I

106TH CONGRESS

1ST SESSION H. R. 2116

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

care services for veterans and to make other improvements in health

care programs of the Department of Veterans Affairs.

IN THE HOUSE OF REPRESENTATIVES

JUNE 9, 1999

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

A BILL

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,

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

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

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

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

8 this Act is as follows:
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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.

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.
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1 TITLE I—ACCESS TO CARE

2 SEC. 101. EXTENDED CARE SERVICES.

3 (a) REQUIREMENT TO PROVIDE EXTENDED CARE

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

5 section 1710 the following new section:

6 ‘‘§ 1710A. Extended care services

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

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

9 and maintain a program to provide extended care services

10 to eligible veterans in accordance with this section. Such

11 services shall include the following:

12 ‘‘(1) Geriatric evaluation.

13 ‘‘(2) Nursing home care (A) in facilities oper14 ated by the Secretary, and (B) in community-based

15 facilities through contracts under section 1720 of

16 this title.

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

18 of this title.

19 ‘‘(4) Adult day health care under section

20 1720(f) of this title.

21 ‘‘(5) Such other noninstitutional alternatives to

22 nursing home care, including those described in sec23 tion 1720C of this title, as the Secretary considers

24 reasonable and appropriate.
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1 ‘‘(6) Respite care under section 1720B of this

2 title.

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

4 shall provide extended care services which the Secretary

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

6 care for a service-connected disability, and (B) to any vet7 eran who is in need of such care and who has a service8 connected disability rated at 50 percent or more.

9 ‘‘(2) The Secretary, in making placements for nurs10 ing home care in Department facilities, shall give highest

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

12 a service-connected disability, or (B) who have a service13 connected disability rated at 50 percent or more. The Sec14 retary shall ensure that a veteran described in this sub15 section who continues to need nursing home care shall not

16 after placement in a Department nursing home be trans17 ferred from the facility without the consent of the veteran,

18 or, in the event the veteran cannot provide informed con19 sent, the representative of the veteran.

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

21 shall prescribe regulations governing the priorities for the

22 provision of nursing home care in Department facilities

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

24 for patient rehabilitation, (B) for clinically complex pa-
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1 tient populations, and (C) for patients for whom there are

2 not other suitable placement options.

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

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

5 in the case of a veteran who has a service-connected dis6 ability rated at 50 percent or more unless the veteran

7 agrees to pay to the United States a copayment for ex8 tended care services of more than 21 days in any year.

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

10 services under this chapter and who is required under sub11 section (c)(2) to pay an amount to the United States in

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

13 United States for that amount.

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

15 shall develop a methodology for establishing the amount

16 of the copayment for which a veteran described in sub17 section (c) is liable. That methodology shall provide for—

18 ‘‘(A) establishing a maximum monthly copay19 ment (based on all income and assets of the veteran

20 and the spouse of such veteran);

21 ‘‘(B) protecting the spouse of a veteran from fi22 nancial hardship by not counting all of the income

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

24 a spouse who resides in the community) as available

25 for determining the copayment obligation; and
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1 ‘‘(C) allowing the veteran to retain a monthly

2 personal allowance.

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

4 United States a revolving fund known as the Department

5 of Veterans Affairs Extended Care Fund (hereinafter in

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

7 fund shall be available, without fiscal year limitation and

8 without further appropriation, exclusively for the purpose

9 of providing extended care services under subsection (a).

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

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

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

13 chapter is amended by inserting after the item relating

14 to section 1710 the following new item:

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

15 (b) REQUIREMENT TO INCREASE EXTENDED CARE

16 SERVICES.—(1) Not later than January 1, 2000, the Sec17 retary of Veterans Affairs shall develop and begin to im18 plement a plan for carrying out the recommendation of

19 the Federal Advisory Committee on the Future of Long20 Term Care to increase, above the level of extended care

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

22 (A) the options and services for home and com23 munity-based care for eligible veterans; and
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1 (B) the percentage of the Department of Vet2 erans Affairs medical care budget dedicated to such

3 care.

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

5 level of extended care services provided by the Secretary

6 nationally in facilities operated by the Secretary during

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

8 provided nationally in facilities operated by the Secretary

9 during fiscal year 1998.

10 (c) ADULT DAY HEALTH CARE.—Section

11 1720(f)(1)(A) is amended to read as follows:

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

13 health care services to a veteran enrolled under section

14 1705(a) of this title who would otherwise require nursing

15 home care.’’

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

17 amended—

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

19 inserting ‘‘enrolled’’;

20 (2) in subsection (b)—

21 (A) by striking ‘‘the term ‘respite care’

22 means hospital or nursing home care’’ and in23 serting ‘‘the term ‘respite care services’ means

24 care and services’’;
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1 (B) by striking ‘‘is’’ at the beginning of

2 each of paragraphs (1), (2), and (3) and insert3 ing ‘‘are’’; and

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

5 in paragraph (2); and

6 (3) by adding at the end the following new sub7 section:

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

9 may enter into contract arrangements.’’.

10 (e) CONFORMING AMENDMENTS.—Section 1710 is

11 amended—

12 (1) in subsection (a)(1), by striking ‘‘may fur13 nish nursing home care,’’; and

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

15 requirement in section 1710A of this title that the

16 Secretary provide a program of extended care serv17 ices,’’ after ‘‘medical services’’.

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

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

20 inserting ‘‘extended care services described in any of para21 graphs (3) through (6) of section 1710A(a) of this title

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

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

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

25 take effect on the date of the enactment of this Act.
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1 (2) Subsection (c)(2) of section 1710A(a) of title 38,

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

3 take effect on the effective date of regulations prescribed

4 by the Secretary of Veterans Affairs under subsections

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

6 the effective date of such regulations in the Federal Reg7 ister.

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

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

10 home care on or after the effective date of regulations

11 under paragraph (2).

12 SEC. 102. REIMBURSEMENT FOR EMERGENCY TREATMENT.

13 (a) AUTHORITY TO PROVIDE REIMBURSEMENT.—

14 Chapter 17 is amended by inserting after section 1724 the

15 following new section:

16 ‘‘§ 1725. Reimbursement for emergency treatment

17 ‘‘(a) GENERAL AUTHORITY.—(1) Subject to sub18 sections (c) and (d), the Secretary may reimburse a vet19 eran described in subsection (b) for the reasonable value

20 of emergency treatment furnished the veteran in a non21 Department facility.

22 ‘‘(2) In any case in which reimbursement is author23 ized under subsection (a)(1), the Secretary, in the Sec24 retary’s discretion, may, in lieu of reimbursing the vet-
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1 eran, make payment of the reasonable value of the fur2 nished emergency treatment directly—

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

4 that furnished the treatment; or

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

6 such treatment on behalf of such veteran.

