•H.R. 2116 RH
ning more than 180 days after the date of the enact-
ment of this section and ending three years after that
day.
‘‘(2) The term ‘eligible dependent’ means an in-
dividual who—
‘‘(A) is the spouse or child of a veteran who
is enrolled in the system of patient enrollment es-
tablished by the Secretary under section 1705 of
this title; and
‘‘(B) is determined by the Secretary to have
the ability to pay for such care or services either
directly or through reimbursement or indem-
nification from a third party.
‘‘(c) The Secretary may furnish health care services to
an eligible dependent under this section only if the depend-
ent (or, in the case of a minor, the parent or guardian of
the dependent) agrees—
‘‘(1) to pay to the United States an amount rep-
resenting the reasonable charges for the care or serv-
ices furnished (as determined by the Secretary); and
‘‘(2) to cooperate with and provide the Secretary
an appropriate assignment of benefits, authorization
to release medical records, and any other executed
documents, information, or evidence reasonably need-
ed by the Secretary to recover the Department’s
•H.R. 2116 RH
charges for the care or services furnished by the Sec-
retary.
‘‘(d)(1) The health care services provided under the
pilot program under this section may consist of such pri-
mary hospital care services and such primary medical serv-
ices as may be authorized by the Secretary. The Secretary
may furnish those services directly through a Department
medical facility or, subject to paragraphs (2) and (3), pur-
suant to a contract or other agreement with a non-Depart-
ment facility (including a health-care provider, as defined
in section 8152(2) of this title).
‘‘(2) The Secretary may enter into a contract or agree-
ment to furnish primary health care services under this sec-
tion in a non-Department facility on the same basis as pro-
vided under subsections (a) and (b) of section 1703 of this
title or may include such care in an existing or new agree-
ment under section 8153 of this title when the Secretary
determines it to be in the best interest of the prevailing
standards of the Department medical care program.
‘‘(3) Primary health care services may not be author-
ized to be furnished under this section at any medical facil-
ity if the furnishing of those services would result in the
denial of, or a delay in providing, access to care for any
enrolled veteran at that facility.
•H.R. 2116 RH
‘‘(e)(1) In the case of an eligible dependent who is fur-
nished primary health care services under this section and
who has coverage under a health-plan contract, as defined
in section 1729(i)(1) of this title, the United States shall
have the right to recover or collect the reasonable charges
for such care or services from such health-plan contract to
the extent that the individual or the provider of the care
or services would be eligible to receive payment for such care
or services from such health-plan contract if the care or
services had not been furnished by a department or agency
of the United States.
‘‘(2) The right of the United States to recover under
paragraph (1) shall be enforceable with respect to an eligible
dependent in the same manner as applies under subsections
(a)(3), (b), (c)(1), (c)(2), (d), (f), (h), and (i) of section 1729
of this title with respect to a veteran.
‘‘(f)(1) Subject to paragraphs (2) and (3), the pilot
program under this section shall be carried out during the
program period in not more than four veterans integrated
service networks, as designated by the Secretary. In desig-
nating networks under the preceding sentence, the Secretary
shall favor designation of networks that are suited to serve
dependents of veterans because of—
‘‘(A) the capability of one or more medical facili-
ties within the network to furnish primary health
•H.R. 2116 RH
care services to eligible dependents while assuring that
veterans continue to receive priority for care and
services;
‘‘(B) the demonstrated success of such medical fa-
cilities in billings and collections;
‘‘(C) support for initiating such a pilot program
among veterans in the network; and
‘‘(D) such other criteria as the Secretary con-
siders appropriate.
‘‘(2) In implementing the pilot program, the Secretary
may not provide health care services for dependents who
are children—
‘‘(A) in more than one of the participating net-
works during the first year of the program period;
and
‘‘(B) in more than two of the participating net-
works during the second year of the program period.
‘‘(3) In implementing the pilot program, the Secretary
shall give priority to facilities which operate women vet-
erans’ clinics.’’.
(2) The table of sections at the beginning of such chap-
ter is amended by inserting after the item relating to section
1713 the following new item:
‘‘1713A. Medical care for certain dependents and enrolled veterans: pilot pro-
gram.’’.
•H.R. 2116 RH
(b) GAO REVIEW AND RECOMMENDATIONS.—(1) Be-
ginning six months after the commencement of the pilot
program, the Comptroller General, in consultation with the
Under Secretary for Health of the Department of Veterans
Affairs, shall monitor the conduct of the pilot program.
(2) Not later than 14 months after the commencement
of the pilot program, the Comptroller General shall submit
to the Secretary of Veterans Affairs a report setting forth
the Comptroller General’s findings and recommendations
with respect to the first 12 months of operation of the pilot
program.
(3)(A) The report under paragraph (2) shall include
the findings of the Comptroller General regarding—
(i) whether the collection of reasonable charges
for the care or services provided reasonably covers the
costs of providing such care and services; and
(ii) whether the Secretary, in carrying out the
program, is in compliance with the limitation in sub-
section (d)(3) of section 1713A of title 38, United
States Code, as added by subsection (a).
(B) The report shall include the recommendations of
the Comptroller General regarding any remedial steps that
the Secretary should take in the conduct of the program
or in the billing and collection of charges under the pro-
gram.
•H.R. 2116 RH
(4) The Secretary, in consultation with, and following
receipt of the report of, the Comptroller General, shall take
such steps as may be needed to ensure that any rec-
ommendations of the Comptroller General in the report
under paragraph (2) with respect to billings and collections,
and with respect to compliance with the limitation in sub-
section (d)(3) of such section, are carried out.
(5) For purposes of this subsection, the term ‘‘com-
mencement of the pilot program’’ means the date on which
the Secretary of Veterans Affairs begins to furnish services
to eligible dependents under the pilot program under section
1713A of title 38, United States Code, as added by sub-
section (a).
SEC. 107. ENHANCED SERVICES PROGRAM AT DESIGNATED
MEDICAL CENTERS.
