Veterans Health Care Act of 1992
PL 102-585 (H.R.5193), enacted 11/04/1992

PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4943 
Public Law 102-585 
102d Congress 
An Act 
To amend title 38, United States Code, to improve health care services for women 
veterans, to expand authority for health care sharing agreements between the 
Department of Veterans Affairs and the Department of Defense to revise certain 
pay authorities that apply to Department of Veterans Affairs nurses, to improve 
Nov. 4,1992 
preventive health services for veterans, to establish discounts on pharmaceuticals 
[H.R. 5193] 
purchased by the Department of Veterans Affairs, to provide for a Persian Gulf 
War Veterans Health Registry, and to make other improvements in the delivery 
and administration of health care by the Department of Veterans Affairs. 
Be it enacted by the Senate and House of Representatives of 
the United States of 
America in Congress assembled. 
Veterans 
Health Care 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
Act of 1992. 
(a) SHORT TITLE.—This Act may be cited as the "Veterans ssuscioi 
Health Care Act of 1992". 
''°*® 
(b) TABLE OF CONTENTS.—The table of contents of this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. References to title 38, United States Code. 
TITLE I—WOMEN VETERANS HEALTH PROGRAMS 
Sec. 101. Short title. 
Sec. 102. Sexual trauma coimseling. 
Sec. 103. Priority for outpatient care for sexual trauma counseling. 
Sec. 104. Commencement of provision of information on services. 
Sec. 105. Report on implementation of sexual trauma counseling program. 
Sec. 106. Health care services for women. 
Sec. 107. Report on health care and research. 
Sec. 108. Coordination of services. 
Sec. 109. Research relating to women veterans health. 
Sec. 110. Popiilation study of women veterans. 
TITLE n—HEALTH-CARE SHARING AGREEMENTS BETWEEN DEPARTMENT 
OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE 
Sec. 201. Temi>orary expansion of authority for sharing agreements. 
Sec. 202. Requirement tor improvement in services for veterans. 
Sec. 203. Expanded sharing agreements with Department of Defense. 
Sec. 204. Expiration of authority. 
Sec. 205. Consultation with veterans service organizations. 
Sec. 206. Annual report. 
TITLE m—NURSE PAY 
Sec. 301. Revision to nurse pay grade schedtde. 
Sec. 302. Authority to establish special rates of pay for employees of facilities 
located outside the contiguous United States, Alaska, and Hawaii. 
Sec. 303. Salary data for nurse anesthetists. 
Sec. 304. Rates of pay for transferring nurses. 
Sec. 305. Nursing personnel qualification standards. 
Sec. 306. Report on pay for chief nurse position. 
Sec. 307. Report on pay compression. 
Sec. 308. Effective date. 
TITLE IV—STATE HOME AMENDMENTS 
Sec. 401. Treatment of earnings of veterans under certain rehabilitative services 
programs. 
Sec. 402. Permanent authority to make grants to States relating to State homes. 
59-194 O—93 
13:QL3{Pt. 6) 
106 STAT. 4944 
PUBLIC LAW 102-585—NOV. 4, 1992 
Sec. 403. Extension of period for completion of conditionally approved applications 
for construction. 
Sec. 404. Limited prohibition on obligation of funds for rescinded projects. 
Sec. 405. Commencement date for recapture period. 
Sec. 406. Commencement date for payment of per diem. 
TITLE V—GENERAL HEALTH CARE AND ADMINISTRATION 
Subtitle A—General Health 
Sec. 501. Contract hospital care for veterans with permanent and total service-con-
nected disabilities. 
Sec. 502. Permanent authority for respite care program. 
Sec. 503. Extension of authority to contract with the Veterans Memorial Medical 
Center, Republic of die Philippines. 
Subtitle B—Preventive Health 
Sec. 511. National Center for Preventive Health. 
Sec. 512. Annual report on preventive health services. 
Sec. 513. Preventive health services. 
Sec. 514. Repeal of pilot program. 
Subtitle C—Health Care Administration and Personnel 
Sec. 521. Geriatric research, education, and clinical centers. 
Sec. 522. Extension of authority to waive certain limitations applicable to receipt 
of retirement pay by nurses. 
Sec. 523. Health professionals education programs. 
Sec. 524. Real property at Temple Junior College, Temple, Texas. 
Sec. 525. Demonstration project to evaluate installation of telephones for patient 
use at Department health-care facilities. 
Sec. 526. Useof Tobacco Products in Department Facilities. 
Women 
Veterans 
Health 
Programs 
Act of 1992. 
38 u s e 101 
note. 
TITLE VI—DRUG PRICING AGREEMENTS 
Sec. 601. Treatment of prescription drugs procured by Department of Veterans 
Affairs or purchased bv certain chnics and hospitals. 
Sec. 602. Limitations on prices of drugs purchased by cenain clinics and hospitals. 
Sec. 603. Limitation on prices of drugs procured by Department of Veterans Affairs 
and certain other Federal agencies. 
TITLE VII—PERSIAN GULF WAR VETERANS'HEALTH STATUS 
Sec. 701. Short title. 
Sec. 702. Persian Gulf War Veterans Health Registry. 
Sec. 703. Health examinations and counseling tor veterans eligible for inclusion in 
certain health-related registries. 
Sec. 704. Expansion of coverage of Persian Gulf Registry. 
Sec. 705. Study by Office of Technolo^ Assessment of Persian Gulf Registry and 
Persian Gulf War Veterans Health Registry. 
Sec. 706. Agreement with National Academy of Sciences for review of health con-
sequences of service during the Persian Gulf War. 
Sec. 707. Coordination of government activities on health-related research on the 
Persian Gulf War. 
Sec. 708. Definition. 
TITLE VIII—COURT OF VETERANS APPEALS 
Sec. 801. Disciplinary procedures for judges of Court of Veterans Appeals. 
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 consiaered to be made to a section or other provision of title 
38, United States Code. 
TITLE I—WOMEN VETERANS HEALTH 
PROGRAMS 
SEC. 101. SHORT TITLE. 
This title may be cited as the "Women Veterans Health Pro-
grams Act of 1992". 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4945 
SEC. 102. SEXUAL TRAUMA COUNSELING. 
(a) IN GENERAL.—(1) Chapter 17 of title 38, United States 
Code, is amended by adding at the end of subchapter II the following 
new section: 
*
*
§ 1720D. Counseling to women veterans for sexual trauma 
"(aXl) During the period through December 31, 1995, the 
Secretary may provide counseling to a woman veteran who the 
Secretary determines requires such counseling to overcome psycho-
logical trauma, which in the judgment of a mental health profes-
sional employed by the Department, resulted from a physical assault 
of a sexual nature, battery of a sexual nature, or sexual harassment 
which occurred while the veteran was serving on active duty. 
"(2) To be eUgible to receive counseling imder this subsection, 
a veteran must seek such counseling from the Secretary within 
two years after the date of the veteran's discharge or release from 
active military, naval, or air service. 
"(3) In furnishing counseling to a veteran under this subsection, 
the Secretary may, during the period through December 31, 1994, 
provide such counseling pursueuit to a contract with a qualified 
mental health professional if (A) in the judgment of a mental 
health professional employed by the Department, the receipt of 
counseling by that veteran in facilities of the Department would 
be clinically inadvisable, or (B) Department facilities are not capable 
of furnishing such counseling to that veteran economically because 
of geographical inaccessibility. 
"(b) In providing services to a veteran under subsection (a), 
the period for which coimseling is provided may not exceed one 
year from the date of the commencement of the furnishing of 
such counseling to the veteran. However, the Secretary may author-
ize a longer period in any case if, in the judgment of the Secretary, 
a longer period of counseling is required. 
"(cXl) The Secretary shall give priority to the establishment 
and operation of the program to provide counseling imder subsection 
(a). In the case of a veteran eligible for such counseling who requires 
other care or services under this chapter for trauma described 
in subsection (aXD, the Secretary shall ensure that the veteran 
is furnished counseling under this section in a way that is coordi-
nated with the fiunishing of such other care and services under 
this chapter. 
"(2) In establishing a program to provide counseling imder 
subsection (a), the Secretary shall— 
"(A) provide for appropriate training of mental health 
professionals and such other health care personnel as the Sec-
retary determines necessary to carry out the program 
effectively; 
"(B) seek to ensure that such counseling is furnished in 
a setting that is therapeutically appropriate, taking into 
account the circumstances that resulted in the need for such 
counseling; and 
"(C) provide referral services to assist women veterans 
who are not eligible for services under this chapter to obtain 
those from sources outside the Department. 
"(d) The Secretary shall provide mformation on the counseling Public 
available to women veterans under this section. Efforts by the ^formation. 
Secretary to provide such information— 
106 STAT. 4946 
PUBLIC LAW 102-585—NOV. 4, 1992 
"(1) may include establishment of an information system 
involving the use of a toll-free telephone number (commonly 
referred to as an 800 number), and 
"(2) shall include coordination with the Secretary of Defense 
seeking to ensure that women who are being separated from 
active militanr, naval, or air service are provided appropriate 
information about programs, requirements, and procedures for 
appljdng for counseling under this section. 
"(e) In this section, the term 'sexual harassment' means 
repeated, imsolicited verbal or physical contact of a sexual nature 
which is threatening in character.". 
(2) The table of sections at the beginning of chapter 17 is 
amended by inserting after the item relating to section 1720C 
tiie following new item: 
38 use 1720D 
note. 
38 use 1720D 
note. 
38 use 1720D 
note. 
"17200. Counseling to women veterans for sexual trauma.". 
(b) TRANSITION PROVISION.—In the case of a veteran who was 
discharged or released from active military, naval, or air service 
before December 31, 1991, the two-year period specified in section 
1720D(aX2) of title 38, United States Code, as added by subsection 
(a), shall be treated as ending on December 31,1993. 
SEC. 103. PRIORITY FOR OUTPATIENT CARE FOR SEXUAL TRAUMA 
COUNSELING. 
Section 1712(iX2) is amended— 
(1) by striking out "or (B)" and inserting in lieu thereof 
",(6)"; and 
(2) by inserting before the period at the end thereof the 
following: ", or (C) who is eligible for counseling luider section 
1720D of this title, for the purposes of such coimseling". 
SEC. 104. COMMENCEMENT OF PROVISION OF INFORMATION ON 
SERVICES. 
Not later than 90 days after the date of the enactment of 
this Act, the Secretary of Veterans Affairs shall commence the 
provision of information on the counseling relating to sexual trauma 
that is available to women veterans under section 1720D of title 
38, United States Code (as added by section 102) in accordance 
with the provisions of subsection (d) of that section. 
SEC. 
1
0
6
. 
REPORT 
ON 
IMPLEMENTATION OF 
SEXUAL 
TRAUMA COUN-
SELING 
PROGRAM. 
Not later than March 31, 1994, the Secretary of Veterans 
Affairs shall submit to the Committees on Veterans' Affairs of 
the Senate and House of Representatives a comprehensive report 
on the Secretaiys actions under section 1720D of title 38, United 
States Code (as added by section 102), and on the use made of 
the authority provided imder that section. The report shall include 
the following: 
(1) The numbers of veterans who have received coimseling 
under such section, shown by reference to the facility that 
provided that counseling and including the use made of the 
contract authority under such section. 
(2) The number of veterans who received care or services 
under chapter 17 of title 38, United States Code, under the 
circumstances described in subsection (cXD of such section 
and the numbers referred to sources outside the Department, 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4947 
shown by reference to the facility that provided those services 
or made those referrals. 
(3) A listing and description of the specific training pro-
grams which the Secretary has instituted to ensure that the 
counseling program established under such section is carried 
out effectively. 
(4) A description of the specific efforts taken by the Sec-
retary to ensure that the coimseling furnished by the Secretary 
luider such section is fiimished in settings that are therapeuti-
cally appropriate, taking into account the circumstances that 
resulted in the need for such counseling. 
SEC. 106. HEALTH CARE SERVICES FOR WOMEN. 
38 USC 1710 
(a) GENERAL AUTHORITY.—In furnishing hospital care and medi-
cal services under chapter 17 of title 38, United States Code, the 
Secretary of Veterans Affairs may provide to women the following 
health care services: 
(1) Papanicolaou tests (pap smears). 
(2) Breast examinations and mammography. 
(3) General reproductive health care, including the manage-
ment of menopause, but not including under this section 
infertility services, abortions, or pregnancy care (including pre-
natal and delivery care), except for sucn care relating to a 
pregnancy that is complicated or in which the risks of complica-
tion are increased by a service-connected condition. 
(b) RESPONSIBILITIES OF DIRECTORS OF FACILITIES.—The Sec-
retary shall ensure that directors of medical facilities of the Depart-
ment identify and assess opportunities under the authority provided 
in title II of this Act to (1) expand the availability of, and access 
to, health care services for women veterans under sections 1710 
and 1712 of title 38, United States Code, and (2) provide counseling, 
care, and services authorized by this title. 
SEC. 107. REPORT ON HEALTH CARE AND RESEARCH. 
