Union Calendar No. 188

103D CONGRESS

1ST SESSION H. R. 3313

[Report No. 103–349]

A BILL

To amend title 38, United States Code, to improve

Centers, and for other purposes.that may be provided to veterans through Vetto Agent Orange, to expand the scope of serviceserans who were exposed to ionizing radiation orans Affairs to provide priority health care to vetand expand authority for the Secretary of Veterans Affairs relating to women veterans, to extendhealth care services of the Department of VeterNOVEMBER 10, 1993

Reported with amendments, committed to the Committee

dered to be printedof the Whole House on the State of the Union, and or-
IB

Union Calendar No. 188

103D CONGRESS

1ST SESSION H. R. 3313

[Report No. 103–349]

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

of the Department of Veterans Affairs relating to women veterans, to

extend and expand authority for the Secretary of Veterans Affairs to

provide priority health care to veterans who were exposed to ionizing

radiation or to Agent Orange, to expand the scope of services that

may be provided to veterans through Vet Centers, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

OCTOBER 19, 1993

Mr. ROWLAND (for himself, Mr. MONTGOMERY, Mr. STUMP, Mr. EDWARDS

of Texas, Mr. SMITH of New Jersey, Mr. FILNER, Mr. BILIRAKIS, Mr.

BISHOP, Mr. HUTCHINSON, Mr. KREIDLER, Mr. EVERETT, Mr. BUYER,

and Mr. LINDER) introduced the following bill; which was referred to the

Committee on Veterans’ Affairs

NOVEMBER 10, 1993

Additional sponsors: Mr. STEARNS, Mr. QUINN, Mr. SPENCE, Mr. RIDGE, Mr.

KING, Mr. HEFNER, Mr. RICHARDSON, Mr. STENHOLM, Mr. PAYNE of

Virginia, Mr. PARKER, and Ms. WOOLSEY

NOVEMBER 10, 1993

Reported with amendments, committed to the Committee of the Whole House

on the State of the Union, and ordered to be printed

[Omit the part struck through and insert the part printed in italic]

A BILL

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

care services of the Department of Veterans Affairs relat-
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ing to women veterans, to extend and expand authority

for the Secretary of Veterans Affairs to provide priority

health care to veterans who were exposed to ionizing

radiation or to Agent Orange, to expand the scope of

services that may be provided to veterans through Vet

Centers, 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.

4 This Act may be cited as the ‘‘Veterans Health Im5 provements Act of 1993’’.

6 TITLE I—WOMEN VETERANS

7 HEALTH IMPROVEMENTS

8 SEC. 101. SHORT TITLE.

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

10 Health Improvements Act of 1993’’.

11 SEC. 102. HEALTH CARE SERVICES FOR WOMEN.

12 (a) ENSURED PROVISION OF SERVICES.—The Sec13 retary of Veterans Affairs shall ensure that each health14 care facility under the direct jurisdiction of the Secretary

15 is able, through services made available either by individ16 uals appointed to positions in the Veterans Health Admin17 istration or under contracts or other agreements made

18 under section 7409, 8111, or 8153 of title 38, United

19 States Code, or title II of Public Law 102–585, to provide

20 in a timely and appropriate manner women’s health serv-
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1 ices (as defined in section 1701(10) of title 38, United

2 States Code (as added by section 3)) to any veteran de3 scribed in section 1710(a)(1) of title 38, United States

4 Code, who is eligible for such services.

5 (b) ROUTINE HEALTH CARE SERVICES.—The Sec6 retary shall ensure that each health-care facility under the

7 direct jurisdiction of the Secretary that serves a catchment

8 area in which the number of women veterans described

9 in section 1710(a)(1) of title 38, United States Code,

10 makes it cost effective to do so shall provide routine wom11 en’s health services directly (rather than by contract or

12 other agreement). The Secretary shall ensure that each

13 such facility is provided appropriate equipment, facilities,

14 and staff to carry out the preceding sentence and to en15 sure that the quality of care provided under the preceding

16 sentence is in accordance with professional standards.

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

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

20 SEC. 103. WOMEN’S HEALTH SERVICES.

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

3 following health care services provided to women:

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

5 ‘‘(B) Breast examinations and mammography.

