I

104TH CONGRESS

1ST SESSION H. R. 1468

To amend title 38, United States Code, to revise and improve veterans’

health care programs, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

APRIL 7, 1995

Mr. EDWARDS (for himself and Mr. MONTGOMERY) introduced the following

bill; which was referred to the Committee on Veterans’ Affairs

A BILL

To amend title 38, United States Code, to revise and improve

veterans’ health care programs, and for other purposes.

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Veterans Health Improvements Act of 1995’’.

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

7 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. References to title 38, United States Code.

TITLE I—WOMEN VETERANS HEALTH IMPROVEMENTS

Sec. 101. Short title.

Sec. 102. Health care services for women.
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Sec. 103. Women’s health services.

Sec. 104. Mammography quality standards.

Sec. 105. Coordinators of women’s services.

Sec. 106. Patient privacy for women patients.

TITLE II—CARE FOR VETERANS EXPOSED TO TOXIC

SUBSTANCES

Sec. 201. Authority to provide priority health care.

Sec. 202. Savings provision.

TITLE III—READJUSTMENT SERVICES

Sec. 301. Scope of services provided in vet centers.

Sec. 302. Advisory committee on the readjustment of veterans.

TITLE IV—SERVICES FOR MENTALLY ILL VETERANS

Sec. 401. Authority to establish nonprofit corporations.

Sec. 402. Extension of demonstration program.

Sec. 403. Department committee on care of severely chronically mentally ill veterans.

Sec. 404. Centers for mental illness research, education, and clinical activities.

Sec. 405. Codification and extension of authority for community-based residential care for homeless chronically mentally ill veterans and

other veterans.

TITLE V—CONSTRUCTION PLANNING

Sec. 501. Strategic planning.

Sec. 502. Revision to prospectus requirements.

Sec. 503. Annual compilation of construction priorities.

Sec. 504. Definition of major medical facility project.

TITLE VI—GENERAL HEALTH ADMINISTRATION

Subtitle A—Health Care Administration

Sec. 601. Overnight lodging in Department facilities when necessary for outpatient care.

Sec. 602. Pilot program for noninstitutional alternatives to nursing home care.

Sec. 603. Drug and alcohol abuse and dependence.

Sec. 604. Per diem for adult day health care.

Sec. 605. State home construction assistance program.

Subtitle B—Personnel Administration

Sec. 611. Limitation on reduction in full-time equivalent positions.

Sec. 612. Permanent authority for waiver of reduction of retirement pay for

registered-nurse positions.

Sec. 613. Staffing flexibility.

Sec. 614. Protection against certain prohibited personnel practices.

Sec. 615. Extension of Health Scholarship Program.

Subtitle C—Health Care Resource Agreements

Sec. 621. Repeal of termination of authority for expanded sharing arrangements.

Sec. 622. Acquisition of health care resources.
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Sec. 623. Sharing agreements for specialized medical resources.

Subtitle D—Miscellaneous

Sec. 631. Department of Veterans Affairs research advisory committees.

Sec. 632. Technical amendments.

Sec. 633. Submittal date for report on annual analysis of departmentwide admissions policies.

Sec. 634. Child care services.

Sec. 635. Contracts for utilities, Audie L. Murphy Memorial Hospital.

Sec. 636. Authority to enter into agreement for use of property at Edward

Hines, Jr., Department of Veterans Affairs Hospital.

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

2 Except as otherwise expressly provided, whenever in

3 this Act an amendment or repeal is expressed in terms

4 of an amendment to, or repeal of, a section or other provi5 sion, the reference shall be considered to be made to a

6 section or other provision of title 38, United States Code.

7 TITLE I—WOMEN VETERANS

8 HEALTH IMPROVEMENTS

9 SEC. 101. SHORT TITLE.

10 This title may be cited as the ‘‘Women Veterans

11 Health Improvements Act of 1995’’.

12 SEC. 102. HEALTH CARE SERVICES FOR WOMEN.

13 (a) ENSURED PROVISION OF SERVICES.—The Sec14 retary of Veterans Affairs shall ensure that each health15 care facility under the direct jurisdiction of the Secretary

16 is able, through services made available either by individ17 uals appointed to positions in the Veterans Health Admin18 istration or under contracts or other agreements made

19 under section 7409, 8111, or 8152 of title 38, United

20 States Code, or title II of Public Law 102–585, to provide
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1 in a timely and appropriate manner women’s health serv2 ices (as defined in section 1701(10) of title 38, United

3 States Code (as added by section 103)) to any veteran

4 described in section 1710(a)(1) of title 38, United States

5 Code, who is eligible for such services.

6 (b) HEALTH CARE SERVICES TO BE PROVIDED DI7 RECTLY WHEN COST EFFECTIVE.—(1) The Secretary

8 shall ensure that each health-care facility under the direct

9 jurisdiction of the Secretary shall provide women’s health

10 services directly (rather than by contract or other agree11 ment) when it is cost effective to do so.

12 (2) The Secretary shall ensure that each such facility

13 is provided appropriate equipment, treatment facilities,

14 and staff to carry out paragraph (1) and to ensure that

15 the quality of care provided under that paragraph is in

16 accordance with professional standards.

17 (c) CONFORMING REPEAL.—Section 302 of the Vet18 erans’ Health Care Amendments of 1983 (Public Law 98–

19 160; 97 Stat. 1004; 38 U.S.C. 1701 note) is repealed.

20 SEC. 103. WOMEN’S HEALTH SERVICES.

21 (a) WOMEN’S HEALTH SERVICES.—Section 1701 is

22 amended—

23 (1) in paragraph (6)(A)(i), by inserting ‘‘wom24 en’s health services,’’ after ‘‘preventive health serv25 ices,’’; and
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1 (2) by adding at the end the following:

2 ‘‘(10) The term ‘women’s health services’ means—

3 ‘‘(A) health care services to prevent diseases

4 specific to women, including—

5 ‘‘(i) papanicolaou tests (pap smears); and

6 ‘‘(ii) breast examinations and mammog7 raphy;

8 ‘‘(B) health care services to treat disabilities

9 specific to women, including management and treat10 ment of osteoporosis;

11 ‘‘(C) health care services for management of

12 menopause;

13 ‘‘(D) health care services for the management

14 and prevention of sexually-transmitted diseases in

15 women;

16 ‘‘(F) counseling and treatment of women for

17 physical or psychological conditions arising out of

18 acts of sexual violence;

19 ‘‘(G) early detection, management, and treat20 ment for cardiac disease, in the case of women who

21 are determined to be at risk of cardiac disease; and

22 ‘‘(H) health care authorized by paragraph (3)

23 of section 106(a) of Public Law 102–585 (38 U.S.C.

24 1710 note), subject to the limitations in that para25 graph.’’.
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1 (b) EXTENSION OF ANNUAL REPORT REQUIRE2 MENT.—Section 107(a) of the Veterans Health Care Act

3 of 1992 (Public Law 102–585; 38 U.S.C. 1710 note) is

4 amended by striking out ‘‘Not later than January 1, 1993,

5 January 1, 1994, and January 1, 1995’’ and inserting in

6 lieu thereof ‘‘Not later than January 1 of 1993 and each

7 year thereafter through 1998’’.

8 (c) REPORT ON HEALTH CARE AND RESEARCH.—

9 Section 107(b) of such Act is amended—

10 (1) in paragraph (1), by striking out ‘‘services

11 described in section 106 of this Act’’ and inserting

12 in lieu thereof ‘‘women’s health services (as such

13 term is defined in section 1701(10) of title 38, Unit14 ed States Code)’’;

15 (2) in paragraph (2)(A), by inserting ‘‘(includ16 ing information on the number of inpatient stays

17 and the number of outpatient visits through which

18 such services were provided)’’ after ‘‘facility’’; and

19 (3) by adding at the end the following new

20 paragraph:

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

22 Secretary to foster and encourage the expansion of

23 such research.’’.
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1 SEC. 104. MAMMOGRAPHY QUALITY STANDARDS.

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

3 is amended by adding at the end the following new section:

4 ‘‘§ 7319. Mammography quality standards

5 ‘‘(a) A mammogram may not be performed at a De6 partment facility unless that facility is accredited for that

7 purpose by a private nonprofit organization designated by

8 the Secretary. An organization designated by the Sec9 retary under this subsection shall meet the standards for

10 accrediting bodies established under section 354(e) of the

11 Public Health Service Act (42 U.S.C. 263b(e)).

12 ‘‘(b) The Secretary, in consultation with the Sec13 retary of Health and Human Services, shall prescribe

14 quality assurance and quality control standards relating

15 to the performance and interpretation of mammograms

16 and use of mammogram equipment and facilities of the

17 Department of Veterans Affairs consistent with the re18 quirements of section 354(f)(1) of the Public Health Serv19 ice Act. Such standards shall be no less stringent than

20 the standards prescribed by the Secretary of Health and

21 Human Services under section 354(f) of the Public Health

22 Service Act.

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

24 standards prescribed under subsection (b), shall provide

25 for an annual inspection of the equipment and facilities

26 used by and in Department health care facilities for the
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1 performance of mammograms. Such inspections shall be

2 carried out in a manner consistent with the inspection of

3 certified facilities by the Secretary of Health and Human

4 Services under section 354(g) of the Public Health Service

5 Act.

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

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

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

9 performed for the Department under contract with any

10 non-Department facility or provider conform to the quality

11 standards prescribed by the Secretary of Health and

12 Human Services under section 354 of the Public Health

13 Service Act.

14 ‘‘(e) For the purposes of this section, the term ‘mam15 mogram’ has the meaning given such term in paragraph

16 (5) of section 354(a) of the Public Health Service Act (42

17 U.S.C. 263b(a)).’’.

18 (2) The table of sections at the beginning of such

19 chapter is amended by inserting after the item relating

20 to section 7318 the following new item:

‘‘7319. Mammography quality standards.’’.

