In the Senate of the United States,

September 28, 1996.

Resolved, That the bill from the House of Representatives (H.R. 3118) entitled ‘‘An Act to amend title 38, United

States Code, to reform eligibility for health care provided by

the Department of Veterans Affairs.’’, do pass with the following

AMENDMENTS:

Strike out all after the enacting clause and insert:

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

2 (a) SHORT TITLE.—This Act may be cited as the ‘‘Vet3 erans’ Health Care Eligibility Reform Act of 1996’’.

4 (b) TABLE OF CONTENTS.—The table of contents of this

5 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.
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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.

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.
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Sec. 352. Evaluation of health status of spouses and children of Persian Gulf War

veterans.

1 SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.

2 Except as otherwise expressly provided, whenever in

3 this Act an amendment or repeal is expressed in terms of

4 an amendment to or repeal of a section or other provision,

5 the reference shall be considered to be made to a section or

6 other provision of title 38, United States Code.

7 TITLE I—ELIGIBILITY REFORM

8 SEC. 101. ELIGIBILITY FOR HOSPITAL CARE AND MEDICAL

9 SERVICES.

10 (a) NEW CRITERIA FOR ELIGIBILITY FOR CARE.—Sec11 tion 1710(a) is amended to read as follows:

12 ‘‘(a)(1) The Secretary (subject to paragraph (4)) shall

13 furnish hospital care and medical services, and may furnish

14 nursing home care, which the Secretary determines to be

15 needed—

16 ‘‘(A) to any veteran for a service-connected dis17 ability; and

18 ‘‘(B) to any veteran who has a service-connected

19 disability rated at 50 percent or more.

20 ‘‘(2) The Secretary (subject to paragraph (4)) shall

21 furnish hospital care and medical services, and may furnish

22 nursing home care, which the Secretary determines to be

23 needed to any veteran—
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1 ‘‘(A) who has a compensable service-connected

2 disability rated less than 50 percent;

3 ‘‘(B) whose discharge or release from active mili4 tary, naval, or air service was for a compensable dis5 ability that was incurred or aggravated in the line of

6 duty;

7 ‘‘(C) who is in receipt of, or who, but for a sus8 pension pursuant to section 1151 of this title (or both

9 a suspension and the receipt of retired pay), would be

10 entitled to disability compensation, but only to the ex11 tent that such veteran’s continuing eligibility for such

12 care is provided for in the judgment or settlement

13 provided for in such section;

14 ‘‘(D) who is a former prisoner of war;

15 ‘‘(E) who is a veteran of the Mexican border pe16 riod or of World War I;

17 ‘‘(F) who was exposed to a toxic substance, radi18 ation, or environmental hazard, as provided in sub19 section (e); or

20 ‘‘(G) who is unable to defray the expenses of nec21 essary care as determined under section 1722(a) of

22 this title.

23 ‘‘(3) In the case of a veteran who is not described in

24 paragraphs (1) and (2), the Secretary may, to the extent

25 resources and facilities are available and subject to the pro-
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1 visions of subsections (f) and (g), furnish hospital care,

2 medical services, and nursing home care which the Sec3 retary determines to be needed.

4 ‘‘(4) The requirement in paragraphs (1) and (2) that

5 the Secretary furnish hospital care and medical services

6 shall be effective in any fiscal year only to the extent and

7 in the amount provided in advance in appropriations Acts

8 for such purposes.’’.

9 (b) TRANSFER OF PROVISION.—Chapter 17 is amend10 ed—

11 (1) by redesignating subsection (g) of section

12 1710 as subsection (h); and

13 (2) by transferring subsection (f) of section 1712

14 to section 1710 and inserting such subsection so as to

15 appear after subsection (f), redesignating such sub16 section as subsection (g), and amending such sub17 section by striking out ‘‘section 1710(a)(2) of this

18 title’’ in paragraph (1) and inserting in lieu thereof

19 ‘‘subsection (a)(3) of this section’’.

20 (c) REPEAL OF SEPARATE OUTPATIENT CARE PRIOR21 ITIES.—(1) Section 1712 is amended—

22 (A) by striking out subsections (a) and (i);

23 (B) by redesignating subsections (b), (c), (d), (h)

24 and (j), as subsections (a), (b), (c), (d), and (e), re25 spectively; and
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1 (C) in subsection (b), as so redesignated, by

2 striking out ‘‘subsection (b) of this section’’ and in3 serting in lieu thereof ‘‘subsection (a)’’.

4 (2)(A) The heading of such section is amended to read

5 as follows:

6 ‘‘§ 1712. Dental care; drugs and medicines for certain

7 disabled veterans; vaccines’’.

8 (B) The item relating to such section in the table of

9 sections at the beginning of chapter 17 is amended to read

10 as follows:

‘‘1712. Dental care; drugs and medicines for certain disabled veterans; vaccines.’’.

11 (d) CONFORMING AMENDMENTS TO CHAPTER 17.—

12 Chapter 17 is further amended as follows:

13 (1) Section 1701(6)(B)(i) is amended—

14 (A) in subclause (I), by striking out ‘‘sec15 tion 1712(a)’’ and inserting in lieu thereof

16 ‘‘paragraph (1) or (2) of section 1710(a)’’; and

17 (B) in subclause (II), by striking out ‘‘sec18 tion 1712(a)(5)(B)’’ and inserting in lieu thereof

19 ‘‘paragraph (1), (2) or (3) of section 1710(a)’’.

20 (2) Section 1710(c)(1) is amended by striking

21 out ‘‘section 1712(b)’’ and inserting in lieu thereof

22 ‘‘section 1712(a)’’.

23 (3) Section 1710(e)(1)(C) is amended by striking

24 out ‘‘hospital care and nursing home care under sub25 section (a)(1)(G) of this section’’ and inserting in lieu
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1 thereof ‘‘hospital care, medical services, and nursing

2 home care under subsection (a)(2)(F)’’.

3 (4) Section 1710(f) is amended—

4 (A) in paragraph (1), by striking out ‘‘sub5 section (a)(2)’’ and inserting in lieu thereof

6 ‘‘subsection (a)(3)’’; and

7 (B) in paragraph (3)(E)—

8 (i) by striking out ‘‘section 1712(a) of

9 this title’’ and inserting in lieu thereof

10 ‘‘paragraph (3) of subsection (a)’’; and

11 (ii) by striking out ‘‘section 1712(f) of

12 this title’’ and inserting in lieu thereof

13 ‘‘subsection (g)’’; and

14 (C) in paragraph (3)(F), by striking out

15 ‘‘section 1712(f) of this title’’ and inserting in

16 lieu thereof ‘‘subsection (g)’’.

17 (5) Section 1712A is amended—

18 (A) in subsection (b)(1), by striking out

19 ‘‘under the conditions specified in section

20 1712(a)(5)(B) of this title’’; and

21 (B) in subsection (e)(1), by striking out

22 ‘‘sections 1712(a)(1)(B) and 1703(a)(2)’’ and in23 serting in lieu thereof ‘‘sections 1703(a)(2) and

24 1710(a)(1)(B)’’.

25 (6) Section 1717(a) is amended—
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1 (A) in paragraph (1), by striking out ‘‘sec2 tion 1712(a)’’ and inserting in lieu thereof ‘‘sec3 tion 1710(a)’’; and

4 (B) in paragraph (2)—

5 (i) in subparagraph (A), by striking

6 out ‘‘paragraph (1) of section 1712(a) of

7 this title’’ and inserting in lieu thereof ‘‘sec8 tion 1710(a)(1) of this title, or for a disabil9 ity described in section 1710(a)(2)(C) of

10 this title’’; and

11 (ii) in subparagraph (B), by striking

12 out ‘‘section 1712’’ and inserting in lieu

13 thereof ‘‘section 1710(a)(2)’’.

14 (7) Section 1718(e) is amended by striking out

15 ‘‘section 1712(i)’’ and inserting in lieu thereof ‘‘sec16 tion 1705’’.

17 (8) Section 1720(f) is amended—

18 (A) in paragraph (1)(A)(ii), by striking out

19 ‘‘section 1712(a)(1)(B)’’ and inserting in lieu

20 thereof ‘‘paragraph (1), (2), or (3) of section

21 1710(a)’’; and

22 (B) by striking out paragraph (3).

23 (9) Section 1722 is amended—
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1 (A) in subsection (a), by striking out ‘‘sec2 tion 1710(a)(1)(I)’’ and inserting in lieu thereof

3 ‘‘section 1710(a)(2)(G)’’; and

4 (B) in subsection (f)(3), by striking out ‘‘or

5 1712(f)’’.

6 (10) Section 1729(g)(3)(A) is amended by strik7 ing out ‘‘under section 1710(f) of this title for hospital

8 care or nursing home care, under section 1712(f) of

9 this title for medical services,’’ and inserting in lieu

10 thereof ‘‘under subsection (f) or (g) of section 1710 of

11 this title for hospital care, medical services, or nurs12 ing home care’’.

13 (e) OTHER CONFORMING AND TECHNICAL AMEND14 MENTS.—

15 (1) Section 1525 is amended—

16 (A) in subsection (a), by striking out ‘‘sec17 tion 1712(h) of this title’’ and all that follows

18 through the period at the end and inserting in

19 lieu thereof ‘‘section 1712(d) of this title.’’; and

20 (B) in subsection (b), by striking out ‘‘re21 numeration’’ and inserting in lieu thereof ‘‘re22 muneration’’.

23 (2) Section 2104(b) is amended—
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1 (A) in the first sentence, by striking out

2 ‘‘section 1712(a)’’ and inserting in lieu thereof

3 ‘‘section 1717(a)(2)’’; and

4 (B) in the second sentence, by striking out

5 ‘‘section 1712(a)’’ and inserting in lieu thereof

6 ‘‘section 1717(a)(2)’’.

7 (3) Section 5317(c)(3) is amended by striking

8 out ‘‘sections 1710(a)(1)(I), 1710(a)(2), 1710(b), and

9 1712(a)(2)(B)’’ and inserting in lieu thereof ‘‘sub10 sections (a)(2)(G), (a)(3), and (b) of section 1710’’.

11 (4) Section 8110(a)(2) is amended by striking

12 out ‘‘section 1712’’ and inserting in lieu thereof ‘‘sec13 tion 1710(a)’’.

14 (5) Section 8111A(b)(2)(A) is amended by strik15 ing out ‘‘subsection (f) of section 1712’’ and inserting

16 in lieu thereof ‘‘subsection (a) of section 1710’’.

17 SEC. 102. REVISION IN AUTHORITIES FOR PROVISION OF

18 PRIORITY HEALTH CARE FOR CERTAIN VET19 ERANS EXPOSED TO SPECIFIED TOXIC SUB20 STANCES.

21 (a) AUTHORIZED INPATIENT CARE.—Section 1710(e)

22 is amended—

23 (1) in paragraph (1), by striking out subpara24 graphs (A) and (B) and inserting in lieu thereof the

25 following:
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1 ‘‘(A) A Vietnam-era herbicide-exposed veteran is eligi2 ble (subject to paragraph (2)) for hospital care, medical

3 services, and nursing home care under subsection (a)(2)(F)

4 for any disability, notwithstanding that there is insufficient

5 medical evidence to conclude that such disability may be

6 associated with such exposure.

7 ‘‘(B) A radiation-exposed veteran is eligible for hos8 pital care, medical services, and nursing home care under

9 subsection (a)(2)(F) for any disease suffered by the veteran

10 that is—

11 ‘‘(i) a disease listed in section 1112(c)(2) of this

12 title; or

13 ‘‘(ii) any other disease for which the Secretary,

14 based on the advice of the Advisory Committee on En15 vironmental Hazards, determines that there is credi16 ble evidence of a positive association between occur17 rence of the disease in humans and exposure to ioniz18 ing radiation.’’; and

19 (2) by striking out paragraphs (2) and (3) and

20 inserting in lieu thereof the following:

21 ‘‘(2)(A) In the case of a veteran described in paragraph

22 (1)(A), hospital care, medical services, and nursing home

23 care may not be provided under subsection (a)(2)(F) with

24 respect to—
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1 ‘‘(i) a disability that is found, in accordance

2 with guidelines issued by the Under Secretary for

3 Health, to have resulted from a cause other than an

4 exposure described in paragraph (4)(A)(ii); or

5 ‘‘(ii) a disease for which the National Academy

6 of Sciences, in a report issued in accordance with sec7 tion 2 of the Agent Orange Act of 1991, has deter8 mined that there is limited or suggestive evidence of

9 the lack of a positive association between occurrence

10 of the disease in humans and exposure to a herbicide

11 agent.

