[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4425 Engrossed in House (EH)]
103d CONGRESS
2d Session
H. R. 4425
_______________________________________________________________________
AN ACT
To authorize major medical facility construction projects for the
Department of Veterans Affairs for fiscal year 1995, to revise and
improve veterans' health programs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
TITLE I--CONSTRUCTION AUTHORIZATION
SEC. 101. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS AND MAJOR
MEDICAL FACILITY LEASES.
(a) Projects in President's Budget.--(1) Except as provided in
paragraph (2), the Secretary of Veterans Affairs may carry out the
major medical facility projects for the Department of Veterans Affairs,
and may carry out the major medical facility leases for that
Department, for which funds are requested in the budget of the
President for fiscal year 1995.
(2) The Secretary is not authorized to carry out--
(A) the project described in the budget of the President
for fiscal year 1995 for the construction of a research
addition at Huntington, West Virginia; or
(B) the project described in the budget of the President
for fiscal year 1995 for the construction of a research
addition at Portland, Oregon.
(b) Additional Projects.--In addition to the projects authorized in
subsection (a), the Secretary may carry out the following major medical
facility projects, in the amounts specified:
(1) The projects for ambulatory care facilities that are
proposed in the budget for fiscal year 1995 to be financed with
funds from the Health Care Investment Fund.
(2) Construction of a nursing home facility at the
Department of Veterans Affairs Medical Center in Charleston,
South Carolina, $7,300,000.
(3) A lease/purchase of a nursing home facility near Ft.
Myers, Florida, $18,630,000.
(4) Construction of an outpatient care addition at the
Department of Veterans Affairs medical center in Phoenix,
Arizona, in the amount of $50,000,000.
(c) Projects for Which Funds Appropriated.--In addition to the
projects authorized in subsections (a) and (b), the Secretary may carry
out the following major medical facility projects for which funds were
appropriated in the Emergency Supplemental Appropriations Act of 1994
(Public Law 103-211) in the amounts specified:
(1) Construction of an ambulatory care/support services
facility at the Department of Veterans Affairs Medical Center
in Sepulveda, California, $53,700,000.
(2) Other major medical facility projects required to
repair, restore, or replace earthquake-damaged facilities at
the Department of Veterans Affairs Medical Center in Sepulveda,
California, $50,000,000.
SEC. 102. AUTHORIZATION OF APPROPRIATIONS.
(a) In General.--There is hereby authorized to be appropriated to
the Secretary of Veterans Affairs for fiscal year 1995--
(1) $343,800,000 for the major medical facility projects
authorized in subsections (a) and (b) of section 101; and
(2) $15,800,000 for the major medical facility leases
authorized in section 101(a).
(b) Limitation.--The projects authorized in subsections (a) and (b)
of section 101 may only be carried out using--
(1) funds appropriated for fiscal year 1995 pursuant to the
authorization of appropriations in subsection (a);
(2) funds appropriated for Construction, Major Projects for
a fiscal year before fiscal year 1995 that remain available for
obligation; and
(3) funds appropriated for Construction, Major Projects for
fiscal year 1995 for a category of activity not specific to a
project.
(c) Limitation on Certain Projects.--The projects authorized in
subsection (c) of section 101 may only be carried out using--
(1) funds appropriated, as well as funds transferred by the
President, to the Construction, Major Projects account pursuant
to the Emergency Supplemental Appropriations Act of 1994
(Public Law 103-211);
(2) funds appropriated to the Medical Care account by the
Emergency Supplemental Appropriations Act of 1994 (Public Law
103-211) that are transferred by law to the Construction, Major
Projects account;
(3) funds appropriated to the Construction, Major Projects
account for a fiscal year before fiscal year 1994 that remain
available for obligation; and
(4) funds appropriated to the Construction, Major Projects
account for fiscal year 1994 for a category of activity not
specific to a project.
TITLE II--HEALTH CARE PLANNING AND PROGRAMS
SEC. 201. HEALTH CARE FACILITIES MISSIONS.
