I
103D CONGRESS
1ST SESSION
H. R. 1463
To amend title 38, United States Code, to implement recommendations made
by the Commission on the Future Structure of Veterans Health Care.
IN THE HOUSE OF REPRESENTATIVES
MARCH 24, 1993
Mr. MONTGOMERY (by request) introduced the following bill; which was
referred to the Committee on Veterans’ Affairs
A BILL
To amend title 38, United States Code, to implement rec-
ommendations made by the Commission on the Future
Structure of Veterans Health Care.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Veterans Health-Care
Reform Act of 1993’’.
SEC. 2. RESTRUCTURING OF VETERANS HEALTH CARE.
Chapter 17 of title 38, United States Code, is amend-
ed as follows:
(1) The heading for subchapter I is amended to
read as follows:
‘‘SUBCHAPTER I—HEALTH CARE AND HEALTH-
CARE RELATED BENEFITS’’;
(2) The heading for subchapter II is repealed.
(3) Subchapters III, IV, V, and VI, are redesig-
nated as subchapters II, III, IV, and V, respectively.
(4) The heading of subchapter II, as so redesig-
nated, is amended to read as follows:
‘‘SUBCHAPTER 
II—MISCELLANEOUS 
PROVI-
SIONS RELATING TO HEALTH CARE AND
HEALTH-CARE RELATED BENEFITS’’.
(5) Sections 1701, 1703, 1710, 1712, 1717,
1719, 1720, 1720B, 1720C, 1722, 1722A, and sub-
chapter VII are repealed.
(6)(A) Section 1702 is transferred to sub-
chapter II, as so redesignated, inserted after section
1721, and redesignated as section 1722.
(B) Sections 1711, 1712A, and 1712B are re-
designated as sections 1704, 1705, and 1706, re-
spectively.
(C) Section 1720A is transferred to appear
after section 1706, as so redesignated, and is redes-
ignated as section 1707.
(D) Section 1720D is transferred to appear
after 1707, as so transferred and redesignated, and
is redesignated as section 1708.
(E) Sections 1713, 1714, 1715, 1716, and
1718 are redesignated as sections 1709, 1710, 1711,
1712, and 1713, respectively.
(7) Subchapter I is further amended by insert-
ing after the subchapter heading (as amended by
paragraph (1)) the following new sections:
‘‘§ 1701. Eligibility for health-care benefits
‘‘(a) The Secretary shall provide such care as the Sec-
retary determines is needed for any disability of a veteran
who meets any of the following conditions:
‘‘(1) The veteran has a service-connected dis-
ability.
‘‘(2) The annual attributable income of the vet-
eran does not exceed the amount established under
subsection (b).
‘‘(3) The discharge or release of the veteran
from the active military, naval, or air service was for
a disability incurred or aggravated in line of duty.
‘‘(4) The veteran is in receipt of, or but for a
suspension pursuant to section 1151 of this title (or
both such suspension and the receipt of retired pay),
would be entitled to disability compensation, but
only to the extent that such veteran’s continuing eli-
gibility for such care is provided for in the judgment
or settlement described in such section.
‘‘(3) The term ‘corpus of the estate of the veteran’
includes the corpus of the estates of the veteran’s spouse
and dependent children, if any.
‘‘(d)(1) The term ‘attributable income’ means the in-
come of a veteran for the previous calendar year deter-
mined in the same manner as the manner in which a de-
termination is made of the total amount of income by
which the rate of pension of such veteran under section
1521 of this title would be reduced if such veteran were
eligible for pension under that section.
‘‘(2) Notwithstanding paragraph (1), the current pro-
jections of a veteran’s income for the current year shall
be considered the attributable income if the projected in-
come is substantially below the amount determined under
paragraph (1).
‘‘(e) The Secretary, under such regulations as the
Secretary shall prescribe, may provide such care and such
health-related benefits under section 1702 of this title, as
the Secretary determines are needed for any disability of
any veteran who does not meet any of the conditions listed
in subsection (a). In prescribing regulations to carry out
this subsection, the Secretary may provide for payments
at rates prescribed by the Secretary.
‘‘(f) The term ‘disability’ means a disease, injury, or
other physical or mental defect.
