IIA
104TH CONGRESS
2D SESSION
H. R. 3643
To amend title 38, United States Code, to extend through December 31,
1998, the period during which the Secretary of Veterans Affairs is
authorized to provide priority health care to certain veterans who were
exposed to Agent Orange or who served in the Persian Gulf War and
to make such authority permanent in the case of certain veterans exposed
to ionizing radiation, and for other purposes.
IN THE SENATE OF THE UNITED STATES
JULY 17, 1996
Received; read twice and referred to the Committee on Veterans’ Affairs
AN ACT
To amend title 38, United States Code, to extend through
December 31, 1998, the period during which the Sec-
retary of Veterans Affairs is authorized to provide prior-
ity health care to certain veterans who were exposed
to Agent Orange or who served in the Persian Gulf
War and to make such authority permanent in the case
of certain veterans exposed to ionizing radiation, and
for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. AUTHORITY TO PROVIDE PRIORITY HEALTH
CARE.
(a) 
AUTHORIZED
INPATIENT
CARE.—Section
1710(e) of title 38, United States Code, is amended—
(1) in paragraph (1), by striking out subpara-
graphs (A) and (B) and inserting in lieu thereof the
following:
‘‘(e)(1)(A) A herbicide-exposed veteran is eligible for
hospital care and nursing home care under subsection
(a)(1)(G) for any disease suffered by the veteran that is—
‘‘(i) among those diseases for which the Na-
tional Academy of Sciences, in a report issued in ac-
cordance with section 2 of the Agent Orange Act of
1991, has determined—
‘‘(I) that there is sufficient evidence to
conclude that there is a positive association be-
tween occurrence of the disease in humans and
exposure to a herbicide agent;
‘‘(II) that there is evidence which is sug-
gestive of an association between occurrence of
the disease in humans and exposure to a herbi-
cide agent, but such evidence is limited in na-
ture; or
‘‘(III) that available studies are insufficient
to permit a conclusion about the presence or
absence of an association between occurrence of
the disease in humans and exposure to a herbi-
cide agent; or
‘‘(ii) a disease for which the Secretary, pursu-
ant to a recommendation of the Under Secretary for
Health on the basis of a peer-reviewed research
study or studies published within 20 months after
the most recent report of the National Academy
under section 2 of the Agent Orange Act of 1991,
determines there is credible evidence suggestive of
an association between occurrence of the disease in
humans and exposure to a herbicide agent.
‘‘(B) A radiation-exposed veteran is eligible for hos-
pital care and nursing home care under subsection
(a)(1)(G) 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
Environmental Hazards, determines that there is
credible evidence of a positive association between
occurrence of the disease in humans and exposure to
ionizing radiation.’’;
(2) in paragraph (2)—
(A) by striking out ‘‘Hospital’’ and insert-
ing in lieu thereof ‘‘In the case of a veteran de-
scribed in paragraph (1)(C), hospital’’; and
(B) by striking out ‘‘subparagraph’’ and
all that follows through ‘‘subsection’’ and in-
serting in lieu thereof ‘‘paragraph (1)(C)’’;
(3) in paragraph (3), by striking out ‘‘of this
section after December 31, 1996’’ and inserting in
lieu thereof ‘‘after December 31, 1998, in the case
of care for a veteran described in paragraph (1)(A)
or paragraph (1)(C)’’; and
(4) by adding at the end the following new
paragraph:
‘‘(4) For purposes of this subsection and section
1712 of this title:
‘‘(A) The term ‘herbicide-exposed veteran’
means a veteran (i) who served on active duty in the
Republic of Vietnam during the Vietnam era, and
(ii) who the Secretary finds may have been exposed
during such service to a herbicide agent.
‘‘(B) The term ‘herbicide agent’ has the mean-
ing given that term in section 1116(a)(4) of this
title.
‘‘(C) The term ‘radiation-exposed veteran’ has
the meaning given that term in section 1112(c)(4) of
this title.’’.
(b) AUTHORIZED OUTPATIENT CARE.—Section 1712
of such title is amended—
(1) in subsection (a)(1)—
(A) by striking out ‘‘and’’ at the end of
subparagraph (C);
(B) in subparagraph (D)—
(i) by striking out ‘‘before December
31, 1996,’’ and inserting in lieu thereof
‘‘before January 1, 1999,’’; and
(ii) by striking out the period at the
end of subparagraph (D) and inserting in
lieu thereof a semicolon;
(C) by adding at the end the following new
subparagraphs:
‘‘(E) during the period before January 1, 1999,
to any herbicide-exposed veteran (as defined in sec-
tion 1710(e)(4)(A) of this title) for any disease spec-
ified in section 1710(e)(1)(A) of this title; and
‘‘(F) to any radiation-exposed veteran (as de-
fined in section 1112(c)(4) of this title) for any dis-
ease covered under section 1710(e)(1)(B) of this
title.’’; and
(2) in subsection (i)(3)—
(A) by striking out ‘‘(A)’’; and
(B) by striking out ‘‘, or (B)’’ and all that
follows through ‘‘title’’.
