Union Calendar No. 327

104TH CONGRESS

2D SESSION H. R. 3643

[Report No. 104–648]

A BILL

To amend title 38, United States Code, to extend

other purposes.veterans exposed to ionizing radiation, and forsuch authority permanent in the case of certainwho served in the Persian Gulf War and to makeveterans who were exposed to Agent Orange orthorized to provide priority health care to certainwhich the Secretary of Veterans Affairs is authrough December 31, 1998, the period during

JUNE 27, 1996

Reported with amendments, committed to the Committee

dered to be printedof the Whole House on the State of the Union, and or-
IB

Union Calendar No. 327

104TH CONGRESS

2D SESSION H. R. 3643

[Report No. 104–648]

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

JUNE 27, 1996

Addtional sponsors: Mr. WELLER, Mr. WATTS of Oklahoma, Mr. BILIRAKIS,

Mr. SMITH of New Jersey, Ms. BROWN of Florida, Mr. FLANAGAN, Mr.

STEARNS, Mr. DEAL of Georgia, Mr. QUINN, Mr. FOX of Pennsylvania,

Mr. CLEMENT, Mr. TEJEDA, and Mr. MASCARA

JUNE 27, 1996

Reported with amendments, committed to the Committee of the Whole House

on the State of the Union, and ordered to be printed

[Insert the part printed in italic]

A BILL

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

December 31, 1998, the period during which the Sec-
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retary 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,

3 SECTION 1. AUTHORITY TO PROVIDE PRIORITY HEALTH

4 CARE.

5 (a) AUTHORIZED INPATIENT CARE.—Section

6 1710(e) of title 38, United States Code, is amended—

7 (1) in paragraph (1), by striking out subpara8 graphs (A) and (B) and inserting in lieu thereof the

9 following:

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

11 hospital care and nursing home care under subsection

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

13 ‘‘(i) among those diseases for which the Na14 tional Academy of Sciences, in a report issued in ac15 cordance with section 2 of the Agent Orange Act of

16 1991, has determined—

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

18 conclude that there is a positive association be19 tween occurrence of the disease in humans and

20 exposure to a herbicide agent;
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1 ‘‘(II) that there is evidence which is sug2 gestive of an association between occurrence of

3 the disease in humans and exposure to a herbi4 cide agent, but such evidence is limited in na5 ture; or

6 ‘‘(III) that available studies are insufficient

7 to permit a conclusion about the presence or

8 absence of an association between occurrence of

9 the disease in humans and exposure to a herbi10 cide agent; or

11 ‘‘(ii) a disease for which the Secretary, pursu12 ant to a recommendation of the Under Secretary for

13 Health on the basis of a peer-reviewed research

14 study or studies published within 20 months after

15 the most recent report of the National Academy

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

17 determines there is credible evidence suggestive of

18 an association between occurrence of the disease in

19 humans and exposure to a herbicide agent.

20 ‘‘(B) A radiation-exposed veteran is eligible for hos21 pital care and nursing home care under subsection

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

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

24 this title; or
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1 ‘‘(ii) any other disease for which the Secretary,

2 based on the advice of the Advisory Committee on

3 Environmental Hazards, determines that there is

4 credible evidence of a positive association between

5 occurrence of the disease in humans and exposure to

6 ionizing radiation.’’;

7 (2) in paragraph (2)—

8 (A) by striking out ‘‘Hospital’’ and insert9 ing in lieu thereof ‘‘In the case of a veteran de10 scribed in paragraph (1)(C), hospital’’; and

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

12 all that follows through ‘‘subsection’’ and in13 serting in lieu thereof ‘‘paragraph (1)(C)’’;

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

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

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

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

18 or paragraph (1)(C)’’; and

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

20 paragraph:

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

22 1712 of this title:

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

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

25 Republic of Vietnam during the Vietnam era, and
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1 (ii) who the Secretary finds may have been exposed

2 during such service to a herbicide agent.

