II 

Calendar No. 284 

109TH CONGRESS 

1ST SESSION S. 1182 

[Report No. 109–177] 

To amend title 38, United States Code, to improve health care for veterans, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 7, 2005 

Mr. CRAIG introduced the following bill; which was read twice and referred 

to the Committee on Veterans’ Affairs 

NOVEMBER 10, 2005 

Reported by Mr. CRAIG, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To amend title 38, United States Code, to improve health 

care for veterans, 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; REFERENCES TO TITLE 38, 

4 UNITED STATES CODE. 

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

6 ‘‘Veterans Health Care Act of 2005’’. 
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1 (b) REFERENCES.—Except as otherwise expressly 

2 provided, whenever in this Act an amendment or repeal 

3 is expressed in terms of an amendment or repeal to a sec4 tion or other provision, the reference shall be considered 

5 to be made to a section or other provision of title 38, 

6 United States Code. 

7 SEC. 2. COPAYMENT EXEMPTION FOR HOSPICE CARE. 

8 Section 1710 is amended— 

9 (1) in subsection (f)(1), by inserting ‘‘(other 

10 than hospice care)’’ after ‘‘nursing home care’’; and 

11 (2) in subsection (g)(1), by inserting ‘‘(other 

12 than hospice care)’’ after ‘‘medical services’’. 

13 SEC. 3. NURSING HOME BED LEVELS; EXEMPTION FROM 

14 EXTENDED CARE SERVICES COPAYMENTS 

15 FOR FORMER POWS. 

16 Section 1710B is amended— 

17 (1) by striking subsection (b); 

18 (2) by redesignating subsections (c) through (e) 

19 as subsections (b) through (d), respectively; and 

20 (3) in subsection (b)(2), as redesignated— 

21 (A) by redesignating subparagraphs (B) 

22 and (C) as subparagraphs (C) and (D), respec23 tively; and 

24 (B) by inserting after subparagraph (A) 

25 the following: 
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1 ‘‘(B) to a veteran who is a former prisoner 

2 of war;’’. 

3 SEC. 4. REIMBURSEMENT FOR CERTAIN VETERANS’ OUT4 STANDING EMERGENCY TREATMENT EX5 PENSES. . 

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

7 amended by inserting after section 1725 the following: 

8 ‘‘§ 1725A. Reimbursement for emergency treatment 

9 expenses for which certain veterans re10 main personally liable 

11 ‘‘(a)(1) Subject to subsection (c), the Secretary may 

12 reimburse a veteran described in subsection (b) for ex13 penses resulting from emergency treatment furnished to 

14 the veteran in a non-Department facility for which the vet15 eran remains personally liable. 

16 ‘‘(2) In any case in which reimbursement is author17 ized under subsection (a)(1), the Secretary, in the Sec18 retary’s discretion, may, in lieu of reimbursing the vet19 eran, make payment— 

20 ‘‘(A) to a hospital or other health care provider 

21 that furnished the treatment; or 

22 ‘‘(B) to the person or organization that paid for 

23 such treatment on behalf of the veteran. 

24 ‘‘(b) A veteran referred to in subsection (a) is an indi25 vidual who— 
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1 ‘‘(1) is enrolled in the health care system estab2 lished under section 1705(a) of this title; 

3 ‘‘(2) received care under this chapter during the 

4 24-month period preceding the furnishing of such 

5 emergency treatment; 

6 ‘‘(3) is entitled to care or services under a 

7 health-plan contract that partially reimburses the 

8 cost of the veteran’s emergency treatment; 

9 ‘‘(4) is financially liable to the provider of emer10 gency care treatment for costs not covered by the 

11 veteran’s health-plan contract, including copayments 

12 and deductibles; and 

13 ‘‘(5) is not eligible for reimbursement for med14 ical care or services under section 1725 or 1728 of 

15 this title. 

16 ‘‘(c)(1) Any amount paid by the Secretary under sub17 section (a) shall exclude the amount of any payment the 

18 veteran would have been required to make to the United 

19 States under this chapter if the veteran had received the 

20 emergency treatment from the Department. 

21 ‘‘(2) The Secretary may not provide reimbursement 

22 under this section with respect to any item or service— 

23 ‘‘(A) provided or for which payment has been 

24 made, or can reasonably be expected to be made, 

25 under the veteran’s health-plan contract; or 
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1 ‘‘(B) for which payment has been made or can 

2 reasonably be expected to be made by a third party. 

3 ‘‘(3)(A) Payment by the Secretary under this section 

4 on behalf of a veteran to a provider of emergency treat5 ment shall, unless rejected and refunded by the provider 

6 within 30 days of receipt, extinguish any liability on the 

7 part of the veteran for that treatment. 

8 ‘‘(B) The absence of a contract or agreement between 

9 the Secretary and the provider, any provision of a contract 

10 or agreement, or an assignment to the contrary shall not 

11 operate to modify, limit, or negate the requirement under 

12 subparagraph (A). 

13 ‘‘(4) In accordance with regulations prescribed by the 

14 Secretary, the Secretary shall— 

15 ‘‘(A) establish criteria for determining the 

16 amount of reimbursement (which may include a 

17 maximum amount) payable under this section; and 

18 ‘‘(B) delineate the circumstances under which 

19 such payment may be made, including requirements 

20 for requesting reimbursement. 

21 ‘‘(d)(1) In accordance with regulations prescribed by 

22 the Secretary, the United States shall have the inde23 pendent right to recover any amount paid under this sec24 tion if, and to the extent that, a third party subsequently 

25 makes a payment for the same emergency treatment. 
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1 ‘‘(2) Any amount paid by the United States to the 

2 veteran, the veteran’s personal representative, successor, 

3 dependents, or survivors, or to any other person or organi4 zation paying for such treatment shall constitute a lien 

5 in favor of the United States against any recovery the 

6 payee subsequently receives from a third party for the 

7 same treatment. 

8 ‘‘(3) Any amount paid by the United States to the 

9 provider that furnished the veteran’s emergency treatment 

10 shall constitute a lien against any subsequent amount the 

11 provider receives from a third party for the same emer12 gency treatment for which the United States made pay13 ment. 

14 ‘‘(4) The veteran or the veteran’s personal represent15 ative, successor, dependents, or survivors shall— 

16 ‘‘(A) ensure that the Secretary is promptly noti17 fied of any payment received from any third party 

18 for emergency treatment furnished to the veteran; 

19 ‘‘(B) immediately forward all documents relat20 ing to a payment described in subparagraph (A); 

21 ‘‘(C) cooperate with the Secretary in an inves22 tigation of a payment described in subparagraph 

23 (A); and 
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1 ‘‘(D) assist the Secretary in enforcing the 

2 United States right to recover any payment made 

3 under subsection (c)(3). 

