Union Calendar No. 47

103D CONGRESS

1ST SESSION H. R. 2034

[Report No. 103–92]

A BILL

To amend title 38, United States Code, to revise

other purposes.and improve veterans’ health programs, and for

MAY 13, 1993

Committed to the Committee of the Whole House on the

State of the Union and ordered to be printed
IB

Union Calendar No. 47

103D CONGRESS

1ST SESSION H. R. 2034

[Report No. 103–92]

To amend title 38, United States Code, to revise and improve veterans’

health programs, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

MAY 6, 1993

Mr. ROWLAND (for himself and Mr. SMITH of New Jersey) introduced the

following bill; which was referred to the Committee on Veterans’ Affairs

MAY 13, 1993

Additional sponsors: Mr. KENNEDY, and Mr. BISHOP

MAY 13, 1993

Committed to the Committee of the Whole House on the State of the Union

and ordered to be printed

A BILL

To amend title 38, United States Code, to revise and improve

veterans’ health programs, 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. SHORT TITLE; REFERENCES TO TITLE 38, UNIT2 ED STATES CODE; TABLE OF CONTENTS.

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

4 ‘‘Veterans’ Health Programs Amendments of 1993’’.

5 (b) REFERENCES TO TITLE 38, UNITED STATES

6 CODE.—Except as otherwise expressly provided, whenever

7 in this Act an amendment or repeal is expressed in terms

8 of an amendment to, or repeal of, a section or other provi9 sion, the reference shall be considered to be made to a

10 section or other provision of title 38, United States Code.

11 (c) TABLE OF CONTENTS.—The table of contents of

12 this Act is as follows:

Sec. 1. Short title; references to title 38, United States Code; table of contents.

TITLE I—HEALTH CARE PLANNING AND PROGRAMS

Sec. 101. Health care facilities missions.

Sec. 102. Pilot program for noninstitutional alternatives to nursing home care.

TITLE II—MEDICAL FACILITIES ACQUISITION

Sec. 201. Major construction projects authorization.

Sec. 202. Revision to prospectus requirements.

Sec. 203. Prioritization methodology.

Sec. 204. Assessment of need for nursing home beds in Chesapeake network

area.

TITLE III—ADMINISTRATION

Sec. 301. Authority for expedited reorganization of medical facilities in event of

a life-threatening emergency.

Sec. 302. Clarification of contracting limitation.

TITLE IV—STATE HOME PROGRAM

Sec. 401. Per diem for adult day health care.

Sec. 402. Construction assistance program.

Sec. 403. Sharing of resources with State homes.

TITLE V—MISCELLANEOUS

Sec. 501. Department of Veterans Affairs research advisory committees.

Sec. 502. Limitation on claims for copayments.

Sec. 503. Child care services.
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1 TITLE I—HEALTH CARE

2 PLANNING AND PROGRAMS

3 SEC. 101. HEALTH CARE FACILITIES MISSIONS.

4 (a) IN GENERAL.—The Secretary of Veterans Affairs

5 shall prescribe a specific, detailed statement of the mission

6 of, and the clinical programs to be operated at, each health

7 care facility of the Department, determined based upon

8 a requirement that each such facility operate within a net9 work of Department facilities in the same geographic area

10 which, taken together, provide a full range of services for

11 veterans.

12 (b) PURPOSES OF MISSION STATEMENTS.—The mis13 sion statements shall be designed so as to permit—

14 (1) effective planning;

15 (2) reduction in duplication of services and pro16 grams in the same geographic area;

17 (3) realignment of services among facilities

18 within each network;

19 (4) improved means of resource distribution;

20 and

21 (5) more efficient delivery of needed services.

22 (c) REVIEW OF CURRENT MISSIONS.—In preparing

23 the mission statements under subsection (a), the Secretary

24 shall review the existing missions and clinical programs

25 at each health care facility of the Department.
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1 (d) DEADLINE AND REPORT.—The Secretary, not

2 later than nine months after the date of the enactment

3 of this Act, shall—

4 (1) prescribe the mission statements required

5 by subsection (a); and

6 (2) submit to the Committees on Veterans’ Af7 fairs of the Senate and House of Representatives a

8 report on the implementation of this section and on

9 the timetable and projected milestones for imple10 menting actions to enable each such facility to carry

11 out fully its prescribed missions.