3 ‘‘(B) The term ‘herbicide agent’ has the mean4 ing given that term in section 1116(a)(4) of this

5 title.

6 ‘‘(C) The term ‘radiation-exposed veteran’ has

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

8 this title.’’.

9 (b) AUTHORIZED OUTPATIENT CARE.—Section 1712

10 of such title is amended—

11 (1) in subsection (a)(1)—

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

13 subparagraph (C);

14 (B) in subparagraph (D)—

15 (i) by striking out ‘‘before December

16 31, 1996,’’ and inserting in lieu thereof

17 ‘‘before January 1, 1999,’’; and

18 (ii) by striking out the period at the

19 end of subparagraph (D) and inserting in

20 lieu thereof a semicolon;

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

22 subparagraphs:

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

24 to any herbicide-exposed veteran (as defined in sec-
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1 tion 1710(e)(4)(A) of this title) for any disease spec2 ified in section 1710(e)(1)(A) of this title; and

3 ‘‘(F) to any radiation-exposed veteran (as de4 fined in section 1112(c)(4) of this title) for any dis5 ease covered under section 1710(e)(1)(B) of this

6 title.’’; and

7 (2) in subsection (i)(3)—

8 (A) by striking out ‘‘(A)’’; and

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

10 follows through ‘‘title’’.

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

12 1710(e) and 1712(a) of title 38, United States Code, as

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

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

15 with respect to the furnishing of hospital care, nursing

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

17 furnished such care or services before such date of enact18 ment on the basis of presumed exposure to a substance

19 or radiation under the authority of those provisions, but

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

21 services were furnished before such date.

22 (d) PRIORITY HEALTH CARE FOR SERVICE IN ISRAEL

23 OR TURKEY DURING PERSIAN GULF WAR.—(1) Section

24 1710(e)(1)(C) of title 38, United States Code, is amended

25 by inserting after ‘‘Southwest Asia theater of operations’’
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1 the following: ‘‘, or who may have been exposed while serv2 ing on active duty in Israel or Turkey during the period

3 beginning on August 2, 1990, and ending on July 31,

4 1991,’’.

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

6 inserting after ‘‘during the Persian Gulf War’’ the follow7 ing: ‘‘, or who served on active duty in Israel or Turkey

8 during the period beginning on August 2, 1990, and ending

9 on July 31, 1991,’’.

10 SEC. 2. DEPARTMENT COMMITTEE ON CARE OF SEVERELY

11 CHRONICALLY MENTALLY ILL VETERANS.

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

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

14 after section 7318 the following new section:

15 ‘‘§ 7319. Committee on Care of Severely Chronically

16 Mentally Ill Veterans

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

18 through the Under Secretary for Health, shall establish

19 in the Veterans Health Administration a Committee on

20 Care of Severely Chronically Mentally Ill Veterans. The

21 Under Secretary shall appoint employees of the Depart22 ment with expertise in the care of the chronically mentally

23 ill to serve on the committee.

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

25 out a continuing assessment of, the capability of the Vet-
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1 erans Health Administration to meet effectively the treat2 ment and rehabilitation needs of mentally ill veterans

3 whose mental illness is severe and chronic and who are

4 eligible for health care furnished by the Department, in5 cluding the needs of such veterans who are women. In carry6 ing out that responsibility, the committee shall—

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

8 through the Veterans Health Administration;

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

10 such veterans in facilities of the Veterans Health

11 Administration;

12 ‘‘(3) identify specific facilities within the Veter13 ans Health Administration at which program enrich14 ment is needed to improve treatment and rehabilita15 tion of such veterans; and

16 ‘‘(4) identify model programs which the com17 mittee considers to have been successful in the treat18 ment and rehabilitation of such veterans and which

19 should be implemented more widely in or through fa20 cilities of the Veterans Health Administration.