12 ‘‘(B) In the case of a veteran described in paragraph

13 (1)(C), hospital care, medical services, and nursing home

14 care may not be provided under subsection (a)(2)(F) with

15 respect to a disability that is found, in accordance with

16 guidelines issued by the Under Secretary for Health, to have

17 resulted from a cause other than an exposure described in

18 that paragraph.

19 ‘‘(3) Hospital care, medical services, and nursing home

20 care may not be provided under or by virtue of subsection

21 (a)(2)(F)—

22 ‘‘(A) in the case of care for a veteran described

23 in paragraph (1)(A), after December 31, 2002; and

24 ‘‘(B) in the case of care for a veteran described

25 in paragraph (1)(C), after December 31, 1998.
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1 ‘‘(4) For purposes of this subsection—

2 ‘‘(A) The term ‘Vietnam-era herbicide-exposed

3 veteran’ means a veteran (i) who served on active

4 duty in the Republic of Vietnam during the Vietnam

5 era, and (ii) who the Secretary finds may have been

6 exposed during such service to dioxin or was exposed

7 during such service to a toxic substance found in a

8 herbicide or defoliant used for military purposes dur9 ing such era.

10 ‘‘(B) The term ‘radiation-exposed veteran’ has

11 the meaning given that term in section 1112(c)(3) of

12 this title.’’.

13 (b) SAVINGS PROVISIONS.—The provisions of sections

14 1710(e) and 1712(a) of title 38, United States Code, as in

15 effect on the day before the date of the enactment of this

16 Act, shall continue to apply on and after such date with

17 respect to the furnishing of hospital care, nursing home

18 care, and medical services for any veteran who was fur19 nished such care or services before such date of enactment

20 on the basis of presumed exposure to a substance or radi21 ation under the authority of those provisions, but only for

22 treatment for a disability for which such care or services

23 were furnished before such date.
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1 SEC. 103. PROSTHETICS AND PREVENTIVE CARE.

2 (a) ELIGIBILITY.—Section 1701(6)(A)(i) is amend3 ed—

4 (1) by striking out ‘‘(in the case of a person oth5 erwise receiving care or services under this chapter)’’

6 and ‘‘(except under the conditions described in section

7 1712(a)(5)(A) of this title),’’;

8 (2) by inserting ‘‘(in the case of a person other9 wise receiving care or services under this chapter)’’

10 before ‘‘wheelchairs,’’; and

11 (3) by inserting ‘‘except that the Secretary may

12 not furnish sensori-neural aids other than in accord13 ance with guidelines which the Secretary shall pre14 scribe,’’ after ‘‘reasonable and necessary,’’.

15 (b) REGULATIONS.—Not later than 30 days after the

16 date of the enactment of this Act, the Secretary of Veterans

17 Affairs shall prescribe the guidelines required by the amend18 ments made by subsection (a) and shall furnish a copy of

19 those guidelines to the Committees on Veterans’ Affairs of

20 the Senate and House of Representatives.

21 SEC. 104. MANAGEMENT OF HEALTH CARE.

22 (a) IN GENERAL.—(1) Chapter 17 is amended by in23 serting after section 1704 the following new sections:
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1 ‘‘§ 1705. Management of health care: patient enroll2 ment system

3 ‘‘(a) In managing the provision of hospital care and

4 medical services under section 1710(a) of this title, the Sec5 retary, in accordance with regulations the Secretary shall

6 prescribe, shall establish and operate a system of annual

7 patient enrollment. The Secretary shall manage the enroll8 ment of veterans in accordance with the following priorities,

9 in the order listed:

10 ‘‘(1) Veterans with service-connected disabilities

11 rated 50 percent or greater.

12 ‘‘(2) Veterans with service-connected disabilities

13 rated 30 percent or 40 percent.

14 ‘‘(3) Veterans who are former prisoners of war,

15 veterans with service-connected disabilities rated 10

16 percent or 20 percent, and veterans described in sub17 paragraphs (B) and (C) of section 1710(a)(2) of this

18 title.

19 ‘‘(4) Veterans who are in receipt of increased

20 pension based on a need of regular aid and attend21 ance or by reason of being permanently housebound

22 and other veterans who are catastrophically disabled.

23 ‘‘(5) Veterans not covered by paragraphs (1)

24 through (4) who are unable to defray the expenses of

25 necessary care as determined under section 1722(a) of

26 this title.
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1 ‘‘(6) All other veterans eligible for hospital care,

2 medical services, and nursing home care under section

3 1710(a)(2) of this title.

4 (7) Veterans described in section 1710(a)(3) of

5 this title.

6 ‘‘(b) In the design of an enrollment system under sub7 section (a), the Secretary—

8 ‘‘(1) shall ensure that the system will be man9 aged in a manner to ensure that the provision of care

10 to enrollees is timely and acceptable in quality;

11 ‘‘(2) may establish additional priorities within

12 each priority group specified in subsection (a), as the

13 Secretary determines necessary; and

14 ‘‘(3) may provide for exceptions to the specified

15 priorities where dictated by compelling medical rea16 sons.

17 ‘‘(c)(1) Effective on October 1, 1998, the Secretary may

18 not provide hospital care or medical services to a veteran

19 under paragraph (2) or (3) of section 1710(a) of this title

20 unless the veteran enrolls in the system of patient enroll21 ment established by the Secretary under subsection (a).

22 ‘‘(2) The Secretary shall provide hospital care and

23 medical services under section 1710(a)(1) of this title, and

24 under subparagraph (B) of section 1710(a)(2) of this title,

25 for the 12-month period following such veteran’s discharge
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1 or release from service, to any veteran referred to in such

2 sections for a disability specified in the applicable subpara3 graph of such section, notwithstanding the failure of the vet4 eran to enroll in the system of patient enrollment referred

5 to in subsection (a) of this section.

6 ‘‘§ 1706. Management of health care: other require7 ments

8 ‘‘(a) In managing the provision of hospital care and

9 medical services under section 1710(a) of this title, the Sec10 retary shall, to the extent feasible, design, establish and

11 manage health care programs in such a manner as to pro12 mote cost-effective delivery of health care services in the

13 most clinically appropriate setting.

14 ‘‘(b)(1) In managing the provision of hospital care and

15 medical services under such section, the Secretary shall en16 sure that the Department maintains its capacity to provide

17 for the specialized treatment and rehabilitative needs of dis18 abled veterans (including veterans with spinal cord dys19 function, blindness, amputations, and mental illness) with20 in distinct programs or facilities of the Department that

21 are dedicated to the specialized needs of those veterans in

22 a manner that (A) affords those veterans reasonable access

23 to care and services for those specialized needs, and (B) en24 sures that overall capacity of the Department to provide

25 such services is not reduced below the capacity of the De-
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1 partment, nationwide, to provide those services, as of the

2 date of the enactment of this section. The Secretary shall

3 carry out this paragraph in consultation with the Advisory

4 Committee on Prosthetics and Special Disabilities Pro5 grams and the Committee on Care of Severely Chronically

6 Mentally Ill Veterans.

7 ‘‘(2) Not later than April 1, 1997, April 1, 1998, and

8 April 1, 1999, the Secretary shall submit to the Committees

9 on Veterans’ Affairs of the Senate and House of Representa10 tives a report on the Secretary’s compliance, by facility and

11 by service-network, with the requirements of this sub12 section.’’.

13 (2) The table of sections at the beginning of chapter

14 17 is amended by inserting after the item relating to section

15 1704 the following new items:

‘‘1705. Management of health care: patient enrollment system.

‘‘1706. Management of health care: other requirements.’’.

16 (b) CONFORMING AMENDMENTS TO SECTION 1703.—

17 Section 1703(a) is amended—

18 (1) in the matter preceding paragraph (1), by

19 striking out ‘‘or 1712’’;

20 (2) in paragraph (2)—

21 (A) by striking out ‘‘1712(a)(1)(B)’’ in sub22 paragraph (A) and inserting in lieu thereof

23 ‘‘1710(a)(1)(B)’’;
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1 (B) by striking out subparagraph (B) and

2 inserting in lieu thereof the following:

3 ‘‘(B) a veteran who (i) has been furnished

4 hospital care, nursing home care, domiciliary

5 care, or medical services, and (ii) requires medi6 cal services to complete treatment incident to

7 such care or services; or’’; and

8 (C) by striking ‘‘section 1712(a)(3) (other

9 than a veteran who is a former prisoner of war)

10 of this title’’ in subparagraph (C) and inserting

11 in lieu thereof ‘‘section 1710(a)(2)(E) of this

12 title, or a veteran who is in receipt of increased

13 pension, or additional compensation or allow14 ances based on the need of regular aid and at15 tendance or by reason of being permanently

16 housebound (or who, but for the receipt of retired

17 pay, would be in receipt of such pension, com18 pensation, or allowance),’’; and

19 (3) in paragraph (7), by striking out

20 ‘‘1712(b)(1)(F)’’ and inserting in lieu thereof

21 ‘‘1712(a)(1)(F)’’.

22 SEC. 105. AUTHORIZATION OF APPROPRIATIONS.

23 There is authorized to be appropriated for the Depart24 ment of Veterans Affairs for the Medical Care account, for

25 the purposes specified for that account in Public Law 103–
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1 327 (108 Stat. 2300), including the cost of providing hos2 pital care and medical services under the amendments made

3 by section this title, not to exceed $17,250,000,000 for fiscal

4 year 1997 and not to exceed $17,900,000,000 for fiscal year

5 1998.

6 SEC. 106. ASSESSMENT OF IMPLEMENTATION AND OPER7 ATION.

8 (a) ASSESSMENT SYSTEMS.—The Secretary of Veter9 ans Affairs shall establish information systems to assess the

10 experience of the Department of Veterans Affairs in imple11 menting sections 101, 103, and 104, including the amend12 ments made by those sections, during fiscal year 1997. The

13 Secretary shall establish those information systems in time

14 to include assessments under such systems in the report re15 quired under subsection (b).

16 (b) REPORT.—Not later than March 1, 1998, the Sec17 retary shall submit to the Committees on Veterans’ Affairs

18 of the Senate and House of Representatives a report reflect19 ing the experience of the Department during fiscal year

20 1997 on—

21 (1) the effect of implementation of, and provision

22 and management of care under, sections 101, 103,

23 and 104 (including the amendments made by those

24 sections) on demand for health care services from the

25 Department of Veterans Affairs by veterans described
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1 in paragraphs (1), (2), and (3) of section 1710(a) of

2 title 38, United States Code, as amended by section

3 101;

4 (2) any differing patterns of demand on the part

5 of such veterans relating to such factors as relative

6 distance from Department facilities and prior experi7 ence, or lack of experience, as recipients of care from

8 the Department;

9 (3) the extent to which the Department has met

10 such demand for care; and

11 (4) changes in health-care delivery patterns in

12 Department facilities and the fiscal impact of such

13 changes.

14 (c) MATTERS TO BE INCLUDED.—The report under

15 subsection (b) shall include detailed information with re16 spect to fiscal year 1997 regarding the following:

17 (1) The number of veterans enrolled for care at

18 each Department medical facility and, of such veter19 ans, the number enrolled at each such facility who

20 had not received care from the Department during the

21 preceding three fiscal years.

22 (2) With respect to the veterans who had not re23 ceived care from the Department during the three pre24 ceding fiscal years, the total cost of providing care to

25 such veterans, shown in total and separately (A) by
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1 level of care, and (B) by reference to whether care was

2 furnished in Department facilities or under contract

3 arrangements.

4 (3) With respect to the number of veterans de5 scribed in paragraphs (1), (2), and (3) of section

6 1710(a) of title 38, United States Code, as amended

7 by section 101, who applied for health care from the

8 Department during fiscal year 1997—

9 (A) the number who applied for care (shown

10 in total and separately by facility);

11 (B) the number who were denied enrollment

12 (shown in total and separately by facility); and

13 (C) the number who were denied care which

14 was considered to be medically necessary but not

15 of an emergency nature (shown in total and sep16 arately by facility).

