In the Senate of the United States,
September 28, 1996.
Resolved, That the bill from the House of Representa-
tives (H.R. 3118) entitled ‘‘An Act to amend title 38, United
States Code, to reform eligibility for health care provided by
the Department of Veterans Affairs.’’, do pass with the fol-
lowing
AMENDMENTS:
Strike out all after the enacting clause and insert:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the ‘‘Vet-
erans’ Health Care Eligibility Reform Act of 1996’’.
(b) TABLE OF CONTENTS.—The table of contents of this
Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
TITLE I—ELIGIBILITY REFORM
Sec. 101. Eligibility for hospital care and medical services.
Sec. 102. Revision in authorities for provision of priority health care for certain
veterans exposed to specified toxic substances.
Sec. 103. Prosthetics and preventive care.
Sec. 104. Management of health care.
Sec. 105. Authorization of appropriations.
Sec. 106. Assessment of implementation and operation.
HR 3118 EAS
TITLE II—CONSTRUCTION AUTHORIZATION
Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of major medical facility leases.
Sec. 203. Authorization of appropriations.
Sec. 204. Strategic planning.
Sec. 205. Revision to prospectus requirements.
Sec. 206. Construction authorization requirements.
Sec. 207. Terminology changes.
TITLE III—HEALTH CARE AND ADMINISTRATION
Subtitle A—Health Care Sharing and Administration
Sec. 301. Revision of authority to share medical facilities, equipment, and infor-
mation.
Sec. 302. Improved efficiency in health care resource management.
Sec. 303. Personnel furnishing shared resources.
Sec. 304. Waiting period for administrative reorganizations.
Sec. 305. Repeal of limitations on contracts for conversion of performance of ac-
tivities of Department health-care facilities and revised annual
reporting requirement.
Subtitle B—Care of Women Veterans
Sec. 321. Mammography quality standards.
Sec. 322. Patient privacy for women patients.
Sec. 323. Assessment of use by women veterans of Department health services.
Sec. 324. Reporting requirements.
Subtitle C—Readjustment Counseling and Mental Health Care
Sec. 331. Expansion of eligibility for readjustment counseling and certain related
counseling services.
Sec. 332. Reports relating to Vet Centers.
Sec. 333. Advisory Committee on the Readjustment of Veterans.
Sec. 334. Centers for mental illness research, education, and clinical activities.
Sec. 335. Committee on Care of Severely Chronically Mentally Ill Veterans.
Subtitle D—Other Provisions
Sec. 341. Hospice care study.
Sec. 342. Payment to States of per diem for veterans receiving adult day health
care.
Sec. 343. Research corporations.
Sec. 344. Veterans Health Administration headquarters.
Sec. 345. Disbursement agreements relating to medical residents and interns.
Sec. 346. Authority to suspend special pay agreements for physicians and den-
tists who enter residency training programs.
Sec. 347. Remunerated outside professional activities by Veterans Health Admin-
istration personnel.
Sec. 348. Modification of restrictions on real property, Milwaukee County, Wis-
consin.
Sec. 349. Modification of restrictions on real property, Cheyenne, Wyoming.
Sec. 350. Name of Department of Veterans Affairs Medical Center, Johnson City,
Tennessee.
Sec. 351. Report on health care needs of veterans in east central Florida.
HR 3118 EAS
Sec. 352. Evaluation of health status of spouses and children of Persian Gulf War
veterans.
SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.
Except as otherwise expressly provided, whenever in
this Act an amendment or repeal is expressed in terms of
an amendment to or repeal of a section or other provision,
the reference shall be considered to be made to a section or
other provision of title 38, United States Code.
TITLE I—ELIGIBILITY REFORM
SEC. 101. ELIGIBILITY FOR HOSPITAL CARE AND MEDICAL
SERVICES.
(a) NEW CRITERIA FOR ELIGIBILITY FOR CARE.—Sec-
tion 1710(a) is amended to read as follows:
‘‘(a)(1) The Secretary (subject to paragraph (4)) shall
furnish hospital care and medical services, and may furnish
nursing home care, which the Secretary determines to be
needed—
‘‘(A) to any veteran for a service-connected dis-
ability; and
‘‘(B) to any veteran who has a service-connected
disability rated at 50 percent or more.
‘‘(2) The Secretary (subject to paragraph (4)) shall
furnish hospital care and medical services, and may furnish
nursing home care, which the Secretary determines to be
needed to any veteran—
HR 3118 EAS
‘‘(A) who has a compensable service-connected
disability rated less than 50 percent;
‘‘(B) whose discharge or release from active mili-
tary, naval, or air service was for a compensable dis-
ability that was incurred or aggravated in the line of
duty;
‘‘(C) who is in receipt of, or who, but for a sus-
pension pursuant to section 1151 of this title (or both
a suspension and the receipt of retired pay), would be
entitled to disability compensation, but only to the ex-
tent that such veteran’s continuing eligibility for such
care is provided for in the judgment or settlement
provided for in such section;
‘‘(D) who is a former prisoner of war;
‘‘(E) who is a veteran of the Mexican border pe-
riod or of World War I;
‘‘(F) who was exposed to a toxic substance, radi-
ation, or environmental hazard, as provided in sub-
section (e); or
‘‘(G) who is unable to defray the expenses of nec-
essary care as determined under section 1722(a) of
this title.
‘‘(3) In the case of a veteran who is not described in
paragraphs (1) and (2), the Secretary may, to the extent
resources and facilities are available and subject to the pro-
HR 3118 EAS
visions of subsections (f) and (g), furnish hospital care,
medical services, and nursing home care which the Sec-
retary determines to be needed.
‘‘(4) The requirement in paragraphs (1) and (2) that
the Secretary furnish hospital care and medical services
shall be effective in any fiscal year only to the extent and
in the amount provided in advance in appropriations Acts
for such purposes.’’.
(b) TRANSFER OF PROVISION.—Chapter 17 is amend-
ed—
(1) by redesignating subsection (g) of section
1710 as subsection (h); and
(2) by transferring subsection (f) of section 1712
to section 1710 and inserting such subsection so as to
appear after subsection (f), redesignating such sub-
section as subsection (g), and amending such sub-
section by striking out ‘‘section 1710(a)(2) of this
title’’ in paragraph (1) and inserting in lieu thereof
‘‘subsection (a)(3) of this section’’.
(c) REPEAL OF SEPARATE OUTPATIENT CARE PRIOR-
ITIES.—(1) Section 1712 is amended—
(A) by striking out subsections (a) and (i);
(B) by redesignating subsections (b), (c), (d), (h)
and (j), as subsections (a), (b), (c), (d), and (e), re-
spectively; and
HR 3118 EAS
(C) in subsection (b), as so redesignated, by
striking out ‘‘subsection (b) of this section’’ and in-
serting in lieu thereof ‘‘subsection (a)’’.
(2)(A) The heading of such section is amended to read
as follows:
‘‘§ 1712. Dental care; drugs and medicines for certain
disabled veterans; vaccines’’.
(B) The item relating to such section in the table of
sections at the beginning of chapter 17 is amended to read
as follows:
‘‘1712. Dental care; drugs and medicines for certain disabled veterans; vaccines.’’.
(d) CONFORMING AMENDMENTS TO CHAPTER 17.—
Chapter 17 is further amended as follows:
(1) Section 1701(6)(B)(i) is amended—
(A) in subclause (I), by striking out ‘‘sec-
tion 1712(a)’’ and inserting in lieu thereof
‘‘paragraph (1) or (2) of section 1710(a)’’; and
(B) in subclause (II), by striking out ‘‘sec-
tion 1712(a)(5)(B)’’ and inserting in lieu thereof
‘‘paragraph (1), (2) or (3) of section 1710(a)’’.
(2) Section 1710(c)(1) is amended by striking
out ‘‘section 1712(b)’’ and inserting in lieu thereof
‘‘section 1712(a)’’.
(3) Section 1710(e)(1)(C) is amended by striking
out ‘‘hospital care and nursing home care under sub-
section (a)(1)(G) of this section’’ and inserting in lieu
HR 3118 EAS
thereof ‘‘hospital care, medical services, and nursing
home care under subsection (a)(2)(F)’’.
(4) Section 1710(f) is amended—
(A) in paragraph (1), by striking out ‘‘sub-
section (a)(2)’’ and inserting in lieu thereof
‘‘subsection (a)(3)’’; and
(B) in paragraph (3)(E)—
(i) by striking out ‘‘section 1712(a) of
this title’’ and inserting in lieu thereof
‘‘paragraph (3) of subsection (a)’’; and
(ii) by striking out ‘‘section 1712(f) of
this title’’ and inserting in lieu thereof
‘‘subsection (g)’’; and
(C) in paragraph (3)(F), by striking out
‘‘section 1712(f) of this title’’ and inserting in
lieu thereof ‘‘subsection (g)’’.
(5) Section 1712A is amended—
(A) in subsection (b)(1), by striking out
‘‘under the conditions specified in section
1712(a)(5)(B) of this title’’; and
(B) in subsection (e)(1), by striking out
‘‘sections 1712(a)(1)(B) and 1703(a)(2)’’ and in-
serting in lieu thereof ‘‘sections 1703(a)(2) and
1710(a)(1)(B)’’.
(6) Section 1717(a) is amended—
HR 3118 EAS
(A) in paragraph (1), by striking out ‘‘sec-
tion 1712(a)’’ and inserting in lieu thereof ‘‘sec-
tion 1710(a)’’; and
(B) in paragraph (2)—
(i) in subparagraph (A), by striking
out ‘‘paragraph (1) of section 1712(a) of
this title’’ and inserting in lieu thereof ‘‘sec-
tion 1710(a)(1) of this title, or for a disabil-
ity described in section 1710(a)(2)(C) of
this title’’; and
(ii) in subparagraph (B), by striking
out ‘‘section 1712’’ and inserting in lieu
thereof ‘‘section 1710(a)(2)’’.
