IIA

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 SENATE OF THE UNITED STATES

JULY 17, 1996

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

AN ACT

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 (d) PRIORITY HEALTH CARE FOR SERVICE IN IS17 RAEL OR TURKEY DURING PERSIAN GULF WAR.—(1)

18 Section 1710(e)(1)(C) of title 38, United States Code, is

19 amended by inserting after ‘‘Southwest Asia theater of op20 erations’’ the following: ‘‘, or who may have been exposed

21 while serving on active duty in Israel or Turkey during

22 the period beginning on August 2, 1990, and ending on

23 July 31, 1991,’’.

24 (2) Section 1712(a)(1)(D) of such title is amended

25 by inserting after ‘‘during the Persian Gulf War’’ the fol-
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1 lowing: ‘‘, or who served on active duty in Israel or Turkey

2 during the period beginning on August 2, 1990, and end3 ing on July 31, 1991,’’.

4 SEC. 2. DEPARTMENT COMMITTEE ON CARE OF SEVERELY

5 CHRONICALLY MENTALLY ILL VETERANS.

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

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

8 after section 7318 the following new section:

9 ‘‘§ 7319. Committee on Care of Severely Chronically

10 Mentally Ill Veterans

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

12 through the Under Secretary for Health, shall establish

13 in the Veterans Health Administration a Committee on

14 Care of Severely Chronically Mentally Ill Veterans. The

15 Under Secretary shall appoint employees of the Depart16 ment with expertise in the care of the chronically mentally

17 ill to serve on the committee.

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

19 out a continuing assessment of, the capability of the Vet20 erans Health Administration to meet effectively the treat21 ment and rehabilitation needs of mentally ill veterans

22 whose mental illness is severe and chronic and who are

23 eligible for health care furnished by the Department, in24 cluding the needs of such veterans who are women. In car25 rying out that responsibility, the committee shall—
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1 ‘‘(1) evaluate the care provided to such veterans

2 through the Veterans Health Administration;

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

4 such veterans in facilities of the Veterans Health

5 Administration;

6 ‘‘(3) identify specific facilities within the Veter7 ans Health Administration at which program enrich8 ment is needed to improve treatment and rehabilita9 tion of such veterans; and

10 ‘‘(4) identify model programs which the com11 mittee considers to have been successful in the treat12 ment and rehabilitation of such veterans and which

13 should be implemented more widely in or through fa14 cilities of the Veterans Health Administration.

15 ‘‘(c) ADVICE AND RECOMMENDATIONS.—The com16 mittee shall—

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

18 development of policies for the care and rehabilita19 tion of severely chronically mentally ill veterans; and

20 ‘‘(2) make recommendations to the Under Sec21 retary—

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

23 such veterans at specific facilities and through24 out the Veterans Health Administration;
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1 ‘‘(B) for establishing special programs of

2 education and training relevant to the care of

3 such veterans for employees of the Veterans

4 Health Administration;

5 ‘‘(C) regarding research needs and prior6 ities relevant to the care of such veterans; and

7 ‘‘(D) regarding the appropriate allocation

8 of resources for all such activities.

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

10 1997, the Secretary shall submit to the Committees on

11 Veterans’ Affairs of the Senate and House of Representa12 tives a report on the implementation of this section. The

13 report shall include the following:

14 ‘‘(A) A list of the members of the committee.

15 ‘‘(B) The assessment of the Under Secretary

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

17 committee, regarding the capability of the Veterans

18 Health Administration, on a systemwide and facility19 by-facility basis, to meet effectively the treatment

20 and rehabilitation needs of severely chronically men21 tally ill veterans who are eligible for Department

22 care.

23 ‘‘(C) The plans of the committee for further as24 sessments.
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1 ‘‘(D) The findings and recommendations made

2 by the committee to the Under Secretary for Health

3 and the views of the Under Secretary on such find4 ings and recommendations.

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

6 made (and a timetable for their execution), and re7 sources to be applied toward improving the capabil8 ity of the Veterans Health Administration to meet

9 effectively the treatment and rehabilitation needs of

10 severely chronically mentally ill veterans who are eli11 gible for Department care.

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

13 1 of each of the three following years, the Secretary shall

14 submit to the Committees on Veterans’ Affairs of the Sen15 ate and House of Representatives a report containing in16 formation updating the reports submitted under this sub17 section before the submission of such report.’’.