38 USC 1710 
(a) IN GENERAL.—^Not later than January 1, 1993, January 
1, 1994, and January 1, 1995, the Secretary of Veterans Affairs 
shall submit to the Committees on Veterans' Affairs of the Senate 
and House of Representatives a report on the provision of health 
care services and the conduct of research carried out by, or under 
the jurisdiction of, the Secretary relating to women veterans. 
(b) CONTENTS.—The report under subsection (a) shall include 
the following information with respect to the most recent fiscal 
year before the date of the report: 
(1) The number of women veterans who have received 
services described in section 106 of this Act in facilities under 
the jurisdiction of the Secretary (or the Secretary of Defense), 
shown by reference to the Department facility which provided 
(or, in the case of Department of Defense facilities, arranged) 
those services; 
(2) A description of (A) the services provided at each such 
facility, and (B) the extent to which each such facility relies 
on contractual arrangements under section 1703 or 8153 of 
title 38, United States Code, to furnish care to women veterans 
in facilities which are not under the jurisdiction of the Secretary 
where the provision of such care is not fiunished in a medical 
emergency. 
106 STAT. 4948 
PUBLIC LAW 102-585--NOV. 4, 1992 
(3) The steps taken by each such facility to expand the 
provision of services at such facility (or under arrangements 
with a Department of Defense facilily) to women veterans. 
(4) A description (as of October 1 of the year preceding 
the year in which the report is submitted) of the status of 
any research relating to women veterans being carried out 
by or under the jurismction of the Secretary, including research 
imder section 109 of 
tihis 
Act. 
38 u s e 1710 
SEC. 108. COORDINATION OF SERVICES. 
"° ' 
The Secretary of Veterans Affairs shall ensure that an ofi&cial 
in each regional office of the Veterans Health Administration shall 
serve as a coordinator of women's services. The responsibilities 
of such official shall include the following: 
(1) Conducting periodic assessments of the needs for serv-
ices of women veterans within such region. 
(2) Planning to meet such needs. 
(3) Assisting in carrying out the purposes of section 106(b) 
of this title. 
(4) Coordinating the training of women veterans coordina-
tors who are assigned to Department facilities in the region 
vmder the jurisdiction of such regional coordinator. 
(5) Providing appropriate technical support and guidance 
to Department facilities in that region with respect to outreach 
activities to women veterans. 
38 use 7303 
SEC. 109. RESEARCH RELATING TO WOMEN VETERANS HEALTH. 
°°*® 
(a) INITIATION AND EXPANSION OF RESEARCH.—The Secretary 
of Veterans Affairs, in carrying out the Secretary's responsibilities 
under section 7303 of title 38, United States Code, shall foster 
and encourage the initiation and expansion of research relating 
to the health of veterans who are women. 
(b) AUTHORIZATION OF APPROPRIATIONS.—-(1) Funds are author-
ized to be appropriated to the Secretary to initiate new studies 
in accordance with subsection (a) as follows: 
(A) For fiscal year 1993, $1,500,000. 
(B) For fiscal year 1994, $2,000,000. 
(C) For fiscal year 1995, $2,500,000. 
(2) Amounts appropriated pursuant to the authorization of 
appropriations in paragraph (1) are in addition to other funds 
appropriated or otnerwise made available to the Department of 
Veterans Affairs for research. 
38 u s e 1710 
SEC. no. POPULATION STUDY OF WOBIEN VETERANS. 
°*'*® 
(a) STUDY.—<1) The Secretary, subject to subsection (d), shall 
conduct a study to determine the needs of veterans who are women 
for health-care services. The study shall be based on an appropriate 
sample of veterans who are women. 
(2) Before carrying out the study, the Secretaiy shall request 
the advice of the Advisory Committee on Women Veterans on the 
conduct of the study. 
(3) In carrying out the study, the Secretary shall include in 
the sample veterans who are women and members of the Armed 
Forces serving on active duty who are women. 
(b) REPORTS.—^The Secretary shall submit to the Committees 
on Veterans Affairs of the Senate and House of Representatives 
reports relating to the study as follows: 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4949 
(1) Not later than 9 months after the date of the enactment 
of this Act, an interim report describing (A) the information 
and advice obtained by the Secretary from the Advisory 
Committee on Women Veterans, and (B) the status of the 
study. 
(2) Not later than December 31,1995, a final report describ-
ing the results of the study. 
(c) AUTHORIZATION OF APPROPRIATIONS.—There is authorized 
to be appropriated to the general operating expenses account of 
the Department of Veterans Affairs $2,000,000 to carry out the 
purposes of this section. Amounts appropriated pursuant to this 
authorization of appropriations shall be available for obligation 
until expended without fiscal year limitation. 
(d) LIMITATION.—^No funds may be used to conduct the study 
described in subsection (a) unless expressly provided for in an 
appropriation Act. 
TITLE 
II—HEALTH-CARE 
SHARING 
AGREEMENTS 
BETWEEN 
DEPART-
MENT OF VETERANS AFFAIRS AND 
DEPARTMENT OF DEFENSE 
SEC. 201. TEMPORARY EXPANSION OF AUTHORITY FOR SHARING 
AGREEMENTS. 
The Secretary of Veterans Affairs may enter into an agreement 
with the Secretary of Defense under tlus section to expand the 
availability of health-care sharing arrangements with the Depart-
ment of Defense under section 8111(c) of title 38, United States 
Code. Under such an agreement— 
(1) the head of a Department of Veterans Affairs medical 
facility may enter into agreements imder section 8111(d) of 
that title with (A) the head of a Department of Defense medical 
facility, (B) with any other official of the Department of Defense 
responsible for the provision of care under chapter 55 of title 
10, United States Code, to persons who are covered beneficiaries 
under that chapter, in the region of the Department of Veterans 
Affairs medical facility, or (C) with a contractor of the Depart-
ment of Defense responsible for the provision of care imder 
chapter 55 of title 10, United States Code, to persons who 
are covered beneficiaries imder that chapter, in the region 
of the Department of Veterans Affairs medical facility; and 
(2) the term "primary beneficiarjr" shall be treated as 
including— 
(A) with respect to the Department of Veterans Affairs, 
any person who is described in section 1713 of title 38, 
United States Code; and 
(B) with respect to the Department of Defense, any 
person who is a covered beneficiary under chapter 55 of 
title 10, United States Code. 
SEC. 202. REQUIREMENT FOR IMPROVEMENT IN SERVICES FOR 
VETERANS. 
A proposed agreement authorized by section 201 that is entered 
into by the head of a Department of Veterans Affairs medical 
facility may take effect only if the Chief Medical Director finds, 
38 use 8111 
note. 
106 STAT, 4950 
PUBLIC LAW 102-585—NOV. 4, 1992 
and certifies to the Secretary of Veterans Affairs, that implementa-
tion of the agreement— 
(1) will result in the improvement of services to eligible 
veterans at that facility; and 
(2) will not result in the denial of, or a delay in providing, 
access to care for any veteran at that facility. 
SEC. 203. EXPANDED SHARING AGREEMENTS WITH DEPARTMENT OF 
DEFENSE. 
Under an agreement under section 201, guidelines under sec-
tion 8111(b) of title 38, United States Code, may be modified to 
provide that, notwithstanding any other provision of law, any person 
who is a covered beneficiary under chapter 55 of title 10 and 
who is furnished care or services by a facility of the Department 
of Veterans Affairs under an agreement entered into imder section 
8111 of that title, or who is described in section 1713 of title 
38, United States Code, and who is furnished care or services 
by a faciUty of the Department of Defense, may be authorized 
to receive such care or services— 
(1) without regard to any otherwise appUcable requirement 
for the payment of a copayment or deductible; or 
(2) subject to a requirement to pay only part of any such 
otherwise applicable copayment or deductible, as specified in 
the guidelines. 
SEC. 204. EXPIRATION OF AUTHORITY. 
The authority to provide services pursuant to agreements 
entered into under section 201 expires on October 1,1996. 
SEC. 205. CONSULTATION WITH VETERANS SERVICE ORGANIZATIONS. 
In canying out this title, the Secretary of Veterans Affairs 
shall consult with organizations named in or approved under section 
5902 of title 38, United States Code. 
SEC. 206. ANNUAL REPORT. 
(a) IN GENERAL.—For each of fiscal years 1993 through 1996, 
the Secretary of Defense and the Secretary of Veterans Affairs 
shall include in the anniial report of the Seoretaries under section 
8111(f) of title 38, United States Code, a description of the Secretar-
ies' implementation of this section. 
(b) ADDITIONAL MATTERS FOR FISCAL YEAR 1996 REPORT.— 
In the report under subsection (a) for fiscal year 1996, the Secretar-
ies shall include the following: 
(1) An assessment of the effect of agreements entered into 
under section 201 on the delivery of health care to eligible 
veterans. 
(2) An assessment of the cost savings, if any, associated 
with provision of services under such agreements to retired 
members of the Armed Forces, dependents of members or 
former members of a uniformed service, and beneficiaries under 
section 1713 of title 38, United States Code. 
(3) Any plans for administrative action, and any rec-
ommendations for legislation, that the Secretaries consider 
appropriate to include in the report. 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4951 
TITLE in—NURSE PAY 
SEC. 301. REVISION TO NURSE PAY GRADE SCHEDULE. 
(a) REVISION.—Section 7404(bXl) is amended in the matter 
relating to "NURSE SCHEDULE" by striking out "Director ^ade." 
and sdl that follows through "Entry grade." and inserting m lieu 
thereof the following: 
"Nurse V. 
"Nurse IV. 
"Nurse III. 
"Nurse II. 
"Nurse I.". 
(b) CONFORMING AMENDMENT.—Section 7451(b) of such title 
is amended by striking out "four" and inserting in lieu thereof 
"five". 
SEC. 302. AUTHORITY TO ESTABLISH SPECIAL RATES OF PAY FOR 
EMPLOYEES OF FACIUTIES LOCATED OUTSIDE THE 
CONTIGUOUS UNITED STATES, ALASKA, AND HAWAH. 
Section 7451(aX3) is amended— 
(1) by striking out "(3) The rates" and inserting in lieu 
thereof "(3XA) Except as provided in subparagraph (B), the 
rates"; and 
(2) by adding at the end the following new subparagraph: 
"(B) Under such regulations as the Secretary shall prescribe, Regulations, 
the Secretary shall establish and adjust the rates of basic pay 
for covered positions at the following health-care facilities in order 
to provide rates of basic pay that enable the Secretary to recruit 
and retain sufficient numbers of health-care personnel in such 
positions at those facilities: 
"(i) The Veterans Memorial Medical Center in the Republic 
of the Philippines. 
"(ii) Department of Veterans Affairs health-care facilities 
located outside the contiguous States, Alaska, and Hawaii.". 
SEC. 303. SALARY DATA FOR NURSE ANESTHETISTS. 
Section 7451(dX3) is amended— 
(1) by redesignating subparagraphs (C) and (D) as subpara-
graphs (D) and (E), respectively; and 
(2) by inserting after subparagraph (B) the following new 
subparagraph (C): 
"(CXi) A director of a Department health-care facility may 
use data on the beginning rates of compensation paid to certified 
registered nurse anesthetists who are employed on a salary basis 
by entities that provide anesthesia services through certified reg-
istered nurse anesthetists in the labor-market area only if the 
director— 
"(I) has conducted a survey of beginning rates of compensa-
tion for certified registered nurse anesthetists in the local labor 
market area of 
the facility under subparagraph (B); 
"(II) has used all available administrative authority with 
regard to collection of survey data; and 
"(III) makes a determination (imder regulations prescribed 
by the Secretary) that such survey methods are insufficient 
to permit the adjustments referred to in subparagraph (B) 
for such nurse anesthetists employed by the facility. 
106 STAT. 4952 
PUBLIC LAW 102-585—NOV. 4, 1992 
"(ii) For the purposes of this subparagraph, certified registered 
nurse anesthetists who are so employed by such entities shall 
be deemed to be corresponding health-care professionals to the 
certified registered nurse anesthetists employed by the facility. 
"(iii) The authority of the director to use such additional data 
under this subparagraph with respect to certified registered nurse 
anesthetists expires on April 1,1995.". 
SEC. 304. RATES OF PAY FOR TRANSFERRING NURSES. 
(a) 
SAVE-PAY 
AUTHORITY FOR NURSES 
TRANSFERRING TO 
ANOTHER FACILITY.—Section 7452(e) is amended by striking out 
the period at the end and inserting in lieu thereof *
*
, except that 
in the case of an employee whose transfer (other than pursuant 
to a disciplinary action otherwise authorized by law) to another 
health-care facility is at the request of the Secretary, the Secretary 
may provide that for at least the first year following such transfer 
the employee shall be paid at a rate of basic pay up to the rate 
applicable to such employee before the transfer, if the Secretary 
determines that such rate of pay is necessary to fill the position. 
Whenever the Secretary exercises the authority imder the preceding 
sentence relating to the rate of basic pay of a transferred employee, 
the Secretary shall, in the next annual report required under section 
7451(g) of this title, provide justification for doing so.". 
(b) CONFORMING AMENDMENT.—Section 7451(g) is amended by 
adding at the end the following new paragraph: 
"(9) The justification required oy section 7452(e) of this 
title.". 
