H. R. 3118
One Hundred Fourth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Wednesday,
the third day of January, one thousand nine hundred and ninety-six
An Act
To amend title 38, United States Code, to reform eligibility for health care provided
by the Department of Veterans Affairs, to authorize major medical facility construc-
tion projects for the Department, to improve administration of health care by
the Department, and for other purposes.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the ‘‘Veterans’
Health Care Eligibility Reform Act of 1996’’.
(b) TABLE OF CONTENTS.—The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
TITLE I—ELIGIBILITY REFORM
Sec. 101. Eligibility for hospital care and medical services.
Sec. 102. Revision in authorities for provision of priority health care for certain vet-
erans exposed to specified toxic substances.
Sec. 103. Prosthetics and preventive care.
Sec. 104. Management of health care.
Sec. 105. Authorization of appropriations.
Sec. 106. Assessment of implementation and operation.
TITLE II—CONSTRUCTION AUTHORIZATION
Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of major medical facility leases.
Sec. 203. Authorization of appropriations.
Sec. 204. Strategic planning.
Sec. 205. Revision to prospectus requirements.
Sec. 206. Construction authorization requirements.
Sec. 207. Terminology changes.
TITLE III—HEALTH CARE AND ADMINISTRATION
Subtitle A—Health Care Sharing and Administration
Sec. 301. Revision of authority to share medical facilities, equipment, and informa-
tion.
Sec. 302. Improved efficiency in health care resource management.
Sec. 303. Personnel furnishing shared resources.
Sec. 304. Waiting period for administrative reorganizations.
Sec. 305. Repeal of limitations on contracts for conversion of performance of activi-
ties of Department health-care facilities and revised annual reporting
requirement.
Subtitle B—Care of Women Veterans
Sec. 321. Mammography quality standards.
Sec. 322. Patient privacy for women patients.
Sec. 323. Assessment of use by women veterans of Department health services.
Sec. 324. Reporting requirements.
H. R. 3118—2
Subtitle C—Readjustment Counseling and Mental Health Care
Sec. 331. Expansion of eligibility for readjustment counseling and certain related
counseling services.
Sec. 332. Reports relating to Vet Centers.
Sec. 333. Advisory Committee on the Readjustment of Veterans.
Sec. 334. Centers for mental illness research, education, and clinical activities.
Sec. 335. Committee on Care of Severely Chronically Mentally Ill Veterans.
Subtitle D—Other Provisions
Sec. 341. Hospice care study.
Sec. 342. Payment to States of per diem for veterans receiving adult day health
care.
Sec. 343. Research corporations.
Sec. 344. Veterans Health Administration headquarters.
Sec. 345. Disbursement agreements relating to medical residents and interns.
Sec. 346. Authority to suspend special pay agreements for physicians and dentists
who enter residency training programs.
Sec. 347. Remunerated outside professional activities by Veterans Health Adminis-
tration personnel.
Sec. 348. Modification of restrictions on real property, Milwaukee County,
Wisconsin.
Sec. 349. Modification of restrictions on real property, Cheyenne, Wyoming.
Sec. 350. Name of Department of Veterans Affairs Medical Center, Johnson City,
Tennessee.
Sec. 351. Report on health care needs of veterans in east central Florida.
Sec. 352. Evaluation of health status of spouses and children of Persian Gulf War
veterans.
SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.
Except as otherwise expressly provided, whenever in this Act
an amendment or repeal is expressed in terms of an amendment
to or repeal of a section or other provision, the reference shall
be considered to be made to a section or other provision of title
38, United States Code.
TITLE I—ELIGIBILITY REFORM
SEC. 101. ELIGIBILITY FOR HOSPITAL CARE AND MEDICAL SERVICES.
(a) NEW CRITERIA FOR ELIGIBILITY FOR CARE.—Section 1710(a)
is amended to read as follows:
‘‘(a)(1) The Secretary (subject to paragraph (4)) shall furnish
hospital care and medical services, and may furnish nursing home
care, which the Secretary determines to be needed—
‘‘(A) to any veteran for a service-connected disability; and
‘‘(B) to any veteran who has a service-connected disability
rated at 50 percent or more.
‘‘(2) The Secretary (subject to paragraph (4)) shall furnish hos-
pital care and medical services, and may furnish nursing home
care, which the Secretary determines to be needed to any veteran—
‘‘(A) who has a compensable service-connected disability
rated less than 50 percent;
‘‘(B) whose discharge or release from active military, naval,
or air service was for a compensable disability that was incurred
or aggravated in the line of duty;
‘‘(C) who is in receipt of, or who, but for a suspension
pursuant to section 1151 of this title (or both a suspension
and the receipt of retired pay), would be entitled to disability
compensation, but only to the extent that such veteran’s
continuing eligibility for such care is provided for in the judg-
ment or settlement provided for in such section;
‘‘(D) who is a former prisoner of war;
H. R. 3118—3
‘‘(E) who is a veteran of the Mexican border period or
of World War I;
‘‘(F) who was exposed to a toxic substance, radiation, or
environmental hazard, as provided in subsection (e); or
‘‘(G) who is unable to defray the expenses of necessary
care as determined under section 1722(a) of this title.
‘‘(3) In the case of a veteran who is not described in paragraphs
(1) and (2), the Secretary may, to the extent resources and facilities
are available and subject to the provisions of subsections (f) and
(g), furnish hospital care, medical services, and nursing home care
which the Secretary determines to be needed.
‘‘(4) The requirement in paragraphs (1) and (2) that the Sec-
retary furnish hospital care and medical services shall be effective
in any fiscal year only to the extent and in the amount provided
in advance in appropriations Acts for such purposes.’’.
(b) TRANSFER OF PROVISION.—Chapter 17 is amended—
(1) by redesignating subsection (g) of section 1710 as sub-
section (h); and
(2) by transferring subsection (f) of section 1712 to section
1710 and inserting such subsection so as to appear after sub-
section (f), redesignating such subsection as subsection (g),
and amending such subsection by striking out ‘‘section
1710(a)(2) of this title’’ in paragraph (1) and inserting in lieu
thereof ‘‘subsection (a)(3) of this section’’.