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

19 at the beginning of chapter 73 is amended by inserting

20 after the item relating to section 7318 the following new

21 item:

‘‘7319. Committee on Care of Severely Chronically Mentally Ill Veterans.’’.
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1 SEC. 3. CENTERS FOR MENTAL ILLNESS RESEARCH, EDU2 CATION, AND CLINICAL ACTIVITIES.

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

4 is amended by adding after section 7319, as added by sec5 tion 2(a), the following new section:

6 ‘‘§ 7320. Centers for mental illness research, edu7 cation, and clinical activities

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

9 improvement of the provision of health-care services and

10 related counseling services to eligible veterans suffering

11 from mental illness (especially mental illness related to

12 service-related conditions) through—

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

14 on improving mental health service facilities of the

15 Department and on improving the delivery of mental

16 health services by the Department);

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

18 personnel of the Department; and

19 ‘‘(3) the development of improved models and

20 systems for the furnishing of mental health services

21 by the Department.

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

23 centers for mental illness research, education, and clinical

24 activities. Such centers shall be established and operated

25 by collaborating Department facilities as provided in sub-
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1 section (c)(1). Each such center shall function as a center

2 for—

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

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

5 models for furnishing services to treat serious men6 tal illness;

7 ‘‘(C) education and training of health-care pro8 fessionals of the Department; and

9 ‘‘(D) the development and implementation of

10 innovative clinical activities and systems of care with

11 respect to the delivery of such services by the De12 partment.

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

14 of the Under Secretary for Health, designate the centers

15 under this section. In making such designations, the Sec16 retary shall ensure that the centers designated are located

17 in various geographic regions of the United States. The

18 Secretary may designate a center under this section only

19 if—

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

21 of the center meets the requirements of subsection

22 (c);

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

24 in subsection (d); and
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1 ‘‘(C) the peer review panel established under

2 subsection (e) makes the determination specified in

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

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

5 under this section.

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

7 operate centers under this section is subject to the appro8 priation of funds for that purpose.

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

10 center under this section shall—

11 ‘‘(1) provide for close collaboration in the estab12 lishment and operation of the center, and for the

13 provision of care and the conduct of research and

14 education at the center, by a Department facility or

15 facilities in the same geographic area which have a

16 mission centered on care of the mentally ill and a

17 Department facility in that area which has a mission

18 of providing tertiary medical care;

19 ‘‘(2) provide that no less than 50 percent of the

20 funds appropriated for the center for support of clin21 ical care, research, and education will be provided to

22 the collaborating facility or facilities that have a

23 mission centered on care of the mentally ill; and

24 ‘‘(3) provide for a governance arrangement be25 tween the collaborating Department facilities which
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1 ensures that the center will be established and oper2 ated in a manner aimed at improving the quality of

3 mental health care at the collaborating facility or fa4 cilities which have a mission centered on care of the

5 mentally ill.

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

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

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

9 Secretary, upon the recommendation of the Under Sec10 retary for Health, that the facilities submitting the pro11 posal have developed (or may reasonably be anticipated

12 to develop) each of the following:

13 ‘‘(1) An arrangement with an accredited medi14 cal school that provides education and training in

15 psychiatry and with which one or more of the par16 ticipating Department facilities is affiliated under

17 which medical residents receive education and train18 ing in psychiatry through regular rotation through

19 the participating Department facilities so as to pro20 vide such residents with training in the diagnosis

21 and treatment of mental illness.

22 ‘‘(2) An arrangement with an accredited grad23 uate school of psychology under which students re24 ceive education and training in clinical, counseling,

25 or professional psychology through regular rotation
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1 through the participating Department facilities so as

2 to provide such students with training in the diag3 nosis and treatment of mental illness.

4 ‘‘(3) An arrangement under which nursing, so5 cial work, or allied health personnel receive training

6 and education in mental health care through regular

7 rotation through the participating Department facili8 ties.

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

10 demonstrated achievement in research—

11 ‘‘(A) into the evaluation of innovative ap12 proaches to the design of mental health serv13 ices; or

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

15 treatment of mental illness.

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

17 activities of the center, including activities relating

18 to the evaluation of specific efforts to improve the

19 quality and effectiveness of mental health services

20 provided by the Department at or through individual

21 facilities.

22 ‘‘(e)(1) In order to provide advice to assist the Sec23 retary and the Under Secretary for Health to carry out

24 their responsibilities under this section, the official within

25 the central office of the Veterans Health Administration
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1 responsible for mental health and behavioral sciences mat2 ters shall establish a peer review panel to assess the sci3 entific and clinical merit of proposals that are submitted

4 to the Secretary for the designation of centers under this

5 section.