17 (4) The numbers and characteristics of, and the

18 type and extent of health care furnished to, veterans

19 enrolled for care (shown in total and separately by fa20 cility).

21 (5) The numbers and characteristics of, and the

22 type and extent of health care furnished to, veterans

23 not enrolled for care (shown separately by reference to

24 each class of eligibility, both in total and separately

25 by facility).
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1 (6) The specific fiscal impact (shown in total

2 and by geographic health-care delivery areas) of

3 changes in delivery patterns instituted under the

4 amendments made by this title.

5 TITLE II—CONSTRUCTION

6 AUTHORIZATION

7 SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY

8 PROJECTS.

9 (a) AMBULATORY CARE ADDITION PROJECTS.—The

10 Secretary of Veterans Affairs may carry out the following

11 ambulatory care addition major medical facility projects,

12 with each project to be carried out in the amount specified

13 for that project:

14 (1) Construction of an ambulatory care facility

15 and renovation of ‘‘E’’ wing, Tripler Army Hospital,

16 Honolulu, Hawaii, $43,000,000.

17 (2) Addition of ambulatory care facilities at the

18 Department of Veterans Affairs medical center in

19 Brockton, Massachusetts, $13,500,000.

20 (3) Addition of ambulatory care facilities for

21 outpatient improvements at the Department of Veter22 ans Affairs medical center in Shreveport, Louisiana,

23 $25,000,000.
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1 (4) Addition of ambulatory care facilities at the

2 Department of Veterans Affairs medical center in

3 Lyons, New Jersey, $21,100,000.

4 (5) Addition of ambulatory care facilities at the

5 Department of Veterans Affairs medical center in

6 Tomah, Wisconsin, $12,700,000.

7 (6) Addition of ambulatory care facilities at the

8 Department of Veterans Affairs medical center in

9 Asheville, North Carolina, $26,300,000.

10 (7) Addition of ambulatory care facilities at the

11 Department of Veterans Affairs medical center in

12 Temple, Texas, $9,800,000.

13 (8) Addition of ambulatory care facilities at the

14 Department of Veterans Affairs medical center in

15 Tucson, Arizona, $35,500,000.

16 (9) Construction of an ambulatory care facility

17 at the Department of Veterans Affairs medical center

18 in Leavenworth, Kansas, $27,750,000.

19 (b) ENVIRONMENTAL IMPROVEMENT PROJECTS.—The

20 Secretary may carry out the following environmental im21 provement major medical facility projects, with each project

22 to be carried out in the amount specified for that project:

23 (1) Environmental improvements for the renova24 tion of nursing home facilities at the Department of
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1 Veterans Affairs medical center in Lebanon, Penn2 sylvania, $9,500,000.

3 (2) Environmental improvements at the Depart4 ment of Veterans Affairs medical center in Marion,

5 Illinois, $11,500,000.

6 (3) Environmental improvements for ward ren7 ovation for patient privacy at the Department of Vet8 erans Affairs medical center in Omaha, Nebraska,

9 $7,700,000.

10 (4) Environmental improvements at the Depart11 ment of Veterans Affairs medical center in Pittsburgh,

12 Pennsylvania, $17,400,000.

13 (5) Environmental improvements for the renova14 tion of various buildings at the Department of Veter15 ans Affairs medical center in Waco, Texas,

16 $26,000,000.

17 (6) Environmental improvements for the replace18 ment of psychiatric beds at the Department of Veter19 ans Affairs medical center in Marion, Indiana,

20 $17,300,000.

21 (7) Environmental improvements for the renova22 tion of psychiatric wards at the Department of Veter23 ans Affairs medical center in Perry Point, Maryland,

24 $15,100,000.
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1 (8) Environmental enhancement at the Depart2 ment of Veterans Affairs medical center in Salisbury,

3 North Carolina, $18,200,000.

4 (c) SEISMIC CORRECTION PROJECT.—The Secretary

5 may carry out seismic corrections to Building Number 324

6 at the Department of Veterans Affairs medical center in

7 Palo Alto, California, in the amount of $20,800,000.

8 (d) PROJECT AUTHORIZATION WHEN PARTIAL FUND9 ING PROVIDED.—If the amount of funds appropriated for

10 fiscal year 1997 or 1998 for design and partial construction

11 of a major medical facility project that is authorized in

12 this section is less than the amount required to complete

13 the construction of that project as authorized and if the Sec14 retary obligates funds for such construction, such project

15 shall be deemed to be fully authorized. Any such authoriza16 tion shall cease to have effect at the close of fiscal year 2001.

17 SEC. 202. AUTHORIZATION OF MAJOR MEDICAL FACILITY

18 LEASES.

19 The Secretary of Veterans Affairs may enter into leases

20 for medical facilities as follows:

21 (1) Lease of a satellite outpatient clinic in Allen22 town, Pennsylvania, in an amount not to exceed

23 $2,159,000.

24 (2) Lease of a satellite outpatient clinic in Beau25 mont, Texas, in an amount not to exceed $1,940,000.
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1 (3) Lease of a satellite outpatient clinic in Bos2 ton, Massachusetts, in an amount not to exceed

3 $2,358,000.

4 (4) Lease of a parking facility in Cleveland,

5 Ohio, in an amount not to exceed $1,300,000.

6 (5) Lease of a satellite outpatient clinic and Vet7 erans Benefits Administration field office in San An8 tonio, Texas, in an amount not to exceed $2,256,000.

9 (6) Lease of a satellite outpatient clinic in To10 ledo, Ohio, in an amount not to exceed $2,223,000.

11 SEC. 203. AUTHORIZATION OF APPROPRIATIONS.

12 (a) IN GENERAL.—There are authorized to be appro13 priated to the Secretary of Veterans Affairs for fiscal year

14 1997 and fiscal year 1998—

15 (1) for the Construction, Major Projects, account,

16 a total of $358,150,000 for the projects authorized in

17 section 201; and

18 (2) for the Medical Care account, a total of

19 $12,236,000 for the leases authorized in section 202.

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

21 201 may only be carried out using—

22 (1) funds appropriated for fiscal year 1997 or

23 fiscal year 1998 consistent with the authorization of

24 appropriations in subsection (a);
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1 (2) funds appropriated for Construction, Major

2 Projects for a fiscal year before fiscal year 1997 that

3 remain available for obligation; and

4 (3) funds appropriated for Construction, Major

5 Projects for fiscal year 1997 or fiscal year 1998 for

6 a category of activity not specific to a project.

7 SEC. 204. STRATEGIC PLANNING.

8 Section 8107 is amended—

9 (1) by redesignating subsection (b) as subsection

10 (c);

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

12 in lieu thereof the following new subsections:

13 ‘‘(a) In order to promote effective planning for the effi14 cient provision of care to eligible veterans, the Secretary,

15 based on the analysis and recommendations of the Under

16 Secretary for Health, shall submit to each committee an an17 nual report regarding long-range health planning of the De18 partment. The report shall be submitted each year not later

19 than the date on which the budget for the next fiscal year

20 is submitted to the Congress under section 1105 of title 31.

21 ‘‘(b) Each report under subsection (a) shall include the

22 following:

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

24 of care under chapter 17 of this title to eligible veter25 ans through coordinated networks of medical facilities
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1 operating within prescribed geographic service-deliv2 ery areas, such plan to include provision of services

3 for the specialized treatment and rehabilitative needs

4 of disabled veterans (including veterans with spinal

5 cord dysfunction, blindness, amputations, and mental

6 illness) through distinct programs or facilities of the

7 Department dedicated to the specialized needs of those

8 veterans.

9 ‘‘(2) A description of how planning for the net10 works will be coordinated.

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

12 medical facilities which identifies—

13 ‘‘(A) the mission of each existing or pro14 posed medical facility in the network;

15 ‘‘(B) any planned change in the mission for

16 any such facility and the rationale for such

17 planned change;

18 ‘‘(C) the population of veterans to be served

19 by the network and anticipated changes over a

20 five-year period and a ten-year period, respec21 tively, in that population and in the health-care

22 needs of that population;

23 ‘‘(D) information relevant to assessing

24 progress toward the goal of achieving relative

25 equivalency in the level of resources per patient
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1 distributed to each network, such information to

2 include the plans for and progress toward lower3 ing the cost of care-delivery in the network (by

4 means such as changes in the mix in the network

5 of physicians, nurses, physician assistants, and

6 advance practice nurses);

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

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

9 specialized treatment and rehabilitative services

10 (described in section 7305 of this title), and de11 terminations regarding the extent to which serv12 ices to be provided in each service-delivery area

13 and each facility in such area should be provided

14 directly through facilities of the Department or

15 through contract or other arrangements, includ16 ing arrangements authorized under sections 8111

17 and 8153 of this title; and

18 ‘‘(F) a five-year plan for construction, re19 placement, or alteration projects in support of

20 the approved mission of each facility in the net21 work and a description of how those projects will

22 improve access to care, or quality of care, for pa23 tients served in the network.

24 ‘‘(4) A status report for each facility on progress

25 toward—
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1 ‘‘(A) instituting planned mission changes

2 identified under paragraph (3)(B);

3 ‘‘(B) implementing principles of managed

4 care of eligible veterans; and

5 ‘‘(C) developing and instituting cost-effec6 tive alternatives to provision of institutional

7 care.’’; and

8 (3) by adding at the end the following new sub9 section:

10 ‘‘(d)(1) The Secretary shall submit to each committee,

11 not later than January 31 of each year, a report showing

12 the current priorities of the Department for proposed major

13 medical construction projects. Each such report shall iden14 tify the 20 projects, from within all the projects in the De15 partment’s inventory of proposed projects, that have the

16 highest priority and, for those 20 projects, the relative pri17 ority and rank scoring of each such project and the pro18 jected cost of such project (including the projected operating

19 costs, including both recurring and nonrecurring costs). The

20 20 projects shall be compiled, and their relative rankings

21 shall be shown, by category of project (including the cat22 egories of ambulatory care projects, nursing home care

23 projects, and such other categories as the Secretary deter24 mines).
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1 ‘‘(2) The Secretary shall include in each report, for

2 each project listed, a description of the specific factors that

3 account for the relative ranking of that project in relation

4 to other projects within the same category.

5 ‘‘(3) In a case in which the relative ranking of a pro6 posed project has changed since the last report under this

7 subsection was submitted, the Secretary shall also include

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

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

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

11 system for proposed major medical construction projects.’’.

12 SEC. 205. REVISION TO PROSPECTUS REQUIREMENTS.

13 (a) ADDITIONAL INFORMATION.—Section 8104(b) is

14 amended—

15 (1) by striking out the matter preceding para16 graph (1) and inserting in lieu thereof the following:

17 ‘‘(b) Whenever the President or the Secretary submit

18 to the Congress a request for the funding of a major medical

19 facility project (as defined in subsection (a)(3)(A)) or a

20 major medical facility lease (as defined in subsection

21 (a)(3)(B)), the Secretary shall submit to each committee,

22 on the same day, a prospectus of the proposed medical facil23 ity. Any such prospectus shall include the following:’’;

24 (2) in paragraph (1)—
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1 (A) by striking out ‘‘a detailed’’ and insert2 ing in lieu thereof ‘‘A detailed’’; and

3 (B) by striking out the semicolon at the end

4 and inserting in lieu thereof a period;

5 (3) in paragraph (2)—

6 (A) by striking out ‘‘an estimate’’ and in7 serting in lieu thereof ‘‘An estimate’’; and

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

9 in lieu thereof a period;

10 (4) in paragraph (3), by striking out ‘‘an esti11 mate’’ and inserting in lieu thereof ‘‘An estimate’’;

12 and

13 (5) by adding at the end the following new para14 graphs:

15 ‘‘(4) Demographic data applicable to such facil16 ity, including information on projected changes in the

17 population of veterans to be served by the facility over

18 a five-year period and a ten-year period.

19 ‘‘(5) Current and projected workload and utiliza20 tion data regarding the facility.

21 ‘‘(6) Current and projected operating costs of the

22 facility, including both recurring and non-recurring

23 costs.

24 ‘‘(7) The priority score assigned to the project or

25 lease under the Department’s prioritization methodol-
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1 ogy and, if the project or lease is being proposed for

2 funding before a project or lease with a higher score,

3 a specific explanation of the factors other than the

4 priority score that were considered and the basis on

5 which the project or lease is proposed for funding

6 ahead of projects or leases with higher priority scores.

