IIB

106TH CONGRESS

1ST SESSION H. R. 2116

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 22, 1999

Received; read twice and referred to the Committee on Veterans’ Affairs

AN ACT

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.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS; REF2 ERENCES TO TITLE 38, UNITED STATES CODE.

3 (a) SHORT TITLE.—This Act may be cited as the

4 ‘‘Veterans’ Millennium Health Care Act’’.

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

6 this 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.

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.
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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

6 section 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 oper20 ated by the Secretary, and (B) in community-based

21 facilities through contracts under section 1720 of

22 this title.

23 ‘‘(3) Domiciliary services under section 1710(b)

24 of this title.
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1 ‘‘(4) Adult day health care under section

2 1720(f) of this title.

3 ‘‘(5) Such other noninstitutional alternatives to

4 nursing home care, including those described in sec5 tion 1720C of this title, as the Secretary considers

6 reasonable and appropriate.

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

8 title.

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

10 shall provide extended care services which the Secretary

11 determines are needed (A) to any veteran in need of such

12 care for a service-connected disability, and (B) to any vet13 eran who is in need of such care and who has a service14 connected disability rated at 50 percent or more.

15 ‘‘(2) The Secretary, in making placements for nurs16 ing home care in Department facilities, shall give highest

17 priority to veterans (A) who are in need of such care for

18 a service-connected disability, or (B) who have a service19 connected disability rated at 50 percent or more. The Sec20 retary shall ensure that a veteran described in this sub21 section who continues to need nursing home care shall not

22 after placement in a Department nursing home be trans23 ferred from the facility without the consent of the veteran,

24 or, in the event the veteran cannot provide informed con25 sent, the representative of the veteran.
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1 ‘‘(c)(1) The Secretary, in carrying out subsection (a),

2 shall prescribe regulations governing the priorities for the

3 provision of nursing home care in Department facilities

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

5 for patient rehabilitation, (B) for clinically complex pa6 tient populations, and (C) for patients for whom there are

7 not other suitable placement options.

8 ‘‘(2) The Secretary may not furnish extended care

9 services for a non-service-connected disability other than

10 in the case of a veteran who has a service-connected dis11 ability rated at 50 percent or more unless the veteran

12 agrees to pay to the United States a copayment for ex13 tended care services of more than 21 days in any year.

14 ‘‘(d)(1) A veteran who is furnished extended care

15 services under this chapter and who is required under sub16 section (c)(2) to pay an amount to the United States in

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

18 United States for that amount.

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

20 shall develop a methodology for establishing the amount

21 of the copayment for which a veteran described in sub22 section (c) is liable. That methodology shall provide for—

23 ‘‘(A) establishing a maximum monthly copay24 ment (based on all income and assets of the veteran

25 and the spouse of such veteran);
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1 ‘‘(B) protecting the spouse of a veteran from fi2 nancial hardship by not counting all of the income

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

4 a spouse who resides in the community) as available

5 for determining the copayment obligation; and

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

7 personal allowance.

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

9 United States a revolving fund known as the Department

10 of Veterans Affairs Extended Care Fund (hereinafter in

11 this section referred to as the ‘fund’). Amounts in the fund

12 shall be available, without fiscal year limitation and with13 out further appropriation, exclusively for the purpose of

14 providing extended care services under subsection (a).

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

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

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

18 chapter is amended by inserting after the item relating

19 to section 1710 the following new item:

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

20 (b) REQUIREMENT TO INCREASE EXTENDED CARE

21 SERVICES.—(1) Not later than January 1, 2000, the Sec22 retary of Veterans Affairs shall develop and begin to im23 plement a plan for carrying out the recommendation of

24 the Federal Advisory Committee on the Future of Long-
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1 Term Care to increase, above the level of extended care

2 services which were provided as of September 30, 1998—

3 (A) the options and services for home and com4 munity-based care for eligible veterans; and

5 (B) the percentage of the Department of Vet6 erans Affairs medical care budget dedicated to such

7 care.

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

9 level of extended care services provided by the Secretary

10 nationally in facilities operated by the Secretary during

11 any fiscal year is not less than the level of such services

12 provided nationally in facilities operated by the Secretary

13 during fiscal year 1998.

14 (c) ADULT DAY HEALTH CARE.—Section

15 1720(f)(1)(A) is amended to read as follows:

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

17 health care services to a veteran enrolled under section

18 1705(a) of this title who would otherwise require nursing

19 home care.’’

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

21 amended—

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

23 inserting ‘‘enrolled’’;

24 (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

23 by striking ‘‘adult day health care in a State home’’ and

24 inserting ‘‘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

8 take effect on the effective date of regulations prescribed

9 by the Secretary of Veterans Affairs under subsections

10 (c)(2) and (d) of such section. The Secretary shall publish

11 the effective date of such regulations in the Federal Reg12 ister.

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

14 United States Code, shall not apply to any day of nursing

15 home care on or after the effective date of regulations

16 under paragraph (2).

17 SEC. 102. REIMBURSEMENT FOR EMERGENCY TREATMENT.

18 (a) AUTHORITY TO PROVIDE REIMBURSEMENT.—

19 Chapter 17 is amended by inserting after section 1724 the

20 following new section:

21 ‘‘§ 1725. Reimbursement for emergency treatment

22 ‘‘(a) GENERAL AUTHORITY.—(1) Subject to sub23 sections (c) and (d), the Secretary may reimburse a vet24 eran described in subsection (b) for the reasonable value
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1 of emergency treatment furnished the veteran in a non2 Department facility.

3 ‘‘(2) In any case in which reimbursement is author4 ized under subsection (a)(1), the Secretary, in the Sec5 retary’s discretion, may, in lieu of reimbursing the vet6 eran, make payment of the reasonable value of the fur7 nished emergency treatment directly—

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

9 that furnished the treatment; or

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

11 such treatment on behalf of such veteran.

12 ‘‘(b) ELIGIBILITY.—(1) A veteran referred to in sub13 section (a)(1) is an individual who is an active Department

14 health-care participant who is personally liable for emer15 gency treatment furnished the veteran in a non-Depart16 ment facility.

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

18 participant if the veteran—

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

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

21 ‘‘(B) is enrolled in the health care system estab22 lished under such section; and

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

24 12-month period preceding the furnishing of such

25 emergency treatment.
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1 ‘‘(3) A veteran is personally liable for emergency

2 treatment furnished the veteran in a non-Department fa3 cility if the veteran—

4 ‘‘(A) is financially liable to the provider of

5 emergency treatment for that treatment;

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

7 under 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

14 Secretary, in accordance with regulations prescribed by

15 the 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 re20 quirements on requesting reimbursement as the Sec21 retary 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

2 provide reimbursement under this section only after the

3 veteran or the provider of emergency treatment has ex4 hausted without success all claims and remedies reason5 ably available to the veteran or provider against a third

6 party for payment of such treatment.

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

8 behalf of a veteran described in subsection (b), to a pro9 vider of emergency treatment, shall, unless rejected and

10 refunded by the provider within 30 days of receipt, extin11 guish any liability on the part of the veteran for that treat12 ment. Neither the absence of a contract or agreement be13 tween the Secretary and the provider nor any provision

14 of a contract, agreement, or assignment to the contrary

15 shall operate to modify, limit, or negate the requirement

16 in the preceding sentence.