12 SEC. 102. PILOT PROGRAM FOR NONINSTITUTIONAL AL13 TERNATIVES TO NURSING HOME CARE.

14 (a) EXTENSION OF PROGRAM.—Subsection (a) of

15 section 1720C is amended by striking out ‘‘During the

16 four-year period beginning on October 1, 1990,’’ and in17 serting in lieu thereof ‘‘During the period through Sep18 tember 30, 1997,’’.

19 (b) VETERANS ELIGIBLE TO PARTICIPATE IN PRO20 GRAM.—Such subsection is further amended by striking

21 out ‘‘care and who—’’ and inserting in lieu thereof ‘‘care.

22 The Secretary shall give priority for participation in such

23 program to veterans who—’’.
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1 (c) PROGRAM FUNDING.—Such section is further

2 amended by adding at the end the following new sub3 section:

4 ‘‘(f) The Secretary shall carry out the pilot program

5 under this section using funds available for the community

6 nursing home program under section 1720 of this title.’’.

7 (d) REPORT DEADLINES.—Section 201(b) of the De8 partment of Veterans Affairs Nurse Pay Act of 1990

9 (Public Law 101–366; 104 Stat. 438) is amended—

10 (1) by striking out ‘‘February 1, 1994,’’ and in11 serting in lieu thereof ‘‘February 1, 1997,’’; and

12 (2) by striking out ‘‘September 30, 1993,’’ and

13 inserting in lieu thereof ‘‘September 30, 1996,’’.

14 TITLE II—MEDICAL FACILITIES

15 ACQUISITION

16 SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY

17 PROJECTS AND MAJOR MEDICAL FACILITY

18 LEASES.

19 (a) AUTHORIZATION OF PROJECTS AND LEASES IN

20 BUDGET.—Except as provided in subsection (b), the Sec21 retary of Veterans Affairs may carry out the major medi22 cal facility projects for the Department of Veterans Af23 fairs, and may carry out the major medical facility leases

24 for that Department, for which funds are requested in the

25 budget of the President for fiscal year 1994.
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1 (b) NONAUTHORIZED PROJECTS.—The Secretary is

2 not authorized to carry out the project for which funds

3 are requested in the budget of the President for fiscal year

4 1994 for the construction of a nursing home facility in

5 Baltimore, Maryland.

6 (c) AUTHORIZATION OF DESIGN FOR CERTAIN FU7 TURE PROJECTS.—In addition to the projects authorized

8 in subsection (a), the Secretary may carry out design of

9 the following major medical facility projects, in the

10 amounts specified:

11 (1) Construction of an outpatient care addition

12 at the Department of Veterans Affairs Medical Cen13 ter in San Juan, Puerto Rico, $3,970,000.

14 (2) Construction of a spinal cord injury unit

15 and energy center at the Department of Veterans

16 Affairs Medical Center in Tampa, Florida,

17 $4,490,000.

18 (3) Construction of an outpatient care addition

19 at the Department of Veterans Affairs Medical Cen20 ter in West Haven, Connecticut, $4,860,000.

21 (d) AUTHORIZATION OF APPROPRIATIONS.—There is

22 hereby authorized to be appropriated to the Secretary of

23 Veterans Affairs for fiscal year 1994—

24 (1) $110,420,000 for the major medical facility

25 projects authorized in subsections (a) and (c); and
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1 (2) $50,123,105 for the major medical facility

2 leases authorized in subsection (a).

3 (e) LIMITATION.—The projects authorized in sub4 sections (a) and (c) may only be carried out using—

5 (1) funds appropriated for fiscal year 1994 pur6 suant to the authorization of appropriations in sub7 section (d);

8 (2) funds appropriated for Construction, Major

9 Projects for a fiscal year before fiscal year 1994 that

10 remain available for obligation; and

11 (3) funds appropriated for Construction, Major

12 Projects for fiscal year 1994 for a category of activ13 ity not specific to a project.

14 SEC. 202. REVISION TO PROSPECTUS REQUIREMENTS.

15 (a) ADDITIONAL INFORMATION.—Section 8104(b) is

16 amended—

17 (1) by striking out ‘‘shall include—’’ and insert18 ing in lieu thereof ‘‘shall include:’’;

19 (2) in paragraph (1)—

20 (A) by striking out ‘‘a detailed’’ and insert21 ing in lieu thereof ‘‘A detailed’’; and

22 (B) by striking out the semicolon at the

23 end and inserting in lieu thereof a period;

24 (3) in paragraph (2)—
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1 (A) by striking out ‘‘an estimate’’ and in2 serting in lieu thereof ‘‘An estimate’’; and

3 (B) by striking out ‘‘; and’’ and inserting

4 in lieu thereof a period;

5 (4) in paragraph (3), by striking out ‘‘an esti6 mate’’ and inserting in lieu thereof ‘‘An estimate’’;

7 and

8 (5) by adding at the end the following new

9 paragraphs:

10 ‘‘(4) Demographic data applicable to the

11 project.