21 (b) DEADLINE FOR PRESCRIBING STANDARDS.—The

22 Secretary of Veterans Affairs shall prescribe standards

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

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

25 the end of the 120-day period beginning on the later of—
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1 (1) the date on which the Secretary of Health

2 and Human Services prescribes quality standards

3 under section 354(f) of the Public Health Service

4 Act (42 U.S.C. 263b(f)); or

5 (2) the date of the enactment of this Act.

6 (c) TRANSITION.—(1) Subsection (a) of section 7319

7 of title 38, United States Code, as added by subsection

8 (a), shall take effect on the date on which standards are

9 prescribed by the Secretary of Veterans Affairs under sub10 section (b) of that section.

11 (2) During the transition period, the Secretary of

12 Veterans Affairs may waive the requirement of subsection

13 (a) of section 7319 of title 38, United States Code, as

14 added by subsection (a), to any facility of the Department.

15 The Secretary may provide such a waiver in the case of

16 any facility only if the Secretary determines, based upon

17 the recommendation of the Under Secretary for Health

18 of the Department of Veterans Affairs, that during the

19 period such a waiver is in effect for such facility (including

20 any extension of the waiver under paragraph (3)) the facil21 ity will be operated in accordance with standards pre22 scribed by the Secretary under subsection (b) of such sec23 tion to assure the safety and accuracy of mammography

24 services provided.
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1 (3) The transition period for purposes of this section

2 is the six-month period beginning on the date specified in

3 paragraph (1). The Secretary may extend such period for

4 a period not to exceed 90 days in the case of any Depart5 ment facility. Any such extension may be made only if the

6 Under Secretary for Health determines that—

7 (A) without the extension access of veterans to

8 mammography services in the geographic area

9 served by the facility would be significantly reduced;

10 and

11 (B) appropriate steps will be taken before the

12 end of the transition period (as extended) to obtain

13 accreditation of the facility as required by subsection

14 (a) of section 7319 of title 38, United States Code,

15 as added by subsection (a).

16 (d) IMPLEMENTATION REPORT.—The Secretary of

17 Veterans Affairs shall submit to the Committees on Veter18 ans’ Affairs of the Senate and House of Representatives

19 a report on the Secretary’s implementation of section

20 7319 of title 38, United States Code, as added by sub21 section (a). The report shall be submitted not later than

22 120 days after the date on which the Secretary prescribes

23 the quality standards required under subsection (b) of that

24 section.
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1 SEC. 105. COORDINATORS OF WOMEN’S SERVICES.

2 (a) FULL-TIME STATUS.—Section 108 of the Veter3 ans Health Care Act of 1992 (Public Law 102–585; 106

4 Stat. 4948; 38 U.S.C. 1710 note) is amended—

5 (1) by inserting ‘‘(a)’’ before ‘‘The Secretary’’;

6 and

7 (2) by adding at the end the following:

8 ‘‘(b) Each official who serves in the position of coordi9 nator of women’s services under subsection (a) shall serve

10 in such position on a full-time basis.’’.

11 (b) SUPPORT FOR WOMEN’S SERVICES COORDINA12 TORS.—The Secretary of Veterans Affairs shall take ap13 propriate actions to ensure—

14 (1) that sufficient funding is provided to each

15 Department of Veterans Affairs facility in order to

16 permit the coordinator of women’s services assigned

17 to that facility to carry out the responsibilities of the

18 coordinator at the facility; and

19 (2) that each such coordinator has direct access

20 to the Director or Chief of Staff of the facility to

21 which the coordinator is assigned.

22 SEC. 106. PATIENT PRIVACY FOR WOMEN PATIENTS.

23 (a) IDENTIFICATION OF DEFICIENCIES.—The Sec24 retary of Veterans Affairs shall conduct a survey of each

25 medical center under the jurisdiction of the Secretary to

26 identify deficiencies relating to patient privacy afforded to
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1 women patients in the clinical areas at each such center

2 which may interfere with appropriate treatment of such

3 patients.

4 (b) CORRECTION OF DEFICIENCIES.—The Secretary

5 shall ensure that plans and, where appropriate, interim

6 steps, to correct the deficiencies identified in the survey

7 conducted under subsection (a) are developed and are in8 corporated into the Department’s construction planning

9 processes and given a high priority.

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

11 compile an annual inventory, by medical center, of defi12 ciencies identified under subsection (a) and of plans and,

13 where appropriate, interim steps, to correct such defi14 ciencies. The Secretary shall submit to the Committees on

15 Veterans’ Affairs of the Senate and House of Representa16 tives, not later than October 1, 1995, and not later than

17 October 1 each year thereafter through 1997 a report on

18 such deficiencies. The Secretary shall include in such re19 port the inventory compiled by the Secretary, the proposed

20 corrective plans, and the status of such plans.
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1 TITLE II—CARE FOR VETERANS

2 EXPOSED TO TOXIC SUB3 STANCES

4 SEC. 201. AUTHORITY TO PROVIDE PRIORITY HEALTH

5 CARE.

6 (a) AUTHORIZED INPATIENT CARE.—Section

7 1710(e) of title 38, United States Code, is amended to

8 read as follows:

9 ‘‘(e)(1)(A) Subject to paragraph (2), a herbicide-ex10 posed veteran is eligible for hospital care and nursing

11 home care under subsection (a)(1)(G) for any disease

12 specified in subparagraph (B).

13 ‘‘(B) The diseases referred to in subparagraph (A)

14 are those for which the National Academy of Sciences, in

15 a report issued in accordance with section 2 of the Agent

16 Orange Act of 1991, has determined—

17 ‘‘(i) that there is sufficient evidence to conclude

18 that there is a positive association between occur19 rence of the disease in humans and exposure to a

20 herbicide agent;

21 ‘‘(ii) that there is evidence which is suggestive

22 of an association between occurrence of the disease

23 in humans and exposure to a herbicide agent, but

24 such evidence is limited in nature; or
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1 ‘‘(iii) that available studies are insufficient to

2 permit a conclusion about the presence or absence of

3 an association between occurrence of the disease in

4 humans and exposure to a herbicide agent.

5 ‘‘(C) A radiation-exposed veteran is eligible for hos6 pital care and nursing home care under subsection

7 (a)(1)(G) for—

8 ‘‘(i) any disease listed in section 1112(c)(2) of

9 this title; and

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

11 based on the advice of the Advisory Committee on

12 Environmental Hazards, determines that there is

13 credible evidence of a positive association between

14 occurrence of the disease in humans and exposure to

15 ionizing radiation.

16 ‘‘(D) Subject to paragraph (2), a veteran who the

17 Secretary finds may have been exposed while serving on

18 active duty in the Southwest Asia theater of operations

19 during the Persian Gulf War to a toxic substance or envi20 ronmental hazard is eligible for hospital care and nursing

21 home care under subsection (a)(1)(G) of this section for

22 any disability which becomes manifest before October 1,

23 1996, notwithstanding that there is insufficient medical

24 evidence to conclude that such disability may be associated

25 with such exposure.
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1 ‘‘(2) Hospital and nursing home care may not be pro2 vided under or by virtue of paragraph (1)(A) after Decem3 ber 31, 1996, and may not be provided under or by virtue

4 of paragraph (1)(D) after December 31, 1998.

5 ‘‘(3) For purposes of this subsection and section

6 1712 of this title—

7 ‘‘(A) the term ‘herbicide-exposed veteran’

8 means a veteran (i) who served on active duty in the

9 Republic of Vietnam during the Vietnam era, and

10 (ii) who the Secretary finds may have been exposed

11 during such service to a herbicide agent;

12 ‘‘(B) the term ‘herbicide agent’ has the mean13 ing given that term in section 1116(a)(4) of this

14 title; and

15 ‘‘(C) the term ‘radiation-exposed veteran’ has

16 the meaning given that term in section 1112(c)(4) of

17 this title.’’.

18 (b) AUTHORIZED OUTPATIENT CARE.—Section 1712

19 of such title is amended—

20 (1) in subsection (a)(1)—

21 (A) by striking out ‘‘and’’ at the end of

22 subparagraph (C);

23 (B) in subparagraph (D)—
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1 (i) by striking out ‘‘December 31,

2 1995’’ and inserting in lieu thereof ‘‘De3 cember 31, 1998’’; and

4 (ii) by striking out the period at the

5 end and inserting in lieu thereof a semi6 colon; and

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

8 ‘‘(E) during the period before January 1,

9 1997, to any herbicide-exposed veteran for any

10 disease listed in section 1710(e)(1)(B) of this

11 title; and

12 ‘‘(F) to any radiation-exposed veteran for

13 any disease covered under section

14 1710(e)(1)(C) of this title.’’; and

15 (2) in subsection (i)(3)—

16 (A) by striking out ‘‘(A)’’; and

17 (B) by striking out ‘‘, or (B)’’ and all that

18 follows through ‘‘title’’.

19 SEC. 202. SAVINGS PROVISION.

20 The provisions of sections 1710(e) and 1712(a) of

21 title 38, United States Code, as in effect on the day before

22 the date of the enactment of this Act, shall continue to

23 apply on and after such date with respect to the furnishing

24 of hospital care, nursing home care, and medical services

25 for any veteran who was furnished such care or services
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1 before such date of enactment on the basis of presumed

2 exposure to a substance or radiation under the authority

3 of those provisions, but only for treatment for a disability

4 for which such care or services were furnished before such

5 date.

6 TITLE III—READJUSTMENT

7 SERVICES

8 SEC. 301. SCOPE OF SERVICES PROVIDED IN VET CENTERS.

9 (a) EXPANSION OF SERVICES.—Section 1712A is

10 amended—

11 (1) in subsection (a)(1) by inserting ‘‘and, to

12 the extent otherwise authorized by law, may furnish

13 such additional needed services as described in sub14 section (i)’’ in the first sentence after ‘‘life’’;

15 (2) by redesignating subsection (i) as subsection

16 (j); and

17 (3) by inserting after subsection (g) the follow18 ing new subsections:

19 ‘‘(h) The Secretary may, to the extent resources and

20 facilities are available, furnish to any veteran who served

21 in combat during World War II or the Korean conflict

22 counseling in a center to assist such veteran in overcoming

23 the effects of the veteran’s combat experience.