17 ‘‘(d) INDEPENDENT RIGHT OF RECOVERY.—(1) In

18 accordance with regulations prescribed by the Secretary,

19 the United States shall have the independent right to re20 cover any amount paid under this section when, and to

21 the extent that, a third party subsequently makes a pay22 ment for the same emergency treatment.

23 ‘‘(2) Any amount paid by the United States to the

24 veteran (or the veteran’s personal representative, suc25 cessor, dependents, or survivors) or to any other person
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1 or organization paying for such treatment shall constitute

2 a lien in favor of the United States against any recovery

3 the payee subsequently receives from a third party for the

4 same treatment.

5 ‘‘(3) Any amount paid by the United States to the

6 provider that furnished the veteran’s emergency treatment

7 shall constitute a lien against any subsequent amount the

8 provider receives from a third party for the same emer9 gency treatment for which the United States made pay10 ment.

11 ‘‘(4) The veteran (or the veteran’s personal rep12 resentative, successor, dependents, or survivors) shall en13 sure that the Secretary is promptly notified of any pay14 ment received from any third party for emergency treat15 ment furnished to the veteran. The veteran (or the vet16 eran’s personal representative, successor, dependents, or

17 survivors) shall immediately forward all documents relat18 ing to such payment, cooperate with the Secretary in the

19 investigation of such payment, and assist the Secretary

20 in enforcing the United States right to recover any pay21 ment made under subsection (c)(3).

22 ‘‘(e) WAIVER.—The Secretary, in the Secretary’s dis23 cretion, may waive recovery of a payment made to a vet24 eran under this section that is otherwise required by sub25 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

5 medical care or services furnished, in the judgment

6 of the Secretary—

7 ‘‘(A) when Department or other Federal

8 facilities are not feasibly available and an at9 tempt to use them beforehand would not be rea10 sonable;

11 ‘‘(B) when such care or services are ren12 dered in a medical emergency of such nature

13 that delay would be hazardous to life or health;

14 and

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

16 transferred safely to a Department facility or

17 other Federal facility.

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

19 any of the following:

20 ‘‘(A) An insurance policy or contract, med21 ical or hospital service agreement, membership

22 or subscription contract, or similar arrangement

23 under which health services for individuals are

24 provided or the expenses of such services are

25 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

7 U.S.C. 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

14 following:

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 sec10 tion 1724 the following new item:

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

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

12 this section shall take effect 180 days after the date of

13 the enactment 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

20 subsection (a). Each such report shall include information

21 on the experience of the Department under that section

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

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

2 VETERANS.

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

6 of 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

15 enemy of the United States or otherwise wounded in

16 action by weapon fire while directly engaged in

17 armed conflict (other than as the result of willful

18 misconduct by 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 subpara23 graph (F);

24 (B) by striking the period at the end of sub25 paragraph (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 sec16 tion 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 pe19 riod at the end.

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

21 of Defense shall enter into an agreement (characterized

22 as a memorandum of understanding or otherwise) with the

23 Secretary of Veterans Affairs with respect to the provision

24 of medical care by the Secretary of Veterans Affairs to

25 eligible military retirees in accordance with the amend-
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1 ments made by subsection (a). That agreement shall in2 clude provisions for reimbursement of the Secretary of

3 Veterans Affairs by the Secretary of Defense for medical

4 care provided by the Secretary of Veterans Affairs to an

5 eligible military retiree and may include such other provi6 sions with respect to the terms and conditions of such care

7 as may be agreed upon 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 reim11 bursement may be made by the Secretary of Defense or

12 by the appropriate TRICARE Managed Care Support con13 tractor, 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

17 Defense shall consult with TRICARE Managed Care Sup18 port 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,

23 or a part of any such area, of the Veterans Health Admin24 istration unless—
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1 (A) in the judgment of that Secretary, the De2 partment of Veterans Affairs will recover the costs

3 of providing such care to eligible military retirees;

4 and

5 (B) that Secretary has certified and docu6 mented, with respect to any geographic service area

7 in which the Secretary proposes to provide care in

8 accordance with the amendments made by sub9 section (a), that such geographic service area, or

10 designated part of any such area, has adequate ca11 pacity (consistent with the requirements in section

12 1705(b)(1) of title 38, United States Code, that care

13 to enrollees shall be timely and acceptable in quality)

14 to provide such care.

15 (5) The agreement under paragraph (1) shall be en16 tered into by the Secretaries not later than nine months

17 after the date of the enactment of this Act. If the Secre18 taries are unable to reach agreement, they shall jointly re19 port, by that date or within 30 days thereafter, to the

20 Committees on Armed Services and the Committees on

21 Veterans’ Affairs of the Senate and House of Representa22 tives on the reasons for their inability to reach an agree23 ment and their mutually agreed plan for removing any im24 pediments to final agreement.
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1 (c) DEPOSITING OF REIMBURSEMENTS.—Amounts

2 received by the Secretary of Veterans Affairs under the

3 agreement under subsection (b) shall be deposited in the

4 Department of Veterans Affairs Health Services Improve5 ment Fund established under section 1729B of title 38,

6 United States Code, as added by section 202.

7 (d) PHASED IMPLEMENTATION.—(1) The Secretary

8 of Defense shall include in each TRICARE contract en9 tered into after the date of the enactment of this Act pro10 visions to implement the agreement under subsection (b).

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

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

13 apply to the furnishing of medical care by the Secretary

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

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

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

17 (e) ELIGIBLE MILITARY RETIREES.—For purposes

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

19 of the Army, Navy, Air Force, or Marine Corps who—

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

21 air service;

22 (2) is eligible for care under the TRICARE pro23 gram established by the Secretary of Defense;

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

25 title 38, United States Code; and
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1 (4) is not described in paragraph (1) or (2) of

2 section 1710(a) of such title (other than subpara3 graph (H) of such paragraph (2)), as amended by

4 subsection (a).

5 SEC. 105. BENEFITS FOR PERSONS DISABLED BY PARTICI6 PATION IN COMPENSATED WORK THERAPY

7 PROGRAM.

8 Section 1151(a)(2) is amended—

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

10 caused’’; and

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

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

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

14 under section 1718 of this title’’.

15 SEC. 106. PILOT PROGRAM OF MEDICAL CARE FOR CER16 TAIN DEPENDENTS OF ENROLLED VET17 ERANS.

18 (a) IN GENERAL.—(1) Chapter 17 is amended by in19 serting after section 1713 the following new section:

20 ‘‘§ 1713A. Medical care for certain dependents of en21 rolled veterans: pilot program

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

23 carry out a pilot program to provide primary health care

24 services for eligible dependents of veterans in accordance

25 with this section.
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1 ‘‘(b) For purposes of this section:

2 ‘‘(1) The term ‘program period’ means the pe3 riod beginning on the first day of the first month be4 ginning more than 180 days after the date of the en5 actment of this section and ending three years after

6 that day.

7 ‘‘(2) The term ‘eligible dependent’ means an in8 dividual who—

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

10 who is enrolled in the system of patient enroll11 ment established by the Secretary under section

12 1705 of this title; and

13 ‘‘(B) is determined by the Secretary to

14 have the ability to pay for such care or services

15 either directly or through reimbursement or in16 demnification from a third party.

