TASK DEFINITION: In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.
PROBLEM: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Travel Facilitation and Safety Act 
of 2015''.

SEC. 2. RECOVERY OF INITIAL PRECLEARANCE OPERATION COSTS.

    (a) Cost Sharing Agreements With Relevant Airport Authorities.--The 
Commissioner of U.S. Customs and Border Protection may enter into a 
cost sharing agreement with airport authorities in foreign countries at 
which preclearance operations are to be established or maintained if--
            (1) an executive agreement to establish or maintain such 
        preclearance operations pursuant to the authorities under 
        section 629 of the Tariff Act of 1930 (19 U.S.C. 1629) and 
        section 103(a)(7) of the Immigration and Nationality Act (8 
        U.S.C. 1103(a)(7)) has been signed, but has not yet entered 
        into force; and
            (2) U.S. Customs and Border Protection has incurred, or 
        expects to incur, initial preclearance operations costs in 
        order to establish or maintain preclearance operations under 
        the agreement described in paragraph (1).
    (b) Contents of Cost Sharing Agreements.--
            (1) In general.--Notwithstanding section 13031(e) of the 
        Consolidated Omnibus Budget Reconciliation Act of 1985 (19 
        U.S.C. 58c(e)) and section 286(g) of the Immigration and 
        Nationality Act (8 U.S.C. 1356(g)), any cost sharing agreement 
        authorized under subsection (a) may provide for the airport 
        authority's payment to U.S. Customs and Border Protection of 
        its initial preclearance operations costs.
            (2) Timing of payments.--The airport authority's payment to 
        U.S. Customs and Border Protection for its initial preclearance 
        operations costs may be made in advance of the incurrence of 
        the costs or on a reimbursable basis.
    (c) Account.--
            (1) In general.--All amounts collected pursuant to any cost 
        sharing agreement authorized under subsection (a)--
                    (A) shall be credited as offsetting collections to 
                the currently applicable appropriation, account, or 
                fund of U.S. Customs and Border Protection;
                    (B) shall remain available, until expended, for the 
                purposes for which such appropriation, account, or fund 
                is authorized to be used; and
                    (C) may be collected and shall be available only to 
                the extent provided in appropriations Acts.
            (2) Return of unused funds.--Any advances or reimbursements 
        not used by U.S. Customs and Border Protection may be returned 
        to the relevant airport authority.
            (3) Rule of construction.--Nothing in this subsection may 
        be construed to preclude the use of appropriated funds, from 
        sources other than the payments collected under this Act, to 
        pay initial preclearance operation costs.
    (d) Initial Preclearance Operations Costs Defined.--
            (1) In general.--In this section, the term ``initial 
        preclearance operations costs'' means the costs incurred, or 
        expected to be incurred, by U.S. Customs and Border Protection 
        to establish or maintain preclearance operations at an airport 
        in a foreign country, including costs relating to--
                    (A) hiring, training, and equipping new officers of 
                U.S. Customs and Border Protection who will be 
                stationed at United States domestic ports of entry or 
                other facilities of U.S. Customs and Border Protection 
                to backfill such officers to be stationed at an airport 
                in a foreign country to conduct preclearance 
                operations; and
                    (B) visits to the airport authority conducted by 
                personnel of U.S. Customs and Border Protection 
                necessary to prepare for the establishment or 
                maintenance of preclearance operations at such airport, 
                including the compensation, travel expenses, and 
                allowances payable to such personnel attributable to 
                such visits.
            (2) Exception.--The costs described in paragraph (1)(A) 
        shall not include the salaries and benefits of new officers of 
        U.S. Customs and Border Protection once such officers are 
        permanently stationed at a domestic United States port of entry 
        or other domestic facility of U.S. Customs and Border 
        Protection after being hired, trained, and equipped.

SEC. 3. COLLECTION AND DISPOSITION OF FUNDS COLLECTED FOR IMMIGRATION 
              INSPECTION SERVICES AND PRECLEARANCE ACTIVITIES.

    (a) Immigration and Nationality Act.--Section 286(i) of the 
Immigration and Nationality Act (8 U.S.C. 1356(i)) is amended by 
striking the last sentence and inserting ``Reimbursements under this 
subsection may be collected in advance of the provision of such 
immigration inspection services. Notwithstanding subsection (h)(1)(B), 
and only to the extent provided in appropriations Acts, any amounts 
collected under this subsection shall be credited as offsetting 
collections to the currently applicable appropriation, account, or fund 
of U.S. Customs and Border Protection, remain available until expended, 
and be available for the purposes for which such appropriation, 
account, or fund is authorized to be used.''.
    (b) Farm Security and Rural Investment Act of 2002.--Section 
10412(b) of the Farm Security and Rural Investment Act of 2002 (7 
U.S.C. 8311(b)) is amended to read as follows:
    ``(b) Funds Collected for Preclearance.--Funds collected for 
preclearance activities--
            ``(1) may be collected in advance of the provision of such 
        activities;
            ``(2) shall be credited as offsetting collections to the 
        currently applicable appropriation, account, or fund of U.S. 
        Customs and Border Protection;
            ``(3) shall remain available until expended;
            ``(4) shall be available for the purposes for which such 
        appropriation, account, or fund is authorized to be used; and
            ``(5) may be collected and shall be available only to the 
        extent provided in appropriations Acts.''.