(c) 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
furnished such care or services before such date of enact-
ment on the basis of presumed exposure to a substance
or radiation under the authority of those provisions, but
only for treatment for a disability for which such care or
services were furnished before such date.
(d) PRIORITY HEALTH CARE FOR SERVICE IN IS-
RAEL OR TURKEY DURING PERSIAN GULF WAR.—(1)
Section 1710(e)(1)(C) of title 38, United States Code, is
amended by inserting after ‘‘Southwest Asia theater of op-
erations’’ the following: ‘‘, or who may have been exposed
while serving on active duty in Israel or Turkey during
the period beginning on August 2, 1990, and ending on
July 31, 1991,’’.
(2) Section 1712(a)(1)(D) of such title is amended
by inserting after ‘‘during the Persian Gulf War’’ the fol-
lowing: ‘‘, or who served on active duty in Israel or Turkey
during the period beginning on August 2, 1990, and end-
ing on July 31, 1991,’’.
SEC. 2. DEPARTMENT COMMITTEE ON CARE OF SEVERELY
CHRONICALLY MENTALLY ILL VETERANS.
(a) ESTABLISHMENT.—Subchapter II of chapter 73
of title 38, United States Code, is amended by adding
after section 7318 the following new section:
‘‘§ 7319. Committee on Care of Severely Chronically
Mentally Ill Veterans
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting
through the Under Secretary for Health, shall establish
in the Veterans Health Administration a Committee on
Care of Severely Chronically Mentally Ill Veterans. The
Under Secretary shall appoint employees of the Depart-
ment with expertise in the care of the chronically mentally
ill to serve on the committee.
‘‘(b) DUTIES.—The committee shall assess, and carry
out a continuing assessment of, the capability of the Vet-
erans Health Administration to meet effectively the treat-
ment and rehabilitation needs of mentally ill veterans
whose mental illness is severe and chronic and who are
eligible for health care furnished by the Department, in-
cluding the needs of such veterans who are women. In car-
rying out that responsibility, the committee shall—
‘‘(1) evaluate the care provided to such veterans
through the Veterans Health Administration;
‘‘(2) identify systemwide problems in caring for
such veterans in facilities of the Veterans Health
Administration;
‘‘(3) identify specific facilities within the Veter-
ans Health Administration at which program enrich-
ment is needed to improve treatment and rehabilita-
tion of such veterans; and
‘‘(4) identify model programs which the com-
mittee considers to have been successful in the treat-
ment and rehabilitation of such veterans and which
should be implemented more widely in or through fa-
cilities of the Veterans Health Administration.
‘‘(c) ADVICE AND RECOMMENDATIONS.—The com-
mittee shall—
‘‘(1) advise the Under Secretary regarding the
development of policies for the care and rehabilita-
tion of severely chronically mentally ill veterans; and
‘‘(2) make recommendations to the Under Sec-
retary—
‘‘(A) for improving programs of care of
such veterans at specific facilities and through-
out the Veterans Health Administration;
‘‘(B) for establishing special programs of
education and training relevant to the care of
such veterans for employees of the Veterans
Health Administration;
‘‘(C) regarding research needs and prior-
ities relevant to the care of such veterans; and
‘‘(D) regarding the appropriate allocation
of resources for all such activities.
‘‘(d) ANNUAL REPORT.—(1) Not later than April 1,
1997, the Secretary shall submit to the Committees on
Veterans’ Affairs of the Senate and House of Representa-
tives a report on the implementation of this section. The
report shall include the following:
‘‘(A) A list of the members of the committee.
‘‘(B) The assessment of the Under Secretary
for Health, after review of the initial findings of the
committee, regarding the capability of the Veterans
Health Administration, on a systemwide and facility-
by-facility basis, to meet effectively the treatment
and rehabilitation needs of severely chronically men-
tally ill veterans who are eligible for Department
care.
‘‘(C) The plans of the committee for further as-
sessments.
