Calendar No. 193

103D CONGRESS

1ST SESSION S. 1030

[Report No. 103–136]

A BILL

To amend chapter 17 of title 38, United States

S

Veterans Affairs programs for women veterans.veterans and to improve certain Department offairs program of sexual trauma counseling forCode, to improve the Department of Veterans AfEPTEMBER 8 (legislative day, SEPTEMBER 7), 1993

Reported with an amendment and an amendment to the

title
II

Calendar No. 193

103D CONGRESS

1ST SESSION S. 1030

[Report No. 103–136]

To amend chapter 17 of title 38, United States Code, to improve the Department of Veterans Affairs program of sexual trauma counseling for veterans and to improve certain Department of Veterans Affairs programs

for women veterans.

IN THE SENATE OF THE UNITED STATES

MAY 26 (legislative day, APRIL 19), 1993

Mr. ROCKEFELLER (for himself, Mr. DECONCINI, Mr. GRAHAM, Mr. AKAKA,

Mr. DASCHLE, Mr. CAMPBELL, Mr. KENNEDY, Mr. CONRAD, Mrs. MURRAY, Mr. JEFFORDS, Ms. MIKULSKI, Ms. MOSELEY-BRAUN, and Mrs.

BOXER) introduced the following bill; which was read twice and referred

to the Committee on Veterans’ Affairs

SEPTEMBER 8 (legislative day, SEPTEMBER 7), 1993

Reported by Mr. ROCKEFELLER with an amendment and an amendment to

the title

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

A BILL

To amend chapter 17 of title 38, United States Code, to

improve the Department of Veterans Affairs program

of sexual trauma counseling for veterans and to improve

certain Department of Veterans Affairs programs for

women veterans.
2

•S 1030 RS

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

3 SECTION 1. DEPARTMENT OF VETERANS AFFAIRS SEXUAL

4 TRAUMA COUNSELING PROGRAM.

5 (a) EXTENSION OF PERIOD OF AUTHORITY TO PRO6 VIDE SEXUAL TRAUMA COUNSELING.—Subsection (a) of

7 section 1720D of title 38, United States Code, is amend8 ed—

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

10 paragraph (1) and inserting in lieu thereof ‘‘Decem11 ber 31, 1998,’’; and

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

13 paragraph (3) and inserting in lieu thereof ‘‘Decem14 ber 31, 1998,’’.

15 (b) PERIOD OF ELIGIBILITY TO SEEK COUNSEL16 ING.—(1) Such subsection is further amended—

17 (A) by striking out paragraph (2); and

18 (B) by redesignating paragraph (3) (as amend19 ed by subsection (a)(2)) as paragraph (2).

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

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

22 1720D note) is repealed.

23 (c) REPEAL OF LIMITATION ON PERIOD OF RECEIPT

24 OF COUNSELING.—Section 1720D of title 38, United

25 States Code, is further amended—
3

•S 1030 RS

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

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

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

4 (d) INCREASED PRIORITY OF CARE.—Section 1712(i)

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

6 (1) in paragraph (1)—

7 (A) by inserting ‘‘(A)’’ after ‘‘To a vet8 eran’’; and

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

10 for counseling under section 1720D of this title,

11 for the purposes of such counseling’’ before the

12 period at the end; and

13 (2) in paragraph (2)—

14 (A) by striking out ‘‘, (B)’’ and inserting

15 in lieu thereof ‘‘or (B)’’; and

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

17 follows through ‘‘such counseling’’.

18 (e) PROGRAM REVISION.—(1) Section 1720D of title

19 38, United States Code, is further amended—

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

21 (a)(1);

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

23 (b)(2)(C) and in the first sentence of subsection (c),

24 as redesignated by subsection (c); and
4

•S 1030 RS

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

2 (c)(2), as so redesignated, and inserting in lieu

3 thereof ‘‘individuals’’.

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

5 read as follows:

6 ‘‘§ 1720D. Counseling for sexual trauma’’.

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

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

9 amended to read as follows:

‘‘1720D. Counseling for sexual trauma.’’.

10 (f) INFORMATION ON COUNSELING BY TELE11 PHONE.—(1) Paragraph (1) of section 1720D(c) of title

12 38, United States Code, as redesignated by subsection (c)

13 of this section, is amended by striking out ‘‘may’’ and in14 serting in lieu thereof ‘‘shall’’.

15 (2) In providing information on counseling available

16 to veterans through the information system required

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

18 (as amended by this section), the Secretary of Veterans

19 Affairs shall ensure—

20 (A) that the telephone system described in such

21 section is operated by Department of Veterans Af22 fairs personnel who are trained in the provision to

23 persons who have experienced sexual trauma of in24 formation about the care and services relating to

25 sexual trauma that are available to veterans in the
5

•S 1030 RS

1 communities in which such veterans reside, including

2 care and services available under programs of the

3 Department (including the care and services avail4 able under section 1720D of such title) and from

5 non-Department agencies or organizations;

6 (B) that such personnel are provided with infor7 mation on the care and services relating to sexual

8 trauma that are available to veterans and the loca9 tions in which such care and services are available;

10 (C) that such personnel refer veterans seeking

11 such care and services to appropriate providers of

12 such care and services (including care and services

13 that are available in the communities in which such

14 veterans reside);

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

16 manner that protects the confidentiality of persons

17 who place telephone calls to the system; and

18 (E) that the telephone system operates at all

19 times.

20 (3) The Secretary shall ensure that information about

21 the availability of the telephone system is visibly posted

22 in Department medical facilities and is advertised through

23 public service announcements, pamphlets, and other

24 means.
6

•S 1030 RS

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

2 enactment of this Act, the Secretary shall submit to Con3 gress a report on the operation of the telephone system

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

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

6 the following:

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

8 system during the period covered by the report, with

9 a separate display of (i) the number of calls placed

10 to the system from each State (as such term is de11 fined in section 101(20) of title 38, United States

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

13 persons who placed more than one call to the system

14 during that period.

15 (B) The types of sexual trauma described to

16 personnel operating the system by persons placing

17 calls to the system.

18 (C) A description of the difficulties, if any, ex19 perienced by persons placing calls to the system in

20 obtaining care and services for sexual trauma in the

21 communities in which such persons live, including

22 counseling and care and services available from the

23 Department and from non-Department agencies and

24 organizations.
7

•S 1030 RS

1 (D) A description of the training provided to

2 the personnel operating the system.

3 (E) The recommendations and plans of the Sec4 retary for the improvement of the system.

5 (4) The Secretary shall commence operation of the

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

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

8 than 180 days after the date of the enactment of this Act.

9 SEC. 2. REPORT RELATING TO DETERMINATIONS OF SERV10 ICE CONNECTION FOR SEXUAL TRAUMA.

11 (a) REPORT.—The Secretary of Veterans Affairs

12 shall submit to the Committees on Veterans’ Affairs of

13 the Senate and House of Representatives a report contain14 ing the Secretary’s assessment of—

15 (1) the difficulties that veterans encounter in

16 obtaining from the Department of Veterans Affairs

17 determinations that disabilities relating to sexual

18 trauma resulting from events that occurred during

19 active duty are service-connected disabilities; and

20 (2) the extent to which Department personnel

21 fail to make determinations that such disabilities are

22 service-connected disabilities.