12 ‘‘(5) Current and projected workload and utili13 zation data.

14 ‘‘(6) The relationship between the mission of

15 the facility and the missions and capabilities of other

16 nearby Department facilities and, as applicable, the

17 availability or lack of availability of alternative

18 sources of service in the community and the cost-ef19 fectiveness of using such alternative sources.

20 ‘‘(7) Current and projected operating costs of

21 the facility.

22 ‘‘(8) The raw score assigned to the proposal

23 under the Department’s prioritization methodology

24 and, if the project is being proposed for funding

25 ahead of a project with a higher score, a comprehen-
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1 sive explanation of the specific factors on the basis

2 of which the project is being proposed for funding

3 ahead of each such higher-scored project.

4 ‘‘(9) A listing of each alternative to construc5 tion of the facility that has been considered.’’.

6 (b) APPLICABILITY.—The amendments made by sub7 section (a) shall apply with respect to any prospectus sub8 mitted by the Secretary of Veterans Affairs after the date

9 of the enactment of this Act.

10 SEC. 203. PRIORITIZATION METHODOLOGY.

11 (a) REVIEW OF METHODOLOGY.—The Secretary of

12 Veterans Affairs shall conduct a review of the methodology

13 used by the Department for establishing the relative prior14 ity for major construction projects under consideration in

15 the Department.

16 (b) REVISION.—Based upon the review under sub17 section (a), the Secretary shall revise the prioritization

18 methodology so as to give additional weight, as determined

19 appropriate by the Secretary taking into consideration

20 particularly the needs of the aging veteran population, to

21 projects intended to expand long-term care and ambula22 tory care programs.

23 (c) REPORT.—Not later than 120 days after the date

24 of the enactment of this Act, the Secretary shall submit

25 to the Committees on Veterans’ Affairs of the Senate and
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1 House of Representatives a report on the actions of the

2 Secretary in carrying out this section.

3 SEC. 204. ASSESSMENT OF NEED FOR NURSING HOME BEDS

4 IN CHESAPEAKE NETWORK AREA.

5 (a) ASSESSMENT.—The Secretary of Veterans Affairs

6 shall conduct an assessment of the need for nursing home

7 beds operated by the Secretary in the area (referred to

8 as the ‘‘Chesapeake network’’) served by the Department

9 of Veterans Affairs medical centers in Baltimore, Mary10 land; Fort Howard, Maryland; Martinsburg, West Vir11 ginia; Perry Point, Maryland; and Washington, DC.

12 (b) MATTERS TO BE DETERMINED BY SEC13 RETARY.—In conducting the assessment, the Secretary

14 shall determine—

15 (1) what the specific mission of each medical

16 center operated by the Secretary in the Chesapeake

17 network should be to achieve the purposes identified

18 in section 101;

19 (2) whether there is a need for expansion and

20 modernization of the nursing home care unit at the

21 medical center at Fort Howard, Maryland; and

22 (3) what effect the construction of nursing

23 home beds in Baltimore, Maryland, as proposed in

24 the President’s budget for the Department of Veter25 ans Affairs for fiscal year 1994, would have for the
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1 missions of each of the other medical centers oper2 ated by the Secretary in the Chesapeake network.

3 (c) REPORT ON ASSESSMENT.—Not later than 90

4 days after the date of the enactment of this Act, the Sec5 retary shall submit to the Committees on Veterans’ Affairs

6 of the Senate and House of Representatives a report on

7 the assessment under subsection (a). The Secretary shall

8 include in the report a statement of each determination

9 made by the Secretary under subsection (b).

