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[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3118 Engrossed Amendment Senate (EAS)]

  
  
  
  
  
  
  
  
  
  

                  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:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Veterans' Health 
Care Eligibility Reform Act of 1996''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.

                      TITLE I--ELIGIBILITY REFORM

Sec. 101. Eligibility for hospital care and medical services.
Sec. 102. Revision in authorities for provision of priority health care 
                            for certain veterans exposed to specified 
                            toxic substances.
Sec. 103. Prosthetics and preventive care.
Sec. 104. Management of health care.
Sec. 105. Authorization of appropriations.
Sec. 106. Assessment of implementation and operation.

                  TITLE II--CONSTRUCTION AUTHORIZATION

Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of major medical facility leases.
Sec. 203. Authorization of appropriations.
Sec. 204. Strategic planning.
Sec. 205. Revision to prospectus requirements.
Sec. 206. Construction authorization requirements.
Sec. 207. Terminology changes.

               TITLE III--HEALTH CARE AND ADMINISTRATION

           Subtitle A--Health Care Sharing and Administration

Sec. 301. Revision of authority to share medical facilities, equipment, 
                            and information.
Sec. 302. Improved efficiency in health care resource management.
Sec. 303. Personnel furnishing shared resources.
Sec. 304. Waiting period for administrative reorganizations.
Sec. 305. Repeal of limitations on contracts for conversion of 
                            performance of activities of Department 
                            health-care facilities and revised annual 
                            reporting requirement.

                   Subtitle B--Care of Women Veterans

Sec. 321. Mammography quality standards.
Sec. 322. Patient privacy for women patients.
Sec. 323. Assessment of use by women veterans of Department health 
                            services.
Sec. 324. Reporting requirements.

       Subtitle C--Readjustment Counseling and Mental Health Care

Sec. 331. Expansion of eligibility for readjustment counseling and 
                            certain related counseling services.
Sec. 332. Reports relating to Vet Centers.
Sec. 333. Advisory Committee on the Readjustment of Veterans.
Sec. 334. Centers for mental illness research, education, and clinical 
                            activities.
Sec. 335. Committee on Care of Severely Chronically Mentally Ill 
                            Veterans.

                      Subtitle D--Other Provisions

Sec. 341. Hospice care study.
Sec. 342. Payment to States of per diem for veterans receiving adult 
                            day health care.
Sec. 343. Research corporations.
Sec. 344. Veterans Health Administration headquarters.
Sec. 345. Disbursement agreements relating to medical residents and 
                            interns.
Sec. 346. Authority to suspend special pay agreements for physicians 
                            and dentists who enter residency training 
                            programs.
Sec. 347. Remunerated outside professional activities by Veterans 
                            Health Administration personnel.
Sec. 348. Modification of restrictions on real property, Milwaukee 
                            County, Wisconsin.
Sec. 349. Modification of restrictions on real property, Cheyenne, 
                            Wyoming.
Sec. 350. Name of Department of Veterans Affairs Medical Center, 
                            Johnson City, Tennessee.
Sec. 351. Report on health care needs of veterans in east central 
                            Florida.
Sec. 352. Evaluation of health status of spouses and children of 
                            Persian Gulf War veterans.

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

    Except as otherwise expressly provided, whenever in this Act an 
amendment or repeal is expressed in terms of an amendment to or repeal 
of a section or other provision, the reference shall be considered to 
be made to a section or other provision of title 38, United States 
Code.

                      TITLE I--ELIGIBILITY REFORM

SEC. 101. ELIGIBILITY FOR HOSPITAL CARE AND MEDICAL SERVICES.

    (a) New Criteria for Eligibility for Care.--Section 1710(a) is 
amended to read as follows:
    ``(a)(1) The Secretary (subject to paragraph (4)) shall furnish 
hospital care and medical services, and may furnish nursing home care, 
which the Secretary determines to be needed--
            ``(A) to any veteran for a service-connected disability; 
        and
            ``(B) to any veteran who has a service-connected disability 
        rated at 50 percent or more.
    ``(2) The Secretary (subject to paragraph (4)) shall furnish 
hospital care and medical services, and may furnish nursing home care, 
which the Secretary determines to be needed to any veteran--
            ``(A) who has a compensable service-connected disability 
        rated less than 50 percent;
            ``(B) whose discharge or release from active military, 
        naval, or air service was for a compensable disability that was 
        incurred or aggravated in the line of duty;
            ``(C) who is in receipt of, or who, but for a suspension 
        pursuant to section 1151 of this title (or both a suspension 
        and the receipt of retired pay), would be entitled to 
        disability compensation, but only to the extent that such 
        veteran's continuing eligibility for such care is provided for 
        in the judgment or settlement provided for in such section;
            ``(D) who is a former prisoner of war;
            ``(E) who is a veteran of the Mexican border period or of 
        World War I;
            ``(F) who was exposed to a toxic substance, radiation, or 
        environmental hazard, as provided in subsection (e); or
            ``(G) who is unable to defray the expenses of necessary 
        care as determined under section 1722(a) of this title.
    ``(3) In the case of a veteran who is not described in paragraphs 
(1) and (2), the Secretary may, to the extent resources and facilities 
are available and subject to the provisions of subsections (f) and (g), 
furnish hospital care, medical services, and nursing home care which 
the Secretary determines to be needed.
    ``(4) The requirement in paragraphs (1) and (2) that the Secretary 
furnish hospital care and medical services shall be effective in any 
fiscal year only to the extent and in the amount provided in advance in 
appropriations Acts for such purposes.''.
    (b) Transfer of Provision.--Chapter 17 is amended--
            (1) by redesignating subsection (g) of section 1710 as 
        subsection (h); and
            (2) by transferring subsection (f) of section 1712 to 
        section 1710 and inserting such subsection so as to appear 
        after subsection (f), redesignating such subsection as 
        subsection (g), and amending such subsection by striking out 
        ``section 1710(a)(2) of this title'' in paragraph (1) and 
        inserting in lieu thereof ``subsection (a)(3) of this 
        section''.
    (c) Repeal of Separate Outpatient Care Priorities.--(1) Section 
1712 is amended--
            (A) by striking out subsections (a) and (i);
            (B) by redesignating subsections (b), (c), (d), (h) and 
        (j), as subsections (a), (b), (c), (d), and (e), respectively; 
        and
            (C) in subsection (b), as so redesignated, by striking out 
        ``subsection (b) of this section'' and inserting in lieu 
        thereof ``subsection (a)''.
    (2)(A) The heading of such section is amended to read as follows:
``Sec. 1712. Dental care; drugs and medicines for certain disabled 
              veterans; vaccines''.
    (B) The item relating to such section in the table of sections at 
the beginning of chapter 17 is amended to read as follows:

``1712. Dental care; drugs and medicines for certain disabled veterans; 
                            vaccines.''.
    (d) Conforming Amendments to Chapter 17.--Chapter 17 is further 
amended as follows:
            (1) Section 1701(6)(B)(i) is amended--
                    (A) in subclause (I), by striking out ``section 
                1712(a)'' and inserting in lieu thereof ``paragraph (1) 
                or (2) of section 1710(a)''; and
                    (B) in subclause (II), by striking out ``section 
                1712(a)(5)(B)'' and inserting in lieu thereof 
                ``paragraph (1), (2) or (3) of section 1710(a)''.
            (2) Section 1710(c)(1) is amended by striking out ``section 
        1712(b)'' and inserting in lieu thereof ``section 1712(a)''.
            (3) Section 1710(e)(1)(C) is amended by striking out 
        ``hospital care and nursing home care under subsection 
        (a)(1)(G) of this section'' and inserting in lieu thereof 
        ``hospital care, medical services, and nursing home care under 
        subsection (a)(2)(F)''.
            (4) Section 1710(f) is amended--
                    (A) in paragraph (1), by striking out ``subsection 
                (a)(2)'' and inserting in lieu thereof ``subsection 
                (a)(3)''; and
                    (B) in paragraph (3)(E)--
                            (i) by striking out ``section 1712(a) of 
                        this title'' and inserting in lieu thereof 
                        ``paragraph (3) of subsection (a)''; and
                            (ii) by striking out ``section 1712(f) of 
                        this title'' and inserting in lieu thereof 
                        ``subsection (g)''; and
                    (C) in paragraph (3)(F), by striking out ``section 
                1712(f) of this title'' and inserting in lieu thereof 
                ``subsection (g)''.
            (5) Section 1712A is amended--
                    (A) in subsection (b)(1), by striking out ``under 
                the conditions specified in section 1712(a)(5)(B) of 
                this title''; and
                    (B) in subsection (e)(1), by striking out 
                ``sections 1712(a)(1)(B) and 1703(a)(2)'' and inserting 
                in lieu thereof ``sections 1703(a)(2) and 
                1710(a)(1)(B)''.
            (6) Section 1717(a) is amended--
                    (A) in paragraph (1), by striking out ``section 
                1712(a)'' and inserting in lieu thereof ``section 
                1710(a)''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A), by striking out 
                        ``paragraph (1) of section 1712(a) of this 
                        title'' and inserting in lieu thereof ``section 
                        1710(a)(1) of this title, or for a disability 
                        described in section 1710(a)(2)(C) of this 
                        title''; and
                            (ii) in subparagraph (B), by striking out 
                        ``section 1712'' and inserting in lieu thereof 
                        ``section 1710(a)(2)''.
            (7) Section 1718(e) is amended by striking out ``section 
        1712(i)'' and inserting in lieu thereof ``section 1705''.
            (8) Section 1720(f) is amended--
                    (A) in paragraph (1)(A)(ii), by striking out 
                ``section 1712(a)(1)(B)'' and inserting in lieu thereof 
                ``paragraph (1), (2), or (3) of section 1710(a)''; and
                    (B) by striking out paragraph (3).
            (9) Section 1722 is amended--
                    (A) in subsection (a), by striking out ``section 
                1710(a)(1)(I)'' and inserting in lieu thereof ``section 
                1710(a)(2)(G)''; and
                    (B) in subsection (f)(3), by striking out ``or 
                1712(f)''.
            (10) Section 1729(g)(3)(A) is amended by striking out 
        ``under section 1710(f) of this title for hospital care or 
        nursing home care, under section 1712(f) of this title for 
        medical services,'' and inserting in lieu thereof ``under 
        subsection (f) or (g) of section 1710 of this title for 
        hospital care, medical services, or nursing home care''.
    (e) Other Conforming and Technical Amendments.--
            (1) Section 1525 is amended--
                    (A) in subsection (a), by striking out ``section 
                1712(h) of this title'' and all that follows through 
                the period at the end and inserting in lieu thereof 
                ``section 1712(d) of this title.''; and
                    (B) in subsection (b), by striking out 
                ``renumeration'' and inserting in lieu thereof 
                ``remuneration''.
            (2) Section 2104(b) is amended--
                    (A) in the first sentence, by striking out 
                ``section 1712(a)'' and inserting in lieu thereof 
                ``section 1717(a)(2)''; and
                    (B) in the second sentence, by striking out 
                ``section 1712(a)'' and inserting in lieu thereof 
                ``section 1717(a)(2)''.
            (3) Section 5317(c)(3) is amended by striking out 
        ``sections 1710(a)(1)(I), 1710(a)(2), 1710(b), and 
        1712(a)(2)(B)'' and inserting in lieu thereof ``subsections 
        (a)(2)(G), (a)(3), and (b) of section 1710''.
            (4) Section 8110(a)(2) is amended by striking out ``section 
        1712'' and inserting in lieu thereof ``section 1710(a)''.
            (5) Section 8111A(b)(2)(A) is amended by striking out 
        ``subsection (f) of section 1712'' and inserting in lieu 
        thereof ``subsection (a) of section 1710''.