(a) In General.--The Secretary of Veterans Affairs shall prescribe
a specific, detailed statement of the mission of, and the clinical
programs to be operated at, each health care facility of the
Department, determined based upon a requirement that each such facility
operate within a network of Department facilities in the same
geographic area which, taken together, provide a full range of services
for veterans.
(b) Purposes of Mission Statements.--The mission statements shall
be designed so as to permit--
(1) effective planning;
(2) reduction in duplication of services and programs in
the same geographic area;
(3) realignment of services among facilities within each
network;
(4) improved means of resource distribution; and
(5) more efficient delivery of needed services.
(c) Review of Current Missions.--In preparing the mission
statements under subsection (a), the Secretary shall review the
existing missions and clinical programs at each health care facility of
the Department.
(d) Deadline and Report.--The Secretary, not later than nine months
after the date of the enactment of this Act, shall--
(1) prescribe the mission statements required by subsection
(a); and
(2) submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the
implementation of this section and on the timetable and
projected milestones for implementing actions to enable each
such facility to carry out fully its prescribed missions.
SEC. 202. PILOT PROGRAM FOR NONINSTITUTIONAL ALTERNATIVES TO NURSING
HOME CARE.
(a) Extension of Program.--Subsection (a) of section 1720C of title
38, United States Code, is amended by striking out ``During the four-
year period beginning on October 1, 1990,'' and inserting in lieu
thereof ``During the period through September 30, 1997,''.
(b) Veterans Eligible To Participate in Program.--Such subsection
is further amended by striking out ``care and who--'' and inserting in
lieu thereof ``care. The Secretary shall give priority for
participation in such program to veterans who--''.
(c) Report Deadlines.--Section 201(b) of the Department of Veterans
Affairs Nurse Pay Act of 1990 (Public Law 101-366; 104 Stat. 438) is
amended--
(1) by striking out ``February 1, 1994,'' and inserting in
lieu thereof ``February 1, 1997,''; and
(2) by striking out ``September 30, 1993,'' and inserting
in lieu thereof ``September 30, 1996,''.
TITLE III--MEDICAL FACILITIES ACQUISITION
SEC. 301. REVISION TO PROSPECTUS REQUIREMENTS.
(a) Additional Information.--Section 8104(b) of title 38, United
States Code, is amended--
(1) by striking out ``shall include--'' and inserting in
lieu thereof ``shall include:'';
(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
inserting 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 the project.
``(5) Current and projected workload and utilization data.
``(6) The relationship between the mission of the facility
and the missions and capabilities of other nearby Department
facilities and, as applicable, the availability or lack of
availability of alternative sources of service in the community
and the cost-effectiveness of using such alternative sources.
``(7) Current and projected operating costs of the
facility.
``(8) The raw score assigned to the proposal under the
Department's prioritization methodology and, if the project is
being proposed for funding ahead of a project with a higher
score, a comprehensive explanation of the specific factors on
the basis of which the project is being proposed for funding
ahead of each such higher-scored project.
``(9) A listing of each alternative to construction of the
facility that has been considered.''.
(b) Applicability.--The amendments made by subsection (a) shall
apply with respect to any prospectus submitted by the Secretary of
Veterans Affairs after the date of the enactment of this Act.
SEC. 302. PRIORITIZATION METHODOLOGY.
(a) Review of Methodology.--The Secretary of Veterans Affairs shall
conduct a review of the methodology used by the Department for
establishing the relative priority for major construction projects
under consideration in the Department.
(b) Revision.--Based upon the review under subsection (a), the
Secretary shall revise the prioritization methodology so as to give
additional weight, as determined appropriate by the Secretary taking
into consideration particularly the needs of the aging veteran
population, to projects intended to expand long-term care and
ambulatory care programs.
(c) Report.--Not later than 120 days after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a report
on the actions of the Secretary in carrying out this section.
SEC. 303. SEMIANNUAL COMPILATION OF CONSTRUCTION PRIORITIES.
Section 8107 of title 38, United States Code, is amended by adding
at the end the following new subsection:
``(c)(1) The Secretary shall submit to each committee, not later
than January 31 and July 31 of each year, a report showing the current
priorities 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. 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 Secretary
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. 304. DEFINITION OF MAJOR MEDICAL FACILITY PROJECT.