38 use 7451 
SEC. SOS. NURSING PERSONNEL QUALIFICATION STANDARDS. 
(a) REVISION.—^The Secretary of Veterans Affairs shall conduct 
a review of the qualification standards used for nursing personnel 
at Department health-care facilities and the relationship between 
those standards and the compression of nursing personnel in the 
existing intermediate and senior grades. Based upon that review, 
the Secretary shall revise those qualification standards— 
(1) to reflect the five grade levels for nursing personnel 
imder the Nurse Schedule, as amended by section 301; and 
(2) to reduce the compression of nursing personnel in the 
existing intermediate and senior grades. 
(b) DEADLINE FOR PRESCRIBING STANDARDS.—The Secretary 
shall prescribe revised qualification standards for nursing personnel 
pursuant to subsection (a) not later than six months after the 
date of the enactment of this Act. 
(c) REPORT.—^The Secretary shall submit to the Committees 
on Veterans' AfTairs of the Senate and House of Representatives 
a report on the Secretary's findings and actions imder this section. 
The report shall be submitted not later than six months after 
the date on which revised qualification standards for nursing 
personnel are prescribed pursuant to subsection (b). 
38 use 7451 
SEC. 306. REPORT ON PAY FOR CHIEF NURSE POSITION. 
(a) REVIEW.—^The Secretary of Veterans Affairs shall conduct 
a review of— 
(1) the process for determining the rate of basic pay 
applicable to the Chief Nurse position at Department of Veter-
ans Affairs health-care facilities; and 
(2) the relationship between the rate of such basic pay 
and the rate of basic pay applicable to nurses in positions 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4953 
subordinate to the CMef Nurse at the respective Department 
facilities. 
The review shall include an assessment of the adequacy of that 
process in determining an equitable pay rate for the Chief Nurse 
position, including an assessment of the accuracy of data collected 
m the survey process and the difficulties in obtaining accurate 
data. 
(b) REPORT.—^The Secretary shall submit to the Committees 
on Veterans' Affairs of the Senate and House of Representatives 
a report on the review and assessment conducted under subsection 
(a). To the extent that the review discloses difficulties in obtaining 
accurate data in the survcnr process with respect to the Chief Nurse 
position at Department mcilities, the Secretairy shall include in 
the report recommendations for corrective action. The Secretary 
shall also include in the report (1) a listing of the salary differential 
(expressed as a percentage) between the Chief Nurse at a facility 
and the highest paid nurse (excluding certified registered nurse 
anesthetists) serving in a position subordinate to the Chief Nurse, 
and (2) an analysis of such data. The report shall be submitted 
not later than 12 months after the date of the enactment of this 
Act. 
SEC. 307. REPORT ON PAY COMPRESSION. 
Section 7451(g) (as amended by section 304(b)) is further 
amended by adding at the end the following new paragraph: 
"(10) The number of nurses, shown by facility and by 
grade, who are on pay retention or in the top step of any 
^ade and, with respect to those employees, comprehensive 
information (by facility) as to whether an extension of the 
pay grades was sought for these positions, and with respect 
to each such request for extension, whether such request was 
granted or denied.". 
SEC. 308. EFFECTIVE DATE. 
38 USC 7404 
The amendments made by sections 301, 302, 303, and 304 
shall take effect with respect to the first pay period beginning 
on or after the end of the six-month period beginning on the 
date of the enactment of tliis Act. 
TITLE IV—STATE HOME AMENDMENTS 
SEC. 401. TREATMENT OF EARNINGS OF VETERANS UNDER CERTAIN 
REHABILITATIVE SERVICES PROGRAMS. 
Subsection (f) of section 1718 is amended to read as follows: 
"(fXD The Secretary ma^ not consider any of the matters stated 
in paragraph (2) as a basis for the denial or discontinuance of 
a rating of total disability for purposes of compensation or pension 
based on the veteran's inability to secure or follow a substantially 
gainful occupation as a result of disability. 
"(2) Paragraph (1) app>lies to the following: 
"(A) A veteran s participation in an activity carried out 
under this section. 
"(B) A veteran's receipt of a distribution as a result of 
participation in an activity carried out imder this section. 
"(C) A veteran's participation in a program of rehabilitative 
services that (i) is provided as part of the veteran's care fur-
nished by a State home and (ii) is approved by the Secretary 
106 STAT. 4954 
PUBLIC LAW 102-585—NOV. 4,1992 
as conforming appropriately to standards for activities carried 
out under this section. 
'^D) A veteran's receipt of pa3rment as a result of participa-
tion in a program described in subparagraph (C). 
"(3) A distribution of funds made under this section and a 
payment made to a veteran under a program of rehabilitative 
services described in paragraph (2XC) shall be considered for the 
purposes of chapter 15 of this title to be a donation from a public 
or private reliefer welfare organization.". 
SEC. 402. PERMANENT AUTHORITY TO MAKE GRANTS TO STATES 
RELATING TO STATE HOBfE& 
Section 8133(a) is amended in the first sentence by striking 
out "through September 30,1992". 
SEC. 403. EXTENSION OF PERIOD FOR COMPLETION OF CONDI-
TIONALLY 
APPROVED 
APPUCATIONS 
FOR 
CONSTRUCTION. 
(a) EXTENSION OF PERIOD.—Section 8135(bX6XA) is amended 
by striking out ' ^ days" and inserting in lieu thereof "180 days". 
38 use 8135 
(b) EFFECTIVE DATE.—^The amendment made by subsection (a) 
shall apply to projects that are conditionally approved after Septem-
ber 30,1992. 
note. 
SEC. 404. LIMITED PROHIBITION ON OBUGATION OF FUNDS FOR 
RESCINDED PROJECTS. 
(a) PROHIBITION.—Section 8135(bX6XB) is amended by adding 
at the end the following: "In the event the Secretary rescinds 
conditional approval of a project under this subparagraph, the Sec-
retary may not further obligate funds for the project during tiie 
fiscal year in which the Secretary rescinds such approval.". 
38 use 8135 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
^°^- 
shall apply to rescissions of conditional approval of projects after 
the date of the enactment of this Act. 
) 
SEC. 40S. COMMENCEMENT DATE FOR RECAPTURE PERIOD. 
(a) COMMENCEMENT DATE.—Section 8136 is amended by strik-
ing out "If, within 20 years after completion of any project" and 
inserting in lieu thereof "If, within the 20-year period beginning 
on the date of the approval by the Secretary of the final architec-
tural and engineering inspection of any project". 
(b) TECHNICAL AMENDMENT.—Such section is further amended 
by striking out "such facilities cease" and inserting in lieu thereof 
"the facilities covered by the project cease". 
SEC. 406. COMMENCEMENT DATE FOR PAYMENT OF PER DIEM. 
Section 1741 is amended by adding at the end the following 
new subsection: 
"(e) Subject to section 1743 of this title, the payment of per 
diem for care furnished in a State home facility shall commence 
on the date of the completion of the inspection for recognition 
of the facility under section 1742(a) of this title if the Seoretaxy 
determines, as a result of that inspection, that the State home 
meets the standards described in such section.". 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4955 
TITLE V—GENERAL HEALTH CARE AND 
ADMINISTRATION 
Subtitle A—General Health 
SEC. 501. CONTRACT HOSPITAL CARE FOR VETERANS WITH PERMA-
NENT AND TOTAL SERVICE-CONNECTED DISABILITIES. 
Section 1703(aXl) is amended— 
(1) by striking out ''or^ at the end of subparagraph (A); 
(2) by striking out the period at the end of subparagraph 
(B) and inserting in lieu thereof; or^; and 
(3) by adding at the end the following new subparagraph: 
"(C) a disability of a veteran who nas a total disability 
permanent in nature from a service-connected disability. . 
SEC. 502. 
PERMANENT 
AUTHORITY 
FOR 
RESPITE 
CARE 
PROGRAM. 
Section 1720B is amended by striking out subsection (c). 
SEC. 503. ElOENSION OF AIJTHORmr TO CONTRACT WITH THE VETER-
ANS MEMORIAI^ MEDICAL CENTER, REPUBLIC OF THE 
PHILIPPINES. 
Section 1732(a) is amended by striking out "September 30, 
1992" and inserting in lieu thereof "September 30,1994 . 
Subtitle B—Preventive Health 
SEC. 511. 
NATIONAL 
CENTER 
FOR 
PREVENTIVE 
HEALTH. 
(a) ESTABLISHMENT.--(1) Subchapter II of chapter 73 is 
amended by adding at the end the following new section: 
**% 7318. National Center for Preventive Health 
"(aXD The Chief Medical Director shall establish and operate 
in the Veterans Health Administration a National Center for 
Preventive Health (hereinafter in this section referred to as the 
'Center*). The Center shall be located at a Department health care 
facility. 
"(2) The head of the Center is the Director of Preventive Health 
(hereinafter in this section referred to as the 'Director*). 
"(3) The Chief Medical Director shall provide the Center with 
such staff and other support as may be necessary for the Center 
to carry out effectively its functions under this section. 
"(b) The purposes of the Center are the following: 
"(1) To provide a central office for monitoring and encourag-
ing the activities of the Veterans Health Administration wiui 
respect to the provision, evcduation, and improvement of 
preventive health services. 
"(2) To promote the expansion and improvement of clinical, 
research, and educational activities of the Veterans Health 
Administration with respect to such services, 
"(c) In carrying out the purposes of the Center, the Director 
shall do the following: 
"(1) Develop and maintain current information on clinical 
activities of the Veterans Health Administration relating to 
preventive health services, including activities relating to— 
106 STAT. 4956 
PUBLIC LAW 102-585—NOV. 4, 1992 
"(A) the on-going provision of regularly-furnished serv-
ices; and 
"(B) patient education and screening programs carried 
out throughout the Administration. 
"(2) Develop and maintain detailed current information 
on research activities of the Veterans Health Administration 
relating to preventive health services. 
*'(3) In order to encourage the effective provision of preven-
tive health services by veterans Health Administration 
personnel— 
"(A) ensure the dissemination to such personnel of 
any appropriate information on such services that is 
derivea from research carried out by the Administration; 
and 
"(B) acquire and ensure the dissemination to such 
personnel of any appropriate information on research and 
clinical practices relating to such services that are carried 
out by researchers, clinicians, and educators who are not 
affiliated with the Administration. 
"(4) Facilitate the optimal use of the unique resources 
of the Department for cooperative research into health outcomes 
by initiating recommendations, and responding to requests of 
the Chief Medical Director and the Director of the Medical 
and Prosthetic Research Service, for such research into preven-
tive health services. 
'^5) Provide advisory services to personnel of Department 
health-care facilities wim respect to the planning or furnishing 
of preventive health services by such personnel. 
Appropriation 
"(d) There is authorized to be appropriated $1,500,000 to the 
authorization. 
Medical Care General and Special Fund of the Department of 
Veterans Affairs for each fiscal year for the purpose of permitting 
the National Center for Preventive Health to carry out research, 
clinical, educational, and administrative activities luider this sec-
tion. Such activities shall be considered to be part of the operation 
of health-care facilities of the Department without regard to the 
location at which such activities are carried out. 
''(e) In this section, the term 'preventive health services' has 
the meaning given such term in section 1701(9) of this title.**. 
(2) The table of sections at the beginning of chapter 73 is 
amended by inserting after the item relating section 7317 the 
following new item: 
"7318. National Center for Preventive Health.". 
(b) DIRECTOR OF CENTER.—(1) Subsection (a) of section 7306 
is amended— 
(A) by redesi^ating paragraph (7) as paragraph (8); and 
(B) by inserting after paragraph (6) the following new 
paragraph (7): 
^7) The Director of the National Center for Preventive 
Healtii, who shall be responsible to the Chief Medical Director 
for the operation of the Center.". 
(2) Subsection (c) of such section is amended in the second 
sentence by striking out "and (4)" and inserting in lieu thereof 
«(4),and(7)''. 
38 use 7318 
(c) SELECTION OF FACILITY AT WmcH CENTER TO BE ESTAB-
"°'®- 
LISHED.—^In order to establish the National Center for Preventive 
Health pursuant to section 7318 of title 38, United Stetes Code, 
as added by subsection (a), the Chief Medical Director of the Depart-
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4957 
ment of Veterans Affairs shall solicit proposals from Department 
health care facilities to establish the center. The Chief Medical 
Director shall establish such center at the facility or facilities which 
the Chief Medical Director determines, on the basis of a review 
and analysis of such proposals, would most effectively carry out 
the purposes set forth in subsection (b) of such section. 
SEC. 512. 
ANNUAL 
REPORT 
ON 
PREVENTIVE 
HEALTH 
SERVICES. 
(a) ANNUAL REPORT.—Chapter 17 is amended by inserting after 
section 1703 the following new section: 
*
*
§ 1704. Preventive health services: annual report 
"Not later than October 31 each year, the Secretary shall submit 
to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report on preventive health services. Each 
such report shall include the following: 
"(1) A description of the programs and activities of the 
Department with respect to preventive health services during 
the preceding fiscal year, including a description of the 
following: 
"(A) The programs conducted by the Department— 
"(i) to educate veterans with respect to health pro-
motion and disease prevention; and 
"(ii) to provide veterans with preventive health 
screenings and other clinical services, with such 
description setting forth the types of resources used 
by the Department to conduct such screenings and 
services and the nmnber of veterans reached by such 
screenings and services. 