SEC. 102. REVISION IN AUTHORITIES FOR PROVISION OF PRIORITY HEALTH CARE 
              FOR CERTAIN VETERANS EXPOSED TO SPECIFIED TOXIC 
              SUBSTANCES.

    (a) Authorized Inpatient Care.--Section 1710(e) is amended--
            (1) in paragraph (1), by striking out subparagraphs (A) and 
        (B) and inserting in lieu thereof the following:
    ``(A) A Vietnam-era herbicide-exposed veteran is eligible (subject 
to paragraph (2)) for hospital care, medical services, and nursing home 
care under subsection (a)(2)(F) for any disability, notwithstanding 
that there is insufficient medical evidence to conclude that such 
disability may be associated with such exposure.
    ``(B) A radiation-exposed veteran is eligible for hospital care, 
medical services, and nursing home care under subsection (a)(2)(F) for 
any disease suffered by the veteran that is--
            ``(i) a disease listed in section 1112(c)(2) of this title; 
        or
            ``(ii) any other disease for which the Secretary, based on 
        the advice of the Advisory Committee on Environmental Hazards, 
        determines that there is credible evidence of a positive 
        association between occurrence of the disease in humans and 
        exposure to ionizing radiation.''; and
            (2) by striking out paragraphs (2) and (3) and inserting in 
        lieu thereof the following:
    ``(2)(A) In the case of a veteran described in paragraph (1)(A), 
hospital care, medical services, and nursing home care may not be 
provided under subsection (a)(2)(F) with respect to--
            ``(i) a disability that is found, in accordance with 
        guidelines issued by the Under Secretary for Health, to have 
        resulted from a cause other than an exposure described in 
        paragraph (4)(A)(ii); or
            ``(ii) a disease for which the National Academy of 
        Sciences, in a report issued in accordance with section 2 of 
        the Agent Orange Act of 1991, has determined that there is 
        limited or suggestive evidence of the lack of a positive 
        association between occurrence of the disease in humans and 
        exposure to a herbicide agent.
    ``(B) In the case of a veteran described in paragraph (1)(C), 
hospital care, medical services, and nursing home care may not be 
provided under subsection (a)(2)(F) with respect to a disability that 
is found, in accordance with guidelines issued by the Under Secretary 
for Health, to have resulted from a cause other than an exposure 
described in that paragraph.
    ``(3) Hospital care, medical services, and nursing home care may 
not be provided under or by virtue of subsection (a)(2)(F)--
            ``(A) in the case of care for a veteran described in 
        paragraph (1)(A), after December 31, 2002; and
            ``(B) in the case of care for a veteran described in 
        paragraph (1)(C), after December 31, 1998.
    ``(4) For purposes of this subsection--
            ``(A) The term `Vietnam-era herbicide-exposed veteran' 
        means a veteran (i) who served on active duty in the Republic 
        of Vietnam during the Vietnam era, and (ii) who the Secretary 
        finds may have been exposed during such service to dioxin or 
        was exposed during such service to a toxic substance found in a 
        herbicide or defoliant used for military purposes during such 
        era.
            ``(B) The term `radiation-exposed veteran' has the meaning 
        given that term in section 1112(c)(3) of this title.''.
    (b) Savings Provisions.--The provisions of sections 1710(e) and 
1712(a) of title 38, United States Code, as in effect on the day before 
the date of the enactment of this Act, shall continue to apply on and 
after such date with respect to the furnishing of hospital care, 
nursing home care, and medical services for any veteran who was 
furnished such care or services before such date of enactment on the 
basis of presumed exposure to a substance or radiation under the 
authority of those provisions, but only for treatment for a disability 
for which such care or services were furnished before such date.

SEC. 103. PROSTHETICS AND PREVENTIVE CARE.

    (a) Eligibility.--Section 1701(6)(A)(i) is amended--
            (1) by striking out ``(in the case of a person otherwise 
        receiving care or services under this chapter)'' and ``(except 
        under the conditions described in section 1712(a)(5)(A) of this 
        title),'';
            (2) by inserting ``(in the case of a person otherwise 
        receiving care or services under this chapter)'' before 
        ``wheelchairs,''; and
            (3) by inserting ``except that the Secretary may not 
        furnish sensori-neural aids other than in accordance with 
        guidelines which the Secretary shall prescribe,'' after 
        ``reasonable and necessary,''.
    (b) Regulations.--Not later than 30 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
prescribe the guidelines required by the amendments made by subsection 
(a) and shall furnish a copy of those guidelines to the Committees on 
Veterans' Affairs of the Senate and House of Representatives.

SEC. 104. MANAGEMENT OF HEALTH CARE.

    (a) In General.--(1) Chapter 17 is amended by inserting after 
section 1704 the following new sections:
``Sec. 1705. Management of health care: patient enrollment system
    ``(a) In managing the provision of hospital care and medical 
services under section 1710(a) of this title, the Secretary, in 
accordance with regulations the Secretary shall prescribe, shall 
establish and operate a system of annual patient enrollment. The 
Secretary shall manage the enrollment of veterans in accordance with 
the following priorities, in the order listed:
            ``(1) Veterans with service-connected disabilities rated 50 
        percent or greater.
            ``(2) Veterans with service-connected disabilities rated 30 
        percent or 40 percent.
            ``(3) Veterans who are former prisoners of war, veterans 
        with service-connected disabilities rated 10 percent or 20 
        percent, and veterans described in subparagraphs (B) and (C) of 
        section 1710(a)(2) of this title.
            ``(4) Veterans who are in receipt of increased pension 
        based on a need of regular aid and attendance or by reason of 
        being permanently housebound and other veterans who are 
        catastrophically disabled.
            ``(5) Veterans not covered by paragraphs (1) through (4) 
        who are unable to defray the expenses of necessary care as 
        determined under section 1722(a) of this title.
            ``(6) All other veterans eligible for hospital care, 
        medical services, and nursing home care under section 
        1710(a)(2) of this title.
            (7) Veterans described in section 1710(a)(3) of this title.
    ``(b) In the design of an enrollment system under subsection (a), 
the Secretary--
            ``(1) shall ensure that the system will be managed in a 
        manner to ensure that the provision of care to enrollees is 
        timely and acceptable in quality;
            ``(2) may establish additional priorities within each 
        priority group specified in subsection (a), as the Secretary 
        determines necessary; and
            ``(3) may provide for exceptions to the specified 
        priorities where dictated by compelling medical reasons.
    ``(c)(1) Effective on October 1, 1998, the Secretary may not 
provide hospital care or medical services to a veteran under paragraph 
(2) or (3) of section 1710(a) of this title unless the veteran enrolls 
in the system of patient enrollment established by the Secretary under 
subsection (a).
    ``(2) The Secretary shall provide hospital care and medical 
services under section 1710(a)(1) of this title, and under subparagraph 
(B) of section 1710(a)(2) of this title, for the 12-month period 
following such veteran's discharge or release from service, to any 
veteran referred to in such sections for a disability specified in the 
applicable subparagraph of such section, notwithstanding the failure of 
the veteran to enroll in the system of patient enrollment referred to 
in subsection (a) of this section.
``Sec. 1706. Management of health care: other requirements
    ``(a) In managing the provision of hospital care and medical 
services under section 1710(a) of this title, the Secretary shall, to 
the extent feasible, design, establish and manage health care programs 
in such a manner as to promote cost-effective delivery of health care 
services in the most clinically appropriate setting.
    ``(b)(1) In managing the provision of hospital care and medical 
services under such section, the Secretary shall ensure that the 
Department maintains its capacity to provide for the specialized 
treatment and rehabilitative needs of disabled veterans (including 
veterans with spinal cord dysfunction, blindness, amputations, and 
mental illness) within distinct programs or facilities of the 
Department that are dedicated to the specialized needs of those 
veterans in a manner that (A) affords those veterans reasonable access 
to care and services for those specialized needs, and (B) ensures that 
overall capacity of the Department to provide such services is not 
reduced below the capacity of the Department, nationwide, to provide 
those services, as of the date of the enactment of this section. The 
Secretary shall carry out this paragraph in consultation with the 
Advisory Committee on Prosthetics and Special Disabilities Programs and 
the Committee on Care of Severely Chronically Mentally Ill Veterans.
    ``(2) Not later than April 1, 1997, April 1, 1998, and April 1, 
1999, the Secretary shall submit to the Committees on Veterans' Affairs 
of the Senate and House of Representatives a report on the Secretary's 
compliance, by facility and by service-network, with the requirements 
of this subsection.''.
    (2) The table of sections at the beginning of chapter 17 is amended 
by inserting after the item relating to section 1704 the following new 
items:

``1705. Management of health care: patient enrollment system.
``1706. Management of health care: other requirements.''.
    (b) Conforming Amendments to Section 1703.--Section 1703(a) is 
amended--
            (1) in the matter preceding paragraph (1), by striking out 
        ``or 1712'';
            (2) in paragraph (2)--
                    (A) by striking out ``1712(a)(1)(B)'' in 
                subparagraph (A) and inserting in lieu thereof 
                ``1710(a)(1)(B)'';
                    (B) by striking out subparagraph (B) and inserting 
                in lieu thereof the following:
                    ``(B) a veteran who (i) has been furnished hospital 
                care, nursing home care, domiciliary care, or medical 
                services, and (ii) requires medical services to 
                complete treatment incident to such care or services; 
                or''; and
                    (C) by striking ``section 1712(a)(3) (other than a 
                veteran who is a former prisoner of war) of this 
                title'' in subparagraph (C) and inserting in lieu 
                thereof ``section 1710(a)(2)(E) of this title, or a 
                veteran who is in receipt of increased pension, or 
                additional compensation or allowances based on the need 
                of regular aid and attendance or by reason of being 
                permanently housebound (or who, but for the receipt of 
                retired pay, would be in receipt of such pension, 
                compensation, or allowance),''; and
            (3) in paragraph (7), by striking out ``1712(b)(1)(F)'' and 
        inserting in lieu thereof ``1712(a)(1)(F)''.

SEC. 105. AUTHORIZATION OF APPROPRIATIONS.

    There is authorized to be appropriated for the Department of 
Veterans Affairs for the Medical Care account, for the purposes 
specified for that account in Public Law 103-327 (108 Stat. 2300), 
including the cost of providing hospital care and medical services 
under the amendments made by section this title, not to exceed 
$17,250,000,000 for fiscal year 1997 and not to exceed $17,900,000,000 
for fiscal year 1998.

SEC. 106. ASSESSMENT OF IMPLEMENTATION AND OPERATION.

