Calendar No. 297

103D CONGRESS

1ST SESSION H. R. 3313

AN ACT

To amend title 38, United States Code, to improve

N

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 VeterOVEMBER 18 (legislative day, NOVEMBER 2), 1993

Placed on the calendar
II

Calendar No. 297

103D CONGRESS

1ST SESSION H. R. 3313

IN THE SENATE OF THE UNITED STATES

NOVEMBER 18 (legislative day, NOVEMBER 2), 1993

Received; read twice and placed on the calendar

AN ACT

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.

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’’.
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1 TITLE I—WOMEN VETERANS

2 HEALTH IMPROVEMENTS

3 SEC. 101. SHORT TITLE.

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

5 Health Improvements Act of 1993’’.

6 SEC. 102. HEALTH CARE SERVICES FOR WOMEN.

7 (a) ENSURED PROVISION OF SERVICES.—The Sec8 retary of Veterans Affairs shall ensure that each health9 care facility under the direct jurisdiction of the Secretary

10 is able, through services made available either by individ11 uals appointed to positions in the Veterans Health Admin12 istration or under contracts or other agreements made

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

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

15 in a timely and appropriate manner women’s health serv16 ices (as defined in section 1701(10) of title 38, United

17 States Code (as added by section 3)) to any veteran de18 scribed in section 1710(a)(1) of title 38, United States

19 Code, who is eligible for such services.

20 (b) ROUTINE HEALTH CARE SERVICES.—The Sec21 retary shall ensure that each health-care facility under the

22 direct jurisdiction of the Secretary that serves a catchment

23 area in which the number of women veterans described

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

25 makes it cost effective to do so shall provide routine wom-
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1 en’s health services directly (rather than by contract or

2 other agreement). The Secretary shall ensure that each

3 such facility is provided appropriate equipment, facilities,

4 and staff to carry out the preceding sentence and to en5 sure that the quality of care provided under the preceding

6 sentence is in accordance with professional standards.

7 (c) CONFORMING REPEAL.—Section 302 of the Vet8 erans’ Health Care Amendments of 1983 (Public Law 98–

9 160; 97 Stat. 1004; 38 U.S.C. 1701 note) is repealed.

10 SEC. 103. WOMEN’S HEALTH SERVICES.

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

12 title 38, United States Code, is amended—

13 (1) in paragraph (6)(A)(i), by inserting ‘‘wom14 en’s health services,’’ after ‘‘preventive health serv15 ices,’’; and

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

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

18 following health care services provided to women:

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

20 ‘‘(B) Breast examinations and mammography.

21 ‘‘(C) General reproductive health care (includ22 ing the management of menopause), but not includ23 ing infertility services (other than infertility counsel24 ing), abortions, or pregnancy care (including

25 prenatal and delivery care), except for such care re-
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1 lating to a pregnancy that is complicated or in which

2 the risks of complication are increased by a service3 connected condition.

4 ‘‘(D) The management and prevention of sexu5 ally-transmitted diseases.

6 ‘‘(E) The management and treatment of

7 osteoporosis.

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

9 psychological conditions arising out of acts of sexual

10 violence.

11 ‘‘(G) Early detection, management, and treat12 ment for cardiac disease, in the case of women who

13 are determined to be at risk of cardiac disease.’’.

14 (b) REPEAL OF SUPERSEDED AUTHORITY.—Section

15 106 of the Veterans Health Care Act of 1992 (Public Law

16 102–585; 38 U.S.C. 1710 note) is amended—

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

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

19 DIRECTORS OF FACILITIES.—’’ before ‘‘The Sec20 retary’’.

21 (c) EXTENSION OF ANNUAL REPORT REQUIRE22 MENT.—Section 107(a) of such Act is amended by strik23 ing out ‘‘Not later than January 1, 1993, January 1,

24 1994, and January 1, 1995’’ and inserting in lieu thereof
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1 ‘‘Not later than January 1 of 1993 and each year there2 after through 1998’’.

