IIA
103D CONGRESS
2D SESSION
H. R. 4425
IN THE SENATE OF THE UNITED STATES
MAY 25 (legislative day, MAY 16), 1994
Received; read twice and referred to the Committee on Veterans’ Affairs
AN ACT
To authorize major medical facility construction projects for
the Department of Veterans Affairs for fiscal year 1995,
to revise and improve veterans’ health programs, and
for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
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TITLE I—CONSTRUCTION
AUTHORIZATION
SEC. 101. AUTHORIZATION OF MAJOR MEDICAL FACILITY
PROJECTS AND MAJOR MEDICAL FACILITY
LEASES.
(a) PROJECTS IN PRESIDENT’S BUDGET.—(1) Ex-
cept as provided in paragraph (2), the Secretary of Veter-
ans Affairs may carry out the major medical facility
projects for the Department of Veterans Affairs, and may
carry out the major medical facility leases for that Depart-
ment, for which funds are requested in the budget of the
President for fiscal year 1995.
(2) The Secretary is not authorized to carry out—
(A) the project described in the budget of the
President for fiscal year 1995 for the construction of
a research addition at Huntington, West Virginia; or
(B) the project described in the budget of the
President for fiscal year 1995 for the construction of
a research addition at Portland, Oregon.
(b) ADDITIONAL PROJECTS.—In addition to the
projects authorized in subsection (a), the Secretary may
carry out the following major medical facility projects, in
the amounts specified:
(1) The projects for ambulatory care facilities
that are proposed in the budget for fiscal year 1995
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to be financed with funds from the Health Care
Investment Fund.
(2) Construction of a nursing home facility at
the Department of Veterans Affairs Medical Center
in Charleston, South Carolina, $7,300,000.
(3) A lease/purchase of a nursing home facility
near Ft. Myers, Florida, $18,630,000.
(4) Construction of an outpatient care addition
at the Department of Veterans Affairs medical cen-
ter in Phoenix, Arizona, in the amount of
$50,000,000.
(c) PROJECTS FOR WHICH FUNDS APPROPRIATED.—
In addition to the projects authorized in subsections (a)
and (b), the Secretary may carry out the following major
medical facility projects for which funds were appropriated
in the Emergency Supplemental Appropriations Act of
1994 (Public Law 103–211) in the amounts specified:
(1) Construction of an ambulatory care/support
services facility at the Department of Veterans Af-
fairs Medical Center in Sepulveda, California,
$53,700,000.
(2) Other major medical facility projects re-
quired to repair, restore, or replace earthquake-dam-
aged facilities at the Department of Veterans Affairs
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Medical 
Center 
in 
Sepulveda, 
California,
$50,000,000.
SEC. 102. AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—There is hereby authorized to be
appropriated to the Secretary of Veterans Affairs for fiscal
year 1995—
(1) $343,800,000 for the major medical facility
projects authorized in subsections (a) and (b) of sec-
tion 101; and
(2) $15,800,000 for the major medical facility
leases authorized in section 101(a).
(b) LIMITATION.—The projects authorized in sub-
sections (a) and (b) of section 101 may only be carried
out using—
(1) funds appropriated for fiscal year 1995 pur-
suant to the authorization of appropriations in sub-
section (a);
(2) funds appropriated for Construction, Major
Projects for a fiscal year before fiscal year 1995 that
remain available for obligation; and
(3) funds appropriated for Construction, Major
Projects for fiscal year 1995 for a category of activ-
ity not specific to a project.
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(c) LIMITATION
ON
CERTAIN
PROJECTS.—The
projects authorized in subsection (c) of section 101 may
only be carried out using—
(1) funds appropriated, as well as funds trans-
ferred by the President, to the Construction, Major
Projects account pursuant to the Emergency Supple-
mental Appropriations Act of 1994 (Public Law
103–211);
(2) funds appropriated to the Medical Care ac-
count by the Emergency Supplemental Appropria-
tions Act of 1994 (Public Law 103–211) that are
transferred by law to the Construction, Major
Projects account;
(3) funds appropriated to the Construction,
Major Projects account for a fiscal year before fiscal
year 1994 that remain available for obligation; and
(4) funds appropriated to the Construction,
Major Projects account for fiscal year 1994 for a
category of activity not specific to a project.