(a) FINDINGS.—Congress makes the following findings:
(1) Historically, health care facilities under the
jurisdiction of the Department of Veterans Affairs
have not consistently been located in proximity to vet-
eran population concentrations.
(2) Hospital occupancy rates at numbers of De-
partment medical centers are at levels substantially
below a level needed for efficient operation and opti-
mal quality of care.
•H.R. 2116 RH
(3) The costs of maintaining highly inefficient
medical centers, which were designed and constructed
decades ago to standards no longer considered accept-
able, substantially diminish the availability of re-
sources which could be devoted to the provision of
needed direct care services.
(4) Freeing resources currently devoted to highly
inefficient provision of hospital care could, through
contracting for acute hospital care and establishing
new facilities for provision of outpatient care, yield
improved access and service to veterans.
(b) ENHANCED SERVICES PROGRAM AT DESIGNATED
MEDICAL CENTERS.—The Secretary of Veterans Affairs, in
carrying out the responsibilities of the Secretary to furnish
hospital care and medical services through network-based
planning, shall establish an enhanced service program at
Department medical centers (hereinafter in this section re-
ferred to as ‘‘designated centers’’) that are designated by
the Secretary for the purposes of this section. Medical cen-
ters shall be designated to improve access, and quality of
service provided, to veterans served by those medical centers.
The Secretary may designate a medical center for the pro-
gram only if the Secretary determines, on the basis of a
market and data analysis (which shall include a study of
•H.R. 2116 RH
the cost-effectiveness of the care provided at such center),
that the medical center—
(1) can, in whole or in part, no longer be oper-
ated in a manner that provides hospital or other care
efficiently and at optimal quality because of such fac-
tors as—
(A) the current and projected need for hos-
pital or other care capacity at such center;
(B) the extent to which the facility is func-
tionally obsolete; and
(C) the cost of operation and maintenance
of the physical plant; and
(2) is located in proximity (A) to one or more
community hospitals which have the capacity to pro-
vide primary and secondary hospital care of appro-
priate quality to veterans under contract arrange-
ments with the Secretary which the Secretary deter-
mines are advantageous to the Department, or (B) to
another Department medical center which is capable
of absorbing some or all of the patient workload of
such medical center.
(c) MEDICAL CENTER PLAN.—The Secretary shall,
with respect to each designated center, develop a plan aimed
at improving the accessibility and quality of service pro-
vided to veterans. Each plan shall be developed in accord-
•H.R. 2116 RH
ance with the requirements for strategic network-based
planning described in section 8107 of title 38, United States
Code. In the plan for a designated center, the Secretary
shall describe a program which, if implemented, would
allow the Secretary to do any of the following:
(1) Provide for a Department facility described
in subsection (b)(2)(B) to absorb some or all of the
patient workload of the designated center.
(2) Contract, under such arrangements as the
Secretary determines appropriate, for needed primary
and secondary hospital care for veterans—
(A) who reside in the catchment area of
each designated center;
(B) who are described in paragraphs (1)
through (6) of section 1705(a) of title 38, United
States Code; and
(C) whom the Secretary has enrolled for
care pursuant to section 1705 of title 38, United
States Code.
(3) Cease to provide hospital care, or hospital
care and other medical services, at such center.
(4) If practicable, lease, under subchapter V of
chapter 81 of title 38, United States Code, land and
improvements which had been dedicated to providing
care described in paragraph (3).
•H.R. 2116 RH
(5) Establish, through reallocation of operational
funds and through appropriate lease arrangements or
renovations, facilities for—
(A) delivery of outpatient care; and
(B) services which would obviate a need for
nursing home care or other long-term institu-
tional care.
(d) EMPLOYEE PROTECTIONS.—(1) In entering into
any contract or lease under subsection (c), the Secretary
shall attempt to ensure that employees of the Secretary who
would be displaced under this section be given priority in
hiring by such contractor, lessee, or other entity.
(2) In carrying out subsection (c)(5), the Secretary
shall give preference to providing services through employee-
based delivery models.
(e) REQUIRED CONSULTATION.—In developing a plan
under subsection (c), the Secretary shall obtain the views
of veterans organizations, exclusive employee representa-
tives, and other interested parties and provide for such or-
ganizations and parties to participate in the development
of the plan.
(f) SUBMISSION OF PLAN TO CONGRESS.—The Sec-
retary may not implement a plan described in subsection
(c) with respect to a medical center unless the Secretary
has first submitted a report containing a detailed plan and
•H.R. 2116 RH
justification to the appropriate committees of Congress. No
action to carry out such plan may be taken after the sub-
mission of such report until the end of a 45-day period fol-
lowing the date of the submission of the report, not less than
30 days of which shall be days during which Congress shall
have been in continuous session. For purposes of the pre-
ceding sentence, continuity of a session of Congress is bro-
ken only by adjournment sine die, and there shall be ex-
cluded from the computation of any period of continuity
of session any day during which either House of Congress
is not in session during an adjournment of more than three
days to a day certain.
(g) IMPLEMENTATION OF PLAN.—In carrying out the
plan described in subsection (c), or a modification to that
plan following the submission of such plan to the appro-
priate committees of Congress, the Secretary—
(1) may, without regard to any limitation under
section 1703 of title 38, United States Code, contract
for hospital care for veterans who are—
(A) described in paragraphs (1) through (6)
of section 1705(a) of title 38, United States Code;
and
(B) enrolled under subsection (a) of such
section 1705;
•H.R. 2116 RH
(2) may enter into any contract under section
8153 of title 38, United States Code;
(3) shall, in exercising the authority of the Sec-
retary under this section to contract for hospital care,
provide for ongoing oversight and management, by
employees of the Department, of the hospital care fur-
nished such veterans; and
(4) shall, in the case of a designated center which
ceases to provide services under the program—
(A) ensure a reallocation of funds as pro-
vided in subsection (h); and
(B) provide reemployment assistance to em-
ployees.
