I
104TH CONGRESS
1ST SESSION
H. R. 1468
To amend title 38, United States Code, to revise and improve veterans’
health care programs, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
APRIL 7, 1995
Mr. EDWARDS (for himself and Mr. MONTGOMERY) introduced the following
bill; which was referred to the Committee on Veterans’ Affairs
A BILL
To amend title 38, United States Code, to revise and improve
veterans’ health care 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; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Veterans Health Improvements Act of 1995’’.
(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—WOMEN VETERANS HEALTH IMPROVEMENTS
Sec. 101. Short title.
Sec. 102. Health care services for women.
Sec. 103. Women’s health services.
Sec. 104. Mammography quality standards.
Sec. 105. Coordinators of women’s services.
Sec. 106. Patient privacy for women patients.
TITLE II—CARE FOR VETERANS EXPOSED TO TOXIC
SUBSTANCES
Sec. 201. Authority to provide priority health care.
Sec. 202. Savings provision.
TITLE III—READJUSTMENT SERVICES
Sec. 301. Scope of services provided in vet centers.
Sec. 302. Advisory committee on the readjustment of veterans.
TITLE IV—SERVICES FOR MENTALLY ILL VETERANS
Sec. 401. Authority to establish nonprofit corporations.
Sec. 402. Extension of demonstration program.
Sec. 403. Department committee on care of severely chronically mentally ill vet-
erans.
Sec. 404. Centers for mental illness research, education, and clinical activities.
Sec. 405. Codification and extension of authority for community-based residen-
tial care for homeless chronically mentally ill veterans and
other veterans.
TITLE V—CONSTRUCTION PLANNING
Sec. 501. Strategic planning.
Sec. 502. Revision to prospectus requirements.
Sec. 503. Annual compilation of construction priorities.
Sec. 504. Definition of major medical facility project.
TITLE VI—GENERAL HEALTH ADMINISTRATION
Subtitle A—Health Care Administration
Sec. 601. Overnight lodging in Department facilities when necessary for out-
patient care.
Sec. 602. Pilot program for noninstitutional alternatives to nursing home care.
Sec. 603. Drug and alcohol abuse and dependence.
Sec. 604. Per diem for adult day health care.
Sec. 605. State home construction assistance program.
Subtitle B—Personnel Administration
Sec. 611. Limitation on reduction in full-time equivalent positions.
Sec. 612. Permanent authority for waiver of reduction of retirement pay for
registered-nurse positions.
Sec. 613. Staffing flexibility.
Sec. 614. Protection against certain prohibited personnel practices.
Sec. 615. Extension of Health Scholarship Program.
Subtitle C—Health Care Resource Agreements
Sec. 621. Repeal of termination of authority for expanded sharing arrange-
ments.
Sec. 622. Acquisition of health care resources.
Sec. 623. Sharing agreements for specialized medical resources.
Subtitle D—Miscellaneous
Sec. 631. Department of Veterans Affairs research advisory committees.
Sec. 632. Technical amendments.
Sec. 633. Submittal date for report on annual analysis of departmentwide ad-
missions policies.
Sec. 634. Child care services.
Sec. 635. Contracts for utilities, Audie L. Murphy Memorial Hospital.
Sec. 636. Authority to enter into agreement for use of property at Edward
Hines, Jr., Department of Veterans Affairs Hospital.
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 provi-
sion, the reference shall be considered to be made to a
section or other provision of title 38, United States Code.
TITLE I—WOMEN VETERANS
HEALTH IMPROVEMENTS
SEC. 101. SHORT TITLE.
This title may be cited as the ‘‘Women Veterans
Health Improvements Act of 1995’’.
SEC. 102. HEALTH CARE SERVICES FOR WOMEN.
(a) ENSURED PROVISION OF SERVICES.—The Sec-
retary of Veterans Affairs shall ensure that each health-
care facility under the direct jurisdiction of the Secretary
is able, through services made available either by individ-
uals appointed to positions in the Veterans Health Admin-
istration or under contracts or other agreements made
under section 7409, 8111, or 8152 of title 38, United
States Code, or title II of Public Law 102–585, to provide
in a timely and appropriate manner women’s health serv-
ices (as defined in section 1701(10) of title 38, United
States Code (as added by section 103)) to any veteran
described in section 1710(a)(1) of title 38, United States
Code, who is eligible for such services.
(b) HEALTH CARE SERVICES TO BE PROVIDED DI-
RECTLY WHEN COST EFFECTIVE.—(1) The Secretary
shall ensure that each health-care facility under the direct
jurisdiction of the Secretary shall provide women’s health
services directly (rather than by contract or other agree-
ment) when it is cost effective to do so.
(2) The Secretary shall ensure that each such facility
is provided appropriate equipment, treatment facilities,
and staff to carry out paragraph (1) and to ensure that
the quality of care provided under that paragraph is in
accordance with professional standards.
(c) CONFORMING REPEAL.—Section 302 of the Vet-
erans’ Health Care Amendments of 1983 (Public Law 98–
160; 97 Stat. 1004; 38 U.S.C. 1701 note) is repealed.
SEC. 103. WOMEN’S HEALTH SERVICES.
(a) WOMEN’S HEALTH SERVICES.—Section 1701 is
amended—
(1) in paragraph (6)(A)(i), by inserting ‘‘wom-
en’s health services,’’ after ‘‘preventive health serv-
ices,’’; and
(2) by adding at the end the following:
‘‘(10) The term ‘women’s health services’ means—
‘‘(A) health care services to prevent diseases
specific to women, including—
‘‘(i) papanicolaou tests (pap smears); and
‘‘(ii) breast examinations and mammog-
raphy;
‘‘(B) health care services to treat disabilities
specific to women, including management and treat-
ment of osteoporosis;
‘‘(C) health care services for management of
menopause;
‘‘(D) health care services for the management
and prevention of sexually-transmitted diseases in
women;
‘‘(F) counseling and treatment of women for
physical or psychological conditions arising out of
acts of sexual violence;
‘‘(G) early detection, management, and treat-
ment for cardiac disease, in the case of women who
are determined to be at risk of cardiac disease; and
‘‘(H) health care authorized by paragraph (3)
of section 106(a) of Public Law 102–585 (38 U.S.C.
1710 note), subject to the limitations in that para-
graph.’’.
(b) EXTENSION
OF ANNUAL REPORT REQUIRE-
MENT.—Section 107(a) of the Veterans Health Care Act
of 1992 (Public Law 102–585; 38 U.S.C. 1710 note) is
amended by striking out ‘‘Not later than January 1, 1993,
January 1, 1994, and January 1, 1995’’ and inserting in
lieu thereof ‘‘Not later than January 1 of 1993 and each
year thereafter through 1998’’.
(c) REPORT ON HEALTH CARE AND RESEARCH.—
Section 107(b) of such Act is amended—
(1) in paragraph (1), by striking out ‘‘services
described in section 106 of this Act’’ and inserting
in lieu thereof ‘‘women’s health services (as such
term is defined in section 1701(10) of title 38, Unit-
ed States Code)’’;
(2) in paragraph (2)(A), by inserting ‘‘(includ-
ing information on the number of inpatient stays
and the number of outpatient visits through which
such services were provided)’’ after ‘‘facility’’; and
(3) by adding at the end the following new
paragraph:
‘‘(5) A description of the actions taken by the
Secretary to foster and encourage the expansion of
such research.’’.
SEC. 104. MAMMOGRAPHY QUALITY STANDARDS.
(a) IN GENERAL.—(1) Subchapter II of chapter 73
is amended by adding at the end the following new section:
‘‘§ 7319. Mammography quality standards
‘‘(a) A mammogram may not be performed at a De-
partment facility unless that facility is accredited for that
purpose by a private nonprofit organization designated by
the Secretary. An organization designated by the Sec-
retary under this subsection shall meet the standards for
accrediting bodies established under section 354(e) of the
Public Health Service Act (42 U.S.C. 263b(e)).
