II 

109TH CONGRESS 

1ST SESSION S. 1182 

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 

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’’. 

7 (b) REFERENCES.—Except as otherwise expressly 

8 provided, whenever in this Act an amendment or repeal 

9 is expressed in terms of an amendment or repeal to a sec10 tion or other provision, the reference shall be considered 
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1 to be made to a section or other provision of title 38, 

2 United States Code. 

3 SEC. 2. COPAYMENT EXEMPTION FOR HOSPICE CARE. 

4 Section 1710 is amended— 

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

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

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

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

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

10 EXTENDED CARE SERVICES COPAYMENTS 

11 FOR FORMER POWS. 

12 Section 1710B is amended— 

13 (1) by striking subsection (b); 

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

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

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

17 (A) by redesignating subparagraphs (B) 

18 and (C) as subparagraphs (C) and (D), respec19 tively; and 

20 (B) by inserting after subparagraph (A) 

21 the following: 

22 ‘‘(B) to a veteran who is a former prisoner 

23 of war;’’. 
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1 SEC. 4. REIMBURSEMENT FOR CERTAIN VETERANS’ OUT2 STANDING EMERGENCY TREATMENT EX3 PENSES. . 

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

5 amended by inserting after section 1725 the following: 

6 ‘‘§ 1725A. Reimbursement for emergency treatment 

7 expenses for which certain veterans re8 main personally liable 

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

10 reimburse a veteran described in subsection (b) for ex11 penses resulting from emergency treatment furnished to 

12 the veteran in a non-Department facility for which the vet13 eran remains personally liable. 

14 ‘‘(2) In any case in which reimbursement is author15 ized under subsection (a)(1), the Secretary, in the Sec16 retary’s discretion, may, in lieu of reimbursing the vet17 eran, make payment— 

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

19 that furnished the treatment; or 

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

21 such treatment on behalf of the veteran. 

22 ‘‘(b) A veteran referred to in subsection (a) is an indi23 vidual who— 

24 ‘‘(1) is enrolled in the health care system estab25 lished under section 1705(a) of this title; 
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1 ‘‘(2) received care under this chapter during the 

2 24-month period preceding the furnishing of such 

3 emergency treatment; 

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

5 health-plan contract that partially reimburses the 

6 cost of the veteran’s emergency treatment; 

7 ‘‘(4) is financially liable to the provider of emer8 gency care treatment for costs not covered by the 

9 veteran’s health-plan contract, including copayments 

10 and deductibles; and 

11 ‘‘(5) is not eligible for reimbursement for med12 ical care or services under section 1725 or 1728 of 

13 this title. 

14 ‘‘(c)(1) Any amount paid by the Secretary under sub15 section (a) shall exclude the amount of any payment the 

16 veteran would have been required to make to the United 

17 States under this chapter if the veteran had received the 

18 emergency treatment from the Department. 

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

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

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

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

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

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

25 reasonably be expected to be made by a third party. 
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1 ‘‘(3)(A) Payment by the Secretary under this section 

2 on behalf of a veteran to a provider of emergency treat3 ment shall, unless rejected and refunded by the provider 

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

5 part of the veteran for that treatment. 

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

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

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

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

10 subparagraph (A). 

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

12 Secretary, the Secretary shall— 

13 ‘‘(A) establish criteria for determining the 

14 amount of reimbursement (which may include a 

15 maximum amount) payable under this section; and 

16 ‘‘(B) delineate the circumstances under which 

17 such payment may be made, including requirements 

18 for requesting reimbursement. 

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

20 the Secretary, the United States shall have the inde21 pendent right to recover any amount paid under this sec22 tion if, and to the extent that, a third party subsequently 

23 makes a payment for the same emergency treatment. 

24 ‘‘(2) Any amount paid by the United States to the 

25 veteran, the veteran’s personal representative, successor, 
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1 dependents, or survivors, or to any other person or organi2 zation paying for such treatment shall constitute a lien 

3 in favor of the United States against any recovery the 

4 payee subsequently receives from a third party for the 

5 same treatment. 

