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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2116 Referred in Senate (RFS)]

  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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS; REFERENCES TO TITLE 38, 
              UNITED STATES CODE.

    (a) Short Title.--This Act may be cited as the ``Veterans' 
Millennium Health Care Act''.
    (b) Table of Contents.--The table of contents of 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.
    (c) References to Title 38, United States Code.--Except as 
otherwise expressly provided, whenever in this Act an amendment or 
repeal is expressed in terms of an amendment to, or repeal of, a 
section or other provision, the reference shall be considered to be 
made to a section or other provision of title 38, United States Code.

                        TITLE I--ACCESS TO CARE

SEC. 101. EXTENDED CARE SERVICES.

    (a) Requirement To Provide Extended Care Services.--(1) Chapter 17 
is amended by inserting after section 1710 the following new section:
``Sec. 1710A. Extended care services
    ``(a) The Secretary (subject to section 1710(a)(4) of this title 
and subsection (c) of this section) shall operate and maintain a 
program to provide extended care services to eligible veterans in 
accordance with this section. Such services shall include the 
following:
            ``(1) Geriatric evaluation.
            ``(2) Nursing home care (A) in facilities operated by the 
        Secretary, and (B) in community-based facilities through 
        contracts under section 1720 of this title.
            ``(3) Domiciliary services under section 1710(b) of this 
        title.
            ``(4) Adult day health care under section 1720(f) of this 
        title.
            ``(5) Such other noninstitutional alternatives to nursing 
        home care, including those described in section 1720C of this 
        title, as the Secretary considers reasonable and appropriate.
            ``(6) Respite care under section 1720B of this title.
    ``(b)(1) In carrying out subsection (a), the Secretary shall 
provide extended care services which the Secretary determines are 
needed (A) to any veteran in need of such care for a service-connected 
disability, and (B) to any veteran who is in need of such care and who 
has a service-connected disability rated at 50 percent or more.
    ``(2) The Secretary, in making placements for nursing home care in 
Department facilities, shall give highest priority to veterans (A) who 
are in need of such care for a service-connected disability, or (B) who 
have a service-connected disability rated at 50 percent or more. The 
Secretary shall ensure that a veteran described in this subsection who 
continues to need nursing home care shall not after placement in a 
Department nursing home be transferred from the facility without the 
consent of the veteran, or, in the event the veteran cannot provide 
informed consent, the representative of the veteran.
    ``(c)(1) The Secretary, in carrying out subsection (a), shall 
prescribe regulations governing the priorities for the provision of 
nursing home care in Department facilities so as to ensure that 
priority for such care is given (A) for patient rehabilitation, (B) for 
clinically complex patient populations, and (C) for patients for whom 
there are not other suitable placement options.
    ``(2) The Secretary may not furnish extended care services for a 
non-service-connected disability other than in the case of a veteran 
who has a service-connected disability rated at 50 percent or more 
unless the veteran agrees to pay to the United States a copayment for 
extended care services of more than 21 days in any year.
    ``(d)(1) A veteran who is furnished extended care services under 
this chapter and who is required under subsection (c)(2) to pay an 
amount to the United States in order to be furnished such services 
shall be liable to the United States for that amount.
    ``(2) In implementing subsection (c)(2), the Secretary shall 
develop a methodology for establishing the amount of the copayment for 
which a veteran described in subsection (c) is liable. That methodology 
shall provide for--
            ``(A) establishing a maximum monthly copayment (based on 
        all income and assets of the veteran and the spouse of such 
        veteran);
            ``(B) protecting the spouse of a veteran from financial 
        hardship by not counting all of the income and assets of the 
        veteran and spouse (in the case of a spouse who resides in the 
        community) as available for determining the copayment 
        obligation; and
            ``(C) allowing the veteran to retain a monthly personal 
        allowance.
    ``(e)(1) There is established in the Treasury of the United States 
a revolving fund known as the Department of Veterans Affairs Extended 
Care Fund (hereinafter in this section referred to as the `fund'). 
Amounts in the fund shall be available, without fiscal year limitation 
and without further appropriation, exclusively for the purpose of 
providing extended care services under subsection (a).
    ``(2) All amounts received by the Department under this section 
shall be deposited in or credited to the fund.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1710 the 
following new item:

``1710A. Requirement to provide extended care.''.
    (b) Requirement To Increase Extended Care Services.--(1) Not later 
than January 1, 2000, the Secretary of Veterans Affairs shall develop 
and begin to implement a plan for carrying out the recommendation of 
the Federal Advisory Committee on the Future of Long-Term Care to 
increase, above the level of extended care services which were provided 
as of September 30, 1998--
            (A) the options and services for home and community-based 
        care for eligible veterans; and
            (B) the percentage of the Department of Veterans Affairs 
        medical care budget dedicated to such care.
    (2) The Secretary shall ensure that the staffing and level of 
extended care services provided by the Secretary nationally in 
facilities operated by the Secretary during any fiscal year is not less 
than the level of such services provided nationally in facilities 
operated by the Secretary during fiscal year 1998.
    (c) Adult Day Health Care.--Section 1720(f)(1)(A) is amended to 
read as follows:
    ``(f)(1)(A) The Secretary may furnish adult day health care 
services to a veteran enrolled under section 1705(a) of this title who 
would otherwise require nursing home care.''
    (d) Respite Care Program.--Section 1720B is amended--
            (1) in subsection (a), by striking ``eligible'' and 
        inserting ``enrolled'';
            (2) in subsection (b)--
                    (A) by striking ``the term `respite care' means 
                hospital or nursing home care'' and inserting ``the 
                term `respite care services' means care and services'';
                    (B) by striking ``is'' at the beginning of each of 
                paragraphs (1), (2), and (3) and inserting ``are''; and
                    (C) by striking ``in a Department facility'' in 
                paragraph (2); and
            (3) by adding at the end the following new subsection:
    ``(c) In furnishing respite care services, the Secretary may enter 
into contract arrangements.''.
    (e) Conforming Amendments.--Section 1710 is amended--
            (1) in subsection (a)(1), by striking ``may furnish nursing 
        home care,''; and
            (2) in subsection (a)(4), by inserting ``, and the 
        requirement in section 1710A of this title that the Secretary 
        provide a program of extended care services,'' after ``medical 
        services''.
    (f) State Homes.--Section 1741(a)(2) is amended by striking ``adult 
day health care in a State home'' and inserting ``extended care 
services described in any of paragraphs (4) through (6) of section 
1710A(a) of this title under a program administered by a State home''.
    (g) Effective Date.--(1) Except as provided in paragraph (2), the 
amendments made by this section shall take effect on the date of the 
enactment of this Act.
    (2) Subsection (c)(2) of section 1710A(a) of title 38, United 
States Code (as added by subsection (a)), shall take effect on the 
effective date of regulations prescribed by the Secretary of Veterans 
Affairs under subsections (c)(2) and (d) of such section. The Secretary 
shall publish the effective date of such regulations in the Federal 
Register.
    (3) The provisions of section 1710(f) of title 38, United States 
Code, shall not apply to any day of nursing home care on or after the 
effective date of regulations under paragraph (2).

SEC. 102. REIMBURSEMENT FOR EMERGENCY TREATMENT.

    (a) Authority To Provide Reimbursement.--Chapter 17 is amended by 
inserting after section 1724 the following new section:
``Sec. 1725. Reimbursement for emergency treatment
    ``(a) General Authority.--(1) Subject to subsections (c) and (d), 
the Secretary may reimburse a veteran described in subsection (b) for 
the reasonable value of emergency treatment furnished the veteran in a 
non-Department facility.
    ``(2) In any case in which reimbursement is authorized under 
subsection (a)(1), the Secretary, in the Secretary's discretion, may, 
in lieu of reimbursing the veteran, make payment of the reasonable 
value of the furnished emergency treatment directly--
            ``(A) to a hospital or other health care provider that 
        furnished the treatment; or
            ``(B) to the person or organization that paid for such 
        treatment on behalf of such veteran.
    ``(b) Eligibility.--(1) A veteran referred to in subsection (a)(1) 
is an individual who is an active Department health-care participant 
who is personally liable for emergency treatment furnished the veteran 
in a non-Department facility.
    ``(2) A veteran is an active Department health-care participant if 
the veteran--
            ``(A) is described in any of paragraphs (1) through (6) of 
        section 1705(a) of this title;
            ``(B) is enrolled in the health care system established 
        under such section; and
            ``(C) received care under this chapter within the 12-month 
        period preceding the furnishing of such emergency treatment.
    ``(3) A veteran is personally liable for emergency treatment 
furnished the veteran in a non-Department facility if the veteran--
            ``(A) is financially liable to the provider of emergency 
        treatment for that treatment;
            ``(B) has no entitlement to care or services under a 
        health-plan contract;
            ``(C) has no other contractual or legal recourse against a 
        third party that would, in whole or in part, extinguish such 
        liability to the provider; and
            ``(D) is not eligible for reimbursement for medical care or 
        services under section 1728 of this title.
    ``(c) Limitations on Reimbursement.--(1) The Secretary, in 
accordance with regulations prescribed by the Secretary, shall--
            ``(A) establish the maximum amount payable under subsection 
        (a);
            ``(B) delineate the circumstances under which such payments 
        may be made, to include such requirements on requesting 
        reimbursement as the Secretary shall establish; and
            ``(C) provide that in no event may a payment under that 
        subsection include any amount for which the veteran is not 
        personally liable.
    ``(2) Subject to paragraph (1), the Secretary may provide 
reimbursement under this section only after the veteran or the provider 
of emergency treatment has exhausted without success all claims and 
remedies reasonably available to the veteran or provider against a 
third party for payment of such treatment.
    ``(3) Payment by the Secretary under this section, on behalf of a 
veteran described in subsection (b), to a provider of emergency 
treatment, shall, unless rejected and refunded by the provider within 
30 days of receipt, extinguish any liability on the part of the veteran 
for that treatment. Neither the absence of a contract or agreement 
between the Secretary and the provider nor any provision of a contract, 
agreement, or assignment to the contrary shall operate to modify, 
limit, or negate the requirement in the preceding sentence.
    ``(d) Independent Right of Recovery.--(1) In accordance with 
regulations prescribed by the Secretary, the United States shall have 
the independent right to recover any amount paid under this section 
when, and to the extent that, a third party subsequently makes a 
payment for the same emergency treatment.
    ``(2) Any amount paid by the United States to the veteran (or the 
veteran's personal representative, successor, dependents, or survivors) 
or to any other person or organization paying for such treatment shall 
constitute a lien in favor of the United States against any recovery 
the payee subsequently receives from a third party for the same 
treatment.
    ``(3) Any amount paid by the United States to the provider that 
furnished the veteran's emergency treatment shall constitute a lien 
against any subsequent amount the provider receives from a third party 
for the same emergency treatment for which the United States made 
payment.
    ``(4) The veteran (or the veteran's personal representative, 
successor, dependents, or survivors) shall ensure that the Secretary is 
promptly notified of any payment received from any third party for 
emergency treatment furnished to the veteran. The veteran (or the 
veteran's personal representative, successor, dependents, or survivors) 
shall immediately forward all documents relating to such payment, 
cooperate with the Secretary in the investigation of such payment, and 
assist the Secretary in enforcing the United States right to recover 
any payment made under subsection (c)(3).
    ``(e) Waiver.--The Secretary, in the Secretary's discretion, may 
waive recovery of a payment made to a veteran under this section that 
is otherwise required by subsection (d)(1) when the Secretary 
determines that such waiver would be in the best interest of the United 
States, as defined by regulations prescribed by the Secretary.
    ``(f) Definitions.--For purposes of this section:
            ``(1) The term `emergency treatment' means medical care or 
        services furnished, in the judgment of the Secretary--
                    ``(A) when Department or other Federal facilities 
                are not feasibly available and an attempt to use them 
                beforehand would not be reasonable;
                    ``(B) when such care or services are rendered in a 
                medical emergency of such nature that delay would be 
                hazardous to life or health; and
                    ``(C) until such time as the veteran can be 
                transferred safely to a Department facility or other 
                Federal facility.
            ``(2) The term `health-plan contract' includes any of the 
        following:
                    ``(A) An insurance policy or contract, medical or 
                hospital service agreement, membership or subscription 
                contract, or similar arrangement under which health 
                services for individuals are provided or the expenses 
                of such services are paid.
                    ``(B) An insurance program described in section 
                1811 of the Social Security Act (42 U.S.C. 1395c) or 
                established by section 1831 of such Act (42 U.S.C. 
                1395j).
                    ``(C) A State plan for medical assistance approved 
                under title XIX of such Act (42 U.S.C. 1396 et seq.).
                    ``(D) A workers' compensation law or plan described 
                in section 1729(a)(2)(A) of this title.
                    ``(E) A law of a State or political subdivision 
                described in section 1729(a)(2)(B) of this title.
            ``(3) The term `third party' means any of the following:
                    ``(A) A Federal entity.
                    ``(B) A State or political subdivision of a State.
                    ``(C) An employer or an employer's insurance 
                carrier.
                    ``(D) An automobile accident reparations insurance 
                carrier.
                    ``(E) A person or entity obligated to provide, or 
                to pay the expenses of, health services under a health-
                plan contract.''.
    (b) Conforming Amendments.--(1) Section 1729A(b) is amended--
            (A) by redesignating paragraph (6) as paragraph (7); and
            (B) by inserting after paragraph (5) the following new 
        paragraph:
            ``(6) Section 1725 of this title.''.
    (2) The table of sections at the beginning of chapter 17 is amended 
by inserting after the item relating to section 1724 the following new 
item:

``1725. Reimbursement for emergency treatment.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect 180 days after the date of the enactment of this Act.
    (d) Implementation Reports.--The Secretary of Veterans Affairs 
shall include with the budget justification materials submitted to 
Congress in support of the Department of Veterans Affairs budget for 
fiscal year 2002 and for fiscal year 2003 a report on the 
implementation of section 1725 of title 38, United States Code, as 
added by subsection (a). Each such report shall include information on 
the experience of the Department under that section and the costs 
incurred, and expected to be incurred, under that section.

SEC. 103. ELIGIBILITY FOR CARE OF COMBAT-INJURED VETERANS.

    (a) Priority of Care.--Chapter 17 is amended --
            (1) in section 1710(a)(2)(D), by inserting ``or who was 
        injured in combat'' after ``former prisoner of war''; and
            (2) in section 1705(a)(3), by inserting ``or who were 
        injured in combat'' after ``former prisoners of war''.
    (b) Definition of Injured in Combat.--Section 1701 is amended by 
adding at the end the following new paragraph:
            ``(10) The term `injured in combat' means wounded in action 
        as the result of an act of an enemy of the United States or 
        otherwise wounded in action by weapon fire while directly 
        engaged in armed conflict (other than as the result of willful 
        misconduct by the wounded individual).''.

SEC. 104. ACCESS TO CARE FOR MILITARY RETIREES.

    (a) Improved Access.--(1) Section 1710(a)(2) is amended--
            (A) by striking ``or'' at the end of subparagraph (F);
            (B) by striking the period at the end of subparagraph (G) 
        and inserting ``; or''; and
            (C) by adding at the end the following new subparagraph:
            ``(H) who has retired from active military, naval, or air 
        service in the Army, Navy, Air Force, or Marine Corps, is 
        eligible for care under the TRICARE program established by the 
        Secretary of Defense, and is not otherwise described in 
        paragraph (1) or in this paragraph.''.
    (2) Section 1705(a) is amended--
            (A) by redesignating paragraph (7) as paragraph (8);
            (B) by inserting after paragraph (6) the following new 
        paragraph (7):
            ``(7) Veterans who are eligible for hospital care, medical 
        services, and nursing home care under section 1710(a)(2)(H) of 
        this title.''; and
            (C) in paragraph (6), by inserting ``(other than 
        subparagraph (H) of such section)'' before the period at the 
        end.
    (b) Interagency Agreement.--(1) The Secretary of Defense shall 
enter into an agreement (characterized as a memorandum of understanding 
or otherwise) with the Secretary of Veterans Affairs with respect to 
the provision of medical care by the Secretary of Veterans Affairs to 
eligible military retirees in accordance with the amendments made by 
subsection (a). That agreement shall include provisions for 
reimbursement of the Secretary of Veterans Affairs by the Secretary of 
Defense for medical care provided by the Secretary of Veterans Affairs 
to an eligible military retiree and may include such other provisions 
with respect to the terms and conditions of such care as may be agreed 
upon by the two Secretaries.
    (2) Reimbursement under that agreement shall be in accordance with 
rates agreed upon by the Secretary of Defense and the Secretary of 
Veterans Affairs. Such reimbursement may be made by the Secretary of 
Defense or by the appropriate TRICARE Managed Care Support contractor, 
as determined in accordance with that agreement.
    (3) In entering into the agreement under paragraph (1), 
particularly with respect to determination of the rates of 
reimbursement under paragraph (2), the Secretary of Defense shall 
consult with TRICARE Managed Care Support contractors.
    (4) The Secretary of Veterans Affairs may not enter into an 
agreement under paragraph (1) for the provision of care in accordance 
with the amendments made by subsection (a) with respect to any 
geographic service area, or a part of any such area, of the Veterans 
Health Administration unless--
            (A) in the judgment of that Secretary, the Department of 
        Veterans Affairs will recover the costs of providing such care 
        to eligible military retirees; and
            (B) that Secretary has certified and documented, with 
        respect to any geographic service area in which the Secretary 
        proposes to provide care in accordance with the amendments made 
        by subsection (a), that such geographic service area, or 
        designated part of any such area, has adequate capacity 
        (consistent with the requirements in section 1705(b)(1) of 
        title 38, United States Code, that care to enrollees shall be 
        timely and acceptable in quality) to provide such care.
    (5) The agreement under paragraph (1) shall be entered into by the 
Secretaries not later than nine months after the date of the enactment 
of this Act. If the Secretaries are unable to reach agreement, they 
shall jointly report, by that date or within 30 days thereafter, to the 
Committees on Armed Services and the Committees on Veterans' Affairs of 
the Senate and House of Representatives on the reasons for their 
inability to reach an agreement and their mutually agreed plan for 
removing any impediments to final agreement.
    (c) Depositing of Reimbursements.--Amounts received by the 
Secretary of Veterans Affairs under the agreement under subsection (b) 
shall be deposited in the Department of Veterans Affairs Health 
Services Improvement Fund established under section 1729B of title 38, 
United States Code, as added by section 202.
    (d) Phased Implementation.--(1) The Secretary of Defense shall 
include in each TRICARE contract entered into after the date of the 
enactment of this Act provisions to implement the agreement under 
subsection (b).
    (2) The amendments made by subsection (a) and the provisions of the 
agreement under subsection (b)(2) shall apply to the furnishing of 
medical care by the Secretary of Veterans Affairs in any area of the 
United States only if that area is covered by a TRICARE contract that 
was entered into after the date of the enactment of this Act.
    (e) Eligible Military Retirees.--For purposes of subsection (b), an 
eligible military retiree is a member of the Army, Navy, Air Force, or 
Marine Corps who--
            (1) has retired from active military, naval, or air 
        service;
            (2) is eligible for care under the TRICARE program 
        established by the Secretary of Defense;
            (3) has enrolled for care under section 1705 of title 38, 
        United States Code; and
            (4) is not described in paragraph (1) or (2) of section 
        1710(a) of such title (other than subparagraph (H) of such 
        paragraph (2)), as amended by subsection (a).

SEC. 105. BENEFITS FOR PERSONS DISABLED BY PARTICIPATION IN COMPENSATED 
              WORK THERAPY PROGRAM.

    Section 1151(a)(2) is amended--
            (1) by inserting ``(A)'' after ``proximately caused''; and
            (2) by inserting before the period at the end the 
        following: ``, or (B) by participation in a program (known as a 
        `compensated work therapy program') under section 1718 of this 
        title''.

SEC. 106. PILOT PROGRAM OF MEDICAL CARE FOR CERTAIN DEPENDENTS OF 
              ENROLLED VETERANS.

    (a) In General.--(1) Chapter 17 is amended by inserting after 
section 1713 the following new section:
``Sec. 1713A. Medical care for certain dependents of enrolled veterans: 
              pilot program
    ``(a) The Secretary may, during the program period, carry out a 
pilot program to provide primary health care services for eligible 
dependents of veterans in accordance with this section.
    ``(b) For purposes of this section:
            ``(1) The term `program period' means the period beginning 
        on the first day of the first month beginning more than 180 
        days after the date of the enactment of this section and ending 
        three years after that day.
            ``(2) The term `eligible dependent' means an individual 
        who--
                    ``(A) is the spouse or child of a veteran who is 
                enrolled in the system of patient enrollment 
                established by the Secretary under section 1705 of this 
                title; and
                    ``(B) is determined by the Secretary to have the 
                ability to pay for such care or services either 
                directly or through reimbursement or indemnification 
                from a third party.
    ``(c) The Secretary may furnish health care services to an eligible 
dependent under this section only if the dependent (or, in the case of 
a minor, the parent or guardian of the dependent) agrees--
            ``(1) to pay to the United States an amount representing 
        the reasonable charges for the care or services furnished (as 
        determined by the Secretary); and
            ``(2) to cooperate with and provide the Secretary an 
        appropriate assignment of benefits, authorization to release 
        medical records, and any other executed documents, information, 
        or evidence reasonably needed by the Secretary to recover the 
        Department's charges for the care or services furnished by the 
        Secretary.
    ``(d)(1) The health care services provided under the pilot program 
under this section may consist of such primary hospital care services 
and such primary medical services as may be authorized by the 
Secretary. The Secretary may furnish those services directly through a 
Department medical facility or, subject to paragraphs (2) and (3), 
pursuant to a contract or other agreement with a non-Department 
facility (including a health-care provider, as defined in section 
8152(2) of this title).
    ``(2) The Secretary may enter into a contract or agreement to 
furnish primary health care services under this section in a non-
Department facility on the same basis as provided under subsections (a) 
and (b) of section 1703 of this title or may include such care in an 
existing or new agreement under section 8153 of this title when the 
Secretary determines it to be in the best interest of the prevailing 
standards of the Department medical care program.
    ``(3) Primary health care services may not be authorized to be 
furnished under this section at any medical facility if the furnishing 
of those services would result in the denial of, or a delay in 
providing, access to care for any enrolled veteran at that facility.
    ``(e)(1) In the case of an eligible dependent who is furnished 
primary health care services under this section and who has coverage 
under a health-plan contract, as defined in section 1729(i)(1) of this 
title, the United States shall have the right to recover or collect the 
reasonable charges for such care or services from such health-plan 
contract to the extent that the individual or the provider of the care 
or services would be eligible to receive payment for such care or 
services from such health-plan contract if the care or services had not 
been furnished by a department or agency of the United States.
    ``(2) The right of the United States to recover under paragraph (1) 
shall be enforceable with respect to an eligible dependent in the same 
manner as applies under subsections (a)(3), (b), (c)(1), (c)(2), (d), 
(f), (h), and (i) of section 1729 of this title with respect to a 
veteran.
    ``(f)(1) Subject to paragraphs (2) and (3), the pilot program under 
this section shall be carried out during the program period in not more 
than four veterans integrated service networks, as designated by the 
Secretary. In designating networks under the preceding sentence, the 
Secretary shall favor designation of networks that are suited to serve 
dependents of veterans because of--
            ``(A) the capability of one or more medical facilities 
        within the network to furnish primary health care services to 
        eligible dependents while assuring that veterans continue to 
        receive priority for care and services;
            ``(B) the demonstrated success of such medical facilities 
        in billings and collections;
            ``(C) support for initiating such a pilot program among 
        veterans in the network; and
            ``(D) such other criteria as the Secretary considers 
        appropriate.
    ``(2) In implementing the pilot program, the Secretary may not 
provide health care services for dependents who are children--
            ``(A) in more than one of the participating networks during 
        the first year of the program period; and
            ``(B) in more than two of the participating networks during 
        the second year of the program period.
    ``(3) In implementing the pilot program, the Secretary shall give 
priority to facilities which operate women veterans' clinics.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1713 the 
following new item:

``1713A. Medical care for certain dependents and enrolled veterans: 
                            pilot program.''.
    (b) GAO Review and Recommendations.--(1) Beginning six months after 
the commencement of the pilot program, the Comptroller General, in 
consultation with the Under Secretary for Health of the Department of 
Veterans Affairs, shall monitor the conduct of the pilot program.
    (2) Not later than 14 months after the commencement of the pilot 
program, the Comptroller General shall submit to the Secretary of 
Veterans Affairs a report setting forth the Comptroller General's 
findings and recommendations with respect to the first 12 months of 
operation of the pilot program.
    (3)(A) The report under paragraph (2) shall include the findings of 
the Comptroller General regarding--
            (i) whether the collection of reasonable charges for the 
        care or services provided reasonably covers the costs of 
        providing such care and services; and
            (ii) whether the Secretary, in carrying out the program, is 
        in compliance with the limitation in subsection (d)(3) of 
        section 1713A of title 38, United States Code, as added by 
        subsection (a).
    (B) The report shall include the recommendations of the Comptroller 
General regarding any remedial steps that the Secretary should take in 
the conduct of the program or in the billing and collection of charges 
under the program.
    (4) The Secretary, in consultation with, and following receipt of 
the report of, the Comptroller General, shall take such steps as may be 
needed to ensure that any recommendations of the Comptroller General in 
the report under paragraph (2) with respect to billings and 
collections, and with respect to compliance with the limitation in 
subsection (d)(3) of such section, are carried out.
    (5) For purposes of this subsection, the term ``commencement of the 
pilot program'' means the date on which the Secretary of Veterans 
Affairs begins to furnish services to eligible dependents under the 
pilot program under section 1713A of title 38, United States Code, as 
added by subsection (a).

SEC. 107. ENHANCED SERVICES PROGRAM AT DESIGNATED MEDICAL CENTERS.

    (a) Findings.--Congress makes the following findings:
            (1) Historically, health care facilities under the 
        jurisdiction of the Department of Veterans Affairs have not 
        consistently been located in proximity to veteran population 
        concentrations.
            (2) Hospital occupancy rates at numbers of Department 
        medical centers are at levels substantially below a level 
        needed for efficient operation and optimal quality of care.
            (3) The costs of maintaining highly inefficient medical 
        centers, which were designed and constructed decades ago to 
        standards no longer considered acceptable, substantially 
        diminish the availability of resources which could be devoted 
        to the provision of needed direct care services.
            (4) Freeing resources currently devoted to highly 
        inefficient provision of hospital care could, through 
        contracting for acute hospital care and establishing new 
        facilities for provision of outpatient care, yield improved 
        access and service to veterans.
    (b) Enhanced Services Program at Designated Medical Centers.--The 
Secretary of Veterans Affairs, in carrying out the responsibilities of 
the Secretary to furnish hospital care and medical services through 
network-based planning, shall establish an enhanced service program at 
Department medical centers (hereinafter in this section referred to as 
``designated centers'') that are designated by the Secretary for the 
purposes of this section. Medical centers shall be designated to 
improve access, and quality of service provided, to veterans served by 
those medical centers. The Secretary may designate a medical center for 
the program only if the Secretary determines, on the basis of a market 
and data analysis (which shall include a study of the cost-
effectiveness of the care provided at such center), that the medical 
center--
            (1) can, in whole or in part, no longer be operated in a 
        manner that provides hospital or other care efficiently and at 
        optimal quality because of such factors as--
                    (A) the current and projected need for hospital or 
                other care capacity at such center;
                    (B) the extent to which the facility is 
                functionally obsolete; and
                    (C) the cost of operation and maintenance of the 
                physical plant; and
            (2) is located in proximity (A) to one or more community 
        hospitals which have the capacity to provide primary and 
        secondary hospital care of appropriate quality to veterans 
        under contract arrangements with the Secretary which the 
        Secretary determines are advantageous to the Department, or (B) 
        to another Department medical center which is capable of 
        absorbing some or all of the patient workload of such medical 
        center.
    (c) Medical Center Plan.--The Secretary shall, with respect to each 
designated center, develop a plan aimed at improving the accessibility 
and quality of service provided to veterans. Each plan shall be 
developed in accordance with the requirements for strategic network-
based planning described in section 8107 of title 38, United States 
Code. In the plan for a designated center, the Secretary shall describe 
a program which, if implemented, would allow the Secretary to do any of 
the following:
            (1) Provide for a Department facility described in 
        subsection (b)(2)(B) to absorb some or all of the patient 
        workload of the designated center.
            (2) Contract, under such arrangements as the Secretary 
        determines appropriate, for needed primary and secondary 
        hospital care for veterans--
                    (A) who reside in the catchment area of each 
                designated center;
                    (B) who are described in paragraphs (1) through (6) 
                of section 1705(a) of title 38, United States Code; and
                    (C) whom the Secretary has enrolled for care 
                pursuant to section 1705 of title 38, United States 
                Code.
            (3) Cease to provide hospital care, or hospital care and 
        other medical services, at such center.
            (4) If practicable, lease, under subchapter V of chapter 81 
        of title 38, United States Code, land and improvements which 
        had been dedicated to providing care described in paragraph 
        (3).
            (5) Establish, through reallocation of operational funds 
        and through appropriate lease arrangements or renovations, 
        facilities for--
                    (A) delivery of outpatient care; and
                    (B) services which would obviate a need for nursing 
                home care or other long-term institutional care.
    (d) Employee Protections.--(1) In entering into any contract or 
lease under subsection (c), the Secretary shall attempt to ensure that 
employees of the Secretary who would be displaced under this section be 
given priority in hiring by such contractor, lessee, or other entity.
    (2) In carrying out subsection (c)(5), the Secretary shall give 
preference to providing services through employee-based delivery 
models.
    (e) Required Consultation.--In developing a plan under subsection 
(c), the Secretary shall obtain the views of veterans organizations, 
exclusive employee representatives, and other interested parties and 
provide for such organizations and parties to participate in the 
development of the plan.
    (f) Submission of Plan to Congress.--The Secretary may not 
implement a plan described in subsection (c) with respect to a medical 
center unless the Secretary has first submitted a report containing a 
detailed plan and justification to the appropriate committees of 
Congress. No action to carry out such plan may be taken after the 
submission of such report until the end of a 45-day period following 
the date of the submission of the report, not less than 30 days of 
which shall be days during which Congress shall have been in continuous 
session. For purposes of the preceding sentence, continuity of a 
session of Congress is broken only by adjournment sine die, and there 
shall be excluded from the computation of any period of continuity of 
session any day during which either House of Congress is not in session 
during an adjournment of more than three days to a day certain.
    (g) Implementation of Plan.--In carrying out the plan described in 
subsection (c), or a modification to that plan following the submission 
of such plan to the appropriate committees of Congress, the Secretary--
            (1) may, without regard to any limitation under section 
        1703 of title 38, United States Code, contract for hospital 
        care for veterans who are--
                    (A) described in paragraphs (1) through (6) of 
                section 1705(a) of title 38, United States Code; and
                    (B) enrolled under subsection (a) of such section 
                1705;
            (2) may enter into any contract under section 8153 of title 
        38, United States Code;
            (3) shall, in exercising the authority of the Secretary 
        under this section to contract for hospital care, provide for 
        ongoing oversight and management, by employees of the 
        Department, of the hospital care furnished such veterans; and
            (4) shall, in the case of a designated center which ceases 
        to provide services under the program--
                    (A) ensure a reallocation of funds as provided in 
                subsection (h); and
                    (B) provide reemployment assistance to employees.
    (h) Funds Allocation.--In carrying out subsection (g)(4), the 
Secretary shall ensure that not less than 90 percent of the funds that 
would have been made available to a designated center to support the 
provision of services, but for such mission change, shall be made 
available to the appropriate health care region of the Veterans Health 
Administration to ensure that the implementation of the plan under 
subsection (g) will result in demonstrable improvement in the 
accessibility, and quality of service provided, to veterans in the 
catchment area of such center.
    (i) Specialized Services.--The provisions of this section do not 
diminish the obligations of the Secretary under section 1706(b) of 
title 38, United States Code.
    (j) Report.--Not later than 12 months after implementation of any 
plan under subsection (b), the Secretary shall submit to Congress a 
report on the implementation of the enhanced service program.
    (k) Residual Authority.--Nothing in this section may be construed 
to diminish the authority of the Secretary to--
            (1) consolidate, eliminate, abolish, or redistribute the 
        functions or missions of facilities in the Department;
            (2) revise the functions or missions of any such facility 
        or activity; or
            (3) create new facilities or activities in the Department.

SEC. 108. COUNSELING AND TREATMENT FOR VETERANS WHO HAVE EXPERIENCED 
              SEXUAL TRAUMA.

    (a) Extension of Period of Program.--Subsection (a) of section 
1720D is amended--
            (1) in paragraph (1), by striking ``December 31, 2001'' and 
        inserting ``December 31, 2002''; and
            (2) in paragraph (3), by striking ``December 31, 2001'' and 
        inserting ``December 31, 2002''.
    (b) Mandatory Nature of Program.--(1) Subsection (a)(1) of such 
section is further amended by striking ``may provide counseling to a 
veteran who the Secretary determines requires such counseling'' and 
inserting ``shall operate a program under which the Secretary provides 
counseling and appropriate care and services to veterans who the 
Secretary determines require such counseling and care and services''.
    (2) Subsection (a) of such section is further amended--
            (A) by striking paragraph (2); and
            (B) by redesignating paragraph (3) (as amended by 
        subsection (a)(2)) as paragraph (2).
    (c) Outreach Efforts.--Subsection (c) of such section is amended--
            (1) by inserting ``and treatment'' in the first sentence 
        and in paragraph (2) after ``counseling'';
            (2) by striking ``and'' at the end of paragraph (1);
            (3) by redesignating paragraph (2) as paragraph (3); and
            (4) by inserting after paragraph (1) the following new 
        paragraph (2):
            ``(2) shall ensure that information about the counseling 
        and treatment available to veterans under this section--
                    ``(A) is revised and updated as appropriate;
                    ``(B) is made available and visibly posted at 
                appropriate facilities of the Department; and
                    ``(C) is made available through appropriate public 
                information services; and''.
    (d) Report on Implementation of Outreach Activities.--Not later 
than six months after the date of the enactment of this Act, the 
Secretary of Veterans Affairs shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
on the Secretary's implementation of paragraph (2) of section 1720D(c) 
of title 38, United States Code, as added by subsection (c). Such 
report shall include examples of the documents and other means of 
communication developed for compliance with that paragraph.
    (e) Study of Expanding Eligibility for Counseling and Treatment.--
(1) The Secretary of Veterans Affairs, in consultation with the 
Secretary of Defense, shall conduct a study to determine--
            (A) the extent to which former members of the reserve 
        components of the Armed Forces experienced physical assault of 
        a sexual nature or battery of a sexual nature while serving on 
        active duty for training;
            (B) the extent to which such former members have sought 
        counseling from the Department of Veterans Affairs relating to 
        those incidents; and
            (C) the additional resources that, in the judgment of the 
        Secretary, would be required to meet the projected need of 
        those former members for such counseling.
    (2) Not later than 16 months after the date of the enactment of 
this Act, the Secretary of Veterans Affairs shall submit to the 
Committees on Veterans' Affairs of the Senate and House of 
Representatives a report on the results of the study conducted under 
paragraph (1).
    (f) Oversight of Outreach Activities.--Not later than 14 months 
after the date of the enactment of this Act, the Secretary of Veterans 
Affairs and the Secretary of Defense shall submit to the appropriate 
congressional committees a joint report describing in detail the 
collaborative efforts of the Department of Veterans Affairs and the 
Department of Defense to ensure that members of the Armed Forces, upon 
separation from active military, naval, or air service, are provided 
appropriate and current information about programs of the Department of 
Veterans Affairs to provide counseling and treatment for sexual trauma 
that may have been experienced by those members while in the active 
military, naval, or air service, including information about 
eligibility requirements for, and procedures for applying for, such 
counseling and treatment. The report shall include proposed 
recommendations from both the Secretary of Veterans Affairs and the 
Secretary of Defense for the improvement of their collaborative efforts 
to provide such information.
    (g) Report on Implementation of Sexual Trauma Treatment Program.--
Not later than 14 months after the date of the enactment of this Act, 
the Secretary of Veterans Affairs shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a report 
on the use made of the authority provided under section 1720D of title 
38, United States Code, as amended by this section. The report shall 
include the following with respect to activities under that section 
since the enactment of this Act:
            (1) The number of veterans who have received counseling 
        under that section.
            (2) The number of veterans who have been referred to non-
        Department mental health facilities and providers in connection 
        with sexual trauma counseling and treatment.

                    TITLE II--PROGRAM ADMINISTRATION

SEC. 201. MEDICAL CARE COLLECTIONS.

    (a) Limited Authority To Set Copayments.--(1) Section 1722A is 
amended--
            (A) by redesignating subsections (b) and (c) as subsections 
        (c) and (d), respectively;
            (B) by inserting after subsection (a) the following new 
        subsection (b):
    ``(b) The Secretary, pursuant to regulations which the Secretary 
shall prescribe, may--
            ``(1) increase the copayment amount in effect under 
        subsection (a);
            ``(2) establish a maximum annual pharmaceutical copayment 
        amount under subsection (a) for veterans who have multiple 
        outpatient prescriptions; and
            ``(3) require a veteran, other than a veteran described in 
        subsection (a)(3), to pay to the United States a reasonable 
        copayment for sensori-neural aids, electronic equipment, and 
        any other costly item or equipment furnished the veteran for a 
        nonservice-connected condition, other than a wheelchair or 
        artificial limb.''; and
            (C) in subsection (c), as redesignated by subparagraph 
        (A)--
                    (i) by striking ``this section'' and inserting 
                ``subsection (a)''; and
                    (ii) by adding at the end the following new 
                sentence: ``Amounts collected through use of the 
                authority under subsection (b) shall be deposited in 
                Department of Veterans Affairs Health Services 
                Improvement Fund.''.
    (2)(A) The heading of such section is amended to read as follows:
``Sec. 1722A. Copayments for medications and certain costly items and 
              equipment''.
    (B) The item relating to such section in the table of sections at 
the beginning of chapter 17 is amended to read as follows:

``1722A. Copayments for medications and certain costly items and 
                            equipment.''.
    (b) Outpatient Treatment of Category C Veterans.--(1) Section 
1710(g) is amended--
            (A) in paragraph (1), by striking ``the amount under 
        paragraph (2) of this subsection'' and inserting ``in the case 
        of each outpatient visit the applicable amount or amounts 
        established by the Secretary by regulation''; and
            (B) in paragraph (2), by striking all after ``for an 
        amount'' and inserting ``which the Secretary shall establish by 
        regulation.''.

SEC. 202. HEALTH SERVICES IMPROVEMENT FUND.

    (a) Establishment of Fund.--Chapter 17 is amended by inserting 
after section 1729A the following new section:
``Sec. 1729B. Health Services Improvement Fund
    ``(a) There is established in the Treasury of the United States a 
fund to be known as the `Department of Veterans Affairs Health Services 
Improvement Fund'.
    ``(b) Amounts received or collected after the date of the enactment 
of this section under any of the following provisions of law shall be 
deposited in the fund:
            ``(1) Section 1713A of this title.
            ``(2) Section 1722A(b) of this title.
            ``(3) Section 8165(a) of this title.
            ``(4) Section 104(c) of the Veterans' Millennium Health 
        Care Act.
    ``(c) Amounts in the fund are hereby available, without fiscal year 
limitation, to the Secretary for the purposes stated in subparagraphs 
(A) and (B) of section 1729A(c)(1) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1729A the following new item:

``1729B. Health Services Improvement Fund.''.

SEC. 203. VETERANS TOBACCO TRUST FUND.

