Veterans' Health Care Eligibility Reform Act of 1996
PL 104-262 (H.R.3118), enacted 10/09/1996

PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3177 
Public Law 104-262 
104th Congress 
An Act 
To amend title 38, United States Code, to reform eligibility for health care provided 
by the Department of Veterans Affairs, to authorize major medical facility construe- 
Oct. 9, 1996 
tion projects for the Department, to improve administration of health care by 
[H R 3118] 
the Department, and for other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
Veterans' Health 
Care Eligibility 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
Reform Act of 
(a) SHORT TITLE.—This Act may be cited as the "Veterans' 
Jc^n«?r ioi nntP 
Health Care EUgibihty Reform Act of 1996". 
(b) TABLE OF CONTENTS.—The table of contents of this Act 
is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. References to title 38, United States Code. 
TITLE I—ELIGIBILITY REFORM 
Sec. 101. Eligibility for hospital care and medical services. 
Sec. 102. Revision in authorities for provision of priority health care for certain vet-
erans exposed to specified toxic substances. 
Sec. 103. Prosthetics and preventive care. 
Sec. 104. Management of health care. 
Sec. 105. Authorization of appropriations. 
Sec. 106. Assessment of implementation and operation. 
TITLE II—CONSTRUCTION AUTHORIZATION 
Sec. 201. Authorization of major medical facility projects. 
Sec. 202. Authorization of major medical facility leases. 
Sec. 203. Authorization of appropriations. 
Sec. 204. Strategic planning. 
Sec. 205. Revision to prospectus requirements. 
Sec. 206. Construction authorization requirements. 
Sec. 207. Terminology changes. 
TITLE III—HEALTH CARE AND ADMINISTRATION 
Subtitle A—Health Care Sharing and Administration 
Sec. 301. Revision of authority to share medical facilities, equipment, and informa-
tion. 
Sec. 302. Improved efficiency in health care resource management. 
Sec. 303. Personnel furnishing shared resources. 
Sec. 304. Waiting period for administrative reorganizations. 
Sec. 305. Repeal of limitations on contracts for conversion of performance of activi-
ties of Department health-care facilities and revised annual reporting 
requirement. 
Subtitle B—Care of Women Veterans 
Sec. 321. Mammography quality standards. 
Sec. 322. Patient privacy for women patients. 
Sec. 323. Assessment of use by women veterans of Department health services. 
Sec. 324. Reporting requirements. 
110 STAT. 3178 
PUBLIC LAW 104-262—OCT. 9, 1996 
Subtitle C—Readjustment Counseling and Mental Health Care 
Sec. 331. Expansion of eligibility for readjustment counseling and certain related 
counseling services. 
Sec. 332. Reports relating to Vet Centers. 
Sec. 333. Advisory Committee on the Readjustment of Veterans. 
Sec. 334. Centers for mental illness research, education, and clinical activities. 
Sec. 335. Committee on Care of Severely Chronically Mentally 111 Veterans. 
Subtitle D—Other Provisions 
Sec. 341. Hospice care study. 
Sec. 342. Payment to States of per diem for veterans receiving adult day health 
care. 
Sec. 343. Research corporations. 
Sec. 344. Veterans Health Administration headquarters. 
Sec. 345. Disbursement agreements relating to medical residents and interns. 
Sec. 346. Authority to suspend special pay agreements for physicians and dentists 
who enter residency training programs. 
Sec. 347. Remunerated outside professional activities by Veterans Health Adminis-
tration personnel. 
Sec. 348. Modification 
of restrictions on real property, Milwaukee County, 
Wisconsin. 
Sec. 349. Modification of restrictions on real property, Cheyenne, Wyoming. 
Sec. 350. Name of Department of Veterans Affairs Medical Center, Johnson City, 
Tennessee. 
Sec. 351. Report on health care needs of veterans in east central Florida. 
Sec. 352. Evaluation of health status of spouses and children of Persian Gulf War 
veterans. 
SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE. 
Except as otherwise expressly provided, whenever in this Act 
an amendment or repeal is expressed in terms of an amendment 
to or repeal of a section or other provision, the reference shall 
be considered to be made to a section or other provision of title 
38, United States Code. 
TITLE I—ELIGIBILITY REFORM 
SEC. 101. ELIGIBILITY FOR HOSPITAL CARE AND MEDICAL SERVICES. 
(a) NEW CRITERIA FOR ELIGIBILITY FOR CARE.—Section 1710(a) 
is amended to read as follows: 
"(a)(1) The Secretary (subject to paragraph (4)) shall furnish 
hospital care and medical services, and may furnish nursing home 
care, which the Secretary determines to be needed— 
"(A) to any veteran for a service-connected disability; and 
"(B) to any veteran who has a service-connected disability 
rated at 50 percent or more. 
"(2) The Secretary (subject to paragraph (4)) shall furnish hos-
pital care and medical services, £ind may furnish nursing home 
care, which the Secretary determines to be needed to any veteran— 
"(A) who has a compensable service-connected disability 
rated less than 50 percent; 
"(B) whose discharge or release from active military, naval, 
or air service was for a compensable disability that was incurred 
or aggravated in the line of duty; 
"(C) who is in receipt of, or who, but for a suspension 
pursuant to section 1151 of this title (or both a suspension 
and the receipt of retired pay), would be entitled to disability 
compensation, but only to the extent that such veteran's 
continuing eligibility for such care is provided for in the judg-
ment or settlement provided for in such section; 
"(D) who is a former prisoner of war; 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3179 
"(E) who is a veteran of the Mexican border period or 
ofWorldWarl; 
"(F) who was exposed to a toxic substance, radiation, or 
environmental hazard, as provided in subsection (e); or 
"(G) who is unable to defray the expenses of necessary 
care as determined under section 1722(a) of this title. 
"(3) In the case of a veteran who is not described in paragraphs 
(1) and (2), the Secretary may, to the extent resources £ind facilities 
are available and subject to the provisions of subsections (f) and 
(g), furnish hospital care, medical services, and nursing home care 
which the Secretary determines to be needed. 
"(4) The requirement in paragraphs (1) and (2) that the Sec-
retary furnish hospital care and medical services shall be effective 
in any fiscal year only to the extent and in the amount provided 
in advance in appropriations Acts for such purposes.". 
(b) TRANSFER OF PROVISION.—Chapter 17 is amended— 
(1) by redesignating subsection (g) of section 1710 as sub-
section (h); and 
(2) by transferring subsection (f) of section 1712 to section 
1710 and inserting such subsection so as to appear after sub-
section (f), redesignating such subsection as subsection (g), 
and amending such subsection by striking out "section 
1710(a)(2) of this title" in paragraph (1) and inserting in lieu 
thereof "subsection (a)(3) of this section". 
(c) REPEAL OF SEPARATE OUTPATIENT CARE 
PRIORITIES.—(1) 
Section 1712 is amended— 
(A) by striking out subsections (a) and (i); 
(B) by redesignating subsections (b), (c), (d), (h) and (j), 
as subsections (a), (b), (c), (d), and (e), respectively; and 
(C) in subsection (b), as so redesignated, by striking out 
"subsection (b) of this section" and inserting in lieu thereof 
"subsection (a)". 
(2)(A) The heading of such section is amended to read as 
follows: 
*
*
§ 1712. Dental care; drugs and medicines for certain disabled 
veterans; vaccines'*. 
(B) The item relating to such section in the table of sections 
at the beginning of chapter 17 is amended to read as follows: 
"1712. Dental care; drugs and medicines for certain disabled veterans; vaccines.". 
(d) CONFORMING AMENDMENTS TO CHAPTER 17.—Chapter 17 
is further amended as follows: 
(1) Section 170l(6)(B)(i) is amended— 
(A) in subclause (I), by striking out "section 1712(a)" 
and inserting in lieu thereof "paragraph (1) or (2) of section 
1710(a)"; and 
(B) in 
subclause (II), by striking out "section 
1712(a)(5)(B)" and inserting in lieu thereof "paragraph (1), 
(2) or (3) of section 1710(a)". 
(2) Section 1710(c)(1) is amended by striking out "section 
1712(b)" and inserting in lieu thereof "section 1712(a)". 
(3) Section 1710(e)(1)(C) is amended by striking out "hos-
pital care and nursing home care under subsection (a)(1)(G) 
of this section" and inserting in lieu thereof "hospital care, 
medical services, and nursing home care under subsection 
(a)(2)(F)". 
(4) Section 1710(f) is amended— 
110 STAT. 3180 
PUBLIC LAW 104-262—OCT. 9, 1996 
(A) in paragraph (1), by striking out "subsection (a)(2)" 
and inserting in lieu thereof "subsection (a)(3)"; and 
(B) in paragraph (3)(E)— 
(i) by striking out "section 1712(a) of this title" 
and inserting in lieu thereof "paragraph (3) of sub-
section (a)"; £ind 
(ii) by striking out "section 1712(f) of this title" 
and inserting in lieu thereof "subsection (g)"; and 
(C) in paragraph (3)(F), by striking out "section 1712(f) 
of this title" and inserting in lieu thereof "subsection (g)". 
(5) Section 1712A is amended— 
(A) in subsection (b)(1), by striking out "under the 
conditions specified in section 1712(a)(5)(B) of this title"; 
and 
(B) in subsection (e)(1), by striking out "sections 
1712(a)(1)(B) and 1703(a)(2)" and inserting in lieu thereof 
"sections 1703(a)(2) and 1710(a)(1)(B)". 
(6) Section 1717(a) is simended— 
(A) in paragraph (1), by striking out "section 1712(a)" 
and inserting in lieu thereof "section 1710(a)"; and 
(B) in paragraph (2)— 
(i) in subparagraph (A), by striking out "paragraph 
(1) of section 1712(a) of this title" and inserting in 
lieu thereof "section 1710(a)(1) of this title, or for a 
disability described in section 1710(a)(2)(C) of this 
title"; and 
(ii) in subparagraph (B), by striking out "section 
1712" and inserting in lieu thereof "section 1710(a)(2)". 
(7) Section 1718(e) is amended by striking out "section 
1712(i)" and inserting in lieu thereof "section 1705". 
(8) Section 1720(f) is amended— 
(A) in paragraph (l)(A)(ii), by striking out "section 
1712(a)(1)(B)" and inserting in lieu thereof "paragraph (1), 
(2), or (3) of section 1710(a)"; and 
(B) by striking out paragraph (3). 
(9) Section 1722 is amended— 
(A) in 
subsection 
(a), by striking 
out 
"section 
1710(a)(l)(I)" and 
inserting 
in lieu 
thereof 
"section 
1710(a)(2)(G)"; and 
(B) in subsection (f)(3), by striking out "or 1712(f)". 
(10) Section 1729(g)(3)(A) is amended by striking out "under 
section 1710(f) of this title for hospital care or nursing home 
care, under section 1712(f) of this title for medical services," 
and inserting in lieu thereof "under subsection (f) or (g) of 
section 1710 of this title for hospital care, medical services, 
or nursing home care". 
(e) OTHER CONFORMING AND TECHNICAL AMENDMENTS.— 
(1) Section 1525 is amended— 
(A) in subsection (a), by striking out "section 1712(h) 
of this title" and all that follows through the period at 
the end and inserting in lieu thereof "section 1712(d) of 
this title."; and 
(B) in subsection (b), by striking out "renumeration" 
and inserting in lieu thereof "remuneration". 
(2) Section 2104(b) is amended— 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3181 
(A) in the first sentence, by striking out "section 
1712(a)" and inserting in lieu thereof "section 1717(aX2)"; 
and 
(B) in the second sentence, by striking out "section 
1712(a)" and inserting in lieu thereof "section 1717(aX2)". 