Subparagraph (A) of section 8104(a)(3) of title 38, United States
Code, is amended by inserting before the period at the end the
following: ``, and, in the case of a project which is principally for
the alteration of a medical facility to provide additional space for
provision of ambulatory care, such term means a project involving a
total expenditure of more than $5,000,000''.
TITLE IV--STATE HOME PROGRAM
SEC. 401. PER DIEM FOR ADULT DAY HEALTH CARE.
(a) In General.--Subsection (a) of section 1741 of title 38, United
States Code, is amended to read as follows:
``(a)(1) The Secretary shall pay to each State a per diem amount
for each veteran receiving domiciliary care, nursing home care,
hospital care, or adult day health care in a State home if the veteran
is eligible to receive that care in a Department facility.
``(2) The per diem rate to be paid under this subsection is as
follows:
``(A) For domiciliary care, $15.11 for each day.
``(B) For nursing home care and hospital care, $35.37 for
each day.
``(C) For adult day health care, $16.28 for each day.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to adult day health care provided in a State home
after September 30, 1994.
SEC. 402. CONSTRUCTION ASSISTANCE PROGRAM.
(a) In General.--Subchapter III of chapter 81 of title 38, United
States Code, is amended as follows:
(1) Section 8131(3) is amended by inserting ``or adult day
health care'' after ``hospital care''.
(2) Section 8132 is amended by inserting ``adult day health
care'' after ``hospital care''.
(3) Section 8135(a)(4) is amended by inserting ``and, in
the case of adult day health care, not more than 25 percent of
the number of patients participating in that program,'' after
``occupancy''.
(4) 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 would
involve expansion, remodeling, or alteration of
existing buildings for the furnishing of adult day
health care'' after ``buildings''.
(5) Section 8136 is amended by inserting ``adult day health
care'' after ``hospital care''.
(6) The heading of such subchapter is amended to read as
follows:
``SUBCHAPTER III--STATE HOME FACILITIES FOR FURNISHING DOMICILIARY
CARE, NURSING HOME CARE, ADULT DAY HEALTH CARE, AND HOSPITAL CARE''.
(b) Clerical Amendment.--The item relating to subchapter III in the
table of sections at the beginning of such chapter is amended to read
as follows:
``subchapter iii--state home facilities for furnishing domiciliary
care, nursing home care, adult day health care, and hospital care''.
(c) Effective Date.--The amendments made by subsection (a) shall
apply with respect to grants made to States using funds appropriated
after the date of the enactment of this Act.
TITLE V--MISCELLANEOUS
SEC. 501. DEPARTMENT OF VETERANS AFFAIRS RESEARCH ADVISORY COMMITTEES.
(a) Statutory Basis for Research Advisory Committees.--Chapter 5 of
title 38, United States Code, is amended by adding at the end of
subchapter III the following new section:
``Sec. 544. Veterans research advisory committees
``(a) Congress declares that each of the veterans research advisory
committees specified in subsection (c) (previously established by the
Secretary in carrying out the duties of the Secretary under section
7303 of this title) has a continuing, ongoing function that is
integrally related to the successful completion by the Department of
its statutory duties. Each such committee shall, for all purposes,
operate as though such committee had been established by, and chartered
pursuant to, law. The objectives and scope of the activities of each
such committee and the duties for which the committee is responsible,
as specified by the Secretary as of March 1, 1993, shall be those in
effect as of that date.
``(b) The Secretary may not terminate a veterans' research advisory
committee specified in subsection (c) unless the Secretary finds that
the committee is no longer needed. Not less than 120 days before
terminating such a committee, the Secretary shall submit to the
congressional veterans' affairs committees a report on the proposed
termination. The report shall include an explanation of (1) the basis
for the Secretary's determination that such committee is no longer
needed, and (2) the manner in which the Secretary will carry out the
Secretary's responsibilities under section 7303 of this title in the
absence of the committee.