6 ‘‘(C) General reproductive health care (includ7 ing the management of menopause), but not includ8 ing infertility services (other than infertility counsel9 ing), abortions, or pregnancy care (including

10 prenatal and delivery care), except for such care re11 lating to a pregnancy that is complicated or in which

12 the risks of complication are increased by a service13 connected condition.

14 ‘‘(D) The management and prevention of sexu15 ally-transmitted diseases.

16 ‘‘(E) The management and treatment of

17 osteoporosis.

18 ‘‘(F) Counseling and treatment for physical or

19 psychological conditions arising out of acts of sexual

20 violence.’’.

21 ‘‘(G) Early detection, management, and treat22 ment for cardiac disease, in the case of women who

23 are determined to be at risk of cardiac disease.’’.
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1 (b) 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 (c) EXTENSION OF ANNUAL REPORT REQUIRE9 MENT.—Section 107(a) of such Act is amended by strik10 ing out ‘‘Not later than January 1, 1993, January 1,

11 1994, and January 1, 1995’’ and inserting in lieu thereof

12 ‘‘Not later than January 1 of 1993 and each year there13 after through 1998’’.

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

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

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

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

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

19 term is defined in section 1701(10) of title 38,

20 United States Code)’’;

21 (2) in paragraph (2)(A), by inserting ‘‘(includ22 ing information on the number of inpatient stays

23 and the number of outpatient visits through which

24 such services were provided)’’ after ‘‘facility’’; and
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1 (3) by adding at the end the following new

2 paragraph:

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

4 Secretary to foster and encourage the expansion of

5 such research.’’.

6 SEC. 104. MAMMOGRAPHY QUALITY STANDARDS.

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

8 of title 38, United States Code, is amended by adding at

9 the end the following new section:

10 ‘‘§ 7318 7319. Mammography quality standards

11 ‘‘(a) A mammogram may not be performed at a De12 partment facility unless that facility is accredited for that

13 purpose by a private nonprofit organization designated by

14 the Secretary. An organization designated by the Sec15 retary under this subsection shall meet the standards for

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

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

18 ‘‘(b) The Secretary, in consultation with the Sec19 retary of Health and Human Services, shall prescribe

20 quality assurance and quality control standards relating

21 to the performance and interpretation of mammograms

22 and use of mammogram equipment and facilities of the

23 Department of Veterans Affairs consistent with the re24 quirements of section 354(f)(1) of the Public Health Serv25 ice Act. Such standards shall be no less stringent than
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1 the standards prescribed by the Secretary of Health and

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

3 Service Act and shall be prescribed during the 120-day

4 period beginning on the date on which the Secretary of

5 Health and Human Services prescribes quality standards

6 under section 354(f) of the Public Health Service Act (42

7 U.S.C. 263b(f)).

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

9 standards prescribed under subsection (b), shall provide

10 for an annual inspection of the equipment and facilities

11 used by and in Department health care facilities for the

12 performance of mammograms. Such inspections shall be

13 carried out in a manner consistent with the inspection of

14 certified facilities by the Secretary of Health and Human

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

16 Act.

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

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

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

20 performed for the Department under contract with any

21 non-Department facility or provider conform to the quality

22 standards prescribed by the Secretary of Health and

23 Human Services under section 354 of the Public Health

24 Service Act.
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1 ‘‘(e) For the purposes of this section, the term ‘mam2 mogram’ has the meaning given such term in section

3 354(a)(5) of the Public Health Service Act (42 U.S.C.

4 263b(a)).’’.

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

6 chapter is amended by inserting after the item relating

7 to section 7317 7318 the following new item:

‘‘7318 7319. Mammography quality standards.’’.

8 (b) TRANSITION.—(1) Subsection (a) of section 7318

9 7319 of title 38, United States Code, as added by sub10 section (a), shall take effect on the date on which stand11 ards are prescribed by the Secretary of Veterans Affairs

12 under subsection (b) of such section.