‘‘§ 1702. Eligibility for health-related benefits
‘‘(a) The Secretary shall provide any veteran eligible
for care under section 1701 of this title with the following:
‘‘(1) Such preventive health care services as the
Secretary determines are efficacious.
‘‘(2) Social support services, including personal
care and homemaker services, if needed to enable
the veteran to reside in the home, or another
noninstitutional setting, while receiving care under
section 1701 of this title.
‘‘(3) The opportunity to receive hospital or
nursing home care of limited duration on an inter-
mittent basis for the purpose of helping a veteran
who is suffering from a chronic illness to continue
residing primarily at home.
‘‘(4) Hospice care services in such cases as the
Secretary determines to be clinically appropriate.
‘‘(5) Wheelchairs, artificial limbs, and other
prosthetic devices, and such medical and rehabilita-
tive devices, equipment, and supplies as the Sec-
retary determines to be medically indicated.
‘‘(6) Improvements and structural alterations to
the veteran’s home if necessary to assure the con-
tinuation of care under section 1701 of this title or
to provide access to the home or to essential lavatory
and sanitary facilities.
‘‘(b) The cost of improvements and structural alter-
ations (or the amount of reimbursement therefor) under
subsection (a)(6) may not exceed $4,100 in the case of
veterans eligible for care under paragraphs (1), (3), and
(4) of section 1701(a) of this title, or $1,200 in the case
of veterans eligible for care under paragraph (2) of section
1701(a) of this title.
‘‘(c) The Secretary shall provide any person (includ-
ing family members of a veteran or others residing in the
same household as the veteran) with (1) counseling, train-
ing in the provision of care, or any other service needed
for the effective provision of care to the veteran under sec-
tion 1701 of this title, and (2) bereavement counseling in
connection with the death of a veteran who had been re-
ceiving care under section 1701 or section 1702(a)(4) of
this title at the time of the death of such veteran.
‘‘(d) The Secretary may contract for services author-
ized pursuant to this section.
‘‘§ 1703. Contracts for care
‘‘(a) The Secretary shall contract for needed care for
veterans eligible for care under section 1701 of this title
when Department facilities are geographically inaccessible,
lack sufficient capacity, or are otherwise not capable of
furnishing needed care.
‘‘(b) No veteran may be transferred or admitted to
any institution for nursing home care under this chapter,
unless such institution is determined by the Secretary to
meet such standards as the Secretary may prescribe. The
standards prescribed and any report of inspection of insti-
tutions furnishing care to veterans under this section
made by or for the Secretary shall, to the extent possible,
be made available to all Federal, State, and local agencies
charged with the responsibility of licensing or otherwise
regulating or inspecting such institutions.
‘‘(c) In applying the provisions of section 2(b)(1) of
the Service Contract Act of 1965 (41 U.S.C. 351(b)(1))
with respect to any contract entered into under this sec-
tion to provide nursing home care of veterans, the pay-
ment of wages not less than those specified in section 6(b)
of the Fair Labor Standards Act of 1938 (29 U.S.C.
206(b)) shall be deemed to constitute compliance with
such provisions.
‘‘(d) In arranging to provide adult day health care
and other health-related services in noninstitutional set-
tings under section 1702 of this title, the Secretary may
provide in-kind assistance (through the services of Depart-
ment employees and the sharing of other Department re-
sources) to a facility furnishing such services to veterans
under this chapter. Any such in-kind assistance shall be
provided under a contract between the Secretary and the
facility concerned. The Secretary may provide such assist-
ance only for use solely in the furnishing of adult day
health care or other health-related services and only if,
under such contract, the Department receives reimburse-
ment for the full cost of such assistance, including the cost
of services and supplies and normal depreciation and am-
ortization of equipment. Such reimbursement may be
made by reduction in the charges to the United States
or by payment to the United States. Any funds received
through such reimbursement shall be credited to funds al-
lotted to the Department facility that provided the assist-
ance.’’.