"(B) The means by which the Secretary addressed the 
specific preventive health services needs of particular 
groups of veterans (including veterans with service-con-
nected disabilities, elderly veterans, low-income veterans, 
women veterans, institutionalized veterans, and veterans 
who are at risk for mental illness). 
"(C) The manner in which the provision of such services 
was coordinated with the activities of the Medical and 
Prosthetic Research Service of the Department and the 
National Center for Preventive Health. 
"(D) The manner in which the provision of such services 
was integrated into training programs of the Department, 
including initial and continuing medical training of medical 
students, residents, and Department staff. 
"(E) The manner in which the Department participated 
in cooperative preventive health efforts with other govem-
mentsd and private entities (including State and local 
health promotion offices and not-for-profit organizations). 
"(F) The specific research carried out by the Depart-
ment with respect to the long-term relationships among 
screening activities, treatment, and morbidity and mortal-
ity outcomes. 
"(G) The cost effectiveness of such programs and activi-
ties, including an explanation of the means by which the 
costs and benefits (including the quality of life of veterans 
who participate in such programs and activities) of such 
programs and activities are measured. 
106 STAT. 4958 
PUBLIC LAW 102-585—NOV. 4, 1992 
"(2) A specific description of research activities on preven-
tive healtii services carried out during tiiat period using employ-
ees, funds, equipment, office space, or other support services 
of tiie Department, with such description setting forth— 
(A) the source of funds for those activities; 
"(B) the articles or publications (including the authors 
of the articles and publications) in which those activities 
are described; 
"(C) the Federal, State, or local governmental entity 
or private entity, if any, with which such activities were 
carried out; and 
"(D) the clinical, research, or stafiT education projects 
for which funding applications were submitted (including 
the source of the funds applied for) and upon which a 
decision is pending or was denied. 
"(3) An accounting of the expenditure of funds during that 
period by the National Center for Preventive Health under 
section 7318 of this title.". 
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of such chapter is amended by inserting after the item relating 
to section 1703 the following new item: 
"1704. Preventive health services: annual report.". 
SEC. 613. PREVENTIVE HEALTH SERVICES. 
(a) IN GENERAL.—The text of section 1762 is transferred to 
the end of section 1701, redesignated as paragraph (9), and 
amended— 
(1) by striking out Tor the purposes of this subchapter, 
the term 'preventive health-care services' means" and insertii^ 
in lieu thereof The term 'preventive health services' means'^ 
and 
(2) by redesignating paragraphs (1), (2), (3), (4), (5), (6), 
(7), (8), (9), (10), and (11) as subparagraphs (A), (B), (C), (D), 
(E), (F), (G), (H), (I), (J), and (K), respectivelv. 
(b) CONFORMING AMENDMENT.—Section 1701(6XAXi) is amend-
ed by striking out "preventive health-care services as defined in 
section 1762 of this title," and inserting in lieu thereof "preventive 
healtii services,". 
SEC. 514. REPEAL OF PILOT PROGRABf. 
(a) REPEAL.—Subchapter VII ofchapter 17 is repealed. 
(b) CLERICAL AMENDMENT.—^The table of sections at the beg^-
ning of chapter 17 is amended by striking out the items relating 
to subchapter VII (including the items relating to the sections 
of that subchapter). 
Subtitle C—^Health Care Administration 
and Personnel 
SEC. sai. GERIATRIC 
RESEARCH, 
EDUCATION, 
AND CLINICAL 
CENTERS. 
Section 7314 is amended— 
(1) in subsection (c), by inserting after 'Hmless" in the 
matter preceding paragraph (1) the following: '*ih.e peer review 
panel established under subsection (d) has determined under 
T 
that subsection that tiie proposal submitted by such fadlily 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4959 
as a location for a new center under subsection (a) is among 
those proposals which have met the highest competitive stand-
ards of scientific and clinical merit, and ; 
(2) by redesignating subsections (d), (e), and (f) as sub-
sections (e), (f), and (g), respectively; and 
(3) by inserting a ^ r subsection (c) the following new sub-
section (d): 
"(dXl) In order to pi*ovide advice to assist the Chief Medical 
Director and the Secretary to carry out their responsibilities under 
this section, the Assistant Chief Medical Director described in sec-
tion 7306(bX3) of this title shall establish a panel to assess the 
scientific and clinical merit of proposals that are submitted to 
the Secretary for the establishment of new centers under this 
section. 
"(2) The membership of the panel shsdl consist of experts in 
the fields of geriatric and gerontological research, education, and 
clinical care. Members of the panel shall serve as consultants to 
the Department for a period of no longer than six months. 
"(3) The panel shall review each proposal submitted to the 
panel by the Assistant Chief Medical Director and shall submit 
its views on the relative scientific and clinical merit of each such 
proposal to the Assistant Chief Medical Director. 
"(4) The panel shall not be subject to the Federal Advisory 
Committee Act.". 
SEC. 522. EXTENSION OF AUTHORITY TO WAIVE CERTAIN LIMITA-
TIONS APPUCABLE TO RECEIPT OF RETIREMENT PAY BY 
NURSES. 
Section 7426(c) is amended by striking out ''September 30, 
1992" and inserting in lieu thereof "December 31,1994". 
SEC. 523. HEALTH PROFESSIONALS EDUCATION PROGRAMS. 
(a) EXTENSION OF HEALTH SCHOLARSHIP PROGRAM.—Section 
7618 is amended by striking out "September 30,1992" and inserting 
in lieu thereof "December 31,1995". 
(b) HEALTH PROFESSIONALS.—Notwithstanding any other provi- 38 use 760i 
sion of law, the Secretary of Veterans Affairs may not provide '
^
°
*
®
-
payments to health-care professional emoloyees of the Department 
of Veterans Affairs for payment of tuition loans. 
SEC. 524. REAL PROPERTY AT TEMPLE JUNIOR COLLEGE, TEMPLE, 
TEXAS. 
(a) REMOVAL OF RESTRICTIONS ON USE OF PREVIOUSLY CON-
VEYED LAND.— Subject to subsection (b), the Secretary of Veterans 
Affairs shall release all restrictions and conditions (including a 
right of reverter) imposed in a quitclaim deed executed by the 
Administrator of Vetersms Affedrs on March 8, 1968, pursuant to 
Public Law 90-197 (81 Stat. 582; December 14, 1967), in which 
the United States, acting through the Administrator of Veterans 
Affairs, conveyed a tract of land consisting of 73 acres, more or 
less, to Temple Junior College, Temple, Texas. 
(b) REQUIREMENT F
O
R PAYMENT.—Subsection (a) shall be effec-
tive upon the pajrment to the Secretary of Veterans Affairs of 
such monetary consideration as the Secretary determines to be 
appropriate. Any amount received by the Secretary pursuant to 
this subsection shall Ibe deposited in the general fund of the 
Treasury. 
106 STAT. 4960 
PUBLIC LAW 102-585—NOV. 4, 1992 
(c) EXECUTION OF LEGAL INSTRUMENTS.—The Secretary of Vet-
erans Affairs shall execute such legal documents as necessary to 
carry out subsection (a). The Secretary may include in such legal 
documents such terms, conditions, reservations, easements, and 
restrictions (other than those released pursuant to subsection (a)) 
as the Secretary considers necessary to protect the interest of 
the United States. 
'38 use 1710 
SEC. 525. DEMONSTRATION PROJECT TO EVALUATE INSTALLATION 
note. 
OF TELEPHONES FOR PATIENT USE AT DEPARTMENT 
HEALTH-CARE FACILITIES. 
(a) DEMONSTRATION PROJECT.—The Secretary of Veterans 
Affairs shall carry out a demonstration project to evaluate— 
(1) the feasibility and desirability of (A) providing telephone 
service in patient rooms in Department of Veterans Affairs 
health-care facilities which do not currently provide such serv-
ice, and (B) the use of telephones by the patients of such 
health-care facilities; and 
(2) the relative feasibility and cost-effectiveness of a variety 
of options for providing such service. 
(b) PROJECT ACTIVITIES.—(1) In carrying out the demonstration 
project under this section, the Secretary shsill, at an appropriate 
number (as determined by the Secretary) of health care facilities, 
provide patients reasonable access to telephone service in patients' 
rooms to the extent feasible, and subject to paragraph (2). 
(2) The Secretary shall ensure that patients who use such 
telephones bear financial responsibility for the cost of any long-
distance telephone calls made during such use. 
(c) PROJECT EVALUATION.—In carrying out the evaluation under 
subsection (a), the Secretary shall determine— 
(1) the cost of the installation, use, and maintenance of 
such telephones, including— 
(A) the amount of any savings which accrue to the 
facility by reason of such installation £uid use (including 
the amount of euiy savings that may result from any 
decrease in the amount of assistance in using telephones 
that the staff of the facility would otherwise provide to 
patients); and 
(B) any costs that result from providing special tele-
phones or other special equipment to facilitate the use 
of telephones by disabled veterans; and 
(2) the effect of the use of such telephones on the thera-
peutic course of veterans who receive care at the facility; and 
(3) the relative feasibility and cost effectiveness of a range 
of options for providing access to telephone service, including— 
(A) the expenditure of appropriated funds; 
(B) the receipt of donated funds, equipment, and serv-
ices; and 
(C) the procuring of equipment and services by the 
Veterans Csinteen Service. 
(d) REPORT.—Not later than September 30, 1994, the Secretary 
shall submit to the Committees on Veterans' Affairs of the Senate 
and the House of Representatives a report on the demonstration 
project. The report shall contain the following: 
(1) The determinations of the Secretary under sub-
section (c). 
PUBLIC LAW 102-585—NOV. 4,1992 
106 STAT. 4961 
(2) An assessment by the Secretary of the feasibility and 
desirability of providing telephones for patients in other health-
care facilities of 
the Department. 
(3) The experience of ihe Secretary in using, and an assess-
ment by the Secretaiy of the feasibility and cost effectiveness 
of, alternative arrangements to the expenditure of appropriated 
fimds for securing telephone service for patients ui health-
care facilities of the Department. 
(4) Any additional information and recommendations with 
respect to the provision and use of patient telephones at Depart-
ment health-care facilities as the Secretary considers 
appropriate. 
SEC. Sae. USE OF TOBACCO PRODUCTS IN DEPARTMENT FACILITIE& 38 use 1715 
(a) IN GENERAL.—^The Secretary of Veterans Affairs shall take 
appropriate actions to ensure that, consistent with medic&l require-
ments and limitations, each facility of the Department described 
in subsection (b)— 
(1) establishes and maintains— 
(A) a suitable indoor area in which patients or residents 
may smoke and which is ventilated in a manner that, 
to the maximum extent feasible, prevents smoke firom 
entering other aiecus of the facility; or 
(B) an area in a building that—• 
(i) is detached from the facility; 
(ii) is accessible to patients or residents of the 
facility; and 
(iii) has appropriate heating and air conditioning; 
and 
(2) provides accciss to an area established and maintained 
under paragraph (1), consistent with medical requirements and 
limitations, for patients or residents of the facility who are 
receiving care or services and who desire to smoke tobacco 
products. 
(b) COVERED FACIUTIES.—^A Department facility referred to 
in subsection (a) is any Department of Veterans Affairs medical 
center, nursing home, or domiciliary care facility. 
(c) REPORTS.—(1) Not later than 180 days after the date of 
the enactment of this Act, the Comptroller General shall submit 
to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report on the feasibility of the establishment 
and maintenance of areas for smoking in Department facilities 
under this section. The report shall include information on— 
(A) the cost of, and a proposed schedule for, the establish-
ment of such an area at each Department facility covered 
by this section; 
(B) the extent to which the ventilating system of each 
facility is adequate to ensure that use of the area for smoking 
does not result in health problems for other patients or resi-
dents of the facility; and 
(C) the effect of the establishment and maintenance of 
an area for smoking in each facility on the accreditation score 
issued for the facility by the Joint Commission on the Accredita-
tion of Health Organizations. 
(2) Not later than 120 days after the effective date of this 
section, the Secretary shall submit to the committees referred to 
in paragraph (1) a report on the implementation of this section. 
106 STAT. 4962 
PUBLIC LAW 102-585—NOV. 4, 1992 
The report shall include a description of the actions taken at each 
covered facility to ensure compliance with this section. 
(d) EFFECTIVE DATE.—^The requirement to establish and main-
tain areas for smoking imder subsection (a) shall take effect 60 
days after the date on which the Comptroller General submits 
to the committees referred to in subsection (cXD that report 
required imder that subsection. 
TITLE VI—DRUG PRICING AGREEMENTS 
SEC. 601. TREATMENT OF PRESCRIPTION DRUGS PROCURED BY 
DEPARTMENT OF VETERANS AFFAIRS OR PURCHASED BY 
CERTAIN CLINICS AND HOSPITALS. 