    (a) Assessment Systems.--The Secretary of Veterans Affairs shall 
establish information systems to assess the experience of the 
Department of Veterans Affairs in implementing sections 101, 103, and 
104, including the amendments made by those sections, during fiscal 
year 1997. The Secretary shall establish those information systems in 
time to include assessments under such systems in the report required 
under subsection (b).
    (b) Report.--Not later than March 1, 1998, the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report reflecting the experience of the Department 
during fiscal year 1997 on--
            (1) the effect of implementation of, and provision and 
        management of care under, sections 101, 103, and 104 (including 
        the amendments made by those sections) on demand for health 
        care services from the Department of Veterans Affairs by 
        veterans described in paragraphs (1), (2), and (3) of section 
        1710(a) of title 38, United States Code, as amended by section 
        101;
            (2) any differing patterns of demand on the part of such 
        veterans relating to such factors as relative distance from 
        Department facilities and prior experience, or lack of 
        experience, as recipients of care from the Department;
            (3) the extent to which the Department has met such demand 
        for care; and
            (4) changes in health-care delivery patterns in Department 
        facilities and the fiscal impact of such changes.
    (c) Matters To Be Included.--The report under subsection (b) shall 
include detailed information with respect to fiscal year 1997 regarding 
the following:
            (1) The number of veterans enrolled for care at each 
        Department medical facility and, of such veterans, the number 
        enrolled at each such facility who had not received care from 
        the Department during the preceding three fiscal years.
            (2) With respect to the veterans who had not received care 
        from the Department during the three preceding fiscal years, 
        the total cost of providing care to such veterans, shown in 
        total and separately (A) by level of care, and (B) by reference 
        to whether care was furnished in Department facilities or under 
        contract arrangements.
            (3) With respect to the number of veterans described in 
        paragraphs (1), (2), and (3) of section 1710(a) of title 38, 
        United States Code, as amended by section 101, who applied for 
        health care from the Department during fiscal year 1997--
                    (A) the number who applied for care (shown in total 
                and separately by facility);
                    (B) the number who were denied enrollment (shown in 
                total and separately by facility); and
                    (C) the number who were denied care which was 
                considered to be medically necessary but not of an 
                emergency nature (shown in total and separately by 
                facility).
            (4) The numbers and characteristics of, and the type and 
        extent of health care furnished to, veterans enrolled for care 
        (shown in total and separately by facility).
            (5) The numbers and characteristics of, and the type and 
        extent of health care furnished to, veterans not enrolled for 
        care (shown separately by reference to each class of 
        eligibility, both in total and separately by facility).
            (6) The specific fiscal impact (shown in total and by 
        geographic health-care delivery areas) of changes in delivery 
        patterns instituted under the amendments made by this title.

                  TITLE II--CONSTRUCTION AUTHORIZATION

SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

    (a) Ambulatory Care Addition Projects.--The Secretary of Veterans 
Affairs may carry out the following ambulatory care addition major 
medical facility projects, with each project to be carried out in the 
amount specified for that project:
            (1) Construction of an ambulatory care facility and 
        renovation of ``E'' wing, Tripler Army Hospital, Honolulu, 
        Hawaii, $43,000,000.
            (2) Addition of ambulatory care facilities at the 
        Department of Veterans Affairs medical center in Brockton, 
        Massachusetts, $13,500,000.
            (3) Addition of ambulatory care facilities for outpatient 
        improvements at the Department of Veterans Affairs medical 
        center in Shreveport, Louisiana, $25,000,000.
            (4) Addition of ambulatory care facilities at the 
        Department of Veterans Affairs medical center in Lyons, New 
        Jersey, $21,100,000.
            (5) Addition of ambulatory care facilities at the 
        Department of Veterans Affairs medical center in Tomah, 
        Wisconsin, $12,700,000.
            (6) Addition of ambulatory care facilities at the 
        Department of Veterans Affairs medical center in Asheville, 
        North Carolina, $26,300,000.
            (7) Addition of ambulatory care facilities at the 
        Department of Veterans Affairs medical center in Temple, Texas, 
        $9,800,000.
            (8) Addition of ambulatory care facilities at the 
        Department of Veterans Affairs medical center in Tucson, 
        Arizona, $35,500,000.
            (9) Construction of an ambulatory care facility at the 
        Department of Veterans Affairs medical center in Leavenworth, 
        Kansas, $27,750,000.
    (b) Environmental Improvement Projects.--The Secretary may carry 
out the following environmental improvement major medical facility 
projects, with each project to be carried out in the amount specified 
for that project:
            (1) Environmental improvements for the renovation of 
        nursing home facilities at the Department of Veterans Affairs 
        medical center in Lebanon, Pennsylvania, $9,500,000.
            (2) Environmental improvements at the Department of 
        Veterans Affairs medical center in Marion, Illinois, 
        $11,500,000.
            (3) Environmental improvements for ward renovation for 
        patient privacy at the Department of Veterans Affairs medical 
        center in Omaha, Nebraska, $7,700,000.
            (4) Environmental improvements at the Department of 
        Veterans Affairs medical center in Pittsburgh, Pennsylvania, 
        $17,400,000.
            (5) Environmental improvements for the renovation of 
        various buildings at the Department of Veterans Affairs medical 
        center in Waco, Texas, $26,000,000.
            (6) Environmental improvements for the replacement of 
        psychiatric beds at the Department of Veterans Affairs medical 
        center in Marion, Indiana, $17,300,000.
            (7) Environmental improvements for the renovation of 
        psychiatric wards at the Department of Veterans Affairs medical 
        center in Perry Point, Maryland, $15,100,000.
            (8) Environmental enhancement at the Department of Veterans 
        Affairs medical center in Salisbury, North Carolina, 
        $18,200,000.
    (c) Seismic Correction Project.--The Secretary may carry out 
seismic corrections to Building Number 324 at the Department of 
Veterans Affairs medical center in Palo Alto, California, in the amount 
of $20,800,000.
    (d) Project Authorization When Partial Funding Provided.--If the 
amount of funds appropriated for fiscal year 1997 or 1998 for design 
and partial construction of a major medical facility project that is 
authorized in this section is less than the amount required to complete 
the construction of that project as authorized and if the Secretary 
obligates funds for such construction, such project shall be deemed to 
be fully authorized. Any such authorization shall cease to have effect 
at the close of fiscal year 2001.

SEC. 202. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

    The Secretary of Veterans Affairs may enter into leases for medical 
facilities as follows:
            (1) Lease of a satellite outpatient clinic in Allentown, 
        Pennsylvania, in an amount not to exceed $2,159,000.
            (2) Lease of a satellite outpatient clinic in Beaumont, 
        Texas, in an amount not to exceed $1,940,000.
            (3) Lease of a satellite outpatient clinic in Boston, 
        Massachusetts, in an amount not to exceed $2,358,000.
            (4) Lease of a parking facility in Cleveland, Ohio, in an 
        amount not to exceed $1,300,000.
            (5) Lease of a satellite outpatient clinic and Veterans 
        Benefits Administration field office in San Antonio, Texas, in 
        an amount not to exceed $2,256,000.
            (6) Lease of a satellite outpatient clinic in Toledo, Ohio, 
        in an amount not to exceed $2,223,000.

SEC. 203. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to the 
Secretary of Veterans Affairs for fiscal year 1997 and fiscal year 
1998--
            (1) for the Construction, Major Projects, account, a total 
        of $358,150,000 for the projects authorized in section 201; and
            (2) for the Medical Care account, a total of $12,236,000 
        for the leases authorized in section 202.
    (b) Limitation.--The projects authorized in section 201 may only be 
carried out using--
            (1) funds appropriated for fiscal year 1997 or fiscal year 
        1998 consistent with the authorization of appropriations in 
        subsection (a);
            (2) funds appropriated for Construction, Major Projects for 
        a fiscal year before fiscal year 1997 that remain available for 
        obligation; and
            (3) funds appropriated for Construction, Major Projects for 
        fiscal year 1997 or fiscal year 1998 for a category of activity 
        not specific to a project.

SEC. 204. STRATEGIC PLANNING.

    Section 8107 is amended--
            (1) by redesignating subsection (b) as subsection (c);
            (2) by striking out subsection (a) and inserting in lieu 
        thereof the following new subsections:
    ``(a) In order to promote effective planning for the efficient 
provision of care to eligible veterans, the Secretary, based on the 
analysis and recommendations of the Under Secretary for Health, shall 
submit to each committee an annual report regarding long-range health 
planning of the Department. The report shall be submitted each year not 
later than the date on which the budget for the next fiscal year is 
submitted to the Congress under section 1105 of title 31.
    ``(b) Each report under subsection (a) shall include the following:
            ``(1) A five-year strategic plan for the provision of care 
        under chapter 17 of this title to eligible veterans through 
        coordinated networks of medical facilities operating within 
        prescribed geographic service-delivery areas, such plan to 
        include provision of services for the specialized treatment and 
        rehabilitative needs of disabled veterans (including veterans 
        with spinal cord dysfunction, blindness, amputations, and 
        mental illness) through distinct programs or facilities of the 
        Department dedicated to the specialized needs of those 
        veterans.
            ``(2) A description of how planning for the networks will 
        be coordinated.
            ``(3) A profile regarding each such network of medical 
        facilities which identifies--
                    ``(A) the mission of each existing or proposed 
                medical facility in the network;
                    ``(B) any planned change in the mission for any 
                such facility and the rationale for such planned 
                change;
                    ``(C) the population of veterans to be served by 
                the network and anticipated changes over a five-year 
                period and a ten-year period, respectively, in that 
                population and in the health-care needs of that 
                population;
                    ``(D) information relevant to assessing progress 
                toward the goal of achieving relative equivalency in 
                the level of resources per patient distributed to each 
                network, such information to include the plans for and 
                progress toward lowering the cost of care-delivery in 
                the network (by means such as changes in the mix in the 
                network of physicians, nurses, physician assistants, 
                and advance practice nurses);
                    ``(E) the capacity of non-Federal facilities in the 
                network to provide acute, long-term, and specialized 
                treatment and rehabilitative services (described in 
                section 7305 of this title), and determinations 
                regarding the extent to which services to be provided 
                in each service-delivery area and each facility in such 
                area should be provided directly through facilities of 
                the Department or through contract or other 
                arrangements, including arrangements authorized under 
                sections 8111 and 8153 of this title; and
                    ``(F) a five-year plan for construction, 
                replacement, or alteration projects in support of the 
                approved mission of each facility in the network and a 
                description of how those projects will improve access 
                to care, or quality of care, for patients served in the 
                network.
            ``(4) A status report for each facility on progress 
        toward--
                    ``(A) instituting planned mission changes 
                identified under paragraph (3)(B);
                    ``(B) implementing principles of managed care of 
                eligible veterans; and
                    ``(C) developing and instituting cost-effective 
                alternatives to provision of institutional care.''; and
            (3) by adding at the end the following new subsection:
    ``(d)(1) The Secretary shall submit to each committee, not later 
than January 31 of each year, a report showing the current priorities 
of the Department for proposed major medical construction projects. 
Each such report shall identify the 20 projects, from within all the 
projects in the Department's inventory of proposed projects, that have 
the highest priority and, for those 20 projects, the relative priority 
and rank scoring of each such project and the projected cost of such 
project (including the projected operating costs, including both 
recurring and nonrecurring costs). The 20 projects shall be compiled, 
and their relative rankings shall be shown, by category of project 
(including the categories of ambulatory care projects, nursing home 
care projects, and such other categories as the Secretary determines).
    ``(2) The Secretary shall include in each report, for each project 
listed, a description of the specific factors that account for the 
relative ranking of that project in relation to other projects within 
the same category.
    ``(3) In a case in which the relative ranking of a proposed project 
has changed since the last report under this subsection was submitted, 
the Secretary shall also include in the report a description of the 
reasons for the change in the ranking, including an explanation of any 
change in the scoring of the project under the Department's scoring 
system for proposed major medical construction projects.''.