‘‘(D) The findings and recommendations made
by the committee to the Under Secretary for Health
and the views of the Under Secretary on such find-
ings and recommendations.
‘‘(E) A description of the steps taken, plans
made (and a timetable for their execution), and re-
sources to be applied toward improving the capabil-
ity of the Veterans Health Administration to meet
effectively the treatment and rehabilitation needs of
severely chronically mentally ill veterans who are eli-
gible for Department care.
‘‘(2) Not later than February 1, 1998, and February
1 of each of the three following years, the Secretary shall
submit to the Committees on Veterans’ Affairs of the Sen-
ate and House of Representatives a report containing in-
formation updating the reports submitted under this sub-
section before the submission of such report.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of chapter 73 is amended by inserting
after the item relating to section 7318 the following new
item:
‘‘7319. Committee on Care of Severely Chronically Mentally Ill Veterans.’’.
SEC. 3. 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 sec-
tion 2(a), the following new section:
‘‘§ 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
related counseling services to eligible veterans suffering
from mental illness (especially mental illness related to
service-related conditions) through—
‘‘(1) the conduct of research (including research
on improving mental health service facilities of the
Department and on improving the delivery of mental
health services by the Department);
‘‘(2) the education and training of health care
personnel of the Department; and
‘‘(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
centers for mental illness research, education, and clinical
activities. 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
models for furnishing services to treat serious men-
tal illness;
‘‘(C) education and training of health-care pro-
fessionals of the Department; and
‘‘(D) the development and implementation of
innovative clinical activities and systems of care with
respect to the delivery of such services by the De-
partment.
‘‘(2) The Secretary shall, upon the recommendation
of the Under Secretary for Health, designate the centers
under this section. In making such designations, the Sec-
retary shall ensure that the centers designated are located
in various 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
subsection (e) makes the determination specified in
subsection (e)(3) with respect to that proposal.
‘‘(3) Not more than five centers may be designated
under this section.
‘‘(4) The authority of the Secretary to establish and
operate centers under this section is subject to the appro-
priation of funds for that purpose.
‘‘(c) A proposal submitted for the designation of a
center under this section shall—
‘‘(1) provide for close collaboration in the estab-
lishment and operation of the center, and for the
provision of care and the conduct of research and
education at the center, by a Department facility or
facilities in the same geographic area which have a
mission centered on care of the mentally ill and a
Department facility in that area which has a mission
of providing tertiary medical care;
‘‘(2) provide that no less than 50 percent of the
funds appropriated for the center for support of clin-
ical care, research, and education will be provided to
the collaborating facility or facilities that have a
mission centered on care of the mentally ill; and
‘‘(3) provide for a governance arrangement be-
tween the collaborating Department facilities which
ensures that the center will be established and oper-
ated in a manner aimed at improving the quality of
mental health care at the collaborating facility or fa-
cilities which have a mission centered on care of the
mentally ill.
‘‘(d) The finding referred to in subsection (b)(2)(B)
with respect to a proposal for designation of a site as a
location of a center under this section is a finding by the
Secretary, upon the recommendation of the Under Sec-
retary for Health, that the facilities submitting the pro-
posal have developed (or may reasonably be anticipated
to develop) each of the following:
‘‘(1) An arrangement with an accredited medi-
cal school that provides education and training in
psychiatry and with which one or more of the par-
ticipating Department facilities is affiliated under
which medical residents receive education and train-
ing in psychiatry through regular rotation through
the participating Department facilities so as to pro-
vide such residents with training in the diagnosis
and treatment of mental illness.
‘‘(2) An arrangement with an accredited grad-
uate school of psychology under which students re-
ceive education and training in clinical, counseling,
or professional psychology through regular rotation
through the participating Department facilities so as
to provide such students with training in the diag-
nosis and treatment of mental illness.
‘‘(3) An arrangement under which nursing, so-
cial work, or allied health personnel receive training
and education in mental health care through regular
rotation through the participating Department facili-
ties.
‘‘(4) The ability to attract scientists who have
demonstrated achievement in research—
‘‘(A) into the evaluation of innovative ap-
proaches to the design of mental health serv-
ices; or
‘‘(B) into the causes, prevention, and
treatment of mental illness.
‘‘(5) The capability to evaluate effectively the
activities of the center, including activities relating
to the evaluation of specific efforts to improve the
quality and effectiveness of mental health services
provided by the Department at or through individual
facilities.