(a) EXCLUSION OF PRICES FROM CALCULATION OF BEST PRICES 
FOR MEDICAID REBATE AGREEMENTS.—Section 1927(cXlXC) of the 
Social Security Act (42 U.S.C. 1396r-8(cXlXC)) is amended by 
striking "(excluding" and inserting "(excluding any prices charged 
on or after October 1, 1992, to the Indian Health Service, the 
Department of Veterans Affairs, a State home receiving funds under 
section 1741 of title 38, United States Code, the Department of 
Defense, the Public Health Service, or a covered entity described 
in subsection (a)(5XB), any prices charged under the Federal Sui)ply 
Schedule of the (Jeneral Services Administration, or any prices 
used under a State pharmaceutical assistance program, and 
excluding". 
(b) AGREEMENTS REQUIRED To RECEIVE PAYMENT.— 
(1) IN GENERAL.—The first sentence of section 1927(aXl) 
of such Act (42 U.S.C. 1396r-8(aXl)) is amended by striking 
"manufacturer)." and inserting "manufacturer), and must meet 
the requirements of paragraph (5) (with respect to drugs pur-
chased by a covered entity on or after the first day of the 
first month that begins after the date of the enactment of 
title VI of the Veterans Health Care Act of 1992) and paragraph 
(6).". 
(2) AGREEMENTS DESCRIBED.—Section 1927(a) of such Act 
(42 U.S.C. 1396r-8(a)) is amended by adding at the end the 
following new paragraphs: 
"(5) LIMITATION ON PRICES OF DRUGS PURCHASED BY COV-
ERED ENTITIES.— 
"(A) AGREEMENT WITH SECRETARY.—A manufacturer 
meets the requirements of this paragraph if the manufac-
turer has entered into an agreement with the Secretary 
that meets the requirements of section 340B of the Public 
Health Service Act with respect to covered outpatient drugs 
purchased by a covered entity on or after the first day 
of the first month that begins after the date of the enact-
ment of this paragraph. 
"(B) COVERED ENTITY DEFINED.—In this subsection, the 
term 'covered entity* means an entity described in section 
340B(aX4) of the Public Health Service Act. 
"(C) ESTABLISHMENT OF ALTERNATIVE MECHANISM TO 
ENSURE AGAINST DUPLICATE DISCOUNTS OR REBATES.—If the 
Secretary does not establish a mechanism under section 
340B(aX5XA) of the Public Health Service Act within 12 
months of the date of the enactment of such section, the 
following requirements shall apply: 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4963 
"(i) ENTITIES.—^Each covered entity shall inform 
the single State agency under section 1902(aX5) when 
it is seeking reimbursement from the State plan for 
medical assistance described in section 1905(aX12) 
with respect to a unit of any covered outpatient drug 
which is subject to an agreement under section 340B(a) 
of such Act. 
"(ii) STATE AGENCY.—Each such single State 
agency shall provide a means by which a covered entity 
shall mdicatci on any drug reimbursement claims form 
(or format, where electronic claims management is 
used) that a unit of the drug that is the subject of 
the form is subject to an agreement under section 
340B of such Act, and not submit to any manufacturer 
a cl€dm for a rebate payment under subsection (b) 
with respect to such a drug. 
"(D) EFFECT OF SUBSEQUENT AMENDMENTS.—In deter-
mining whether an agreement under subpeiragraph (A) 
meets the requirements of section 340B of the Public 
Health Service Act, the Secretary shall not take into 
account any amendnients to such section that are enacted 
after the enactment of title VI of the Veterans Health 
Care Act of 1992. 
"(E) DETERMINATION OF COMPLIANCE.—A manufacturer 
is deemed to meet the requirements of this paragraph 
if the manufacturer establishes to the satisfaction of the 
Secretary that the manvifacturer would comply (and has 
offered to comply) with the provisions of section 340B of 
the Public Health Service Act (as in effect inmiediately 
after the enactment of this paragraph) and would have 
entered into an agreement imder such section (as such 
section was in effect at such time), but for a legislative 
change in such section after the date of the enactment 
of this paragraph. 
"(6) REQUIREMENTS RELATING TO MASTER AGREEMENTS FOR 
DRUGS PROCURED BY DEPARTMENT OF VETERANS AFFAIRS AND 
CERTAIN 
OTHER 
FEDERAL 
AGENCIES.— 
"(A) IN G
E
N
E
R
A
L
.
—
A manufacturer meets the require-
ments of this paragraph if the manufacturer complies with 
the provisions of section 8126 of title 38, United Stetes 
Code, including the requirement of entering into a master 
agreement wiui the Secretary of Veterans Affairs under 
such section. 
**(B) EFFECT OP SUBSEQUENT AMENDMENTS.—^In deter-
mining whether a master agreement described in subpara-
graph (A) meeti} the requirements of section 8126 of title 
38, United States Code, the Secretary shall not take into 
account any amendments to such section that are enacted 
after the enactment of title VI of the Veterans Health 
Care Act of 1992. 
"(C) DETERMINATION OF COMPLIANCE.—A manufacturer 
is deemed to meet the requiremente of this paragraph 
if the manufactiirer estoblishes to the satisfaction of the 
Secretary that the manufacturer would comply (and has 
offered to comply) with the provisions of section 8126 of 
title 38, United Stetes Code (as in effect immediately after 
the enactment of this paragraph) and would have entered 
106 STAT. 4964 
PUBLIC LAW 102-585—NOV. 4, 1992 
into an agreement under such section (as such section 
was in effect at such time), but for a legislative change 
in such section after the date of the enactment of this 
paragraph.". 
(3) 
CoNFiDENTiALnY 
OF 
INFORMATION.—Section 
1927(bX3XD) of such Act (42 U.S.C. 1396r-8(bX3XD)) is 
amended— 
(A) by striking "this paragraph" and inserting "this 
paragraph or under an agreement with the Secretary of 
Veterans Affairs described in subsection (aX6XAXiir; 
(B) by striking "Secretary" each place it appears and 
inserting "Secretary or the Secretary of Veterans Affairs"; 
and 
(C) by striking "except" and all that follows through 
the period and inserting: "except— 
"(i) as the Secretary determines to be necessary 
to carry out this section, 
"(ii) to permit the Comptroller (jreneral to review 
the information provided, and 
"(iii) to permit the Director of the Congressional 
Budget Office to review the information provided.". 
(4) 
TERMINATION 
OF 
REBATE 
AGREEMENTS.—Section 
1927(bX4XB) of such Act (42 U.S.C. 1396r-8(bX4XB)) is 
amended— 
(i) in clause (ii), by striking "such period" sind inserting 
"the calendar quarter beginning at least 60 days", 
(ii) in clause (ii), by striking "of the notice" and all 
through "the agreement)." and inserting "the manufacturer 
provides notice to the Secretary.", and 
(iii) by adding at the end the following new clauses: 
"(iv) NOTICE TO STATES.—^In the case of a termi-
nation tmder this subparagraph, the Secretary shall 
provide notice of such termination to the States within 
not less than 30 days before the effective date of such 
termination. 
"(v) 
APPLICATION TO TERMINATIONS OF OTHER 
AGREEMENTS.—^The provisions of this subparagraph 
shall apply to the terminations of agreements described 
in section 340B(aXl) of the Public Health Service Act 
£md master agreements described in section 8126(a) 
of title 38, United States Code.". 
(c) BUDGET NEUTRALITY ADJUSTMENT.—Section 1927(cXlXB) of 
the Social Security Act (42 U.S.C. 1396r-8(cXlXB)) is amended— 
(1) by striking "January 1, 1993," and inserting "October 
1,1992,"; 
(2) by striking "and" at the end of clause (i); and 
(3) by striking clause (ii) and inserting the following: 
"(ii) for quarters (or other periods) beginning after 
September 30, 1992, and before January 1, 1994, the 
greater o
f
— 
"(I) 15.7 percent of the average manufacturer price 
for the drug, or 
"(II) the difference between the average manufac-
turer price for the drug and the best price (as defined 
in subparagraph (O) for such quarter (or period) for 
such drug; 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4965 
"(iii) for quarters (or other periods) beginning after 
December 31,1993, and before January 1,1995, the greater 
of— 
"(I) 15.4 percent of the average manufacturer price 
for the drug, or 
"(II) the difference between the average manufac-
turer price for the drug and the best price (as defined 
in subparagraph (C)) for such quarter (or period) for 
such drug; 
"(iv) for quarters (or other periods) beginning after 
December 31,1994, and before January 1,1996, the greater 
of— 
"(I) 15.2 percent of the average manufacturer price 
for the drug, or 
"(II) the difference between the average manufac-
turer price for the drug and the best price (as defined 
in subparagraph (C)) for such quarter (or period) for 
such drug; and 
"(v) for quarters (or other periods) beginning after 
December 31,1995, the greater of— 
"(I) 15.1 percent of the average manufacturer price 
for the drug, or 
"(II) the difference between the average manufac-
turer price for the drug and the best price (as defined 
in subparagraph (O) for such quarter (or period) for 
such drug.". 
; 
(d) 
REPORTS ON BEST PRICE CHANGES AND PAYMENT OF 42 use i396r-8 
REBATES.— 
^°^-
(1) IN GENERAL.—^Not later than 90 days after the expira-
tion of each calendar quarter that begins on or after October 
1,1992, and ends on or before December 31,1995, the Secretary 
of Health and Human Services shall submit a report to Con-
gress that contains the following information relating to 
prescription drugs dispensed in the quarter (subject to para-
graph (2)): 
(A) With respect to single source drugs and innovator 
multiple source drugs (as such terms are defined in section 
1927(kX7) of the Social Security Act)— 
(i) the percentage of such drugs whose best price 
(as reported to the Secretary under section 1927(b) 
of the Social Secxuity Act) increased compared to the 
best price during the previous calendar quarter, and 
the amount of expenditures under State plans imder 
title XIX of such Act attributable to such drugs; 
(ii) the percentage of such drugs whose best price 
(as so reported) decreased compared to the best price 
during the previous calendar quarter, and the amount 
of expenditures under State plans under title XIX of 
such Act attributable to such drugs; 
(iii) the percentage of such drugs whose best price 
(as so reported) was the same as the best price during 
the previous calendar quarter, and the amount of 
expenditures imder State plans under title XIX of such 
Act attributable to such drugs; 
(iv) the median and mean percentage increase (or 
decrease) in the best price of such single source drugs 
(as so reported) compared to the best price during 
106 STAT. 4966 
PUBLIC LAW 102-585—NOV. 4, 1992 
the previous calendar quarter, unweighted and 
weighted (in the case of the mean percentage increase 
or decrease) by the dollar volume of drugs dispensed; 
(v) the median and mean percentage increase (or 
decrease) in the best price of such innovator multiple 
source drugs (as so reported) compared to the best 
price during the previous calendar quarter, unweighted 
and weighted (in the case of the mean percentage 
increase or decrease) by the dollar volume of drugs 
dispensed; and 
(vi) the median and mean percentage increase (or 
decrease) in the best price of all such drugs (as so 
reported) compared to the best price during the pre-
vious calendar quarter, unweighted and weighted (in 
the case of the mean percentage increase or decrease) 
by the dollar volume of drugs dispensed. 
(B) With respect to all drugs for which mcinufacturers 
are required to pay rebates under section 1927(c) of the 
Social Security Act, the Secretary's estimate, on a State-
by-State and a national aggregate basis, o
f
— 
(i) the total amount of all rebates paid under such 
section diiring the quarter, broken down by the por-
tions of such total amount attributable to rebates 
described in paragraphs (1), (2), and (3) of such section; 
(ii) the percentages of such total amount attrib-
utable to rebates described in paragraphs (1), (2), and 
(3) of such section; and 
(iii) the amount of the portion of such total amount 
attributable to the rebate described in paragraph (1) 
of such section that is solely attributable to the applica-
tion of subclause (II) of clause (i), (ii), (iii), (iv), or 
(v) of such paragraph. 
(2) LIMITATION ON DRUGS SUBJECT TO REPORT.—NO report 
submitted imder paragraph (1) shall include any information 
relating to any prescription drug unless the Secretary finds 
that expenditures for the drug are significant expenditures 
under the medicaid program. In the previous sentence, expendi-
tures for a drug are "significant" if the drug was one of the 
1,000 drugs for which the greatest amount of the Federal 
financial assistance attributable to prescription drugs was paid 
under section 1903(a) of the Social Security Act during calendar 
year 1991. 
(3) SPECIAL RULE FOR INITIAL REPORT.—For purposes of 
the first report required to be submitted under paragraph (1)— 
(A) the Secretary shall submit the report not later 
than May 1,1993; and 
(B) the information contained in the report shall 
include information on prescription drugs dispensed during 
each calendar quarter that began on or after January 1, 
1991, and ended on or before December 31,1992. 
42 use l396r-8 
(e) EFFECTIVE DATE.—^The amendments made by this section 
"°*®' 
shall apply with respect to payments to State plans imder title 
XIX of the Social Security Act for calendar quarters (or periods) 
beginning on or after January 1, 1993 (without regard to whether 
or not regulations to carry out such amendments have been promul-
gated by such date). 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4967 
SEC. 602. LIMITATIONS ON PRICES OF DRUGS PURCHASED BY CER-
TAIN CLINICS AND HOSPITALS. 