SEC. 205. REVISION TO PROSPECTUS REQUIREMENTS.

    (a) Additional Information.--Section 8104(b) is amended--
            (1) by striking out the matter preceding paragraph (1) and 
        inserting in lieu thereof the following:
    ``(b) Whenever the President or the Secretary submit to the 
Congress a request for the funding of a major medical facility project 
(as defined in subsection (a)(3)(A)) or a major medical facility lease 
(as defined in subsection (a)(3)(B)), the Secretary shall submit to 
each committee, on the same day, a prospectus of the proposed medical 
facility. Any such prospectus shall include the following:'';
            (2) in paragraph (1)--
                    (A) by striking out ``a detailed'' and inserting in 
                lieu thereof ``A detailed''; and
                    (B) by striking out the semicolon at the end and 
                inserting in lieu thereof a period;
            (3) in paragraph (2)--
                    (A) by striking out ``an estimate'' and inserting 
                in lieu thereof ``An estimate''; and
                    (B) by striking out ``; and'' and inserting in lieu 
                thereof a period;
            (4) in paragraph (3), by striking out ``an estimate'' and 
        inserting in lieu thereof ``An estimate''; and
            (5) by adding at the end the following new paragraphs:
            ``(4) Demographic data applicable to such facility, 
        including information on projected changes in the population of 
        veterans to be served by the facility over a five-year period 
        and a ten-year period.
            ``(5) Current and projected workload and utilization data 
        regarding the facility.
            ``(6) Current and projected operating costs of the 
        facility, including both recurring and non-recurring costs.
            ``(7) The priority score assigned to the project or lease 
        under the Department's prioritization methodology and, if the 
        project or lease is being proposed for funding before a project 
        or lease with a higher score, a specific explanation of the 
        factors other than the priority score that were considered and 
        the basis on which the project or lease is proposed for funding 
        ahead of projects or leases with higher priority scores.
            ``(8) In the case of a prospectus proposing the 
        construction of a new or replacement medical facility, a 
        description of each alternative to construction of the facility 
        that was considered.''.
    (b) Applicability.--The amendments made by subsection (a) shall 
apply with respect to any prospectus submitted by the Secretary of 
Veterans Affairs after the date of the enactment of this Act.

SEC. 206. CONSTRUCTION AUTHORIZATION REQUIREMENTS.

    (a) Definition of Major Medical Facility Project.--Paragraph (3)(A) 
of section 8104(a) is amended by striking out ``$3,000,000'' and 
inserting in lieu thereof ``$4,000,000''.
    (b) Applicability of Construction Authorization Requirement.--(1) 
Subsection (b) of section 301 of the Veterans' Medical Programs 
Amendments of 1992 (Public Law 102-405; 106 Stat. 1984) is repealed.
    (2) The amendments made by subsection (a) of such section shall 
apply with respect to any major medical facility project or any major 
medical facility lease of the Department of Veterans Affairs, 
regardless of when funds are first appropriated for that project or 
lease, except that in the case of a project for which funds were first 
appropriated before October 9, 1992, such amendments shall not apply 
with respect to amounts appropriated for that project for a fiscal year 
before fiscal year 1998.
    (c) Limitation on Obligations for Advance Planning.--Section 8104 
is amended by adding at the end the following new subsection:
    ``(f) The Secretary may not obligate funds in an amount in excess 
of $500,000 from the Advance Planning Fund of the Department toward 
design or development of a major medical facility project (as defined 
in subsection (a)(3)(A)) until--
            ``(1) the Secretary submits to the committees a report on 
        the proposed obligation; and
            ``(2) a period of 30 days has passed after the date on 
        which the report is received by the committees.''.

SEC. 207. TERMINOLOGY CHANGES.

    (a) Definition of ``Construct''.--Section 8101(2) is amended--
            (1) by striking out ``working drawings'' and inserting in 
        lieu thereof ``construction documents''; and
            (2) by striking out ``preliminary plans'' and inserting in 
        lieu thereof ``design development''.
    (b) Parking Facilities.--Section 8109(h)(3)(B) is amended by 
striking out ``working drawings'' and inserting in lieu thereof 
``construction documents''.

               TITLE III--HEALTH CARE AND ADMINISTRATION

           Subtitle A--Health Care Sharing and Administration

SEC. 301. REVISION OF AUTHORITY TO SHARE MEDICAL FACILITIES, EQUIPMENT, 
              AND INFORMATION.

    (a) Statement of Purpose.--The text of section 8151 is amended to 
read as follows:
    ``It is the purpose of this subchapter to strengthen the medical 
programs at Department facilities and improve the quality of health 
care provided veterans under this title by authorizing the Secretary to 
enter into agreements with health-care providers in order to share 
health-care resources with, and receive health-care resources from, 
such providers while ensuring no diminution of services to veterans.''.
    (b) Definitions.--Section 8152 is amended--
            (1) by striking out paragraphs (1), (2), and (3) and 
        inserting in lieu thereof the following new paragraphs (1) and 
        (2):
            ``(1) The term `health-care resource' includes hospital 
        care and medical services (as those terms are defined in 
        section 1701 of this title), any other health-care service, and 
        any health-care support or administrative resource.
            ``(2) The term `health-care providers' includes health-care 
        plans and insurers and any organizations, institutions, or 
        other entities or individuals who furnish health-care 
        resources.''; and
            (2) by redesignating paragraph (4) as paragraph (3).
    (c) Authority To Secure Health-Care Resources.--Section 8153 is 
amended as follows:
            (1) Subsection (a) is amended--
                    (A) in paragraph (1)--
                            (i) by striking out ``certain specialized 
                        medical resources'' and inserting in lieu 
                        thereof ``health-care resources'';
                            (ii) by striking out ``other medical 
                        resources'' and inserting in lieu thereof 
                        ``other health-care resources''; and
                            (iii) by striking out ``of--'' and all that 
                        follows through ``section 1742(a) of this 
                        title'' and inserting in lieu thereof ``of 
                        health-care resources between Department 
                        health-care facilities and any health-care 
                        provider, or other entity or individual'';
                    (B) in paragraph (2), by striking out ``only'' and 
                all that follows through ``are not'' and inserting in 
                lieu thereof ``if such resources are not, or would not 
                be,''; and
                    (C) by adding at the end the following:
    ``(3)(A) If the health-care resource required is a commercial 
service, the use of medical equipment or space, or research, and is to 
be acquired from an institution affiliated with the Department in 
accordance with section 7302 of this title, including medical practice 
groups and other entities associated with affiliated institutions, 
blood banks, organ banks, or research centers, the Secretary may make 
arrangements for acquisition of the resource without regard to any law 
or regulation that would otherwise require the use of competitive 
procedures for acquiring the resource.
    ``(B)(i) If the health-care resource required is a commercial 
service or the use of medical equipment or space, and is not to be 
acquired from an entity described in subparagraph (A), any procurement 
of the resource may be conducted without regard to any law or 
regulation that would otherwise require the use of competitive 
procedures for procuring the resource, but only if the procurement is 
conducted in accordance with the simplified procedures prescribed 
pursuant to clause (ii).
    ``(ii) The Secretary, in consultation with the Administrator for 
Federal Procurement Policy, may prescribe simplified procedures for the 
procurement of health-care resources under this subparagraph. The 
Secretary shall publish such procedures for public comment in 
accordance with section 22 of the Office of Federal Procurement Policy 
Act (41 U.S.C. 418b). Such procedures shall permit all responsible 
sources to submit a bid, proposal, or quotation (as appropriate) for 
the resources to be procured and provide for the consideration by the 
Department of bids, proposals, or quotations so submitted.
    ``(iii) Pending publication of the procedures under clause (ii), 
the Secretary shall (except as provided under subparagraph (A)) procure 
health-care resources referred to in clause (i) in accordance with all 
procurement laws and regulations.
    ``(C) Any procurement of health-care resources other than those 
covered by subparagraph (A) or (B) shall be conducted in accordance 
with all procurement laws and regulations.
    ``(D) For any procurement to be conducted on a sole source basis 
other than a procurement covered by subparagraph (A), a written 
justification shall be prepared that includes the information and is 
approved at the levels prescribed in section 303(f) of the Federal 
Property and Administrative Services Act of 1949 (41 U.S.C. 253(f)).
    ``(E) As used in this paragraph, the term `commercial service' 
means a service that is offered and sold competitively in the 
commercial marketplace, is performed under standard commercial terms 
and conditions, and is procured using firm-fixed price contracts.''.
            (2) Subsection (b) is amended by striking out ``reciprocal 
        reimbursement'' in the first sentence and all that follows 
        through the period at the end of that sentence and inserting in 
        lieu thereof ``payment to the Department in accordance with 
        procedures that provide appropriate flexibility to negotiate 
        payment which is in the best interest of the Government.''.
            (3) Subsection (d) is amended by striking out ``preclude 
        such payment, in accordance with--'' and all that follows 
        through ``to such facility therefor'' and inserting in lieu 
        thereof ``preclude such payment to such facility for such care 
        or services''.
            (4) Such section is further amended--
                    (A) by redesignating subsection (e) as subsection 
                (g); and
                    (B) by inserting after subsection (d) the following 
                new subsections:
    ``(e) The Secretary may make an arrangement that authorizes the 
furnishing of services by the Secretary under this section to 
individuals who are not veterans only if the Secretary determines--
            ``(1) that veterans will receive priority under such an 
        arrangement; and
            ``(2) that such an arrangement--
                    ``(A) is necessary to maintain an acceptable level 
                and quality of service to veterans at that facility; or
                    ``(B) will result in the improvement of services to 
                eligible veterans at that facility.
    ``(f) Any amount received by the Secretary from a non-Federal 
entity as payment for services provided by the Secretary during a prior 
fiscal year under an agreement entered into under this section may be 
obligated by the Secretary during the fiscal year in which the 
Secretary receives the payment.''.
    (d) Clerical Amendments.--(1) The heading of section 8153 is 
amended to read as follows:
``Sec. 8153. Sharing of health-care resources''.
    (2) The item relating to section 8153 in the table of sections at 
the beginning of chapter 81 is amended to read as follows:

``8153. Sharing of health-care resources.''.

SEC. 302. IMPROVED EFFICIENCY IN HEALTH CARE RESOURCE MANAGEMENT.