13 (2) During the transition period, the Secretary may

14 waive the requirement of subsection (a) of section 7318

15 7319 of title 38, United States Code, as added by sub16 section (a), to any facility of the Department. The Sec17 retary may provide such a waiver in the case of any facility

18 only if the Secretary determines, based upon the rec19 ommendation of the Under Secretary for Health, that dur20 ing the period such a waiver is in effect for such facility

21 (including any extension of the waiver under paragraph

22 (3)) the facility will be operated in accordance with stand23 ards prescribed by the Secretary under subsection (b) of

24 such section to assure the safety and accuracy of mam25 mography services provided.
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1 (3) The transition period for purposes of this section

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

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

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

6 Under Secretary for Health determines that—

7 (A) without the extension access of veterans to

8 mammography services in the geographic area

9 served by the facility would be significantly reduced;

10 and

11 (B) appropriate steps will be taken before the

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

13 accreditation of the facility as required by subsection

14 (a) of section 7318 7319 of title 38, United States

15 Code, as added by subsection (a).

16 (c) IMPLEMENTATION REPORT.—The Secretary of

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

19 a report on the Secretary’s implementation of section

20 7318 7319 of title 38, United States Code, as added by

21 subsection (a). The report shall be submitted not later

22 than 120 days after the date on which the Secretary pre23 scribes the quality standards required under subsection

24 (b) of that section.
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1 SEC. 105. RESEARCH RELATING TO WOMEN VETERANS.

2 (a) INCLUSION OF WOMEN AND MINORITIES IN

3 CLINICAL RESEARCH PROJECTS.—(1) In conducting or

4 supporting clinical research, the Secretary of Veterans Af5 fairs shall ensure that, whenever possible and appro6 priate—

7 (A) women who are veterans are included as

8 subjects in each project of such research; and

9 (B) members of minority groups who are veter10 ans are included as subjects of such research.

11 (2) In the case of a project of clinical research in

12 which women or members of minority groups will under

13 paragraph (1) be included as subjects of the research, the

14 Secretary of Veterans Affairs shall ensure that the project

15 is designed and carried out so as to provide for a valid

16 analysis of whether the variables being tested in the re17 search affect women or members of minority groups, as

18 the case may be, differently than other persons who are

19 subjects of the research.

20 (b) POPULATION STUDY.—Section 110(a) of the Vet21 erans Health Care Act of 1992 (Public Law 102–585; 106

22 Stat. 4948) is amended by adding at the end of paragraph

23 (3) the following: ‘‘If it is feasible to do so within the

24 amounts available for the conduct of the study, the Sec25 retary shall ensure that the sample referred to in sub26 section (a) constitutes a representative sampling (as deter-
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1 mined by the Secretary) of the ages, the ethnic, social and

2 economic backgrounds, the enlisted and officer grades,

3 and the branches of service of all veterans who are

4 women.’’.

5 SEC. 106. SEXUAL TRAUMA COUNSELING.

6 (a) EXTENSION OF PERIOD OF AUTHORITY TO PRO7 VIDE SEXUAL TRAUMA COUNSELING.—Subsection (a) of

8 section 1720D of title 38, United States Code, is amend9 ed—

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

11 paragraph (1) and inserting in lieu thereof ‘‘Decem12 ber 31, 1998,’’; and

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

14 paragraph (3) and inserting in lieu thereof ‘‘Decem15 ber 31, 1998,’’.

16 (b) PERIOD OF ELIGIBILITY TO SEEK COUNSEL17 ING.—(1) Such subsection is further amended—

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

19 (B) by redesignating paragraph (3) (as amend20 ed by subsection (a)(2)) as paragraph (2).

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

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

23 1720D note) is repealed.
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1 (c) REPEAL OF LIMITATION ON PERIOD OF RECEIPT

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

3 States Code, is further amended—

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

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

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

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

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

9 (1) in paragraph (1)—

10 (A) by inserting ‘‘(A)’’ after ‘‘To a vet11 eran’’; and

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

13 for counseling under section 1720D of this title,

14 for the purposes of such counseling’’ before the

15 period at the end; and

16 (2) in paragraph (2)—

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

18 in lieu thereof ‘‘or (B)’’; and

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

20 follows through ‘‘such counseling’’.

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

22 38, United States Code, is further amended—

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

24 (a)(1);
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1 (B) by striking out ‘‘women’’ in subsection

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

3 as redesignated by subsection (c); and

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

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

6 thereof ‘‘individuals’’.

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

8 read as follows:

9 ‘‘§ 1720D. Counseling for sexual trauma’’.

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

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

12 amended to read as follows:

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

13 (f) INFORMATION BY TELEPHONE.—(1) Paragraph

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

15 as redesignated by subsection (c) of this section, is amend16 ed to read as follows:

17 ‘‘(1) shall include availability of a toll-free tele18 phone number (commonly referred to as an 800

19 number), and’’.