23 (b) RECOMMENDATIONS.—The Secretary shall in24 clude in the report the Secretary’s recommendations for

25 actions to be taken to respond in a fair manner to the
8

•S 1030 RS

1 difficulties described in the report and to eliminate failures

2 to make determinations that such disabilities are service3 connected disabilities.

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

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

6 psychological trauma resulting from rape, sexual assault,

7 aggravated sexual abuse (as such term is described in sec8 tion 2241 of title 18, United States Code), sexual harass9 ment, or other act of sexual violence.

10 (d) DEADLINE FOR REPORT.—The report required

11 by this section shall be submitted not later than June 30,

12 1994.

13 SEC. 3. COORDINATORS OF WOMEN’S SERVICES.

14 (a) REQUIREMENT OF FULL-TIME SERVICE.—Sec15 tion 108 of the Veterans Health Care Act of 1992 (Public

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

17 amended—

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

19 and

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

21 ‘‘(b) Each official who serves in the position of coordi22 nator of women’s services under subsection (a) shall so

23 serve on a full-time basis.’’.
9

•S 1030 RS

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

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

3 section) is further amended—

4 (1) by redesignating paragraph (5) as para5 graph (6); and

6 (2) by inserting after paragraph (4) the follow7 ing new paragraph (5):

8 ‘‘(5) Facilitating communication between

9 women veterans coordinators under the jurisdiction

10 of such regional coordinator and the Under Sec11 retary for Health and the Secretary.’’.

12 (c) SUPPORT FOR WOMEN’S SERVICES COORDINA13 TORS.—The Secretary of Veterans Affairs shall take

14 appropriate actions to ensure that—

15 (1) sufficient funding is provided to each De16 partment of Veterans Affairs facility in order to per17 mit the coordinator of women’s services to carry out

18 the responsibilities of the coordinator at the facility;

19 (2) sufficient clerical and communications sup20 port is provided to each such coordinator for that

21 purpose; and

22 (3) each such coordinator has direct access to

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

24 the coordinator is assigned.
10

•S 1030 RS

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

2 (a) SHORT TITLE.—This Act may be cited as the ‘‘Vet3 erans Health Programs Improvement Act of 1993’’.

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

5 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. Authority to provide priority health care to 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.

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.
11

•S 1030 RS

1 TITLE I—WOMEN VETERANS

2 SEC. 101. DEPARTMENT OF VETERANS AFFAIRS SEXUAL

3 TRAUMA SERVICES PROGRAM.

4 (a) AUTHORITY TO PROVIDE SERVICES FOR SEXUAL

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

6 38, United States Code is amended—

7 (A) by inserting ‘‘(A)’’ before ‘‘During the pe8 riod’’; and

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

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

11 (A), the Secretary may provide appropriate care and serv12 ices to a veteran for an injury, illness, or other psycho13 logical condition which the Secretary determines to be the

14 result of a physical assault, battery, or harassment referred

15 to in that subparagraph.’’.

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

17 as follows:

18 ‘‘(1) The Secretary shall give priority to the establish19 ment and operation of the program to provide counseling

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

21 a veteran eligible for counseling and care and services under

22 subsection (a)(1), the Secretary shall ensure that the veteran

23 is furnished counseling under this section in a way that

24 is coordinated with the furnishing of such care and services

25 under this chapter.’’.
12

•S 1030 RS

1 (3) Subsection (d) of such section is amended by insert2 ing ‘‘and care and services’’ after ‘‘counseling’’ each place

3 it appears.

4 (b) AUTHORITY TO PROVIDE SERVICES BY CON5 TRACT.—Subsection (a)(3) of such section is amended—

6 (1) by inserting ‘‘(A)’’ before ‘‘In furnishing’’;

7 (2) in subparagraph (A), as so designated—

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

9 lieu thereof ‘‘(i)’’; and

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

11 lieu thereof ‘‘(ii)’’; and

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

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

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

15 with a qualified non-Department health professional or fa16 cility if Department facilities are not capable of furnishing

17 such care and services to that veteran economically because

18 of geographic inaccessibility.’’.

19 (c) EXTENSION OF AUTHORITY TO PROVIDE SEXUAL

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

21 amended by subsections (a) and (b) of this section, is further

22 amended—

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

24 paragraph (1)(A) and inserting in lieu thereof ‘‘De25 cember 31, 1998,’’; and
13

•S 1030 RS

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

2 paragraph (3) and inserting in lieu thereof ‘‘Decem3 ber 31, 1998,’’.

4 (d) PERIOD OF ELIGIBILITY TO SEEK SERVICES.—(1)

5 Such subsection, as amended by subsections (a), (b), and

6 (c) of this section, is further amended—

7 (A) by striking out paragraph (2); and

8 (B) by redesignating paragraph (3) as para9 graph (2).

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

11 1992 (Public Law 102–585; 106 Stat. 4946; 38 U.S.C.

12 1720D note) is repealed.

13 (e) REPEAL OF LIMITATION ON PERIOD OF RECEIPT

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

15 Code (as amended by subsections (a) through (d) of this sec16 tion), is further amended—

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

18 (2) by redesignating subsections (c), (d), and (e)

19 as subsections (b), (c), and (d), respectively.

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

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

22 (1) in paragraph (1)—

23 (A) by inserting ‘‘(A)’’ after ‘‘To a veteran’’;

24 and
14

•S 1030 RS

1 (B) by inserting ‘‘, or (B) who is eligible for

2 counseling and care and services under section

3 1720D of this title, for the purposes of such coun4 seling and care and services’’ before the period at

5 the end; and

6 (2) in paragraph (2)—

7 (A) by striking out ‘‘, (B)’’ and inserting in

8 lieu thereof ‘‘or (B)’’; and

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

10 follows through ‘‘such counseling’’.

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

12 38, United States Code (as amended by subsections (a)

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

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

15 (a)(1)(A);

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

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

18 and

19 (C) by striking out ‘‘women’’ in subsection (c)(2)

20 and inserting in lieu thereof ‘‘individuals’’.

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

22 as follows:
15

•S 1030 RS

1 ‘‘§ 1720D. Counseling, care, and services for sexual

2 trauma’’.

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

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

5 amended to read as follows:

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

6 (h) INFORMATION ON COUNSELING BY TELEPHONE.—

7 (1) Paragraph (1) of section 1720D(c) of title 38, United

8 States Code, as redesignated by subsection (d) of this sec9 tion, is amended by striking out ‘‘may’’ and inserting in

10 lieu thereof ‘‘shall’’.

11 (2) In providing information on counseling available

12 to veterans through the information system required under

13 section 1720D(c)(1) of title 38, United States Code, as

14 amended by this section, the Secretary of Veterans Affairs

15 shall ensure—

16 (A) that the telephone system described in such

17 section is operated by Department of Veterans Affairs

18 personnel who are trained in the provision to persons

19 who have experienced sexual trauma of information

20 about the counseling and care and services relating to

21 sexual trauma that are available to veterans in the

22 communities in which such veterans reside, including

23 counseling and care and services available under pro24 grams of the Department (including the care and
16

•S 1030 RS

1 services available under section 1720D of such title)

2 and from non-Department agencies or organizations;

3 (B) that such personnel are provided with infor4 mation on the counseling and care and services relat5 ing to sexual trauma that are available to veterans

6 and the locations in which such care and services are

7 available;

8 (C) that such personnel refer veterans seeking

9 such counseling and care and services to appropriate

10 providers of such counseling and care and services

11 (including counseling and care and services that are

12 available in the communities in which such veterans

13 reside);

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

15 manner that protects the confidentiality of persons

16 who place telephone calls to the system; and

17 (E) that the telephone system operates at all

18 times.