    (a) Temporary Expansion of Authority for Sharing Agreements.--
Section 201 of the Veterans Health Care Act of 1992 (Public Law 102-
585; 38 U.S.C. 8111 note) is amended--
            (1) by inserting ``(a) Authority.--'' before ``The 
        Secretary of Veterans Affairs''; and
            (2) by adding at the end thereof the following new 
        subsection:
    ``(b) Use of Funds.--Any amount received by the Secretary from a 
non-Federal entity as payment for services provided by the Secretary 
during a prior fiscal year under an agreement entered into under this 
section may be obligated by the Secretary during the fiscal year in 
which the Secretary receives the payment.''.
    (b) Repeal of Sunset Provision.--(1) Section 204 of such Act (38 
U.S.C. 8111 note) is repealed.
    (2) Any services provided pursuant to agreements entered into under 
section 201 of such Act (38 U.S.C. 8111 note) during the period 
beginning on October 1, 1996, and ending on the date of the enactment 
of this Act are hereby ratified.
    (c) Cost Recovery.--Title II of such Act is further amended by 
adding at the end the following new section:

``SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.

    ``(a) Right To Recover.--In the case of a primary beneficiary (as 
described in section 201(a)(2)(B)) who has coverage under a health-plan 
contract, as defined in section 1729(i)(1)(A) of title 38, United 
States Code, and who is furnished care or services by a Department 
medical facility pursuant to this title, the United States shall have 
the right to recover or collect charges for such care or services from 
such health-plan contract to the extent that the beneficiary (or the 
provider of the care or services) would be eligible to receive payment 
for such care or services from such health-plan contract if the care or 
services had not been furnished by a department or agency of the United 
States. Any funds received from such health-plan contract shall be 
credited to funds that have been allotted to the facility that 
furnished the care or services.
    ``(b) Enforcement.--The right of the United States to recover under 
such a beneficiary's health-plan contract shall be enforceable in the 
same manner as that provided by subsections (a)(3), (b), (c)(1), (d), 
(f), (h), and (i) of section 1729 of title 38, United States Code.''.

SEC. 303. PERSONNEL FURNISHING SHARED RESOURCES.

    Section 712(b)(2) is amended--
            (1) by striking out ``the sum of--'' and inserting in lieu 
        thereof ``the sum of the following:'';
            (2) by capitalizing the first letter of the first word of 
        each of subparagraphs (A) and (B);
            (3) by striking out ``; and'' at the end of subparagraph 
        (A) and inserting in lieu thereof a period; and
            (4) by adding at the end the following new subparagraph:
                    ``(C) The number of such positions in the 
                Department during that fiscal year held by persons 
                involved in providing health-care resources under 
                section 8111 or 8153 of this title or under section 201 
                of the Veterans Health Care Act of 1992 (Public Law 
                102-585; 106 Stat. 4949; 38 U.S.C. 8111 note).''.

SEC. 304. WAITING PERIOD FOR ADMINISTRATIVE REORGANIZATIONS.

    Section 510(b) is amended--
            (1) in the second sentence, by striking out ``a 90-day 
        period of continuous session of Congress following the date of 
        the submission of the report'' and inserting in lieu thereof 
        ``a 45-day period following the date of the submission of the 
        report, not less than 30 days of which shall be days during 
        which Congress shall have been in continuous session''; and
            (2) in the third sentence, by striking out ``such 90-day 
        period'' and inserting in lieu thereof ``any period of 
        continuity of session''.

SEC. 305. REPEAL OF LIMITATIONS ON CONTRACTS FOR CONVERSION OF 
              PERFORMANCE OF ACTIVITIES OF DEPARTMENT HEALTH-CARE 
              FACILITIES AND REVISED ANNUAL REPORTING REQUIREMENT.

    Subsection (c) of section 8110 is amended to read as follows:
    ``(c) The Secretary shall include in the materials submitted to 
Congress each year in support of the budget of the Department for the 
next fiscal year a report on activities and proposals involving 
contracting for performance by contractor personnel of work previously 
performed by Department employees. The report shall--
            ``(1) identify those specific activities that are currently 
        performed at a Department facility by more than 10 Department 
        employees which the Secretary proposes to study for possible 
        contracting involving conversion from performance by Department 
        employees to performance by employees of a contractor; and
            ``(2) identify those specific activities that have been 
        contracted for performance by contractor employees during the 
        prior fiscal year (shown by location, subject, scope of 
        contracts, and savings) and shall describe the effect of such 
        contracts on the quality of delivery of health services during 
        such year.''.

                   Subtitle B--Care of Women Veterans

SEC. 321. MAMMOGRAPHY QUALITY STANDARDS.

    (a) In General.--(1) Subchapter II of chapter 73 is amended by 
adding after section 7318 the following new section:
``Sec. 7319. Mammography quality standards
    ``(a) A mammogram may not be performed at a Department facility 
unless that facility is accredited for that purpose by a private 
nonprofit organization designated by the Secretary. An organization 
designated by the Secretary under this subsection shall meet the 
standards for accrediting bodies established under subsection (e) of 
section 354 of the Public Health Service Act (42 U.S.C. 263b).
    ``(b) The Secretary, in consultation with the Secretary of Health 
and Human Services, shall prescribe quality assurance and quality 
control standards relating to the performance and interpretation of 
mammograms and use of mammogram equipment and facilities of the 
Department of Veterans Affairs consistent with the requirements of 
section 354(f)(1) of the Public Health Service Act. Such standards 
shall be no less stringent than the standards prescribed by the 
Secretary of Health and Human Services under section 354(f) of the 
Public Health Service Act.
    ``(c)(1) The Secretary, to ensure compliance with the standards 
prescribed under subsection (b), shall provide for an annual inspection 
of the equipment and facilities used by and in Department health care 
facilities for the performance of mammograms. Such inspections shall be 
carried out in a manner consistent with the inspection of certified 
facilities by the Secretary of Health and Human Services under section 
354(g) of the Public Health Service Act.
    ``(2) The Secretary may not provide for an inspection under 
paragraph (1) to be performed by a State agency.
    ``(d) The Secretary shall ensure that mammograms performed for the 
Department under contract with any non-Department facility or provider 
conform to the quality standards prescribed by the Secretary of Health 
and Human Services under section 354 of the Public Health Service Act.
    ``(e) For the purposes of this section, the term `mammogram' has 
the meaning given such term in paragraph (5) of section 354(a) of the 
Public Health Service Act.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 7318 the 
following new item:

``7319. Mammography quality standards.''.
    (b) Deadline for Prescribing Standards.--The Secretary of Veterans 
Affairs shall prescribe standards under subsection (b) of section 7319 
of title 38, United States Code, as added by subsection (a), not later 
than the end of the 120-day period beginning on the date of the 
enactment of this Act.
    (c) Implementation Report.--The Secretary shall submit to the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives a report on the Secretary's implementation of section 
7319 of title 38, United States Code, as added by subsection (a). The 
report shall be submitted not later than 120 days after the date of the 
enactment of this Act.

SEC. 322. PATIENT PRIVACY FOR WOMEN PATIENTS.

    (a) Identification of Deficiencies.--The Secretary of Veterans 
Affairs shall conduct a survey of each medical center under the 
jurisdiction of the Secretary to identify deficiencies relating to 
patient privacy afforded to women patients in the clinical areas at 
each such center which may interfere with appropriate treatment of such 
patients.
    (b) Correction of Deficiencies.--The Secretary shall ensure that 
plans and, where appropriate, interim steps to correct the deficiencies 
identified in the survey conducted under subsection (a) are developed 
and are incorporated into the Department's construction planning 
processes and, in cases in which it is cost-effective to do so, are 
given a high priority.
    (c) Reports to Congress.--The Secretary shall compile an annual 
inventory, by medical center, of deficiencies identified under 
subsection (a) and of plans and, where appropriate, interim steps, to 
correct such deficiencies. The Secretary shall submit to the Committees 
on Veterans' Affairs of the Senate and House of Representatives, not 
later than October 1, 1997, and not later than October 1 each year 
thereafter through 1999 a report on such deficiencies. The Secretary 
shall include in such report the inventory compiled by the Secretary, 
the proposed corrective plans, and the status of such plans.

SEC. 323. ASSESSMENT OF USE BY WOMEN VETERANS OF DEPARTMENT HEALTH 
              SERVICES.

    (a) Reports to Under Secretary for Health.--The Center for Women 
Veterans of the Department of Veterans Affairs (established under 
section 509 of Public Law 103-446), in consultation with the Advisory 
Committee on Women Veterans, shall assess the use by women veterans of 
health services through the Department of Veterans Affairs, including 
counseling for sexual trauma and mental health services. The Center 
shall submit to the Under Secretary for Health of the Department of 
Veterans Affairs a report not later than April 1, 1997, and April 1 of 
each of the two following years, on--
            (1) the extent to which women veterans described in 
        paragraphs (1) and (2) of section 1710(a) of title 38, United 
        States Code, fail to seek, or face barriers in seeking, health 
        services through the Department, and the reasons therefor; and
            (2) recommendations, if indicated, for encouraging greater 
        use of such services, including (if appropriate) public service 
        announcements and other outreach efforts.
    (b) Reports to Congressional Committees.--Not later than July 1, 
1997, and July 1 of each of the two following years, the Secretary of 
Veterans Affairs shall submit to the Committees on Veterans' Affairs of 
the Senate and House of Representatives a report containing--
            (1) the most recent report of the Center for Women Veterans 
        under subsection (a);
            (2) the views of the Under Secretary for Health on such 
        report's findings and recommendations; and
            (3) a description of the steps being taken by the Secretary 
        to remedy any problems described in the report.

SEC. 324. REPORTING REQUIREMENTS.

    (a) Extension of Annual Report Requirement.--Section 107(a) of the 
Veterans Health Care Act of 1992 (Public Law 102-585; 106 Stat. 4947) 
is amended by striking out ``Not later than January 1, 1993, January 1, 
1994, and January 1, 1995'' and inserting in lieu thereof ``Not later 
than January 1 of 1993 and each year thereafter through 1998''.
    (b) Report on Health Care and Research.--Section 107(b) of such Act 
is amended--
            (1) in paragraph (2)(A), by inserting ``(including 
        information on the number of inpatient stays and the number of 
        outpatient visits through which such services were provided)'' 
        after ``facility''; and
            (2) by adding at the end the following new paragraph:
            ``(5) A description of the actions taken by the Secretary 
        to foster and encourage the expansion of such research.''.

       Subtitle C--Readjustment Counseling and Mental Health Care

SEC. 331. EXPANSION OF ELIGIBILITY FOR READJUSTMENT COUNSELING AND 
              CERTAIN RELATED COUNSELING SERVICES.