    (a) Findings.--Congress finds the following:
            (1) Smoking related illnesses, including cancer, heart 
        disease, and emphysema, are highly prevalent among the more 
        than 3,000,000 veterans who use the Department of Veterans 
        Affairs health care system annually.
            (2) The Department of Veterans Affairs estimates that it 
        spent $3,600,000,000 in 1997 to treat smoking-related illnesses 
        and that over the next five years it will spend $20,000,000,000 
        on such care.
            (3) Congress established the Department of Veterans Affairs 
        in furtherance of its constitutional power to provide for the 
        national defense in order to provide benefits and services to 
        veterans of the uniformed services.
            (4) There is in the Department of Veterans Affairs a health 
        care system which has as its primary function to provide a 
        complete medical and hospital service for the medical care and 
        treatment of such veterans as can be served through available 
        appropriations.
            (5) The Federal Government, including the Department of 
        Veterans Affairs, has lacked the means to prevent the onset of 
        smoking-related illnesses among veterans and has had no 
        authority to deny needed treatment to any veteran on the basis 
        that an illness is or might be smoking-related.
            (6) With some 20 percent of its health care budget absorbed 
        in treating smoking-related illnesses, the Department of 
        Veterans Affairs health care system has lacked resources to 
        provide needed nursing home care, home care, community-based 
        ambulatory care, and other services to tens of thousands of 
        other veterans.
            (7) The network of academically affiliated medical centers 
        of the Department of Veterans Affairs provides a unique system 
        within which outstanding medical research is conducted and 
        which has the potential to expand significantly ongoing 
        research on tobacco-related illnesses.
    (b) Establishment of Trust Fund.--(1) Chapter 17 is amended by 
inserting after section 1729B, as added by section 202(a), the 
following new section:
``Sec. 1729C. Veterans Tobacco Trust Fund
    ``(a) There is established in the Treasury of the United States a 
trust fund to be known as the `Veterans Tobacco Trust Fund', consisting 
of such amounts as may be appropriated, credited, or donated to the 
trust fund.
    ``(b) If the United States pursues recovery (other than a recovery 
authorized under this title) from a party or parties specifically for 
health care costs incurred or to be incurred by the United States that 
are attributable to tobacco-related illnesses, there shall be credited 
to the trust fund from the amount of any such recovery by the United 
States, without further appropriation, the amount that bears the same 
ratio to the amount recovered as the amount of the Department's costs 
for health care attributable to tobacco-related illnesses for which 
recovery is sought bears to the total amount sought by the United 
States.
    ``(c) After September 30, 2004, amounts in the trust fund shall be 
available, without fiscal year limitation, to the Secretary for the 
following purposes:
            ``(1) Furnishing medical care and services under this 
        chapter, to be available during any fiscal year for the same 
        purposes and subject to the same limitations (other than with 
        respect to the period of availability for obligation) as apply 
        to amounts appropriated from the general fund of the Treasury 
        for that fiscal year for medical care.
            ``(2) Conducting medical research, rehabilitation research, 
        and health systems research, with particular emphasis on 
        research relating to prevention and treatment of, and 
        rehabilitation from, tobacco addiction and diseases associated 
        with tobacco use.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1729B, as added 
by section 202(b), the following new item:

``1729C. Veterans Tobacco Trust Fund.''.

SEC. 204. AUTHORITY TO ACCEPT FUNDS FOR EDUCATION AND TRAINING.

    (a) Establishment of Nonprofit Corporations at Medical Centers.--
Section 7361(a) is amended--
            (1) by inserting ``and education'' after ``research''; and
            (2) by adding at the end the following: ``Such a 
        corporation may be established to facilitate either research or 
        education or both research and education.''.
    (b) Purpose of Corporations.--Section 7362 is amended--
            (1) in the first sentence, by inserting ``and education and 
        training as described in sections 7302, 7471, 8154, and 
        1701(6)(B) of this title'' after ``of this title''; and
            (2) in the second sentence--
                    (A) by inserting ``or education'' after 
                ``research''; and
                    (B) by striking ``that purpose'' and inserting 
                ``these purposes''.
    (c) Board of Directors.--Section 7363(a) is amended--
            (1) in subsection (a)(1), by striking all after ``medical 
        center, and'' and inserting ``as appropriate, the assistant 
        chief of staff for research for the medical center and the 
        associate chief of staff for education for the medical center, 
        or, in the case of a facility at which such positions do not 
        exist, those officials who are responsible for carrying out the 
        responsibilities of the medical center director, chief of 
        staff, and, as appropriate, the assistant chief of staff for 
        research and the assistant chief for education; and'';
            (2) in subsection (a)(2), by inserting ``or education, as 
        appropriate'' after ``research''; and
            (3) in subsection (c), by inserting ``or education'' after 
        ``research''.
    (d) Approval of Expenditures.--Section 7364 is amended by adding at 
the end the following new subsection:
    ``(c)(1) A corporation established under this subchapter may not 
spend funds for an education activity unless the activity is approved 
in accordance with procedures prescribed by the Under Secretary for 
Health.
    ``(2) The Under Secretary for Health shall prescribe policies and 
procedures to guide the expenditure of funds by corporations under 
paragraph (1) consistent with the purpose of such corporations as 
flexible funding mechanisms.''.

SEC. 205. EXTENSION AND REVISION OF CERTAIN AUTHORITIES.

    (a) Readjustment Counseling Program.--Section 1712A(a)(1)(B)(ii) is 
amended by striking ``2000'' and inserting ``2003''.
    (b) Committee on Mentally Ill Veterans.--Section 7321(d)(2) is 
amended by striking ``three'' and inserting ``five''.
    (c) Committee on Post-Traumatic Stress Disorder.--Section 110 of 
Public Law 98-528 (38 U.S.C. 1712A note) is amended--
            (1) in subsection (e)(1), by striking ``March 1, 1985'' and 
        inserting ``March 1, 2000''; and
            (2) in subsection (e)(2), by striking ``February 1, 1986'' 
        and inserting ``February 1, 2001''.
    (d) Extension of Authority To Make Grants.--Section 3(a)(2) of the 
Homeless Veterans Comprehensive Service Programs Act of 1992 (38 U.S.C. 
7721 note) is amended by striking ``September 30, 1999'' and inserting 
``September 30, 2002''.
    (e) Authority To Make Grants for Homeless Veterans.--Section 
3(b)(2) of the Homeless Veterans Comprehensive Service Programs Act of 
1992 (38 U.S.C. 7721 note) is amended by striking ``and no more than 20 
programs which incorporate the procurement of vans as described in 
paragraph (1)''.

SEC. 206. STATE HOME GRANT PROGRAM.