24 ‘‘(i) In operating centers under this section, the Sec25 retary may provide (1) preventive health care services, (2)
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1 medical services reasonably necessary in preparation for

2 hospital admission or to complete treatment furnished

3 under section 1710 or 1712(a) of this title, and (3) refer4 ral services to assist in obtaining specialized care. The

5 Secretary shall provide such services through such health

6 care personnel as the Secretary determines appropriate.’’.

7 (b) REPORT.—Not later than one year after the date

8 of the enactment of this Act, the Secretary of Veterans

9 Affairs shall submit to the Committees on Veterans’ Af10 fairs of the Senate and House of Representatives a report

11 relating to the implementation of the amendments made

12 by subsection (a). The report shall include the following:

13 (1) The number of veterans provided services

14 described in section 1712A(i) of title 38, United

15 States Code, as added by subsection (a).

16 (2) The number of centers which provided serv17 ices described in that section.

18 (3) An assessment of the effect providing such

19 services has had on access to and timeliness of serv20 ice delivery, both for veterans to whom services de21 scribed in that section were provided and for other

22 veterans.
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1 SEC. 302. ADVISORY COMMITTEE ON THE READJUSTMENT

2 OF VETERANS.

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

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

5 ‘‘§ 545. Advisory Committee on Veterans Readjust6 ment Counseling

7 ‘‘(a)(1) There is in the Department the Advisory

8 Committee on Veterans Readjustment Counseling (herein9 after in this section referred to as the ‘Committee’).

10 ‘‘(2) The members of the Committee shall be ap11 pointed by the Secretary and shall include individuals who

12 are recognized authorities in fields pertinent to the social,

13 psychological, economic, or educational readjustment of

14 veterans. At least two-thirds of the members of the Com15 mittee shall be veterans of the Vietnam era or other period

16 of war. Appointments of members of the Committee shall

17 be made from among individuals who have experience with

18 the provision of veterans benefits and services by the De19 partment or who are otherwise familiar with programs of

20 the Department.

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

22 appointed to the Committee include persons from a wide

23 variety of geographic areas, persons from veterans service

24 organizations, minorities, and women.

25 ‘‘(4) The Secretary shall determine the terms of serv26 ice and pay and allowances of the members of the Commit-
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1 tee, except that a term of service may not exceed two

2 years. The Secretary may reappoint any member for addi3 tional terms of service.

4 ‘‘(b)(1) The Secretary shall, on a regular basis, con5 sult with and seek the advice of the Committee with re6 spect to the provision by the Department of benefits and

7 services to veterans in order to assist veterans in the read8 justment to civilian life.

9 ‘‘(2) In providing advice to the Secretary under this

10 subsection, the Committee shall—

11 ‘‘(A) assemble and review information relating

12 to the needs of veterans in readjusting to civilian

13 life;

14 ‘‘(B) provide information relating to the nature

15 and character of psychological problems arising from

16 military service;

17 ‘‘(C) provide an on-going assessment of the ef18 fectiveness of the policies, organizational structures,

19 and services of the Department in assisting veterans

20 in readjusting to civilian life; and

21 ‘‘(D) provide on-going advice on the most ap22 propriate means of responding to the readjustment

23 needs of future veterans.

24 ‘‘(3) In carrying out its duties under paragraph (2),

25 the Committee shall take into special account veterans of
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1 the Vietnam era and the readjustment needs of those vet2 erans.

3 ‘‘(c)(1) Not later than March 31 of each year, the

4 Committee shall submit to the Secretary a report on the

5 programs and activities of the Department that relate to

6 the readjustment of veterans to civilian life. Each such

7 report shall include—

8 ‘‘(A) an assessment of the needs of veterans

9 with respect to readjustment to civilian life;

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

11 the Department designed to meet such needs; and

12 ‘‘(C) such recommendations (including rec13 ommendations for administrative and legislative ac14 tion) as the Committee considers appropriate.

15 ‘‘(2) Not later than 90 days after the receipt of each

16 report under paragraph (1), the Secretary shall transmit

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

18 House of Representatives a copy of the report, together

19 with any comments and recommendations concerning the

20 report that the Secretary considers appropriate.

21 ‘‘(3) The Committee may also submit to the Sec22 retary such other reports and recommendations as the

23 Committee considers appropriate.

24 ‘‘(4) The Secretary shall submit with each annual re25 port submitted to the Congress pursuant to section 529
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1 of this title a summary of all reports and recommendations

2 of the Committee submitted to the Secretary since the pre3 vious annual report of the Secretary submitted pursuant

4 to that section.’’.

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

6 5 is amended by adding at the end the following new item:

‘‘545. Advisory Committee on Veterans Readjustment Counseling.’’.

7 (b) ORIGINAL MEMBERS.—(1) Notwithstanding sub8 section (a)(2) of section 545 of title 38, United States

9 Code (as added by subsection (a)), the members of the

10 Advisory Committee on the Readjustment of Vietnam and

11 Other War Veterans on the date of the enactment of this

12 Act shall be the original members of the advisory commit13 tee established under that section.

14 (2) The original members shall so serve until the Sec15 retary of Veterans Affairs carries out appointments under

16 such subsection (a)(2). The Secretary shall carry out such

17 appointments as soon as is practicable. The Secretary may

18 make such appointments from among such original mem19 bers.

20 TITLE IV—SERVICES FOR

21 MENTALLY ILL VETERANS

22 SEC. 401. AUTHORITY TO ESTABLISH NONPROFIT COR23 PORATIONS.

24 (a) IN GENERAL.—Chapter 17 is amended by insert25 ing after section 1718 the following new section:
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1 ‘‘§ 1718A. Nonprofit corporations

2 ‘‘(a) The Secretary may authorize the establishment

3 at any Veterans Health Administration facility of a non4 profit corporation (1) to arrange for therapeutic work for

5 patients of such facility or patients of other such Depart6 ment facilities pursuant to section 1718(b) of this title,

7 and (2) to provide a funding mechanism to achieve the

8 purposes of section 1718 of this title.

9 ‘‘(b) The Secretary shall provide for the appointment

10 of a board of directors for any corporation established

11 under this section and shall determine the number of di12 rectors and the composition of the board of directors. The

13 board of directors shall include—

14 ‘‘(1) the director of the facility and other offi15 cials or employees of the facility; and

16 ‘‘(2) members appointed from among individ17 uals who are not officers or employees of the De18 partment.

19 ‘‘(c) Each such corporation shall have an executive

20 director who shall be appointed by the board of directors

21 with concurrence of the Under Secretary for Health. The

22 executive director of a corporation shall be responsible for

23 the operations of the corporation and shall have such spe24 cific duties and responsibilities as the board may pre25 scribe.
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1 ‘‘(d)(1) A corporation established under this section

2 shall arrange with the Department under section

3 1718(b)(2) of this title to provide for therapeutic work for

4 patients.

5 ‘‘(2) Such a corporation may—

6 ‘‘(A) accept gifts and grants from, and enter

7 into contracts with, individuals and public and pri8 vate entities solely to carry out the purposes of this

9 section; and

10 ‘‘(B) employ such employees as it considers nec11 essary for such purposes and fix the compensation

12 of such employees.

13 ‘‘(e)(1) Except as provided in paragraph (2), any

14 funds received by a corporation established under this sec15 tion through arrangements authorized under subsection

16 (d)(1) in excess of amounts reasonably required to carry

17 out this section (including expenditures under subsection

18 (d)(3)) shall be deposited in or credited to the fund estab19 lished under section 1718(c) of this title.

20 ‘‘(2) The Secretary, in consultation with the Inspec21 tor General, shall prescribe regulations to govern the ad22 ministration of funds received by a corporation established

23 under this section. Such regulations may authorize a cor24 poration to retain funds derived from arrangements au25 thorized under subsection (d)(1).
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1 ‘‘(3) Any funds received by a corporation established

2 under this section through arrangements authorized under

3 subsection (d)(2) may be transferred to the fund estab4 lished under section 1718(c) of this title.

5 ‘‘(f) A corporation established under this section shall

6 be established in accordance with the nonprofit corpora7 tion laws of the State in which the applicable medical facil8 ity is located and shall, to the extent not inconsistent with

9 Federal law, be subject to the laws of such State.

10 ‘‘(g)(1)(A) The records of a corporation established

11 under this section shall be available to the Secretary.

12 ‘‘(B) For the purposes of sections 4(a)(1) and 6(a)(1)

13 of the Inspector General Act of 1978, the programs and

14 operations of such a corporation shall be considered to be

15 programs and operations of the Department with respect

16 to which the Inspector General of the Department has re17 sponsibilities under such Act.

18 ‘‘(2) Such a corporation shall be considered an agen19 cy for the purposes of section 716 of title 31 (relating to

20 availability of information and inspection of records by the

21 Comptroller General).

22 ‘‘(3) Each such corporation shall submit to the Sec23 retary an annual report providing a detailed statement of

24 its operations, activities, and accomplishments during that

25 year. The corporation shall obtain a report of independent
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1 auditors concerning the receipts and expenditures of funds

2 by the corporation during that year and shall include that

3 report in the corporation’s report to the Secretary for that

4 year.

5 ‘‘(4) Each member of the board of directors of a cor6 poration established under this section, each employee of

7 such corporation, and each employee of the Department

8 who is involved in the functions of the corporation during

9 any year shall—

10 ‘‘(A) be subject to Federal laws and regulations

11 applicable to Federal employees with respect to con12 flicts of interest in the performance of official func13 tions; and

14 ‘‘(B) submit to the Secretary an annual state15 ment signed by the director or employee certifying

16 that the director or employee is aware of, and has

17 complied with, such laws and regulations in the

18 same manner as Federal employees are required to.