20 (2) In providing information on counseling available

21 to veterans as required under section 1720D(c)(1) of title

22 38, United States Code (as amended by this section), the

23 Secretary of Veterans Affairs shall ensure that the De24 partment of Veterans Affairs personnel who provide as25 sistance under such section are trained in the provision
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1 to persons who have experienced sexual trauma of infor2 mation about the care and services relating to sexual trau3 ma that are available to veterans in the communities in

4 which such veterans reside, including care and services

5 available under programs of the Department (including

6 the care and services available under section 1720D of

7 such title) and from non-Department agencies or organi8 zations.

9 (3) Not later than 18 months after the date of the

10 enactment of this Act, the Secretary shall submit to Con11 gress a report on the operation of the telephone assistance

12 service required under section 1720D(c)(1) of title 38,

13 United States Code (as so amended). The report shall set

14 forth the following:

15 (A) The number of persons who sought infor16 mation during the period covered by the report

17 through a toll free telephone number regarding serv18 ices available to veterans relating to sexual trauma,

19 with a separate display of the number of such per20 sons arrayed by State (as such term is defined in

21 section 101(20) of title 38, United States Code).

22 (B) A description of the training provided to

23 the personnel who provide such assistance.

24 (C) The recommendations and plans of the Sec25 retary for the improvement of the service.
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1 SEC. 107. COORDINATORS OF WOMEN’S SERVICES.

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

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

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

6 and

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

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

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

11 (b) EMPOWERMENT.—The Secretary of Veterans Af12 fairs shall take appropriate actions to ensure that the co13 ordinator of women’s services at each facility of the Veter14 ans Health Administration—

15 (1) is able to carry out the responsibilities of a

16 coordinator in ensuring that women veterans receive

17 quality medical care and, to the extent practicable,

18 have equal access to Veterans Administration facili19 ties; and

20 (2) has direct access to the Director or Chief of

21 Staff of the facility to which the coordinator is as22 signed.

23 SEC. 108. PATIENT PRIVACY.

24 (a) IDENTIFICATION OF DEFICIENCIES.—The Sec25 retary of Veterans Affairs shall conduct a survey of each

26 medical center under the jurisdiction of the Secretary to
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1 identify deficiencies relating to patient privacy afforded to

2 women patients in the clinical areas at each such center

3 which may interfere with appropriate treatment of such

4 patients.

5 (b) CORRECTION OF DEFICIENCIES.—The Secretary

6 shall ensure that plans and, where appropriate, interim

7 steps, to correct the deficiencies identified in the survey

8 conducted under subsection (a) are developed and are in9 corporated into the Department’s construction planning

10 processes and given a high priority.

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

12 compile an annual inventory, by medical center, of defi13 ciencies identified under subsection (a) and of plans and,

14 where appropriate, interim steps, to correct such defi15 ciencies. The Secretary shall submit to the Committees on

16 Veterans’ Affairs of the Senate and the House of Rep17 resentatives, not later than October 1, 1994, and not later

18 than October 1 each year thereafter through 1996 a report

19 on such deficiencies. The Secretary shall include in such

20 report the inventory compiled by the Secretary, the pro21 posed corrective plans, and the status of such plans.
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1 TITLE II—CARE FOR VETERANS

2 EXPOSED TO TOXIC SUB3 STANCES

4 SEC. 201. AUTHORITY TO PROVIDE HEALTH CARE.

5 (a) AUTHORIZED INPATIENT CARE.—Section

6 1710(e) of title 38, United States Code, is amended to

7 read as follows:

8 ‘‘(e)(1)(A) Subject to paragraph (2), a herbicide-ex9 posed veteran is eligible for hospital care and nursing

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

11 specified in subparagraph (B).

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

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

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

15 Orange Act of 1991, has determined—

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

17 that there is a positive association between occur18 rence of the disease in humans and exposure to a

19 herbicide agent;

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

21 of an association between occurrence of the disease

22 in humans and exposure to a herbicide agent, but

23 such evidence is limited in nature; or

24 ‘‘(iii) that available studies are insufficient to

25 permit a conclusion about the presence or absence of
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1 an association between occurrence of the disease in

2 humans and exposure to a herbicide agent.

