[Pages H9217-H9225]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROGRAMS ENHANCEMENT ACT OF
2001

Mr. SMITH of New Jersey. Mr. Speaker, I move to suspend the rules and
pass the bill (H.R. 3447) to amend title 38, United States Code, to
enhance the authority of the Secretary of Veterans Affairs to recruit
and retain qualified nurses for the Veterans Health Administration, to
provide an additional basis for establishing the inability of veterans
to defray expenses of necessary medical care, to enhance certain health
care programs of the Department of Veterans Affairs, and for other
purposes.
The Clerk read as follows:

H.R. 3447

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Department
of Veterans Affairs Health Care Programs Enhancement Act of
2001''.
(b) Table of Contents.--The table of contents for this Act
is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.

TITLE I--ENHANCEMENT OF NURSE RECRUITMENT AND RETENTION AUTHORITIES

Subtitle A--Recruitment Authorities

Sec. 101. Enhancement of employee incentive scholarship program.
Sec. 102. Enhancement of education debt reduction program.
Sec. 103. Report on requests for waivers of pay reductions for
reemployed annuitants to fill nurse positions.

Subtitle B--Retention Authorities

Sec. 121. Additional pay for Saturday tours of duty for additional
health care professionals in the Veterans Health
Administration.
Sec. 122. Unused sick leave included in annuity computation of
registered nurses within the Veterans Health
Administration.
Sec. 123. Evaluation of Department of Veterans Affairs nurse managed
clinics.
Sec. 124. Staffing levels for operations of medical facilities.
Sec. 125. Annual report on use of authorities to enhance retention of
experienced nurses.
Sec. 126. Report on mandatory overtime for nurses and nursing
assistants in Department of Veterans Affairs facilities.

Subtitle C--Other Authorities

Sec. 131. Organizational responsibility of the Director of the Nursing
Service.
Sec. 132. Computation of annuity for part-time service performed by
certain health-care professionals before April 7, 1986.

[[Page H9218]]

Sec. 133. Modification of nurse locality pay authorities.

Subtitle D--National Commission on VA Nursing

Sec. 141. Establishment of Commission.
Sec. 142. Duties of Commission.
Sec. 143. Reports.
Sec. 144. Powers.
Sec. 145. Personnel matters.
Sec. 146. Termination of Commission.

TITLE II--OTHER MATTERS

Sec. 201. Authority for Secretary of Veterans Affairs to provide
service dogs for veterans with certain disabilities.
Sec. 202. Management of health care for certain low-income veterans.
Sec. 203. Maintenance of capacity for specialized treatment and
rehabilitative needs of disabled veterans.
Sec. 204. Program for provision of chiropractic care and services to
veterans.
Sec. 205. Funds for field offices of the Office of Research Compliance
and Assurance.
Sec. 206. Major medical facility construction.
Sec. 207. Sense of Congress on special telephone services for veterans.
Sec. 208. Recodification of bereavement counseling authority and
certain other health-related authorities.
Sec. 209. Extension of expiring collections authorities.
Sec. 210. Personal emergency response system for veterans with service-
connected disabilities.
Sec. 211. One-year extension of eligibility for health care of veterans
who served in Southwest Asia during the Persian Gulf War.

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--ENHANCEMENT OF NURSE RECRUITMENT AND RETENTION AUTHORITIES

Subtitle A--Recruitment Authorities

SEC. 101. ENHANCEMENT OF EMPLOYEE INCENTIVE SCHOLARSHIP
PROGRAM.

(a) Permanent Authority.--(1) Section 7676 is repealed.
(2) The table of sections at the beginning of chapter 76 is
amended by striking the item relating to section 7676.
(b) Minimum Period of Department Employment for
Eligibility.--Section 7672(b) is amended by striking ``2
years'' and inserting ``one year''.
(c) Scholarship Amount.--Subsection (b) of section 7673 is
amended--
(1) in paragraph (1), by striking ``for any 1 year'' and
inserting ``for the equivalent of one year of full-time
coursework''; and
(2) by striking paragraph (2) and inserting the following
new paragraph (2):
``(2) in the case of a participant in the Program who is a
part-time student, shall bear the same ratio to the amount
that would be paid under paragraph (1) if the participant
were a full-time student in the course of education or
training being pursued by the participant as the coursework
carried by the participant to full-time coursework in that
course of education or training.''.
(d) Limitation on Payment.--Subsection (c) of section 7673
is amended to read as follows:
``(c) Limitations on Period of Payment.--(1) The maximum
number of school years for which a scholarship may be paid
under subsection (a) to a participant in the Program shall be
six school years.
``(2) A participant in the Program may not receive a
scholarship under subsection (a) for more than the equivalent
of three years of full-time coursework.''.
(e) Full-Time Coursework.--Section 7673 is further amended
by adding at the end the following new subsection:
``(e) Full-Time Coursework.--For purposes of this section,
full-time coursework shall consist of the following:
``(1) In the case of undergraduate coursework, 30 semester
hours per undergraduate school year.
``(2) In the case of graduate coursework, 18 semester hours
per graduate school year.''.
(f) Annual Adjustment of Maximum Scholarship Amount.--
Section 7631 is amended--
(1) in subsection (a)(1), by striking ``and the maximum
Selected Reserve member stipend amount'' and inserting ``the
maximum Selected Reserve member stipend amount, the maximum
employee incentive scholarship amount,''; and
(2) in subsection (b)--
(A) by redesignating paragraph (4) as paragraph (6); and
(B) by inserting after paragraph (3) the following new
paragraph (4):
``(4) The term `maximum employee incentive scholarship
amount' means the maximum amount of the scholarship payable
to a participant in the Department of Veterans Affairs
Employee Incentive Scholarship Program under subchapter VI of
this chapter, as specified in section 7673(b)(1) of this
title and as previously adjusted (if at all) in accordance
with this section.''.
(g) Technical Amendments.--Section 7631(b) is further
amended by striking ``this subsection'' each place it appears
and inserting ``this section''.

SEC. 102. ENHANCEMENT OF EDUCATION DEBT REDUCTION PROGRAM.

(a) Permanent Authority.--(1) Section 7684 is repealed.
(2) The table of sections at the beginning of chapter 76 is
amended by striking the item relating to section 7684.
(b) Eligible Individuals.--Subsection (a)(1) of section
7682 is amended--
(1) by striking ``under an appointment under section
7402(b) of this title in a position'' and inserting ``in a
position (as determined by the Secretary) providing direct-
patient care services or services incident to direct-patient
care services''; and
(2) by striking ``(as determined by the Secretary)'' and
inserting ``(as so determined)''.
(c) Maximum Debt Reduction Amount.--Section 7683(d)(1) is
amended--
(1) by striking ``for a year''; and
(2) by striking ``exceed--'' and all that follows through
the end of the paragraph and inserting ``exceed $44,000 over
a total of five years of participation in the Program, of
which not more than $10,000 of such payments may be made in
each of the fourth and fifth years of participation in the
Program.''.
(d) Annual Adjustment of Maximum Debt Reduction Payments
Amount.--(1) Section 7631, as amended by section 101(f) of
this Act, is further amended--
(A) in subsection (a)(1), by inserting before the period at
the end of the first sentence the following: ``and the
maximum education debt reduction payments amount''; and
(B) in subsection (b), by inserting after paragraph (4) the
following new paragraph (5):
``(5) The term `maximum education debt reduction payments
amount' means the maximum amount of education debt reduction
payments payable to a participant in the Department of
Veterans Affairs Education Debt Reduction Program under
subchapter VII of this chapter, as specified in section
7683(d)(1) of this title and as previously adjusted (if at
all) in accordance with this section.''.
(2) Notwithstanding section 7631(a)(1) of title 38, United
States Code, as amended by paragraph (1), the Secretary of
Veterans Affairs shall not increase the maximum education
debt reduction payments amount under that section in calendar
year 2002.
(e) Temporary Expansion of Individuals Eligible for
Participation in Program.--(1) Notwithstanding section
7682(c) of title 38, United States Code, the Secretary of
Veterans Affairs may treat a covered individual as being a
recently appointed employee in the Veterans Health
Administration under section 7682(a) of that title for
purposes of eligibility in the Education Debt Reduction
Program if the Secretary determines that the participation of
the individual in the Program under this subsection would
further the purposes of the Program.
(2) For purposes of this subsection, a covered individual
is any individual otherwise described by section 7682(a) of
title 38, United States Code, as in effect on the day before
the date of the enactment of this Act, who--
(A) was appointed as an employee in a position described in
paragraph (1) of that section, as so in effect, between
January 1, 1999, and December 31, 2001; and
(B) is an employee in such position, or in another position
described in paragraph (1) of that section, as so in effect,
at the time of application for treatment as a covered
individual under this subsection.
(3) The Secretary shall make determinations regarding the
exercise of the authority in this subsection on a case-by-
case basis.
(4) The Secretary may not exercise the authority in this
subsection after June 30, 2002. The expiration of the
authority in this subsection shall not affect the treatment
of an individual under this subsection before that date as a
covered individual for purposes of eligibility in the
Education Debt Reduction Program.
(5) In this subsection, the term ``Education Debt Reduction
Program'' means the Department of Veterans Affairs Education
Debt Reduction Program under subchapter VII of chapter 76 of
title 38, United States Code.

