Union Calendar No. 135

106TH CONGRESS

1ST SESSION H. R. 2116

[Report No. 106–237]

A BILL

To amend title 38, United States Code, to establish

programs of the Department of Veterans Affairs.and to make other improvements in health carea program of extended care services for veterans

JULY 16, 1999

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union,
IB

Union Calendar No. 135

106TH CONGRESS

1ST SESSION H. R. 2116

[Report No. 106–237]

To amend title 38, United States Code, to establish a program of extended

care services for veterans and to make other improvements in health

care programs of the Department of Veterans Affairs.

IN THE HOUSE OF REPRESENTATIVES

JUNE 9, 1999

Mr. STEARNS (for himself, Mr. GUTIERREZ, Mr. STUMP, and Mr. EVANS) introduced the following bill; which was referred to the Committee on

Veterans’ Affairs

JULY 16, 1999

Additional sponsors: Mr. COOKSEY, Mr. RODRIGUEZ, Mr. SMITH of New Jersey, Mr. BILIRAKIS, Mr. MCINTOSH, Mrs. CUBIN, Mr. TANCREDO, Mr.

HANSEN, Mr. LAHOOD, Mr. REYES, Ms. CARSON, Ms. BROWN of Florida, Ms. BERKLEY, Mr. HILL of Indiana, Mr. FILNER, Mr. UDALL of

New Mexico, and Mr. SHOWS

JULY 16, 1999

Reported with an amendment, committed to the Committee of the Whole

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

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

[For text of introduced bill, see copy of bill as introduced on July 27, 1999]

A BILL

To amend title 38, United States Code, to establish a program of extended care services for veterans and to make
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other improvements in health care programs of the Department of Veterans Affairs.

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS; REF4 ERENCES TO TITLE 38, UNITED STATES CODE.

5 (a) SHORT TITLE.—This Act may be cited as the ‘‘Vet6 erans’ Millennium Health Care Act’’.

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

8 Act is as follows:

Sec. 1. Short title; table of contents; references to title 38, United States Code.

TITLE I—ACCESS TO CARE

Sec. 101. Extended care services.

Sec. 102. Reimbursement for emergency treatment.

Sec. 103. Eligibility for care of combat-injured veterans.

Sec. 104. Access to care for military retirees.

Sec. 105. Benefits for persons disabled by participation in compensated work

therapy program.

Sec. 106. Pilot program of medical care for certain dependents of enrolled veterans.

Sec. 107. Enhanced services program at designated medical centers.

Sec. 108. Counseling and treatment for veterans who have experienced sexual

trauma.

TITLE II—PROGRAM ADMINISTRATION

Sec. 201. Medical care collections.

Sec. 202. Health Services Improvement Fund.

Sec. 203. Veterans Tobacco Trust Fund.

Sec. 204. Authority to accept funds for education and training.

Sec. 205. Extension and revision of certain authorities.

Sec. 206. State Home grant program.

Sec. 207. Expansion of enhanced-use lease authority.

Sec. 208. Ineligibility for employment by Veterans Health Administration of

health care professionals who have lost license to practice in one

jurisdiction while still licensed in another jurisdiction.

TITLE III—MISCELLANEOUS

Sec. 301. Review of proposed changes to operation of medical facilities.

Sec. 302. Patient services at Department facilities.

Sec. 303. Report on assisted living services.

Sec. 304. Chiropractic treatment.
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Sec. 305. Designation of hospital bed replacement building at Ioannis A.

Lougaris Department of Veterans Affairs Medical Center, Reno,

Nevada.

TITLE IV—CONSTRUCTION AND FACILITIES MATTERS

Sec. 401. Authorization of major medical facility projects.

Sec. 402. Authorization of major medical facility leases.

Sec. 403. Authorization of appropriations.

1 (c) REFERENCES TO TITLE 38, UNITED STATES

2 CODE.—Except as otherwise expressly provided, whenever

3 in this Act an amendment or repeal is expressed in terms

4 of an amendment to, or repeal of, a section or other provi5 sion, the reference shall be considered to be made to a section

6 or other provision of title 38, United States Code.

7 TITLE I—ACCESS TO CARE

8 SEC. 101. EXTENDED CARE SERVICES.

9 (a) REQUIREMENT TO PROVIDE EXTENDED CARE

10 SERVICES.—(1) Chapter 17 is amended by inserting after

11 section 1710 the following new section:

12 ‘‘§ 1710A. Extended care services

13 ‘‘(a) The Secretary (subject to section 1710(a)(4) of

14 this title and subsection (c) of this section) shall operate

15 and maintain a program to provide extended care services

16 to eligible veterans in accordance with this section. Such

17 services shall include the following:

18 ‘‘(1) Geriatric evaluation.

19 ‘‘(2) Nursing home care (A) in facilities operated

20 by the Secretary, and (B) in community-based facili21 ties through contracts under section 1720 of this title.
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1 ‘‘(3) Domiciliary services under section 1710(b)

2 of this title.

3 ‘‘(4) Adult day health care under section 1720(f)

4 of this title.

5 ‘‘(5) Such other noninstitutional alternatives to

6 nursing home care, including those described in sec7 tion 1720C of this title, as the Secretary considers

8 reasonable and appropriate.

9 ‘‘(6) Respite care under section 1720B of this

10 title.

11 ‘‘(b)(1) In carrying out subsection (a), the Secretary

12 shall provide extended care services which the Secretary de13 termines are needed (A) to any veteran in need of such care

14 for a service-connected disability, and (B) to any veteran

15 who is in need of such care and who has a service-connected

16 disability rated at 50 percent or more.

17 ‘‘(2) The Secretary, in making placements for nursing

18 home care in Department facilities, shall give highest pri19 ority to veterans (A) who are in need of such care for a

20 service-connected disability, or (B) who have a service-con21 nected disability rated at 50 percent or more. The Secretary

22 shall ensure that a veteran described in this subsection who

23 continues to need nursing home care shall not after place24 ment in a Department nursing home be transferred from

25 the facility without the consent of the veteran, or, in the
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1 event the veteran cannot provide informed consent, the rep2 resentative of the veteran.

3 ‘‘(c)(1) The Secretary, in carrying out subsection (a),

4 shall prescribe regulations governing the priorities for the

5 provision of nursing home care in Department facilities so

6 as to ensure that priority for such care is given (A) for

7 patient rehabilitation, (B) for clinically complex patient

8 populations, and (C) for patients for whom there are not

9 other suitable placement options.

10 ‘‘(2) The Secretary may not furnish extended care serv11 ices for a non-service-connected disability other than in the

12 case of a veteran who has a service-connected disability

13 rated at 50 percent or more unless the veteran agrees to

14 pay to the United States a copayment for extended care

15 services of more than 21 days in any year.

16 ‘‘(d)(1) A veteran who is furnished extended care serv17 ices under this chapter and who is required under sub18 section (c)(2) to pay an amount to the United States in

19 order to be furnished such services shall be liable to the

20 United States for that amount.

21 ‘‘(2) In implementing subsection (c)(2), the Secretary

22 shall develop a methodology for establishing the amount of

23 the copayment for which a veteran described in subsection

24 (c) is liable. That methodology shall provide for—
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1 ‘‘(A) establishing a maximum monthly copay2 ment (based on all income and assets of the veteran

3 and the spouse of such veteran);

4 ‘‘(B) protecting the spouse of a veteran from fi5 nancial hardship by not counting all of the income

6 and assets of the veteran and spouse (in the case of

7 a spouse who resides in the community) as available

8 for determining the copayment obligation; and

9 ‘‘(C) allowing the veteran to retain a monthly

10 personal allowance.

11 ‘‘(e)(1) There is established in the Treasury of the

12 United States a revolving fund known as the Department

13 of Veterans Affairs Extended Care Fund (hereinafter in this

14 section referred to as the ‘‘fund’’). Amounts in the fund shall

15 be available, without fiscal year limitation and without fur16 ther appropriation, exclusively for the purpose of providing

17 extended care services under subsection (a).

18 ‘‘(2) All amounts received by the Department under

19 this section shall be deposited in or credited to the fund.’’.

20 (2) The table of sections at the beginning of such chap21 ter is amended by inserting after the item relating to section

22 1710 the following new item:

‘‘1710A. Requirement to provide extended care.’’.

23 (b) REQUIREMENT TO INCREASE EXTENDED CARE

24 SERVICES.—(1) Not later than January 1, 2000, the Sec25 retary of Veterans Affairs shall develop and begin to imple-
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1 ment a plan for carrying out the recommendation of the

2 Federal Advisory Committee on the Future of Long-Term

3 Care to increase, above the level of extended care services

4 which were provided as of September 30, 1998—

5 (A) the options and services for home and com6 munity-based care for eligible veterans; and

7 (B) the percentage of the Department of Veterans

8 Affairs medical care budget dedicated to such care.

9 (2) The Secretary shall ensure that the staffing and

10 level of extended care services provided by the Secretary na11 tionally in facilities operated by the Secretary during any

12 fiscal year is not less than the level of such services provided

13 nationally in facilities operated by the Secretary during fis14 cal year 1998.

15 (c) ADULT DAY HEALTH CARE.—Section

16 1720(f)(1)(A) is amended to read as follows:

17 ‘‘(f)(1)(A) The Secretary may furnish adult day health

18 care services to a veteran enrolled under section 1705(a)

19 of this title who would otherwise require nursing home

20 care.’’