3 ‘‘(C) A radiation-exposed veteran is eligible for hos4 pital care and nursing home care under subsection

5 (a)(1)(G) for—

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

7 this title; and

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

9 based on the advice of the Advisory Committee on

10 Environmental Hazards, determines that there is

11 credible evidence of a positive association between

12 occurrence of the disease in humans and exposure to

13 ionizing radiation.

14 ‘‘(2) Hospital and nursing home care may not be pro15 vided under or by virtue of paragraph (1)(A) after Sep16 tember 30, 1996.

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

18 1712 of this title—

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

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

21 Republic of Vietnam during the Vietnam era, and

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

23 during such service to a herbicide agent;
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1 ‘‘(B) the term ‘herbicide agent’ has the mean2 ing given that term in section 1116(a)(4) of this

3 title; and

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

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

6 this title.’’.

7 (b) AUTHORIZED OUTPATIENT CARE.—Section 1712

8 of such title is amended—

9 (1) in subsection (a)(1)—

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

11 subparagraph (B);

12 (B) by striking out the period at the end

13 of subparagraph (C) and inserting in lieu there14 of a semicolon; and

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

16 ‘‘(D) during the period before October 1,

17 1996, to any herbicide-exposed veteran for any

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

19 title; and

20 ‘‘(E) to any radiation-exposed veteran for

21 any disease covered under section

22 1710(e)(1)(C) of this title.’’; and

23 (2) in subsection (i)(3)—

24 (A) by striking out ‘‘(A)’’; and
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1 (B) by striking out ‘‘, or (B)’’ and all that

2 follows through ‘‘title’’.

3 SEC. 202. SAVINGS PROVISION.

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

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

6 the date of the enactment of this Act, shall apply with

7 respect to hospital care, nursing home care, and medical

8 services in the case of any veteran furnished care or serv9 ices before such date of enactment on the basis of pre10 sumed exposure to a substance or radiation under the au11 thority of those provisions.

12 TITLE III—READJUSTMENT

13 SERVICES

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

15 (a) EXPANSION OF SERVICES.—Section 1712A of

16 title 38, United States Code, is amended—

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

18 the extent otherwise authorized by law, may furnish

19 such additional needed services as described in sub20 section (i)’’ in the first sentence after ‘‘life’’; and

21 (2) by adding at the end the following new sub22 sections:

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

24 (j); and
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1 (3) by inserting after subsection (g) the following

2 new subsections:

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

4 facilities are available, furnish to any veteran who served

5 in combat during World War II or the Korean conflict

6 counseling in a center to assist such veteran in overcoming

7 the effects of the veteran’s combat experience.

8 ‘‘(i) In operating centers under this section, the Sec9 retary may provide (1) preventive health care services, (2)

10 medical services reasonably necessary in preparation for

11 hospital admission, and (3) referral services to assist in

12 obtaining specialized care. The Secretary shall provide

13 such services through such health care personnel as the

14 Secretary determines appropriate.’’.

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

16 of the enactment of this Act, the Secretary shall submit

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

18 House of Representatives a report relating to the imple19 mentation of the amendments made by subsection (a). The

20 report shall include the following:

21 (1) The number of veterans provided services

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

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

24 (2) The number of centers which provided serv25 ices described in that section.
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1 (3) An assessment of the effect providing such

2 services has had on access to and timeliness of serv3 ice delivery.

4 SEC. 302. ADVISORY COMMITTEE ON THE READJUSTMENT

5 OF VETERANS.

6 (a) IN GENERAL.—(1) Subchapter II of chapter 17

7 of title 38, United States Code, is amended by inserting

8 after section 1712B the following new section:

9 ‘‘§ 1712C. Advisory Committee on Veterans Readjust10 ment Counseling

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

12 Committee on Veterans Readjustment Counseling (herein13 after in this section referred to as the ‘Committee’).

14 ‘‘(2) The Committee shall consist of 18 members.

15 The members of the Committee shall be appointed by the

16 Secretary and shall include individuals who are recognized

17 authorities in fields pertinent to the social, psychological,

18 economic, or educational readjustment of veterans. An of19 ficer or employee of the United States may not be ap20 pointed as a member of the Committee. At least 12 of

21 the Committee shall be veterans of the Vietnam era or

22 other period of war. Appointments of members of the

23 Committee shall be made from among individuals who

24 have experience with the provision of veterans benefits and
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1 services by the Department or who are otherwise familiar

2 with programs of the Department.