SEC. 103. REPORT ON REQUESTS FOR WAIVERS OF PAY REDUCTIONS
FOR REEMPLOYED ANNUITANTS TO FILL NURSE
POSITIONS.

(a) Report.--Not later than March 28 of each of 2002 and
2003, the Secretary of Veterans Affairs shall submit to the
Committees on Veterans' Affairs of the Senate and the House
of Representatives and to the National Commission on VA
Nursing established under subtitle D a report describing each
request of the Secretary, during the fiscal year preceding
such report, to the Director of the Office of Personnel
Management for the following:
(1) A waiver under subsection (i)(1)(A) of section 8344 of
title 5, United States Code, of the provisions of such
section in order to meet requirements of the Department of
Veterans Affairs for appointments to nurse positions in the
Veterans Health Administration.
(2) A waiver under subsection (f)(1)(A) of section 8468 of
title 5, United States Code, of the provisions of such
section in order to meet requirements of the Department for
appointments to such positions.
(3) A grant of authority under subsection (i)(1)(B) of
section 8344 of title 5, United States Code, for the waiver
of the provisions of such section in order to meet
requirements of the Department for appointments to such
positions.

[[Page H9219]]

(4) A grant of authority under subsection (f)(1)(B) of
section 8468 of title 5, United States Code, for the waiver
of the provisions of such section in order to meet
requirements of the Department for appointments to such
positions.
(b) Information on Responses to Requests.--The report under
subsection (a) shall specify for each request covered by the
report--
(1) the response of the Director to such request; and
(2) if such request was granted, whether or not the waiver
or authority, as the case may be, assisted the Secretary in
meeting requirements of the Department for appointments to
nurse positions in the Veterans Health Administration.

Subtitle B--Retention Authorities

SEC. 121. ADDITIONAL PAY FOR SATURDAY TOURS OF DUTY FOR
ADDITIONAL HEALTH CARE PROFESSIONALS IN THE
VETERANS HEALTH ADMINISTRATION.

(a) In General.--Section 7454(b) is amended--
(1) by inserting ``(1)'' after ``(b)''; and
(2) by adding at the end the following new paragraph:
``(2) Health care professionals employed in positions
referred to in paragraph (1) shall be entitled to additional
pay on the same basis as provided for nurses in section
7453(c) of this title.''.
(b) Applicability.--The amendments made by subsection (a)
shall apply with respect to pay periods beginning on or after
the date of the enactment of this Act.

SEC. 122. UNUSED SICK LEAVE INCLUDED IN ANNUITY COMPUTATION
OF REGISTERED NURSES WITHIN THE VETERANS HEALTH
ADMINISTRATION.

(a) Annuity Computation.--Section 8415 of title 5, United
States Code, is amended by adding at the end the following
new subsection:
``(i) In computing an annuity under this subchapter, the
total service of an employee who retires from the position of
a registered nurse with the Veterans Health Administration on
an immediate annuity, or dies while employed in that position
leaving any survivor entitled to an annuity, includes the
days of unused sick leave to the credit of that employee
under a formal leave system, except that such days shall not
be counted in determining average pay or annuity eligibility
under this subchapter.''.
(b) Deposit Not Required.--Section 8422(d) of such title is
amended--
(1) by inserting ``(1)'' before ``Under such regulations'';
and
(2) by adding at the end the following:
``(2) Deposit may not be required for days of unused sick
leave credited under section 8415(i).''.
(c) Effective Date.--The amendments made by this section
shall take effect 60 days after the date of the enactment of
this Act and shall apply to individuals who separate from
service on or after that effective date.

SEC. 123. EVALUATION OF DEPARTMENT OF VETERANS AFFAIRS NURSE
MANAGED CLINICS.

(a) Evaluation.--The Secretary of Veterans Affairs shall
carry out an evaluation of the efficacy of the nurse managed
health care clinics of the Department of Veterans Affairs.
The Secretary shall complete the evaluation not later than 18
months after the date of the enactment of this Act.
(b) Clinics To Be Evaluated.--(1) In carrying out the
evaluation under subsection (a), the Secretary shall consider
nurse managed health care clinics, including primary care
clinics and geriatric care clinics, located in three
different geographic service areas of the Department.
(2) If there are not nurse managed health care clinics
located in three different geographic service areas as of the
commencement of the evaluation, the Secretary shall--
(A) establish nurse managed health care clinics in
additional geographic service areas such that there are nurse
managed health care clinics in three different geographic
service areas for purposes of the evaluation; and
(B) include such clinics, as so established, in the
evaluation.
(c) Matters To Be Evaluated.--In carrying out the
evaluation under subsection (a), the Secretary shall address
the following:
(1) Patient satisfaction.
(2) Provider experiences.
(3) Cost of care.
(4) Access to care, including waiting time for care.
(5) The functional status of patients receiving care.
(6) Any other matters the Secretary considers appropriate.
(d) Report.--Not later than 18 months after the date of the
enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and the House
of Representatives a report on the evaluation carried out
under subsection (a). The report shall address the matters
specified in subsection (c) and include any other
information, and any recommendations, that the Secretary
considers appropriate. The Secretary shall provide a copy of
the report to the National Commission on VA Nursing
established under subtitle D.

SEC. 124. STAFFING LEVELS FOR OPERATIONS OF MEDICAL
FACILITIES.

(a) In General.--Section 8110(a) is amended--
(1) in paragraph (1), by inserting after ``complete care of
patients,'' in the fifth sentence the following: ``and in a
manner consistent with the policies of the Secretary on
overtime,''; and
(2) in paragraph (2)--
(A) by inserting ``, including the staffing required to
maintain such capacities,'' after ``all Department medical
facilities'';
(B) by striking ``and to minimize'' and inserting ``, to
minimize''; and
(C) by inserting before the period the following: ``, and
to ensure that eligible veterans are provided such care and
services in an appropriate manner''.
(b) Nationwide Policy on Staffing.--Paragraph (3) of that
section is amended--
(1) in subparagraph (A), by inserting ``the adequacy of
staff levels for compliance with the policy established under
subparagraph (C),'' after ``regarding''; and
(2) by inserting after subparagraph (B) the following new
subparagraph:
``(C) The Secretary shall, in consultation with the Under
Secretary for Health, establish a nationwide policy on the
staffing of Department medical facilities in order to ensure
that such facilities have adequate staff for the provision to
veterans of appropriate, high-quality care and services. The
policy shall take into account the staffing levels and
mixture of staff skills required for the range of care and
services provided veterans in Department facilities.''.

SEC. 125. ANNUAL REPORT ON USE OF AUTHORITIES TO ENHANCE
RETENTION OF EXPERIENCED NURSES.