(8) Section 1705 (as redesignated by paragraph
(6)) is amended—
(A) in subsection (b)—
(i) by striking out ‘‘under the condi-
tions specified in section 1712(a)(5)(B) of
this title’’ in paragraph (1) and inserting
in lieu thereof ‘‘for a period not in excess
of 12 months unless the Secretary deter-
mines that a longer period is required by
reason of the disability being treated’’; and
(ii) by striking out ‘‘and expenses as
are described in section 1701(6)(B) of this
title’’ in paragraph (2) and inserting in
lieu thereof ‘‘and beneficiary travel ex-
penses under section 111 of this title, for
the members of the immediate family or
legal guardian of a veteran, or the individ-
ual in whose household such veteran cer-
tifies an intention to live’’; and
(B) in subsection (e)(1), by striking out
‘‘sections 1712(a)(1)(B) and 1703(a)(2)’’ and
inserting in lieu thereof ‘‘section 1703’’.
(9) Section 1707 (as transferred and redesig-
nated by paragraph (6)) is amended—
(A) by striking out subsections (e) and (g);
and
(B) by redesignating subsection (f) as sub-
section (e).
(10)(A) The heading of section 1709 (as redes-
ignated by paragraph (6)) is amended to read as
follows:
‘‘§ 1709. Use of prosthetic appliances; aids for the
blind and hearing-impaired’’.
(B) Such section is amended by adding at the
end the following:
‘‘(c) The Secretary may repair or replace any artifi-
cial limb, truss, brace, hearing aid, spectacles, or similar
appliance (not including dental appliances) reasonably
necessary to a veteran and belonging to such veteran
which was damaged or destroyed by a fall or other acci-
dent.
‘‘(d) The Secretary may furnish devices for assisting
in overcoming the handicap of deafness (including
telecaptioning television decoders) to any veteran who is
profoundly deaf and is entitled to compensation on ac-
count of hearing impairment.’’.
(11) Section 1712 (as redesignated by para-
graph (6)) is amended by striking out subsection (e)
and redesignating subsection (f) as subsection (e).
(12) Section 1721 is amended—
(A) in the first sentence, by striking out
‘‘hospital, nursing home, and domiciliary care
and medical services’’ and inserting in lieu
thereof ‘‘care’’; and
(B) in the second sentence, by striking out
‘‘and services’’.
(13) Section 1724(d) is amended to read as
follows:
‘‘(d)(1) Subject to paragraph (2), the Secretary may
contract for nursing home care for any veteran who has
been furnished hospital care in the Philippines pursuant
SEC. 4. RECOVERY OF COST OF PROVIDING CARE.
Section 1729 of title 38, United States Code, is
amended as follows:
(1) The heading of such section is amended by
striking out ‘‘by the United States’’.
(2) Subsections (a) and (b) are amended by
striking out ‘‘United States’’ each place it appears
and inserting in lieu thereof ‘‘Secretary’’.
(3) Subsection (a)(1) is amended—
(A) by striking out ‘‘Subject’’ and insert-
ing in lieu thereof ‘‘Notwithstanding any other
provision of this title or any other law but sub-
ject’’;
(B) by inserting ‘‘such care or services, or
receive’’ before ‘‘payment’’; and
(C) by striking out ‘‘a department or agen-
cy of the United States’’ and inserting in lieu
thereof ‘‘the Secretary’’.
(4) Subsection (a)(2) is amended—
(A) by inserting ‘‘or’’ at the end of sub-
paragraph (A);
(B) by striking out ‘‘, or’’ at the end of
subparagraph (D)(ii) and inserting in lieu
thereof a period; and
(C) by striking out subparagraph (E).
(5) Subsection (b)(2) is amended—
(A) in subparagraph (A), by inserting
‘‘other than a Federal agency’’ before the pe-
riod; and
(B) in subparagraph (B), by striking out
‘‘against’’ and inserting in lieu thereof ‘‘against
a non-Federal’’.
(6)(A) Subsection (g)(3) is amended—
(i) by redesignating subparagraphs (A)
and (B) as subparagraphs (B) and (C), respec-
tively; and
(ii) by inserting before subparagraph (B),
as so redesignated, the following new subpara-
graph:
‘‘(A) Reimbursement for the cost of care or
services furnished under this chapter.’’; and
(B) by striking out paragraph (4).
(7) Subsection (i)(1) is amended—
(A) in subparagraph (A), by striking out
‘‘or similar arrangement,’’ and inserting in lieu
thereof ‘‘similar arrangement, or eligibility
under a Federal program or the Federal portion
of a program of any State or political subdivi-
sion of any State’’; and
(B) in subparagraph (B), by striking out
clauses (i) and (ii) and redesignating clauses
(iii) and (iv) as clauses (i) and (ii), respectively.