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

4 appointed to the Committee include persons from a wide

5 variety of geographic areas and ethnic backgrounds, per6 sons from veterans service organizations, minorities, and

7 women.

8 ‘‘(4) The Secretary shall determine the terms of serv9 ice and pay and allowances of the members of the Commit10 tee, except that a term of service may not exceed two

11 years. The Secretary may reappoint any member for addi12 tional terms of service.

13 ‘‘(b)(1) The Secretary shall, on a regular basis, con14 sult with and seek the advice of the Committee with re15 spect to the provision by the Department of benefits and

16 services to veterans in order to assist veterans in the re17 adjustment to civilian life.

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

19 subsection, the Committee shall—

20 ‘‘(A) assemble and review information relating

21 to the needs of veterans in readjusting to civilian

22 life;

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

24 and character of psychological problems arising from

25 military service;
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1 ‘‘(C) provide an on-going assessment of the ef2 fectiveness of the policies, organizational structures,

3 and services of the Department in assisting veterans

4 in readjusting to civilian life; and

5 ‘‘(D) provide on-going advice on the most ap6 propriate means of responding to the readjustment

7 needs of future veterans.

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

9 the Committee shall take into special account veterans of

10 the Vietnam era and the readjustment needs of those vet11 erans.

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

13 Committee shall submit to the Secretary a report on the

14 programs and activities of the Department that relate to

15 the readjustment of veterans to civilian life. Each such

16 report shall include—

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

18 with respect to readjustment to civilian life;

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

20 the Department designed to meet such needs; and

21 ‘‘(C) such recommendations (including rec22 ommendations for administrative and legislative ac23 tion) as the Committee considers appropriate.

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

25 report under paragraph (1), the Secretary shall transmit
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1 to the Committees on Veterans’ Affairs of the Senate and

2 House of Representatives a copy of the report, together

3 with any comments and recommendations concerning the

4 report that the Secretary considers appropriate.

5 ‘‘(3) The Committee may also submit to the Sec6 retary such other reports and recommendations as the

7 Committee considers appropriate.

8 ‘‘(4) The Secretary shall submit with each annual re9 port submitted to the Congress pursuant to section 529

10 of this title a summary of all reports and recommendations

11 of the Committee submitted to the Secretary since the pre12 vious annual report of the Secretary submitted pursuant

13 to that section.’’.

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

15 17 of such title is amended by inserting after the item

16 relating to section 1712B the following:

‘‘1712C. Advisory Committee on Veterans Readjustment Counseling.’’.

17 (b) ORIGINAL MEMBERS.—(1) Notwithstanding sub18 section (a)(2) of section 1712C of title 38, United States

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

20 Advisory Committee on the Readjustment of Vietnam and

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

22 Act shall be the original members of the advisory commit23 tee established under that section.

24 (2) The original members shall so serve until the Sec25 retary of Veterans Affairs carries out appointments under
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1 such subsection (a)(2). The Secretary shall carry out such

2 appointments as soon as is practicable. The Secretary may

3 make such appointments from among such original mem4 bers.

5 SEC. 303. PLAN FOR EXPANSION OF VIETNAM VETERAN RE6 SOURCE CENTERS PILOT PROGRAM.

7 (a) PLAN.—The Secretary of Veterans Affairs shall

8 submit to the Committees on Veterans’ Affairs of the Sen9 ate and House of Representatives a plan for expansion of

10 the Vietnam Veteran Resource Centers program estab11 lished by section 1712A(h) of title 38, United States Code.

12 The plan submitted shall be a plan which the Secretary

13 would implement if resources for such implementation

14 were available.

15 (b) SUBMISSION OF PLAN.—The plan, together with

16 an analysis setting forth in detail the resources required

17 for the implementation of the plan, shall be submitted

18 under subsection (a) not later than four months after the

19 date of the enactment of this Act.
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1 TITLE IV—SERVICES FOR

2 MENTALLY ILL VETERANS

3 SEC. 401. AUTHORITY TO ESTABLISH NONPROFIT COR4 PORATIONS.

5 (a) IN GENERAL.—Chapter 17 of title 38, United

6 States Code, is amended by inserting after section 1718

7 the following new section:

8 ‘‘§ 1718A. Nonprofit corporations

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

10 at any Veterans Health Administration facility of a non11 profit corporation (1) to arrange for therapeutic work for

12 patients of such facility or patients of other such Depart13 ment facilities pursuant to section 1718(b) of this title,

14 and (2) to provide a flexible funding mechanism to achieve

15 the purposes of section 1718 of this title.