(a) IN GENERAL.—Part D of title III of the Public Health Service 
Act is amended by adding the following subpart: 
"Subpart VII—^Drug Pricing Agreements 
"LIMITATION ON PRICES OF DRUGS PURCHASED BY COVERED ENTmES 
"SEC 
340B. (a) 
REQUIREMENTS FOR AGREEMENT WITH 42 use 256b. 
SECRETARY.— 
"(1) IN GENERAL.—^The Secretary shall enter into an agree-
ment with each manufacturer of covered drugs under whidi 
the amount required to be paid (taking into account any rebate 
or discount, as provided by the Secretory) to the manmacturer 
for covered drugs (other than drugs described in paragraph 
(3)) purchased by a covered entity on or after the first day 
of the first month that begins after the date of the enactment 
of this section, does not exceed an amount equal to the average 
manufacturer price for the drug under title XIX of the Social 
Security Act in the preceding calendar quarter, reduced by 
the rebate percentoge described in paragrapn (2). 
"(2) REBATE PERCENTAGE DEFINED.— 
"(A) IN GENERAL.—^For a covered outpatient drug pur-
chased in a calendar quarter, the 'rebate percentoge' is 
the amount (expressed as a percentoge) ec^ual t o ^ 
"(i) tiie average total rebate reqmred under section 
1927(c) of the Social Security Act with respect to the 
drug (for a unit of the dosage form and strength 
involved) during the preceding calendar quarter; 
divided by 
"(ii) the average manufacturer price for such a 
unit of the diug during such quarter. 
"(B) OVER THE COUNTER DRUGS.— 
"(i) IN GENERAL.—^For purposes of subparagraph 
(A), in the case of over the counter drugs, uie 'rebate 
percentage' shall be determined as u the rebate 
required under section 1927(c) of the Social Security 
Act is based on the applicable percentoge provided 
under section 1927(cX4) of such Act. 
"(ii) DEFINITION.—^The term 'over the counter drug' 
means a drug that may be sold without a prescription 
and which is prescribeid by a physician (or other per-
sons authorized to prescribe such drug under Stote 
law). 
"(3) DRUGS PROVIDED UNDER STATE MEDICAID PLANS.— 
Drugs described in this paragraph are drugs purchased by 
the entity for which payment is made by the Stote under 
the Stote plan for medical assistance under title XIX of the 
Social Security Act. 
"(4) COVERED ENTITY DEFINED.—^In this section, the term 
'covered entity* means an entity that meete the requiremento 
described in pars^aph (5) and is one of the following: 
"(A) A Federally-qualified health center (as defined 
in section 1905aX2XB) of the Social Security Act). 
"(B) An entity receiving a grant imder section 340A 
106 STAT. 4968 
PUBLIC LAW 102-585—NOV. 4, 1992 
"(C) A family planning project receiving a grant or 
contract under section 1001. 
,. 
, 
"(D) An entity receiving a grant under subpart II of 
part C of title XXVI (relating to categorical grants for 
outpatient early intervention services for HIV disease). 
"(E) A State-operated AIDS drug purchasing assistance 
program receiving financial assistance under title XXVI. 
"(F) A black Tung clinic receiving funds under section 
427(a) of the Black Lung Benefits Act. 
"(G) A comprehensive hemophilia diagnostic treatment 
center receiving a grant imder section 501(a)(2) of the 
Social Security Act. 
"(H) A Native Hawaiian Health Center receiving funds 
imder the Native Hawaiian Health Care Act of 1988. 
"(I) An urban Indian organization receiving funds 
under title V of the Indian Health Care Improvement Act. 
"(J) Any entity receiving assistance imder title XXVI 
(other than a State or unit of local government or an 
- 
entity described in subparagraph (D)), but only if the entity 
is certified by the Secretary pursuant to i)aragraph (7). 
"(K) An entity receiving funds under section 318 (relat-
ing to treatment of sexually transmitted diseases) or section 
317(iX2) (relating to treatment of tuberculosis) through 
a State or unit of local government, but only if the entity 
is certified by the Secretary pursuant to para^aph (7). 
"(L) A subsection (d) hospital (as defined m section 
1886(dXlXB) of the Social Security Act) that— 
"(i) is owned or operated by a imit of State or 
local government, is a public or private non-profit cor-
poration which is formally granted governmental pow-
ers by a unit of State or local government, or is a 
private non-profit hospital which nas a contract with 
a State or local government to provide health care 
services to low income individuals who are not entitled 
to benefits under title XVIII of the Social Security 
Act or eligible for assistance under the State plan 
under this title; 
"(ii) for the most recent cost reporting period that 
ended before the calendar quarter involved, had a dis-
proportionate share adjustment percentage (as deter-
mined under section 1886(dX5)(F) of the Social Security 
Act) greater than 11.75 percent or was described in 
section 1886(dX5XFXiXII) of such Act; and 
"(iii) does not obtain covered outpatient drugs 
through a group purchasing organization or other 
group purchasing arrangement. 
"(5) REQUIREMENTS FOR COVERED ENTITIES.— 
"(A) PROHIBITING DUPLICATE DISCOUNTS OR REBATES.— 
"(i) IN GENERAL.—^A covered entity shall not 
V 
.
^ 
request payment imder title XIX of the Social Security 
Act for medical assistance described in 
section 
1905(aX12) of such Act with respect to a drug that 
is subject to an agreement under this section if the 
drug is subject to the payment of a rebate to the 
State under section 1927 of such Act. 
"(ii) ESTABLISHMENT OF MECHANISM.—The Sec-
retary shall establish a mechanism to ensure that cov-
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4969 
ered entities comply with clause (i). If the Secretary 
does not establish a mechanism within 12 months 
under the previous sentence, the requirements of sec-
tion 1927(aX5XC) of the Social Security Act shall apply. 
"(B) PROHmrriNG RESALE OF DRUGS.—With respect to 
any covered outpatient drug that is subject to an agreement 
under this subsection, a covered entity shall not resell 
or otherwise transfer the drug to a person who is not 
a patient of the entity. 
**(C) AUDITING.—^A covered entity shall permit the Sec-
retary and the manufacturer of a covered outpatient drug 
that 18 subject to an agreement under this subsection with 
the entity (acting in accordance with procedures established 
by the Secretary relating to the number, duration, and 
scope of audits) to audit at the Secretary's or the manufac-
turer's expense the records of the entity that directly per-
tain to the entity's compliance with the requirements 
described in subparagraphs (A) or (B) with respect to drugs 
of the manufacturer. 
"(D) ADDITIONAL SANCJTION FOR NONCOMPLIANCE.—If 
the Secretary finds, after notice and hearing, that a covered 
entitv is in violation of a requirement described in subpara-
grapns (A) or (B), the covered entity shall be liable to 
the manufacturer of the covered outpatient drug that is 
the subject of the violation in an amount equsd to the 
reduction in the price of the drug (as described in subpara-
graph (A)) provided under the agreement between the 
entity and the manufacturer under this paragraph. 
"(6) TREATMENT OF DISTINCT UNITS OF HOSPITALS.—In the 
case of a covered entity that is a distinct part of a hospital, 
the hospital shall not be considered a covered entity under 
this paragraph unless the hospital is otherwise a covered entity 
under this subsection. 
"(7) CERTIFICATION OF CERTAIN COVERED ENTITIES.— 
"(A) DEVELOPMENT OF PROCESS.—^Not later than 60 
days after the date of enactment of this subsection, the 
Secretary shall develop and implement a process for the 
certification of entities described in subparagraphs (J) and 
(10 of paragraph (4). 
"(B) INCLUSION OF PURCHASE INFORMATION.—The proc-
ess developed under subparagraph (A) shall include a 
requirement that an entity applying for certification under 
this paragraph submit information to the Secretary 
concerning the amount such entity expended for covered 
outpatient dru^ in the preceding year so as to assist 
the Secretary m evaluating the validity of the entity's 
subsequent purchases of covered outpatient drugs at cUs-
counted prices. 
"(C) CRITERIA.—The Secretary shall make available 
to all manufacturers of covered outpatient drugs a descrip-
tion of the criteria for certification under this paragrapn. 
"(D) LIST OF PURCHASERS AND DISPENSERS.—The certifi-
cation process developed by the Secretary under subpara-
graph (A) shall iinclude procedures imder which each State 
shall, not later than 30 days afi^er the submission of the 
descriptions imder subparagraph (C), prepare and submit 
a report to the Secretary tnat contains a list of entities 
106 STAT. 4970 
PUBLIC LAW 102-585—NOV. 4, 1992 
described in subparagraphs (J) and (K) of paragraph (4) 
that are located in the State. 
**(E) RECERTIFICATION.—The Secretary shall require 
the recertification of entities certified pursuant to this para-
graph on a not more frequent than annual basis, and 
shall require that such entities submit information to the 
Secretary to permit the Secretary to evaluate the vsdidity 
of subsequent purchases by such entities in the same man-
ner as that required under subparagraph (B). 
"(8) DEVELOPMENT OF PRIME VENDOR PROGRAM.—The Sec-
retary shall establish a prime vendor program imder which 
covered entities may enter into contracts with prime vendors 
for the distribution of covered outpatient drugs. If a covered 
entity obtains drugs directly from a manufacturer, the manufac-
turer shall be responsible for the costs of distribution. 
"(9) NOTICE TO MANUFACTURERS.—The Secretary shall 
notify manufacturers of covered outpatient drugs and single 
State agencies imder section 1902(aX5) of the Social Security 
Act of me identities of covered entities under this paragraph, 
and of entities that no longer meet the requirements of para-
graph (5) or that are no longer certified pursuant to paragraph 
(7). 
"(10) N o PROHIBITION ON LARGER DISCOUNT.—Nothing in 
this subsection shall prohibit a manufacturer from charging 
a price for a drug that is lower than the maximum price 
that may be charged under paragraph (1). 
"(b) OTHER DEFINITIONS.—In this section, the terms 'average 
manufacturer price*, 'covered outpatient drug*, and 'manufacturer^ 
have the meaning given such terms in section 1927(k) of the Social 
Security Act. 
"(c) REFERENCES TO SOCIAL SECURITY ACT.—Any reference in 
this section to a provision of the Social Security Act shall be deemed 
to be a reference to the provision as in effect on the date of 
the enactment of this section. 
"(d) COMPLIANCE WITH REQUIREMENTS.—A manufacturer is 
deemed to meet the requirements of subsection (a) if the 
manufacturer establishes to the satisfaction of the Secretary that 
the manufacturer would comply (and has offered to comply) with 
the provisions of this section (as in effect immediately after the 
enactment of the Veterans Health Care Act of 1992), as applied 
by the Secretary, and would have entered into an agreement under 
this section (as such section was in effect at such time), but for 
a legislative change in this section (or the application of this section) 
after the date of the enactment of such Act.". 
42 use 256b 
(b) STUDY OF TREATMENT OF CERTAIN CLINICS AS COVERED 
^o^- 
ENTITIES ELIGIBLE FOR PRESCRIPTION DRUG DISCOUNTS.— 
(1) STUDY.—^The Secretary of Health and Human Services 
shall conduct a study of the feasibility and desirability of includ-
ing entities described in paragraph (3) as covered entities 
eligible for limitations on the prices of covered outpatient drugs 
under section 340B(a) of the Public Health Service Act (as 
added by subsection (a)). 
(2) REPORT.—Not later than 1 year after the date of the 
enactment of this Act, the Secretary shall submit a report 
to Congress on the study conducted under paragraph (1), and 
shall include in the report— 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4971 
(A) a description of the entities that are the subject 
of the study; 
(B) an analysis of the extent to which such entities 
procure prescription drugs; and 
(C) an analysis of the impact of the inclusion of such 
entities as covered entities under section 340B(a) of the 
Public Health Se:rvice Act on the qiudity of care provided 
to and the health status of the patients of such entities. 
(3) ENTITIES DESC;RIBED.—^An entity described in this para-
graph is an entity— 
(A) receiving funds from a State for the provision of 
mental health or substance abuse treatment services under 
subparts I or II of part B of title XIX of the Public Health 
Service Act or under title V of such Act; or 
(B) receiving funds from a State under title V of the 
Social Security Act for the provision of maternal and child 
health services that are furnished on an outpatient basis 
(other than an entity described in section 340B(aX4XG) 
of the Public Health Service Act). 
SEC. 603. LIMITATION ON PRICES OF DRUGS PROCURED BY DEPART-
MENT OF VETERANS AFFAIRS AND CERTAIN OTHER FED-
ERAL AGENCIES. 