TITLE II—HEALTH CARE
PLANNING AND PROGRAMS
SEC. 201. HEALTH CARE FACILITIES MISSIONS.
(a) IN GENERAL.—The Secretary of Veterans Affairs
shall prescribe a specific, detailed statement of the mission
of, and the clinical programs to be operated at, each health
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care facility of the Department, determined based upon
a requirement that each such facility operate within a net-
work of Department facilities in the same geographic area
which, taken together, provide a full range of services for
veterans.
(b) PURPOSES OF MISSION STATEMENTS.—The mis-
sion statements shall be designed so as to permit—
(1) effective planning;
(2) reduction in duplication of services and pro-
grams in the same geographic area;
(3) realignment of services among facilities
within each network;
(4) improved means of resource distribution;
and
(5) more efficient delivery of needed services.
(c) REVIEW OF CURRENT MISSIONS.—In preparing
the mission statements under subsection (a), the Secretary
shall review the existing missions and clinical programs
at each health care facility of the Department.
(d) DEADLINE AND REPORT.—The Secretary, not
later than nine months after the date of the enactment
of this Act, shall—
(1) prescribe the mission statements required
by subsection (a); and
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(2) submit to the Committees on Veterans’ Af-
fairs of the Senate and House of Representatives a
report on the implementation of this section and on
the timetable and projected milestones for imple-
menting actions to enable each such facility to carry
out fully its prescribed missions.
SEC. 202. PILOT PROGRAM FOR NONINSTITUTIONAL AL-
TERNATIVES TO NURSING HOME CARE.
(a) EXTENSION
OF PROGRAM.—Subsection (a) of
section 1720C of title 38, United States Code, is amended
by striking out ‘‘During the four-year period beginning on
October 1, 1990,’’ and inserting in lieu thereof ‘‘During
the period through September 30, 1997,’’.
(b) VETERANS ELIGIBLE TO PARTICIPATE IN PRO-
GRAM.—Such subsection is further amended by striking
out ‘‘care and who—’’ and inserting in lieu thereof ‘‘care.
The Secretary shall give priority for participation in such
program to veterans who—’’.
(c) REPORT DEADLINES.—Section 201(b) of the De-
partment of Veterans Affairs Nurse Pay Act of 1990
(Public Law 101–366; 104 Stat. 438) is amended—
(1) by striking out ‘‘February 1, 1994,’’ and in-
serting in lieu thereof ‘‘February 1, 1997,’’; and
(2) by striking out ‘‘September 30, 1993,’’ and
inserting in lieu thereof ‘‘September 30, 1996,’’.
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TITLE III—MEDICAL FACILITIES
ACQUISITION
SEC. 301. REVISION TO PROSPECTUS REQUIREMENTS.
(a) ADDITIONAL INFORMATION.—Section 8104(b) of
title 38, United States Code, is amended—
(1) by striking out ‘‘shall include—’’ and insert-
ing in lieu thereof ‘‘shall include:’’;
(2) in paragraph (1)—
(A) by striking out ‘‘a detailed’’ and insert-
ing in lieu thereof ‘‘A detailed’’; and
(B) by striking out the semicolon at the
end and inserting in lieu thereof a period;
(3) in paragraph (2)—
(A) by striking out ‘‘an estimate’’ and in-
serting in lieu thereof ‘‘An estimate’’; and
(B) by striking out ‘‘; and’’ and inserting
in lieu thereof a period;
(4) in paragraph (3), by striking out ‘‘an esti-
mate’’ and inserting in lieu thereof ‘‘An estimate’’;
and
(5) by adding at the end the following new
paragraphs:
‘‘(4) Demographic data applicable to the
project.
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‘‘(5) Current and projected workload and utili-
zation data.