(a) Annual Report.--(1) Subchapter II of chapter 73 is
amended by adding at the end the following new section:

``Sec. 7324. Annual report on use of authorities to enhance
retention of experienced nurses

``(a) Annual Report.--Not later than January 31 each year,
the Secretary, acting through the Under Secretary for Health,
shall submit to Congress a report on the use during the
preceding year of authorities for purposes of retaining
experienced nurses in the Veterans Health Administration, as
follows:
``(1) The authorities under chapter 76 of this title.
``(2) The authority under VA Directive 5102.1, relating to
the Department of Veterans Affairs nurse qualification
standard, dated November 10, 1999, or any successor
directive.
``(3) Any other authorities available to the Secretary for
those purposes.
``(b) Report Elements.--Each report under subsection (a)
shall specify for the period covered by such report, for each
Department medical facility and for each geographic service
area of the Department, the following:
``(1) The number of waivers requested under the authority
referred to in subsection (a)(2), and the number of waivers
granted under that authority, to promote to the Nurse II
grade or Nurse III grade under the Nurse Schedule under
section 7404(b)(1) of this title any nurse who has not
completed a baccalaureate degree in nursing in a recognized
school of nursing, set forth by age, race, and years of
experience of the individuals subject to such waiver requests
and waivers, as the case may be.
``(2) The programs carried out to facilitate the use of
nursing education programs by experienced nurses, including
programs for flexible scheduling, scholarships, salary
replacement pay, and on-site classes.''.
(2) The table of sections at the beginning of chapter 73 is
amended by inserting after the item relating to section 7323
the following new item:

``7324. Annual report on use of authorities to enhance retention of
experienced nurses.''.

(b) Initial Report.--The initial report required under
section 7324 of title 38, United States Code, as added by
subsection (a), shall be submitted to the National Commission
on VA Nursing established under subtitle D as well as to
Congress.

SEC. 126. REPORT ON MANDATORY OVERTIME FOR NURSES AND NURSING
ASSISTANTS IN DEPARTMENT OF VETERANS AFFAIRS
FACILITIES.

(a) Report.--Not later than 180 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 the House of Representatives and to the National
Commission on VA Nursing established under subtitle D a
report on the mandatory overtime required of licensed nurses
and nursing assistants providing direct patient care at
Department of Veterans Affairs medical facilities during
2001.
(b) Mandatory Overtime.--For purposes of the report under
subsection (a), mandatory overtime shall consist of any
period in which a nurse or nursing assistant is mandated or
otherwise required, whether directly or indirectly, to work
or be in on-duty status in excess of--
(1) a scheduled workshift or duty period;
(2) 12 hours in any 24-hour period; or
(3) 80 hours in any period of 14 consecutive days.
(c) Elements.--The report under subsection (a) shall
include the following:
(1) A description of the amount of mandatory overtime
described in that subsection at each Department medical
facility during the period covered by the report.
(2) A description of the mechanisms employed by the
Secretary to monitor overtime of the nurses and nursing
assistants referred to in that subsection.
(3) An assessment of the effects of the mandatory overtime
of such nurses and nursing

[[Page H9220]]

assistants on patient care, including any reported
association with medical errors.
(4) Recommendations regarding mechanisms for preventing
mandatory overtime in other than emergency situations by such
nurses and nursing assistants.
(5) Any other matters that the Secretary considers
appropriate.

Subtitle C--Other Authorities

SEC. 131. ORGANIZATIONAL RESPONSIBILITY OF THE DIRECTOR OF
THE NURSING SERVICE.

Section 7306(a)(5) is amended by inserting ``, and report
directly to,'' after ``responsible to''.

SEC. 132. COMPUTATION OF ANNUITY FOR PART-TIME SERVICE
PERFORMED BY CERTAIN HEALTH-CARE PROFESSIONALS
BEFORE APRIL 7, 1986.

Section 7426 is amended by adding at the end the following
new subsection:
``(c) The provisions of subsection (b) shall not apply to
the part-time service before April 7, 1986, of a registered
nurse, physician assistant, or expanded-function dental
auxiliary. In computing the annuity under the applicable
provision of law specified in that subsection of an
individual covered by the preceding sentence, the service
described in that sentence shall be credited as full-time
service.''.

SEC. 133. MODIFICATION OF NURSE LOCALITY PAY AUTHORITIES.

Section 7451 is amended--
(1) in subsection (d)(3)--
(A) in subparagraph (A), by striking ``beginning rates of''
each place it appears;
(B) in subparagraph (B), by striking ``beginning rates of''
the first place it appears; and
(C) in subparagraph (C)(i), by striking ``beginning rates
of'' each place it appears;
(2) in subsection (d)(4)--
(A) by striking ``or at any other time that an adjustment
in rates of pay is scheduled to take place under this
subsection'' in the first sentence; and
(B) by striking the second sentence; and
(3) in subsection (e)(4)--
(A) in subparagraph (A), by striking ``grade in a'';
(B) in subparagraph (B)--
(i) by striking ``grade of a''; and
(ii) by striking ``that grade'' and inserting ``that
position''; and
(C) in subparagraph (D), by striking ``grade of a''.

Subtitle D--National Commission on VA Nursing

SEC. 141. ESTABLISHMENT OF COMMISSION.

(a) Establishment.--There is hereby established in the
Department of Veterans Affairs a commission to be known as
the ``National Commission on VA Nursing'' (hereinafter in
this subtitle referred to as the ``Commission'').
(b) Composition.--The Commission shall be composed of 12
members appointed by the Secretary of Veterans Affairs as
follows:
(1) At least two shall be recognized representatives of
employees (including nurses) of the Department of Veterans
Affairs.
(2) At least one shall be a representative of professional
associations of nurses of the Department or similar
organizations affiliated with the Department's health care
practitioners.
(3) At least one shall be a nurse from a nursing school
affiliated with the Department of Veterans Affairs.
(4) At least two shall be representatives of veterans.
(5) At least one shall be an economist.
(6) The remainder shall be appointed in such manner as the
Secretary considers appropriate.
(c) Chair of Commission.--The Secretary of Veterans Affairs
shall designate one of the members of the Commission to chair
the Commission.
(d) Period of Appointment; Vacancies.--Members shall be
appointed for the life of the Commission. Any vacancy in the
Commission shall be filled in the same manner as the original
appointment.
(e) Initial Organization Requirements.--All appointments to
the Commission shall be made not later than 60 days after the
date of the enactment of this Act. The Commission shall
convene its first meeting not later than 60 days after the
date as of which all members of the Commission have been
appointed.

SEC. 142. DUTIES OF COMMISSION.

(a) Assessment.--The Commission shall--
(1) consider legislative and organizational policy changes
to enhance the recruitment and retention of nurses and other
nursing personnel by the Department of Veterans Affairs; and
(2) assess the future of the nursing profession within the
Department.
(b) Recommendations.--The Commission shall recommend
legislative and organizational policy changes to enhance the
recruitment and retention of nurses and other nursing
personnel in the Department.

SEC. 143. REPORTS.

(a) Commission Report.--The Commission shall, not later
than two years after the date of its first meeting, submit to
Congress and the Secretary of Veterans Affairs a report on
the Commission's findings and recommendations.
(b) Secretary of Veterans Affairs Report.--Not later than
60 days after the date of the Commission's report under
subsection (a), the Secretary shall submit to Congress a
report--
(1) providing the Secretary's views on the Commission's
findings and recommendations; and
(2) explaining what actions, if any, the Secretary intends
to take to implement the recommendations of the Commission
and the Secretary's reasons for doing so.

SEC. 144. POWERS.

(a) Hearings.--The Commission or, at its direction, any
panel or member of the Commission, may, for the purpose of
carrying out the provisions of this subtitle, hold hearings
and take testimony to the extent that the Commission or any
member considers advisable.
(b) Information.--The Commission may secure directly from
any Federal department or agency information that the
Commission considers necessary to enable the Commission to
carry out its responsibilities under this subtitle.

SEC. 145. PERSONNEL MATTERS.