‘‘(b) The Secretary, in consultation with the Sec-
retary of Health and Human Services, shall prescribe
quality assurance and quality control standards relating
to the performance and interpretation of mammograms
and use of mammogram equipment and facilities of the
Department of Veterans Affairs consistent with the re-
quirements of section 354(f)(1) of the Public Health Serv-
ice Act. Such standards shall be no less stringent than
the standards prescribed by the Secretary of Health and
Human Services under section 354(f) of the Public Health
Service Act.
‘‘(c)(1) The Secretary, to ensure compliance with the
standards prescribed under subsection (b), shall provide
for an annual inspection of the equipment and facilities
used by and in Department health care facilities for the
performance of mammograms. Such inspections shall be
carried out in a manner consistent with the inspection of
certified facilities by the Secretary of Health and Human
Services under section 354(g) of the Public Health Service
Act.
‘‘(2) The Secretary may not provide for an inspection
under paragraph (1) to be performed by a State agency.
‘‘(d) The Secretary shall ensure that mammograms
performed for the Department under contract with any
non-Department facility or provider conform to the quality
standards prescribed by the Secretary of Health and
Human Services under section 354 of the Public Health
Service Act.
‘‘(e) For the purposes of this section, the term ‘mam-
mogram’ has the meaning given such term in paragraph
(5) of section 354(a) of the Public Health Service Act (42
U.S.C. 263b(a)).’’.
(2) The table of sections at the beginning of such
chapter is amended by inserting after the item relating
to section 7318 the following new item:
‘‘7319. Mammography quality standards.’’.
(b) DEADLINE FOR PRESCRIBING STANDARDS.—The
Secretary of Veterans Affairs shall prescribe standards
under subsection (b) of section 7319 of title 38, United
States Code, as added by subsection (a), not later than
the end of the 120-day period beginning on the later of—
(1) the date on which the Secretary of Health
and Human Services prescribes quality standards
under section 354(f) of the Public Health Service
Act (42 U.S.C. 263b(f)); or
(2) the date of the enactment of this Act.
(c) TRANSITION.—(1) Subsection (a) of section 7319
of title 38, United States Code, as added by subsection
(a), shall take effect on the date on which standards are
prescribed by the Secretary of Veterans Affairs under sub-
section (b) of that section.
(2) During the transition period, the Secretary of
Veterans Affairs may waive the requirement of subsection
(a) of section 7319 of title 38, United States Code, as
added by subsection (a), to any facility of the Department.
The Secretary may provide such a waiver in the case of
any facility only if the Secretary determines, based upon
the recommendation of the Under Secretary for Health
of the Department of Veterans Affairs, that during the
period such a waiver is in effect for such facility (including
any extension of the waiver under paragraph (3)) the facil-
ity will be operated in accordance with standards pre-
scribed by the Secretary under subsection (b) of such sec-
tion to assure the safety and accuracy of mammography
services provided.
(3) The transition period for purposes of this section
is the six-month period beginning on the date specified in
paragraph (1). The Secretary may extend such period for
a period not to exceed 90 days in the case of any Depart-
ment facility. Any such extension may be made only if the
Under Secretary for Health determines that—
(A) without the extension access of veterans to
mammography services in the geographic area
served by the facility would be significantly reduced;
and
(B) appropriate steps will be taken before the
end of the transition period (as extended) to obtain
accreditation of the facility as required by subsection
(a) of section 7319 of title 38, United States Code,
as added by subsection (a).
(d) IMPLEMENTATION REPORT.—The Secretary of
Veterans Affairs shall submit to the Committees on Veter-
ans’ Affairs of the Senate and House of Representatives
a report on the Secretary’s implementation of section
7319 of title 38, United States Code, as added by sub-
section (a). The report shall be submitted not later than
120 days after the date on which the Secretary prescribes
the quality standards required under subsection (b) of that
section.
SEC. 105. COORDINATORS OF WOMEN’S SERVICES.
(a) FULL-TIME STATUS.—Section 108 of the Veter-
ans Health Care Act of 1992 (Public Law 102–585; 106
Stat. 4948; 38 U.S.C. 1710 note) is amended—
(1) by inserting ‘‘(a)’’ before ‘‘The Secretary’’;
and
(2) by adding at the end the following:
‘‘(b) Each official who serves in the position of coordi-
nator of women’s services under subsection (a) shall serve
in such position on a full-time basis.’’.
(b) SUPPORT FOR WOMEN’S SERVICES COORDINA-
TORS.—The Secretary of Veterans Affairs shall take ap-
propriate actions to ensure—
(1) that sufficient funding is provided to each
Department of Veterans Affairs facility in order to
permit the coordinator of women’s services assigned
to that facility to carry out the responsibilities of the
coordinator at the facility; and
(2) that each such coordinator has direct access
to the Director or Chief of Staff of the facility to
which the coordinator is assigned.
SEC. 106. PATIENT PRIVACY FOR WOMEN PATIENTS.
(a) IDENTIFICATION OF DEFICIENCIES.—The Sec-
retary of Veterans Affairs shall conduct a survey of each
medical center under the jurisdiction of the Secretary to
identify deficiencies relating to patient privacy afforded to
women patients in the clinical areas at each such center
which may interfere with appropriate treatment of such
patients.
(b) CORRECTION OF DEFICIENCIES.—The Secretary
shall ensure that plans and, where appropriate, interim
steps, to correct the deficiencies identified in the survey
conducted under subsection (a) are developed and are in-
corporated into the Department’s construction planning
processes and given a high priority.
(c) REPORTS TO CONGRESS.—The Secretary shall
compile an annual inventory, by medical center, of defi-
ciencies identified under subsection (a) and of plans and,
where appropriate, interim steps, to correct such defi-
ciencies. The Secretary shall submit to the Committees on
Veterans’ Affairs of the Senate and House of Representa-
tives, not later than October 1, 1995, and not later than
October 1 each year thereafter through 1997 a report on
such deficiencies. The Secretary shall include in such re-
port the inventory compiled by the Secretary, the proposed
corrective plans, and the status of such plans.
TITLE II—CARE FOR VETERANS
EXPOSED 
TO 
TOXIC 
SUB-
STANCES
SEC. 201. AUTHORITY TO PROVIDE PRIORITY HEALTH
CARE.
(a) 
AUTHORIZED
INPATIENT
CARE.—Section
1710(e) of title 38, United States Code, is amended to
read as follows:
‘‘(e)(1)(A) Subject to paragraph (2), a herbicide-ex-
posed veteran is eligible for hospital care and nursing
home care under subsection (a)(1)(G) for any disease
specified in subparagraph (B).
‘‘(B) The diseases referred to in subparagraph (A)
are those 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—
‘‘(i) that there is sufficient evidence to conclude
that there is a positive association between occur-
rence of the disease in humans and exposure to a
herbicide agent;
‘‘(ii) that there is evidence which is suggestive
of an association between occurrence of the disease
in humans and exposure to a herbicide agent, but
such evidence is limited in nature; or
‘‘(iii) that available studies are insufficient to
permit a conclusion about the presence or absence of
an association between occurrence of the disease in
humans and exposure to a herbicide agent.
‘‘(C) A radiation-exposed veteran is eligible for hos-
pital care and nursing home care under subsection
(a)(1)(G) for—
‘‘(i) any disease listed in section 1112(c)(2) of
this title; and
‘‘(ii) any other disease for which the Secretary,
based on the advice of the Advisory Committee on
Environmental Hazards, determines that there is
credible evidence of a positive association between
occurrence of the disease in humans and exposure to
ionizing radiation.
‘‘(D) Subject to paragraph (2), a veteran who the
Secretary finds may have been exposed while serving on
active duty in the Southwest Asia theater of operations
during the Persian Gulf War to a toxic substance or envi-
ronmental hazard is eligible for hospital care and nursing
home care under subsection (a)(1)(G) of this section for
any disability which becomes manifest before October 1,
1996, notwithstanding that there is insufficient medical
evidence to conclude that such disability may be associated
with such exposure.