7 ‘‘(b) ELIGIBILITY.—(1) A veteran referred to in sub8 section (a)(1) is an individual who is an active Department

9 health-care participant who is personally liable for emer10 gency treatment furnished the veteran in a non-Depart11 ment facility.

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

13 participant if the veteran—

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

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

16 ‘‘(B) is enrolled in the health care system estab17 lished under such section; and

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

19 12-month period preceding the furnishing of such

20 emergency treatment.

21 ‘‘(3) A veteran is personally liable for emergency

22 treatment furnished the veteran in a non-Department fa23 cility if the veteran—

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

25 emergency treatment for that treatment;
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1 ‘‘(B) has no entitlement to care or services

2 under a health-plan contract;

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

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

5 extinguish such liability to the provider; and

6 ‘‘(D) is not eligible for reimbursement for med7 ical care or services under section 1728 of this title.

8 ‘‘(c) LIMITATIONS ON REIMBURSEMENT.—(1) The

9 Secretary, in accordance with regulations prescribed by

10 the Secretary, shall—

11 ‘‘(A) establish the maximum amount payable

12 under subsection (a);

13 ‘‘(B) delineate the circumstances under which

14 such payments may be made, to include such re15 quirements on requesting reimbursement as the Sec16 retary shall establish; and

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

18 under that subsection include any amount for which

19 the veteran is not personally liable.

20 ‘‘(2) Subject to paragraph (1), the Secretary may

21 provide reimbursement under this section only after the

22 veteran or the provider of emergency treatment has ex23 hausted without success all claims and remedies reason24 ably available to the veteran or provider against a third

25 party for payment of such treatment.
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1 ‘‘(3) Payment by the Secretary under this section, on

2 behalf of a veteran described in subsection (b), to a pro3 vider of emergency treatment, shall, unless rejected and

4 refunded by the provider within 30 days of receipt, extin5 guish any liability on the part of the veteran for that treat6 ment. Neither the absence of a contract or agreement be7 tween the Secretary and the provider nor any provision

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

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

10 in the preceding sentence.

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

12 accordance with regulations prescribed by the Secretary,

13 the United States shall have the independent right to re14 cover any amount paid under this section when, and to

15 the extent that, a third party subsequently makes a pay16 ment for the same emergency treatment.

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

18 veteran (or the veteran’s personal representative, suc19 cessor, dependents, or survivors) or to any other person

20 or organization paying for such treatment shall constitute

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

22 the payee subsequently receives from a third party for the

23 same treatment.

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

25 provider that furnished the veteran’s emergency treatment
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1 shall constitute a lien against any subsequent amount the

2 provider receives from a third party for the same emer3 gency treatment for which the United States made pay4 ment.

5 ‘‘(4) The veteran (or the veteran’s personal rep6 resentative, successor, dependents, or survivors) shall en7 sure that the Secretary is promptly notified of any pay8 ment received from any third party for emergency treat9 ment furnished to the veteran. The veteran (or the vet10 eran’s personal representative, successor, dependents, or

11 survivors) shall immediately forward all documents relat12 ing to such payment, cooperate with the Secretary in the

13 investigation of such payment, and assist the Secretary

14 in enforcing the United States right to recover any pay15 ment made under subsection (c)(3).

16 ‘‘(e) WAIVER.—The Secretary, in the Secretary’s dis17 cretion, may waive recovery of a payment made to a vet18 eran under this section that is otherwise required by sub19 section (d)(1) when the Secretary determines that such

20 waiver would be in the best interest of the United States,

21 as defined by regulations prescribed by the Secretary.

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

23 ‘‘(1) The term ‘emergency treatment’ means

24 medical care or services furnished, in the judgment

25 of the Secretary—
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1 ‘‘(A) when Department or other Federal

2 facilities are not feasibly available and an at3 tempt to use them beforehand would not be rea4 sonable;

5 ‘‘(B) when such care or services are ren6 dered in a medical emergency of such nature

7 that delay would be hazardous to life or health;

8 and

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

10 transferred safely to a Department facility or

11 other Federal facility.

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

13 any of the following:

14 ‘‘(A) An insurance policy or contract, med15 ical or hospital service agreement, membership

16 or subscription contract, or similar arrangement

17 under which health services for individuals are

18 provided or the expenses of such services are

19 paid.

20 ‘‘(B) An insurance program described in

21 section 1811 of the Social Security Act (42

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

23 such Act (42 U.S.C. 1395j).
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1 ‘‘(C) A State plan for medical assistance

2 approved under title XIX of such Act (42

3 U.S.C. 1396 et seq.).

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

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

6 ‘‘(E) A law of a State or political subdivi7 sion described in section 1729(a)(2)(B) of this

8 title.

9 ‘‘(3) The term ‘third party’ means any of the

10 following:

11 ‘‘(A) A Federal entity.

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

13 State.

14 ‘‘(C) An employer or an employer’s insur15 ance carrier.

16 ‘‘(D) An automobile accident reparations

17 insurance carrier.

18 ‘‘(E) A person or entity obligated to pro19 vide, or to pay the expenses of, health services

20 under a health-plan contract.’’.

21 (b) CONFORMING AMENDMENTS.—(1) Section

22 1729A(b) is amended—

23 (A) by redesignating paragraph (6) as para24 graph (7); and
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1 (B) by inserting after paragraph (5) the fol2 lowing new paragraph:

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

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

5 17 is amended by inserting after the item relating to sec6 tion 1724 the following new item:

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

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

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

9 the enactment of this Act.

10 (d) IMPLEMENTATION REPORTS.—The Secretary of

11 Veterans Affairs shall include with the budget justification

12 materials submitted to Congress in support of the Depart13 ment of Veterans Affairs budget for fiscal year 2002 and

14 for fiscal year 2003 a report on the implementation of sec15 tion 1725 of title 38, United States Code, as added by

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

17 on the experience of the Department under that section

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

19 that section.

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

21 VETERANS.

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

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

24 who was injured in combat’’ after ‘‘former prisoner

25 of war’’; and
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1 (2) in section 1705(a)(3), by inserting ‘‘or who

2 were injured in combat’’ after ‘‘former prisoner of

3 war’’.

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

5 1701 is amended by adding at the end the following new

6 paragraph:

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

8 wounded in action as the result of an act of an

9 enemy of the United States or otherwise wounded in

10 action by weapon fire while directly engaged in

11 armed conflict (other than as the result of willful

12 misconduct by the wounded individual).’’.

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

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

15 amended—

16 (A) by striking ‘‘or’’ at the end of subpara17 graph (F);

18 (B) by striking the period at the end of sub19 paragraph (G) and inserting ‘‘; or’’; and

20 (C) by adding at the end the following new sub21 paragraph:

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

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

24 or Marine Corps, is eligible for care under the

25 TRICARE program established by the Secretary of
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1 Defense, and is not otherwise described in paragraph

2 (1) or in this paragraph.’’.

