103D CONGRESS

2D SESSION S. 1030

AN ACT

To amend title 38, United States Code, to improve

purposes.education debt reduction program, and for otherfor adult day health care services, to establish anpayments and construction grants to State homesretary of Veterans Affairs to provide per diemhealth care clinics program, to authorize the Seca hospice care pilot program, to establish a ruralAgent Orange or ionizing radiation, to establishtlement to inpatient care for veterans exposed tofor women veterans, to extend the period of enticertain Department of Veterans Affairs programssexual trauma services for veterans, to improvethe Department of Veterans Affairs program of
★

103D CONGRESS

2D SESSION S. 1030

AN ACT

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

Department of Veterans Affairs program of sexual trauma services for veterans, to improve certain Department

of Veterans Affairs programs for women veterans, to

extend the period of entitlement to inpatient care for

veterans exposed to Agent Orange or ionizing radiation,

to establish a hospice care pilot program, to establish

a rural health care clinics program, to authorize the

Secretary of Veterans Affairs to provide per diem payments and construction grants to State homes for adult

day health care services, to establish an education debt

reduction program, 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 Programs Improvement Act of 1994’’.
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1 (b) TABLE OF CONTENTS.—The table of contents of

2 this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—WOMEN VETERANS

Sec. 101. Department of Veterans Affairs sexual trauma services program.

Sec. 102. Reports relating to determinations of service connection for sexual

trauma.

Sec. 103. Coordinators of women’s services.

Sec. 104. Women’s health services.

Sec. 105. Expansion of research relating to women veterans.

Sec. 106. Mammography quality standards.

TITLE II—GENERAL HEALTH CARE SERVICES

Sec. 201. Extension of period of eligibility for medical care for exposure to

dioxin or ionizing radiation.

Sec. 202. Extension of period of eligibility for priority health care for veterans

of the Persian Gulf War.

Sec. 203. Programs for furnishing hospice care to veterans.

Sec. 204. Rural health-care clinic program.

Sec. 205. Payment to States of per diem for veterans receiving adult day health

care.

Sec. 206. Revision of authority on use of tobacco products in department facilities.

TITLE III—MISCELLANEOUS

Subtitle A—Education Debt Reduction Program

Sec. 301. Short title.

Sec. 302. Program of assistance in the payment of education debts incurred by

certain Veterans Health Administration employees.

Subtitle B—Other Provisions

Sec. 311. Extension of authority of Advisory Committee on Education.

Sec. 312. Extension of authority to maintain regional office in the Philippines.

3 TITLE I—WOMEN VETERANS

4 SEC. 101. DEPARTMENT OF VETERANS AFFAIRS SEXUAL

5 TRAUMA SERVICES PROGRAM.

6 (a) AUTHORITY TO PROVIDE SERVICES FOR SEXUAL

7 TRAUMA.—(1) Subsection (a)(1) of section 1720D of title

8 38, United States Code is amended—
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1 (A) by inserting ‘‘(A)’’ before ‘‘During the pe2 riod’’; and

3 (B) by adding at the end the following:

4 ‘‘(B) During the period referred to in subparagraph

5 (A), the Secretary may provide appropriate care and serv6 ices to a veteran for an injury, illness, or other psycho7 logical condition which the Secretary determines to be the

8 result of a physical assault, battery, or harassment re9 ferred to in that subparagraph.’’.

10 (2) Subsection (c)(1) of such section is amended to

11 read as follows:

12 ‘‘(1) The Secretary shall give priority to the establish13 ment and operation of the program to provide counseling

14 and care and services under subsection (a). In the case

15 of a veteran eligible for counseling and care and services

16 under subsection (a)(1), the Secretary shall ensure that

17 the veteran is furnished counseling under this section in

18 a way that is coordinated with the furnishing of such care

19 and services under this chapter.’’.

20 (3) Subsection (d) of such section is amended by in21 serting ‘‘and care and services’’ after ‘‘counseling’’ each

22 place it appears.

23 (b) AUTHORITY TO PROVIDE SERVICES BY CON24 TRACT.—Subsection (a)(3) of such section is amended—

25 (1) by inserting ‘‘(A)’’ before ‘‘In furnishing’’;
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1 (2) in subparagraph (A), as so designated—

2 (i) by striking out ‘‘(A)’’ and inserting in

3 lieu thereof ‘‘(i)’’; and

4 (ii) by striking out ‘‘(B)’’ and inserting in

5 lieu thereof ‘‘(ii)’’; and

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

7 ‘‘(B) The Secretary may provide care and services to

8 a veteran under paragraph (1)(B) pursuant to a contract

9 with a qualified non-Department health professional or fa10 cility if Department facilities are not capable of furnishing

11 such care and services to that veteran economically be12 cause of geographic inaccessibility.’’.

13 (c) EXTENSION OF AUTHORITY TO PROVIDE SEXUAL

14 TRAUMA SERVICES.—Subsection (a) of such section, as

15 amended by subsections (a) and (b) of this section, is fur16 ther amended—

17 (1) by striking out ‘‘December 31, 1995,’’ in

18 paragraph (1)(A) and inserting in lieu thereof ‘‘De19 cember 31, 1998,’’; and

20 (2) by striking out ‘‘December 31, 1994,’’ in

21 paragraph (3) and inserting in lieu thereof ‘‘Decem22 ber 31, 1998,’’.

23 (d) PERIOD OF ELIGIBILITY TO SEEK SERVICES.—

24 (1) Such subsection, as amended by subsections (a), (b),

25 and (c) of this section, is further amended—
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1 (A) by striking out paragraph (2); and

2 (B) by redesignating paragraph (3) as para3 graph (2).

4 (2) Section 102(b) of the Veterans Health Care Act

5 of 1992 (Public Law 102–585; 106 Stat. 4946; 38 U.S.C.

6 1720D note) is repealed.

7 (e) REPEAL OF LIMITATION ON PERIOD OF RECEIPT

8 OF SERVICES.—Section 1720D of title 38, United States

9 Code (as amended by subsections (a) through (d) of this

10 section), is further amended—

11 (1) by striking out subsection (b); and

12 (2) by redesignating subsections (c), (d), and

13 (e) as subsections (b), (c), and (d), respectively.

14 (f) INCREASED PRIORITY OF CARE.—Section 1712(i)

15 of title 38, United States Code, is amended—

16 (1) in paragraph (1)—

17 (A) by inserting ‘‘(A)’’ after ‘‘To a vet18 eran’’; and

19 (B) by inserting ‘‘, or (B) who is eligible

20 for counseling and care and services under sec21 tion 1720D of this title, for the purposes of

22 such counseling and care and services’’ before

23 the period at the end; and

24 (2) in paragraph (2)—
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1 (A) by striking out ‘‘, (B)’’ and inserting

2 in lieu thereof ‘‘or (B)’’; and

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

4 follows through ‘‘such counseling’’.

5 (g) PROGRAM REVISION.—(1) Section 1720D of title

6 38, United States Code (as amended by subsections (a)

7 through (e) of this section), is further amended—

8 (A) by striking out ‘‘woman’’ in subsection

9 (a)(1)(A);

10 (B) by striking out ‘‘women’’ in subsection

11 (b)(2)(C) and in the first sentence of subsection (c);

12 and

13 (C) by striking out ‘‘women’’ in subsection

14 (c)(2) and inserting in lieu thereof ‘‘individuals’’.