19 (3) The Secretary shall ensure that information about

20 the availability of the telephone system is visibly posted in

21 Department medical facilities and is advertised through

22 public service announcements, pamphlets, and other means.

23 (4) Not later than 18 months after the date of the en24 actment of this Act, the Secretary shall submit to Congress

25 a report on the operation of the telephone system required
17

•S 1030 RS

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

2 (as so amended). The report shall set forth the following:

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

4 system during the period covered by the report, with

5 a separate display of (i) the number of calls placed

6 to the system from each State (as such term is defined

7 in section 101(20) of title 38, United States Code)

8 during that period, and (ii) the number of persons

9 who placed more than one call to the system during

10 that period.

11 (B) The types of sexual trauma described to per12 sonnel operating the system by persons placing calls

13 to the system.

14 (C) A description of the difficulties, if any, expe15 rienced by persons placing calls to the system in ob16 taining counseling and care and services for sexual

17 trauma in the communities in which such persons

18 live, including counseling and care and services avail19 able from the Department and from non-Department

20 agencies and organizations.

21 (D) A description of the training provided to the

22 personnel operating the system.

23 (E) The recommendations and plans of the Sec24 retary for the improvement of the system.
18

•S 1030 RS

1 (5) The Secretary shall commence operation of the tele2 phone system required under section 1720D(c)(1) of title 38,

3 United States Code (as so amended), not later than 180

4 days after the date of the enactment of this Act.

5 SEC. 102. REPORTS RELATING TO DETERMINATIONS OF

6 SERVICE CONNECTION FOR SEXUAL TRAUMA.

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

8 shall submit to the Committees on Veterans’ Affairs of the

9 Senate and House of Representatives a report containing

10 the Secretary’s assessment of—

11 (A) the difficulties that veterans encounter in ob12 taining from the Department of Veterans Affairs de13 terminations that disabilities relating to sexual trau14 ma resulting from events that occurred during active

15 duty are service-connected disabilities; and

16 (B) the extent to which Department personnel

17 fail to make determinations that such disabilities are

18 service-connected disabilities.

19 (2) The Secretary shall include in the report the Sec20 retary’s recommendations for actions to be taken to respond

21 in a fair manner to the difficulties described in the report

22 and to eliminate failures to make determinations that such

23 disabilities are service-connected disabilities.

24 (3) The report required by this subsection shall be sub25 mitted not later than June 30, 1994.
19

•S 1030 RS

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

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

3 committees referred to in paragraph (1) of subsection (a)

4 a report on the actions taken by the Secretary to implement

5 the recommendations referred to in paragraph (2) of that

6 subsection.

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

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

9 psychological trauma resulting from rape, sexual assault,

10 aggravated sexual abuse (as such term is described in sec11 tion 2241 of title 18, United States Code), sexual harass12 ment, or other act of sexual violence.

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

14 (a) REQUIREMENT OF FULL-TIME SERVICE.—Section

15 108 of the Veterans Health Care Act of 1992 (Public Law

16 102–585; 106 Stat. 4948; 38 U.S.C. 1710 note) is amend17 ed—

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

19 and

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

21 ‘‘(b) Each official who serves in the position of coordi22 nator of women’s services under subsection (a) shall so serve

23 on a full-time basis.’’.
20

•S 1030 RS

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

2 of such section (as designated by subsection (a) of this sec3 tion) is further amended—

4 (1) by redesignating paragraph (5) as para5 graph (6); and

6 (2) by inserting after paragraph (4) the follow7 ing new paragraph (5):

8 ‘‘(5) Facilitating communication between women

9 veterans coordinators under the jurisdiction of such

10 regional coordinator and the Under Secretary for

11 Health and the Secretary.’’.

12 (c) SUPPORT FOR WOMEN’S SERVICES COORDINA13 TORS.—The Secretary of Veterans Affairs shall take appro14 priate actions to ensure that—

15 (1) sufficient funding is provided to each De16 partment of Veterans Affairs facility in order to per17 mit the coordinator of women’s services to carry out

18 the responsibilities of the coordinator at the facility;

19 (2) sufficient clerical and communications sup20 port is provided to each such coordinator for that

21 purpose; and

22 (3) each such coordinator has direct access to the

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

24 coordinator is assigned.
21

•S 1030 RS

1 SEC. 104. WOMEN’S HEALTH SERVICES.

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

3 title 38, United States Code, is amended—

4 (1) in paragraph (6)(A)(i), by inserting ‘‘wom5 en’s health services,’’ after ‘‘preventive health serv6 ices,’’; and

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

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

9 care services provided to women, including counseling and

10 services relating to the following:

11 ‘‘(A) Papanicolaou tests (pap smear).

12 ‘‘(B) Breast examinations and mammography.

13 ‘‘(C) Comprehensive reproductive health care, in14 cluding pregnancy-related care.

15 ‘‘(D) The management of infertility.

16 ‘‘(E) The management and prevention of sexu17 ally-transmitted diseases.

18 ‘‘(F) Menopause.

19 ‘‘(G) Physical or psychological conditions arising

20 out of acts of sexual violence.’’.

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

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

23 end the following:

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

25 ambulatory or outpatient basis.’’.
22

•S 1030 RS

1 (c) REPEAL OF SUPERSEDED AUTHORITY.—Section

2 106 of the Veterans Health Care Act of 1992 (Public Law

3 102–585; 38 U.S.C. 1710 note) is amended—

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

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

6 DIRECTORS OF FACILITIES.—’’ before ‘‘The Sec7 retary’’.

8 (d) REPORT ON HEALTH CARE AND RESEARCH.—Sec9 tion 107(b) of such Act (38 U.S.C. 1710 note) is amended—

10 (1) in paragraph (1), by inserting ‘‘and women’s

11 health services (as such term is defined in section

12 1701(10) of title 38, United States Code)’’ after ‘‘sec13 tion 106 of this Act’’;

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

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

16 amount of services provided by such personnel, in17 cluding information on the numbers of inpatient

18 stays and the number of outpatient visits through

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

20 (3) by redesignating paragraph (4) as para21 graph (7);

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

23 new paragraphs:

24 ‘‘(4) A description of the personnel of the De25 partment who provided such services to women veter-
23

•S 1030 RS

1 ans, including the number of employees (including

2 both the number of individual employees and the

3 number of full-time employee equivalents) and the

4 professional qualifications or specialty training of

5 such employees and the Department facilities to which

6 such personnel were assigned.

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

8 Secretary to ensure the retention of the personnel de9 scribed in paragraph (4), and any actions undertaken

10 to recruit additional such personnel or personnel to

11 replace such personnel.