SEC. 4. EXPANSION OF PRECLEARANCE AT FOREIGN AIRPORTS.

    (a) Findings.--Congress makes the following findings:
            (1) Preclearance operations provide the ultimate ability 
        for the United States to address potential threats at the 
        earliest possible moment and prior to departure, through the 
        forward deployment of officers of U.S. Customs and Border 
        Protection to last points of departure in a foreign country.
            (2) With inspections and examination operations of U.S. 
        Customs and Border Protection located in a foreign country, 
        preclearance provides the capability to interdict, address, and 
        work with host-country law enforcement in furtherance of both 
        aviation security and border security in the United States.
            (3) Under current preclearance operations, officers of the 
        U.S. Customs and Border Protection collect biometrics in the 
        same way that is currently done upon arrival in the United 
        States, in accordance with current regulation, and as part of 
        the routine entry process from certain aliens who are not 
        citizens of the United States prior to boarding flights 
        destined to the United States.
            (4) Preclearance operations provide the best means for 
        existing and future biometric security capabilities beyond the 
        United States. Support for preclearance expansion will greatly 
        increase border and aviation security in the United States and 
        foreign countries.
    (b) Sense of Congress.--It is the sense of Congress that each 
country designated as a visa waiver program country under section 217 
of the Immigration and Nationality Act (8 U.S.C. 1187) should seek to 
participate in the preclearance program with the United States, to 
jointly address security concerns through additional exchange of 
information and to improve joint ability to secure the that visa waiver 
program while maintaining the original intent of the program.

SEC. 5. BIOMETRIC DEMONSTRATION PROGRAMS AT PRECLEARANCE LOCATIONS.

    (a) Authority.--The Secretary of Homeland Security is authorized to 
select preclearance locations, including preclearance expansion 
locations, and enter into an agreement with a foreign government or 
airport to conduct a collaborative biometric demonstration program at 
such a location to test emerging biometric technologies. The scope of 
the demonstration program may encompass travelers other than those 
utilizing preclearance at such a location, provided that such program 
includes means for information sharing with U.S. Customs and Border 
Protection operations.
    (b) International Cooperation and Coordination.--Section 233(a) of 
the Security and Accountability For Every Port Act of 2006 (6 U.S.C. 
983(a)) is amended--
            (1) in paragraph (1), by striking the period at the end and 
        inserting ``, and to establish and maintain, in partnership 
        with foreign governments, demonstration programs to test 
        emerging biometric technologies at foreign airports at which 
        the Secretary has established preclearance operations.''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (A), by striking ``and'' at the 
                end;
                    (B) in subparagraph (B), by striking the period at 
                the end and inserting a semicolon and ``and''; and
                    (C) by adding the following:
                    ``(C) lease, loan, provide, or otherwise assist in 
                the deployment of biometric technologies at foreign 
                airports at which the Secretary has established 
                preclearance operations under such terms and conditions 
                as the Secretary prescribes, including nonreimbursable 
                loans or the transfer of ownership of such 
                technologies, and provide the necessary training and 
                technical assistance related to the biometric 
                demonstration programs referred to in paragraph (1).''.

SEC. 6. VISA WAIVER PROGRAM REQUIREMENTS.

    (a) Information Sharing Process.--The Director of National 
Intelligence shall--
            (1) develop a process to share information derived from the 
        Terrorist Identities Datamart Environment (TIDE) database and 
        the Terrorist Screening Database (TSDB), including biometric 
        and biographic information, with countries participating in the 
        visa waiver program established under section 217(a) of the 
        Immigration and Nationality Act (8 U.S.C. 1187(a)); and
            (2) not later than 1 year after the date of the enactment 
        of this Act, certify to Congress that such process may be 
        utilized by such countries.
    (b) Continuing Qualification and Designation Terminations.--
Subsection (c) of section 217 of the Immigration and Nationality Act (8 
U.S.C. 1187) is amended--
            (1) in paragraph (1), by striking ``Attorney General,'' and 
        inserting ``Secretary of Homeland Security,''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (C)(iii)--
                            (i) by striking ``and the Committee on 
                        International Relations'' and inserting ``, the 
                        Committee on Foreign Affairs, and the Committee 
                        on Homeland Security''; and
                            (ii) by striking ``and the Committee on 
                        Foreign Relations'' and inserting ``, the 
                        Committee on Foreign Relations, and the 
                        Committee on Homeland Security and Governmental 
                        Affairs''; and
                    (B) by adding at the end the following:
                    ``(G) Border security.--The government of the 
                country utilizes the process developed by the Director 
                of National Intelligence under section 6(a) of the 
                Travel Facilitation and Safety Act of 2015 to utilize 
                information derived from the Terrorist Identities 
                Datamart Environment (TIDE) database and the Terrorist 
                Screening Database (TSDB) for border security and 
                immigration purposes, including the screening of aliens 
                seeking asylum or refugee status in that country.''.