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

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

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

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

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

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

9 United States Code)’’;

10 (2) in paragraph (2)(A), by inserting ‘‘(includ11 ing information on the number of inpatient stays

12 and the number of outpatient visits through which

13 such services were provided)’’ after ‘‘facility’’; and

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

15 paragraph:

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

17 Secretary to foster and encourage the expansion of

18 such research.’’.

19 SEC. 104. MAMMOGRAPHY QUALITY STANDARDS.

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

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

22 the end the following new section:

23 ‘‘§ 7319. Mammography quality standards

24 ‘‘(a) A mammogram may not be performed at a De25 partment facility unless that facility is accredited for that
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1 purpose by a private nonprofit organization designated by

2 the Secretary. An organization designated by the Sec3 retary under this subsection shall meet the standards for

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

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

6 ‘‘(b) The Secretary, in consultation with the Sec7 retary of Health and Human Services, shall prescribe

8 quality assurance and quality control standards relating

9 to the performance and interpretation of mammograms

10 and use of mammogram equipment and facilities of the

11 Department of Veterans Affairs consistent with the re12 quirements of section 354(f)(1) of the Public Health Serv13 ice Act. Such standards shall be no less stringent than

14 the standards prescribed by the Secretary of Health and

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

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

17 period beginning on the date on which the Secretary of

18 Health and Human Services prescribes quality standards

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

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

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

22 standards prescribed under subsection (b), shall provide

23 for an annual inspection of the equipment and facilities

24 used by and in Department health care facilities for the

25 performance of mammograms. Such inspections shall be
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1 carried out in a manner consistent with the inspection of

2 certified facilities by the Secretary of Health and Human

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

4 Act.

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

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

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

8 performed for the Department under contract with any

9 non-Department facility or provider conform to the quality

10 standards prescribed by the Secretary of Health and

11 Human Services under section 354 of the Public Health

12 Service Act.

13 ‘‘(e) For the purposes of this section, the term ‘mam14 mogram’ has the meaning given such term in section

15 354(a)(5) of the Public Health Service Act (42 U.S.C.

16 263b(a)).’’.

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

18 chapter is amended by inserting after the item relating

19 to section 7318 the following new item:

‘‘7319. Mammography quality standards.’’.

20 (b) TRANSITION.—(1) Subsection (a) of section 7319

21 of title 38, United States Code, as added by subsection

22 (a), shall take effect on the date on which standards are

23 prescribed by the Secretary of Veterans Affairs under sub24 section (b) of such section.
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1 (2) During the transition period, the Secretary may

2 waive the requirement of subsection (a) of section 7319

3 of title 38, United States Code, as added by subsection

4 (a), to any facility of the Department. The Secretary may

5 provide such a waiver in the case of any facility only if

6 the Secretary determines, based upon the recommendation

7 of the Under Secretary for Health, that during the period

8 such a waiver is in effect for such facility (including any

9 extension of the waiver under paragraph (3)) the facility

10 will be operated in accordance with standards prescribed

11 by the Secretary under subsection (b) of such section to

12 assure the safety and accuracy of mammography services

13 provided.

14 (3) The transition period for purposes of this section

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

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

17 a period not to exceed 90 days in the case of any Depart18 ment facility. Any such extension may be made only if the

19 Under Secretary for Health determines that—

20 (A) without the extension access of veterans to

21 mammography services in the geographic area

22 served by the facility would be significantly reduced;

23 and

24 (B) appropriate steps will be taken before the

25 end of the transition period (as extended) to obtain
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1 accreditation of the facility as required by subsection

2 (a) of section 7319 of title 38, United States Code,

3 as added by subsection (a).