(h) FUNDS ALLOCATION.—In carrying out subsection
(g)(4), the Secretary shall ensure that not less than 90 per-
cent of the funds that would have been made available to
a designated center to support the provision of services, but
for such mission change, shall be made available to the ap-
propriate health care region of the Veterans Health Admin-
istration to ensure that the implementation of the plan
under subsection (g) will result in demonstrable improve-
ment in the accessibility, and quality of service provided,
to veterans in the catchment area of such center.
•H.R. 2116 RH
(i) SPECIALIZED SERVICES.—The provisions of this
section do not diminish the obligations of the Secretary
under section 1706(b) of title 38, United States Code.
(j) REPORT.—Not later than 12 months after imple-
mentation of any plan under subsection (b), the Secretary
shall submit to Congress a report on the implementation
of the enhanced service program.
(k) RESIDUAL AUTHORITY.—Nothing in this section
may be construed to diminish the authority of the Secretary
to—
(1) consolidate, eliminate, abolish, or redistribute
the functions or missions of facilities in the Depart-
ment;
(2) revise the functions or missions of any such
facility or activity; or
(3) create new facilities or activities in the De-
partment.
SEC. 108. COUNSELING AND TREATMENT FOR VETERANS
WHO HAVE EXPERIENCED SEXUAL TRAUMA.
(a) EXTENSION OF PERIOD OF PROGRAM.—Subsection
(a) of section 1720D is amended—
(1) in paragraph (1), by striking ‘‘December 31,
2001’’ and inserting ‘‘December 31, 2002’’; and
(2) in paragraph (3), by striking ‘‘December 31,
2001’’ and inserting ‘‘December 31, 2002’’.
•H.R. 2116 RH
(b) MANDATORY NATURE
OF PROGRAM.—(1) Sub-
section (a)(1) of such section is further amended by striking
‘‘may provide counseling to a veteran who the Secretary
determines requires such counseling’’ and inserting ‘‘shall
operate a program under which the Secretary provides
counseling and appropriate care and services to veterans
who the Secretary determines require such counseling and
care and services’’.
(2) Subsection (a) of such section is further amended—
(A) by striking paragraph (2); and
(B) by redesignating paragraph (3) (as amended
by subsection (a)(2)) as paragraph (2).
(c) OUTREACH EFFORTS.—Subsection (c) of such sec-
tion is amended—
(1) by inserting ‘‘and treatment’’ in the first sen-
tence and in paragraph (2) after ‘‘counseling’’;
(2) by striking ‘‘and’’ at the end of paragraph
(1);
(3) by redesignating paragraph (2) as para-
graph (3); and
(4) by inserting after paragraph (1) the fol-
lowing new paragraph (2):
‘‘(2) shall ensure that information about the
counseling and treatment available to veterans under
this section—
•H.R. 2116 RH
‘‘(A) is revised and updated as appropriate;
‘‘(B) is made available and visibly posted
at appropriate facilities of the Department; and
‘‘(C) is made available through appropriate
public information services; and’’.
(d) REPORT ON IMPLEMENTATION OF OUTREACH AC-
TIVITIES.—Not later than six months after the date of the
enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committees on Veterans’ Affairs of the
Senate and House of Representatives a report on the Sec-
retary’s implementation of paragraph (2) of section
1720D(c) of title 38, United States Code, as added by sub-
section (c). Such report shall include examples of the docu-
ments and other means of communication developed for
compliance with that paragraph.
(e) STUDY OF EXPANDING ELIGIBILITY FOR COUN-
SELING AND TREATMENT.—(1) The Secretary of Veterans
Affairs, in consultation with the Secretary of Defense, shall
conduct a study to determine—
(A) the extent to which former members of the re-
serve components of the Armed Forces experienced
physical assault of a sexual nature or battery of a
sexual nature while serving on active duty for train-
ing;
•H.R. 2116 RH
(B) the extent to which such former members
have sought counseling from the Department of Vet-
erans Affairs relating to those incidents; and
(C) the additional resources that, in the judg-
ment of the Secretary, would be required to meet the
projected need of those former members for such coun-
seling.
(2) Not later than 16 months after the date of the en-
actment of this Act, the Secretary of Veterans Affairs shall
submit to the Committees on Veterans’ Affairs of the Senate
and House of Representatives a report on the results of the
study conducted under paragraph (1).
(f) OVERSIGHT OF OUTREACH ACTIVITIES.—Not later
than 14 months after the date of the enactment of this Act,
the Secretary of Veterans Affairs and the Secretary of De-
fense shall submit to the appropriate congressional commit-
tees a joint report describing in detail the collaborative ef-
forts of the Department of Veterans Affairs and the Depart-
ment of Defense to ensure that members of the Armed
Forces, upon separation from active military, naval, or air
service, are provided appropriate and current information
about programs of the Department of Veterans Affairs to
provide counseling and treatment for sexual trauma that
may have been experienced by those members while in the
active military, naval, or air service, including information
•H.R. 2116 RH
about eligibility requirements for, and procedures for ap-
plying for, such counseling and treatment. The report shall
include proposed recommendations from both the Secretary
of Veterans Affairs and the Secretary of Defense for the im-
provement of their collaborative efforts to provide such in-
formation.
(g) REPORT ON IMPLEMENTATION OF SEXUAL TRAUMA
TREATMENT PROGRAM.—Not later than 14 months after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans’ Affairs
of the Senate and House of Representatives a report on the
use made of the authority provided under section 1720D
of title 38, United States Code, as amended by this section.
The report shall include the following with respect to activi-
ties under that section since the enactment of this Act:
(1) The number of veterans who have received
counseling under that section.
(2) The number of veterans who have been re-
ferred to non-Department mental health facilities and
providers in connection with sexual trauma coun-
seling and treatment.
•H.R. 2116 RH
TITLE II—PROGRAM
ADMINISTRATION
SEC. 201. MEDICAL CARE COLLECTIONS.