(c) REPEAL OF SEPARATE OUTPATIENT CARE PRIORITIES.—(1)
Section 1712 is amended—
(A) by striking out subsections (a) and (i);
(B) by redesignating subsections (b), (c), (d), (h) and (j),
as subsections (a), (b), (c), (d), and (e), respectively; and
(C) in subsection (b), as so redesignated, by striking out
‘‘subsection (b) of this section’’ and inserting in lieu thereof
‘‘subsection (a)’’.
(2)(A) The heading of such section is amended to read as
follows:
‘‘§ 1712. Dental care; drugs and medicines for certain disabled
veterans; vaccines’’.
(B) The item relating to such section in the table of sections
at the beginning of chapter 17 is amended to read as follows:
‘‘1712. Dental care; drugs and medicines for certain disabled veterans; vaccines.’’.
(d) CONFORMING AMENDMENTS TO CHAPTER 17.—Chapter 17
is further amended as follows:
(1) Section 1701(6)(B)(i) is amended—
(A) in subclause (I), by striking out ‘‘section 1712(a)’’
and inserting in lieu thereof ‘‘paragraph (1) or (2) of section
1710(a)’’; and
(B) in subclause (II), by striking out ‘‘section
1712(a)(5)(B)’’ and inserting in lieu thereof ‘‘paragraph (1),
(2) or (3) of section 1710(a)’’.
(2) Section 1710(c)(1) is amended by striking out ‘‘section
1712(b)’’ and inserting in lieu thereof ‘‘section 1712(a)’’.
(3) Section 1710(e)(1)(C) is amended by striking out ‘‘hos-
pital care and nursing home care under subsection (a)(1)(G)
of this section’’ and inserting in lieu thereof ‘‘hospital care,
medical services, and nursing home care under subsection
(a)(2)(F)’’.
(4) Section 1710(f) is amended—
H. R. 3118—4
(A) in paragraph (1), by striking out ‘‘subsection (a)(2)’’
and inserting in lieu thereof ‘‘subsection (a)(3)’’; and
(B) in paragraph (3)(E)—
(i) by striking out ‘‘section 1712(a) of this title’’
and inserting in lieu thereof ‘‘paragraph (3) of sub-
section (a)’’; and
(ii) by striking out ‘‘section 1712(f) of this title’’
and inserting in lieu thereof ‘‘subsection (g)’’; and
(C) in paragraph (3)(F), by striking out ‘‘section 1712(f)
of this title’’ and inserting in lieu thereof ‘‘subsection (g)’’.
(5) Section 1712A is amended—
(A) in subsection (b)(1), by striking out ‘‘under the
conditions specified in section 1712(a)(5)(B) of this title’’;
and
(B) in subsection (e)(1), by striking out ‘‘sections
1712(a)(1)(B) and 1703(a)(2)’’ and inserting in lieu thereof
‘‘sections 1703(a)(2) and 1710(a)(1)(B)’’.
(6) Section 1717(a) is amended—
(A) in paragraph (1), by striking out ‘‘section 1712(a)’’
and inserting in lieu thereof ‘‘section 1710(a)’’; and
(B) in paragraph (2)—
(i) in subparagraph (A), by striking out ‘‘paragraph
(1) of section 1712(a) of this title’’ and inserting in
lieu thereof ‘‘section 1710(a)(1) of this title, or for a
disability described in section 1710(a)(2)(C) of this
title’’; and
(ii) in subparagraph (B), by striking out ‘‘section
1712’’ and inserting in lieu thereof ‘‘section 1710(a)(2)’’.
(7) Section 1718(e) is amended by striking out ‘‘section
1712(i)’’ and inserting in lieu thereof ‘‘section 1705’’.
(8) Section 1720(f) is amended—
(A) in paragraph (1)(A)(ii), by striking out ‘‘section
1712(a)(1)(B)’’ and inserting in lieu thereof ‘‘paragraph (1),
(2), or (3) of section 1710(a)’’; and
(B) by striking out paragraph (3).
(9) Section 1722 is amended—
(A) in subsection (a), by striking out ‘‘section
1710(a)(1)(I)’’ and inserting in lieu thereof ‘‘section
1710(a)(2)(G)’’; and
(B) in subsection (f)(3), by striking out ‘‘or 1712(f)’’.
(10) Section 1729(g)(3)(A) is amended by striking out ‘‘under
section 1710(f) of this title for hospital care or nursing home
care, under section 1712(f) of this title for medical services,’’
and inserting in lieu thereof ‘‘under subsection (f) or (g) of
section 1710 of this title for hospital care, medical services,
or nursing home care’’.
(e) OTHER CONFORMING AND TECHNICAL AMENDMENTS.—
(1) Section 1525 is amended—
(A) in subsection (a), by striking out ‘‘section 1712(h)
of this title’’ and all that follows through the period at
the end and inserting in lieu thereof ‘‘section 1712(d) of
this title.’’; and
(B) in subsection (b), by striking out ‘‘renumeration’’
and inserting in lieu thereof ‘‘remuneration’’.
(2) Section 2104(b) is amended—
H. R. 3118—5
(A) in the first sentence, by striking out ‘‘section
1712(a)’’ and inserting in lieu thereof ‘‘section 1717(a)(2)’’;
and
(B) in the second sentence, by striking out ‘‘section
1712(a)’’ and inserting in lieu thereof ‘‘section 1717(a)(2)’’.
(3) Section 5317(c)(3) is amended by striking out ‘‘sections
1710(a)(1)(I), 1710(a)(2), 1710(b), and 1712(a)(2)(B)’’ and insert-
ing in lieu thereof ‘‘subsections (a)(2)(G), (a)(3), and (b) of section
1710’’.
(4) Section 8110(a)(2) is amended by striking out ‘‘section
1712’’ and inserting in lieu thereof ‘‘section 1710(a)’’.
(5) Section 8111A(b)(2)(A) is amended by striking out ‘‘sub-
section (f) of section 1712’’ and inserting in lieu thereof ‘‘sub-
section (a) of section 1710’’.