19 ‘‘(h) The Secretary shall submit to the Committees

20 on Veterans’ Affairs of the Senate and House of Rep21 resentatives an annual report on the number and location

22 of corporations established and the amount of the con23 tributions made to each such corporation.

24 ‘‘(i) No corporation may be established under this

25 section after September 30, 1999.
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1 ‘‘(j) If by the end of the four-year period beginning

2 on the date of the establishment of a corporation under

3 this section the corporation is not recognized as an entity

4 the income of which is exempt from taxation under the

5 Internal Revenue Code of 1986, the Secretary shall dis6 solve the corporation.’’.

7 (b) CLERICAL AMENDMENT.—The table of sections

8 at the beginning of such chapter is amended by inserting

9 after the item relating to section 1718 the following new

10 item:

‘‘1718A. Nonprofit corporations.’’.

11 SEC. 402. EXTENSION OF DEMONSTRATION PROGRAM.

12 Section 7(a) of Public Law 102–54 (105 Stat. 269;

13 38 U.S.C. 1718 note) is amended by striking out ‘‘1995’’

14 and inserting in lieu thereof ‘‘1998’’.

15 SEC. 403. DEPARTMENT COMMITTEE ON CARE OF SE16 VERELY CHRONICALLY MENTALLY ILL VET17 ERANS.

18 (a) ESTABLISHMENT.—Subchapter II of chapter 73

19 is amended by adding after section 7320, as added by sec20 tion 304(c), the following new section:

21 ‘‘§ 7321. Committee on Care of Severely Chronically

22 Mentally Ill Veterans

23 ‘‘(a) ESTABLISHMENT.—The Secretary, acting

24 through the Under Secretary for Health, shall establish

25 in the Veterans Health Administration a Committee on
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1 Care of Severely Chronically Mentally Ill Veterans. The

2 Under Secretary shall appoint employees of the Depart3 ment with expertise in the care of the chronically mentally

4 ill to serve on the committee.

5 ‘‘(b) DUTIES.—The committee shall assess, and carry

6 out a continuing assessment of, the capability of the Vet7 erans Health Administration to meet effectively the treat8 ment and rehabilitation needs of mentally ill veterans

9 whose mental illness is severe and chronic and who are

10 eligible for health care furnished by the Department. In

11 carrying out that responsibility, the committee shall—

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

13 through the Veterans Health Administration;

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

15 such veterans in facilities of the Veterans Health

16 Administration;

17 ‘‘(3) identify specific facilities within the Veter18 ans Health Administration at which program enrich19 ment is needed to improve treatment and rehabilita20 tion of such veterans; and

21 ‘‘(4) identify model programs which the com22 mittee considers to have been successful in the treat23 ment and rehabilitation of such veterans and which

24 should be implemented more widely in or through fa25 cilities of the Veterans Health Administration.
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1 ‘‘(c) ADVICE AND RECOMMENDATIONS.—The com2 mittee shall—

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

4 development of policies for the care and rehabilita5 tion of severely chronically mentally ill veterans; and

6 ‘‘(2) make recommendations to the Under Sec7 retary—

8 ‘‘(A) for improving programs of care of

9 such veterans at specific facilities and through10 out the Veterans Health Administration;

11 ‘‘(B) for establishing special programs of

12 education and training relevant to the care of

13 such veterans for employees of the Veterans

14 Health Administration;

15 ‘‘(C) regarding research needs and prior16 ities relevant to the care of such veterans; and

17 ‘‘(D) regarding the appropriate allocation

18 of resources for all such activities.

19 ‘‘(d) ANNUAL REPORT.—(1) Not later than April 1,

20 1996, the Secretary shall submit to the Committees on

21 Veterans’ Affairs of the Senate and House of Representa22 tives a report on the implementation of this section. The

23 report shall include the following:

24 ‘‘(A) A list of the members of the committee.
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1 ‘‘(B) The assessment of the Under Secretary

2 for Health, after review of the initial findings of the

3 committee, regarding the capability of the Veterans

4 Health Administration, on a systemwide and facility5 by-facility basis, to meet effectively the treatment

6 and rehabilitation needs of severely chronically men7 tally ill veterans who are eligible for Department

8 care.

9 ‘‘(C) The plans of the committee for further as10 sessments.

11 ‘‘(D) The findings and recommendations made

12 by the committee to the Under Secretary for Health

13 and the views of the Under Secretary on such find14 ings and recommendations.

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

16 made (and a timetable for their execution), and re17 sources to be applied toward improving the capabil18 ity of the Veterans Health Administration to meet

19 effectively the treatment and rehabilitation needs of

20 severely chronically mentally ill veterans who are eli21 gible for Department care.

22 ‘‘(2) Not later than February 1, 1997, and February

23 1 of each of the three following years, the Secretary shall

24 submit to the Committees on Veterans’ Affairs of the Sen25 ate and House of Representatives a report containing in-
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1 formation updating the reports submitted under this sub2 section before the submission of such report.’’.

3 (b) CLERICAL AMENDMENT.—The table of sections

4 at the beginning of chapter 73 is amended by inserting

5 after the item relating to section 7320, as added by section

6 304(b), the following new item:

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

7 SEC. 404. CENTERS FOR MENTAL ILLNESS RESEARCH, EDU8 CATION, AND CLINICAL ACTIVITIES.

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

10 is amended by adding after section 7321, as added by sec11 tion 403(a), the following new section:

12 ‘‘§ 7322. Centers for mental illness research, edu13 cation, and clinical activities

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

15 improvement of the provision of health-care services and

16 related counseling services to eligible veterans suffering

17 from mental illness (especially mental illness related to

18 service-related conditions) through—

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

20 on improving mental health service facilities of the

21 Department and on improving the delivery of mental

22 health services by the Department);

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

24 personnel of the Department; and
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1 ‘‘(3) the development of improved models and

2 systems for the furnishing of mental health services

3 by the Department.

4 ‘‘(b)(1) The Secretary shall establish and operate

5 centers for mental illness research, education, and clinical

6 activities. Such centers shall be established and operated

7 by collaborating Department facilities as provided in sub8 section (c)(1). Each such center shall function as a center

9 for—

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

11 ‘‘(B) the use by the Department of specific

12 models for furnishing services to treat serious men13 tal illness;

14 ‘‘(C) education and training of health-care pro15 fessionals of the Department; and

16 ‘‘(D) the development and implementation of

17 innovative clinical activities and systems of care with

18 respect to the delivery of such services by the De19 partment.

20 ‘‘(2) The Secretary shall, upon the recommendation

21 of the Under Secretary for Health, designate the centers

22 under this section. In making such designations, the Sec23 retary shall ensure that the centers designated are located

24 in various geographic regions of the United States. The
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1 Secretary may designate a center under this section only

2 if—

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

4 of the center meets the requirements of subsection

5 (c);

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

7 in subsection (d); and

8 ‘‘(C) the peer review panel established under

9 subsection (e) makes the determination specified in

10 subsection (e)(3) with respect to that proposal.

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

12 under this section.

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

14 operate centers under this section is subject to the appro15 priation of funds for that purpose.

16 ‘‘(c) A proposal submitted for the designation of a

17 center under this section shall—

18 ‘‘(1) provide for close collaboration in the estab19 lishment and operation of the center, and for the

20 provision of care and the conduct of research and

21 education at the center, by a Department facility or

22 facilities in the same geographic area which have a

23 mission centered on care of the mentally ill and a

24 Department facility in that area which has a mission

25 of providing tertiary medical care;
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1 ‘‘(2) provide that no less than 50 percent of the

2 funds appropriated for the center for support of clin3 ical care, research, and education will be provided to

4 the collaborating facility or facilities that have a

5 mission centered on care of the mentally ill; and

6 ‘‘(3) provide for a governance arrangement be7 tween the collaborating Department facilities which

8 ensures that the center will be established and oper9 ated in a manner aimed at improving the quality of

10 mental health care at the collaborating facility or fa11 cilities which have a mission centered on care of the

12 mentally ill.

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

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

15 location of a center under this section is a finding by the

16 Secretary, upon the recommendation of the Under Sec17 retary for Health, that the facilities submitting the pro18 posal have developed (or may reasonably be anticipated

19 to develop) each of the following:

20 ‘‘(1) An arrangement with an accredited medi21 cal school that provides education and training in

22 psychiatry and with which one or more of the par23 ticipating Department facilities is affiliated under

24 which medical residents receive education and train25 ing in psychiatry through regular rotation through
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•HR 1468 IH

1 the participating Department facilities so as to pro2 vide such residents with training in the diagnosis

3 and treatment of mental illness.

4 ‘‘(2) An arrangement with an accredited grad5 uate school of psychology under which students re6 ceive education and training in clinical, counseling,

7 or professional psychology through regular rotation

8 through the participating Department facilities so as

9 to provide such students with training in the diag10 nosis and treatment of mental illness.

11 ‘‘(3) An arrangement under which nursing, so12 cial work, or allied health personnel receive training

13 and education in mental health care through regular

14 rotation through the participating Department facili15 ties.

16 ‘‘(4) The ability to attract scientists who have

17 demonstrated achievement in research—

18 ‘‘(A) into the evaluation of innovative ap19 proaches to the design of mental health serv20 ices; or

21 ‘‘(B) into the causes, prevention, and

22 treatment of mental illness.

23 ‘‘(5) The capability to evaluate effectively the

24 activities of the center, including activities relating

25 to the evaluation of specific efforts to improve the
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1 quality and effectiveness of mental health services

2 provided by the Department at or through individual

3 facilities.

4 ‘‘(e)(1) In order to provide advice to assist the Sec5 retary and the Under Secretary for Health to carry out

6 their responsibilities under this section, the official within

7 the central office of the Veterans Health Administration

8 responsible for mental health and behavioral sciences mat9 ters shall establish a peer review panel to assess the sci10 entific and clinical merit of proposals that are submitted

11 to the Secretary for the designation of centers under this

12 section.