(7) Section 1718(e) is amended by striking out
‘‘section 1712(i)’’ and inserting in lieu thereof ‘‘sec-
tion 1705’’.
(8) Section 1720(f) is amended—
(A) in paragraph (1)(A)(ii), by striking out
‘‘section 1712(a)(1)(B)’’ and inserting in lieu
thereof ‘‘paragraph (1), (2), or (3) of section
1710(a)’’; and
(B) by striking out paragraph (3).
(9) Section 1722 is amended—
HR 3118 EAS
(A) in subsection (a), by striking out ‘‘sec-
tion 1710(a)(1)(I)’’ and inserting in lieu thereof
‘‘section 1710(a)(2)(G)’’; and
(B) in subsection (f)(3), by striking out ‘‘or
1712(f)’’.
(10) Section 1729(g)(3)(A) is amended by strik-
ing out ‘‘under section 1710(f) of this title for hospital
care or nursing home care, under section 1712(f) of
this title for medical services,’’ and inserting in lieu
thereof ‘‘under subsection (f) or (g) of section 1710 of
this title for hospital care, medical services, or nurs-
ing home care’’.
(e) OTHER CONFORMING
AND TECHNICAL AMEND-
MENTS.—
(1) Section 1525 is amended—
(A) in subsection (a), by striking out ‘‘sec-
tion 1712(h) of this title’’ and all that follows
through the period at the end and inserting in
lieu thereof ‘‘section 1712(d) of this title.’’; and
(B) in subsection (b), by striking out ‘‘re-
numeration’’ and inserting in lieu thereof ‘‘re-
muneration’’.
(2) Section 2104(b) is amended—
HR 3118 EAS
(A) in the first sentence, by striking out
‘‘section 1712(a)’’ and inserting in lieu thereof
‘‘section 1717(a)(2)’’; and
(B) in the second sentence, by striking out
‘‘section 1712(a)’’ and inserting in lieu thereof
‘‘section 1717(a)(2)’’.
(3) Section 5317(c)(3) is amended by striking
out ‘‘sections 1710(a)(1)(I), 1710(a)(2), 1710(b), and
1712(a)(2)(B)’’ and inserting in lieu thereof ‘‘sub-
sections (a)(2)(G), (a)(3), and (b) of section 1710’’.
(4) Section 8110(a)(2) is amended by striking
out ‘‘section 1712’’ and inserting in lieu thereof ‘‘sec-
tion 1710(a)’’.
(5) Section 8111A(b)(2)(A) is amended by strik-
ing out ‘‘subsection (f) of section 1712’’ and inserting
in lieu thereof ‘‘subsection (a) of section 1710’’.
SEC. 102. REVISION IN AUTHORITIES FOR PROVISION OF
PRIORITY HEALTH CARE FOR CERTAIN VET-
ERANS EXPOSED TO SPECIFIED TOXIC SUB-
STANCES.
(a) AUTHORIZED INPATIENT CARE.—Section 1710(e)
is amended—
(1) in paragraph (1), by striking out subpara-
graphs (A) and (B) and inserting in lieu thereof the
following:
HR 3118 EAS
‘‘(A) A Vietnam-era herbicide-exposed veteran is eligi-
ble (subject to paragraph (2)) for hospital care, medical
services, and nursing home care under subsection (a)(2)(F)
for any disability, notwithstanding that there is insufficient
medical evidence to conclude that such disability may be
associated with such exposure.
‘‘(B) A radiation-exposed veteran is eligible for hos-
pital care, medical services, and nursing home care under
subsection (a)(2)(F) for any disease suffered by the veteran
that is—
‘‘(i) a disease listed in section 1112(c)(2) of this
title; or
‘‘(ii) any other disease for which the Secretary,
based on the advice of the Advisory Committee on En-
vironmental Hazards, determines that there is credi-
ble evidence of a positive association between occur-
rence of the disease in humans and exposure to ioniz-
ing radiation.’’; and
(2) by striking out paragraphs (2) and (3) and
inserting in lieu thereof the following:
‘‘(2)(A) In the case of a veteran described in paragraph
(1)(A), hospital care, medical services, and nursing home
care may not be provided under subsection (a)(2)(F) with
respect to—
HR 3118 EAS
‘‘(i) a disability that is found, in accordance
with guidelines issued by the Under Secretary for
Health, to have resulted from a cause other than an
exposure described in paragraph (4)(A)(ii); or
‘‘(ii) a disease for which the National Academy
of Sciences, in a report issued in accordance with sec-
tion 2 of the Agent Orange Act of 1991, has deter-
mined that there is limited or suggestive evidence of
the lack of a positive association between occurrence
of the disease in humans and exposure to a herbicide
agent.
‘‘(B) In the case of a veteran described in paragraph
(1)(C), hospital care, medical services, and nursing home
care may not be provided under subsection (a)(2)(F) with
respect to a disability that is found, in accordance with
guidelines issued by the Under Secretary for Health, to have
resulted from a cause other than an exposure described in
that paragraph.
‘‘(3) Hospital care, medical services, and nursing home
care may not be provided under or by virtue of subsection
(a)(2)(F)—
‘‘(A) in the case of care for a veteran described
in paragraph (1)(A), after December 31, 2002; and
‘‘(B) in the case of care for a veteran described
in paragraph (1)(C), after December 31, 1998.
HR 3118 EAS
‘‘(4) For purposes of this subsection—
‘‘(A) The term ‘Vietnam-era herbicide-exposed
veteran’ means a veteran (i) who served on active
duty in the Republic of Vietnam during the Vietnam
era, and (ii) who the Secretary finds may have been
exposed during such service to dioxin or was exposed
during such service to a toxic substance found in a
herbicide or defoliant used for military purposes dur-
ing such era.
‘‘(B) The term ‘radiation-exposed veteran’ has
the meaning given that term in section 1112(c)(3) of
this title.’’.
(b) SAVINGS PROVISIONS.—The provisions of sections
1710(e) and 1712(a) of title 38, United States Code, as in
effect on the day before the date of the enactment of this
Act, shall continue to apply on and after such date with
respect to the furnishing of hospital care, nursing home
care, and medical services for any veteran who was fur-
nished such care or services before such date of enactment
on the basis of presumed exposure to a substance or radi-
ation under the authority of those provisions, but only for
treatment for a disability for which such care or services
were furnished before such date.
HR 3118 EAS
SEC. 103. PROSTHETICS AND PREVENTIVE CARE.
(a) ELIGIBILITY.—Section 1701(6)(A)(i) is amend-
ed—
(1) by striking out ‘‘(in the case of a person oth-
erwise receiving care or services under this chapter)’’
and ‘‘(except under the conditions described in section
1712(a)(5)(A) of this title),’’;
(2) by inserting ‘‘(in the case of a person other-
wise receiving care or services under this chapter)’’
before ‘‘wheelchairs,’’; and
(3) by inserting ‘‘except that the Secretary may
not furnish sensori-neural aids other than in accord-
ance with guidelines which the Secretary shall pre-
scribe,’’ after ‘‘reasonable and necessary,’’.
(b) REGULATIONS.—Not later than 30 days after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall prescribe the guidelines required by the amend-
ments made by subsection (a) and shall furnish a copy of
those guidelines to the Committees on Veterans’ Affairs of
the Senate and House of Representatives.
SEC. 104. MANAGEMENT OF HEALTH CARE.
(a) IN GENERAL.—(1) Chapter 17 is amended by in-
serting after section 1704 the following new sections:
HR 3118 EAS
‘‘§ 1705. Management of health care: patient enroll-
ment system
‘‘(a) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the Sec-
retary, in accordance with regulations the Secretary shall
prescribe, shall establish and operate a system of annual
patient enrollment. The Secretary shall manage the enroll-
ment of veterans in accordance with the following priorities,
in the order listed:
‘‘(1) Veterans with service-connected disabilities
rated 50 percent or greater.
‘‘(2) Veterans with service-connected disabilities
rated 30 percent or 40 percent.
‘‘(3) Veterans who are former prisoners of war,
veterans with service-connected disabilities rated 10
percent or 20 percent, and veterans described in sub-
paragraphs (B) and (C) of section 1710(a)(2) of this
title.
‘‘(4) Veterans who are in receipt of increased
pension based on a need of regular aid and attend-
ance or by reason of being permanently housebound
and other veterans who are catastrophically disabled.
‘‘(5) Veterans not covered by paragraphs (1)
through (4) who are unable to defray the expenses of
necessary care as determined under section 1722(a) of
this title.
HR 3118 EAS
‘‘(6) All other veterans eligible for hospital care,
medical services, and nursing home care under section
1710(a)(2) of this title.
(7) Veterans described in section 1710(a)(3) of
this title.
‘‘(b) In the design of an enrollment system under sub-
section (a), the Secretary—
‘‘(1) shall ensure that the system will be man-
aged in a manner to ensure that the provision of care
to enrollees is timely and acceptable in quality;
‘‘(2) may establish additional priorities within
each priority group specified in subsection (a), as the
Secretary determines necessary; and
‘‘(3) may provide for exceptions to the specified
priorities where dictated by compelling medical rea-
sons.
‘‘(c)(1) Effective on October 1, 1998, the Secretary may
not provide hospital care or medical services to a veteran
under paragraph (2) or (3) of section 1710(a) of this title
unless the veteran enrolls in the system of patient enroll-
ment established by the Secretary under subsection (a).
‘‘(2) The Secretary shall provide hospital care and
medical services under section 1710(a)(1) of this title, and
under subparagraph (B) of section 1710(a)(2) of this title,
for the 12-month period following such veteran’s discharge
HR 3118 EAS
or release from service, to any veteran referred to in such
sections for a disability specified in the applicable subpara-
graph of such section, notwithstanding the failure of the vet-
eran to enroll in the system of patient enrollment referred
to in subsection (a) of this section.
