H. R. 3118

One Hundred Fourth Congress

of the

United States of America

AT THE SECOND SESSION

Begun and held at the City of Washington on Wednesday,

the third day of January, one thousand nine hundred and ninety-six

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.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. 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.
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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;
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‘‘(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:

‘‘§ 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—
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(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—
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(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.
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‘‘(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 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 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:

‘‘§ 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:
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‘‘(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.

‘‘§ 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
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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) 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. 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,
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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.
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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.
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(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.
H. R. 3118—12

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) 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 longrange 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—
H. R. 3118—13

‘‘(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 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
H. R. 3118—14

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 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 REQUIRE- MENT.—(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 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) 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’’.
H. R. 3118—15

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 healthcare 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
H. R. 3118—16

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—
H. R. 3118—17

‘‘(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:

‘‘§ 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) 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. 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.
H. R. 3118—18

‘‘(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.’’.
H. R. 3118—19

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:

‘‘§ 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 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 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.
H. R. 3118—20

SEC. 322. 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 costeffective 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. 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.
H. R. 3118—21

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) 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.’’.
H. R. 3118—22

(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-
H. R. 3118—23

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:

‘‘§ 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) Not later than March 31 of each year, the Committee

shall submit to the Secretary a report on the programs and activities
H. R. 3118—24

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 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:

‘‘§ 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
H. R. 3118—25

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.
H. R. 3118—26

‘‘(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—
H. R. 3118—27

‘‘(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) 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 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.
H. R. 3118—28

(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 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:

‘‘§ 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;
H. R. 3118—29

‘‘(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) 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. 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);
H. R. 3118—30

(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.
H. R. 3118—31

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 REGU- LATIONS.—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
H. R. 3118—32

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
H. R. 3118—33

(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 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,
H. R. 3118—34

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’’.
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(b) RATIFICATION 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.

Speaker of the House of Representatives.

Vice President of the United States and

President of the Senate.