21 (d) RESPITE CARE PROGRAM.—Section 1720B is

22 amended—

23 (1) in subsection (a), by striking ‘‘eligible’’ and

24 inserting ‘‘enrolled’’;

25 (2) in subsection (b)—
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1 (A) by striking ‘‘the term ‘respite care’

2 means hospital or nursing home care’’ and in3 serting ‘‘the term ‘respite care services’ means

4 care and services’’;

5 (B) by striking ‘‘is’’ at the beginning of

6 each of paragraphs (1), (2), and (3) and insert7 ing ‘‘are’’; and

8 (C) by striking ‘‘in a Department facility’’

9 in paragraph (2); and

10 (3) by adding at the end the following new sub11 section:

12 ‘‘(c) In furnishing respite care services, the Secretary

13 may enter into contract arrangements.’’.

14 (e) CONFORMING AMENDMENTS.—Section 1710 is

15 amended—

16 (1) in subsection (a)(1), by striking ‘‘may fur17 nish nursing home care,’’; and

18 (2) in subsection (a)(4), by inserting ‘‘, and the

19 requirement in section 1710A of this title that the

20 Secretary provide a program of extended care serv21 ices,’’ after ‘‘medical services’’.

22 (f) STATE HOMES.—Section 1741(a)(2) is amended by

23 striking ‘‘adult day health care in a State home’’ and in24 serting ‘‘extended care services described in any of para-
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1 graphs (4) through (6) of section 1710A(a) of this title

2 under a program administered by a State home’’.

3 (g) EFFECTIVE DATE.—(1) Except as provided in

4 paragraph (2), the amendments made by this section shall

5 take effect on the date of the enactment of this Act.

6 (2) Subsection (c)(2) of section 1710A(a) of title 38,

7 United States Code (as added by subsection (a)), shall take

8 effect on the effective date of regulations prescribed by the

9 Secretary of Veterans Affairs under subsections (c)(2) and

10 (d) of such section. The Secretary shall publish the effective

11 date of such regulations in the Federal Register.

12 (3) The provisions of section 1710(f) of title 38, United

13 States Code, shall not apply to any day of nursing home

14 care on or after the effective date of regulations under para15 graph (2).

16 SEC. 102. REIMBURSEMENT FOR EMERGENCY TREATMENT.

17 (a) AUTHORITY TO PROVIDE REIMBURSEMENT.—

18 Chapter 17 is amended by inserting after section 1724 the

19 following new section:

20 ‘‘§ 1725. Reimbursement for emergency treatment

21 ‘‘(a) GENERAL AUTHORITY.—(1) Subject to subsections

22 (c) and (d), the Secretary may reimburse a veteran de23 scribed in subsection (b) for the reasonable value of emer24 gency treatment furnished the veteran in a non-Department

25 facility.
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1 ‘‘(2) In any case in which reimbursement is authorized

2 under subsection (a)(1), the Secretary, in the Secretary’s

3 discretion, may, in lieu of reimbursing the veteran, make

4 payment of the reasonable value of the furnished emergency

5 treatment directly—

6 ‘‘(A) to a hospital or other health care provider

7 that furnished the treatment; or

8 ‘‘(B) to the person or organization that paid for

9 such treatment on behalf of such veteran.

10 ‘‘(b) ELIGIBILITY.—(1) A veteran referred to in sub11 section (a)(1) is an individual who is an active Department

12 health-care participant who is personally liable for emer13 gency treatment furnished the veteran in a non-Department

14 facility.

15 ‘‘(2) A veteran is an active Department health-care

16 participant if the veteran—

17 ‘‘(A) is described in any of paragraphs (1)

18 through (6) of section 1705(a) of this title;

19 ‘‘(B) is enrolled in the health care system estab20 lished under such section; and

21 ‘‘(C) received care under this chapter within the

22 12-month period preceding the furnishing of such

23 emergency treatment.
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1 ‘‘(3) A veteran is personally liable for emergency treat2 ment furnished the veteran in a non-Department facility

3 if the veteran—

4 ‘‘(A) is financially liable to the provider of emer5 gency treatment for that treatment;

6 ‘‘(B) has no entitlement to care or services under

7 a health-plan contract;

8 ‘‘(C) has no other contractual or legal recourse

9 against a third party that would, in whole or in part,

10 extinguish such liability to the provider; and

11 ‘‘(D) is not eligible for reimbursement for med12 ical care or services under section 1728 of this title.

13 ‘‘(c) LIMITATIONS ON REIMBURSEMENT.—(1) The Sec14 retary, in accordance with regulations prescribed by the

15 Secretary, shall—

16 ‘‘(A) establish the maximum amount payable

17 under subsection (a);

18 ‘‘(B) delineate the circumstances under which

19 such payments may be made, to include such require20 ments on requesting reimbursement as the Secretary

21 shall establish; and

22 ‘‘(C) provide that in no event may a payment

23 under that subsection include any amount for which

24 the veteran is not personally liable.
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1 ‘‘(2) Subject to paragraph (1), the Secretary may pro2 vide reimbursement under this section only after the veteran

3 or the provider of emergency treatment has exhausted with4 out success all claims and remedies reasonably available to

5 the veteran or provider against a third party for payment

6 of such treatment.

7 ‘‘(3) Payment by the Secretary under this section, on

8 behalf of a veteran described in subsection (b), to a provider

9 of emergency treatment, shall, unless rejected and refunded

10 by the provider within 30 days of receipt, extinguish any

11 liability on the part of the veteran for that treatment. Nei12 ther the absence of a contract or agreement between the Sec13 retary and the provider nor any provision of a contract,

14 agreement, or assignment to the contrary shall operate to

15 modify, limit, or negate the requirement in the preceding

16 sentence.

17 ‘‘(d) INDEPENDENT RIGHT OF RECOVERY.—(1) In ac18 cordance with regulations prescribed by the Secretary, the

19 United States shall have the independent right to recover

20 any amount paid under this section when, and to the extent

21 that, a third party subsequently makes a payment for the

22 same emergency treatment.

23 ‘‘(2) Any amount paid by the United States to the vet24 eran (or the veteran’s personal representative, successor, de25 pendents, or survivors) or to any other person or organiza-
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1 tion paying for such treatment shall constitute a lien in

2 favor of the United States against any recovery the payee

3 subsequently receives from a third party for the same treat4 ment.

5 ‘‘(3) Any amount paid by the United States to the pro6 vider that furnished the veteran’s emergency treatment shall

7 constitute a lien against any subsequent amount the pro8 vider receives from a third party for the same emergency

9 treatment for which the United States made payment.

10 ‘‘(4) The veteran (or the veteran’s personal representa11 tive, successor, dependents, or survivors) shall ensure that

12 the Secretary is promptly notified of any payment received

13 from any third party for emergency treatment furnished to

14 the veteran. The veteran (or the veteran’s personal rep15 resentative, successor, dependents, or survivors) shall imme16 diately forward all documents relating to such payment, co17 operate with the Secretary in the investigation of such pay18 ment, and assist the Secretary in enforcing the United

19 States right to recover any payment made under subsection

20 (c)(3).

21 ‘‘(e) WAIVER.—The Secretary, in the Secretary’s dis22 cretion, may waive recovery of a payment made to a vet23 eran under this section that is otherwise required by sub24 section (d)(1) when the Secretary determines that such
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1 waiver would be in the best interest of the United States,

2 as defined by regulations prescribed by the Secretary.

3 ‘‘(f) DEFINITIONS.—For purposes of this section:

4 ‘‘(1) The term ‘emergency treatment’ means med5 ical care or services furnished, in the judgment of the

6 Secretary—

7 ‘‘(A) when Department or other Federal fa8 cilities are not feasibly available and an attempt

9 to use them beforehand would not be reasonable;

10 ‘‘(B) when such care or services are ren11 dered in a medical emergency of such nature

12 that delay would be hazardous to life or health;

13 and

14 ‘‘(C) until such time as the veteran can be

15 transferred safely to a Department facility or

16 other Federal facility.

17 ‘‘(2) The term ‘health-plan contract’ includes

18 any of the following:

19 ‘‘(A) An insurance policy or contract, med20 ical or hospital service agreement, membership

21 or subscription contract, or similar arrangement

22 under which health services for individuals are

23 provided or the expenses of such services are

24 paid.
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1 ‘‘(B) An insurance program described in

2 section 1811 of the Social Security Act (42

3 U.S.C. 1395c) or established by section 1831 of

4 such Act (42 U.S.C. 1395j).

5 ‘‘(C) A State plan for medical assistance

6 approved under title XIX of such Act (42 U.S.C.

7 1396 et seq.).

8 ‘‘(D) A workers’ compensation law or plan

9 described in section 1729(a)(2)(A) of this title.

10 ‘‘(E) A law of a State or political subdivi11 sion described in section 1729(a)(2)(B) of this

12 title.

13 ‘‘(3) The term ‘third party’ means any of the fol14 lowing:

15 ‘‘(A) A Federal entity.

16 ‘‘(B) A State or political subdivision of a

17 State.

18 ‘‘(C) An employer or an employer’s insur19 ance carrier.

20 ‘‘(D) An automobile accident reparations

21 insurance carrier.

22 ‘‘(E) A person or entity obligated to pro23 vide, or to pay the expenses of, health services

24 under a health-plan contract.’’.
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1 (b) CONFORMING AMENDMENTS.—(1) Section

2 1729A(b) is amended—

3 (A) by redesignating paragraph (6) as para4 graph (7); and

5 (B) by inserting after paragraph (5) the fol6 lowing new paragraph:

7 ‘‘(6) Section 1725 of this title.’’.

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

9 17 is amended by inserting after the item relating to section

10 1724 the following new item:

‘‘1725. Reimbursement for emergency treatment.’’.

11 (c) EFFECTIVE DATE.—The amendments made by this

12 section shall take effect 180 days after the date of the enact13 ment of this Act.

14 (d) IMPLEMENTATION REPORTS.—The Secretary of

15 Veterans Affairs shall include with the budget justification

16 materials submitted to Congress in support of the Depart17 ment of Veterans Affairs budget for fiscal year 2002 and

18 for fiscal year 2003 a report on the implementation of sec19 tion 1725 of title 38, United States Code, as added by sub20 section (a). Each such report shall include information on

21 the experience of the Department under that section and

22 the costs incurred, and expected to be incurred, under that

23 section.
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1 SEC. 103. ELIGIBILITY FOR CARE OF COMBAT-INJURED VET2 ERANS.