17 ‘‘(c) The Secretary may furnish health care services

18 to an eligible dependent under this section only if the de19 pendent (or, in the case of a minor, the parent or guardian

20 of the dependent) agrees—

21 ‘‘(1) to pay to the United States an amount

22 representing the reasonable charges for the care or

23 services furnished (as determined by the Secretary);

24 and
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1 ‘‘(2) to cooperate with and provide the Sec2 retary an appropriate assignment of benefits, au3 thorization to release medical records, and any other

4 executed documents, information, or evidence rea5 sonably needed by the Secretary to recover the De6 partment’s charges for the care or services furnished

7 by the Secretary.

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

9 pilot program under this section may consist of such pri10 mary hospital care services and such primary medical

11 services as may be authorized by the Secretary. The Sec12 retary may furnish those services directly through a De13 partment medical facility or, subject to paragraphs (2)

14 and (3), pursuant to a contract or other agreement with

15 a non-Department facility (including a health-care pro16 vider, as defined in section 8152(2) of this title).

17 ‘‘(2) The Secretary may enter into a contract or

18 agreement to furnish primary health care services under

19 this section in a non-Department facility on the same basis

20 as provided under subsections (a) and (b) of section 1703

21 of this title or may include such care in an existing or

22 new agreement under section 8153 of this title when the

23 Secretary determines it to be in the best interest of the

24 prevailing standards of the Department medical care pro25 gram.
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1 ‘‘(3) Primary health care services may not be author2 ized to be furnished under this section at any medical fa3 cility if the furnishing of those services would result in

4 the denial of, or a delay in providing, access to care for

5 any enrolled veteran at that facility.

6 ‘‘(e)(1) In the case of an eligible dependent who is

7 furnished primary health care services under this section

8 and who has coverage under a health-plan contract, as de9 fined in section 1729(i)(1) of this title, the United States

10 shall have the right to recover or collect the reasonable

11 charges for such care or services from such health-plan

12 contract to the extent that the individual or the provider

13 of the care or services would be eligible to receive payment

14 for such care or services from such health-plan contract

15 if the care or services had not been furnished by a depart16 ment or agency of the United States.

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

18 paragraph (1) shall be enforceable with respect to an eligi19 ble dependent in the same manner as applies under sub20 sections (a)(3), (b), (c)(1), (c)(2), (d), (f), (h), and (i) of

21 section 1729 of this title with respect to a veteran.

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

23 program under this section shall be carried out during the

24 program period in not more than four veterans integrated

25 service networks, as designated by the Secretary. In desig-
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1 nating networks under the preceding sentence, the Sec2 retary shall favor designation of networks that are suited

3 to serve dependents of veterans because of—

4 ‘‘(A) the capability of one or more medical fa5 cilities within the network to furnish primary health

6 care services to eligible dependents while assuring

7 that veterans continue to receive priority for care

8 and services;

9 ‘‘(B) the demonstrated success of such medical

10 facilities in billings and collections;

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

12 among veterans in the network; and

13 ‘‘(D) such other criteria as the Secretary con14 siders appropriate.

15 ‘‘(2) In implementing the pilot program, the Sec16 retary may not provide health care services for dependents

17 who are children—

18 ‘‘(A) in more than one of the participating net19 works during the first year of the program period;

20 and

21 ‘‘(B) in more than two of the participating net22 works during the second year of the program period.

23 ‘‘(3) In implementing the pilot program, the Sec24 retary shall give priority to facilities which operate women

25 veterans’ clinics.’’.
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1 (2) The table of sections at the beginning of such

2 chapter is amended by inserting after the item relating

3 to section 1713 the following new item:

‘‘1713A. Medical care for certain dependents and enrolled veterans: pilot program.’’.

4 (b) GAO REVIEW AND RECOMMENDATIONS.—(1) Be5 ginning six months after the commencement of the pilot

6 program, the Comptroller General, in consultation with

7 the Under Secretary for Health of the Department of Vet8 erans Affairs, shall monitor the conduct of the pilot pro9 gram.

10 (2) Not later than 14 months after the commence11 ment of the pilot program, the Comptroller General shall

12 submit to the Secretary of Veterans Affairs a report set13 ting forth the Comptroller General’s findings and rec14 ommendations with respect to the first 12 months of oper15 ation of the pilot program.

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

17 the findings of the Comptroller General regarding—

18 (i) whether the collection of reasonable charges

19 for the care or services provided reasonably covers

20 the costs of providing such care and services; and

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

22 program, is in compliance with the limitation in sub23 section (d)(3) of section 1713A of title 38, United

24 States Code, as added by subsection (a).
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1 (B) The report shall include the recommendations of

2 the Comptroller General regarding any remedial steps that

3 the Secretary should take in the conduct of the program

4 or in the billing and collection of charges under the pro5 gram.

6 (4) The Secretary, in consultation with, and following

7 receipt of the report of, the Comptroller General, shall

8 take such steps as may be needed to ensure that any rec9 ommendations of the Comptroller General in the report

10 under paragraph (2) with respect to billings and collec11 tions, and with respect to compliance with the limitation

12 in subsection (d)(3) of such section, are carried out.

13 (5) For purposes of this subsection, the term ‘‘com14 mencement of the pilot program’’ means the date on which

15 the Secretary of Veterans Affairs begins to furnish serv16 ices to eligible dependents under the pilot program under

17 section 1713A of title 38, United States Code, as added

18 by subsection (a).

19 SEC. 107. ENHANCED SERVICES PROGRAM AT DESIGNATED

20 MEDICAL CENTERS.

21 (a) FINDINGS.—Congress makes the following find22 ings:

23 (1) Historically, health care facilities under the

24 jurisdiction of the Department of Veterans Affairs
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1 have not consistently been located in proximity to

2 veteran population concentrations.

3 (2) Hospital occupancy rates at numbers of De4 partment medical centers are at levels substantially

5 below a level needed for efficient operation and opti6 mal quality of care.

7 (3) The costs of maintaining highly inefficient

8 medical centers, which were designed and con9 structed decades ago to standards no longer consid10 ered acceptable, substantially diminish the avail11 ability of resources which could be devoted to the

12 provision of needed direct care services.

13 (4) Freeing resources currently devoted to high14 ly inefficient provision of hospital care could,

15 through contracting for acute hospital care and es16 tablishing new facilities for provision of outpatient

17 care, yield improved access and service to veterans.

18 (b) ENHANCED SERVICES PROGRAM AT DESIGNATED

19 MEDICAL CENTERS.—The Secretary of Veterans Affairs,

20 in carrying out the responsibilities of the Secretary to fur21 nish hospital care and medical services through network22 based planning, shall establish an enhanced service pro23 gram at Department medical centers (hereinafter in this

24 section referred to as ‘‘designated centers’’) that are des25 ignated by the Secretary for the purposes of this section.
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1 Medical centers shall be designated to improve access, and

2 quality of service provided, to veterans served by those

3 medical centers. The Secretary may designate a medical

4 center for the program only if the Secretary determines,

5 on the basis of a market and data analysis (which shall

6 include a study of the cost-effectiveness of the care pro7 vided at such center), that the medical center—

8 (1) can, in whole or in part, no longer be oper9 ated in a manner that provides hospital or other

10 care efficiently and at optimal quality because of

11 such factors as—

12 (A) the current and projected need for hos13 pital or other care capacity at such center;

14 (B) the extent to which the facility is func15 tionally obsolete; and

16 (C) the cost of operation and maintenance

17 of the physical plant; and

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

19 community hospitals which have the capacity to pro20 vide primary and secondary hospital care of appro21 priate quality to veterans under contract arrange22 ments with the Secretary which the Secretary deter23 mines are advantageous to the Department, or (B)

24 to another Department medical center which is capa-
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1 ble of absorbing some or all of the patient workload

2 of such medical center.