3 (2) Section 1705(a) is amended—

4 (A) by redesignating paragraph (7) as para5 graph (8);

6 (B) by inserting after paragraph (6) the fol7 lowing new paragraph (7):

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

9 medical services, and nursing home care under sec10 tion 1710(a)(2)(H) of this title.’’; and

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

12 subparagraph (H) of such section)’’ before the pe13 riod at the end.

14 (b) MEMORANDUM OF UNDERSTANDING.—(1) The

15 Secretary of Defense, not later than May 1, 2000, shall

16 enter into a memorandum of understanding with the Sec17 retary of Veterans Affairs which shall provide for the Sec18 retary of Defense to reimburse the Secretary of Veterans

19 Affairs for medical care provided by the Secretary of Vet20 erans Affairs to a member of the Army, Navy, Air Force,

21 or Marine Corps who (A) has retired from active military,

22 naval, or air service, (B) is eligible for care under the

23 TRICARE program established by the Secretary of De24 fense, (C) has enrolled for care under section 1705 of title

25 38, United States Code, and (D) is not described in para-
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1 graph (1) or (2) of section 1710(a) of such title (other

2 than subparagraph (H) of such paragraph (2)), as amend3 ed by subsection (a).

4 (2) Such reimbursement shall be at the rate which

5 the Secretary of Defense would have paid to a contractor

6 for the care of such retired member under the TRICARE

7 program in the region in which the retired member re8 sides.

9 (c) REIMBURSEMENTS UNDER MEMORANDUM OF

10 UNDERSTANDING.—Amounts received by the Secretary of

11 Veterans Affairs under the memorandum of under12 standing with the Secretary of Defense under subsection

13 (b) shall be deposited in the Department of Veterans Af14 fairs Health Services Improvement Fund established

15 under section 1729B of title 38, United States Code, as

16 added by section 202.

17 (d) EFFECTIVE DATE.—The amendments made by

18 subsection (a) and the provisions of the agreement under

19 subsection (b)(2) shall take effect on October 1, 2000.

20 SEC. 105. BENEFITS FOR PERSONS DISABLED BY PARTICI21 PATION IN COMPENSATED WORK THERAPY

22 PROGRAM.

23 Section 1151(a)(2) is amended—

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

25 caused’’; and
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1 (2) by inserting before the period at the end the

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

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

4 under section 1718 of this title’’.

5 SEC. 106. PILOT PROGRAM OF MEDICAL CARE FOR CER6 TAIN DEPENDENTS OF ENROLLED VET7 ERANS.

8 (a) IN GENERAL.—(1) Chapter 17 is amended by in9 serting after section 1713 the following new section:

10 ‘‘§ 1713A. Medical care for certain dependents of en11 rolled veterans: pilot program

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

13 carry out a pilot program to provide primary health care

14 services for eligible dependents of veterans in accordance

15 with this section.

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

17 ‘‘(1) The term ‘program period’ means the pe18 riod beginning on the first day of the first month be19 ginning more than 180 days after the date of the en20 actment of this section and ending three years after

21 that day.

22 ‘‘(2) The term ‘eligible dependent’ means an in23 dividual who—

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

25 who is enrolled in the system of patient enroll-
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1 ment established by the Secretary under section

2 1705 of this title; and

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

4 have the ability to pay for such care or services

5 either directly or through reimbursement or in6 demnification from a third party.

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

8 to an eligible dependent under this section only if the de9 pendent (or, in the case of a minor, the parent or guardian

10 of the dependent) agrees—

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

12 representing the reasonable charges for the care or

13 services furnished (as determined by the Secretary);

14 and

15 ‘‘(2) to cooperate with and provide the Sec16 retary an appropriate assignment of benefits, au17 thorization to release medical records, and any other

18 executed documents, information, or evidence rea19 sonably needed by the Secretary to recover the De20 partment’s charges for the care or services furnished

21 by the Secretary.

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

23 pilot program under this section may consist of such pri24 mary hospital care services and such primary medical

25 services as may be authorized by the Secretary. The Sec-
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1 retary may furnish those services directly through a De2 partment medical facility or, subject to paragraphs (2)

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

4 a non-Department facility (including a health-care pro5 vider, as defined in section 8152(2) of this title).

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

7 agreement to furnish primary health care services under

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

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

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

11 new agreement under section 8153 of this title when the

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

13 prevailing standards of the Department medical care pro14 gram.

15 ‘‘(3) Primary health care services may not be author16 ized to be furnished under this section at any medical fa17 cility if the furnishing of those services would result in

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

19 any enrolled veteran at that facility.

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

21 furnished primary health care services under this section

22 and who has coverage under a health-plan contract, as de23 fined in section 1729(i)(1) of this title, the United States

24 shall have the right to recover or collect the reasonable

25 charges for such care or services from such health-plan
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1 contract to the extent that the individual or the provider

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

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

4 if the care or services had not been furnished by a depart5 ment or agency of the United States.

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

7 paragraph (1) shall be enforceable with respect to an eligi8 ble dependent in the same manner as applies under sub9 sections (a)(3), (b), (c)(1), (d), (f), (h), and (i) of section

10 1729 of this title with respect to a veteran.

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

12 program under this section shall be carried out during the

13 program period in not more than four veterans integrated

14 service networks, as designated by the Secretary. In desig15 nating networks under the preceding sentence, the Sec16 retary shall favor designation of networks that are suited

17 to serve dependents of veterans because of—

18 ‘‘(A) the capability of one or more medical fa19 cilities within the network to furnish primary health

20 care services to eligible dependents while assuring

21 that veterans continue to receive priority for care

22 and services;

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

24 facilities in billings and collections;
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1 ‘‘(C) support for initiating such a pilot program

2 among veterans in the network; and

3 ‘‘(D) such other criteria as the Secretary con4 siders appropriate.

5 ‘‘(2) In implementing the pilot program, the Sec6 retary may not provide health care services for dependents

7 who are children—

8 ‘‘(A) in more than one of the participating net9 works during the first year of the program period;

10 and

11 ‘‘(B) in more than two of the participating net12 works during the second year of the program period.

13 ‘‘(3) In implementing the pilot program, the Sec14 retary shall give priority to facilities which operate women

15 veterans’ clinics.’’.