‘‘§ 1706. Management of health care: other require-
ments
‘‘(a) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the Sec-
retary shall, to the extent feasible, design, establish and
manage health care programs in such a manner as to pro-
mote cost-effective delivery of health care services in the
most clinically appropriate setting.
‘‘(b)(1) In managing the provision of hospital care and
medical services under such section, the Secretary shall en-
sure that the Department maintains its capacity to provide
for the specialized treatment and rehabilitative needs of dis-
abled veterans (including veterans with spinal cord dys-
function, blindness, amputations, and mental illness) with-
in distinct programs or facilities of the Department that
are dedicated to the specialized needs of those veterans in
a manner that (A) affords those veterans reasonable access
to care and services for those specialized needs, and (B) en-
sures that overall capacity of the Department to provide
such services is not reduced below the capacity of the De-
HR 3118 EAS
partment, nationwide, to provide those services, as of the
date of the enactment of this section. The Secretary shall
carry out this paragraph in consultation with the Advisory
Committee on Prosthetics and Special Disabilities Pro-
grams and the Committee on Care of Severely Chronically
Mentally Ill Veterans.
‘‘(2) Not later than April 1, 1997, April 1, 1998, and
April 1, 1999, the Secretary shall submit to the Committees
on Veterans’ Affairs of the Senate and House of Representa-
tives a report on the Secretary’s compliance, by facility and
by service-network, with the requirements of this sub-
section.’’.
(2) The table of sections at the beginning of chapter
17 is amended by inserting after the item relating to section
1704 the following new items:
‘‘1705. Management of health care: patient enrollment system.
‘‘1706. Management of health care: other requirements.’’.
(b) CONFORMING AMENDMENTS TO SECTION 1703.—
Section 1703(a) is amended—
(1) in the matter preceding paragraph (1), by
striking out ‘‘or 1712’’;
(2) in paragraph (2)—
(A) by striking out ‘‘1712(a)(1)(B)’’ in sub-
paragraph (A) and inserting in lieu thereof
‘‘1710(a)(1)(B)’’;
HR 3118 EAS
(B) by striking out subparagraph (B) and
inserting in lieu thereof the following:
‘‘(B) a veteran who (i) has been furnished
hospital care, nursing home care, domiciliary
care, or medical services, and (ii) requires medi-
cal services to complete treatment incident to
such care or services; or’’; and
(C) by striking ‘‘section 1712(a)(3) (other
than a veteran who is a former prisoner of war)
of this title’’ in subparagraph (C) and inserting
in lieu thereof ‘‘section 1710(a)(2)(E) of this
title, or a veteran who is in receipt of increased
pension, or additional compensation or allow-
ances based on the need of regular aid and at-
tendance or by reason of being permanently
housebound (or who, but for the receipt of retired
pay, would be in receipt of such pension, com-
pensation, or allowance),’’; and
(3) 
in 
paragraph 
(7), 
by 
striking 
out
‘‘1712(b)(1)(F)’’ 
and 
inserting 
in 
lieu 
thereof
‘‘1712(a)(1)(F)’’.
SEC. 105. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated for the Depart-
ment of Veterans Affairs for the Medical Care account, for
the purposes specified for that account in Public Law 103–
HR 3118 EAS
level of care, and (B) by reference to whether care was
furnished in Department facilities or under contract
arrangements.
(3) With respect to the number of veterans de-
scribed in paragraphs (1), (2), and (3) of section
1710(a) of title 38, United States Code, as amended
by section 101, who applied for health care from the
Department during fiscal year 1997—
(A) the number who applied for care (shown
in total and separately by facility);
(B) the number who were denied enrollment
(shown in total and separately by facility); and
(C) the number who were denied care which
was considered to be medically necessary but not
of an emergency nature (shown in total and sep-
arately by facility).
(4) The numbers and characteristics of, and the
type and extent of health care furnished to, veterans
enrolled for care (shown in total and separately by fa-
cility).
(5) The numbers and characteristics of, and the
type and extent of health care furnished to, veterans
not enrolled for care (shown separately by reference to
each class of eligibility, both in total and separately
by facility).
HR 3118 EAS
(6) The specific fiscal impact (shown in total
and by geographic health-care delivery areas) of
changes in delivery patterns instituted under the
amendments made by this title.
TITLE II—CONSTRUCTION
AUTHORIZATION
SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY
PROJECTS.
(a) AMBULATORY CARE ADDITION PROJECTS.—The
Secretary of Veterans Affairs may carry out the following
ambulatory care addition major medical facility projects,
with each project to be carried out in the amount specified
for that project:
(1) Construction of an ambulatory care facility
and renovation of ‘‘E’’ wing, Tripler Army Hospital,
Honolulu, Hawaii, $43,000,000.
(2) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in
Brockton, Massachusetts, $13,500,000.
(3) Addition of ambulatory care facilities for
outpatient improvements at the Department of Veter-
ans Affairs medical center in Shreveport, Louisiana,
$25,000,000.
HR 3118 EAS
(4) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in
Lyons, New Jersey, $21,100,000.
(5) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in
Tomah, Wisconsin, $12,700,000.
(6) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in
Asheville, North Carolina, $26,300,000.
(7) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in
Temple, Texas, $9,800,000.
(8) Addition of ambulatory care facilities at the
Department of Veterans Affairs medical center in
Tucson, Arizona, $35,500,000.
(9) Construction of an ambulatory care facility
at the Department of Veterans Affairs medical center
in Leavenworth, Kansas, $27,750,000.
(b) ENVIRONMENTAL IMPROVEMENT PROJECTS.—The
Secretary may carry out the following environmental im-
provement major medical facility projects, with each project
to be carried out in the amount specified for that project:
(1) Environmental improvements for the renova-
tion of nursing home facilities at the Department of
HR 3118 EAS
Veterans Affairs medical center in Lebanon, Penn-
sylvania, $9,500,000.
(2) Environmental improvements at the Depart-
ment of Veterans Affairs medical center in Marion,
Illinois, $11,500,000.
(3) Environmental improvements for ward ren-
ovation for patient privacy at the Department of Vet-
erans Affairs medical center in Omaha, Nebraska,
$7,700,000.
(4) Environmental improvements at the Depart-
ment of Veterans Affairs medical center in Pittsburgh,
Pennsylvania, $17,400,000.
(5) Environmental improvements for the renova-
tion of various buildings at the Department of Veter-
ans 
Affairs 
medical 
center 
in 
Waco, 
Texas,
$26,000,000.
(6) Environmental improvements for the replace-
ment of psychiatric beds at the Department of Veter-
ans Affairs medical center in Marion, Indiana,
$17,300,000.
(7) Environmental improvements for the renova-
tion of psychiatric wards at the Department of Veter-
ans Affairs medical center in Perry Point, Maryland,
$15,100,000.
HR 3118 EAS
(8) Environmental enhancement at the Depart-
ment of Veterans Affairs medical center in Salisbury,
North Carolina, $18,200,000.
(c) SEISMIC CORRECTION PROJECT.—The Secretary
may carry out seismic corrections to Building Number 324
at the Department of Veterans Affairs medical center in
Palo Alto, California, in the amount of $20,800,000.
(d) PROJECT AUTHORIZATION WHEN PARTIAL FUND-
ING PROVIDED.—If the amount of funds appropriated for
fiscal year 1997 or 1998 for design and partial construction
of a major medical facility project that is authorized in
this section is less than the amount required to complete
the construction of that project as authorized and if the Sec-
retary obligates funds for such construction, such project
shall be deemed to be fully authorized. Any such authoriza-
tion shall cease to have effect at the close of fiscal year 2001.
SEC. 202. AUTHORIZATION OF MAJOR MEDICAL FACILITY
LEASES.
The Secretary of Veterans Affairs may enter into leases
for medical facilities as follows:
(1) Lease of a satellite outpatient clinic in Allen-
town, Pennsylvania, in an amount not to exceed
$2,159,000.
(2) Lease of a satellite outpatient clinic in Beau-
mont, Texas, in an amount not to exceed $1,940,000.
HR 3118 EAS
(3) Lease of a satellite outpatient clinic in Bos-
ton, Massachusetts, in an amount not to exceed
$2,358,000.
(4) Lease of a parking facility in Cleveland,
Ohio, in an amount not to exceed $1,300,000.
(5) Lease of a satellite outpatient clinic and Vet-
erans Benefits Administration field office in San An-
tonio, Texas, in an amount not to exceed $2,256,000.
(6) Lease of a satellite outpatient clinic in To-
ledo, Ohio, in an amount not to exceed $2,223,000.
SEC. 203. AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—There are authorized to be appro-
priated to the Secretary of Veterans Affairs for fiscal year
1997 and fiscal year 1998—
(1) for the Construction, Major Projects, account,
a total of $358,150,000 for the projects authorized in
section 201; and
(2) for the Medical Care account, a total of
$12,236,000 for the leases authorized in section 202.
(b) LIMITATION.—The projects authorized in section
201 may only be carried out using—
(1) funds appropriated for fiscal year 1997 or
fiscal year 1998 consistent with the authorization of
appropriations in subsection (a);
HR 3118 EAS
operating within prescribed geographic service-deliv-
ery areas, such plan to include provision of services
for the specialized treatment and rehabilitative needs
of disabled veterans (including veterans with spinal
cord dysfunction, blindness, amputations, and mental
illness) through distinct programs or facilities of the
Department dedicated to the specialized needs of those
veterans.
‘‘(2) A description of how planning for the net-
works will be coordinated.