SOLUTION: Travel Facilitation and Safety Act of 2015 This bill authorizes the U.S. Customs and Border Protection (CBP) of the Department of Homeland Security (DHS) to enter into cost-sharing agreements with airport authorities in foreign countries at which preclearance operations will be established or maintained if certain circumstances apply. Any cost-sharing agreement may provide for an airport authority's payment to the CBP of its initial preclearance operations costs. The Immigration and Nationality Act is amended with respect to reimbursements to the Department of Justice received from commercial aircraft or vessel owners, operators, or agents, or from any airport or seaport authority, for expenses incurred for immigration inspection services they have requested. Such reimbursements may be collected in advance of those services, and shall be credited as offsetting collections to the currently applicable CBP appropriation, account, or fund. The Farm Security and Rural Investment Act of 2002 is amended to make the same disposition for reimbursements to the Department of Agriculture for preclearance of animals or articles at locations outside the United States for movement into the United States. The bill expresses the sense of Congress that each visa waiver program country should seek to participate in the U.S. preclearance program. DHS may select preclearance locations and enter into agreements with foreign governments or airports to conduct a collaborative demonstration program at those locations to test emerging biometric technologies.  The Office of the Director of National Intelligence shall develop a process to share information derived from the Terrorist Identities Datamart Environment database and the Terrorist Screening Database with countries participating in the visa waiver program.

PROBLEM: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Readjustment Counseling Service 
Amendments of 1995''.

SEC. 2. ORGANIZATION OF THE READJUSTMENT COUNSELING SERVICE IN THE 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Section 7305 of title 38, United States Code, is 
amended--
            (1) by redesignating paragraph (7) as paragraph (8); and
            (2) by inserting after paragraph (6) the following new 
        paragraph (7):
            ``(7) A Readjustment Counseling Service.''.
    (b) Organization.--The Readjustment Counseling Service shall have 
the organizational structure and administrative structure of that 
service as such structures were in existence on January 1, 1993.
    (c) Revision of Organizational Structure.--(1) The Secretary of 
Veterans Affairs may not alter or revise the organizational structure 
or the administrative structure of the Readjustment Counseling Service 
until--
            (A) the Secretary has submitted to the Committees on 
        Veterans' Affairs of the Senate and House of Representatives a 
        report containing a full and complete statement of the proposed 
        alteration or revision; and
            (B) a period of 60 days has elapsed after the date on which 
        the report is received by the committees.
    (2) In the computation of the 60-day period under paragraph (1)(B), 
there shall be excluded any day on which either House of Congress is 
not in session because of an adjournment of more than 3 calendar days 
to a day certain.
    (d) Budget Information Relating to the Service.--Each budget 
submitted to Congress by the President under section 1105 of title 31, 
United States Code, shall set forth the amount requested in the budget 
for the operation of the Readjustment Counseling Service in the fiscal 
year covered by the budget and shall set forth separately the amount 
requested for administrative oversight of the activities of the service 
(including the amount requested for funding of the Advisory Committee 
on Readjustment of Veterans).

SEC. 3. DIRECTOR OF THE READJUSTMENT COUNSELING SERVICE.

    (a) Director.--Section 7306(b) of title 38, United States Code, is 
amended--
            (1) by striking out ``and'' at the end of paragraph (2);
            (2) by striking out the period at the end of paragraph (3) 
        and inserting in lieu thereof ``; and''; and
            (3) by adding at the end the following:
            ``(4) one shall be a person who (A)(i) is a qualified 
        psychiatrist, (ii) is a qualified psychologist holding a 
        diploma as a doctorate in clinical or counseling psychology 
        from an authority approved by the American Psychological 
        Association and has successfully undergone an internship 
        approved by that association, (iii) is a qualified holder of a 
        master in social work degree, or (iv) is a registered nurse 
        holding a master of science in nursing degree in psychiatric 
        nursing or any other mental-health related degree approved by 
        the Secretary, and (B) has at least 3 years of clinical 
        experience and 2 years of administrative experience in the 
        Readjustment Counseling Service or other comparable mental 
        health care counseling service (as determined by the 
        Secretary), who shall be the director of the Readjustment 
        Counseling Service.''.
    (b) Status of Director.--Section 7306(a)(3) of such title is 
amended by striking out ``eight'' and inserting in lieu thereof 
``nine''.
    (c) Organizational Requirement.--The Director of the Readjustment 
Counseling Service shall report to the Under Secretary for Health of 
the Department of Veterans Affairs through the Associate Deputy Under 
Secretary for Health for Clinical Programs.

SEC. 4. EXPANSION OF ELIGIBILITY FOR READJUSTMENT COUNSELING AND 
              CERTAIN RELATED COUNSELING SERVICES.