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

7 of mental health research, education and training, and

8 clinical care. Members of the panel shall serve as consult9 ants to the Department.

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

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

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

13 scientific and clinical merit of each such proposal. The

14 panel shall specifically determine with respect to each such

15 proposal whether that proposal is among those proposals

16 which have met the highest competitive standards of sci17 entific and clinical merit.

18 ‘‘(4) The panel shall not be subject to the Federal

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

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

21 each center established under this section—

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

23 from amounts appropriated for the Department of

24 Veterans Affairs medical and prosthetics research

25 account; and
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1 ‘‘(2) shall receive priority in the award of fund2 ing from such account insofar as funds are awarded

3 to projects and activities relating to mental illness.

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

5 that at least three centers designated under this section

6 emphasize research into means of improving the quality

7 of care for veterans suffering from mental illness through

8 the development of community-based alternatives to insti9 tutional treatment for such illness.

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

11 that information produced by the research, education and

12 training, and clinical activities of centers established under

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

14 Veterans Health Administration is disseminated through15 out the Veterans Health Administration. Such dissemina16 tion shall be made through publications, through pro17 grams of continuing medical and related education pro18 vided through regional medical education centers under

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

20 other means. Such programs of continuing medical edu21 cation shall receive priority in the award of funding.

22 ‘‘(i) The official within the central office of the Veter23 ans Health Administration responsible for mental health

24 and behavioral sciences matters shall be responsible for

25 supervising the operation of the centers established pursu-
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1 ant to this section and shall provide for ongoing evaluation

2 of the centers and their compliance with the requirements

3 of this section.

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

5 the Department of Veterans Affairs for the basic support

6 of the research and education and training activities of

7 centers established pursuant to this section amounts as

8 follows:

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

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

11 through 2001.

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

13 year pursuant to the authorization of appropriations in

14 paragraph (1), the Under Secretary for Health shall allo15 cate to such centers from other funds appropriated for

16 that fiscal year generally for the Department of Veterans

17 Affairs medical care account and the Department of Vet18 erans Affairs medical and prosthetics research account

19 such amounts as the Under Secretary for Health deter20 mines appropriate to carry out the purposes of this sec21 tion.’’.

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

23 73 is amended by inserting after the item relating to sec24 tion 7319, as added by section 2(b), the following new

25 item:

‘‘7320. Centers for mental illness research, education, and clinical activities.’’.
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1 (b) ANNUAL REPORTS.—Not later than February 1

2 of each of 1998, 1999, and 2000, the Secretary of Veter3 ans Affairs shall submit to the Committees on Veterans’

4 Affairs of the Senate and House of Representatives a re5 port on the status and activities during the previous fiscal

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

7 and clinical activities established pursuant to section 7320

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

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

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

11 each center and the funding provided for such activi12 ties.

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

14 of the participating facilities of the center in re15 search, education and training, and clinical activities

16 relating to mental illness in veterans.

17 (3) A description of the actions taken by the

18 Under Secretary for Health pursuant to subsection

19 (h) of that section (as so added) to disseminate in20 formation derived from such activities throughout

21 the Veterans Health Administration.

22 (4) The Secretary’s evaluations of the effective23 ness of the centers in fulfilling the purposes of the

24 centers.
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1 (c) IMPLEMENTATION.—The Secretary of Veterans

2 Affairs shall designate at least one center under section

3 7320 of title 38, United States Code, not later than Janu4 ary 1, 1998.

5 SEC. 4. DISBURSEMENT AGREEMENTS RELATING TO MEDI6 CAL RESIDENTS AND INTERNS.

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

8 amended—

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

10 place it appears and inserting in lieu thereof ‘‘De11 partment facility furnishing hospital care or medical

12 services’’;

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

14 paragraph (4)(C) and inserting in lieu thereof ‘‘par15 ticipating facility’’; and

16 (3) by striking out ‘‘hospital’’ both places it ap17 pears in paragraph (5) and inserting in lieu thereof

18 ‘‘facility’’.

19 SEC. 5. AUTHORITY TO SUSPEND SPECIAL PAY AGREE20 MENTS FOR PHYSICIANS AND DENTISTS WHO

21 ENTER RESIDENCY TRAINING PROGRAMS.

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

23 is amended—

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

25 (2) by adding at the end the following:
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1 ‘‘(B) The Secretary may suspend a special pay agree2 ment entered into under this section in the case of a physi3 cian or dentist who, having entered into the special pay

4 agreement, enters a residency training program. Any such

5 suspension shall terminate when the physician or dentist

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

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

8 the physician or dentist is not subject to the provisions

9 of paragraph (1).’’.