21 ‘‘(c) ADVICE AND RECOMMENDATIONS.—The com22 mittee shall—

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

24 development of policies for the care and rehabilita25 tion of severely chronically mentally ill veterans; and
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1 ‘‘(2) make recommendations to the Under Sec2 retary—

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

4 such veterans at specific facilities and through5 out the Veterans Health Administration;

6 ‘‘(B) for establishing special programs of

7 education and training relevant to the care of

8 such veterans for employees of the Veterans

9 Health Administration;

10 ‘‘(C) regarding research needs and prior11 ities relevant to the care of such veterans; and

12 ‘‘(D) regarding the appropriate allocation

13 of resources for all such activities.

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

15 1997, the Secretary shall submit to the Committees on

16 Veterans’ Affairs of the Senate and House of Representa17 tives a report on the implementation of this section. The

18 report shall include the following:

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

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

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

22 committee, regarding the capability of the Veterans

23 Health Administration, on a systemwide and facility24 by-facility basis, to meet effectively the treatment

25 and rehabilitation needs of severely chronically men-
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1 tally ill veterans who are eligible for Department

2 care.

3 ‘‘(C) The plans of the committee for further as4 sessments.

5 ‘‘(D) The findings and recommendations made

6 by the committee to the Under Secretary for Health

7 and the views of the Under Secretary on such find8 ings and recommendations.

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

10 made (and a timetable for their execution), and re11 sources to be applied toward improving the capabil12 ity of the Veterans Health Administration to meet

13 effectively the treatment and rehabilitation needs of

14 severely chronically mentally ill veterans who are eli15 gible for Department care.

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

17 1 of each of the three following years, the Secretary shall

18 submit to the Committees on Veterans’ Affairs of the Sen19 ate and House of Representatives a report containing in20 formation updating the reports submitted under this sub21 section before the submission of such report.’’.

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

23 at the beginning of chapter 73 is amended by inserting

24 after the item relating to section 7318 the following new

25 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 REQUIREMENT.—

12 Section 107(a) of the Veterans Health Care Act of 1992

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

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

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

16 ‘‘Not later than January 1 of 1993 and each year thereafter

17 through 1998’’.

18 (b) REPORT ON HEALTH CARE AND RESEARCH.—Sec19 tion 107(b) of such Act is amended—

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

22 the number of outpatient visits through which such

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

24 (2) by adding at the end the following new para25 graph:
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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 HEALTH.—

7 The Center for Women Veterans of the Department of Veter8 ans Affairs (established under section 509 of Public Law

9 103–446), in consultation with the Advisory Committee on

10 Women Veterans, shall assess the use by women veterans

11 of health services through the Department of Veterans Af12 fairs, including counseling for sexual trauma and mental

13 health services. The Center shall submit to the Under Sec14 retary for Health of the Department of Veterans Affairs a

15 report not later than April 1, 1997, and April 1 of each

16 of the two following years, on—

17 (1) the extent to which women veterans described

18 in section 1710(a)(1) of title 38, United States Code,

19 fail to seek, or face barriers in seeking, health services

20 through the Department, and the reasons therefor; and

21 (2) recommendations, if indicated, for encourag22 ing greater use of such services, including (if appro23 priate) public service announcements and other out24 reach efforts.
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1 (b) REPORTS TO CONGRESSIONAL COMMITTEES.—Not

2 later than July 1, 1997, and July 1 of each of the two fol3 lowing years, the Secretary of Veterans Affairs shall submit

4 to the Committees on Veterans’ Affairs of the Senate and

5 House of Representatives a report containing—

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

7 Women Veterans under subsection (a);

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

9 on such report’s findings and recommendations; and

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

11 Secretary to remedy any problems described in the re12 port.

13 SEC. 8. MAMMOGRAPHY QUALITY STANDARDS.

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

15 title 38, United States Code, is amended by adding after

16 section 7320, as added by section 3(a), the following new

17 section:

18 ‘‘§ 7321. Mammography quality standards

19 ‘‘(a) A mammogram may not be performed at a De20 partment facility unless that facility is accredited for that