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

4 with respect to each designated center, develop a plan

5 aimed at improving the accessibility and quality of service

6 provided to veterans. Each plan shall be developed in ac7 cordance with the requirements for strategic network8 based planning described in section 8107 of title 38,

9 United States Code. In the plan for a designated center,

10 the Secretary shall describe a program which, if imple11 mented, would allow the Secretary to do any of the fol12 lowing:

13 (1) Provide for a Department facility described

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

15 patient workload of the designated center.

16 (2) Contract, under such arrangements as the

17 Secretary determines appropriate, for needed pri18 mary and secondary hospital care for veterans—

19 (A) who reside in the catchment area of

20 each designated center;

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

22 through (6) of section 1705(a) of title 38,

23 United States Code; and
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1 (C) whom the Secretary has enrolled for

2 care pursuant to section 1705 of title 38,

3 United States Code.

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

5 care and other medical services, at such center.

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

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

8 improvements which had been dedicated to providing

9 care described in paragraph (3).

10 (5) Establish, through reallocation of oper11 ational funds and through appropriate lease arrange12 ments or renovations, facilities for—

13 (A) delivery of outpatient care; and

14 (B) services which would obviate a need for

15 nursing home care or other long-term institu16 tional care.

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

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

19 shall attempt to ensure that employees of the Secretary

20 who would be displaced under this section be given priority

21 in hiring by such contractor, lessee, or other entity.

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

23 shall give preference to providing services through em24 ployee-based delivery models.
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1 (e) REQUIRED CONSULTATION.—In developing a

2 plan under subsection (c), the Secretary shall obtain the

3 views of veterans organizations, exclusive employee rep4 resentatives, and other interested parties and provide for

5 such organizations and parties to participate in the devel6 opment of the plan.

7 (f) SUBMISSION OF PLAN TO CONGRESS.—The Sec8 retary may not implement a plan described in subsection

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

10 has first submitted a report containing a detailed plan and

11 justification to the appropriate committees of Congress.

12 No action to carry out such plan may be taken after the

13 submission of such report until the end of a 45-day period

14 following the date of the submission of the report, not less

15 than 30 days of which shall be days during which Con16 gress shall have been in continuous session. For purposes

17 of the preceding sentence, continuity of a session of Con18 gress is broken only by adjournment sine die, and there

19 shall be excluded from the computation of any period of

20 continuity of session any day during which either House

21 of Congress is not in session during an adjournment of

22 more than three days to a day certain.

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

24 plan described in subsection (c), or a modification to that
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1 plan following the submission of such plan to the appro2 priate committees of Congress, the Secretary—

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

4 section 1703 of title 38, United States Code, con5 tract for hospital care for veterans who are—

6 (A) described in paragraphs (1) through

7 (6) of section 1705(a) of title 38, United States

8 Code; and

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

10 section 1705;

11 (2) may enter into any contract under section

12 8153 of title 38, United States Code;

13 (3) shall, in exercising the authority of the Sec14 retary under this section to contract for hospital

15 care, provide for ongoing oversight and management,

16 by employees of the Department, of the hospital care

17 furnished such veterans; and

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

19 which ceases to provide services under the

20 program—

21 (A) ensure a reallocation of funds as pro22 vided in subsection (h); and

23 (B) provide reemployment assistance to

24 employees.
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1 (h) FUNDS ALLOCATION.—In carrying out subsection

2 (g)(4), the Secretary shall ensure that not less than 90

3 percent of the funds that would have been made available

4 to a designated center to support the provision of services,

5 but for such mission change, shall be made available to

6 the appropriate health care region of the Veterans Health

7 Administration to ensure that the implementation of the

8 plan under subsection (g) will result in demonstrable im9 provement in the accessibility, and quality of service pro10 vided, to veterans in the catchment area of such center.

11 (i) SPECIALIZED SERVICES.—The provisions of this

12 section do not diminish the obligations of the Secretary

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

14 (j) REPORT.—Not later than 12 months after imple15 mentation of any plan under subsection (b), the Secretary

16 shall submit to Congress a report on the implementation

17 of the enhanced service program.

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

19 may be construed to diminish the authority of the Sec20 retary to—

21 (1) consolidate, eliminate, abolish, or redis22 tribute the functions or missions of facilities in the

23 Department;

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

25 facility or activity; or
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1 (3) create new facilities or activities in the De2 partment.

3 SEC. 108. COUNSELING AND TREATMENT FOR VETERANS

4 WHO HAVE EXPERIENCED SEXUAL TRAUMA.

5 (a) EXTENSION OF PERIOD OF PROGRAM.—Sub6 section (a) of section 1720D is amended—

7 (1) in paragraph (1), by striking ‘‘December

8 31, 2001’’ and inserting ‘‘December 31, 2002’’; and

9 (2) in paragraph (3), by striking ‘‘December

10 31, 2001’’ and inserting ‘‘December 31, 2002’’.

11 (b) MANDATORY NATURE OF PROGRAM.—(1) Sub12 section (a)(1) of such section is further amended by strik13 ing ‘‘may provide counseling to a veteran who the Sec14 retary determines requires such counseling’’ and inserting

15 ‘‘shall operate a program under which the Secretary pro16 vides counseling and appropriate care and services to vet17 erans who the Secretary determines require such coun18 seling and care and services’’.

19 (2) Subsection (a) of such section is further

20 amended—

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

22 (B) by redesignating paragraph (3) (as amend23 ed by subsection (a)(2)) as paragraph (2).

24 (c) OUTREACH EFFORTS.—Subsection (c) of such

25 section is amended—
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1 (1) by inserting ‘‘and treatment’’ in the first

2 sentence and in paragraph (2) after ‘‘counseling’’;

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

4 (1);

5 (3) by redesignating paragraph (2) as para6 graph (3); and

7 (4) by inserting after paragraph (1) the fol8 lowing new paragraph (2):

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

10 counseling and treatment available to veterans under

11 this section—

12 ‘‘(A) is revised and updated as appro13 priate;

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

15 at appropriate facilities of the Department; and

16 ‘‘(C) is made available through appropriate

17 public information services; and’’.

18 (d) REPORT ON IMPLEMENTATION OF OUTREACH

19 ACTIVITIES.—Not later than six months after the date of

20 the enactment of this Act, the Secretary of Veterans Af21 fairs shall submit to the Committees on Veterans’ Affairs

22 of the Senate and House of Representatives a report on

23 the Secretary’s implementation of paragraph (2) of section

24 1720D(c) of title 38, United States Code, as added by

25 subsection (c). Such report shall include examples of the
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1 documents and other means of communication developed

2 for compliance with that paragraph.

3 (e) STUDY OF EXPANDING ELIGIBILITY FOR COUN4 SELING AND TREATMENT.—(1) The Secretary of Veterans

5 Affairs, in consultation with the Secretary of Defense,

6 shall conduct a study to determine—

7 (A) the extent to which former members of the

8 reserve components of the Armed Forces experienced

9 physical assault of a sexual nature or battery of a

10 sexual nature while serving on active duty for train11 ing;

12 (B) the extent to which such former members

13 have sought counseling from the Department of Vet14 erans Affairs relating to those incidents; and

15 (C) the additional resources that, in the judg16 ment of the Secretary, would be required to meet the

17 projected need of those former members for such

18 counseling.