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

17 of a board of directors for any corporation established

18 under this section and shall determine the number of di19 rectors and the composition of the board of directors. The

20 board of directors shall include—

21 ‘‘(1) the director of the facility and other offi22 cials or employees of the facility; and

23 ‘‘(2) members appointed from among individ24 uals who are not officers or employees of the De25 partment of Veterans Affairs.
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1 ‘‘(c) Each such corporation shall have an executive

2 director who shall be appointed by the board of directors

3 with concurrence of the Under Secretary for Health of the

4 Department. The executive director of a corporation shall

5 be responsible for the operations of the corporation and

6 shall have such specific duties and responsibilities as the

7 board may prescribe.

8 ‘‘(d) A corporation established under this section

9 may—

10 ‘‘(1) arrange with the Department of Veterans

11 Affairs under section 1718(b)(2) of this title to pro12 vide for therapeutic work for patients;

13 ‘‘(2) accept gifts and grants from, and enter

14 into contracts with, individuals and public and pri15 vate entities solely to carry out the purposes of this

16 section; and

17 ‘‘(3) employ such employees as it considers nec18 essary for such purposes and fix the compensation

19 of such employees.

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

21 funds received by a corporation established under this sec22 tion through arrangements authorized under subsection

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

24 out obligations of the corporation authorized under sub25 section (d)(3) shall be deposited in or credited to the Spe-
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1 cial Therapeutic and Rehabilitation Activities Fund estab2 lished under section 1718(c) of this title.

3 ‘‘(2) The Secretary, in accordance with guidelines

4 which the Secretary shall prescribe, may authorize a cor5 poration established under this section to retain funds de6 rived from arrangements authorized under subsection

7 (d)(1).

8 ‘‘(3) Any funds received by a corporation established

9 under this section through arrangements authorized under

10 subsection (d)(2) may be transferred to the Special Thera11 peutics and Rehabilitation Activities Fund.

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

13 be established in accordance with the nonprofit corpora14 tion laws of the State in which the applicable medical facil15 ity is located and shall, to the extent not inconsistent with

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

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

18 under this section shall be available to the Secretary.

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

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

21 operations of such a corporation shall be considered to be

22 programs and operations of the Department with respect

23 to which the Inspector General of the Department has re24 sponsibilities under such Act.
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1 ‘‘(2) Such a corporation shall be considered an agen2 cy for the purposes of section 716 of title 31 (relating to

3 availability of information and inspection of records by the

4 Comptroller General).

5 ‘‘(3) Each such corporation shall submit to the Sec6 retary an annual report providing a detailed statement of

7 its operations, activities, and accomplishments during that

8 year. The corporation shall obtain a report of independent

9 auditors concerning the receipts and expenditures of funds

10 by the corporation during that year and shall include that

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

12 year.

13 ‘‘(4) Each member of the board of directors of a cor14 poration established under this section, each employee of

15 such corporation, and each employee of the Department

16 who is involved in the functions of the corporation during

17 any year shall—

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

19 applicable to Federal employees with respect to con20 flicts of interest in the performance of official func21 tions; and

22 ‘‘(B) submit to the Secretary an annual state23 ment signed by the director or employee certifying

24 that the director or employee is aware of, and has
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1 complied with, such laws and regulations in the

2 same manner as Federal employees are required to.

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

4 on Veterans’ Affairs of the Senate and House of Rep5 resentatives an annual report on the number and location

6 of corporations established and the amount of the con7 tributions made to each such corporation.

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

9 section after September 30, 1999.

10 ‘‘(j) If by the end of the four-year period beginning

11 on the date of the establishment of a corporation under

12 this section the corporation is not recognized as an entity

13 the income of which is exempt from taxation under the

14 Internal Revenue Code of 1986, the Secretary shall dis15 solve the corporation.’’.

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

17 at the beginning of such chapter is amended by inserting

18 after the item relating to section 1718 the following new

19 item:

‘‘1718A. Nonprofit corporations.’’.