    (a) Expansion of Eligibility.--Subsection (a) of section 1712A is 
amended to read as follows:
    ``(a)(1)(A) Upon the request of any veteran referred to in 
subparagraph (B), the Secretary shall furnish counseling to the veteran 
to assist the veteran in readjusting to civilian life. Such counseling 
may include a general mental and psychological assessment of the 
veteran to ascertain whether such veteran has mental or psychological 
problems associated with readjustment to civilian life.
    ``(B) Subparagraph (A) applies to the following veterans:
            ``(i) Any veteran who served on active duty--
                    ``(I) in a theater of combat operations (as 
                determined by the Secretary in consultation with the 
                Secretary of Defense) during the Vietnam era; or
                    ``(II) after May 7, l975, in an area at a time 
                during which hostilities occurred in that area.
            ``(ii) Any veteran (other than a veteran covered by clause 
        (i)) who served on active duty during the Vietnam era who seeks 
        or is furnished such counseling before January 1, 2000.
    ``(2)(A) Upon the request of any veteran (other than a veteran 
covered by paragraph (1)) who served in the active military, naval, or 
air service in a theater of combat operations (as so determined) during 
a period of war, or in any other area during a period in which 
hostilities (as defined in subparagraph (B)) occurred in such area, the 
Secretary may furnish counseling to the veteran to assist the veteran 
in readjusting to civilian life.
    ``(B) For the purposes of subparagraph (A), the term `hostilities' 
means an armed conflict in which the members of the Armed Forces are 
subjected to danger comparable to the danger to which members of the 
Armed Forces have been subjected in combat with enemy armed forces 
during a period of war, as determined by the Secretary in consultation 
with the Secretary of Defense.''.
    (b) Repeal of Referral Provisions.--Subsection (c) of such section 
is repealed.

SEC. 332. REPORTS RELATING TO VET CENTERS.

    (a) Report on Collocation of Vet Centers and Department Outpatient 
Clinics.--(1) Not later than six months after the date of the enactment 
of this Act, the Secretary of Veterans Affairs shall submit to the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives a report on the feasibility and desirability of 
providing for the collocation of Vet Centers and outpatient clinics 
(including rural mobile clinics) of the Department of Veterans Affairs 
as current leases for such centers and clinics expire.
    (2) The report shall include an assessment of the following:
            (A) The results of any collocation of Vet Centers and 
        outpatient clinics carried out by the Secretary before the date 
        of the enactment of this Act, including the effects of such 
        collocation on the quality of care provided at such centers and 
        clinics.
            (B) The effect of such collocation on the capacity of such 
        centers and clinics to carry out their primary mission.
            (C) The extent to which such collocation will impair the 
        operational independence or administrative integrity of such 
        centers and clinics.
            (D) The feasibility of combining the services provided by 
        such centers and clinics in the course of such collocation.
            (E) The advisability of the collocation of centers and 
        clinics of significantly different size.
            (F) The effect of the locations (including urban and rural 
        locations) of the centers and clinics on the feasibility and 
        desirability of such collocation.
            (G) The amount of any costs savings to be achieved by 
        Department as a result of such collocation.
            (H) Any other matter that the Secretary considers 
        appropriate.
    (b) Report on Provision of Limited Health Care Services at 
Readjustment Counseling Centers.--(1) Not later than six months after 
the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall submit to the Committees on Veterans' Affairs of the 
Senate and House of Representatives a report on the feasibility and 
desirability of providing a limited battery of health care services 
(including ambulatory services and health care screening services) to 
veterans at Department of Veterans Affairs readjustment counseling 
centers.
    (2) The report shall include a discussion of the following:
            (A) The effect on the advisability of providing health care 
        services at readjustment counseling centers of the geographic 
        location of such centers, including the urban location and 
        rural location of such centers and the proximity of such 
        centers to Department of Veterans Affairs medical facilities.
            (B) The effect on the advisability of providing such 
        services at such centers of the type and level of services to 
        be provided, and the demographic characteristics (including 
        age, socio-economic status, ethnicity, and sex) of veterans 
        likely to be provided the services.
            (C) The effect of providing such services at such centers 
        on the readjustment counseling center program in general and on 
        the efficiency and autonomy of the clinical and administrative 
        operations of the readjustment counseling centers in 
        particular.
            (D) Any other matter that the Secretary considers 
        appropriate.
    (c) Rule of Construction.--Nothing in this section is intended to 
preclude the Secretary, during the period before the submission of the 
reports under this section, from providing limited health care services 
at Vet Centers.

SEC. 333. ADVISORY COMMITTEE ON THE READJUSTMENT OF VETERANS.

    (a) In General.--(1) Subchapter III of chapter 5 is amended by 
inserting after section 544 the following new section:
``Sec. 545. Advisory Committee on the Readjustment of Veterans
    ``(a)(1) There is in the Department the Advisory Committee on the 
Readjustment of Veterans (hereinafter in this section referred to as 
the `Committee').
    ``(2) The Committee shall consist of not more than 18 members 
appointed by the Secretary from among individuals who--
            ``(A) have demonstrated significant civic or professional 
        achievement; and
            ``(B) have experience with the provision of veterans 
        benefits and services by the Department.
    ``(3) The Secretary shall seek to ensure that members appointed to 
the Committee include individuals from a wide variety of geographic 
areas and ethnic backgrounds, individuals from veterans service 
organizations, individuals with combat experience, and women.
    ``(4) The Secretary shall determine the terms of service and pay 
and allowances of the members of the Committee, except that a term of 
service may not exceed two years. The Secretary may reappoint any 
member for additional terms of service.
    ``(b)(1) The Secretary shall, on a regular basis, consult with and 
seek the advice of the Committee with respect to the provision by the 
Department of benefits and services to veterans in order to assist 
veterans in the readjustment to civilian life.
    ``(2)(A) In providing advice to the Secretary under this 
subsection, the Committee shall--
            ``(i) assemble and review information relating to the needs 
        of veterans in readjusting to civilian life;
            ``(ii) provide information relating to the nature and 
        character of psychological problems arising from service in the 
        Armed Forces;
            ``(iii) provide an on-going assessment of the effectiveness 
        of the policies, organizational structures, and services of the 
        Department in assisting veterans in readjusting to civilian 
        life; and
            ``(iv) provide on-going advice on the most appropriate 
        means of responding to the readjustment needs of veterans in 
        the future.
    ``(B) In carrying out its duties under subparagraph (A), the 
Committee shall take into special account the needs of veterans who 
have served in a theater of combat operations.
    ``(c)(1) Not later than March 31 of each year, the Committee shall 
submit to the Secretary a report on the programs and activities of the 
Department that relate to the readjustment of veterans to civilian 
life. Each such report shall include--
            ``(A) an assessment of the needs of veterans with respect 
        to readjustment to civilian life;
            ``(B) a review of the programs and activities of the 
        Department designed to meet such needs; and
            ``(C) such recommendations (including recommendations for 
        administrative and legislative action) as the Committee 
        considers appropriate.
    ``(2) Not later than 90 days after the receipt of a report under 
paragraph (1), the Secretary shall transmit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a copy of 
the report, together with any comments and recommendations concerning 
the report that the Secretary considers appropriate.
    ``(3) The Committee may also submit to the Secretary such other 
reports and recommendations as the Committee considers appropriate.
    ``(4) The Secretary shall submit with each annual report submitted 
to the Congress pursuant to section 529 of this title a summary of all 
reports and recommendations of the Committee submitted to the Secretary 
since the previous annual report of the Secretary submitted pursuant to 
that section.
    ``(d)(1) Except as provided in paragraph (2), the provisions of the 
Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the 
activities of the Committee under this section.
    ``(2) Section 14 of such Act shall not apply to the Committee.''.
    (2) The table of sections at the beginning of chapter 5 is amended 
by inserting after the item relating to section 544 the following new 
item:

``545. Advisory Committee on the Readjustment of Veterans.''.
    (b) Original Members.--(1) Notwithstanding subsection (a)(2) of 
section 545 of title 38, United States Code (as added by subsection 
(a)), the members of the Advisory Committee on the Readjustment of 
Vietnam and Other War Veterans on the date of the enactment of this Act 
shall be the original members of the advisory committee recognized 
under such section.
    (2) The original members shall so serve until the Secretary of 
Veterans Affairs carries out appointments under such subsection (a)(2). 
The Secretary of Veterans Affairs shall carry out such appointments as 
soon after such date as is practicable. The Secretary may make such 
appointments from among such original members.

SEC. 334. CENTERS FOR MENTAL ILLNESS RESEARCH, EDUCATION, AND CLINICAL 
              ACTIVITIES.