3 (a) PRIORITY OF CARE.—Chapter 17 is amended —

4 (1) in section 1710(a)(2)(D), by inserting ‘‘or

5 who was injured in combat’’ after ‘‘former prisoner of

6 war’’; and

7 (2) in section 1705(a)(3), by inserting ‘‘or who

8 were injured in combat’’ after ‘‘former prisoners of

9 war’’.

10 (b) DEFINITION OF INJURED IN COMBAT.—Section

11 1701 is amended by adding at the end the following new

12 paragraph:

13 ‘‘(10) The term ‘injured in combat’ means

14 wounded in action as the result of an act of an enemy

15 of the United States or otherwise wounded in action

16 by weapon fire while directly engaged in armed con17 flict (other than as the result of willful misconduct by

18 the wounded individual).’’.

19 SEC. 104. ACCESS TO CARE FOR MILITARY RETIREES.

20 (a) IMPROVED ACCESS.—(1) Section 1710(a)(2) is

21 amended—

22 (A) by striking ‘‘or’’ at the end of subparagraph

23 (F);

24 (B) by striking the period at the end of subpara25 graph (G) and inserting ‘‘; or’’; and
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1 (C) by adding at the end the following new sub2 paragraph:

3 ‘‘(H) who has retired from active military,

4 naval, or air service in the Army, Navy, Air Force,

5 or Marine Corps, is eligible for care under the

6 TRICARE program established by the Secretary of

7 Defense, and is not otherwise described in paragraph

8 (1) or in this paragraph.’’.

9 (2) Section 1705(a) is amended—

10 (A) by redesignating paragraph (7) as para11 graph (8);

12 (B) by inserting after paragraph (6) the fol13 lowing new paragraph (7):

14 ‘‘(7) Veterans who are eligible for hospital care,

15 medical services, and nursing home care under section

16 1710(a)(2)(H) of this title.’’; and

17 (C) in paragraph (6), by inserting ‘‘(other than

18 subparagraph (H) of such section)’’ before the period

19 at the end.

20 (b) INTERAGENCY AGREEMENT.—(1) The Secretary of

21 Defense shall enter into an agreement (characterized as a

22 memorandum of understanding or otherwise) with the Sec23 retary of Veterans Affairs with respect to the provision of

24 medical care by the Secretary of Veterans Affairs to eligible

25 military retirees in accordance with the amendments made
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1 by subsection (a). That agreement shall include provisions

2 for reimbursement of the Secretary of Veterans Affairs by

3 the Secretary of Defense for medical care provided by the

4 Secretary of Veterans Affairs to an eligible military retiree

5 and may include such other provisions with respect to the

6 terms and conditions of such care as may be agreed upon

7 by the two Secretaries.

8 (2) Reimbursement under that agreement shall be in

9 accordance with rates agreed upon by the Secretary of De10 fense and the Secretary of Veterans Affairs. Such reimburse11 ment may be made by the Secretary of Defense or by the

12 appropriate TRICARE Managed Care Support contractor,

13 as determined in accordance with that agreement.

14 (3) In entering into the agreement under paragraph

15 (1), particularly with respect to determination of the rates

16 of reimbursement under paragraph (2), the Secretary of De17 fense shall consult with TRICARE Managed Care Support

18 contractors.

19 (4) The Secretary of Veterans Affairs may not enter

20 into an agreement under paragraph (1) for the provision

21 of care in accordance with the amendments made by sub22 section (a) with respect to any geographic service area, or

23 a part of any such area, of the Veterans Health Administra24 tion unless—
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1 (A) in the judgment of that Secretary, the De2 partment of Veterans Affairs will recover the costs of

3 providing such care to eligible military retirees; and

4 (B) that Secretary has certified and documented,

5 with respect to any geographic service area in which

6 the Secretary proposes to provide care in accordance

7 with the amendments made by subsection (a), that

8 such geographic service area, or designated part of

9 any such area, has adequate capacity (consistent with

10 the requirements in section 1705(b)(1) of title 38,

11 United States Code, that care to enrollees shall be

12 timely and acceptable in quality) to provide such

13 care.

14 (5) The agreement under paragraph (1) shall be en15 tered into by the Secretaries not later than nine months

16 after the date of the enactment of this Act. If the Secretaries

17 are unable to reach agreement, they shall jointly report, by

18 that date or within 30 days thereafter, to the Committees

19 on Armed Services and the Committees on Veterans’ Affairs

20 of the Senate and House of Representatives on the reasons

21 for their inability to reach an agreement and their mutu22 ally agreed plan for removing any impediments to final

23 agreement.

24 (c) DEPOSITING OF REIMBURSEMENTS.—Amounts re25 ceived by the Secretary of Veterans Affairs under the agree-
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1 ment under subsection (b) shall be deposited in the Depart2 ment of Veterans Affairs Health Services Improvement

3 Fund established under section 1729B of title 38, United

4 States Code, as added by section 202.

5 (d) PHASED IMPLEMENTATION.—(1) The Secretary of

6 Defense shall include in each TRICARE contract entered

7 into after the date of the enactment of this Act provisions

8 to implement the agreement under subsection (b).

9 (2) The amendments made by subsection (a) and the

10 provisions of the agreement under subsection (b)(2) shall

11 apply to the furnishing of medical care by the Secretary

12 of Veterans Affairs in any area of the United States only

13 if that area is covered by a TRICARE contract that was

14 entered into after the date of the enactment of this Act.

15 (e) ELIGIBLE MILITARY RETIREES.—For purposes of

16 subsection (b), an eligible military retiree is a member of

17 the Army, Navy, Air Force, or Marine Corps who—

18 (1) has retired from active military, naval, or

19 air service;

20 (2) is eligible for care under the TRICARE pro21 gram established by the Secretary of Defense;

22 (3) has enrolled for care under section 1705 of

23 title 38, United States Code; and

24 (4) is not described in paragraph (1) or (2) of

25 section 1710(a) of such title (other than subparagraph
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1 (H) of such paragraph (2)), as amended by subsection

2 (a).

3 SEC. 105. BENEFITS FOR PERSONS DISABLED BY PARTICI4 PATION IN COMPENSATED WORK THERAPY

5 PROGRAM.

6 Section 1151(a)(2) is amended—

7 (1) by inserting ‘‘(A)’’ after ‘‘proximately

8 caused’’; and

9 (2) by inserting before the period at the end the

10 following: ‘‘, or (B) by participation in a program

11 (known as a ‘compensated work therapy program’)

12 under section 1718 of this title’’.

13 SEC. 106. PILOT PROGRAM OF MEDICAL CARE FOR CERTAIN

14 DEPENDENTS OF ENROLLED VETERANS.

15 (a) IN GENERAL.—(1) Chapter 17 is amended by in16 serting after section 1713 the following new section:

17 ‘‘§ 1713A. Medical care for certain dependents of en18 rolled veterans: pilot program

19 ‘‘(a) The Secretary may, during the program period,

20 carry out a pilot program to provide primary health care

21 services for eligible dependents of veterans in accordance

22 with this section.

23 ‘‘(b) For purposes of this section:

24 ‘‘(1) The term ‘program period’ means the period

25 beginning on the first day of the first month begin-
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1 ning more than 180 days after the date of the enact2 ment of this section and ending three years after that

3 day.

4 ‘‘(2) The term ‘eligible dependent’ means an in5 dividual who—

6 ‘‘(A) is the spouse or child of a veteran who

7 is enrolled in the system of patient enrollment es8 tablished by the Secretary under section 1705 of

9 this title; and

10 ‘‘(B) is determined by the Secretary to have

11 the ability to pay for such care or services either

12 directly or through reimbursement or indem13 nification from a third party.

14 ‘‘(c) The Secretary may furnish health care services to

15 an eligible dependent under this section only if the depend16 ent (or, in the case of a minor, the parent or guardian of

17 the dependent) agrees—

18 ‘‘(1) to pay to the United States an amount rep19 resenting the reasonable charges for the care or serv20 ices furnished (as determined by the Secretary); and

21 ‘‘(2) to cooperate with and provide the Secretary

22 an appropriate assignment of benefits, authorization

23 to release medical records, and any other executed

24 documents, information, or evidence reasonably need25 ed by the Secretary to recover the Department’s
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1 charges for the care or services furnished by the Sec2 retary.

3 ‘‘(d)(1) The health care services provided under the

4 pilot program under this section may consist of such pri5 mary hospital care services and such primary medical serv6 ices as may be authorized by the Secretary. The Secretary

7 may furnish those services directly through a Department

8 medical facility or, subject to paragraphs (2) and (3), pur9 suant to a contract or other agreement with a non-Depart10 ment facility (including a health-care provider, as defined

11 in section 8152(2) of this title).

12 ‘‘(2) The Secretary may enter into a contract or agree13 ment to furnish primary health care services under this sec14 tion in a non-Department facility on the same basis as pro15 vided under subsections (a) and (b) of section 1703 of this

16 title or may include such care in an existing or new agree17 ment under section 8153 of this title when the Secretary

18 determines it to be in the best interest of the prevailing

19 standards of the Department medical care program.

20 ‘‘(3) Primary health care services may not be author21 ized to be furnished under this section at any medical facil22 ity if the furnishing of those services would result in the

23 denial of, or a delay in providing, access to care for any

24 enrolled veteran at that facility.
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1 ‘‘(e)(1) In the case of an eligible dependent who is fur2 nished primary health care services under this section and

3 who has coverage under a health-plan contract, as defined

4 in section 1729(i)(1) of this title, the United States shall

5 have the right to recover or collect the reasonable charges

6 for such care or services from such health-plan contract to

7 the extent that the individual or the provider of the care

8 or services would be eligible to receive payment for such care

9 or services from such health-plan contract if the care or

10 services had not been furnished by a department or agency

11 of the United States.