‘‘(2) Hospital and nursing home care may not be pro-
vided under or by virtue of paragraph (1)(A) after Decem-
ber 31, 1996, and may not be provided under or by virtue
of paragraph (1)(D) after December 31, 1998.
‘‘(3) For purposes of this subsection and section
1712 of this title—
‘‘(A) the term ‘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 a herbicide agent;
‘‘(B) the term ‘herbicide agent’ has the mean-
ing given that term in section 1116(a)(4) of this
title; and
‘‘(C) the term ‘radiation-exposed veteran’ has
the meaning given that term in section 1112(c)(4) of
this title.’’.
(b) AUTHORIZED OUTPATIENT CARE.—Section 1712
of such title is amended—
(1) in subsection (a)(1)—
(A) by striking out ‘‘and’’ at the end of
subparagraph (C);
(B) in subparagraph (D)—
(i) by striking out ‘‘December 31,
1995’’ and inserting in lieu thereof ‘‘De-
cember 31, 1998’’; and
(ii) by striking out the period at the
end and inserting in lieu thereof a semi-
colon; and
(C) by adding at the end the following:
‘‘(E) during the period before January 1,
1997, to any herbicide-exposed veteran for any
disease listed in section 1710(e)(1)(B) of this
title; and
‘‘(F) to any radiation-exposed veteran for
any 
disease 
covered 
under 
section
1710(e)(1)(C) of this title.’’; and
(2) in subsection (i)(3)—
(A) by striking out ‘‘(A)’’; and
(B) by striking out ‘‘, or (B)’’ and all that
follows through ‘‘title’’.
SEC. 202. SAVINGS PROVISION.
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.
TITLE III—READJUSTMENT
SERVICES
SEC. 301. SCOPE OF SERVICES PROVIDED IN VET CENTERS.
(a) EXPANSION
OF SERVICES.—Section 1712A is
amended—
(1) in subsection (a)(1) by inserting ‘‘and, to
the extent otherwise authorized by law, may furnish
such additional needed services as described in sub-
section (i)’’ in the first sentence after ‘‘life’’;
(2) by redesignating subsection (i) as subsection
(j); and
(3) by inserting after subsection (g) the follow-
ing new subsections:
‘‘(h) The Secretary may, to the extent resources and
facilities are available, furnish to any veteran who served
in combat during World War II or the Korean conflict
counseling in a center to assist such veteran in overcoming
the effects of the veteran’s combat experience.
‘‘(i) In operating centers under this section, the Sec-
retary may provide (1) preventive health care services, (2)
medical services reasonably necessary in preparation for
hospital admission or to complete treatment furnished
under section 1710 or 1712(a) of this title, and (3) refer-
ral services to assist in obtaining specialized care. The
Secretary shall provide such services through such health
care personnel as the Secretary determines appropriate.’’.
(b) REPORT.—Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans’ Af-
fairs of the Senate and House of Representatives a report
relating to the implementation of the amendments made
by subsection (a). The report shall include the following:
(1) The number of veterans provided services
described in section 1712A(i) of title 38, United
States Code, as added by subsection (a).
(2) The number of centers which provided serv-
ices described in that section.
(3) An assessment of the effect providing such
services has had on access to and timeliness of serv-
ice delivery, both for veterans to whom services de-
scribed in that section were provided and for other
veterans.
SEC. 302. ADVISORY COMMITTEE ON THE READJUSTMENT
OF VETERANS.
(a) IN GENERAL.—(1) Subchapter III of chapter 5
is amended by adding at the end the following new section:
‘‘§ 545. Advisory Committee on Veterans Readjust-
ment Counseling
‘‘(a)(1) There is in the Department the Advisory
Committee on Veterans Readjustment Counseling (herein-
after in this section referred to as the ‘Committee’).
‘‘(2) The members of the Committee shall be ap-
pointed by the Secretary and shall include individuals who
are recognized authorities in fields pertinent to the social,
psychological, economic, or educational readjustment of
veterans. At least two-thirds of the members of the Com-
mittee shall be veterans of the Vietnam era or other period
of war. Appointments of members of the Committee shall
be made from among individuals who have experience with
the provision of veterans benefits and services by the De-
partment or who are otherwise familiar with programs of
the Department.
‘‘(3) The Secretary shall seek to ensure that members
appointed to the Committee include persons from a wide
variety of geographic areas, persons from veterans service
organizations, minorities, and women.
‘‘(4) The Secretary shall determine the terms of serv-
ice and pay and allowances of the members of the Commit-
tee, except that a term of service may not exceed two
years. The Secretary may reappoint any member for addi-
tional terms of service.
‘‘(b)(1) The Secretary shall, on a regular basis, con-
sult with and seek the advice of the Committee with re-
spect to the provision by the Department of benefits and
services to veterans in order to assist veterans in the read-
justment to civilian life.
‘‘(2) In providing advice to the Secretary under this
subsection, the Committee shall—
‘‘(A) assemble and review information relating
to the needs of veterans in readjusting to civilian
life;
‘‘(B) provide information relating to the nature
and character of psychological problems arising from
military service;
‘‘(C) provide an on-going assessment of the ef-
fectiveness of the policies, organizational structures,
and services of the Department in assisting veterans
in readjusting to civilian life; and
‘‘(D) provide on-going advice on the most ap-
propriate means of responding to the readjustment
needs of future veterans.
‘‘(3) In carrying out its duties under paragraph (2),
the Committee shall take into special account veterans of
the Vietnam era and the readjustment needs of those vet-
erans.
‘‘(c)(1) Not later than March 31 of each year, the
Committee shall submit to the Secretary a report on the
programs and activities of the Department that relate to
the readjustment of veterans to civilian life. Each such
report shall include—
‘‘(A) an assessment of the needs of veterans
with respect to readjustment to civilian life;
‘‘(B) a review of the programs and activities of
the Department designed to meet such needs; and
‘‘(C) such recommendations (including rec-
ommendations for administrative and legislative ac-
tion) as the Committee considers appropriate.
‘‘(2) Not later than 90 days after the receipt of each
report under paragraph (1), the Secretary shall transmit
to the Committees on Veterans’ Affairs of the Senate and
House of Representatives a copy of the report, together
with any comments and recommendations concerning the
report that the Secretary considers appropriate.
‘‘(3) The Committee may also submit to the Sec-
retary such other reports and recommendations as the
Committee considers appropriate.
‘‘(4) The Secretary shall submit with each annual re-
port submitted to the Congress pursuant to section 529
of this title a summary of all reports and recommendations
of the Committee submitted to the Secretary since the pre-
vious annual report of the Secretary submitted pursuant
to that section.’’.
(2) The table of sections at the beginning of chapter
5 is amended by adding at the end the following new item:
‘‘545. Advisory Committee on Veterans Readjustment Counseling.’’.
(b) ORIGINAL MEMBERS.—(1) Notwithstanding sub-
section (a)(2) of section 545 of title 38, United States
Code (as added by subsection (a)), the members of the
Advisory Committee on the Readjustment of Vietnam and
Other War Veterans on the date of the enactment of this
Act shall be the original members of the advisory commit-
tee established under that section.
(2) The original members shall so serve until the Sec-
retary of Veterans Affairs carries out appointments under
such subsection (a)(2). The Secretary shall carry out such
appointments as soon as is practicable. The Secretary may
make such appointments from among such original mem-
bers.
TITLE IV—SERVICES FOR
MENTALLY ILL VETERANS
SEC. 401. AUTHORITY TO ESTABLISH NONPROFIT COR-
PORATIONS.
(a) IN GENERAL.—Chapter 17 is amended by insert-
ing after section 1718 the following new section:
‘‘§ 1718A. Nonprofit corporations
‘‘(a) The Secretary may authorize the establishment
at any Veterans Health Administration facility of a non-
profit corporation (1) to arrange for therapeutic work for
patients of such facility or patients of other such Depart-
ment facilities pursuant to section 1718(b) of this title,
and (2) to provide a funding mechanism to achieve the
purposes of section 1718 of this title.