‘‘(e)(1) In order to provide advice to assist the Sec-
retary and the Under Secretary for Health to carry out
their responsibilities under this section, the official within
the central office of the Veterans Health Administration
responsible for mental health and behavioral sciences mat-
ters shall establish a peer review panel to assess the sci-
entific and clinical merit of proposals that are submitted
to the Secretary for the designation of centers under this
section.
‘‘(2) The panel shall consist of experts in the fields
of mental health research, education and training, and
clinical care. Members of the panel shall serve as consult-
ants to the Department.
‘‘(3) The panel shall review each proposal submitted
to the panel by the official referred to in paragraph (1)
and shall submit to that official its views on the relative
scientific and clinical merit of each such proposal. The
panel shall specifically determine with respect to each such
proposal whether that proposal is among those proposals
which have met the highest competitive standards of sci-
entific and clinical merit.
‘‘(4) The panel shall not be subject to the Federal
Advisory Committee Act (5 U.S.C. App.).
‘‘(f) Clinical and scientific investigation activities at
each center established under this section—
‘‘(1) may compete for the award of funding
from amounts appropriated for the Department of
Veterans Affairs medical and prosthetics research
account; and
‘‘(2) shall receive priority in the award of fund-
ing from such account insofar as funds are awarded
to projects and activities relating to mental illness.
‘‘(g) The Under Secretary for Health shall ensure
that at least three centers designated under this section
emphasize research into means of improving the quality
of care for veterans suffering from mental illness through
the development of community-based alternatives to insti-
tutional treatment for such illness.
‘‘(h) The Under Secretary for Health shall ensure
that information produced by the research, education and
training, and clinical activities of centers established under
this section that may be useful for other activities of the
Veterans Health Administration is disseminated through-
out the Veterans Health Administration. Such dissemina-
tion shall be made through publications, through pro-
grams of continuing medical and related education pro-
vided through regional medical education centers under
subchapter VI of chapter 74 of this title, and through
other means. Such programs of continuing medical edu-
cation shall receive priority in the award of funding.
‘‘(i) The official within the central office of the Veter-
ans Health Administration responsible for mental health
and behavioral sciences matters shall be responsible for
supervising the operation of the centers established pursu-
ant to this section and shall provide for ongoing evaluation
of the centers and their compliance with the requirements
of this section.
‘‘(j)(1) There are authorized to be appropriated to
the Department of Veterans Affairs for the basic support
of the research and education and training activities of
centers established pursuant to this section amounts as
follows:
‘‘(A) $3,125,000 for fiscal year 1998.
‘‘(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 Vet-
erans Affairs medical and prosthetics research account
such amounts as the Under Secretary for Health deter-
mines appropriate to carry out the purposes of this sec-
tion.’’.
(2) The table of sections at the beginning of chapter
73 is amended by inserting after the item relating to sec-
tion 7319, as added by section 2(b), 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 1998, 1999, and 2000, the Secretary of Veter-
ans Affairs shall submit to the Committees on Veterans’
Affairs of the Senate and House of Representatives a re-
port on the status and activities during the previous fiscal
year of the centers for mental illness, research, education,
and clinical activities established pursuant to section 7320
of title 38, United States Code (as added by subsection
(a)). Each such report shall include the following:
(1) A description of the activities carried out at
each center and the funding provided for such activi-
ties.
(2) A description of the advances made at each
of the participating facilities of the center in re-
search, education and training, and clinical activities
relating to mental illness in veterans.
(3) A description of the actions taken by the
Under Secretary for Health pursuant to subsection
(h) of that section (as so added) to disseminate in-
formation derived from such activities throughout
the Veterans Health Administration.
(4) The Secretary’s evaluations of the effective-
ness of the centers in fulfilling the purposes of the
centers.
(c) IMPLEMENTATION.—The Secretary of Veterans
Affairs shall designate at least one center under section
7320 of title 38, United States Code, not later than Janu-
ary 1, 1998.
SEC. 4. DISBURSEMENT AGREEMENTS RELATING TO MEDI-
CAL RESIDENTS AND INTERNS.
Section 7406(c) of title 38, United States Code, 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
(3) by striking out ‘‘hospital’’ both places it ap-
pears in paragraph (5) and inserting in lieu thereof
‘‘facility’’.
SEC. 5. AUTHORITY TO SUSPEND SPECIAL PAY AGREE-
MENTS FOR PHYSICIANS AND DENTISTS WHO
ENTER RESIDENCY TRAINING PROGRAMS.
Section 7432(b)(2) of title 38, United States Code,
is amended—
(1) by inserting ‘‘(A)’’ after ‘‘(2)’’; and
(2) by adding at the end the following: