I

104TH CONGRESS

2D SESSION H. R. 3643

To amend title 38, United States Code, to extend through December 31,

1998, the period during which the Secretary of Veterans Affairs is

authorized to provide priority health care to certain veterans who were

exposed to Agent Orange or who served in the Persian Gulf War and

to make such authority permanent in the case of certain veterans exposed

to ionizing radiation, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JUNE 13, 1996

Mr. HUTCHINSON (for himself, Mr. EDWARDS, Mr. STUMP, and Mr. MONTGOMERY) introduced the following bill; which was referred to the Committee on Veterans’ Affairs

A BILL

To amend title 38, United States Code, to extend through

December 31, 1998, the period during which the Secretary of Veterans Affairs is authorized to provide priority health care to certain veterans who were exposed

to Agent Orange or who served in the Persian Gulf

War and to make such authority permanent in the case

of certain veterans exposed to ionizing radiation, and

for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. AUTHORITY TO PROVIDE PRIORITY HEALTH

2 CARE.

3 (a) AUTHORIZED INPATIENT CARE.—Section

4 1710(e) of title 38, United States Code, is amended—

5 (1) in paragraph (1), by striking out subpara6 graphs (A) and (B) and inserting in lieu thereof the

7 following:

8 ‘‘(e)(1)(A) A herbicide-exposed veteran is eligible for

9 hospital care and nursing home care under subsection

10 (a)(1)(G) for any disease suffered by the veteran that is—

11 ‘‘(i) among those diseases for which the Na12 tional Academy of Sciences, in a report issued in ac13 cordance with section 2 of the Agent Orange Act of

14 1991, has determined—

15 ‘‘(I) that there is sufficient evidence to

16 conclude that there is a positive association be17 tween occurrence of the disease in humans and

18 exposure to a herbicide agent;

19 ‘‘(II) that there is evidence which is sug20 gestive of an association between occurrence of

21 the disease in humans and exposure to a herbi22 cide agent, but such evidence is limited in na23 ture; or

24 ‘‘(III) that available studies are insufficient

25 to permit a conclusion about the presence or

26 absence of an association between occurrence of
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1 the disease in humans and exposure to a herbi2 cide agent; or

3 ‘‘(ii) a disease for which the Secretary, pursu4 ant to a recommendation of the Under Secretary for

5 Health on the basis of a peer-reviewed research

6 study or studies published within 20 months after

7 the most recent report of the National Academy

8 under section 2 of the Agent Orange Act of 1991,

9 determines there is credible evidence suggestive of

10 an association between occurrence of the disease in

11 humans and exposure to a herbicide agent.

12 ‘‘(B) A radiation-exposed veteran is eligible for hos13 pital care and nursing home care under subsection

14 (a)(1)(G) for any disease suffered by the veteran that is—

15 ‘‘(i) a disease listed in section 1112(c)(2) of

16 this title; or

17 ‘‘(ii) any other disease for which the Secretary,

18 based on the advice of the Advisory Committee on

19 Environmental Hazards, determines that there is

20 credible evidence of a positive association between

21 occurrence of the disease in humans and exposure to

22 ionizing radiation.’’;

23 (2) in paragraph (2)—
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1 (A) by striking out ‘‘Hospital’’ and insert2 ing in lieu thereof ‘‘In the case of a veteran de3 scribed in paragraph (1)(C), hospital’’; and

4 (B) by striking out ‘‘subparagraph’’ and

5 all that follows through ‘‘subsection’’ and in6 serting in lieu thereof ‘‘paragraph (1)(C)’’;

7 (3) in paragraph (3), by striking out ‘‘of this

8 section after December 31, 1996’’ and inserting in

9 lieu thereof ‘‘after December 31, 1998, in the case

10 of care for a veteran described in paragraph (1)(A)

11 or paragraph (1)(C)’’; and

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

13 paragraph:

14 ‘‘(4) For purposes of this subsection and section

15 1712 of this title:

16 ‘‘(A) The term ‘herbicide-exposed veteran’

17 means a veteran (i) who served on active duty in the

18 Republic of Vietnam during the Vietnam era, and

19 (ii) who the Secretary finds may have been exposed

20 during such service to a herbicide agent.

21 ‘‘(B) The term ‘herbicide agent’ has the mean22 ing given that term in section 1116(a)(4) of this

23 title.
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1 ‘‘(C) The term ‘radiation-exposed veteran’ has

2 the meaning given that term in section 1112(c)(4) of

3 this title.’’.