(a) LIMITED AUTHORITY TO SET COPAYMENTS.—(1)
Section 1722A is amended—
(A) by redesignating subsections (b) and (c) as
subsections (c) and (d), respectively;
(B) by inserting after subsection (a) the fol-
lowing new subsection (b):
‘‘(b) The Secretary, pursuant to regulations which the
Secretary shall prescribe, may—
‘‘(1) increase the copayment amount in effect
under subsection (a);
‘‘(2) establish a maximum annual pharma-
ceutical copayment amount under subsection (a) for
veterans who have multiple outpatient prescriptions;
and
‘‘(3) require a veteran, other than a veteran de-
scribed in subsection (a)(3), to pay to the United
States a reasonable copayment for sensori-neural
aids, electronic equipment, and any other costly item
or equipment furnished the veteran for a nonservice-
connected condition, other than a wheelchair or artifi-
cial limb.’’; and
•H.R. 2116 RH
(C) in subsection (c), as redesignated by sub-
paragraph (A)—
(i) by striking ‘‘this section’’ and inserting
‘‘subsection (a)’’; and
(ii) by adding at the end the following new
sentence: ‘‘Amounts collected through use of the
authority under subsection (b) shall be deposited
in Department of Veterans Affairs Health Serv-
ices Improvement Fund.’’.
(2)(A) The heading of such section is amended to read
as follows:
‘‘§ 1722A. Copayments for medications and certain
costly items and equipment’’.
(B) The item relating to such section in the table of
sections at the beginning of chapter 17 is amended to read
as follows:
‘‘1722A. Copayments for medications and certain costly items and equipment.’’.
(b) OUTPATIENT TREATMENT OF CATEGORY C VET-
ERANS.—(1) Section 1710(g) is amended—
(A) in paragraph (1), by striking ‘‘the amount
under paragraph (2) of this subsection’’ and inserting
‘‘in the case of each outpatient visit the applicable
amount or amounts established by the Secretary by
regulation’’; and
•H.R. 2116 RH
(B) in paragraph (2), by striking all after ‘‘for
an amount’’ and inserting ‘‘which the Secretary shall
establish by regulation.’’.
SEC. 202. HEALTH SERVICES IMPROVEMENT FUND.
(a) ESTABLISHMENT
OF
FUND.—Chapter 17 is
amended by inserting after section 1729A the following new
section:
‘‘§ 1729B. Health Services Improvement Fund
‘‘(a) There is established in the Treasury of the United
States a fund to be known as the ‘Department of Veterans
Affairs Health Services Improvement Fund’.
‘‘(b) Amounts received or collected after the date of the
enactment of this section under any of the following provi-
sions of law shall be deposited in the fund:
‘‘(1) Section 1713A of this title.
‘‘(2) Section 1722A(b) of this title.
‘‘(3) Section 8165(a) of this title.
‘‘(4) Section 104(c) of the Veterans’ Millennium
Health Care Act.
‘‘(c) Amounts in the fund are hereby available, without
fiscal year limitation, to the Secretary for the purposes stat-
ed in subparagraphs (A) and (B) of section 1729A(c)(1)
of this title.’’.
•H.R. 2116 RH
(b) CLERICAL AMENDMENT.—The table of sections at
the beginning of such chapter is amended by inserting after
the item relating to section 1729A the following new item:
‘‘1729B. Health Services Improvement Fund.’’.
SEC. 203. VETERANS TOBACCO TRUST FUND.
(a) FINDINGS.—Congress finds the following:
(1) Smoking related illnesses, including cancer,
heart disease, and emphysema, are highly prevalent
among the more than 3,000,000 veterans who use the
Department of Veterans Affairs health care system
annually.
(2) The Department of Veterans Affairs estimates
that it spent $3,600,000,000 in 1997 to treat smok-
ing-related illnesses and that over the next five years
it will spend $20,000,000,000 on such care.
(3) Congress established the Department of Vet-
erans Affairs in furtherance of its constitutional
power to provide for the national defense in order to
provide benefits and services to veterans of the uni-
formed services.
(4) There is in the Department of Veterans Af-
fairs a health care system which has as its primary
function to provide a complete medical and hospital
service for the medical care and treatment of such vet-
erans as can be served through available appropria-
tions.
•H.R. 2116 RH
(5) The Federal Government, including the De-
partment of Veterans Affairs, has lacked the means to
prevent the onset of smoking-related illnesses among
veterans and has had no authority to deny needed
treatment to any veteran on the basis that an illness
is or might be smoking-related.
(6) With some 20 percent of its health care budg-
et absorbed in treating smoking-related illnesses, the
Department of Veterans Affairs health care system
has lacked resources to provide needed nursing home
care, home care, community-based ambulatory care,
and other services to tens of thousands of other vet-
erans.
(7) The network of academically affiliated med-
ical centers of the Department of Veterans Affairs
provides a unique system within which outstanding
medical research is conducted and which has the po-
tential to expand significantly ongoing research on
tobacco-related illnesses.
(8) It is in the public interest for Congress to
enact legislation requiring that a portion of any
amounts received from manufacturers of tobacco prod-
ucts be used to meet the costs of (A) treatment for dis-
eases and adverse health effects associated with the use
of tobacco products by those who served their country
•H.R. 2116 RH
in uniform, and (B) medical and health services re-
search relating to prevention and treatment of, and
rehabilitation from, tobacco addiction and diseases
associated with tobacco use.
(b) ESTABLISHMENT OF TRUST FUND.—(1) Chapter
17 is amended by inserting after section 1729B, as added
by section 202(a), the following new section:
‘‘§ 1729C. Veterans Tobacco Trust Fund
‘‘(a) There is established in the Treasury of the United
States a trust fund to be known as the ‘Veterans Tobacco
Trust Fund’, consisting of such amounts as may be appro-
priated, credited, or donated to the trust fund.