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

16 read as follows:

17 ‘‘§ 1720D. Counseling, care, and services for sexual

18 trauma’’.

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

20 sections at the beginning of chapter 17 of such title is

21 amended to read as follows:

‘‘1720D. Counseling, care, and services for sexual trauma.’’.

22 (h) INFORMATION ON COUNSELING BY TELE23 PHONE.—(1) Paragraph (1) of section 1720D(c) of title

24 38, United States Code, as redesignated by subsection (d)
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1 of this section, is amended by striking out ‘‘may’’ and in2 serting in lieu thereof ‘‘shall’’.

3 (2) In providing information on counseling available

4 to veterans through the information system required

5 under section 1720D(c)(1) of title 38, United States Code,

6 as amended by this section, the Secretary of Veterans Af7 fairs shall ensure—

8 (A) that the telephone system described in such

9 section is operated by Department of Veterans Af10 fairs personnel who are trained in the provision to

11 persons who have experienced sexual trauma of in12 formation about the counseling and care and serv13 ices relating to sexual trauma that are available to

14 veterans in the communities in which such veterans

15 reside, including counseling and care and services

16 available under programs of the Department (includ17 ing the care and services available under section

18 1720D of such title) and from non-Department

19 agencies or organizations;

20 (B) that such personnel are provided with infor21 mation on the counseling and care and services re22 lating to sexual trauma that are available to veter23 ans and the locations in which such care and serv24 ices are available;
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1 (C) that such personnel refer veterans seeking

2 such counseling and care and services to appropriate

3 providers of such counseling and care and services

4 (including counseling and care and services that are

5 available in the communities in which such veterans

6 reside);

7 (D) that the telephone system is operated in a

8 manner that protects the confidentiality of persons

9 who place telephone calls to the system; and

10 (E) that the telephone system operates at all

11 times.

12 (3) The Secretary shall ensure that information about

13 the availability of the telephone system is visibly posted

14 in Department medical facilities and is advertised through

15 public service announcements, pamphlets, and other

16 means.

17 (4) Not later than 18 months after the date of the

18 enactment of this Act, the Secretary shall submit to Con19 gress a report on the operation of the telephone system

20 required under section 1720D(c)(1) of title 38, United

21 States Code (as so amended). The report shall set forth

22 the following:

23 (A) The number of telephone calls placed to the

24 system during the period covered by the report, with

25 a separate display of (i) the number of calls placed
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1 to the system from each State (as such term is de2 fined in section 101(20) of title 38, United States

3 Code) during that period, and (ii) the number of

4 persons who placed more than one call to the system

5 during that period.

6 (B) The types of sexual trauma described to

7 personnel operating the system by persons placing

8 calls to the system.

9 (C) A description of the difficulties, if any, ex10 perienced by persons placing calls to the system in

11 obtaining counseling and care and services for sexual

12 trauma in the communities in which such persons

13 live, including counseling and care and services

14 available from the Department and from non-De15 partment agencies and organizations.

16 (D) A description of the training provided to

17 the personnel operating the system.

18 (E) The recommendations and plans of the Sec19 retary for the improvement of the system.

20 (5) The Secretary shall commence operation of the

21 telephone system required under section 1720D(c)(1) of

22 title 38, United States Code (as so amended), not later

23 than 180 days after the date of the enactment of this Act.
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1 SEC. 102. REPORTS RELATING TO DETERMINATIONS OF

2 SERVICE CONNECTION FOR SEXUAL TRAUMA.

3 (a) REPORT.—(1) The Secretary of Veterans Affairs

4 shall submit to the Committees on Veterans’ Affairs of

5 the Senate and House of Representatives a report contain6 ing the Secretary’s assessment of—

7 (A) the difficulties that veterans encounter in

8 obtaining from the Department of Veterans Affairs

9 determinations that disabilities relating to sexual

10 trauma resulting from events that occurred during

11 active duty are service-connected disabilities; and

12 (B) the extent to which Department personnel

13 fail to make determinations that such disabilities are

14 service-connected disabilities.

15 (2) The Secretary shall include in the report the Sec16 retary’s recommendations for actions to be taken to re17 spond in a fair manner to the difficulties described in the

18 report and to eliminate failures to make determinations

19 that such disabilities are service-connected disabilities.

20 (3) The report required by this subsection shall be

21 submitted not later than June 30, 1994.

22 (b) FOLLOW-UP REPORTS.—Not later than June 30

23 of each of 1995 and 1996, the Secretary shall submit to

24 the committees referred to in paragraph (1) of subsection

25 (a) a report on the actions taken by the Secretary to im-
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1 plement the recommendations referred to in paragraph (2)

2 of that subsection.

3 (c) DEFINITION.—In this section, the term ‘‘sexual

4 trauma’’ means the immediate and long-term physical or

5 psychological trauma resulting from rape, sexual assault,

6 aggravated sexual abuse (as such term is described in sec7 tion 2241 of title 18, United States Code), sexual harass8 ment, or other act of sexual violence.

9 SEC. 103. COORDINATORS OF WOMEN’S SERVICES.

10 (a) REQUIREMENT OF FULL-TIME SERVICE.—Sec11 tion 108 of the Veterans Health Care Act of 1992 (Public

12 Law 102–585; 106 Stat. 4948; 38 U.S.C. 1710 note) is

13 amended—

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

15 and

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

17 ‘‘(b) Each official who serves in the position of coordi18 nator of women’s services under subsection (a) shall so

19 serve on a full-time basis.’’.

20 (b) ADDITIONAL RESPONSIBILITIES.—Subsection (a)

21 of such section (as designated by subsection (a) of this

22 section) is further amended—

23 (1) by redesignating paragraph (5) as para24 graph (6); and
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1 (2) by inserting after paragraph (4) the follow2 ing new paragraph (5):

3 ‘‘(5) Facilitating communication between

4 women veterans coordinators under the jurisdiction

5 of such regional coordinator and the Under Sec6 retary for Health and the Secretary.’’.

7 (c) SUPPORT FOR WOMEN’S SERVICES COORDINA8 TORS.—The Secretary of Veterans Affairs shall take ap9 propriate actions to ensure that—

10 (1) sufficient funding is provided to each De11 partment of Veterans Affairs facility in order to per12 mit the coordinator of women’s services to carry out

13 the responsibilities of the coordinator at the facility;

14 (2) sufficient clerical and communications sup15 port is provided to each such coordinator for that

16 purpose; and

17 (3) each such coordinator has direct access to

18 the Director or Chief of Staff of the facility to which

19 the coordinator is assigned.

20 SEC. 104. WOMEN’S HEALTH SERVICES.

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

22 title 38, United States Code, is 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 health care services provided to women, including counsel4 ing and services relating to the following:

5 ‘‘(A) Papanicolaou tests (pap smears).

6 ‘‘(B) Breast examinations and mammography.

7 ‘‘(C) Maternity care, including pre-natal care,

8 delivery, and post-natal care.