4 (c) IMPLEMENTATION REPORT.—The Secretary of

5 Veterans Affairs shall submit to the Committees on Veter6 ans’ Affairs of the Senate and House of Representatives

7 a report on the Secretary’s implementation of section

8 7319 of title 38, United States Code, as added by sub9 section (a). The report shall be submitted not later than

10 120 days after the date on which the Secretary prescribes

11 the quality standards required under subsection (b) of that

12 section.

13 SEC. 105. RESEARCH RELATING TO WOMEN VETERANS.

14 (a) INCLUSION OF WOMEN AND MINORITIES IN

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

16 supporting clinical research, the Secretary of Veterans Af17 fairs shall ensure that, whenever possible and appro18 priate—

19 (A) women who are veterans are included as

20 subjects in each project of such research; and

21 (B) members of minority groups who are veter22 ans are included as subjects of such research.

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

24 which women or members of minority groups will under

25 paragraph (1) be included as subjects of the research, the
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1 Secretary of Veterans Affairs shall ensure that the project

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

3 analysis of whether the variables being tested in the re4 search affect women or members of minority groups, as

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

6 subjects of the research.

7 (b) POPULATION STUDY.—Section 110(a) of the Vet8 erans Health Care Act of 1992 (Public Law 102–585; 106

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

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

11 amounts available for the conduct of the study, the Sec12 retary shall ensure that the sample referred to in sub13 section (a) constitutes a representative sampling (as deter14 mined by the Secretary) of the ages, the ethnic, social and

15 economic backgrounds, the enlisted and officer grades,

16 and the branches of service of all veterans who are

17 women.’’.

18 SEC. 106. SEXUAL TRAUMA COUNSELING.

19 (a) EXTENSION OF PERIOD OF AUTHORITY TO PRO20 VIDE SEXUAL TRAUMA COUNSELING.—Subsection (a) of

21 section 1720D of title 38, United States Code, is amend22 ed—

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

24 paragraph (1) and inserting in lieu thereof ‘‘Decem25 ber 31, 1998,’’; and
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1 (2) by striking out ‘‘December 31, 1994,’’ in

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

4 (b) PERIOD OF ELIGIBILITY TO SEEK COUNSEL5 ING.—(1) Such subsection is further amended—

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

7 (B) by redesignating paragraph (3) (as amend8 ed by subsection (a)(2)) as paragraph (2).

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

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

11 1720D note) is repealed.

12 (c) REPEAL OF LIMITATION ON PERIOD OF RECEIPT

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

14 States Code, is further amended—

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

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

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

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

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

20 (1) in paragraph (1)—

21 (A) by inserting ‘‘(A)’’ after ‘‘To a vet22 eran’’; and

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

24 for counseling under section 1720D of this title,
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1 for the purposes of such counseling’’ before the

2 period at the end; and

3 (2) in paragraph (2)—

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

5 in lieu thereof ‘‘or (B)’’; and

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

7 follows through ‘‘such counseling’’.

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

9 38, United States Code, is further amended—

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

11 (a)(1);

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

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

14 as redesignated by subsection (c); and

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

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

17 thereof ‘‘individuals’’.

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

19 read as follows:

20 ‘‘§ 1720D. Counseling for sexual trauma’’.

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

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

23 amended to read as follows:

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

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

25 (1) of section 1720D(c) of title 38, United States Code,
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1 as redesignated by subsection (c) of this section, is amend2 ed to read as follows:

3 ‘‘(1) shall include availability of a toll-free tele4 phone number (commonly referred to as an 800

5 number), and’’.

6 (2) In providing information on counseling available

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

8 38, United States Code (as amended by this section), the

9 Secretary of Veterans Affairs shall ensure that the De10 partment of Veterans Affairs personnel who provide as11 sistance under such section are trained in the provision

12 to persons who have experienced sexual trauma of infor13 mation about the care and services relating to sexual trau14 ma that are available to veterans in the communities in

15 which such veterans reside, including care and services

16 available under programs of the Department (including

17 the care and services available under section 1720D of

18 such title) and from non-Department agencies or organi19 zations.