SEC. 102. REVISION IN AUTHORITIES FOR PROVISION OF PRIORITY
HEALTH CARE FOR CERTAIN VETERANS EXPOSED TO
SPECIFIED TOXIC SUBSTANCES.
(a) 
AUTHORIZED
INPATIENT
CARE.—Section 
1710(e) 
is
amended—
(1) in paragraph (1), by striking out subparagraphs (A)
and (B) and inserting in lieu thereof the following:
‘‘(A) A Vietnam-era herbicide-exposed veteran is eligible (subject
to paragraph (2)) for hospital care, medical services, and nursing
home care under subsection (a)(2)(F) for any disability, notwith-
standing that there is insufficient medical evidence to conclude
that such disability may be associated with such exposure.
‘‘(B) A radiation-exposed veteran is eligible for hospital care,
medical services, and nursing home care under subsection (a)(2)(F)
for any disease suffered by the veteran that is—
‘‘(i) a disease listed in section 1112(c)(2) of this title; or
‘‘(ii) any other disease for which the Secretary, based on
the advice of the Advisory Committee on Environmental Haz-
ards, determines that there is credible evidence of a positive
association between occurrence of the disease in humans and
exposure to ionizing radiation.’’; and
(2) by striking out paragraphs (2) and (3) and inserting
in lieu thereof the following:
‘‘(2)(A) In the case of a veteran described in paragraph (1)(A),
hospital care, medical services, and nursing home care may not
be provided under subsection (a)(2)(F) with respect to—
‘‘(i) a disability that is found, in accordance with guidelines
issued by the Under Secretary for Health, to have resulted
from a cause other than an exposure described in paragraph
(4)(A)(ii); or
‘‘(ii) a disease for which the National Academy of Sciences,
in a report issued in accordance with section 2 of the Agent
Orange Act of 1991, has determined that there is limited or
suggestive evidence of the lack of a positive association between
occurrence of the disease in humans and exposure to a herbicide
agent.
‘‘(B) In the case of a veteran described in paragraph (1)(C),
hospital care, medical services, and nursing home care may not
be provided under subsection (a)(2)(F) with respect to a disability
that is found, in accordance with guidelines issued by the Under
Secretary for Health, to have resulted from a cause other than
an exposure described in that paragraph.
H. R. 3118—6
‘‘(3) Hospital care, medical services, and nursing home care
may not be provided under or by virtue of subsection (a)(2)(F)—
‘‘(A) in the case of care for a veteran described in paragraph
(1)(A), after December 31, 2002; and
‘‘(B) in the case of care for a veteran described in paragraph
(1)(C), after December 31, 1998.
‘‘(4) For purposes of this subsection—
‘‘(A) The term ‘Vietnam-era herbicide-exposed veteran’
means a veteran (i) who served on active duty in the Republic
of Vietnam during the Vietnam era, and (ii) who the Secretary
finds may have been exposed during such service to dioxin
or was exposed during such service to a toxic substance found
in a herbicide or defoliant used for military purposes during
such era.
‘‘(B) The term ‘radiation-exposed veteran’ has the meaning
given that term in section 1112(c)(3) of this title.’’.
(b) SAVINGS PROVISIONS.—The provisions of sections 1710(e)
and 1712(a) of title 38, United States Code, as in effect on the
day before the date of the enactment of this Act, shall continue
to apply on and after such date with respect to the furnishing
of hospital care, nursing home care, and medical services for any
veteran who was furnished such care or services before such date
of enactment on the basis of presumed exposure to a substance
or radiation under the authority of those provisions, but only for
treatment for a disability for which such care or services were
furnished before such date.
SEC. 103. PROSTHETICS AND PREVENTIVE CARE.
(a) ELIGIBILITY.—Section 1701(6)(A)(i) is amended—
(1) by striking out ‘‘(in the case of a person otherwise
receiving care or services under this chapter)’’ and ‘‘(except
under the conditions described in section 1712(a)(5)(A) of this
title),’’;
(2) by inserting ‘‘(in the case of a person otherwise receiving
care or services under this chapter)’’ before ‘‘wheelchairs,’’; and
(3) by inserting ‘‘except that the Secretary may not furnish
sensori-neural aids other than in accordance with guidelines
which the Secretary shall prescribe,’’ after ‘‘reasonable and
necessary,’’.
(b) REGULATIONS.—Not later than 30 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs shall
prescribe the guidelines required by the amendments made by
subsection (a) and shall furnish a copy of those guidelines to the
Committees on Veterans’ Affairs of the Senate and House of Rep-
resentatives.
SEC. 104. MANAGEMENT OF HEALTH CARE.
(a) IN GENERAL.—(1) Chapter 17 is amended by inserting after
section 1704 the following new sections:
‘‘§ 1705. Management of health care: patient enrollment
system
‘‘(a) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary, in accord-
ance with regulations the Secretary shall prescribe, shall establish
and operate a system of annual patient enrollment. The Secretary
shall manage the enrollment of veterans in accordance with the
following priorities, in the order listed:
H. R. 3118—7
‘‘(1) Veterans with service-connected disabilities rated 50
percent or greater.
‘‘(2) Veterans with service-connected disabilities rated 30
percent or 40 percent.
‘‘(3) Veterans who are former prisoners of war, veterans
with service-connected disabilities rated 10 percent or 20 per-
cent, and veterans described in subparagraphs (B) and (C)
of section 1710(a)(2) of this title.
‘‘(4) Veterans who are in receipt of increased pension based
on a need of regular aid and attendance or by reason of being
permanently housebound and other veterans who are cata-
strophically disabled.
‘‘(5) Veterans not covered by paragraphs (1) through (4)
who are unable to defray the expenses of necessary care as
determined under section 1722(a) of this title.
‘‘(6) All other veterans eligible for hospital care, medical
services, and nursing home care under section 1710(a)(2) of
this title.
‘‘(7) Veterans described in section 1710(a)(3) of this title.