9 ‘‘(D) Menopause.’’.

10 (b) CONTRACTS FOR WOMEN’S HEALTH SERVICES.—

11 Section 1703(a) of such title is amended by adding at the

12 end the following:

13 ‘‘(9) Women’s health services for veterans on

14 an ambulatory or outpatient basis.’’.

15 (c) REPEAL OF SUPERSEDED AUTHORITY.—Section

16 106 of the Veterans Health Care Act of 1992 (Public Law

17 102–585; 38 U.S.C. 1710 note) is amended—

18 (1) by striking out subsection (a); and

19 (2) by striking out ‘‘(b) RESPONSIBILITIES OF

20 DIRECTORS OF FACILITIES.—’’ before ‘‘The Sec21 retary’’.

22 (d) REPORT ON HEALTH CARE AND RESEARCH.—

23 Section 107(b) of such Act (38 U.S.C. 1710 note) is

24 amended—
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1 (1) in paragraph (1), by inserting ‘‘and wom2 en’s health services (as such term is defined in sec3 tion 1701(10) of title 38, United States Code)’’ after

4 ‘‘section 106 of this Act’’;

5 (2) in paragraph (2), by striking out ‘‘and (B)’’

6 and inserting in lieu thereof ‘‘(B) the type and

7 amount of services provided by such personnel, in8 cluding information on the numbers of inpatient

9 stays and the number of outpatient visits through

10 which such services were provided, and (C)’’;

11 (3) by redesignating paragraph (4) as para12 graph (7);

13 (4) by adding after paragraph (3) the following

14 new paragraphs:

15 ‘‘(4) A description of the personnel of the De16 partment who provided such services to women vet17 erans, including the number of employees (including

18 both the number of individual employees and the

19 number of full-time employee equivalents) and the

20 professional qualifications or specialty training of

21 such employees and the Department facilities to

22 which such personnel were assigned.

23 ‘‘(5) A description of any actions taken by the

24 Secretary to ensure the retention of the personnel

25 described in paragraph (4), and any actions under-
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1 taken to recruit additional such personnel or person2 nel to replace such personnel.

3 ‘‘(6) An assessment by the Secretary of any dif4 ficulties experienced by the Secretary in the furnish5 ing of such services and the actions taken by the

6 Secretary to resolve such difficulties.’’; and

7 (5) by adding after paragraph (7), as redesig8 nated by paragraph (3) of this subsection, the fol9 lowing:

10 ‘‘(8) A description of the actions taken by the

11 Secretary to foster and encourage the expansion of

12 such research.’’.

13 SEC. 105. EXPANSION OF RESEARCH RELATING TO WOMEN

14 VETERANS.

15 (a) HEALTH RESEARCH.—Section 109(a) of the Vet16 erans Health Care Act of 1992 (Public Law 102–585; 38

17 U.S.C. 7303 note) is amended—

18 (1) by inserting ‘‘(1)’’ before ‘‘The Secretary’’;

19 (2) in paragraph (1), as so designated, by strik20 ing out ‘‘veterans who are women’’ and inserting in

21 lieu thereof ‘‘women veterans’’; and

22 (3) by adding at the end the following:

23 ‘‘(2) In carrying out this section, the Secretary shall

24 consult with the following:

25 ‘‘(A) The Director of the Nursing Service.
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1 ‘‘(B) Officials of the Central Office assigned re2 sponsibility for women’s health programs and sexual

3 trauma services.

4 ‘‘(C) The members of the Advisory Committee

5 on Women Veterans established under section 542 of

6 title 38, United States Code.

7 ‘‘(D) Members of appropriate task forces and

8 working groups within the Department of Veterans

9 Affairs (including the Women Veterans Working

10 Group and the Task Force on Treatment of Women

11 Who Suffer Sexual Abuse).

12 ‘‘(3) The Secretary shall foster and encourage re13 search under this section on the following matters as they

14 relate to women:

15 ‘‘(A) Breast cancer.

16 ‘‘(B) Gynecological and reproductive health, in17 cluding gynecological cancer, infertility, sexually18 transmitted diseases, and pregnancy.

19 ‘‘(C) Human Immunodeficiency Virus and Ac20 quired Immune Deficiency Syndrome.

21 ‘‘(D) Mental health, including post-traumatic

22 stress disorder and depression.

23 ‘‘(E) Diseases related to aging, including meno24 pause, osteoporosis, and Alzheimer’s Disease.

25 ‘‘(F) Substance abuse.
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1 ‘‘(G) Sexual violence and related trauma.

2 ‘‘(H) Exposure to toxic chemicals and other en3 vironmental hazards.

4 ‘‘(4) The Secretary shall, to the maximum extent

5 practicable, ensure that personnel of the Department of

6 Veterans Affairs engaged in the research referred to in

7 paragraph (1) include the following:

8 ‘‘(A) Personnel of the geriatric research, edu9 cation, and clinical centers designated pursuant to

10 section 7314 of title 38, United States Code.

11 ‘‘(B) Personnel of the National Center for Post12 Traumatic Stress Disorder established pursuant to

13 section 110(c) of the Veterans Health Care Act of

14 1984 (Public Law 98–528; 98 Stat. 2692).

15 ‘‘(5) The Secretary shall, to the maximum extent

16 practicable, ensure that personnel of the Department en17 gaged in research relating to the health of women veterans

18 are advised and informed of such research engaged in by

19 other personnel of the Department.’’.

20 (b) POPULATION STUDY.—Section 110(a) of such

21 Act (38 U.S.C. 1710 note) is amended—

22 (1) in paragraph (1), by striking out the second

23 sentence; and

24 (2) by amending paragraph (3) to read as fol25 lows:
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1 ‘‘(3)(A) Subject to subparagraph (B), the study shall

2 be based on—

3 ‘‘(i) an appropriate sample of veterans who are

4 women and of women who are serving on active mili5 tary, naval, or air service; and

6 ‘‘(ii) an examination of the medical and demo7 graphic histories of the women comprising such sam8 ple.

9 ‘‘(B) The sample referred to in subparagraph (A)

10 shall, to the maximum extent practicable, constitute a rep11 resentative sampling (as determined by the Secretary) of

12 the ages, the ethnic, social and economic backgrounds, the

13 enlisted and officer grades, and the branches of service

14 of all veterans who are women and women who are serving

15 on such duty.

16 ‘‘(C) In carrying out the examination referred to in

17 subparagraph (A)(ii), the Secretary shall determine the

18 number of women of the sample who have used medical

19 facilities of the Department, nursing home facilities of or

20 under the jurisdiction of the Department, and outpatient

21 care facilities of or under the jurisdiction of the Depart22 ment.’’.

23 SEC. 106. MAMMOGRAPHY QUALITY STANDARDS.

24 (a) PERFORMANCE OF MAMMOGRAMS.—Mammo25 grams may not be performed at a Department of Veterans
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1 Affairs facility unless that facility is accredited for that

2 purpose by a private nonprofit organization designated by

3 the Secretary of Veterans Affairs. The organization des4 ignated by the Secretary under this subsection shall meet

5 the standards for accrediting bodies established by the

6 Secretary of Health and Human Services under section

7 354(e) of the Public Health Service Act (42 U.S.C.