12 ‘‘(6) An assessment by the Secretary of any dif13 ficulties experienced by the Secretary in the furnish14 ing of such services and the actions taken by the Sec15 retary to resolve such difficulties.’’; and

16 (5) by adding after paragraph (7), as redesig17 nated by paragraph (3) of this subsection, the follow18 ing:

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

20 Secretary to foster and encourage the expansion of

21 such research.’’.
24

•S 1030 RS

1 SEC. 105. EXPANSION OF RESEARCH RELATING TO WOMEN

2 VETERANS.

3 (a) HEALTH RESEARCH.—Section 109(a) of the Veter4 ans Health Care Act of 1992 (Public Law 102–585; 38

5 U.S.C. 7303 note) is amended—

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

7 (2) in paragraph (1), as so designated, by strik8 ing out ‘‘veterans who are women’’ and inserting in

9 lieu thereof ‘‘women veterans’’; and

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

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

12 consult with the following:

13 ‘‘(A) The Director of the Nursing Service.

14 ‘‘(B) Officials of the Central Office assigned re15 sponsibility for women’s health programs and sexual

16 trauma services.

17 ‘‘(C) The members of the Advisory Committee on

18 Women Veterans established under section 542 of title

19 38, United States Code.

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

21 working groups within the Department of Veterans

22 Affairs (including the Women Veterans Working

23 Group and the Task Force on Treatment of Women

24 Who Suffer Sexual Abuse).
25

•S 1030 RS

1 ‘‘(3) The Secretary shall foster and encourage research

2 under this section on the following matters as they relate

3 to women:

4 ‘‘(A) Breast cancer.

5 ‘‘(B) Gynecological and reproductive health, in6 cluding gynecological cancer, infertility, sexually7 transmitted diseases, and pregnancy.

8 ‘‘(C) Human Immunodeficiency Virus and Ac9 quired Immune Deficiency Syndrome.

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

11 stress disorder and depression.

12 ‘‘(E) Diseases related to aging, including meno13 pause, osteoporosis, and Alzheimer’s Disease.

14 ‘‘(F) Substance abuse.

15 ‘‘(G) Sexual violence and related trauma.

16 ‘‘(H) Exposure to toxic chemicals and other envi17 ronmental hazards.

18 ‘‘(4) The Secretary shall, to the maximum extent prac19 ticable, ensure that personnel of the Department of Veterans

20 Affairs engaged in the research referred to in paragraph

21 (1) include the following:

22 ‘‘(A) Personnel of the geriatric research, edu23 cation, and clinical centers designated pursuant to

24 section 7314 of title 38, United States Code.
26

•S 1030 RS

1 ‘‘(B) Personnel of the National Center for Post2 Traumatic Stress Disorder established pursuant to

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

4 1984 (Public Law 98–528; 98 Stat. 2692).

5 ‘‘(5) The Secretary shall, to the maximum extent prac6 ticable, ensure that personnel of the Department engaged

7 in research relating to the health of women veterans are

8 advised and informed of such research engaged in by other

9 personnel of the Department.’’.

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

11 (38 U.S.C. 1710 note) is amended—

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

13 sentence; and

14 (2) by amending paragraph (3) to read as fol15 lows:

16 ‘‘(3)(A) Subject to subparagraph (B), the study shall

17 be based on—

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

19 women and of women who are serving on active mili20 tary, naval, or air service; and

21 ‘‘(ii) an examination of the medical and demo22 graphic histories of the women comprising such sam23 ple.

24 ‘‘(B) The sample referred to in subparagraph (A) shall,

25 to the maximum extent practicable, constitute a representa-
27

•S 1030 RS

1 tive sampling (as determined by the Secretary) of the ages,

2 the ethnic, social and economic backgrounds, the enlisted

3 and officer grades, and the branches of service of all veterans

4 who are women and women who are serving on such duty.

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

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

7 number of women of the sample who have used medical fa8 cilities of the Department, nursing home facilities of or

9 under the jurisdiction of the Department, and outpatient

10 care facilities of or under the jurisdiction of the Depart11 ment.’’.

12 SEC. 106. MAMMOGRAPHY QUALITY STANDARDS.

13 (a) PERFORMANCE OF MAMMOGRAMS.—Mammograms

14 may not be performed at a Department of Veterans Affairs

15 facility unless that facility is accredited for that purpose

16 by a private nonprofit organization designated by the Sec17 retary of Veterans Affairs. The organization designated by

18 the Secretary under this subsection shall meet the standards

19 for accrediting bodies established by the Secretary of Health

20 and Human Services under section 354(e) of the Public

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

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

23 Veterans Affairs shall prescribe quality assurance and qual24 ity control standards relating to the performance and inter25 pretation of mammograms and use of mammogram equip-
28

•S 1030 RS

1 ment and facilities by personnel of the Department of Veter2 ans Affairs. Such standards shall be no less stringent than

3 the standards prescribed by the Secretary of Health and

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

5 Service Act.

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

7 Veterans Affairs shall consult with the Secretary of Health

8 and Human Services.

9 (2) The Secretary of Veterans Affairs shall prescribe

10 such standards not later than 120 days after the Secretary

11 of Health and Human Services prescribes quality standards

12 under such section 354(f).

13 (c) INSPECTION OF DEPARTMENT EQUIPMENT.—(1)

14 The Secretary of Veterans Affairs shall, on an annual basis,

15 inspect the equipment and facilities utilized by and in De16 partment of Veterans Affairs health-care facilities for the

17 performance of mammograms in order to ensure the compli18 ance of such equipment and facilities with the standards

19 prescribed under subsection (b). Such inspection shall be

20 carried out in a manner consistent with the inspection of

21 certified facilities by the Secretary of Health and Human

22 Services under section 354(g) of the Public Health Services

23 Act.
29

•S 1030 RS

1 (2) The Secretary of Veterans Affairs may not delegate

2 the responsibility of such secretary under paragraph (1) to

3 a State agency.

4 (d) APPLICATION OF STANDARDS TO CONTRACT PRO5 VIDERS.—The Secretary of Veterans Affairs shall ensure

6 that mammograms performed for the Department of Veter7 ans Affairs under contract with any non-Department facil8 ity or provider conform to the quality standards prescribed

9 by the Secretary of Health and Human Services under sec10 tion 354 of the Public Health Service Act.

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

12 Committees on Veterans’ Affairs of the Senate and House

13 of Representatives a report on the quality standards pre14 scribed by the Secretary under subsection (b)(1).

15 (2) The Secretary shall submit the report not later

16 than 180 days after the date on which the Secretary pre17 scribes such regulations.

18 (f) DEFINITION.—In this section, the term ‘‘mammo19 gram’’ shall have the meaning given such term in section

20 354(a)(5) of the Public Health Service Act (42 U.S.C.

21 263b(a)).
30

•S 1030 RS

1 TITLE II—GENERAL HEALTH

2 CARE SERVICES

3 SEC. 201. EXTENSION OF PERIOD OF ELIGIBILITY FOR MED4 ICAL CARE FOR EXPOSURE TO DIOXIN OR

5 IONIZING RADIATION.

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

7 amended by striking out ‘‘December 31, 1993’’ and insert8 ing in lieu thereof ‘‘December 31, 2003’’.

9 SEC. 202. AUTHORITY TO PROVIDE PRIORITY HEALTH CARE

10 TO VETERANS OF THE PERSIAN GULF WAR.

11 (a) AUTHORIZED INPATIENT CARE.—(1) Section

12 1710(a)(1)(G) of title 38, United States Code, is amended

13 by striking out ‘‘or radiation’’ and inserting in lieu thereof

14 ‘‘, radiation, or environmental hazard’’.