(a) AGREEMENTS WITH SECRETARY OF VETERANS AFFAIRS.— 
(1) Subchapter II of chapter 81 is amended by adding at the end 
the following new section: 
^§8126. Limitation on prices of drugs procured by Depart-
ment and certain other Federal agencies 
''(a) Each manufacturer of covered drugs shall enter into a 
master agreement with the Secretary imder which— 
"(1) beginning January 1, 1993, the manufacturer shall 
make available for procurement on the Federal Supply Schedule 
of the Greneral Services Administration each covered drug of 
the manufacturer; 
"(2) with respect to each covered drug of the manufacturer 
procured by a Federal agency described in subsection (b) on 
or after January 1, 1993, that is purchased under depot 
contracting systems or listed on the Federal Supply Schedule, 
the manufacturer has entered into and has in effect a pharma-
ceutical pricing agreement with the Secretary (or the Federal 
agency involved, if the Secretary delegates to the Federal 
agency the authority to enter into such a pharmaceutical pricing 
agreement) under which the price charged during the one-
year period beginning on the date on which the agreement 
takes effect may not exceed 76 percent of the non-Federal 
average manufacturer price (less the amount of any additional 
discount required under subsection (c)) during the one-year 
period ending one month before such date (or, in the case 
of a covered drug for which sufficient data for determining 
the non-Federal average manufacturer price during such period 
are not available, during such period preceding such date as 
the Secretaiy considers appropriate), except that such price 
may nominally exceed such amount if found by the Secretary 
to be in the best interests of the Department or such Federal 
agencies; 
106 STAT. 4972 
PUBLIC LAW 102-585—NOV. 4, 1992 
"(3) with respect to each covered drug of the manufacturer 
procured by a State home receiving fundb under section 1741 
of this title, the price charged may not exceed the price charged 
under the Federal Supply Schedule at the time the drug is 
procured; and 
''(4) unless the mcmufacturer meets the requirements of 
paragraphs (1), (2), and (3), the manufacturer may not receive 
payment for the purchase of drugs or biologicals from— 
"(A) a State plan imder title XIX of the Social Securitv 
Act, except as authorized imder section 1927(aX3) of sucn 
Act, 
"(B) any Federal agency described in subsection (b), 
or 
"(C) any entity that receives funds imder the Public 
\ 
Health Service Act. 
"(h) The Federal agencies described in this subsection are as 
follows: 
"(1) The Department. 
"(2) The Department of Defense. 
"(3) The Public Health Service, including the Indian Health 
Service. 
"(c) With respect to any covered drug the price of which is 
determined in accordance with a pharmaceutical pricing agreement 
entered into pursuant to subsection (aX2), for calendar quarters 
beginning on or after January 1, 1993, the manufacturer shall 
provide a discount in an amoimt equal to the amount by which 
the change in non-Federal price exceeds the amount equal to— 
"(1) the non-Federal average manufacturer price of the 
drug during the 3-month period that ends one year before 
the last day of the month preceding the month during which 
the contract for the covered drug goes into effect (or, in the 
case of a covered drug for which sufficient data for determining 
the non-Federal average manufacturer price during such period 
is not available, during such period preceding the month auring 
which the contract goes into effect as the Secretary considers 
appropriate); increased by 
"(2) the percentage increase in the Consume^ Price Index 
for all urban consumers (U.S. city average) between the last 
month of the period described in paragraph (1) and the last 
month preceding the month during which the contract goes 
into effect for which Consumer Price Index data is available. 
"(d) In the case of a covered drug of a manufacturer that 
has entered into a multi-year contract with the Secretary under 
subsection (aX2) for the procurement of the drug— 
"(1) during any one-year period that follows the first year 
for which the contract is in effect, the price charged may 
not exceed the price charged during the preceding one-year 
period, increased by the percentage mcrease in the Consumer 
Price Index for all urbem consumers (U.S. city average) between 
the last months of such one-year periods for which Consumer 
Price Index data is avedlable; and 
"(2) in applying subsection (c) to determine the amoimt 
of the discount provided with respect to the drug diuing a 
year that follows the first year for which the contract is in 
effect, any reference in such subsection to 'the month during 
which the contract goes into effect' shall be considered a ref-
erence to the first month of such following year. 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4973 
**(eXl) The manufacturer of any covered drug the price of which Reports, 
is determined in accordance with a pharmaceutical pricing agree-
ment entered into pursuant to subsection (aX2) shall— 
"(A) not later than 30 days after the first day of the 
last quarter that begins before the agreement takes effect (or, 
in the case of an agreement that takes effect on January 
1, 1993, not later than 30 days after the date of the enactment 
of this section), report to the Secretary the non-Federal average 
manufacturer price for the drug during the 1-year period that 
ends on the last day of the previous quarter; and 
"(B) not later than 30 days after the last day of each 
quarter for which the agreement is in effect, report to the 
Secretary the non-Federal average manufacturer price for the 
drug during such quarter. 
''(2) The provisions of subparagraphs (B) and (C) of section 
1927(bX3) of the Social Security Act shall apply to drugs described 
in paragraph (1) and the Secretary in the same manner as such 
provisions apply to covered outpatient drugs and the Secretary 
of Health and Human S<3rvices under such subparagraphs, except 
that references in such subparagraphs to prices or information 
reported or required under 'subparagraph (A)' shall be deemed 
to refer to information reported under paragraph (1). 
"(3) In order to determine the accuracy of a drug price that 
is reported to the Secretary under paragraph (1), the Secretary 
may audit the relevant records of the manufacturer or of any 
wholesaler that distributes the drug, and may delegate the authority 
to audit such records to the appropriate Federal agency described 
in subsection (b). 
"(4) Any information conttdned in a report submitted to the Privacy. 
Secretaiy imder paragraph (1) or obtained by the Secretary through 
any audit conducted imder paragraph (3) shall remain confidential, 
except as the Secretary determines necessary to carry out this 
section and to permit the Comptroller General and the Director 
of the Congressional Budget OfiEice to review the information 
provided. 
**({) The Secretary shall supply to the Secretary of Health and 
Human Services— 
"(1) upon the execution or termination of any master agree-
ment, the name of the manufacturer, and 
"(2) on a quarterly basis, a list of manufacturers who 
have entered into master agreements under this section, and 
"(gXD Any reference in this section to a provision of the Social 
Security Act shcQl be deemed to be a reference to the provision 
as in effect on the date of the enactment of this section. 
''(2) A manufacturer is deemed to meet the requirements of 
subsection (a) if the manufacturer establishes to the satisfaction 
of the Secretary that the manufacturer would comply (and has 
offered to comply) with the provisions of this section (as in effect 
immediately after the enactment of this section), and would have 
entered into an agreement imder this section (as such section 
was in effect at such time), but for a legislative change in this 
section after the date of the enactment of this section. 
"(h) In this section: 
"(1) The term 'change in non-Federal price' means, with 
respect to a covered drug that is subject to an agreement 
under this section, an amount equal to— 
106 STAT. 4974 
PUBLIC LAW 102-585—NOV. 4, 1992 
"(A) the non-Federal average manufacturer price of 
the drug during the 3-month period that ends with the 
month preceding the month during which a contract goes 
into e£rect (or, in the case of a covered drug for which 
sufficient data for determining the non-Federal average 
manufacturer price during such period is not available, 
during such period as the Secretary considers appropriate); 
minus 
"(B) the non-Federal average manufacturer price of 
the drug during the 3-month period that ends one year 
before tihe end of the period described in subpsuragraph 
(A) (or, in the case of a covered drug for which sufficient 
data for determining the non-Federal average manufac-
turer price during such period is not available, during 
such period precec&ig the period described in subparagraph 
(A) as the Secretary considers appropriate). 
**(2) The term 'covered drug* means— 
"(A) a drug described in section 1927(kX7XAXii) of 
the Social Seciuity Act, or that would be described in 
such section but for the application of the first sentence 
of section 1927(kX3) of such Act; 
"(B) a drug described in section 1927(kX7XAXiv) of 
the Social Security Act, or that would be described in 
, 
such section but for the appUcation of the first sentence 
of section 1927(kX3) of such Act; 
"(C) any biological product identified under section 
600.3 of title 21, Code of Federal Regulations; or 
"(D) insulin certified under section 506 of the Federal 
/ 
Food, Drug, and Cosmetic Act. 
"(3) The term 'depot' means a centralized commodity 
management system through which covered drugs procured 
by an agency of the Federal Government are— 
"(A) received, stored, and deHvered through— 
"(i) a federally owned and operated warehouse sys-
tem, or 
"(ii) a commercial entity operating under contract 
with such agency; or 
"(B) delivered directly fix)m the commercial source to 
the entity using such covered drugs. 
"(4) The term 'manufacturer* means any entity which is 
engaged in— 
"(A) 
the 
production, 
preparation, 
propagation, 
compounding, conversion, or processing of prescription drug 
products, either directly or indirectly by extraction firom 
substances of natural origin, or independently by means 
of chemical synthesis, or by a combination of extraction 
and chemical synthesis, or 
"(B) in the packaging, repackaging, labeling, relabeling, 
or distribution of 
prescription drug products. 
Such term does not include a wholesale distributor of drugs 
or a retailpharmacy licensed under State law. 
"(5) Tiie term 'non-Federal average manufacturer price' 
means, wiUi respect to a covered drug and a period of time 
(as determined by the Secretary), the weighted average price 
of a single form and dosage unit of the drug that is paid 
by wholesalers in the United States to the manufacturer, taking 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4975 
into account any cash discounts or similar price reductions 
during that period, but not taking into account— 
"(A) any prices paid bv the Federal Government; or 
"(B) any prices round by the Secretary to be merely 
nominal in amount. 
"(6) The term Veighted average price' means, with respect 
to a covered drug and a period of time (as determined by 
the Secretary) an amount equal to— 
'*(A) the sum of the products of the average price per 
package unit of each quantiW of the drug sold dunng 
the period and the number of package units of the drug 
sold during the period; divided by 
"(B) the total number of package imits of the drug 
sold during the period.". 
(2) The table of sections at the beginning of such chapter 
is amended by inserting after the item relating to section 8125 
the following new item: 
"8126. limitation on prices of drugs procured by Department.". 
TITLE Vn—PERSIAN GULF WAR 
VETERANS' HEALTH STATUS 
SEC. 701. SHORT TITLB. 
This title may be cited as the Tersian Gulf War Veterans' 
Health Status Act. 
SEC. 702. PERSIAN G
U
L
F W
A
R V
E
T
E
R
A
N
S H
E
A
L
T
H REGISTRY. 
(a) E
S
T
A
B
U
S
H
M
E
N
T O
F REGISTRY.—The Secretary of Veterans 
Affairs shall establish and maintain a special record to be known 
as the "Persian Gulf War Veterans Healtn Registry'* (in this section 
referred to as the llegistry"). 
(b) CONTENTS OF REGISTRY.—^Except as provided in subsection 
(c), the Registry shall include Uie followmg imormation: 
(1) A Ust containing the name of each individual who 
served as a member of the Armed Forces in the Persian Gulf 
theater of operations during the Persian Gulf War and who— 
(A) applies for care or services from the Department 
of Veterans Affairs under chapter 17 of title 38, United 
States Code; 
(B) files a claim for compensation under chapter 11 
of such title on the basis of any disability which may 
be associated with such service; 
(C) dies and is survived by a spouse, child, or parent 
who files a claim for dependency and indemnity compensa-
tion under chapter 13 of such title on the basis of such 
service; 
(D) requests 
firom 
the Department a health examina-
tion under section 703; or 
(E) receives 
firom 
the Department of Defense a health 
examination similar to the health examination referred 
to in subparagraph (D) and requests inclusion in the 
Registry. 
(2) Relevant medical data relating to the health status 
of, and other informiation that the Secretary considers relevant 
and appropriate with respect to, each individual described in 
paragraph (1) who— 
Persian Gulf 
War Veterans' 
Health Status 
Act. 
38 use 527 
note. 
59-194 O—93 
14:QL3(Pt. S) 
106 STAT. 4976 
PUBLIC LAW 102-585—NOV. 4, 1992 
(A) grants to the Secretary permission to include such 
information in the Registry; or 
(B) at the time the individual is listed in the Registry, 
is deceased. 
(c) INDIVIDUALS SUBMITTING CLAIMS OR MAKING REQUESTS 
BEFORE DATE OF ENACTMENT.—^If in the case of an individual 
described in subsection (bXD the application, claim, or request 
referred to in such subsection was submitted, filed, or made, before 
the date of the enactment of this Act, the Secretary shall, to 
the extent feasible, include in the Registry such individual's name 
and the data and information, if any, described in subsection (bX2) 
relating to the individual. 
(d) DEPARTMENT OF DEFENSE INFORMATION.—The Secretary of 
Defense shall furnish to the Secretary of Veterans Affairs such 
information maintained by the Department of Defense as the Sec-
retary of Veterans Affairs considers necessary to establish and 
maintain the Registry. 
(e) RELATION TO DEPARTMENT OF DEFENSE REGISTRY.—The Sec-
retary of Veterans Affairs, in consultation with the Secretary of 
Defense, shall ensure that information is collected and maintained 
in the Registry in a manner that permits effective and efficient 
cross-reference between the Registry and the registry established 
under section 734 of the National Defense Authorization Act for 
Fiscal Years 1992 and 1993 (PubUc Law 102-190; 105 Stat. 1411; 
10 U.S.C. 1074 note), as amended by section 704. 
(f) ONGOING OUTREACH TO INDIVIDUALS LISTED IN REGISTRY.— 
The Secretary of Veterans Affairs shall, from time to time, notify 
individuals listed in the Registry of significant developments in 
research on the health consequences of military service in the 
Persian Gulf theater of operations during the Persian Gulf War. 