10 TITLE III—ADMINISTRATION

11 SEC. 301. AUTHORITY FOR EXPEDITED REORGANIZATION

12 OF MEDICAL FACILITIES IN EVENT OF A LIFE13 THREATENING EMERGENCY.

14 Section 510 is amended—

15 (1) by redesignating subsections (e) and (f) as

16 subsections (f) and (g), respectively; and

17 (2) by inserting after subsection (d) the follow18 ing new subsection (e):

19 ‘‘(e)(1) The limitation in subsection (b) does not

20 apply with respect to an administrative reorganization at

21 a medical facility if the Secretary determines that the reor22 ganization is necessary to respond to an emergency situa23 tion at that facility.

24 ‘‘(2) The Secretary may determine that there is an

25 emergency situation at a medical facility for purposes of
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1 paragraph (1) only if the Secretary determines (A) that

2 circumstances at the facility are such that patients and

3 employees at the facility face imminent danger because of

4 conditions at the facility that are permanent in nature,

5 and (B) that those conditions are not susceptible to repair

6 or that it is not feasible to repair those conditions.

7 ‘‘(3) For purposes of this subsection, an emergency

8 situation may not be considered to exist in anticipation

9 of, but before the occurrence of an event giving rise to

10 any consideration of an administrative reorganization.

11 ‘‘(4) Whenever the Secretary determines under para12 graph (1) that it is necessary to carry out an administra13 tive reorganization at a medical facility without regard to

14 the limitation in subsection (b), the Secretary shall

15 promptly submit to the Committees on Veterans’ Affairs

16 of the Senate and House of Representatives a report de17 scribing the administrative reorganization. The report

18 shall provide the same information as is provided in a de19 tailed plan and justification under subsection (g)(2). The

20 Secretary shall include in the report an explanation of

21 each alternative to the proposed administrative organiza22 tion that was considered and each factor that was consid23 ered in the decision to reject each such alternative.’’.

24 SEC. 302. CLARIFICATION OF CONTRACTING LIMITATION.

25 Section 8110(c)(3) is amended—
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1 (1) by striking out ‘‘or’’ at the end of subpara2 graph (A);

3 (2) by redesignating subparagraph (B) as sub4 paragraph (C) and in that subparagraph striking

5 out ‘‘section 213 or 4117’’ and inserting in lieu

6 thereof ‘‘section 7409’’; and

7 (3) by inserting after subparagraph (A) the fol8 lowing new subparagraph (B):

9 ‘‘(B) to a contract under section 513 of this

10 title if the Under Secretary for Health certifies to

11 the Secretary in writing, before the contract is en12 tered into, that the contract is necessary in order to

13 provide services to eligible veterans at a Department

14 health-care facility that could not otherwise be pro15 vided at such facility; or’’.

16 TITLE IV—STATE HOME

17 PROGRAM

18 SEC. 401. PER DIEM FOR ADULT DAY HEALTH CARE.

19 (a) IN GENERAL.—Subsection (a) of section 1741 is

20 amended to read as follows:

21 ‘‘(a)(1) The Secretary shall pay to each State a per

22 diem amount for each veteran receiving domiciliary care,

23 nursing home care, hospital care, or adult day health care

24 in a State home if the veteran is eligible to receive that

25 care in a Department facility.
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1 ‘‘(2) The per diem rate to be paid under this sub2 section is as follows:

3 ‘‘(A) For domiciliary care, $11.79 for each day.

4 ‘‘(B) For nursing home care and hospital care,

5 $27.61 for each day.

6 ‘‘(C) For adult day health care, $16.50 for each

7 day.’’.

8 (b) EFFECTIVE DATE.—The amendment made by

9 subsection (a) shall apply with respect to adult day health

10 care provided in a State home after September 30, 1993.

11 SEC. 402. CONSTRUCTION ASSISTANCE PROGRAM.

12 (a) IN GENERAL.—Subchapter III of chapter 81 is

13 amended as follows:

14 (1) Section 8131(3) is amended by inserting

15 ‘‘or adult day health care’’ after ‘‘hospital care’’.

16 (2) Section 8132 is amended by inserting

17 ‘‘adult day health care’’ after ‘‘hospital care’’.

18 (3) Section 8135(a)(4) is amended by inserting

19 ‘‘and, in the case of adult day health care, not more

20 than 25 percent of the number of patients partici21 pating in that program,’’ after ‘‘occupancy’’.

22 (4) Section 8135(b) is amended—

23 (A) in paragraph (2)(C), by inserting ‘‘or

24 adult day health care facilities’’ after ‘‘domi25 ciliary beds’’; and
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1 (B) in paragraph (3)(A), by inserting ‘‘, or

2 would involve expansion, remodeling, or alter3 ation of existing buildings for the furnishing of

4 adult day health care’’ after ‘‘buildings’’.