7 ‘‘(8) In the case of a prospectus proposing the

8 construction of a new or replacement medical facility,

9 a description of each alternative to construction of the

10 facility that was considered.’’.

11 (b) APPLICABILITY.—The amendments made by sub12 section (a) shall apply with respect to any prospectus sub13 mitted by the Secretary of Veterans Affairs after the date

14 of the enactment of this Act.

15 SEC. 206. CONSTRUCTION AUTHORIZATION REQUIRE16 MENTS.

17 (a) DEFINITION OF MAJOR MEDICAL FACILITY

18 PROJECT.—Paragraph (3)(A) of section 8104(a) is amend19 ed by striking out ‘‘$3,000,000’’ and inserting in lieu there20 of ‘‘$4,000,000’’.

21 (b) APPLICABILITY OF CONSTRUCTION AUTHORIZA22 TION REQUIREMENT.—(1) Subsection (b) of section 301 of

23 the Veterans’ Medical Programs Amendments of 1992 (Pub24 lic Law 102–405; 106 Stat. 1984) is repealed.
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1 (2) The amendments made by subsection (a) of such

2 section shall apply with respect to any major medical facil3 ity project or any major medical facility lease of the De4 partment of Veterans Affairs, regardless of when funds are

5 first appropriated for that project or lease, except that in

6 the case of a project for which funds were first appropriated

7 before October 9, 1992, such amendments shall not apply

8 with respect to amounts appropriated for that project for

9 a fiscal year before fiscal year 1998.

10 (c) LIMITATION ON OBLIGATIONS FOR ADVANCE PLAN11 NING.—Section 8104 is amended by adding at the end the

12 following new subsection:

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

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

15 Fund of the Department toward design or development of

16 a major medical facility project (as defined in subsection

17 (a)(3)(A)) until—

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

19 report on the proposed obligation; and

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

21 date on which the report is received by the commit22 tees.’’.

23 SEC. 207. TERMINOLOGY CHANGES.

24 (a) DEFINITION OF ‘‘CONSTRUCT’’.—Section 8101(2)

25 is amended—
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1 (1) by striking out ‘‘working drawings’’ and in2 serting in lieu thereof ‘‘construction documents’’; and

3 (2) by striking out ‘‘preliminary plans’’ and in4 serting in lieu thereof ‘‘design development’’.

5 (b) PARKING FACILITIES.—Section 8109(h)(3)(B) is

6 amended by striking out ‘‘working drawings’’ and inserting

7 in lieu thereof ‘‘construction documents’’.

8 TITLE III—HEALTH CARE AND

9 ADMINISTRATION

10 Subtitle A—Health Care Sharing

11 and Administration

12 SEC. 301. REVISION OF AUTHORITY TO SHARE MEDICAL FA13 CILITIES, EQUIPMENT, AND INFORMATION.

14 (a) STATEMENT OF PURPOSE.—The text of section

15 8151 is amended to read as follows:

16 ‘‘It is the purpose of this subchapter to strengthen the

17 medical programs at Department facilities and improve the

18 quality of health care provided veterans under this title by

19 authorizing the Secretary to enter into agreements with

20 health-care providers in order to share health-care resources

21 with, and receive health-care resources from, such providers

22 while ensuring no diminution of services to veterans.’’.

23 (b) DEFINITIONS.—Section 8152 is amended—
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1 (1) by striking out paragraphs (1), (2), and (3)

2 and inserting in lieu thereof the following new para3 graphs (1) and (2):

4 ‘‘(1) The term ‘health-care resource’ includes hos5 pital care and medical services (as those terms are de6 fined in section 1701 of this title), any other health7 care service, and any health-care support or adminis8 trative resource.

9 ‘‘(2) The term ‘health-care providers’ includes

10 health-care plans and insurers and any organiza11 tions, institutions, or other entities or individuals

12 who furnish health-care resources.’’; and

13 (2) by redesignating paragraph (4) as para14 graph (3).

15 (c) AUTHORITY TO SECURE HEALTH-CARE RE16 SOURCES.—Section 8153 is amended as follows:

17 (1) Subsection (a) is amended—

18 (A) in paragraph (1)—

19 (i) by striking out ‘‘certain specialized

20 medical resources’’ and inserting in lieu

21 thereof ‘‘health-care resources’’;

22 (ii) by striking out ‘‘other medical re23 sources’’ and inserting in lieu thereof ‘‘other

24 health-care resources’’; and
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1 (iii) by striking out ‘‘of—’’ and all

2 that follows through ‘‘section 1742(a) of this

3 title’’ and inserting in lieu thereof ‘‘of

4 health-care resources between Department

5 health-care facilities and any health-care

6 provider, or other entity or individual’’;

7 (B) in paragraph (2), by striking out

8 ‘‘only’’ and all that follows through ‘‘are not’’

9 and inserting in lieu thereof ‘‘if such resources

10 are not, or would not be,’’; and

11 (C) by adding at the end the following:

12 ‘‘(3)(A) If the health-care resource required is a com13 mercial service, the use of medical equipment or space, or

14 research, and is to be acquired from an institution affiliated

15 with the Department in accordance with section 7302 of

16 this title, including medical practice groups and other enti17 ties associated with affiliated institutions, blood banks,

18 organ banks, or research centers, the Secretary may make

19 arrangements for acquisition of the resource without regard

20 to any law or regulation that would otherwise require the

21 use of competitive procedures for acquiring the resource.

22 ‘‘(B)(i) If the health-care resource required is a com23 mercial service or the use of medical equipment or space,

24 and is not to be acquired from an entity described in sub25 paragraph (A), any procurement of the resource may be
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1 conducted without regard to any law or regulation that

2 would otherwise require the use of competitive procedures

3 for procuring the resource, but only if the procurement is

4 conducted in accordance with the simplified procedures pre5 scribed pursuant to clause (ii).

6 ‘‘(ii) The Secretary, in consultation with the Adminis7 trator for Federal Procurement Policy, may prescribe sim8 plified procedures for the procurement of health-care re9 sources under this subparagraph. The Secretary shall pub10 lish such procedures for public comment in accordance with

11 section 22 of the Office of Federal Procurement Policy Act

12 (41 U.S.C. 418b). Such procedures shall permit all respon13 sible sources to submit a bid, proposal, or quotation (as ap14 propriate) for the resources to be procured and provide for

15 the consideration by the Department of bids, proposals, or

16 quotations so submitted.

17 ‘‘(iii) Pending publication of the procedures under

18 clause (ii), the Secretary shall (except as provided under

19 subparagraph (A)) procure health-care resources referred to

20 in clause (i) in accordance with all procurement laws and

21 regulations.

22 ‘‘(C) Any procurement of health-care resources other

23 than those covered by subparagraph (A) or (B) shall be con24 ducted in accordance with all procurement laws and regula25 tions.
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1 ‘‘(D) For any procurement to be conducted on a sole

2 source basis other than a procurement covered by subpara3 graph (A), a written justification shall be prepared that in4 cludes the information and is approved at the levels pre5 scribed in section 303(f) of the Federal Property and Ad6 ministrative Services Act of 1949 (41 U.S.C. 253(f)).

7 ‘‘(E) As used in this paragraph, the term ‘commercial

8 service’ means a service that is offered and sold competi9 tively in the commercial marketplace, is performed under

10 standard commercial terms and conditions, and is procured

11 using firm-fixed price contracts.’’.

12 (2) Subsection (b) is amended by striking out

13 ‘‘reciprocal reimbursement’’ in the first sentence and

14 all that follows through the period at the end of that

15 sentence and inserting in lieu thereof ‘‘payment to the

16 Department in accordance with procedures that pro17 vide appropriate flexibility to negotiate payment

18 which is in the best interest of the Government.’’.

19 (3) Subsection (d) is amended by striking out

20 ‘‘preclude such payment, in accordance with—’’ and

21 all that follows through ‘‘to such facility therefor’’ and

22 inserting in lieu thereof ‘‘preclude such payment to

23 such facility for such care or services’’.

24 (4) Such section is further amended—
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1 (A) by redesignating subsection (e) as sub2 section (g); and

3 (B) by inserting after subsection (d) the fol4 lowing new subsections:

5 ‘‘(e) The Secretary may make an arrangement that au6 thorizes the furnishing of services by the Secretary under

7 this section to individuals who are not veterans only if the

8 Secretary determines—

9 ‘‘(1) that veterans will receive priority under

10 such an arrangement; and

11 ‘‘(2) that such an arrangement—

12 ‘‘(A) is necessary to maintain an acceptable

13 level and quality of service to veterans at that fa14 cility; or

15 ‘‘(B) will result in the improvement of serv16 ices to eligible veterans at that facility.

17 ‘‘(f) Any amount received by the Secretary from a non18 Federal entity as payment for services provided by the Sec19 retary during a prior fiscal year under an agreement en20 tered into under this section may be obligated by the Sec21 retary during the fiscal year in which the Secretary receives

22 the payment.’’.

23 (d) CLERICAL AMENDMENTS.—(1) The heading of sec24 tion 8153 is amended to read as follows:
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1 ‘‘§ 8153. Sharing of health-care resources’’.

2 (2) The item relating to section 8153 in the table of

3 sections at the beginning of chapter 81 is amended to read

4 as follows:

‘‘8153. Sharing of health-care resources.’’.

5 SEC. 302. IMPROVED EFFICIENCY IN HEALTH CARE RE6 SOURCE MANAGEMENT.

7 (a) TEMPORARY EXPANSION OF AUTHORITY FOR

8 SHARING AGREEMENTS.—Section 201 of the Veterans

9 Health Care Act of 1992 (Public Law 102–585; 38 U.S.C.

10 8111 note) is amended—

11 (1) by inserting ‘‘(a) AUTHORITY.—’’ before ‘‘The

12 Secretary of Veterans Affairs’’; and

13 (2) by adding at the end thereof the following

14 new subsection:

15 ‘‘(b) USE OF FUNDS.—Any amount received by the

16 Secretary from a non-Federal entity as payment for services

17 provided by the Secretary during a prior fiscal year under

18 an agreement entered into under this section may be obli19 gated by the Secretary during the fiscal year in which the

20 Secretary receives the payment.’’.

21 (b) REPEAL OF SUNSET PROVISION.—(1) Section 204

22 of such Act (38 U.S.C. 8111 note) is repealed.

23 (2) Any services provided pursuant to agreements en24 tered into under section 201 of such Act (38 U.S.C. 8111

25 note) during the period beginning on October 1, 1996, and
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1 ending on the date of the enactment of this Act are hereby

2 ratified.

3 (c) COST RECOVERY.—Title II of such Act is further

4 amended by adding at the end the following new section:

5 ‘‘SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.

6 ‘‘(a) RIGHT TO RECOVER.—In the case of a primary

7 beneficiary (as described in section 201(a)(2)(B)) who has

8 coverage under a health-plan contract, as defined in section

9 1729(i)(1)(A) of title 38, United States Code, and who is

10 furnished care or services by a Department medical facility

11 pursuant to this title, the United States shall have the right

12 to recover or collect charges for such care or services from

13 such health-plan contract to the extent that the beneficiary

14 (or the provider of the care or services) would be eligible

15 to receive payment for such care or services from such

16 health-plan contract if the care or services had not been fur17 nished by a department or agency of the United States. Any

18 funds received from such health-plan contract shall be cred19 ited to funds that have been allotted to the facility that fur20 nished the care or services.

21 ‘‘(b) ENFORCEMENT.—The right of the United States

22 to recover under such a beneficiary’s health-plan contract

23 shall be enforceable in the same manner as that provided

24 by subsections (a)(3), (b), (c)(1), (d), (f), (h), and (i) of

25 section 1729 of title 38, United States Code.’’.
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1 SEC. 303. PERSONNEL FURNISHING SHARED RESOURCES.