15 (2) Section 1710(e) of such title is amended—

16 (A) by inserting at the end of paragraph (1) the

17 following new subparagraph:

18 ‘‘(C) Subject to paragraphs (2) and (3) of this sub19 section, a veteran who the Secretary finds may have been

20 exposed while serving on active duty in the Southwest Asia

21 theater of operations during the Persian Gulf War to a toxic

22 substance or environmental hazard (including petrochemi23 cals, the fumes of burning landfills or petrochemicals, phar24 maceuticals or other chemical agents administered by the

25 Department of Defense, indigenous diseases, pesticides, and
31

•S 1030 RS

1 inhalation or ingestion of depleted uranium or wounds

2 caused by depleted uranium) is eligible for hospital care

3 and nursing home care under subsection (a)(1)(G) of this

4 section for any disability, notwithstanding that there is in5 sufficient medical evidence to conclude that such disability

6 may be associated with such exposure.’’;

7 (B) in paragraph (2), by striking out ‘‘subpara8 graph (A) or (B)’’ and inserting in lieu thereof ‘‘sub9 paragraph (A), (B), or (C)’’; and

10 (C) in paragraph (3), by striking out the period

11 at the end and inserting in lieu thereof ‘‘, or, in the

12 case of care for a veteran described in paragraph

13 (1)(C), after September 30, 2003.’’.

14 (b) AUTHORIZED OUTPATIENT CARE.—Section

15 1712(a) of such title is amended—

16 (1) in paragraph (1)—

17 (A) by striking out ‘‘and’’ at the end of sub18 paragraph (B);

19 (B) by striking out the period at the end of

20 subparagraph (C) and inserting in lieu thereof ‘‘;

21 and’’; and

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

23 ‘‘(D) during the period before October 1, 2003,

24 for any disability in the case of a veteran who served

25 on active duty in the Southwest Asia theater of oper-
32

•S 1030 RS

1 ations during the Persian Gulf War and who the Sec2 retary finds may have been exposed to a toxic sub3 stance or environmental hazard (including petro4 chemicals, the fumes of burning landfills or petro5 chemicals, pharmaceuticals or other chemical agents

6 administered by the Department of Defense, indige7 nous diseases, pesticides, and inhalation or ingestion

8 of depleted uranium or wounds caused by depleted

9 uranium) during such service, notwithstanding that

10 there is insufficient medical evidence to conclude that

11 the disability may be associated with such exposure.’’;

12 and

13 (2) by adding at the end the following new para14 graph:

15 ‘‘(7) Medical services may not be furnished under

16 paragraph (1)(D) with respect to a disability that is found,

17 in accordance with guidelines issued by the Under Sec18 retary for Health, to have resulted from a cause other than

19 an exposure described in that paragraph.’’.

20 (c) EFFECTIVE DATE.—(1) The amendments made by

21 subsections (a) and (b) shall take effect as of August 2, 1990.

22 (2) The Secretary of Veterans Affairs shall, upon re23 quest, reimburse any veteran who paid the United States

24 an amount under section 1710(f) or 1712(f) of title 38,

25 United States Code, as the case may be, for hospital care,
33

•S 1030 RS

1 nursing home care, or outpatient services, as the case may

2 be, furnished by the Secretary to the veteran before the date

3 of the enactment of this Act as a result of the exposure of

4 the veteran to a toxic substance or environmental hazards

5 during the Persian Gulf War. The amount of the reimburse6 ment shall be the amount paid by the veteran for such care

7 or services under such section 1710(f) or 1712(f).

8 SEC. 203. PROGRAMS FOR FURNISHING HOSPICE CARE TO

9 VETERANS.

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

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

12 end the following:

13 ‘‘SUBCHAPTER VII—HOSPICE CARE PILOT PROGRAM;

14 HOSPICE CARE SERVICES

15 ‘‘§ 1761. Definitions

16 ‘‘For the purposes of this subchapter—

17 ‘‘(1) The term ‘terminally ill veteran’ means any

18 veteran—

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

20 care in a medical facility of the Department

21 under section 1710(a)(1) of this title, (ii) eligible

22 for hospital or nursing home care in such a fa23 cility and receiving such care, (iii) receiving

24 care in a State home facility for which care the

25 Secretary is paying per diem under section 1741

26 of this title, or (iv) transferred to a non-Depart-
34

•S 1030 RS

1 ment nursing home for nursing home care under

2 section 1720 of this title and receiving such care;

3 and

4 ‘‘(B) who has a medical prognosis (as cer5 tified by a Department physician) of a life ex6 pectancy of six months or less.

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

8 the care, items, and services referred to in subpara9 graphs (A) through (H) of section 1861(dd)(1) of the

10 Social Security Act (42 U.S.C. 1395x(dd)(1)), and

11 (B) personal care services.

12 ‘‘(3) The term ‘hospice program’ means any pro13 gram that satisfies the requirements of section

14 1861(dd)(2) of the Social Security Act (42 U.S.C.

15 1395x(dd)(2)).

16 ‘‘(4) The term ‘medical facility of the Depart17 ment’ means a facility referred to in section

18 1701(4)(A) of this title.

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

20 facility (other than a medical facility of the Depart21 ment) at which care to terminally ill veterans is fur22 nished, regardless of whether such care is furnished

23 pursuant to a contract, agreement, or other arrange24 ment referred to in section 1762(b)(1)(D) of this title.
35

•S 1030 RS

1 ‘‘(6) The term ‘personal care services’ means any

2 care or service furnished to a person that is necessary

3 to maintain a person’s health and safety within the

4 home or nursing home of the person, including care

5 or services related to dressing and personal hygiene,

6 feeding and nutrition, and environmental support.

7 ‘‘§ 1762. Hospice care: pilot program requirements

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

9 1993, and ending on December 31, 1998, the Secretary shall

10 conduct a pilot program in order—

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

12 furnishing hospice care services to terminally ill vet13 erans; and

14 ‘‘(B) to determine the most efficient and effective

15 means of furnishing such services to such veterans.

16 ‘‘(2) The Secretary shall conduct the pilot program in

17 accordance with this section.

18 ‘‘(b)(1) Under the pilot program, the Secretary shall—

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

20 30 medical facilities of the Department at or through

21 which to conduct hospice care services demonstration

22 projects;

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

24 services shall be provided to terminally ill veterans
36

•S 1030 RS

1 under each demonstration project pursuant to sub2 section (c);

3 ‘‘(C) allocate such personnel and other resources

4 of the Department as the Secretary considers nec5 essary to ensure that services are provided to termi6 nally ill veterans by the designated means under each

7 demonstration project; and

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

9 arrangement that the Secretary considers necessary to

10 ensure the provision of such services by the designated

11 means under each such project.

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

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

14 to provide for and conduct the demonstration projects so

15 as to provide the Secretary with such information as is nec16 essary for the Secretary to evaluate and assess the furnish17 ing of hospice care services to terminally ill veterans by a

18 variety of means and in a variety of circumstances.

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

20 paragraph (2), the Secretary shall ensure, to the maximum

21 extent feasible, that—

22 ‘‘(A) the medical facilities of the Department se23 lected to conduct demonstration projects under the

24 pilot program include facilities located in urban
37

•S 1030 RS

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 termi18 nally ill veterans shall be furnished under a demonstration

19 project by one or more of the following means designated

20 by the Secretary:

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

22 Department providing hospice care services pursuant

23 to a hospice program established by the Secretary at

24 that facility.
38

•S 1030 RS

1 ‘‘(B) By a hospice program providing hospice

2 care services under a contract with that program and

3 pursuant to which contract any necessary inpatient

4 services are provided at a medical facility of the De5 partment.