12 ‘‘(2) The right of the United States to recover under

13 paragraph (1) shall be enforceable with respect to an eligible

14 dependent in the same manner as applies under subsections

15 (a)(3), (b), (c)(1), (c)(2), (d), (f), (h), and (i) of section 1729

16 of this title with respect to a veteran.

17 ‘‘(f)(1) Subject to paragraphs (2) and (3), the pilot

18 program under this section shall be carried out during the

19 program period in not more than four veterans integrated

20 service networks, as designated by the Secretary. In desig21 nating networks under the preceding sentence, the Secretary

22 shall favor designation of networks that are suited to serve

23 dependents of veterans because of—

24 ‘‘(A) the capability of one or more medical facili25 ties within the network to furnish primary health
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1 care services to eligible dependents while assuring that

2 veterans continue to receive priority for care and

3 services;

4 ‘‘(B) the demonstrated success of such medical fa5 cilities in billings and collections;

6 ‘‘(C) support for initiating such a pilot program

7 among veterans in the network; and

8 ‘‘(D) such other criteria as the Secretary con9 siders appropriate.

10 ‘‘(2) In implementing the pilot program, the Secretary

11 may not provide health care services for dependents who

12 are children—

13 ‘‘(A) in more than one of the participating net14 works during the first year of the program period;

15 and

16 ‘‘(B) in more than two of the participating net17 works during the second year of the program period.

18 ‘‘(3) In implementing the pilot program, the Secretary

19 shall give priority to facilities which operate women vet20 erans’ clinics.’’.

21 (2) The table of sections at the beginning of such chap22 ter is amended by inserting after the item relating to section

23 1713 the following new item:

‘‘1713A. Medical care for certain dependents and enrolled veterans: pilot program.’’.
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1 (b) GAO REVIEW AND RECOMMENDATIONS.—(1) Be2 ginning six months after the commencement of the pilot

3 program, the Comptroller General, in consultation with the

4 Under Secretary for Health of the Department of Veterans

5 Affairs, shall monitor the conduct of the pilot program.

6 (2) Not later than 14 months after the commencement

7 of the pilot program, the Comptroller General shall submit

8 to the Secretary of Veterans Affairs a report setting forth

9 the Comptroller General’s findings and recommendations

10 with respect to the first 12 months of operation of the pilot

11 program.

12 (3)(A) The report under paragraph (2) shall include

13 the findings of the Comptroller General regarding—

14 (i) whether the collection of reasonable charges

15 for the care or services provided reasonably covers the

16 costs of providing such care and services; and

17 (ii) whether the Secretary, in carrying out the

18 program, is in compliance with the limitation in sub19 section (d)(3) of section 1713A of title 38, United

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

21 (B) The report shall include the recommendations of

22 the Comptroller General regarding any remedial steps that

23 the Secretary should take in the conduct of the program

24 or in the billing and collection of charges under the pro25 gram.
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1 (4) The Secretary, in consultation with, and following

2 receipt of the report of, the Comptroller General, shall take

3 such steps as may be needed to ensure that any rec4 ommendations of the Comptroller General in the report

5 under paragraph (2) with respect to billings and collections,

6 and with respect to compliance with the limitation in sub7 section (d)(3) of such section, are carried out.

8 (5) For purposes of this subsection, the term ‘‘com9 mencement of the pilot program’’ means the date on which

10 the Secretary of Veterans Affairs begins to furnish services

11 to eligible dependents under the pilot program under section

12 1713A of title 38, United States Code, as added by sub13 section (a).

14 SEC. 107. ENHANCED SERVICES PROGRAM AT DESIGNATED

15 MEDICAL CENTERS.

16 (a) FINDINGS.—Congress makes the following findings:

17 (1) Historically, health care facilities under the

18 jurisdiction of the Department of Veterans Affairs

19 have not consistently been located in proximity to vet20 eran population concentrations.

21 (2) Hospital occupancy rates at numbers of De22 partment medical centers are at levels substantially

23 below a level needed for efficient operation and opti24 mal quality of care.
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1 (3) The costs of maintaining highly inefficient

2 medical centers, which were designed and constructed

3 decades ago to standards no longer considered accept4 able, substantially diminish the availability of re5 sources which could be devoted to the provision of

6 needed direct care services.

7 (4) Freeing resources currently devoted to highly

8 inefficient provision of hospital care could, through

9 contracting for acute hospital care and establishing

10 new facilities for provision of outpatient care, yield

11 improved access and service to veterans.

12 (b) ENHANCED SERVICES PROGRAM AT DESIGNATED

13 MEDICAL CENTERS.—The Secretary of Veterans Affairs, in

14 carrying out the responsibilities of the Secretary to furnish

15 hospital care and medical services through network-based

16 planning, shall establish an enhanced service program at

17 Department medical centers (hereinafter in this section re18 ferred to as ‘‘designated centers’’) that are designated by

19 the Secretary for the purposes of this section. Medical cen20 ters shall be designated to improve access, and quality of

21 service provided, to veterans served by those medical centers.

22 The Secretary may designate a medical center for the pro23 gram only if the Secretary determines, on the basis of a

24 market and data analysis (which shall include a study of
30

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1 the cost-effectiveness of the care provided at such center),

2 that the medical center—

3 (1) can, in whole or in part, no longer be oper4 ated in a manner that provides hospital or other care

5 efficiently and at optimal quality because of such fac6 tors as—

7 (A) the current and projected need for hos8 pital or other care capacity at such center;

9 (B) the extent to which the facility is func10 tionally obsolete; and

11 (C) the cost of operation and maintenance

12 of the physical plant; and

13 (2) is located in proximity (A) to one or more

14 community hospitals which have the capacity to pro15 vide primary and secondary hospital care of appro16 priate quality to veterans under contract arrange17 ments with the Secretary which the Secretary deter18 mines are advantageous to the Department, or (B) to

19 another Department medical center which is capable

20 of absorbing some or all of the patient workload of

21 such medical center.

22 (c) MEDICAL CENTER PLAN.—The Secretary shall,

23 with respect to each designated center, develop a plan aimed

24 at improving the accessibility and quality of service pro25 vided to veterans. Each plan shall be developed in accord-
31

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1 ance with the requirements for strategic network-based

2 planning described in section 8107 of title 38, United States

3 Code. In the plan for a designated center, the Secretary

4 shall describe a program which, if implemented, would

5 allow the Secretary to do any of the following:

6 (1) Provide for a Department facility described

7 in subsection (b)(2)(B) to absorb some or all of the

8 patient workload of the designated center.

9 (2) Contract, under such arrangements as the

10 Secretary determines appropriate, for needed primary

11 and secondary hospital care for veterans—

12 (A) who reside in the catchment area of

13 each designated center;

14 (B) who are described in paragraphs (1)

15 through (6) of section 1705(a) of title 38, United

16 States Code; and

17 (C) whom the Secretary has enrolled for

18 care pursuant to section 1705 of title 38, United

19 States Code.

20 (3) Cease to provide hospital care, or hospital

21 care and other medical services, at such center.

22 (4) If practicable, lease, under subchapter V of

23 chapter 81 of title 38, United States Code, land and

24 improvements which had been dedicated to providing

25 care described in paragraph (3).
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1 (5) Establish, through reallocation of operational

2 funds and through appropriate lease arrangements or

3 renovations, facilities for—

4 (A) delivery of outpatient care; and

5 (B) services which would obviate a need for

6 nursing home care or other long-term institu7 tional care.

8 (d) EMPLOYEE PROTECTIONS.—(1) In entering into

9 any contract or lease under subsection (c), the Secretary

10 shall attempt to ensure that employees of the Secretary who

11 would be displaced under this section be given priority in

12 hiring by such contractor, lessee, or other entity.

13 (2) In carrying out subsection (c)(5), the Secretary

14 shall give preference to providing services through employee15 based delivery models.

16 (e) REQUIRED CONSULTATION.—In developing a plan

17 under subsection (c), the Secretary shall obtain the views

18 of veterans organizations, exclusive employee representa19 tives, and other interested parties and provide for such or20 ganizations and parties to participate in the development

21 of the plan.

22 (f) SUBMISSION OF PLAN TO CONGRESS.—The Sec23 retary may not implement a plan described in subsection

24 (c) with respect to a medical center unless the Secretary

25 has first submitted a report containing a detailed plan and
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1 justification to the appropriate committees of Congress. No

2 action to carry out such plan may be taken after the sub3 mission of such report until the end of a 45-day period fol4 lowing the date of the submission of the report, not less than

5 30 days of which shall be days during which Congress shall

6 have been in continuous session. For purposes of the pre7 ceding sentence, continuity of a session of Congress is bro8 ken only by adjournment sine die, and there shall be ex9 cluded from the computation of any period of continuity

10 of session any day during which either House of Congress

11 is not in session during an adjournment of more than three

12 days to a day certain.

13 (g) IMPLEMENTATION OF PLAN.—In carrying out the

14 plan described in subsection (c), or a modification to that

15 plan following the submission of such plan to the appro16 priate committees of Congress, the Secretary—

17 (1) may, without regard to any limitation under

18 section 1703 of title 38, United States Code, contract

19 for hospital care for veterans who are—

20 (A) described in paragraphs (1) through (6)

21 of section 1705(a) of title 38, United States Code;

22 and

23 (B) enrolled under subsection (a) of such

24 section 1705;
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1 (2) may enter into any contract under section

2 8153 of title 38, United States Code;

3 (3) shall, in exercising the authority of the Sec4 retary under this section to contract for hospital care,

5 provide for ongoing oversight and management, by

6 employees of the Department, of the hospital care fur7 nished such veterans; and

8 (4) shall, in the case of a designated center which

9 ceases to provide services under the program—

10 (A) ensure a reallocation of funds as pro11 vided in subsection (h); and

12 (B) provide reemployment assistance to em13 ployees.

