision

9 of ambulatory care, such term means a project involving

10 a total expenditure of more than $5,000,000’’.

11 (b) APPLICABILITY OF CONSTRUCTION AUTHORIZA12 TION REQUIREMENT.—(1) Subsection (b) of section 301

13 of the Veterans’ Medical Programs Amendments of 1992

14 (Public Law 102–405; 106 Stat. 1984) is repealed.

15 (2) The amendments made by subsection (a) of such

16 section shall apply with respect to any major medical facil17 ity project or any major medical facility lease of the De18 partment of Veterans Affairs, regardless of when funds

19 are first appropriated for that project or lease, except that

20 in the case of a project for which funds were first appro21 priated before October 9, 1992, such amendments shall

22 not apply with respect to amounts appropriated for that

23 project for a fiscal year before fiscal year 1997.

24 (c) LIMITATION ON OBLIGATIONS FOR ADVANCE

25 PLANNING.—Section 8104 of title 38, United States Code,
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1 is amended by adding at the end the following new sub2 section:

3 ‘‘(f) The Secretary may not obligate funds in an

4 amount in excess of $500,000 from the Advance Planning

5 Fund of the Department toward design or development

6 of a major medical facility project until—

7 ‘‘(1) the Secretary submits to the committees a

8 report on the proposed obligation; and

9 ‘‘(2) a period of 30 days has passed after the

10 date on which the report is received by the commit11 tees.’’.

12 SEC. 204. TERMINOLOGY CHANGES.

13 (a) DEFINITION OF ‘‘CONSTRUCT’’.—Section

14 8101(2) of title 38, United States Code, is amended—

15 (1) by striking out ‘‘working drawings’’ and in16 serting in lieu thereof ‘‘construction documents’’;

17 and

18 (2) by striking out ‘‘preliminary plans’’ and in19 serting in lieu thereof ‘‘design development’’.

20 (b) PARKING FACILITIES.—Section 8109(h)(3)(B) of

21 such title is amended by striking out ‘‘working drawings’’

22 and inserting in lieu thereof ‘‘construction documents’’.
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1 SEC. 205. VETERANS HEALTH ADMINISTRATION HEAD2 QUARTERS.

3 (a) REPEAL OF STATUTORY SPECIFICATION OF OR4 GANIZATIONAL SERVICES.—The text of section 7305 of

5 title 38, United States Code, is amended to read as fol6 lows:

7 ‘‘(a) The Veterans Health Administration shall in8 clude the Office of the Under Secretary for Health and

9 such professional and auxiliary services as the Secretary

10 may find to be necessary to carry out the functions of the

11 Administration.

12 ‘‘(b) In organizing, and appointing persons to posi13 tions in, the Office, the Under Secretary shall ensure that

14 the Office is staffed so as to provide the Under Secretary

15 with appropriate expertise, including expertise in—

16 ‘‘(1) unique programs operated by the Adminis17 tration to provide for the specialized treatment and

18 rehabilitation of disabled veterans (including blind

19 rehabilitation, spinal cord dysfunction, mental ill20 ness, and geriatrics and long-term care); and

21 ‘‘(2) appropriate clinical care disciplines.’’.

22 (b) OFFICE OF THE UNDER SECRETARY.—Section

23 7306 of such title is amended—

24 (1) in subsection (a)—

25 (A) by striking out ‘‘and who shall be a

26 qualified doctor of medicine’’ in paragraph (2);
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1 (B) by striking out paragraphs (5), (6),

2 and (7); and

3 (C) by redesignating the succeeding two

4 paragraphs as paragraphs (5) and (6), respec5 tively; and

6 (2) in subsection (b)—

7 (A) by striking out ‘‘subsection (a)(3)’’

8 and all that follows through ‘‘two may be’’ and

9 inserting in lieu thereof ‘‘subsection (a)(3), not

10 more than two may be’’;

11 (B) by striking out the semicolon after

12 ‘‘dental medicines’’ and inserting in lieu thereof

13 a period; and

14 (C) by striking out paragraphs (2) and (3).

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