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

21 enactment of this Act, the Secretary shall submit to Con22 gress a report on the operation of the telephone assistance

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

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

25 forth the following:
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1 (A) The number of persons who sought infor2 mation during the period covered by the report

3 through a toll free telephone number regarding serv4 ices available to veterans relating to sexual trauma,

5 with a separate display of the number of such per6 sons arrayed by State (as such term is defined in

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

8 (B) A description of the training provided to

9 the personnel who provide such assistance.

10 (C) The recommendations and plans of the Sec11 retary for the improvement of the service.

12 SEC. 107. COORDINATORS OF WOMEN’S SERVICES.

13 (a) FULL-TIME STATUS.—Section 108 of the Veter14 ans Health Care Act of 1992 (Public Law 102–585; 106

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

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

17 and

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

19 ‘‘(b) Each official who serves in the position of coordi20 nator of women’s services under subsection (a) shall serve

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

22 (b) EMPOWERMENT.—The Secretary of Veterans Af23 fairs shall take appropriate actions to ensure that the co24 ordinator of women’s services at each facility of the Veter25 ans Health Administration—
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1 (1) is able to carry out the responsibilities of a

2 coordinator in ensuring that women veterans receive

3 quality medical care and, to the extent practicable,

4 have equal access to Veterans Administration facili5 ties; and

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

7 Staff of the facility to which the coordinator is as8 signed.

9 SEC. 108. PATIENT PRIVACY.

10 (a) IDENTIFICATION OF DEFICIENCIES.—The Sec11 retary of Veterans Affairs shall conduct a survey of each

12 medical center under the jurisdiction of the Secretary to

13 identify deficiencies relating to patient privacy afforded to

14 women patients in the clinical areas at each such center

15 which may interfere with appropriate treatment of such

16 patients.

17 (b) CORRECTION OF DEFICIENCIES.—The Secretary

18 shall ensure that plans and, where appropriate, interim

19 steps, to correct the deficiencies identified in the survey

20 conducted under subsection (a) are developed and are in21 corporated into the Department’s construction planning

22 processes and given a high priority.

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

24 compile an annual inventory, by medical center, of defi25 ciencies identified under subsection (a) and of plans and,
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1 where appropriate, interim steps, to correct such defi2 ciencies. The Secretary shall submit to the Committees on

3 Veterans’ Affairs of the Senate and the House of Rep4 resentatives, not later than October 1, 1994, and not later

5 than October 1 each year thereafter through 1996 a report

6 on such deficiencies. The Secretary shall include in such

7 report the inventory compiled by the Secretary, the pro8 posed corrective plans, and the status of such plans.

9 TITLE II—CARE FOR VETERANS

10 EXPOSED TO TOXIC SUB11 STANCES

12 SEC. 201. AUTHORITY TO PROVIDE HEALTH CARE.

13 (a) AUTHORIZED INPATIENT CARE.—Section

14 1710(e) of title 38, United States Code, is amended to

15 read as follows:

16 ‘‘(e)(1)(A) Subject to paragraph (2), a herbicide-ex17 posed veteran is eligible for hospital care and nursing

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

19 specified in subparagraph (B).

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

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

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

23 Orange Act of 1991, has determined—

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

25 that there is a positive association between occur-
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1 rence of the disease in humans and exposure to a

2 herbicide agent;

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

4 of an association between occurrence of the disease

5 in humans and exposure to a herbicide agent, but

6 such evidence is limited in nature; or

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

8 permit a conclusion about the presence or absence of

9 an association between occurrence of the disease in

10 humans and exposure to a herbicide agent.

11 ‘‘(C) A radiation-exposed veteran is eligible for hos12 pital care and nursing home care under subsection

13 (a)(1)(G) for—

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

15 this title; and

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

17 based on the advice of the Advisory Committee on

18 Environmental Hazards, determines that there is

19 credible evidence of a positive association between

20 occurrence of the disease in humans and exposure to

21 ionizing radiation.