‘‘(3) A profile regarding each such network of
medical facilities which identifies—
‘‘(A) the mission of each existing or pro-
posed medical facility in the network;
‘‘(B) any planned change in the mission for
any such facility and the rationale for such
planned change;
‘‘(C) the population of veterans to be served
by the network and anticipated changes over a
five-year period and a ten-year period, respec-
tively, in that population and in the health-care
needs of that population;
‘‘(D) information relevant to assessing
progress toward the goal of achieving relative
equivalency in the level of resources per patient
HR 3118 EAS
distributed to each network, such information to
include the plans for and progress toward lower-
ing the cost of care-delivery in the network (by
means such as changes in the mix in the network
of physicians, nurses, physician assistants, and
advance practice nurses);
‘‘(E) the capacity of non-Federal facilities
in the network to provide acute, long-term, and
specialized treatment and rehabilitative services
(described in section 7305 of this title), and de-
terminations regarding the extent to which serv-
ices to be provided in each service-delivery area
and each facility in such area should be provided
directly through facilities of the Department or
through contract or other arrangements, includ-
ing arrangements authorized under sections 8111
and 8153 of this title; and
‘‘(F) a five-year plan for construction, re-
placement, or alteration projects in support of
the approved mission of each facility in the net-
work and a description of how those projects will
improve access to care, or quality of care, for pa-
tients served in the network.
‘‘(4) A status report for each facility on progress
toward—
HR 3118 EAS
‘‘(A) instituting planned mission changes
identified under paragraph (3)(B);
‘‘(B) implementing principles of managed
care of eligible veterans; and
‘‘(C) developing and instituting cost-effec-
tive alternatives to provision of institutional
care.’’; and
(3) by adding at the end the following new sub-
section:
‘‘(d)(1) The Secretary shall submit to each committee,
not later than January 31 of each year, a report showing
the current priorities of the Department for proposed major
medical construction projects. Each such report shall iden-
tify the 20 projects, from within all the projects in the De-
partment’s inventory of proposed projects, that have the
highest priority and, for those 20 projects, the relative pri-
ority and rank scoring of each such project and the pro-
jected cost of such project (including the projected operating
costs, including both recurring and nonrecurring costs). The
20 projects shall be compiled, and their relative rankings
shall be shown, by category of project (including the cat-
egories of ambulatory care projects, nursing home care
projects, and such other categories as the Secretary deter-
mines).
HR 3118 EAS
‘‘(2) The Secretary shall include in each report, for
each project listed, a description of the specific factors that
account for the relative ranking of that project in relation
to other projects within the same category.
‘‘(3) In a case in which the relative ranking of a 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. 205. REVISION TO PROSPECTUS REQUIREMENTS.
(a) ADDITIONAL INFORMATION.—Section 8104(b) is
amended—
(1) by striking out the matter preceding para-
graph (1) and inserting in lieu thereof the following:
‘‘(b) Whenever the President or the Secretary submit
to the Congress a request for the funding of a major medical
facility project (as defined in subsection (a)(3)(A)) or a
major medical facility lease (as defined in subsection
(a)(3)(B)), the Secretary shall submit to each committee,
on the same day, a prospectus of the proposed medical facil-
ity. Any such prospectus shall include the following:’’;
(2) in paragraph (1)—
HR 3118 EAS
(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 para-
graphs:
‘‘(4) Demographic data applicable to such facil-
ity, including information on projected changes in the
population of veterans to be served by the facility over
a five-year period and a ten-year period.
‘‘(5) Current and projected workload and utiliza-
tion data regarding the facility.
‘‘(6) Current and projected operating costs of the
facility, including both recurring and non-recurring
costs.
‘‘(7) The priority score assigned to the project or
lease under the Department’s prioritization methodol-
HR 3118 EAS
ogy and, if the project or lease is being proposed for
funding before a project or lease with a higher score,
a specific explanation of the factors other than the
priority score that were considered and the basis on
which the project or lease is proposed for funding
ahead of projects or leases with higher priority scores.
‘‘(8) In the case of a prospectus proposing the
construction of a new or replacement medical facility,
a description of each alternative to construction of the
facility that was considered.’’.
(b) APPLICABILITY.—The amendments made by 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. 
206. 
CONSTRUCTION 
AUTHORIZATION 
REQUIRE-
MENTS.
(a) DEFINITION
OF
MAJOR
MEDICAL
FACILITY
PROJECT.—Paragraph (3)(A) of section 8104(a) is amend-
ed by striking out ‘‘$3,000,000’’ and inserting in lieu there-
of ‘‘$4,000,000’’.
(b) APPLICABILITY
OF CONSTRUCTION AUTHORIZA-
TION REQUIREMENT.—(1) Subsection (b) of section 301 of
the Veterans’ Medical Programs Amendments of 1992 (Pub-
lic Law 102–405; 106 Stat. 1984) is repealed.
HR 3118 EAS
(2) The amendments made by subsection (a) of such
section shall apply with respect to any major medical facil-
ity project or any major medical facility lease of the De-
partment of Veterans Affairs, regardless of when funds are
first appropriated for that project or lease, except that in
the case of a project for which funds were first appropriated
before October 9, 1992, such amendments shall not apply
with respect to amounts appropriated for that project for
a fiscal year before fiscal year 1998.
(c) LIMITATION ON OBLIGATIONS FOR ADVANCE PLAN-
NING.—Section 8104 is amended by adding at the end the
following new subsection:
‘‘(f) The Secretary may not obligate funds in an
amount in excess of $500,000 from the Advance Planning
Fund of the Department toward design or development of
a major medical facility project (as defined in subsection
(a)(3)(A)) until—
‘‘(1) the Secretary submits to the committees a
report on the proposed obligation; and
‘‘(2) a period of 30 days has passed after the
date on which the report is received by the commit-
tees.’’.
SEC. 207. TERMINOLOGY CHANGES.
(a) DEFINITION OF ‘‘CONSTRUCT’’.—Section 8101(2)
is amended—
HR 3118 EAS
(1) by striking out ‘‘working drawings’’ and in-
serting in lieu thereof ‘‘construction documents’’; and
(2) by striking out ‘‘preliminary plans’’ and in-
serting in lieu thereof ‘‘design development’’.
(b) PARKING FACILITIES.—Section 8109(h)(3)(B) is
amended by striking out ‘‘working drawings’’ and inserting
in lieu thereof ‘‘construction documents’’.
TITLE III—HEALTH CARE AND
ADMINISTRATION
Subtitle A—Health Care Sharing
and Administration
SEC. 301. REVISION OF AUTHORITY TO SHARE MEDICAL FA-
CILITIES, EQUIPMENT, AND INFORMATION.
(a) STATEMENT OF PURPOSE.—The text of section
8151 is amended to read as follows:
‘‘It is the purpose of this subchapter to strengthen the
medical programs at Department facilities and improve the
quality of health care provided veterans under this title by
authorizing the Secretary to enter into agreements with
health-care providers in order to share health-care resources
with, and receive health-care resources from, such providers
while ensuring no diminution of services to veterans.’’.
(b) DEFINITIONS.—Section 8152 is amended—
HR 3118 EAS
(1) by striking out paragraphs (1), (2), and (3)
and inserting in lieu thereof the following new para-
graphs (1) and (2):
‘‘(1) The term ‘health-care resource’ includes hos-
pital care and medical services (as those terms are de-
fined in section 1701 of this title), any other health-
care service, and any health-care support or adminis-
trative resource.
‘‘(2) The term ‘health-care providers’ includes
health-care plans and insurers and any organiza-
tions, institutions, or other entities or individuals
who furnish health-care resources.’’; and
(2) by redesignating paragraph (4) as para-
graph (3).
(c) AUTHORITY
TO
SECURE
HEALTH-CARE
RE-
SOURCES.—Section 8153 is amended as follows:
(1) Subsection (a) is amended—
(A) in paragraph (1)—
(i) by striking out ‘‘certain specialized
medical resources’’ and inserting in lieu
thereof ‘‘health-care resources’’;
(ii) by striking out ‘‘other medical re-
sources’’ and inserting in lieu thereof ‘‘other
health-care resources’’; and
HR 3118 EAS
(iii) by striking out ‘‘of—’’ and all
that follows through ‘‘section 1742(a) of this
title’’ and inserting in lieu thereof ‘‘of
health-care resources between Department
health-care facilities and any health-care
provider, or other entity or individual’’;
(B) in paragraph (2), by striking out
‘‘only’’ and all that follows through ‘‘are not’’
and inserting in lieu thereof ‘‘if such resources
are not, or would not be,’’; and
(C) by adding at the end the following:
‘‘(3)(A) If the health-care resource required is a com-
mercial service, the use of medical equipment or space, or
research, and is to be acquired from an institution affiliated
with the Department in accordance with section 7302 of
this title, including medical practice groups and other enti-
ties associated with affiliated institutions, blood banks,
organ banks, or research centers, the Secretary may make
arrangements for acquisition of the resource without regard
to any law or regulation that would otherwise require the
use of competitive procedures for acquiring the resource.
‘‘(B)(i) If the health-care resource required is a com-
mercial service or the use of medical equipment or space,
and is not to be acquired from an entity described in sub-
paragraph (A), any procurement of the resource may be
HR 3118 EAS
conducted without regard to any law or regulation that
would otherwise require the use of competitive procedures
for procuring the resource, but only if the procurement is
conducted in accordance with the simplified procedures pre-
scribed pursuant to clause (ii).
‘‘(ii) The Secretary, in consultation with the Adminis-
trator for Federal Procurement Policy, may prescribe sim-
plified procedures for the procurement of health-care re-
sources under this subparagraph. The Secretary shall pub-
lish such procedures for public comment in accordance with
section 22 of the Office of Federal Procurement Policy Act
(41 U.S.C. 418b). Such procedures shall permit all respon-
sible sources to submit a bid, proposal, or quotation (as ap-
propriate) for the resources to be procured and provide for
the consideration by the Department of bids, proposals, or
quotations so submitted.
‘‘(iii) Pending publication of the procedures under
clause (ii), the Secretary shall (except as provided under
subparagraph (A)) procure health-care resources referred to
in clause (i) in accordance with all procurement laws and
regulations.
‘‘(C) Any procurement of health-care resources other
than those covered by subparagraph (A) or (B) shall be con-
ducted in accordance with all procurement laws and regula-
tions.