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

14 of mental health research, education and training, and

15 clinical care. Members of the panel shall serve as consult16 ants to the Department.

17 ‘‘(3) The panel shall review each proposal submitted

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

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

20 scientific and clinical merit of each such proposal. The

21 panel shall specifically determine with respect to each such

22 proposal whether that proposal is among those proposals

23 which have met the highest competitive standards of sci24 entific and clinical merit.
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1 ‘‘(4) The panel shall not be subject to the Federal

2 Advisory Committee Act (5 U.S.C. App.).

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

4 each center established under this section—

5 ‘‘(1) may compete for the award of funding

6 from amounts appropriated for the Department of

7 Veterans Affairs medical and prosthetics research

8 account; and

9 ‘‘(2) shall receive priority in the award of fund10 ing from such account insofar as funds are awarded

11 to projects and activities relating to mental illness.

12 ‘‘(g) The Under Secretary for Health shall ensure

13 that at least three centers designated under this section

14 emphasize research into means of improving the quality

15 of care for veterans suffering from mental illness through

16 the development of community-based alternatives to insti17 tutional treatment for such illness.

18 ‘‘(h) The Under Secretary for Health shall ensure

19 that information produced by the research, education and

20 training, and clinical activities of centers established under

21 this section that may be useful for other activities of the

22 Veterans Health Administration is disseminated through23 out the Veterans Health Administration. Such dissemina24 tion shall be made through publications, through pro25 grams of continuing medical and related education pro-
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1 vided through regional medical education centers under

2 subchapter VI of chapter 74 of this title, and through

3 other means. Such programs of continuing medical edu4 cation shall receive priority in the award of funding.

5 ‘‘(i) The official within the central office of the Veter6 ans Health Administration responsible for mental health

7 and behavioral sciences matters shall be responsible for

8 supervising the operation of the centers established pursu9 ant to this section and shall provide for ongoing evaluation

10 of the centers and their compliance with the requirements

11 of this section.

12 ‘‘(j)(1) There are authorized to be appropriated to

13 the Department of Veterans Affairs for the basic support

14 of the research and education and training activities of

15 centers established pursuant to this section amounts as

16 follows:

17 ‘‘(A) $3,125,000 for fiscal year 1997.

18 ‘‘(B) $6,250,000 for each of fiscal years 1998

19 through 2000.

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

21 year pursuant to the authorization of appropriations in

22 paragraph (1), the Under Secretary for Health shall allo23 cate to such centers from other funds appropriated for

24 that fiscal year generally for the Department of Veterans

25 Affairs medical care account and the Department of Vet-
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1 erans Affairs medical and prosthetics research account

2 such amounts as the Under Secretary for Health deter3 mines appropriate to carry out the purposes of this sec4 tion.’’.

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

6 73 is amended by inserting after the item relating to sec7 tion 7321, as added by section 403(b), the following new

8 item:

‘‘7322. Centers for mental illness research, education, and clinical activities.’’.

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

10 of each of 1997, 1998, and 1999, the Secretary of Veter11 ans Affairs shall submit to the Committees on Veterans’

12 Affairs of the Senate and House of Representatives a re13 port on the status and activities during the previous fiscal

14 year of the centers for mental illness, research, education,

15 and clinical activities established pursuant to section 7322

16 of title 38, United States Code (as added by subsection

17 (a)). Each such report shall include the following:

18 (1) A description of the activities carried out at

19 each center and the funding provided for such activi20 ties.

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

22 of the participating facilities of the center in re23 search, education and training, and clinical activities

24 relating to mental illness in veterans.
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1 (3) A description of the actions taken by the

2 Under Secretary for Health pursuant to subsection

3 (h) of that section (as so added) to disseminate in4 formation derived from such activities throughout

5 the Veterans Health Administration.

6 (4) The Secretary’s evaluations of the effective7 ness of the centers in fulfilling the purposes of the

8 centers.

9 (c) IMPLEMENTATION.—The Secretary of Veterans

10 Affairs shall designate at least one center under section

11 7322 of title 38, United States Code, not later than Janu12 ary 1, 1997.

13 SEC. 405. CODIFICATION AND EXTENSION OF AUTHORITY

14 FOR COMMUNITY-BASED RESIDENTIAL CARE

15 FOR HOMELESS CHRONICALLY MENTALLY

16 ILL VETERANS AND OTHER VETERANS.

17 (a) IN GENERAL.—Subchapter II of chapter 17 is

18 amended by adding at the end the following:

19 ‘‘§ 1720E. Community-based residential care: home20 less chronically mentally ill veterans and

21 other veterans

22 ‘‘(a)(1) The Secretary may provide to homeless veterans

23 suffering from chronic mental illness disabilities who are

24 eligible for care under section 1710(a)(1) of this title care
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1 and treatment and rehabilitative services (directly or by

2 contract) in—

3 ‘‘(A) halfway houses;

4 ‘‘(B) therapeutic communities;

5 ‘‘(C) psychiatric residential treatment centers;

6 and

7 ‘‘(D) other community-based treatment facili8 ties.

9 ‘‘(2) In providing care and treatment and rehabilitative

10 services under paragraph (1), the Secretary may also pro11 vide such care and treatment and rehabilitative services—

12 ‘‘(A) to veterans being furnished hospital or nurs13 ing home care by the Secretary for a chronic mental

14 illness disability; and

15 ‘‘(B) to veterans with service-connected chronic

16 mental illness disabilities.

17 ‘‘(b)(1) Before furnishing care and treatment and reha18 bilitative services by contract under subsection (a) to a

19 veteran through a facility described in subsection (a), the

20 Secretary shall approve the quality and effectiveness of the

21 program operated by such facility for the purpose for

22 which the veteran is to be furnished such care and serv23 ices.
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1 ‘‘(2) The Secretary shall prescribe criteria for the ap2 proval under paragraph (1) of the quality and effective3 ness of programs.

4 ‘‘(c)(1) The Secretary may provide in-kind assistance

5 (through the services of Department employees and the

6 sharing of other Department resources) to a facility de7 scribed in subsection (a) under this section. The Secretary

8 shall provide such assistance to a facility under a contract

9 between the Secretary and the facility.

10 ‘‘(2) The Secretary may provide assistance under

11 paragraph (1)—

12 ‘‘(A) only for use solely in the furnishing of ap13 propriate care and services under this section; and

14 ‘‘(B) only if, under such contract, the Secretary

15 receives reimbursement for the full cost of such as16 sistance, including the cost of services and supplies

17 and normal depreciation and amortization of equip18 ment.

19 ‘‘(3) Reimbursement under paragraph (2)(B) may be

20 made by reduction in the charges to the United States

21 or by payment to the United States.

22 ‘‘(4) Any funds received through reimbursement

23 under paragraph (3) shall be credited to funds allotted to

24 the Department facility that provided the assistance.
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1 ‘‘(d) The Secretary may not provide care and treat2 ment and rehabilitative services under this section after

3 September 30, 1999.’’.

4 (b) CLERICAL AMENDMENT.—The table of sections

5 at the beginning of such chapter is amended by inserting

6 after the item relating to section 1720D the following new

7 item:

‘‘1720E. Community-based residential care: homeless chronically mentally ill veterans and other veterans.’’.

8 (c) REPEAL OF SUPERSEDED AUTHORITY.—Section

9 115 of the Veterans’ Benefits and Services Act of 1988

10 (38 U.S.C. 1712 note) is repealed.

11 TITLE V—CONSTRUCTION

12 PLANNING

13 SEC. 501. STRATEGIC PLANNING.

14 (a) DEVELOPMENT OF PLAN.—The Secretary of Vet15 erans Affairs shall develop and implement a plan to pro16 mote efficient delivery of health care services and to re17 duce unnecessary duplication of health care resources. The

18 plan shall provide for delivering health care to veterans

19 through a coordinated network of facilities operating with20 in prescribed geographic areas. Each such area shall be

21 referred to as a ‘‘service-delivery area’’.

22 (b) IMPLEMENTATION OF PLAN.—The Under Sec23 retary for Health shall use the plan to—
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1 (1) determine and prescribe the specific mission

2 of, and clinical programs to be operated at, each

3 health care facility of the Department;

4 (2) determine, with respect to each such serv5 ice-delivery area and each facility in such area, the

6 extent to which services provided under the auspices

7 of the Secretary should be provided directly through

8 facilities of the Department or through contract or

9 other arrangements, including arrangements author10 ized under sections 8111 and 8153 of title 38, Unit11 ed States Code;

12 (3) provide for a reduction in duplication of

13 services and programs within such service-delivery

14 areas and a realignment of services among facilities

15 within such areas as necessary to promote efficiency;

16 (4) develop medical facility construction

17 projects and other capital projects;

18 (5) carry out such other purposes as the Sec19 retary shall prescribe.

20 (c) REPORT ON IMPLEMENTATION.—Not later than

21 12 months after the date of the enactment of this Act,

22 the Secretary shall submit to the Committees on Veterans’

23 Affairs of the Senate and House of Representatives a re24 port on the implementation of this section. The report

25 shall—
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1 (1) include the plan established pursuant to

2 subsection (a);

3 (2) identify the service-delivery areas described

4 in such subsection and provide demographic data on

5 the veteran population in each such service area, in6 cluding projections of the number of veterans who

7 are likely to avail themselves of Department of Vet8 erans Affairs care in each such area;

9 (3) identify the specific missions required by

10 subsection (a)(1) and the projected timetable and

11 milestones necessary for each facility to carry out its

12 prescribed mission; and

13 (4) identify and assess the nature and impact

14 of such plan, including provision of an analysis of

15 specific effects nationally and within each service-de16 livery area, on the health-professions education and

17 training, research, and contingency support func18 tions of the Veterans Health Administration.

