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[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 1503 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                S. 1503

 To expand services provided by the Department of Veterans Affairs for 
     veterans suffering from post-traumatic stress disorder (PTSD).

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

           September 30 (legislative day, September 27), 1993

 Mr. Wellstone introduced the following bill; which was read twice and 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL

 
 To expand services provided by the Department of Veterans Affairs for 
     veterans suffering from post-traumatic stress disorder (PTSD).

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veterans PTSD Treatment and 
Psychological Readjustment Act of 1993''.

SEC. 2. FINDINGS.

    The Congress finds--
            (1) that a study carried out pursuant to the Veterans' 
        Health Care Amendments of 1983 (Public Law 98-160; 97 Stat. 
        993) on the readjustment of Vietnam-era veterans estimated that 
        approximately 479,000 Vietnam-theater veterans currently suffer 
        from full-blown post-traumatic stress disorder (PTSD);
            (2) that such study found that during the final year in 
        which such study was conducted only 10 percent of the Vietnam-
        era veterans suffering from post-traumatic stress disorder were 
        provided services by the Department of Veterans Affairs for 
        post-traumatic stress disorder;
            (3) that the conflict in the Persian Gulf resulted in an 
        increased demand for services provided by the Department of 
        Veterans Affairs for post-traumatic stress disorder;
            (4) that expansion of the current programs of the 
        Department of Veterans Affairs to provide services to veterans 
        suffering from post-traumatic stress disorder (including 
        specialized inpatient PTSD units, PTSD clinical teams, 
        readjustment centers, and other services) would be an effective 
        means of reaching those veterans who have not previously been 
        provided such services; and
            (5) that implementing the recommendations of the Special 
        Committee on Post-Traumatic Stress Disorder would be an 
        effective means of reaching veterans suffering from post-
        traumatic stress disorder who have not been provided services.

SEC. 3. EXPANSION OF THE SPECIALIZED INPATIENT POST-TRAUMATIC STRESS 
              DISORDER UNIT PROGRAM.

    (a) Policy.--It shall be the policy of the Secretary of Veterans 
Affairs to implement the recommendations of the Special Committee on 
Post-Traumatic Stress Disorder with respect to the program of the 
Department of Veterans Affairs to establish and operate specialized 
inpatient post-traumatic stress disorder units (SIPUs) at Department 
medical centers. In operating such units, the Secretary shall ensure 
that the facilities and services of such units are available to all 
eligible veterans, including veterans of the Persian Gulf conflict.
    (b) Increase in Number of SIPUs.--The Secretary shall increase the 
number of specialized inpatient post-traumatic stress disorder units 
existing on the date of the enactment of this Act by not less than 30. 
Of such number--
            (1) not less than five such units shall be established by 
        December 31, 1994;
            (2) not less than a total of 15 such units shall be 
        established by December 31, 1995;
            (3) not less than a total of 25 such units shall be 
        established by December 31, 1996; and
            (4) not less than a total of 30 such units shall be 
        established by December 31, 1997.

SEC. 4. EXPANSION OF THE VET CENTER PROGRAM AND OUTREACH EFFORTS FOR 
              VETERANS WITH READJUSTMENT COUNSELING NEEDS.