‘‘(b) The Secretary shall provide for the appointment
of a board of directors for any corporation established
under this section and shall determine the number of di-
rectors and the composition of the board of directors. The
board of directors shall include—
‘‘(1) the director of the facility and other offi-
cials or employees of the facility; and
‘‘(2) members appointed from among individ-
uals who are not officers or employees of the De-
partment.
‘‘(c) Each such corporation shall have an executive
director who shall be appointed by the board of directors
with concurrence of the Under Secretary for Health. The
executive director of a corporation shall be responsible for
the operations of the corporation and shall have such spe-
cific duties and responsibilities as the board may pre-
scribe.
‘‘(3) Any funds received by a corporation established
under this section through arrangements authorized under
subsection (d)(2) may be transferred to the fund estab-
lished under section 1718(c) of this title.
‘‘(f) A corporation established under this section shall
be established in accordance with the nonprofit corpora-
tion laws of the State in which the applicable medical facil-
ity is located and shall, to the extent not inconsistent with
Federal law, be subject to the laws of such State.
‘‘(g)(1)(A) The records of a corporation established
under this section shall be available to the Secretary.
‘‘(B) For the purposes of sections 4(a)(1) and 6(a)(1)
of the Inspector General Act of 1978, the programs and
operations of such a corporation shall be considered to be
programs and operations of the Department with respect
to which the Inspector General of the Department has re-
sponsibilities under such Act.
‘‘(2) Such a corporation shall be considered an agen-
cy for the purposes of section 716 of title 31 (relating to
availability of information and inspection of records by the
Comptroller General).
‘‘(3) Each such corporation shall submit to the Sec-
retary an annual report providing a detailed statement of
its operations, activities, and accomplishments during that
year. The corporation shall obtain a report of independent
auditors concerning the receipts and expenditures of funds
by the corporation during that year and shall include that
report in the corporation’s report to the Secretary for that
year.
‘‘(4) Each member of the board of directors of a cor-
poration established under this section, each employee of
such corporation, and each employee of the Department
who is involved in the functions of the corporation during
any year shall—
‘‘(A) be subject to Federal laws and regulations
applicable to Federal employees with respect to con-
flicts of interest in the performance of official func-
tions; and
‘‘(B) submit to the Secretary an annual state-
ment signed by the director or employee certifying
that the director or employee is aware of, and has
complied with, such laws and regulations in the
same manner as Federal employees are required to.
‘‘(h) The Secretary shall submit to the Committees
on Veterans’ Affairs of the Senate and House of Rep-
resentatives an annual report on the number and location
of corporations established and the amount of the con-
tributions made to each such corporation.
‘‘(i) No corporation may be established under this
section after September 30, 1999.
‘‘(j) If by the end of the four-year period beginning
on the date of the establishment of a corporation under
this section the corporation is not recognized as an entity
the income of which is exempt from taxation under the
Internal Revenue Code of 1986, the Secretary shall dis-
solve the corporation.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of such chapter is amended by inserting
after the item relating to section 1718 the following new
item:
‘‘1718A. Nonprofit corporations.’’.
SEC. 402. EXTENSION OF DEMONSTRATION PROGRAM.
Section 7(a) of Public Law 102–54 (105 Stat. 269;
38 U.S.C. 1718 note) is amended by striking out ‘‘1995’’
and inserting in lieu thereof ‘‘1998’’.
SEC. 403. DEPARTMENT COMMITTEE ON CARE OF SE-
VERELY CHRONICALLY MENTALLY ILL VET-
ERANS.
(a) ESTABLISHMENT.—Subchapter II of chapter 73
is amended by adding after section 7320, as added by sec-
tion 304(c), the following new section:
‘‘§ 7321. Committee on Care of Severely Chronically
Mentally Ill Veterans
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting
through the Under Secretary for Health, shall establish
in the Veterans Health Administration a Committee on
Care of Severely Chronically Mentally Ill Veterans. The
Under Secretary shall appoint employees of the Depart-
ment with expertise in the care of the chronically mentally
ill to serve on the committee.
‘‘(b) DUTIES.—The committee shall assess, and carry
out a continuing assessment of, the capability of the Vet-
erans Health Administration to meet effectively the treat-
ment and rehabilitation needs of mentally ill veterans
whose mental illness is severe and chronic and who are
eligible for health care furnished by the Department. In
carrying out that responsibility, the committee shall—
‘‘(1) evaluate the care provided to such veterans
through the Veterans Health Administration;
‘‘(2) identify systemwide problems in caring for
such veterans in facilities of the Veterans Health
Administration;
‘‘(3) identify specific facilities within the Veter-
ans Health Administration at which program enrich-
ment is needed to improve treatment and rehabilita-
tion of such veterans; and
‘‘(4) identify model programs which the com-
mittee considers to have been successful in the treat-
ment and rehabilitation of such veterans and which
should be implemented more widely in or through fa-
cilities of the Veterans Health Administration.
‘‘(c) ADVICE AND RECOMMENDATIONS.—The com-
mittee shall—
‘‘(1) advise the Under Secretary regarding the
development of policies for the care and rehabilita-
tion of severely chronically mentally ill veterans; and
‘‘(2) make recommendations to the Under Sec-
retary—
‘‘(A) for improving programs of care of
such veterans at specific facilities and through-
out the Veterans Health Administration;
‘‘(B) for establishing special programs of
education and training relevant to the care of
such veterans for employees of the Veterans
Health Administration;
‘‘(C) regarding research needs and prior-
ities relevant to the care of such veterans; and
‘‘(D) regarding the appropriate allocation
of resources for all such activities.
‘‘(d) ANNUAL REPORT.—(1) Not later than April 1,
1996, the Secretary shall submit to the Committees on
Veterans’ Affairs of the Senate and House of Representa-
tives a report on the implementation of this section. The
report shall include the following:
‘‘(A) A list of the members of the committee.
‘‘(B) The assessment of the Under Secretary
for Health, after review of the initial findings of the
committee, regarding the capability of the Veterans
Health Administration, on a systemwide and facility-
by-facility basis, to meet effectively the treatment
and rehabilitation needs of severely chronically men-
tally ill veterans who are eligible for Department
care.
‘‘(C) The plans of the committee for further as-
sessments.
‘‘(D) The findings and recommendations made
by the committee to the Under Secretary for Health
and the views of the Under Secretary on such find-
ings and recommendations.
‘‘(E) A description of the steps taken, plans
made (and a timetable for their execution), and re-
sources to be applied toward improving the capabil-
ity of the Veterans Health Administration to meet
effectively the treatment and rehabilitation needs of
severely chronically mentally ill veterans who are eli-
gible for Department care.
‘‘(2) Not later than February 1, 1997, and February
1 of each of the three following years, the Secretary shall
submit to the Committees on Veterans’ Affairs of the Sen-
ate and House of Representatives a report containing in-
formation updating the reports submitted under this sub-
section before the submission of such report.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of chapter 73 is amended by inserting
after the item relating to section 7320, as added by section
304(b), the following new item:
‘‘7321. Committee on Care of Severely Chronically Mentally Ill Veterans.’’.
SEC. 404. CENTERS FOR MENTAL ILLNESS RESEARCH, EDU-
CATION, AND CLINICAL ACTIVITIES.
(a) IN GENERAL.—(1) Subchapter II of chapter 73
is amended by adding after section 7321, as added by sec-
tion 403(a), the following new section:
‘‘§ 7322. Centers for mental illness research, edu-
cation, and clinical activities
‘‘(a) The purpose of this section is to provide for the
improvement of the provision of health-care services and
related counseling services to eligible veterans suffering
from mental illness (especially mental illness related to
service-related conditions) through—
‘‘(1) the conduct of research (including research
on improving mental health service facilities of the
Department and on improving the delivery of mental
health services by the Department);
‘‘(2) the education and training of health care
personnel of the Department; and
Secretary may designate a center under this section only
if—
‘‘(A) the proposal submitted for the designation
of the center meets the requirements of subsection
(c);
‘‘(B) the Secretary makes the finding described
in subsection (d); and
‘‘(C) the peer review panel established under
subsection (e) makes the determination specified in
subsection (e)(3) with respect to that proposal.