2 Section 712(b)(2) is amended—

3 (1) by striking out ‘‘the sum of—’’ and inserting

4 in lieu thereof ‘‘the sum of the following:’’;

5 (2) by capitalizing the first letter of the first

6 word of each of subparagraphs (A) and (B);

7 (3) by striking out ‘‘; and’’ at the end of sub8 paragraph (A) and inserting in lieu thereof a period;

9 and

10 (4) by adding at the end the following new sub11 paragraph:

12 ‘‘(C) The number of such positions in the

13 Department during that fiscal year held by per14 sons involved in providing health-care resources

15 under section 8111 or 8153 of this title or under

16 section 201 of the Veterans Health Care Act of

17 1992 (Public Law 102–585; 106 Stat. 4949; 38

18 U.S.C. 8111 note).’’.

19 SEC. 304. WAITING PERIOD FOR ADMINISTRATIVE REORGA20 NIZATIONS.

21 Section 510(b) is amended—

22 (1) in the second sentence, by striking out ‘‘a 90-

23 day period of continuous session of Congress following

24 the date of the submission of the report’’ and inserting

25 in lieu thereof ‘‘a 45-day period following the date of

26 the submission of the report, not less than 30 days of
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1 which shall be days during which Congress shall have

2 been in continuous session’’; and

3 (2) in the third sentence, by striking out ‘‘such

4 90–day period’’ and inserting in lieu thereof ‘‘any pe5 riod of continuity of session’’.

6 SEC. 305. REPEAL OF LIMITATIONS ON CONTRACTS FOR

7 CONVERSION OF PERFORMANCE OF ACTIVI8 TIES OF DEPARTMENT HEALTH-CARE FACILI9 TIES AND REVISED ANNUAL REPORTING RE10 QUIREMENT.

11 Subsection (c) of section 8110 is amended to read as

12 follows:

13 ‘‘(c) The Secretary shall include in the materials sub14 mitted to Congress each year in support of the budget of

15 the Department for the next fiscal year a report on activi16 ties and proposals involving contracting for performance by

17 contractor personnel of work previously performed by De18 partment employees. The report shall—

19 ‘‘(1) identify those specific activities that are

20 currently performed at a Department facility by more

21 than 10 Department employees which the Secretary

22 proposes to study for possible contracting involving

23 conversion from performance by Department employ24 ees to performance by employees of a contractor; and
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1 ‘‘(2) identify those specific activities that have

2 been contracted for performance by contractor em3 ployees during the prior fiscal year (shown by loca4 tion, subject, scope of contracts, and savings) and

5 shall describe the effect of such contracts on the qual6 ity of delivery of health services during such year.’’.

7 Subtitle B—Care of Women

8 Veterans

9 SEC. 321. MAMMOGRAPHY QUALITY STANDARDS.

10 (a) IN GENERAL.—(1) Subchapter II of chapter 73 is

11 amended by adding after section 7318 the following new

12 section:

13 ‘‘§ 7319. Mammography quality standards

14 ‘‘(a) A mammogram may not be performed at a De15 partment facility unless that facility is accredited for that

16 purpose by a private nonprofit organization designated by

17 the Secretary. An organization designated by the Secretary

18 under this subsection shall meet the standards for accredit19 ing bodies established under subsection (e) of section 354

20 of the Public Health Service Act (42 U.S.C. 263b).

21 ‘‘(b) The Secretary, in consultation with the Secretary

22 of Health and Human Services, shall prescribe quality as23 surance and quality control standards relating to the per24 formance and interpretation of mammograms and use of

25 mammogram equipment and facilities of the Department
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1 of Veterans Affairs consistent with the requirements of sec2 tion 354(f)(1) of the Public Health Service Act. Such stand3 ards shall be no less stringent than the standards prescribed

4 by the Secretary of Health and Human Services under sec5 tion 354(f) of the Public Health Service Act.

6 ‘‘(c)(1) The Secretary, to ensure compliance with the

7 standards prescribed under subsection (b), shall provide for

8 an annual inspection of the equipment and facilities used

9 by and in Department health care facilities for the perform10 ance of mammograms. Such inspections shall be carried out

11 in a manner consistent with the inspection of certified fa12 cilities by the Secretary of Health and Human Services

13 under section 354(g) of the Public Health Service Act.

14 ‘‘(2) The Secretary may not provide for an inspection

15 under paragraph (1) to be performed by a State agency.

16 ‘‘(d) The Secretary shall ensure that mammograms

17 performed for the Department under contract with any non18 Department facility or provider conform to the quality

19 standards prescribed by the Secretary of Health and

20 Human Services under section 354 of the Public Health

21 Service Act.

22 ‘‘(e) For the purposes of this section, the term ‘mammo23 gram’ has the meaning given such term in paragraph (5)

24 of section 354(a) of the Public Health Service Act.’’.
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1 (2) The table of sections at the beginning of such chap2 ter is amended by inserting after the item relating to section

3 7318 the following new item:

‘‘7319. Mammography quality standards.’’.

4 (b) DEADLINE FOR PRESCRIBING STANDARDS.—The

5 Secretary of Veterans Affairs shall prescribe standards

6 under subsection (b) of section 7319 of title 38, United

7 States Code, as added by subsection (a), not later than the

8 end of the 120-day period beginning on the date of the en9 actment of this Act.

10 (c) IMPLEMENTATION REPORT.—The Secretary shall

11 submit to the Committees on Veterans’ Affairs of the Senate

12 and House of Representatives a report on the Secretary’s

13 implementation of section 7319 of title 38, United States

14 Code, as added by subsection (a). The report shall be sub15 mitted not later than 120 days after the date of the enact16 ment of this Act.

17 SEC. 322. PATIENT PRIVACY FOR WOMEN PATIENTS.

18 (a) IDENTIFICATION OF DEFICIENCIES.—The Sec19 retary of Veterans Affairs shall conduct a survey of each

20 medical center under the jurisdiction of the Secretary to

21 identify deficiencies relating to patient privacy afforded to

22 women patients in the clinical areas at each such center

23 which may interfere with appropriate treatment of such pa24 tients.
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1 (b) CORRECTION OF DEFICIENCIES.—The Secretary

2 shall ensure that plans and, where appropriate, interim

3 steps to correct the deficiencies identified in the survey con4 ducted under subsection (a) are developed and are incor5 porated into the Department’s construction planning proc6 esses and, in cases in which it is cost-effective to do so, are

7 given a high priority.

8 (c) REPORTS TO CONGRESS.—The Secretary shall

9 compile an annual inventory, by medical center, of defi10 ciencies identified under subsection (a) and of plans and,

11 where appropriate, interim steps, to correct such defi12 ciencies. The Secretary shall submit to the Committees on

13 Veterans’ Affairs of the Senate and House of Representa14 tives, not later than October 1, 1997, and not later than

15 October 1 each year thereafter through 1999 a report on

16 such deficiencies. The Secretary shall include in such report

17 the inventory compiled by the Secretary, the proposed cor18 rective plans, and the status of such plans.

19 SEC. 323. ASSESSMENT OF USE BY WOMEN VETERANS OF

20 DEPARTMENT HEALTH SERVICES.

21 (a) REPORTS TO UNDER SECRETARY FOR HEALTH.—

22 The Center for Women Veterans of the Department of Veter23 ans Affairs (established under section 509 of Public Law

24 103–446), in consultation with the Advisory Committee on

25 Women Veterans, shall assess the use by women veterans
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1 of health services through the Department of Veterans Af2 fairs, including counseling for sexual trauma and mental

3 health services. The Center shall submit to the Under Sec4 retary for Health of the Department of Veterans Affairs a

5 report not later than April 1, 1997, and April 1 of each

6 of the two following years, on—

7 (1) the extent to which women veterans described

8 in paragraphs (1) and (2) of section 1710(a) of title

9 38, United States Code, fail to seek, or face barriers

10 in seeking, health services through the Department,

11 and the reasons therefor; and

12 (2) recommendations, if indicated, for encourag13 ing greater use of such services, including (if appro14 priate) public service announcements and other out15 reach efforts.

16 (b) REPORTS TO CONGRESSIONAL COMMITTEES.—Not

17 later than July 1, 1997, and July 1 of each of the two fol18 lowing years, the Secretary of Veterans Affairs shall submit

19 to the Committees on Veterans’ Affairs of the Senate and

20 House of Representatives a report containing—

21 (1) the most recent report of the Center for

22 Women Veterans under subsection (a);

23 (2) the views of the Under Secretary for Health

24 on such report’s findings and recommendations; and
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1 (3) a description of the steps being taken by the

2 Secretary to remedy any problems described in the re3 port.

4 SEC. 324. REPORTING REQUIREMENTS.

5 (a) EXTENSION OF ANNUAL REPORT REQUIREMENT.—

6 Section 107(a) of the Veterans Health Care Act of 1992

7 (Public Law 102–585; 106 Stat. 4947) is amended by strik8 ing out ‘‘Not later than January 1, 1993, January 1, 1994,

9 and January 1, 1995’’ and inserting in lieu thereof ‘‘Not

10 later than January 1 of 1993 and each year thereafter

11 through 1998’’.

12 (b) REPORT ON HEALTH CARE AND RESEARCH.—Sec13 tion 107(b) of such Act is amended—

14 (1) in paragraph (2)(A), by inserting ‘‘(includ15 ing information on the number of inpatient stays and

16 the number of outpatient visits through which such

17 services were provided)’’ after ‘‘facility’’; and

18 (2) by adding at the end the following new para19 graph:

20 ‘‘(5) A description of the actions taken by the

21 Secretary to foster and encourage the expansion of

22 such research.’’.
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1 Subtitle C—Readjustment Counsel2 ing and Mental Health Care

3 SEC. 331. EXPANSION OF ELIGIBILITY FOR READJUSTMENT

4 COUNSELING AND CERTAIN RELATED COUN5 SELING SERVICES.

6 (a) EXPANSION OF ELIGIBILITY.—Subsection (a) of

7 section 1712A is amended to read as follows:

8 ‘‘(a)(1)(A) Upon the request of any veteran referred

9 to in subparagraph (B), the Secretary shall furnish counsel10 ing to the veteran to assist the veteran in readjusting to

11 civilian life. Such counseling may include a general mental

12 and psychological assessment of the veteran to ascertain

13 whether such veteran has mental or psychological problems

14 associated with readjustment to civilian life.

15 ‘‘(B) Subparagraph (A) applies to the following veter16 ans:

17 ‘‘(i) Any veteran who served on active duty—

18 ‘‘(I) in a theater of combat operations (as

19 determined by the Secretary in consultation with

20 the Secretary of Defense) during the Vietnam

21 era; or

22 ‘‘(II) after May 7, l975, in an area at a

23 time during which hostilities occurred in that

24 area.
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1 ‘‘(ii) Any veteran (other than a veteran covered

2 by clause (i)) who served on active duty during the

3 Vietnam era who seeks or is furnished such counseling

4 before January 1, 2000.

5 ‘‘(2)(A) Upon the request of any veteran (other than

6 a veteran covered by paragraph (1)) who served in the ac7 tive military, naval, or air service in a theater of combat

8 operations (as so determined) during a period of war, or

9 in any other area during a period in which hostilities (as

10 defined in subparagraph (B)) occurred in such area, the

11 Secretary may furnish counseling to the veteran to assist

12 the veteran in readjusting to civilian life.

13 ‘‘(B) For the purposes of subparagraph (A), the term

14 ‘hostilities’ means an armed conflict in which the members

15 of the Armed Forces are subjected to danger comparable to

16 the danger to which members of the Armed Forces have been

17 subjected in combat with enemy armed forces during a pe18 riod of war, as determined by the Secretary in consultation

19 with the Secretary of Defense.’’.

20 (b) REPEAL OF REFERRAL PROVISIONS.—Subsection

21 (c) of such section is repealed.

22 SEC. 332. REPORTS RELATING TO VET CENTERS.

23 (a) REPORT ON COLLOCATION OF VET CENTERS AND

24 DEPARTMENT OUTPATIENT CLINICS.—(1) Not later than

25 six months after the date of the enactment of this Act, the
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1 Secretary of Veterans Affairs shall submit to the Committees

2 on Veterans’ Affairs of the Senate and House of Representa3 tives a report on the feasibility and desirability of provid4 ing for the collocation of Vet Centers and outpatient clinics

5 (including rural mobile clinics) of the Department of Veter6 ans Affairs as current leases for such centers and clinics

7 expire.

8 (2) The report shall include an assessment of the fol9 lowing:

10 (A) The results of any collocation of Vet Centers

11 and outpatient clinics carried out by the Secretary

12 before the date of the enactment of this Act, including

13 the effects of such collocation on the quality of care

14 provided at such centers and clinics.