‘‘(6) The relationship between the mission of
the facility and the missions and capabilities of other
nearby Department facilities and, as applicable, the
availability or lack of availability of alternative
sources of service in the community and the cost-ef-
fectiveness of using such alternative sources.
‘‘(7) Current and projected operating costs of
the facility.
‘‘(8) The raw score assigned to the proposal
under the Department’s prioritization methodology
and, if the project is being proposed for funding
ahead of a project with a higher score, a comprehen-
sive explanation of the specific factors on the basis
of which the project is being proposed for funding
ahead of each such higher-scored project.
‘‘(9) A listing of each alternative to construc-
tion of the facility that has been considered.’’.
(b) APPLICABILITY.—The amendments made by sub-
section (a) shall apply with respect to any prospectus sub-
mitted by the Secretary of Veterans Affairs after the date
of the enactment of this Act.
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SEC. 302. PRIORITIZATION METHODOLOGY.
(a) REVIEW OF METHODOLOGY.—The Secretary of
Veterans Affairs shall conduct a review of the methodology
used by the Department for establishing the relative prior-
ity for major construction projects under consideration in
the Department.
(b) REVISION.—Based upon the review under sub-
section (a), the Secretary shall revise the prioritization
methodology so as to give additional weight, as determined
appropriate by the Secretary taking into consideration
particularly the needs of the aging veteran population, to
projects intended to expand long-term care and ambula-
tory care programs.
(c) REPORT.—Not later than 120 days after the date
of the enactment of this Act, the Secretary shall submit
to the Committees on Veterans’ Affairs of the Senate and
House of Representatives a report on the actions of the
Secretary in carrying out this section.
SEC. 303. SEMIANNUAL COMPILATION OF CONSTRUCTION
PRIORITIES.
Section 8107 of title 38, United States Code, is
amended by adding at the end the following new sub-
section:
‘‘(c)(1) The Secretary shall submit to each commit-
tee, not later than January 31 and July 31 of each year,
a report showing the current priorities of the Department
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for proposed major medical construction projects. Each
such report shall identify the 20 projects, from within all
the projects in the Department’s inventory of proposed
projects, that have the highest priority and, for those 20
projects, the relative priority and rank scoring of each
such project. The 20 projects shall be compiled, and their
relative rankings shall be shown, by category of project
(including the categories of ambulatory care projects,
nursing home care projects, and such other categories as
the Secretary determines).
‘‘(2) The Secretary shall include in each report, for
each project listed, a description of the specific factors
that account for the relative ranking of that project in re-
lation to other projects within the same category.
‘‘(3) In a case in which the relative ranking of a pro-
posed project has changed since the last report under this
subsection was submitted, the Secretary shall also include
in the report a description of the reasons for the change
in the ranking, including an explanation of any change in
the scoring of the project under the Department’s scoring
system 
for 
proposed 
major 
medical 
construction
projects.’’.
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SEC. 304. DEFINITION OF MAJOR MEDICAL FACILITY
PROJECT.
Subparagraph (A) of section 8104(a)(3) of title 38,
United States Code, is amended by inserting before the
period at the end the following: ‘‘, and, in the case of a
project which is principally for the alteration of a medical
facility to provide additional space for provision of ambula-
tory care, such term means a project involving a total ex-
penditure of more than $5,000,000’’.
TITLE IV—STATE HOME
PROGRAM
SEC. 401. PER DIEM FOR ADULT DAY HEALTH CARE.
(a) IN GENERAL.—Subsection (a) of section 1741 of
title 38, United States Code, is amended to read as
follows:
‘‘(a)(1) The Secretary shall pay to each State a per
diem amount for each veteran receiving domiciliary care,
nursing home care, hospital care, or adult day health care
in a State home if the veteran is eligible to receive that
care in a Department facility.
‘‘(2) The per diem rate to be paid under this sub-
section is as follows:
‘‘(A) For domiciliary care, $15.11 for each day.
‘‘(B) For nursing home care and hospital care,
$35.37 for each day.