10 SEC. 6. REPORTING REQUIREMENTS.

11 (a) EXTENSION OF ANNUAL REPORT REQUIRE12 MENT.—Section 107(a) of the Veterans Health Care Act

13 of 1992 (Public Law 102–585; 38 U.S.C. 1710 note) is

14 amended by striking out ‘‘Not later than January 1, 1993,

15 January 1, 1994, and January 1, 1995’’ and inserting in

16 lieu thereof ‘‘Not later than January 1 of 1993 and each

17 year thereafter through 1998’’.

18 (b) REPORT ON HEALTH CARE AND RESEARCH.—

19 Section 107(b) of such Act is amended—

20 (1) in paragraph (2)(A), by inserting ‘‘(includ21 ing information on the number of inpatient stays

22 and the number of outpatient visits through which

23 such services were provided)’’ after ‘‘facility’’; and

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

25 paragraph:
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1 ‘‘(5) A description of the actions taken by the

2 Secretary to foster and encourage the expansion of

3 such research.’’.

4 SEC. 7. ASSESSMENT OF USE BY WOMEN VETERANS OF DE5 PARTMENT HEALTH SERVICES.

6 (a) REPORTS TO UNDER SECRETARY FOR

7 HEALTH.—The Center for Women Veterans of the De8 partment of Veterans Affairs (established under section

9 509 of Public Law 103–446), in consultation with the Ad10 visory Committee on Women Veterans, shall assess the use

11 by women veterans of health services through the Depart12 ment of Veterans Affairs, including counseling for sexual

13 trauma and mental health services. The Center shall sub14 mit to the Under Secretary for Health of the Department

15 of Veterans Affairs a report not later than April 1, 1997,

16 and April 1 of each of the two following years, on—

17 (1) the extent to which women veterans de18 scribed in section 1710(a)(1) of title 38, United

19 States Code, fail to seek, or face barriers in seeking,

20 health services through the Department, and the

21 reasons therefor; and

22 (2) recommendations, if indicated, for encour23 aging greater use of such services, including (if ap24 propriate) public service announcements and other

25 outreach efforts.
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1 (b) REPORTS TO CONGRESSIONAL COMMITTEES.—

2 Not later than July 1, 1997, and July 1 of each of the

3 two following years, the Secretary of Veterans Affairs

4 shall submit to the Committees on Veterans’ Affairs of

5 the Senate and House of Representatives a report contain6 ing—

7 (1) the most recent report of the Center for

8 Women Veterans under subsection (a);

9 (2) the views of the Under Secretary for Health

10 on such report’s findings and recommendations; and

11 (3) a description of the steps being taken by the

12 Secretary to remedy any problems described in the

13 report.

14 SEC. 8. MAMMOGRAPHY QUALITY STANDARDS.

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

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

17 after section 7320, as added by section 3(a), the following

18 new section:

19 ‘‘§ 7321. Mammography quality standards

20 ‘‘(a) A mammogram may not be performed at a De21 partment facility unless that facility is accredited for that

22 purpose by a private nonprofit organization designated by

23 the Secretary. An organization designated by the Sec24 retary under this subsection shall meet the standards for
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1 accrediting bodies established under section 354(e) of the

2 Public Health Service Act (42 U.S.C. 263b(e)).

3 ‘‘(b) The Secretary, in consultation with the Sec4 retary of Health and Human Services, shall prescribe

5 quality assurance and quality control standards relating

6 to the performance and interpretation of mammograms

7 and use of mammogram equipment and facilities of the

8 Department of Veterans Affairs consistent with the re9 quirements of section 354(f)(1) of the Public Health Serv10 ice Act. Such standards shall be no less stringent than

11 the standards prescribed by the Secretary of Health and

12 Human Services under section 354(f) of the Public Health

13 Service Act.

14 ‘‘(c)(1) The Secretary, to ensure compliance with the

15 standards prescribed under subsection (b), shall provide

16 for an annual inspection of the equipment and facilities

17 used by and in Department health care facilities for the

18 performance of mammograms. Such inspections shall be

19 carried out in a manner consistent with the inspection of

20 certified facilities by the Secretary of Health and Human

21 Services under section 354(g) of the Public Health Service

22 Act.

23 ‘‘(2) The Secretary may not provide for an inspection

24 under paragraph (1) to be performed by a State agency.
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1 ‘‘(d) The Secretary shall ensure that mammograms

2 performed for the Department under contract with any

3 non-Department facility or provider conform to the quality

4 standards prescribed by the Secretary of Health and

5 Human Services under section 354 of the Public Health

6 Service Act.

7 ‘‘(e) For the purposes of this section, the term ‘mam8 mogram’ has the meaning given such term in paragraph

9 (5) of section 354(a) of the Public Health Service Act (42

10 U.S.C. 263b(a)).’’.

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

12 chapter is amended by inserting after the item relating

13 to section 7320, as added by section 3(b), the following

14 new item:

‘‘7321. Mammography quality standards.’’.