15 (B) The effect of such collocation on the capacity

16 of such centers and clinics to carry out their primary

17 mission.

18 (C) The extent to which such collocation will im19 pair the operational independence or administrative

20 integrity of such centers and clinics.

21 (D) The feasibility of combining the services pro22 vided by such centers and clinics in the course of such

23 collocation.

24 (E) The advisability of the collocation of centers

25 and clinics of significantly different size.
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1 (F) The effect of the locations (including urban

2 and rural locations) of the centers and clinics on the

3 feasibility and desirability of such collocation.

4 (G) The amount of any costs savings to be

5 achieved by Department as a result of such colloca6 tion.

7 (H) Any other matter that the Secretary consid8 ers appropriate.

9 (b) REPORT ON PROVISION OF LIMITED HEALTH CARE

10 SERVICES AT READJUSTMENT COUNSELING CENTERS.—(1)

11 Not later than six months after the date of the enactment

12 of this Act, the Secretary of Veterans Affairs shall submit

13 to the Committees on Veterans’ Affairs of the Senate and

14 House of Representatives a report on the feasibility and de15 sirability of providing a limited battery of health care serv16 ices (including ambulatory services and health care screen17 ing services) to veterans at Department of Veterans Affairs

18 readjustment counseling centers.

19 (2) The report shall include a discussion of the follow20 ing:

21 (A) The effect on the advisability of providing

22 health care services at readjustment counseling centers

23 of the geographic location of such centers, including

24 the urban location and rural location of such centers
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1 and the proximity of such centers to Department of

2 Veterans Affairs medical facilities.

3 (B) The effect on the advisability of providing

4 such services at such centers of the type and level of

5 services to be provided, and the demographic charac6 teristics (including age, socio-economic status, eth7 nicity, and sex) of veterans likely to be provided the

8 services.

9 (C) The effect of providing such services at such

10 centers on the readjustment counseling center pro11 gram in general and on the efficiency and autonomy

12 of the clinical and administrative operations of the

13 readjustment counseling centers in particular.

14 (D) Any other matter that the Secretary consid15 ers appropriate.

16 (c) RULE OF CONSTRUCTION.—Nothing in this section

17 is intended to preclude the Secretary, during the period be18 fore the submission of the reports under this section, from

19 providing limited health care services at Vet Centers.

20 SEC. 333. ADVISORY COMMITTEE ON THE READJUSTMENT

21 OF VETERANS.

22 (a) IN GENERAL.—(1) Subchapter III of chapter 5 is

23 amended by inserting after section 544 the following new

24 section:
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1 ‘‘§ 545. Advisory Committee on the Readjustment of

2 Veterans

3 ‘‘(a)(1) There is in the Department the Advisory Com4 mittee on the Readjustment of Veterans (hereinafter in this

5 section referred to as the ‘Committee’).

6 ‘‘(2) The Committee shall consist of not more than 18

7 members appointed by the Secretary from among individ8 uals who—

9 ‘‘(A) have demonstrated significant civic or pro10 fessional achievement; and

11 ‘‘(B) have experience with the provision of veter12 ans benefits and services by the Department.

13 ‘‘(3) The Secretary shall seek to ensure that members

14 appointed to the Committee include individuals from a

15 wide variety of geographic areas and ethnic backgrounds,

16 individuals from veterans service organizations, individuals

17 with combat experience, and women.

18 ‘‘(4) The Secretary shall determine the terms of service

19 and pay and allowances of the members of the Committee,

20 except that a term of service may not exceed two years. The

21 Secretary may reappoint any member for additional terms

22 of service.

23 ‘‘(b)(1) The Secretary shall, on a regular basis, consult

24 with and seek the advice of the Committee with respect to

25 the provision by the Department of benefits and services to
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1 veterans in order to assist veterans in the readjustment to

2 civilian life.

3 ‘‘(2)(A) In providing advice to the Secretary under

4 this subsection, the Committee shall—

5 ‘‘(i) assemble and review information relating to

6 the needs of veterans in readjusting to civilian life;

7 ‘‘(ii) provide information relating to the nature

8 and character of psychological problems arising from

9 service in the Armed Forces;

10 ‘‘(iii) provide an on-going assessment of the ef11 fectiveness of the policies, organizational structures,

12 and services of the Department in assisting veterans

13 in readjusting to civilian life; and

14 ‘‘(iv) provide on-going advice on the most appro15 priate means of responding to the readjustment needs

16 of veterans in the future.

17 ‘‘(B) In carrying out its duties under subparagraph

18 (A), the Committee shall take into special account the needs

19 of veterans who have served in a theater of combat oper20 ations.

21 ‘‘(c)(1) Not later than March 31 of each year, the Com22 mittee shall submit to the Secretary a report on the pro23 grams and activities of the Department that relate to the

24 readjustment of veterans to civilian life. Each such report

25 shall include—
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1 ‘‘(A) an assessment of the needs of veterans with

2 respect to readjustment to civilian life;

3 ‘‘(B) a review of the programs and activities of

4 the Department designed to meet such needs; and

5 ‘‘(C) such recommendations (including rec6 ommendations for administrative and legislative ac7 tion) as the Committee considers appropriate.

8 ‘‘(2) Not later than 90 days after the receipt of a report

9 under paragraph (1), the Secretary shall transmit to the

10 Committees on Veterans’ Affairs of the Senate and House

11 of Representatives a copy of the report, together with any

12 comments and recommendations concerning the report that

13 the Secretary considers appropriate.

14 ‘‘(3) The Committee may also submit to the Secretary

15 such other reports and recommendations as the Committee

16 considers appropriate.

17 ‘‘(4) The Secretary shall submit with each annual re18 port submitted to the Congress pursuant to section 529 of

19 this title a summary of all reports and recommendations

20 of the Committee submitted to the Secretary since the pre21 vious annual report of the Secretary submitted pursuant

22 to that section.

23 ‘‘(d)(1) Except as provided in paragraph (2), the pro24 visions of the Federal Advisory Committee Act (5 U.S.C.
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1 App.) shall apply to the activities of the Committee under

2 this section.

3 ‘‘(2) Section 14 of such Act shall not apply to the Com4 mittee.’’.

5 (2) The table of sections at the beginning of chapter

6 5 is amended by inserting after the item relating to section

7 544 the following new item:

‘‘545. Advisory Committee on the Readjustment of Veterans.’’.

8 (b) ORIGINAL MEMBERS.—(1) Notwithstanding sub9 section (a)(2) of section 545 of title 38, United States Code

10 (as added by subsection (a)), the members of the Advisory

11 Committee on the Readjustment of Vietnam and Other War

12 Veterans on the date of the enactment of this Act shall be

13 the original members of the advisory committee recognized

14 under such section.

15 (2) The original members shall so serve until the Sec16 retary of Veterans Affairs carries out appointments under

17 such subsection (a)(2). The Secretary of Veterans Affairs

18 shall carry out such appointments as soon after such date

19 as is practicable. The Secretary may make such appoint20 ments from among such original members.

21 SEC. 334. CENTERS FOR MENTAL ILLNESS RESEARCH, EDU22 CATION, AND CLINICAL ACTIVITIES.

23 (a) IN GENERAL.—(1) Subchapter II of chapter 73 is

24 amended by adding after section 7319, as added by section

25 321(a)(1), the following new section:
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1 ‘‘§ 7320. Centers for mental illness research, edu2 cation, and clinical activities

3 ‘‘(a) The purpose of this section is to provide for the

4 improvement of the provision of health-care services and re5 lated counseling services to eligible veterans suffering from

6 mental illness (especially mental illness related to service7 related conditions) through—

8 ‘‘(1) the conduct of research (including research

9 on improving mental health service facilities of the

10 Department and on improving the delivery of mental

11 health services by the Department);

12 ‘‘(2) the education and training of health care

13 personnel of the Department; and

14 ‘‘(3) the development of improved models and

15 systems for the furnishing of mental health services by

16 the Department.

17 ‘‘(b)(1) The Secretary shall establish and operate cen18 ters for mental illness research, education, and clinical ac19 tivities. Such centers shall be established and operated by

20 collaborating Department facilities as provided in sub21 section (c)(1). Each such center shall function as a center

22 for—

23 ‘‘(A) research on mental health services;

24 ‘‘(B) the use by the Department of specific mod25 els for furnishing services to treat serious mental ill26 ness;
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1 ‘‘(C) education and training of health-care pro2 fessionals of the Department; and

3 ‘‘(D) the development and implementation of in4 novative clinical activities and systems of care with

5 respect to the delivery of such services by the Depart6 ment.

7 ‘‘(2) The Secretary shall, upon the recommendation of

8 the Under Secretary for Health, designate the centers under

9 this section. In making such designations, the Secretary

10 shall ensure that the centers designated are located in var11 ious geographic regions of the United States. The Secretary

12 may designate a center under this section only if—

13 ‘‘(A) the proposal submitted for the designation

14 of the center meets the requirements of subsection (c);

15 ‘‘(B) the Secretary makes the finding described

16 in subsection (d); and

17 ‘‘(C) the peer review panel established under sub18 section (e) makes the determination specified in sub19 section (e)(3) with respect to that proposal.

20 ‘‘(3) Not more than five centers may be designated

21 under this section.

22 ‘‘(4) The authority of the Secretary to establish and

23 operate centers under this section is subject to the appro24 priation of funds for that purpose.
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1 ‘‘(c) A proposal submitted for the designation of a cen2 ter under this section shall—

3 ‘‘(1) provide for close collaboration in the estab4 lishment and operation of the center, and for the pro5 vision of care and the conduct of research and edu6 cation at the center, by a Department facility or fa7 cilities in the same geographic area which have a

8 mission centered on care of the mentally ill and a De9 partment facility in that area which has a mission

10 of providing tertiary medical care;

11 ‘‘(2) provide that no less than 50 percent of the

12 funds appropriated for the center for support of clini13 cal care, research, and education will be provided to

14 the collaborating facility or facilities that have a mis15 sion centered on care of the mentally ill; and

16 ‘‘(3) provide for a governance arrangement be17 tween the collaborating Department facilities which

18 ensures that the center will be established and oper19 ated in a manner aimed at improving the quality of

20 mental health care at the collaborating facility or fa21 cilities which have a mission centered on care of the

22 mentally ill.

23 ‘‘(d) The finding referred to in subsection (b)(2)(B)

24 with respect to a proposal for designation of a site as a

25 location of a center under this section is a finding by the
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1 Secretary, upon the recommendation of the Under Secretary

2 for Health, that the facilities submitting the proposal have

3 developed (or may reasonably be anticipated to develop)

4 each of the following:

5 ‘‘(1) An arrangement with an accredited medical

6 school that provides education and training in psy7 chiatry and with which one or more of the participat8 ing Department facilities is affiliated under which

9 medical residents receive education and training in

10 psychiatry through regular rotation through the par11 ticipating Department facilities so as to provide such

12 residents with training in the diagnosis and treat13 ment of mental illness.

14 ‘‘(2) An arrangement with an accredited grad15 uate program of psychology under which students re16 ceive education and training in clinical, counseling,

17 or professional psychology through regular rotation

18 through the participating Department facilities so as

19 to provide such students with training in the diag20 nosis and treatment of mental illness.

21 ‘‘(3) An arrangement under which nursing, so22 cial work, counseling, or allied health personnel re23 ceive training and education in mental health care

24 through regular rotation through the participating

25 Department facilities.
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1 ‘‘(4) The ability to attract scientists who have

2 demonstrated achievement in research—

3 ‘‘(A) into the evaluation of innovative ap4 proaches to the design of mental health services;

5 or

6 ‘‘(B) into the causes, prevention, and treat7 ment of mental illness.

8 ‘‘(5) The capability to evaluate effectively the ac9 tivities of the center, including activities relating to

10 the evaluation of specific efforts to improve the qual11 ity and effectiveness of mental health services pro12 vided by the Department at or through individual fa13 cilities.