4 (b) AUTHORIZED OUTPATIENT CARE.—Section 1712

5 of such title is amended—

6 (1) in subsection (a)(1)—

7 (A) by striking out ‘‘and’’ at the end of

8 subparagraph (C);

9 (B) in subparagraph (D)—

10 (i) by striking out ‘‘before December

11 31, 1996,’’ and inserting in lieu thereof

12 ‘‘before January 1, 1999,’’; and

13 (ii) by striking out the period at the

14 end of subparagraph (D) and inserting in

15 lieu thereof a semicolon;

16 (C) by adding at the end the following new

17 subparagraphs:

18 ‘‘(E) during the period before January 1, 1999,

19 to any herbicide-exposed veteran (as defined in sec20 tion 1710(e)(4)(A) of this title) for any disease spec21 ified in section 1710(e)(1)(A) of this title; and

22 ‘‘(F) to any radiation-exposed veteran (as de23 fined in section 1112(c)(4) of this title) for any dis24 ease covered under section 1710(e)(1)(B) of this

25 title.’’; and
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1 (2) in subsection (i)(3)—

2 (A) by striking out ‘‘(A)’’; and

3 (B) by striking out ‘‘, or (B)’’ and all that

4 follows through ‘‘title’’.

5 (c) SAVINGS PROVISIONS.—The provisions of sections

6 1710(e) and 1712(a) of title 38, United States Code, as

7 in effect on the day before the date of the enactment of

8 this Act, shall continue to apply on and after such date

9 with respect to the furnishing of hospital care, nursing

10 home care, and medical services for any veteran who was

11 furnished such care or services before such date of enact12 ment on the basis of presumed exposure to a substance

13 or radiation under the authority of those provisions, but

14 only for treatment for a disability for which such care or

15 services were furnished before such date.

16 SEC. 2. DEPARTMENT COMMITTEE ON CARE OF SEVERELY

17 CHRONICALLY MENTALLY ILL VETERANS.

18 (a) ESTABLISHMENT.—Subchapter II of chapter 73

19 of title 38, United States Code, is amended by adding

20 after section 7318 the following new section:

21 ‘‘§ 7319. Committee on Care of Severely Chronically

22 Mentally Ill Veterans

23 ‘‘(a) ESTABLISHMENT.—The Secretary, acting

24 through the Under Secretary for Health, shall establish

25 in the Veterans Health Administration a Committee on
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1 Care of Severely Chronically Mentally Ill Veterans. The

2 Under Secretary shall appoint employees of the Depart3 ment with expertise in the care of the chronically mentally

4 ill to serve on the committee.

5 ‘‘(b) DUTIES.—The committee shall assess, and carry

6 out a continuing assessment of, the capability of the Vet7 erans Health Administration to meet effectively the treat8 ment and rehabilitation needs of mentally ill veterans

9 whose mental illness is severe and chronic and who are

10 eligible for health care furnished by the Department. In

11 carrying out that responsibility, the committee shall—

12 ‘‘(1) evaluate the care provided to such veterans

13 through the Veterans Health Administration;

14 ‘‘(2) identify systemwide problems in caring for

15 such veterans in facilities of the Veterans Health

16 Administration;

17 ‘‘(3) identify specific facilities within the Veter18 ans Health Administration at which program enrich19 ment is needed to improve treatment and rehabilita20 tion of such veterans; and

21 ‘‘(4) identify model programs which the com22 mittee considers to have been successful in the treat23 ment and rehabilitation of such veterans and which

24 should be implemented more widely in or through fa25 cilities of the Veterans Health Administration.
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1 ‘‘(c) ADVICE AND RECOMMENDATIONS.—The com2 mittee shall—

3 ‘‘(1) advise the Under Secretary regarding the

4 development of policies for the care and rehabilita5 tion of severely chronically mentally ill veterans; and

6 ‘‘(2) make recommendations to the Under Sec7 retary—

8 ‘‘(A) for improving programs of care of

9 such veterans at specific facilities and through10 out the Veterans Health Administration;

11 ‘‘(B) for establishing special programs of

12 education and training relevant to the care of

13 such veterans for employees of the Veterans

14 Health Administration;

15 ‘‘(C) regarding research needs and prior16 ities relevant to the care of such veterans; and

17 ‘‘(D) regarding the appropriate allocation

18 of resources for all such activities.