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

7 care services under a contract with that program and

8 pursuant to which contract any necessary inpatient

9 services are provided at a non-Department medical

10 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 in

16 subparagraphs (B) and (C) of paragraph (1) in con17 nection with not less than five such facilities for each

18 such means.

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

20 under subparagraph (B) or (C) of paragraph (1) that inpa21 tient care may be provided to terminally ill veterans at a

22 medical facility other than that designated in the contract

23 if the provision of such care at such other facility is nec24 essary under the circumstances.
39

•S 1030 RS

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 for

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

8 of such Act.

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

10 the amount referred to in paragraph (1) (or furnish services

11 whose value, together with any payment by the Secretary,

12 exceeds such amount) to a hospice program for furnishing

13 care to a terminally ill veteran pursuant to subparagraph

14 (B) or (C) of subsection (c)(1) if the Secretary determines,

15 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 pro19 gram under section 1814(i) of the Social Security Act

20 would not compensate the program for the cost of fur21 nishing 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
40

•S 1030 RS

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 at

8 or through medical facilities of the Department.

9 ‘‘(B) By personnel of the Department monitoring

10 the furnishing of one or more of such services to such

11 veterans at or through non-Department facilities.

12 ‘‘(2) The Secretary shall furnish care by the means re13 ferred to in each of subparagraphs (A) and (B) of para14 graph (1) at not less than five medical facilities designated

15 under subsection (a).

16 ‘‘§ 1764. Information relating to hospice care services

17 ‘‘The Secretary shall ensure to the extent practicable

18 that terminally ill veterans who have been informed of their

19 medical prognosis receive information relating to the eligi20 bility, if any, of such veterans for hospice care and services

21 under title XVIII of the Social Security Act (42 U.S.C.

22 1395 et seq.).

23 ‘‘§ 1765. Evaluation and reports

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

25 annual basis thereafter until October 1, 1999, the Secretary
41

•S 1030 RS

1 shall submit a written report to the Committees on Veter2 ans’ Affairs of the Senate and House of Representatives re3 lating to the conduct of the pilot program under section

4 1762 of this title and the furnishing of hospice care services

5 under section 1763 of this title. Each report shall include

6 the following information:

7 ‘‘(1) The location of the sites of the demonstra8 tion projects provided for under the pilot program.

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

10 Department at or through which hospice care services

11 are being furnished under section 1763 of this title.

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

13 veterans is being furnished under each such project

14 and at or through each such facility.

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

16 such care under each such project and at or through

17 each such facility.

18 ‘‘(5) An assessment by the Secretary of any dif19 ficulties in furnishing such care and the actions taken

20 to resolve such difficulties.

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

22 submit to the committees referred to in subsection (a) a re23 port containing an evaluation and assessment by the Direc24 tor of the Health Services Research and Development Serv25 ice of the hospice care pilot program under section 1762
42

•S 1030 RS

1 of this title and the furnishing of hospice care services under

2 section 1763 of this title. The report shall contain such in3 formation (and shall be presented in such form) as will en4 able the committees to evaluate fully the feasibility and de5 sirability of furnishing hospice care services to terminally

6 ill veterans.

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

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

9 program.

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

11 conducted under the pilot program—

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

13 project;

14 ‘‘(B) a description of the facility conducting

15 the demonstration project and a discussion of

16 how such facility was selected in accordance with

17 the criteria set out in, or prescribed by the Sec18 retary pursuant to, subparagraphs (A) through

19 (D) of section 1762(b)(3) of this title;

20 ‘‘(C) the means by which hospice care serv21 ices care are being furnished to terminally ill

22 veterans under the demonstration project;

23 ‘‘(D) the personnel used to furnish such

24 services under the demonstration project;
43

•S 1030 RS

1 ‘‘(E) a detailed factual analysis with re2 spect to the furnishing of such services, including

3 (i) the number of veterans being furnished such

4 services, (ii) the number, if any, of inpatient ad5 missions for each veteran being furnished such

6 services and the length of stay for each such ad7 mission, (iii) the number, if any, of outpatient

8 visits for each such veteran, and (iv) the number,

9 if any, of home-care visits provided to each such

10 veteran;

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

12 terminally ill veterans, the members of the fami13 lies of such veterans, and other individuals in

14 close relationships with such veterans in connec15 tion with the participation of veterans in the

16 demonstration project;

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

18 in conducting the demonstration project, includ19 ing an analysis of the costs, if any, of the dem20 onstration project that are attributable to (i) fur21 nishing such services in facilities of the Depart22 ment, (ii) furnishing such services in non-De23 partment facilities, and (iii) administering the

24 furnishing of such services; and
44

•S 1030 RS

1 ‘‘(H) the unreimbursed costs, if any, in2 curred by any other entity in furnishing services

3 to terminally ill veterans under the project pur4 suant to section 1762(c)(1)(C) of this title.

5 ‘‘(3) An analysis of the level of the following per6 sons’ satisfaction with the services furnished to termi7 nally ill veterans under each demonstration project:

8 ‘‘(A) Terminally ill veterans who receive

9 such services, members of the families of such vet10 erans, and other individuals in close relation11 ships with such veterans.

12 ‘‘(B) Personnel of the Department respon13 sible for furnishing such services under the

14 project.

15 ‘‘(C) Personnel of non-Department facilities

16 responsible for furnishing such services under the

17 project.

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

19 furnishing hospice care services at or through each

20 medical facility of the Department designated under

21 section 1763(a)(1) of this title.

22 ‘‘(5) With respect to each such means, the infor23 mation referred to in paragraphs (2) and (3).

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

25 the services furnished to terminally ill veterans under
45

•S 1030 RS

1 the various demonstration projects referred to in sec2 tion 1762 of this title and at or through the des3 ignated facilities referred to in section 1763 of this

4 title, with an emphasis in such analysis on a com5 parison relating to—

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

7 symptoms of terminally ill veterans by such

8 projects and facilities;

9 ‘‘(B) the number of inpatient admissions of

10 such veterans and the length of inpatient stays

11 for such admissions under such projects and fa12 cilities;

13 ‘‘(C) the number and type of medical proce14 dures employed with respect to such veterans by

15 such projects and facilities; and

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

17 facilities in providing care to such veterans at

18 the homes of such veterans or in nursing homes.

19 ‘‘(7) An assessment by the Director of the fea20 sibility and desirability of furnishing hospice care

21 services by various means to terminally ill veterans,

22 including an assessment by the Director of the opti23 mal means of furnishing such services to such veter24 ans.
46

•S 1030 RS

1 ‘‘(8) Any recommendations for additional legis2 lation regarding the furnishing of care to terminally

3 ill veterans that the Secretary considers appro4 priate.’’.

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

6 the beginning of such chapter is amended by adding at the

7 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.’’.

8 (c) AUTHORITY TO CARRY OUT OTHER HOSPICE

9 CARE PROGRAMS.—The amendments made by subsection

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

11 the Secretary of Veterans Affairs to provide hospice care

12 services to terminally ill veterans under any program in

13 addition to the programs required under the provisions

14 added by such amendments.