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

7 provider that furnished the veteran’s emergency treatment 

8 shall constitute a lien against any subsequent amount the 

9 provider receives from a third party for the same emer10 gency treatment for which the United States made pay11 ment. 

12 ‘‘(4) The veteran or the veteran’s personal represent13 ative, successor, dependents, or survivors shall— 

14 ‘‘(A) ensure that the Secretary is promptly noti15 fied of any payment received from any third party 

16 for emergency treatment furnished to the veteran; 

17 ‘‘(B) immediately forward all documents relat18 ing to a payment described in subparagraph (A); 

19 ‘‘(C) cooperate with the Secretary in an inves20 tigation of a payment described in subparagraph 

21 (A); and 

22 ‘‘(D) assist the Secretary in enforcing the 

23 United States right to recover any payment made 

24 under subsection (c)(3). 
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1 ‘‘(e) The Secretary may waive recovery of a payment 

2 made to a veteran under this section that is otherwise re3 quired under subsection (d)(1) if the Secretary determines 

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

5 United States, as defined by regulations prescribed by the 

6 Secretary. 

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

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

9 ‘‘(A) an insurance policy or contract, med10 ical or hospital service agreement, membership 

11 or subscription contract, or similar arrange12 ment, under which health services for individ13 uals are provided or the expenses of such serv14 ices are paid; 

15 ‘‘(B) an insurance program described in 

16 section 1811 of the Social Security Act (42 

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

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

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

20 approved under title XIX of such Act (42 

21 U.S.C. 1396 et seq.); and 

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

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

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

25 ‘‘(A) a Federal entity; 
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1 ‘‘(B) a State or political subdivision of a 

2 State; 

3 ‘‘(C) an employer or an employer’s insur4 ance carrier; and 

5 ‘‘(D) a person or entity obligated to pro6 vide, or pay the expenses of, such emergency 

7 treatment; and 

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

9 meaning given such term in section 1725 of this 

10 title.’’. 

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

12 at the beginning of chapter 17 is amended by inserting 

13 after the item relating to section 1725 the following:

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

14 SEC. 5. CARE FOR NEWBORN CHILDREN OF WOMEN VET15 ERANS RECEIVING MATERNITY CARE . 

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

17 amended by adding at the end the following: 

18 ‘‘§ 1786. Care for newborn children of women vet19 erans receiving maternity care 

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

21 of a woman veteran, who is receiving maternity care fur22 nished by the Department, for not more than 14 days 

23 after the birth of the child if the veteran delivered the child 
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1 in a Department facility or in another facility pursuant 

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

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

4 at the beginning of chapter 17 is amended by inserting 

5 after the item relating to section 1785 the following:

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

care.’’.

6 SEC. 6. ENHANCEMENT OF PAYER PROVISIONS FOR 

7 HEALTH CARE FURNISHED TO CERTAIN 

8 CHILDREN OF VIETNAM VETERANS. 

9 (a) HEALTH CARE FOR SPINA BIFIDA AND ASSOCI10 ATED DISABILITIES.—Section 1803 is amended— 

11 (1) by redesignating subsection (c) as sub12 section (d); and 

13 (2) by inserting after subsection (b) the fol14 lowing: 

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

16 health care under this section is less than the amount 

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

18 agent of the health care provider may, in accordance with 

19 paragraphs (2) through (4), seek payment for the dif20 ference between the amount billed and the amount paid 

21 by the Secretary from a responsible third party to the ex22 tent that the provider or agent would be eligible to receive 

23 payment for such health care from such third party. 
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1 ‘‘(2) The health care provider or agent may not im2 pose any additional charge on the beneficiary who received 

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

4 service or item for which the Secretary has made payment 

5 under this section; 

6 ‘‘(3) The total amount of payment a health care pro7 vider or agent may receive for health care furnished under 

8 this section may not exceed the amount billed to the Sec9 retary. 