‘‘(b) If a lawsuit is brought by the United States
against the tobacco manufacturers seeking recovery of costs
incurred or to be incurred by the United States that are
attributable to tobacco-related illnesses, there shall be cred-
ited to the trust fund from any amount recovered by the
United States pursuant to that lawsuit, without further ap-
propriation, the amount that bears the same ratio to the
amount recovered as the amount of the Department’s costs
for health care attributable to tobacco-related illnesses for
which recovery is sought in the suit bears to the total
amount sought by the United States in the suit.
•H.R. 2116 RH
‘‘(c) After September 30, 2004, amounts in the trust
fund shall be available, without fiscal year limitation, to
the Secretary of Veterans Affairs for the following purposes:
‘‘(1) Furnishing medical care and services under
this chapter, to be available during any fiscal year for
the same purposes and subject to the same limitations
(other than with respect to the period of availability
for obligation) as apply to amounts appropriated
from the general fund of the Treasury for that fiscal
year for medical care.
‘‘(2) Conducting medical research, rehabilitation
research, and health systems research, with particular
emphasis on research relating to prevention and
treatment of, and rehabilitation from, tobacco addic-
tion and diseases associated with tobacco use.’’.
(2) The table of sections at the beginning of such chap-
ter is amended by inserting after the item relating to section
1729B, as added by section 202(b), the following new item:
‘‘1729C. Veterans Tobacco Trust Fund.’’.
SEC. 204. AUTHORITY TO ACCEPT FUNDS FOR EDUCATION
AND TRAINING.
(a) ESTABLISHMENT OF NONPROFIT CORPORATIONS
AT MEDICAL CENTERS.—Section 7361(a) is amended—
(1) by inserting ‘‘and education’’ after ‘‘re-
search’’;
•H.R. 2116 RH
(2) by adding at the end the following: ‘‘Such a
corporation may be established to facilitate either re-
search or education or both research and education.’’.
(b) PURPOSE
OF CORPORATIONS.—Section 7362 is
amended—
(1) in the first sentence, by inserting ‘‘and edu-
cation and training as described in sections 7302,
7471, 8154, and 1701(6)(B) of this title’’ after ‘‘of
this title’’; and
(2) in the second sentence—
(A) by inserting ‘‘or education’’ after ‘‘re-
search’’; and
(B) by striking ‘‘that purpose’’ and insert-
ing ‘‘these purposes’’.
(c) BOARD
OF
DIRECTORS.—Section 7363(a) is
amended—
(1) in subsection (a)(1), by striking all after
‘‘medical center, and’’ and inserting ‘‘as appropriate,
the assistant chief of staff for research for the medical
center and the associate chief of staff for education for
the medical center, or, in the case of a facility at
which such positions do not exist, those officials who
are responsible for carrying out the responsibilities of
the medical center director, chief of staff, and, as ap-
•H.R. 2116 RH
propriate, the assistant chief of staff for research and
the assistant chief for education; and’’;
(2) in subsection (a)(2), by inserting ‘‘or edu-
cation, as appropriate’’ after ‘‘research’’; and
(3) in subsection (c), by inserting ‘‘or education’’
after ‘‘research’’.
(d) APPROVAL OF EXPENDITURES.—Section 7364 is
amended by adding at the end the following new subsection:
‘‘(c)(1) A corporation established under this subchapter
may not spend funds for an education activity unless the
activity is approved in accordance with procedures pre-
scribed by the Under Secretary for Health.
‘‘(2) The Under Secretary for Health shall prescribe
policies and procedures to guide the expenditure of funds
by corporations under paragraph (1) consistent with the
purpose of such corporations as flexible funding mecha-
nisms.’’.
SEC. 205. EXTENSION AND REVISION OF CERTAIN AUTHORI-
TIES.
(a) READJUSTMENT COUNSELING PROGRAM.—Section
1712A(a)(1)(B)(ii) is amended by striking ‘‘2000’’ and in-
serting ‘‘2003’’.
(b) COMMITTEE ON MENTALLY ILL VETERANS.—Sec-
tion 7321(d)(2) is amended by striking ‘‘three’’ and insert-
ing ‘‘five’’.
•H.R. 2116 RH
(c) COMMITTEE ON POST-TRAUMATIC STRESS DIS-
ORDER.—Section 110 of Public Law 98–528 (38 U.S.C.
1712A note) is amended—
(1) in subsection (e)(1), by striking ‘‘March 1,
1985’’ and inserting ‘‘March 1, 2000’’; and
(2) in subsection (e)(2), by striking ‘‘February 1,
1986’’ and inserting ‘‘February 1, 2001’’.
(d) EXTENSION OF AUTHORITY TO MAKE GRANTS.—
Section 3(a)(2) of the Homeless Veterans Comprehensive
Service Programs Act of 1992 (38 U.S.C. 7721 note) is
amended by striking ‘‘September 30, 1999’’ and inserting
‘‘September 30, 2002’’.
(e) AUTHORITY TO MAKE GRANTS FOR HOMELESS
VETERANS.—Section 3(b)(2) of the Homeless Veterans Com-
prehensive Service Programs Act of 1992 (38 U.S.C. 7721
note) is amended by striking ‘‘and no more than 20 pro-
grams which incorporate the procurement of vans as de-
scribed in paragraph (1)’’.
SEC. 206. STATE HOME GRANT PROGRAM.
(a) 
GENERAL
REGULATIONS.—Section 
8134 
is
amended—
(1) by redesignating subsection (b) as subsection
(c);
(2) by striking the matter in subsection (a) pre-
ceding paragraph (2) and inserting the following:
•H.R. 2116 RH
‘‘(a)(1) The Secretary shall prescribe regulations for
the purposes of this subchapter.
‘‘(2) In those regulations, the Secretary shall prescribe
for each State the number of nursing home and domiciliary
beds for which assistance under this subchapter may be fur-
nished. Such regulations shall be based on projected demand
for such care 10 years after the date of the enactment of
the Veterans Millennium Health Care Act by veterans who
at such time are 65 years of age or older and who reside
in that State. In determining such projected demand, the
Secretary shall take into account travel distances for vet-
erans and their families.