``(c) For purposes of this section, each of the following
committees and boards, as established by the Secretary as of March 1,
1993, shall be considered to be a veterans' research advisory
committee:
``(1) The Career Development Committee.
``(2) The Department of Veterans Affairs Cooperative
Studies Evaluation Committee.
``(3) The Merit Review Board for Basic Sciences Programs.
``(4) The Merit Review Board for Cardiovascular Programs.
``(5) The Merit Review Board for Clinical Pharmacology,
Alcoholism, and Drug Dependence Programs.
``(6) The Merit Review Board for Endocrinology Programs.
``(7) The Merit Review Board for Gastroenterology Programs.
``(8) The Merit Review Board for Hematology Programs.
``(9) The Merit Review Board for Immunology Programs.
``(10) The Merit Review Board for Infectious Diseases
Programs.
``(11) The Merit Review Board for Mental Health and
Behavioral Sciences Programs.
``(12) The Merit Review Board for Nephrology Programs.
``(13) The Merit Review Board for Neurobiology Programs.
``(14) The Merit Review Board for Oncology Programs.
``(15) The Merit Review Board for Respiration Programs.
``(16) The Merit Review Board for Surgery Programs.
``(17) The Scientific Review Evaluation Board for Health
Services Research and Development.
``(18) The Scientific Review Evaluation Board for
Rehabilitation Research and Development.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
543 the following new item:
``544. Veterans research advisory committees.''.
SEC. 502. CHILD CARE SERVICES.
(a) Revised Child Care Authority.--Chapter 81 of title 38, United
States Code, is amended by inserting after section 8116 the following
new section:
``Sec. 8117. Child care centers
``(a) The Secretary may provide for the operation of child care
centers at Department facilities. The operation of such centers under
this section shall be carried out to the extent that the Secretary
determines, based on the demand of employees of the Department for the
care involved, that such operation is in the best interest of the
Department and that it is practicable to do so.
``(b)(1) In offering child care services under this section, the
Secretary shall give priority (in the following order) to employees
of--
``(A) the Department;
``(B) other departments and agencies of the Federal
Government, and
``(C) schools affiliated with the Department and
corporations created under section 7361 of this title.
``(2) To the extent that space is available, the Secretary may
provide child care services to members of the public at a child care
center operated under this section if the Secretary determines that to
do so is necessary to assure the financial success of that center.
``(c)(1) The Secretary shall establish reasonable charges for child
care services provided at each child care center operated under this
section. Such charges may be established at different rates for
different centers.
``(2) In establishing charges for child care services provided at a
center, the Secretary--
``(A) shall (except as provided in paragraph (3)) establish
the charges so as to ensure that the sum of all charges for
child care services at that center is sufficient to meet the
staffing expenses of that center; and
``(B) may also consider the expenses of constructing or
acquiring space for the center, the expenses of converting
existing space into the center, and the expenses of equipment
and services furnished to the center under subsection (d)(2).
``(3) The Secretary may establish charges for child care services
provided at a center at rates less than those necessary to ensure that
the sum of all charges for child care services at that center is
sufficient to meet the staffing expenses of that center if the
Secretary determines (with respect to a particular facility of the
Department) that--
``(A) the operation of a child care center at that facility
would help overcome serious recruitment or retention problems;
``(B) adherence to the requirement to establish charges for
child care services at that center at rates sufficient to meet
the staffing expenses of that center would make the operation
of a child care center at that facility unfeasible; and
``(C) there are no other practical alternatives to meeting
the needs of employees at that facility for child care
services.
``(4) Proceeds from charges for child care services shall be
credited to the applicable Department of Veterans Affairs account and
shall be allotted to the facility served by the child care center and
shall remain available until expended.
``(d) In connection with the establishment and operation of a child
care center under this section, the Secretary--
``(1) may construct or alter space in any Department
facility, and may lease space in a non-Department facility for
a term not to exceed 20 years, for use as a child care center;
``(2) may provide, out of operating funds, other items and
services necessary for the operation of the center, including
furniture, office machines and equipment, utility and custodial
services, and other necessary services and amenities;
``(3) shall provide for the participation (directly or
through a parent advisory committee) of parents of children
receiving care in the center in the establishment of policies
to govern the operation of the center and in the oversight of
the implementation of such policies;
``(4) shall require the development and use of a process
for determining the fitness and suitability of prospective
employees of or volunteers at the center; and
``(5) shall require in connection with the operation of the
center compliance with all State and local laws, ordinances,
and regulations relating to health and safety and the operation
of child care centers.