19 ‘‘(d) ANNUAL REPORT.—(1) Not later than April 1,

20 1997, the Secretary shall submit to the Committees on

21 Veterans’ Affairs of the Senate and House of Representa22 tives a report on the implementation of this section. The

23 report shall include the following:

24 ‘‘(A) A list of the members of the committee.
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1 ‘‘(B) The assessment of the Under Secretary

2 for Health, after review of the initial findings of the

3 committee, regarding the capability of the Veterans

4 Health Administration, on a systemwide and facility5 by-facility basis, to meet effectively the treatment

6 and rehabilitation needs of severely chronically men7 tally ill veterans who are eligible for Department

8 care.

9 ‘‘(C) The plans of the committee for further as10 sessments.

11 ‘‘(D) The findings and recommendations made

12 by the committee to the Under Secretary for Health

13 and the views of the Under Secretary on such find14 ings and recommendations.

15 ‘‘(E) A description of the steps taken, plans

16 made (and a timetable for their execution), and re17 sources to be applied toward improving the capabil18 ity of the Veterans Health Administration to meet

19 effectively the treatment and rehabilitation needs of

20 severely chronically mentally ill veterans who are eli21 gible for Department care.

22 ‘‘(2) Not later than February 1, 1998, and February

23 1 of each of the three following years, the Secretary shall

24 submit to the Committees on Veterans’ Affairs of the Sen25 ate and House of Representatives a report containing in-
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1 formation updating the reports submitted under this sub2 section before the submission of such report.’’.

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

4 at the beginning of chapter 73 is amended by inserting

5 after the item relating to section 7318 the following new

6 item:

‘‘7319. Committee on Care of Severely Chronically Mentally Ill Veterans.’’.

7 SEC. 3. CENTERS FOR MENTAL ILLNESS RESEARCH, EDU8 CATION, AND CLINICAL ACTIVITIES.

9 (a) IN GENERAL.—(1) Subchapter II of chapter 73

10 is amended by adding after section 7319, as added by sec11 tion 2(a), the following new section:

12 ‘‘§ 7320. Centers for mental illness research, edu13 cation, and clinical activities

14 ‘‘(a) The purpose of this section is to provide for the

15 improvement of the provision of health-care services and

16 related counseling services to eligible veterans suffering

17 from mental illness (especially mental illness related to

18 service-related conditions) through—

19 ‘‘(1) the conduct of research (including research

20 on improving mental health service facilities of the

21 Department and on improving the delivery of mental

22 health services by the Department);

23 ‘‘(2) the education and training of health care

24 personnel of the Department; and
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1 ‘‘(3) the development of improved models and

2 systems for the furnishing of mental health services

3 by the Department.

4 ‘‘(b)(1) The Secretary shall establish and operate

5 centers for mental illness research, education, and clinical

6 activities. Such centers shall be established and operated

7 by collaborating Department facilities as provided in sub8 section (c)(1). Each such center shall function as a center

9 for—

10 ‘‘(A) research on mental health services;

11 ‘‘(B) the use by the Department of specific

12 models for furnishing services to treat serious men13 tal illness;

14 ‘‘(C) education and training of health-care pro15 fessionals of the Department; and

16 ‘‘(D) the development and implementation of

17 innovative clinical activities and systems of care with

18 respect to the delivery of such services by the De19 partment.

20 ‘‘(2) The Secretary shall, upon the recommendation

21 of the Under Secretary for Health, designate the centers

22 under this section. In making such designations, the Sec23 retary shall ensure that the centers designated are located

24 in various geographic regions of the United States. The
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1 Secretary may designate a center under this section only

2 if—

3 ‘‘(A) the proposal submitted for the designation

4 of the center meets the requirements of subsection

5 (c);

6 ‘‘(B) the Secretary makes the finding described

7 in subsection (d); and

8 ‘‘(C) the peer review panel established under

9 subsection (e) makes the determination specified in

10 subsection (e)(3) with respect to that proposal.

11 ‘‘(3) Not more than five centers may be designated

12 under this section.

13 ‘‘(4) The authority of the Secretary to establish and

14 operate centers under this section is subject to the appro15 priation of funds for that purpose.