5 (5) Section 8136 is amended by inserting

6 ‘‘adult day health care’’ after ‘‘hospital care’’.

7 (6) The heading of such subchapter is amended

8 to read as follows:

9 ‘‘SUBCHAPTER III—STATE HOME FACILITIES

10 FOR FURNISHING DOMICILIARY CARE,

11 NURSING HOME CARE, ADULT DAY HEALTH

12 CARE, AND HOSPITAL CARE’’.

13 (b) CLERICAL AMENDMENT.—The item relating to

14 subchapter III in the table of sections at the beginning

15 of chapter 81 is amended to read as follows:

‘‘SUBCHAPTER III—STATE HOME FACILITIES FOR FURNISHING

DOMICILIARY CARE, NURSING HOME CARE, ADULT DAY

HEALTH CARE, AND HOSPITAL CARE’’.

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

17 subsection (a) shall apply with respect to grants made to

18 States using funds appropriated after the date of the en19 actment of this Act.

20 SEC. 403. SHARING OF RESOURCES WITH STATE HOMES.

21 (a) PURPOSE.—Section 8151 is amended by adding

22 at the end the following: ‘‘It is further the purpose of this

23 subchapter to improve the provision of care to veterans
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1 under this title by authorizing the Secretary to enter into

2 agreements with State veterans facilities for the sharing

3 of health-care resources.’’.

4 (b) DEFINITION.—Section 8152 is amended—

5 (1) by redesignating paragraph (3) as para6 graph (4); and

7 (2) by inserting after paragraph (2) the follow8 ing new paragraph (3):

9 ‘‘(3) The term ‘health-care resource’ includes

10 hospital care, medical services, and rehabilitative

11 services, as those terms are defined in paragraphs

12 (5), (6), and (8), respectively, of section 1701 of this

13 title, any other health-care service, and any health14 care support or administrative resource.’’.

15 (c) SHARING OF HEALTH-CARE RESOURCES.—Sec16 tion 8153(a) is amended—

17 (1) by inserting ‘‘(1)’’ after ‘‘(a)’’; and

18 (2) by striking out ‘‘other form of agreement,’’

19 and all that follows and inserting in lieu thereof

20 ‘‘other form of agreement for the mutual use, or exchange

21 of use, of—

22 ‘‘(A) specialized medical resources between De23 partment health-care facilities and other health-care

24 facilities (including organ banks, blood banks, or
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1 similar institutions), research centers, or medical

2 schools; and

3 ‘‘(B) health-care resources between Department

4 health-care facilities and State home facilities recog5 nized under section 1742(a) of this title.

6 ‘‘(2) The Secretary may execute a contract or other

7 agreement under paragraph (1) only if (A) such an agree8 ment will obviate the need for a similar resource to be

9 provided in a Department health care facility, or (B) the

10 Department resources which are the subject of the agree11 ment and which have been justified on the basis of

12 veterans’ care are not used to their maximum effective

13 capacity.’’.

14 TITLE V—MISCELLANEOUS

15 SEC. 501. DEPARTMENT OF VETERANS AFFAIRS RESEARCH

16 ADVISORY COMMITTEES.

17 (a) STATUTORY BASIS FOR RESEARCH ADVISORY

18 COMMITTEES.—Chapter 5 is amended by adding at the

19 end of subchapter III the following new section:

20 ‘‘§ 544. Veterans research advisory committees

21 ‘‘(a) Congress declares that each of the veterans re22 search advisory committees specified in subsection (c)

23 (previously established by the Secretary in carrying out

24 the duties of the Secretary under section 7303 of this title)

25 has a continuing, ongoing function that is integrally relat-
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1 ed to the successful completion by the Department of its

2 statutory duties. Each such committee shall, for all pur3 poses, operate as though such committee had been estab4 lished by, and chartered pursuant to, law. The objectives

5 and scope of the activities of each such committee and the

6 duties for which the committee is responsible, as specified

7 by the Secretary as of March 1, 1993, shall be those in

8 effect as of that date.