SEC. 708. HEALTH EXAMINATIONS AND COUNSELING FOR VETERANS 
E U G I B L E F O R INCLUSION I N CERTAIN HEALTH-RELATED 
REGISTRIES. 
(a) IN GENERAL.—(1) The Secretary of Veterans Affairs— 
(A) shall, upon the request of a veteran described in sub-
section (bXl), provide the veteran, with a health examination 
and consultation and counseling with respect to the results 
of the examination; and 
(B) may, upon the request of a veteran described in sub-
section (bX2), provide the veteran with such an examination 
and such consultation and counseling. 
(2) The Secretary shall carry out appropriate outreach activities 
with respect to the provision of any health examinations and con-
sultation and counsehng services under paragraph (1). 
(b) COVERED VETERANS.—(1) In accordance with subsection 
(aXlXA), the Secretary shall provide an examination, consultation, 
and counseling under that subsection to any veteran who is eligible 
for Usting or inclusion in the Persian G
u
U
" War Veterans Health 
Registry established by section 702. 
(2) In accordance with subsection (aXlXB), the Secretary may 
provide an examination, consultation, and counseling under that 
subsection to any veteran who is eligible for listing or inclusion 
in any other similar health-related registry administered by the 
Secretaxy. 
PUBLIC LAW 102-585—NOV. 4,1992 
106 STAT. 4977 
SEC. 704. EXPANSION OF COVERAGE OF PERSIAN GULF REGISTRY. 
(a) IN GENERAL.—Subsections (a) and (b) of section 734 of 
the National Defense Authorization Act for Fiscal Years 1992 and 
1993 (PubUc Law 102-190; 105 Stat. 1411; 10 U.S.C. 1074 note) 
are amended to read as follows: 
"(a) E
S
T
A
B
U
S
H
M
E
N
T O
F REGISTRY.—The Secretary of Defense 
shall establish and maintain a special record (in this section referred 
to as the 'Registry') relating to uie following members of the Armed 
Forces: 
"(1) Members who, as determined by the Secretary, were 
exposed to the fumes of burning oil in the Operation Desert 
Storm theater of operations during the Persian Gulf conflict. 
"(2) Any other members who served in the Operation Desert 
Storm theater of operations during the Persian Gulf conflict. 
*
*
(
b
) CONTENTS OF REGISTRY.—<1) The Registry shall include— 
"(A) with respect to each class of members referred to 
in each of paragraphs (1) and (2) of subsection (a)— 
"(i) a list containing each such member's name and 
other relevant identifying information with respect to the 
member; and 
"(ii) to the extent that data are available and inclusion 
of the data is feasible, a description of the circumstcuices 
of the member's service during the Persian Gulf conflict, 
including the locations in the Operation Desert Storm thea-
ter of operations in which such service occurred and the 
atmospheric and other environmental circumstances in 
such locations at the time of such service; and 
"(B) with respect to the members referred to in subsection 
(aXD, a description of the circumstances of each exposure of 
each such member to the fumes of burning oil as described 
in such subsection (aXl), including the length of time of the 
exposure. 
"(2) The Secretary shall establish the Registry with the advice 
of an independent scientific organization.". 
(b) CONFORMING AMENDMENTS.—<1) Subsection (cXD of such 
section is amended by striking out "subsection (a)" and inserting 
in lieu thereof "subsection (aXiy*. 
(2) Subsection (d) of such section is amended by inserting 
"pursuant to subsection (aXl)" after "Registry^. 
SEC. 706. STUDY BY OFFICE OF TECHNOLOGY ASSESSMENT OF PER^ 
SIAN GULF REGISTRY AND PERSIAN GULF WAR VETERANS 
HEALTH REGISTRY. 
(a) STUDY.—^The Director of the Office of Technology Assess-
ment shall, in a manner consistent with the Technology Assessment 
Act of 1972 (2 U.S.C. 472(d)), assess— 
(1) the potential utility of each of the Persian Gulf Registry 
and the Persian Gulf War Veterans Health Registry for sci-
entific study and ^assessment of the intermediate and long-
term health consequences of militanr service in the Persian 
Gulf theater of operations during the Persian Gulf War; 
(2) the extent to which each registry meets the require-
ments of the provisions of law under which the registry is 
estabhshed; 
(3) the extent to which data contained in each registry— 
(A) are maintained in a manner that ensures perma-
nent preservation and faciUtates the effective, efficient 
106 STAT. 4978 
PUBLIC LAW 102-585—NOV. 4, 1992 
retrieval of information that is potentially relevant to tiie 
scientific study of the intermediate and long-term health 
consequences of military service in the Persian Gulf theater 
of operations during the Persian Gulf War; and 
(B) would be useful for scientific study regarding such 
health consequences; 
(4) the adequacy of any plans to update each of the 
registries; 
(5) the extent to which the Department of Defense or 
the Department of Veterans Affairs, as the case may be, is 
assembling and maintaining information on the Persian Gulf 
theater of operations (includUng information on troop locations 
and atmospneric and weather conditions) in a manner that 
facilitates the usefulness of, maintenance of, and retrieval of 
information from, the appUcable registry; and 
(6) the adequacy and compatibihty of protocols for the 
health examinations and counseling provided under section 
703 and health examinations provided by the Department of 
Defense to members of the Anned Forces for the purpose of 
assessing the health status of members of the Armed Forces 
who served in the Persian Gulf theater of operations during 
the Persian Gulf War. 
(b) ACCESS TO INFORMATION.—The Secretary of 
Veterans Affairs 
and the Secretary of Defense shall provide the Director with access 
to such records and information imder the jurisdiction of each 
such secretary as the Director determines necessary to permit the 
Director to carry out the study required under this section. 
(c) REPORTS.—The Director shall— 
(1) not later than 270 days after the date of the enactment 
of this Act, submit to Congress a report on the results of 
the assessment carried out under this section of the Persian 
Gulf Registry and health-examination protocols; and 
(2) not later than 15 months after such date, submit to 
Congress a report on the results of the assessment carried 
out under this section of the Persian Gulf War Veterans Health 
Registry. 
) 
(d) DEFiNmONS.—^For the purposes of this section: 
(1) The term Tersian Gulf Registry" means the registry 
established under section 734 of the National Defense 
Authorization Act for Fiscal Years 1992 and 1993 (Public Law 
102-190; 105 Stat. 1411; 10 U.S.C. 1074 note), as amended 
(2) The term Tersian Gulf War Veterans Health Registrv" 
means the Persian Gulf War Veterans Health Registry estab-
lished under section 702. 
SEC. 706. AGREEMENT WITH NATIONAL ACADEMY OF SCIENCES FOR 
REVIEW OF HEALTH CONSEQUENCES OF SERVICE DURING 
THE PERSIAN GULF WAR. 
(a) AGREEMENT.—<1) The Secretary of Veterans Affairs and 
Secretary of Defense jointly shall seek to enter into an agreement 
with tiie National ^ademy of Sciences for the Medical Follow-
Up Agency (MFUA) of the Institute of Medicine of the Academy 
to review existing scientific, medical, and other information on 
the health consequences of militaiy service in the Persian Gulf 
theater of 
operations during the Persian Gulf 
War. 
PUBLIC LAW 102-585—NOV. 4, 1992 
106 STAT. 4979 
(2) The agreement shall require MFUA to provide members 
of veterans organizations and members of the scientific community 
(including the Director of the Office of Technology Assessment) 
with the opportunity to comment on the method or methods MFUA 
proposes to use in conducting the review. 
(3) The agreement shall permit MFUA, in conducting the 
review, to examine and evaluate medical records of individuals 
who are included in the registries referred to in section 705(d) 
for purposes that MFUA considers appropriate, including the pur-
pose of identifying illnesses of those inmviauals. 
(4) The Secretary of Veterans Afiairs and the Secretary of 
Defense shall seek to enter into the agreement under this section 
not later than 180 days after the date of the enactment of this 
Act. 
(b) REPORT.—(1) The agreement under this section shall require 
the National Academy of Sciences to submit to the committees 
and secretaries referred to in paragraph (2) a report on the results 
of the review carried out under the agreement. Such report shall 
contain the following: 
(A) An assessment of the efiTectiveness of actions taken 
by the Secretary of Veterans Affairs and the Secretary of 
Defense to collect and maintein information that is potentially 
useful for assessing the health consequences of the military 
service referred to in subsection (a). 
(B) Recommendations on means of improving the collection 
and maintenance of such information. 
(C) Recommendations on whether there is sound scientific 
basis for an epidemiological study or studies on the health 
consequences of such service, and if the recommendation is 
that there is sound scientific basis for such a study or studies, 
the nature of the study or studies. 
(2) The committees and secretaries referred to in paragraph 
(1) are the following: 
(A) The (jommjittees on Veterans' Affairs of the Senate 
and House of Representetives. 
(B) The Committees on Armed Services of the Senate and 
House of Representetives. 
(C) The Secretjuy of Veterans Affairs. 
(D) The Secreteiy of Defense. 
(c) FUNDING.—(1) The Secretary of Veterans Affairs and the 
Secretary of Defense shall make available up to a total of $500,000 
in fisc€d year 1993, from funds available to the Department of 
Veterans Affairs and the Department of Defense in that fiscal 
year, to carry out the review. Any amounte provided by iAte two 
departmente shall be provided in equal amounts. 
(2) If the Secretary of Veterans Affairs and the Secretary of 
Defense enter into an agreement under subsection (a) wiUi the 
National Acadennr of Sciences— 
(A) the Secretary of Veterans Affairs shall make available 
$250,000 in each of fiscal years 1994 through 2003, firom 
amounte available to the Department of Veterans Affairs in 
each such fiscal year, to the National Academy of Sciences 
for the general purposes of conducting epidemiological research 
with respect to military and veterans populations; and 
(B) the Secretary of Defense shall make available $250,000 
in each of fiscal years 1994 through 2003, from amounte avail-
able to the Department of Defense in each such fiscal year, 
106 STAT. 4980 
PUBLIC LAW 102-585—NOV. 4, 1992 
to the National Academy of Sciences for the purposes of carrying 
out the research referred to in subparagraph (A). 
SEC. 707. COORDINATION OF GOVERNMENT ACTIVITIES ON HEALTH. 
RELATED RESEARCH ON THE PERSIAN GULF WAR. 
(a) DESIGNATION OF COORDINATING ORGANIZATION.—The Presi-
dent shall designate, and may redesignate from time to time, the 
head of an appropriate department or agen^ of the Federal Govern-
ment to coordinate all research activities undertaken or funded 
by the Executive Branch of the Federal Government on the health 
consequences of miUtary service in the Persian Gulf theater of 
operations during the Persian Gulf War. 
(b) REPORT.—^Not later than March 1 of each year, the head 
of the department or agency designated under subsection (a) shall 
submit to the Committees on Veterans' Afifairs of the Senate and 
House of Representetives a report on the stetus and resulte of 
all such research activities undertaken or by the Executive Branch 
of the Federid Government during the previous year. 
SEC. 
706. 
DEFINITION. 
For the purposes of this title, the term Tersian Gulf War* 
has the meaning given such term in section 101(33) of title 38, 
United Stetes Code. 
TITLE Vni—COURT OF VETERANS 
APPEALS 
SEC. 801. DISCIPLINARY PROCEDURES FOR JUDGES OF COURT OF 
VETERANS APPEALS. 
Section 7253(g) is amended— 
(1) by inserting "(ir after "(g)"; and 
(2) by adding at the end the following: 
"(2) The provisions of paragraphs (7) through (15) of section 
372(c) of title 28, regarding referral or certification to, and petition 
for review in, the Judicial Conference of the United Stetes and 
action thereon, shall apply to the exercise by the Court of the 
powers of a judicial council underparagraph (1) of this subsection. 
The grounds for removal from office specified in subsection (f)(1) 
shall provide a basis for a determination pursuant to paragraph 
(7) or (8) of section 372(c) of title 28, and certification and transmit-
tal by the Conference shall be made to the President for consider-
ation under subsection (f). 
''(3XA) In conducting hearings pursuant to paragraph (1), the 
Court may exercise the authority provided under section 1821 of 
title 28 to pay the fees and allowances described in that section. 
PUBLIC LAW 102-585-NOV. 4, 1992 
106 STAT. 4981 
"(B) The Court shall have the power provided under section 
372(cX16) of title 28 to award reimbursement for the reasonable 
expenses described in that section. Reimbursements under this 
subparagraph shall be made from funds appropriated to the Court.". 
Approved November 4, 1992. 
LEGISLATIVE HISTORY—H.R. 5193 (S. 2575): 
HOUSE REPORTS: No. 102-714, Pt. 1 (Comm. on Veterans' Affairs). 
SENATE REPORTS: No. 102-401 accompanying S. 2575 (Comm. on Veterans' Affairs). 
CONGRESSIONAL RECORD, Vol. 138 (1992): 
Aug. 4, considered and passed House. 
Oct. 1, H.R. 5193 considered and passed Senate, amended, in lieu of S. 2575. 
Oct. 5, House concurred in Senate amendments with amendments. 
Oct. 8, Senate concurred in House amendments. 
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 28 (1992): 
Nov. 4, Presidential statement.