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‘‘(C) For adult day health care, $16.28 for each
day.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply with respect to adult day health
care provided in a State home after September 30, 1994.
SEC. 402. CONSTRUCTION ASSISTANCE PROGRAM.
(a) IN GENERAL.—Subchapter III of chapter 81 of
title 38, United States Code, is amended as follows:
(1) Section 8131(3) is amended by inserting
‘‘or adult day health care’’ after ‘‘hospital care’’.
(2) Section 8132 is amended by inserting
‘‘adult day health care’’ after ‘‘hospital care’’.
(3) Section 8135(a)(4) is amended by inserting
‘‘and, in the case of adult day health care, not more
than 25 percent of the number of patients partici-
pating in that program,’’ after ‘‘occupancy’’.
(4) Section 8135(b) is amended—
(A) in paragraph (2)(C), by inserting ‘‘or
adult day health care facilities’’ after ‘‘domi-
ciliary beds’’; and
(B) in paragraph (3)(A), by inserting ‘‘, or
would involve expansion, remodeling, or alter-
ation of existing buildings for the furnishing of
adult day health care’’ after ‘‘buildings’’.
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(5) Section 8136 is amended by inserting
‘‘adult day health care’’ after ‘‘hospital care’’.
(6) The heading of such subchapter 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’’.
(b) CLERICAL AMENDMENT.—The item relating to
subchapter III in the table of sections at the beginning
of such chapter 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’’.
(c) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply with respect to grants made to
States using funds appropriated after the date of the en-
actment of this Act.
TITLE V—MISCELLANEOUS
SEC. 501. DEPARTMENT OF VETERANS AFFAIRS RESEARCH
ADVISORY COMMITTEES.
(a) STATUTORY BASIS
FOR RESEARCH ADVISORY
COMMITTEES.—Chapter 5 of title 38, United States Code,
is amended by adding at the end of subchapter III the
following new section:
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‘‘§ 544. Veterans research advisory committees
‘‘(a) Congress declares that each of the veterans re-
search advisory committees specified in subsection (c)
(previously established by the Secretary in carrying out
the duties of the Secretary under section 7303 of this title)
has a continuing, ongoing function that is integrally relat-
ed to the successful completion by the Department of its
statutory duties. Each such committee shall, for all pur-
poses, operate as though such committee had been estab-
lished by, and chartered pursuant to, law. The objectives
and scope of the activities of each such committee and the
duties for which the committee is responsible, as specified
by the Secretary as of March 1, 1993, shall be those in
effect as of that date.
‘‘(b) The Secretary may not terminate a veterans’ re-
search advisory committee specified in subsection (c) un-
less the Secretary finds that the committee is no longer
needed. Not less than 120 days before terminating such
a committee, the Secretary shall submit to the congres-
sional veterans’ affairs committees a report on the pro-
posed termination. The report shall include an explanation
of (1) the basis for the Secretary’s determination that
such committee is no longer needed, and (2) the manner
in which the Secretary will carry out the Secretary’s re-
sponsibilities under section 7303 of this title in the ab-
sence of the committee.
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‘‘(c) For purposes of this section, each of the follow-
ing committees and boards, as established by the Sec-
retary as of March 1, 1993, shall be considered to be a
veterans’ research advisory committee:
‘‘(1) The Career Development Committee.
‘‘(2) The Department of Veterans Affairs Coop-
erative Studies Evaluation Committee.
‘‘(3) The Merit Review Board for Basic
Sciences Programs.
‘‘(4) The Merit Review Board for Cardio-
vascular Programs.
‘‘(5) The Merit Review Board for Clinical Phar-
macology, Alcoholism, and Drug Dependence Pro-
grams.
‘‘(6) The Merit Review Board for Endocrinol-
ogy Programs.
‘‘(7) The Merit Review Board for Gastro-
enterology Programs.
‘‘(8) The Merit Review Board for Hematology
Programs.
‘‘(9) The Merit Review Board for Immunology
Programs.