14 (h) FUNDS ALLOCATION.—In carrying out subsection

15 (g)(4), the Secretary shall ensure that not less than 90 per16 cent of the funds that would have been made available to

17 a designated center to support the provision of services, but

18 for such mission change, shall be made available to the ap19 propriate health care region of the Veterans Health Admin20 istration to ensure that the implementation of the plan

21 under subsection (g) will result in demonstrable improve22 ment in the accessibility, and quality of service provided,

23 to veterans in the catchment area of such center.
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1 (i) SPECIALIZED SERVICES.—The provisions of this

2 section do not diminish the obligations of the Secretary

3 under section 1706(b) of title 38, United States Code.

4 (j) REPORT.—Not later than 12 months after imple5 mentation of any plan under subsection (b), the Secretary

6 shall submit to Congress a report on the implementation

7 of the enhanced service program.

8 (k) RESIDUAL AUTHORITY.—Nothing in this section

9 may be construed to diminish the authority of the Secretary

10 to—

11 (1) consolidate, eliminate, abolish, or redistribute

12 the functions or missions of facilities in the Depart13 ment;

14 (2) revise the functions or missions of any such

15 facility or activity; or

16 (3) create new facilities or activities in the De17 partment.

18 SEC. 108. COUNSELING AND TREATMENT FOR VETERANS

19 WHO HAVE EXPERIENCED SEXUAL TRAUMA.

20 (a) EXTENSION OF PERIOD OF PROGRAM.—Subsection

21 (a) of section 1720D is amended—

22 (1) in paragraph (1), by striking ‘‘December 31,

23 2001’’ and inserting ‘‘December 31, 2002’’; and

24 (2) in paragraph (3), by striking ‘‘December 31,

25 2001’’ and inserting ‘‘December 31, 2002’’.
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1 (b) MANDATORY NATURE OF PROGRAM.—(1) Sub2 section (a)(1) of such section is further amended by striking

3 ‘‘may provide counseling to a veteran who the Secretary

4 determines requires such counseling’’ and inserting ‘‘shall

5 operate a program under which the Secretary provides

6 counseling and appropriate care and services to veterans

7 who the Secretary determines require such counseling and

8 care and services’’.

9 (2) Subsection (a) of such section is further amended—

10 (A) by striking paragraph (2); and

11 (B) by redesignating paragraph (3) (as amended

12 by subsection (a)(2)) as paragraph (2).

13 (c) OUTREACH EFFORTS.—Subsection (c) of such sec14 tion is amended—

15 (1) by inserting ‘‘and treatment’’ in the first sen16 tence and in paragraph (2) after ‘‘counseling’’;

17 (2) by striking ‘‘and’’ at the end of paragraph

18 (1);

19 (3) by redesignating paragraph (2) as para20 graph (3); and

21 (4) by inserting after paragraph (1) the fol22 lowing new paragraph (2):

23 ‘‘(2) shall ensure that information about the

24 counseling and treatment available to veterans under

25 this section—
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1 ‘‘(A) is revised and updated as appropriate;

2 ‘‘(B) is made available and visibly posted

3 at appropriate facilities of the Department; and

4 ‘‘(C) is made available through appropriate

5 public information services; and’’.

6 (d) REPORT ON IMPLEMENTATION OF OUTREACH AC7 TIVITIES.—Not later than six months after the date of the

8 enactment of this Act, the Secretary of Veterans Affairs

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

10 Senate and House of Representatives a report on the Sec11 retary’s implementation of paragraph (2) of section

12 1720D(c) of title 38, United States Code, as added by sub13 section (c). Such report shall include examples of the docu14 ments and other means of communication developed for

15 compliance with that paragraph.

16 (e) STUDY OF EXPANDING ELIGIBILITY FOR COUN17 SELING AND TREATMENT.—(1) The Secretary of Veterans

18 Affairs, in consultation with the Secretary of Defense, shall

19 conduct a study to determine—

20 (A) the extent to which former members of the re21 serve components of the Armed Forces experienced

22 physical assault of a sexual nature or battery of a

23 sexual nature while serving on active duty for train24 ing;
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1 (B) the extent to which such former members

2 have sought counseling from the Department of Vet3 erans Affairs relating to those incidents; and

4 (C) the additional resources that, in the judg5 ment of the Secretary, would be required to meet the

6 projected need of those former members for such coun7 seling.

8 (2) Not later than 16 months after the date of the en9 actment of this Act, the Secretary of Veterans Affairs shall

10 submit to the Committees on Veterans’ Affairs of the Senate

11 and House of Representatives a report on the results of the

12 study conducted under paragraph (1).

13 (f) OVERSIGHT OF OUTREACH ACTIVITIES.—Not later

14 than 14 months after the date of the enactment of this Act,

15 the Secretary of Veterans Affairs and the Secretary of De16 fense shall submit to the appropriate congressional commit17 tees a joint report describing in detail the collaborative ef18 forts of the Department of Veterans Affairs and the Depart19 ment of Defense to ensure that members of the Armed

20 Forces, upon separation from active military, naval, or air

21 service, are provided appropriate and current information

22 about programs of the Department of Veterans Affairs to

23 provide counseling and treatment for sexual trauma that

24 may have been experienced by those members while in the

25 active military, naval, or air service, including information
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1 about eligibility requirements for, and procedures for ap2 plying for, such counseling and treatment. The report shall

3 include proposed recommendations from both the Secretary

4 of Veterans Affairs and the Secretary of Defense for the im5 provement of their collaborative efforts to provide such in6 formation.

7 (g) REPORT ON IMPLEMENTATION OF SEXUAL TRAUMA

8 TREATMENT PROGRAM.—Not later than 14 months after the

9 date of the enactment of this Act, the Secretary of Veterans

10 Affairs shall submit to the Committees on Veterans’ Affairs

11 of the Senate and House of Representatives a report on the

12 use made of the authority provided under section 1720D

13 of title 38, United States Code, as amended by this section.

14 The report shall include the following with respect to activi15 ties under that section since the enactment of this Act:

16 (1) The number of veterans who have received

17 counseling under that section.

18 (2) The number of veterans who have been re19 ferred to non-Department mental health facilities and

20 providers in connection with sexual trauma coun21 seling and treatment.
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1 TITLE II—PROGRAM

2 ADMINISTRATION

3 SEC. 201. MEDICAL CARE COLLECTIONS.

4 (a) LIMITED AUTHORITY TO SET COPAYMENTS.—(1)

5 Section 1722A is amended—

6 (A) by redesignating subsections (b) and (c) as

7 subsections (c) and (d), respectively;

8 (B) by inserting after subsection (a) the fol9 lowing new subsection (b):

10 ‘‘(b) The Secretary, pursuant to regulations which the

11 Secretary shall prescribe, may—

12 ‘‘(1) increase the copayment amount in effect

13 under subsection (a);

14 ‘‘(2) establish a maximum annual pharma15 ceutical copayment amount under subsection (a) for

16 veterans who have multiple outpatient prescriptions;

17 and

18 ‘‘(3) require a veteran, other than a veteran de19 scribed in subsection (a)(3), to pay to the United

20 States a reasonable copayment for sensori-neural

21 aids, electronic equipment, and any other costly item

22 or equipment furnished the veteran for a nonservice23 connected condition, other than a wheelchair or artifi24 cial limb.’’; and
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1 (C) in subsection (c), as redesignated by sub2 paragraph (A)—

3 (i) by striking ‘‘this section’’ and inserting

4 ‘‘subsection (a)’’; and

5 (ii) by adding at the end the following new

6 sentence: ‘‘Amounts collected through use of the

7 authority under subsection (b) shall be deposited

8 in Department of Veterans Affairs Health Serv9 ices Improvement Fund.’’.

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

11 as follows:

12 ‘‘§ 1722A. Copayments for medications and certain

13 costly items and equipment’’.

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

15 sections at the beginning of chapter 17 is amended to read

16 as follows:

‘‘1722A. Copayments for medications and certain costly items and equipment.’’.

17 (b) OUTPATIENT TREATMENT OF CATEGORY C VET18 ERANS.—(1) Section 1710(g) is amended—

19 (A) in paragraph (1), by striking ‘‘the amount

20 under paragraph (2) of this subsection’’ and inserting

21 ‘‘in the case of each outpatient visit the applicable

22 amount or amounts established by the Secretary by

23 regulation’’; and
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1 (B) in paragraph (2), by striking all after ‘‘for

2 an amount’’ and inserting ‘‘which the Secretary shall

3 establish by regulation.’’.

4 SEC. 202. HEALTH SERVICES IMPROVEMENT FUND.

5 (a) ESTABLISHMENT OF FUND.—Chapter 17 is

6 amended by inserting after section 1729A the following new

7 section:

8 ‘‘§ 1729B. Health Services Improvement Fund

9 ‘‘(a) There is established in the Treasury of the United

10 States a fund to be known as the ‘Department of Veterans

11 Affairs Health Services Improvement Fund’.

12 ‘‘(b) Amounts received or collected after the date of the

13 enactment of this section under any of the following provi14 sions of law shall be deposited in the fund:

15 ‘‘(1) Section 1713A of this title.

16 ‘‘(2) Section 1722A(b) of this title.

17 ‘‘(3) Section 8165(a) of this title.