HR 3118 EAS
‘‘(D) For any procurement to be conducted on a sole
source basis other than a procurement covered by subpara-
graph (A), a written justification shall be prepared that in-
cludes the information and is approved at the levels pre-
scribed in section 303(f) of the Federal Property and Ad-
ministrative Services Act of 1949 (41 U.S.C. 253(f)).
‘‘(E) As used in this paragraph, the term ‘commercial
service’ means a service that is offered and sold competi-
tively in the commercial marketplace, is performed under
standard commercial terms and conditions, and is procured
using firm-fixed price contracts.’’.
(2) Subsection (b) is amended by striking out
‘‘reciprocal reimbursement’’ in the first sentence and
all that follows through the period at the end of that
sentence and inserting in lieu thereof ‘‘payment to the
Department in accordance with procedures that pro-
vide appropriate flexibility to negotiate payment
which is in the best interest of the Government.’’.
(3) Subsection (d) is amended by striking out
‘‘preclude such payment, in accordance with—’’ and
all that follows through ‘‘to such facility therefor’’ and
inserting in lieu thereof ‘‘preclude such payment to
such facility for such care or services’’.
(4) Such section is further amended—
HR 3118 EAS
‘‘§ 8153. Sharing of health-care resources’’.
(2) The item relating to section 8153 in the table of
sections at the beginning of chapter 81 is amended to read
as follows:
‘‘8153. Sharing of health-care resources.’’.
SEC. 302. IMPROVED EFFICIENCY IN HEALTH CARE RE-
SOURCE MANAGEMENT.
(a) TEMPORARY
EXPANSION
OF
AUTHORITY
FOR
SHARING AGREEMENTS.—Section 201 of the Veterans
Health Care Act of 1992 (Public Law 102–585; 38 U.S.C.
8111 note) is amended—
(1) by inserting ‘‘(a) AUTHORITY.—’’ before ‘‘The
Secretary of Veterans Affairs’’; and
(2) by adding at the end thereof the following
new subsection:
‘‘(b) USE OF FUNDS.—Any amount received by the
Secretary from a non-Federal entity as payment for services
provided by the Secretary during a prior fiscal year under
an agreement entered into under this section may be obli-
gated by the Secretary during the fiscal year in which the
Secretary receives the payment.’’.
(b) REPEAL OF SUNSET PROVISION.—(1) Section 204
of such Act (38 U.S.C. 8111 note) is repealed.
(2) Any services provided pursuant to agreements en-
tered into under section 201 of such Act (38 U.S.C. 8111
note) during the period beginning on October 1, 1996, and
HR 3118 EAS
ending on the date of the enactment of this Act are hereby
ratified.
(c) COST RECOVERY.—Title II of such Act is further
amended by adding at the end the following new section:
‘‘SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.
‘‘(a) RIGHT TO RECOVER.—In the case of a primary
beneficiary (as described in section 201(a)(2)(B)) who has
coverage under a health-plan contract, as defined in section
1729(i)(1)(A) of title 38, United States Code, and who is
furnished care or services by a Department medical facility
pursuant to this title, the United States shall have the right
to recover or collect charges for such care or services from
such health-plan contract to the extent that the beneficiary
(or the provider of the care or services) would be eligible
to receive payment for such care or services from such
health-plan contract if the care or services had not been fur-
nished by a department or agency of the United States. Any
funds received from such health-plan contract shall be cred-
ited to funds that have been allotted to the facility that fur-
nished the care or services.
‘‘(b) ENFORCEMENT.—The right of the United States
to recover under such a beneficiary’s health-plan contract
shall be enforceable in the same manner as that provided
by subsections (a)(3), (b), (c)(1), (d), (f), (h), and (i) of
section 1729 of title 38, United States Code.’’.
HR 3118 EAS
SEC. 303. PERSONNEL FURNISHING SHARED RESOURCES.
Section 712(b)(2) is amended—
(1) by striking out ‘‘the sum of—’’ and inserting
in lieu thereof ‘‘the sum of the following:’’;
(2) by capitalizing the first letter of the first
word of each of subparagraphs (A) and (B);
(3) by striking out ‘‘; and’’ at the end of sub-
paragraph (A) and inserting in lieu thereof a period;
and
(4) by adding at the end the following new sub-
paragraph:
‘‘(C) The number of such positions in the
Department during that fiscal year held by per-
sons involved in providing health-care resources
under section 8111 or 8153 of this title or under
section 201 of the Veterans Health Care Act of
1992 (Public Law 102–585; 106 Stat. 4949; 38
U.S.C. 8111 note).’’.
SEC. 304. WAITING PERIOD FOR ADMINISTRATIVE REORGA-
NIZATIONS.
Section 510(b) is amended—
(1) in the second sentence, by striking out ‘‘a 90-
day period of continuous session of Congress following
the date of the submission of the report’’ and inserting
in lieu thereof ‘‘a 45-day period following the date of
the submission of the report, not less than 30 days of
HR 3118 EAS
which shall be days during which Congress shall have
been in continuous session’’; and
(2) in the third sentence, by striking out ‘‘such
90–day period’’ and inserting in lieu thereof ‘‘any pe-
riod of continuity of session’’.
SEC. 305. REPEAL OF LIMITATIONS ON CONTRACTS FOR
CONVERSION OF PERFORMANCE OF ACTIVI-
TIES OF DEPARTMENT HEALTH-CARE FACILI-
TIES AND REVISED ANNUAL REPORTING RE-
QUIREMENT.
Subsection (c) of section 8110 is amended to read as
follows:
‘‘(c) The Secretary shall include in the materials sub-
mitted to Congress each year in support of the budget of
the Department for the next fiscal year a report on activi-
ties and proposals involving contracting for performance by
contractor personnel of work previously performed by De-
partment employees. The report shall—
‘‘(1) identify those specific activities that are
currently performed at a Department facility by more
than 10 Department employees which the Secretary
proposes to study for possible contracting involving
conversion from performance by Department employ-
ees to performance by employees of a contractor; and
HR 3118 EAS
‘‘(2) identify those specific activities that have
been contracted for performance by contractor em-
ployees during the prior fiscal year (shown by loca-
tion, subject, scope of contracts, and savings) and
shall describe the effect of such contracts on the qual-
ity of delivery of health services during such year.’’.
Subtitle B—Care of Women
Veterans
SEC. 321. MAMMOGRAPHY QUALITY STANDARDS.
(a) IN GENERAL.—(1) Subchapter II of chapter 73 is
amended by adding after section 7318 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 Secretary
under this subsection shall meet the standards for accredit-
ing bodies established under subsection (e) of section 354
of the Public Health Service Act (42 U.S.C. 263b).
‘‘(b) The Secretary, in consultation with the Secretary
of Health and Human Services, shall prescribe quality as-
surance and quality control standards relating to the per-
formance and interpretation of mammograms and use of
mammogram equipment and facilities of the Department
HR 3118 EAS
of Veterans Affairs consistent with the requirements of sec-
tion 354(f)(1) of the Public Health Service Act. Such stand-
ards shall be no less stringent than the standards prescribed
by the Secretary of Health and Human Services under sec-
tion 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 perform-
ance of mammograms. Such inspections shall be carried out
in a manner consistent with the inspection of certified fa-
cilities 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 ‘mammo-
gram’ has the meaning given such term in paragraph (5)
of section 354(a) of the Public Health Service Act.’’.
HR 3118 EAS
(2) The table of sections at the beginning of such chap-
ter 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 date of the en-
actment of this Act.
(c) IMPLEMENTATION REPORT.—The Secretary shall
submit to the Committees on Veterans’ 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 subsection (a). The report shall be sub-
mitted not later than 120 days after the date of the enact-
ment of this Act.
SEC. 322. 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 pa-
tients.
HR 3118 EAS
(b) CORRECTION OF DEFICIENCIES.—The Secretary
shall ensure that plans and, where appropriate, interim
steps to correct the deficiencies identified in the survey con-
ducted under subsection (a) are developed and are incor-
porated into the Department’s construction planning proc-
esses and, in cases in which it is cost-effective to do so, are
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, 1997, and not later than
October 1 each year thereafter through 1999 a report on
such deficiencies. The Secretary shall include in such report
the inventory compiled by the Secretary, the proposed cor-
rective plans, and the status of such plans.
SEC. 323. ASSESSMENT OF USE BY WOMEN VETERANS OF
DEPARTMENT HEALTH SERVICES.
(a) REPORTS TO UNDER SECRETARY FOR HEALTH.—
The Center for Women Veterans of the Department of Veter-
ans Affairs (established under section 509 of Public Law
103–446), in consultation with the Advisory Committee on
Women Veterans, shall assess the use by women veterans
HR 3118 EAS
of health services through the Department of Veterans Af-
fairs, including counseling for sexual trauma and mental
health services. The Center shall submit to the Under Sec-
retary for Health of the Department of Veterans Affairs a
report not later than April 1, 1997, and April 1 of each
of the two following years, on—
(1) the extent to which women veterans described
in paragraphs (1) and (2) of section 1710(a) of title
38, United States Code, fail to seek, or face barriers
in seeking, health services through the Department,
and the reasons therefor; and
(2) recommendations, if indicated, for encourag-
ing greater use of such services, including (if appro-
priate) public service announcements and other out-
reach efforts.
(b) REPORTS TO CONGRESSIONAL COMMITTEES.—Not
later than July 1, 1997, and July 1 of each of the two fol-
lowing years, the Secretary of Veterans Affairs shall submit
to the Committees on Veterans’ Affairs of the Senate and
House of Representatives a report containing—
(1) the most recent report of the Center for
Women Veterans under subsection (a);
(2) the views of the Under Secretary for Health
on such report’s findings and recommendations; and
HR 3118 EAS
(3) a description of the steps being taken by the
Secretary to remedy any problems described in the re-
port.
SEC. 324. REPORTING REQUIREMENTS.
(a) EXTENSION OF ANNUAL REPORT REQUIREMENT.—
Section 107(a) of the Veterans Health Care Act of 1992
(Public Law 102–585; 106 Stat. 4947) is amended by strik-
ing 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’’.