‘‘(10) The Merit Review Board for Infectious
Diseases Programs.
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‘‘(11) The Merit Review Board for Mental
Health and Behavioral Sciences Programs.
‘‘(12) The Merit Review Board for Nephrology
Programs.
‘‘(13) 
The 
Merit 
Review 
Board 
for
Neurobiology Programs.
‘‘(14) The Merit Review Board for Oncology
Programs.
‘‘(15) The Merit Review Board for Respiration
Programs.
‘‘(16) The Merit Review Board for Surgery
Programs.
‘‘(17) The Scientific Review Evaluation Board
for Health Services Research and Development.
‘‘(18) The Scientific Review Evaluation Board
for Rehabilitation Research and Development.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of such chapter is amended by inserting
after the item relating to section 543 the following new
item:
‘‘544. Veterans research advisory committees.’’.
SEC. 502. CHILD CARE SERVICES.
(a) REVISED CHILD CARE AUTHORITY.—Chapter 81
of title 38, United States Code, is amended by inserting
after section 8116 the following new section:
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‘‘§ 8117. Child care centers
‘‘(a) The Secretary may provide for the operation of
child care centers at Department facilities. The operation
of such centers under this section shall be carried out to
the extent that the Secretary determines, based on the de-
mand of employees of the Department for the care in-
volved, that such operation is in the best interest of the
Department and that it is practicable to do so.
‘‘(b)(1) In offering child care services under this sec-
tion, the Secretary shall give priority (in the following
order) to employees of—
‘‘(A) the Department;
‘‘(B) other departments and agencies of the
Federal Government, and
‘‘(C) schools affiliated with the Department and
corporations created under section 7361 of this title.
‘‘(2) To the extent that space is available, the Sec-
retary may provide child care services to members of the
public at a child care center operated under this section
if the Secretary determines that to do so is necessary to
assure the financial success of that center.
‘‘(c)(1) The Secretary shall establish reasonable
charges for child care services provided at each child care
center operated under this section. Such charges may be
established at different rates for different centers.
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‘‘(2) In establishing charges for child care services
provided at a center, the Secretary—
‘‘(A) shall (except as provided in paragraph (3))
establish the charges so as to ensure that the sum
of all charges for child care services at that center
is sufficient to meet the staffing expenses of that
center; and
‘‘(B) may also consider the expenses of con-
structing or acquiring space for the center, the ex-
penses of converting existing space into the center,
and the expenses of equipment and services fur-
nished to the center under subsection (d)(2).
‘‘(3) The Secretary may establish charges for child
care services provided at a center at rates less than those
necessary to ensure that the sum of all charges for child
care services at that center is sufficient to meet the staff-
ing expenses of that center if the Secretary determines
(with respect to a particular facility of the Department)
that—
‘‘(A) the operation of a child care center at that
facility would help overcome serious recruitment or
retention problems;
‘‘(B) adherence to the requirement to establish
charges for child care services at that center at rates
sufficient to meet the staffing expenses of that cen-
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ter would make the operation of a child care center
at that facility unfeasible; and
‘‘(C) there are no other practical alternatives to
meeting the needs of employees at that facility for
child care services.
‘‘(4) Proceeds from charges for child care services
shall be credited to the applicable Department of Veterans
Affairs account and shall be allotted to the facility served
by the child care center and shall remain available until
expended.
‘‘(d) In connection with the establishment and oper-
ation of a child care center under this section, the Sec-
retary—
‘‘(1) may construct or alter space in any De-
partment facility, and may lease space in a non-De-
partment facility for a term not to exceed 20 years,
for use as a child care center;
‘‘(2) may provide, out of operating funds, other
items and services necessary for the operation of the
center, including furniture, office machines and
equipment, utility and custodial services, and other
necessary services and amenities;
‘‘(3) shall provide for the participation (directly
or through a parent advisory committee) of parents
of children receiving care in the center in the estab-
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lishment of policies to govern the operation of the
center and in the oversight of the implementation of
such policies;
‘‘(4) shall require the development and use of a
process for determining the fitness and suitability of
prospective employees of or volunteers at the center;
and
‘‘(5) shall require in connection with the oper-
ation of the center compliance with all State and
local laws, ordinances, and regulations relating to
health and safety and the operation of child care
centers.