21 purpose by a private nonprofit organization designated by

22 the Secretary. An organization designated by the Secretary

23 under this subsection shall meet the standards for accredit24 ing bodies established under section 354(e) of the Public

25 Health Service Act (42 U.S.C. 263b(e)).
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1 ‘‘(b) The Secretary, in consultation with the Secretary

2 of Health and Human Services, shall prescribe quality as3 surance and quality control standards relating to the per4 formance and interpretation of mammograms and use of

5 mammogram equipment and facilities of the Department

6 of Veterans Affairs consistent with the requirements of sec7 tion 354(f)(1) of the Public Health Service Act. Such stand8 ards shall be no less stringent than the standards prescribed

9 by the Secretary of Health and Human Services under sec10 tion 354(f) of the Public Health Service Act.

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

12 standards prescribed under subsection (b), shall provide for

13 an annual inspection of the equipment and facilities used

14 by and in Department health care facilities for the perform15 ance of mammograms. Such inspections shall be carried out

16 in a manner consistent with the inspection of certified fa17 cilities by the Secretary of Health and Human Services

18 under section 354(g) of the Public Health Service Act.

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

20 under paragraph (1) to be performed by a State agency.

21 ‘‘(d) The Secretary shall ensure that mammograms

22 performed for the Department under contract with any non23 Department facility or provider conform to the quality

24 standards prescribed by the Secretary of Health and
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1 Human Services under section 354 of the Public Health

2 Service Act.

3 ‘‘(e) For the purposes of this section, the term ‘mammo4 gram’ has the meaning given such term in paragraph (5)

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

6 U.S.C. 263b(a)).’’.

7 (2) The table of sections at the beginning of such chap8 ter is amended by inserting after the item relating to section

9 7320, as added by section 3(b), the following new item:

‘‘7321. Mammography quality standards.’’.

10 (b) DEADLINE FOR PRESCRIBING STANDARDS.—The

11 Secretary of Veterans Affairs shall prescribe standards

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

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

14 end of the 120-day period beginning on the date of the en15 actment of this Act.

16 (c) IMPLEMENTATION REPORT.—The Secretary of Vet17 erans Affairs shall submit to the Committees on Veterans’

18 Affairs of the Senate and House of Representatives a report

19 on the Secretary’s implementation of section 7321 of title

20 38, United States Code, as added by subsection (a). The

21 report shall be submitted not later than 120 days after the

22 later of (1) the date on which the Secretary prescribes the

23 quality standards required under subsection (b) of that sec24 tion, or (2) the date of the enactment of this Act.
26

•HR 3643 RH

1 SEC. 9. PATIENT PRIVACY FOR WOMEN PATIENTS.

2 (a) IDENTIFICATION OF DEFICIENCIES.—The Sec3 retary of Veterans Affairs shall conduct a survey of each

4 medical center under the jurisdiction of the Secretary to

5 identify deficiencies relating to patient privacy afforded to

6 women patients in the clinical areas at each such center

7 which may interfere with appropriate treatment of such pa8 tients.

9 (b) CORRECTION OF DEFICIENCIES.—The Secretary

10 shall ensure that plans and, where appropriate, interim

11 steps, to correct the deficiencies identified in the survey con12 ducted under subsection (a) are developed and are incor13 porated into the Department’s construction planning proc14 esses and given a high priority.

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

16 compile an annual inventory, by medical center, of defi17 ciencies identified under subsection (a) and of plans and,

18 where appropriate, interim steps, to correct such defi19 ciencies. The Secretary shall submit to the Committees on

20 Veterans’ Affairs of the Senate and House of Representa21 tives, not later than October 1, 1997, and not later than

22 October 1 each year thereafter through 1999 a report on

23 such deficiencies. The Secretary shall include in such report

24 the inventory compiled by the Secretary, the proposed cor25 rective plans, and the status of such plans.