19 (2) Not later than 16 months after the date of the

20 enactment of this Act, the Secretary of Veterans Affairs

21 shall submit to the Committees on Veterans’ Affairs of

22 the Senate and House of Representatives a report on the

23 results of the study conducted under paragraph (1).

24 (f) OVERSIGHT OF OUTREACH ACTIVITIES.—Not

25 later than 14 months after the date of the enactment of
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1 this Act, the Secretary of Veterans Affairs and the Sec2 retary of Defense shall submit to the appropriate congres3 sional committees a joint report describing in detail the

4 collaborative efforts of the Department of Veterans Affairs

5 and the Department of Defense to ensure that members

6 of the Armed Forces, upon separation from active mili7 tary, naval, or air service, are provided appropriate and

8 current information about programs of the Department of

9 Veterans Affairs to provide counseling and treatment for

10 sexual trauma that may have been experienced by those

11 members while in the active military, naval, or air service,

12 including information about eligibility requirements for,

13 and procedures for applying for, such counseling and

14 treatment. The report shall include proposed recommenda15 tions from both the Secretary of Veterans Affairs and the

16 Secretary of Defense for the improvement of their collabo17 rative efforts to provide such information.

18 (g) REPORT ON IMPLEMENTATION OF SEXUAL

19 TRAUMA TREATMENT PROGRAM.—Not later than 14

20 months after the date of the enactment of this Act, the

21 Secretary of Veterans Affairs shall submit to the Commit22 tees on Veterans’ Affairs of the Senate and House of Rep23 resentatives a report on the use made of the authority pro24 vided under section 1720D of title 38, United States Code,

25 as amended by this section. The report shall include the
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1 following with respect to activities under that section since

2 the enactment of this Act:

3 (1) The number of veterans who have received

4 counseling under that section.

5 (2) The number of veterans who have been re6 ferred to non-Department mental health facilities

7 and providers in connection with sexual trauma

8 counseling and treatment.

9 TITLE II—PROGRAM

10 ADMINISTRATION

11 SEC. 201. MEDICAL CARE COLLECTIONS.

12 (a) LIMITED AUTHORITY TO SET COPAYMENTS.—

13 (1) Section 1722A is amended—

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

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

16 (B) by inserting after subsection (a) the fol17 lowing new subsection (b):

18 ‘‘(b) The Secretary, pursuant to regulations which

19 the Secretary shall prescribe, may—

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

21 under subsection (a);

22 ‘‘(2) establish a maximum annual pharma23 ceutical copayment amount under subsection (a) for

24 veterans who have multiple outpatient prescriptions;

25 and
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1 ‘‘(3) require a veteran, other than a veteran de2 scribed in subsection (a)(3), to pay to the United

3 States a reasonable copayment for sensori-neural

4 aids, electronic equipment, and any other costly item

5 or equipment furnished the veteran for a nonservice6 connected condition, other than a wheelchair or arti7 ficial limb.’’; and

8 (C) in subsection (c), as redesignated by sub9 paragraph (A)—

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

11 ‘‘subsection (a)’’; and

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

13 sentence: ‘‘Amounts collected through use of

14 the authority under subsection (b) shall be de15 posited in Department of Veterans Affairs

16 Health Services Improvement Fund.’’.

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

18 read as follows:

19 ‘‘§ 1722A. Copayments for medications and certain

20 costly items and equipment’’.

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

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

23 as follows:

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

24 (b) OUTPATIENT TREATMENT OF CATEGORY C VET25 ERANS.—(1) Section 1710(g) is amended—
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1 (A) in paragraph (1), by striking ‘‘the amount

2 under paragraph (2) of this subsection’’ and insert3 ing ‘‘in the case of each outpatient visit the applica4 ble amount or amounts established by the Secretary

5 by regulation’’; and

6 (B) in paragraph (2), by striking all after ‘‘for

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

8 establish by regulation.’’.

9 SEC. 202. HEALTH SERVICES IMPROVEMENT FUND.

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

11 amended by inserting after section 1729A the following

12 new section:

13 ‘‘§ 1729B. Health Services Improvement Fund

14 ‘‘(a) There is established in the Treasury of the

15 United States a fund to be known as the ‘Department of

16 Veterans Affairs Health Services Improvement Fund’.

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

18 the enactment of this section under any of the following

19 provisions of law shall be deposited in the fund:

20 ‘‘(1) Section 1713A of this title.

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

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

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

24 Health Care Act.
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1 ‘‘(c) Amounts in the fund are hereby available, with2 out fiscal year limitation, to the Secretary for the purposes

3 stated in subparagraphs (A) and (B) of section

4 1729A(c)(1) of this title.’’.

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

6 at the beginning of such chapter is amended by inserting

7 after the item relating to section 1729A the following new

8 item:

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

9 SEC. 203. VETERANS TOBACCO TRUST FUND.

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

11 (1) Smoking related illnesses, including cancer,

12 heart disease, and emphysema, are highly prevalent

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

14 the Department of Veterans Affairs health care sys15 tem annually.

16 (2) The Department of Veterans Affairs esti17 mates that it spent $3,600,000,000 in 1997 to treat

18 smoking-related illnesses and that over the next five

19 years it will spend $20,000,000,000 on such care.

20 (3) Congress established the Department of

21 Veterans Affairs in furtherance of its constitutional

22 power to provide for the national defense in order to

23 provide benefits and services to veterans of the uni24 formed services.
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1 (4) There is in the Department of Veterans Af2 fairs a health care system which has as its primary

3 function to provide a complete medical and hospital

4 service for the medical care and treatment of such

5 veterans as can be served through available appro6 priations.

7 (5) The Federal Government, including the De8 partment of Veterans Affairs, has lacked the means

9 to prevent the onset of smoking-related illnesses

10 among veterans and has had no authority to deny

11 needed treatment to any veteran on the basis that

12 an illness is or might be smoking-related.

13 (6) With some 20 percent of its health care

14 budget absorbed in treating smoking-related ill15 nesses, the Department of Veterans Affairs health

16 care system has lacked resources to provide needed

17 nursing home care, home care, community-based

18 ambulatory care, and other services to tens of thou19 sands of other veterans.

20 (7) The network of academically affiliated med21 ical centers of the Department of Veterans Affairs

22 provides a unique system within which outstanding

23 medical research is conducted and which has the po24 tential to expand significantly ongoing research on

25 tobacco-related illnesses.
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1 (b) ESTABLISHMENT OF TRUST FUND.—(1) Chapter

2 17 is amended by inserting after section 1729B, as added

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

4 ‘‘§ 1729C. Veterans Tobacco Trust Fund

5 ‘‘(a) There is established in the Treasury of the

6 United States a trust fund to be known as the ‘Veterans

7 Tobacco Trust Fund’, consisting of such amounts as may

8 be appropriated, credited, or donated to the trust fund.

9 ‘‘(b) If the United States pursues recovery (other

10 than a recovery authorized under this title) from a party

11 or parties specifically for health care costs incurred or to

12 be incurred by the United States that are attributable to

13 tobacco-related illnesses, there shall be credited to the

14 trust fund from the amount of any such recovery by the

15 United States, without further appropriation, the amount

16 that bears the same ratio to the amount recovered as the

17 amount of the Department’s costs for health care attrib18 utable to tobacco-related illnesses for which recovery is

19 sought bears to the total amount sought by the United

20 States.

21 ‘‘(c) After September 30, 2004, amounts in the trust

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

23 the Secretary for the following purposes:

24 ‘‘(1) Furnishing medical care and services

25 under this chapter, to be available during any fiscal
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1 year for the same purposes and subject to the same

2 limitations (other than with respect to the period of

3 availability for obligation) as apply to amounts ap4 propriated from the general fund of the Treasury for

5 that fiscal year for medical care.