‘‘(3)(A) In those regulations, the Secretary shall estab-
lish criteria under which the Secretary shall determine,
with respect to an application for assistance under this sub-
chapter for a project described in subparagraph (B) which
is from a State that has a need for additional beds as deter-
mined under subsections (a)(2) and (d)(1), whether the need
for such beds is most aptly characterized as great, signifi-
cant, or limited. Such criteria shall take into account the
availability of beds already operated by the Secretary and
other providers which appropriately serve the needs which
the State proposes to meet with its application.
‘‘(B) This paragraph applies to a project for the con-
struction or acquisition of a new State home facility, to
•H.R. 2116 RH
a project to increase the number of beds available at a State
home facility, and a project to replace beds at a State home
facility.
‘‘(4) The Secretary shall review and, as necessary, re-
vise regulations prescribed under paragraphs (2) and (3)
not less often than every four years.
‘‘(b) The Secretary shall prescribe the following by reg-
ulation:’’;
(3) by redesignating paragraphs (2) and (3) of
subsection (b), as designated by paragraph (2), as
paragraphs (1) and (2);
(4) in subsection (c), as redesignated by para-
graph (1), by striking ‘‘subsection (a)(3)’’ and insert-
ing ‘‘subsection (b)(2)’’; and
(5) by adding at the end the following new sub-
section:
‘‘(d)(1) In prescribing regulations to carry out this
subchapter, the Secretary shall provide that in the case of
a State that seeks assistance under this subchapter for a
project described in subsection (a)(3)(B), the determination
of the unmet need for beds for State homes in that State
shall be reduced by the number of beds in all previous appli-
cations submitted by that State under this subchapter, in-
cluding beds which have not been recognized by the Sec-
retary under section 1741 of this title.
•H.R. 2116 RH
‘‘(2)(A) Financial assistance under this subchapter for
a renovation project may only be provided for a project for
which the total cost of construction is in excess of $400,000
(as adjusted from time to time in such regulations to reflect
changes in costs of construction).
‘‘(B) For purposes of this paragraph, a renovation
project is a project to remodel or alter existing buildings
for which financial assistance under this subchapter may
be provided and does not include maintenance and repair
work which is the responsibility of the State.’’.
(b) APPLICATIONS WITH RESPECT TO PROJECTS.—
Section 8135 is amended—
(1) in subsection (a)—
(A) by striking ‘‘set forth—’’ in the matter
preceding paragraph (1) and inserting ‘‘set forth
the following:’’;
(B) by capitalizing the first letter of the
first word in each of paragraphs (1) through (9);
(C) by striking the comma at the end of
each of paragraphs (1) through (7) and inserting
a period; and
(D) by striking ‘‘, and’’ at the end of para-
graph (8) and inserting a period;
(2) by redesignating subsections (b), (c), (d), and
(e) as subsections (c), (d), (e), and (f), respectively;
•H.R. 2116 RH
(3) by inserting after subsection (a) the following
new subsection (b):
‘‘(b)(1) Any State seeking to receive assistance under
this subchapter for a project that would involve construction
or acquisition of either nursing home or domiciliary facili-
ties shall include with its application under subsection (a)
the following:
‘‘(A) Documentation (i) that the site for the
project is in reasonable proximity to a sufficient con-
centration and population of veterans who are 65
years of age and older, and (ii) that there is a reason-
able basis to conclude that the facilities when complete
will be fully occupied.
‘‘(B) A financial plan for the first three years of
operation of such facilities.
‘‘(C) A five-year capital plan for the State home
program for that State.
‘‘(2) Failure to provide adequate documentation under
paragraph (1)(A) or to provide an adequate financial plan
under paragraph (1)(B) shall be a basis for disapproving
the application.’’;
(4) in subsection (c), as redesignated by para-
graph (2)—
(A) in paragraph (1), by striking ‘‘for a
grant under subsection (a) of this section’’ in the
•H.R. 2116 RH
matter preceding subparagraph (A) and insert-
ing ‘‘under subsection (a) for financial assistance
under this subchapter’’;
(B) in paragraph (2)—
(i) by striking ‘‘the construction or ac-
quisition of’’ in subparagraph (A); and
(ii) by striking subparagraphs (B),
(C), and (D) and inserting the following:
‘‘(B) An application from a State for a project
at an existing facility to remedy a condition or con-
ditions that have been cited by an accrediting institu-
tion, by the Secretary, or by a local licensing or ap-
proving body of the State as being threatening to the
lives or safety of the patients in the facility.
‘‘(C) An application from a State that has not
previously applied for award of a grant under this
subchapter for construction or acquisition of a State
nursing home.
‘‘(D) An application for construction or acquisi-
tion of a nursing home or domiciliary from a State
that the Secretary determines, in accordance with reg-
ulations under this subchapter, has a great need for
the beds to be established at such home or facility.
•H.R. 2116 RH
title, as in effect on that date, that are identified on the
list that (1) is described in section 8135(b)(4) of such title,
as in effect on that date, and (2) was established by the
Secretary of Veterans Affairs on October 29, 1998.
(d) EFFECTIVE DATE FOR INITIAL REGULATIONS.—
The Secretary of Veterans Affairs shall prescribe the initial
regulations under subsection (a) of section 8134 of title 38,
United States Code, as added by subsection (a), not later
than April 30, 2000.
SEC. 207. EXPANSION OF ENHANCED-USE LEASE AUTHOR-
ITY.