(8) Subsection (i)(3) is amended—
(A) by redesignating subparagraphs (A),
(B), (C), and (D), as subparagraphs (B), (C),
(D), and (E), respectively; and
(B) by inserting before subparagraph (B),
as so redesignated, the following new subpara-
graph:
‘‘(A) an agency or instrumentality of the
United States;’’.
SEC. 5. STATE HOMES.
(a) CRITERIA FOR PAYMENT.—(1) Subsection (c) of
section 1741 of title 38, United States Code, is amended
by striking out ‘‘sections 1710 and 1720’’ and inserting
in lieu thereof ‘‘section 1701’’.
(2) Subsection (d) of such section is amended to read
as follows:
‘‘(d) The Secretary shall periodically determine the
cost of care furnished in a general hospital under the di-
rect jurisdiction of the Secretary, and if that cost has in-
creased, the Secretary may increase the rates paid under
subsection (a) by a percentage not greater than the per-
centage of the increase in the cost of the care furnished
in the general hospital.’’.
(b) STANDARDS FOR STATE HOMES.—Section 1742
of such title is amended by striking out ‘‘, which stand-
ards’’ and all that follows through ‘‘of this title’’.
SEC. 6. CONFORMING AMENDMENT.
The table of sections at the beginning of chapter 17
of title 38, United States Code, is amended to read as
follows:
‘‘SUBCHAPTER I—HEALTH CARE AND HEALTH-CARE RELATED BENEFITS
‘‘Sec.
‘‘1701. Eligibility for health-care benefits.
‘‘1702. Eligibility for health-related benefits.
‘‘1703. Contracts for care.
‘‘1704. Care during examinations and in emergencies.
‘‘1705. Eligibility for readjustment counseling and related mental health serv-
ices.
‘‘1706. Counseling for former prisoners of war.
‘‘1707. Treatment and rehabilitation for alcohol or drug dependence or abuse
disabilities.
‘‘1708. Counseling to women veterans for sexual trauma.
‘‘1709. Medical care for survivors and dependents of certain veterans.
‘‘1710. Use of prosthetic appliances; aids for the blind and hearing-impaired.
‘‘1711. Tobacco for hospitalized veterans.
‘‘1712. Hospital care by other agencies of the United States.
‘‘1713. Therapeutic and rehabilitative activities.
‘‘SUBCHAPTER II—MISCELLANEOUS PROVISIONS RELATING TO HEALTH CARE
AND HEALTH-CARE RELATED BENEFITS
‘‘1721. Power to make rules and regulations.
‘‘1722. Presumption relating to psychosis.
‘‘1723. Furnishing of clothing.
‘‘1724. Hospital care, medical services, and nursing home care abroad.
‘‘1726. Reimbursement for loss of personal effects by natural disaster.
‘‘1727. Persons eligible under prior law.
‘‘1728. Reimbursement of certain medical expenses.
‘‘1729. Recovery of the cost of certain care and services.
‘‘1730. Community residential care.
‘‘SUBCHAPTER III—HOSPITAL CARE AND MEDICAL TREATMENT FOR VETERANS
IN THE REPUBLIC OF THE PHILIPPINES
‘‘1731. Assistance to the Republic of the Philippines.
‘‘1732. Contracts and grants to provide for the care and treatment of United
States veterans by the Veterans Memorial Medical Center.
‘‘1733. Supervision of program by the President.
‘‘1734. Hospital and nursing home care and medical services in the United
States.
‘‘1735. Definitions.
‘‘SUBCHAPTER IV—PAYMENTS TO STATE HOMES
‘‘1741. Criteria for payment.
‘‘1742. Inspections of such homes; restrictions on beneficiaries.
‘‘1743. Applications.
‘‘SUBCHAPTER VI—SICKLE CELL ANEMIA
‘‘1751. Screening, counseling, and medical treatment.
‘‘1752. Research.
‘‘1753. Voluntary participation; confidentiality.
‘‘1754. Reports.’’.
Æ
HR 1463 IH——2