18 ‘‘(4) Section 104(c) of the Veterans’ Millennium

19 Health Care Act.

20 ‘‘(c) Amounts in the fund are hereby available, without

21 fiscal year limitation, to the Secretary for the purposes stat22 ed in subparagraphs (A) and (B) of section 1729A(c)(1)

23 of this title.’’.
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1 (b) CLERICAL AMENDMENT.—The table of sections at

2 the beginning of such chapter is amended by inserting after

3 the item relating to section 1729A the following new item:

‘‘1729B. Health Services Improvement Fund.’’.

4 SEC. 203. VETERANS TOBACCO TRUST FUND.

5 (a) FINDINGS.—Congress finds the following:

6 (1) Smoking related illnesses, including cancer,

7 heart disease, and emphysema, are highly prevalent

8 among the more than 3,000,000 veterans who use the

9 Department of Veterans Affairs health care system

10 annually.

11 (2) The Department of Veterans Affairs estimates

12 that it spent $3,600,000,000 in 1997 to treat smok13 ing-related illnesses and that over the next five years

14 it will spend $20,000,000,000 on such care.

15 (3) Congress established the Department of Vet16 erans Affairs in furtherance of its constitutional

17 power to provide for the national defense in order to

18 provide benefits and services to veterans of the uni19 formed services.

20 (4) There is in the Department of Veterans Af21 fairs a health care system which has as its primary

22 function to provide a complete medical and hospital

23 service for the medical care and treatment of such vet24 erans as can be served through available appropria25 tions.
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1 (5) The Federal Government, including the De2 partment of Veterans Affairs, has lacked the means to

3 prevent the onset of smoking-related illnesses among

4 veterans and has had no authority to deny needed

5 treatment to any veteran on the basis that an illness

6 is or might be smoking-related.

7 (6) With some 20 percent of its health care budg8 et absorbed in treating smoking-related illnesses, the

9 Department of Veterans Affairs health care system

10 has lacked resources to provide needed nursing home

11 care, home care, community-based ambulatory care,

12 and other services to tens of thousands of other vet13 erans.

14 (7) The network of academically affiliated med15 ical centers of the Department of Veterans Affairs

16 provides a unique system within which outstanding

17 medical research is conducted and which has the po18 tential to expand significantly ongoing research on

19 tobacco-related illnesses.

20 (8) It is in the public interest for Congress to

21 enact legislation requiring that a portion of any

22 amounts received from manufacturers of tobacco prod23 ucts be used to meet the costs of (A) treatment for dis24 eases and adverse health effects associated with the use

25 of tobacco products by those who served their country
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1 in uniform, and (B) medical and health services re2 search relating to prevention and treatment of, and

3 rehabilitation from, tobacco addiction and diseases

4 associated with tobacco use.

5 (b) ESTABLISHMENT OF TRUST FUND.—(1) Chapter

6 17 is amended by inserting after section 1729B, as added

7 by section 202(a), the following new section:

8 ‘‘§ 1729C. Veterans Tobacco Trust Fund

9 ‘‘(a) There is established in the Treasury of the United

10 States a trust fund to be known as the ‘Veterans Tobacco

11 Trust Fund’, consisting of such amounts as may be appro12 priated, credited, or donated to the trust fund.

13 ‘‘(b) If a lawsuit is brought by the United States

14 against the tobacco manufacturers seeking recovery of costs

15 incurred or to be incurred by the United States that are

16 attributable to tobacco-related illnesses, there shall be cred17 ited to the trust fund from any amount recovered by the

18 United States pursuant to that lawsuit, without further ap19 propriation, the amount that bears the same ratio to the

20 amount recovered as the amount of the Department’s costs

21 for health care attributable to tobacco-related illnesses for

22 which recovery is sought in the suit bears to the total

23 amount sought by the United States in the suit.
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1 ‘‘(c) After September 30, 2004, amounts in the trust

2 fund shall be available, without fiscal year limitation, to

3 the Secretary of Veterans Affairs for the following purposes:

4 ‘‘(1) Furnishing medical care and services under

5 this chapter, to be available during any fiscal year for

6 the same purposes and subject to the same limitations

7 (other than with respect to the period of availability

8 for obligation) as apply to amounts appropriated

9 from the general fund of the Treasury for that fiscal

10 year for medical care.

11 ‘‘(2) Conducting medical research, rehabilitation

12 research, and health systems research, with particular

13 emphasis on research relating to prevention and

14 treatment of, and rehabilitation from, tobacco addic15 tion and diseases associated with tobacco use.’’.

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

18 1729B, as added by section 202(b), the following new item:

‘‘1729C. Veterans Tobacco Trust Fund.’’.

19 SEC. 204. AUTHORITY TO ACCEPT FUNDS FOR EDUCATION

20 AND TRAINING.

21 (a) ESTABLISHMENT OF NONPROFIT CORPORATIONS

22 AT MEDICAL CENTERS.—Section 7361(a) is amended—

23 (1) by inserting ‘‘and education’’ after ‘‘re24 search’’;
47

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1 (2) by adding at the end the following: ‘‘Such a

2 corporation may be established to facilitate either re3 search or education or both research and education.’’.

4 (b) PURPOSE OF CORPORATIONS.—Section 7362 is

5 amended—

6 (1) in the first sentence, by inserting ‘‘and edu7 cation and training as described in sections 7302,

8 7471, 8154, and 1701(6)(B) of this title’’ after ‘‘of

9 this title’’; and

10 (2) in the second sentence—

11 (A) by inserting ‘‘or education’’ after ‘‘re12 search’’; and

13 (B) by striking ‘‘that purpose’’ and insert14 ing ‘‘these purposes’’.

15 (c) BOARD OF DIRECTORS.—Section 7363(a) is

16 amended—

17 (1) in subsection (a)(1), by striking all after

18 ‘‘medical center, and’’ and inserting ‘‘as appropriate,

19 the assistant chief of staff for research for the medical

20 center and the associate chief of staff for education for

21 the medical center, or, in the case of a facility at

22 which such positions do not exist, those officials who

23 are responsible for carrying out the responsibilities of

24 the medical center director, chief of staff, and, as ap-
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1 propriate, the assistant chief of staff for research and

2 the assistant chief for education; and’’;

3 (2) in subsection (a)(2), by inserting ‘‘or edu4 cation, as appropriate’’ after ‘‘research’’; and

5 (3) in subsection (c), by inserting ‘‘or education’’

6 after ‘‘research’’.

7 (d) APPROVAL OF EXPENDITURES.—Section 7364 is

8 amended by adding at the end the following new subsection:

9 ‘‘(c)(1) A corporation established under this subchapter

10 may not spend funds for an education activity unless the

11 activity is approved in accordance with procedures pre12 scribed by the Under Secretary for Health.

13 ‘‘(2) The Under Secretary for Health shall prescribe

14 policies and procedures to guide the expenditure of funds

15 by corporations under paragraph (1) consistent with the

16 purpose of such corporations as flexible funding mecha17 nisms.’’.

18 SEC. 205. EXTENSION AND REVISION OF CERTAIN AUTHORI19 TIES.

20 (a) READJUSTMENT COUNSELING PROGRAM.—Section

21 1712A(a)(1)(B)(ii) is amended by striking ‘‘2000’’ and in22 serting ‘‘2003’’.

23 (b) COMMITTEE ON MENTALLY ILL VETERANS.—Sec24 tion 7321(d)(2) is amended by striking ‘‘three’’ and insert25 ing ‘‘five’’.
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1 (c) COMMITTEE ON POST-TRAUMATIC STRESS DIS2 ORDER.—Section 110 of Public Law 98–528 (38 U.S.C.

3 1712A note) is amended—

4 (1) in subsection (e)(1), by striking ‘‘March 1,

5 1985’’ and inserting ‘‘March 1, 2000’’; and

6 (2) in subsection (e)(2), by striking ‘‘February 1,

7 1986’’ and inserting ‘‘February 1, 2001’’.

8 (d) EXTENSION OF AUTHORITY TO MAKE GRANTS.—

9 Section 3(a)(2) of the Homeless Veterans Comprehensive

10 Service Programs Act of 1992 (38 U.S.C. 7721 note) is

11 amended by striking ‘‘September 30, 1999’’ and inserting

12 ‘‘September 30, 2002’’.

13 (e) AUTHORITY TO MAKE GRANTS FOR HOMELESS

14 VETERANS.—Section 3(b)(2) of the Homeless Veterans Com15 prehensive Service Programs Act of 1992 (38 U.S.C. 7721

16 note) is amended by striking ‘‘and no more than 20 pro17 grams which incorporate the procurement of vans as de18 scribed in paragraph (1)’’.

19 SEC. 206. STATE HOME GRANT PROGRAM.

20 (a) GENERAL REGULATIONS.—Section 8134 is

21 amended—

22 (1) by redesignating subsection (b) as subsection

23 (c);

24 (2) by striking the matter in subsection (a) pre25 ceding paragraph (2) and inserting the following:
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1 ‘‘(a)(1) The Secretary shall prescribe regulations for

2 the purposes of this subchapter.

3 ‘‘(2) In those regulations, the Secretary shall prescribe

4 for each State the number of nursing home and domiciliary

5 beds for which assistance under this subchapter may be fur6 nished. Such regulations shall be based on projected demand

7 for such care 10 years after the date of the enactment of

8 the Veterans Millennium Health Care Act by veterans who

9 at such time are 65 years of age or older and who reside

10 in that State. In determining such projected demand, the

11 Secretary shall take into account travel distances for vet12 erans and their families.

13 ‘‘(3)(A) In those regulations, the Secretary shall estab14 lish criteria under which the Secretary shall determine,

15 with respect to an application for assistance under this sub16 chapter for a project described in subparagraph (B) which

17 is from a State that has a need for additional beds as deter18 mined under subsections (a)(2) and (d)(1), whether the need

19 for such beds is most aptly characterized as great, signifi20 cant, or limited. Such criteria shall take into account the

21 availability of beds already operated by the Secretary and

22 other providers which appropriately serve the needs which

23 the State proposes to meet with its application.