19 SEC. 502. REVISION TO PROSPECTUS REQUIREMENTS.

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

21 amended—

22 (1) by striking out ‘‘shall include—’’ and insert23 ing in lieu thereof ‘‘shall include the following:’’;

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

3 (B) by striking out the semicolon at the

4 end and inserting in lieu thereof a period;

5 (3) in paragraph (2)—

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

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

9 in lieu thereof a period;

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

12 and

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

14 paragraphs:

15 ‘‘(4) Demographic data applicable to the

16 project.

17 ‘‘(5) Current and projected workload and utili18 zation data.

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

20 the facility, to include both recurring and non-recur21 ring costs.

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

23 under the Department’s prioritization methodology

24 and, if the project is being proposed for funding

25 ahead of a project with a higher score, a specific ex-
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1 planation of the factors other than the priority that

2 were considered and the basis on which the project

3 is proposed for funding ahead of projects with high4 er priority scores.

5 ‘‘(8) A listing of each alternative to construc6 tion of the facility that has been considered.’’.

7 (b) APPLICABILITY.—The amendments made by sub8 section (a) shall apply with respect to any prospectus sub9 mitted by the Secretary of Veterans Affairs after the date

10 of the enactment of this Act.

11 SEC. 503. ANNUAL COMPILATION OF CONSTRUCTION PRI12 ORITIES.

13 Section 8107 is amended—

14 (1) in subsection (a)(2)—

15 (A) by inserting ‘‘and’’ at the end of sub16 paragraph (A);

17 (B) by striking out subparagraph (B); and

18 (C) by redesignating subparagraph (C) as

19 subparagraph (B); and

20 (2) by adding at the end the following new sub21 section:

22 ‘‘(c)(1) The Secretary shall submit to each commit23 tee, not later than January 31 of each year, a report show24 ing the current priorities of the Department for proposed

25 major medical construction projects. Each such report
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1 shall identify the 20 projects, from within all the projects

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

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

4 relative priority and rank scoring of each such project.

5 The 20 projects shall be compiled, and their relative

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

7 the categories of ambulatory care projects, nursing home

8 care projects, and such other categories as the Secretary

9 determines).

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

11 each project listed, a description of the specific factors

12 that account for the relative ranking of that project in re13 lation to other projects within the same category.

14 ‘‘(3) In a case in which the relative ranking of a pro15 posed project has changed since the last report under this

16 subsection was submitted, the Secretary shall also include

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

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

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

20 system for proposed major medical construction

21 projects.’’.

22 SEC. 504. CONSTRUCTION AUTHORIZATION.

23 (a) CONGRESSIONAL APPROVAL OF DESIGN WORK.—

24 Paragraph (2) of section 8104(a) is amended by striking

25 out ‘‘and design’’.
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1 (b) DEFINITION OF MAJOR MEDICAL FACILITY

2 PROJECT.—Paragraph (3)(A) of such section is amended

3 by inserting before the period at the end the following:

4 ‘‘, and, in the case of a project which is principally for

5 the alteration of a medical facility to provide additional

6 space for provision of ambulatory care, such term means

7 a project involving a total expenditure of more than

8 $5,000,000’’.

9 TITLE VI—GENERAL HEALTH

10 ADMINISTRATION

11 Subtitle A—Health Care

12 Administration

13 SEC. 601. OVERNIGHT LODGING IN DEPARTMENT FACILI14 TIES WHEN NECESSARY FOR OUTPATIENT

15 CARE.

16 Section 1701(6)(A)(i) is amended by inserting ‘‘over17 night lodging in Department facilities when necessary for

18 the provision of services on an outpatient basis,’’ after

19 ‘‘prosthetic appliances,’’.

20 SEC. 602. PILOT PROGRAM FOR NONINSTITUTIONAL AL21 TERNATIVES TO NURSING HOME CARE.

22 (a) EXTENSION OF PROGRAM.—Section 1720C(a) is

23 amended by striking out ‘‘September 30, 1995’’ and in24 serting in lieu thereof ‘‘September 30, 1997’’.
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1 (b) REPORT DEADLINES.—Section 201(b) of the De2 partment of Veterans Affairs Nurse Pay Act of 1990

3 (Public Law 101–366; 38 U.S.C. 1720C note) is

4 amended—

5 (1) by striking out ‘‘February 1, 1995,’’ and in6 serting in lieu thereof ‘‘February 1, 1997,’’; and

7 (2) by striking out ‘‘September 30, 1993,’’ and

8 inserting in lieu thereof ‘‘September 30, 1996,’’.

9 SEC. 603. DRUG AND ALCOHOL ABUSE AND DEPENDENCE.

10 Section 1720A(e) is amended by striking out ‘‘De11 cember 31, 1995’’ and inserting in lieu thereof ‘‘December

12 31, 1997’’.

13 SEC. 604. PER DIEM FOR ADULT DAY HEALTH CARE.

14 (a) IN GENERAL.—Subsection (a) of section 1741 is

15 amended to read as follows:

16 ‘‘(a)(1) The Secretary shall pay to each State a per

17 diem amount for each veteran receiving domiciliary care,

18 nursing home care, hospital care, or adult day health care

19 in a State home if the veteran is eligible to receive that

20 care in a Department facility.

21 ‘‘(2) The per diem amount to be paid under this sub22 section is as follows:

23 ‘‘(A) For domiciliary care, $15.11.

24 ‘‘(B) For nursing home care and hospital care,

25 $35.37.
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1 ‘‘(C) For adult day health care, an amount to

2 be prescribed by the Secretary, not in excess of the

3 amount under subparagraph (A).’’.

4 (b) EFFECTIVE DATE.—The amendment made by

5 subsection (a) shall apply with respect to adult day health

6 care provided in a State home after the date of the enact7 ment of this Act.

8 SEC. 605. STATE HOME CONSTRUCTION ASSISTANCE PRO9 GRAM.

10 (a) IN GENERAL.—Subchapter III of chapter 81 is

11 amended as follows:

12 (1) Section 8131(3) is amended by inserting

13 ‘‘or adult day health care’’ after ‘‘hospital care’’.

14 (2) Section 8132 is amended by inserting ‘‘or

15 adult day health care’’ after ‘‘hospital care’’.

16 (3) Section 8135(a)(4) is amended by inserting

17 ‘‘and, in the case of adult day health care, not more

18 than 25 percent of the number of patients partici19 pating in that program,’’ after ‘‘occupancy’’.

20 (4) Section 8135(b) is amended—

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

22 adult day health care facilities’’ after ‘‘domi23 ciliary beds’’; and

24 (B) in paragraph (3)(A), by inserting ‘‘, or

25 would involve expansion, remodeling, or alter-
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1 ation of existing buildings for the furnishing of

2 adult day health care’’ after ‘‘buildings’’.

3 (5) Section 8136 is amended by inserting ‘‘or

4 adult day health care’’ after ‘‘hospital care’’.

5 (6) The heading of such subchapter is amended

6 to read as follows:

7 ‘‘SUBCHAPTER III—STATE HOME FACILITIES

8 FOR FURNISHING DOMICILIARY CARE,

9 NURSING HOME CARE, ADULT DAY HEALTH

10 CARE, AND HOSPITAL CARE’’.

11 (b) CLERICAL AMENDMENT.—The item relating to

12 subchapter III in the table of sections at the beginning

13 of such chapter is amended to read as follows:

‘‘SUBCHAPTER III—STATE HOME FACILITIES FOR FURNISHING DOMICILIARY

CARE, NURSING HOME CARE, ADULT DAY HEALTH CARE, AND HOSPITAL

CARE’’.

14 (c) EFFECTIVE DATE.—The amendments made by

15 subsection (a) shall apply with respect to grants made to

16 States using funds appropriated after the date of the en17 actment of this Act.

18 Subtitle B—Personnel

19 Administration

20 SEC. 611. LIMITATION ON REDUCTION IN FULL-TIME

21 EQUIVALENT POSITIONS.

22 Section 712(b)(2) is amended—

23 (1) by striking out ‘‘the sum of—’’ and insert24 ing in lieu thereof ‘‘the sum of the following:’’;
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1 (2) by capitalizing the first letter of the first

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

3 (3) by striking out ‘‘; and’’ at the end of sub4 paragraph (A) and inserting in lieu thereof a period;

5 and

6 (4) by adding at the end the following:

7 ‘‘(C) The number of such positions in the De8 partment during that fiscal year held by persons in9 volved in providing medical resources under section

10 8111 or 8152 of this title, reduced by the number

11 of persons (as determined by the Secretary) involved

12 in furnishing medical resources to the Department

13 under those sections.’’.

14 SEC. 612. PERMANENT AUTHORITY FOR WAIVER OF REDUC15 TION OF RETIREMENT PAY FOR REGISTERED16 NURSE POSITIONS.

17 Section 7426(c) is amended by striking out the sec18 ond sentence.

19 SEC. 613. STAFFING FLEXIBILITY.

20 (a) AUTHORITY TO CONVERT POSITION TO HYBRID

21 TITLE 38 PERSONNEL SYSTEM.—Section 7401(3) is

22 amended by striking out ‘‘and occupational therapists’’

23 and inserting in lieu thereof ‘‘occupational therapists, and

24 such other persons in health care occupations as the Sec25 retary considers necessary’’.
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1 (b) CONTRACTING FLEXIBILITY.—(1) Section 7409

2 is amended by striking out ‘‘scarce’’ in subsections (a) and

3 (b)(3).

4 (2)(A) The heading of such section, and the item re5 lating to such section in the table of sections at the begin6 ning of chapter 74, are each amended by striking out the

7 third word.

8 SEC. 614. PROTECTION AGAINST CERTAIN PROHIBITED

9 PERSONNEL PRACTICES.

10 (a) IN GENERAL.—Subchapter II of chapter 74 is

11 amended by adding at the end the following:

12 ‘‘§ 7427. Protection from prohibited personnel prac13 tices

14 ‘‘(a)(1) The provisions of law specified in paragraph

15 (2) apply to any individual appointed as an employee of

16 the Veterans Health Administration under chapter 73 of

17 this title or under this chapter.

