I

104TH CONGRESS

1ST SESSION H. R. 2814

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

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,

3 TITLE I—CONSTRUCTION

4 AUTHORIZATION

5 SEC. 101. AUTHORIZATION OF MAJOR MEDICAL FACILITY

6 PROJECTS.

7 (a) AUTHORIZED PROJECTS.—The Secretary of Vet8 erans Affairs may carry out the following major medical
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1 facility projects, with each project to be carried out in the

2 amount specified for that project:

3 (1) Construction of an outpatient clinic in

4 Brevard County, Florida, in the amount of

5 $25,000,000.

6 (2) Construction of an outpatient clinic at

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

8 amount of $25,000,000.

9 (3) Renovation of nursing home facilities at the

10 Department of Veterans Affairs medical center in

11 Lebanon, Pennsylvania, in the amount of

12 $9,000,000.

13 (4) Environmental improvements at the Depart14 ment of Veterans Affairs medical center in Marion,

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

16 (5) Replacement of psychiatric beds at the De17 partment of Veterans Affairs medical center in Mar18 ion, Indiana, in the amount of $17,300,000.

19 (6) Renovation of psychiatric wards at the De20 partment of Veterans Affairs medical center in

21 Perry Point, Maryland, in the amount of

22 $15,100,000.

23 (7) Environmental enhancement at the Depart24 ment of Veterans Affairs medical center in Salis-
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1 bury, North Carolina, in the amount of

2 $17,200,000.

3 (8) Construction of an ambulatory care addition

4 at the Department of Veterans Affairs medical cen5 ter in Asheville, North Carolina, in the amount of

6 $28,500,000.

7 (9) Construction of an ambulatory care addition

8 at the Department of Veterans Affairs medical cen9 ter in Temple, Texas, in the amount of $9,800,000.

10 (10) Construction of an ambulatory care addi11 tion at the Department of Veterans Affairs medical

12 center in Tucson, Arizona, in the amount of

13 $35,500,000.

14 (11) Seismic corrections at the Department of

15 Veterans Affairs medical center in Palo Alto, Cali16 fornia, in the amount of $36,800,000.

17 (12) Seismic corrections at the Department of

18 Veterans Affairs medical center in Long Beach,

19 California, in the amount of $20,200,000.

20 (b) LIMITATION CONCERNING OUTPATIENT CLINIC

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

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

23 subsection (a)—

24 (1) the Secretary of Veterans Affairs may not

25 obligate any funds for that project until the Sec-
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1 retary determines, and certifies to the Committees

2 on Veterans’ Affairs of the Senate and House of

3 Representatives, the amount required for the

4 project; and

5 (2) the amount obligated for the project may

6 not exceed the amount certified under paragraph (1)

7 with respect to that project.

8 SEC. 102. AUTHORIZATION OF MAJOR MEDICAL FACILITY

9 LEASES.

10 The Secretary of Veterans Affairs may enter into

11 leases for medical facilities as follows:

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

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

14 (2) Lease of a National Footwear Center in

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

16 SEC. 103. AUTHORIZATION OF APPROPRIATIONS.

17 (a) IN GENERAL.—There are authorized to be appro18 priated to the Secretary of Veterans Affairs for fiscal year

19 1996—

20 (1) for the Construction, Major Projects, ac21 count, $250,900,000 for the projects authorized in

22 section 101;

23 (2) for the Construction, Major Projects, ac24 count $28,000,000, for construction of an ambula25 tory care addition at the Department of Veterans
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1 Affairs medical center in Boston, Massachusetts, as

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

3 Health Programs Extension Act of 1994 (Public

4 Law 103–452; 108 Stat. 4787); and

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

6 for the leases authorized in section 102.

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

8 101, and the project referred to in subsection (a)(2), may

9 only be carried out using—

10 (1) funds appropriated for fiscal year 1996 pur11 suant to the authorization of appropriations in sub12 section (a);

13 (2) funds appropriated for Construction, Major

14 Projects for a fiscal year before fiscal year 1996 that

15 remain available for obligation; and

16 (3) funds appropriated for Construction, Major

17 Projects for fiscal year 1996 for a category of activ18 ity not specific to a project.

19 SEC. 104. REPORT ON HEALTH CARE NEEDS OF VETERANS

20 IN EAST CENTRAL FLORIDA.

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

22 1996, the Secretary of Veterans Affairs shall submit to

23 the Committees on Veterans’ Affairs of the Senate and

24 House of Representatives a report on the health care

25 needs of veterans in east central Florida. In preparing the
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1 report, the Secretary shall consider the needs of such vet2 erans for psychiatric and long-term care. The Secretary

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

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

5 means of meeting such needs using the amounts appro6 priated pursuant to the authorization of appropriations in

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

8 the health care needs of such veterans. The Secretary

9 may, subject to the availability of appropriations for such

10 purpose, use an independent contractor to assist in the

11 determination of such health care needs.