8 263b(e)).

9 (b) QUALITY STANDARDS.—(1)(A) The Secretary of

10 Veterans Affairs shall prescribe quality assurance and

11 quality control standards relating to the performance and

12 interpretation of mammograms and use of mammogram

13 equipment and facilities by personnel of the Department

14 of Veterans Affairs. Such standards shall be no less strin15 gent than the standards prescribed by the Secretary of

16 Health and Human Services under section 354(f) of the

17 Public Health Service Act.

18 (B) In prescribing such standards, the Secretary of

19 Veterans Affairs shall consult with the Secretary of Health

20 and Human Services.

21 (2) The Secretary of Veterans Affairs shall prescribe

22 such standards not later than 120 days after the Secretary

23 of Health and Human Services prescribes quality stand24 ards under such section 354(f).
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1 (c) INSPECTION OF DEPARTMENT EQUIPMENT.—(1)

2 The Secretary of Veterans Affairs shall, on an annual

3 basis, inspect the equipment and facilities utilized by and

4 in Department of Veterans Affairs health-care facilities

5 for the performance of mammograms in order to ensure

6 the compliance of such equipment and facilities with the

7 standards prescribed under subsection (b). Such inspec8 tion shall be carried out in a manner consistent with the

9 inspection of certified facilities by the Secretary of Health

10 and Human Services under section 354(g) of the Public

11 Health Services Act.

12 (2) The Secretary of Veterans Affairs may not dele13 gate the responsibility of such secretary under paragraph

14 (1) to a State agency.

15 (d) APPLICATION OF STANDARDS TO CONTRACT

16 PROVIDERS.—The Secretary of Veterans Affairs shall en17 sure that mammograms performed for the Department of

18 Veterans Affairs under contract with any non-Department

19 facility or provider conform to the quality standards pre20 scribed by the Secretary of Health and Human Services

21 under section 354 of the Public Health Service Act.

22 (e) REPORT.—(1) The Secretary shall submit to the

23 Committees on Veterans’ Affairs of the Senate and House

24 of Representatives a report on the quality standards pre25 scribed by the Secretary under subsection (b)(1).
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1 (2) The Secretary shall submit the report not later

2 than 180 days after the date on which the Secretary pre3 scribes such regulations.

4 (f) DEFINITION.—In this section, the term ‘‘mammo5 gram’’ shall have the meaning given such term in section

6 354(a)(5) of the Public Health Service Act (42 U.S.C.

7 263b(a)).

8 TITLE II—GENERAL HEALTH

9 CARE SERVICES

10 SEC. 201. EXTENSION OF PERIOD OF ELIGIBILITY FOR MED11 ICAL CARE FOR EXPOSURE TO DIOXIN OR

12 IONIZING RADIATION.

13 Section 1710(e)(3) of title 38, United States Code,

14 is amended by striking out ‘‘June 30, 1994’’ and inserting

15 in lieu thereof ‘‘December 31, 2003’’.

16 SEC. 202. EXTENSION OF PERIOD OF ELIGIBILITY FOR PRI17 ORITY HEALTH CARE FOR VETERANS OF THE

18 PERSIAN GULF WAR.

19 (a) INPATIENT CARE.—Section 1710(e)(3) of title

20 38, United States Code, is amended by striking out ‘‘after

21 December 31, 1994’’ and inserting in lieu thereof ‘‘after

22 September 30, 2003’’.

23 (b) OUTPATIENT CARE.—Section 1712(a)(1)(D) of

24 such title is amended by striking out ‘‘before December
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1 31, 1994’’ and inserting in lieu thereof ‘‘before October

2 1, 2003’’.

3 SEC. 203. PROGRAMS FOR FURNISHING HOSPICE CARE TO

4 VETERANS.

5 (a) ESTABLISHMENT OF PROGRAMS.—Chapter 17 of

6 title 38, United States Code, is amended by adding at the

7 end the following:

8 ‘‘SUBCHAPTER VII—HOSPICE CARE PILOT PROGRAM;

9 HOSPICE CARE SERVICES

10 ‘‘§ 1761. Definitions

11 ‘‘For the purposes of this subchapter—

12 ‘‘(1) The term ‘terminally ill veteran’ means

13 any veteran—

14 ‘‘(A) who is (i) entitled to receive hospital

15 care in a medical facility of the Department

16 under section 1710(a)(1) of this title, (ii) eligi17 ble for hospital or nursing home care in such a

18 facility and receiving such care, (iii) receiving

19 care in a State home facility for which care the

20 Secretary is paying per diem under section

21 1741 of this title, or (iv) transferred to a non22 Department nursing home for nursing home

23 care under section 1720 of this title and receiv24 ing such care; and
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1 ‘‘(B) who has a medical prognosis (as cer2 tified by a Department physician) of a life ex3 pectancy of six months or less.

4 ‘‘(2) The term ‘hospice care services’ means (A)

5 the care, items, and services referred to in subpara6 graphs (A) through (H) of section 1861(dd)(1) of

7 the Social Security Act (42 U.S.C. 1395x(dd)(1)),

8 and (B) personal care services.

9 ‘‘(3) The term ‘hospice program’ means any

10 program that satisfies the requirements of section

11 1861(dd)(2) of the Social Security Act (42 U.S.C.

12 1395x(dd)(2)).

13 ‘‘(4) The term ‘medical facility of the Depart14 ment’ means a facility referred to in section

15 1701(4)(A) of this title.

16 ‘‘(5) The term ‘non-Department facility’ means

17 a facility (other than a medical facility of the De18 partment) at which care to terminally ill veterans is

19 furnished, regardless of whether such care is fur20 nished pursuant to a contract, agreement, or other

21 arrangement referred to in section 1762(b)(1)(D) of

22 this title.

23 ‘‘(6) The term ‘personal care services’ means

24 any care or service furnished to a person that is nec25 essary to maintain a person’s health and safety
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1 within the home or nursing home of the person, in2 cluding care or services related to dressing and per3 sonal hygiene, feeding and nutrition, and environ4 mental support.

5 ‘‘§ 1762. Hospice care: pilot program requirements

6 ‘‘(a)(1) During the period beginning on October 1,

7 1993, and ending on December 31, 1998, the Secretary

8 shall conduct a pilot program in order—

9 ‘‘(A) to assess the feasibility and desirability of

10 furnishing hospice care services to terminally ill vet11 erans; and

12 ‘‘(B) to determine the most efficient and effec13 tive means of furnishing such services to such veter14 ans.

15 ‘‘(2) The Secretary shall conduct the pilot program

16 in accordance with this section.

17 ‘‘(b)(1) Under the pilot program, the Secretary

18 shall—

19 ‘‘(A) designate not less than 15 nor more than

20 30 medical facilities of the Department at or

21 through which to conduct hospice care services dem22 onstration projects;

23 ‘‘(B) designate the means by which hospice care

24 services shall be provided to terminally ill veterans
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1 under each demonstration project pursuant to sub2 section (c);

3 ‘‘(C) allocate such personnel and other re4 sources of the Department as the Secretary consid5 ers necessary to ensure that services are provided to

6 terminally ill veterans by the designated means

7 under each demonstration project; and

8 ‘‘(D) enter into any contract, agreement, or

9 other arrangement that the Secretary considers nec10 essary to ensure the provision of such services by the

11 designated means under each such project.