18 ‘‘(2) The provisions of law referred to in paragraph

19 (1) are sections 1212, 1213, 1214, 1215, 1216, 1221,

20 1222, and 2302 of title 5.

21 ‘‘(b) The authority of the Merit Systems Protection

22 Board and of the Office of Special Counsel to review any

23 personnel action under the authority provided for under

24 a provision of law specified in subsection (a)(2) shall apply

25 only to the extent specified in that provision of law.’’.
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1 (b) CLERICAL AMENDMENT.—The table of sections

2 at the beginning of such chapter is amended by inserting

3 after the item relating to section 7426 the following new

4 item:

‘‘7427. Protection from prohibited personnel practices.’’.

5 SEC. 615. EXTENSION OF HEALTH SCHOLARSHIP PROGRAM.

6 Section 7618 is amended by striking out ‘‘December

7 31, 1995’’ and inserting in lieu thereof ‘‘December 31,

8 1998’’.

9 Subtitle C—Health Care Resource

10 Agreements

11 SEC. 621. REPEAL OF TERMINATION OF AUTHORITY FOR

12 EXPANDED SHARING ARRANGEMENTS.

13 Section 204 of the Veterans Health Care Act of 1992

14 (Public Law 102–585; 106 Stat. 4950) is repealed.

15 SEC. 622. ACQUISITION OF HEALTH CARE RESOURCES.

16 (a) AUTHORITY IN STATES WITH HEALTH CARE RE17 FORM PLANS.—Section 8123 is amended—

18 (1) by inserting ‘‘(a)’’ at the beginning of the

19 text;

20 (2) by inserting after subsection (a) the follow21 ing:

22 ‘‘(b)(1) The director of a Department health care fa23 cility located in a State that has established a State health

24 care reform plan may, without regard to section 1703 of

25 this title, or any other law or regulation pertaining to com-
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1 petitive procedures, acquisition procedures, or policies

2 (other than contract dispute procedures), or bid protests,

3 contract with any entity or individual to procure or furnish

4 any health care resource, as that term is defined in section

5 8151 of this title. The references in this subsection to laws

6 or regulations shall not be construed to apply to any provi7 sion of title XVIII or XIX of the Social Security Act.

8 ‘‘(2) A director may contract to furnish services

9 under this subsection to individuals who are not veterans

10 only if the director determines that a contract to furnish

11 such services—

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

13 level and quality of service to veterans at that facil14 ity;

15 ‘‘(B) will result in the improvement of services

16 to eligible veterans at that facility; and

17 ‘‘(C) will not result in the denial of, or a delay

18 in providing access to, care to any veteran at that

19 facility.

20 ‘‘(3) In entering into a contract to provide services

21 under this subsection, the director may provide for pay22 ment to the Department in accordance with procedures

23 that provide appropriate flexibility to negotiate an appro24 priate rate of reimbursement. Any proceeds to the Govern25 ment received therefrom shall be credited to the applicable
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1 appropriation of the Department and to funds that have

2 been allotted to the facility that furnished the care or serv3 ices.

4 ‘‘(4) For purposes of this subsection, a State health

5 care reform plan shall be considered to have been estab6 lished in a State if the Secretary determines that the State

7 has enacted legislation that is intended, at least in part,

8 to provide residents of that State who lack, or have inad9 equate, health insurance coverage access to health care

10 services.

11 ‘‘(c) A provision of law enacted after the date of en12 actment of this subsection shall not be construed as appli13 cable to purchases of prosthetic appliances or health care

14 resources by the Department unless that provision of law

15 specifically refers to this section and specifically states

16 that such provision of law modifies or supersedes this sec17 tion.

18 ‘‘(d) The authority to enter into a contract under

19 subsection (b) shall expire on September 30, 2000.’’.

20 (b) CLERICAL AMENDMENTS.—(1) The heading of

21 section 8123 is amended to read:
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1 ‘‘§ 8123. Procurement of prosthetic appliances and

2 health care resources’’.

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

4 81 is amended by striking out the item relating to section

5 8123 and inserting in lieu thereof the following:

‘‘8123. Procurement of prosthetic appliances and health care resources.’’.

6 SEC. 623. SHARING AGREEMENTS FOR SPECIALIZED MEDI7 CAL RESOURCES.

8 (a) REPEAL OF SECTION 8151.—(1) Subchapter IV

9 of chapter 81 is amended—

10 (A) by striking out section 8151; and

11 (B) by redesignating sections 8152, 8153,

12 8154, 8155, 8156, 8157, and 8158 as sections 8151,

13 8152, 8153, 8154, 8155, 8156, and 8157, respec14 tively.

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

16 81 is amended—

17 (A) by striking out the item relating to section

18 8151; and

19 (B) by revising the items relating to sections

20 8152, 8153, 8154, 8155, and 8156 to reflect the

21 redesignations by paragraph (1)(B).

22 (b) REVISED AUTHORITY FOR SHARING AGREE23 MENTS.—Section 8152, as redesignated by subsection

24 (a)(1)(B), is amended—

25 (1) in subsection (a)—
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1 (A) by striking out ‘‘certain specialized

2 medical’’ and inserting in lieu thereof ‘‘health

3 care’’;

4 (B) by striking out ‘‘clauses (i)’’ and all

5 that follows through ‘‘medical schools:’’ and in6 serting in lieu thereof ‘‘paragraphs (1) and (2),

7 between Department health-care facilities and

8 any medical school, health care provider, health

9 care plan, insurer, or other entity or individ10 ual:’’;

11 (C) by striking out ‘‘specialized medical’’

12 in paragraphs (1) and (2) and inserting in lieu

13 thereof ‘‘health care’’; and

14 (D) by striking out ‘‘have been justified on

15 the basis of veterans’ care, but which are not

16 utilized’’ in paragraph (2) and inserting in lieu

17 thereof ‘‘are not, or would not be, used’’;

18 (2) in subsection (b), by striking out ‘‘reciprocal

19 reimbursement’’ in the first sentence and all that

20 follows through the period at the end of that sen21 tence and inserting in lieu thereof ‘‘payment to the

22 Department in accordance with procedures that pro23 vide appropriate flexibility to negotiate payment

24 which is in the best interest of the Government.’’;
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1 (3) in subsection (d), by striking out ‘‘preclude

2 such payment, in accordance with—’’ and all that

3 follows through ‘‘to such facility therefor’’ and in4 serting in lieu thereof ‘‘preclude such payment to

5 such facility for such care or services’’;

6 (4) by redesignating subsection (e) as sub7 section (f); and

8 (5) by inserting after subsection (d) the follow9 ing new subsection (e):

10 ‘‘(e) The Secretary may make an arrangement that

11 authorizes the furnishing of services by the Secretary

12 under this section to individuals who are not veterans only

13 if the Secretary determines that such an arrangment—

14 ‘‘(1) is necessary to maintain an acceptable

15 level and quality of service to veterans at that facil16 ity;

17 ‘‘(2) will result in the improvement of services

18 to eligible veterans at that facility; and

19 ‘‘(3) will not result in the denial of, or a delay

20 in providing access to, care to any veteran at that

21 facility.’’.

22 (c) CROSS-REFERENCE AMENDMENTS.—(1) Section

23 8110(c)(3)(A) is amended by striking out ‘‘8153’’ and in24 serting in lieu thereof ‘‘8152’’.
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1 (2) Subsection (b) of section 8154 (as redesignated

2 by subsection (a)(1)(B)) is amended by striking out ‘‘sec3 tion 8154’’ and inserting in lieu thereof ‘‘section 8153’’.

4 (3) Section 8156 (as redesignated by subsection

5 (a)(1)(B)) is amended—

6 (A) in subsection (a), by striking out ‘‘section

7 8153(a)’’ and inserting in lieu thereof ‘‘section

8 8152(a)’’; and

9 (B) in subsection (b)(3), by striking out ‘‘sec10 tion 8153’’ and inserting in lieu thereof ‘‘section

11 8152’’.

12 (4) Subsection (a) of section 8157 (as redesignated

13 by subsection (a)(1)(B)) is amended—

14 (A) in the matter preceding paragraph (1), by

15 striking out ‘‘section 8157’’ and ‘‘section 8153(a)’’

16 and inserting in lieu thereof ‘‘section 8156’’ and

17 ‘‘section 8152(a)’’, respectively; and

18 (B) in paragraph (1), by striking out ‘‘section

19 8157(b)(4)’’ and inserting in lieu thereof ‘‘section

20 8156(b)(4)’’.

21 Subtitle D—Miscellaneous

22 SEC. 631. DEPARTMENT OF VETERANS AFFAIRS RESEARCH

23 ADVISORY COMMITTEES.

24 (a) STATUTORY BASIS FOR RESEARCH ADVISORY

25 COMMITTEES.—Subchapter III of chapter 5 is amended
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1 by adding after section 545, as added by section 302(a),

2 the following new section:

3 ‘‘§ 546. Veterans research advisory committees

4 ‘‘(a) Congress declares that each of the veterans re5 search advisory committees specified in subsection (c)

6 (previously established by the Secretary in carrying out

7 the duties of the Secretary under section 7303 of this title)

8 has a continuing, ongoing function that is integrally relat9 ed to the successful completion by the Department of its

10 statutory duties. Each such committee shall, for all pur11 poses, operate as though such committee had been estab12 lished by, and chartered pursuant to, law. The objectives

13 and scope of the activities of each such committee and the

14 duties for which the committee is responsible, as specified

15 by the Secretary as of September 1, 1993, shall be those

16 in effect as of that date.

17 ‘‘(b) The Secretary may not terminate a veterans’ re18 search advisory committee specified in subsection (c) un19 less the Secretary finds that the committee is no longer

20 needed. Not less than 120 days before terminating such

21 a committee, the Secretary shall submit to the Committees

22 on Veterans’ Affairs of the Senate and House of Rep23 resentatives a report on the proposed termination. The re24 port shall include an explanation of (1) the basis for the

25 Secretary’s determination that such committee is no
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1 longer needed, and (2) the manner in which the Secretary

2 will carry out the Secretary’s responsibilities under section

3 7303 of this title in the absence of the committee.