    (a) Readjustment Counseling.--(1) Subsection (a) of section 1712A 
of title 38, United States Code, is amended to read as follows:
    ``(a)(1)(A) Upon the request of any veteran referred to in 
subparagraph (B) of this paragraph, the Secretary shall furnish 
counseling to the veteran to assist the veteran in readjusting to 
civilian life.
    ``(B) A veteran referred to in subparagraph (A) of this paragraph 
is any veteran who--
            ``(i) served on active duty during the Vietnam era; or
            ``(ii) served on active military, naval, or air service in 
        a theater of combat operations (as determined by the Secretary, 
        in consultation with the Secretary of Defense) during a period 
        of war or in any other area during a period in which 
        hostilities (as defined in subparagraph (D) of this paragraph) 
        occurred in such area.
    ``(C) Upon the request of any veteran other than a veteran referred 
to in subparagraph (A) of this paragraph, the Secretary may furnish 
counseling to the veteran to assist the veteran in readjusting to 
civilian life.
    ``(D) For the purposes of subparagraph (A) of this paragraph, 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 period of war, as determined by the Secretary in 
consultation with the Secretary of Defense.
    ``(2) The counseling referred to in paragraph (1) shall include a 
general mental and psychological assessment of a covered veteran to 
ascertain whether such veteran has mental or psychological problems 
associated with readjustment to civilian life.''.
    (2) Subsection (c) of such section is repealed.
    (b) Other Counseling.--Such section is further amended by inserting 
after subsection (b) the following new subsection (c):
    ``(c)(1) The Secretary shall provide the counseling services 
described in section 1701(6)(B)(ii) of this title to the surviving 
parents, spouse, and children of any member of the Armed Forces who is 
killed during service on active military, naval, or air service in a 
theater of combat operations (as determined by the Secretary, in 
consultation with the Secretary of Defense) during a period of war or 
in any other area during a period in which hostilities (as defined in 
subsection (a)(1)(D) of this section) occurred in such area.
    ``(2) The Secretary may provide the counseling services referred to 
in paragraph (1) to the surviving parents, spouse, and children of any 
member of the Armed Forces who dies while serving on active duty or 
from a condition (as determined by the Secretary) incurred in or 
aggravated by such service.''.
    (c) Authority To Contract for Counseling Services.--Subsection (e) 
of such section is amended by striking out ``subsections (a) and (b)'' 
each place it appears and inserting in lieu thereof ``subsections (a), 
(b), and (c)''.

SEC. 5. ADVISORY COMMITTEE ON THE READJUSTMENT OF VETERANS.

    (a) In General.--(1) Subchapter II of chapter 17 of title 38, 
United States Code, is amended by inserting after section 1712B the 
following:
``Sec. 1712C. Advisory Committee on the Readjustment of Veterans
    ``(a)(1) There is in the Department the Advisory Committee on the 
Readjustment of Veterans (hereafter 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 veterans who--
            ``(A) have demonstrated significant civic or professional 
        achievement; and
            ``(B) have experience with the provision of veterans 
        benefits and services by the Department.
    ``(3) The Secretary shall seek to ensure that members appointed to 
the Committee include persons from a wide variety of geographic areas 
and ethnic backgrounds, persons from veterans service organizations, 
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 2 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 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 effectiveness 
        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 appropriate 
        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 veterans of the Vietnam era, 
and the readjustment needs of such veterans.
    ``(c)(1) Not later than March 31 of each year, the Committee shall 
submit to the Secretary a report on the programs and activities of the 
Department that relate to the readjustment of veterans to civilian 
life. Each such report shall include--
            ``(A) an assessment of the needs of veterans with respect 
        to readjustment to civilian life;
            ``(B) a review of the programs and activities of the 
        Department designed to meet such needs; and
            ``(C) such recommendations (including recommendations for 
        administrative and legislative action) as the Committee 
        considers appropriate.
    ``(2) Not later than 90 days after the receipt of each report under 
paragraph (1), the Secretary shall transmit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a copy of 
the report, together with any comments and recommendations concerning 
the report that the Secretary considers appropriate.
    ``(3) The Committee may also submit to the Secretary such other 
reports and recommendations as the Committee considers appropriate.
    ``(4) The Secretary shall submit with each annual report 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 previous annual report of the Secretary submitted pursuant to 
that section.
    ``(d)(1) Except as provided in paragraph (2), the provisions of the 
Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the 
activities of the Committee under this section.
    ``(2) Section 14 of such Act shall not apply to the Committee.''.
    (2) The table of sections at the beginning of chapter 17 of such 
title is amended by inserting after the item relating to section 1712B 
the following:

``1712C. Advisory Committee on the Readjustment of Veterans.''.
    (b) Original Members.--(1) Notwithstanding subsection (a)(2) of 
section 1712C of such title (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 Secretary of 
Veterans Affairs carries out appointments under such subsection (a)(2). 
The Secretary shall carry out such appointments as soon after such date 
as is practicable. The Secretary may make such appointments from among 
such original members.

SEC. 6. PLAN FOR EXPANSION OF VIETNAM VETERAN RESOURCE CENTER PILOT 
              PROGRAM.

    (a) Requirement.--(1) The Secretary of Veterans Affairs shall 
submit to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a plan for the expansion of the Vietnam Veteran 
Resource Center program established pursuant to the amendment made by 
section 105 of the Veterans' Administration Health-Care Amendments of 
1985 (Public Law 99-166; 99 Stat. 944). The plan shall include a 
schedule for, and an assessment of the cost of, the implementation of 
the program at or through all Department of Veterans Affairs 
readjustment counseling centers.
    (2) The Secretary shall submit the plan not later than 4 months 
after the date of the enactment of this Act.
    (b) Definition.--In this section, the term ``Department of Veterans 
Affairs readjustment counseling centers'' has the same meaning given 
the term ``center'' in section 1712A(i)(1) of title 38, United States 
Code.