4 ‘‘(e) The Secretary may waive recovery of a payment 

5 made to a veteran under this section that is otherwise re6 quired under subsection (d)(1) if the Secretary determines 

7 that such waiver would be in the best interest of the 

8 United States, as defined by regulations prescribed by the 

9 Secretary. 

10 ‘‘(f) For purposes of this section— 

11 ‘‘(1) the term ‘health-plan contract’ includes— 

12 ‘‘(A) an insurance policy or contract, med13 ical or hospital service agreement, membership 

14 or subscription contract, or similar arrange15 ment, under which health services for individ16 uals are provided or the expenses of such serv17 ices are paid; 

18 ‘‘(B) an insurance program described in 

19 section 1811 of the Social Security Act (42 

20 U.S.C. 1395c) or established by section 1831 of 

21 that Act (42 U.S.C. 1395j); 

22 ‘‘(C) a State plan for medical assistance 

23 approved under title XIX of such Act (42 

24 U.S.C. 1396 et seq.); and 
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1 ‘‘(D) a workers’ compensation law or plan 

2 described in section 1729(A)(2)(B) of this title; 

3 ‘‘(2) the term ‘third party’ means— 

4 ‘‘(A) a Federal entity; 

5 ‘‘(B) a State or political subdivision of a 

6 State; 

7 ‘‘(C) an employer or an employer’s insur8 ance carrier; and 

9 ‘‘(D) a person or entity obligated to pro10 vide, or pay the expenses of, such emergency 

11 treatment; and 

12 ‘‘(3) the term ‘emergency treatment’ has the 

13 meaning given such term in section 1725 of this 

14 title.’’. 

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

16 at the beginning of chapter 17 is amended by inserting 

17 after the item relating to section 1725 the following: 

‘‘Sec. 1725A. Reimbursement for emergency treatment expenses for which certain veterans remain personally liable.’’. 

18 SEC. 5. CARE FOR NEWBORN CHILDREN OF WOMEN VET19 ERANS RECEIVING MATERNITY CARE . 

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

21 amended by adding at the end the following: 
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1 ‘‘§ 1786. Care for newborn children of women vet2 erans receiving maternity care 

3 ‘‘The Secretary may furnish care to a newborn child 

4 of a woman veteran, who is receiving maternity care fur5 nished by the Department, for not more than 14 days 

6 after the birth of the child if the veteran delivered the child 

7 in a Department facility or in another facility pursuant 

8 to a Department contract for the delivery services.’’. 

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

10 at the beginning of chapter 17 is amended by inserting 

11 after the item relating to section 1785 the following: 

‘‘Sec. 1786. Care for newborn children of women veterans receiving maternity 

care.’’. 

12 SEC. 6. ENHANCEMENT OF PAYER PROVISIONS FOR 

13 HEALTH CARE FURNISHED TO CERTAIN 

14 CHILDREN OF VIETNAM VETERANS. 

15 (a) HEALTH CARE FOR SPINA BIFIDA AND ASSOCI16 ATED DISABILITIES.—Section 1803 is amended— 

17 (1) by redesignating subsection (c) as sub18 section (d); and 

19 (2) by inserting after subsection (b) the fol20 lowing: 

21 ‘‘(c)(1) If a payment made by the Secretary for 

22 health care under this section is less than the amount 

23 billed for such health care, the health care provider or 

24 agent of the health care provider may, in accordance with 
10 

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1 paragraphs (2) through (4), seek payment for the dif2 ference between the amount billed and the amount paid 

3 by the Secretary from a responsible third party to the ex4 tent that the provider or agent would be eligible to receive 

5 payment for such health care from such third party. 

6 ‘‘(2) The health care provider or agent may not im7 pose any additional charge on the beneficiary who received 

8 the health care, or the family of such beneficiary, for any 

9 service or item for which the Secretary has made payment 

10 under this section; 

11 ‘‘(3) The total amount of payment a health care pro12 vider or agent may receive for health care furnished under 

13 this section may not exceed the amount billed to the Sec14 retary. 

15 ‘‘(4) The Secretary, upon request, shall disclose to 

16 such third party information received for the purposes of 

17 carrying out this section.’’. 

18 (b) HEALTH CARE FOR BIRTH DEFECTS AND ASSO19 CIATED DISABILITIES.—Section 1813 is amended— 

20 (1) by redesignating subsection (c) as sub21 section (d); and 

22 (2) by inserting after subsection (b) the fol23 lowing: 

24 ‘‘(c)(1) If payment made by the Secretary for health 

25 care under this section is less than the amount billed for 
11 

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1 such health care, the health care provider or agent of the 

2 health care provider may, in accordance with paragraphs 

3 (2) through (4), seek payment for the difference between 

4 the amount billed and the amount paid by the Secretary 

5 from a responsible third party to the extent that the pro6 vider or agent would be eligible to receive payment for 

7 such health care from such third party. 

8 ‘‘(2) The health care provider or agent may not im9 pose any additional charge on the beneficiary who received 

10 health care, or the family of such beneficiary, for any serv11 ice or item for which the Secretary has made payment 

12 under this section; 

13 ‘‘(3) The total amount of payment a health care pro14 vider or agent may receive for health care furnished under 

15 this section may not exceed the amount billed to the Sec16 retary; and 

17 ‘‘(4) The Secretary, upon request, shall disclose to 

18 such third party information received for the purposes of 

19 carrying out this section.’’. 

20 SEC. 7. IMPROVEMENTS TO HOMELESS PROVIDERS GRANT 

21 AND PER DIEM PROGRAM. 

22 (a) PERMANENT AUTHORITY.—Section 2011 (a) is 

23 amended— 

24 (1) in paragraph (1), by striking ‘‘(1)’’; and 

25 (2) by striking paragraph (2). 
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1 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

2 2013 is amended to read as follows: 

3 ‘‘§ 2013. Authorization of appropriations 

4 ‘‘There are authorized to be appropriated 

5 $130,000,000 for fiscal year 2006 and each subsequent 

6 fiscal year to carry out this subchapter.’’. 

7 SEC. 8. MARRIAGE AND FAMILY THERAPISTS. 

8 (a) QUALIFICATIONS.—Section 7402(b) is amend9 ed— 

10 (1) by redesignating paragraph (10) as para11 graph (11); and 

12 (2) by inserting after paragraph (9) the fol13 lowing: 

14 ‘‘(10) MARRIAGE AND FAMILY THERAPIST.—To be 

15 eligible to be appointed to a marriage and family therapist 

16 position, a person must— 

17 ‘‘(A) hold a master’s degree in marriage and 

18 family therapy, or a comparable degree in mental 

19 health, from a college or university approved by the 

20 Secretary; and 

21 ‘‘(B) be licensed or certified to independently 

22 practice marriage and family therapy in a State, ex23 cept that the Secretary may waive the requirement 

24 of licensure or certification for an individual mar25 riage and family therapist for a reasonable period of 
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1 time recommended by the Under Secretary for 

2 Health.’’. 

3 (b) REPORT ON MARRIAGE AND FAMILY THERAPY

4 WORKLOAD.— 

5 (1) IN GENERAL.—Not later than 90 days after 

6 the date of enactment of this Act, the Under Sec7 retary for Health, Department of Veterans Affairs, 

8 shall submit to the Committee on Veterans’ Affairs 

9 of the Senate and the Committee on Veterans’ Af10 fairs of the House of Representatives a report on the 

11 provisions of post-traumatic stress disorder treat12 ment by marriage and family therapists. 