24 ‘‘(B) This paragraph applies to a project for the con25 struction or acquisition of a new State home facility, to
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1 a project to increase the number of beds available at a State

2 home facility, and a project to replace beds at a State home

3 facility.

4 ‘‘(4) The Secretary shall review and, as necessary, re5 vise regulations prescribed under paragraphs (2) and (3)

6 not less often than every four years.

7 ‘‘(b) The Secretary shall prescribe the following by reg8 ulation:’’;

9 (3) by redesignating paragraphs (2) and (3) of

10 subsection (b), as designated by paragraph (2), as

11 paragraphs (1) and (2);

12 (4) in subsection (c), as redesignated by para13 graph (1), by striking ‘‘subsection (a)(3)’’ and insert14 ing ‘‘subsection (b)(2)’’; and

15 (5) by adding at the end the following new sub16 section:

17 ‘‘(d)(1) In prescribing regulations to carry out this

18 subchapter, the Secretary shall provide that in the case of

19 a State that seeks assistance under this subchapter for a

20 project described in subsection (a)(3)(B), the determination

21 of the unmet need for beds for State homes in that State

22 shall be reduced by the number of beds in all previous appli23 cations submitted by that State under this subchapter, in24 cluding beds which have not been recognized by the Sec25 retary under section 1741 of this title.
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1 ‘‘(2)(A) Financial assistance under this subchapter for

2 a renovation project may only be provided for a project for

3 which the total cost of construction is in excess of $400,000

4 (as adjusted from time to time in such regulations to reflect

5 changes in costs of construction).

6 ‘‘(B) For purposes of this paragraph, a renovation

7 project is a project to remodel or alter existing buildings

8 for which financial assistance under this subchapter may

9 be provided and does not include maintenance and repair

10 work which is the responsibility of the State.’’.

11 (b) APPLICATIONS WITH RESPECT TO PROJECTS.—

12 Section 8135 is amended—

13 (1) in subsection (a)—

14 (A) by striking ‘‘set forth—’’ in the matter

15 preceding paragraph (1) and inserting ‘‘set forth

16 the following:’’;

17 (B) by capitalizing the first letter of the

18 first word in each of paragraphs (1) through (9);

19 (C) by striking the comma at the end of

20 each of paragraphs (1) through (7) and inserting

21 a period; and

22 (D) by striking ‘‘, and’’ at the end of para23 graph (8) and inserting a period;

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

25 (e) as subsections (c), (d), (e), and (f), respectively;
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1 (3) by inserting after subsection (a) the following

2 new subsection (b):

3 ‘‘(b)(1) Any State seeking to receive assistance under

4 this subchapter for a project that would involve construction

5 or acquisition of either nursing home or domiciliary facili6 ties shall include with its application under subsection (a)

7 the following:

8 ‘‘(A) Documentation (i) that the site for the

9 project is in reasonable proximity to a sufficient con10 centration and population of veterans who are 65

11 years of age and older, and (ii) that there is a reason12 able basis to conclude that the facilities when complete

13 will be fully occupied.

14 ‘‘(B) A financial plan for the first three years of

15 operation of such facilities.

16 ‘‘(C) A five-year capital plan for the State home

17 program for that State.

18 ‘‘(2) Failure to provide adequate documentation under

19 paragraph (1)(A) or to provide an adequate financial plan

20 under paragraph (1)(B) shall be a basis for disapproving

21 the application.’’;

22 (4) in subsection (c), as redesignated by para23 graph (2)—

24 (A) in paragraph (1), by striking ‘‘for a

25 grant under subsection (a) of this section’’ in the
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1 matter preceding subparagraph (A) and insert2 ing ‘‘under subsection (a) for financial assistance

3 under this subchapter’’;

4 (B) in paragraph (2)—

5 (i) by striking ‘‘the construction or ac6 quisition of’’ in subparagraph (A); and

7 (ii) by striking subparagraphs (B),

8 (C), and (D) and inserting the following:

9 ‘‘(B) An application from a State for a project

10 at an existing facility to remedy a condition or con11 ditions that have been cited by an accrediting institu12 tion, by the Secretary, or by a local licensing or ap13 proving body of the State as being threatening to the

14 lives or safety of the patients in the facility.

15 ‘‘(C) An application from a State that has not

16 previously applied for award of a grant under this

17 subchapter for construction or acquisition of a State

18 nursing home.

19 ‘‘(D) An application for construction or acquisi20 tion of a nursing home or domiciliary from a State

21 that the Secretary determines, in accordance with reg22 ulations under this subchapter, has a great need for

23 the beds to be established at such home or facility.
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1 ‘‘(E) An application from a State for renova2 tions to a State home facility other than renovations

3 described in subparagraph (B).

4 ‘‘(F) An application for construction or acquisi5 tion of a nursing home or domiciliary from a State

6 that the Secretary determines, in accordance with reg7 ulations under this subchapter, has a significant need

8 for the beds to be established at such home or facility.

9 ‘‘(G) An application that meets other criteria as

10 the Secretary determines appropriate and has estab11 lished in regulations.

12 ‘‘(H) An application for construction or acquisi13 tion of a nursing home or domiciliary from a State

14 that the Secretary determines, in accordance with reg15 ulations under this subchapter, has a limited need for

16 the beds to be established at such home or facility.’’;

17 and

18 (C) in paragraph (3), by striking subpara19 graph (A) and inserting the following:

20 ‘‘(A) may not accord any priority to a project

21 for the construction or acquisition of a hospital; and’’.

22 (c) TRANSITION.—The provisions of sections 8134 and

23 8135 of title 38, United States Code, as in effect on June

24 1, 1999, shall continue in effect after such date with respect

25 to applications described in section 8135(b)(2)(A) of such
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1 title, as in effect on that date, that are identified on the

2 list that (1) is described in section 8135(b)(4) of such title,

3 as in effect on that date, and (2) was established by the

4 Secretary of Veterans Affairs on October 29, 1998.

5 (d) EFFECTIVE DATE FOR INITIAL REGULATIONS.—

6 The Secretary of Veterans Affairs shall prescribe the initial

7 regulations under subsection (a) of section 8134 of title 38,

8 United States Code, as added by subsection (a), not later

9 than April 30, 2000.

10 SEC. 207. EXPANSION OF ENHANCED-USE LEASE AUTHOR11 ITY.

12 (a) AUTHORITY.—Section 8162(a)(2) is amended—

13 (1) by striking ‘‘only if the Secretary’’ and in14 serting ‘‘only if—

15 ‘‘(A) the Secretary’’;

16 (2) by redesignating subparagraphs (A), (B),

17 and (C) as clauses (i), (ii), and (iii), respectively,

18 and realigning those clauses so as to be four ems from

19 the left margin;

20 (3) by striking the period at the end of clause

21 (iii), as so redesignated, and inserting ‘‘; or’’; and

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

23 ‘‘(B) the Secretary determines that the imple24 mentation of a business plan proposed by the Under

25 Secretary for Health for applying the consideration
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1 under such a lease to the provision of medical care

2 and services would result in a demonstrable improve3 ment of services to eligible veterans in the geographic

4 service-delivery area within which the property is lo5 cated.’’.

6 (b) TERM OF ENHANCED-USE LEASE.—Section

7 8162(b) is amended—

8 (1) in paragraph (2), by striking ‘‘may not ex9 ceed—’’ and all that follows and inserting ‘‘may not

10 exceed 75 years.’’; and

11 (2) by striking paragraph (4) and inserting the

12 following:

13 ‘‘(4) The terms of an enhanced-use lease may provide

14 for the Secretary to—

15 ‘‘(A) obtain facilities, space, or services on the

16 leased property; and

17 ‘‘(B) use minor construction funds for capital

18 contribution payments.’’.

19 (c) DESIGNATION OF PROPERTY PROPOSED TO BE

20 LEASED.—(1) Subsection (b) of section 8163 is amended—

21 (A) by striking ‘‘include—’’ and inserting ‘‘in22 clude the following:’’;

23 (B) by capitalizing the first letter of the first

24 word of each of paragraphs (1), (2), (3), (4), and (5);
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1 (C) by striking the semicolon at the end of para2 graphs (1), (2), and (3) and inserting a period; and

3 (D) by striking subparagraphs (A), (B), and (C)

4 of paragraph (4) and inserting the following:

5 ‘‘(A) would—

6 ‘‘(i) contribute in a cost-effective man7 ner to the mission of the Department;

8 ‘‘(ii) not be inconsistent with the mis9 sion of the Department;

10 ‘‘(iii) not adversely affect the mission

11 of the Department; and

12 ‘‘(iv) affect services to veterans; or

13 ‘‘(B) would result in a demonstrable im14 provement of services to eligible veterans in the

15 geographic service-delivery area within which the

16 property is located.’’.

17 (2) Subparagraph (E) of subsection (c)(1) of that sec18 tion is amended by striking clauses (i), (ii), and (iii) and

19 inserting the following:

20 ‘‘(i) would—

21 ‘‘(I) contribute in a cost-effective man22 ner to the mission of the Department;

23 ‘‘(II) not be inconsistent with the mis24 sion of the Department;
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1 ‘‘(III) not adversely affect the mission

2 of the Department; and

3 ‘‘(IV) affect services to veterans; or

4 ‘‘(ii) would result in a demonstrable im5 provement of services to eligible veterans in the

6 geographic service-delivery area within which the

7 property is located.’’.