16 ‘‘(c) A proposal submitted for the designation of a

17 center under this section shall—

18 ‘‘(1) provide for close collaboration in the estab19 lishment and operation of the center, and for the

20 provision of care and the conduct of research and

21 education at the center, by a Department facility or

22 facilities in the same geographic area which have a

23 mission centered on care of the mentally ill and a

24 Department facility in that area which has a mission

25 of providing tertiary medical care;
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1 ‘‘(2) provide that no less than 50 percent of the

2 funds appropriated for the center for support of clin3 ical care, research, and education will be provided to

4 the collaborating facility or facilities that have a

5 mission centered on care of the mentally ill; and

6 ‘‘(3) provide for a governance arrangement be7 tween the collaborating Department facilities which

8 ensures that the center will be established and oper9 ated in a manner aimed at improving the quality of

10 mental health care at the collaborating facility or fa11 cilities which have a mission centered on care of the

12 mentally ill.

13 ‘‘(d) The finding referred to in subsection (b)(2)(B)

14 with respect to a proposal for designation of a site as a

15 location of a center under this section is a finding by the

16 Secretary, upon the recommendation of the Under Sec17 retary for Health, that the facilities submitting the pro18 posal have developed (or may reasonably be anticipated

19 to develop) each of the following:

20 ‘‘(1) An arrangement with an accredited medi21 cal school that provides education and training in

22 psychiatry and with which one or more of the par23 ticipating Department facilities is affiliated under

24 which medical residents receive education and train25 ing in psychiatry through regular rotation through
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1 the participating Department facilities so as to pro2 vide such residents with training in the diagnosis

3 and treatment of mental illness.

4 ‘‘(2) An arrangement with an accredited grad5 uate school of psychology under which students re6 ceive education and training in clinical, counseling,

7 or professional psychology through regular rotation

8 through the participating Department facilities so as

9 to provide such students with training in the diag10 nosis and treatment of mental illness.

11 ‘‘(3) An arrangement under which nursing, so12 cial work, or allied health personnel receive training

13 and education in mental health care through regular

14 rotation through the participating Department facili15 ties.

16 ‘‘(4) The ability to attract scientists who have

17 demonstrated achievement in research—

18 ‘‘(A) into the evaluation of innovative ap19 proaches to the design of mental health serv20 ices; or

21 ‘‘(B) into the causes, prevention, and

22 treatment of mental illness.

23 ‘‘(5) The capability to evaluate effectively the

24 activities of the center, including activities relating

25 to the evaluation of specific efforts to improve the
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1 quality and effectiveness of mental health services

2 provided by the Department at or through individual

3 facilities.

4 ‘‘(e)(1) In order to provide advice to assist the Sec5 retary and the Under Secretary for Health to carry out

6 their responsibilities under this section, the official within

7 the central office of the Veterans Health Administration

8 responsible for mental health and behavioral sciences mat9 ters shall establish a peer review panel to assess the sci10 entific and clinical merit of proposals that are submitted

11 to the Secretary for the designation of centers under this

12 section.

13 ‘‘(2) The panel shall consist of experts in the fields

14 of mental health research, education and training, and

15 clinical care. Members of the panel shall serve as consult16 ants to the Department.

17 ‘‘(3) The panel shall review each proposal submitted

18 to the panel by the official referred to in paragraph (1)

19 and shall submit to that official its views on the relative

20 scientific and clinical merit of each such proposal. The

21 panel shall specifically determine with respect to each such

22 proposal whether that proposal is among those proposals

23 which have met the highest competitive standards of sci24 entific and clinical merit.
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1 ‘‘(4) The panel shall not be subject to the Federal

2 Advisory Committee Act (5 U.S.C. App.).

3 ‘‘(f) Clinical and scientific investigation activities at

4 each center established under this section—

5 ‘‘(1) may compete for the award of funding

6 from amounts appropriated for the Department of

7 Veterans Affairs medical and prosthetics research

8 account; and

9 ‘‘(2) shall receive priority in the award of fund10 ing from such account insofar as funds are awarded

11 to projects and activities relating to mental illness.

12 ‘‘(g) The Under Secretary for Health shall ensure

13 that at least three centers designated under this section

14 emphasize research into means of improving the quality

15 of care for veterans suffering from mental illness through

16 the development of community-based alternatives to insti17 tutional treatment for such illness.

18 ‘‘(h) The Under Secretary for Health shall ensure

19 that information produced by the research, education and

20 training, and clinical activities of centers established under

21 this section that may be useful for other activities of the

22 Veterans Health Administration is disseminated through23 out the Veterans Health Administration. Such dissemina24 tion shall be made through publications, through pro25 grams of continuing medical and related education pro-
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1 vided through regional medical education centers under

2 subchapter VI of chapter 74 of this title, and through

3 other means. Such programs of continuing medical edu4 cation shall receive priority in the award of funding.