SEC. 7. REPORT ON COLLOCATION OF VET CENTERS AND DEPARTMENT OF VETERANS 
              AFFAIRS OUTPATIENT CLINICS.

    (a) Requirement.--(1) 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 desirability of the 
collocation of Vet Centers and outpatient clinics (including rural 
mobile clinics) of the Department of Veterans Affairs as current leases 
for such centers and clinics expire.
    (2) The Secretary shall submit the report not later than 6 months 
after the date of the enactment of this Act.
    (b) Covered Matters.--The report under this section shall include 
an assessment of the following:
            (1) The results of any collocation of Vet Centers and 
        outpatient clinics carried out by the Secretary before the date 
        of the enactment of this Act, including the effects of such 
        collocation on the quality of care provided at such centers and 
        clinics.
            (2) The effect of such collocation on the capacity of such 
        centers to carry out their primary mission.
            (3) The extent to which such collocation will impair the 
        operational independence or administrative integrity of such 
        centers.
            (4) The feasibility of combining the services provided by 
        such centers and clinics in the course of the collocation of 
        such centers and clinics.
            (5) The advisability of the collocation of centers and 
        clinics of significantly different size.
            (6) The effect of the locations (including urban and rural 
        locations) of the centers and clinics on the feasibility and 
        desirability of such collocation.
            (7) The amount of any costs savings to be achieved by 
        Department as a result of such collocation.
            (8) The desirability of such collocation in light of plans 
        for the provision of health care services by the Department 
        under national health care reform.
            (9) Any other matters that the Secretary determines 
        appropriate.

SEC. 8. VET CENTER HEALTH CARE PILOT PROGRAM.

    (a) In General.--The Secretary of Veterans Affairs shall carry out 
a pilot program for the provision of health-related services to 
eligible veterans at readjustment counseling centers. The Secretary 
shall carry out the pilot program in accordance with this section.
    (b) Services.--(1) In carrying out the pilot program, the Secretary 
shall provide the services referred to in paragraph (2) at not less 
than 10 readjustment counseling centers in existence on the date of the 
enactment of this Act.
    (2) The Secretary shall provide basic ambulatory services and 
health care screening services by such personnel as the Secretary 
considers appropriate at each readjustment counseling center under the 
pilot program. The Secretary shall assign not less than one-half of a 
full-time employee equivalent at each such center in order to provide 
such services under the pilot program.
    (3) In determining the location of the readjustment counseling 
centers at which to provide services under the pilot program, the 
Secretary shall select centers that are located in a variety of 
geographic areas and that serve veterans of a variety of economic, 
social, and ethnic backgrounds.
    (c) Period of Operation.--(1) The Secretary shall commence the 
provision of health-related services at readjustment counseling centers 
under the pilot program not later than 4 months after the date of the 
enactment of this Act.
    (2) The pilot program shall terminate 2 years after the date on 
which the Secretary commences the provision of services under paragraph 
(1).
    (d) Report.--(1) The Secretary shall submit to Congress a report on 
the pilot program established under this section. The report shall 
include the following:
            (A) A description of the program, including information 
        on--
                    (i) the number of veterans provided basic 
                ambulatory services and health care screening services 
                under the pilot program;
                    (ii) the number of such veterans referred to 
                Department of Veterans Affairs general health-care 
                facilities in order to provide such services to such 
                veterans; and
                    (iii) the cost to the Department of Veterans 
                Affairs of the pilot program.
            (B) An analysis of the effectiveness of the services 
        provided to veterans under the pilot program.
            (C) The recommendations of the Secretary for means of 
        improving the pilot program, and an estimate of the cost to the 
        Department of implementing such recommendations.
            (D) An assessment of the desirability of expanding the type 
        or nature of services provided under the pilot program in light 
        of plans for the provision of health care services by the 
        Department under national health care reform.
            (E) An assessment of the extent to which the provision of 
        services under the pilot program impairs the operational or 
        administrative independence of the readjustment counseling 
        centers at which such services are provided.
            (F) An assessment of the effect of the location of the 
        centers on the effectiveness for the Department and for 
        veterans of the services provided under the pilot program.
            (G) Such other information as the Secretary considers 
        appropriate.
    (2) The Secretary shall submit the report not later than 18 months 
after the date of the enactment of this Act.
    (e) Definitions.--For the purposes of this section:
            (1) The term ``Department of Veterans Affairs general 
        health-care facility'' has the meaning given such term in 
        section 1712A(i)(2) of title 38, United States Code.
            (2) The term ``eligible veteran'' means any veteran 
        eligible for outpatient services under paragraph (1), (2), or 
        (3) of section 1712(a) of such title.
            (3) The term ``readjustment counseling center'' has the 
        same meaning given the term ``center'' in section 1712A(i)(1) 
        of such title.
                                 