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

17 chapter is amended by inserting after the item relating

18 to section 1713 the following new item:

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

19 (b) GAO REVIEW AND RECOMMENDATIONS.—(1) Be20 ginning six months after the commencement of the pilot

21 program, the Comptroller General, in consultation with

22 the Under Secretary for Health of the Department of Vet23 erans Affairs, shall monitor the conduct of the pilot pro24 gram.
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1 (2) Not later than 14 months after the commence2 ment of the pilot program, the Comptroller General shall

3 submit to the Secretary of Veterans Affairs a report set4 ting forth the Comptroller General’s findings and rec5 ommendations with respect to the first 12 months of oper6 ation of the pilot program.

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

8 the findings of the Comptroller General regarding—

9 (i) whether the collection of reasonable charges

10 for the care or services provided reasonably covers

11 the costs of providing such care and services; and

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

13 program, is in compliance with the limitation in sub14 section (d)(3) of section 1713A of title 38, United

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

16 (B) The report shall include the recommendations of

17 the Comptroller General regarding any remedial steps that

18 the Secretary should take in the conduct of the program

19 or in the billing and collection of charges under the pro20 gram.

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

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

23 take such steps as may be needed to ensure that any rec24 ommendations of the Comptroller General in the report

25 under paragraph (2) with respect to billings and collec-
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1 tions, and with respect to compliance with the limitation

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

3 (5) For purposes of this subsection, the term ‘‘com4 mencement of the pilot program’’ means the date on which

5 the Secretary of Veterans Affairs begins to furnish serv6 ices to eligible dependents under the pilot program under

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

8 by subsection (a).

9 SEC. 107. ENHANCED SERVICES PROGRAM AT DESIGNATED

10 MEDICAL CENTERS.

11 (a) FINDINGS.—Congress makes the following find12 ings:

13 (1) Historically, health care facilities under the

14 jurisdiction of the Department of Veterans Affairs

15 have not consistently been located in proximity to

16 veteran population concentrations.

17 (2) Hospital occupancy rates at numbers of De18 partment medical centers are at levels substantially

19 below a level needed for efficient operation and opti20 mal quality of care.

21 (3) The costs of maintaining highly inefficient

22 medical centers, which were designed and con23 structed decades ago to standards no longer consid24 ered acceptable, substantially diminish the avail-
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1 ability of resources which could be devoted to the

2 provision of needed direct care services.

3 (4) Freeing resources currently devoted to high4 ly inefficient provision of hospital care could,

5 through contracting for acute hospital care and es6 tablishing new facilities for provision of outpatient

7 care, yield improved access and service to veterans.

8 (b) ENHANCED SERVICES PROGRAM AT DESIGNATED

9 MEDICAL CENTERS.—The Secretary of Veterans Affairs,

10 in carrying out the responsibilities of the Secretary to fur11 nish hospital care and medical services through network12 based planning, shall establish an enhanced service pro13 gram at Department medical centers (hereinafter in this

14 section referred to as ‘‘designated centers’’) that are des15 ignated by the Secretary for the purposes of this section.

16 Medical centers shall be designated to improve access, and

17 quality of service provided, to veterans served by those

18 medical centers. The Secretary may designate a medical

19 center for the program only if the Secretary determines,

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

21 include a study of the cost-effectiveness of the care pro22 vided at such center), that the medical center—

23 (1) can, in whole or in part, no longer be oper24 ated in a manner that provides hospital or other
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1 care efficiently and at optimal quality because of

2 such factors as—

3 (A) the current and projected need for hos4 pital or other care capacity at such center;

5 (B) the extent to which the facility is func6 tionally obsolete; and

7 (C) the cost of operation and maintenance

8 of the physical plant; and

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

10 community hospitals which have the capacity to pro11 vide primary and secondary hospital care of appro12 priate quality to veterans under contract arrange13 ments with the Secretary which the Secretary deter14 mines are advantageous to the Department, or (B)

15 to another Department medical center which is capa16 ble of absorbing some or all of the patient workload

17 of such medical center.

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

19 with respect to each designated center, develop a plan

20 aimed at improving the accessibility and quality of service

21 provided to veterans. Each plan shall be developed in ac22 cordance with the requirements for strategic network23 based planning described in section 8107 of title 38,

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

25 the Secretary shall describe a program which, if imple-
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1 mented, would allow the Secretary to do any of the fol2 lowing:

3 (1) Provide for a Deparment facility described

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

5 patient workload of the designated center.

6 (2) Contract, under such arrangements as the

7 Secretary determines appropriate, for needed pri8 mary and secondary hospital care for veterans—

9 (A) who reside in the catchment area of

10 each designated center;

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

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

13 United States Code; and

14 (C) whom the Secretary has enrolled for

15 care pursuant to section 1705 of title 38,

16 United States Code.

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

18 care and other medical services, at such center.

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

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

21 improvements which had been dedicated to providing

22 care described in paragraph (3).

23 (5) Establish, through reallocation of oper24 ational funds and through appropriate lease arrange25 ments or renovations, facilities for—
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1 (A) delivery of outpatient care; and

2 (B) services which would obviate a need for

3 nursing home care or other long-term institu4 tional care.

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

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

7 shall attempt to ensure that employees of the Secretary

8 who would be displaced under this section be given priority

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

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

11 shall give preference to providing services through em12 ployee-based delivery models.

13 (e) REQUIRED CONSULTATION.—In developing a

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

15 views of veterans organizations, exclusive employee rep16 resentatives, and other interested parties and provide for

17 such organizations and parties to participate in the devel18 opment of the plan.

19 (f) SUBMISSION OF PLAN TO CONGRESS.—The Sec20 retary may not implement a plan described in subsection

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

22 has first submitted a report containing a detailed plan and

23 justification to the appropriate committees of Congress.

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

25 submission of such report until the end of a 45-day period
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1 following the date of the submission of the report, not less

2 than 30 days of which shall be days during which Con3 gress shall have been in continuous session. For purposes

4 of the preceding sentence, continuity of a session of Con5 gress is broken only by adjournment sine die, and there

6 shall be excluded from the computation of any period of

7 continuity of session any day during which either House

8 of Congress is not in session during an adjournment of

9 more than three days to a day certain.

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

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

12 plan following the submission of such plan to the appro13 priate committees of Congress, the Secretary—

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

15 section 1703 of title 38, United States Code, con16 tract for hospital care for veterans who are—

17 (A) described in paragraphs (1) through

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

19 Code; and

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

21 section 1705;

22 (2) may enter into any contract under section

23 8153 of title 38, United States Code;

24 (3) shall, in exercising the authority of the Sec25 retary under this section to contract for hospital
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1 care, provide for ongoing oversight and management,

2 by employees of the Department, of the hospital care

3 furnished such veterans; and

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

5 which ceases to provide services under the

6 program—

7 (A) ensure a reallocation of funds as pro8 vided in subsection (g); and

9 (B) provide reemployment assistance to

10 employees.