13 (2) CONTENTS.—The report submitted under 

14 paragraph (1) shall include— 

15 (A) the actual and projected workloads in 

16 facilities of the Veterans Readjustment Coun17 seling Service and the Veterans Health Admin18 istration for the provision of marriage and fam19 ily counseling for veterans diagnosed with, or 

20 otherwise in need of treatment for, post-trau21 matic stress disorder; 

22 (B) the resources available and needed to 

23 support the workload projections described in 

24 subparagraph (A); 
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1 (C) an assessment by the Under Secretary 

2 for Health of the effectiveness of treatment by 

3 marriage and family therapists; and 

4 (D) recommendations, if any, for improve5 ments in the provision of such counseling treat6 ment. 

7 SEC. 9. PAY COMPARABILITY FOR CHIEF NURSING OFFI8 CER, OFFICE OF NURSING SERVICES. 

9 Section 7404 is amended— 

10 (1) in subsection (d), by striking ‘‘subchapter 

11 III’’ and inserting ‘‘paragraph (e), subchapter III,’’; 

12 and 

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

14 ‘‘(e) The position of Chief Nursing Officer, Office of 

15 Nursing Services, shall be exempt from the provisions of 

16 section 7451 of this title and shall be paid at a rate not 

17 to exceed the maximum rate established for the Senior Ex18 ecutive Service under section 5382 of title 5 United States 

19 Code, as determined by the Secretary.’’. 

20 SEC. 10. REPEAL OF COST COMPARISON STUDIES PROHIBI21 TION. 

22 Section 8110(a) is amended— 

23 (1) by striking paragraph (5); and 

24 (2) by redesignating paragraph (6) as para25 graph (5). 
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1 SEC. 11. IMPROVEMENTS AND EXPANSION OF MENTAL 

2 HEALTH SERVICES. 

3 (a) IN GENERAL.—The Secretary of Veterans affairs 

4 shall— 

5 (1) expand the number of clinical treatment 

6 teams principally dedicated to the treatment of post7 traumatic stress disorder in medical facilities of the 

8 Department of Veterans Affairs; 

9 (2) expand and improve the services available to 

10 diagnose and treat substance abuse; 

11 (3) expand and improve tele-health initiatives to 

12 provide better access to mental health services in 

13 areas of the country in which the Secretary deter14 mines that a need for such services exist due to the 

15 distance of such locations from an appropriate facil16 ity of the Department of Veterans Affairs; 

17 (4) improve education programs available to 

18 primary care delivery professionals and dedicate 

19 such programs to recognize, treat, and clinically 

20 manage veterans with mental health care needs; 

21 (5) expand the delivery of mental health serv22 ices in community-based outpatient clinics of the De23 partment of Veterans Affairs in which such services 

24 are not available as of the date of enactment of this 

25 Act; and 
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1 (6) expand and improve the Mental Health In2 tensive Case Management Teams for the treatment 

3 and clinical case management of veterans with seri4 ous or chronic mental illness. 

5 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated in each of fiscal years 

7 2006 and 2007, $95,000,000 to improve and expand the 

8 treatment services and options available to veterans in 

9 need of mental health treatment from the Department of 

10 Veterans Affairs, of which— 

11 (1) $5,000,000 shall be allocated to carry out 

12 subsection (a)(1); 

13 (2) $50,000,000 shall be allocated to carry out 

14 subsection (a)(2); 

15 (3) $10,000,000 shall be allocated to carry out 

16 subsection (a)(3); 

17 (4) $1,000,000 shall be allocated to carry out 

18 subsection (a)(4); 

19 (5) $20,000,000 shall be allocated to carry out 

20 subsection (a)(5); and 

21 (6) $5,000,000 shall be allocated to carry out 

22 subsection (a)(6). 
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1 SEC. 12. DATA SHARING IMPROVEMENTS. 

2 Notwithstanding any other provision of law, the De3 partment of Veterans Affairs and the Department of De4 fense may exchange protected health information for— 

5 (1) patients receiving treatment from the De6 partment of Veterans Affairs; or 

7 (2) individuals who may receive treatment from 

8 the Department of Veterans Affairs in the future, 

9 including all current and former members of the 

10 Armed Services. 

11 SEC. 13. EXPANSION OF NATIONAL GUARD OUTREACH PRO12 GRAM. 

13 (a) REQUIREMENT.—The Secretary of Veterans Af14 fairs shall expand the total number of personal employed 

15 by the Department of Veterans Affairs as part of the Re16 adjustment Counseling Service’s Global War on Terrorism 

17 Outreach Program (referred to in this section as the ‘‘Pro18 gram’’). 

19 (b) COORDINATION.—In carrying out subsection (a), 

20 the Secretary shall coordinate participation in the Pro21 gram by appropriate employees of the Veterans Benefits 

22 Administration and the Veterans Health Administration. 

23 (c) INFORMATION AND ASSESSMENTS.—The Sec24 retary shall ensure that— 
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1 (1) all appropriate health, education, and bene2 fits information is available to returning members of 

3 the National Guard; and 

4 (2) proper assessments of the needs in each of 

5 these areas is made by the Department of Veterans 

6 Affairs. 

7 (d) COLLABORATION.—The Secretary of Veterans 

8 Affairs shall collaborate with appropriate State National 

9 Guard officials and provide such officials with any assets 

10 or services of the Department of Veterans Affairs that the 

11 Secretary determines to be necessary to carry out the 

12 Global War on Terrorism Outreach Program. 

13 SEC. 14. EXPANSION OF TELE-HEALTH SERVICES. 

14 (a) IN GENERAL.—The Secretary shall increase the 

15 number of Veterans Readjustment Counseling Service fa16 cilities capable of providing health services and counseling 

17 through tele-health linkages with facilities of the Veterans 

18 Health Administration. 

19 (b) PLAN.—The Secretary shall submit to the Com20 mittee on Veterans’ Affairs of the Senate and the Com21 mittee on Veterans’ Affairs of the House of Representa22 tives a plan to implement the requirement under sub23 section (a), which shall describe the facilities that will have 

24 such capabilities at the end of each of fiscal years 2005, 

25 2006, and 2007. 
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1 SEC. 15. MENTAL HEALTH DATA SOURCES REPORT. 

2 (a) IN GENERAL.—Not less than 180 days after the 

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

4 Affairs shall submit a report to the Committee on Vet5 erans’ Affairs of the Senate and the Committee on Vet6 erans’ Affairs of the House of Representatives describing 

7 the mental health data maintained by the Department of 

8 Veterans Affairs. 

9 (b) CONTENTS.—The report submitted under sub10 section (a) shall include— 

11 (1) a comprehensive list of the sources of all 

12 such data, including the geographic locations of fa13 cilities of the Department of Veterans Affairs main14 taining such data; 

15 (2) an assessment of the limitations or advan16 tages to maintaining the current data configuration 

17 and locations; and 

18 (3) any recommendations, if any, for improving 

19 the collection, use, and location of mental health 

20 data maintained by the Department of Veterans Af21 fairs. 

22 SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, 

23 UNITED STATES CODE; TABLE OF CONTENTS. 

24 (a) SHORT TITLE.—This Act may be cited as the ‘‘Vet25 erans Health Care Act of 2005’’. 
20 

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1 (b) REFERENCES.—Except as otherwise expressly pro2 vided, whenever in this Act an amendment or repeal is ex3 pressed in terms of an amendment or repeal to a section 

4 or other provision, the reference shall be considered to be 

5 made to a section or other provision of title 38, United 

6 States Code. 

7 (c) TABLE OF CONTENTS.—The table of contents for 

8 this Act is as follows: 

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

Sec. 2. Care for newborn children of women veterans receiving maternity care. 