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

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

14 of the former Orlando Naval Training Center Hospital in

15 Orlando, Florida (now under the jurisdiction of the Sec16 retary of Veterans Affairs), to a nursing home care unit

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

18 by subsection (a) is submitted.

19 TITLE II—STRATEGIC PLANNING

20 FOR HEALTH CARE RESOURCES

21 SEC. 201. STRATEGIC PLANNING.

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

23 amended—

24 (1) by redesignating subsection (b) as sub25 section (c);
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1 (2) by striking out subsection (a) and inserting

2 in lieu thereof the following new subsections:

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

4 efficient provision of care to eligible veterans, the Sec5 retary, based on the analysis and recommendations of the

6 Under Secretary for Health, shall submit to each commit7 tee, not later than January 31 of each year, a report re8 garding long-range health planning of the Department.

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

10 the following:

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

12 of care under chapter 17 of this title to eligible vet13 erans through coordinated networks of medical fa14 cilities operating within prescribed geographic serv15 ice-delivery areas, such plan to include provision of

16 services for the specialized treatment and rehabilita17 tive needs of disabled veterans (including veterans

18 with spinal cord dysfunction, blindness, amputations,

19 and mental illness) through distinct programs or fa20 cilities of the Department dedicated to the special21 ized needs of those veterans.

22 ‘‘(2) A description of how planning for the net23 works will be coordinated.

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

25 medical facilities which identifies—
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1 ‘‘(A) the mission of each existing or pro2 posed medical facility in the network;

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

4 for any such facility and the rationale for such

5 planned change;

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

7 served by the network and anticipated changes

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

9 respectively, in that population and in the

10 health-care needs of that population;

11 ‘‘(D) information relevant to assessing

12 progress toward the goal of achieving relative

13 equivalency in the level of resources per patient

14 distributed to each network, such information

15 to include the plans for and progress toward

16 lowering the cost of care-delivery in the network

17 (by means such as changes in the mix in the

18 network of physicians, nurses, physician assist19 ants, and advance practice nurses);

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

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

22 specialized treatment and rehabilitative services

23 (described in section 7305 of this title), and de24 terminations regarding the extent to which

25 services to be provided in each service-delivery
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1 area and each facility in such area should be

2 provided directly through facilities of the De3 partment or through contract or other arrange4 ments, including arrangements authorized

5 under sections 8111 and 8153 of this title; and

6 ‘‘(F) a five-year plan for construction, re7 placement, or alteration projects in support of

8 the approved mission of each facility in the net9 work and a description of how those projects

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

11 for patients served in the network.

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

13 progress toward—

14 ‘‘(A) instituting planned mission changes

15 identified under paragraph (3)(B);

16 ‘‘(B) implementing principles of managed

17 care of eligible veterans; and

18 ‘‘(C) developing and instituting cost-effec19 tive alternatives to provision of institutional

20 care.’’; and

21 (3) by adding at the end the following new sub22 section:

23 ‘‘(d)(1) The Secretary shall submit to each commit24 tee, not later than January 31 of each year, a report show25 ing the current priorities of the Department for proposed
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1 major medical construction projects. Each such report

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

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

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

5 relative priority and rank scoring of each such project.

6 The 20 projects shall be compiled, and their relative

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

8 the categories of ambulatory care projects, nursing home

9 care projects, and such other categories as the Secretary

10 determines).

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

12 each project listed, a description of the specific factors

13 that account for the relative ranking of that project in re14 lation to other projects within the same category.

15 ‘‘(3) In a case in which the relative ranking of a pro16 posed project has changed since the last report under this

17 subsection was submitted, the Secretary shall also include

18 in the report a description of the reasons for the change

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

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

21 system for proposed major medical construction

22 projects.’’.