‘‘(3) Not more than five centers may be designated
under this section.
‘‘(4) The authority of the Secretary to establish and
operate centers under this section is subject to the appro-
priation of funds for that purpose.
‘‘(c) A proposal submitted for the designation of a
center under this section shall—
‘‘(1) provide for close collaboration in the estab-
lishment and operation of the center, and for the
provision of care and the conduct of research and
education at the center, by a Department facility or
facilities in the same geographic area which have a
mission centered on care of the mentally ill and a
Department facility in that area which has a mission
of providing tertiary medical care;
‘‘(2) provide that no less than 50 percent of the
funds appropriated for the center for support of clin-
ical care, research, and education will be provided to
the collaborating facility or facilities that have a
mission centered on care of the mentally ill; and
‘‘(3) provide for a governance arrangement be-
tween the collaborating Department facilities which
ensures that the center will be established and oper-
ated in a manner aimed at improving the quality of
mental health care at the collaborating facility or fa-
cilities which have a mission centered on care of the
mentally ill.
‘‘(d) The finding referred to in subsection (b)(2)(B)
with respect to a proposal for designation of a site as a
location of a center under this section is a finding by the
Secretary, upon the recommendation of the Under Sec-
retary for Health, that the facilities submitting the pro-
posal have developed (or may reasonably be anticipated
to develop) each of the following:
‘‘(1) An arrangement with an accredited medi-
cal school that provides education and training in
psychiatry and with which one or more of the par-
ticipating Department facilities is affiliated under
which medical residents receive education and train-
ing in psychiatry through regular rotation through
the participating Department facilities so as to pro-
vide such residents with training in the diagnosis
and treatment of mental illness.
‘‘(2) An arrangement with an accredited grad-
uate school of psychology under which students re-
ceive education and training in clinical, counseling,
or professional psychology through regular rotation
through the participating Department facilities so as
to provide such students with training in the diag-
nosis and treatment of mental illness.
‘‘(3) An arrangement under which nursing, so-
cial work, or allied health personnel receive training
and education in mental health care through regular
rotation through the participating Department facili-
ties.
‘‘(4) The ability to attract scientists who have
demonstrated achievement in research—
‘‘(A) into the evaluation of innovative ap-
proaches to the design of mental health serv-
ices; or
‘‘(B) into the causes, prevention, and
treatment of mental illness.
‘‘(5) The capability to evaluate effectively the
activities of the center, including activities relating
to the evaluation of specific efforts to improve the
quality and effectiveness of mental health services
provided by the Department at or through individual
facilities.
‘‘(e)(1) In order to provide advice to assist the Sec-
retary and the Under Secretary for Health to carry out
their responsibilities under this section, the official within
the central office of the Veterans Health Administration
responsible for mental health and behavioral sciences mat-
ters shall establish a peer review panel to assess the sci-
entific and clinical merit of proposals that are submitted
to the Secretary for the designation of centers under this
section.
‘‘(2) The panel shall consist of experts in the fields
of mental health research, education and training, and
clinical care. Members of the panel shall serve as consult-
ants to the Department.
‘‘(3) The panel shall review each proposal submitted
to the panel by the official referred to in paragraph (1)
and shall submit to that official its views on the relative
scientific and clinical merit of each such proposal. The
panel shall specifically determine with respect to each such
proposal whether that proposal is among those proposals
which have met the highest competitive standards of sci-
entific and clinical merit.
‘‘(4) The panel shall not be subject to the Federal
Advisory Committee Act (5 U.S.C. App.).
‘‘(f) Clinical and scientific investigation activities at
each center established under this section—
‘‘(1) may compete for the award of funding
from amounts appropriated for the Department of
Veterans Affairs medical and prosthetics research
account; and
‘‘(2) shall receive priority in the award of fund-
ing from such account insofar as funds are awarded
to projects and activities relating to mental illness.
‘‘(g) The Under Secretary for Health shall ensure
that at least three centers designated under this section
emphasize research into means of improving the quality
of care for veterans suffering from mental illness through
the development of community-based alternatives to insti-
tutional treatment for such illness.
‘‘(h) The Under Secretary for Health shall ensure
that information produced by the research, education and
training, and clinical activities of centers established under
this section that may be useful for other activities of the
Veterans Health Administration is disseminated through-
out the Veterans Health Administration. Such dissemina-
tion shall be made through publications, through pro-
grams of continuing medical and related education pro-
vided through regional medical education centers under
subchapter VI of chapter 74 of this title, and through
other means. Such programs of continuing medical edu-
cation shall receive priority in the award of funding.
‘‘(i) The official within the central office of the Veter-
ans Health Administration responsible for mental health
and behavioral sciences matters shall be responsible for
supervising the operation of the centers established pursu-
ant to this section and shall provide for ongoing evaluation
of the centers and their compliance with the requirements
of this section.
‘‘(j)(1) There are authorized to be appropriated to
the Department of Veterans Affairs for the basic support
of the research and education and training activities of
centers established pursuant to this section amounts as
follows:
‘‘(A) $3,125,000 for fiscal year 1997.
‘‘(B) $6,250,000 for each of fiscal years 1998
through 2000.
‘‘(2) In addition to funds appropriated for a fiscal
year pursuant to the authorization of appropriations in
paragraph (1), the Under Secretary for Health shall allo-
cate to such centers from other funds appropriated for
that fiscal year generally for the Department of Veterans
Affairs medical care account and the Department of Vet-
erans Affairs medical and prosthetics research account
such amounts as the Under Secretary for Health deter-
mines appropriate to carry out the purposes of this sec-
tion.’’.
(2) The table of sections at the beginning of chapter
73 is amended by inserting after the item relating to sec-
tion 7321, as added by section 403(b), the following new
item:
‘‘7322. Centers for mental illness research, education, and clinical activities.’’.
(b) ANNUAL REPORTS.—Not later than February 1
of each of 1997, 1998, and 1999, the Secretary of Veter-
ans Affairs shall submit to the Committees on Veterans’
Affairs of the Senate and House of Representatives a re-
port on the status and activities during the previous fiscal
year of the centers for mental illness, research, education,
and clinical activities established pursuant to section 7322
of title 38, United States Code (as added by subsection
(a)). Each such report shall include the following:
(1) A description of the activities carried out at
each center and the funding provided for such activi-
ties.
(2) A description of the advances made at each
of the participating facilities of the center in re-
search, education and training, and clinical activities
relating to mental illness in veterans.
(3) A description of the actions taken by the
Under Secretary for Health pursuant to subsection
(h) of that section (as so added) to disseminate in-
formation derived from such activities throughout
the Veterans Health Administration.
(4) The Secretary’s evaluations of the effective-
ness of the centers in fulfilling the purposes of the
centers.
(c) IMPLEMENTATION.—The Secretary of Veterans
Affairs shall designate at least one center under section
7322 of title 38, United States Code, not later than Janu-
ary 1, 1997.
SEC. 405. CODIFICATION AND EXTENSION OF AUTHORITY
FOR COMMUNITY-BASED RESIDENTIAL CARE
FOR HOMELESS CHRONICALLY MENTALLY
ILL VETERANS AND OTHER VETERANS.
(a) IN GENERAL.—Subchapter II of chapter 17 is
amended by adding at the end the following:
‘‘§ 1720E. Community-based residential care: home-
less chronically mentally ill veterans and
other veterans
‘‘(a)(1) The Secretary may provide to homeless veterans
suffering from chronic mental illness disabilities who are
eligible for care under section 1710(a)(1) of this title care
and treatment and rehabilitative services (directly or by
contract) in—
‘‘(A) halfway houses;
‘‘(B) therapeutic communities;
‘‘(C) psychiatric residential treatment centers;
and
‘‘(D) other community-based treatment facili-
ties.
‘‘(2) In providing care and treatment and rehabilitative
services under paragraph (1), the Secretary may also pro-
vide such care and treatment and rehabilitative services—
‘‘(A) to veterans being furnished hospital or nurs-
ing home care by the Secretary for a chronic mental
illness disability; and
‘‘(B) to veterans with service-connected chronic
mental illness disabilities.