(3) Section 5317(c)(3) is amended by striking out "sections 
1710(a)(l)(I), 1710(a)(2), 1710(b), and 1712(a)(2)(B)" and insert-
ing in lieu thereof "subsections (a)(2)(G), (a)(3), and (b) of section 
1710". 
(4) Section 8110(a)(2) is amended by striking out "section 
1712" and inserting in lieu thereof "section 1710(a)". 
(5) Section 8111A(b)(2XA) is amended by striking out "sub-
section (f) of section 1712" and inserting in lieu thereof "sub-
section (a) of section 1710". 
SEC. 102. REVISION IN AUTHORITIES FOR PROVISION OF PRIORITY 
HEALTH CARE FOR CERTAIN VETERANS EXPOSED TO 
SPECIFIED TOXIC SUBSTANCES. 
(a) 
AUTHORIZED 
INPATIENT 
CARE.—Section 
1710(e) 
is 
amended— 
(1) in paragraph (1), by striking out subparagraphs (A) 
and (B) and inse^rting in lieu thereof the following: 
"(A) A Vietnam-era herbicide-exposed veteran is eligible (subject 
to paragraph (2)) for hospital care, medical services, and nursing 
home care under subsection (aX2)(F) for any disability, notwith-
standing that there is insufficient medical evidence to conclude 
that such disability may be associated with such exposure. 
"(B) A radiation-exposed veteran is eligible for hospital care, 
medical services, and nursing home care under subsection (a)(2)(F) 
for any disease suffered by the veteran that is— 
"(i) a disease listed in section 1112(c)(2) of this title; or 
"(ii) any other disease for which the Secretary, based on 
the advice of the Advisory Committee on Environmental Haz-
ards, determines that there is credible evidence of a positive 
association between occurrence of the disease in humans and 
exposure to ionizing radiation."; and 
(2) by striking out paragraphs (2) and (3) and inserting 
in lieu thereof the following: 
"(2)(A) In the case of a veteran described in paragraph (1)(A), 
hospital care, medical services, and nursing home care may not 
be provided under subsection (a)(2)(F) with respect to— 
"(i) a disability that is found, in accordance with guidelines 
issued by the Under Secretary for Health, to have resulted 
from a cause other than an exposure described in paragraph 
(4)(AXii); or 
"(ii) a disease for which the National Academy of Sciences, 
in a report issued in accordance with section 2 of the Agent 
Orange Act of 1991, has determined that there is limited or 
suggestive evidence of the lack of a positive association between 
occurrence of the disease in humans and exposure to a herbicide 
agent. 
"(B) In the case of a veteran described in paragraph (1)(C), 
hospital care, medical services, and nursing home care may not 
be provided under subsection (a)(2)(F) with respect to a disability 
that is found, in accordance with guidelines issued by the Under 
Secretary for Health, to have resulted from a cause other than 
an exposure described in that paragraph. 
110 STAT. 3182 
PUBLIC LAW 104-262—OCT. 9, 1996 
"(3) Hospital care, medical services, and nursing home care 
may not be provided under or by virtue of subsection (a)(2)(F)— 
"(A) in the case of care for a veteran described in paragraph 
(1)(A), after December 31, 2002; and 
"(B) in the case of care for a veteran described in paragraph 
(1)(C), after December 31, 1998. 
"(4) For purposes of this subsection— 
"(A) The term 'Vietnam-era herbicide-exposed veteran' 
means a veteran (i) who served on active duty in the Republic 
of Vietnam during the Vietnam era, and (ii) who the Secretary 
finds may have been exposed during such service to dioxin 
or was exposed during such service to a toxic substance found 
in a herbicide or defoliant used for military purposes during 
such era. 
"(B) The term 'radiation-exposed veteran' has the meaning 
given that term in section 1112(c)(3) of this title.". 
38 use 1710 
(b) SAVINGS PROVISIONS.—^The provisions of sections 1710(e) 
note. 
and 1712(a) of title 38, United States Code, as in effect on the 
day before the date of the enactment of this Act, shall continue 
to apply on and after such date with respect to the furnishing 
of hospital care, nursing home care, £ind medical services for any 
veteran who was furnished such care or services before such date 
of enactment on the basis of presumed exposure to a substance 
or radiation under the authority of those provisions, but only for 
treatment for a disability for which such care or services were 
furnished before such date. 
SEC. 
1
0
3
. 
PROSTHETICS 
AND 
PREVENTIVE 
CARE. 
(a) ELIGIBILITY.—Section 1701(6)(A)(i) is amended— 
(1) by striking out "(in the case of a person otherwise 
receiving care or services under this chapter)" and "(except 
under the conditions described in section 1712(a)(5)(A) of thas 
title),"; 
(2) by inserting "(in the case of a person otherwise receiving 
care or services under this chapter)" oefore "wheelchairs,"; and 
(3) by inserting "except that the Secretary may not furnish 
sensori-neural aids other than in accordance with guidelines 
which the Secretary shall prescribe," after "reasonable and 
necessary,". 
38USC1701 
(b) REGULATIONS.—^Not later than 30 days after the date of 
note. 
the enactment of this Act, the Secretary of Veterans Affairs shall 
prescribe the guidelines required by the amendments made by 
subsection (a) and shall furnish a copy of those guidelines to the 
Committees on Veterans' Affairs of the Senate and House of Rep-
resentatives. 
SEC. 
1
0
4
. 
M A N A G E M E N T 
OF 
HEALTH 
CARE. 
(a) IN GENERAL.—(1) Chapter 17 is gimended by inserting after 
section 1704 the following new sections: 
**§1705. Management of health care: patient 
enrollment 
system 
"(a) In managing the provision of hospital care and medical 
services under section 1710(a) of this title, the Secretary, in accord-
ance with regulations the Secretary shall prescribe, shall establish 
and operate a system of annual patient enrollment. The Secretary 
shall manage the enrollment of veterans in accordance with the 
following priorities, in the order listed: 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3183 
"(1) Veterans with service-connected disabilities rated 50 
percent or greater. 
"(2) Veterans with service-connected disabilities rated 30 
percent or 40 percent. 
"(3) Veterans who are former prisoners of war, veterans 
with service-connected disabilities rated 10 percent or 20 per-
cent, and vetersms described in subparagraphs (B) and (C) 
of section 1710(a)(2) of this title. 
"(4) Veterans who are in receipt of increased pension based 
on a need of regular aid and attendance or by reason of being 
permanently housebound and other veterans who are cata-
strophically disabled. 
"(5) Veterans not covered by paragraphs (1) through (4) 
who are unable to defray the expenses of necessary care as 
determined under section 1722(a) of this title. 
"(6) All other veterans eligible for hospital care, medical 
services, and nursing home care under section 1710(a)(2) of 
this title. 
"(7) Veterans described in section 1710(aX3) of this title. 
"(b) In the design of an enrollment system under subsection 
(a), the Secretary— 
"(1) shall ensure that the system will be managed in a 
manner to ensure that the provision of care to enroUees is 
timely and acceptable in quality; 
"(2) may establish additional priorities within each priority 
group specified in subsection (a), as the Secretary determines 
necessary; and 
"(3) may provide for exceptions to the specified priorities 
where dictated by compelling medical reasons. 
"(c)(1) Effective on October 1, 1998, the Secretary may not 
provide hospital care or medical services to a veteran under para-
graph (2) or (3) of section 1710(a) of this title unless the veteran 
enrolls in the system of patient enrollment established by the 
Secretary under subsection (a). 
"(2) The Secretary shall provide hospital care and medical 
services under section 1710(a)(1) of this title, and under subpara-
graph (B) of section 1710(a)(2) of this title, for the 12-month period 
following such veteran's discharge or release from service, to any 
veterEin referred to in such sections for a disability specified in 
the applicable subparagraph of such section, notwithstanding the 
failure of the veteran to enroll in the system of patient enrollment 
referred to in subsection (a) of this section. 
"§ 1706. Management of health care: other requirements 
"(a) In managing the provision of hospital care and medical 
services under section 1710(a) of this title, the Secretary shall, 
to the extent feasible, design, establish and manage health care 
programs in such a manner as to promote cost-effective delivery 
of health care services in the most clinically appropriate setting. 
"(b)(1) In managing the provision of hospital care and medical 
services under such section, the Secretary shall ensure that the 
Department maintains its capacity to provide for the specialized 
treatment and rehabilitative needs of disabled veterans (including 
veterans with spinal cord dysfunction, blindness, amputations, and 
mental illness) within distinct programs or facilities of the Depart-
ment that are dedicated to the specialized needs of those veterans 
in a manner that (A) Eiffords those veterans reasonable access 
110 STAT. 3184 
PUBLIC LAW 104-262—OCT. 9, 1996 
to care and services for those specialized needs, and (B) ensures 
that overall capacity of the Department to provide such services 
is not reduced below the capacity of the Department, nationwide, 
to provide those services, as of the date of the enactment of this 
section. The Secretary shall carry out this paragraph in consultation 
with the Advisory Committee on Prosthetics and Special Disabilities 
Programs and the Committee on Care of Severely Chronically Men-
tally 111 Vetersins. 
Reports. 
"(2) Not later than April 1, 1997, April 1, 1998, and April 
1, 1999, the Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and House of Representatives a report on 
the Secretary's compliance, by facility and by service-network, with 
the requirements of this subsection.". 
(2) The table of sections at the beginning of chapter 17 is 
Eimended by inserting after the item relating to section 1704 the 
following new items: 
"1705. Management of health care: patient enrollment system. 
"1706. Management of health care: other requirements.". 
(b) CONFORMING AMENDMENTS TO SECTION 1703.—Section 
1703(a) is amended— 
(1) in the matter preceding paragraph (1), by striking out 
"or 1712"; 
(2) in paragraph (2)— 
(A) by striking out "1712(a)(1)(B)" in subparagraph 
(A) and inserting in Heu thereof "1710(a)(1)(B)"; 
(B) by striking out subparagraph (B) and inserting 
in lieu thereof the following: 
"(B) a veteran who (i) has been furnished hospital 
care, nursing home care, domiciliary care, or medical serv-
ices, and (ii) requires medical services to complete treat-
ment incident to such care or services; or"; and 
(C) by striking "section 1712(a)(3) (other than a veteran 
who is a former prisoner of war) of this title" in subpara-
graph 
(C) and inserting 
in 
lieu 
thereof 
"section 
1710(a)(2)(E) of this title, or a veteran who is in receipt 
of increased pension, or additional compensation or allow-
ances based on the need of regular aid and attendance 
or by reason of being permanently housebound (or who, 
but for the receipt of retired pay, would be in receipt 
of such pension, compensation, or allowance),"; and 
(3) in paragraph (7), by striking out "1712(b)(1)(F)" and 
inserting in lieu thereof "1712(a)(1)(F)". 
SEC. 105. AUTHORIZATION OF APPROPRIATIONS. 
There is authorized to be appropriated for the Department 
of Veterans Affairs for the Medical Care account, for the purposes 
specified for that account in Public Law 103-327 (108 Stat. 2300), 
including the cost of providing hospital care and medical services 
under the amendments made by section 101 of this title, not to 
exceed $17,250,000,000 for fiscal year 1997 and not to exceed 
$17,900,000,000 for fiscal year 1998. 
38 use 1705 
SEC. 106. ASSESSMENT OF IMPLEMENTATION AND OPERATION. 
^^^' 
(a) ASSESSMENT SYSTEMS.—The Secretary of Veterans Affairs 
shall establish information systems to assess the experience of 
the Department of Veterans Affairs in implementing sections 101, 
103, and 104, including the amendments made by those sections. 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3185 
during fiscal year 1997. The Secretary shall establish those informa-
tion systems in time to include assessments under such systems 
in the report required under subsection (b). 