    (a) In General.--(1) Subchapter II of chapter 73 is amended by 
adding after section 7319, as added by section 321(a)(1), the following 
new section:
``Sec. 7320. Centers for mental illness research, education, and 
              clinical activities
    ``(a) The purpose of this section is to provide for the improvement 
of the provision of health-care services and related counseling 
services to eligible veterans suffering from mental illness (especially 
mental illness related to service-related conditions) through--
            ``(1) the conduct of research (including research on 
        improving mental health service facilities of the Department 
        and on improving the delivery of mental health services by the 
        Department);
            ``(2) the education and training of health care personnel 
        of the Department; and
            ``(3) the development of improved models and systems for 
        the furnishing of mental health services by the Department.
    ``(b)(1) The Secretary shall establish and operate centers for 
mental illness research, education, and clinical activities. Such 
centers shall be established and operated by collaborating Department 
facilities as provided in subsection (c)(1). Each such center shall 
function as a center for--
            ``(A) research on mental health services;
            ``(B) the use by the Department of specific models for 
        furnishing services to treat serious mental illness;
            ``(C) education and training of health-care professionals 
        of the Department; and
            ``(D) the development and implementation of innovative 
        clinical activities and systems of care with respect to the 
        delivery of such services by the Department.
    ``(2) The Secretary shall, upon the recommendation of the Under 
Secretary for Health, designate the centers under this section. In 
making such designations, the Secretary shall ensure that the centers 
designated are located in various geographic regions of the United 
States. The Secretary may designate a center under this section only 
if--
            ``(A) the proposal submitted for the designation of the 
        center meets the requirements of subsection (c);
            ``(B) the Secretary makes the finding described in 
        subsection (d); and
            ``(C) the peer review panel established under subsection 
        (e) makes the determination specified in subsection (e)(3) with 
        respect to that proposal.
    ``(3) Not more than five centers may be designated under this 
section.
    ``(4) The authority of the Secretary to establish and operate 
centers under this section is subject to the appropriation of funds for 
that purpose.
    ``(c) A proposal submitted for the designation of a center under 
this section shall--
            ``(1) provide for close collaboration in the establishment 
        and operation of the center, and for the provision of care and 
        the conduct of research and education at the center, by a 
        Department facility or facilities in the same geographic area 
        which have a mission centered on care of the mentally ill and a 
        Department facility in that area which has a mission of 
        providing tertiary medical care;
            ``(2) provide that no less than 50 percent of the funds 
        appropriated for the center for support of clinical care, 
        research, and education will be provided to the collaborating 
        facility or facilities that have a mission centered on care of 
        the mentally ill; and
            ``(3) provide for a governance arrangement between the 
        collaborating Department facilities which ensures that the 
        center will be established and operated in a manner aimed at 
        improving the quality of mental health care at the 
        collaborating facility or facilities which have a mission 
        centered on care of the mentally ill.
    ``(d) The finding referred to in subsection (b)(2)(B) with respect 
to a proposal for designation of a site as a location of a center under 
this section is a finding by the Secretary, upon the recommendation of 
the Under Secretary for Health, that the facilities submitting the 
proposal have developed (or may reasonably be anticipated to develop) 
each of the following:
            ``(1) An arrangement with an accredited medical school that 
        provides education and training in psychiatry and with which 
        one or more of the participating Department facilities is 
        affiliated under which medical residents receive education and 
        training in psychiatry through regular rotation through the 
        participating Department facilities so as to provide such 
        residents with training in the diagnosis and treatment of 
        mental illness.
            ``(2) An arrangement with an accredited graduate program of 
        psychology under which students receive education and training 
        in clinical, counseling, or professional psychology through 
        regular rotation through the participating Department 
        facilities so as to provide such students with training in the 
        diagnosis and treatment of mental illness.
            ``(3) An arrangement under which nursing, social work, 
        counseling, or allied health personnel receive training and 
        education in mental health care through regular rotation 
        through the participating Department facilities.
            ``(4) The ability to attract scientists who have 
        demonstrated achievement in research--
                     ``(A) into the evaluation of innovative approaches 
                to the design of mental health services; or
                    ``(B) into the causes, prevention, and treatment of 
                mental illness.
            ``(5) The capability to evaluate effectively the activities 
        of the center, including activities relating to the evaluation 
        of specific efforts to improve the quality and effectiveness of 
        mental health services provided by the Department at or through 
        individual facilities.
    ``(e)(1) In order to provide advice to assist the Secretary and the 
Under Secretary for Health to carry out their responsibilities under 
this section, the official within the central office of the Veterans 
Health Administration responsible for mental health and behavioral 
sciences matters shall establish a peer review panel to assess the 
scientific and clinical merit of proposals that are submitted to the 
Secretary for the designation of centers under this section.
    ``(2) The panel shall consist of experts in the fields of mental 
health research, education and training, and clinical care. Members of 
the panel shall serve as consultants to the Department.
    ``(3) The panel shall review each proposal submitted to the panel 
by the official referred to in paragraph (1) and shall submit to that 
official its views on the relative scientific and clinical merit of 
each such proposal. The panel shall specifically determine with respect 
to each such proposal whether that proposal is among those proposals 
which have met the highest competitive standards of scientific and 
clinical merit.
    ``(4) The panel shall not be subject to the Federal Advisory 
Committee Act (5 U.S.C. App.).
    ``(f) Clinical and scientific investigation activities at each 
center established under this section--
            ``(1) may compete for the award of funding from amounts 
        appropriated for the Department of Veterans Affairs medical and 
        prosthetics research account; and
            ``(2) shall receive priority in the award of funding from 
        such account insofar as funds are awarded to projects and 
        activities relating to mental illness.
    ``(g) The Under Secretary for Health shall ensure that at least 
three centers designated under this section emphasize research into 
means of improving the quality of care for veterans suffering from 
mental illness through the development of community-based alternatives 
to institutional treatment for such illness.
    ``(h) The Under Secretary for Health shall ensure that information 
produced by the research, education and training, and clinical 
activities of centers established under this section that may be useful 
for other activities of the Veterans Health Administration is 
disseminated throughout the Veterans Health Administration. Such 
dissemination shall be made through publications, through programs of 
continuing medical and related education provided through regional 
medical education centers under subchapter VI of chapter 74 of this 
title, and through other means. Such programs of continuing medical 
education shall receive priority in the award of funding.
    ``(i) The official within the central office of the Veterans Health 
Administration responsible for mental health and behavioral sciences 
matters shall be responsible for supervising the operation of the 
centers established pursuant to this section and shall provide for 
ongoing evaluation of the centers and their compliance with the 
requirements of this section.
    ``(j)(1) There are authorized to be appropriated to the Department 
of Veterans Affairs for the basic support of the research and education 
and training activities of centers established pursuant to this section 
amounts as follows:
            ``(A) $3,125,000 for fiscal year 1998.
            ``(B) $6,250,000 for each of fiscal years 1999 through 
        2001.
    ``(2) In addition to funds appropriated for a fiscal year pursuant 
to the authorization of appropriations in paragraph (1), the Under 
Secretary for Health shall allocate to such centers from other funds 
appropriated for that fiscal year generally for the Department of 
Veterans Affairs medical care account and the Department of Veterans 
Affairs medical and prosthetics research account such amounts as the 
Under Secretary for Health determines appropriate to carry out the 
purposes of this section.''.
    (2) The table of sections at the beginning of chapter 73 is amended 
by inserting after the item relating to section 7319, as added by 
section 321(a)(2), the following new item:

``7320. Centers for mental illness research, education, and clinical 
                            activities.''.
    (b) Annual Reports.--Not later than February 1 of each of 1999, 
2000, 2001, and 2002, the Secretary of Veterans Affairs shall submit to 
the Committees on Veterans' Affairs of the Senate and House of 
Representatives a report on the status and activities during the 
previous fiscal year of the centers for mental illness research, 
education, and clinical activities established pursuant to section 7320 
of title 38, United States Code (as added by subsection (a)). Each such 
report shall include the following:
            (1) A description of the activities carried out at each 
        center and the funding provided for such activities.
            (2) A description of the advances made at each of the 
        participating facilities of the center in research, education 
        and training, and clinical activities relating to mental 
        illness in veterans.
            (3) A description of the actions taken by the Under 
        Secretary for Health pursuant to subsection (h) of that section 
        (as so added) to disseminate information derived from such 
        activities throughout the Veterans Health Administration.
            (4) The Secretary's evaluations of the effectiveness of the 
        centers in fulfilling the purposes of the centers.
    (c) Implementation.--The Secretary of Veterans Affairs shall 
designate at least one center under section 7320 of title 38, United 
States Code, not later than January 1, 1998.

SEC. 335. COMMITTEE ON CARE OF SEVERELY CHRONICALLY MENTALLY ILL 
              VETERANS.

    (a) Establishment.--Subchapter II of chapter 73 is amended by 
adding after section 7320, as added by section 334(a)(1), the following 
new section:
``Sec. 7321. Committee on Care of Severely Chronically Mentally Ill 
              Veterans
    ``(a) The Secretary, acting through the Under Secretary for Health, 
shall establish in the Veterans Health Administration a Committee on 
Care of Severely Chronically Mentally Ill Veterans. The Under Secretary 
shall appoint employees of the Department with expertise in the care of 
the chronically mentally ill to serve on the committee.
    ``(b) The committee shall assess, and carry out a continuing 
assessment of, the capability of the Veterans Health Administration to 
meet effectively the treatment and rehabilitation needs of mentally ill 
veterans whose mental illness is severe and chronic and who are 
eligible for health care furnished by the Department, including the 
needs of such veterans who are women. In carrying out that 
responsibility, the committee shall--
            ``(1) evaluate the care provided to such veterans through 
        the Veterans Health Administration;
            ``(2) identify systemwide problems in caring for such 
        veterans in facilities of the Veterans Health Administration;
            ``(3) identify specific facilities within the Veterans 
        Health Administration at which program enrichment is needed to 
        improve treatment and rehabilitation of such veterans; and
            ``(4) identify model programs which the committee considers 
        to have been successful in the treatment and rehabilitation of 
        such veterans and which should be implemented more widely in or 
        through facilities of the Veterans Health Administration.
    ``(c) The committee shall--
            ``(1) advise the Under Secretary regarding the development 
        of policies for the care and rehabilitation of severely 
        chronically mentally ill veterans; and
            ``(2) make recommendations to the Under Secretary--
                    ``(A) for improving programs of care of such 
                veterans at specific facilities and throughout the 
                Veterans Health Administration;
                    ``(B) for establishing special programs of 
                education and training relevant to the care of such 
                veterans for employees of the Veterans Health 
                Administration;
                    ``(C) regarding research needs and priorities 
                relevant to the care of such veterans; and
                    ``(D) regarding the appropriate allocation of 
                resources for all such activities.
    ``(d)(1) Not later than April 1, 1997, the Secretary shall submit 
to the Committees on Veterans' Affairs of the Senate and House of 
Representatives a report on the implementation of this section. The 
report shall include the following:
            ``(A) A list of the members of the committee.
            ``(B) The assessment of the Under Secretary for Health, 
        after review of the initial findings of the committee, 
        regarding the capability of the Veterans Health Administration, 
        on a systemwide and facility-by-facility basis, to meet 
        effectively the treatment and rehabilitation needs of severely 
        chronically mentally ill veterans who are eligible for 
        Department care.
            ``(C) The plans of the committee for further assessments.
            ``(D) The findings and recommendations made by the 
        committee to the Under Secretary for Health and the views of 
        the Under Secretary on such findings and recommendations.
            ``(E) A description of the steps taken, plans made (and a 
        timetable for their execution), and resources to be applied 
        toward improving the capability of the Veterans Health 
        Administration to meet effectively the treatment and 
        rehabilitation needs of severely chronically mentally ill 
        veterans who are eligible for Department care.
    ``(2) Not later than February 1, 1998, and February 1 of each of 
the three following years, the Secretary shall submit to the Committees 
on Veterans' Affairs of the Senate and House of Representatives a 
report containing information updating the reports submitted under this 
subsection before the submission of such report.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 73 is amended by inserting after the item relating to section 
7320, as added by section 334(a)(2) the following new item:

``7321. Committee on Care of Severely Chronically Mentally Ill 
                            Veterans.''.

                      Subtitle D--Other Provisions

SEC. 341. HOSPICE CARE STUDY.

    (a) Study Required.--The Secretary of Veterans Affairs shall 
conduct a research study to determine the desirability of the Secretary 
furnishing hospice care to terminally ill veterans and to evaluate the 
most cost effective and efficient way to do so. The Secretary shall 
carry out the study using resources and personnel of the Department.
    (b) Conduct of Study.--In carrying out the study required by 
subsection (a), the Secretary shall--
            (1) evaluate the programs, and the program models, through 
        which the Secretary furnishes hospice care services within or 
        through facilities of the Department of Veterans Affairs and 
        the programs and program models through which non-Department 
        facilities provide such services;
            (2) assess the satisfaction of patients, and family members 
        of patients, in each of the program models covered by paragraph 
        (1);
            (3) compare the costs (or range of costs) of providing care 
        through each of the program models covered by paragraph (1); 
        and
            (4) identify any barriers to providing, procuring, or 
        coordinating hospice services through any of the program models 
        covered by paragraph (1).
    (c) Program Models.--For purposes of subsection (b)(1), the 
Secretary shall evaluate a variety of types of models for delivery of 
hospice care, including the following:
            (1) Direct furnishing of full hospice care by the 
        Secretary.
            (2) Direct furnishing of some hospice services by the 
        Secretary.
            (3) Contracting by the Secretary for the furnishing of 
        hospice care, with a commitment that the Secretary will provide 
        any further required hospital care for the patient.
            (4) Contracting for all required care to be furnished 
        outside the Department.
            (5) Referral of the patient for hospice care without a 
        contract.
    (d) Report.--Not later than April 1, 1998, the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report on the research study. The report shall set 
forth the Secretary's findings and recommendations. The Secretary shall 
include in the report information on the extent to which the Secretary 
advises veterans concerning their eligibility for hospice care and 
information on the number of veterans (as of the time of the report) 
who are in each model of hospice care described in subsection (c) and 
the average cost per patient of hospice care for each such model.

SEC. 342. PAYMENT TO STATES OF PER DIEM FOR VETERANS RECEIVING ADULT 
              DAY HEALTH CARE.

    (a) Payment of Per Diem for Veterans Receiving Adult Day Care.--
Section 1741 is amended--
            (1) by inserting ``(1)'' after ``(a)'';
            (2) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively; and
            (3) by adding at the end the following new paragraph (2):
    ``(2) The Secretary may pay each State per diem at a rate 
determined by the Secretary for each veteran receiving adult day health 
care in a State home, if such veteran is eligible for such care under 
laws administered by the Secretary.''.
    (b) Assistance to States for Construction of Adult Day Care 
Facilities.--(1) Section 8131(3) is amended by inserting ``adult day 
health,'' before ``or hospital care''.
    (2) Section 8132 is amended by inserting ``adult day health,'' 
before ``or hospital care''.
    (3) Section 8135(b) is amended--
            (A) in paragraph (2)(C), by inserting ``or adult day health 
        care facilities'' after ``domiciliary beds''; and
            (B) in paragraph (3)(A), by inserting ``or construction 
        (other than new construction) of adult day health care 
        buildings'' before the semicolon.

SEC. 343. RESEARCH CORPORATIONS.

    (a) Renewal of Authority.--Section 7368 is amended by striking out 
``December 31, 1992'' and inserting in lieu thereof ``December 31, 
2000''.
    (b) Clarification of Tax-Exempt Status.--Sections 7361(b) and 
7363(c) are amended by striking out ``section 501(c)(3) of''.
    (c) Periodic Audits.--Subsection (b) of section 7366 is amended by 
striking out ``The corporation'' in the second sentence and all that 
follows through ``shall include that report'' and inserting in lieu 
thereof the following: ``A corporation with revenues in excess of 
$300,000 for any year shall obtain an audit of the corporation for that 
year. A corporation with annual revenues between $10,000 and $300,000 
shall obtain an independent audit of the corporation at least once 
every three years. Any audit under the preceding sentences shall be 
performed by an independent auditor. The corporation shall include the 
most recent such audit''.
    (d) Compliance With Conflict of Interest Laws and Regulations.--
Subsection (c)(2) of section 7366 is amended by striking out ``an 
annual statement signed by the director or employee certifying that the 
director or'' and inserting in lieu thereof ``a statement signed by the 
executive director of the corporation certifying that each director 
and''.
    (e) Revised Reporting Requirement.--Subsection (d) of section 7366 
is amended to read as follows:
    ``(d) The Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and House of Representatives an annual report on 
the corporations established under this subchapter. The report shall 
set forth the following information:
            ``(1) The location of each corporation.
            ``(2) The amount received by each corporation during the 
        previous year, including--
                    ``(A) the total amount received;
                    ``(B) the amount received from governmental 
                entities;
                    ``(C) the amount received from all other sources; 
                and
                    ``(D) if the amount received from a source referred 
                to in subparagraph (C) exceeded $25,000, information 
                that identifies the source.
            ``(3) The amount expended by each corporation during the 
        year, including--
                    ``(A) the amount expended for salary for research 
                staff and for salary for support staff;
                    ``(B) the amount expended for direct support of 
                research; and
                    ``(C) if the amount expended with respect to any 
                payee exceeded $35,000, information that identifies the 
                payee.''.

SEC. 344. VETERANS HEALTH ADMINISTRATION HEADQUARTERS.

    Section 7306 is amended by adding at the end the following new 
subsection:
    ``(f) In organizing the Office and appointing persons to positions 
in the Office, the Under Secretary shall ensure that--
            ``(1) the Office is staffed so as to provide the Under 
        Secretary, through a designated clinician in the appropriate 
        discipline in each instance, with expertise and direct policy 
        guidance on--
                    ``(A) unique programs operated by the 
                Administration to provide for the specialized treatment 
                and rehabilitation of disabled veterans (including 
                blind rehabilitation, care of spinal cord dysfunction, 
                mental illness, and long-term care); and
                    ``(B) the programs established under section 1712A 
                of this title; and
            ``(2) with respect to the programs established under 
        section 1712A of this title, a clinician with appropriate 
        expertise in those programs is responsible to the Under 
        Secretary for the management of those programs.''.

SEC. 345. DISBURSEMENT AGREEMENTS RELATING TO MEDICAL RESIDENTS AND 
              INTERNS.

    Section 7406(c) is amended--
            (1) by striking out ``Department hospital'' each place it 
        appears and inserting in lieu thereof ``Department facility 
        furnishing hospital care or medical services'';
            (2) by striking out ``participating hospital'' in paragraph 
        (4)(C) and inserting in lieu thereof ``participating 
        facility''; and
            (3) by striking out ``hospital'' both places it appears in 
        paragraph (5) and inserting in lieu thereof ``facility''.

SEC. 346. AUTHORITY TO SUSPEND SPECIAL PAY AGREEMENTS FOR PHYSICIANS 
              AND DENTISTS WHO ENTER RESIDENCY TRAINING PROGRAMS.

    Section 7432(b)(2) is amended--
            (1) by inserting ``(A)'' after ``(2)''; and
            (2) by adding at the end the following:
    ``(B) The Secretary may suspend a special pay agreement entered 
into under this section in the case of a physician or dentist who, 
having entered into the special pay agreement, enters a residency 
training program. Any such suspension shall terminate when the 
physician or dentist completes, withdraws from, or is no longer a 
participant in the program. During the period of such a suspension, the 
physician or dentist is not subject to the provisions of paragraph 
(1).''.

SEC. 347. REMUNERATED OUTSIDE PROFESSIONAL ACTIVITIES BY VETERANS 
              HEALTH ADMINISTRATION PERSONNEL.

    (a) Authority.--Subsection (b) of section 7423 is amended--
            (1) by striking out paragraph (1); and
            (2) by redesignating paragraphs (2) through (6) as 
        paragraphs (1) through (5), respectively.
    (b) Conforming Amendment.--Subsection (c) of such section is 
amended in the matter preceding paragraph (1) by striking out 
``subsection (b)(6)'' and inserting in lieu thereof ``subsection 
(b)(5)''.

SEC. 348. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY, MILWAUKEE 
              COUNTY, WISCONSIN.

    (a) Modification of Reversionary Interest.--The Secretary of 
Veterans Affairs is authorized to execute such instruments as may be 
necessary to modify the conditions under which the land described in 
subsection (b) will revert to the United States in order--
            (1) to permit Milwaukee County, Wisconsin, to grant all or 
        part of such land to another party with a condition on such 
        grant that the grantee use such land only for civic and 
        recreational purposes; and
            (2) to provide that the conditions under which title to all 
        or any part of such land reverts to the United States are 
        stated so that any such reversion would occur at the option of 
        the United States.
    (b) Description of Land.--The land covered by this section is the 
tract of 28 acres of land, more or less, conveyed to Milwaukee County, 
Wisconsin, pursuant to the Act entitled ``An Act authorizing the 
Administrator of Veterans' Affairs to convey certain property to 
Milwaukee County, Wisconsin'', approved August 27, 1954 (68 Stat. 866).
    (c) General Authorities.--The Secretary may carry out this section 
subject to such terms and conditions (including reservations of rights 
for the United States) as the Secretary considers necessary to protect 
the interests of the United States. In carrying out this section, the 
Secretary may eliminate any existing covenant or restriction with 
respect to the tract of land described in subsection (b) which the 
Secretary determines to be no longer necessary to protect the interests 
of the United States.

SEC. 349. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY, CHEYENNE, 
              WYOMING.

    (a) Modification of Reversionary Interest.--The Secretary of 
Veterans Affairs of Veterans Affairs is authorized to execute such 
instruments as may be necessary to modify the conditions under which 
the land described in subsection (b) will revert to the United States 
in order to permit the City of Cheyenne, Wyoming, to grant all or part 
of such land to the First Cheyenne Federal Credit Union (formerly known 
as the Cheyenne VAF Federal Credit Union) with a condition on such 
grant that the First Cheyenne Federal Credit Union use such land only 
for the purpose of constructing a building to house its operations.
    (b) Description of Land.--The land covered by this section is the 
tract of 27 acres of land, more or less, conveyed to the City of 
Cheyenne, Wyoming, pursuant to the Act entitled ``An Act authorizing 
the Administrator of Veterans' Affairs to convey certain property to 
the City of Cheyenne, Wyoming'', approved November 8, 1965 (79 Stat. 
1304).
    (c) Terms of Reversionary Interest.--In carrying out this section, 
the Secretary may cause the statement of the conditions under which 
title to all or any part of the land described in subsection (b) 
reverts to the United States to be revised so that any such reversion 
would occur at the option of the United States.
    (d) General Authorities.--The Secretary may carry out this section 
subject to such terms and conditions (including reservations of rights 
for the United States) as the Secretary considers necessary to protect 
the interests of the United States. In carrying out this section, the 
Secretary may eliminate any existing covenant or restriction with 
respect to the tract of land described in subsection (b) which the 
Secretary determines to be no longer necessary to protect the interests 
of the United States.

SEC. 350. NAME OF DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER, 
              JOHNSON CITY, TENNESSEE.

    (a) Name.--The Mountain Home Department of Veterans Affairs Medical 
Center in Johnson City, Tennessee, shall after the date of the 
enactment of this Act be known and designated as the ``James H. Quillen 
Department of Veterans Affairs Medical Center''. Any reference to such 
medical center in any law, regulation, map, document, record, or other 
paper of the United States shall be considered to be a reference to the 
James H. Quillen Department of Veterans Affairs Medical Center.
    (b) Effective Date.--Subsection (a) shall take effect at noon on 
January 3, 1997.

SEC. 351. REPORT ON HEALTH CARE NEEDS OF VETERANS IN EAST CENTRAL 
              FLORIDA.

    (a) Report Required.--Not later than 60 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to the Committees on Veterans' Affairs of the Senate and House of 
Representatives a report on the health care needs of veterans in east 
central Florida. In preparing the report, the Secretary shall consider 
the needs of such veterans for psychiatric and long-term care. The 
Secretary shall include in the report the Secretary's views, based on 
the Secretary's determination of such needs, as to the best means of 
meeting such needs using the amounts appropriated pursuant to the 
authorization of appropriations in this Act and Public Law 103-452 for 
projects to meet the health care needs of such veterans. The Secretary 
may, subject to the availability of appropriations for such purpose, 
use an independent contractor to assist in the determination of such 
health care needs.
    (b) Limitation.--The Secretary may not obligate any funds, other 
than for design work, for the conversion of the former Orlando Naval 
Training Center Hospital in Orlando, Florida (now under the 
jurisdiction of the Secretary of Veterans Affairs), to a nursing home 
care unit until 45 days after the date on which the report required by 
subsection (a) is submitted.

SEC. 352. EVALUATION OF HEALTH STATUS OF SPOUSES AND CHILDREN OF 
              PERSIAN GULF WAR VETERANS.

    (a) Extension of Authority.--Subsection (b) of section 107 of the 
Persian Gulf War Veterans' Benefits Act (title I of Public Law 103-446; 
108 Stat. 4652; 38 U.S.C. 1117 note) is amended by striking out 
``September 30, 1996'' and inserting in lieu thereof ``December 31, 
1998''.
    (b) Ratification of Actions.--Any diagnostic testing and medical 
examinations undertaken by the Secretary of Veterans Affairs for the 
purpose of the study required by subsection (a) of such section during 
the period beginning on October 1, 1996, and ending on the date of the 
enactment of this Act is hereby ratified.

            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

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                               AMENDMENTS

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