(a) AUTHORITY.—Section 8162(a)(2) is amended—
(1) by striking ‘‘only if the Secretary’’ and in-
serting ‘‘only if—
‘‘(A) the Secretary’’;
(2) by redesignating subparagraphs (A), (B),
and (C) as clauses (i), (ii), and (iii), respectively,
and realigning those clauses so as to be four ems from
the left margin;
(3) by striking the period at the end of clause
(iii), as so redesignated, and inserting ‘‘; or’’; and
(4) by adding at the end the following:
‘‘(B) the Secretary determines that the imple-
mentation of a business plan proposed by the Under
Secretary for Health for applying the consideration
•H.R. 2116 RH
under such a lease to the provision of medical care
and services would result in a demonstrable improve-
ment of services to eligible veterans in the geographic
service-delivery area within which the property is lo-
cated.’’.
(b) TERM
OF
ENHANCED-USE
LEASE.—Section
8162(b) is amended—
(1) in paragraph (2), by striking ‘‘may not ex-
ceed—’’ and all that follows and inserting ‘‘may not
exceed 75 years.’’; and
(2) by striking paragraph (4) and inserting the
following:
‘‘(4) The terms of an enhanced-use lease may provide
for the Secretary to—
‘‘(A) obtain facilities, space, or services on the
leased property; and
‘‘(B) use minor construction funds for capital
contribution payments.’’.
(c) DESIGNATION OF PROPERTY PROPOSED TO BE
LEASED.—(1) Subsection (b) of section 8163 is amended—
(A) by striking ‘‘include—’’ and inserting ‘‘in-
clude the following:’’;
(B) by capitalizing the first letter of the first
word of each of paragraphs (1), (2), (3), (4), and (5);
•H.R. 2116 RH
(C) by striking the semicolon at the end of para-
graphs (1), (2), and (3) and inserting a period; and
(D) by striking subparagraphs (A), (B), and (C)
of paragraph (4) and inserting the following:
‘‘(A) would—
‘‘(i) contribute in a cost-effective man-
ner to the mission of the Department;
‘‘(ii) not be inconsistent with the mis-
sion of the Department;
‘‘(iii) not adversely affect the mission
of the Department; and
‘‘(iv) affect services to veterans; or
‘‘(B) would result in a demonstrable im-
provement of services to eligible veterans in the
geographic service-delivery area within which the
property is located.’’.
(2) Subparagraph (E) of subsection (c)(1) of that sec-
tion is amended by striking clauses (i), (ii), and (iii) and
inserting the following:
‘‘(i) would—
‘‘(I) contribute in a cost-effective man-
ner to the mission of the Department;
‘‘(II) not be inconsistent with the mis-
sion of the Department;
•H.R. 2116 RH
‘‘(III) not adversely affect the mission
of the Department; and
‘‘(IV) affect services to veterans; or
‘‘(ii) would result in a demonstrable im-
provement of services to eligible veterans in the
geographic service-delivery area within which the
property is located.’’.
(d) 
USE
OF
PROCEEDS.—Section 
8165(a) 
is
amended—
(1) by striking paragraph (1) and inserting the
following:
‘‘(a)(1) Funds received by the Department under an
enhanced-use lease and remaining after any deduction from
those funds under subsection (b) shall be deposited in the
Department of Veterans Affairs Health Services Improve-
ment Fund established under section 1729B of this title.
The Secretary shall make available to the designated health
care region of the Veterans Health Administration within
which the leased property is located not less than 75 percent
of the amount deposited in the fund attributable to that
lease.’’; and
(2) by adding at the end the following new para-
graph:
‘‘(3) For the purposes of paragraph (1), the term ‘des-
ignated health care region of the Veterans Health Adminis-
•H.R. 2116 RH
tration’ means a geographic area designated by the Sec-
retary for the purposes of the management of, and alloca-
tion of resources for, health care services provided by the
Veterans Health Administration.’’.
(e) REPEAL OF TERMINATION PROVISION.—(1) Sec-
tion 8169 is repealed.
(2) The table of sections at the beginning of chapter
81 is amended by striking the item relating to section 8169.
(f) REPEAL OF OBSOLETE PROVISIONS.—Section 8162
is amended—
(1) by striking the last sentence of subsection
(a)(1); and
(2) by striking subsection (c).
SEC. 208. INELIGIBILITY FOR EMPLOYMENT BY VETERANS
HEALTH ADMINISTRATION OF HEALTH CARE
PROFESSIONALS WHO HAVE LOST LICENSE
TO PRACTICE IN ONE JURISDICTION WHILE
STILL LICENSED IN ANOTHER JURISDICTION.
Section 7402 is amended by adding at the end the fol-
lowing new subsection:
‘‘(f) A person may not be employed in a position under
subsection (b) (other than under paragraph (4) of that sub-
section) if—
•H.R. 2116 RH
‘‘(1) the person is or has been licensed, registered,
or certified (as applicable to such position) in more
than one State; and
‘‘(2) either—
‘‘(A) any of those States has terminated
such license, registration, or certification for
cause; or
‘‘(B) the person has voluntarily relinquished
such license, registration, or certification in any
of those States after being notified in writing by
that State of potential termination for cause.’’.
TITLE III—MISCELLANEOUS
SEC. 301. REVIEW OF PROPOSED CHANGES TO OPERATION
OF MEDICAL FACILITIES.
Section 8110 of title 38, United States Code, is amend-
ed by adding at the end the following new subsections:
‘‘(d) The Secretary may not in any fiscal year close
more than 50 percent of the beds within a bed section (of
20 or more beds) of a Department medical center unless
the Secretary first submits to the Committees on Veterans’
Affairs of the Senate and the House of Representatives a
report providing a justification for the closure. No action
to carry out such closure may be taken after the submission
of such report until the end of the 21-day period beginning
on the date of the submission of the report.
•H.R. 2116 RH
‘‘(e) The Secretary shall submit to the Committees on
Veterans’ Affairs of the Senate and the House of Representa-
tives, not later than January 20 of each year, a report docu-
menting by network for the preceding fiscal year the fol-
lowing:
‘‘(1) The number of medical service and surgical
service beds, respectively, that were closed during that
fiscal year and, for each such closure, a description
of the changes in delivery of services that allowed such
closure to occur.