‘‘(b)(1) Before furnishing care and treatment and reha-
bilitative services by contract under subsection (a) to a
veteran through a facility described in subsection (a), the
Secretary shall approve the quality and effectiveness of the
program operated by such facility for the purpose for
which the veteran is to be furnished such care and serv-
ices.
‘‘(2) The Secretary shall prescribe criteria for the ap-
proval under paragraph (1) of the quality and effective-
ness of programs.
‘‘(c)(1) The Secretary may provide in-kind assistance
(through the services of Department employees and the
sharing of other Department resources) to a facility de-
scribed in subsection (a) under this section. The Secretary
shall provide such assistance to a facility under a contract
between the Secretary and the facility.
‘‘(2) The Secretary may provide assistance under
paragraph (1)—
‘‘(A) only for use solely in the furnishing of ap-
propriate care and services under this section; and
‘‘(B) only if, under such contract, the Secretary
receives reimbursement for the full cost of such as-
sistance, including the cost of services and supplies
and normal depreciation and amortization of equip-
ment.
‘‘(3) Reimbursement under paragraph (2)(B) may be
made by reduction in the charges to the United States
or by payment to the United States.
‘‘(4) Any funds received through reimbursement
under paragraph (3) shall be credited to funds allotted to
the Department facility that provided the assistance.
‘‘(d) The Secretary may not provide care and treat-
ment and rehabilitative services under this section after
September 30, 1999.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of such chapter is amended by inserting
after the item relating to section 1720D the following new
item:
‘‘1720E. Community-based residential care: homeless chronically mentally ill vet-
erans and other veterans.’’.
(c) REPEAL OF SUPERSEDED AUTHORITY.—Section
115 of the Veterans’ Benefits and Services Act of 1988
(38 U.S.C. 1712 note) is repealed.
TITLE V—CONSTRUCTION
PLANNING
SEC. 501. STRATEGIC PLANNING.
(a) DEVELOPMENT OF PLAN.—The Secretary of Vet-
erans Affairs shall develop and implement a plan to pro-
mote efficient delivery of health care services and to re-
duce unnecessary duplication of health care resources. The
plan shall provide for delivering health care to veterans
through a coordinated network of facilities operating with-
in prescribed geographic areas. Each such area shall be
referred to as a ‘‘service-delivery area’’.
(b) IMPLEMENTATION OF PLAN.—The Under Sec-
retary for Health shall use the plan to—
(1) determine and prescribe the specific mission
of, and clinical programs to be operated at, each
health care facility of the Department;
(2) determine, with respect to each such serv-
ice-delivery area and each facility in such area, the
extent to which services provided under the auspices
of the Secretary should be provided directly through
facilities of the Department or through contract or
other arrangements, including arrangements author-
ized under sections 8111 and 8153 of title 38, Unit-
ed States Code;
(3) provide for a reduction in duplication of
services and programs within such service-delivery
areas and a realignment of services among facilities
within such areas as necessary to promote efficiency;
(4) 
develop 
medical 
facility 
construction
projects and other capital projects;
(5) carry out such other purposes as the Sec-
retary shall prescribe.
(c) REPORT ON IMPLEMENTATION.—Not later than
12 months 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 re-
port on the implementation of this section. The report
shall—
(1) include the plan established pursuant to
subsection (a);
(2) identify the service-delivery areas described
in such subsection and provide demographic data on
the veteran population in each such service area, in-
cluding projections of the number of veterans who
are likely to avail themselves of Department of Vet-
erans Affairs care in each such area;
(3) identify the specific missions required by
subsection (a)(1) and the projected timetable and
milestones necessary for each facility to carry out its
prescribed mission; and
(4) identify and assess the nature and impact
of such plan, including provision of an analysis of
specific effects nationally and within each service-de-
livery area, on the health-professions education and
training, research, and contingency support func-
tions of the Veterans Health Administration.
SEC. 502. 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 the following:’’;
(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) Current and projected operating costs of
the facility, to include both recurring and non-recur-
ring costs.
‘‘(7) The priority score assigned to the project
under the Department’s prioritization methodology
and, if the project is being proposed for funding
ahead of a project with a higher score, a specific ex-
planation of the factors other than the priority that
were considered and the basis on which the project
is proposed for funding ahead of projects with high-
er priority scores.
‘‘(8) 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. 503. ANNUAL COMPILATION OF CONSTRUCTION PRI-
ORITIES.
Section 8107 is amended—
(1) in subsection (a)(2)—
(A) by inserting ‘‘and’’ at the end of sub-
paragraph (A);
(B) by striking out subparagraph (B); and
(C) by redesignating subparagraph (C) as
subparagraph (B); and
(2) 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 of each year, a report show-
ing 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. 504. CONSTRUCTION AUTHORIZATION.
(a) CONGRESSIONAL APPROVAL OF DESIGN WORK.—
Paragraph (2) of section 8104(a) is amended by striking
out ‘‘and design’’.
(b) DEFINITION
OF MAJOR MEDICAL FACILITY
PROJECT.—Paragraph (3)(A) of such section 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 ambulatory care, such term means
a project involving a total expenditure of more than
$5,000,000’’.
TITLE VI—GENERAL HEALTH
ADMINISTRATION
Subtitle A—Health Care
Administration
SEC. 601. OVERNIGHT LODGING IN DEPARTMENT FACILI-
TIES WHEN NECESSARY FOR OUTPATIENT
CARE.
Section 1701(6)(A)(i) is amended by inserting ‘‘over-
night lodging in Department facilities when necessary for
the provision of services on an outpatient basis,’’ after
‘‘prosthetic appliances,’’.
SEC. 602. PILOT PROGRAM FOR NONINSTITUTIONAL AL-
TERNATIVES TO NURSING HOME CARE.
(a) EXTENSION OF PROGRAM.—Section 1720C(a) is
amended by striking out ‘‘September 30, 1995’’ and in-
serting in lieu thereof ‘‘September 30, 1997’’.
(b) REPORT DEADLINES.—Section 201(b) of the De-
partment of Veterans Affairs Nurse Pay Act of 1990
(Public Law 101–366; 38 U.S.C. 1720C note) is
amended—
(1) by striking out ‘‘February 1, 1995,’’ 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,’’.
SEC. 603. DRUG AND ALCOHOL ABUSE AND DEPENDENCE.
Section 1720A(e) is amended by striking out ‘‘De-
cember 31, 1995’’ and inserting in lieu thereof ‘‘December
31, 1997’’.
SEC. 604. 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 amount to be paid under this sub-
section is as follows:
‘‘(A) For domiciliary care, $15.11.
‘‘(B) For nursing home care and hospital care,
$35.37.
‘‘(C) For adult day health care, an amount to
be prescribed by the Secretary, not in excess of the
amount under subparagraph (A).’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply with respect to adult day health
care provided in a State home after the date of the enact-
ment of this Act.
SEC. 605. STATE HOME CONSTRUCTION ASSISTANCE PRO-
GRAM.
(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 such chapter is amended to read as follows:
‘‘SUBCHAPTER
III—STATE
HOME
FACILITIES
FOR
FURNISHING
DOMICILIARY
CARE, NURSING
HOME
CARE, ADULT
DAY
HEALTH
CARE, AND
HOSPITAL
CARE’’.
(c) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply with respect to grants made to
States using funds appropriated after the date of the en-
actment of this Act.
Subtitle B—Personnel
Administration
SEC. 611. LIMITATION ON REDUCTION IN FULL-TIME
EQUIVALENT POSITIONS.
Section 712(b)(2) is amended—
(1) by striking out ‘‘the sum of—’’ and insert-
ing 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 sub-
paragraph (A) and inserting in lieu thereof a period;
and
(4) by adding at the end the following:
‘‘(C) The number of such positions in the De-
partment during that fiscal year held by persons in-
volved in providing medical resources under section
8111 or 8152 of this title, reduced by the number
of persons (as determined by the Secretary) involved
in furnishing medical resources to the Department
under those sections.’’.