    (a) Special Committee Recommendation.--(1) The Secretary of 
Veterans Affairs, acting through the Under Secretary for Health of the 
Department of Veterans Affairs, shall direct the Special Committee on 
Post-Traumatic Stress Disorder to identify areas of the country in 
which there are significant needs for expanding the Vet Center program, 
especially areas in which there are relatively high numbers of veterans 
who are members of minority groups and areas that are currently not 
well-served by Vet Centers.
    (2) The Special Committee, based on its findings under paragraph 
(1), shall present a list of not less than 40 areas as candidates for 
new Vet Centers to the Readjustment Counseling Service of the 
Department of Veterans Affairs not later than September 30, 1994.
    (b) Vet Center Program Expansion.--Based on the requirements 
identified pursuant to subsection (a), the Readjustment Counseling 
Service shall increase the number of Vet Centers existing on the date 
of the enactment of this Act by not less than 40. Of such number--
            (1) not less than five such centers shall be established by 
        December 31, 1994;
            (2) not less than a total of 20 such centers shall be 
        established by December 31, 1995;
            (3) not less than a total of 30 such centers shall be 
        established by December 31, 1996; and
            (4) not less than a total of 40 such centers shall be 
        established by December 31, 1997.
    (c) Outreach Recommendations.--The Advisory Committee on Veteran 
Readjustment Counseling shall prepare a report on recommendations to 
increase outreach efforts to veterans of the Vietnam-era and periods 
after the Vietnam-era who have readjustment counseling needs. The 
Advisory Committee shall submit such report to the Secretary not later 
than July 29, 1994. Not later than 60 days after receiving such report, 
the Secretary shall transmit a copy of the report, together with the 
Secretary's comments and recommendations, to Congress.

SEC. 5. EXPANSION OF ELIGIBILITY FOR READJUSTMENT COUNSELING AND 
              CERTAIN RELATED COUNSELING SERVICES.

    (a) Readjustment Counseling.--(1) Subsection (a) of section 1712A 
of title 38, United States Code, is amended to read as follows:
    ``(a)(1) Upon the request of any veteran who while in the active 
military, naval, or air service served in a combat theater of 
operations (as defined by the Secretary of Defense), the Secretary 
shall furnish counseling to such veteran to assist such veteran in 
readjusting to civilian life. Upon the request of any veteran other 
than a veteran described in the preceding sentence, the Secretary 
shall, within the limits of Department facilities, furnish counseling 
to such veteran to assist such veteran in readjusting to civilian life.
    ``(2) Such counseling shall include a general mental and 
psychological assessment to ascertain whether such veteran has mental 
or psychological problems associated with readjustment to civilian 
life.''.
    (2) Subsection (c) of such section is repealed.
    (b) Other Counseling.--Such section is further amended by inserting 
after subsection (b) the following new subsection (c):
    ``(c)(1) The Secretary may provide the counseling services 
described in section 1701(6)(B)(ii) of this title to the surviving 
parents, spouse, and children of any member of the Armed Forces who 
dies while serving on active duty or from a condition (as determined by 
the Secretary) incurred in or aggravated by such service.
    ``(2) The Secretary may make the facilities and services of Vet 
Centers available to provide appropriate counseling and other services 
to family members of any member of the Armed Forces who is receiving 
combat pay.''.
    (c) Authority To Contract for Counseling Services.--Subsection (e) 
of such section is amended by striking out ``subsections (a) and (b)'' 
each place it appears and inserting in lieu thereof ``subsections (a), 
(b), and (c)''.

SEC. 6. ADVISORY COMMITTEE ON THE READJUSTMENT OF VETERANS.