(a) Pay of Members.--Members of the Commission shall serve
without pay by reason of their work on the Commission.
(b) Travel Expenses.--The members of the Commission shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of
business in the performance of services for the Commission.
(c) Staff.--(1) The Secretary may, without regard to the
provisions of title 5, United States Code, governing
appointments in the competitive service, appoint a staff
director and such additional personnel as may be necessary to
enable the Commission to perform its duties.
(2) The Secretary may fix the pay of the staff director and
other personnel appointed under paragraph (1) without regard
to the provisions of chapter 51 and subchapter III of chapter
53 of title 5, United States Code, relating to classification
of positions and General Schedule pay rates, except that the
rate of pay fixed under this paragraph for the staff director
may not exceed the rate payable for level V of the Executive
Schedule under section 5316 of such title and the rate of pay
for other personnel may not exceed the maximum rate payable
for grade GS-15 of the General Schedule.
(d) Detail of Government Employees.--Upon request of the
Secretary, the head of any Federal department or agency may
detail, on a nonreimbursable basis, any personnel of that
department or agency to the Commission to assist it in
carrying out its duties.

SEC. 146. TERMINATION OF COMMISSION.

The Commission shall terminate 90 days after the date of
the submission of its report under section 143(a).

TITLE II--OTHER MATTERS

SEC. 201. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO
PROVIDE SERVICE DOGS FOR VETERANS WITH CERTAIN
DISABILITIES.

(a) Authority.--Section 1714 is amended--
(1) in subsection (b)--
(A) by striking ``seeing-eye or'' the first place it
appears;
(B) by striking ``who are entitled to disability
compensation'' and inserting ``who are enrolled under section
1705 of this title'';
(C) by striking ``, and may pay'' and all that follows
through ``such seeing-eye or guide dogs''; and
(D) by striking ``handicap'' and inserting ``disability'';
and
(2) by adding at the end the following new subsections:
``(c) The Secretary may, in accordance with the priority
specified in section 1705 of this title, provide--
``(1) service dogs trained for the aid of the hearing
impaired to veterans who are hearing impaired and are
enrolled under section 1705 of this title; and
``(2) service dogs trained for the aid of persons with
spinal cord injury or dysfunction or other chronic impairment
that substantially limits mobility to veterans with such
injury, dysfunction, or impairment who are enrolled under
section 1705 of this title.
``(d) In the case of a veteran provided a dog under
subsection (b) or (c), the Secretary may pay travel and
incidental expenses for that veteran under the terms and
conditions set forth in section 111 of this title to and from
the veteran's home for expenses incurred in becoming adjusted
to the dog.''.
(b) Clerical Amendments.--(1) The heading for such section
is amended to read as follows:

``Sec. 1714. Fitting and training in use of prosthetic
appliances; guide dogs; service dogs''.

(2) The item relating to such section in the table of
sections at the beginning of chapter 17 is amended to read as
follows:

``1714. Fitting and training in use of prosthetic appliances; guide
dogs; service dogs.''.

SEC. 202. MANAGEMENT OF HEALTH CARE FOR CERTAIN LOW-INCOME
VETERANS.

(a) Priority of Enrollment in Patient Enrollment System.--
Section 1705(a) is amended by striking paragraph (7) and
inserting the following new paragraphs:
``(7) Veterans described in section 1710(a)(3) of this
title who are eligible for treatment as a low-income family
under section 3(b) of the United States Housing Act of 1937
(42 U.S.C. 1437a(b)) for the area in which such veterans
reside, regardless of whether such veterans are treated as
single person families under paragraph (3)(A) of such section
3(b) or as families under paragraph (3)(B) of such section
3(b).
``(8) Veterans described in section 1710(a)(3) of this
title who are not covered by paragraph (7).''.

[[Page H9221]]

(b) Reduced Copayments for Care.--Subsection (f) of section
1710 is amended--
(1) in paragraph (1), by inserting ``or (4)'' after
``paragraph (2)'';
(2) by redesignating paragraph (4) as paragraph (5); and
(3) by inserting after paragraph (3) the following new
paragraph (4):
``(4) In the case of a veteran covered by this subsection
who is also described by section 1705(a)(7) of this title,
the amount for which the veteran shall be liable to the
United States for hospital care under this subsection shall
be an amount equal to 20 percent of the total amount for
which the veteran would otherwise be liable for such care
under subparagraphs (2)(B) and (3)(A) but for this
paragraph.''.
(c) Effective Date.--The amendments made by this section
shall take effect on October 1, 2002.

SEC. 203. MAINTENANCE OF CAPACITY FOR SPECIALIZED TREATMENT
AND REHABILITATIVE NEEDS OF DISABLED VETERANS.

(a) Maintenance of Capacity on a Geographic Service Area
Basis.--Section 1706(b) is amended--
(1) in paragraph (1)--
(A) in the first sentence, by inserting ``(and each
geographic service area of the Veterans Health
Administration)'' after ``ensure that the Department''; and
(B) in clause (B), by inserting ``(and each geographic
service area of the Veterans Health Administration)'' after
``overall capacity of the Department'';
(2) by redesignating paragraphs (2) and (3) as paragraphs
(5) and (6), respectively; and
(3) by inserting after paragraph (1) the following new
paragraphs;
``(2) For purposes of paragraph (1), the capacity of the
Department (and each geographic service area of the Veterans
Health Administration) to provide for the specialized
treatment and rehabilitative needs of disabled veterans
(including veterans with spinal cord dysfunction, traumatic
brain injury, blindness, prosthetics and sensory aids, and
mental illness) within distinct programs or facilities shall
be measured for seriously mentally ill veterans as follows
(with all such data to be provided by geographic service area
and totaled nationally):
``(A) For mental health intensive community-based care, the
number of discrete intensive care teams constituted to
provide such intensive services to seriously mentally ill
veterans and the number of veterans provided such care.
``(B) For opioid substitution programs, the number of
patients treated annually and the amounts expended.
``(C) For dual-diagnosis patients, the number treated
annually and the amounts expended.
``(D) For substance-use disorder programs--
``(i) the number of beds (whether hospital, nursing home,
or other designated beds) employed and the average bed
occupancy of such beds;
``(ii) the percentage of unique patients admitted directly
to outpatient care during the fiscal year who had two or more
additional visits to specialized outpatient care within 30
days of their first visit, with a comparison from 1996 until
the date of the report;
``(iii) the percentage of unique inpatients with substance-
use disorder diagnoses treated during the fiscal year who had
one or more specialized clinic visits within three days of
their index discharge, with a comparison from 1996 until the
date of the report;
``(iv) the percentage of unique outpatients seen in a
facility or geographic service area during the fiscal year
who had one or more specialized clinic visits, with a
comparison from 1996 until the date of the report; and
``(v) the rate of recidivism of patients at each
specialized clinic in each geographic service area of the
Veterans Health Administration.
``(E) For mental health programs, the number and type of
staff that are available at each facility to provide
specialized mental health treatment, including satellite
clinics, outpatient programs, and community-based outpatient
clinics, with a comparison from 1996 to the date of the
report.
``(F) The number of such clinics providing mental health
care, the number and type of mental health staff at each such
clinic, and the type of mental health programs at each such
clinic.
``(G) The total amounts expended for mental health during
the fiscal year.
``(3) For purposes of paragraph (1), the capacity of the
Department (and each geographic service area of the Veterans
Health Administration) to provide for the specialized
treatment and rehabilitative needs of disabled veterans
within distinct programs or facilities shall be measured for
veterans with spinal cord dysfunction, traumatic brain
injury, blindness, or prosthetics and sensory aids as follows
(with all such data to be provided by geographic service area
and totaled nationally):
``(A) For spinal cord injury and dysfunction specialized
centers and for blind rehabilitation specialized centers, the
number of staffed beds and the number of full-time equivalent
employees assigned to provide care at such centers.
``(B) For prosthetics and sensory aids, the annual amount
expended.
``(C) For traumatic brain injury, the number of patients
treated annually and the amounts expended.
``(4) In carrying out paragraph (1), the Secretary may not
use patient outcome data as a substitute for, or the
equivalent of, compliance with the requirement under that
paragraph for maintenance of capacity.''.
(b) Extension of Annual Report Requirement.--Paragraph (5)
of such section, as so redesignated, is amended--
(1) by inserting ``(A)'' before ``Not later than'';
(2) by striking ``April 1, 1999, April 1, 2000, and April
1, 2001'' and inserting ``April 1 of each year through
2004'';
(3) by adding at the end of subparagraph (A), as designated
by paragraph (1), the following new sentence: ``Each such
report shall include information on recidivism rates
associated with substance-use disorder treatment.''; and
(4) by adding at the end of such paragraph the following
new subparagraphs:
``(B) In preparing each report under subparagraph (A), the
Secretary shall use standardized data and data definitions.
``(C) Each report under subparagraph (A) shall be audited
by the Inspector General of the Department, who shall submit
to Congress a certification as to the accuracy of each such
report.''.