15 (d) AUTHORIZATION OF APPROPRIATIONS.—Funds are

16 authorized to be appropriated for the Department of Veter17 ans Affairs for the purposes of carrying out the evaluation

18 of the hopice care pilot programs under section 1765 of title

19 38, United States Code (as added by subsection (a)), as fol20 lows:

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

22 (2) For fiscal year 1995, $2,500,000.
47

•S 1030 RS

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

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

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

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

5 States Code, is amended by adding at the end of subchapter

6 II the following:

7 ‘‘§ 1720E. Rural health-care clinics: pilot program

8 ‘‘(a) During the three-year period beginning on Octo9 ber 1, 1993, the Secretary shall conduct a rural health-care

10 clinic program in States where significant numbers of vet11 erans reside in areas geographically remote from existing

12 health-care facilities (as determined by the Secretary). The

13 Secretary shall conduct the program in accordance with

14 this section.

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

16 program, the Secretary shall furnish medical services to the

17 veterans described in subsection (c) through use of—

18 ‘‘(A) mobile health-care clinics equipped, oper19 ated, and maintained by personnel of the Depart20 ment; and

21 ‘‘(B) other types of rural clinics, including part22 time stationary clinics for which the Secretary con23 tracts and part-time stationary clinics operated by

24 personnel of the Department.
48

•S 1030 RS

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

2 rural health-care clinic program in areas—

3 ‘‘(A) that are more than 100 miles from a De4 partment general health-care facility; and

5 ‘‘(B) that are less than 100 miles from such a fa6 cility, if the Secretary determines that the furnishing

7 of such services in such areas is appropriate.

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

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

10 veteran eligible for medical services under section 1712 of

11 this title.

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

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

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

15 the program. The Secretary may not operate more than one

16 mobile health-care clinic under the authority of this section

17 in any State in any such fiscal year.

18 ‘‘(e) Not later than 120 days after the date of the enact19 ment of this Act, the Secretary shall submit to Congress a

20 report on the Secretary’s plans for the implementation of

21 the pilot program required under this section.

22 ‘‘(f) Not later than December 31, 1997, the Secretary

23 shall submit to Congress a report containing an evaluation

24 of the program. The report shall include the following:
49

•S 1030 RS

1 ‘‘(1) A description of the program, including in2 formation with respect to—

3 ‘‘(A) the number and type of rural health4 care clinics operated under the program;

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

6 operated;

7 ‘‘(C) the medical services furnished under

8 the program, including a detailed specification

9 of the cost of such services;

10 ‘‘(D) the veterans who were furnished serv11 ices under the program, setting forth (i) the

12 numbers and percentages of the veterans who had

13 service-connected disabilities, (ii) of the veterans

14 having such disabilities, the numbers and per15 centages who were furnished care for such dis16 abilities, (iii) the ages of the veterans, (iv) taking

17 into account the veterans’ past use of Depart18 ment health-care facilities, an analysis of the ex19 tent to which the veterans would have received

20 medical services from the Department outside the

21 program and the types of services they would

22 have received, and (v) the financial cir23 cumstances of the veterans; and

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

25 services to veterans under the program, including
50

•S 1030 RS

1 any difficulties in the recruitment or retention of

2 such personnel.

3 ‘‘(2) An assessment by the Secretary of the cost4 effectiveness and efficiency of furnishing medical serv5 ices to veterans through various types of rural clinics

6 (including mobile health-care clinics operated under

7 the pilot program conducted pursuant to section 113

8 of the Veterans’ Benefits and Services Act of 1988

9 (Public Law 100–322; 38 U.S.C. 1712 note)).

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

11 any recommendations for legislation, that the Sec12 retary considers appropriate.

13 ‘‘(g) For the purposes of this section, the term ‘Depart14 ment general health-care facility’ has the meaning given

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

16 (2) The table of sections at the beginning of such chap17 ter is amended by inserting after the item relating to section

18 1720D the following new item:

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

19 (b) AUTHORIZATION OF APPROPRIATIONS.—(1) There

20 is authorized to be appropriated for the Department of Vet21 erans Affairs to carry out the rural health-care clinics pro22 gram provided for in section 1720E of title 38, United

23 States Code (as added by subsection (a)), the following:

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

25 (B) For fiscal year 1995, $6,000,000.
51

•S 1030 RS

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

2 (2) Amounts appropriated pursuant to such authoriza3 tion may not be used for any other purpose.

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

5 health-care clinics program provided for in such section

6 1720E unless expressly provided for in an appropriations

7 Act.

8 SEC. 205. PAYMENT TO STATES OF PER DIEM FOR VETER9 ANS RECEIVING ADULT DAY HEALTH CARE.

10 (a) PAYMENT OF PER DIEM FOR VETERANS RECEIV11 ING ADULT DAY CARE.—Section 1741 of title 38, United

12 States Code, is amended—

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

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

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

16 (3) by adding at the end the following new para17 graph (2):

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

19 a rate determined by the Secretary for each veteran receiv20 ing adult day health care in a State home, if such veteran

21 is eligible for such care under laws administered by the Sec22 retary.’’.

23 (b) ASSISTANCE TO STATES FOR CONSTRUCTION OF

24 ADULT DAY CARE FACILITIES.—(1) Section 8131(3) of title
52

•S 1030 RS

1 38, United States Code, is amended by inserting ‘‘adult day

2 health,’’ before ‘‘or hospital care’’.

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

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

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

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

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

8 and

9 (B) in paragraph (3)(A), by inserting ‘‘or con10 struction (other than new construction) of adult day

11 health care buildings’’ before the semicolon.

12 TITLE III—MISCELLANEOUS

13 Subtitle A—Education Debt

14 Reduction Program

15 SEC. 301. SHORT TITLE.

16 This subtitle may be cited as the ‘‘Department of Veter17 ans Affairs Health Professionals Education Debt Reduction

18 Act’’.

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

20 EDUCATION DEBTS INCURRED BY CERTAIN

21 VETERANS HEALTH ADMINISTRATION EM22 PLOYEES.

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

24 States Code, is amended by adding at the end the following:
53

•S 1030 RS

1 ‘‘SUBCHAPTER VI—EDUCATION DEBT

2 REDUCTION PROGRAM

3 ‘‘§ 7661. Authority for program

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

5 reduction program under this subchapter. The program

6 shall be known as the Department of Veterans Affairs Edu7 cation Debt Reduction Program (hereafter in this chapter

8 referred to as the ‘Education Debt Reduction Program’).

9 The purpose of the program is to assist personnel serving

10 in health-care positions in the Veterans Health Administra11 tion in reducing the amount of debt incurred by such per12 sonnel in completing educational programs that qualify

13 such personnel for such service.

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

15 Education Debt Reduction Program shall be in addition

16 to the assistance available to individuals under the Edu17 cational Assistance Program established under this chapter.

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

19 both the Education Debt Reduction Program and the Edu20 cational Assistance Program for the same period of service

21 in the Department.