    (a) In General.--(1) Subchapter II of chapter 17 of title 38, 
United States Code, is amended by inserting after section 1712B the 
following:
``Sec. 1712C. Advisory Committee on Veteran-Readjustment Counseling
    ``(a)(1) There is in the Department the Advisory Committee on 
Veteran Readjustment Counseling (hereinafter in this section referred 
to as the `Committee').
    ``(2) The Committee shall consist of 18 members. The members of the 
Committee shall be appointed by the Secretary and shall include 
individuals who are recognized authorities in fields pertinent to the 
social, psychological, economic, or educational readjustment of 
veterans. An officer or employee of the United States may not be 
appointed as a member of the Committee. At least 12 members of the 
Committee shall be veterans of the Vietnam era or other period of war. 
Appointments of members of the Committee shall be made from among 
individuals who have experience with the provision of veterans benefits 
and services by the Department or who are otherwise familiar with 
programs of the Department.
    ``(3) The Secretary shall seek to ensure that members appointed to 
the Committee include persons from a wide variety of geographic areas 
and ethnic backgrounds, persons from veterans service organizations, 
minorities, and women.
    ``(4) The Secretary shall determine the terms of service and pay 
and allowances of the members of the Committee, except that a term of 
service may not exceed two years. The Secretary may reappoint any 
member for additional terms of service.
    ``(b)(1) The Secretary shall, on a regular basis, consult with and 
seek the advice of the Committee with respect to the provision by the 
Department of benefits and services to veterans in order to assist 
veterans in the readjustment to civilian life.
    ``(2)(A) In providing advice to the Secretary under this 
subsection, the Committee shall--
            ``(i) assemble and review information relating to the needs 
        of veterans in readjusting to civilian life;
            ``(ii) provide information relating to the nature and 
        character of psychological problems arising from military 
        service;
            ``(iii) provide an on-going assessment of the effectiveness 
        of the policies, organizational structures, and services of the 
        Department in assisting veterans in readjusting to civilian 
        life; and
            ``(iv) provide on-going advice on the most appropriate 
        means of responding to the readjustment needs of future 
        veterans.
    ``(B) In carrying out its duties under subparagraph (A), the 
Committee shall take into special account veterans of the Vietnam era, 
and the readjustment needs of such veterans.
    ``(c)(1) Not later than March 31 of each year, the Committee shall 
submit to the Secretary a report on the programs and activities of the 
Department that relate to the readjustment of veterans to civilian 
life. Each such report shall include--
            ``(A) an assessment of the needs of veterans with respect 
        to readjustment to civilian life;
            ``(B) a review of the programs and activities of the 
        Department designed to meet such needs; and
            ``(C) such recommendations (including recommendations for 
        administrative and legislative action) as the Committee 
        considers appropriate.
    ``(2) Not later than 90 days after the receipt of each report under 
paragraph (1), the Secretary shall transmit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a copy of 
the report, together with any comments and recommendations concerning 
the report that the Secretary considers appropriate.
    ``(3) The Committee may also submit to the Secretary such other 
reports and recommendations as the Committee considers appropriate.
    ``(4) The Secretary shall submit with each annual report submitted 
to the Congress pursuant to section 529 of this title a summary of all 
reports and recommendations of the Committee submitted to the Secretary 
since the previous annual report of the Secretary submitted pursuant to 
that section.
    ``(d)(1) Except as provided in paragraph (2), the provisions of the 
Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the 
activities of the Committee under this section.
    ``(2) Section 14 of such Act shall not apply to the Committee.''.
    (2) The table of sections at the beginning of chapter 17 of such 
title is amended by inserting after the item relating to section 1712B 
the following:

``1712C. Advisory Committee on Veteran Readjustment Counseling.''.
    (b) Original Members.--(1) Notwithstanding subsection (a)(2) of 
section 1712C of title 38, United States Code (as added by subsection 
(a)), the members of the Advisory Committee on the Readjustment of 
Vietnam and Other War Veterans on the date of the enactment of this Act 
shall be the original members of the advisory committee established 
under that section.
    (2) The original members shall so serve until the Secretary of 
Veterans Affairs carries out appointments under such subsection (a)(2). 
The Secretary shall carry out such appointments as soon as is 
practicable. The Secretary may make such appointments from among such 
original members.

SEC. 7. PILOT PROGRAM FOR TREATMENT OF POST-TRAUMATIC STRESS DISORDER.