14 ‘‘(e)(1) In order to provide advice to assist the Sec15 retary and the Under Secretary for Health to carry out

16 their responsibilities under this section, the official within

17 the central office of the Veterans Health Administration re18 sponsible for mental health and behavioral sciences matters

19 shall establish a peer review panel to assess the scientific

20 and clinical merit of proposals that are submitted to the

21 Secretary for the designation of centers under this section.

22 ‘‘(2) The panel shall consist of experts in the fields of

23 mental health research, education and training, and clini24 cal care. Members of the panel shall serve as consultants

25 to the Department.
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1 ‘‘(3) The panel shall review each proposal submitted

2 to the panel by the official referred to in paragraph (1)

3 and shall submit to that official its views on the relative

4 scientific and clinical merit of each such proposal. The

5 panel shall specifically determine with respect to each such

6 proposal whether that proposal is among those proposals

7 which have met the highest competitive standards of sci8 entific and clinical merit.

9 ‘‘(4) The panel shall not be subject to the Federal Advi10 sory Committee Act (5 U.S.C. App.).

11 ‘‘(f) Clinical and scientific investigation activities at

12 each center established under this section—

13 ‘‘(1) may compete for the award of funding from

14 amounts appropriated for the Department of Veterans

15 Affairs medical and prosthetics research account; and

16 ‘‘(2) shall receive priority in the award of fund17 ing from such account insofar as funds are awarded

18 to projects and activities relating to mental illness.

19 ‘‘(g) The Under Secretary for Health shall ensure that

20 at least three centers designated under this section empha21 size research into means of improving the quality of care

22 for veterans suffering from mental illness through the devel23 opment of community-based alternatives to institutional

24 treatment for such illness.
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1 ‘‘(h) The Under Secretary for Health shall ensure that

2 information produced by the research, education and train3 ing, and clinical activities of centers established under this

4 section that may be useful for other activities of the Veterans

5 Health Administration is disseminated throughout the Vet6 erans Health Administration. Such dissemination shall be

7 made through publications, through programs of continuing

8 medical and related education provided through regional

9 medical education centers under subchapter VI of chapter

10 74 of this title, and through other means. Such programs

11 of continuing medical education shall receive priority in

12 the award of funding.

13 ‘‘(i) The official within the central office of the Veter14 ans Health Administration responsible for mental health

15 and behavioral sciences matters shall be responsible for su16 pervising the operation of the centers established pursuant

17 to this section and shall provide for ongoing evaluation of

18 the centers and their compliance with the requirements of

19 this section.

20 ‘‘(j)(1) There are authorized to be appropriated to the

21 Department of Veterans Affairs for the basic support of the

22 research and education and training activities of centers

23 established pursuant to this section amounts as follows:

24 ‘‘(A) $3,125,000 for fiscal year 1998.
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1 ‘‘(B) $6,250,000 for each of fiscal years 1999

2 through 2001.

3 ‘‘(2) In addition to funds appropriated for a fiscal

4 year pursuant to the authorization of appropriations in

5 paragraph (1), the Under Secretary for Health shall allo6 cate to such centers from other funds appropriated for that

7 fiscal year generally for the Department of Veterans Affairs

8 medical care account and the Department of Veterans Af9 fairs medical and prosthetics research account such

10 amounts as the Under Secretary for Health determines ap11 propriate to carry out the purposes of this section.’’.

12 (2) The table of sections at the beginning of chapter

13 73 is amended by inserting after the item relating to section

14 7319, as added by section 321(a)(2), the following new item:

‘‘7320. Centers for mental illness research, education, and clinical activities.’’.

15 (b) ANNUAL REPORTS.—Not later than February 1 of

16 each of 1999, 2000, 2001, and 2002, the Secretary of Veter17 ans Affairs shall submit to the Committees on Veterans’ Af18 fairs of the Senate and House of Representatives a report

19 on the status and activities during the previous fiscal year

20 of the centers for mental illness research, education, and

21 clinical activities established pursuant to section 7320 of

22 title 38, United States Code (as added by subsection (a)).

23 Each such report shall include the following:
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1 (1) A description of the activities carried out at

2 each center and the funding provided for such activi3 ties.

4 (2) A description of the advances made at each

5 of the participating facilities of the center in research,

6 education and training, and clinical activities relat7 ing to mental illness in veterans.

8 (3) A description of the actions taken by the

9 Under Secretary for Health pursuant to subsection

10 (h) of that section (as so added) to disseminate infor11 mation derived from such activities throughout the

12 Veterans Health Administration.

13 (4) The Secretary’s evaluations of the effective14 ness of the centers in fulfilling the purposes of the cen15 ters.

16 (c) IMPLEMENTATION.—The Secretary of Veterans Af17 fairs shall designate at least one center under section 7320

18 of title 38, United States Code, not later than January 1,

19 1998.

20 SEC. 335. COMMITTEE ON CARE OF SEVERELY CHRON21 ICALLY MENTALLY ILL VETERANS.

22 (a) ESTABLISHMENT.—Subchapter II of chapter 73 is

23 amended by adding after section 7320, as added by section

24 334(a)(1), the following new section:
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1 ‘‘§ 7321. Committee on Care of Severely Chronically

2 Mentally Ill Veterans

3 ‘‘(a) The Secretary, acting through the Under Sec4 retary for Health, shall establish in the Veterans Health Ad5 ministration a Committee on Care of Severely Chronically

6 Mentally Ill Veterans. The Under Secretary shall appoint

7 employees of the Department with expertise in the care of

8 the chronically mentally ill to serve on the committee.

9 ‘‘(b) The committee shall assess, and carry out a con10 tinuing assessment of, the capability of the Veterans Health

11 Administration to meet effectively the treatment and reha12 bilitation needs of mentally ill veterans whose mental illness

13 is severe and chronic and who are eligible for health care

14 furnished by the Department, including the needs of such

15 veterans who are women. In carrying out that responsibil16 ity, the committee shall—

17 ‘‘(1) evaluate the care provided to such veterans

18 through the Veterans Health Administration;

19 ‘‘(2) identify systemwide problems in caring for

20 such veterans in facilities of the Veterans Health Ad21 ministration;

22 ‘‘(3) identify specific facilities within the Veter23 ans Health Administration at which program enrich24 ment is needed to improve treatment and rehabilita25 tion of such veterans; and
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1 ‘‘(4) identify model programs which the commit2 tee considers to have been successful in the treatment

3 and rehabilitation of such veterans and which should

4 be implemented more widely in or through facilities

5 of the Veterans Health Administration.

6 ‘‘(c) The committee shall—

7 ‘‘(1) advise the Under Secretary regarding the

8 development of policies for the care and rehabilitation

9 of severely chronically mentally ill veterans; and

10 ‘‘(2) make recommendations to the Under Sec11 retary—

12 ‘‘(A) for improving programs of care of such

13 veterans at specific facilities and throughout the

14 Veterans Health Administration;

15 ‘‘(B) for establishing special programs of

16 education and training relevant to the care of

17 such veterans for employees of the Veterans

18 Health Administration;

19 ‘‘(C) regarding research needs and priorities

20 relevant to the care of such veterans; and

21 ‘‘(D) regarding the appropriate allocation

22 of resources for all such activities.

23 ‘‘(d)(1) Not later than April 1, 1997, the Secretary

24 shall submit to the Committees on Veterans’ Affairs of the

25 Senate and House of Representatives a report on the imple-
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1 mentation of this section. The report shall include the fol2 lowing:

3 ‘‘(A) A list of the members of the committee.

4 ‘‘(B) The assessment of the Under Secretary for

5 Health, after review of the initial findings of the com6 mittee, regarding the capability of the Veterans

7 Health Administration, on a systemwide and facility8 by-facility basis, to meet effectively the treatment and

9 rehabilitation needs of severely chronically mentally

10 ill veterans who are eligible for Department care.

11 ‘‘(C) The plans of the committee for further as12 sessments.

13 ‘‘(D) The findings and recommendations made

14 by the committee to the Under Secretary for Health

15 and the views of the Under Secretary on such findings

16 and recommendations.

17 ‘‘(E) A description of the steps taken, plans

18 made (and a timetable for their execution), and re19 sources to be applied toward improving the capability

20 of the Veterans Health Administration to meet effec21 tively the treatment and rehabilitation needs of se22 verely chronically mentally ill veterans who are eligi23 ble for Department care.

24 ‘‘(2) Not later than February 1, 1998, and February

25 1 of each of the three following years, the Secretary shall
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1 submit to the Committees on Veterans’ Affairs of the Senate

2 and House of Representatives a report containing informa3 tion updating the reports submitted under this subsection

4 before the submission of such report.’’.

5 (b) CLERICAL AMENDMENT.—The table of sections at

6 the beginning of chapter 73 is amended by inserting after

7 the item relating to section 7320, as added by section

8 334(a)(2) the following new item:

‘‘7321. Committee on Care of Severely Chronically Mentally Ill Veterans.’’.

9 Subtitle D—Other Provisions

10 SEC. 341. HOSPICE CARE STUDY.

11 (a) STUDY REQUIRED.—The Secretary of Veterans Af12 fairs shall conduct a research study to determine the desir13 ability of the Secretary furnishing hospice care to termi14 nally ill veterans and to evaluate the most cost effective and

15 efficient way to do so. The Secretary shall carry out the

16 study using resources and personnel of the Department.

17 (b) CONDUCT OF STUDY.—In carrying out the study

18 required by subsection (a), the Secretary shall—

19 (1) evaluate the programs, and the program

20 models, through which the Secretary furnishes hospice

21 care services within or through facilities of the De22 partment of Veterans Affairs and the programs and

23 program models through which non-Department fa24 cilities provide such services;
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1 (2) assess the satisfaction of patients, and family

2 members of patients, in each of the program models

3 covered by paragraph (1);

4 (3) compare the costs (or range of costs) of pro5 viding care through each of the program models cov6 ered by paragraph (1); and

7 (4) identify any barriers to providing, procur8 ing, or coordinating hospice services through any of

9 the program models covered by paragraph (1).

10 (c) PROGRAM MODELS.—For purposes of subsection

11 (b)(1), the Secretary shall evaluate a variety of types of

12 models for delivery of hospice care, including the following:

13 (1) Direct furnishing of full hospice care by the

14 Secretary.

15 (2) Direct furnishing of some hospice services by

16 the Secretary.

17 (3) Contracting by the Secretary for the furnish18 ing of hospice care, with a commitment that the Sec19 retary will provide any further required hospital care

20 for the patient.

21 (4) Contracting for all required care to be fur22 nished outside the Department.

23 (5) Referral of the patient for hospice care with24 out a contract.
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1 (d) REPORT.—Not later than April 1, 1998, the Sec2 retary shall submit to the Committees on Veterans’ Affairs

3 of the Senate and House of Representatives a report on the

4 research study. The report shall set forth the Secretary’s

5 findings and recommendations. The Secretary shall include

6 in the report information on the extent to which the Sec7 retary advises veterans concerning their eligibility for hos8 pice care and information on the number of veterans (as

9 of the time of the report) who are in each model of hospice

10 care described in subsection (c) and the average cost per

11 patient of hospice care for each such model.

12 SEC. 342. PAYMENT TO STATES OF PER DIEM FOR VETER13 ANS RECEIVING ADULT DAY HEALTH CARE.

14 (a) PAYMENT OF PER DIEM FOR VETERANS RECEIV15 ING ADULT DAY CARE.—Section 1741 is amended—

16 (1) by inserting ‘‘(1)’’ after ‘‘(a)’’;

17 (2) by redesignating paragraphs (1) and (2) as

18 subparagraphs (A) and (B), respectively; and

19 (3) by adding at the end the following new para20 graph (2):

21 ‘‘(2) The Secretary may pay each State per diem at

22 a rate determined by the Secretary for each veteran receiv23 ing adult day health care in a State home, if such veteran

24 is eligible for such care under laws administered by the Sec25 retary.’’.
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1 (b) ASSISTANCE TO STATES FOR CONSTRUCTION OF

2 ADULT DAY CARE FACILITIES.—(1) Section 8131(3) is

3 amended by inserting ‘‘adult day health,’’ before ‘‘or hos4 pital care’’.

5 (2) Section 8132 is amended by inserting ‘‘adult day

6 health,’’ before ‘‘or hospital care’’.

7 (3) Section 8135(b) is amended—

8 (A) in paragraph (2)(C), by inserting ‘‘or adult

9 day health care facilities’’ after ‘‘domiciliary beds’’;

10 and

11 (B) in paragraph (3)(A), by inserting ‘‘or con12 struction (other than new construction) of adult day

13 health care buildings’’ before the semicolon.