(b) REPORT ON HEALTH CARE AND RESEARCH.—Sec-
tion 107(b) of such Act is amended—
(1) 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
(2) by adding at the end the following new para-
graph:
‘‘(5) A description of the actions taken by the
Secretary to foster and encourage the expansion of
such research.’’.
HR 3118 EAS
Subtitle C—Readjustment Counsel-
ing and Mental Health Care
SEC. 331. EXPANSION OF ELIGIBILITY FOR READJUSTMENT
COUNSELING AND CERTAIN RELATED COUN-
SELING SERVICES.
(a) EXPANSION OF ELIGIBILITY.—Subsection (a) of
section 1712A is amended to read as follows:
‘‘(a)(1)(A) Upon the request of any veteran referred
to in subparagraph (B), the Secretary shall furnish counsel-
ing to the veteran to assist the veteran in readjusting to
civilian life. Such counseling may include a general mental
and psychological assessment of the veteran to ascertain
whether such veteran has mental or psychological problems
associated with readjustment to civilian life.
‘‘(B) Subparagraph (A) applies to the following veter-
ans:
‘‘(i) Any veteran who served on active duty—
‘‘(I) in a theater of combat operations (as
determined by the Secretary in consultation with
the Secretary of Defense) during the Vietnam
era; or
‘‘(II) after May 7, l975, in an area at a
time during which hostilities occurred in that
area.
HR 3118 EAS
‘‘(ii) Any veteran (other than a veteran covered
by clause (i)) who served on active duty during the
Vietnam era who seeks or is furnished such counseling
before January 1, 2000.
‘‘(2)(A) Upon the request of any veteran (other than
a veteran covered by paragraph (1)) who served in the ac-
tive military, naval, or air service in a theater of combat
operations (as so determined) during a period of war, or
in any other area during a period in which hostilities (as
defined in subparagraph (B)) occurred in such area, the
Secretary may furnish counseling to the veteran to assist
the veteran in readjusting to civilian life.
‘‘(B) For the purposes of subparagraph (A), the term
‘hostilities’ means an armed conflict in which the members
of the Armed Forces are subjected to danger comparable to
the danger to which members of the Armed Forces have been
subjected in combat with enemy armed forces during a pe-
riod of war, as determined by the Secretary in consultation
with the Secretary of Defense.’’.
(b) REPEAL OF REFERRAL PROVISIONS.—Subsection
(c) of such section is repealed.
SEC. 332. REPORTS RELATING TO VET CENTERS.
(a) REPORT ON COLLOCATION OF VET CENTERS AND
DEPARTMENT OUTPATIENT CLINICS.—(1) Not later than
six months after the date of the enactment of this Act, the
HR 3118 EAS
(F) The effect of the locations (including urban
and rural locations) of the centers and clinics on the
feasibility and desirability of such collocation.
(G) The amount of any costs savings to be
achieved by Department as a result of such colloca-
tion.
(H) Any other matter that the Secretary consid-
ers appropriate.
(b) REPORT ON PROVISION OF LIMITED HEALTH CARE
SERVICES AT READJUSTMENT COUNSELING CENTERS.—(1)
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 feasibility and de-
sirability of providing a limited battery of health care serv-
ices (including ambulatory services and health care screen-
ing services) to veterans at Department of Veterans Affairs
readjustment counseling centers.
(2) The report shall include a discussion of the follow-
ing:
(A) The effect on the advisability of providing
health care services at readjustment counseling centers
of the geographic location of such centers, including
the urban location and rural location of such centers
HR 3118 EAS
and the proximity of such centers to Department of
Veterans Affairs medical facilities.
(B) The effect on the advisability of providing
such services at such centers of the type and level of
services to be provided, and the demographic charac-
teristics (including age, socio-economic status, eth-
nicity, and sex) of veterans likely to be provided the
services.
(C) The effect of providing such services at such
centers on the readjustment counseling center pro-
gram in general and on the efficiency and autonomy
of the clinical and administrative operations of the
readjustment counseling centers in particular.
(D) Any other matter that the Secretary consid-
ers appropriate.
(c) RULE OF CONSTRUCTION.—Nothing in this section
is intended to preclude the Secretary, during the period be-
fore the submission of the reports under this section, from
providing limited health care services at Vet Centers.
SEC. 333. ADVISORY COMMITTEE ON THE READJUSTMENT
OF VETERANS.
(a) IN GENERAL.—(1) Subchapter III of chapter 5 is
amended by inserting after section 544 the following new
section:
HR 3118 EAS
‘‘§ 545. Advisory Committee on the Readjustment of
Veterans
‘‘(a)(1) There is in the Department the Advisory Com-
mittee on the Readjustment of Veterans (hereinafter in this
section referred to as the ‘Committee’).
‘‘(2) The Committee shall consist of not more than 18
members appointed by the Secretary from among individ-
uals who—
‘‘(A) have demonstrated significant civic or pro-
fessional achievement; and
‘‘(B) have experience with the provision of veter-
ans benefits and services by the Department.
‘‘(3) The Secretary shall seek to ensure that members
appointed to the Committee include individuals from a
wide variety of geographic areas and ethnic backgrounds,
individuals from veterans service organizations, individuals
with combat experience, and women.
‘‘(4) The Secretary shall determine the terms of service
and pay and allowances of the members of the Committee,
except that a term of service may not exceed two years. The
Secretary may reappoint any member for additional terms
of service.
‘‘(b)(1) The Secretary shall, on a regular basis, consult
with and seek the advice of the Committee with respect to
the provision by the Department of benefits and services to
HR 3118 EAS
veterans in order to assist veterans in the readjustment to
civilian life.
‘‘(2)(A) In providing advice to the Secretary under
this subsection, the Committee shall—
‘‘(i) assemble and review information relating to
the needs of veterans in readjusting to civilian life;
‘‘(ii) provide information relating to the nature
and character of psychological problems arising from
service in the Armed Forces;
‘‘(iii) 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
‘‘(iv) provide on-going advice on the most appro-
priate means of responding to the readjustment needs
of veterans in the future.
‘‘(B) In carrying out its duties under subparagraph
(A), the Committee shall take into special account the needs
of veterans who have served in a theater of combat oper-
ations.
‘‘(c)(1) Not later than March 31 of each year, the Com-
mittee shall submit to the Secretary a report on the pro-
grams and activities of the Department that relate to the
readjustment of veterans to civilian life. Each such report
shall include—
HR 3118 EAS
‘‘(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 a 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 Secretary
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.
‘‘(d)(1) Except as provided in paragraph (2), the pro-
visions of the Federal Advisory Committee Act (5 U.S.C.
HR 3118 EAS
App.) shall apply to the activities of the Committee under
this section.
‘‘(2) Section 14 of such Act shall not apply to the Com-
mittee.’’.
(2) The table of sections at the beginning of chapter
5 is amended by inserting after the item relating to section
544 the following new item:
‘‘545. Advisory Committee on the Readjustment of Veterans.’’.
(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 committee recognized
under such 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 of Veterans Affairs
shall carry out such appointments as soon after such date
as is practicable. The Secretary may make such appoint-
ments from among such original members.
SEC. 334. 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 7319, as added by section
321(a)(1), the following new section:
HR 3118 EAS
‘‘§ 7320. 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 re-
lated 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
‘‘(3) the development of improved models and
systems for the furnishing of mental health services by
the Department.
‘‘(b)(1) The Secretary shall establish and operate cen-
ters for mental illness research, education, and clinical ac-
tivities. Such centers shall be established and operated by
collaborating Department facilities as provided in sub-
section (c)(1). Each such center shall function as a center
for—
‘‘(A) research on mental health services;
‘‘(B) the use by the Department of specific mod-
els for furnishing services to treat serious mental ill-
ness;
HR 3118 EAS
‘‘(C) education and training of health-care pro-
fessionals of the Department; and
‘‘(D) the development and implementation of in-
novative clinical activities and systems of care with
respect to the delivery of such services by the Depart-
ment.
‘‘(2) The Secretary shall, upon the recommendation of
the Under Secretary for Health, designate the centers under
this section. In making such designations, the Secretary
shall ensure that the centers designated are located in var-
ious geographic regions of the United States. The 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 sub-
section (e) makes the determination specified in sub-
section (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.
HR 3118 EAS
‘‘(c) A proposal submitted for the designation of a cen-
ter under this section shall—
‘‘(1) provide for close collaboration in the estab-
lishment and operation of the center, and for the pro-
vision of care and the conduct of research and edu-
cation at the center, by a Department facility or fa-
cilities in the same geographic area which have a
mission centered on care of the mentally ill and a De-
partment 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 clini-
cal care, research, and education will be provided to
the collaborating facility or facilities that have a mis-
sion 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
HR 3118 EAS
Secretary, upon the recommendation of the Under Secretary
for Health, that the facilities submitting the proposal have
developed (or may reasonably be anticipated to develop)
each of the following:
‘‘(1) An arrangement with an accredited medical
school that provides education and training in psy-
chiatry and with which one or more of the participat-
ing Department facilities is affiliated under which
medical residents receive education and training in
psychiatry through regular rotation through the par-
ticipating Department facilities so as to provide such
residents with training in the diagnosis and treat-
ment of mental illness.
‘‘(2) An arrangement with an accredited grad-
uate program 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, counseling, or allied health personnel re-
ceive training and education in mental health care
through regular rotation through the participating
Department facilities.
HR 3118 EAS
‘‘(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 services;
or
‘‘(B) into the causes, prevention, and treat-
ment of mental illness.
‘‘(5) The capability to evaluate effectively the ac-
tivities of the center, including activities relating to
the evaluation of specific efforts to improve the qual-
ity and effectiveness of mental health services pro-
vided by the Department at or through individual fa-
cilities.
‘‘(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 re-
sponsible for mental health and behavioral sciences matters
shall establish a peer review panel to assess the scientific
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 clini-
cal care. Members of the panel shall serve as consultants
to the Department.