S 403 IS----2

SOLUTION: Readjustment Counseling Service Amendments of 1995 - Includes a Readjustment Counseling Service (RCS) as part of the Veterans Health Administration of the Department of Veterans Affairs.  Prohibits the Secretary of Veterans Affairs from altering or revising the organizational structure of RCS until the Secretary has notified specified congressional committees and 60 days have elapsed since such notification.  Requires RCS budget information to be included annually in the President's budget submitted to the Congress. 
Outlines eligibility requirements for one of the Assistant Under Secretaries for Health in the Department, including at least three years of clinical experience and two years of administrative experience in RCS or other comparable mental health care counseling service.  Makes such a qualified person the director of RCS. 
Increases from eight to nine the authorized number of Assistant Under Secretaries for Health. 
Directs the Secretary to furnish readjustment counseling to any veteran who:  (1) served on active duty during the Vietnam era; or (2) served on active duty in a theater of combat during a period of war (currently, only after May 7, 1975) in any area in which hostilities occurred.  Authorizes the Secretary to furnish such assistance to any other veteran upon request.   Directs the Secretary to provide counseling to survivors and dependents of members of the armed forces killed while performing such duty.  Allows the Secretary to provide such counseling to the survivors and dependents of other members killed during active duty or from a condition incurred in or aggravated by such service. 
Establishes in the Department the Advisory Committee on the Readjustment of Veterans to perform advisory services with respect to veterans' readjustment, taking into special account Vietnam era veterans.  Requires specified reports from the Advisory Committee and the Secretary. 
Directs the Secretary to report to the congressional veterans' affairs committees: (1) a plan for the expansion of the Vietnam Veteran Resource Center program; and (2) on the feasibility and desirability of the collocation of Vet Centers and outpatient clinics of the Department as current leases for such centers and clinics expire. 
Directs the Secretary to carry out and report to the Congress on a pilot program for the provision of health-related services to eligible veterans at readjustment counseling centers.

PROBLEM: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Patient Choice Act of 
1995''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) There should be no unreasonable barriers or impediments 
        to the ability of individuals enrolled in health care plans to 
        obtain appropriate specialized medical services.
            (2) The patient's first point of contact in a health care 
        plan must be encouraged to make all appropriate medical 
        referrals and should not be constrained financially from making 
        such referrals.
            (3) Some health care plans may impede timely access to 
        specialty care.
            (4) At any time, patients must be able to access out-of-
        network items, treatment, and services at an additional cost to 
        the patient which is not so prohibitive that they are deterred 
        from seeing the health care provider of their own choice.
            (5) Specialty care must be available for the full duration 
        of the patient's medical needs and not limited by time or 
        number of visits.
            (6) Direct access to specialty care is essential for 
        patients in emergency and nonemergency situations and for 
        patients with chronic and temporary conditions.

SEC. 3. PROTECTION FOR MEDICARE HMO ENROLLEES.