    (a) Establishment of Program.--(1) Subchapter II of chapter 17 of 
title 38, United States Code, is amended by adding at the end the 
following:
``Sec. 1720E. Treatment and rehabilitation for post-traumatic stress 
              disorder; pilot program
    ``(a)(1) The Secretary, in furnishing hospital, nursing home, and 
domiciliary care and medical and rehabilitative services under this 
chapter, shall conduct a pilot program under which the Secretary may 
contract for care and treatment and rehabilitative services in halfway 
houses, therapeutic communities, psychiatric residential treatment 
centers, and other community based treatment facilities, for eligible 
veterans suffering from post-traumatic stress disorder. Such pilot 
program shall be planned, designed, and conducted by the Under 
Secretary for Health, with the approval of the Secretary, so as to 
demonstrate any medical advantages and cost effectiveness that may 
result from furnishing such care and services to veterans with post-
traumatic stress disorder in contract facilities as authorized by this 
section, rather than in facilities over which the Secretary has direct 
jurisdiction.
    ``(2) Before furnishing such care and services to a veteran through 
a contract facility as authorized by paragraph (1), the Secretary shall 
approve (in accordance with criteria which the Secretary shall 
prescribe by regulation) the quality and effectiveness of the program 
operated by such facility for the purpose for which such veteran is to 
be furnished such care and services.
    ``(b) The Secretary, in consultation with the Secretary of Labor 
and the Director of the Office of Personnel Management, shall take 
appropriate steps to--
            ``(1) urge all Federal agencies and appropriate private and 
        public firms, organizations, agencies, and persons to provide 
        appropriate employment and training opportunities for veterans 
        who have been provided treatment and rehabilitative services 
        under this title for post-traumatic stress disorder and have 
        been determined by competent medical authority to be 
        sufficiently rehabilitated to be employable; and
            ``(2) provide all possible assistance to the Secretary of 
        Labor in providing such veterans with such employment and 
        training opportunities.
    ``(c) Upon receipt of an application for treatment and 
rehabilitative services under this title for post-traumatic stress 
disorder from any individual who has been discharged or released from 
active military, naval, or air service but who is not eligible for such 
treatment and services, the Secretary shall--
            ``(1) provide referral services to assist such individual, 
        to the maximum extent practicable, in obtaining treatment and 
        rehabilitative services from sources outside the Department; 
        and
            ``(2) if pertinent, advise such individual of such 
        individual's rights to apply to the appropriate military, 
        naval, or air service and the Department for review of such 
        individual's discharge or release from such service.
    ``(d) The capacity of the pilot program under subsection (a) shall 
be maintained at 500 eligible individuals.
    ``(e) The Secretary may not furnish care and treatment and 
rehabilitative services under subsection (a) after the last day of the 
fifth fiscal year following the fiscal year during which the pilot 
program authorized by that subsection is begun.
    ``(f) Not later than March 31, 1998, the Secretary shall submit to 
the Committees on Veterans' Affairs of the Senate and House of 
Representatives a report on the findings and recommendations of the 
Secretary pertaining to the operation through September 30, 1997, of 
the pilot program authorized by subsection (a).
    ``(g) The authority of the Secretary to enter into contracts under 
this section shall be effective for any fiscal year only to such extent 
or in such amounts as are provided in appropriation Acts.''.
    (2) The table of sections at the beginning of chapter 17 of such 
title is amended by inserting after the item relating to section 1720D 
the following:

``1720E. Treatment and rehabilitation for post-traumatic stress 
                            disorder; pilot program.''.
    (b) Effective Date.--The Secretary of Veterans Affairs may not 
furnish care and treatment and rehabilitation services under subsection 
(a) of section 1720E of title 38, United States Code, as added by 
subsection (a), before October 1, 1993.

SEC. 8. REPORT ON POST-TRAUMATIC STRESS DISORDER CONTRACT CARE.

    (a) Examination of Effectiveness.--The Special Committee on Post-
Traumatic Stress Disorder, in consultation with the Advisory Committee 
on Veterans Readjustment Counseling, shall examine the effectiveness of 
contracts for the treatment of post-traumatic stress disorder with 
private facilities and therapists under section 1712A(e) of title 38, 
United States Code.
    (b) Report.--Not later than December 31, 1994, the Special 
Committee shall submit to the Committees on Veterans' Affairs of the 
Senate and House of Representatives a report of its findings and 
recommendations pertaining to--
            (1) establishing stable funding for post-traumatic stress 
        disorder contract care, and
            (2) the availability of post-traumatic stress disorder 
        contract care for eligible individuals in rural areas and such 
        individuals who are not currently well-served by other 
        Department of Veterans Affairs medical services.