SEC. 612. PERMANENT AUTHORITY FOR WAIVER OF REDUC-
TION OF RETIREMENT PAY FOR REGISTERED-
NURSE POSITIONS.
Section 7426(c) is amended by striking out the sec-
ond sentence.
SEC. 613. STAFFING FLEXIBILITY.
(a) AUTHORITY TO CONVERT POSITION TO HYBRID
TITLE 38 PERSONNEL SYSTEM.—Section 7401(3) is
amended by striking out ‘‘and occupational therapists’’
and inserting in lieu thereof ‘‘occupational therapists, and
such other persons in health care occupations as the Sec-
retary considers necessary’’.
(b) CONTRACTING FLEXIBILITY.—(1) Section 7409
is amended by striking out ‘‘scarce’’ in subsections (a) and
(b)(3).
(2)(A) The heading of such section, and the item re-
lating to such section in the table of sections at the begin-
ning of chapter 74, are each amended by striking out the
third word.
SEC. 614. PROTECTION AGAINST CERTAIN PROHIBITED
PERSONNEL PRACTICES.
(a) IN GENERAL.—Subchapter II of chapter 74 is
amended by adding at the end the following:
‘‘§ 7427. Protection from prohibited personnel prac-
tices
‘‘(a)(1) The provisions of law specified in paragraph
(2) apply to any individual appointed as an employee of
the Veterans Health Administration under chapter 73 of
this title or under this chapter.
‘‘(2) The provisions of law referred to in paragraph
(1) are sections 1212, 1213, 1214, 1215, 1216, 1221,
1222, and 2302 of title 5.
‘‘(b) The authority of the Merit Systems Protection
Board and of the Office of Special Counsel to review any
personnel action under the authority provided for under
a provision of law specified in subsection (a)(2) shall apply
only to the extent specified in that provision of law.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of such chapter is amended by inserting
after the item relating to section 7426 the following new
item:
‘‘7427. Protection from prohibited personnel practices.’’.
SEC. 615. EXTENSION OF HEALTH SCHOLARSHIP PROGRAM.
Section 7618 is amended by striking out ‘‘December
31, 1995’’ and inserting in lieu thereof ‘‘December 31,
1998’’.
Subtitle C—Health Care Resource
Agreements
SEC. 621. REPEAL OF TERMINATION OF AUTHORITY FOR
EXPANDED SHARING ARRANGEMENTS.
Section 204 of the Veterans Health Care Act of 1992
(Public Law 102–585; 106 Stat. 4950) is repealed.
SEC. 622. ACQUISITION OF HEALTH CARE RESOURCES.
(a) AUTHORITY IN STATES WITH HEALTH CARE RE-
FORM PLANS.—Section 8123 is amended—
(1) by inserting ‘‘(a)’’ at the beginning of the
text;
(2) by inserting after subsection (a) the follow-
ing:
‘‘(b)(1) The director of a Department health care fa-
cility located in a State that has established a State health
care reform plan may, without regard to section 1703 of
this title, or any other law or regulation pertaining to com-
petitive procedures, acquisition procedures, or policies
(other than contract dispute procedures), or bid protests,
contract with any entity or individual to procure or furnish
any health care resource, as that term is defined in section
8151 of this title. The references in this subsection to laws
or regulations shall not be construed to apply to any provi-
sion of title XVIII or XIX of the Social Security Act.
‘‘(2) A director may contract to furnish services
under this subsection to individuals who are not veterans
only if the director determines that a contract to furnish
such services—
‘‘(A) is necessary to maintain an acceptable
level and quality of service to veterans at that facil-
ity;
‘‘(B) will result in the improvement of services
to eligible veterans at that facility; and
‘‘(C) will not result in the denial of, or a delay
in providing access to, care to any veteran at that
facility.
‘‘(3) In entering into a contract to provide services
under this subsection, the director may provide for pay-
ment to the Department in accordance with procedures
that provide appropriate flexibility to negotiate an appro-
priate rate of reimbursement. Any proceeds to the Govern-
ment received therefrom shall be credited to the applicable
appropriation of the Department and to funds that have
been allotted to the facility that furnished the care or serv-
ices.
‘‘(4) For purposes of this subsection, a State health
care reform plan shall be considered to have been estab-
lished in a State if the Secretary determines that the State
has enacted legislation that is intended, at least in part,
to provide residents of that State who lack, or have inad-
equate, health insurance coverage access to health care
services.
‘‘(c) A provision of law enacted after the date of en-
actment of this subsection shall not be construed as appli-
cable to purchases of prosthetic appliances or health care
resources by the Department unless that provision of law
specifically refers to this section and specifically states
that such provision of law modifies or supersedes this sec-
tion.
‘‘(d) The authority to enter into a contract under
subsection (b) shall expire on September 30, 2000.’’.
(b) CLERICAL AMENDMENTS.—(1) The heading of
section 8123 is amended to read:
‘‘§ 8123. Procurement of prosthetic appliances and
health care resources’’.
(2) The table of sections at the beginning of chapter
81 is amended by striking out the item relating to section
8123 and inserting in lieu thereof the following:
‘‘8123. Procurement of prosthetic appliances and health care resources.’’.
SEC. 623. SHARING AGREEMENTS FOR SPECIALIZED MEDI-
CAL RESOURCES.
(a) REPEAL OF SECTION 8151.—(1) Subchapter IV
of chapter 81 is amended—
(A) by striking out section 8151; and
(B) by redesignating sections 8152, 8153,
8154, 8155, 8156, 8157, and 8158 as sections 8151,
8152, 8153, 8154, 8155, 8156, and 8157, respec-
tively.
(2) The table of sections at the beginning of chapter
81 is amended—
(A) by striking out the item relating to section
8151; and
(B) by revising the items relating to sections
8152, 8153, 8154, 8155, and 8156 to reflect the
redesignations by paragraph (1)(B).
(b) REVISED AUTHORITY
FOR SHARING AGREE-
MENTS.—Section 8152, as redesignated by subsection
(a)(1)(B), is amended—
(1) in subsection (a)—
(A) by striking out ‘‘certain specialized
medical’’ and inserting in lieu thereof ‘‘health
care’’;
(B) by striking out ‘‘clauses (i)’’ and all
that follows through ‘‘medical schools:’’ and in-
serting in lieu thereof ‘‘paragraphs (1) and (2),
between Department health-care facilities and
any medical school, health care provider, health
care plan, insurer, or other entity or individ-
ual:’’;
(C) by striking out ‘‘specialized medical’’
in paragraphs (1) and (2) and inserting in lieu
thereof ‘‘health care’’; and
(D) by striking out ‘‘have been justified on
the basis of veterans’ care, but which are not
utilized’’ in paragraph (2) and inserting in lieu
thereof ‘‘are not, or would not be, used’’;
(2) in subsection (b), by striking out ‘‘reciprocal
reimbursement’’ in the first sentence and all that
follows through the period at the end of that sen-
tence and inserting in lieu thereof ‘‘payment to the
Department in accordance with procedures that pro-
vide appropriate flexibility to negotiate payment
which is in the best interest of the Government.’’;
(3) in subsection (d), by striking out ‘‘preclude
such payment, in accordance with—’’ and all that
follows through ‘‘to such facility therefor’’ and in-
serting in lieu thereof ‘‘preclude such payment to
such facility for such care or services’’;
(4) by redesignating subsection (e) as sub-
section (f); and
(5) by inserting after subsection (d) the follow-
ing new subsection (e):
‘‘(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 that such an arrangment—
‘‘(1) is necessary to maintain an acceptable
level and quality of service to veterans at that facil-
ity;
‘‘(2) will result in the improvement of services
to eligible veterans at that facility; and
‘‘(3) will not result in the denial of, or a delay
in providing access to, care to any veteran at that
facility.’’.
(c) CROSS-REFERENCE AMENDMENTS.—(1) Section
8110(c)(3)(A) is amended by striking out ‘‘8153’’ and in-
serting in lieu thereof ‘‘8152’’.