    (a) In General.--Section 1876 of the Social Security Act (42 U.S.C. 
1395mm) is amended--
            (1) in subsection (c)(1), by striking ``subsection (e)'' 
        and inserting ``subsections (e) and (k)'', and
            (2) by adding at the end the following new subsection:
    ``(k) Beneficiary Protection.--
            ``(1) Minimum loss ratio.--
                    ``(A) In general.--Each eligible organization shall 
                have a loss-ratio that is not less than 85 percent for 
                each contract year.
                    ``(B) Loss ratio defined.--In subparagraph (A), the 
                term `loss-ratio' means, with respect to an 
                organization for a contract year, the ratio of (i) the 
                anticipated aggregate benefits provided under this 
                section to enrollees for the year, to (ii) the 
                aggregate amount of the premiums collected (including 
                payments to the organization under subsection (a) for 
                the year, as estimated on the basis of incurred claims 
                experience and earned premium for the year.
            ``(2) Assuring adequate in-network access.--
                    ``(A) Timely access.--An eligible organization that 
                restricts the providers from whom benefits may be 
                obtained must guarantee to enrollees under this section 
                timely access to primary and specialty health care 
                providers who are appropriate to the enrollee's 
                condition.
                    ``(B) Access to specialized care.--Enrollees must 
                have access to specialized treatment when the treating 
                provider deems necessary. This access may be satisfied 
                through contractual arrangements with specialized 
                providers outside of the network.
                    ``(C) Continuity of care.--An eligible 
                organization's use of case management may not create an 
                undue burden for enrollees under this section. An 
                organization must ensure direct access to specialists 
                for ongoing care as so determined by the case manager 
                in consultation with the specialty care provider. This 
                continuity of care may be satisfied for enrollees with 
                chronic conditions through the use of a specialist 
                serving as case manager.
            ``(3) Assuring out-of-network access.--
                    ``(A) In general.--An eligible organization that 
                contracts with a specific network of providers must 
                offer its enrollees or their treating provider with the 
                patient's authorization under this section, the ability 
                at any time, to seek items, services, and treatment 
                from out-of-network providers for all covered benefits.
                    ``(B) Reimbursement for out-of-network services.--
                An eligible organization under this section shall 
                provide for reimbursement for the enrollee, consistent 
                with the cost-sharing schedule established under 
                subparagraph (C), with respect to out-of-network 
                services which are described in subparagraph (A), so 
                long as the services were medically appropriate, and 
                were covered benefits in-network.
                    ``(C) Establishment of cost-sharing schedule.--In 
                consultation with the National Association of Insurance 
                Commissioners, the Secretary shall establish (by not 
                later than one year after enactment of this Act) a 
                cost-sharing schedule which applies to payment required 
                under subparagraph (B) for out-of-network services.
            ``(4) Appropriate range of services.--A health plan shall 
        not deny any health care professionals, based solely on the 
        license or certification as applicable under State law, the 
        ability to participate in providing covered health care 
        services, or be reimbursed or indemnified or by a network plan 
        for providing such services. Organizations must ensure a 
        sufficient number, mix, and distribution of health care 
        professionals within a network plan to ensure enrollees access 
        to appropriate medical services.
            ``(5) Grievance and appeals processes.--
                    ``(A) Grievance process.--The organization must 
                provide meaningful procedures for hearing and resolving 
                grievances between the organization (including any 
                entity or individual through which the organization 
                provides health care services) and members enrolled 
                with the organization under this section.
                    ``(B) Board of appeals.--
                            ``(i) In general.--Each eligible 
                        organization shall establish a board of appeals 
                        to hear and make determinations on complaints 
                        by enrollees concerning denials of coverage or 
                        payment for services (whether in-network or 
                        out-of-network) and the medical necessity and 
                        appropriateness of covered items and services.
                            ``(ii) Composition.--A board of appeals of 
                        an eligible organization shall consist of--
                                    ``(I) representatives of the 
                                organization, including physicians, 
                                nonphysicians, administrators, and 
                                enrollees;
                                    ``(II) consumers who are not 
                                enrollees and those who have 
                                disenrolled; and
                                    ``(III) providers with expertise in 
                                the field of medicine which 
                                necessitates treatment.
                            ``(iii) Deadline for decision.--A board of 
                        appeals shall hear and resolve complaints 
                        within 30 days after the date the complaint is 
                        filed with the board.
                    ``(C) Appeal to secretary.--A member enrolled in an 
                eligible organization under this section who is 
                dissatisfied with a determination of a board of appeals 
                of the organization under subparagraph (B) is entitled, 
                if the amount in controversy is $100 or more, to a 
                hearing before the Secretary to the same extent as is 
                provided in section 205(b), and in any such hearing the 
                Secretary shall make the eligible organization a party. 
                If the amount in controversy is $1,000 or more, the 
                individual or eligible organization shall, upon 
                notifying the other party, be entitled to judicial 
                review of the Secretary's final decision as provided in 
                section 205(g), and both the individual and the 
                eligible organization shall be entitled to be parties 
                to that judicial review. In applying sections 205(b) 
                and 205(g) as provided in this subparagraph, and in 
                applying section 205(l) thereto, any reference therein 
                to the Commissioner of Social Security or the Social 
                Security Administration shall be considered a reference 
                to the Secretary or the Department of Health and Human 
                Services, respectively.
            ``(6) Notice of enrollee rights and consumer report card.--
                    ``(A) In general.--Each eligible organization shall 
                provide each enrollee, at the time of enrollment and 
                not less frequently than annually thereafter, an 
                explanation of the enrollee's rights under this section 
                and a copy of the most recent consumer report card for 
                the organization (as described in subparagraph (C)).
                    ``(B) Rights described.--The explanation of rights 
                under subparagraph (A) shall include an explanation 
                of--
                            ``(i) the enrollee's rights to benefits 
                        from the organization;
                            ``(ii) the restrictions on payments under 
                        this title for services furnished other than by 
                        or through the organization;
                            ``(iii) out-of-area coverage provided by 
                        the organization;
                            ``(iv) the organization's coverage of 
                        emergency services and urgently needed care;
                            ``(v) the organization's coverage of out-
                        of-network services, including services that 
                        are additional to the items and services 
                        covered under parts A and B; and
                            ``(vi) appeal rights of enrollees.
                    ``(C) Consumer report card.--For purposes of 
                subparagraph (A), the term `consumer report card' 
                means, with respect to an eligible organization for a 
                year, a report issued by the organization which 
                contains indicators of the quality of the services 
                under this section provided by the organization during 
                the year. Information must be provided in a manner that 
                permits consumers to compare organizations with respect 
                to the following:
                            ``(i) For each plan, on--
                                    ``(I) the premium for the plan,
                                    ``(II) identity, location, 
                                qualifications, and availability of 
                                providers in any provider networks of 
                                the plan,
                                    ``(III) the number of individuals 
                                enrolling and disenrolling from the 
                                plan,
                                    ``(IV) procedures used by the plan 
                                to control utilization of services and 
                                expenditures,
                                    ``(V) procedures used by the plan 
                                to assure quality of care,
                                    ``(VI) the plan's loss ratio, and
                                    ``(VII) rights and responsibilities 
                                of enrollees.
                            ``(ii) In addition, for each managed care 
                        plan, on--
                                    ``(I) restrictions on payment for 
                                services provided outside the plan's 
                                provider network,
                                    ``(II) the process by which 
                                services may be obtained through the 
                                plan's provider network,
                                    ``(III) coverage for out-of-area 
                                services, and
                                    ``(IV) any exclusions in the types 
                                of providers participating in the 
                                plan's provider network.
            ``(7) Restrictions on provider incentive plans.--
                    ``(A) In general.--Each contract with an eligible 
                organization under this section shall provide that the 
                organization may not operate any provider incentive 
                plan (as defined in subparagraph (B)) unless the 
                following requirements are met:
                            ``(i) No specific payment is made directly 
                        or indirectly under the plan to a provider or 
                        provider group as an inducement to reduce or 
                        limit medically necessary services provided 
                        with respect to a specific individual enrolled 
                        with the organization.
                            ``(ii) If the plan places a provider or 
                        provider group at substantial financial risk 
                        (as determined by the Secretary) for services 
                        not provided by the provider or provider group, 
                        the organization--
                                    ``(I) provides stop-loss protection 
                                for the provider or group that is 
                                adequate and appropriate, based on
                                 standards developed by the Secretary 
that take into account the number (and type) of providers placed at 
such substantial financial risk in the group or under the plan and the 
number of individuals enrolled with the organization who receive 
services from the provider or the group, and
                                    ``(II) conducts periodic surveys of 
                                both individuals enrolled and 
                                individuals previously enrolled with 
                                the organization to determine the 
                                degree of access of such individuals to 
                                services provided by the organization 
                                and satisfaction with the quality of 
                                such services.
                            ``(iii) The organization provides the 
                        Secretary with descriptive information 
                        regarding the plan, sufficient to permit the 
                        Secretary to determine whether the plan is in 
                        compliance with the requirements of this 
                        subparagraph.
                    ``(B) Provider incentive plan defined.--In this 
                paragraph, the term `provider incentive plan' means any 
                compensation arrangement between an eligible 
                organization and a provider or provider group that may 
                directly or indirectly have the effect of reducing or 
                limiting services provided with respect to individuals 
                enrolled with the organization.
            ``(8) Additional definitions.--
                    ``(A) In-network.--The term `in-network' means 
                services provided by health care providers who have 
                entered into a contract or agreement with the 
                organization under which such providers are obligated 
                to provide items, treatment, and services under this 
                section to individuals enrolled with the organization 
                under this section.
                    ``(B) Network.--The term `network' means, with 
                respect to an eligible organization, the health care 
                providers who have entered into a contract or agreement 
                with the organization under which such providers are 
                obligated to provide items, treatment, and services 
                under this section to individuals enrolled with the 
                organization under this section.
                    ``(C) Out-of-network.--The term `out-of-network' 
                means services provided by health care providers who 
                have not entered into a contract agreement with the 
                organization under which such providers are obligated 
                to provide items, treatment, and services under this 
                section to individuals enrolled with the organization 
                under this section.''.
    (b) Conforming Amendments.--Section 1876 of such Act is further 
amended--
            (1) by striking subparagraph (E) of subsection (c)(3);
            (2) by striking paragraphs (4) and (5) of subsection (c); 
        and
            (3) by striking paragraph (8) of subsection (i).
    (c) Effective Date.--The amendments made by this section shall 
apply to contract years beginning at least 60 days after the date the 
Secretary establishes the cost-sharing schedule for out-of-network 
services under section 1876(k)(2)(C) of the Social Security Act (as 
added by subsection (a)(2)).