(b) REPORT.—Not later than March 1, 1998, the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and 
House of Representatives a report reflecting the experience of the 
Department during fiscal year 1997 on— 
(1) the effect of implementation of, and provision and 
management of care under, sections 101, 103, and 104 (includ-
ing the amendments made by those sections) on demand for 
health care services from the Department of Veterans Affairs 
by veterans described in paragraphs (1), (2), and (3) of section 
1710(a) of title 38, United States Code, as amended by section 
101; 
(2) any differing patterns of demand on the part of such 
veterans relating to such factors as relative distance from 
Department facilities and prior experience, or lack of experi-
ence, as recipients of care from the Department; 
(3) the extent to which the Department has met such 
demand for care; and 
(4) changes in health-care delivery patterns in Department 
facilities and the fiscal impact of such changes. 
(c) MATTERS TO BE INCLUDED.—^The report under subsection 
(b) shall include detailed information with respect to fiscal year 
1997 regarding the following: 
(1) The number of veterans enrolled for care at each Depart-
ment medical facility and, of such veterans, the number enrolled 
at each such facility who had not received care from the Depart-
ment during the preceding three fiscal years. 
(2) With respect to the veterans who had not received 
care from the Department during the three preceding fiscal 
years, the total cost of providing care to such veterans, shown 
in total and separately (A) by level of care, and (B) by reference 
to whether care was furnished in Department facilities or under 
contract arrangements. 
(3) With respect to the number of veterans described in 
paragraphs (1), (2), and (3) of section 1710(a) of title 38, United 
States Code, as amended by section 101, who applied for health 
care from the Department during fiscal year 1997— 
(A) the number who applied for care (shown in total 
and separately by facility); 
(B) the number who were denied enrollment (shown 
in total and separately by facility); and 
(C) the number who were denied care which was 
considered to be medically necessary but not of an emer-
gency nature (shown in total and separately by facility). 
(4) The numbers and characteristics of, and the type and 
extent of health care furnished to, veterans enrolled for care 
(shown in total and separately by facility). 
(5) The numbers and characteristics of, and the type and 
extent of health care furnished to, veterans not enrolled for 
care (shown separately by reference to each class of eligibility, 
both in total and separately by facility). 
(6) The specific fiscal impact (shown in total and by 
geographic health-care delivery areas) of changes in delivery 
patterns instituted under the amendments made by this title. 
110 STAT. 3186 
PUBLIC LAW 104-262—OCT. 9, 1996 
TITLE II—CONSTRUCTION 
AUTHORIZATION 
SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACIUTY PROJECTS. 
(a) AMBULATORY CARE ADDITION PROJECTS.—^The Secretary of 
Veterans Affairs may carry out the following ambulatory care addi-
tion major medical facility projects, with each project to be carried 
out in the amount specified for that project: 
(1) Construction of an ambulatory care facility and renova-
tion of "E" wing, Tripler Army Hospital, Honolulu, Hawaii, 
$43,000,000. 
(2) Addition of ambulatory care facilities at the Department 
of Veterans Affairs medical center in Brockton, Massachusetts, 
$13,500,000. 
(3) Addition of ambulatory care facilities for outpatient 
improvements at the Department of Veterans Affairs medical 
center in Shreveport, Louisiana, $25,000,000. 
(4) Addition of ambulatory care facilities at the Department 
of Veterans Affairs medical center in Lyons, New Jersey, 
$21,100,000. 
(5) Addition of ambulatory care facilities at the Department 
of Veterans Affairs medicad center in Tomah, Wisconsin, 
$12,700,000. 
(6) Addition of ambulatory care facilities at the Department 
of Veterans Affairs medicsd center in Asheville, North Carolina, 
$26,300,000. 
(7) Addition of ambulatory care facilities at the Department 
of Veterans Affairs medical center in Temple, Texas, $9,800,000. 
(8) Addition of ambulatory care facilities at the Department 
of Veterans Affairs 
medical center in Tucson, Arizona, 
$35,500,000. 
(9) Construction of an ambulatory care facility at the 
Department of Veterans Affairs medical center in Leavenworth, 
Kansas, $27,750,000. 
(b) ENVIRONMENTAL IMPROVEMENT PROJECTS.—The Secretary 
may carry out the following environmentsd improvement major 
medical facility projects, with each project to be carried out in 
the amount specified for that project: 
(1) Environmental improvements for the renovation of 
nursing home facilities at the Department of Veterans Affairs 
medical center in Lebanon, Pennsylvania, $9,500,000. 
(2) Environmental improvements at the Department of 
Veterans Affairs medical center in Marion, Illinois, $11,500,000. 
(3) Environmental improvements for ward renovation for 
patient privacy at the Department of Veterans Affairs medical 
center in Omaha, Nebraska, $7,700,000. 
(4) Environmental improvements at the Department of 
Veterans Affairs medical center in Pittsburgh, Pennsylvania, 
$17,400,000. 
(5) Environmental improvements for the renovation of 
various buildings at the Department of Veterans Affairs medical 
center in Waco, Texas, $26,000,000. 
(6) Environmental improvements for the replacement of 
psychiatric beds at the Department of Veterans Affairs medical 
center in Marion, Indiana, $17,300,000. 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3187 
(7) Environmental improvements for the renovation of 
psychiatric wards at the Department of Veterans Affairs medi-
cal center in Perry Point, Maryland, $15,100,000, 
(8) Environmental enhancement at the Department of Vet-
erans Affairs medical center in Salisbury, North Carolina, 
$18,200,000. 
(c) SEISMIC CORRECTION PROJECT.—^The Secretary may carry 
out seismic corrections to Building Number 324 at the Department 
of Veterans Affairs medical center in Palo Alto, California, in the 
amount of $20,800,000. 
(d) 
PROJECT 
AUTHORIZATION 
WHEN 
PARTIAL 
FUNDING 
PROVIDED.—If the amount of funds appropriated for fiscal year 
1997 or 1998 for design and partial construction of a major medical 
facility project that is authorized in this section is less than the 
amount required to complete the construction of that project as 
authorized and if the Secretary obligates funds for such construc-
tion, such project shall be deemed to be fully authorized. Any 
such authorization shall cease to have effect at the close of fiscsd 
year 2001. 
SEC. 202. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES. 
The Secretary of Veterans Affairs may enter into leases for 
medical facilities as follows: 
(1) Lease of a satellite outpatient clinic in Allentown, Penn-
sylvania, in an amount not to exceed $2,159,000. 
(2) Lease of a satellite outpatient clinic in Beaumont, Texas, 
in an amount not to exceed $1,940,000. 
(3) Lease of a satellite outpatient clinic in Boston, 
Massachusetts, in an amount not to exceed $2,358,000. 
(4) Lease of a parking facility in Cleveland, Ohio, in an 
amount not to exceed $1,300,000. 
(5) Lease of a satellite outpatient clinic and Veterans Bene-
fits Administration field office in San Antonio, Texas, in £in 
amount not to exceed $2,256,000. 
(6) Lease of a satellite outpatient clinic in Toledo, Ohio, 
in an amount not to exceed $2,223,000. 
SEC. 203. AUTHORIZATION OF APPROPRIATIONS. 
(a) IN GENERAL.—^There are authorized to be appropriated to 
the Secretary of Veterans Affairs for fiscal year 1997 and fiscal 
year 1998— 
(1) for the Construction, Major Projects, account, a total 
of $358,150,000 for the projects authorized in section 201; and 
(2) for the Medical Care account, a total of $12,236,000 
for the leases authorized in section 202. 
(b) LIMITATION.—^The projects authorized in section 201 may 
only be carried out using— 
(1) funds appropriated for fiscal year 1997 or fiscal year 
1998 consistent with the authorization of appropriations in 
subsection (a); 
(2) funds appropriated for Construction, Major Projects for 
a fiscal year before fiscal year 1997 that remain available 
for obligation; and 
(3) funds appropriated for Construction, Major Projects for 
fiscal year 1997 or fiscal year 1998 for a category of activity 
not specific to a project. 
110 STAT. 3188 
PUBLIC LAW 104-262—OCT. 9, 1996 
SEC. 204. STRATEGIC PLANNING. 
Section 8107 is amended— 
(1) by redesignating subsection (b) as subsection (c); 
(2) by striking out subsection (a) and inserting in lieu 
thereof the following new subsections: 
Reports. 
"(a) In order to promote effective planning for the efficient 
provision of care to eligible veterans, the Secretary, based on the 
analysis and recommendations of the Under Secretary for Health, 
shall submit to each committee an annual report regarding long-
range health planning of the Department. The report shall be 
submitted each year not later than the date on which the budget 
for the next fiscal year is submitted to the Congress under section 
1105 of title 31. 
"(b) Each report under subsection (a) shall include the following: 
"(1) A five-year strategic plan for the provision of care 
under chapter 17 of this title to eligible veterans through coordi-
nated networks of medical facilities operating within prescribed 
geographic service-delivery areas, such plan to include provision 
of services for the specialized treatment and rehabilitative 
needs of disabled veterans (including veterans with spinal cord 
dysfunction, 
blindness, amputations, and 
mental 
illness) 
through distinct programs or facilities of the Department dedi-
cated to the specialized needs of those veterans. 
"(2) A description of how planning for the networks will 
be coordinated. 
"(3) A profile regarding each such network of medical facili-
ties which identifies— 
"(A) the mission of each existing or proposed medical 
facility in the network; 
"(B) any planned change in the mission for any such 
facility and the rationale for such planned change; 
"(C) the population of veterans to be served by the 
network and anticipated changes over a five-year period 
and a ten-year period, respectively, in that population and 
in the health-care needs of that population; 
"(D) information relevant to assessing progress toward 
the goal of achieving relative equivalency in the level of 
resources per patient distributed to each network, such 
information to include the plans for £ind progress toward 
lowering the cost of care-delivery in the network (by megins 
such as changes in the mix in the network of physicians, 
nurses, physician assistants, and advance practice nurses); 
"(E) the capacity of non-Federal facilities in the net-
work to provide acute, long-term, and specialized treatment 
and rehabilitative services (described in section 7305 of 
this title), and determinations regarding the extent to 
which services to be provided in each service-delivery area 
and each facility in such area should be provided directly 
through facilities of the Department or through contract 
or other arrangements, including arrangements authorized 
under sections 8111 and 8153 of this title; and 
"(F) a five-year plan for construction, replacement, or 
alteration projects in support of the approved mission of 
each facility in the network and a description of how those 
projects will improve access to care, or quality of care, 
for patients served in the network. 
"(4) A status report for each facility on progress toward— 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3189 
"(A) instituting planned mission changes identified 
under paragraph (3XB); 
"(B) implementing principles of managed care of 
eligible veterans; and 
"(C) developing and instituting cost-effective alter-
natives to provision of institutional care."; and 
(3) by adding at the end the following new subsection: 
"(d)(1) The Secretary shall submit to each committee, not later Reports, 
than January 31 of each year, a report showing the current prior-
ities of the Department for proposed major medical construction 
projects. Each such report shall identify the 20 projects, from within 
all the projects in the Department's inventory of proposed projects, 
that have the highest priority and, for those 20 projects, the relative 
priority and rank scoring of each such project and the projected 
cost of such project (including the projected operating costs, includ-
ing both recurring and nonrecurring costs). The 20 projects shall 
be compiled, and their relative rankings shall be shown, by category 
of project (including the categories of ambulatory care projects, 
nursing home care projects, and such other categories as the Sec-
retary determines). 
"(2) The Secretary shall include in each report, for each project 
listed, a description of the specific factors that account for the 
relative ranking of that project in relation to other projects within 
the same category. 
"(3) In a case in which the relative ranking of a proposed 
project has changed since the last report under this subsection 
was submitted, the Secretary shall also include in the report a 
description of the reasons for the change in the ranking, including 
an explanation of any change in the scoring of the project under 
the Department's scoring system for proposed major medical 
construction projects.". 
SEC. 205. REVISION TO PROSPECTUS REQUIREMENTS. 