SEC. 204. PROGRAM FOR PROVISION OF CHIROPRACTIC CARE AND
SERVICES TO VETERANS.

(a) Requirement for Program.--Subject to the provisions of
this section, the Secretary of Veterans Affairs shall carry
out a program to provide chiropractic care and services to
veterans through Department of Veterans Affairs medical
centers and clinics.
(b) Eligible Veterans.--Veterans eligible to receive
chiropractic care and services under the program are veterans
who are enrolled in the system of patient enrollment under
section 1705 of title 38, United States Code.
(c) Location of Program.--The program shall be carried out
at sites designated by the Secretary for purposes of the
program. The Secretary shall designate at least one site for
such program in each geographic service area of the Veterans
Health Administration. The sites so designated shall be
medical centers and clinics located in urban areas and in
rural areas.
(d) Care and Services Available.--The chiropractic care and
services available under the program shall include a variety
of chiropractic care and services for neuro-musculoskeletal
conditions, including subluxation complex.
(e) Other Administrative Matters.--(1) The Secretary shall
carry out the program through personal service contracts and
by appointment of licensed chiropractors in Department
medical centers and clinics.
(2) As part of the program, the Secretary shall provide
training and materials relating to chiropractic care and
services to Department health care providers assigned to
primary care teams for the purpose of familiarizing such
providers with the benefits of chiropractic care and
services.
(f) Regulations.--The Secretary shall prescribe regulations
to carry out this section.
(g) Chiropractic Advisory Committee.--(1) The Secretary
shall establish an advisory committee to provide direct
assistance and advice to the Secretary in the development and
implementation of the chiropractic health program.
(2) The membership of the advisory committee shall include
members of the chiropractic care profession and such other
members as the Secretary considers appropriate.
(3) Matters on which the advisory committee shall assist
and advise the Secretary shall include the following:
(A) Protocols governing referral to chiropractors.
(B) Protocols governing direct access to chiropractic care.
(C) Protocols governing scope of practice of chiropractic
practitioners.
(D) Definition of services to be provided.
(E) Such other matters the Secretary determines to be
appropriate.
(4) The advisory committee shall cease to exist on December
31, 2004.

SEC. 205. FUNDS FOR FIELD OFFICES OF THE OFFICE OF RESEARCH
COMPLIANCE AND ASSURANCE.

(a) In General.--Section 7303 is amended by adding at the
end the following new subsection:
``(e) Amounts for the activities of the field offices of
the Office of Research Compliance and Assurance of the
Department shall be derived from amounts appropriated for the
Veterans Health Administration for Medical Care (rather than
from amounts appropriated for the Veterans Health
Administration for Medical and Prosthetic Research).''.
(b) Applicability to Fiscal Year 2002.--In order to carry
out subsection (e) of section 7303 of title 38, United States
Code, as added by subsection (a), for fiscal year 2002, the
Secretary of Veterans Affairs shall transfer such sums as
necessary for that purpose from amounts appropriated for the
Veterans Health Administration for Medical and Prosthetic
Research for fiscal year 2002 to amounts appropriated for the
Veterans Health Administration for Medical Care for that
fiscal year.

SEC. 206. MAJOR MEDICAL FACILITY CONSTRUCTION.

(a) Project Authorized.--The Secretary of Veterans Affairs
may carry out a major medical facility project for the
renovation from electrical fire of the Department of Veterans
Affairs Medical Center, Miami, Florida, in an amount not to
exceed $28,300,000.
(b) Authorization of Appropriations.--There is authorized
to be appropriated to the

[[Page H9222]]

Secretary of Veterans Affairs for the Construction, Major
Projects Account, for fiscal year 2002, $28,300,000 for the
project authorized by subsection (a).
(c) Limitation.--The project authorized by subsection (a)
may only be carried out using--
(1) funds appropriated for fiscal year 2002 pursuant to the
authorization of appropriations in subsection (b);
(2) funds appropriated for Construction, Major Projects,
for a fiscal year before fiscal year 2002 that remain
available for obligation; and
(3) funds appropriated for Construction, Major Projects,
for fiscal year 2002 for a category of activity not specific
to a project.

SEC. 207. SENSE OF CONGRESS ON SPECIAL TELEPHONE SERVICES FOR
VETERANS.

It is the sense of Congress that the Secretary of Veterans
Affairs should conduct an assessment of all special telephone
services for veterans (such as help lines and hotlines) that
are provided by the Department of Veterans Affairs and that
any such assessment, if conducted, should include assessment
of the geographical coverage, availability, utilization,
effectiveness, management, coordination, staffing, and cost
of those services and should include a survey of veterans to
measure their satisfaction with current special telephone
services and the demand for additional services.

SEC. 208. RECODIFICATION OF BEREAVEMENT COUNSELING AUTHORITY
AND CERTAIN OTHER HEALTH-RELATED AUTHORITIES.

(a) Statutory Reorganization.--Subchapter I of chapter 17
is amended--
(1) in section 1701(6)--
(A) by striking subparagraph (B) and the sentence following
that subparagraph;
(B) by striking ``services--'' in the matter preceding
subparagraph (A) and inserting ``services, the following:'';
and
(C) by striking subparagraph (A) and inserting the
following:
``(A) Surgical services.
``(B) Dental services and appliances as described in
sections 1710 and 1712 of this title.
``(C) Optometric and podiatric services.
``(D) Preventive health services.
``(E) In the case of a person otherwise receiving care or
services under this chapter--
``(i) wheelchairs, artificial limbs, trusses, and similar
appliances;
``(ii) special clothing made necessary by the wearing of
prosthetic appliances; and
``(iii) such other supplies or services as the Secretary
determines to be reasonable and necessary.
``(F) Travel and incidental expenses pursuant to section
111 of this title.''; and
(2) in section 1707--
(A) by inserting ``(a)'' at the beginning of the text of
the section; and
(B) by adding at the end the following:
``(b) The Secretary may furnish sensori-neural aids only in
accordance with guidelines prescribed by the Secretary.''.
(b) Consolidation of Provisions Relating to Persons Other
Than Veterans.--Such chapter is further amended by adding at
the end the following new subchapter:

``SUBCHAPTER VIII--HEALTH CARE OF PERSONS OTHER THAN VETERANS

``Sec. 1782. Counseling, training, and mental health services
for immediate family members

``(a) Counseling for Family Members of Veterans Receiving
Service-Connected Treatment.--In the case of a veteran who is
receiving treatment for a service-connected disability
pursuant to paragraph (1) or (2) of section 1710(a) of this
title, the Secretary shall provide to individuals described
in subsection (c) such consultation, professional counseling,
training, and mental health services as are necessary in
connection with that treatment.
``(b) Counseling for Family Members of Veterans Receiving
Non-Service-Connected Treatment.--In the case of a veteran
who is eligible to receive treatment for a non-service-
connected disability under the conditions described in
paragraph (1), (2), or (3) of section 1710(a) of this title,
the Secretary may, in the discretion of the Secretary,
provide to individuals described in subsection (c) such
consultation, professional counseling, training, and mental
health services as are necessary in connection with that
treatment if--
``(1) those services were initiated during the veteran's
hospitalization; and
``(2) the continued provision of those services on an
outpatient basis is essential to permit the discharge of the
veteran from the hospital.
``(c) Eligible Individuals.--Individuals who may be
provided services under this subsection are--
``(1) the members of the immediate family or the legal
guardian of a veteran; or
``(2) the individual in whose household such veteran
certifies an intention to live.
``(d) Travel and Transportation Authorized.--Services
provided under subsections (a) and (b) may include, under the
terms and conditions set forth in section 111 of this title,
travel and incidental expenses of individuals described in
subsection (c) in the case of any of the following:
``(1) A veteran who is receiving care for a service-
connected disability.
``(2) A dependent or survivor receiving care under the last
sentence of section 1783(b) of this title.