Sec. 3. Enhancement of payer provisions for health care furnished to certain children of Vietnam veterans. 

Sec. 4. Improvements to homeless veterans service providers programs. 

Sec. 5. Additional mental health providers. 

Sec. 6. Pay comparability for Chief Nursing Officer, Office of Nursing Services. 

Sec. 7. Repeal of cost comparison studies prohibition. 

Sec. 8. Improvements and expansion of mental health services. 

Sec. 9. Data sharing improvements. 

Sec. 10. Expansion of National Guard Outreach Program. 

Sec. 11. Expansion of tele-health services. 

Sec. 12. Mental health data sources report. 

Sec. 13. Strategic plan for long-term care. 

Sec. 14. Blind rehabilitation outpatient specialists. 

Sec. 15. Compliance report. 

Sec. 16. Health care and services for veterans affected by Hurricane Katrina. 

Sec. 17. Reimbursement for certain veterans’ outstanding emergency treatment 

expenses. 

9 SEC. 2. CARE FOR NEWBORN CHILDREN OF WOMEN VET10 ERANS RECEIVING MATERNITY CARE. 

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

12 amended by adding at the end the following: 

13 ‘‘§ 1786. Care for newborn children of women veterans 

14 receiving maternity care 

15 ‘‘The Secretary may furnish care to a newborn child 

16 of a woman veteran, who is receiving maternity care fur-
21 

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1 nished by the Department, for not more than 14 days after 

2 the birth of the child if the veteran delivered the child in 

3 a Department facility or in another facility pursuant to 

4 a Department contract for the delivery services.’’. 

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

6 the beginning of chapter 17 is amended by inserting after 

7 the item relating to section 1785 the following: 

‘‘Sec. 1786. Care for newborn children of women veterans receiving maternity 

care.’’. 

8 SEC. 3. ENHANCEMENT OF PAYER PROVISIONS FOR 

9 HEALTH CARE FURNISHED TO CERTAIN CHIL10 DREN OF VIETNAM VETERANS. 

11 (a) HEALTH CARE FOR SPINA BIFIDA AND ASSOCI12 ATED DISABILITIES.—Section 1803 is amended— 

13 (1) by redesignating subsection (c) as subsection 

14 (d); and 

15 (2) by inserting after subsection (b) the fol16 lowing: 

17 ‘‘(c)(1) If a payment made by the Secretary for health 

18 care under this section is less than the amount billed for 

19 such health care, the health care provider or agent of the 

20 health care provider may, in accordance with paragraphs 

21 (2) through (4), seek payment for the difference between the 

22 amount billed and the amount paid by the Secretary from 

23 a responsible third party to the extent that the provider or 
22 

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1 agent would be eligible to receive payment for such health 

2 care from such third party. 

3 ‘‘(2) The health care provider or agent may not impose 

4 any additional charge on the beneficiary who received the 

5 health care, or the family of such beneficiary, for any serv6 ice or item for which the Secretary has made payment 

7 under this section. 

8 ‘‘(3) The total amount of payment a health care pro9 vider or agent may receive for health care furnished under 

10 this section may not exceed the amount billed to the Sec11 retary. 

12 ‘‘(4) The Secretary, upon request, shall disclose to such 

13 third party information received for the purposes of car14 rying out this section.’’. 

15 (b) HEALTH CARE FOR BIRTH DEFECTS AND ASSOCI16 ATED DISABILITIES.—Section 1813 is amended— 

17 (1) by redesignating subsection (c) as subsection 

18 (d); and 

19 (2) by inserting after subsection (b) the fol20 lowing: 

21 ‘‘(c)(1) If payment made by the Secretary for health 

22 care under this section is less than the amount billed for 

23 such health care, the health care provider or agent of the 

24 health care provider may, in accordance with paragraphs 

25 (2) through (4), seek payment for the difference between the 
23 

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1 amount billed and the amount paid by the Secretary from 

2 a responsible third party to the extent that the provider or 

3 agent would be eligible to receive payment for such health 

4 care from such third party. 

5 ‘‘(2) The health care provider or agent may not impose 

6 any additional charge on the beneficiary who received 

7 health care, or the family of such beneficiary, for any serv8 ice or item for which the Secretary has made payment 

9 under this section. 

10 ‘‘(3) The total amount of payment a health care pro11 vider or agent may receive for health care furnished under 

12 this section may not exceed the amount billed to the Sec13 retary. 

14 ‘‘(4) The Secretary, upon request, shall disclose to such 

15 third party information received for the purposes of car16 rying out this section.’’. 

17 SEC. 4. IMPROVEMENTS TO HOMELESS VETERANS SERVICE 

18 PROVIDERS PROGRAMS. 

19 (a) PERMANENT AUTHORITY.—Section 2011 (a) is 

20 amended— 

21 (1) in paragraph (1), by striking ‘‘(1)’’; and 

22 (2) by striking paragraph (2). 

23 (b) AUTHORIZATION OF APPROPRIATIONS.— 
24 

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1 (1) COMPREHENSIVE SERVICE PROGRAMS FOR

2 HOMELESS VETERANS.—Section 2013 is amended to 

3 read as follows: 

4 ‘‘§ 2013. Authorization of appropriations 

5 ‘‘There are authorized to be appropriated $130,000,000 

6 for fiscal year 2006 and each subsequent fiscal year to carry 

7 out this subchapter.’’. 

8 (2) HOMELESS VETERAN SERVICE PROVIDER

9 TECHNICAL ASSISTANCE PROGRAM.—Section 2064(b) 

10 is amended to read as follows: 

11 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated $1,000,000 for each of 

13 fiscal years 2006 through 2011 to carry out the programs 

14 under this section.’’. 

15 SEC. 5. ADDITIONAL MENTAL HEALTH PROVIDERS. 

16 (a) QUALIFICATIONS.—Section 7402(b) is amended— 

17 (1) by redesignating paragraph (10) as para18 graph (12); and 

19 (2) by inserting after paragraph (9) the fol20 lowing: 

21 ‘‘(10) MARRIAGE AND FAMILY THERAPIST.—To be eli22 gible to be appointed to a marriage and family therapist 

23 position, a person shall— 

24 ‘‘(A) hold a master’s degree in marriage and 

25 family therapy, or a comparable degree in mental 
25 

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1 health, from a college or university approved by the 

2 Secretary; and 

3 ‘‘(B) be licensed or certified to independently 

4 practice marriage and family therapy in a State, ex5 cept that the Secretary may waive the requirement of 

6 licensure or certification for an individual marriage 

7 and family therapist for a reasonable period of time 

8 recommended by the Under Secretary for Health. 

9 ‘‘(11) LICENSED PROFESSIONAL MENTAL HEALTH

10 COUNSELORS.—To be eligible to be appointed to a licensed 

11 professional mental health counselor position, a person 

12 shall— 

13 ‘‘(A) hold a master’s degree in mental health 

14 counseling, or a related field, from a college or univer15 sity approved by the Secretary; and 

16 ‘‘(B) be licensed or certified to independently 

17 practice mental health counseling.’’. 

18 (b) REPORT ON MARRIAGE AND FAMILY THERAPY

19 WORKLOAD.— 

20 (1) IN GENERAL.—Not later than 90 days after 

21 the date of enactment of this Act, the Under Secretary 

22 for Health, Department of Veterans Affairs, shall sub23 mit to the Committee on Veterans’ Affairs of the Sen24 ate and the Committee on Veterans’ Affairs of the 

25 House of Representatives a report on the provisions of 
26 

•S 1182 RS

1 post-traumatic stress disorder treatment by marriage 

2 and family therapists. 

3 (2) CONTENTS.—The report submitted under 

4 paragraph (1) shall include— 

5 (A) the actual and projected workloads in 

6 facilities of the Veterans Readjustment Coun7 seling Service and the Veterans Health Adminis8 tration for the provision of marriage and family 

9 counseling for veterans diagnosed with, or other10 wise in need of treatment for, post-traumatic 

11 stress disorder; 

12 (B) the resources available and needed to 

13 support the workload projections described in 

14 subparagraph (A); 

15 (C) an assessment by the Under Secretary 

16 for Health of the effectiveness of treatment by 

17 marriage and family therapists; and 

18 (D) recommendations, if any, for improve19 ments in the provision of such counseling treat20 ment. 

21 SEC. 6. PAY COMPARABILITY FOR CHIEF NURSING OFFICER, 

22 OFFICE OF NURSING SERVICES. 

23 Section 7404 is amended— 
27 

•S 1182 RS

1 (1) in subsection (d), by striking ‘‘subchapter III 

2 and in’’ and inserting ‘‘subsection (e), subchapter III, 

3 and’’; and 

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

5 ‘‘(e) The position of Chief Nursing Officer, Office of 

6 Nursing Services, shall be exempt from the provisions of sec7 tion 7451 of this title and shall be paid at a rate not to 

8 exceed the maximum rate established for the Senior Execu9 tive Service under section 5382 of title 5 United States 

10 Code, as determined by the Secretary.’’. 

11 SEC. 7. REPEAL OF COST COMPARISON STUDIES PROHIBI12 TION. 

13 Section 8110(a) is amended— 

14 (1) by striking paragraph (5); and 

15 (2) by redesignating paragraph (6) as para16 graph (5). 

17 SEC. 8. IMPROVEMENTS AND EXPANSION OF MENTAL 

18 HEALTH SERVICES. 

19 (a) FINDINGS.—Congress makes the following findings: 

20 (1) Mental health treatment capacity at commu21 nity-based outpatient clinics remains inadequate and 

22 inconsistent, despite the requirement under section 

23 1706(c) of title 38, United States Code, that every 

24 primary care health care facility of the Department 

25 of Veterans Affairs develop and carry out a plan to 
28 

•S 1182 RS

1 meet the mental health care needs of veterans who re2 quire such services. 

3 (2) In 2001, the minority staff of the Committee 

4 on Veterans’ Affairs of the Senate conducted a survey 

5 of community-based outpatient clinics and found that 

6 there was no established systemwide baseline of ac7 ceptable mental health service levels at such clinics. 

8 (3) In February 2005, the Government Account9 ability Office reported that the Department of Vet10 erans Affairs had not fully met any of the 24 clinical 

11 care and education recommendations made in 2004 

12 by the Special Committee on Post-Traumatic Stress 

13 Disorder of the Under Secretary for Health, Veterans 

14 Health Administration. 

15 (b) CLINICAL SERVICES AND EDUCATION.— 

16 (1) IN GENERAL.—The Secretary of Veterans af17 fairs shall— 

18 (A) expand the number of clinical treatment 

19 teams principally dedicated to the treatment of 

20 post-traumatic stress disorder in medical facili21 ties of the Department of Veterans Affairs; 

22 (B) expand and improve the services avail23 able to diagnose and treat substance abuse; 

24 (C) expand and improve tele-health initia25 tives to provide better access to mental health 
29 

•S 1182 RS

1 services in areas of the country in which the Sec2 retary determines that a need for such services 

3 exist due to the distance of such locations from 

4 an appropriate facility of the Department of Vet5 erans Affairs; 

6 (D) improve education programs available 

7 to primary care delivery professionals and dedi8 cate such programs to recognize, treat, and clini9 cally manage veterans with mental health care 

10 needs; 

11 (E) expand the delivery of mental health 

12 services in community-based outpatient clinics of 

13 the Department of Veterans Affairs in which 

14 such services are not available as of the date of 

15 enactment of this Act; and 

16 (F) expand and improve the Mental Health 

17 Intensive Case Management Teams for the treat18 ment and clinical case management of veterans 

19 with serious or chronic mental illness. 

20 (2) AUTHORIZATION OF APPROPRIATIONS.— 

21 There are authorized to be appropriated $95,000,000 

22 in each of fiscal years 2006 and 2007 to improve and 

23 expand the treatment services and options available to 

24 veterans in need of mental health treatment from the 

25 Department of Veterans Affairs, of which— 
30 

•S 1182 RS

1 (A) $5,000,000 shall be allocated to carry 

2 out paragraph (1)(A); 

3 (B) $50,000,000 shall be allocated to carry 

4 out paragraph (1)(B); 

5 (C) $10,000,000 shall be allocated to carry 

6 out paragraph (1)(C); 

7 (D) $1,000,000 shall be allocated to carry 

8 out paragraph (1)(D); 

9 (E) $20,000,000 shall be allocated to carry 

10 out paragraph (1)(E); and 

11 (F) $5,000,000 shall be allocated to carry 

12 out paragraph (1)(F). 

13 (c) REQUIRED CAPACITY FOR COMMUNITY-BASED

14 OUTPATIENT CLINICS.— 

15 (1) ACCOUNTABILITY FOR THE PROVISION OF

16 MENTAL HEALTH SERVICES.—The Under Secretary 

17 shall take appropriate steps and provide necessary in18 centives (including appropriate performance incen19 tives) to ensure that each Regional Director of the 

20 Veterans Health Administration is encouraged to— 

21 (A) prioritize the provision of mental health 

22 services to veterans in need of such services; 

23 (B) foster collaborative working environ24 ments among clinicians for the provision of men25 tal health services; and 
31 

•S 1182 RS

1 (C) conduct mental health consultations 

2 during primary care appointments. 

3 (2) MENTAL HEALTH AND SUBSTANCE ABUSE

4 SERVICES.— 

5 (A) IN GENERAL.—The Secretary shall en6 sure that each community-based outpatient clin7 ic of the Department has the capacity to provide, 

8 or monitor the provision of, mental health serv9 ices to enrolled veterans in need of such services. 

10 (B) SETTINGS.—In carrying out subpara11 graph (A), the Secretary shall ensure that mental 

12 health services are provided through— 

13 (i) a community-based outpatient clin14 ic of the Department by an employee of the 

15 Department; 

16 (ii) referral to another facility of the 

17 Department; 

18 (iii) contract with an appropriate 

19 mental health professional in the local com20 munity; or 

21 (iv) tele-mental health service. 