5 ‘‘(i) The official within the central office of the Veter6 ans Health Administration responsible for mental health

7 and behavioral sciences matters shall be responsible for

8 supervising the operation of the centers established pursu9 ant to this section and shall provide for ongoing evaluation

10 of the centers and their compliance with the requirements

11 of this section.

12 ‘‘(j)(1) There are authorized to be appropriated to

13 the Department of Veterans Affairs for the basic support

14 of the research and education and training activities of

15 centers established pursuant to this section amounts as

16 follows:

17 ‘‘(A) $3,125,000 for fiscal year 1998.

18 ‘‘(B) $6,250,000 for each of fiscal years 1999

19 through 2001.

20 ‘‘(2) In addition to funds appropriated for a fiscal

21 year pursuant to the authorization of appropriations in

22 paragraph (1), the Under Secretary for Health shall allo23 cate to such centers from other funds appropriated for

24 that fiscal year generally for the Department of Veterans

25 Affairs medical care account and the Department of Vet-
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1 erans Affairs medical and prosthetics research account

2 such amounts as the Under Secretary for Health deter3 mines appropriate to carry out the purposes of this sec4 tion.’’.

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

6 73 is amended by inserting after the item relating to sec7 tion 7319, as added by section 2(b), the following new

8 item:

‘‘7320. Centers for mental illness research, education, and clinical activities.’’.

9 (b) ANNUAL REPORTS.—Not later than February 1

10 of each of 1998, 1999, and 2000, the Secretary of Veter11 ans Affairs shall submit to the Committees on Veterans’

12 Affairs of the Senate and House of Representatives a re13 port on the status and activities during the previous fiscal

14 year of the centers for mental illness, research, education,

15 and clinical activities established pursuant to section 7320

16 of title 38, United States Code (as added by subsection

17 (a)). Each such report shall include the following:

18 (1) A description of the activities carried out at

19 each center and the funding provided for such activi20 ties.

21 (2) A description of the advances made at each

22 of the participating facilities of the center in re23 search, education and training, and clinical activities

24 relating to mental illness in veterans.
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1 (3) A description of the actions taken by the

2 Under Secretary for Health pursuant to subsection

3 (h) of that section (as so added) to disseminate in4 formation derived from such activities throughout

5 the Veterans Health Administration.

6 (4) The Secretary’s evaluations of the effective7 ness of the centers in fulfilling the purposes of the

8 centers.

9 (c) IMPLEMENTATION.—The Secretary of Veterans

10 Affairs shall designate at least one center under section

11 7320 of title 38, United States Code, not later than Janu12 ary 1, 1998.

13 SEC. 4. DISBURSEMENT AGREEMENTS RELATING TO MEDI14 CAL RESIDENTS AND INTERNS.

15 Section 7406(c) of title 38, United States Code, is

16 amended—

17 (1) by striking out ‘‘Department hospital’’ each

18 place it appears and inserting in lieu thereof ‘‘De19 partment facility furnishing hospital care or medical

20 services’’;

21 (2) by striking out ‘‘participating hospital’’ in

22 paragraph (4)(C) and inserting in lieu thereof ‘‘par23 ticipating facility’’; and
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1 (3) by striking out ‘‘hospital’’ both places it ap2 pears in paragraph (5) and inserting in lieu thereof

3 ‘‘facility’’.

4 SEC. 5. AUTHORITY TO SUSPEND SPECIAL PAY AGREE5 MENTS FOR PHYSICIANS AND DENTISTS WHO

6 ENTER RESIDENCY TRAINING PROGRAMS.

7 Section 7432(b)(2) of title 38, United States Code,

8 is amended—

9 (1) by inserting ‘‘(A)’’ after ‘‘(2)’’; and

10 (2) by adding at the end the following:

11 ‘‘(B) The Secretary may suspend a special pay agree12 ment entered into under this section in the case of a physi13 cian or dentist who, having entered into the special pay

14 agreement, enters a residency training program. Any such

15 suspension shall terminate when the physician or dentist

16 completes, withdraws from, or is no longer a participant

17 in the program. During the period of such a suspension,

18 the physician or dentist is not subject to the provisions

19 of paragraph (1).’’.

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