(a) ADDITIONAL INFORMATION.—Section 8104(b) is amended— 
(1) by striking out the matter preceding paragraph (1) 
and inserting in lieu thereof the following: 
"(b) Whenever the President or the Secretary submit to the 
Congress a request for the funding of a major medical facility 
project (as defined in subsection (a)(3XA)) or a major medical facility 
lease (as defined in subsection (a)(3)(B)), the Secretary shall submit 
to each committee, on the same day, a prospectus of the proposed 
medical facility. Any such prospectus shall include the following:"; 
(2) in paragraph (1)— 
(A) by striking out "a detailed" and inserting in lieu 
thereof "A detailed"; and 
(B) by striking out the semicolon at the end and insert-
ing in lieu thereof a period; 
(3) in paragraph (2)-— 
(A) by striking out "an estimate" and inserting in lieu 
thereof "An estimate"; and 
(B) by striking out "; and" and inserting in lieu thereof 
a period; 
(4) in paragraph (3), by striking out "an estimate" and 
inserting in lieu thereof "An estimate"; and 
(5) by adding at the end the following new paragraphs: 
"(4) Demographic data applicable to such facility, including 
information on projected changes in the population of veterans 
110 STAT. 3190 
PUBLIC LAW 104-262—OCT. 9, 1996 
to be served by the facility over a five-year period and a 
ten-year period. 
"(5) Current and projected workload and utilization data 
regarding the facility. 
"(6) Current and projected operating costs of the facility, 
including both recurring and non-recurring costs. 
"(7) The priority score assigned to the project or lease 
under the Department's prioritization methodology and, if the 
project or lease is being proposed for funding before a project 
or lease with a higher score, a specific explanation of the 
factors other than the priority score that were considered and 
the basis on which the project or lease is proposed for funding 
ahead of projects or leases with higher priority scores. 
"(8) In the case of a prospectus proposing the construction 
of a new or replacement medical facility, a description of each 
alternative to construction of the facility that was considered.". 
38 use 8104 
(b) APPLICABILITY.—The amendments made by subsection (a) 
note. 
shall apply with respect to any prospectus submitted by the Sec-
retary of Veterans Affairs after the date of the enactment of this 
Act. 
SEC. 206. CONSTRUCTION AUTHORIZATION REQUIREMENTS. 
(a) DEFINITION OF MAJOR MEDICAL FACILITY PROJECT.—Para-
graph (3)(A) of section 8104(a) is amended by striking out 
^$3,000,000" and inserting in heu thereof "$4,000,000". 
(b) APPLICABILITY OF CONSTRUCTION AUTHORIZATION REQUIRE-
MENT.—(1) Subsection (b) of section 301 of the Veterans' Medical 
Programs Amendments of 1992 (Pubhc Law 102-405; 106 Stat. 
38 use 8104 
1984) is repealed. 
note. 
(2) The amendments made by subsection (a) of such section 
shall apply with respect to any major medical facility project or 
any major medical facility lease of the Department of Veterans 
Affairs, regardless of when funds are first appropriated for that 
E
roject or lease, except that in the case of a project for which 
mds were first appropriated before October 9, 1992, such amend-
ments shall not apply with respect to amounts appropriated for 
that project for a fiscal year before fiscal year 1998. 
(c) LIMITATION ON OBLIGATIONS FOR ADVANCE PLANNING.—Sec-
tion 8104 is amended by adding at the end the following new 
subsection: 
"(f) The Secretary may not obligate funds in an amount in 
excess of $500,000 from the Advance Planning Fund of the Depart-
ment toward design or development of a major medical facility 
project (as defined in subsection (a)(3)(A)) until— 
Reports. 
"(1) the Secretary submits to the committees a report on 
the proposed obligation; and 
"(2) a period of 30 days has passed after the date on 
which the report is received by the committees.". 
SEC. 207. TERMINOLOGY CHANGES. 
(a) DEFINITION OF "CONSTRUCT".—Section 8101(2) is amended— 
(1) by striking out "working drawings" and inserting in 
lieu thereof "construction documents"; and 
(2) by striking out "preliminary plans" and inserting in 
lieu thereof "design development". 
(b) PARKING FACILITIES.—Section 8109(h)(3)(B) is amended by 
striking out "working drawings" and inserting in lieu thereof 
"construction documents". 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3191 
TITLE III—HEALTH CARE AND 
ADMINISTRATION 
Subtitle A—^Health Care Sharing and 
Administration 
SEC. 301. REVISION OF AUTHORITY TO SHARE MEDICAL FAdLITIES, 
EQUIPMENT, AND INFORMATION. 
(a) STATEMENT OF PURPOSE.—^The text of section 8151 is 
amended to read as follows: 
"It is the purpose of this subchapter to strengthen the medical 
programs at Department facilities and improve the quality of health 
care provided veterans under this title by authorizing the Secretary 
to enter into agreements with health-care providers in order to 
share health-care resources with, and receive health-care resources 
from, such providers while ensuring no diminution of services to 
veterans.". 
(b) DEFINITIONS.—Section 8152 is amended— 
(1) by striking out paragraphs (1), (2), and (3) and inserting 
in lieu thereof the following new paragraphs (1) and (2): 
"(1) The term 'health-care resource' includes hospital care 
and medical services (as those terms are defined in section 
1701 of this title), any other health-care service, and £iny health-
care support or administrative resource. 
"(2) The term *health-care providers' includes health-care 
plans and insurers and any organizations, institutions, or other 
entities or individuals who furnish health-cEire resources."; and 
(2) by redesignating paragraph (4) as paragraph (3). 
(c) AUTHORITY TO SECURE HEALTH-CARE RESOURCES.—Section 
8153 is amended as follows: 
(1) Subsection (a) is amended— 
(A) in paragraph (1)— 
(i) by striking out "certain specialized medical 
resources" and inserting in lieu thereof "health-care 
resources"; 
(ii) by striking out "other medical resources" and 
inserting in lieu thereof "other health-care resources"; 
and 
(iii) by striking out "of—" and all that follows 
through "section 1742(a) of this title" and inserting 
in lieu thereof "of health-care resources between 
Department health-care facilities and any health-care 
provider, or other entity or individual"; 
(B) in paragraph (2), by striking out "only" and all 
that follows through "are not" and inserting in lieu thereof 
"if such resources are not, or would not be,"; and 
(C) by adding at the end the following: 
"(3)(A) If the health-care resource required is a commercial 
service, the use of medical equipment or space, or research, and 
is to be acquired from an institution affiliated with the Department 
in accordance with section 7302 of this title, including medical 
practice groups and other entities associated with affiliated institu-
tions, blood bginks, organ banks, or research centers, the Secretary 
may make arrangements for acquisition of the resource without 
110 STAT. 3192 
PUBLIC LAW 104-262—OCT. 9, 1996 
regard to any law or regulation that would otherwise require the 
use of competitive procedures for acquiring the resource. 
"(BXi) If the health-care resource required is a commercial 
service or the use of medical equipment or space, and is not to 
be acquired from an entity described in subparagraph (A), any 
procurement of the resource may be conducted without regard to 
any law or regulation that would otherwise require the use of 
competitive procedures for procuring the resource, but only if the 
procurement is conducted in accordance with the simplified proce-
dures prescribed pursuant to clause (ii). 
"(ii) The Secretary, in consultation with the Administrator for 
Federal Procurement Policy, may prescribe simplified procedures 
for the procurement of health-care resources under this subpara-
graph. The Secretary shall publish such procedures for public com-
ment in accordance with section 22 of the Office of Federal Procure-
ment Policy Act (41 U.S.C. 418b). Such procedures shall permit 
all responsible sources to submit a bid, proposal, or quotation (as 
appropriate) for the resources to be procured and provide for the 
consiaeration by the Department of bids, proposals, or quotations 
so submitted. 
"(iii) Pending publication of the procedures under clause (ii), 
the Secretary shall (except as provided under subparagraph (A)) 
procure health-care resources referred to in clause (i) in accordance 
with all procurement laws and regulations. 
"(C) Any procurement of health-care resources other than those 
covered by subparagraph (A) or (B) shall be conducted in accordance 
with all procurement laws and regulations. 
"(D) For any procurement to be conducted on a sole source 
basis other than a procurement covered by subparagraph (A), a 
written justification shall be prepared that includes the information 
and is approved at the levels prescribed in section 303(f) of the 
Federal Property and Administrative Services Act of 1949 (41 U.S.C. 
253(f)). 
"(E) As used in this paragraph, the term 'commercial service' 
means a service that is offered and sold competitively in the 
commercial marketplace, is performed under standard commercial 
terms and conditions, and is procured using firm-fixed price con-
tracts.". 
(2) Subsection (b) is amended by striking out "reciprocal 
reimbursement" in the first sentence and all that follows 
through the period at the end of that sentence and inserting 
in lieu thereof "payment to the Department in accordance with 
procedures that provide appropriate flexibility to negotiate pay-
ment which is in the best interest of the Government.". 
(3) Subsection (d) is amended by striking out "preclude 
such pajonent, in accordance with—" and all that follows 
through "to such facility therefor" and inserting in lieu thereof 
"preclude such pajmaent to such facility for such care or serv-
ices". 
(4) Such section is further amended— 
(A) by redesignating subsection (e) as subsection 
(g); and 
(B) by inserting after subsection (d) the following new 
subsections: 
"(e) The Secretary may make an arrangement that authorizes 
the furnishing of services by the Secretary under this section to 
individuals who are not veterans only if the Secretary determines— 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3193 
"(1) that veterans will receive priority under such an 
arrangement; and 
"(2) that such an arrangement— 
"(A) is necessary to maintain an acceptable level and 
quality of service to veterans at that facility; or 
"(B) will result in the improvement of services to 
eligible veterans at that facility. 
"(f) Any amount received by the Secretary from a non-Federal 
entity as pa3nnent for services provided by the Secretary during 
a prior fiscal year under an agreement entered into under this 
section may be obligated by the Secretary during the fiscal year 
in which the Secretary receives the payment.". 
(d) CLERICAL AMENDMENTS.—(1) The heading of section 8153 
is amended to read as follows: 
''§ 8153. Sharing of health-care resources'*. 
(2) The item relating to section 8153 in the table of sections 
at the beginning of chapter 81 is amended to read as follows: 
"8153. Sharing of health-care resources.". 
SEC. 302. IMPROVED EFFICIENCY 
IN HEALTH CARE 
RESOURCE 
MANAGEMENT. 
(a) TEMPORARY EXPANSION OF AUTHORITY FOR SHARING AGREE-
MENTS.—Section 201 of the Veterans Health Care Act of 1992 
(Public Law 102-585; 38 U.S.C. 8111 note) is amended— 
(1) by inserting "(a) AUTHORITY.—" before 'The Secretary 
of Veterans Affairs"; and 
(2) by adding at the end thereof the following new sub-
section: 
"(b) USE OF FUNDS.—^Any amount received by the Secretary 
from a non-Federal entity as pajrment for services provided by 
the Secretary during a prior fiscal year under an agreement entered 
into under this section may be obligated by the Secretary during 
the fiscal year in which the Secretary receives the payment.". 
(b) REPEAL OF SUNSET PROVISION.—(1) Section 204 of such 
Act (38 U.S.C. 8111 note) is repealed. 
(2) Any services provided pursuant to agreements entered into 
38 USC 8111 
under section 201 of such Act (38 U.S.C. 8111 note) during the note. 
period beginning on October 1, 1996, and ending on the date of 
the enactment of this Act are hereby ratified. 
(c) COST RECOVERY.—Title II of such Act is further amended 
by adding at the end the following new section: 
"SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS. 