6 ‘‘(2) Conducting medical research, rehabilita7 tion research, and health systems research, with par8 ticular emphasis on research relating to prevention

9 and treatment of, and rehabilitation from, tobacco

10 addiction and diseases associated with tobacco use.’’.

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

12 chapter is amended by inserting after the item relating

13 to section 1729B, as added by section 202(b), the fol14 lowing new item:

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

15 SEC. 204. AUTHORITY TO ACCEPT FUNDS FOR EDUCATION

16 AND TRAINING.

17 (a) ESTABLISHMENT OF NONPROFIT CORPORATIONS

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

19 (1) by inserting ‘‘and education’’ after ‘‘re20 search’’; and

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

22 a corporation may be established to facilitate either

23 research or education or both research and edu24 cation.’’.
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1 (b) PURPOSE OF CORPORATIONS.—Section 7362 is

2 amended—

3 (1) in the first sentence, by inserting ‘‘and edu4 cation and training as described in sections 7302,

5 7471, 8154, and 1701(6)(B) of this title’’ after ‘‘of

6 this title’’; and

7 (2) in the second sentence—

8 (A) by inserting ‘‘or education’’ after ‘‘re9 search’’; and

10 (B) by striking ‘‘that purpose’’ and insert11 ing ‘‘these purposes’’.

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

13 amended—

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

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

16 the assistant chief of staff for research for the med17 ical center and the associate chief of staff for edu18 cation for the medical center, or, in the case of a fa19 cility at which such positions do not exist, those offi20 cials who are responsible for carrying out the re21 sponsibilities of the medical center director, chief of

22 staff, and, as appropriate, the assistant chief of staff

23 for research and the assistant chief for education;

24 and’’;
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1 (2) in subsection (a)(2), by inserting ‘‘or edu2 cation, as appropriate’’ after ‘‘research’’; and

3 (3) in subsection (c), by inserting ‘‘or edu4 cation’’ after ‘‘research’’.

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

6 amended by adding at the end the following new sub7 section:

8 ‘‘(c)(1) A corporation established under this sub9 chapter may not spend funds for an education activity un10 less the activity is approved in accordance with procedures

11 prescribed by the Under Secretary for Health.

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

13 policies and procedures to guide the expenditure of funds

14 by corporations under paragraph (1) consistent with the

15 purpose of such corporations as flexible funding mecha16 nisms.’’.

17 SEC. 205. EXTENSION AND REVISION OF CERTAIN AU18 THORITIES.

19 (a) READJUSTMENT COUNSELING PROGRAM.—Sec20 tion 1712A(a)(1)(B)(ii) is amended by striking ‘‘2000’’

21 and inserting ‘‘2003’’.

22 (b) COMMITTEE ON MENTALLY ILL VETERANS.—

23 Section 7321(d)(2) is amended by striking ‘‘three’’ and

24 inserting ‘‘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

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

8 (d) EXTENSION OF AUTHORITY TO MAKE

9 GRANTS.—Section 3(a)(2) of the Homeless Veterans Com10 prehensive Service Programs Act of 1992 (38 U.S.C. 7721

11 note) is amended by striking ‘‘September 30, 1999’’ and

12 inserting ‘‘September 30, 2002’’.

13 (e) AUTHORITY TO MAKE GRANTS FOR HOMELESS

14 VETERANS.—Section 3(b)(2) of the Homeless Veterans

15 Comprehensive Service Programs Act of 1992 (38 U.S.C.

16 7721 note) is amended by striking ‘‘and no more than 20

17 programs which incorporate the procurement of vans as

18 described 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 sub23 section (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 pre4 scribe for each State the number of nursing home and

5 domiciliary beds for which assistance under this sub6 chapter may be furnished. Such regulations shall be based

7 on projected demand for such care 10 years after the date

8 of the enactment of the Veterans’ Millennium Health Care

9 Act by veterans who at such time are 65 years of age or

10 older and who reside in that State. In determining such

11 projected demand, the Secretary shall take into account

12 travel distances for veterans and their families.

13 ‘‘(3)(A) In those regulations, the Secretary shall es14 tablish criteria under which the Secretary shall determine,

15 with respect to an application for assistance under this

16 subchapter for a project described in subparagraph (B)

17 which is from a State that has a need for additional beds

18 as determined under subsections (a)(2) and (d)(1), wheth19 er the need for such beds is most aptly characterized as

20 great, significant, or limited. Such criteria shall take into

21 account the availability of beds already operated by the

22 Secretary and other providers which appropriately serve

23 the needs which the State proposes to meet with its appli24 cation.
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1 ‘‘(B) This paragraph applies to a project for the con2 struction or acquisition of a new State home facility, to

3 a project to increase the number of beds available at a

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

5 State home facility.

6 ‘‘(4) The Secretary shall review and, as necessary, re7 vise regulations prescribed under paragraphs (2) and (3)

8 not less often than every four years.

9 ‘‘(b) The Secretary shall prescribe the following by

10 regulation:’’;

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

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

13 paragraphs (1) and (2);

14 (4) in subsection (c), as redesignated by para15 graph (1), by striking ‘‘subsection (a)(3)’’ and in16 serting ‘‘subsection (b)(2)’’; and

17 (5) by adding at the end the following new sub18 section:

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

20 subchapter, the Secretary shall provide that in the case

21 of a State that seeks assistance under this subchapter for

22 a project described in subsection (a)(3)(B), the determina23 tion of the unmet need for beds for State homes in that

24 State shall be reduced by the number of beds in all pre25 vious applications submitted by that State under this sub-
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1 chapter, including beds which have not been recognized

2 by the Secretary under section 1741 of this title.

3 ‘‘(2)(A) Financial assistance under this subchapter

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

5 for which the total cost of construction is in excess of

6 $400,000 (as adjusted from time to time in such regula7 tions to reflect changes in costs of construction).

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

9 project is a project to remodel or alter existing buildings

10 for which financial assistance under this subchapter may

11 be provided and does not include maintenance and repair

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

13 (b) APPLICATIONS WITH RESPECT TO PROJECTS.—

14 Section 8135 is amended—

15 (1) in subsection (a)—

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

17 preceding paragraph (1) and inserting ‘‘set

18 forth the following:’’;

19 (B) by capitalizing the first letter of the

20 first word in each of paragraphs (1) through

21 (9);

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

23 each of paragraphs (1) through (7) and insert24 ing a period; and
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1 (D) by striking ‘‘, and’’ at the end of para2 graph (8) and inserting a period;

3 (2) by redesignating subsections (b), (c), (d),

4 and (e) as subsections (c), (d), (e), and (f), respec5 tively;

6 (3) by inserting after subsection (a) the fol7 lowing new subsection (b):

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

9 this subchapter for a project that would involve construc10 tion or acquisition of either nursing home or domiciliary

11 facilities shall include with its application under subsection

12 (a) the following:

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

14 project is in reasonable proximity to a sufficient con15 centration and population of veterans who are 65

16 years of age and older, and (ii) that there is a rea17 sonable basis to conclude that the facilities when

18 complete will be fully occupied.