8 (d) USE OF PROCEEDS.—Section 8165(a) is

9 amended—

10 (1) by striking paragraph (1) and inserting the

11 following:

12 ‘‘(a)(1) Funds received by the Department under an

13 enhanced-use lease and remaining after any deduction from

14 those funds under subsection (b) shall be deposited in the

15 Department of Veterans Affairs Health Services Improve16 ment Fund established under section 1729B of this title.

17 The Secretary shall make available to the designated health

18 care region of the Veterans Health Administration within

19 which the leased property is located not less than 75 percent

20 of the amount deposited in the fund attributable to that

21 lease.’’; and

22 (2) by adding at the end the following new para23 graph:

24 ‘‘(3) For the purposes of paragraph (1), the term ‘des25 ignated health care region of the Veterans Health Adminis-
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1 tration’ means a geographic area designated by the Sec2 retary for the purposes of the management of, and alloca3 tion of resources for, health care services provided by the

4 Veterans Health Administration.’’.

5 (e) REPEAL OF TERMINATION PROVISION.—(1) Sec6 tion 8169 is repealed.

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

8 81 is amended by striking the item relating to section 8169.

9 (f) REPEAL OF OBSOLETE PROVISIONS.—Section 8162

10 is amended—

11 (1) by striking the last sentence of subsection

12 (a)(1); and

13 (2) by striking subsection (c).

14 SEC. 208. INELIGIBILITY FOR EMPLOYMENT BY VETERANS

15 HEALTH ADMINISTRATION OF HEALTH CARE

16 PROFESSIONALS WHO HAVE LOST LICENSE

17 TO PRACTICE IN ONE JURISDICTION WHILE

18 STILL LICENSED IN ANOTHER JURISDICTION.

19 Section 7402 is amended by adding at the end the fol20 lowing new subsection:

21 ‘‘(f) A person may not be employed in a position under

22 subsection (b) (other than under paragraph (4) of that sub23 section) if—
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1 ‘‘(1) the person is or has been licensed, registered,

2 or certified (as applicable to such position) in more

3 than one State; and

4 ‘‘(2) either—

5 ‘‘(A) any of those States has terminated

6 such license, registration, or certification for

7 cause; or

8 ‘‘(B) the person has voluntarily relinquished

9 such license, registration, or certification in any

10 of those States after being notified in writing by

11 that State of potential termination for cause.’’.

12 TITLE III—MISCELLANEOUS

13 SEC. 301. REVIEW OF PROPOSED CHANGES TO OPERATION

14 OF MEDICAL FACILITIES.

15 Section 8110 of title 38, United States Code, is amend16 ed by adding at the end the following new subsections:

17 ‘‘(d) The Secretary may not in any fiscal year close

18 more than 50 percent of the beds within a bed section (of

19 20 or more beds) of a Department medical center unless

20 the Secretary first submits to the Committees on Veterans’

21 Affairs of the Senate and the House of Representatives a

22 report providing a justification for the closure. No action

23 to carry out such closure may be taken after the submission

24 of such report until the end of the 21-day period beginning

25 on the date of the submission of the report.
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1 ‘‘(e) The Secretary shall submit to the Committees on

2 Veterans’ Affairs of the Senate and the House of Representa3 tives, not later than January 20 of each year, a report docu4 menting by network for the preceding fiscal year the fol5 lowing:

6 ‘‘(1) The number of medical service and surgical

7 service beds, respectively, that were closed during that

8 fiscal year and, for each such closure, a description

9 of the changes in delivery of services that allowed such

10 closure to occur.

11 ‘‘(2) The number of nursing home beds that were

12 the subject of a mission change during that fiscal year

13 and the nature of each such mission change.

14 ‘‘(f) For purposes of this section:

15 ‘‘(1) The term ‘closure’, with respect to beds in

16 a medical center, means ceasing to provide staffing

17 for, and to operate, those beds. Such term includes

18 converting the provision of such bed care from care in

19 a Department facility to care under contract arrange20 ments.

21 ‘‘(2) The term ‘bed section’, with respect to a

22 medical center, means psychiatric beds (including

23 beds for treatment of substance abuse and post-trau24 matic stress disorder), intermediate, neurology, and
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1 rehabilitation medicine beds, extended care (other

2 than nursing home) beds, and domiciliary beds.

3 ‘‘(3) The term ‘justification’, with respect to clo4 sure of beds, means a written report that includes the

5 following:

6 ‘‘(A) An explanation of the reasons for the

7 determination that the closure is appropriate

8 and advisable.

9 ‘‘(B) A description of the changes in the

10 functions to be carried out and the means by

11 which such care and services would continue to

12 be provided to eligible veterans.

13 ‘‘(C) A description of the anticipated effects

14 of the closure on veterans and on their access to

15 care.’’.

16 SEC. 302. PATIENT SERVICES AT DEPARTMENT FACILITIES.

17 (a) SCOPE OF SERVICES.—Section 7803 is amended—

18 (1) in subsection (a)—

19 (A) by striking ‘‘(a)’’ before ‘‘The canteens’’;

20 and

21 (B) by striking ‘‘in this subsection;’’ and all

22 that follows through ‘‘the premises’’ and insert23 ing ‘‘in this section’’; and

24 (2) by striking subsection (b).
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1 (b) TECHNICAL AMENDMENTS.—(1) Paragraphs (1)

2 and (11) of section 7802 are each amended by striking ‘‘hos3 pitals and homes’’ and inserting ‘‘medical facilities’’.

4 (2) Section 7803, as amended by subsection (a), is

5 amended—

6 (A) by striking ‘‘hospitals and homes’’ each place

7 it appears and inserting ‘‘medical facilities’’; and

8 (B) by striking ‘‘hospital or home’’ and inserting

9 ‘‘medical facility’’.

10 SEC. 303. REPORT ON ASSISTED LIVING SERVICES.

11 Not later than April 1, 2000, the Secretary of Veterans

12 Affairs shall submit to the Committees on Veterans Affairs

13 of the Senate and House of Representatives a report on the

14 feasibility of establishing a pilot program to assist veterans

15 in receiving needed assisted living services. The Secretary

16 shall include in such report recommendations on—

17 (1) the services and staffing that should be pro18 vided to a veteran receiving assisted living services

19 under such a pilot program;

20 (2) the appropriate design of such a pilot pro21 gram; and

22 (3) the issues that such a pilot program should

23 be designed to address.
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1 SEC. 304. CHIROPRACTIC TREATMENT.

2 (a) ESTABLISHMENT OF PROGRAM.—(1) Within 120

3 days after the date of the enactment of this Act, the Under

4 Secretary for Health of the Department of Veterans Affairs,

5 after consultation with chiropractors, shall establish a pol6 icy for the Veterans Health Administration regarding the

7 role of chiropractic treatment in the care of veterans under

8 chapter 17 of title 38, United States Code.

9 (b) DEFINITIONS.—For purposes of this section:

10 (1) The term ‘‘chiropractic treatment’’ means the

11 manual manipulation of the spine performed by a

12 chiropractor for the treatment of such musculo-skeletal

13 conditions as the Secretary considers appropriate.

14 (2) The term ‘‘chiropractor’’ means an indi15 vidual who—

16 (A) is licensed to practice chiropractic in

17 the State in which the individual performs chiro18 practic services; and

19 (B) holds the degree of doctor of chiropractic

20 from a chiropractic college accredited by the

21 Council on Chiropractic Education.
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1 SEC. 305. DESIGNATION OF HOSPITAL BED REPLACEMENT

2 BUILDING AT IOANNIS A. LOUGARIS DEPART3 MENT OF VETERANS AFFAIRS MEDICAL CEN4 TER, RENO, NEVADA.

5 The hospital bed replacement building under construc6 tion at the Ioannis A. Lougaris Department of Veterans Af7 fairs Medical Center in Reno, Nevada, is hereby designated

8 as the ‘‘Jack Streeter Building’’. Any reference to that

9 building in any law, regulation, map, document, record,

10 or other paper of the United States shall be considered to

11 be a reference to the Jack Streeter Building.

12 TITLE IV—CONSTRUCTION AND

13 FACILITIES MATTERS

14 SEC. 401. AUTHORIZATION OF MAJOR MEDICAL FACILITY

15 PROJECTS.

16 The Secretary of Veterans Affairs may carry out the

17 following major medical facility projects, with each project

18 to be carried out in the amount specified for that project:

19 (1) Renovation to provide a domiciliary at Or20 lando, Florida in a total amount not to exceed

21 $2,400,000, to be derived only from funds appro22 priated for Construction, Major Projects, for a fiscal

23 year before fiscal year 2000 that remain available for

24 obligation.
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1 (2) Surgical addition at the Kansas City, Mis2 souri, Department of Veterans Affairs medical center,

3 in an amount not to exceed $13,000,000.

4 SEC. 402. AUTHORIZATION OF MAJOR MEDICAL FACILITY

5 LEASES.

6 The Secretary of Veterans Affairs may enter into leases

7 for medical facilities as follows:

8 (1) Lease of an outpatient clinic, Lubbock,

9 Texas, in an amount not to exceed $1,112,000.

10 (2) Lease of a research building, San Diego,

11 California, in an amount not to exceed $1,066,500.

12 SEC. 403. AUTHORIZATION OF APPROPRIATIONS.

13 (a) IN GENERAL.—There are authorized to be appro14 priated to the Secretary of Veterans Affairs for fiscal year

15 2000 and for fiscal year 2001—

16 (1) for the Construction, Major Projects, account

17 $13,000,000 for the project authorized in section

18 401(2); and

19 (2) for the Medical Care account, $2,178,500 for

20 the leases authorized in section 402.

21 (b) LIMITATION.—The project authorized in section

22 401(2) may only be carried out using—

23 (1) funds appropriated for fiscal year 2000 or

24 fiscal year 2001 pursuant to the authorization of ap25 propriations in subsection (a);
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1 (2) funds appropriated for Construction, Major

2 Projects, for a fiscal year before fiscal year 2000 that

3 remain available for obligation; and

4 (3) funds appropriated for Construction, Major

5 Projects, for fiscal year 2000 for a category of activity

6 not specific to a project.