20 SEC. 402. EXTENSION OF DEMONSTRATION PROGRAM.

21 Section 7 of Public Law 102–54 (105 Stat. 269; 38

22 U.S.C. 618 1718 note) is amended—

23 (1) in subsection (a), by striking out ‘‘1994’’

24 and inserting in lieu thereof ‘‘1998’’;

25 (2) in subsection (c)—
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1 (A) by striking out ‘‘no more than 50’’;

2 and

3 (B) by striking out ‘‘of under this sub4 section.’’ and inserting in lieu thereof ‘‘of under

5 this subsection—

6 ‘‘(1) at no more than 58 sites during fiscal year

7 1994;

8 ‘‘(2) at no more than 70 sites during fiscal year

9 1995;

10 ‘‘(3) at no more than 82 sites during fiscal year

11 1996;

12 ‘‘(4) at no more than 94 sites during fiscal year

13 1997; and

14 ‘‘(5) at no more than 106 sites during fiscal

15 year 1998.’’.

16 SEC. 403. SPECIAL COMMITTEE.

17 (a) ESTABLISHMENT.—The Secretary of Veterans

18 Administration, acting through the Under Secretary for

19 Health of the Department of Veterans Affairs, shall estab20 lish in the Veterans Health Administration a Special Com21 mittee on Care of Severely Chronically Mentally Ill Veter22 ans (hereinafter in this section referred to as the ‘‘Special

23 Committee’’). The Under Secretary shall appoint employ24 ees of the Department with expertise in the care of the

25 chronically mentally ill to serve on the Special Committee.
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1 (b) FUNCTIONS.—The Special Committee may as2 sess, and carry out a continuing assessment of, the capa3 bility of the Veterans Health Administration to meet effec4 tively the treatment and rehabilitation needs of severely,

5 chronically mentally ill veterans. In carrying out that re6 sponsibility, the Special Committee shall—

7 (1) monitor the care provided to such veterans

8 through the Veterans Health Administration;

9 (2) identify systemwide problems in caring for

10 such veterans in facilities of the Veterans Health

11 Administration;

12 (3) identify specific facilities within the Veter13 ans Health Administration at which program sup14 port is needed to improve treatment and rehabilita15 tion of such veterans; and

16 (4) identify model programs which have had

17 demonstrated success in the treatment and rehabili18 tation of such veterans and which should be imple19 mented more widely in or through facilities of the

20 Veterans Health Administration.

21 (c) ADVICE AND RECOMMENDATIONS.—The Special

22 Committee shall—

23 (1) advise the Under Secretary regarding the

24 development of policies for the care and rehabilita25 tion of the severely, chronically mentally ill; and
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1 (2) make recommendations to the Under Sec2 retary—

3 (A) for improving programs of care of such

4 veterans at specific facilities and throughout the

5 Veterans Health Administration;

6 (B) for establishing special programs of

7 education and training relevant to the care of

8 such veterans for employees of the Veterans

9 Health Administration;

10 (C) regarding research needs and priorities

11 relevant to the care of such veterans; and

12 (D) regarding the appropriate allocation of

13 resources for all such activities.

14 (d) ANNUAL REPORTS.—(1) Not later than April 1,

15 1994, the Secretary of Veterans Affairs shall submit to

16 the Committees on Veterans’ Affairs of the Senate and

17 House of Representatives a report on the implementation

18 of this section. The report shall include the following:

19 (A) A list of the members of the Special Com20 mittee.

21 (B) The assessment of the Under Secretary for

22 Health, after review of the findings of the Special

23 Committee, regarding the capability of the Veterans

24 Health Administration, on a systemwide and facility25 by-facility basis, to meet effectively the treatment
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1 and rehabilitation needs of severely, chronically men2 tally ill veterans.

3 (C) The plans of the Special Committee for fur4 ther assessments.

5 (D) The findings and recommendations made

6 by the Special Committee to the Under Secretary for

7 Health and the views of the Under Secretary on

8 such findings and recommendations.

9 (E) A description of the steps taken, plans

10 made (and a timetable for their execution), and re11 sources to be applied toward improving the capabil12 ity of the Veterans Health Administration to meet

13 effectively the treatment and rehabilitation needs of

14 severely, chronically mentally ill veterans.

15 (2) Not later than February 1, 1995, and February

16 1 of each of the three following years, the Secretary shall

17 submit to the Committees on Veterans’ Affairs of the Sen18 ate and House of Representatives a report containing in19 formation updating the reports submitted under this sub20 section before the submission of such report.

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