38 USC 8111 
"(a) RIGHT TO RECOVER.—In the case of a primary beneficiary 
(as described in section 201(a)(2)(B)) who has coverage under a 
health-plan contract, as defined in section 1729(i)(l)(A) of title 
38, United States Code, and who is furnished care or services 
by a Department medical facility pursuant to this title, the United 
States shall have the right to recover or collect charges for such 
care or services from such health-plan contract to the extent that 
the beneficiary (or the provider of the care or services) would 
be eligible to receive payment for such care or services from such 
health-plan contract if the care or services had not been furnished 
by a department or agency of the United States. Any funds received 
from such health-plsm contract shall be credited to funds that 
have been allotted to the facility that furnished the care or services. 
110 STAT. 3194 
PUBLIC LAW 104-262—OCT. 9, 1996 
"(b) ENFORCEMENT.—The right of the United States to recover 
under such a beneficiary's health-plan contract shall be enforceable 
in the same manner as that provided by subsections (a)(3), (b), 
(c)(1), (d), (f), (h), and (i) of section 1729 of title 38, United States 
Code.". 
SEC. 303. PERSONNEL FURNISHING SHARED RESOURCES. 
Section 712(b)(2) is amended— 
(1) by striking out "the sum of—" and inserting in lieu 
thereof "the sum of the following:"; 
(2) by capitalizing the first letter of the first word of each 
of subparagraphs (A) and (B); 
(3) by striking out "; and" at the end of subparagraph 
(A) and inserting in lieu thereof a period; and 
(4) by adding at the end the following new subparagraph: 
"(C) The number of such positions in the Department 
during that fiscal year held by persons involved in provid-
ing health-care resources under section 8111 or 8153 of 
this title or under section 201 of the Veterans Health 
Care Act of 1992 (PubUc Law 102-585; 106 Stat. 4949; 
38 U.S.C. 8111 note).". 
SEC. 304. WATTING PERIOD FOR ADMINISTRATIVE REORGANIZATIONS. 
Section 510(b) is amended— 
(1) in the second sentence, by striking out "a 90-day period 
of continuous session of Congress following the date of the 
submission of the report" and inserting in lieu thereof "a 45-
day period following the date of the submission of the report, 
not less than 30 days of which shall be days during which 
Congress shall have been in continuous session"; and 
(2) in the third sentence, by striking out "such 90-day 
period" and inserting in lieu thereof "giny period of continuity 
of session". 
SEC. 305. REPEAL OF LIMTTATIONS ON CONTRACTS FOR CONVERSION 
OF PERFORMANCE OF ACTIVTTIES OF DEPARTMENT 
HEALTH-CARE 
FACILITIES 
AND 
REVISED 
ANNUAL 
REPORTING REQUIREMENT. 
Subsection (c) of section 8110 is amended to read as follows: 
"(c) The Secretary shall include in the materials submitted 
to Congress each year in support of the budget of the Department 
for the next fiscal year a report on activities and proposals involving 
contracting for performance by contractor personnel of work pre-
viously performed by Department employees. The report shall— 
"(1) identify those specific activities that are currently per-
formed at a Department facility by more than 10 Department 
employees which the Secretary proposes to study for possible 
contracting involving conversion from performance by Depart-
ment employees to performance by employees of a contractor; 
and 
"(2) identify those specific activities that have been con-
tracted for performance by contractor employees during the 
prior fiscal year (shown by location, subject, scope of contracts, 
and savings) and shall describe the effect of such contracts 
on the quality of delivery of health services during such year.". 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3195 
Subtitle B—Care of Women Veterans 
SEC. 321. MAMMOGRAPHY QUAUTY STANDARDS. 
(a) IN GENERAL.—(1) Subchapter II of chapter 73 is amended 
by adding after section 7318 the following new section: 
"§ 7319. Mammography quality standards 
"(a) A mammogram may not be performed at a Department 
facility unless that facility is accredited for that purpose by a 
private nonprofit organization designated by the Secretary. An 
organization designated by the Secretary under this subsection 
shall meet the standards for accrediting bodies established under 
subsection (e) of section 354 of the Public Health Service Act (42 
U.S.C. 263b). 
"(b) The Secretary, in consultation with the Secretary of Hesdth 
and Human Services, shall prescribe quality assurance and quality 
control standards relating to the pertbrmance and interpretation 
of mammograms and use of mammogram equipment and facilities 
of the Department of Veterans Affairs consistent with the require-
ments of section 354(fXl) of the Public Health Service Act. Such 
standards shall be no less stringent than the standards prescribed 
by the Secretary of Health and Human Services under section 
354(f) of the Public Health Service Act. 
"(cXl) The Secretary, to ensure compliance with the standards 
prescribed under subsection (b), shall provide for an annual inspec-
tion of the equipment and facilities used by and in Department 
health care facilities for the performance of mammograms. Such 
inspections shedl be carried out in a manner consistent with the 
inspection of certified facilities by the Secretary of Health and 
Human Services under section 354(g) of the Public Health Service 
Act. 
"(2) The Secretary may not provide for an inspection under 
paragraph (1) to be performed by a State agency. 
^d) The Secretary shall ensure that mammograms performed 
for the Department under contract with any non-Department facility 
or provider conform to the quality standards prescribed by the 
Secretary of Health and Human Services under section 354 of 
the Public Health Service Act. 
"(e) For the purposes of this section, the term 'mammogram' 
has the meaning given such term in paragraph (5) of section 354(a) 
of the Public Health Service Act.". 
(2) The table of sections at the beginning of such chapter 
is amended by inserting after the item relating to section 7318 
the following new item: 
"7319. Mammography quality standards.". 
(b) DEADLINE FOR PRESCRIBING STANDARDS.—^The Secretary of 38 use 7319 
Veterems Affairs shall prescribe standards under subsection (b) ^ote. 
of section 7319 of title 38, United States Code, as added by sub-
section (a), not later than the end of the 120-day period beginning 
on the date of the enactment of this Act. 
(c) IMPLEMENTATION REPORT.—^The Secretary shall submit to 38 use 7319 
the Committees on Veterans' Affairs of the Senate and House note. 
of Representatives a report on the Secretary's implementation of 
section 7319 of title 38, United States Code, as added by subsection 
(a). The report shall be submitted not later than 120 days after 
the date of the enactment of this Act. 
110 STAT. 3196 
PUBLIC LAW 104-262—OCT. 9, 1996 
38 use 1710 
SEC. 322. PATIENT PRIVACY FOR WOMEN PATIENTS. 
™*^' 
(a) IDENTIFICATION OF DEFICIENCIES.—The Secretary of Veter-
ans Affairs shall conduct a survey of each medical center under 
the jurisdiction of the Secretary to identify deficiencies relating 
to patient privacy Eifforded to women patients in the clinical areas 
at each such center which may interfere with appropriate treatment 
of such patients. 
(b) CORRECTION OF DEFICIENCIES.—^The Secretary shall ensure 
that plans and, where appropriate, interim steps to correct the 
deficiencies identified in the survey conducted under subsection 
(a) are developed and are incorporated into the Department's 
construction planning processes and, in cases in which it is cost-
effective to do so, are given a high priority. 
(c) REPORTS TO CONGRESS.—^The Secretary shall compile an 
annual inventory, by medical center, of deficiencies identified under 
subsection (a) and of plans and, where appropriate, interim steps, 
to correct such deficiencies. The Secretary shall submit to the 
Committees on Veterans' Affairs of the Senate and House of Rep-
resentatives, not later than October 1, 1997, and not later than 
October 1 each year thereafter through 1999 a report on such 
deficiencies. The Secretary shall include in such report the inventory 
compiled by the Secretary, the proposed corrective plans, £ind the 
status of such plans. 
38 use 318 note. 
SEC. 323. ASSESSMENT OF USE BY WOMEN VETERANS OF DEPARTMENT 
HEALTH SERVICES. 
(a) REPORTS TO UNDER SECRETARY FOR HEALTH.—^The Center 
for Women Veterans of the Department of Veterans Affairs (estab-
lished under section 509 of Public Law 103-446), in consultation 
with the Advisory Committee on Women Veterans, shall assess 
the use by women veterans of health services through the Depart-
ment of Veterans Affairs, including counseling for sexual trauma 
£ind mental health services. The Center shall submit to the Under 
Secretary for Health of the Department of Veterans Affairs a report 
not later than April 1, 1997, and April 1 of each of the two following 
years, on— 
(1) the extent to which women veterans described in para-
graphs (1) and (2) of section 1710(a) of title 38, United States 
Code, fail to seek, or face barriers in seeking, health services 
through the Department, and the reasons therefor; and 
J 
(2) recommendations, if indicated, for encouraging greater 
use of such services, including (if appropriate) public service 
announcements and other outreach efforts. 
(b) REPORTS TO CONGRESSIONAL COMMITTEES.—^Not later than 
July 1, 1997, and July 1 of each of the two following years, the 
Secretary of Veterans Affairs shall submit to the Committees on 
Veterans' Affairs of the Senate and House of Representatives a 
report containing— 
(1) the most recent report of the Center for Women Veter-
ans under subsection (a); 
(2) the views of the Under Secretary for Health on such 
report's findings and recommendations; and 
(3) a description of the steps being taken by the Secretary 
to remedy any problems described in the report. 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3197 
SEC. 324. REPORTING REQUIREMENTS. 
(a) EXTENSION OF ANNUAL REPORT REQUIREMENT.—Section 
107(a) of the Veterans Health Care Act of 1992 (Public Law 102-
585; 106 Stat. 4947) is amended by striking out "Not later than 
38 USC 1710 
January 1, 1993, January 1, 1994, and January 1, 1995" and note. 
inserting in lieu thereof "Not later than January 1 of 1993 and 
each year thereafter through 1998". 
(b) REPORT ON HEALTH CARE AND RESEARCH.—Section 107(b) 
of such Act is amended— 
(1) in paragraph (2)(A), by inserting "(including information 
on the number of inpatient stays and the number of outpatient 
visits through which such services were provided)" after "facil-
ity"; and 
(2) by adding at the end the following new paragraph: 
"(5) A description of the actions taken by the Secretary 
to foster and encourage the expansion of such research.". 
Subtitle C—Readjustment Counseling and 
Mental Health Care 
SEC. 331. EXPANSION OF ELIGIBILITY FOR READJUSTMENT COUNSEL-
ING AND CERTAIN RELATED COUNSELING SERVICES. 
(a) EXPANSION OF ELIGIBILITY.—Subsection (a) of section 1712A 
is amended to read as follows: 
"(a)(1)(A) Upon the request of any veteran referred to in 
subparagraph (B), the Secretary shall furnish counseling to the 
veteran to assist the veteran in readjusting to civilian life. Such 
counseling may include a general mental and psychological assess-
ment of the veteran to ascertain whether such veteran has mental 
or psychological problems associated with readjustment to civilian 
life. 
"(B) Subparagraph (A) applies to the following veterans: 
"(i) Any veteran who served on active duty— 
"(I) in a theater of combat operations (as determined 
by the Secretary in consultation with the Secretary of 
Defense) during the Vietnam era; or 
"(IT) after May 7, 1975, in an area at a time during 
which hostilities occurred in that area. 
"(ii) Any veteran (other than a veteran covered by clause 
(i)) who served on active duty during the Vietnam era who 
seeks or is furnished such counseling before January 1, 2000. 
"(2)(A) Upon the request of any veteran (other than a veteran 
covered by paragraph (1)) who served in the active military, naval, 
or air service in a theater of combat operations (as so determined) 
during a period of war, or in any other area during a period 
in which hostilities (as defined in subparagraph (B)) occurred in 
such area, the Secretary may furnish counseling to the veteran 
to assist the veteran in readjusting to civilian life. 
"(B) For the purposes of subparagraph (A), the term 'hostilities' 
means an armed conflict in which the members of the Armed 
Forces are subjected to danger comparable to the danger to which 
members of the Armed Forces have been subjected in combat with 
enemy armed forces during a period of war, as determined by 
the Secretary in consultation with the Secretary of Defense.". 