22 ‘‘(2) Hospital and nursing home care may not be pro23 vided under or by virtue of paragraph (1)(A) after Sep24 tember 30, 1996.
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1 ‘‘(3) For purposes of this subsection and section

2 1712 of this title—

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

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

5 Republic of Vietnam during the Vietnam era, and

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

7 during such service to a herbicide agent;

8 ‘‘(B) the term ‘herbicide agent’ has the mean9 ing given that term in section 1116(a)(4) of this

10 title; and

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

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

13 this title.’’.

14 (b) AUTHORIZED OUTPATIENT CARE.—Section 1712

15 of such title is amended—

16 (1) in subsection (a)(1)—

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

18 subparagraph (B);

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

20 of subparagraph (C) and inserting in lieu there21 of a semicolon; and

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

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

24 1996, to any herbicide-exposed veteran for any
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1 disease listed in section 1710(e)(1)(B) of this

2 title; and

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

4 any disease covered under section

5 1710(e)(1)(C) of this title.’’; and

6 (2) in subsection (i)(3)—

7 (A) by striking out ‘‘(A)’’; and

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

9 follows through ‘‘title’’.

10 SEC. 202. SAVINGS PROVISION.

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

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

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

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

15 services in the case of any veteran furnished care or serv16 ices before such date of enactment on the basis of pre17 sumed exposure to a substance or radiation under the au18 thority of those provisions.

19 TITLE III—READJUSTMENT

20 SERVICES

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

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

23 title 38, United States Code, is amended—

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

25 the extent otherwise authorized by law, may furnish
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1 such additional needed services as described in sub2 section (i)’’ in the first sentence after ‘‘life’’;

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

4 (j); and

5 (3) by inserting after subsection (g) the follow6 ing new subsections:

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

8 facilities are available, furnish to any veteran who served

9 in combat during World War II or the Korean conflict

10 counseling in a center to assist such veteran in overcoming

11 the effects of the veteran’s combat experience.

12 ‘‘(i) In operating centers under this section, the Sec13 retary may provide (1) preventive health care services, (2)

14 medical services reasonably necessary in preparation for

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

16 obtaining specialized care. The Secretary shall provide

17 such services through such health care personnel as the

18 Secretary determines appropriate.’’.

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

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

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

22 House of Representatives a report relating to the imple23 mentation of the amendments made by subsection (a). The

24 report shall include the following:
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1 (1) The number of veterans provided services

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

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

4 (2) The number of centers which provided serv5 ices described in that section.

6 (3) An assessment of the effect providing such

7 services has had on access to and timeliness of serv8 ice delivery.

9 SEC. 302. ADVISORY COMMITTEE ON THE READJUSTMENT

10 OF VETERANS.

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

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

13 after section 1712B the following new section:

14 ‘‘§ 1712C. Advisory Committee on Veterans Readjust15 ment Counseling

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

17 Committee on Veterans Readjustment Counseling (herein18 after in this section referred to as the ‘Committee’).

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

20 The members of the Committee shall be appointed by the

21 Secretary and shall include individuals who are recognized

22 authorities in fields pertinent to the social, psychological,

23 economic, or educational readjustment of veterans. An of24 ficer or employee of the United States may not be ap25 pointed as a member of the Committee. At least 12 of
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1 the Committee shall be veterans of the Vietnam era or

2 other period of war. Appointments of members of the

3 Committee shall be made from among individuals who

4 have experience with the provision of veterans benefits and

5 services by the Department or who are otherwise familiar

6 with programs of the Department.

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

8 appointed to the Committee include persons from a wide

9 variety of geographic areas and ethnic backgrounds, per10 sons from veterans service organizations, minorities, and

11 women.

12 ‘‘(4) The Secretary shall determine the terms of serv13 ice and pay and allowances of the members of the Commit14 tee, except that a term of service may not exceed two

15 years. The Secretary may reappoint any member for addi16 tional terms of service.