15 (b) DEADLINE FOR PRESCRIBING STANDARDS.—The

16 Secretary of Veterans Affairs shall prescribe standards

17 under subsection (b) of section 7321 of title 38, United

18 States Code, as added by subsection (a), not later than

19 the end of the 120-day period beginning on the date of

20 the enactment of this Act.

21 (c) IMPLEMENTATION REPORT.—The Secretary of

22 Veterans Affairs shall submit to the Committees on Veter23 ans’ Affairs of the Senate and House of Representatives

24 a report on the Secretary’s implementation of section

25 7321 of title 38, United States Code, as added by sub-
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1 section (a). The report shall be submitted not later than

2 120 days after the later of (1) the date on which the Sec3 retary prescribes the quality standards required under

4 subsection (b) of that section, or (2) the date of the enact5 ment of this Act.

6 SEC. 9. PATIENT PRIVACY FOR WOMEN PATIENTS.

7 (a) IDENTIFICATION OF DEFICIENCIES.—The Sec8 retary of Veterans Affairs shall conduct a survey of each

9 medical center under the jurisdiction of the Secretary to

10 identify deficiencies relating to patient privacy afforded to

11 women patients in the clinical areas at each such center

12 which may interfere with appropriate treatment of such

13 patients.

14 (b) CORRECTION OF DEFICIENCIES.—The Secretary

15 shall ensure that plans and, where appropriate, interim

16 steps, to correct the deficiencies identified in the survey

17 conducted under subsection (a) are developed and are in18 corporated into the Department’s construction planning

19 processes and given a high priority.

20 (c) REPORTS TO CONGRESS.—The Secretary shall

21 compile an annual inventory, by medical center, of defi22 ciencies identified under subsection (a) and of plans and,

23 where appropriate, interim steps, to correct such defi24 ciencies. The Secretary shall submit to the Committees on

25 Veterans’ Affairs of the Senate and House of Representa-
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1 tives, not later than October 1, 1997, and not later than

2 October 1 each year thereafter through 1999 a report on

3 such deficiencies. The Secretary shall include in such re4 port the inventory compiled by the Secretary, the proposed

5 corrective plans, and the status of such plans.

6 SEC. 10. MODIFICATION OF RESTRICTIONS ON REAL PROP7 ERTY, MILWAUKEE COUNTY, WISCONSIN.

8 (a) MODIFICATION OF REVERSIONARY INTEREST.—

9 The Secretary of Veterans Affairs is authorized to execute

10 such instruments as may be necessary to modify the condi11 tions under which the land described in subsection (b) will

12 revert to the United States so as—

13 (1) to permit Milwaukee County, Wisconsin, to

14 grant all or part of such land to another party with

15 a condition on such grant that the grantee use such

16 land only for civic and recreational purposes; and

17 (2) to provide that the conditions under which

18 title to all or any part of such land reverts to the

19 United States are stated so that any such reversion

20 would occur at the option of the United States.

21 (b) DESCRIPTION OF LAND.—The land covered by

22 this section is the tract of 28 acres of land, more or less,

23 conveyed to Milwaukee County, Wisconsin, pursuant to

24 the Act entitled ‘‘An Act authorizing the Administrator

25 of Veterans’ Affairs to convey certain property to Milwau-
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1 kee County, Wisconsin’’, approved August 27, 1954 (68

2 Stat. 866).

3 (c) GENERAL AUTHORITIES.—The Secretary may

4 carry out this section subject to such terms and conditions

5 (including reservations of rights for the United States) as

6 the Secretary considers necessary to protect the interests

7 of the United States. In carrying out this section, the Sec8 retary may eliminate any existing covenant or restriction

9 with respect to the tract of land described in subsection

10 (b) which the Secretary determines to be no longer nec11 essary to protect the interests of the United States.

Passed the House of Representatives July 16, 1996.

Attest: ROBIN H. CARLE,

Clerk.