‘‘(e) The Secretary shall prescribe guidelines to carry
out this section.
‘‘(f) For the purpose of this section, the term ‘parent
advisory committee’ means a committee comprised of, and
selected by, the parents of children receiving care in a
child care center operated under this section.’’.
(b) CONFORMING REPEAL.—Section 7809 of such
title is repealed.
(c) CLERICAL AMENDMENTS.—(1) The table of sec-
tions at the beginning of chapter 81 of such title is amend-
ed by inserting after the item relating to section 8116 the
following new item:
‘‘8117. Child care centers.’’.
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(2) The table of sections at the beginning of chapter
78 of such title is amended by striking out the item relat-
ing to section 7809.
SEC. 503. CONTRACTS FOR UTILITIES, AUDIE L. MURPHY
MEMORIAL HOSPITAL.
(a) AUTHORITY TO CONTACT.—Subject to subsection
(b), the Secretary of Veterans Affairs may enter into con-
tracts for the provision of utilities (including steam and
chilled water) to the Audie L. Murphy Memorial Hospital
in San Antonio, Texas. Each such contract may—
(1) be for a period not to exceed 35 years;
(2) provide for the construction and operation
of a production facility on or near property under
the jurisdiction of the Secretary;
(3) require capital contributions by the parties
involved for the construction of such a facility, such
contribution to be in the form of cash, equipment,
or other in-kind contribution; and
(4) provide for a predetermined formula to
compute the cost of providing such utilities to the
parties for the duration of the contract.
(b) FUNDS.—A contract may be entered into under
subsection (a) only to the extent and in the amount pro-
vided in advance in appropriations Acts.
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(c) ADDITIONAL TERMS.—The Secretary may include
in a contract under subsection (a) such additional provi-
sions as the Secretary considers necessary to secure the
provision of utilities and to protect the interests of the
United States.
SEC. 504. FACILITIES IN REPUBLIC OF THE PHILIPPINES.
Notwithstanding section 1724 of title 38, United
States Code, the Secretary of Veterans Affairs, during the
period from February 28, 1994, through June 1, 1994,
may contract with facilities in the Republic of the Phil-
ippines other than the Veterans Memorial Medical Center
to furnish hospital care and medical services to veterans
for nonservice-connected disabilities if such veterans are
unable to defray the expenses of necessary hospital care.
When the Secretary determines it to be most feasible, the
Secretary may provide medical services to such veterans
at the Department of Veterans Affairs Outpatient Clinic
at Manila, Republic of the Philippines.
SEC. 505. WAIVER OF CONGRESSIONAL WAITING PERIOD
REQUIREMENT FOR A SPECIFIED ADMINIS-
TRATIVE REORGANIZATION.
(a) WAIVER.—The Secretary of Veterans Affairs may
undertake the administrative reorganization described in
subsection (b) of this section without regard to the waiting
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period requirement of section 510(b) of title 38, United
States Code.
(b) COVERED ADMINISTRATIVE REORGANIZATION.—
The administrative reorganization referred to in sub-
section (a) of this section is a reorganization at the De-
partment of Veterans Affairs Medical Center in Sepul-
veda, California, necessitated by the January 1994 earth-
quake damage at that location, as described in the letters
dated April 25, 1994, and the accompanying detailed plan
and justification, submitted by the Secretary of Veterans
Affairs to the chairmen of the House and Senate Commit-
tees on Veterans’ Affairs pursuant to section 510(b) of
title 38, United States Code.
SEC. 506. TECHNICAL AMENDMENT.
Section 7363(c) of title 38, United States Code, is
amended by striking out ‘‘section 501(c)(3) of’’.
Passed the House of Representatives May 23, 1994.
Attest:
DONNALD K. ANDERSON,
Clerk.