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

12 (g)(3), the Secretary shall ensure that not less than 90

13 percent of the funds that would have been made available

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

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

16 the appropriate health care region of the Veterans Health

17 Administration to ensure that the implementation of the

18 plan under subsection (g) will result in demonstrable im19 provement in the accessibility, and quality of service pro20 vided, to veterans in the catchment area of such center.

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

22 section do not diminish the obligations of the Secretary

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

24 (j) REPORT.—Not later than 12 months after imple25 mentation of any plan under subsection (b), the Secretary
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1 shall submit to Congress a report on the implementation

2 of the enhanced service program.

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

4 may be construed to diminish the authority of the Sec5 retary to—

6 (1) consolidate, eliminate, abolish, or redis7 tribute the functions or missions of facilities in the

8 Department;

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

10 facility or activity; or

11 (3) create new facilities or activities in the De12 partment.

13 SEC. 108. COUNSELING AND TREATMENT FOR VETERANS

14 WHO HAVE EXPERIENCED SEXUAL TRAUMA.

15 (a) EXTENSION OF PERIOD OF PROGRAM.—Sub16 section (a) of section 1720D is amended—

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

18 31, 2001’’ and inserting ‘‘December 31, 2002’’; and

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

20 31, 2001’’ and inserting ‘‘December 31, 2002’’.

21 (b) MANDATORY NATURE OF PROGRAM.—(1) Sub22 section (a)(1) of such section is further amended by strik23 ing ‘‘may provide counseling to a veteran who the Sec24 retary determines requires such counseling’’ and inserting

25 ‘‘shall operate a program under which the Secretary pro-
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1 vides counseling and appropriate care and services to vet2 erans who the Secretary determines require such coun3 seling and care and services’’.

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

5 amended—

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

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

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

10 section is amended—

11 (1) by inserting ‘‘and treatment’’ in the first

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

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

14 (1);

15 (3) by redesignating paragraph (2) as para16 graph (3); and

17 (4) by inserting after paragraph (1) the fol18 lowing new paragraph (2):

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

20 counseling and treatment available to veterans under

21 this section—

22 ‘‘(A) is revised and updated as appro23 priate;

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

25 at appropriate facilities of the Department; and
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1 ‘‘(C) is made available through appropriate

2 public information services; and’’.

3 (d) REPORT ON IMPLEMENTATION OF OUTREACH

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

5 the enactment of this Act, the Secretary of Veterans Af6 fairs shall submit to the Committees on Veterans’ Affairs

7 of the Senate and House of Representatives a report on

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

9 1720D(c) of title 38, United States Code, as added by

10 subsection (c). Such report shall include examples of the

11 documents and other means of communication developed

12 for compliance with that paragraph.

13 (e) STUDY OF EXPANDING ELIGIBILITY FOR COUN14 SELING AND TREATMENT.—(1) The Secretary of Veterans

15 Affairs, in consultation with the Secretary of Defense,

16 shall conduct a study to determine—

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

18 reserve components of the Armed Forces experienced

19 physical assault of a sexual nature or battery of a

20 sexual nature while serving on active duty for train21 ing;

22 (B) the extent to which such former members

23 have sought counseling from the Department of Vet24 erans Affairs relating to those incidents; and
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1 (C) the additional resources that, in the judg2 ment of the Secretary, would be required to meet the

3 projected need of those former members for such

4 counseling.

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

6 enactment of this Act, the Secretary of Veterans Affairs

7 shall submit to the Committees on Veterans’ Affairs of

8 the Senate and House of Representatives a report on the

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

10 (f) OVERSIGHT OF OUTREACH ACTIVITIES.—Not

11 later than 14 months after the date of the enactment of

12 this Act, the Secretary of Veterans Affairs and the Sec13 retary of Defense shall submit to the appropriate congres14 sional committees a joint report describing in detail the

15 collaborative efforts of the Department of Veterans Affairs

16 and the Department of Defense to ensure that members

17 of the Armed Forces, upon separation from active mili18 tary, naval, or air service, are provided appropriate and

19 current information about programs of the Department of

20 Veterans Affairs to provide counseling and treatment for

21 sexual trauma that may have been experienced by those

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

23 including information about eligibility requirements for,

24 and procedures for applying for, such counseling and

25 treatment. The report shall include proposed recommenda-
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1 tions from both the Secretary of Veterans Affairs and the

2 Secretary of Defense for the improvement of their collabo3 rative efforts to provide such information.

4 (g) REPORT ON IMPLEMENTATION OF SEXUAL

5 TRAUMA TREATMENT PROGRAM.—Not later than 14

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

7 Secretary of Veterans Affairs shall submit to the Commit8 tees on Veterans’ Affairs of the Senate and House of Rep9 resentatives a report on the use made of the authority pro10 vided under section 1720D of title 38, United States Code,

11 as amended by this section. The report shall include the

12 following with respect to activities under that section since

13 the enactment of this Act:

14 (1) The number of veterans who have received

15 counseling under that section.

16 (2) The number of veterans who have been re17 ferred to non-Department mental health facilities

18 and providers in connection with sexual trauma

19 counseling and treatment.

20 TITLE II—PROGRAM

21 ADMINISTRATION

22 SEC. 201. MEDICAL CARE COLLECTIONS.

23 (a) LIMITED AUTHORITY TO SET COPAYMENTS.—

24 (1) Section 1722A is amended—
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1 (A) by redesignating subsections (b) and (c) as

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

3 (B) by inserting after subsection (a) the fol4 lowing new subsection (b):

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

6 the Secretary shall prescribe, may—

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

8 under subsection (a);

9 ‘‘(2) establish a maximum annual pharma10 ceutical copayment amount under subsection (a) for

11 veterans who have multiple outpatient prescriptions;

12 and

13 ‘‘(3) require a veteran, other than a veteran de14 scribed in subsection (a)(3), to pay to the United

15 States a reasonable copayment for sensori-neural

16 aids, electronic equipment, and any other costly item

17 or equipment furnished the veteran for a nonservice18 connected condition, other than a wheelchair or arti19 ficial limb.’’; and

20 (C) in subsection (c), as redesignated by sub21 paragraph (A)—

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

23 ‘‘subsection (a)’’; and

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

25 sentence: ‘‘Amounts collected through use of
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1 the authority under subsection (b) shall be de2 posited in Department of Veterans Affairs

3 Health Services Improvement Fund.’’.

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

5 read as follows:

6 ‘‘§ 1722A. Copayments for medications and certain

7 costly items and equipment’’.

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

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

10 as follows:

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

11 (b) OUTPATIENT TREATMENT OF CATEGORY C VET12 ERANS.—(1) Section 1710(g) is amended—

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

14 under paragraph (2) of this subsection’’ and insert15 ing ‘‘in the case of each outpatient visit the applica16 ble amount or amounts established by the Secretary

17 by regulation’’; and

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

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

20 establish by regulation.’’.

21 SEC. 202. HEALTH SERVICES IMPROVEMENT FUND.

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

23 amended by inserting after section 1729A the following

24 new section:
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1 ‘‘§ 1729B. Health Services Improvement Fund

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

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

4 Veterans Affairs Health Services Improvement Fund’.

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

6 the enactment of this section under any of the following

7 provisions of law shall be deposited in the fund:

8 ‘‘(1) Section 1713A of this title.

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

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

11 ‘‘(4) Section 4(c) of the Veterans’ Millennium

12 Health Care Act.

13 ‘‘(c) Amounts in the fund are hereby available, with14 out fiscal year limitation, to the Secretary for the purposes

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

16 1729A(c)(1) of this title.’’.

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

18 at the beginning of such chapter is amended by inserting

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

20 item:

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

21 SEC. 203. VETERANS TOBACCO TRUST FUND.

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

23 (1) Smoking related illnesses, including cancer,

24 heart disease, and emphysema, are highly prevalent

25 among the more than 3,000,000 veterans who use
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1 the Department of Veterans Affairs health care sys2 tem annually.

3 (2) The Department of Veterans Affairs esti4 mates that it spent $3,600,000,000 in 1997 to treat

5 smoking-related illnesses and that over the next five

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

7 (3) Congress established the Department of

8 Veterans Affairs in furtherance of its constitutional

9 power to provide for the national defense in order to

10 provide benefits and services to veterans of the uni11 formed services.

12 (4) There is in the Department of Veterans Af13 fairs a health care system which has as its primary

14 function to provide a complete medical and hospital

15 service for the medical care and treatment of such

16 veterans as can be served through available appro17 priations.

18 (5) The Federal Government, including the De19 partment of Veterans Affairs, has lacked the means

20 to prevent the onset of smoking-related illnesses

21 among veterans and has had no authority to deny

22 needed treatment to any veteran on the basis that

23 an illness is or might be smoking-related.

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

25 budget absorbed in treating smoking-related ill-
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1 nesses, the Department of Veterans Affairs health

2 care system has lacked resources to provide needed

3 nursing home care, home care, community-based

4 ambulatory care, and other services to tens of thou5 sands of other veterans.

6 (7) The network of academically affiliated med7 ical centers of the Department of Veterans Affairs

8 provides a unique system within which outstanding

9 medical research is conducted and which has the po10 tential to expand significantly ongoing research on

11 tobacco-related illnesses.

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

13 enact legislation requiring that a portion of any

14 amounts received from manufacturers of tobacco

15 products be used to meet the costs of (A) treatment

16 for diseases and adverse health effects associated

17 with the use of tobacco products by those who served

18 their country in uniform, and (B) medical and

19 health services research relating to prevention and

20 treatment of, and rehabilitation from, tobacco addic21 tion and diseases associated with tobacco use.

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

23 17 is amended by inserting after section 1729B, as added

24 by section 202(a), the following new section:
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1 ‘‘§ 1729C. Veterans Tobacco Trust Fund

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

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

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

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

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

7 against the tobacco manufacturers seeking recovery of

8 costs incurred or to be incurred by the United States that

9 are attributable to tobacco-related illnesses, there shall be

10 credited to the trust fund from any amount recovered by

11 the United States pursuant to that lawsuit, without fur12 ther appropriation, the amount that bears the same ratio

13 to the amount recovered as the amount of the Depart14 ment’s costs for health care attributable to tobacco-related

15 illnesses for which recovery is sought in the suit bears to

16 the total amount sought by the United States in the suit.

17 ‘‘(c) Amounts in the trust fund shall be available,

18 without fiscal year limitation, to the Secretary of Veterans

19 Affairs for the following purposes:

20 ‘‘(1) Furnishing medical care and services

21 under this chapter, to be available during any fiscal

22 year for the same purposes and subject to the same

23 limitations (other than with respect to the period of

24 availability for obligation) as apply to amounts ap25 propriated from the general fund of the Treasury for

26 that fiscal year for medical care.
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1 ‘‘(2) Conducting medical research, rehabilita2 tion research, and health systems research, with par3 ticular emphasis on research relating to prevention

4 and treatment of, and rehabilitation from, tobacco

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

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

7 chapter is amended by inserting after the item relating

8 to section 1729B, as added by section 202(b), the fol9 lowing new item:

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

10 SEC. 204. AUTHORITY TO ACCEPT FUNDS FOR EDUCATION

11 AND TRAINING.

12 (a) ESTABLISHMENT OF NONPROFIT CORPORATIONS

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

14 (1) by inserting ‘‘and education’’ after ‘‘re15 search’’;

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

17 a corporation may be established to facilitate either

18 research or education or both research and edu19 cation.’’.

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

21 amended—

22 (1) in the first sentence, by inserting ‘‘and edu23 cation and training as described in sections 7302,

24 7471, 8154, and 1701(6)(B) of this title’’ after ‘‘of

25 this title’’; and
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1 (2) in the second sentence—

2 (A) by inserting ‘‘or education’’ after ‘‘re3 search’’; and

4 (B) by striking ‘‘that purpose’’ and insert5 ing ‘‘these purposes’’.

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

7 amended—

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

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

10 the assistant chief of staff for research for the med11 ical center and the associate chief of staff for edu12 cation for the medical center, or, in the case of a fa13 cility at which such positions do not exist, those offi14 cials who are responsible for carrying out the re15 sponsibilities of the medical center director, chief of

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

17 for research and the assistant chief for education;

18 and’’;

19 (2) in subsection (a)(2), by inserting ‘‘or edu20 cation, as appropriate’’ after ‘‘research’’; and

21 (3) in subsection (c), by inserting ‘‘or edu22 cation’’ after ‘‘research’’.

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

24 amended by adding at the end the following new sub25 section:
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1 ‘‘(c)(1) A corporation established under this sub2 chapter may not spend funds for an education activity un3 less the activity is approved in accordance with procedures

4 prescribed by the Under Secretary for Health.

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

6 policies and procedures to guide the expenditure of funds

7 by corporations under paragraph (1) consistent with the

8 purpose of such corporations as flexible funding mecha9 nisms.’’.

10 SEC. 205. EXTENSION AND REVISION OF CERTAIN AU11 THORITIES.

12 (a) READJUSTMENT COUNSELING PROGRAM.—Sec13 tion 1712A(a)(1)(B)(ii) is amended by striking ‘‘2000’’

14 and inserting ‘‘2003’’.

15 (b) COMMITTEE ON MENTALLY ILL VETERANS.—

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

17 inserting ‘‘five’’.

18 (c) COMMITTEE ON POST-TRAUMATIC STRESS DIS19 ORDER.—Section 110 of Public Law 98–528 (38 U.S.C.