HR 3118 EAS
‘‘(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 Advi-
sory 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 empha-
size research into means of improving the quality of care
for veterans suffering from mental illness through the devel-
opment of community-based alternatives to institutional
treatment for such illness.
HR 3118 EAS
‘‘(h) The Under Secretary for Health shall ensure that
information produced by the research, education and train-
ing, and clinical activities of centers established under this
section that may be useful for other activities of the Veterans
Health Administration is disseminated throughout the Vet-
erans Health Administration. Such dissemination shall be
made through publications, through programs of continuing
medical and related education provided through regional
medical education centers under subchapter VI of chapter
74 of this title, and through other means. Such programs
of continuing medical education 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 su-
pervising the operation of the centers established pursuant
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 1998.
HR 3118 EAS
‘‘(B) $6,250,000 for each of fiscal years 1999
through 2001.
‘‘(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 Veterans Af-
fairs medical and prosthetics research account such
amounts as the Under Secretary for Health determines ap-
propriate to carry out the purposes of this section.’’.
(2) The table of sections at the beginning of chapter
73 is amended by inserting after the item relating to section
7319, as added by section 321(a)(2), the following new item:
‘‘7320. Centers for mental illness research, education, and clinical activities.’’.
(b) ANNUAL REPORTS.—Not later than February 1 of
each of 1999, 2000, 2001, and 2002, the Secretary of Veter-
ans Affairs shall submit to the Committees on Veterans’ Af-
fairs of the Senate and House of Representatives a report
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 7320 of
title 38, United States Code (as added by subsection (a)).
Each such report shall include the following:
HR 3118 EAS
(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 research,
education and training, and clinical activities relat-
ing 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 infor-
mation 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 cen-
ters.
(c) IMPLEMENTATION.—The Secretary of Veterans Af-
fairs shall designate at least one center under section 7320
of title 38, United States Code, not later than January 1,
1998.
SEC. 335. COMMITTEE ON CARE OF SEVERELY CHRON-
ICALLY MENTALLY ILL VETERANS.
(a) ESTABLISHMENT.—Subchapter II of chapter 73 is
amended by adding after section 7320, as added by section
334(a)(1), the following new section:
HR 3118 EAS
‘‘§ 7321. Committee on Care of Severely Chronically
Mentally Ill Veterans
‘‘(a) The Secretary, acting through the Under Sec-
retary for Health, shall establish in the Veterans Health Ad-
ministration a Committee on Care of Severely Chronically
Mentally Ill Veterans. The Under Secretary shall appoint
employees of the Department with expertise in the care of
the chronically mentally ill to serve on the committee.
‘‘(b) The committee shall assess, and carry out a con-
tinuing assessment of, the capability of the Veterans Health
Administration to meet effectively the treatment and reha-
bilitation needs of mentally ill veterans whose mental illness
is severe and chronic and who are eligible for health care
furnished by the Department, including the needs of such
veterans who are women. In carrying out that responsibil-
ity, 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 Ad-
ministration;
‘‘(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
HR 3118 EAS
‘‘(4) identify model programs which the commit-
tee considers to have been successful in the treatment
and rehabilitation of such veterans and which should
be implemented more widely in or through facilities
of the Veterans Health Administration.
‘‘(c) The committee shall—
‘‘(1) advise the Under Secretary regarding the
development of policies for the care and rehabilitation
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 throughout 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 priorities
relevant to the care of such veterans; and
‘‘(D) regarding the appropriate allocation
of resources for all such activities.
‘‘(d)(1) Not later than April 1, 1997, the Secretary
shall submit to the Committees on Veterans’ Affairs of the
Senate and House of Representatives a report on the imple-
HR 3118 EAS
mentation of this section. The report shall include the fol-
lowing:
‘‘(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 com-
mittee, 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 mentally
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 findings
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 capability
of the Veterans Health Administration to meet effec-
tively the treatment and rehabilitation needs of se-
verely chronically mentally ill veterans who are eligi-
ble for Department care.
‘‘(2) Not later than February 1, 1998, and February
1 of each of the three following years, the Secretary shall
HR 3118 EAS
submit to the Committees on Veterans’ Affairs of the Senate
and House of Representatives a report containing informa-
tion updating the reports submitted under this subsection
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
334(a)(2) the following new item:
‘‘7321. Committee on Care of Severely Chronically Mentally Ill Veterans.’’.
Subtitle D—Other Provisions
SEC. 341. HOSPICE CARE STUDY.
(a) STUDY REQUIRED.—The Secretary of Veterans Af-
fairs shall conduct a research study to determine the desir-
ability of the Secretary furnishing hospice care to termi-
nally ill veterans and to evaluate the most cost effective and
efficient way to do so. The Secretary shall carry out the
study using resources and personnel of the Department.
(b) CONDUCT OF STUDY.—In carrying out the study
required by subsection (a), the Secretary shall—
(1) evaluate the programs, and the program
models, through which the Secretary furnishes hospice
care services within or through facilities of the De-
partment of Veterans Affairs and the programs and
program models through which non-Department fa-
cilities provide such services;
HR 3118 EAS
(2) assess the satisfaction of patients, and family
members of patients, in each of the program models
covered by paragraph (1);
(3) compare the costs (or range of costs) of pro-
viding care through each of the program models cov-
ered by paragraph (1); and
(4) identify any barriers to providing, procur-
ing, or coordinating hospice services through any of
the program models covered by paragraph (1).
(c) PROGRAM MODELS.—For purposes of subsection
(b)(1), the Secretary shall evaluate a variety of types of
models for delivery of hospice care, including the following:
(1) Direct furnishing of full hospice care by the
Secretary.
(2) Direct furnishing of some hospice services by
the Secretary.
(3) Contracting by the Secretary for the furnish-
ing of hospice care, with a commitment that the Sec-
retary will provide any further required hospital care
for the patient.
(4) Contracting for all required care to be fur-
nished outside the Department.
(5) Referral of the patient for hospice care with-
out a contract.
HR 3118 EAS
(d) REPORT.—Not later than April 1, 1998, the Sec-
retary shall submit to the Committees on Veterans’ Affairs
of the Senate and House of Representatives a report on the
research study. The report shall set forth the Secretary’s
findings and recommendations. The Secretary shall include
in the report information on the extent to which the Sec-
retary advises veterans concerning their eligibility for hos-
pice care and information on the number of veterans (as
of the time of the report) who are in each model of hospice
care described in subsection (c) and the average cost per
patient of hospice care for each such model.
SEC. 342. PAYMENT TO STATES OF PER DIEM FOR VETER-
ANS RECEIVING ADULT DAY HEALTH CARE.
(a) PAYMENT OF PER DIEM FOR VETERANS RECEIV-
ING ADULT DAY CARE.—Section 1741 is amended—
(1) by inserting ‘‘(1)’’ after ‘‘(a)’’;
(2) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively; and
(3) by adding at the end the following new para-
graph (2):
‘‘(2) The Secretary may pay each State per diem at
a rate determined by the Secretary for each veteran receiv-
ing adult day health care in a State home, if such veteran
is eligible for such care under laws administered by the Sec-
retary.’’.
HR 3118 EAS
(b) ASSISTANCE TO STATES FOR CONSTRUCTION OF
ADULT DAY CARE FACILITIES.—(1) Section 8131(3) is
amended by inserting ‘‘adult day health,’’ before ‘‘or hos-
pital care’’.
(2) Section 8132 is amended by inserting ‘‘adult day
health,’’ before ‘‘or hospital care’’.
(3) Section 8135(b) is amended—
(A) in paragraph (2)(C), by inserting ‘‘or adult
day health care facilities’’ after ‘‘domiciliary beds’’;
and
(B) in paragraph (3)(A), by inserting ‘‘or con-
struction (other than new construction) of adult day
health care buildings’’ before the semicolon.
SEC. 343. RESEARCH CORPORATIONS.
(a) RENEWAL
OF
AUTHORITY.—Section 7368 is
amended by striking out ‘‘December 31, 1992’’ and insert-
ing in lieu thereof ‘‘December 31, 2000’’.
(b) CLARIFICATION OF TAX-EXEMPT STATUS.—Sec-
tions 7361(b) and 7363(c) are amended by striking out
‘‘section 501(c)(3) of’’.
(c) PERIODIC AUDITS.—Subsection (b) of section 7366
is amended by striking out ‘‘The corporation’’ in the second
sentence and all that follows through ‘‘shall include that re-
port’’ and inserting in lieu thereof the following: ‘‘A cor-
poration with revenues in excess of $300,000 for any year
HR 3118 EAS
shall obtain an audit of the corporation for that year. A
corporation with annual revenues between $10,000 and
$300,000 shall obtain an independent audit of the corpora-
tion at least once every three years. Any audit under the
preceding sentences shall be performed by an independent
auditor. The corporation shall include the most recent such
audit’’.
(d) COMPLIANCE WITH CONFLICT OF INTEREST LAWS
AND REGULATIONS.—Subsection (c)(2) of section 7366 is
amended by striking out ‘‘an annual statement signed by
the director or employee certifying that the director or’’ and
inserting in lieu thereof ‘‘a statement signed by the execu-
tive director of the corporation certifying that each director
and’’.
(e) REVISED REPORTING REQUIREMENT.—Subsection
(d) of section 7366 is amended to read as follows:
‘‘(d) The Secretary shall submit to the Committees on
Veterans’ Affairs of the Senate and House of Representa-
tives an annual report on the corporations established
under this subchapter. The report shall set forth the follow-
ing information:
‘‘(1) The location of each corporation.
‘‘(2) The amount received by each corporation
during the previous year, including—
‘‘(A) the total amount received;
HR 3118 EAS
‘‘(B) the amount received from govern-
mental entities;
‘‘(C) the amount received from all other
sources; and
‘‘(D) if the amount received from a source
referred to in subparagraph (C) exceeded
$25,000, information that identifies the source.
