IIA
103D CONGRESS
1ST SESSION
H. R. 2034
IN THE SENATE OF THE UNITED STATES
MAY 19 (legislative day, APRIL 19), 1993
Received; read twice and referred to the Committee on Veterans’ Affairs
AN ACT
To amend title 38, United States Code, 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,
SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38,
UNITED STATES CODE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Veterans’ Health Programs Amendments of 1993’’.
(b) 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 provi-
sion, the reference shall be considered to be made to a
section or other provision of title 38, United States Code.
(c) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; references to title 38, United States Code; table of contents.
TITLE I—HEALTH CARE PLANNING AND PROGRAMS
Sec. 101. Health care facilities missions.
Sec. 102. Pilot program for noninstitutional alternatives to nursing home care.
TITLE II—MEDICAL FACILITIES ACQUISITION
Sec. 201. Major construction projects authorization.
Sec. 202. Revision to prospectus requirements.
Sec. 203. Prioritization methodology.
Sec. 204. Assessment of need for nursing home beds in Chesapeake network
area.
TITLE III—ADMINISTRATION
Sec. 301. Authority for expedited reorganization of medical facilities in event of
a life-threatening emergency.
Sec. 302. Clarification of contracting limitation.
TITLE IV—STATE HOME PROGRAM
Sec. 401. Per diem for adult day health care.
Sec. 402. Construction assistance program.
Sec. 403. Sharing of resources with State homes.
TITLE V—MISCELLANEOUS
Sec. 501. Department of Veterans Affairs research advisory committees.
Sec. 502. Limitation on claims for copayments.
Sec. 503. Child care services.
TITLE I—HEALTH CARE
PLANNING AND PROGRAMS
SEC. 101. 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
(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. 102. PILOT PROGRAM FOR NONINSTITUTIONAL AL-
TERNATIVES TO NURSING HOME CARE.
(a) EXTENSION
OF PROGRAM.—Subsection (a) of
section 1720C is amended by striking out ‘‘During the
four-year period beginning on October 1, 1990,’’ and in-
serting in lieu thereof ‘‘During the period through Sep-
tember 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) PROGRAM FUNDING.—Such section is further
amended by adding at the end the following new sub-
section:
‘‘(f) The Secretary shall carry out the pilot program
under this section using funds available for the community
nursing home program under section 1720 of this title.’’.
(d) 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,’’.
TITLE II—MEDICAL FACILITIES
ACQUISITION
SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY
PROJECTS AND MAJOR MEDICAL FACILITY
LEASES.
(a) AUTHORIZATION OF PROJECTS AND LEASES IN
BUDGET.—Except as provided in subsection (b), the Sec-
retary of Veterans Affairs may carry out the major medi-
cal facility projects for the Department of Veterans Af-
fairs, and may carry out the major medical facility leases
for that Department, for which funds are requested in the
budget of the President for fiscal year 1994.
(b) NONAUTHORIZED PROJECTS.—The Secretary is
not authorized to carry out the project for which funds
are requested in the budget of the President for fiscal year
1994 for the construction of a nursing home facility in
Baltimore, Maryland.
(c) AUTHORIZATION OF DESIGN FOR CERTAIN FU-
TURE PROJECTS.—In addition to the projects authorized
in subsection (a), the Secretary may carry out design of
the following major medical facility projects, in the
amounts specified:
(1) Construction of an outpatient care addition
at the Department of Veterans Affairs Medical Cen-
ter in San Juan, Puerto Rico, $3,970,000.
(2) Construction of a spinal cord injury unit
and energy center at the Department of Veterans
Affairs 
Medical 
Center 
in 
Tampa, 
Florida,
$4,490,000.
(3) Construction of an outpatient care addition
at the Department of Veterans Affairs Medical
Center in West Haven, Connecticut, $4,860,000.
(d) AUTHORIZATION OF APPROPRIATIONS.—There is
hereby authorized to be appropriated to the Secretary of
Veterans Affairs for fiscal year 1994—
(1) $110,420,000 for the major medical facility
projects authorized in subsections (a) and (c); and
(2) $50,123,105 for the major medical facility
leases authorized in subsection (a).