‘‘(2) The number of nursing home beds that were
the subject of a mission change during that fiscal year
and the nature of each such mission change.
‘‘(f) For purposes of this section:
‘‘(1) The term ‘closure’, with respect to beds in
a medical center, means ceasing to provide staffing
for, and to operate, those beds. Such term includes
converting the provision of such bed care from care in
a Department facility to care under contract arrange-
ments.
‘‘(2) The term ‘bed section’, with respect to a
medical center, means psychiatric beds (including
beds for treatment of substance abuse and post-trau-
matic stress disorder), intermediate, neurology, and
•H.R. 2116 RH
rehabilitation medicine beds, extended care (other
than nursing home) beds, and domiciliary beds.
‘‘(3) The term ‘justification’, with respect to clo-
sure of beds, means a written report that includes the
following:
‘‘(A) An explanation of the reasons for the
determination that the closure is appropriate
and advisable.
‘‘(B) A description of the changes in the
functions to be carried out and the means by
which such care and services would continue to
be provided to eligible veterans.
‘‘(C) A description of the anticipated effects
of the closure on veterans and on their access to
care.’’.
SEC. 302. PATIENT SERVICES AT DEPARTMENT FACILITIES.
(a) SCOPE OF SERVICES.—Section 7803 is amended—
(1) in subsection (a)—
(A) by striking ‘‘(a)’’ before ‘‘The canteens’’;
and
(B) by striking ‘‘in this subsection;’’ and all
that follows through ‘‘the premises’’ and insert-
ing ‘‘in this section’’; and
(2) by striking subsection (b).
•H.R. 2116 RH
(b) TECHNICAL AMENDMENTS.—(1) Paragraphs (1)
and (11) of section 7802 are each amended by striking ‘‘hos-
pitals and homes’’ and inserting ‘‘medical facilities’’.
(2) Section 7803, as amended by subsection (a), is
amended—
(A) by striking ‘‘hospitals and homes’’ each place
it appears and inserting ‘‘medical facilities’’; and
(B) by striking ‘‘hospital or home’’ and inserting
‘‘medical facility’’.
SEC. 303. REPORT ON ASSISTED LIVING SERVICES.
Not later than April 1, 2000, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans Affairs
of the Senate and House of Representatives a report on the
feasibility of establishing a pilot program to assist veterans
in receiving needed assisted living services. The Secretary
shall include in such report recommendations on—
(1) the services and staffing that should be pro-
vided to a veteran receiving assisted living services
under such a pilot program;
(2) the appropriate design of such a pilot pro-
gram; and
(3) the issues that such a pilot program should
be designed to address.
•H.R. 2116 RH
SEC. 304. CHIROPRACTIC TREATMENT.
(a) ESTABLISHMENT OF PROGRAM.—(1) Within 120
days after the date of the enactment of this Act, the Under
Secretary for Health of the Department of Veterans Affairs,
after consultation with chiropractors, shall establish a pol-
icy for the Veterans Health Administration regarding the
role of chiropractic treatment in the care of veterans under
chapter 17 of title 38, United States Code.
(b) DEFINITIONS.—For purposes of this section:
(1) The term ‘‘chiropractic treatment’’ means the
manual manipulation of the spine performed by a
chiropractor for the treatment of such musculo-skeletal
conditions as the Secretary considers appropriate.
(2) The term ‘‘chiropractor’’ means an indi-
vidual who—
(A) is licensed to practice chiropractic in
the State in which the individual performs chiro-
practic services; and
(B) holds the degree of doctor of chiropractic
from a chiropractic college accredited by the
Council on Chiropractic Education.
•H.R. 2116 RH
SEC. 305. DESIGNATION OF HOSPITAL BED REPLACEMENT
BUILDING AT IOANNIS A. LOUGARIS DEPART-
MENT OF VETERANS AFFAIRS MEDICAL CEN-
TER, RENO, NEVADA.
The hospital bed replacement building under construc-
tion at the Ioannis A. Lougaris Department of Veterans Af-
fairs Medical Center in Reno, Nevada, is hereby designated
as the ‘‘Jack Streeter Building’’. Any reference to that
building in any law, regulation, map, document, record,
or other paper of the United States shall be considered to
be a reference to the Jack Streeter Building.
TITLE IV—CONSTRUCTION AND
FACILITIES MATTERS
SEC. 401. AUTHORIZATION OF MAJOR MEDICAL FACILITY
PROJECTS.
The Secretary of Veterans Affairs may carry out the
following major medical facility projects, with each project
to be carried out in the amount specified for that project:
(1) Renovation to provide a domiciliary at Or-
lando, Florida in a total amount not to exceed
$2,400,000, to be derived only from funds appro-
priated for Construction, Major Projects, for a fiscal
year before fiscal year 2000 that remain available for
obligation.
•H.R. 2116 RH
(2) Surgical addition at the Kansas City, Mis-
souri, Department of Veterans Affairs medical center,
in an amount not to exceed $13,000,000.
SEC. 402. AUTHORIZATION OF MAJOR MEDICAL FACILITY
LEASES.
The Secretary of Veterans Affairs may enter into leases
for medical facilities as follows:
(1) Lease of an outpatient clinic, Lubbock,
Texas, in an amount not to exceed $1,112,000.
(2) Lease of a research building, San Diego,
California, in an amount not to exceed $1,066,500.
SEC. 403. AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—There are authorized to be appro-
priated to the Secretary of Veterans Affairs for fiscal year
2000 and for fiscal year 2001—
(1) for the Construction, Major Projects, account
$13,000,000 for the project authorized in section
401(2); and
(2) for the Medical Care account, $2,178,500 for
the leases authorized in section 402.
(b) LIMITATION.—The project authorized in section
401(2) may only be carried out using—
(1) funds appropriated for fiscal year 2000 or
fiscal year 2001 pursuant to the authorization of ap-
propriations in subsection (a);