``Sec. 1783. Bereavement counseling

``(a) Deaths of Veterans.--In the case of an individual who
was a recipient of services under section 1782 of this title
at the time of the death of the veteran, the Secretary may
provide bereavement counseling to that individual in the case
of a death--
``(1) that was unexpected; or
``(2) that occurred while the veteran was participating in
a hospice program (or a similar program) conducted by the
Secretary.
``(b) Deaths In Active Service.--The Secretary may provide
bereavement counseling to an individual who is a member of
the immediate family of a member of the Armed Forces who dies
in the active military, naval, or air service in the line of
duty and under circumstances not due to the person's own
misconduct.
``(c) Bereavement Counseling Defined.--For purposes of this
section, the term `bereavement counseling' means such
counseling services, for a limited period, as the Secretary
determines to be reasonable and necessary to assist an
individual with the emotional and psychological stress
accompanying the death of another individual.

``Sec. 1784. Humanitarian care

``The Secretary may furnish hospital care or medical
services as a humanitarian service in emergency cases, but
the Secretary shall charge for such care and services at
rates prescribed by the Secretary.''.
(c) Transfer of CHAMPVA Section.--Section 1713 is--
(1) transferred to subchapter VIII of chapter 17 of title
38, United States Code, as added by subsection (b), and
inserted after the subchapter heading;
(2) redesignated as section 1781; and
(3) amended by adding at the end of subsection (b) the
following new sentence: ``A dependent or survivor receiving
care under the preceding sentence shall be eligible for the
same medical services as a veteran, including services under
sections 1782 and 1783 of this title.''.
(d) Repeal of Recodified Authority.--Section 1711 is
amended by striking subsection (b).
(e) Cross Reference Amendments.--Title 38, United States
Code, is further amended as follows:
(1) Section 103(d)(5)(B) is amended by striking ``1713''
and inserting ``1781''.
(2) Sections 1701(5) is amended by striking ``1713(b)'' in
subparagraphs (B) and (C)(i) and inserting ``1781(b)''.
(3) Section 1712A(b) is amended--
(A) in the last sentence of paragraph (1), by striking
``section 1711(b)'' and inserting ``section 1784''; and
(A) in paragraph (2), by striking ``section 1701(6)(B)''
and inserting ``sections 1782 and 1783''.
(4) Section 1729(f) is amended by striking ``section
1711(b)'' and inserting ``section 1784''.
(5) Section 1729A(b) is amended--
(A) by redesignating paragraph (7) as paragraph (8); and
(B) by inserting after paragraph (6) the following new
paragraph (7):
``(7) Section 1784 of this title.''.
(6) Section 8111(g) is amended--
(A) in paragraph (4), by inserting ``services under
sections 1782 and 1783 of this title'' after ``of this
title,''; and
(B) in paragraph (5), by striking ``section 1711(b) or
1713'' and inserting ``section 1782, 1783, or 1784''.
(7) Section 8111A(a)(2) is amended by inserting ``, and the
term `medical services' includes services under sections 1782
and 1783 of this title'' before the period at the end.
(8) Section 8152(1) is amended by inserting ``services
under sections 1782 and 1783 of this title,'' after ``of this
title),''.
(9) Sections 8502(b), 8520(a), and 8521 are amended by
striking ``the last sentence of section 1713(b)'' and
inserting ``the penultimate sentence of section 1781(b)''.
(f) Clerical Amendments.--
(1) The table of sections at the beginning of such chapter
is amended--
(A) by striking the item relating to section 1707 and
inserting the following:

``1707. Limitations.'';

(B) by striking the item relating to section 1713; and
(C) by adding at the end the following:

``subchapter viii--health care of persons other than veterans

``1781. Medical care for survivors and dependents of certain veterans.
``1782. Counseling, training, and mental health services for immediate
family members.
``1783. Bereavement counseling.
``1784. Humanitarian care.''.

(2) The heading for section 1707 is amended to read as
follows:

``Sec. 1707. Limitations''.

SEC. 209. EXTENSION OF EXPIRING COLLECTIONS AUTHORITIES.

(a) Health Care Copayments.--Section 1710(f)(2)(B) is
amended by striking ``September 30, 2002'' and inserting
``September 30, 2007''.
(b) Medical Care Cost Recovery.--Section 1729(a)(2)(E) is
amended by striking ``October 1, 2002'' and inserting
``October 1, 2007''.

SEC. 210. PERSONAL EMERGENCY RESPONSE SYSTEM FOR VETERANS
WITH SERVICE-CONNECTED DISABILITIES.

(a) Evaluation and Study.--The Secretary of Veterans
Affairs shall carry out an evaluation and study of the
feasibility and desirability of providing a personal
emergency response system to veterans who have service-

[[Page H9223]]

connected disabilities. The evaluation and study shall be
commenced not later than 60 days after the date of the
enactment of this Act.
(b) Report.--Not later than 180 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 evaluation and study under
subsection (a). The Secretary shall include in the report the
Secretary's findings resulting from the evaluation and study
and the Secretary's conclusion as to whether the Department
of Veterans Affairs should provide a personal emergency
response system to veterans with service-connected
disabilities.
(c) Authority To Provide System.--If the Secretary
concludes in the report under subsection (b) that a personal
emergency response system should be provided by the
Department of Veterans Affairs to veterans with service-
connected disabilities--
(1) the Secretary may provide such a system, without
charge, to any veteran with a service-connected disability
who is enrolled under section 1705 of title 38, United States
Code, and who submits an application for such a system under
subsection (d); and
(2) the Secretary may contract with one or more vendors to
furnish such a system.
(d) Application.--A personal emergency response system may
be provided to a veteran under subsection (c)(1) only upon
the submission by the veteran of an application for the
system. Any such application shall be in such form and manner
as the Secretary may require.
(e) Definition.--For purposes of this section, the term
``personal emergency response system'' means a device--
(1) that can be activated by an individual who is
experiencing a medical emergency to notify appropriate
emergency medical personnel that the individual is
experiencing a medical emergency; and
(2) that provides the individual's location through a
Global Positioning System indicator.

SEC. 211. ONE-YEAR EXTENSION OF ELIGIBILITY FOR HEALTH CARE
OF VETERANS WHO SERVED IN SOUTHWEST ASIA DURING
THE PERSIAN GULF WAR.

Section 1710(e)(3)(B) is amended by striking ``December 31,
2001'' and inserting ``December 31, 2002''.