110 STAT. 3198 
PUBLIC LAW 104-262—OCT. 9, 1996 
(b) REPEAL OF REFERRAL PROVISIONS.—Subsection (c) of such 
section is repealed. 
SEC. 332. REPORTS RELATING TO VET CENTERS. 
(a) REPORT ON COLLOCATION OF VET CENTERS AND DEPARTMENT 
OUTPATIENT CLINICS.—(1) Not later than six months after the date 
of the enactment of this Act, the Secretary of Veterans Affairs 
shall submit to the Committees on Veterans' Affairs of the Senate 
and House of Representatives a report on the feasibility and desir-
ability of providing for the collocation of Vet Centers and outpatient 
clinics (including rural mobile clinics) of the Department of Veterans 
Affairs as current leases for such centers and clinics expire. 
(2) The report shall include an assessment of the following: 
(A) The results of any collocation of Vet Centers and out-
patient clinics carried out by the Secretary before the date 
of the enactment of this Act, including the effects of such 
collocation on the quality of care provided at such centers 
and clinics. 
(B) The effect of such collocation on the capacity of such 
centers and clinics to carry out their primary mission. 
(C) The extent to which such collocation will impair the 
operational independence or administrative integrity of such 
centers and clinics. 
(D) The feasibility of combining the services provided by 
such centers and clinics in the course of such collocation. 
(E) The advisability of the collocation of centers and clinics 
of significantly different size. 
(F) The effect of the locations (including urban and rural 
locations) of the centers and clinics on the feasibility and desir-
ability of such collocation. 
(G) The amount of any costs savings to be achieved by 
the Department as a result of such collocation. 
(H) Any other matter that the Secretary considers appro-
priate. 
(b) REPORT ON PROVISION OF LIMITED HEALTH CARE SERVICES 
AT READJUSTMENT COUNSELING CENTERS.—(1) Not later than six 
months after the date of the enactment of this Act, the Secretary 
of Veterans Affairs shall submit to the Committees on Veterans' 
Affairs of the Senate and House of Representatives a report on 
the feasibility and desirability of providing a limited battery of 
health care services (including ambulatory services and health care 
screening services) to veterans at Department of Veterans Affairs 
readjustment counseling centers. 
(2) The report shall include a discussion of the following: 
(A) The effect on the advisability of providing health care 
services at readjustment counseling centers of the geographic 
location of such centers, including the urban location and rural 
location of such centers and the proximity of such centers 
to Department of Veterans Affairs medical facilities. 
(B) The effect on the advisability of providing such services 
at such centers of the type and level of services to be provided, 
and the demographic characteristics (including age, socio-eco-
nomic status, ethnicity, and sex) of veterans likely to be pro-
vided the services. 
(C) The effect of providing such services at such centers 
on the readjustment counseling center program in general and 
on the efficiency and autonomy of the clinical and administra-
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3199 
tive operations of the readjustment counseling centers in 
particular. 
(D) Any other matter that the Secretary considers appro-
priate. 
(c) RULE OF CONSTRUCTION.—^Nothing in this section is intended 
to preclude the Secretary, during the period before the submission 
of the reports under this section, from providing limited health 
care services at Vet Centers. 
SEC. 3
3
3
. 
ADVISORY COMMITTEE ON THE READJUSTMENT OF 
VETERANS. 
(a) IN GENERAL.—(1) Subchapter III of chapter 5 is amended 
by inserting after section 544 the following new section: 
"§ 545. Advisory Committee on the Readjustment of Veterans 
"(a)(1) There is in the Department the Advisory Committee 
on the Readjustment of Veterans (hereafter in this section referred 
to as the 'Committee'). 
"(2) The Committee shall consist of not more than 18 members 
appointed by the Secretary from among individuals who— 
"(A) have demonstrated significant civic or professional 
achievement; and 
"(B) have experience with the provision of veterans benefits 
and services by the Depsirtment. 
"(3) The SecretEiry shall seek to ensure that members appointed 
to the Committee include individuals from a wide variety of 
geographic areas and ethnic backgrounds, individuals from veterans 
service organizations, individuals with combat experience, £md 
women. 
"(4) The Secretary shall determine the terms of service and 
pay and allowances of the members of the Committee, except that 
a term of service may not exceed two years. The Secretary may 
reappoint any member for additional terms of service. 
"(b)(1) The Secreteiry shall, on a regular basis, consult with 
£ind seek the advice of the Committee with respect to the provision 
by the Department of benefits and services to veterans in order 
to assist veterans in the readjustment to civilian life. 
"(2)(A) In providing advice to the Secretary under this sub-
section, the Committee shall— 
"(i) assemble and review information relating to the needs 
of veterans in readjusting to civilian life; 
"(ii) provide information relating to the nature and char-
acter of psychological problems arising from service in the 
• 
Armed Forces; 
"(iii) provide an on-going assessment of the effectiveness 
of the policies, organizational structures, and services of the 
Department in assisting veterans in readjusting to civilian 
life; and 
"(iv) provide on-going advice on the most appropriate means 
of responding to the readjustment needs of veterans in the 
future. 
"(B) In carrjring out its duties under subparagraph (A), the 
Committee shall take into special account the needs of veterans 
who have served in a theater of combat operations. 
"(c)(1) Not later than March 31 of each year, the Committee Reports, 
shall submit to the Secretary a report on the programs and activities 
110 STAT. 3200 
PUBLIC LAW 104-262—OCT. 9, 1996 
of the Department that relate to the readjustment of veterans 
to civiUan life. Each such report shall include— 
"(A) an assessment of the needs of veterans with respect 
to readjustment to civilian life; 
"(B) a review of the programs and activities of the Depart-
ment designed to meet such needs; and 
"(C) such recommendations (including recommendations for 
administrative and legislative action) as the Committee consid-
ers appropriate. 
"(2) Not later than 90 days after the receipt of a report under 
paragraph (1), the Secretary shall transmit to the Committees 
on "^terans* Affairs of the Senate and House of Representatives 
a copy of the report, together with any comments and recommenda-
tions concerning the report that the Secretary considers appropriate. 
"(3) The Committee may also submit to the Secretary such 
other reports and recommendations as the Committee considers 
appropriate. 
"(4) The Secretary shall submit with each annual report submit-
ted to the Congress pursuant to section 529 of this title a summary 
of all reports and recommendations of the Committee submitted 
to the Secretary since the previous annual report of the Secretary 
submitted pursuant to that section. 
"(d)(1) Except as provided in paragraph (2), the provisions 
of the Federal Advisory Committee Act (5 U.S.C. App.) shall apply 
to the activities of the Committee under this section. 
"(2) Section 14 of such Act shall not apply to the Committee.". 
(2) The table of sections at the beginning of chapter 5 is 
amended by inserting after the item relating to section 544 the 
following new item: 
"545. Advisory Committee on the Readjustment of Veterans.". 
38 use 545 note. 
(b) ORIGINAL MEMBERS.—(1) Notwithstanding subsection (a)(2) 
of section 545 of title 38, United States Code (as added by subsection 
(a)), the members of the Advisory Committee on the Readjustment 
of Vietnam and Other War Veterans on the date of the enactment 
of this Act shall be the original members of the advisory committee 
recognized under such section. 
(2) The original members shall so serve until the Secretary 
of Veterans Affairs carries out appointments under such subsection 
(a)(2). The Secretary of Veterans Affairs shall carry out such 
appointments as soon after such date as is practicable. The Sec-
retary may make such appointments from among such original 
members. 
SEC. 334. CENTERS FOR MENTAL ILLNESS RESEARCH, EDUCATION, 
AND CLINICAL ACTIVITIES. 
(a) IN GENERAL.—(1) Subchapter II of chapter 73 is amended 
by adding after section 7319, as added by section 321(a)(1), the 
following new section: 
**§7320. Centers for mental illness research, education, and 
clinical activities 
"(a) The purpose of this section is to provide for the improve-
ment of the provision of health-care services and related counseling 
services to eligible veterans suffering from mental illness (especially 
mental illness related to service-related conditions) through— 
"(1) the conduct of research (including research on improv-
ing mental health service facilities of the Department and 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3201 
on improving the delivery of mental health services by the 
Department); 
"(2) the education and training of health care personnel 
of the Department; and 
"(3) the development of improved models and systems for 
the furnishing of mental health services by the Department. 
"(b)(1) The Secretary shall establish and operate centers for 
mental illness research, education, and clinical activities. Such cen-
ters shall be established and operated by collaborating Department 
facilities as provided in subsection (c)(1). Each such center shall 
function as a center for— 
"(A) research on mental health services; 
"(B) the use by the Department of specific models for 
furnishing services to treat serious mental illness; 
"(C) education and training of health-care professionals 
of the Department; and 
"(D) the development and implementation of innovative 
clinical activities and systems of care with respect to the deliv-
ery of such services by the Department. 
"(2) The Secretary shall, upon the recommendation of the Under 
Secretary for Health, designate the centers under this section. In 
making such designations, the Secretary shall ensure that the cen-
ters designated are located in various geographic regions of the 
United States. The Secretary may designate a center under this 
section only if— 
"(A) the proposal submitted for the designation of the center 
meets the requirements of subsection (c); 
"(B) the Secretary makes the finding described in sub-
section (d); and 
"(C) the peer review panel established under subsection 
(e) makes the determination specified in subsection (e)(3) with 
respect to that proposal. 
"(3) Not more than five centers may be designated under this 
section. 
"(4) The authority of the Secretary to establish and operate 
centers under this section is subject to the appropriation of funds 
for that purpose. 
"(c) A proposal submitted for the designation of a center under 
this section shall— 
"(1) provide for close collaboration in the establishment 
and operation of the center, and for the provision of care and 
the conduct of research and education at the center, by a 
Department facility or facilities in the same geographic area 
which have a mission centered on care of the mentally ill 
and a Department facility in that area which has a mission 
of providing tertiary medical care; 
"(2) provide that no less than 50 percent of the funds 
appropriated for the center for support of clinical care, research, 
and education will be provided to the collaborating facility 
or facilities that have a mission centered on care of the mentally 
ill; and 
"(3) provide for a governance arrangement between the 
collaborating Department facilities which ensures that the cen-
ter will be established and operated in a manner aimed at 
improving the quality of mental health care at the collaborating 
facility or facilities which have a mission centered on care 
of the mentally ill. 
110 STAT. 3202 
PUBLIC LAW 104-262—OCT. 9, 1996 
"(d) The finding referred to in subsection (b)(2)(B) with respect 
to a proposal for designation of a site as a location of a center 
under this section is a finding by the Secretary, upon the rec-
ommendation of the Under Secretary for Health, that the facilities 
submitting the proposal have developed (or may reasonably be 
anticipated to develop) each of the following: 
"(1) An arrangement with an accredited medical school 
that provides education and training in psychiatry and with 
which one or more of the participating Department facilities 
is afiiliated under which medical residents receive education 
and training in psychiatry through regular rotation through 
the participating Department facilities so as to provide such 
residents with training in the diagnosis and treatment of men-
tal illness. 
"(2) An arrangement with an accredited graduate program 
of psychology under which students receive education and train-
ing in clinical, counseling, or professional psychology through 
regular rotation through the participating Department facilities 
so as to provide such students with training in the diagnosis 
and treatment of mental illness. 
"(3) An arrangement under which nursing, socisJ work, 
counseling, or allied health personnel receive training and edu-
cation in mental health care through regular rotation through 
the participating Department facilities. 
"(4) The ability to attract scientists who have demonstrated 
achievement in research— 
"(A) into the evaluation of innovative approaches to 
the design of mental health services; or 
"(B) into the causes, prevention, and treatment of men-
tal illness. 