20 1712A note) is amended—

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

22 1985’’ and inserting ‘‘March 1, 2000’’; and

23 (2) in subsection (e)(2), by striking ‘‘February

24 1, 1986’’ and inserting ‘‘February 1, 2001’’.
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1 (d) EXTENSION OF AUTHORITY TO MAKE

2 GRANTS.—Section 3(a)(2) of the Homeless Veterans Com3 prehensive Service Programs Act of 1992 (38 U.S.C. 7721

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

5 inserting ‘‘September 30, 2002’’.

6 (e) AUTHORITY TO MAKE GRANTS FOR HOMELESS

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

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

9 7721 note) is amended by striking ‘‘and no more than 20

10 programs which incorporate the procurement of vans as

11 described in paragraph (1)’’.

12 SEC. 206. STATE HOME GRANT PROGRAM.

13 (a) GENERAL REGULATIONS.—Section 8134 is

14 amended—

15 (1) by redesignating subsection (b) as sub16 section (c);

17 (2) by striking the matter in subsection (a) pre18 ceding paragraph (2) and inserting the following:

19 ‘‘(a)(1) The Secretary shall prescribe regulations for

20 the purposes of this subchapter.

21 ‘‘(2) In those regulations, the Secretary shall pre22 scribe for each State the number of nursing home and

23 domiciliary beds for which assistance under this sub24 chapter may be furnished. Such regulations shall be based

25 on projected demand for such care 10 years after the date
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1 of the enactment of the Veterans Millennium Health Care

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

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

4 projected demand, the Secretary shall take into account

5 travel distances for veterans and their families.

6 ‘‘(3)(A) In those regulations, the Secretary shall es7 tablish criteria under which the Secretary shall determine,

8 with respect to an application for assistance under this

9 subchapter for a project described in subparagraph (B)

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

11 as determined under subsections (a)(2) and (d)(1), wheth12 er the need for such beds is most aptly characterized as

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

14 account the availability of beds already operated by the

15 Secretary and other providers which appropriately serve

16 the needs which the State proposes to meet with its appli17 cation.

18 ‘‘(B) This paragraph applies to a project for the con19 struction or acquisition of a new State home facility, to

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

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

22 State home facility.

23 ‘‘(4) The Secretary shall review and, as necessary, re24 vise regulations prescribed under paragraphs (2) and (3)

25 not less often than every four years.
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1 ‘‘(b) The Secretary shall prescribe the following by

2 regulation:’’;

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

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

5 paragraphs (1) and (2);

6 (4) in subsection (c), as redesignated by para7 graph (1), by striking ‘‘subsection (a)(3)’’ and in8 serting ‘‘subsection (b)(2)’’; and

9 (5) by adding at the end the following new sub10 section:

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

12 subchapter, the Secretary shall provide that in the case

13 of a State that seeks assistance under this subchapter for

14 a project described in subsection (a)(3)(B), the determina15 tion of the unmet need for beds for State homes in that

16 State shall be reduced by the number of beds in all pre17 vious applications submitted by that State under this sub18 chapter, including beds which have not been recognized

19 by the Secretary under section 1741 of this title.

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

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

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

23 $400,000 (as adjusted from time to time in such regula24 tions to reflect changes in costs of construction).
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1 ‘‘(B) For purposes of this paragraph, a renovation

2 project is a project to remodel or alter existing buildings

3 for which financial assistance under this subchapter may

4 be provided and does not include maintenance and repair

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

6 (b) APPLICATIONS WITH RESPECT TO PROJECTS.—

7 Section 8135 is amended—

8 (1) in subsection (a)—

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

10 preceding paragraph (1) and inserting ‘‘set

11 forth the following:’’;

12 (B) by capitalizing the first letter of the

13 first word in each of paragraphs (1) through

14 (9);

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

16 each of paragraphs (1) through (7) and insert17 ing a period; and

18 (D) by striking ‘‘, and’’ at the end of para19 graph (8) and inserting a period;

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

21 and (e) as subsections (c), (d), (e), and (f), respec22 tively;

23 (3) by inserting after subsection (a) the fol24 lowing new subsection (b):
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1 ‘‘(b)(1) Any State seeking to receive assistance under

2 this subchapter for a project that would involve construc3 tion or acquisition of either nursing home or domiciliary

4 facilities shall include with its application under subsection

5 (a) the following:

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

7 project is in reasonable proximity to a sufficient con8 centration and population of veterans who are 65

9 years of age and older, and (ii) that there is a rea10 sonable basis to conclude that the facilities when

11 complete will be fully occupied.

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

13 of operation of such facilities.

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

15 program for that State.

16 ‘‘(2) Failure to provide adequate documentation

17 under paragraph (1)(A) or to provide an adequate finan18 cial plan under paragraph (1)(B) shall be a basis for dis19 approving the application.’’;

20 (4) in subsection (c), as redesignated by para21 graph (2)—

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

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

24 the matter preceding subparagraph (A) and in-
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1 serting ‘‘under subsection (a) for financial as2 sistance under this subchapter’’;

3 (B) in paragraph (2)—

4 (i) by striking ‘‘the construction or ac5 quisition of’’ in subparagraph (A); and

6 (ii) by striking subparagraphs (B),

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

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

9 at an existing facility to remedy a condition or con10 ditions that have been cited by an accrediting insti11 tution, by the Secretary, or by a local licensing or

12 approving body of the State as being threatening to

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

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

15 previously applied for award of a grant under this

16 subchapter for construction or acquisition of a State

17 nursing home.

18 ‘‘(D) An application for construction or acquisi19 tion of a nursing home or domiciliary from a State

20 that the Secretary determines, in accordance with

21 regulations under this subchapter, has a great need

22 for the beds to be established at such home or facil23 ity.
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1 ‘‘(E) An application from a State for renova2 tions to a State home facility other than renovations

3 described in subparagraph (B).

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

6 that the Secretary determines, in accordance with

7 regulations under this subchapter, has a significant

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

9 facility.

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

11 the Secretary determines appropriate and has estab12 lished in regulations.

13 ‘‘(H) An application for construction or acquisi14 tion of a nursing home or domiciliary from a State

15 that the Secretary determines, in accordance with

16 regulations under this subchapter, has a limited

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

18 facility’’; and

19 (C) in paragraph (3), by striking subpara20 graph (A) and inserting the following:

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

22 for the construction or acquisition of a hospital;

23 and’’.

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

25 and 8135 of title 38, United States Code, as in effect on
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1 June 1, 1999, shall continue in effect after such date with

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

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

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

5 such title, as in effect on that date, and (2) was estab6 lished by the Secretary of Veterans Affairs on October 29,

7 1998.