22 (3) REPORTING REQUIREMENT.—Not later than 

23 January 31, 2008, the Secretary of Veterans Affairs 

24 shall submit a report to Congress that— 
32 

•S 1182 RS

1 (A) describes the status and availability of 

2 mental health services at community-based out3 patient clinics; 

4 (B) describes the substance of services avail5 able at such clinics; and 

6 (C) includes the ratios between mental 

7 health staff and patients at such clinics. 

8 (d) COOPERATION ON MENTAL HEALTH AWARENESS

9 AND PREVENTION.— 

10 (1) AGREEMENT.—The Secretary of Defense and 

11 the Secretary of Veterans Affairs shall enter into a 

12 Memorandum of Understanding— 

13 (A) to ensure that separating service mem14 bers receive standardized individual mental 

15 health and sexual trauma assessments as part of 

16 separation exams; and 

17 (B) that includes the development of shared 

18 guidelines on how to conduct the assessments. 

19 (2) ESTABLISHMENT OF JOINT VETERANS AF20 FAIRS–DEPARTMENT OF DEFENSE WORKGROUP ON

21 MENTAL HEALTH.— 

22 (A) IN GENERAL.—Not later than 180 days 

23 after the date of enactment of this Act, the Sec24 retary of Defense and the Secretary of Veterans 

25 Affairs shall establish a joint workgroup on men-
33 

•S 1182 RS

1 tal health, which shall be comprised of not less 

2 than 7 leaders in the field of mental health ap3 pointed from their respective departments. 

4 (B) STUDY.—Not later than 1 year after the 

5 establishment of the workgroup under subpara6 graph (A), the workgroup shall analyze the feasi7 bility, content, and scope of initiatives related 

8 to— 

9 (i) combating stigmas and prejudices 

10 associated with service members who suffer 

11 from mental health disorders or readjust12 ment issues, through the use of peer coun13 seling programs or other educational initia14 tives; 

15 (ii) ways in which the Department of 

16 Veterans Affairs can make their expertise in 

17 treating mental health disorders more read18 ily available to Department of Defense men19 tal health care providers; 

20 (iii) family and spousal education to 

21 assist family members of veterans and serv22 ice members to recognize and deal with 

23 signs of potential readjustment issues or 

24 other mental health disorders; and 
34 

•S 1182 RS

1 (iv) the seamless transition of service 

2 members who have been diagnosed with 

3 mental health disorders from active duty to 

4 veteran status (in consultation with the 

5 Seamless Transition Task Force and other 

6 entities assisting in this effort). 

7 (C) REPORT.—Not later than June 30, 

8 2007, the Secretary of Defense and the Secretary 

9 of Veterans Affairs shall submit a report to Con10 gress containing the findings and recommenda11 tions of the workgroup established under this 

12 paragraph. 

13 (e) PRIMARY CARE CONSULTATIONS FOR MENTAL

14 HEALTH.— 

15 (1) GUIDELINES.—The Under Secretary for 

16 Health, Veterans Health Administration, shall estab17 lish systemwide guidelines for screening primary care 

18 patients for mental health disorders and illnesses. 

19 (2) TRAINING.—Based upon the guidelines estab20 lished under paragraph (1), the Under Secretary for 

21 Health, Veterans Health Administration, shall con22 duct appropriate training for clinicians of the De23 partment of Veterans Affairs to carry out mental 

24 health consultations. 

25 (f) CLINICAL TRAINING AND PROTOCOLS.— 
35 

•S 1182 RS

1 (1) FINDINGS.—Congress finds that— 

2 (A) the Iraq War Clinician Guide has tre3 mendous value; and 

4 (B) the Secretary of Defense and the Na5 tional Center on Post Traumatic Stress Disorder 

6 should continue to work together to ensure that 

7 the mental health care needs of servicemembers 

8 and veterans are met. 

9 (2) COLLABORATION.—The National Center on 

10 Post Traumatic Stress Disorder shall collaborate with 

11 the Secretary of Defense— 

12 (A) to enhance the clinical skills of military 

13 clinicians through training, treatment protocols, 

14 web-based interventions, and the development of 

15 evidence-based interventions; and 

16 (B) to promote pre-deployment resilience 

17 and post-deployment readjustment among 

18 servicemembers serving in Operation Iraqi Free19 dom and Operation Enduring Freedom. 

20 (3) TRAINING.—The National Center on Post 

21 Traumatic Stress Disorder shall work with the Sec22 retary of Defense to ensure that clinicians in the De23 partment of Defense are provided with the training 

24 and protocols developed pursuant to paragraph 

25 (2)(A). 
36 

•S 1182 RS

1 (4) AUTHORIZATION OF APPROPRIATIONS.— 

2 There are authorized to be appropriated $2,000,000 

3 for 2006 to carry out this subsection. 

4 SEC. 9. DATA SHARING IMPROVEMENTS. 

5 Notwithstanding any other provision of law, the De6 partment of Veterans Affairs and the Department of Defense 

7 may exchange protected health information for— 

8 (1) patients receiving treatment from the De9 partment of Veterans Affairs; or 

10 (2) individuals who may receive treatment from 

11 the Department of Veterans Affairs in the future, in12 cluding all current and former members of the armed 

13 services. 

14 SEC. 10. EXPANSION OF NATIONAL GUARD OUTREACH PRO15 GRAM. 

16 (a) REQUIREMENT.—The Secretary of Veterans Affairs 

17 shall expand the total number of personal employed by the 

18 Department of Veterans Affairs as part of the Readjustment 

19 Counseling Service’s Global War on Terrorism Outreach 

20 Program (referred to in this section as the ‘‘Program’’). 

21 (b) COORDINATION.—In carrying out subsection (a), 

22 the Secretary shall coordinate participation in the Program 

23 by appropriate employees of the Veterans Benefits Adminis24 tration and the Veterans Health Administration. 
37 

•S 1182 RS

1 (c) INFORMATION AND ASSESSMENTS.—The Secretary 

2 shall ensure that— 

3 (1) all appropriate health, education, and bene4 fits information is available to returning members of 

5 the National Guard; and 

6 (2) proper assessments of the needs in each of 

7 these areas is made by the Department of Veterans 

8 Affairs. 

9 (d) COLLABORATION.—The Secretary of Veterans Af10 fairs shall collaborate with appropriate State National 

11 Guard officials and provide such officials with any assets 

12 or services of the Department of Veterans Affairs that the 

13 Secretary determines to be necessary to carry out the Global 

14 War on Terrorism Outreach Program. 

15 SEC. 11. EXPANSION OF TELE-HEALTH SERVICES. 

16 (a) IN GENERAL.—The Secretary shall increase the 

17 number of Veterans Readjustment Counseling Service facili18 ties capable of providing health services and counseling 

19 through tele-health linkages with facilities of the Veterans 

20 Health Administration. 

21 (b) PLAN.—The Secretary shall submit to the Com22 mittee on Veterans’ Affairs of the Senate and the Committee 

23 on Veterans’ Affairs of the House of Representatives a plan 

24 to implement the requirement under subsection (a), which 
38 

•S 1182 RS

1 shall describe the facilities that will have such capabilities 

2 at the end of each of fiscal years 2005, 2006, and 2007. 