"(5) The capability to evaluate effectively the activities 
of the center, including activities relating to the evaluation 
of specific efforts to improve the quality and effectiveness of 
mental health services provided by the Department at or 
through individual facilities. 
"(e)(1) In order to provide advice to assist the Secretary and 
the Under Secretary for Health to carry out their responsibilities 
under this section, the official within the central office of the 
Veterans Health Administration responsible for mental health and 
behavioral sciences matters shall establish a peer review panel 
to assess the scientific and clinical merit of proposals that are 
submitted to the Secretary for the designation of centers under 
this section. 
"(2) The panel shall consist of experts in the fields of mental 
health research, education and training, and clinical care. Members 
of the panel shall serve as consultants to the Department. 
"(3) The panel shall review each proposal submitted to the 
panel by the official referred to in paragraph (1) and shall submit 
to that official its views on the relative scientific and clinical merit 
of each such proposal. The panel shall specifically determine with 
respect to each such proposal whether that proposal is among 
those proposals which have met the highest competitive standards 
of scientific and clinical merit. 
"(4) The panel shall not be subject to the Federal Advisory 
Committee Act (5 U.S.C. App.). 
"(f) Clinical and scientific investigation activities at each center 
established under this section— 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3203 
"(1) may compete for the award of funding from amounts 
appropriated for the Department of Veterans Affairs medical 
and prosthetics research account; and 
"(2) shall receive priority in the award of funding from 
such account insofar as funds are awarded to projects and 
activities relating to mental illness. 
"(g) The Under Secretary for Health shall ensure that at least 
three centers designated under this section emphasize research 
into means of improving the quality of care for veterans suffering 
from mental illness through the development of community-based 
alternatives to institutional treatment for such illness. 
"(h) The Under Secretary for Health shall ensure that informa-
tion produced by the research, education and training, and clinical 
activities of centers established under this section that may be 
useful for other activities of the Veterans Health Administration 
is disseminated throughout the Veterans Health Administration. 
Such dissemination shall be made through publications, through 
programs of continuing medical and related education provided 
through regional medical education centers under subchapter VI 
of chapter 74 of this title, and through other means. Such programs 
of continuing medical education shall receive priority in the award 
of funding. 
"(i) The official within the central office of the Veterans Health 
Administration responsible for mental health and behaviorsd 
sciences matters shall be responsible for supervising the operation 
of the centers established pursuant to this section and shall provide 
for ongoing evEduation of the centers and their compliance with 
the requirements of this section. 
"(j)(l) There are authorized to be appropriated to the Depart- Appropriation 
ment of Veterans Affairs for the basic support of the research authorization. 
and education and training activities of centers established pursu-
ant to this section amounts as follows: 
"(A) $3,125,000 for fiscal year 1998. 
"(B) $6,250,000 for each of fiscal years 1999 through 2001. 
"(2) In addition to funds appropriated for a fiscal year pursuant 
to the authorization of appropriations in paragraph (1), the Under 
Secretary for Health shall allocate to such centers from other funds 
appropriated for that fiscal year generally for the Department of 
Veterans Affairs medical care account and the Department of Veter-
ans Affairs medical and prosthetics research account such amounts 
as the Under Secretary for Health determines appropriate to carry 
out the purposes of this section.". 
(2) The table of sections at the beginning of chapter 73 is 
amended by inserting after the item relating to section 7319, as 
added by section 321(aX2), the following new item: 
"7320. Centers for mental illness research, education, and clinical activities.". 
(b) ANNUAL REPORTS.—Not later than February 1 of each of 38 use 7320 
1999, 2000, 2001, and 2002, the Secretary of Veterans Affairs 
note, 
shall submit to the Committees on Veterans' Affairs of the Senate 
and House of Representatives a report on the status and activities 
during the previous fiscal year of the centers for mental illness 
research, education, and clinical activities established pursuant to 
section 7320 of title 38, United States Code (as added by subsection 
(a)). Each such report shall include the following: 
(1) A description of the activities carried out at each center 
and the funding provided for such activities. 
29-194 O - 96 - 5: QL 3 Part 5 
110 STAT. 3204 
PUBLIC LAW 104-262—OCT. 9, 1996 
(2) A description of the advances made at each of the 
participating faciUties of the center in research, education and 
training, and chnical activities relating to mental illness in 
veterans. 
(3) A description of the actions taken by the Under Sec-
retary for Health pursuant to subsection (h) of that section 
(as so added) to disseminate information derived from such 
activities throughout the Veterans Health Administration. 
(4) The Secretar^s evaluations of the effectiveness of the 
centers in fulfilling the purposes of the centers. 
38 use 7320 
(c) IMPLEMENTATION.—^The Secretary of Veterans Affairs shall 
note. 
designate at least one center under section 7320 of title 38, United 
States Code, not later than January 1, 1998. 
SEC. 335. COMMITTEE ON CARE OF SEVERELY CHRONICALLY 
MENTALLY ILL VETERANS. 
(a) ESTABLISHMENT.—Subchapter II of chapter 73 is amended 
by adding after section 7320, as added by section 334(a)(1), the 
following new section: 
*
*
§ 7321. Committee on Care of Severely Chronically Mentally 
HI Veterans 
"(a) The Secretary, acting through the Under Secretary for 
Health, shall establish in the Veterans Health Administration a 
Committee on Care of Severely Chronically Mentally 111 Veterans. 
The Under Secretary shall appoint employees of the Department 
with expertise in the care of the chronically mentally ill to serve 
on the committee. 
"(b) The committee shall assess, and carry out a continuing 
assessment of, the capability of the Veterans Health Administration 
to meet effectively the treatment and rehabilitation needs of men-
tally ill veterans whose mental illness is severe and chronic and 
who are eligible for health care furnished by the Department, 
including the needs of such vetergins who are women. In carrying 
out that responsibility, the committee shall— 
"(1) evaluate the care provided to such veterans through 
the Veterans Health Administration; 
"(2) identify systemwide problems in caring for such veter-
ans in facilities of the Veterans Health Administration; 
"(3) identify specific facilities within the Veterans Health 
Administration at which program enrichment is needed to 
improve treatment and rehabilitation of such veterans; and 
"(4) identify model programs which the committee considers 
to have been successful in the treatment and rehabilitation 
of such veterans and which should be implemented more widely 
in or through facilities of the Veterans Health Administration. 
"(c) The committee shall— 
"(1) advise the Under Secretary regarding the development 
of policies for the care and rehabilitation of severely chronically 
mentally ill veterans; and 
"(2) make recommendations to the Under Secretary— 
"(A) for improving programs of care of such veterans 
at specific facilities and throughout the Veterans Health 
Administration; 
"(B) for establishing special programs of education and 
training relevant to the care of such veterans for employees 
of the Veterans Health Administration; 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3205 
"(C) regarding research needs and priorities relevant 
to the care of such veterans; and 
"(D) regarding the appropriate allocation of resources 
for all such activities. 
"(d)(1) Not later than April 1, 1997, the Secretary shall submit 
to the Committees on Veterans' Affairs of the Senate and House 
of Representatives a report on the implementation of this section. 
The report shall include the following: 
"(A) A list of the members of the committee. 
"(B) The assessment of the Under Secretary for Health, 
after review of the initial findings of the committee, regarding 
the capability of the Veterans Health Administration, on a 
systemwide and facility-by-facility basis, to meet effectively the 
treatment and rehabilitation needs of severely chronically men-
tally ill veterans who are eligible for Department care. 
"(C) The plans of the committee for further assessments. 
"(D) The findings and recommendations made by the 
committee to the Under Secretary for Health and the views 
of the Under Secretary on such findings and recommendations. 
"(E) A description of the steps taken, plans made (and 
a timetable for their execution), and resources to be applied 
toward improving the capability of the Veterans Heedth 
Administration to meet effectively the treatment and rehabilita-
tion needs of severely chronically mentally ill veterans who 
are eligible for Department care. 
"(2) Not later than February 1, 1998, and February 1 of each Reports, 
of the three following years, the Secretary shall submit to the 
Committees on Veterans' Affairs of the Senate and House of Rep-
resentatives a report containing information updating the reports 
submitted under this subsection before the submission of such 
report.". 
(b) CLERICAL AMENDMENT.—^The table of sections at the begin-
ning of chapter 73 is amended by inserting after the item relating 
to section 7320, as added by section 334(a)(2), the following new 
item: 
"7321. Committee on Care of Severely Chronically Mentally 1
1
1 Veterans.". 
Subtitle D—Other Provisions 
SEC. 341. HOSPICE CARE STUDY. 
38 USC 1710 
(a) STUDY REQUIRED.—^The Secretary of Veterans Affairs shall 
^^^' 
conduct a research study to determine the desirability of the Sec-
retary furnishing hospice care to terminally ill veterans and to 
evaluate the most cost-effective and efficient way to do so. The 
Secretary shall carry out the study using resources and personnel 
of the Department. 
(b) CONDUCT OF STUDY.—^In carrjdng out the study required 
by subsection (a), the Secretary shall— 
(1) evaluate the programs, and the program models, 
through which the Secretary furnishes hospice care services 
within or through facilities of the Department of Veterans 
Affairs and the programs and program models through which 
non-Depgutment facilities provide such services; 
(2) assess the satisfaction of patients, and family members 
of patients, in each of the program models covered by paragraph 
. 
(1); 
110 STAT. 3206 
PUBLIC LAW 104-262—OCT. 9, 1996 
(3) compare the costs (or reinge of costs) of providing care 
through each of the program models covered by paragraph 
(l);and 
(4) identify any barriers to providing, procuring, or coordi-
nating hospice services through any of the program models 
covered by paragraph (1), 
(c) PROGRAM MODELS.—^For purposes of subsection (b)(1), the 
Secretary shall evaluate a variety of tjrpes of models for delivery 
of hospice care, including the following: 
(1) Direct furnishing of full hospice care by the Secretary. 
(2) Direct furnishing of some hospice services by the 
Secretary. 
(3) Contracting by the Secretary for the furnishing of hos-
pice care, with a commitment that the Secretary will provide 
any further required hospital care for the patient. 
(4) Contracting for adl required care to be furnished outside 
the Department. 
(5) Referral of the patient for hospice care without a 
contract. 
(d) REPORT.—^Not later than April 1, 1998, the Secretary shall 
submit to the Committees on Veterans' Affairs of the Senate and 
House of Representatives a report on the research study. The report 
shall set forth the Secretary's findings and recommendations. The 
Secretary shall include in the report information on the extent 
to which the Secretary advises veterans concerning their eligibility 
for hospice care and information on the number of veterans (as 
of the time of the report) who are in each model of hospice care 
described in subsection (c) and the average cost per patient of 
hospice care for each such model. 
SEC. 342. PAYMENT TO STATES OF PER DIEM FOR VETERANS 
RECEIVING ADULT DAY HEALTH CARE. 
(a) PAYMENT OF PER DIEM FOR VETERANS RECEIVING ADULT 
DAY CARE.—Section 1741 is amended— 
(1) by inserting "(1)" after "(a)"; 
(2) by redesignating paragraphs (1) and (2) as subpara-
graphs (A) and (B), respectively; and 
(3) by adding at the end the following new paragraph 
(2): 
"(2) The Secretary may pay each State per diem at a rate 
determined by the Secretary for each veteran receiving adult day 
health care in a State home, if such veteran is eligible for such 
care under laws administered by the Secretary.". 
(b) ASSISTANCE TO STATES FOR CONSTRUCTION OF ADULT DAY 
CARE FACILITIES.—(1) Section 8131(3) is amended by inserting 
"adult day health," before "or hospital care". 
(2) Section 8132 is amended by inserting "adult day health," 
before "or hospital care". 