12 ‘‘(2) In carrying out the responsibilities referred to

13 in paragraph (1) the Secretary shall take into account the

14 need to provide for and conduct the demonstration

15 projects so as to provide the Secretary with such informa16 tion as is necessary for the Secretary to evaluate and as17 sess the furnishing of hospice care services to terminally

18 ill veterans by a variety of means and in a variety of cir19 cumstances.

20 ‘‘(3) In carrying out the requirement described in

21 paragraph (2), the Secretary shall ensure, to the maxi22 mum extent feasible, that—

23 ‘‘(A) the medical facilities of the Department

24 selected to conduct demonstration projects under the

25 pilot program include facilities located in urban
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1 areas of the United States and rural areas of the

2 United States;

3 ‘‘(B) the full range of affiliations between medi4 cal facilities of the Department and medical schools

5 is represented by the facilities selected to conduct

6 demonstration projects under the pilot program, in7 cluding no affiliation, minimal affiliation, and exten8 sive affiliation;

9 ‘‘(C) such facilities vary in the number of beds

10 that they operate and maintain; and

11 ‘‘(D) the demonstration projects are located or

12 conducted in accordance with any other criteria or

13 standards that the Secretary considers relevant or

14 necessary to furnish and to evaluate and assess fully

15 the furnishing of hospice care services to terminally

16 ill veterans.

17 ‘‘(c)(1) Subject to paragraph (2), hospice care to ter18 minally ill veterans shall be furnished under a demonstra19 tion project by one or more of the following means des20 ignated by the Secretary:

21 ‘‘(A) By the personnel of a medical facility of

22 the Department providing hospice care services pur23 suant to a hospice program established by the Sec24 retary at that facility.
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1 ‘‘(B) By a hospice program providing hospice

2 care services under a contract with that program

3 and pursuant to which contract any necessary inpa4 tient services are provided at a medical facility of

5 the Department.

6 ‘‘(C) By a hospice program providing hospice

7 care services under a contract with that program

8 and pursuant to which contract any necessary inpa9 tient services are provided at a non-Department

10 medical facility.

11 ‘‘(2)(A) The Secretary shall provide that—

12 ‘‘(i) care is furnished by the means described in

13 paragraph (1)(A) at not less than five medical facili14 ties of the Department; and

15 ‘‘(ii) care is furnished by the means described

16 in subparagraphs (B) and (C) of paragraph (1) in

17 connection with not less than five such facilities for

18 each such means.

19 ‘‘(B) The Secretary shall provide in any contract

20 under subparagraph (B) or (C) of paragraph (1) that in21 patient care may be provided to terminally ill veterans at

22 a medical facility other than that designated in the con23 tract if the provision of such care at such other facility

24 is necessary under the circumstances.
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1 ‘‘(d)(1) Except as provided in paragraph (2), the

2 amount paid to a hospice program for care furnished pur3 suant to subparagraph (B) or (C) of subsection (c)(1) may

4 not exceed the amount that would be paid to that program

5 for such care under section 1814(i) of the Social Security

6 Act (42 U.S.C. 1395f(i)) if such care were hospice care

7 for which payment would be made under part A of title

8 XVIII of such Act.

9 ‘‘(2) The Secretary may pay an amount in excess of

10 the amount referred to in paragraph (1) (or furnish serv11 ices whose value, together with any payment by the Sec12 retary, exceeds such amount) to a hospice program for

13 furnishing care to a terminally ill veteran pursuant to sub14 paragraph (B) or (C) of subsection (c)(1) if the Secretary

15 determines, on a case-by-case basis, that—

16 ‘‘(A) the furnishing of such care to the veteran

17 is necessary and appropriate; and

18 ‘‘(B) the amount that would be paid to that

19 program under section 1814(i) of the Social Security

20 Act would not compensate the program for the cost

21 of furnishing such care.

22 ‘‘§ 1763. Care for terminally ill veterans

23 ‘‘(a) During the period referred to in section

24 1762(a)(1) of this title, the Secretary shall designate not

25 less than 10 medical facilities of the Department at which
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1 hospital care is being furnished to terminally ill veterans

2 to furnish the care referred to in subsection (b)(1).

3 ‘‘(b)(1) Palliative care to terminally ill veterans shall

4 be furnished at the facilities referred to in subsection (a)

5 by one of the following means designated by the Secretary:

6 ‘‘(A) By personnel of the Department providing

7 one or more hospice care services to such veterans

8 at or through medical facilities of the Department.

9 ‘‘(B) By personnel of the Department monitor10 ing the furnishing of one or more of such services

11 to such veterans at or through non-Department fa12 cilities.

13 ‘‘(2) The Secretary shall furnish care by the means

14 referred to in each of subparagraphs (A) and (B) of para15 graph (1) at not less than five medical facilities designated

16 under subsection (a).

17 ‘‘§ 1764. Information relating to hospice care services

18 ‘‘The Secretary shall ensure to the extent practicable

19 that terminally ill veterans who have been informed of

20 their medical prognosis receive information relating to the

21 eligibility, if any, of such veterans for hospice care and

22 services under title XVIII of the Social Security Act (42

23 U.S.C. 1395 et seq.).
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1 ‘‘§ 1765. Evaluation and reports

2 ‘‘(a) Not later than September 30, 1994, and on an

3 annual basis thereafter until October 1, 1999, the Sec4 retary shall submit a written report to the Committees on

5 Veterans’ Affairs of the Senate and House of Representa6 tives relating to the conduct of the pilot program under

7 section 1762 of this title and the furnishing of hospice

8 care services under section 1763 of this title. Each report

9 shall include the following information:

10 ‘‘(1) The location of the sites of the demonstra11 tion projects provided for under the pilot program.

12 ‘‘(2) The location of the medical facilities of the

13 Department at or through which hospice care serv14 ices are being furnished under section 1763 of this

15 title.

16 ‘‘(3) The means by which care to terminally ill

17 veterans is being furnished under each such project

18 and at or through each such facility.

19 ‘‘(4) The number of veterans being furnished

20 such care under each such project and at or through

21 each such facility.

22 ‘‘(5) An assessment by the Secretary of any dif23 ficulties in furnishing such care and the actions

24 taken to resolve such difficulties.

25 ‘‘(b) Not later than August 1, 1997, the Secretary

26 shall submit to the committees referred to in subsection
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1 (a) a report containing an evaluation and assessment by

2 the Director of the Health Services Research and Develop3 ment Service of the hospice care pilot program under sec4 tion 1762 of this title and the furnishing of hospice care

5 services under section 1763 of this title. The report shall

6 contain such information (and shall be presented in such

7 form) as will enable the committees to evaluate fully the

8 feasibility and desirability of furnishing hospice care serv9 ices to terminally ill veterans.

10 ‘‘(c) The report shall include the following:

11 ‘‘(1) A description and summary of the pilot

12 program.