3 SEC. 12. MENTAL HEALTH DATA SOURCES REPORT. 

4 (a) IN GENERAL.—Not less than 180 days after the 

5 date of enactment of this Act, the Secretary of Veterans Af6 fairs shall submit a report to the Committee on Veterans’ 

7 Affairs of the Senate and the Committee on Veterans’ Af8 fairs of the House of Representatives describing the mental 

9 health data maintained by the Department of Veterans Af10 fairs. 

11 (b) CONTENTS.—The report submitted under sub12 section (a) shall include— 

13 (1) a comprehensive list of the sources of all such 

14 data, including the geographic locations of facilities of 

15 the Department of Veterans Affairs maintaining such 

16 data; 

17 (2) an assessment of the limitations or advan18 tages to maintaining the current data configuration 

19 and locations; and 

20 (3) any recommendations, if any, for improving 

21 the collection, use, and location of mental health data 

22 maintained by the Department of Veterans Affairs. 
39 

•S 1182 RS

1 SEC. 13. STRATEGIC PLAN FOR LONG-TERM CARE. 

2 (a) PUBLICATION.—Not later than 180 days after the 

3 date of enactment of this Act, the Secretary of Veterans Af4 fairs shall publish a strategic plan for long-term care. 

5 (b) CONTENTS.—The plan published under subsection 

6 (a) shall— 

7 (1) contain policies and strategies for— 

8 (A) the delivery of care in domiciliaries, 

9 residential treatment facilities, and nursing 

10 homes, and for seriously mentally ill veterans; 

11 (B) maximizing the use of State veterans 

12 homes; 

13 (C) locating domiciliary units as close to 

14 patient populations as feasible; and 

15 (D) identifying freestanding nursing homes 

16 as an acceptable care model; 

17 (2) include data on— 

18 (A) the care of catastrophically disabled vet19 erans; and 

20 (B) the geographic distribution of cata21 strophically disabled veterans; 

22 (3) address the spectrum of noninstitutional 

23 long-term care options, including— 

24 (A) respite care; 

25 (B) home-based primary care; 

26 (C) geriatric evaluation; 
40 

•S 1182 RS

1 (D) adult day health care; 

2 (E) skilled home health care; and 

3 (F) community residential care; and 

4 (4) provide— 

5 (A) cost and quality comparison analyses of 

6 all the different levels of care; 

7 (B) detailed information about geographic 

8 distribution of services and gaps in care; and 

9 (C) specific plans for working with Medi10 care, Medicaid, and private insurance companies 

11 to expand care. 

12 SEC. 14. BLIND REHABILITATION OUTPATIENT SPECIAL13 ISTS. 

14 (a) FINDINGS.—Congress makes the following findings: 

15 (1) There are approximately 135,000 blind vet16 erans throughout the United States, including ap17 proximately 35,000 who are enrolled with the Depart18 ment of Veterans Affairs. An aging veteran popu19 lation and injuries incurred in Operation Iraqi Free20 dom and Operation Enduring Freedom are increas21 ing the number of blind veterans. 

22 (2) Since 1996, when the Department of Veterans 

23 Affairs hired its first 14 blind rehabilitation out24 patient specialists (referred to in this section as ‘‘Spe25 cialists’’, Specialists have been a critical part of the 
41 

•S 1182 RS

1 continuum of care for blind and visually impaired 

2 veterans. 

3 (3) The Department of Veterans Affairs operates 

4 10 residential blind rehabilitation centers that are 

5 considered among the best in the world. These centers 

6 have had long waiting lists, with as many as 1,500 

7 blind veterans waiting for openings in 2004. 

8 (4) Specialists provide— 

9 (A) critically needed services to veterans 

10 who are unable to attend residential centers or 

11 are waiting to enter such a program; 

12 (B) a range of services, including training 

13 with living skills, mobility, and adaptation of 

14 manual skills; and 

15 (C) pre-admission screening and follow-up 

16 care for blind rehabilitation centers. 

17 (5) There are not enough Specialist positions to 

18 meet the increased numbers and needs of blind vet19 erans. 

20 (b) ESTABLISHMENT OF SPECIALIST POSITIONS.—Not 

21 later than 30 months after the date of enactment of this 

22 Act, the Secretary of Veterans Affairs shall establish a Spe23 cialist position at not fewer than 35 facilities of the Depart24 ment of Veterans Affairs. 
42 

•S 1182 RS

1 (c) SELECTION OF FACILITIES.—In identifying the 

2 most appropriate facilities to receive a Specialist position 

3 under this section, the Secretary shall— 

4 (1) give priority to facilities with large numbers 

5 of enrolled legally blind veterans; 

6 (2) ensure that each facility does not have such 

7 a position; and 

8 (3) ensure that each facility is in need of the 

9 services of such Specialists. 

10 (d) COORDINATION.—The Secretary shall coordinate 

11 the provision of blind rehabilitation services for veterans 

12 with services for the care of the visually impaired offered 

13 by State and local agencies, especially if such State and 

14 local agencies can provide similar services to veterans in 

15 settings located closer to the residences of such veterans. 

16 (e) AUTHORIZATION OF APPROPRIATIONS.—There are 

17 authorized to be appropriated to carry out this section 

18 $3,500,000 for each of the fiscal years 2006 through 2011. 

19 SEC. 15. COMPLIANCE REPORT. 

20 Section 1706(b)(5)(A) is amended by striking ‘‘2004’’ 

21 and inserting ‘‘2006’’. 
43 

•S 1182 RS

1 SEC. 16. HEALTH CARE AND SERVICES FOR VETERANS AF2 FECTED BY HURRICANE KATRINA. 

3 (a) REQUIREMENT FOR HOSPITAL CARE AND MEDICAL

4 SERVICES FOR PRIORITY 8 VETERANS AFFECTED BY HUR5 RICANE KATRINA.— 

6 (1) IN GENERAL.—Notwithstanding any other 

7 provision of law and any notwithstanding any pre8 vious decisions made by the Secretary of Veterans Af9 fairs pursuant to chapter 17 of title 38 United States 

10 Code, the Secretary shall provide necessary medical 

11 and health care services to any veteran affected by 

12 Hurricane Katrina as if such veteran was enrolled for 

13 care under section 1705 of title 38, United States 

14 Code. 

15 (2) STATUS OF VETERANS.—For purposes of 

16 managing the health care system, as required under 

17 section 1705 of title 38, United States Code, a veteran 

18 who seeks care under paragraph (1) shall not be con19 sidered to be an enrollee of the health care system 

20 under such section unless the Secretary subsequently 

21 designates such a veteran as such an enrollee. 

22 (b) PROHIBITION ON COLLECTION OF COPAYMENTS

23 FOR VETERANS AFFECTED BY HURRICANE KATRINA.—In 

24 furnishing hospital care and medical services to any vet25 eran affected by Hurricane Katrina, the Secretary shall not 

26 collect from, or with respect to, such veteran any payment 
44 

•S 1182 RS

1 for such care and services otherwise required under any pro2 vision of law, including any copayment for medications 

3 otherwise required under section 1722A of title 38, United 

4 States Code. 

5 (c) DEFINITION.—In this section, the term ‘‘veteran af6 fected by Hurricane Katrina’’ means any veteran who, as 

7 of August 29, 2005, resided in the catchment region of the 

8 Department of Veterans Affairs medical center in— 

9 (1) New Orleans, Louisiana; 

10 (2) Biloxi, Mississippi; or 

11 (3) Gulfport, Mississippi. 