(3) Section 8135(b) is amended— 
(A) in paragraph (2)(C), by inserting "or adult day health 
care facilities" after "domiciliary beds"; and 
(B) in paragraph (3)(A), by inserting "or construction (other 
than new construction) of adult day health care buildings" 
before the semicolon. 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3207 
SEC. 343. RESEARCH CORPORATIONS. 
(a) RENEWAL OF AUTHORITY.—Section 7368 is amended by strik-
ing out "December 31, 1992" and inserting in lieu thereof "December 
31, 2000". 
(b) CLARIFICATION OF TAX-EXEMPT STATUS.—Sections 7361(b) 
and 7363(c) are amended by striking out "section 501(c)(3) of. 
(c) PERIODIC AUDITS.—Subsection (b) of section 7366 is amended 
by striking out 'The corporation" in the second sentence and all 
that follows through "sheJl include that report" and inserting in 
lieu thereof the following: "A corporation with revenues in excess 
of $300,000 for any year shall obtain an audit of the corporation 
for that year. A corporation with annual revenues between $10,000 
and $300,000 shall obtain an independent audit of the corporation 
at least once every three years. Any audit under the preceding 
sentences shall be performed by an independent auditor. The cor-
poration shall include the most recent such audit". 
(d) COMPLIANCE WITH CONFLICT OF INTEREST LAWS AND REGU-
LATIONS.—Subsection (cX2) of section 7366 is amended by striking 
out "an annual statement signed by the director or employee certify-
ing that the director or" and inserting in lieu thereof "a statement 
signed by the executive director of the corporation certifying that 
each director and". 
(e) REVISED REPORTING REQUIREMENT.—Subsection (d) of sec-
tion 7366 is amended to read as follows: 
"(d) The Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and House of Representatives an annual 
report on the corporations established under this subchapter. The 
report shall set forth the following information: 
"(1) The location of each corporation. 
"(2) The amount received by each corporation during the 
previous year, including— 
"(A) the total amount received; 
"(B) the amount received from governmental entities; 
"(C) the amount received from all other sources; and 
"(D) if the amount received from a source referred 
to in subparagraph (C) exceeded $25,000, information that 
identifies the source. 
"(3) The amount expended by each corporation during the 
year, including— 
"(A) the amount expended for salary for research staff 
and for salary for support staff; 
"(B) the amount expended for direct support of 
research; and 
"(C) if the amount expended with respect to any payee 
exceeded $35,000, information that identifies the payee.". 
SEC. 344. VETERANS HEALTH ADMINISTRATION HEADQUARTERS. 
Section 7306 is amended by adding at the end the following 
new subsection: 
"(f) In organizing the Office and appointing persons to positions 
in the Office, the Under Secretary shall ensure that— 
"(1) the Office is staffed so as to provide the Under 
Secretary, through a designated clinician in the appropriate 
discipline in each instance, with expertise and direct policy 
guidance on— 
"(A) unique programs operated by the Administration 
to provide for the specialized treatment and rehabilitation 
110 STAT. 3208 
PUBLIC LAW 104-262—OCT. 9, 1996 
of disabled veterans (including blind rehabilitation, care 
of spinal cord dysfunction, mental illness, and long-term 
care); and 
"(B) the programs established under section 1712A 
of this title; and 
"(2) with respect to the programs established under section 
1712A of this title, a clinician with appropriate expertise in 
those programs is responsible to the Under Secretary for the 
management of those programs.". 
SEC. 345. DISBURSEMENT AGREEMENTS RELATING TO MEDICAL 
RESIDENTS AND INTERNS. 
Section 7406(c) is amended— 
(1) by striking out "Department hospital" each place it 
appears and inserting in lieu thereof "Department facility fur-
nishing hospital care or medical services"; 
(2) by striking out "participating hospital" in paragraph 
(4)(C) £ind inserting in lieu thereof "participating facility"; and 
(3) by striking out "hospital" both places it appears in 
paragraph (5) and inserting in lieu thereof "facility". 
SEC. 346. AUTHORITY TO SUSPEND SPECIAL PAY AGREEMENTS FOR 
PHYSICIANS AND DENTISTS WHO ENTER RESIDENCY 
TRAINING PROGRAMS. 
Section 7432(b)(2) is amended— 
, 
(1) by inserting "(A)" after "(2)"; and 
(2) by adding at the end the following: 
"(B) The Secretary may suspend a special pay agreement 
entered into under this section in the case of a physician or dentist 
who, having entered into the special pay agreement, enters a resi-
dency training program. Any such suspension shall terminate when 
the physician or dentist completes, withdraws from, or is no longer 
a participant in the program. During the period of such a suspen-
sion, the physician or dentist is not subject to the provisions of 
paragraph (1).". 
SEC. 347. REMUNERATED OUTSIDE PROFESSIONAL ACTIVITIES BY 
VETERANS HEALTH ADMINISTRATION PERSONNEL. 
(a) AUTHORITY.—Subsection (b) of section 7423 is amended— 
(1) by striking out paragraph (1); and 
(2) by redesignating paragraphs (2) through (6) as para-
graphs (1) through (5), respectively. 
(b) CONFORMING AMENDMENT.—Subsection (c) of such section 
is amended in the matter preceding paragraph (1) by striking 
out "subsection (b)(6)" and inserting in lieu thereof "subsection 
(b)(5)". 
SEC. 348. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY, 
MILWAUKEE COUNTY, WISCONSIN. 
(a) MODIFICATION OF REVERSIONARY INTEREST.—^The Secretary 
of Veterans Affairs is authorized to execute such instruments as 
may be necessary to modify the conditions under which the land 
described in subsection (b) will revert to the United States in 
order— 
(1) to permit Milwaukee County, Wisconsin, to grant all 
or part of such land to another party with a condition on 
such grant that the grantee use such land only for civic and 
recreational purposes; and 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3209 
(2) to provide that the conditions under which title to 
all or any part of such land reverts to the United States 
are stated so that any such reversion would occur at the option 
of the United States. 
(b) DESCRIPTION OF LAND.—^The land covered by this section Wisconsin, 
is the tract of 28 acres of land, more or less, conveyed to Milwaukee 
County, Wisconsin, pursuant to the Act entitled "An Act authorizing 
the Administrator of Veterans' Affairs to convey certsdn property 
to Milwaukee County, Wisconsin", approved August 27, 1954 (68 
Stat. 866). 
(c) GENERAL AUTHORITIES.—^The Secretary may carry out this 
section subject to such terms and conditions (including reservations 
of rights for the United States) as the Secretary considers necessary 
to protect the interests of the United States. In carrying out this 
section, the Secretary may eliminate any existing covenant or 
restriction with respect to the tract of land described in subsection 
(b) which the Secretary determines to be no longer necessary to 
protect the interests of the United States. 
SEC. 349. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY, 
CHEYENNE, WYOMING. 
(a) MODIFICATION OF REVERSIONARY INTEREST.—^The Secretary 
of Veterans Affairs is authorized to execute such instruments as 
may be necessary to modify the conditions under which the land 
described in subsection (b) will revert to the United States in 
order to permit the City of Cheyenne, Wyoming, to grant all or 
part of such land to the First Cheyenne Federal Credit Union 
(formerly known as the Cheyenne VAF Federal Credit Union) with 
a condition on such grant that the First Cheyenne Federal Credit 
Union use such land only for the purpose of constructing a building 
to house its operations. 
(b) DESCRIPTION OF LAND.—^The land covered by this section 
is the tract of 27 acres of land, more or less, conveyed to the 
City of Cheyenne, Wyoming, pursuant to the Act entitled "An Act 
authorizing the Administrator of Veterans' Affairs to convey certain 
property to the City of Cheyenne, Wyoming", approved November 
8, 1965 (79 Stat. 1304). 
(c) TERMS OF REVERSIONARY INTEREST.—In carrying out this 
section, the Secretary may cause the statement of the conditions 
under which title to all or any part of the land described in sub-
section (b) reverts to the United States to be revised so that any 
such reversion would occur at the option of the United States. 
(d) GENERAL AUTHORITIES.—^The Secretary may carry out this 
section subject to such terms and conditions (including reservations 
of rights for the United States) as the Secretary considers necessary 
to protect the interests of the United States. In carrying out this 
section, the Secretary may eliminate any existing covenant or 
restriction with respect to the tract of land described in subsection 
(b) which the Secretary determines to be no longer necessary to 
protect the interests of the United States. 
SEC. 350. NAME OF DEPARTMENT OF VETERANS AFFAIRS MEDICAL 
CENTER, JOHNSON CITY, TENNESSEE. 
(a) NAME.—^The Mountain Home Department of Veterans 
Affairs Medical Center in Johnson City, Tennessee, shall after 
the date of the enactment of this Act be known and designated 
as the "James H. Quillen Department of Veterans Affairs Medical 
Center". Any reference to such medical center in any law. 
110 STAT. 3210 
PUBLIC LAW 104-262—OCT. 9, 1996 
regulation, map, document, record, or other paper of the United 
States shall be considered to be a reference to the James H. Quillen 
Department of Veterans Affairs Medical Center. 
(b) EFFECTIVE DATE.—Subsection (a) shall take effect at noon 
on January 3, 1997. 
SEC. 351. REPORT ON HEALTH CARE NEEDS OF VETERANS IN EAST 
CENTRAL FLORTOA. 
(a) REPORT REQUIRED.—Not later than 60 days after the date 
of the enactment of this Act, the Secretary of Veterans Affairs 
shall submit to the Committees on Veterans' Affairs of the Senate 
and House of Representatives a report on the health care needs 
of veterans in east central Florida. In preparing the report, the 
Secretary shall consider the needs of such veterans for psychiatric 
and long-term care. The Secretary shall include in the report the 
Secretary's views, based on the Secretar3r's determination of such 
needs, as to the best means of meeting such needs using the 
amounts appropriated pursuant to the authorization of appropria-
tions in this Act and Public Law 103-452 for projects to meet 
the health care needs of such veterans. The Secretary may, subject 
to the availability of appropriations for such purpose, use an 
independent contractor to assist in the determination of such health 
care needs. 
(b) LIMITATION.—^The Secretary may not obligate any funds, 
other than for design work, for the conversion of the former Orlando 
Naval Training Center Hospital in Orlando, Florida (now under 
the jurisdiction of the Secretary of Veterans Affairs), to a nursing 
home care unit until 45 days after the date on which the report 
required by subsection (a) is submitted. 
SEC. 
352. EVALUATION OF HEALTH STATUS OF SPOUSES AND 
CHILDREN OF PERSIAN GULF WAR VETERANS. 
(a) EXTENSION OF AUTHORITY.—Subsection (b) of section 107 
of the Persian Gulf War Veterans' Benefits Act (title I of Public 
Law 103-446; 108 Stat. 4652; 38 U.S.C. 1117 note) is amended 
by striking out "September 30, 1996" and inserting in lieu thereof 
"December 31, 1998". 
PUBLIC LAW 104-262—OCT. 9, 1996 
110 STAT. 3211 
(b) RATIFICATION OF AcTiONS.^Any diagnostic testing and 
38 use iiiv 
medical examinations undertaken by the Secretary of Veterans note. 
Affairs for the purpose of the study required by subsection (a) 
of such section during the period beginning on October 1, 1996, 
and ending on the date of the enactment of this Act is hereby 
ratified. 
Approved October 9, 1996. 
LEGISLATIVE HISTORY—H.R. 3118 (S. 1359): 
HOUSE REPORTS: No. 104-690 (Comm. on Veterans' Affairs). 
SENATE REPORTS: No. 104-372 accompanying S. 1359 (Comm. on Veterans' Af-
fairs). 
CONGRESSIONAL RECORD, Vol. 142 (1996): 
July 30, considered and passed House. 
Sept. 28, considered and passed Senate, amended. House concurred in Senate 
amendments. 
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 32 (1996): 
Oct. 9, Presidential statement.