The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New
Jersey (Mr. Smith) and the gentleman from Illinois (Mr. Evans) each
will control 20 minutes.
The Chair recognizes the gentleman from New Jersey (Mr. Smith).
Mr. SMITH of New Jersey. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, I rise in strong support of H.R. 3447, the Department of
Veterans Affairs Health Care Programs Enhancement Act of 2001. Although
this bill was only recently introduced, it is the product of many
months of work by both bodies. It is derived from the following bills:
H.R. 2792 which passed the House on October 23; S. 1160; S. 1188; and
S. 1221. The bill would accomplish improvements in health care and
related services for our Nation's veterans.
The distinguished chairman of the Subcommittee on Health the
gentleman from Kansas (Mr. Moran) deserves special recognition for his
original authorship of major components of this bill. I salute his
leadership in formulating it for final House consideration in the first
session of the 107th Congress. I also appreciate the hard work of our
colleagues on the Senate Committee on Veterans' Affairs who have
contributed major portions of this legislation as well.
Mr. Speaker, this bill would enhance nurse recruitment and staffing
in the Department of Veterans Affairs health care system and improve VA
health care for veterans. The bill would also authorize significant new
veterans health care benefits, including VA chiropractic care for
disabled veterans on a nationwide basis. This legislation would provide
greater accountability in the conduct of VA health care programs and
would give substantial relief from copayments now required of poor
veterans in urban areas.
Mr. Speaker, all of these changes are good for veterans and they are
good for the Nation. I anticipate that, after House passage, this bill
will be taken up immediately by the Senate and passed without further
amendment. It represents an agreement between the two Committees on
Veterans' Affairs on these matters; and while it is a compromise on
several House-authored provisions, we recommend it as sound,
progressive policy.
Mr. Speaker, I want to thank our full committee ranking member the
gentleman from Illinois (Mr. Evans) for his close cooperation on this
bipartisan bill. He is a valued partner as we work together to keep our
great country's commitments to those men and women who have defended
our precious freedoms. The gentleman from California (Mr. Filner), the
ranking member of our Subcommittee on Health, has also worked hard on
this bill, in particular for the new chiropractic care services for our
veterans. I thank him for his contributions as well.
The leadership on both sides of the aisle have facilitated the
clearance for consideration of this bill, which the committee also
deeply appreciates. I want to especially thank the majority leader, the
gentleman from Texas (Mr. Armey), for facilitating that as well. We
were able to work through this process in remarkably short order
because our House leadership continues to make veterans issues a
priority.
Mr. Speaker, I urge all of my colleagues to support this measure. It
has broad backing and sends the right message: Congress will be
attentive to the people's business and stand by those courageous men
and women who have answered the call to arms.
Mr. Speaker, I reserve the balance of my time.
Mr. EVANS. Mr. Speaker, I yield myself such time as I may consume.
(Mr. EVANS asked and was given permission to revise and extend his
remarks, and include extraneous material.)
Mr. EVANS. Mr. Speaker, I rise in support of this legislation. I want
to thank the chairman again, the gentleman from New Jersey, who has
been a long and undeterred advocate for this legislation. I want to
thank the gentleman from Kansas (Mr. Moran) and the gentleman from
California (Mr. Filner), the chairman and ranking member of the
Subcommittee on Health, for their continuing work on the complex issues
in this bill. I want to particularly recognize the abiding interest of
the gentlewoman from California (Mrs. Capps) in ensuring better access
to health care services for our veterans. At her urging, we have
included a comprehensive study of telephone services available through
the Department.
I also want to express my appreciation to members of the committee
staff on both sides of the aisle for their persistence in reaching a
good compromise on this bill.
For many years, I have strongly advocated the provision of
chiropractic care as an alternative source of health care for veterans.
Medicare, most State Medicaid programs, and the Department of Defense
have developed means of reimbursing or even, in the latter case, hiring
chiropractors to meet their beneficiaries' needs. VA, unfortunately,
has been slower to adopt chiropractic care. As a result, the
legislation requires VA to have a permanent, national chiropractic
program; and I trust VA will now ensure that veterans are better able
to access these important services.
The chairman mentioned the nurses that are the backbone of any health
care system. We also listed them. I want to thank the gentleman from
New Mexico (Mr. Udall) for introducing H.R. 3017, which contains many
of the nurse recruitment and retention provisions that have been
included in this bill.
This bill recognizes that income alone is not a fair measure of a
veteran's standard of living because of geographic cost-of-living
differences, which can be significant. Veterans in the Chicago area,
for example, may not be able to stretch their dollars as far as
veterans in lower-cost areas. I am pleased that, in recognition of
these differing costs of living, this bill will reduce the burden of
acute hospital inpatient copayments for some veterans.
In a report I requested from the GAO last year, they said that VA
could not confirm that these important but expensive programs for
veterans with longer term service-connected conditions were not being
eroded under fiscal pressure to treat more veterans at a lower cost per
patient. I am pleased that this bill also provides a strong reporting
requirement for specialized programs for disabled veterans.
Following the trend to place care in community and outpatient
settings, the committee has been greatly concerned with the
availability of VA health care services for seriously mentally ill
veterans. Veterans' advocates, advocates of mentally ill people and
even internal working groups have continually validated these concerns.
The

[[Page H9224]]

legislation will allow the Congress to monitor these important programs
and intervene if measures indicate that would be necessary.
Mr. Speaker, I am proud to support this legislation. I believe in the
long run we will be able to ensure an improved health care system for
our Nation's veterans.
This important measure provides a number of changes in current law
that will allow VA to remain competitive in recruiting and retaining
its nurse workforce. Critically, this measure retains and strengthens
reporting requirements on the specialized programs for veterans with
disabilities, many of which VA has perfected since the days following
World War II. It will provide some relief in meeting VA copayment
requirements for acute hospital inpatient care to veterans with
marginal incomes. It will also address a significant deficit in the
VA's care continuum by developing a permanent program for chiropractic
care within the Department of Veterans Affairs.
I believe this bill moves VA in the right direction to meet new and
evolving challenges and I am proud to have participated in its
development. I want to thank my Committee Chairman, the gentleman from
New Jersey, Chris Smith, who has been a strong and undeterred advocate
of this legislation. I want to thank Jerry Moran and Bob Filner, the
Chairman and Ranking Member of the Health Subcommittee, for continuing
to work on the complex range of issues this bill addresses. I also want
to thank Congresswoman Lois Capps for her abiding interest in ensuring
better access to health care services for veterans. At her urging, we
have included a comprehensive study of telephone services available
through the Department. I also want to express my appreciation to
members of the Committee staff from both sides of the aisle for their
persistence in reaching a good compromise on this bill.
For many years, I have strongly advocated the provision of
chiropractic as an alternative source of health care for veterans.
Chiropractors are capable of promoting wellness and preventing illness
without relying upon pharmaceutical drugs or surgical interventions.
For the millions of Americans who choose to use chiropractors--often
paying for their services ``out-of-pocket''--the benefits of
chiropractic care are clear. Gradually, the federal government has
recognized the importance of the care chiropractors provide in the
health care continuum--Medicare, most state Medicaid programs, and the
Department of Defense have developed means or reimbursing or even, in
the latter case, hiring chiropractors to meet their beneficiaries'
needs. Many private insurers also reimburse care from chiropractors.
VA has been much slower to adopt chiropractic. Under the Veterans
Millennium Health Care and Benefits Act, VA was directed to develop a
policy on chiropractic care. Unfortunately, it appeared that the VA
circled the wagons and resorted to practices that have actually reduced
veterans' use of chiropractic in the last year. I called on VA and
representatives of chiropractic providers to discuss opportunities for
VA to develop a policy on chiropractic care as the Millennium Act had
directed it to do. After several interactions with chiropractor
representatives this summer, VA ultimately told me that if I and the
other Members that participated in this dialogue wanted VA to increase
or enhance its use of chiropractors in VA, we would have to mandate VA
to do it. We have now developed an approach that requires VA to have a
permanent, national chiropractic program, and I trust VA will now
ensure that veterans are better able to access these important
services.
This bill adjusts copayments for veterans with marginal incomes. In
so doing, it recognizes that income alone is not a fair measure of a
veteran's standard of living because of the often significant
differences in geographic costs-of-living. Veterans in the Chicago
area, for example, may not be able to stretch their dollars as far as
veterans in lower cost areas. I am pleased that, in recognition of
these differing ``costs of living'', this bill will reduce the burden
of acute hospital inpatient copayments for some veterans.
The Department of Veterans Affairs Health Care Programs Enhancement
Act of 2001 will allow VA to remain a competitive employer during the
current scarcity of nurses in the labor market. I want to thank my
friend Tom Udall for introducing H.R. 3017, which contains many of the
nurse recruitment and retention provisions that have been included in
this bill.
Nurses are the backbone of any health care system and their role is
no less critical within VA. Yet, it is easy to see why this profession
is once again facing a crisis in developing and maintaining its
workforce. My mother was a nurse so I well understand the demands and
pressures of this vocation--hours are long and often unpredictable. The
work takes a psychic and physical toll. In recent years, nurses
complain of having more of their time devoted to administrative
activities than to working with their patients--often the most
satisfying part of their job. H.R. 3447 will help address some of the
reasons this profession is facing its current challenges by having
experts offer solutions to some of the issues that confront the
profession, by providing more flexible educational tools as incentives
for its current and future workforce, and by ensuring that the
Department is reviewing safe staffing patterns and practices to support
its dedicated workforce.
I am pleased that this bill also provides a strong reporting
requirement for specialized programs for disabled veterans. Some of
these programs were developed in direct response to the needs of
veterans returning from war with combat-incurred disabilities, such as
spinal cord injuries, blindness, or post-traumatic stress disorder, and
have become unique chronic care programs in a health care world that
generally seems to prefer dealing with acute illnesses. In a report I
requested from the General Accounting Office last year, GAO said that
VA could not assure that these important, but expensive, programs for
veterans with longer-term service-connected conditions were not being
eroded under fiscal pressure to treat more veterans at a lower cost per
patient.
Following a new trend to place care in community and outpatient
settings, this Committee has also been greatly concerned with the
availability of VA services for seriously mentally ill veterans--
veterans' advocates, advocates of mentally ill people and even internal
working groups have continually validated these concerns. This
legislation will allow Congress to monitor these important programs and
intervene if measures indicate that would be necessary.
Mr. Speaker, I am proud to support this legislation. I believe that
in so doing we will ensure an improved health care system for our
nation's veterans.