(e) LIMITATION.—The projects authorized in sub-
sections (a) and (c) may only be carried out using—
(1) funds appropriated for fiscal year 1994 pur-
suant to the authorization of appropriations in sub-
section (d);
(2) funds appropriated for Construction, Major
Projects for a fiscal year before fiscal year 1994 that
remain available for obligation; and
(3) funds appropriated for Construction, Major
Projects for fiscal year 1994 for a category of activ-
ity not specific to a project.
SEC. 202. REVISION TO PROSPECTUS REQUIREMENTS.
(a) ADDITIONAL INFORMATION.—Section 8104(b) 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-
effectiveness 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. 203. 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. 204. ASSESSMENT OF NEED FOR NURSING HOME BEDS
IN CHESAPEAKE NETWORK AREA.
(a) ASSESSMENT.—The Secretary of Veterans Affairs
shall conduct an assessment of the need for nursing home
beds operated by the Secretary in the area (referred to
as the ‘‘Chesapeake network’’) served by the Department
of Veterans Affairs medical centers in Baltimore, Mary-
land; Fort Howard, Maryland; Martinsburg, West Vir-
ginia; Perry Point, Maryland; and Washington, D.C.
(b) MATTERS
TO
BE
DETERMINED
BY
SEC-
RETARY.—In conducting the assessment, the Secretary
shall determine—
(1) what the specific mission of each medical
center operated by the Secretary in the Chesapeake
network should be to achieve the purposes identified
in section 101;
(2) whether there is a need for expansion and
modernization of the nursing home care unit at the
medical center at Fort Howard, Maryland; and
(3) what effect the construction of nursing
home beds in Baltimore, Maryland, as proposed in
the President’s budget for the Department of Veter-
ans Affairs for fiscal year 1994, would have for the
missions of each of the other medical centers oper-
ated by the Secretary in the Chesapeake network.
(c) REPORT ON ASSESSMENT.—Not later than 90
days after the date of the enactment of this Act, the Sec-
retary shall submit to the Committees on Veterans’ Affairs
of the Senate and House of Representatives a report on
the assessment under subsection (a). The Secretary shall
include in the report a statement of each determination
made by the Secretary under subsection (b).
TITLE III—ADMINISTRATION
SEC. 301. AUTHORITY FOR EXPEDITED REORGANIZATION
OF MEDICAL FACILITIES IN EVENT OF A LIFE-
THREATENING EMERGENCY.
Section 510 is amended—
(1) by redesignating subsections (e) and (f) as
subsections (f) and (g), respectively; and
(2) by inserting after subsection (d) the follow-
ing new subsection (e):
‘‘(e)(1) The limitation in subsection (b) does not
apply with respect to an administrative reorganization at
a medical facility if the Secretary determines that the reor-
ganization is necessary to respond to an emergency situa-
tion at that facility.
‘‘(2) The Secretary may determine that there is an
emergency situation at a medical facility for purposes of
paragraph (1) only if the Secretary determines (A) that
circumstances at the facility are such that patients and
employees at the facility face imminent danger because of
conditions at the facility that are permanent in nature,
and (B) that those conditions are not susceptible to repair
or that it is not feasible to repair those conditions.
‘‘(3) For purposes of this subsection, an emergency
situation may not be considered to exist in anticipation
of, but before the occurrence of an event giving rise to
any consideration of an administrative reorganization.
‘‘(4) Whenever the Secretary determines under para-
graph (1) that it is necessary to carry out an administra-
tive reorganization at a medical facility without regard to
the limitation in subsection (b), the Secretary shall
promptly submit to the Committees on Veterans’ Affairs
of the Senate and House of Representatives a report de-
scribing the administrative reorganization. The report
shall provide the same information as is provided in a de-
tailed plan and justification under subsection (g)(2). The
Secretary shall include in the report an explanation of
each alternative to the proposed administrative reorga-
nization that was considered and each factor that was con-
sidered in the decision to reject each such alternative.’’.
SEC. 302. CLARIFICATION OF CONTRACTING LIMITATION.