13 ‘‘(2) With respect to each demonstration project

14 conducted under the pilot program—

15 ‘‘(A) a description and summary of the

16 project;

17 ‘‘(B) a description of the facility conduct18 ing the demonstration project and a discussion

19 of how such facility was selected in accordance

20 with the criteria set out in, or prescribed by the

21 Secretary pursuant to, subparagraphs (A)

22 through (D) of section 1762(b)(3) of this title;

23 ‘‘(C) the means by which hospice care serv24 ices care are being furnished to terminally ill

25 veterans under the demonstration project;
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1 ‘‘(D) the personnel used to furnish such

2 services under the demonstration project;

3 ‘‘(E) a detailed factual analysis with re4 spect to the furnishing of such services, includ5 ing (i) the number of veterans being furnished

6 such services, (ii) the number, if any, of inpa7 tient admissions for each veteran being fur8 nished such services and the length of stay for

9 each such admission, (iii) the number, if any, of

10 outpatient visits for each such veteran, and (iv)

11 the number, if any, of home-care visits provided

12 to each such veteran;

13 ‘‘(F) the direct costs, if any, incurred by

14 terminally ill veterans, the members of the fam15 ilies of such veterans, and other individuals in

16 close relationships with such veterans in connec17 tion with the participation of veterans in the

18 demonstration project;

19 ‘‘(G) the costs incurred by the Department

20 in conducting the demonstration project, includ21 ing an analysis of the costs, if any, of the dem22 onstration project that are attributable to (i)

23 furnishing such services in facilities of the De24 partment, (ii) furnishing such services in non-
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1 Department facilities, and (iii) administering

2 the furnishing of such services; and

3 ‘‘(H) the unreimbursed costs, if any, in4 curred by any other entity in furnishing services

5 to terminally ill veterans under the project pur6 suant to section 1762(c)(1)(C) of this title.

7 ‘‘(3) An analysis of the level of the following

8 persons’ satisfaction with the services furnished to

9 terminally ill veterans under each demonstration

10 project:

11 ‘‘(A) Terminally ill veterans who receive

12 such services, members of the families of such

13 veterans, and other individuals in close relation14 ships with such veterans.

15 ‘‘(B) Personnel of the Department respon16 sible for furnishing such services under the

17 project.

18 ‘‘(C) Personnel of non-Department facili19 ties responsible for furnishing such services

20 under the project.

21 ‘‘(4) A description and summary of the means

22 of furnishing hospice care services at or through

23 each medical facility of the Department designated

24 under section 1763(a)(1) of this title.
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1 ‘‘(5) With respect to each such means, the in2 formation referred to in paragraphs (2) and (3).

3 ‘‘(6) A comparative analysis by the Director of

4 the services furnished to terminally ill veterans

5 under the various demonstration projects referred to

6 in section 1762 of this title and at or through the

7 designated facilities referred to in section 1763 of

8 this title, with an emphasis in such analysis on a

9 comparison relating to—

10 ‘‘(A) the management of pain and health

11 symptoms of terminally ill veterans by such

12 projects and facilities;

13 ‘‘(B) the number of inpatient admissions

14 of such veterans and the length of inpatient

15 stays for such admissions under such projects

16 and facilities;

17 ‘‘(C) the number and type of medical pro18 cedures employed with respect to such veterans

19 by such projects and facilities; and

20 ‘‘(D) the effectiveness of such projects and

21 facilities in providing care to such veterans at

22 the homes of such veterans or in nursing

23 homes.

24 ‘‘(7) An assessment by the Director of the fea25 sibility and desirability of furnishing hospice care
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1 services by various means to terminally ill veterans,

2 including an assessment by the Director of the opti3 mal means of furnishing such services to such veter4 ans.

5 ‘‘(8) Any recommendations for additional legis6 lation regarding the furnishing of care to terminally

7 ill veterans that the Secretary considers appro8 priate.’’.

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

10 at the beginning of such chapter is amended by adding

11 at the end the following:

‘‘SUBCHAPTER VII—HOSPICE CARE PILOT PROGRAM; HOSPICE CARE SERVICES

‘‘1761. Definitions.

‘‘1762. Hospice care: pilot program requirements.

‘‘1763. Care for terminally ill veterans.

‘‘1764. Information relating to hospice care services.

‘‘1765. Evaluation and reports.’’.

12 (c) AUTHORITY TO CARRY OUT OTHER HOSPICE

13 CARE PROGRAMS.—The amendments made by subsection

14 (a) may not be construed as terminating the authority of

15 the Secretary of Veterans Affairs to provide hospice care

16 services to terminally ill veterans under any program in

17 addition to the programs required under the provisions

18 added by such amendments.

19 (d) AUTHORIZATION OF APPROPRIATIONS.—Funds

20 are authorized to be appropriated for the Department of

21 Veterans Affairs for the purposes of carrying out the eval22 uation of the hopice care pilot programs under section
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1 1765 of title 38, United States Code (as added by sub2 section (a)), as follows:

3 (1) For fiscal year 1994, $1,200,000.

4 (2) For fiscal year 1995, $2,500,000.

5 (3) For fiscal year 1996, $2,200,000.

6 (4) For fiscal year 1997, $100,000.

7 SEC. 204. RURAL HEALTH-CARE CLINIC PROGRAM.

8 (a) PROGRAM.—(1) Chapter 17 of title 38, United

9 States Code, is amended by adding at the end of sub10 chapter II the following:

11 ‘‘§ 1720E. Rural health-care clinics: pilot program

12 ‘‘(a) During the three-year period beginning on Octo13 ber 1, 1993, the Secretary shall conduct a rural health14 care clinic program in States where significant numbers

15 of veterans reside in areas geographically remote from ex16 isting health-care facilities (as determined by the Sec17 retary). The Secretary shall conduct the program in ac18 cordance with this section.

19 ‘‘(b)(1) In carrying out the rural health-care clinic

20 program, the Secretary shall furnish medical services to

21 the veterans described in subsection (c) through use of—

22 ‘‘(A) mobile health-care clinics equipped, oper23 ated, and maintained by personnel of the Depart24 ment; and
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1 ‘‘(B) other types of rural clinics, including part2 time stationary clinics for which the Secretary con3 tracts and part-time stationary clinics operated by

4 personnel of the Department.

5 ‘‘(2) The Secretary shall furnish services under the

6 rural health-care clinic program in areas—

7 ‘‘(A) that are more than 100 miles from a De8 partment general health-care facility; and

9 ‘‘(B) that are less than 100 miles from such a

10 facility, if the Secretary determines that the furnish11 ing of such services in such areas is appropriate.

12 ‘‘(c) A veteran eligible to receive medical services

13 through rural health-care clinics under the program is any

14 veteran eligible for medical services under section 1712 of

15 this title.

16 ‘‘(d) The Secretary shall commence operation of at

17 least three rural health-care clinics (at least one of which

18 shall be a mobile health-care clinic) in each fiscal year of

19 the program. The Secretary may not operate more than

20 one mobile health-care clinic under the authority of this

21 section in any State in any such fiscal year.