17 ‘‘(b)(1) The Secretary shall, on a regular basis, con18 sult with and seek the advice of the Committee with re19 spect to the provision by the Department of benefits and

20 services to veterans in order to assist veterans in the re21 adjustment to civilian life.

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

23 subsection, the Committee shall—
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1 ‘‘(A) assemble and review information relating

2 to the needs of veterans in readjusting to civilian

3 life;

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

5 and character of psychological problems arising from

6 military service;

7 ‘‘(C) provide an on-going assessment of the ef8 fectiveness of the policies, organizational structures,

9 and services of the Department in assisting veterans

10 in readjusting to civilian life; and

11 ‘‘(D) provide on-going advice on the most ap12 propriate means of responding to the readjustment

13 needs of future veterans.

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

15 the Committee shall take into special account veterans of

16 the Vietnam era and the readjustment needs of those

17 veterans.

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

19 Committee shall submit to the Secretary a report on the

20 programs and activities of the Department that relate to

21 the readjustment of veterans to civilian life. Each such

22 report shall include—

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

24 with respect to readjustment to civilian life;
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1 ‘‘(B) a review of the programs and activities of

2 the Department designed to meet such needs; and

3 ‘‘(C) such recommendations (including rec4 ommendations for administrative and legislative ac5 tion) as the Committee considers appropriate.

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

7 report under paragraph (1), the Secretary shall transmit

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

9 House of Representatives a copy of the report, together

10 with any comments and recommendations concerning the

11 report that the Secretary considers appropriate.

12 ‘‘(3) The Committee may also submit to the Sec13 retary such other reports and recommendations as the

14 Committee considers appropriate.

15 ‘‘(4) The Secretary shall submit with each annual re16 port submitted to the Congress pursuant to section 529

17 of this title a summary of all reports and recommendations

18 of the Committee submitted to the Secretary since the pre19 vious annual report of the Secretary submitted pursuant

20 to that section.’’.

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

22 17 of such title is amended by inserting after the item

23 relating to section 1712B the following:

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

24 (b) ORIGINAL MEMBERS.—(1) Notwithstanding sub25 section (a)(2) of section 1712C of title 38, United States
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1 Code (as added by subsection (a)), the members of the

2 Advisory Committee on the Readjustment of Vietnam and

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

4 Act shall be the original members of the advisory commit5 tee established under that section.

6 (2) The original members shall so serve until the Sec7 retary of Veterans Affairs carries out appointments under

8 such subsection (a)(2). The Secretary shall carry out such

9 appointments as soon as is practicable. The Secretary may

10 make such appointments from among such original mem11 bers.

12 SEC. 303. PLAN FOR EXPANSION OF VIETNAM VETERAN RE13 SOURCE CENTERS PILOT PROGRAM.

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

15 submit to the Committees on Veterans’ Affairs of the Sen16 ate and House of Representatives a plan for expansion of

17 the Vietnam Veteran Resource Centers program estab18 lished by section 1712A(h) of title 38, United States Code.

19 The plan submitted shall be a plan which the Secretary

20 would implement if resources for such implementation

21 were available.

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

23 an analysis setting forth in detail the resources required

24 for the implementation of the plan, shall be submitted
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1 under subsection (a) not later than four months after the

2 date of the enactment of this Act.

3 TITLE IV—SERVICES FOR

4 MENTALLY ILL VETERANS

5 SEC. 401. AUTHORITY TO ESTABLISH NONPROFIT COR6 PORATIONS.

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

8 States Code, is amended by inserting after section 1718

9 the following new section:

10 ‘‘§ 1718A. Nonprofit corporations

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

12 at any Veterans Health Administration facility of a non13 profit corporation (1) to arrange for therapeutic work for

14 patients of such facility or patients of other such Depart15 ment facilities pursuant to section 1718(b) of this title,

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

17 the purposes of section 1718 of this title.