SEC. 4. APPLICATION OF PROTECTIONS TO MEDICARE SELECT POLICIES.

    (a) In General.--Section 1882(t)(1) of the Social Security Act (42 
U.S.C. 1395ss(t)(1)) is amended--
            (1) by striking ``and'' at the end of subparagraph (E);
            (2) by striking the period at the end of subparagraph (F) 
        and inserting a semicolon; and
            (3) by adding at the end the following new subparagraph:
                    ``(G) notwithstanding any other provision of this 
                section to the contrary, if the issuer of the policy--
                            ``(i) meets the requirements of section 
                        1876(k) with respect to individuals enrolled 
                        under the policy in the same manner such 
                        requirements apply with respect to an eligible 
                        organization under such section with respect to 
                        individuals enrolled with the organization 
                        under such section, and
                            ``(ii) discloses (in a form and manner 
                        specified by the Secretary) the loss ratio 
                        described in subsection (r)(1) most recently 
                        calculated for purposes of such subsection.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to policies issued or renewed on or after the effective date 
described in section 3(c).

SOLUTION:
Medicare Patient Choice Act of 1995 - Amends title XVIII (Medicare) of the Social Security Act to require health maintenance organizations and competitive medical plans, among other things, to: (1) have a minimum 85 percent loss-ratio of benefits-to-premiums; (2) assure Medicare enrollees timely access to in-network primary and specialty health care providers and out-of-network providers as well; (3) establish a cost-sharing schedule for out-of-network services; (4) establish a grievance process with board of appeals hearings within 30 days of the filing of a complaint; and (5) provide each enrollee with an explanation of the enrollee's rights and a copy of the most recent consumer report card for the organization.  Prohibits provider incentive plans that fail to meet specified criteria. 
Applies the same requirements to Medicare select policies.