‘‘(b) In the design of an enrollment system under subsection
(a), the Secretary—
‘‘(1) shall ensure that the system will be managed in a
manner to ensure that the provision of care to enrollees is
timely and acceptable in quality;
‘‘(2) may establish additional priorities within each priority
group specified in subsection (a), as the Secretary determines
necessary; and
‘‘(3) may provide for exceptions to the specified priorities
where dictated by compelling medical reasons.
‘‘(c)(1) Effective on October 1, 1998, the Secretary may not
provide hospital care or medical services to a veteran under para-
graph (2) or (3) of section 1710(a) of this title unless the veteran
enrolls in the system of patient enrollment established by the
Secretary under subsection (a).
‘‘(2) The Secretary shall provide hospital care and medical
services under section 1710(a)(1) of this title, and under subpara-
graph (B) of section 1710(a)(2) of this title, for the 12-month period
following such veteran’s discharge or release from service, to any
veteran referred to in such sections for a disability specified in
the applicable subparagraph of such section, notwithstanding the
failure of the veteran to enroll in the system of patient enrollment
referred to in subsection (a) of this section.
‘‘§ 1706. Management of health care: other requirements
‘‘(a) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary shall,
to the extent feasible, design, establish and manage health care
programs in such a manner as to promote cost-effective delivery
of health care services in the most clinically appropriate setting.
‘‘(b)(1) In managing the provision of hospital care and medical
services under such section, the Secretary shall ensure that the
Department maintains its capacity to provide for the specialized
treatment and rehabilitative needs of disabled veterans (including
veterans with spinal cord dysfunction, blindness, amputations, and
mental illness) within distinct programs or facilities of the Depart-
ment that are dedicated to the specialized needs of those veterans
in a manner that (A) affords those veterans reasonable access
H. R. 3118—8
to care and services for those specialized needs, and (B) ensures
that overall capacity of the Department to provide such services
is not reduced below the capacity of the Department, nationwide,
to provide those services, as of the date of the enactment of this
section. The Secretary shall carry out this paragraph in consultation
with the Advisory Committee on Prosthetics and Special Disabilities
Programs and the Committee on Care of Severely Chronically Men-
tally Ill Veterans.
‘‘(2) Not later than April 1, 1997, April 1, 1998, and April
1, 1999, the Secretary shall submit to the Committees on Veterans’
Affairs of the Senate and House of Representatives a report on
the Secretary’s compliance, by facility and by service-network, with
the requirements of this subsection.’’.
(2) The table of sections at the beginning of chapter 17 is
amended by inserting after the item relating to section 1704 the
following new items:
‘‘1705. Management of health care: patient enrollment system.
‘‘1706. Management of health care: other requirements.’’.
(b) CONFORMING
AMENDMENTS
TO
SECTION
1703.—Section
1703(a) is amended—
(1) in the matter preceding paragraph (1), by striking out
‘‘or 1712’’;
(2) in paragraph (2)—
(A) by striking out ‘‘1712(a)(1)(B)’’ in subparagraph
(A) and inserting in lieu thereof ‘‘1710(a)(1)(B)’’;
(B) by striking out subparagraph (B) and inserting
in lieu thereof the following:
‘‘(B) a veteran who (i) has been furnished hospital
care, nursing home care, domiciliary care, or medical serv-
ices, and (ii) requires medical services to complete treat-
ment incident to such care or services; or’’; and
(C) by striking ‘‘section 1712(a)(3) (other than a veteran
who is a former prisoner of war) of this title’’ in subpara-
graph 
(C) 
and 
inserting 
in 
lieu 
thereof 
‘‘section
1710(a)(2)(E) of this title, or a veteran who is in receipt
of increased pension, or additional compensation or allow-
ances based on the need of regular aid and attendance
or by reason of being permanently housebound (or who,
but for the receipt of retired pay, would be in receipt
of such pension, compensation, or allowance),’’; and
(3) in paragraph (7), by striking out ‘‘1712(b)(1)(F)’’ and
inserting in lieu thereof ‘‘1712(a)(1)(F)’’.
SEC. 105. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated for the Department
of Veterans Affairs for the Medical Care account, for the purposes
specified for that account in Public Law 103–327 (108 Stat. 2300),
including the cost of providing hospital care and medical services
under the amendments made by section 101 of this title, not to
exceed $17,250,000,000 for fiscal year 1997 and not to exceed
$17,900,000,000 for fiscal year 1998.
SEC. 106. ASSESSMENT OF IMPLEMENTATION AND OPERATION.
(a) ASSESSMENT SYSTEMS.—The Secretary of Veterans Affairs
shall establish information systems to assess the experience of
the Department of Veterans Affairs in implementing sections 101,
103, and 104, including the amendments made by those sections,
H. R. 3118—9
during fiscal year 1997. The Secretary shall establish those informa-
tion systems in time to include assessments under such systems
in the report required under subsection (b).
(b) REPORT.—Not later than March 1, 1998, the Secretary shall
submit to the Committees on Veterans’ Affairs of the Senate and
House of Representatives a report reflecting the experience of the
Department during fiscal year 1997 on—
(1) the effect of implementation of, and provision and
management of care under, sections 101, 103, and 104 (includ-
ing the amendments made by those sections) on demand for
health care services from the Department of Veterans Affairs
by veterans described in paragraphs (1), (2), and (3) of section
1710(a) of title 38, United States Code, as amended by section
101;
(2) any differing patterns of demand on the part of such
veterans relating to such factors as relative distance from
Department facilities and prior experience, or lack of experi-
ence, as recipients of care from the Department;
(3) the extent to which the Department has met such
demand for care; and
(4) changes in health-care delivery patterns in Department
facilities and the fiscal impact of such changes.
(c) MATTERS TO BE INCLUDED.—The report under subsection
(b) shall include detailed information with respect to fiscal year
1997 regarding the following:
(1) The number of veterans enrolled for care at each Depart-
ment medical facility and, of such veterans, the number enrolled
at each such facility who had not received care from the Depart-
ment during the preceding three fiscal years.
(2) With respect to the veterans who had not received
care from the Department during the three preceding fiscal
years, the total cost of providing care to such veterans, shown
in total and separately (A) by level of care, and (B) by reference
to whether care was furnished in Department facilities or under
contract arrangements.
(3) With respect to the number of veterans described in
paragraphs (1), (2), and (3) of section 1710(a) of title 38, United
States Code, as amended by section 101, who applied for health
care from the Department during fiscal year 1997—
(A) the number who applied for care (shown in total
and separately by facility);
(B) the number who were denied enrollment (shown
in total and separately by facility); and
(C) the number who were denied care which was
considered to be medically necessary but not of an emer-
gency nature (shown in total and separately by facility).
(4) The numbers and characteristics of, and the type and
extent of health care furnished to, veterans enrolled for care
(shown in total and separately by facility).
(5) The numbers and characteristics of, and the type and
extent of health care furnished to, veterans not enrolled for
care (shown separately by reference to each class of eligibility,
both in total and separately by facility).
(6) The specific fiscal impact (shown in total and by
geographic health-care delivery areas) of changes in delivery
patterns instituted under the amendments made by this title.
H. R. 3118—10
TITLE II—CONSTRUCTION
AUTHORIZATION
SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.
(a) AMBULATORY CARE ADDITION PROJECTS.—The Secretary of
Veterans Affairs may carry out the following ambulatory care addi-
tion major medical facility projects, with each project to be carried
out in the amount specified for that project:
(1) Construction of an ambulatory care facility and renova-
tion of ‘‘E’’ wing, Tripler Army Hospital, Honolulu, Hawaii,
$43,000,000.
(2) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Brockton, Massachusetts,
$13,500,000.
(3) Addition of ambulatory care facilities for outpatient
improvements at the Department of Veterans Affairs medical
center in Shreveport, Louisiana, $25,000,000.
(4) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Lyons, New Jersey,
$21,100,000.
(5) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Tomah, Wisconsin,
$12,700,000.
(6) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Asheville, North Carolina,
$26,300,000.
(7) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Temple, Texas, $9,800,000.
(8) Addition of ambulatory care facilities at the Department
of Veterans Affairs medical center in Tucson, Arizona,
$35,500,000.
(9) Construction of an ambulatory care facility at the
Department of Veterans Affairs medical center in Leavenworth,
Kansas, $27,750,000.
(b) ENVIRONMENTAL IMPROVEMENT PROJECTS.—The Secretary
may carry out the following environmental improvement major
medical facility projects, with each project to be carried out in
the amount specified for that project:
(1) Environmental improvements for the renovation of
nursing home facilities at the Department of Veterans Affairs
medical center in Lebanon, Pennsylvania, $9,500,000.
(2) Environmental improvements at the Department of
Veterans Affairs medical center in Marion, Illinois, $11,500,000.
(3) Environmental improvements for ward renovation for
patient privacy at the Department of Veterans Affairs medical
center in Omaha, Nebraska, $7,700,000.
(4) Environmental improvements at the Department of
Veterans Affairs medical center in Pittsburgh, Pennsylvania,
$17,400,000.
(5) Environmental improvements for the renovation of
various buildings at the Department of Veterans Affairs medical
center in Waco, Texas, $26,000,000.
(6) Environmental improvements for the replacement of
psychiatric beds at the Department of Veterans Affairs medical
center in Marion, Indiana, $17,300,000.
H. R. 3118—11
(7) Environmental improvements for the renovation of
psychiatric wards at the Department of Veterans Affairs medi-
cal center in Perry Point, Maryland, $15,100,000.
(8) Environmental enhancement at the Department of Vet-
erans Affairs medical center in Salisbury, North Carolina,
$18,200,000.
(c) SEISMIC CORRECTION PROJECT.—The Secretary may carry
out seismic corrections to Building Number 324 at the Department
of Veterans Affairs medical center in Palo Alto, California, in the
amount of $20,800,000.
(d) 
PROJECT
AUTHORIZATION
WHEN
PARTIAL
FUNDING
PROVIDED.—If the amount of funds appropriated for fiscal year
1997 or 1998 for design and partial construction of a major medical
facility project that is authorized in this section is less than the
amount required to complete the construction of that project as
authorized and if the Secretary obligates funds for such construc-
tion, such project shall be deemed to be fully authorized. Any
such authorization shall cease to have effect at the close of fiscal
year 2001.
SEC. 202. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.
The Secretary of Veterans Affairs may enter into leases for
medical facilities as follows:
(1) Lease of a satellite outpatient clinic in Allentown, Penn-
sylvania, in an amount not to exceed $2,159,000.
(2) Lease of a satellite outpatient clinic in Beaumont, Texas,
in an amount not to exceed $1,940,000.
(3) Lease of a satellite outpatient clinic in Boston,
Massachusetts, in an amount not to exceed $2,358,000.
(4) Lease of a parking facility in Cleveland, Ohio, in an
amount not to exceed $1,300,000.
(5) Lease of a satellite outpatient clinic and Veterans Bene-
fits Administration field office in San Antonio, Texas, in an
amount not to exceed $2,256,000.
(6) Lease of a satellite outpatient clinic in Toledo, Ohio,
in an amount not to exceed $2,223,000.
SEC. 203. AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—There are authorized to be appropriated to
the Secretary of Veterans Affairs for fiscal year 1997 and fiscal
year 1998—
(1) for the Construction, Major Projects, account, a total
of $358,150,000 for the projects authorized in section 201; and
(2) for the Medical Care account, a total of $12,236,000
for the leases authorized in section 202.
(b) LIMITATION.—The projects authorized in section 201 may
only be carried out using—
(1) funds appropriated for fiscal year 1997 or fiscal year
1998 consistent with the authorization of appropriations in
subsection (a);
(2) funds appropriated for Construction, Major Projects for
a fiscal year before fiscal year 1997 that remain available
for obligation; and
(3) funds appropriated for Construction, Major Projects for
fiscal year 1997 or fiscal year 1998 for a category of activity
not specific to a project.
H. R. 3118—12
SEC. 204. STRATEGIC PLANNING.
Section 8107 is amended—
(1) by redesignating subsection (b) as subsection (c);
(2) by striking out subsection (a) and inserting in lieu
thereof the following new subsections:
‘‘(a) In order to promote effective planning for the efficient
provision of care to eligible veterans, the Secretary, based on the
analysis and recommendations of the Under Secretary for Health,
shall submit to each committee an annual report regarding long-
range health planning of the Department. The report shall be
submitted each year not later than the date on which the budget
for the next fiscal year is submitted to the Congress under section
1105 of title 31.
‘‘(b) Each report under subsection (a) shall include the following:
‘‘(1) A five-year strategic plan for the provision of care
under chapter 17 of this title to eligible veterans through coordi-
nated networks of medical facilities operating within prescribed
geographic service-delivery areas, such plan to include provision
of services for the specialized treatment and rehabilitative
needs of disabled veterans (including veterans with spinal cord
dysfunction, blindness, amputations, and mental illness)
through distinct programs or facilities of the Department dedi-
cated to the specialized needs of those veterans.
‘‘(2) A description of how planning for the networks will
be coordinated.
‘‘(3) A profile regarding each such network of medical facili-
ties which identifies—
‘‘(A) the mission of each existing or proposed medical
facility in the network;
‘‘(B) any planned change in the mission for any such
facility and the rationale for such planned change;
‘‘(C) the population of veterans to be served by the
network and anticipated changes over a five-year period
and a ten-year period, respectively, in that population and
in the health-care needs of that population;
‘‘(D) information relevant to assessing progress toward
the goal of achieving relative equivalency in the level of
resources per patient distributed to each network, such
information to include the plans for and progress toward
lowering the cost of care-delivery in the network (by means
such as changes in the mix in the network of physicians,
nurses, physician assistants, and advance practice nurses);
‘‘(E) the capacity of non-Federal facilities in the net-
work to provide acute, long-term, and specialized treatment
and rehabilitative services (described in section 7305 of
this title), and determinations regarding the extent to
which services to be provided in each service-delivery area
and each facility in such area should be provided directly
through facilities of the Department or through contract
or other arrangements, including arrangements authorized
under sections 8111 and 8153 of this title; and
‘‘(F) a five-year plan for construction, replacement, or
alteration projects in support of the approved mission of
each facility in the network and a description of how those
projects will improve access to care, or quality of care,
for patients served in the network.
‘‘(4) A status report for each facility on progress toward—
H. R. 3118—13
‘‘(A) instituting planned mission changes identified
under paragraph (3)(B);
‘‘(B) implementing principles of managed care of
eligible veterans; and
‘‘(C) developing and instituting cost-effective alter-
natives to provision of institutional care.’’; and
(3) by adding at the end the following new subsection:
‘‘(d)(1) The Secretary shall submit to each committee, not later
than January 31 of each year, a report showing the current prior-
ities 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 and the projected
cost of such project (including the projected operating costs, includ-
ing both recurring and nonrecurring costs). 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 Sec-
retary 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 relation to other projects within
the same category.
‘‘(3) In a case in which the relative ranking of a proposed
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. 205. REVISION TO PROSPECTUS REQUIREMENTS.
(a) ADDITIONAL INFORMATION.—Section 8104(b) is amended—
(1) by striking out the matter preceding paragraph (1)
and inserting in lieu thereof the following:
‘‘(b) Whenever the President or the Secretary submit to the
Congress a request for the funding of a major medical facility
project (as defined in subsection (a)(3)(A)) or a major medical facility
lease (as defined in subsection (a)(3)(B)), the Secretary shall submit
to each committee, on the same day, a prospectus of the proposed
medical facility. Any such prospectus shall include the following:’’;
(2) in paragraph (1)—
(A) by striking out ‘‘a detailed’’ and inserting in lieu
thereof ‘‘A detailed’’; and
(B) by striking out the semicolon at the end and insert-
ing in lieu thereof a period;
(3) in paragraph (2)—
(A) by striking out ‘‘an estimate’’ and inserting 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 estimate’’ and
inserting in lieu thereof ‘‘An estimate’’; and
(5) by adding at the end the following new paragraphs:
‘‘(4) Demographic data applicable to such facility, including
information on projected changes in the population of veterans
H. R. 3118—14
to be served by the facility over a five-year period and a
ten-year period.
‘‘(5) Current and projected workload and utilization data
regarding the facility.
‘‘(6) Current and projected operating costs of the facility,
including both recurring and non-recurring costs.
‘‘(7) The priority score assigned to the project or lease
under the Department’s prioritization methodology and, if the
project or lease is being proposed for funding before a project
or lease with a higher score, a specific explanation of the
factors other than the priority score that were considered and
the basis on which the project or lease is proposed for funding
ahead of projects or leases with higher priority scores.
‘‘(8) In the case of a prospectus proposing the construction
of a new or replacement medical facility, a description of each
alternative to construction of the facility that was considered.’’.
(b) APPLICABILITY.—The amendments made by subsection (a)
shall apply with respect to any prospectus submitted by the Sec-
retary of Veterans Affairs after the date of the enactment of this
Act.
SEC. 206. CONSTRUCTION AUTHORIZATION REQUIREMENTS.
(a) DEFINITION OF MAJOR MEDICAL FACILITY PROJECT.—Para-
graph (3)(A) of section 8104(a) is amended by striking out
‘‘$3,000,000’’ and inserting in lieu thereof ‘‘$4,000,000’’.
(b) APPLICABILITY OF CONSTRUCTION AUTHORIZATION REQUIRE-
MENT.—(1) Subsection (b) of section 301 of the Veterans’ Medical
Programs Amendments of 1992 (Public Law 102–405; 106 Stat.
1984) is repealed.
(2) The amendments made by subsection (a) of such section
shall apply with respect to any major medical facility project or
any major medical facility lease of the Department of Veterans
Affairs, regardless of when funds are first appropriated for that
project or lease, except that in the case of a project for which
funds were first appropriated before October 9, 1992, such amend-
ments shall not apply with respect to amounts appropriated for
that project for a fiscal year before fiscal year 1998.
(c) LIMITATION ON OBLIGATIONS FOR ADVANCE PLANNING.—Sec-
tion 8104 is amended by adding at the end the following new
subsection:
‘‘(f) The Secretary may not obligate funds in an amount in
excess of $500,000 from the Advance Planning Fund of the Depart-
ment toward design or development of a major medical facility
project (as defined in subsection (a)(3)(A)) until—
‘‘(1) the Secretary submits to the committees a report on
the proposed obligation; and
‘‘(2) a period of 30 days has passed after the date on
which the report is received by the committees.’’.
SEC. 207. TERMINOLOGY CHANGES.
(a) DEFINITION OF ‘‘CONSTRUCT’’.—Section 8101(2) is amended—
(1) by striking out ‘‘working drawings’’ and inserting in
lieu thereof ‘‘construction documents’’; and
(2) by striking out ‘‘preliminary plans’’ and inserting in
lieu thereof ‘‘design development’’.
(b) PARKING FACILITIES.—Section 8109(h)(3)(B) is amended by
striking out ‘‘working drawings’’ and inserting in lieu thereof
‘‘construction documents’’.
H. R. 3118—15
TITLE III—HEALTH CARE AND
ADMINISTRATION
Subtitle A—Health Care Sharing and
Administration
SEC. 301. REVISION OF AUTHORITY TO SHARE MEDICAL FACILITIES,
EQUIPMENT, AND INFORMATION.
(a) STATEMENT
OF PURPOSE.—The text of section 8151 is
amended to read as follows:
‘‘It is the purpose of this subchapter to strengthen the medical
programs at Department facilities and improve the quality of health
care provided veterans under this title by authorizing the Secretary
to enter into agreements with health-care providers in order to
share health-care resources with, and receive health-care resources
from, such providers while ensuring no diminution of services to
veterans.’’.
(b) DEFINITIONS.—Section 8152 is amended—
(1) by striking out paragraphs (1), (2), and (3) and inserting
in lieu thereof the following new paragraphs (1) and (2):
‘‘(1) The term ‘health-care resource’ includes hospital care
and medical services (as those terms are defined in section
1701 of this title), any other health-care service, and any health-
care support or administrative resource.
‘‘(2) The term ‘health-care providers’ includes health-care
plans and insurers and any organizations, institutions, or other
entities or individuals who furnish health-care resources.’’; and
(2) by redesignating paragraph (4) as paragraph (3).
(c) AUTHORITY TO SECURE HEALTH-CARE RESOURCES.—Section
8153 is amended as follows:
(1) Subsection (a) is amended—
(A) in paragraph (1)—
(i) by striking out ‘‘certain specialized medical
resources’’ and inserting in lieu thereof ‘‘health-care
resources’’;
(ii) by striking out ‘‘other medical resources’’ and
inserting in lieu thereof ‘‘other health-care resources’’;
and
(iii) by striking out ‘‘of—’’ and all that follows
through ‘‘section 1742(a) of this title’’ and inserting
in lieu thereof ‘‘of health-care resources between
Department health-care facilities and any health-care
provider, or other entity or individual’’;
(B) in paragraph (2), by striking out ‘‘only’’ and all
that follows through ‘‘are not’’ and inserting in lieu thereof
‘‘if such resources are not, or would not be,’’; and
(C) by adding at the end the following:
‘‘(3)(A) If the health-care resource required is a commercial
service, the use of medical equipment or space, or research, and
is to be acquired from an institution affiliated with the Department
in accordance with section 7302 of this title, including medical
practice groups and other entities associated with affiliated institu-
tions, blood banks, organ banks, or research centers, the Secretary
may make arrangements for acquisition of the resource without
H. R. 3118—16
regard to any law or regulation that would otherwise require the
use of competitive procedures for acquiring the resource.
‘‘(B)(i) If the health-care resource required is a commercial
service or the use of medical equipment or space, and is not to
be acquired from an entity described in subparagraph (A), any
procurement of the resource may be conducted without regard to
any law or regulation that would otherwise require the use of
competitive procedures for procuring the resource, but only if the
procurement is conducted in accordance with the simplified proce-
dures prescribed pursuant to clause (ii).
‘‘(ii) The Secretary, in consultation with the Administrator for
Federal Procurement Policy, may prescribe simplified procedures
for the procurement of health-care resources under this subpara-
graph. The Secretary shall publish such procedures for public com-
ment in accordance with section 22 of the Office of Federal Procure-
ment Policy Act (41 U.S.C. 418b). Such procedures shall permit
all responsible sources to submit a bid, proposal, or quotation (as
appropriate) for the resources to be procured and provide for the
consideration by the Department of bids, proposals, or quotations
so submitted.
‘‘(iii) Pending publication of the procedures under clause (ii),
the Secretary shall (except as provided under subparagraph (A))
procure health-care resources referred to in clause (i) in accordance
with all procurement laws and regulations.
‘‘(C) Any procurement of health-care resources other than those
covered by subparagraph (A) or (B) shall be conducted in accordance
with all procurement laws and regulations.
‘‘(D) For any procurement to be conducted on a sole source
basis other than a procurement covered by subparagraph (A), a
written justification shall be prepared that includes the information
and is approved at the levels prescribed in section 303(f) of the
Federal Property and Administrative Services Act of 1949 (41 U.S.C.
253(f)).
‘‘(E) As used in this paragraph, the term ‘commercial service’
means a service that is offered and sold competitively in the
commercial marketplace, is performed under standard commercial
terms and conditions, and is procured using firm-fixed price con-
tracts.’’.
(2) Subsection (b) is amended by striking out ‘‘reciprocal
reimbursement’’ in the first sentence and all that follows
through the period at the end of that sentence and inserting
in lieu thereof ‘‘payment to the Department in accordance with
procedures that provide appropriate flexibility to negotiate pay-
ment which is in the best interest of the Government.’’.
(3) Subsection (d) is amended by striking out ‘‘preclude
such payment, in accordance with—’’ and all that follows
through ‘‘to such facility therefor’’ and inserting in lieu thereof
‘‘preclude such payment to such facility for such care or serv-
ices’’.
(4) Such section is further amended—
(A) by redesignating subsection (e) as subsection
(g); and
(B) by inserting after subsection (d) the following new
subsections:
‘‘(e) The Secretary may make an arrangement that authorizes
the furnishing of services by the Secretary under this section to
individuals who are not veterans only if the Secretary determines—
H. R. 3118—17
‘‘(1) that veterans will receive priority under such an
arrangement; and
‘‘(2) that such an arrangement—
‘‘(A) is necessary to maintain an acceptable level and
quality of service to veterans at that facility; or
‘‘(B) will result in the improvement of services to
eligible veterans at that facility.
‘‘(f) Any amount received by the Secretary from a non-Federal
entity as payment for services provided by the Secretary during
a prior fiscal year under an agreement entered into under this
section may be obligated by the Secretary during the fiscal year
in which the Secretary receives the payment.’’.
(d) CLERICAL AMENDMENTS.—(1) The heading of section 8153
is amended to read as follows:
‘‘§ 8153. Sharing of health-care resources’’.
(2) The item relating to section 8153 in the table of sections
at the beginning of chapter 81 is amended to read as follows:
‘‘8153. Sharing of health-care resources.’’.
SEC. 302. IMPROVED EFFICIENCY IN HEALTH CARE RESOURCE
MANAGEMENT.
(a) TEMPORARY EXPANSION OF AUTHORITY FOR SHARING AGREE-
MENTS.—Section 201 of the Veterans Health Care Act of 1992
(Public Law 102–585; 38 U.S.C. 8111 note) is amended—
(1) by inserting ‘‘(a) AUTHORITY.—’’ before ‘‘The Secretary
of Veterans Affairs’’; and
(2) by adding at the end thereof the following new sub-
section:
‘‘(b) USE OF FUNDS.—Any amount received by the Secretary
from a non-Federal entity as payment for services provided by
the Secretary during a prior fiscal year under an agreement entered
into under this section may be obligated by the Secretary during
the fiscal year in which the Secretary receives the payment.’’.
(b) REPEAL OF SUNSET PROVISION.—(1) Section 204 of such
Act (38 U.S.C. 8111 note) is repealed.
(2) Any services provided pursuant to agreements entered into
under section 201 of such Act (38 U.S.C. 8111 note) during the
period beginning on October 1, 1996, and ending on the date of
the enactment of this Act are hereby ratified.
(c) COST RECOVERY.—Title II of such Act is further amended
by adding at the end the following new section:
‘‘SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.
‘‘(a) RIGHT TO RECOVER.—In the case of a primary beneficiary
(as described in section 201(a)(2)(B)) who has coverage under a
health-plan contract, as defined in section 1729(i)(1)(A) of title
38, United States Code, and who is furnished care or services
by a Department medical facility pursuant to this title, the United
States shall have the right to recover or collect charges for such
care or services from such health-plan contract to the extent that
the beneficiary (or the provider of the care or services) would
be eligible to receive payment for such care or services from such
health-plan contract if the care or services had not been furnished
by a department or agency of the United States. Any funds received
from such health-plan contract shall be credited to funds that
have been allotted to the facility that furnished the care or services.
H. R. 3118—18
‘‘(b) ENFORCEMENT.—The right of the United States to recover
under such a beneficiary’s health-plan contract shall be enforceable
in the same manner as that provided by subsections (a)(3), (b),
(c)(1), (d), (f), (h), and (i) of section 1729 of title 38, United States
Code.’’.
SEC. 303. PERSONNEL FURNISHING SHARED RESOURCES.
Section 712(b)(2) is amended—
(1) by striking out ‘‘the sum of—’’ and inserting in lieu
thereof ‘‘the sum of the following:’’;
(2) by capitalizing the first letter of the first word of each
of subparagraphs (A) and (B);
(3) by striking out ‘‘; and’’ at the end of subparagraph
(A) and inserting in lieu thereof a period; and
(4) by adding at the end the following new subparagraph:
‘‘(C) The number of such positions in the Department
during that fiscal year held by persons involved in provid-
ing health-care resources under section 8111 or 8153 of
this title or under section 201 of the Veterans Health
Care Act of 1992 (Public Law 102–585; 106 Stat. 4949;
38 U.S.C. 8111 note).’’.
SEC. 304. WAITING PERIOD FOR ADMINISTRATIVE REORGANIZATIONS.
Section 510(b) is amended—
(1) in the second sentence, by striking out ‘‘a 90-day period
of continuous session of Congress following the date of the
submission of the report’’ and inserting in lieu thereof ‘‘a 45-
day period following the date of the submission of the report,
not less than 30 days of which shall be days during which
Congress shall have been in continuous session’’; and
(2) in the third sentence, by striking out ‘‘such 90-day
period’’ and inserting in lieu thereof ‘‘any period of continuity
of session’’.
SEC. 305. REPEAL OF LIMITATIONS ON CONTRACTS FOR CONVERSION
OF PERFORMANCE OF ACTIVITIES OF DEPARTMENT
HEALTH-CARE 
FACILITIES 
AND 
REVISED 
ANNUAL
REPORTING REQUIREMENT.
Subsection (c) of section 8110 is amended to read as follows:
‘‘(c) The Secretary shall include in the materials submitted
to Congress each year in support of the budget of the Department
for the next fiscal year a report on activities and proposals involving
contracting for performance by contractor personnel of work pre-
viously performed by Department employees. The report shall—
‘‘(1) identify those specific activities that are currently per-
formed at a Department facility by more than 10 Department
employees which the Secretary proposes to study for possible
contracting involving conversion from performance by Depart-
ment employees to performance by employees of a contractor;
and
‘‘(2) identify those specific activities that have been con-
tracted for performance by contractor employees during the
prior fiscal year (shown by location, subject, scope of contracts,
and savings) and shall describe the effect of such contracts
on the quality of delivery of health services during such year.’’.