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

11 such third party information received for the purposes of 

12 carrying out this section.’’. 

13 (b) HEALTH CARE FOR BIRTH DEFECTS AND ASSO14 CIATED DISABILITIES.—Section 1813 is amended— 

15 (1) by redesignating subsection (c) as sub16 section (d); and 

17 (2) by inserting after subsection (b) the fol18 lowing: 

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

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

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

22 health care provider may, in accordance with paragraphs 

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

24 the amount billed and the amount paid by the Secretary 

25 from a responsible third party to the extent that the pro-
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1 vider or agent would be eligible to receive payment for 

2 such health care from such third party. 

3 ‘‘(2) The health care provider or agent may not im4 pose any additional charge on the beneficiary who received 

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; and 

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

13 such third party information received for the purposes of 

14 carrying out this section.’’. 

15 SEC. 7. IMPROVEMENTS TO HOMELESS PROVIDERS GRANT 

16 AND PER DIEM PROGRAM. 

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

18 amended— 

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

20 (2) by striking paragraph (2). 

21 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

22 2013 is amended to read as follows: 
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1 ‘‘§ 2013. Authorization of appropriations 

2 ‘‘There are authorized to be appropriated 

3 $130,000,000 for fiscal year 2006 and each subsequent 

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

5 SEC. 8. MARRIAGE AND FAMILY THERAPISTS. 

6 (a) QUALIFICATIONS.—Section 7402(b) is amend7 ed— 

8 (1) by redesignating paragraph (10) as para9 graph (11); and 

10 (2) by inserting after paragraph (9) the fol11 lowing: 

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

13 eligible to be appointed to a marriage and family therapist 

14 position, a person must— 

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

16 family therapy, or a comparable degree in mental 

17 health, from a college or university approved by the 

18 Secretary; and 

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

20 practice marriage and family therapy in a State, ex21 cept that the Secretary may waive the requirement 

22 of licensure or certification for an individual mar23 riage and family therapist for a reasonable period of 

24 time recommended by the Under Secretary for 

25 Health.’’. 
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1 (b) REPORT ON MARRIAGE AND FAMILY THERAPY

2 WORKLOAD.— 

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

4 the date of enactment of this Act, the Under Sec5 retary for Health, Department of Veterans Affairs, 

6 shall submit to the Committee on Veterans’ Affairs 

7 of the Senate and the Committee on Veterans’ Af8 fairs of the House of Representatives a report on the 

9 provisions of post-traumatic stress disorder treat10 ment by marriage and family therapists. 

11 (2) CONTENTS.—The report submitted under 

12 paragraph (1) shall include— 

13 (A) the actual and projected workloads in 

14 facilities of the Veterans Readjustment Coun15 seling Service and the Veterans Health Admin16 istration for the provision of marriage and fam17 ily counseling for veterans diagnosed with, or 

18 otherwise in need of treatment for, post-trau19 matic stress disorder; 

20 (B) the resources available and needed to 

21 support the workload projections described in 

22 subparagraph (A); 

23 (C) an assessment by the Under Secretary 

24 for Health of the effectiveness of treatment by 

25 marriage and family therapists; and 
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1 (D) recommendations, if any, for improve2 ments in the provision of such counseling treat3 ment. 

4 SEC. 9. PAY COMPARABILITY FOR CHIEF NURSING OFFI5 CER, OFFICE OF NURSING SERVICES. 

6 Section 7404 is amended— 

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

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

9 and 

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

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

12 Nursing Services, shall be exempt from the provisions of 

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

14 to exceed the maximum rate established for the Senior Ex15 ecutive Service under section 5382 of title 5 United States 

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

17 SEC. 10. REPEAL OF COST COMPARISON STUDIES PROHIBI18 TION. 

19 Section 8110(a) is amended— 

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

21 (2) by redesignating paragraph (6) as para22 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.

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