‘‘(3) The amount expended by each corporation
during the year, including—
‘‘(A) the amount expended for salary for re-
search staff and for salary for support staff;
‘‘(B) the amount expended for direct sup-
port of research; and
‘‘(C) if the amount expended with respect to
any payee exceeded $35,000, information that
identifies the payee.’’.
SEC. 344. VETERANS HEALTH ADMINISTRATION HEAD-
QUARTERS.
Section 7306 is amended by adding at the end the fol-
lowing new subsection:
‘‘(f) In organizing the Office and appointing persons
to positions in the Office, the Under Secretary shall ensure
that—
‘‘(1) the Office is staffed so as to provide the
Under Secretary, through a designated clinician in
HR 3118 EAS
the appropriate discipline in each instance, with ex-
pertise and direct policy guidance on—
‘‘(A) unique programs operated by the Ad-
ministration to provide for the specialized treat-
ment and rehabilitation of disabled veterans (in-
cluding blind rehabilitation, care of spinal cord
dysfunction, mental illness, and long-term care);
and
‘‘(B) the programs established under section
1712A of this title; and
‘‘(2) with respect to the programs established
under section 1712A of this title, a clinician with ap-
propriate expertise in those programs is responsible to
the Under Secretary for the management of those pro-
grams.’’.
SEC. 345. DISBURSEMENT AGREEMENTS RELATING TO MED-
ICAL RESIDENTS AND INTERNS.
Section 7406(c) is amended—
(1) by striking out ‘‘Department hospital’’ each
place it appears and inserting in lieu thereof ‘‘De-
partment facility furnishing hospital care or medical
services’’;
(2) by striking out ‘‘participating hospital’’ in
paragraph (4)(C) and inserting in lieu thereof ‘‘par-
ticipating facility’’; and
HR 3118 EAS
(3) by striking out ‘‘hospital’’ both places it ap-
pears in paragraph (5) and inserting in lieu thereof
‘‘facility’’.
SEC. 346. AUTHORITY TO SUSPEND SPECIAL PAY AGREE-
MENTS FOR PHYSICIANS AND DENTISTS WHO
ENTER RESIDENCY TRAINING PROGRAMS.
Section 7432(b)(2) is amended—
(1) by inserting ‘‘(A)’’ after ‘‘(2)’’; and
(2) by adding at the end the following:
‘‘(B) The Secretary may suspend a special pay agree-
ment entered into under this section in the case of a physi-
cian or dentist who, having entered into the special pay
agreement, enters a residency training program. Any such
suspension shall terminate when the physician or dentist
completes, withdraws from, or is no longer a participant
in the program. During the period of such a suspension,
the physician or dentist is not subject to the provisions of
paragraph (1).’’.
SEC. 347. REMUNERATED OUTSIDE PROFESSIONAL ACTIVI-
TIES BY VETERANS HEALTH ADMINISTRA-
TION PERSONNEL.
(a) AUTHORITY.—Subsection (b) of section 7423 is
amended—
(1) by striking out paragraph (1); and
HR 3118 EAS
(2) by redesignating paragraphs (2) through (6)
as paragraphs (1) through (5), respectively.
(b) CONFORMING AMENDMENT.—Subsection (c) of such
section is amended in the matter preceding paragraph (1)
by striking out ‘‘subsection (b)(6)’’ and inserting in lieu
thereof ‘‘subsection (b)(5)’’.
SEC. 348. MODIFICATION OF RESTRICTIONS ON REAL PROP-
ERTY, MILWAUKEE COUNTY, WISCONSIN.
(a) MODIFICATION OF REVERSIONARY INTEREST.—
The Secretary of Veterans Affairs is authorized to execute
such instruments as may be necessary to modify the condi-
tions under which the land described in subsection (b) will
revert to the United States in order—
(1) to permit Milwaukee County, Wisconsin, to
grant all or part of such land to another party with
a condition on such grant that the grantee use such
land only for civic and recreational purposes; and
(2) to provide that the conditions under which
title to all or any part of such land reverts to the
United States are stated so that any such reversion
would occur at the option of the United States.
(b) DESCRIPTION OF LAND.—The land covered by this
section is the tract of 28 acres of land, more or less, con-
veyed to Milwaukee County, Wisconsin, pursuant to the Act
entitled ‘‘An Act authorizing the Administrator of Veterans’
HR 3118 EAS
Affairs to convey certain property to Milwaukee County,
Wisconsin’’, approved August 27, 1954 (68 Stat. 866).
(c) GENERAL
AUTHORITIES.—The Secretary may
carry out this section subject to such terms and conditions
(including reservations of rights for the United States) as
the Secretary considers necessary to protect the interests of
the United States. In carrying out this section, the Sec-
retary may eliminate any existing covenant or restriction
with respect to the tract of land described in subsection (b)
which the Secretary determines to be no longer necessary
to protect the interests of the United States.
SEC. 349. MODIFICATION OF RESTRICTIONS ON REAL PROP-
ERTY, CHEYENNE, WYOMING.
(a) MODIFICATION OF REVERSIONARY INTEREST.—
The Secretary of Veterans Affairs of Veterans Affairs is au-
thorized to execute such instruments as may be necessary
to modify the conditions under which the land described
in subsection (b) will revert to the United States in order
to permit the City of Cheyenne, Wyoming, to grant all or
part of such land to the First Cheyenne Federal Credit
Union (formerly known as the Cheyenne VAF Federal Cred-
it Union) with a condition on such grant that the First
Cheyenne Federal Credit Union use such land only for the
purpose of constructing a building to house its operations.
HR 3118 EAS
(b) DESCRIPTION OF LAND.—The land covered by this
section is the tract of 27 acres of land, more or less, con-
veyed to the City of Cheyenne, Wyoming, pursuant to the
Act entitled ‘‘An Act authorizing the Administrator of Vet-
erans’ Affairs to convey certain property to the City of
Cheyenne, Wyoming’’, approved November 8, 1965 (79 Stat.
1304).
(c) TERMS OF REVERSIONARY INTEREST.—In carry-
ing out this section, the Secretary may cause the statement
of the conditions under which title to all or any part of
the land described in subsection (b) reverts to the United
States to be revised so that any such reversion would occur
at the option of the United States.
(d) GENERAL AUTHORITIES.—The Secretary may
carry out this section subject to such terms and conditions
(including reservations of rights for the United States) as
the Secretary considers necessary to protect the interests of
the United States. In carrying out this section, the Sec-
retary may eliminate any existing covenant or restriction
with respect to the tract of land described in subsection (b)
which the Secretary determines to be no longer necessary
to protect the interests of the United States.
HR 3118 EAS
SEC. 350. NAME OF DEPARTMENT OF VETERANS AFFAIRS
MEDICAL 
CENTER, 
JOHNSON 
CITY, 
TEN-
NESSEE.
(a) NAME.—The Mountain Home Department of Vet-
erans Affairs Medical Center in Johnson City, Tennessee,
shall after the date of the enactment of this Act be known
and designated as the ‘‘James H. Quillen Department of
Veterans Affairs Medical Center’’. Any reference to such
medical center in any law, regulation, map, document,
record, or other paper of the United States shall be consid-
ered to be a reference to the James H. Quillen Department
of Veterans Affairs Medical Center.
(b) EFFECTIVE DATE.—Subsection (a) shall take effect
at noon on January 3, 1997.
SEC. 351. REPORT ON HEALTH CARE NEEDS OF VETERANS
IN EAST CENTRAL FLORIDA.
(a) REPORT REQUIRED.—Not later than 60 days after
the date of the enactment of this Act, the Secretary of Veter-
ans Affairs shall submit to the Committees on Veterans’ Af-
fairs of the Senate and House of Representatives a report
on the health care needs of veterans in east central Florida.
In preparing the report, the Secretary shall consider the
needs of such veterans for psychiatric and long-term care.
The Secretary shall include in the report the Secretary’s
views, based on the Secretary’s determination of such needs,
as to the best means of meeting such needs using the
HR 3118 EAS
amounts appropriated pursuant to the authorization of ap-
propriations in this Act and Public Law 103–452 for
projects to meet the health care needs of such veterans. The
Secretary may, subject to the availability of appropriations
for such purpose, use an independent contractor to assist
in the determination of such health care needs.
(b) LIMITATION.—The Secretary may not obligate any
funds, other than for design work, for the conversion of the
former Orlando Naval Training Center Hospital in Or-
lando, Florida (now under the jurisdiction of the Secretary
of Veterans Affairs), to a nursing home care unit until 45
days after the date on which the report required by sub-
section (a) is submitted.
SEC. 352. EVALUATION OF HEALTH STATUS OF SPOUSES
AND CHILDREN OF PERSIAN GULF WAR VET-
ERANS.
(a) EXTENSION OF AUTHORITY.—Subsection (b) of sec-
tion 107 of the Persian Gulf War Veterans’ Benefits Act
(title I of Public Law 103–446; 108 Stat. 4652; 38 U.S.C.
1117 note) is amended by striking out ‘‘September 30,
1996’’ and inserting in lieu thereof ‘‘December 31, 1998’’.
(b) RATIFICATION OF ACTIONS.—Any diagnostic test-
ing and medical examinations undertaken by the Secretary
of Veterans Affairs for the purpose of the study required
by subsection (a) of such section during the period begin-
HR 3118 EAS
ning on October 1, 1996, and ending on the date of the
enactment of this Act is hereby ratified.
Amend the title so as to read: ‘‘An Act to amend
title 38, United States Code, to reform eligibility for
health care provided by the Department of Veterans Af-
fairs, to authorize major medical facility construction
projects for the Department, to improve administration
of health care by the Department, and for other pur-
poses.’’.
Attest:
Secretary.
HR 3118 EAS——2
HR 3118 EAS——3
HR 3118 EAS——4
HR 3118 EAS——5
HR 3118 EAS——6
HR 3118 EAS——7
HR 3118 EAS——8
HR 3118 EAS——9
HR 3118 EAS——10