22 ‘‘(e) Not later than 120 days after the date of the

23 enactment of this Act, the Secretary shall submit to Con24 gress a report on the Secretary’s plans for the implemen25 tation of the pilot program required under this section.
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1 ‘‘(f) Not later than December 31, 1997, the Secretary

2 shall submit to Congress a report containing an evaluation

3 of the program. The report shall include the following:

4 ‘‘(1) A description of the program, including in5 formation with respect to—

6 ‘‘(A) the number and type of rural health7 care clinics operated under the program;

8 ‘‘(B) the States in which such clinics were

9 operated;

10 ‘‘(C) the medical services furnished under

11 the program, including a detailed specification

12 of the cost of such services;

13 ‘‘(D) the veterans who were furnished serv14 ices under the program, setting forth (i) the

15 numbers and percentages of the veterans who

16 had service-connected disabilities, (ii) of the vet17 erans having such disabilities, the numbers and

18 percentages who were furnished care for such

19 disabilities, (iii) the ages of the veterans, (iv)

20 taking into account the veterans’ past use of

21 Department health-care facilities, an analysis of

22 the extent to which the veterans would have re23 ceived medical services from the Department

24 outside the program and the types of services
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1 they would have received, and (v) the financial

2 circumstances of the veterans; and

3 ‘‘(E) the types of personnel who furnished

4 services to veterans under the program, includ5 ing any difficulties in the recruitment or reten6 tion of such personnel.

7 ‘‘(2) An assessment by the Secretary of the

8 cost-effectiveness and efficiency of furnishing medi9 cal services to veterans through various types of

10 rural clinics (including mobile health-care clinics op11 erated under the pilot program conducted pursuant

12 to section 113 of the Veterans’ Benefits and Services

13 Act of 1988 (Public Law 100–322; 38 U.S.C. 1712

14 note)).

15 ‘‘(3) Any plans for administrative action, and

16 any recommendations for legislation, that the Sec17 retary considers appropriate.

18 ‘‘(g) For the purposes of this section, the term ‘De19 partment general health-care facility’ has the meaning

20 given such term in section 1712A(i)(2) of this title.’’.

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

22 chapter is amended by inserting after the item relating

23 to section 1720D the following new item:

‘‘1720E. Rural health-care clinics: pilot program.’’.

24 (b) AUTHORIZATION OF APPROPRIATIONS.—(1)

25 There is authorized to be appropriated for the Department
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1 of Veterans Affairs to carry out the rural health-care clin2 ics program provided for in section 1720E of title 38,

3 United States Code (as added by subsection (a)), the fol4 lowing:

5 (A) For fiscal year 1994, $3,000,000.

6 (B) For fiscal year 1995, $6,000,000.

7 (C) For fiscal year 1996, $9,000,000.

8 (2) Amounts appropriated pursuant to such author9 ization may not be used for any other purpose.

10 (3) No funds may be expended to carry out the rural

11 health-care clinics program provided for in such section

12 1720E unless expressly provided for in an appropriations

13 Act.

14 SEC. 205. PAYMENT TO STATES OF PER DIEM FOR VETER15 ANS RECEIVING ADULT DAY HEALTH CARE.

16 (a) PAYMENT OF PER DIEM FOR VETERANS RECEIV17 ING ADULT DAY CARE.—Section 1741 of title 38, United

18 States Code, is amended—

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

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

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

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

23 paragraph (2):

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

25 a rate determined by the Secretary for each veteran receiv-
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1 ing adult day health care in a State home, if such veteran

2 is eligible for such care under laws administered by the

3 Secretary.’’.

4 (b) ASSISTANCE TO STATES FOR CONSTRUCTION OF

5 ADULT DAY CARE FACILITIES.—(1) Section 8131(3) of

6 title 38, United States Code, is amended by inserting

7 ‘‘adult day health,’’ before ‘‘or hospital care’’.

8 (2) Section 8132 of such title is amended by inserting

9 ‘‘adult day health,’’ before ‘‘or hospital care’’.

10 (3) Section 8135(b) of such title is amended—

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

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

13 and

14 (B) in paragraph (3)(A), by inserting ‘‘or con15 struction (other than new construction) of adult day

16 health care buildings’’ before the semicolon.

17 SEC. 206. REVISION OF AUTHORITY ON USE OF TOBACCO

18 PRODUCTS IN DEPARTMENT FACILITIES.

19 Section 526(a) of the Veterans Health Care Act of

20 1992 (Public Law 102–585; 38 U.S.C. 1715 note) is

21 amended—

22 (1) in paragraph (1), by striking out ‘‘estab23 lishes and maintains—’’ and inserting in lieu thereof

24 ‘‘may establish and maintain—’’; and
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1 (2) in paragraph (2), by striking out ‘‘provides

2 access’’ and all that follows through ‘‘paragraph

3 (1)’’ and inserting in lieu thereof ‘‘if such an area

4 is established, provides access to the area’’.

5 TITLE III—MISCELLANEOUS

6 Subtitle A—Education Debt

7 Reduction Program

8 SEC. 301. SHORT TITLE.

9 This subtitle may be cited as the ‘‘Department of

10 Veterans Affairs Health Professionals Education Debt Re11 duction Act’’.

12 SEC. 302. PROGRAM OF ASSISTANCE IN THE PAYMENT OF

13 EDUCATION DEBTS INCURRED BY CERTAIN

14 VETERANS HEALTH ADMINISTRATION EM15 PLOYEES.

16 (a) PROGRAM.—(1) Chapter 76 of title 38, United

17 States Code, is amended by adding at the end the follow18 ing:

19 ‘‘SUBCHAPTER VI—EDUCATION DEBT

20 REDUCTION PROGRAM

21 ‘‘§ 7661. Authority for program

22 ‘‘(a) The Secretary shall carry out an education debt

23 reduction program under this subchapter. The program

24 shall be known as the Department of Veterans Affairs

25 Education Debt Reduction Program (hereafter in this
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1 chapter referred to as the ‘Education Debt Reduction Pro2 gram’). The purpose of the program is to assist personnel

3 serving in health-care positions in the Veterans Health

4 Administration in reducing the amount of debt incurred

5 by such personnel in completing educational programs

6 that qualify such personnel for such service.

7 ‘‘(b)(1) Subject to paragraph (2), assistance under

8 the Education Debt Reduction Program shall be in addi9 tion to the assistance available to individuals under the

10 Educational Assistance Program established under this

11 chapter.

12 ‘‘(2) An individual may not receive assistance under

13 both the Education Debt Reduction Program and the

14 Educational Assistance Program for the same period of

15 service in the Department.