23 SEC. 202. REVISION TO PROSPECTUS REQUIREMENTS.

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

25 title 38, United States Code, is amended—
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1 (1) by striking out ‘‘shall include—’’ and insert2 ing in lieu thereof ‘‘shall include the following:’’;

3 (2) in paragraph (1)—

4 (A) by striking out ‘‘a detailed’’ and insert5 ing in lieu thereof ‘‘A detailed’’; and

6 (B) by striking out the semicolon at the

7 end and inserting in lieu thereof a period;

8 (3) in paragraph (2)—

9 (A) by striking out ‘‘an estimate’’ and in10 serting in lieu thereof ‘‘An estimate’’; and

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

12 in lieu thereof a period;

13 (4) in paragraph (3), by striking out ‘‘an esti14 mate’’ and inserting in lieu thereof ‘‘An estimate’’;

15 and

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

17 paragraphs:

18 ‘‘(4) Demographic data applicable to the

19 project, including information on projected changes

20 in the population of veterans to be served by the

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

22 ‘‘(5) Current and projected workload and utili23 zation data.
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1 ‘‘(6) Current and projected operating costs of

2 the facility, to include both recurring and non-recur3 ring costs.

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

5 under the Department’s prioritization methodology

6 and, if the project is being proposed for funding

7 ahead of a project with a higher score, a specific ex8 planation of the factors other than the priority that

9 were considered and the basis on which the project

10 is proposed for funding ahead of projects with high11 er priority scores.

12 ‘‘(8) A listing of each alternative to construc13 tion of the facility that has been considered.’’.

14 (b) APPLICABILITY.—The amendments made by sub15 section (a) shall apply with respect to any prospectus sub16 mitted by the Secretary of Veterans Affairs after the date

17 of the enactment of this Act.

18 SEC. 203. CONSTRUCTION AUTHORIZATION REQUIRE19 MENTS.

20 (a) DEFINITION OF MAJOR MEDICAL FACILITY

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

22 38, United States Code, is amended by inserting before

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

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

25 medical facility to provide additional space for provision
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1 of ambulatory care, such term means a project involving

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

3 (b) APPLICABILITY OF CONSTRUCTION AUTHORIZA4 TION REQUIREMENT.—(1) Subsection (b) of section 301

5 of the Veterans’ Medical Programs Amendments of 1992

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

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

8 section shall apply with respect to any major medical facil9 ity project or any major medical facility lease of the De10 partment of Veterans Affairs, regardless of when funds

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

12 in the case of a project for which funds were first appro13 priated before October 9, 1992, such amendments shall

14 not apply with respect to amounts appropriated for that

15 project for a fiscal year before fiscal year 1997.

16 (c) LIMITATION ON OBLIGATIONS FOR ADVANCE

17 PLANNING.—Section 8104 of title 38, United States Code,

18 is amended by adding at the end the following new sub19 section:

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

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

22 Fund of the Department toward design or development

23 of a major medical facility project until—

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

25 report on the proposed obligation; and
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1 ‘‘(2) a period of 30 days has passed after the

2 date on which the report is received by the commit3 tees.’’.

4 SEC. 204. TERMINOLOGY CHANGES.

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

6 8101(2) of title 38, United States Code, is amended—

7 (1) by striking out ‘‘working drawings’’ and in8 serting in lieu thereof ‘‘construction documents’’;

9 and

10 (2) by striking out ‘‘preliminary plans’’ and in11 serting in lieu thereof ‘‘design development’’.

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

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

14 and inserting in lieu thereof ‘‘construction documents’’.

15 SEC. 205. VETERANS HEALTH ADMINISTRATION HEAD16 QUARTERS.

17 (a) REPEAL OF STATUTORY SPECIFICATION OF OR18 GANIZATIONAL SERVICES.—The text of section 7305 of

19 title 38, United States Code, is amended to read as fol20 lows:

21 ‘‘(a) The Veterans Health Administration shall in22 clude the Office of the Under Secretary for Health and

23 such professional and auxiliary services as the Secretary

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

25 Administration.
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1 ‘‘(b) In organizing, and appointing persons to posi2 tions in, the Office, the Under Secretary shall ensure that

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

4 with appropriate expertise, including expertise in—

5 ‘‘(1) unique programs operated by the Adminis6 tration to provide for the specialized treatment and

7 rehabilitation of disabled veterans (including blind

8 rehabilitation, spinal cord dysfunction, mental ill9 ness, and geriatrics and long-term care); and

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

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

12 7306 of such title is amended—

13 (1) in subsection (a)—

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

15 qualified doctor of medicine’’ in paragraph (2);

16 (B) by striking out paragraphs (5), (6),

17 and (7); and

18 (C) by redesignating the succeeding two

19 paragraphs as paragraphs (5) and (6), respec20 tively; and

21 (2) in subsection (b)—

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

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

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

25 more than two may be’’;
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1 (B) by striking out the semicolon after

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

3 a period; and

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

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