8 (d) EFFECTIVE DATE FOR INITIAL REGULATIONS.—

9 The Secretary of Veterans Affairs shall prescribe the ini10 tial regulations under subsection (a) of section 8134 of

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

12 not later than April 30, 2000,

13 SEC. 207. EXPANSION OF ENHANCED-USE LEASE AUTHOR14 ITY.

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

16 (1) by striking ‘‘only if the Secretary’’ and in17 serting ‘‘only if—

18 ‘‘(A) the Secretary’’;

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

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

21 and realigning those clauses so as to be four ems

22 from the left margin;

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

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

25 (4) by adding at the end the following:
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1 ‘‘(B) the Secretary determines that the imple2 mentation of a business plan proposed by the Under

3 Secretary for Health for applying the consideration

4 under such a lease to the provision of medical care

5 and services would result in a demonstrable improve6 ment of services to eligible veterans in the geo7 graphic service-delivery area within which the prop8 erty is located.’’.

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

10 8162(b) is amended—

11 (1) in paragraph (2), by striking ‘‘may not ex12 ceed—’’ and all that follows and inserting ‘‘may not

13 exceed 75 years.’’; and

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

15 following:

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

17 for the Secretary to—

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

19 leased property; and

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

21 contribution payments.’’.

22 (c) DESIGNATION OF PROPERTY PROPOSED TO BE

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

24 amended—
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1 (A) by striking ‘‘include—’’ and inserting ‘‘in2 clude the following:’’;

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

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

5 (5);

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

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

8 and

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

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

11 ‘‘(A) would—

12 ‘‘(i) contribute in a cost-effective man13 ner to the mission of the Department;

14 ‘‘(ii) not be inconsistent with the mis15 sion of the Department;

16 ‘‘(iii) not adversely affect the mission

17 of the Department; and

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

19 ‘‘(B) would result in a demonstrable im20 provement of services to eligible veterans in the

21 geographic service-delivery area within which

22 the property is located.’’.

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

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

25 and inserting the following:
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1 ‘‘(i) would—

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

3 manner to the mission of the Department;

4 ‘‘(II) not be inconsistent with the mis5 sion of the Department;

6 ‘‘(III) not adversely affect the mission

7 of the Department; and

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

9 ‘‘(ii) would result in a demonstrable im10 provement of services to eligible veterans in the

11 geographic service-delivery area within which

12 the property is located.’’.

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

14 amended—

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

16 following:

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

18 enhanced-use lease and remaining after any deduction

19 from those funds under subsection (b) shall be deposited

20 in the Department of Veterans Affairs Health Services

21 Improvement Fund established under section 1729B of

22 this title. The Secretary shall make available to the des23 ignated health care region of the Veterans Health Admin24 istration within which the leased property is located not
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1 less than 75 percent of the amount deposited in the fund

2 attributable to that lease.’’; and

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

4 paragraph:

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

6 ‘designated health care region of the Veterans Health Ad7 ministration’ means a geographic area designated by the

8 Secretary for the purposes of the management of, and al9 location of resources for, health care services provided by

10 the Veterans Health Administration.’’.

11 (e) REPEAL OF TERMINATION PROVISION.—(1) Sec12 tion 8169 is repealed.

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

14 81 is amended by striking the item relating to section

15 8169.

16 (f) REPEAL OF OBSOLETE PROVISIONS.—Section

17 8162 is amended—

18 (1) by striking the last sentence of subsection

19 (a)(1); and

20 (2) by striking subsection (c).
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1 SEC. 208. INELIGIBILITY FOR EMPLOYMENT BY VETERANS

2 HEALTH ADMINISTRATION OF HEALTH CARE

3 PROFESSIONALS WHO HAVE LOST LICENSE

4 TO PRACTICE IN ONE JURISDICTION WHILE

5 STILL LICENSED IN ANOTHER JURISDICTION.

6 Section 7402 is amended by adding at the end the

7 following new subsection:

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

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

10 that subsection) if—

11 ‘‘(1) the person is or has been licensed, reg12 istered, or certified (as applicable to such position)

13 in more than one State; and

14 ‘‘(2) either—

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

16 such license, registration, or certification for

17 cause; or

18 ‘‘(B) the person has voluntarily relin19 quished such license, registration, or certifi20 cation in any of those States after being noti21 fied in writing by that State of potential termi22 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 of title 38, United States Code, is

5 amended by adding at the end the following new sub6 sections:

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

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

9 (of 20 or more beds) of a Department medical center un10 less the Secretary first submits to the Committees on Vet11 erans’ Affairs of the Senate and the House of Representa12 tives a report providing a justification for the closure. No

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

14 submission of such report until the end of the 21-day pe15 riod beginning on the date of the submission of the report.

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

17 on Veterans’ Affairs of the Senate and the House of Rep18 resentatives, not later than January 20 of each year, a

19 report documenting by network for the preceding fiscal

20 year the following:

21 ‘‘(1) The number of medical service and sur22 gical service beds, respectively, that were closed dur23 ing that fiscal year and, for each such closure, a de24 scription of the changes in delivery of services that

25 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), by striking ‘‘in this sub10 section;’’ and all that follows through ‘‘the premises’’

11 and inserting ‘‘in this section’’; and

12 (2) by striking subsection (b).

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

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

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

16 (2) Section 7803(a) is amended—

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

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

19 and

20 (B) by striking ‘‘hospital or home’’ and insert21 ing ‘‘medical facility’’.

22 SEC. 303. REPORT ON ASSISTED LIVING SERVICES.

23 Not later than April 1, 2000, the Secretary of Vet24 erans Affairs shall submit to the Committees on Veterans

25 Affairs of the Senate and House of Representatives a re-
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1 port on the feasibility of establishing a pilot program to

2 assist veterans in receiving needed assisted living services.

3 The Secretary shall include in such report recommenda4 tions on—

5 (1) the services and staffing that should be pro6 vided to a veteran receiving assisted living services

7 under such a pilot program;

8 (2) the appropriate design of such a pilot pro9 gram; and

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

11 be designed to address.

12 SEC. 304. CHIROPRACTIC TREATMENT.

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

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

15 Secretary for Health of the Department of Veterans Af16 fairs, after consultation with chiropractors, shall establish

17 a policy for the Veterans Health Administration regarding

18 the role of chiropractic treatment in the care of veterans

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

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

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

22 the manual manipulation of the spine performed by

23 a chiropractor for the treatment of such musculo24 skeletal conditions as the Secretary considers appro25 priate.
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1 (2) The term ‘‘chiropractor’’ means an indi2 vidual who—

3 (A) is licensed to practice chiropractic in

4 the State in which the individual performs

5 chiropractic services; and

6 (B) holds the degree of doctor of chiro7 practic from a chiropractic college accredited by

8 the Council on Chiropractic Education.

Æ