22 ‘‘§ 7662. Eligibility; application

23 ‘‘(a) An individual eligible to participate in the Edu24 cation Debt Reduction Program is any individual (other

25 than a physician or dentist) who—
54

•S 1030 RS

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

2 Administration under an appointment under section

3 7402(b) of this title;

4 ‘‘(2) serves in an occupation, specialty, or geo5 graphic area for which the recruitment or retention of

6 an adequate supply of qualified health-care personnel

7 is especially difficult (as determined by the Sec8 retary);

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

10 be—

11 ‘‘(A) a two-year or four-year course of edu12 cation or training at a qualifying undergraduate

13 institution which course qualified or will qual14 ify, as the case may be, the individual for ap15 pointment in a position referred to in paragraph

16 (1); or

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

18 graduate institution which course qualified or

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

20 for appointment in such a position; and

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

22 under a loan or other obligation the proceeds of which

23 were used or are being used, as the case may be, by

24 or on behalf of the individual to pay tuition or other

25 costs incurred by the individual in the pursuit of a
55

•S 1030 RS

1 course of education or training referred to in para2 graph (3).

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

4 the Education Debt Reduction Program shall submit an ap5 plication to the Secretary relating to such participation.

6 ‘‘§ 7663. Agreement

7 ‘‘(a) The Secretary shall enter into an agreement with

8 each individual selected to participate in the Education

9 Debt Reduction Program. The Secretary and the individual

10 shall enter into such an agreement at the beginning of each

11 year for which the individual is selected to so participate.

12 ‘‘(b) An agreement between the Secretary and an indi13 vidual selected to participate in the Education Debt Reduc14 tion Program shall be in writing, shall be signed by the

15 individual, and shall include the following provisions:

16 ‘‘(1) The Secretary’s agreement to provide assist17 ance on behalf of the individual under the program

18 upon the completion by the individual of a one-year

19 period of service in a position referred to in section

20 7662(a) of this title which period begins on the date

21 of the signing of the agreement (or such later date as

22 is jointly agreed upon by the Secretary and the indi23 vidual).

24 ‘‘(2) The individual’s agreement that the Sec25 retary shall pay any assistance provided under the
56

•S 1030 RS

1 program to the holder (as designated by the individ2 ual) of any loan or other obligation of the individual

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

4 to reduce or satisfy the unpaid balance (including

5 principal and interest) due on such loan or other obli6 gation.

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

8 shall not be paid on behalf of the individual under the

9 program for a year unless and until the individual

10 completes the one-year period of service referred to in

11 paragraph (1).

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

13 shall not be paid on behalf of the individual under the

14 program for a year unless the individual maintains

15 (as determined by the Secretary) an acceptable level

16 of performance during the service referred to in para17 graph (3).

18 ‘‘§ 7664. Amount of assistance

19 ‘‘(a) Subject to subsection (b), the amount of assistance

20 provided to an individual under the Education Debt Reduc21 tion Program for a year may not exceed $4,000 (adjusted

22 in accordance with section 7631 of this title).

23 ‘‘(b) The total amount of assistance received by an in24 dividual under the Education Debt Reduction Program

25 may not exceed $12,000 (as so adjusted).’’.
57

•S 1030 RS

1 (2) The table of sections at the beginning of such chap2 ter is amended by adding at the end the following:

‘‘SUBCHAPTER VI—EDUCATION DEBT REDUCTION PROGRAM

‘‘7661. Authority for program.

‘‘7662. Eligibility; application.

‘‘7663. Agreement.

‘‘7664. Amount of assistance.’’.

3 (b) CONFORMING AMENDMENTS.—Section 7631 of title

4 38, United States Code, is amended—

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

6 maximum Selected Reserve member stipend amount’’

7 and inserting in lieu thereof ‘‘the maximum Selected

8 Reserve stipend amount, and the education debt re9 duction amount and limitation’’; and

10 (2) in subsection (b)—

11 (A) by redesignating paragraph (4) as

12 paragraph (5); and

13 (B) by inserting after paragraph (3) the fol14 lowing new paragraph (4):

15 ‘‘(4) The term ‘education debt reduction amount

16 and limitation’ means the maximum amount of as17 sistance, and the limitation applicable to such assist18 ance, for a person receiving assistance under sub19 chapter VI of this chapter, as specified in section

20 7663 of this title and as previously adjusted (if at all)

21 in accordance with this subsection.’’.
58

•S 1030 RS

1 (c) REGULATIONS.—The Secretary of Veterans Affairs

2 shall prescribe regulations necessary to carry out the Edu3 cation Debt Reduction Program established under sub4 chapter VI of chapter 76 of title 38, United States Code

5 (as added by subsection (a)). The Secretary shall prescribe

6 such regulations not later than 90 days after the date of

7 the enactment of this Act.

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

9 Code, is amended—

10 (1) in the matter above paragraph (1), by insert11 ing ‘‘and the Education Debt Reduction Program’’

12 before the period at the end;

13 (2) in paragraph (1)—

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

15 Reduction Program’’ after ‘‘Educational Assist16 ance Program’’;

17 (B) by striking out ‘‘Program and’’ and in18 serting in lieu thereof ‘‘Program,’’; and

19 (C) by inserting ‘‘, and the Education Debt

20 Reduction Program’’ before ‘‘separately’’;

21 (3) in paragraph (3), by striking out ‘‘the Edu22 cational Assistance Program (or predecessor program)

23 has’’ and inserting in lieu thereof ‘‘each of the Edu24 cational Assistance Program (or predecessor program)

25 and the Education Debt Reduction Program have’’;
59

•S 1030 RS

1 (4) in paragraph (4)—

2 (A) by striking out ‘‘and per’’ and inserting

3 in lieu thereof ‘‘, per’’; and

4 (B) by inserting ‘‘, and per participant in

5 the Education Debt Reduction Program’’ before

6 the period at the end.

7 (e) EXEMPTION FROM TAXATION.—Section 7636 of

8 title 38, United States Code, is amended—

9 (1) by inserting ‘‘(a)’’ before ‘‘Notwithstanding’’;

10 and

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

12 ‘‘(b) Notwithstanding any other law, any payment on

13 behalf of a participant in the Education Debt Reduction

14 Program for the tuition or other costs referred to in section

15 7662(a)(4) of this title shall be exempt from taxation.’’.

16 (f) AUTHORIZATION OF APPROPRIATIONS.—(1) There

17 is authorized to be appropriated for the Department of Vet18 erans Affairs $10,000,000 for each of fiscal years 1994

19 through 1998 to carry out the Education Debt Reduction

20 Program.

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

22 the program unless expressly provided for in an appropria23 tions Act.

24 (g) EXEMPTION FROM LIMITATION.—Section 523(b) of

25 the Veterans Health Care Act of 1992 (Public Law 102–
60

•S 1030 RS

1 585; 38 U.S.C. 7601 note) shall not apply to the Education

2 Debt Reduction Program.

3 Subtitle B—Other Provisions

4 SEC. 311. EXTENSION OF AUTHORITY OF ADVISORY COM5 MITTEE ON EDUCATION.

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

7 amended by striking out ‘‘December 31, 1993’’ and insert8 ing in lieu thereof ‘‘December 31, 1997’’.

9 SEC. 312. EXTENSION OF AUTHORITY TO MAINTAIN RE10 GIONAL OFFICE IN THE PHILIPPINES.

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

12 amended by striking out ‘‘March 31, 1994’’ and inserting

13 in lieu thereof ‘‘September 30, 1995’’.

Amend the title so as to read: ‘‘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 estab-
61

•S 1030 RS

lish an education debt reduction program, and for other

purposes.’’.

S 1030 RS——2

S 1030 RS——3

S 1030 RS——4

S 1030 RS——5