I
103D CONGRESS
2D SESSION
H. R. 4425
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.
IN THE HOUSE OF REPRESENTATIVES
MAY 16, 1994
Mr. ROWLAND (for himself and Mr. SMITH of New Jersey) introduced the
following bill; which was referred to the Committee on Veterans’ Affairs
A BILL
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,
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
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
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.
(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
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
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.
‘‘(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.
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
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.
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.
‘‘(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’’.
(5) Section 8136 is amended by inserting
‘‘adult day health care’’ after ‘‘hospital care’’.
‘‘(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-
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-
lishment of policies to govern the operation of the