    (a) General Regulations.--Section 8134 is amended--
            (1) by redesignating subsection (b) as subsection (c);
            (2) by striking the matter in subsection (a) preceding 
        paragraph (2) and inserting the following:
    ``(a)(1) The Secretary shall prescribe regulations for the purposes 
of this subchapter.
    ``(2) In those regulations, the Secretary shall prescribe for each 
State the number of nursing home and domiciliary beds for which 
assistance under this subchapter may be furnished. Such regulations 
shall be based on projected demand for such care 10 years after the 
date of the enactment of the Veterans' Millennium Health Care Act by 
veterans who at such time are 65 years of age or older and who reside 
in that State. In determining such projected demand, the Secretary 
shall take into account travel distances for veterans and their 
families.
    ``(3)(A) In those regulations, the Secretary shall establish 
criteria under which the Secretary shall determine, with respect to an 
application for assistance under this subchapter for a project 
described in subparagraph (B) which is from a State that has a need for 
additional beds as determined under subsections (a)(2) and (d)(1), 
whether the need for such beds is most aptly characterized as great, 
significant, or limited. Such criteria shall take into account the 
availability of beds already operated by the Secretary and other 
providers which appropriately serve the needs which the State proposes 
to meet with its application.
    ``(B) This paragraph applies to a project for the construction or 
acquisition of a new State home facility, to a project to increase the 
number of beds available at a State home facility, and a project to 
replace beds at a State home facility.
    ``(4) The Secretary shall review and, as necessary, revise 
regulations prescribed under paragraphs (2) and (3) not less often than 
every four years.
    ``(b) The Secretary shall prescribe the following by regulation:'';
            (3) by redesignating paragraphs (2) and (3) of subsection 
        (b), as designated by paragraph (2), as paragraphs (1) and (2);
            (4) in subsection (c), as redesignated by paragraph (1), by 
        striking ``subsection (a)(3)'' and inserting ``subsection 
        (b)(2)''; and
            (5) by adding at the end the following new subsection:
    ``(d)(1) In prescribing regulations to carry out this subchapter, 
the Secretary shall provide that in the case of a State that seeks 
assistance under this subchapter for a project described in subsection 
(a)(3)(B), the determination of the unmet need for beds for State homes 
in that State shall be reduced by the number of beds in all previous 
applications submitted by that State under this subchapter, including 
beds which have not been recognized by the Secretary under section 1741 
of this title.
    ``(2)(A) Financial assistance under this subchapter for a 
renovation project may only be provided for a project for which the 
total cost of construction is in excess of $400,000 (as adjusted from 
time to time in such regulations to reflect changes in costs of 
construction).
    ``(B) For purposes of this paragraph, a renovation project is a 
project to remodel or alter existing buildings for which financial 
assistance under this subchapter may be provided and does not include 
maintenance and repair work which is the responsibility of the 
State.''.
    (b) Applications With Respect to Projects.--Section 8135 is 
amended--
            (1) in subsection (a)--
                    (A) by striking ``set forth--'' in the matter 
                preceding paragraph (1) and inserting ``set forth the 
                following:'';
                    (B) by capitalizing the first letter of the first 
                word in each of paragraphs (1) through (9);
                    (C) by striking the comma at the end of each of 
                paragraphs (1) through (7) and inserting a period; and
                    (D) by striking ``, and'' at the end of paragraph 
                (8) and inserting a period;
            (2) by redesignating subsections (b), (c), (d), and (e) as 
        subsections (c), (d), (e), and (f), respectively;
            (3) by inserting after subsection (a) the following new 
        subsection (b):
    ``(b)(1) Any State seeking to receive assistance under this 
subchapter for a project that would involve construction or acquisition 
of either nursing home or domiciliary facilities shall include with its 
application under subsection (a) the following:
            ``(A) Documentation (i) that the site for the project is in 
        reasonable proximity to a sufficient concentration and 
        population of veterans who are 65 years of age and older, and 
        (ii) that there is a reasonable basis to conclude that the 
        facilities when complete will be fully occupied.
            ``(B) A financial plan for the first three years of 
        operation of such facilities.
            ``(C) A five-year capital plan for the State home program 
        for that State.
    ``(2) Failure to provide adequate documentation under paragraph 
(1)(A) or to provide an adequate financial plan under paragraph (1)(B) 
shall be a basis for disapproving the application.''; and
            (4) in subsection (c), as redesignated by paragraph (2)--
                    (A) in paragraph (1), by striking ``for a grant 
                under subsection (a) of this section'' in the matter 
                preceding subparagraph (A) and inserting ``under 
                subsection (a) for financial assistance under this 
                subchapter'';
                    (B) in paragraph (2)--
                            (i) by striking ``the construction or 
                        acquisition of'' in subparagraph (A); and
                            (ii) by striking subparagraphs (B), (C), 
                        and (D) and inserting the following:
            ``(B) An application from a State for a project at an 
        existing facility to remedy a condition or conditions that have 
        been cited by an accrediting institution, by the Secretary, or 
        by a local licensing or approving body of the State as being 
        threatening to the lives or safety of the patients in the 
        facility.
            ``(C) An application from a State that has not previously 
        applied for award of a grant under this subchapter for 
        construction or acquisition of a State nursing home.
            ``(D) An application for construction or acquisition of a 
        nursing home or domiciliary from a State that the Secretary 
        determines, in accordance with regulations under this 
        subchapter, has a great need for the beds to be established at 
        such home or facility.
            ``(E) An application from a State for renovations to a 
        State home facility other than renovations described in 
        subparagraph (B).
            ``(F) An application for construction or acquisition of a 
        nursing home or domiciliary from a State that the Secretary 
        determines, in accordance with regulations under this 
        subchapter, has a significant need for the beds to be 
        established at such home or facility.
            ``(G) An application that meets other criteria as the 
        Secretary determines appropriate and has established in 
        regulations.
            ``(H) An application for construction or acquisition of a 
        nursing home or domiciliary from a State that the Secretary 
        determines, in accordance with regulations under this 
        subchapter, has a limited need for the beds to be established 
        at such home or facility.''; and
                    (C) in paragraph (3), by striking subparagraph (A) 
                and inserting the following:
            ``(A) may not accord any priority to a project for the 
        construction or acquisition of a hospital; and''.
    (c) Transition.--The provisions of sections 8134 and 8135 of title 
38, United States Code, as in effect on June 1, 1999, shall continue in 
effect after such date with respect to applications described in 
section 8135(b)(2)(A) of such title, as in effect on that date, that 
are identified on the list that (1) is described in section 8135(b)(4) 
of such title, as in effect on that date, and (2) was established by 
the Secretary of Veterans Affairs on October 29, 1998.
    (d) Effective Date for Initial Regulations.--The Secretary of 
Veterans Affairs shall prescribe the initial regulations under 
subsection (a) of section 8134 of title 38, United States Code, as 
added by subsection (a), not later than April 30, 2000.

SEC. 207. EXPANSION OF ENHANCED-USE LEASE AUTHORITY.

    (a) Authority.--Section 8162(a)(2) is amended--
            (1) by striking ``only if the Secretary'' and inserting 
        ``only if--
            ``(A) the Secretary'';
            (2) by redesignating subparagraphs (A), (B), and (C) as 
        clauses (i), (ii), and (iii), respectively, and realigning 
        those clauses so as to be four ems from the left margin;
            (3) by striking the period at the end of clause (iii), as 
        so redesignated, and inserting ``; or''; and
            (4) by adding at the end the following:
            ``(B) the Secretary determines that the implementation of a 
        business plan proposed by the Under Secretary for Health for 
        applying the consideration under such a lease to the provision 
        of medical care and services would result in a demonstrable 
        improvement of services to eligible veterans in the geographic 
        service-delivery area within which the property is located.''.
    (b) Term of Enhanced-Use Lease.--Section 8162(b) is amended--
            (1) in paragraph (2), by striking ``may not exceed--'' and 
        all that follows and inserting ``may not exceed 75 years.''; 
        and
            (2) by striking paragraph (4) and inserting the following:
    ``(4) The terms of an enhanced-use lease may provide for the 
Secretary to--
            ``(A) obtain facilities, space, or services on the leased 
        property; and
            ``(B) use minor construction funds for capital contribution 
        payments.''.
    (c) Designation of Property Proposed To Be Leased.--(1) Subsection 
(b) of section 8163 is amended--
            (A) by striking ``include--'' and inserting ``include the 
        following:'';
            (B) by capitalizing the first letter of the first word of 
        each of paragraphs (1), (2), (3), (4), and (5);
            (C) by striking the semicolon at the end of paragraphs (1), 
        (2), and (3) and inserting a period; and
            (D) by striking subparagraphs (A), (B), and (C) of 
        paragraph (4) and inserting the following:
                    ``(A) would--
                            ``(i) contribute in a cost-effective manner 
                        to the mission of the Department;
                            ``(ii) not be inconsistent with the mission 
                        of the Department;
                            ``(iii) not adversely affect the mission of 
                        the Department; and
                            ``(iv) affect services to veterans; or
                    ``(B) would result in a demonstrable improvement of 
                services to eligible veterans in the geographic 
                service-delivery area within which the property is 
                located.''.
    (2) Subparagraph (E) of subsection (c)(1) of that section is 
amended by striking clauses (i), (ii), and (iii) and inserting the 
following:
                    ``(i) would--
                            ``(I) contribute in a cost-effective manner 
                        to the mission of the Department;
                            ``(II) not be inconsistent with the mission 
                        of the Department;
                            ``(III) not adversely affect the mission of 
                        the Department; and
                            ``(IV) affect services to veterans; or
                    ``(ii) would result in a demonstrable improvement 
                of services to eligible veterans in the geographic 
                service-delivery area within which the property is 
                located.''.
    (d) Use of Proceeds.--Section 8165(a) is amended--
            (1) by striking paragraph (1) and inserting the following:
    ``(a)(1) Funds received by the Department under an enhanced-use 
lease and remaining after any deduction from those funds under 
subsection (b) shall be deposited in the Department of Veterans Affairs 
Health Services Improvement Fund established under section 1729B of 
this title. The Secretary shall make available to the designated health 
care region of the Veterans Health Administration within which the 
leased property is located not less than 75 percent of the amount 
deposited in the fund attributable to that lease.''; and
            (2) by adding at the end the following new paragraph:
    ``(3) For the purposes of paragraph (1), the term `designated 
health care region of the Veterans Health Administration' means a 
geographic area designated by the Secretary for the purposes of the 
management of, and allocation of resources for, health care services 
provided by the Veterans Health Administration.''.
    (e) Repeal of Termination Provision.--(1) Section 8169 is repealed.
    (2) The table of sections at the beginning of chapter 81 is amended 
by striking the item relating to section 8169.
    (f) Repeal of Obsolete Provisions.--Section 8162 is amended--
            (1) by striking the last sentence of subsection (a)(1); and
            (2) by striking subsection (c).