Section 8110(c)(3) is amended—
(1) by striking out ‘‘or’’ at the end of subpara-
graph (A);
(2) by redesignating subparagraph (B) as sub-
paragraph (C) and in that subparagraph striking
out ‘‘section 213 or 4117’’ and inserting in lieu
thereof ‘‘section 7409’’; and
(3) by inserting after subparagraph (A) the fol-
lowing new subparagraph (B):
‘‘(B) to a contract under section 513 of this
title if the Under Secretary for Health certifies to
the Secretary in writing, before the contract is en-
tered into, that the contract is necessary in order to
provide services to eligible veterans at a Department
health-care facility that could not otherwise be pro-
vided at such facility; or’’.
TITLE IV—STATE HOME
PROGRAM
SEC. 401. PER DIEM FOR ADULT DAY HEALTH CARE.
(a) IN GENERAL.—Subsection (a) of section 1741 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, $11.79 for each day.
‘‘(B) For nursing home care and hospital care,
$27.61 for each day.
‘‘(C) For adult day health care, $16.50 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, 1993.
SEC. 402. CONSTRUCTION ASSISTANCE PROGRAM.
(a) IN GENERAL.—Subchapter III of chapter 81 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 ‘‘or
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 ‘‘or
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 chapter 81 is amended to read as follows:
‘‘SUBCHAPTER III—STATE HOME FACILITIES FOR FURNISHING
DOMICILIARY 
CARE, 
NURSING 
HOME 
CARE, 
ADULT 
DAY
HEALTH CARE, AND HOSPITAL CARE’’.
(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
enactment of this Act.
SEC. 403. SHARING OF RESOURCES WITH STATE HOMES.
(a) PURPOSE.—Section 8151 is amended by adding
at the end the following: ‘‘It is further the purpose of this
subchapter to improve the provision of care to veterans
under this title by authorizing the Secretary to enter into
agreements with State veterans facilities for the sharing
of health-care resources.’’.
(b) DEFINITION.—Section 8152 is amended—
(1) by redesignating paragraph (3) as para-
graph (4); and
(2) by inserting after paragraph (2) the follow-
ing new paragraph (3):
‘‘(3) The term ‘health-care resource’ includes
hospital care, medical services, and rehabilitative
services, as those terms are defined in paragraphs
(5), (6), and (8), respectively, of section 1701 of this
title, any other health-care service, and any health-
care support or administrative resource.’’.
(c) SHARING OF HEALTH-CARE RESOURCES.—Sec-
tion 8153(a) is amended—
(1) by inserting ‘‘(1)’’ after ‘‘(a)’’; and
(2) by striking out ‘‘other form of agreement,’’
and all that follows and inserting in lieu thereof
‘‘other form of agreement for the mutual use, or ex-
change of use, of—
‘‘(A) specialized medical resources between De-
partment health-care facilities and other health-care
facilities (including organ banks, blood banks, or
similar institutions), research centers, or medical
schools; and
‘‘(B) health-care resources between Department
health-care facilities and State home facilities recog-
nized under section 1742(a) of this title.
‘‘(2) The Secretary may execute a contract or other
agreement under paragraph (1) only if (A) such an agree-
ment will obviate the need for a similar resource to be
provided in a Department health care facility, or (B) the
Department resources which are the subject of the agree-
ment and which have been justified on the basis of
veterans’ care are not used to their maximum effective
capacity.’’.
TITLE V—MISCELLANEOUS
SEC. 501. DEPARTMENT OF VETERANS AFFAIRS RESEARCH
ADVISORY COMMITTEES.
(a) STATUTORY BASIS
FOR RESEARCH ADVISORY
COMMITTEES.—Chapter 5 is amended by adding at the
end of subchapter III the following new section:
‘‘§ 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.
‘‘(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.
‘‘(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 chapter 5 is amended by inserting
after the item relating to section 543 the following new
item:
‘‘544. Veterans research advisory committees.’’.
SEC. 502. LIMITATION ON CLAIMS FOR COPAYMENTS.
(a) HOSPITAL CARE AND NURSING HOME CARE.—
Section 1710(f) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(6) A veteran may not be required to make a pay-
ment under this subsection for any day of care if the Sec-
retary does not notify the veteran in writing of the amount
owed for that care before the end of the two-year period
beginning on the date on which the care is provided, unless
the reason the Secretary did not notify the veteran within
such period was due to reliance by the Secretary on infor-
mation furnished by the veteran to the Secretary which
was subsequently determined to be erroneous.’’.