14 SEC. 343. RESEARCH CORPORATIONS.

15 (a) RENEWAL OF AUTHORITY.—Section 7368 is

16 amended by striking out ‘‘December 31, 1992’’ and insert17 ing in lieu thereof ‘‘December 31, 2000’’.

18 (b) CLARIFICATION OF TAX-EXEMPT STATUS.—Sec19 tions 7361(b) and 7363(c) are amended by striking out

20 ‘‘section 501(c)(3) of’’.

21 (c) PERIODIC AUDITS.—Subsection (b) of section 7366

22 is amended by striking out ‘‘The corporation’’ in the second

23 sentence and all that follows through ‘‘shall include that re24 port’’ and inserting in lieu thereof the following: ‘‘A cor25 poration with revenues in excess of $300,000 for any year
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1 shall obtain an audit of the corporation for that year. A

2 corporation with annual revenues between $10,000 and

3 $300,000 shall obtain an independent audit of the corpora4 tion at least once every three years. Any audit under the

5 preceding sentences shall be performed by an independent

6 auditor. The corporation shall include the most recent such

7 audit’’.

8 (d) COMPLIANCE WITH CONFLICT OF INTEREST LAWS

9 AND REGULATIONS.—Subsection (c)(2) of section 7366 is

10 amended by striking out ‘‘an annual statement signed by

11 the director or employee certifying that the director or’’ and

12 inserting in lieu thereof ‘‘a statement signed by the execu13 tive director of the corporation certifying that each director

14 and’’.

15 (e) REVISED REPORTING REQUIREMENT.—Subsection

16 (d) of section 7366 is amended to read as follows:

17 ‘‘(d) The Secretary shall submit to the Committees on

18 Veterans’ Affairs of the Senate and House of Representa19 tives an annual report on the corporations established

20 under this subchapter. The report shall set forth the follow21 ing information:

22 ‘‘(1) The location of each corporation.

23 ‘‘(2) The amount received by each corporation

24 during the previous year, including—

25 ‘‘(A) the total amount received;
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1 ‘‘(B) the amount received from govern2 mental entities;

3 ‘‘(C) the amount received from all other

4 sources; and

5 ‘‘(D) if the amount received from a source

6 referred to in subparagraph (C) exceeded

7 $25,000, information that identifies the source.

8 ‘‘(3) The amount expended by each corporation

9 during the year, including—

10 ‘‘(A) the amount expended for salary for re11 search staff and for salary for support staff;

12 ‘‘(B) the amount expended for direct sup13 port of research; and

14 ‘‘(C) if the amount expended with respect to

15 any payee exceeded $35,000, information that

16 identifies the payee.’’.

17 SEC. 344. VETERANS HEALTH ADMINISTRATION HEAD18 QUARTERS.

19 Section 7306 is amended by adding at the end the fol20 lowing new subsection:

21 ‘‘(f) In organizing the Office and appointing persons

22 to positions in the Office, the Under Secretary shall ensure

23 that—

24 ‘‘(1) the Office is staffed so as to provide the

25 Under Secretary, through a designated clinician in
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1 the appropriate discipline in each instance, with ex2 pertise and direct policy guidance on—

3 ‘‘(A) unique programs operated by the Ad4 ministration to provide for the specialized treat5 ment and rehabilitation of disabled veterans (in6 cluding blind rehabilitation, care of spinal cord

7 dysfunction, mental illness, and long-term care);

8 and

9 ‘‘(B) the programs established under section

10 1712A of this title; and

11 ‘‘(2) with respect to the programs established

12 under section 1712A of this title, a clinician with ap13 propriate expertise in those programs is responsible to

14 the Under Secretary for the management of those pro15 grams.’’.

16 SEC. 345. DISBURSEMENT AGREEMENTS RELATING TO MED17 ICAL RESIDENTS AND INTERNS.

18 Section 7406(c) is amended—

19 (1) by striking out ‘‘Department hospital’’ each

20 place it appears and inserting in lieu thereof ‘‘De21 partment facility furnishing hospital care or medical

22 services’’;

23 (2) by striking out ‘‘participating hospital’’ in

24 paragraph (4)(C) and inserting in lieu thereof ‘‘par25 ticipating facility’’; and
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1 (3) by striking out ‘‘hospital’’ both places it ap2 pears in paragraph (5) and inserting in lieu thereof

3 ‘‘facility’’.

4 SEC. 346. AUTHORITY TO SUSPEND SPECIAL PAY AGREE5 MENTS FOR PHYSICIANS AND DENTISTS WHO

6 ENTER RESIDENCY TRAINING PROGRAMS.

7 Section 7432(b)(2) is amended—

8 (1) by inserting ‘‘(A)’’ after ‘‘(2)’’; and

9 (2) by adding at the end the following:

10 ‘‘(B) The Secretary may suspend a special pay agree11 ment entered into under this section in the case of a physi12 cian or dentist who, having entered into the special pay

13 agreement, enters a residency training program. Any such

14 suspension shall terminate when the physician or dentist

15 completes, withdraws from, or is no longer a participant

16 in the program. During the period of such a suspension,

17 the physician or dentist is not subject to the provisions of

18 paragraph (1).’’.

19 SEC. 347. REMUNERATED OUTSIDE PROFESSIONAL ACTIVI20 TIES BY VETERANS HEALTH ADMINISTRA21 TION PERSONNEL.

22 (a) AUTHORITY.—Subsection (b) of section 7423 is

23 amended—

24 (1) by striking out paragraph (1); and
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1 (2) by redesignating paragraphs (2) through (6)

2 as paragraphs (1) through (5), respectively.

3 (b) CONFORMING AMENDMENT.—Subsection (c) of such

4 section is amended in the matter preceding paragraph (1)

5 by striking out ‘‘subsection (b)(6)’’ and inserting in lieu

6 thereof ‘‘subsection (b)(5)’’.

7 SEC. 348. MODIFICATION OF RESTRICTIONS ON REAL PROP8 ERTY, MILWAUKEE COUNTY, WISCONSIN.

9 (a) MODIFICATION OF REVERSIONARY INTEREST.—

10 The Secretary of Veterans Affairs is authorized to execute

11 such instruments as may be necessary to modify the condi12 tions under which the land described in subsection (b) will

13 revert to the United States in order—

14 (1) to permit Milwaukee County, Wisconsin, to

15 grant all or part of such land to another party with

16 a condition on such grant that the grantee use such

17 land only for civic and recreational purposes; and

18 (2) to provide that the conditions under which

19 title to all or any part of such land reverts to the

20 United States are stated so that any such reversion

21 would occur at the option of the United States.

22 (b) DESCRIPTION OF LAND.—The land covered by this

23 section is the tract of 28 acres of land, more or less, con24 veyed to Milwaukee County, Wisconsin, pursuant to the Act

25 entitled ‘‘An Act authorizing the Administrator of Veterans’
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1 Affairs to convey certain property to Milwaukee County,

2 Wisconsin’’, approved August 27, 1954 (68 Stat. 866).

3 (c) GENERAL AUTHORITIES.—The Secretary may

4 carry out this section subject to such terms and conditions

5 (including reservations of rights for the United States) as

6 the Secretary considers necessary to protect the interests of

7 the United States. In carrying out this section, the Sec8 retary may eliminate any existing covenant or restriction

9 with respect to the tract of land described in subsection (b)

10 which the Secretary determines to be no longer necessary

11 to protect the interests of the United States.

12 SEC. 349. MODIFICATION OF RESTRICTIONS ON REAL PROP13 ERTY, CHEYENNE, WYOMING.

14 (a) MODIFICATION OF REVERSIONARY INTEREST.—

15 The Secretary of Veterans Affairs of Veterans Affairs is au16 thorized to execute such instruments as may be necessary

17 to modify the conditions under which the land described

18 in subsection (b) will revert to the United States in order

19 to permit the City of Cheyenne, Wyoming, to grant all or

20 part of such land to the First Cheyenne Federal Credit

21 Union (formerly known as the Cheyenne VAF Federal Cred22 it Union) with a condition on such grant that the First

23 Cheyenne Federal Credit Union use such land only for the

24 purpose of constructing a building to house its operations.
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1 (b) DESCRIPTION OF LAND.—The land covered by this

2 section is the tract of 27 acres of land, more or less, con3 veyed to the City of Cheyenne, Wyoming, pursuant to the

4 Act entitled ‘‘An Act authorizing the Administrator of Vet5 erans’ Affairs to convey certain property to the City of

6 Cheyenne, Wyoming’’, approved November 8, 1965 (79 Stat.

7 1304).

8 (c) TERMS OF REVERSIONARY INTEREST.—In carry9 ing out this section, the Secretary may cause the statement

10 of the conditions under which title to all or any part of

11 the land described in subsection (b) reverts to the United

12 States to be revised so that any such reversion would occur

13 at the option of the United States.

14 (d) GENERAL AUTHORITIES.—The Secretary may

15 carry out this section subject to such terms and conditions

16 (including reservations of rights for the United States) as

17 the Secretary considers necessary to protect the interests of

18 the United States. In carrying out this section, the Sec19 retary may eliminate any existing covenant or restriction

20 with respect to the tract of land described in subsection (b)

21 which the Secretary determines to be no longer necessary

22 to protect the interests of the United States.
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1 SEC. 350. NAME OF DEPARTMENT OF VETERANS AFFAIRS

2 MEDICAL CENTER, JOHNSON CITY, TEN3 NESSEE.

4 (a) NAME.—The Mountain Home Department of Vet5 erans Affairs Medical Center in Johnson City, Tennessee,

6 shall after the date of the enactment of this Act be known

7 and designated as the ‘‘James H. Quillen Department of

8 Veterans Affairs Medical Center’’. Any reference to such

9 medical center in any law, regulation, map, document,

10 record, or other paper of the United States shall be consid11 ered to be a reference to the James H. Quillen Department

12 of Veterans Affairs Medical Center.

13 (b) EFFECTIVE DATE.—Subsection (a) shall take effect

14 at noon on January 3, 1997.

15 SEC. 351. REPORT ON HEALTH CARE NEEDS OF VETERANS

16 IN EAST CENTRAL FLORIDA.

17 (a) REPORT REQUIRED.—Not later than 60 days after

18 the date of the enactment of this Act, the Secretary of Veter19 ans Affairs shall submit to the Committees on Veterans’ Af20 fairs of the Senate and House of Representatives a report

21 on the health care needs of veterans in east central Florida.

22 In preparing the report, the Secretary shall consider the

23 needs of such veterans for psychiatric and long-term care.

24 The Secretary shall include in the report the Secretary’s

25 views, based on the Secretary’s determination of such needs,

26 as to the best means of meeting such needs using the
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1 amounts appropriated pursuant to the authorization of ap2 propriations in this Act and Public Law 103–452 for

3 projects to meet the health care needs of such veterans. The

4 Secretary may, subject to the availability of appropriations

5 for such purpose, use an independent contractor to assist

6 in the determination of such health care needs.

7 (b) LIMITATION.—The Secretary may not obligate any

8 funds, other than for design work, for the conversion of the

9 former Orlando Naval Training Center Hospital in Or10 lando, Florida (now under the jurisdiction of the Secretary

11 of Veterans Affairs), to a nursing home care unit until 45

12 days after the date on which the report required by sub13 section (a) is submitted.

14 SEC. 352. EVALUATION OF HEALTH STATUS OF SPOUSES

15 AND CHILDREN OF PERSIAN GULF WAR VET16 ERANS.

17 (a) EXTENSION OF AUTHORITY.—Subsection (b) of sec18 tion 107 of the Persian Gulf War Veterans’ Benefits Act

19 (title I of Public Law 103–446; 108 Stat. 4652; 38 U.S.C.

20 1117 note) is amended by striking out ‘‘September 30,

21 1996’’ and inserting in lieu thereof ‘‘December 31, 1998’’.

22 (b) RATIFICATION OF ACTIONS.—Any diagnostic test23 ing and medical examinations undertaken by the Secretary

24 of Veterans Affairs for the purpose of the study required

25 by subsection (a) of such section during the period begin-
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1 ning on October 1, 1996, and ending on the date of the

2 enactment of this Act is hereby ratified.

Amend the title so as to read: ‘‘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.’’.

Attest:

Secretary.
104TH CONGRESS

2D SESSION H. R. 3118

AMENDMENTS
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