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.

    Section 7402 is amended by adding at the end the following new 
subsection:
    ``(f) A person may not be employed in a position under subsection 
(b) (other than under paragraph (4) of that subsection) if--
            ``(1) the person is or has been licensed, registered, or 
        certified (as applicable to such position) in more than one 
        State; and
            ``(2) either--
                    ``(A) any of those States has terminated such 
                license, registration, or certification for cause; or
                    ``(B) the person has voluntarily relinquished such 
                license, registration, or certification in any of those 
                States after being notified in writing by that State of 
                potential termination for cause.''.

                        TITLE III--MISCELLANEOUS

SEC. 301. REVIEW OF PROPOSED CHANGES TO OPERATION OF MEDICAL 
              FACILITIES.

    Section 8110 is amended by adding at the end the following new 
subsections:
    ``(d) The Secretary may not in any fiscal year close more than 50 
percent of the beds within a bed section (of 20 or more beds) of a 
Department medical center unless the Secretary first submits to the 
Committees on Veterans' Affairs of the Senate and the House of 
Representatives a report providing a justification for the closure. No 
action to carry out such closure may be taken after the submission of 
such report until the end of the 21-day period beginning on the date of 
the submission of the report.
    ``(e) The Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and the House of Representatives, not later than 
January 20 of each year, a report documenting by network for the 
preceding fiscal year the following:
            ``(1) The number of medical service and surgical service 
        beds, respectively, that were closed during that fiscal year 
        and, for each such closure, a description of the changes in 
        delivery of services that allowed such closure to occur.
            ``(2) The number of nursing home beds that were the subject 
        of a mission change during that fiscal year and the nature of 
        each such mission change.
    ``(f) For purposes of this section:
            ``(1) The term `closure', with respect to beds in a medical 
        center, means ceasing to provide staffing for, and to operate, 
        those beds. Such term includes converting the provision of such 
        bed care from care in a Department facility to care under 
        contract arrangements.
            ``(2) The term `bed section', with respect to a medical 
        center, means psychiatric beds (including beds for treatment of 
        substance abuse and post-traumatic stress disorder), 
        intermediate, neurology, and rehabilitation medicine beds, 
        extended care (other than nursing home) beds, and domiciliary 
        beds.
            ``(3) The term `justification', with respect to closure of 
        beds, means a written report that includes the following:
                    ``(A) An explanation of the reasons for the 
                determination that the closure is appropriate and 
                advisable.
                    ``(B) A description of the changes in the functions 
                to be carried out and the means by which such care and 
                services would continue to be provided to eligible 
                veterans.
                    ``(C) A description of the anticipated effects of 
                the closure on veterans and on their access to care.''.

SEC. 302. PATIENT SERVICES AT DEPARTMENT FACILITIES.

    (a) Scope of Services.--Section 7803 is amended--
            (1) in subsection (a)--
                    (A) by striking ``(a)'' before ``The canteens''; 
                and
                    (B) by striking ``in this subsection;'' and all 
                that follows through ``the premises'' and inserting 
                ``in this section''; and
            (2) by striking subsection (b).
    (b) Technical Amendments.--(1) Paragraphs (1) and (11) of section 
7802 are each amended by striking ``hospitals and homes'' and inserting 
``medical facilities''.
    (2) Section 7803, as amended by subsection (a), is amended--
            (A) by striking ``hospitals and homes'' each place it 
        appears and inserting ``medical facilities''; and
            (B) by striking ``hospital or home'' and inserting 
        ``medical facility''.

SEC. 303. REPORT ON ASSISTED LIVING SERVICES.

    Not later than April 1, 2000, the Secretary of Veterans Affairs 
shall submit to the Committees on Veterans Affairs of the Senate and 
House of Representatives a report on the feasibility of establishing a 
pilot program to assist veterans in receiving needed assisted living 
services. The Secretary shall include in such report recommendations 
on--
            (1) the services and staffing that should be provided to a 
        veteran receiving assisted living services under such a pilot 
        program;
            (2) the appropriate design of such a pilot program; and
            (3) the issues that such a pilot program should be designed 
        to address.

SEC. 304. CHIROPRACTIC TREATMENT.

    (a) Establishment of Program.--Within 120 days after the date of 
the enactment of this Act, the Under Secretary for Health of the 
Department of Veterans Affairs, after consultation with chiropractors, 
shall establish a policy for the Veterans Health Administration 
regarding the role of chiropractic treatment in the care of veterans 
under chapter 17 of title 38, United States Code.
    (b) Definitions.--For purposes of this section:
            (1) The term ``chiropractic treatment'' means the manual 
        manipulation of the spine performed by a chiropractor for the 
        treatment of such musculo-skeletal conditions as the Secretary 
        considers appropriate.
            (2) The term ``chiropractor'' means an individual who--
                    (A) is licensed to practice chiropractic in the 
                State in which the individual performs chiropractic 
                services; and
                    (B) holds the degree of doctor of chiropractic from 
                a chiropractic college accredited by the Council on 
                Chiropractic Education.

SEC. 305. DESIGNATION OF HOSPITAL BED REPLACEMENT BUILDING AT IOANNIS 
              A. LOUGARIS DEPARTMENT OF VETERANS AFFAIRS MEDICAL 
              CENTER, RENO, NEVADA.

    The hospital bed replacement building under construction at the 
Ioannis A. Lougaris Department of Veterans Affairs Medical Center in 
Reno, Nevada, is hereby designated as the ``Jack Streeter Building''. 
Any reference to that building in any law, regulation, map, document, 
record, or other paper of the United States shall be considered to be a 
reference to the Jack Streeter Building.

             TITLE IV--CONSTRUCTION AND FACILITIES MATTERS

SEC. 401. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

    The Secretary of Veterans Affairs may carry out the following major 
medical facility projects, with each project to be carried out in the 
amount specified for that project:
            (1) Renovation to provide a domiciliary at Orlando, 
        Florida, in a total amount not to exceed $2,400,000, to be 
        derived only from funds appropriated for Construction, Major 
        Projects, for a fiscal year before fiscal year 2000 that remain 
        available for obligation.
            (2) Surgical addition at the Kansas City, Missouri, 
        Department of Veterans Affairs medical center, in an amount not 
        to exceed $13,000,000.

SEC. 402. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

    The Secretary of Veterans Affairs may enter into leases for medical 
facilities as follows:
            (1) Lease of an outpatient clinic, Lubbock, Texas, in an 
        amount not to exceed $1,112,000.
            (2) Lease of a research building, San Diego, California, in 
        an amount not to exceed $1,066,500.

 SEC. 403. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are authorized to be appropriated to the 
Secretary of Veterans Affairs for fiscal year 2000 and for fiscal year 
2001--
            (1) for the Construction, Major Projects, account 
        $13,000,000 for the project authorized in section 401(2); and
            (2) for the Medical Care account, $2,178,500 for the leases 
        authorized in section 402.
    (b) Limitation.--The project authorized in section 401(2) may only 
be carried out using--
            (1) funds appropriated for fiscal year 2000 or fiscal year 
        2001 pursuant to the authorization of appropriations in 
        subsection (a);
            (2) funds appropriated for Construction, Major Projects, 
        for a fiscal year before fiscal year 2000 that remain available 
        for obligation; and
            (3) funds appropriated for Construction, Major Projects, 
        for fiscal year 2000 for a category of activity not specific to 
        a project.

            Passed the House of Representatives September 21, 1999.

            Attest:

                                                 JEFF TRANDAHL,

                                                                 Clerk.
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