``(e) The Secretary shall prescribe guidelines to carry out this
section.
``(f) For the purpose of this section, the term `parent advisory
committee' means a committee comprised of, and selected by, the parents
of children receiving care in a child care center operated under this
section.''.
(b) Conforming Repeal.--Section 7809 of such title is repealed.
(c) Clerical Amendments.--(1) The table of sections at the
beginning of chapter 81 of such title is amended by inserting after the
item relating to section 8116 the following new item:
``8117. Child care centers.''.
(2) The table of sections at the beginning of chapter 78 of such
title is amended by striking out the item relating to section 7809.
SEC. 503. CONTRACTS FOR UTILITIES, AUDIE L. MURPHY MEMORIAL HOSPITAL.
(a) Authority To Contact.--Subject to subsection (b), the Secretary
of Veterans Affairs may enter into contracts for the provision of
utilities (including steam and chilled water) to the Audie L. Murphy
Memorial Hospital in San Antonio, Texas. Each such contract may--
(1) be for a period not to exceed 35 years;
(2) provide for the construction and operation of a
production facility on or near property under the jurisdiction
of the Secretary;
(3) require capital contributions by the parties involved
for the construction of such a facility, such contribution to
be in the form of cash, equipment, or other in-kind
contribution; and
(4) provide for a predetermined formula to compute the cost
of providing such utilities to the parties for the duration of
the contract.
(b) Funds.--A contract may be entered into under subsection (a)
only to the extent and in the amount provided in advance in
appropriations Acts.
(c) Additional Terms.--The Secretary may include in a contract
under subsection (a) such additional provisions as the Secretary
considers necessary to secure the provision of utilities and to protect
the interests of the United States.
SEC. 504. FACILITIES IN REPUBLIC OF THE PHILIPPINES.
Notwithstanding section 1724 of title 38, United States Code, the
Secretary of Veterans Affairs, during the period from February 28,
1994, through June 1, 1994, may contract with facilities in the
Republic of the Philippines other than the Veterans Memorial Medical
Center to furnish hospital care and medical services to veterans for
nonservice-connected disabilities if such veterans are unable to defray
the expenses of necessary hospital care. When the Secretary determines
it to be most feasible, the Secretary may provide medical services to
such veterans at the Department of Veterans Affairs Outpatient Clinic
at Manila, Republic of the Philippines.
SEC. 505. WAIVER OF CONGRESSIONAL WAITING PERIOD REQUIREMENT FOR A
SPECIFIED ADMINISTRATIVE REORGANIZATION.
(a) Waiver.--The Secretary of Veterans Affairs may undertake the
administrative reorganization described in subsection (b) of this
section without regard to the waiting period requirement of section
510(b) of title 38, United States Code.
(b) Covered Administrative Reorganization.--The administrative
reorganization referred to in subsection (a) of this section is a
reorganization at the Department of Veterans Affairs Medical Center in
Sepulveda, California, necessitated by the January 1994 earthquake
damage at that location, as described in the letters dated April 25,
1994, and the accompanying detailed plan and justification, submitted
by the Secretary of Veterans Affairs to the chairmen of the House and
Senate Committees on Veterans' Affairs pursuant to section 510(b) of
title 38, United States Code.
SEC. 506. TECHNICAL AMENDMENT.
Section 7363(c) of title 38, United States Code, is amended by
striking out ``section 501(c)(3) of''.
Passed the House of Representatives May 23, 1994.
Attest:
Clerk.
103d CONGRESS
2d Session
H. R. 4425
_______________________________________________________________________
AN ACT
To authorize major medical facility construction projects for the
Department of Veterans Affairs for fiscal year 1995, to revise and
improve veterans' health programs, and for other purposes.