(2) Subsection (b) of section 8154 (as redesignated
by subsection (a)(1)(B)) is amended by striking out ‘‘sec-
tion 8154’’ and inserting in lieu thereof ‘‘section 8153’’.
(3) Section 8156 (as redesignated by subsection
(a)(1)(B)) is amended—
(A) in subsection (a), by striking out ‘‘section
8153(a)’’ and inserting in lieu thereof ‘‘section
8152(a)’’; and
(B) in subsection (b)(3), by striking out ‘‘sec-
tion 8153’’ and inserting in lieu thereof ‘‘section
8152’’.
(4) Subsection (a) of section 8157 (as redesignated
by subsection (a)(1)(B)) is amended—
(A) in the matter preceding paragraph (1), by
striking out ‘‘section 8157’’ and ‘‘section 8153(a)’’
and inserting in lieu thereof ‘‘section 8156’’ and
‘‘section 8152(a)’’, respectively; and
(B) in paragraph (1), by striking out ‘‘section
8157(b)(4)’’ and inserting in lieu thereof ‘‘section
8156(b)(4)’’.
Subtitle D—Miscellaneous
SEC. 631. DEPARTMENT OF VETERANS AFFAIRS RESEARCH
ADVISORY COMMITTEES.
(a) STATUTORY BASIS
FOR RESEARCH ADVISORY
COMMITTEES.—Subchapter III of chapter 5 is amended
by adding after section 545, as added by section 302(a),
the following new section:
‘‘§ 546. 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 September 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 Committees
on Veterans’ Affairs of the Senate and House of Rep-
resentatives a report on the proposed termination. The re-
port 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 responsibilities under section
7303 of this title in the absence 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 September 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 and Evaluation
Board for Health Services Research and Develop-
ment.
‘‘(18) The Scientific Review and Evaluation
Board for Rehabilitation Research and Develop-
ment.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of chapter 5 is amended by inserting
after the item relating to section 545, as added by section
302(a), the following new item:
‘‘546. Veterans research advisory committees.’’.
SEC. 632. TECHNICAL AMENDMENTS.
(a) IN GENERAL.—Sections 7361(b) and 7363(c) are
each amended by striking out ‘‘section 501(c)(3) of’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall take effect as of May 20, 1988.
SEC. 633. SUBMITTAL DATE FOR REPORT ON ANNUAL
ANALYSIS 
OF 
DEPARTMENTWIDE 
ADMIS-
SIONS POLICIES.
Section 8110(a)(3)(B) is amended by striking out
‘‘December 1’’ and inserting in lieu thereof ‘‘April 1’’.
SEC. 634. CHILD CARE SERVICES.
(a) REVISED CHILD CARE AUTHORITY.—Chapter 81
is amended by inserting after section 8116 the following
new section:
‘‘§ 8117. Child care centers
‘‘(a) The Secretary may provide for the operation of
child care centers at Department facilities. The operation
of such centers under this section shall be carried out to
the extent that the Secretary determines, based on the de-
mand of employees of the Department for the care in-
volved, that such operation is in the best interest of the
Department and that it is practicable to do so.
‘‘(b)(1) In offering child care services under this sec-
tion, the Secretary shall give priority (in the following
order) to employees of—
‘‘(A) the Department;
‘‘(B) other departments and agencies of the
Federal Government; and
‘‘(C) schools affiliated with the Department and
corporations created under section 7361 of this title.
‘‘(2) To the extent that space is available, the Sec-
retary may provide child care services to members of the
public at a child care center operated under this section
if the Secretary determines that to do so is necessary to
assure the financial success of that center.
‘‘(c)(1) The Secretary shall establish reasonable
charges for child care services provided at each child care
center operated under this section. Such charges may be
established at different rates for different centers.
‘‘(2) In establishing charges for child care services
provided at a center, the Secretary—
‘‘(A) shall (except as provided in paragraph (3))
establish the charges so as to ensure that the sum
of all charges for child care services at that center
is sufficient to meet the staffing expenses of that
center; and
‘‘(B) may also consider the expenses of con-
structing or acquiring space for the center, the ex-
penses of converting existing space into the center,
and the expenses of equipment and services fur-
nished to the center under subsection (d)(2).
‘‘(3) The Secretary may establish charges for child
care services provided at a center at rates less than those
necessary to ensure that the sum of all charges for child
care services at that center is sufficient to meet the staff-
ing expenses of that center if the Secretary determines
(with respect to a particular facility of the Department)
that—
‘‘(A) the operation of a child care center at that
facility would help overcome serious recruitment or
retention problems;
‘‘(B) adherence to the requirement to establish
charges for child care services at that center at rates
sufficient to meet the staffing expenses of that cen-
ter would make the operation of a child care center
at that facility infeasible; 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
center and in the oversight of the implementation of
such policies;
‘‘(4) shall require the development and use of a
process for determining the fitness and suitability of
prospective employees of or volunteers at the center;
and
‘‘(5) shall require in connection with the oper-
ation of the center compliance with all State and
local laws, ordinances, and regulations relating to
health and safety and the operation of child care
centers.
‘‘(e) The Secretary shall prescribe guidelines to carry
out this section.
‘‘(f) For the purpose of this section, the term ‘parent
advisory committee’ means a committee comprised of, and
selected by, the parents of children receiving care in a
child care center operated under this section.’’.
(b) CONFORMING REPEAL.—Section 7809 is re-
pealed.
(c) CLERICAL AMENDMENTS.—(1) The table of sec-
tions at the beginning of chapter 81 is amended by insert-
ing after the item relating to section 8116 the following
new item:
‘‘8117. Child care centers.’’.
(2) The table of sections at the beginning of chapter
78 is amended by striking out the item relating to section
7809.
SEC. 635. CONTRACTS FOR UTILITIES, AUDIE L. MURPHY
MEMORIAL HOSPITAL.
(a) AUTHORITY TO CONTRACT.—Subject to sub-
section (b), the Secretary of Veterans Affairs may enter
into contracts for the provision of utilities (including
steam and chilled water) to the Audie L. Murphy Memo-
rial Hospital in San Antonio, Texas. Each such contract
may—
(1) be for a period not to exceed 35 years;
(2) provide for the construction and operation
of a production facility on or near property under
the jurisdiction of the Secretary;
(3) require capital contributions by the parties
involved for the construction of such a facility, such
contribution to be in the form of cash, equipment,
or other in-kind contribution; and
(4) provide for a predetermined formula to
compute the cost of providing such utilities to the
parties for the duration of the contract.
(b) FUNDS.—A contract may be entered into under
subsection (a) only to the extent that appropriations are
available.
(c) ADDITIONAL TERMS.—The Secretary may include
in a contract under subsection (a) such additional provi-
sions as the Secretary considers necessary to secure the
provision of utilities and to protect the interests of the
United States.
SEC. 636. AUTHORITY TO ENTER INTO AGREEMENT FOR
USE OF PROPERTY AT EDWARD HINES, JR.,
DEPARTMENT OF VETERANS AFFAIRS HOS-
PITAL.
(a) IN GENERAL.—The Secretary of Veterans Affairs
may enter into a long-term lease or similar agreement with
the organization known as The Caring Place at Loyola,
Inc., a not-for-profit organization operating under the
laws of the State of Illinois, to permit that organization
to establish on the grounds of the Edward Hines, Jr., De-
partment of Veterans Affairs Hospital, Hines, Illinois, a
facility to provide temporary accommodations for family
members of severely ill children who are being treated at
the Loyola University of Chicago Medical Center and
other hospitals.
(b) CONDITIONS.—An agreement under subsection
(a)—
(1) shall ensure that there shall be no cost to
the United States as a result of the property use au-
thorized by that subsection;
(2) may permit the use of the property without
rent; and
(3) shall, to the extent practicable, ensure that
one room of the facility is available for the use of
a veteran (at no cost to the veteran) as temporary
accommodations for the veteran while a severely ill
child of the veteran is treated at the Loyola Univer-
sity of Chicago Medical Center or other hospitals.
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