16 ‘‘§ 7662. Eligibility; application

17 ‘‘(a) An individual eligible to participate in the Edu18 cation Debt Reduction Program is any individual (other

19 than a physician or dentist) who—

20 ‘‘(1) serves in a position in the Veterans Health

21 Administration under an appointment under section

22 7402(b) of this title;

23 ‘‘(2) serves in an occupation, specialty, or geo24 graphic area for which the recruitment or retention

25 of an adequate supply of qualified health-care per-
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1 sonnel is especially difficult (as determined by the

2 Secretary);

3 ‘‘(3) has pursued or is pursuing, as the case

4 may be—

5 ‘‘(A) a two-year or four-year course of edu6 cation or training at a qualifying undergraduate

7 institution which course qualified or will qualify,

8 as the case may be, the individual for appoint9 ment in a position referred to in paragraph (1);

10 or

11 ‘‘(B) a course of education at a qualifying

12 graduate institution which course qualified or

13 will qualify, as the case may be, the individual

14 for appointment in such a position; and

15 ‘‘(4) owes any amount of principal or interest

16 under a loan or other obligation the proceeds of

17 which were used or are being used, as the case may

18 be, by or on behalf of the individual to pay tuition

19 or other costs incurred by the individual in the pur20 suit of a course of education or training referred to

21 in paragraph (3).

22 ‘‘(b) Any eligible individual seeking to participate in

23 the Education Debt Reduction Program shall submit an

24 application to the Secretary relating to such participation.
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1 ‘‘§ 7663. Agreement

2 ‘‘(a) The Secretary shall enter into an agreement

3 with each individual selected to participate in the Edu4 cation Debt Reduction Program. The Secretary and the

5 individual shall enter into such an agreement at the begin6 ning of each year for which the individual is selected to

7 so participate.

8 ‘‘(b) An agreement between the Secretary and an in9 dividual selected to participate in the Education Debt Re10 duction Program shall be in writing, shall be signed by

11 the individual, and shall include the following provisions:

12 ‘‘(1) The Secretary’s agreement to provide as13 sistance on behalf of the individual under the pro14 gram upon the completion by the individual of a

15 one-year period of service in a position referred to

16 in section 7662(a) of this title which period begins

17 on the date of the signing of the agreement (or such

18 later date as is jointly agreed upon by the Secretary

19 and the individual).

20 ‘‘(2) The individual’s agreement that the Sec21 retary shall pay any assistance provided under the

22 program to the holder (as designated by the individ23 ual) of any loan or other obligation of the individual

24 referred to in section 7662(a)(4) of this title in

25 order to reduce or satisfy the unpaid balance (in-
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1 cluding principal and interest) due on such loan or

2 other obligation.

3 ‘‘(3) The individual’s agreement that assistance

4 shall not be paid on behalf of the individual under

5 the program for a year unless and until the individ6 ual completes the one-year period of service referred

7 to in paragraph (1).

8 ‘‘(4) The individual’s agreement that assistance

9 shall not be paid on behalf of the individual under

10 the program for a year unless the individual main11 tains (as determined by the Secretary) an acceptable

12 level of performance during the service referred to in

13 paragraph (3).

14 ‘‘§ 7664. Amount of assistance

15 ‘‘(a) Subject to subsection (b), the amount of assist16 ance provided to an individual under the Education Debt

17 Reduction Program for a year may not exceed $4,000 (ad18 justed in accordance with section 7631 of this title).

19 ‘‘(b) The total amount of assistance received by an

20 individual under the Education Debt Reduction Program

21 may not exceed $12,000 (as so adjusted).’’.

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

23 chapter is amended by adding at the end the following:

‘‘SUBCHAPTER VI—EDUCATION DEBT REDUCTION PROGRAM

‘‘7661. Authority for program.

‘‘7662. Eligibility; application.

‘‘7663. Agreement.
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‘‘7664. Amount of assistance.’’.

1 (b) CONFORMING AMENDMENTS.—Section 7631 of

2 title 38, United States Code, is amended—

3 (1) in subsection (a), by striking out ‘‘and the

4 maximum Selected Reserve member stipend

5 amount’’ and inserting in lieu thereof ‘‘the maxi6 mum Selected Reserve stipend amount, and the edu7 cation debt reduction amount and limitation’’; and

8 (2) in subsection (b)—

9 (A) by redesignating paragraph (4) as

10 paragraph (5); and

11 (B) by inserting after paragraph (3) the

12 following new paragraph (4):

13 ‘‘(4) The term ‘education debt reduction

14 amount and limitation’ means the maximum amount

15 of assistance, and the limitation applicable to such

16 assistance, for a person receiving assistance under

17 subchapter VI of this chapter, as specified in section

18 7663 of this title and as previously adjusted (if at

19 all) in accordance with this subsection.’’.

20 (c) REGULATIONS.—The Secretary of Veterans Af21 fairs shall prescribe regulations necessary to carry out the

22 Education Debt Reduction Program established under

23 subchapter VI of chapter 76 of title 38, United States

24 Code (as added by subsection (a)). The Secretary shall
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1 prescribe such regulations not later than 90 days after the

2 date of the enactment of this Act.

3 (d) REPORT.—Section 7632 of title 38, United States

4 Code, is amended—

5 (1) in the matter above paragraph (1), by in6 serting ‘‘and the Education Debt Reduction Pro7 gram’’ before the period at the end;

8 (2) in paragraph (1)—

9 (A) by inserting ‘‘and the Education Debt

10 Reduction Program’’ after ‘‘Educational Assist11 ance Program’’;

12 (B) by striking out ‘‘Program and’’ and in13 serting in lieu thereof ‘‘Program,’’; and

14 (C) by inserting ‘‘, and the Education

15 Debt Reduction Program’’ before ‘‘separately’’;

16 (3) in paragraph (3), by striking out ‘‘the Edu17 cational Assistance Program (or predecessor pro18 gram) has’’ and inserting in lieu thereof ‘‘each of

19 the Educational Assistance Program (or predecessor

20 program) and the Education Debt Reduction Pro21 gram have’’;

22 (4) in paragraph (4)—

23 (A) by striking out ‘‘and per’’ and insert24 ing in lieu thereof ‘‘, per’’; and
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1 (B) by inserting ‘‘, and per participant in

2 the Education Debt Reduction Program’’ before

3 the period at the end.

4 (e) AUTHORIZATION OF APPROPRIATIONS.—(1)

5 There is authorized to be appropriated for the Department

6 of Veterans Affairs $10,000,000 for each of fiscal years

7 1994 through 1998 to carry out the Education Debt Re8 duction Program.

9 (2) No funds may be used to provide assistance under

10 the program unless expressly provided for in an appropria11 tions Act.

12 (f) EXEMPTION FROM LIMITATION.—Section 523(b)

13 of the Veterans Health Care Act of 1992 (Public Law

14 102–585; 38 U.S.C. 7601 note) shall not apply to the

15 Education Debt Reduction Program.

16 Subtitle B—Other Provisions

17 SEC. 311. EXTENSION OF AUTHORITY OF ADVISORY COM18 MITTEE ON EDUCATION.

19 Section 3692(c) of title 38, United States Code, is

20 amended by striking out ‘‘December 31, 1994’’ and insert21 ing in lieu thereof ‘‘December 31, 1997’’.
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1 SEC. 312. EXTENSION OF AUTHORITY TO MAINTAIN RE2 GIONAL OFFICE IN THE PHILIPPINES.

3 Section 315(b) of title 38, United States Code, is

4 amended by striking out ‘‘December 31, 1994’’ and insert5 ing in lieu thereof ‘‘September 30, 1995’’.

Passed the Senate July 26 (legislative day, July 20),

1994.

Attest:

Secretary.
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