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

19 of a board of directors for any corporation established

20 under this section and shall determine the number of di21 rectors and the composition of the board of directors. The

22 board of directors shall include—

23 ‘‘(1) the director of the facility and other offi24 cials or employees of the facility; and
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1 ‘‘(2) members appointed from among individ2 uals who are not officers or employees of the De3 partment of Veterans Affairs.

4 ‘‘(c) Each such corporation shall have an executive

5 director who shall be appointed by the board of directors

6 with concurrence of the Under Secretary for Health of the

7 Department. The executive director of a corporation shall

8 be responsible for the operations of the corporation and

9 shall have such specific duties and responsibilities as the

10 board may prescribe.

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

12 may—

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

14 Affairs under section 1718(b)(2) of this title to pro15 vide for therapeutic work for patients;

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

17 into contracts with, individuals and public and pri18 vate entities solely to carry out the purposes of this

19 section; and

20 ‘‘(3) employ such employees as it considers nec21 essary for such purposes and fix the compensation

22 of such employees.

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

24 funds received by a corporation established under this sec25 tion through arrangements authorized under subsection
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1 (d)(1) in excess of amounts reasonably required to carry

2 out obligations of the corporation authorized under sub3 section (d)(3) shall be deposited in or credited to the Spe4 cial Therapeutic and Rehabilitation Activities Fund estab5 lished under section 1718(c) of this title.

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

7 which the Secretary shall prescribe, may authorize a cor8 poration established under this section to retain funds de9 rived from arrangements authorized under subsection

10 (d)(1).

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

12 under this section through arrangements authorized under

13 subsection (d)(2) may be transferred to the Special Thera14 peutics and Rehabilitation Activities Fund.

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

16 be established in accordance with the nonprofit corpora17 tion laws of the State in which the applicable medical facil18 ity is located and shall, to the extent not inconsistent with

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

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

21 under this section shall be available to the Secretary.

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

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

24 operations of such a corporation shall be considered to be

25 programs and operations of the Department with respect
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1 to which the Inspector General of the Department has re2 sponsibilities under such Act.

3 ‘‘(2) Such a corporation shall be considered an agen4 cy for the purposes of section 716 of title 31 (relating to

5 availability of information and inspection of records by the

6 Comptroller General).

7 ‘‘(3) Each such corporation shall submit to the Sec8 retary an annual report providing a detailed statement of

9 its operations, activities, and accomplishments during that

10 year. The corporation shall obtain a report of independent

11 auditors concerning the receipts and expenditures of funds

12 by the corporation during that year and shall include that

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

14 year.

15 ‘‘(4) Each member of the board of directors of a cor16 poration established under this section, each employee of

17 such corporation, and each employee of the Department

18 who is involved in the functions of the corporation during

19 any year shall—

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

21 applicable to Federal employees with respect to con22 flicts of interest in the performance of official func23 tions; and

24 ‘‘(B) submit to the Secretary an annual state25 ment signed by the director or employee certifying
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1 that the director or employee is aware of, and has

2 complied with, such laws and regulations in the

3 same manner as Federal employees are required to.

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

5 on Veterans’ Affairs of the Senate and House of Rep6 resentatives an annual report on the number and location

7 of corporations established and the amount of the con8 tributions made to each such corporation.

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

10 section after September 30, 1999.

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

12 on the date of the establishment of a corporation under

13 this section the corporation is not recognized as an entity

14 the income of which is exempt from taxation under the

15 Internal Revenue Code of 1986, the Secretary shall dis16 solve the corporation.’’.

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

18 at the beginning of such chapter is amended by inserting

19 after the item relating to section 1718 the following new

20 item:

‘‘1718A. Nonprofit corporations.’’.