12 (d) SUNSET PROVISION.—The authority under this 

13 section shall expire on January 31, 2006. 

14 SEC. 17. REIMBURSEMENT FOR CERTAIN VETERANS’ OUT15 STANDING EMERGENCY TREATMENT EX16 PENSES. . 

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

18 amended by inserting after section 1725 the following: 

19 ‘‘§ 1725A. Reimbursement for emergency treatment ex20 penses for which certain veterans remain 

21 personally liable 

22 ‘‘(a)(1) Subject to subsection (c), the Secretary may 

23 reimburse a veteran described in subsection (b) for expenses 

24 resulting from emergency treatment furnished to the veteran 
45 

•S 1182 RS

1 in a non-Department facility for which the veteran remains 

2 personally liable. 

3 ‘‘(2) In any case in which reimbursement is authorized 

4 under subsection (a)(1), the Secretary, in the Secretary’s 

5 discretion, may, in lieu of reimbursing the veteran, make 

6 payment— 

7 ‘‘(A) to a hospital or other health care provider 

8 that furnished the treatment; or 

9 ‘‘(B) to the person or organization that paid for 

10 such treatment on behalf of the veteran. 

11 ‘‘(b) A veteran referred to in subsection (a) is an indi12 vidual who— 

13 ‘‘(1) is enrolled in the health care system estab14 lished under section 1705(a) of this title; 

15 ‘‘(2) received care under this chapter during the 

16 24-month period preceding the furnishing of such 

17 emergency treatment; 

18 ‘‘(3) is entitled to care or services under a 

19 health-plan contract that partially reimburses the cost 

20 of the veteran’s emergency treatment; 

21 ‘‘(4) is financially liable to the provider of emer22 gency care treatment for costs not covered by the vet23 eran’s health-plan contract, including copayments 

24 and deductibles; and 
46 

•S 1182 RS

1 ‘‘(5) is not eligible for reimbursement for medical 

2 care or services under section 1725 or 1728 of this 

3 title. 

4 ‘‘(c)(1) Any amount paid by the Secretary under sub5 section (a) shall exclude the amount of any payment the 

6 veteran would have been required to make to the United 

7 States under this chapter if the veteran had received the 

8 emergency treatment from the Department. 

9 ‘‘(2) The Secretary may not provide reimbursement 

10 under this section with respect to any item or service— 

11 ‘‘(A) provided or for which payment has been 

12 made, or can reasonably be expected to be made, 

13 under the veteran’s health-plan contract; or 

14 ‘‘(B) for which payment has been made or can 

15 reasonably be expected to be made by a third party. 

16 ‘‘(3)(A) Payment by the Secretary under this section 

17 on behalf of a veteran to a provider of emergency treatment 

18 shall, unless rejected and refunded by the provider within 

19 30 days of receipt, extinguish any liability on the part of 

20 the veteran for that treatment. 

21 ‘‘(B) The absence of a contract or agreement between 

22 the Secretary and the provider, any provision of a contract 

23 or agreement, or an assignment to the contrary shall not 

24 operate to modify, limit, or negate the requirement under 

25 subparagraph (A). 
47 

•S 1182 RS

1 ‘‘(4) In accordance with regulations prescribed by the 

2 Secretary, the Secretary shall— 

3 ‘‘(A) establish criteria for determining the 

4 amount of reimbursement (which may include a max5 imum amount) payable under this section; and 

6 ‘‘(B) delineate the circumstances under which 

7 such payment may be made, including requirements 

8 for requesting reimbursement. 

9 ‘‘(d)(1) In accordance with regulations prescribed by 

10 the Secretary, the United States shall have the independent 

11 right to recover any amount paid under this section if, and 

12 to the extent that, a third party subsequently makes a pay13 ment for the same emergency treatment. 

14 ‘‘(2) Any amount paid by the United States to the vet15 eran, the veteran’s personal representative, successor, de16 pendents, or survivors, or to any other person or organiza17 tion paying for such treatment shall constitute a lien in 

18 favor of the United States against any recovery the payee 

19 subsequently receives from a third party for the same treat20 ment. 

21 ‘‘(3) Any amount paid by the United States to the pro22 vider that furnished the veteran’s emergency treatment shall 

23 constitute a lien against any subsequent amount the pro24 vider receives from a third party for the same emergency 

25 treatment for which the United States made payment. 
48 

•S 1182 RS

1 ‘‘(4) The veteran or the veteran’s personal representa2 tive, successor, dependents, or survivors shall— 

3 ‘‘(A) ensure that the Secretary is promptly noti4 fied of any payment received from any third party 

5 for emergency treatment furnished to the veteran; 

6 ‘‘(B) immediately forward all documents relating 

7 to a payment described in subparagraph (A); 

8 ‘‘(C) cooperate with the Secretary in an inves9 tigation of a payment described in subparagraph (A); 

10 and 

11 ‘‘(D) assist the Secretary in enforcing the United 

12 States right to recover any payment made under sub13 section (c)(3). 

14 ‘‘(e) The Secretary may waive recovery of a payment 

15 made to a veteran under this section that is otherwise re16 quired under subsection (d)(1) if the Secretary determines 

17 that such waiver would be in the best interest of the United 

18 States, as defined by regulations prescribed by the Sec19 retary. 

20 ‘‘(f) For purposes of this section— 

21 ‘‘(1) the term ‘health-plan contract’ includes— 

22 ‘‘(A) an insurance policy or contract, med23 ical or hospital service agreement, membership 

24 or subscription contract, or similar arrangement, 

25 under which health services for individuals are 
49 

•S 1182 RS

1 provided or the expenses of such services are 

2 paid; 

3 ‘‘(B) an insurance program described in 

4 section 1811 of the Social Security Act (42 

5 U.S.C. 1395c) or established by section 1831 of 

6 that Act (42 U.S.C. 1395j); 

7 ‘‘(C) a State plan for medical assistance 

8 approved under title XIX of such Act (42 U.S.C. 

9 1396 et seq.); and 

10 ‘‘(D) a workers’ compensation law or plan 

11 described in section 1729(A)(2)(B) of this title; 

12 ‘‘(2) the term ‘third party’ means— 

13 ‘‘(A) a Federal entity; 

14 ‘‘(B) a State or political subdivision of a 

15 State; 

16 ‘‘(C) an employer or an employer’s insur17 ance carrier; and 

18 ‘‘(D) a person or entity obligated to pro19 vide, or pay the expenses of, such emergency 

20 treatment; and 

21 ‘‘(3) the term ‘emergency treatment’ has the 

22 meaning given such term in section 1725 of this 

23 title.’’. 
50 

•S 1182 RS

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

2 the beginning of chapter 17 is amended by inserting after 

3 the item relating to section 1725 the following: 

‘‘Sec. 1725A. Reimbursement for emergency treatment expenses for which certain 

veterans remain personally liable.’’. 

Calendar No. 284 

109TH CONGRESS 

1ST SESSION S. 1182 

[Report No. 109–177] 

A BILL 

To amend title 38, United States Code, to improve 

health care for veterans, and for other purposes. 

NOVEMBER 10, 2005 

Reported with an amendment