SEC. 9. USE OF SCHOLARSHIP AND TUITION REIMBURSEMENT PROGRAMS FOR 
              MENTAL HEALTH PROFESSIONALS.

    In administering the Health Professionals Educational Assistance 
Program under chapter 76 of title 38, United States Code, the Secretary 
of Veterans Affairs shall seek to encourage the participation of 
individuals in the program who desire to become psychologists, 
psychiatrists, social workers, psychiatric nurses, and other 
professionals specializing in the treatment of post-traumatic stress 
disorder. The Secretary shall designate, pursuant to section 7612(b)(3) 
of that title, additional fields of education or training that may be 
beneficial for the treatment of veterans suffering from post-traumatic 
stress disorder.

SEC. 10. POST-TRAUMATIC STRESS DISORDER RESEARCH PROGRAMS.

    (a) Intermodal Approach.--The Under Secretary for Health of the 
Department of Veterans Affairs shall conduct a research program to 
consider the most effective treatment modalities for the treatment of 
post-traumatic stress disorder. The research program shall be conducted 
at at least one specialized inpatient post-traumatic stress disorder 
unit (SIPU), at least one post-traumatic stress disorder clinical team 
(PCT), and at least one veterans readjustment center, as designated by 
the Under Secretary. The Under Secretary shall report the findings of 
such program to the Committees on Veterans' Affairs of the Senate and 
House of Representatives not later than December 31, 1997.
    (b) Involvement of Family Members.--The Under Secretary shall 
conduct a research program concerning the effectiveness of involving 
the family in the treatment of post-traumatic stress disorder. The 
Under Secretary shall report the findings of such program to the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives not later than December 31, 1996.
    (c) Implementation.--The Under Secretary shall carry out 
subsections (a) and (b) through the National Center on Post-Traumatic 
Stress Disorder.
    (d) Advice.--The Under Secretary shall carry out subsections (a) 
and (b) in consultation with the Special Committee on Post-Traumatic 
Stress Disorder and the Advisory Committee on Veterans Readjustment 
Counseling.

SEC. 11. EXPANSION OF THE POST-TRAUMATIC STRESS DISORDER CLINICAL TEAM 
              PROGRAM.

    (a) Policy.--It shall be the policy of the Secretary of Veterans 
Affairs to implement the recommendations of the Special Committee on 
Post-Traumatic Stress Disorder to establish and operate post-traumatic 
stress disorder clinical teams (PCTs) at Department medical centers 
which provide mental health services. In operating such teams, the 
Secretary shall ensure that the services of such teams are available to 
all eligible veterans.
    (b) Increase in Number of PCTs.--The Secretary shall increase the 
number of clinical teams existing on the date of the enactment of this 
Act by not less than 50. Of such number--
            (1) not less than 15 such units shall be established by 
        December 31, 1994;
            (2) not less than a total of 30 such units shall be 
        established by December 31, 1995;
            (3) not less than a total of 40 such units shall be 
        established by December 31, 1996; and
            (4) not less than a total of 50 such units shall be 
        established by December 31, 1997.
    (c) Locations of New PCTs.--In establishing new post-traumatic 
stress disorder clinical teams pursuant to subsection (a), the 
Secretary shall first locate teams at medical centers that do not have 
a specialized inpatient post-traumatic stress disorder unit (SIPU) and 
do not have an affiliated Vet Center.

SEC. 12. DEFINITIONS.

    For the purposes of this Act--
            (1) The term ``Special Committee on Post-Traumatic Stress 
        Disorder'' means the Special Committee on Post-Traumatic Stress 
        Disorder established by the Under Secretary for Health pursuant 
        to section 110 of the veterans Health Care Act of 1984 (38 
        U.S.C. 1712A note).
            (2) The term ``Advisory Committee on Veteran Readjustment 
        Counseling'' means the Advisory Committee on Veteran 
        Readjustment Counseling established under section 1712C of 
        title 38, United States Code (as added by section 6(a)).

                                 <all>

S 1503 IS----2
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