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

20 of operation of such facilities.

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

22 program for that State.

23 ‘‘(2) Failure to provide adequate documentation

24 under paragraph (1)(A) or to provide an adequate finan-
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1 cial plan under paragraph (1)(B) shall be a basis for dis2 approving the application.’’; and

3 (4) in subsection (c), as redesignated by para4 graph (2)—

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

6 grant under subsection (a) of this section’’ in

7 the matter preceding subparagraph (A) and in8 serting ‘‘under subsection (a) for financial as9 sistance under this subchapter’’;

10 (B) in paragraph (2)—

11 (i) by striking ‘‘the construction or ac12 quisition of’’ in subparagraph (A); and

13 (ii) by striking subparagraphs (B),

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

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

16 at an existing facility to remedy a condition or con17 ditions that have been cited by an accrediting insti18 tution, by the Secretary, or by a local licensing or

19 approving body of the State as being threatening to

20 the lives or safety of the patients in the facility.

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

22 previously applied for award of a grant under this

23 subchapter for construction or acquisition of a State

24 nursing home.
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1 ‘‘(D) An application for construction or acquisi2 tion of a nursing home or domiciliary from a State

3 that the Secretary determines, in accordance with

4 regulations under this subchapter, has a great need

5 for the beds to be established at such home or facil6 ity.

7 ‘‘(E) An application from a State for renova8 tions to a State home facility other than renovations

9 described in subparagraph (B).

10 ‘‘(F) An application for construction or acquisi11 tion of a nursing home or domiciliary from a State

12 that the Secretary determines, in accordance with

13 regulations under this subchapter, has a significant

14 need for the beds to be established at such home or

15 facility.

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

17 the Secretary determines appropriate and has estab18 lished in regulations.

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

21 that the Secretary determines, in accordance with

22 regulations under this subchapter, has a limited

23 need for the beds to be established at such home or

24 facility.’’; and
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1 (C) in paragraph (3), by striking subpara2 graph (A) and inserting the following:

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

4 for the construction or acquisition of a hospital;

5 and’’.

6 (c) TRANSITION.—The provisions of sections 8134

7 and 8135 of title 38, United States Code, as in effect on

8 June 1, 1999, shall continue in effect after such date with

9 respect to applications described in section 8135(b)(2)(A)

10 of such title, as in effect on that date, that are identified

11 on the list that (1) is described in section 8135(b)(4) of

12 such title, as in effect on that date, and (2) was estab13 lished by the Secretary of Veterans Affairs on October 29,

14 1998.

15 (d) EFFECTIVE DATE FOR INITIAL REGULATIONS.—

16 The Secretary of Veterans Affairs shall prescribe the ini17 tial regulations under subsection (a) of section 8134 of

18 title 38, United States Code, as added by subsection (a),

19 not later than April 30, 2000.

20 SEC. 207. EXPANSION OF ENHANCED-USE LEASE AUTHOR21 ITY.

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

23 (1) by striking ‘‘only if the Secretary’’ and in24 serting ‘‘only if—

25 ‘‘(A) the Secretary’’;
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1 (2) by redesignating subparagraphs (A), (B),

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

3 and realigning those clauses so as to be four ems

4 from the left margin;

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

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

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

8 ‘‘(B) the Secretary determines that the imple9 mentation of a business plan proposed by the Under

10 Secretary for Health for applying the consideration

11 under such a lease to the provision of medical care

12 and services would result in a demonstrable improve13 ment of services to eligible veterans in the geo14 graphic service-delivery area within which the prop15 erty is located.’’.

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

17 8162(b) is amended—

18 (1) in paragraph (2), by striking ‘‘may not ex19 ceed—’’ and all that follows and inserting ‘‘may not

20 exceed 75 years.’’; and

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

22 following:

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

24 for the Secretary to—
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1 ‘‘(A) obtain facilities, space, or services on the

2 leased property; and

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

4 contribution payments.’’.

5 (c) DESIGNATION OF PROPERTY PROPOSED TO BE

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

7 amended—

8 (A) by striking ‘‘include—’’ and inserting ‘‘in9 clude the following:’’;

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

11 word of each of paragraphs (1), (2), (3), (4), and

12 (5);

13 (C) by striking the semicolon at the end of

14 paragraphs (1), (2), and (3) and inserting a period;

15 and

16 (D) by striking subparagraphs (A), (B), and

17 (C) of paragraph (4) and inserting the following:

18 ‘‘(A) would—

19 ‘‘(i) contribute in a cost-effective man20 ner to the mission of the Department;

21 ‘‘(ii) not be inconsistent with the mis22 sion of the Department;

23 ‘‘(iii) not adversely affect the mission

24 of the Department; and

25 ‘‘(iv) affect services to veterans; or
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1 ‘‘(B) would result in a demonstrable im2 provement of services to eligible veterans in the

3 geographic service-delivery area within which

4 the property is located.’’.

5 (2) Subparagraph (E) of subsection (c)(1) of that

6 section is amended by striking clauses (i), (ii), and (iii)

7 and inserting the following:

8 ‘‘(i) would—

9 ‘‘(I) contribute in a cost-effective

10 manner to the mission of the Department;

11 ‘‘(II) not be inconsistent with the mis12 sion of the Department;

13 ‘‘(III) not adversely affect the mission

14 of the Department; and

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

16 ‘‘(ii) would result in a demonstrable im17 provement of services to eligible veterans in the

18 geographic service-delivery area within which

19 the property is located.’’.

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

21 amended—

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

23 following:

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

25 enhanced-use lease and remaining after any deduction
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1 from those funds under subsection (b) shall be deposited

2 in the Department of Veterans Affairs Health Services

3 Improvement Fund established under section 1729B of

4 this title. The Secretary shall make available to the des5 ignated health care region of the Veterans Health Admin6 istration within which the leased property is located not

7 less than 75 percent of the amount deposited in the fund

8 attributable to that lease.’’; and

9 (2) by adding at the end the following new

10 paragraph:

11 ‘‘(3) For the purposes of paragraph (1), the term

12 ‘designated health care region of the Veterans Health Ad13 ministration’ means a geographic area designated by the

14 Secretary for the purposes of the management of, and al15 location of resources for, health care services provided by

16 the Veterans Health Administration.’’.

17 (e) REPEAL OF TERMINATION PROVISION.—(1) Sec18 tion 8169 is repealed.

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

20 81 is amended by striking the item relating to section

21 8169.

22 (f) REPEAL OF OBSOLETE PROVISIONS.—Section

23 8162 is amended—

24 (1) by striking the last sentence of subsection

25 (a)(1); and
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1 (2) by striking subsection (c).