21 SEC. 402. EXTENSION OF DEMONSTRATION PROGRAM.

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

23 U.S.C. 1718 note) is amended—

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

25 and inserting in lieu thereof ‘‘1998’’;
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1 (2) in subsection (c)—

2 (A) by striking out ‘‘no more than 50’’;

3 and

4 (B) by striking out ‘‘under this sub5 section.’’ and inserting in lieu thereof ‘‘under

6 this subsection—

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

8 1994;

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

10 1995;

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

12 1996;

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

14 1997; and

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

16 year 1998.’’.

17 SEC. 403. SPECIAL COMMITTEE.

18 (a) ESTABLISHMENT.—The Secretary of Veterans

19 Administration, acting through the Under Secretary for

20 Health of the Department of Veterans Affairs, shall estab21 lish in the Veterans Health Administration a Special Com22 mittee on Care of Severely Chronically Mentally Ill Veter23 ans (hereinafter in this section referred to as the ‘‘Special

24 Committee’’). The Under Secretary shall appoint employ-
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1 ees of the Department with expertise in the care of the

2 chronically mentally ill to serve on the Special Committee.

3 (b) FUNCTIONS.—The Special Committee may as4 sess, and carry out a continuing assessment of, the capa5 bility of the Veterans Health Administration to meet effec6 tively the treatment and rehabilitation needs of severely,

7 chronically mentally ill veterans. In carrying out that re8 sponsibility, the Special Committee shall—

9 (1) monitor the care provided to such veterans

10 through the Veterans Health Administration;

11 (2) identify systemwide problems in caring for

12 such veterans in facilities of the Veterans Health

13 Administration;

14 (3) identify specific facilities within the Veter15 ans Health Administration at which program sup16 port is needed to improve treatment and rehabilita17 tion of such veterans; and

18 (4) identify model programs which have had

19 demonstrated success in the treatment and rehabili20 tation of such veterans and which should be imple21 mented more widely in or through facilities of the

22 Veterans Health Administration.

23 (c) ADVICE AND RECOMMENDATIONS.—The Special

24 Committee shall—
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1 (1) advise the Under Secretary regarding the

2 development of policies for the care and rehabilita3 tion of the severely, chronically mentally ill; and

4 (2) make recommendations to the Under Sec5 retary—

6 (A) for improving programs of care of such

7 veterans at specific facilities and throughout the

8 Veterans Health Administration;

9 (B) for establishing special programs of

10 education and training relevant to the care of

11 such veterans for employees of the Veterans

12 Health Administration;

13 (C) regarding research needs and priorities

14 relevant to the care of such veterans; and

15 (D) regarding the appropriate allocation of

16 resources for all such activities.

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

18 1994, the Secretary of Veterans Affairs shall submit to

19 the Committees on Veterans’ Affairs of the Senate and

20 House of Representatives a report on the implementation

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

22 (A) A list of the members of the Special Com23 mittee.

24 (B) The assessment of the Under Secretary for

25 Health, after review of the findings of the Special
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1 Committee, regarding the capability of the Veterans

2 Health Administration, on a systemwide and facility3 by-facility basis, to meet effectively the treatment

4 and rehabilitation needs of severely, chronically men5 tally ill veterans.

6 (C) The plans of the Special Committee for fur7 ther assessments.

8 (D) The findings and recommendations made

9 by the Special Committee to the Under Secretary for

10 Health and the views of the Under Secretary on

11 such findings and recommendations.

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

13 made (and a timetable for their execution), and re14 sources to be applied toward improving the capabil15 ity of the Veterans Health Administration to meet

16 effectively the treatment and rehabilitation needs of

17 severely, chronically mentally ill veterans.

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

19 1 of each of the three following years, the Secretary shall

20 submit to the Committees on Veterans’ Affairs of the Sen21 ate and House of Representatives a report containing in-
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1 formation updating the reports submitted under this sub2 section before the submission of such report.

Passed the House of Representatives November 16,

1993.

Attest: DONNALD K. ANDERSON,

Clerk.

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