4 ‘‘(c) For purposes of this section, each of the follow5 ing committees and boards, as established by the Sec6 retary as of September 1, 1993, shall be considered to be

7 a veterans’ research advisory committee:

8 ‘‘(1) The Career Development Committee.

9 ‘‘(2) The Department of Veterans Affairs Coop10 erative Studies Evaluation Committee.

11 ‘‘(3) The Merit Review Board for Basic

12 Sciences Programs.

13 ‘‘(4) The Merit Review Board for Cardio14 vascular Programs.

15 ‘‘(5) The Merit Review Board for Clinical Phar16 macology, Alcoholism, and Drug Dependence Pro17 grams.

18 ‘‘(6) The Merit Review Board for Endocrinol19 ogy Programs.

20 ‘‘(7) The Merit Review Board for Gastro21 enterology Programs.

22 ‘‘(8) The Merit Review Board for Hematology

23 Programs.

24 ‘‘(9) The Merit Review Board for Immunology

25 Programs.
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1 ‘‘(10) The Merit Review Board for Infectious

2 Diseases Programs.

3 ‘‘(11) The Merit Review Board for Mental

4 Health and Behavioral Sciences Programs.

5 ‘‘(12) The Merit Review Board for Nephrology

6 Programs.

7 ‘‘(13) The Merit Review Board for

8 Neurobiology Programs.

9 ‘‘(14) The Merit Review Board for Oncology

10 Programs.

11 ‘‘(15) The Merit Review Board for Respiration

12 Programs.

13 ‘‘(16) The Merit Review Board for Surgery

14 Programs.

15 ‘‘(17) The Scientific Review and Evaluation

16 Board for Health Services Research and Develop17 ment.

18 ‘‘(18) The Scientific Review and Evaluation

19 Board for Rehabilitation Research and Develop20 ment.’’.

21 (b) CLERICAL AMENDMENT.—The table of sections

22 at the beginning of chapter 5 is amended by inserting

23 after the item relating to section 545, as added by section

24 302(a), the following new item:

‘‘546. Veterans research advisory committees.’’.
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1 SEC. 632. TECHNICAL AMENDMENTS.

2 (a) IN GENERAL.—Sections 7361(b) and 7363(c) are

3 each amended by striking out ‘‘section 501(c)(3) of’’.

4 (b) EFFECTIVE DATE.—The amendments made by

5 subsection (a) shall take effect as of May 20, 1988.

6 SEC. 633. SUBMITTAL DATE FOR REPORT ON ANNUAL

7 ANALYSIS OF DEPARTMENTWIDE ADMIS8 SIONS POLICIES.

9 Section 8110(a)(3)(B) is amended by striking out

10 ‘‘December 1’’ and inserting in lieu thereof ‘‘April 1’’.

11 SEC. 634. CHILD CARE SERVICES.

12 (a) REVISED CHILD CARE AUTHORITY.—Chapter 81

13 is amended by inserting after section 8116 the following

14 new section:

15 ‘‘§ 8117. Child care centers

16 ‘‘(a) The Secretary may provide for the operation of

17 child care centers at Department facilities. The operation

18 of such centers under this section shall be carried out to

19 the extent that the Secretary determines, based on the de20 mand of employees of the Department for the care in21 volved, that such operation is in the best interest of the

22 Department and that it is practicable to do so.

23 ‘‘(b)(1) In offering child care services under this sec24 tion, the Secretary shall give priority (in the following

25 order) to employees of—

26 ‘‘(A) the Department;
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1 ‘‘(B) other departments and agencies of the

2 Federal Government; and

3 ‘‘(C) schools affiliated with the Department and

4 corporations created under section 7361 of this title.

5 ‘‘(2) To the extent that space is available, the Sec6 retary may provide child care services to members of the

7 public at a child care center operated under this section

8 if the Secretary determines that to do so is necessary to

9 assure the financial success of that center.

10 ‘‘(c)(1) The Secretary shall establish reasonable

11 charges for child care services provided at each child care

12 center operated under this section. Such charges may be

13 established at different rates for different centers.

14 ‘‘(2) In establishing charges for child care services

15 provided at a center, the Secretary—

16 ‘‘(A) shall (except as provided in paragraph (3))

17 establish the charges so as to ensure that the sum

18 of all charges for child care services at that center

19 is sufficient to meet the staffing expenses of that

20 center; and

21 ‘‘(B) may also consider the expenses of con22 structing or acquiring space for the center, the ex23 penses of converting existing space into the center,

24 and the expenses of equipment and services fur25 nished to the center under subsection (d)(2).
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1 ‘‘(3) The Secretary may establish charges for child

2 care services provided at a center at rates less than those

3 necessary to ensure that the sum of all charges for child

4 care services at that center is sufficient to meet the staff5 ing expenses of that center if the Secretary determines

6 (with respect to a particular facility of the Department)

7 that—

8 ‘‘(A) the operation of a child care center at that

9 facility would help overcome serious recruitment or

10 retention problems;

11 ‘‘(B) adherence to the requirement to establish

12 charges for child care services at that center at rates

13 sufficient to meet the staffing expenses of that cen14 ter would make the operation of a child care center

15 at that facility infeasible; and

16 ‘‘(C) there are no other practical alternatives to

17 meeting the needs of employees at that facility for

18 child care services.

19 ‘‘(4) Proceeds from charges for child care services

20 shall be credited to the applicable Department of Veterans

21 Affairs account and shall be allotted to the facility served

22 by the child care center and shall remain available until

23 expended.
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1 ‘‘(d) In connection with the establishment and oper2 ation of a child care center under this section, the Sec3 retary—

4 ‘‘(1) may construct or alter space in any De5 partment facility, and may lease space in a non-De6 partment facility for a term not to exceed 20 years,

7 for use as a child care center;

8 ‘‘(2) may provide, out of operating funds, other

9 items and services necessary for the operation of the

10 center, including furniture, office machines and

11 equipment, utility and custodial services, and other

12 necessary services and amenities;

13 ‘‘(3) shall provide for the participation (directly

14 or through a parent advisory committee) of parents

15 of children receiving care in the center in the estab16 lishment of policies to govern the operation of the

17 center and in the oversight of the implementation of

18 such policies;

19 ‘‘(4) shall require the development and use of a

20 process for determining the fitness and suitability of

21 prospective employees of or volunteers at the center;

22 and

23 ‘‘(5) shall require in connection with the oper24 ation of the center compliance with all State and

25 local laws, ordinances, and regulations relating to
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1 health and safety and the operation of child care

2 centers.

3 ‘‘(e) The Secretary shall prescribe guidelines to carry

4 out this section.

5 ‘‘(f) For the purpose of this section, the term ‘parent

6 advisory committee’ means a committee comprised of, and

7 selected by, the parents of children receiving care in a

8 child care center operated under this section.’’.

9 (b) CONFORMING REPEAL.—Section 7809 is re10 pealed.

11 (c) CLERICAL AMENDMENTS.—(1) The table of sec12 tions at the beginning of chapter 81 is amended by insert13 ing after the item relating to section 8116 the following

14 new item:

‘‘8117. Child care centers.’’.

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

16 78 is amended by striking out the item relating to section

17 7809.

18 SEC. 635. CONTRACTS FOR UTILITIES, AUDIE L. MURPHY

19 MEMORIAL HOSPITAL.

20 (a) AUTHORITY TO CONTRACT.—Subject to sub21 section (b), the Secretary of Veterans Affairs may enter

22 into contracts for the provision of utilities (including

23 steam and chilled water) to the Audie L. Murphy Memo24 rial Hospital in San Antonio, Texas. Each such contract

25 may—
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1 (1) be for a period not to exceed 35 years;

2 (2) provide for the construction and operation

3 of a production facility on or near property under

4 the jurisdiction of the Secretary;

5 (3) require capital contributions by the parties

6 involved for the construction of such a facility, such

7 contribution to be in the form of cash, equipment,

8 or other in-kind contribution; and

9 (4) provide for a predetermined formula to

10 compute the cost of providing such utilities to the

11 parties for the duration of the contract.

12 (b) FUNDS.—A contract may be entered into under

13 subsection (a) only to the extent that appropriations are

14 available.

15 (c) ADDITIONAL TERMS.—The Secretary may include

16 in a contract under subsection (a) such additional provi17 sions as the Secretary considers necessary to secure the

18 provision of utilities and to protect the interests of the

19 United States.

20 SEC. 636. AUTHORITY TO ENTER INTO AGREEMENT FOR

21 USE OF PROPERTY AT EDWARD HINES, JR.,

22 DEPARTMENT OF VETERANS AFFAIRS HOS23 PITAL.

24 (a) IN GENERAL.—The Secretary of Veterans Affairs

25 may enter into a long-term lease or similar agreement with
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1 the organization known as The Caring Place at Loyola,

2 Inc., a not-for-profit organization operating under the

3 laws of the State of Illinois, to permit that organization

4 to establish on the grounds of the Edward Hines, Jr., De5 partment of Veterans Affairs Hospital, Hines, Illinois, a

6 facility to provide temporary accommodations for family

7 members of severely ill children who are being treated at

8 the Loyola University of Chicago Medical Center and

9 other hospitals.

10 (b) CONDITIONS.—An agreement under subsection

11 (a)—

12 (1) shall ensure that there shall be no cost to

13 the United States as a result of the property use au14 thorized by that subsection;

15 (2) may permit the use of the property without

16 rent; and

17 (3) shall, to the extent practicable, ensure that

18 one room of the facility is available for the use of

19 a veteran (at no cost to the veteran) as temporary

20 accommodations for the veteran while a severely ill

21 child of the veteran is treated at the Loyola Univer22 sity of Chicago Medical Center or other hospitals.

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