9 ‘‘(b) The Secretary may not terminate a veterans’ re10 search advisory committee specified in subsection (c) un11 less the Secretary finds that the committee is no longer

12 needed. Not less than 120 days before terminating such

13 a committee, the Secretary shall submit to the congres14 sional veterans’ affairs committees a report on the pro15 posed termination. The report shall include an explanation

16 of (1) the basis for the Secretary’s determination that

17 such committee is no longer needed, and (2) the manner

18 in which the Secretary will carry out the Secretary’s re19 sponsibilities under section 7303 of this title in the ab20 sence of the committee.

21 ‘‘(c) For purposes of this section, each of the follow22 ing committees and boards, as established by the Sec23 retary as of March 1, 1993, shall be considered to be a

24 veterans’ research advisory committee:

25 ‘‘(1) The Career Development Committee.
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1 ‘‘(2) The Department of Veterans Affairs Coop2 erative Studies Evaluation Committee.

3 ‘‘(3) The Merit Review Board for Basic

4 Sciences Programs.

5 ‘‘(4) The Merit Review Board for Cardio6 vascular Programs.

7 ‘‘(5) The Merit Review Board for Clinical Phar8 macology, Alcoholism, and Drug Dependence Pro9 grams.

10 ‘‘(6) The Merit Review Board for Endocrinol11 ogy Programs.

12 ‘‘(7) The Merit Review Board for Gastro13 enterology Programs.

14 ‘‘(8) The Merit Review Board for Hematology

15 Programs.

16 ‘‘(9) The Merit Review Board for Immunology

17 Programs.

18 ‘‘(10) The Merit Review Board for Infectious

19 Diseases Programs.

20 ‘‘(11) The Merit Review Board for Mental

21 Health and Behavioral Sciences Programs.

22 ‘‘(12) The Merit Review Board for Nephrology

23 Programs.

24 ‘‘(13) The Merit Review Board for

25 Neurobiology Programs.
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1 ‘‘(14) The Merit Review Board for Oncology

2 Programs.

3 ‘‘(15) The Merit Review Board for Respiration

4 Programs.

5 ‘‘(16) The Merit Review Board for Surgery

6 Programs.

7 ‘‘(17) The Scientific Review Evaluation Board

8 for Health Services Research and Development.

9 ‘‘(18) The Scientific Review Evaluation Board

10 for Rehabilitation Research and Development.’’.

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

12 at the beginning of chapter 5 is amended by inserting

13 after the item relating to section 543 the following new

14 item:

‘‘544. Veterans research advisory committees.’’.

15 SEC. 502. LIMITATION ON CLAIMS FOR COPAYMENTS.

16 (a) HOSPITAL CARE AND NURSING HOME CARE.—

17 Section 1710(f) is amended by adding at the end the fol18 lowing new paragraph:

19 ‘‘(6) A veteran may not be required to make a pay20 ment under this subsection for any day of care if the Sec21 retary does not notify the veteran in writing of the amount

22 owed for that care before the end of the two-year period

23 beginning on the date on which the care is provided, unless

24 the reason the Secretary did not notify the veteran within

25 such period was due to reliance by the Secretary on infor-
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1 mation furnished by the veteran to the Secretary which

2 was subsequently determined to be erroneous.’’.

3 (b) OUTPATIENT MEDICAL SERVICES.—Section

4 1712(f) is amended by adding at the end the following

5 new paragraph:

6 ‘‘(5) A veteran may not be required to make a pay7 ment under this subsection for any medical services if the

8 Secretary does not notify the veteran in writing of the

9 amount owed for those services before the end of the two10 year period beginning on the date on which the services

11 were provided, unless the reason the Secretary did not no12 tify the veteran within such period was due to reliance

13 by the Secretary on information furnished by the veteran

14 to the Secretary which was subsequently determined to be

15 erroneous.’’.

16 (c) MEDICATIONS.—Section 1722A(a) is amended by

17 adding at the end the following new paragraph:

18 ‘‘(3) A veteran may not be required to make a pay19 ment under this subsection for any supply of medication

20 if the Secretary does not notify the veteran in writing of

21 the amount owed for that medication before the end of

22 the two-year period beginning on the date on which the

23 medication is supplied, unless the reason the Secretary did

24 not notify the veteran within such period was due to reli25 ance by the Secretary on information furnished by the vet-
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1 eran to the Secretary which was subsequently determined

2 to be erroneous.’’.