2 SEC. 208. INELIGIBILITY FOR EMPLOYMENT BY VETERANS

3 HEALTH ADMINISTRATION OF HEALTH CARE

4 PROFESSIONALS WHO HAVE LOST LICENSE

5 TO PRACTICE IN ONE JURISDICTION WHILE

6 STILL LICENSED IN ANOTHER JURISDICTION.

7 Section 7402 is amended by adding at the end the

8 following new subsection:

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

10 under subsection (b) (other than under paragraph (4) of

11 that subsection) if—

12 ‘‘(1) the person is or has been licensed, reg13 istered, or certified (as applicable to such position)

14 in more than one State; and

15 ‘‘(2) either—

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

17 such license, registration, or certification for

18 cause; or

19 ‘‘(B) the person has voluntarily relin20 quished such license, registration, or certifi21 cation in any of those States after being noti22 fied in writing by that State of potential termi23 nation for cause.’’.
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1 TITLE III—MISCELLANEOUS

2 SEC. 301. REVIEW OF PROPOSED CHANGES TO OPERATION

3 OF MEDICAL FACILITIES.

4 Section 8110 is amended by adding at the end the

5 following new subsections:

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

7 more than 50 percent of the beds within a bed section

8 (of 20 or more beds) of a Department medical center un9 less the Secretary first submits to the Committees on Vet10 erans’ Affairs of the Senate and the House of Representa11 tives a report providing a justification for the closure. No

12 action to carry out such closure may be taken after the

13 submission of such report until the end of the 21-day pe14 riod beginning on the date of the submission of the report.

15 ‘‘(e) The Secretary shall submit to the Committees

16 on Veterans’ Affairs of the Senate and the House of Rep17 resentatives, not later than January 20 of each year, a

18 report documenting by network for the preceding fiscal

19 year the following:

20 ‘‘(1) The number of medical service and sur21 gical service beds, respectively, that were closed dur22 ing that fiscal year and, for each such closure, a de23 scription of the changes in delivery of services that

24 allowed such closure to occur.
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1 ‘‘(2) The number of nursing home beds that

2 were the subject of a mission change during that fis3 cal year and the nature of each such mission change.

4 ‘‘(f) For purposes of this section:

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

6 a medical center, means ceasing to provide staffing

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

8 converting the provision of such bed care from care

9 in a Department facility to care under contract ar10 rangements.

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

12 medical center, means psychiatric beds (including

13 beds for treatment of substance abuse and post-trau14 matic stress disorder), intermediate, neurology, and

15 rehabilitation medicine beds, extended care (other

16 than nursing home) beds, and domiciliary beds.

17 ‘‘(3) The term ‘justification’, with respect to

18 closure of beds, means a written report that includes

19 the following:

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

21 determination that the closure is appropriate

22 and advisable.

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

24 functions to be carried out and the means by
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1 which such care and services would continue to

2 be provided to eligible veterans.

3 ‘‘(C) A description of the anticipated ef4 fects of the closure on veterans and on their ac5 cess to care.’’.

6 SEC. 302. PATIENT SERVICES AT DEPARTMENT FACILITIES.

7 (a) SCOPE OF SERVICES.—Section 7803 is

8 amended—

9 (1) in subsection (a)—

10 (A) by striking ‘‘(a)’’ before ‘‘The can11 teens’’; and

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

13 all that follows through ‘‘the premises’’ and in14 serting ‘‘in this section’’; and

15 (2) by striking subsection (b).

16 (b) TECHNICAL AMENDMENTS.—(1) Paragraphs (1)

17 and (11) of section 7802 are each amended by striking

18 ‘‘hospitals and homes’’ and inserting ‘‘medical facilities’’.

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

20 amended—

21 (A) by striking ‘‘hospitals and homes’’ each

22 place it appears and inserting ‘‘medical facilities’’;

23 and

24 (B) by striking ‘‘hospital or home’’ and insert25 ing ‘‘medical facility’’.
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1 SEC. 303. REPORT ON ASSISTED LIVING SERVICES.

2 Not later than April 1, 2000, the Secretary of Vet3 erans Affairs shall submit to the Committees on Veterans

4 Affairs of the Senate and House of Representatives a re5 port on the feasibility of establishing a pilot program to

6 assist veterans in receiving needed assisted living services.

7 The Secretary shall include in such report recommenda8 tions on—

9 (1) the services and staffing that should be pro10 vided to a veteran receiving assisted living services

11 under such a pilot program;

12 (2) the appropriate design of such a pilot pro13 gram; and

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

15 be designed to address.

16 SEC. 304. CHIROPRACTIC TREATMENT.

17 (a) ESTABLISHMENT OF PROGRAM.—Within 120

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

19 Secretary for Health of the Department of Veterans Af20 fairs, after consultation with chiropractors, shall establish

21 a policy for the Veterans Health Administration regarding

22 the role of chiropractic treatment in the care of veterans

23 under chapter 17 of title 38, United States Code.

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

25 (1) The term ‘‘chiropractic treatment’’ means

26 the manual manipulation of the spine performed by
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1 a chiropractor for the treatment of such musculo2 skeletal conditions as the Secretary considers appro3 priate.

4 (2) The term ‘‘chiropractor’’ means an indi5 vidual who—

6 (A) is licensed to practice chiropractic in

7 the State in which the individual performs

8 chiropractic services; and

9 (B) holds the degree of doctor of chiro10 practic from a chiropractic college accredited by

11 the Council on Chiropractic Education.

12 SEC. 305. DESIGNATION OF HOSPITAL BED REPLACEMENT

13 BUILDING AT IOANNIS A. LOUGARIS DEPART14 MENT OF VETERANS AFFAIRS MEDICAL CEN15 TER, RENO, NEVADA.

16 The hospital bed replacement building under con17 struction at the Ioannis A. Lougaris Department of Vet18 erans Affairs Medical Center in Reno, Nevada, is hereby

19 designated as the ‘‘Jack Streeter Building’’. Any reference

20 to that building in any law, regulation, map, document,

21 record, or other paper of the United States shall be consid22 ered to be a reference to the Jack Streeter Building.
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1 TITLE IV—CONSTRUCTION AND

2 FACILITIES MATTERS

3 SEC. 401. AUTHORIZATION OF MAJOR MEDICAL FACILITY

4 PROJECTS.

5 The Secretary of Veterans Affairs may carry out the

6 following major medical facility projects, with each project

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

8 (1) Renovation to provide a domiciliary at Or9 lando, Florida, in a total amount not to exceed

10 $2,400,000, to be derived only from funds appro11 priated for Construction, Major Projects, for a fiscal

12 year before fiscal year 2000 that remain available

13 for obligation.

14 (2) Surgical addition at the Kansas City, Mis15 souri, Department of Veterans Affairs medical cen16 ter, in an amount not to exceed $13,000,000.

17 SEC. 402. AUTHORIZATION OF MAJOR MEDICAL FACILITY

18 LEASES.

19 The Secretary of Veterans Affairs may enter into

20 leases for medical facilities as follows:

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

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

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

24 California, in an amount not to exceed $1,066,500.
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1 SEC. 403. AUTHORIZATION OF APPROPRIATIONS.

2 (a) IN GENERAL.—There are authorized to be appro3 priated to the Secretary of Veterans Affairs for fiscal year

4 2000 and for fiscal year 2001—

5 (1) for the Construction, Major Projects, ac6 count $13,000,000 for the project authorized in sec7 tion 401(2); and

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

9 for the leases authorized in section 402.

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

11 401(2) may only be carried out using—

12 (1) funds appropriated for fiscal year 2000 or

13 fiscal year 2001 pursuant to the authorization of ap14 propriations in subsection (a);

15 (2) funds appropriated for Construction, Major

16 Projects, for a fiscal year before fiscal year 2000

17 that remain available for obligation; and

18 (3) funds appropriated for Construction, Major

19 Projects, for fiscal year 2000 for a category of activ20 ity not specific to a project.

Passed the House of Representatives September 21,

1999.

Attest: JEFF TRANDAHL,

Clerk.