3 SEC. 503. CHILD CARE SERVICES.

4 (a) REVISED CHILD CARE AUTHORITY.—Chapter 81

5 is amended by inserting after section 8116 the following

6 new section:

7 ‘‘§ 8117. Child care centers

8 ‘‘(a) The Secretary may provide for the operation of

9 child care centers at Department facilities. The operation

10 of such centers under this section shall be carried out to

11 the extent that the Secretary determines, based on the de12 mand of employees of the Department for the care in13 volved, that such operation is in the best interest of the

14 Department and that it is practicable to do so.

15 ‘‘(b)(1) In offering child care services under this sec16 tion, the Secretary shall give priority (in the following

17 order) to employees of—

18 ‘‘(A) the Department;

19 ‘‘(B) other departments and agencies of the

20 Federal Government, and

21 ‘‘(C) schools affiliated with the Department and

22 corporations created under section 7361 of this title.

23 ‘‘(2) To the extent that space is available, the Sec24 retary may provide child care services to members of the

25 public at a child care center operated under this section
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1 if the Secretary determines that to do so is necessary to

2 assure the financial success of that center.

3 ‘‘(c)(1) The Secretary shall establish reasonable

4 charges for child care services provided at each child care

5 center operated under this section. Such charges may be

6 established at different rates for different centers.

7 ‘‘(2) In establishing charges for child care services

8 provided at a center, the Secretary—

9 ‘‘(A) shall (except as provided in paragraph (3))

10 establish the charges so as to ensure that the sum

11 of all charges for child care services at that center

12 is sufficient to meet the staffing expenses of that

13 center; and

14 ‘‘(B) may also consider the expenses of con15 structing or acquiring space for the center, the ex16 penses of converting existing space into the center,

17 and the expenses of equipment and services fur18 nished to the center under subsection (d)(2).

19 ‘‘(3) The Secretary may establish charges for child

20 care services provided at a center at rates less than those

21 necessary to ensure that the sum of all charges for child

22 care services at that center is sufficient to meet the staff23 ing expenses of that center if the Secretary determines

24 (with respect to a particular facility of the Department)

25 that—
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1 ‘‘(A) the operation of a child care center at that

2 facility would help overcome serious recruitment or

3 retention problems;

4 ‘‘(B) adherence to the requirement to establish

5 charges for child care services at that center at rates

6 sufficient to meet the staffing expenses of that cen7 ter would make the operation of a child care center

8 at that facility unfeasible; and

9 ‘‘(C) there are no other practical alternatives to

10 meeting the needs of employees at that facility for

11 child care services.

12 ‘‘(4) Proceeds from charges for child care services

13 shall be credited to the applicable Department of Veterans

14 Affairs account and shall be allotted to the facility served

15 by the child care center and shall remain available until

16 expended.

17 ‘‘(d) In connection with the establishment and oper18 ation of a child care center under this section, the Sec19 retary—

20 ‘‘(1) may construct or alter space in any De21 partment facility, and may lease space in a non-De22 partment facility for a term not to exceed 20 years,

23 for use as a child care center;

24 ‘‘(2) may provide, out of operating funds, other

25 items and services necessary for the operation of the
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1 center, including furniture, office machines and

2 equipment, utility and custodial services, and other

3 necessary services and amenities;

4 ‘‘(3) shall provide for the participation (directly

5 or through a parent advisory committee) of parents

6 of children receiving care in the center in the estab7 lishment of policies to govern the operation of the

8 center and in the oversight of the implementation of

9 such policies;

10 ‘‘(4) shall require the development and use of a

11 process for determining the fitness and suitability of

12 prospective employees of or volunteers at the center;

13 and

14 ‘‘(5) shall require in connection with the oper15 ation of the center compliance with all State and

16 local laws, ordinances, and regulations relating to

17 health and safety and the operation of child care

18 centers.

19 ‘‘(e) The Secretary shall prescribe guidelines to carry

20 out this section.

21 ‘‘(f) For the purpose of this section, the term ‘parent

22 advisory committee’ means a committee comprised of, and

23 selected by, the parents of children receiving care in a

24 child care center operated under this section.’’.
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1 (b) CONFORMING REPEAL.—Section 7809 is re2 pealed.

3 (c) CLERICAL AMENDMENTS.—(1) The table of sec4 tions at the beginning of chapter 81 is amended by insert5 ing after the item relating to section 8116 the following

6 new item:

‘‘8117. Child care centers.’’.

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

8 78 is amended by striking out the item relating to section

9 7809.

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