SUMMARY--H.R. 3447--DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROGRAMS
ENHANCEMENT ACT OF 2001

H.R. 3447 would:
1. Enhance eligibility and benefits for the Employee
Incentive Scholarship and Education Debt Reduction Programs
by enabling VA nurses to pursue advanced degrees while
continuing to care for veterans, in order to improve
recruitment and retention of nurses within the VA health care
system.
2. Mandate that VA provide Saturday premium pay to title 5/
title 38 hybrid employees. Such hybrid-authority employees
include licensed vocational nurses, pharmacists, certified or
registered respiratory therapists, physical therapists, and
occupational therapists.
3. Require VA to develop a nationwide policy on staffing
standards to ensure that veterans are provided with safe and
high quality care, taking into consideration the numbers and
skill mix required of staff in specific health care settings.
Require a report on the use of mandatory overtime by licensed
nursing staff and nursing assistants in each VA health care
facility; include in report a description of the amount of
mandatory overtime used by facilities.
4. Change reporting responsibility of the Director of the
Nursing Service to report to the Under Secretary for Health.
5. Recompute annuities for part-time service performed by
certain health care professionals before April 7, 1986.
6. Establish a 12-member National Commission on VA Nursing
that would assess legislative and organizational policy
changes to enhance the recruitment and retention of nurses by
the Department and the future of the nursing profession
within the Department, and recommend legislative and
organizational policy changes to enhance the recruitment and
retention of nursing personnel in the Department.
7. Authorize service dogs to be provided by VA to a veteran
suffering from spinal cord injuries or dysfunction, other
diseases causing physical immobility, hearing loss or other
types of disabilities susceptible to improvement or enhanced
functioning in activities of daily living through employment
of a service dog.
8. Modify VA's system of determining nonservice-connected
veterans' ``ability to pay'' for VA health care services by
introducing (as an upper income bound contrasted with current
income limits) the ``Low Income Housing Limits'' employed by
the Department of Housing and Urban Development (HUD), used
by HUD to determine family income thresholds for housing
assistance. This index is adjusted for all Standard
Metropolitan Statistical Areas (SMSAs), and is updated
periodically by HUD to reflect economic changes within the
SMSAs. Would retain current-law means test national
income threshold, but reduce co-payments by 80 percent for
near-poor veterans who require acute VA hospital inpatient
care.
9. Strengthen the mandate for VA to maintain capacity in
specialized medical programs for veterans by requiring VA and
each of its Veterans Integrated Service Networks to maintain
the national capacity in certain specialized health care
programs for veterans (those with serious mental illness,
including substance use disorders, and spinal cord, brain
injured and blinded veterans; veterans who need prosthetics
and sensory aids); and extend capacity reporting requirement
for 3 years.
10. Establish a program of chiropractic services in each
Veterans Integrated Service

[[Page H9225]]

Network and require VA to provide training and educational
materials on chiropractic services to VA health care
providers. Authorize VA to employ chiropractors as federal
employees and obtain chiropractic services through contracts;
create a VA advisory committee on chiropractic health care.
11. Require the Office of Research Compliance and
Assurance, which conducts oversight and compliance reviews of
VA research and development, be funded by the Medical Care
appropriation, rather than the Medical and Prosthetic
Research appropriation.
12. Authorize $28,300,000 for major medical facility
construction project at the Miami, Florida VA Medical Center.
13. Require Secretary of Veterans Affairs to assess all
special telephone services made available to veterans, such
as ``help lines'' and ``hotlines.'' Assessment would include
geographical coverage, availability, utilization,
effectiveness, management, coordination, staffing, cost, and
a survey of veterans to measure effectiveness of these
telephone services and future needs. A report to Congress
would be required within 1 year of enactment.
14. Extend expiring authorities for VA to collect proceeds
from veterans' health insurance policies for care provided
for non-service connected care.
15. Provide authority for the Secretary to study, and then
if determined feasible, obtain personal emergency-
notification and response systems for service-disabled
veterans.
16. Extend VA's authority to provide health care for those
who served in the Persian Gulf until December 31, 2002.

Mr. FILNER. Mr. Speaker, I rise in support of the ``Department of
Veterans Affairs Health Care Programs Enhancement Act of 2001''. I want
to thank Chairman Christopher Smith, Ranking Member Lane Evans and
Chairman Jerry Moran of the Health Subcommittee for addressing some of
the concerns I raised about earlier versions of the bill. We now have a
bill to which I am pleased to lend my support.
Mr. Speaker, as a long-time advocate of chiropractic and a user of
its services, I am, perhaps, most gratified that we have agreed to a
comprehensive proposal to create a permanent chiropractic program
within the Department of Veterans Affairs. This legislation will
require VA to establish a national chiropractic program that will make
chiropractic services available in each geographic service area. VA has
rebuffed Congress and the chiropractic profession time and time again
in an attempt to bring better access to chiropractic services under the
VA's umbrella. We asked VA to develop a policy under the Veterans
Millennium Health Care and Benefits Act, but leaving the policy
development in VA's hands, veterans' access to chiropractic services
has worsened. We simply cannot allow VA to keep barring the door to
chiropractic care.
Today is a fresh start for chiropractic care in VA. While I prefer
the chiropractic care version this House approved in H.R. 2792, as
amended, the provision in the bill before us today ensures that
chiropractic care will be available in every VA network. To ensure that
this program's implementation is smooth, the conference agreement
establishes a chiropractic advisory committee that will provide VA the
expertise and advocacy needed to address the issues involved in hiring
chiropractors and ensuring that chiropractors are able to participate
in its workforce using their skills and training to their fullest
potential. I believe that this bill offers the fundamentals from which
VA can begin to develop a sound chiropractic program. Eventually, I
believe it will be necessary for VA to establish a director of
chiropractic service and for Congress to specify, in law, an
established number of sites for chiropractic care. Still, for the first
time, this law will ensure that veterans have a real opportunity to
access this important part of the health care continuum.
In our Subcommittee hearing this Fall, we heard from many of the
veterans' service organizations and animal trainers on the invaluable
assistance provided by service dogs to severely disabled people. I am
pleased that this bill retains this provision.
We have strengthened the requirements for VA to report to Congress on
programs that serve some of our most vulnerable veterans. We have
focused these reporting requirements on VA's mental health programs. I
believe this will give Congress a much clearer idea about what types of
valuable specialized services are eroding. I am also pleased that these
reports will make geographic service areas accountable for maintaining
programs under their authority. For too long, we have heard VA's
central office indicate that they are helpless over controlling the
activities of their field managers. Making the networks accountable for
the maintenance of specialized programs to serve disabled veterans puts
the responsibility where the authority lies.
Mr. Speaker, I believe thousands of veterans will benefit from a
provision in this bill, strongly advocated by Chairman Smith, that
adjusts VA copayments for acute hospital inpatient care to the cost-of-
living veterans experience in different areas of the country. Salaries,
food, and housing costs vary greatly across this Nation. This
legislation permits VA to use a widely employed index of geographic
variances in cost of living--one already used by the Department of
Housing and Urban Development to assess a family's ability to afford
housing--to gauge veterans' ability to pay for health care services.
This legislation ensures that veterans, who are eligible for low-income
housing in a given geographic location, but who are not considered
medically indigent under the national Department of Veterans Affairs
means-test, are given a break on the acute inpatient hospital
copayments they would otherwise have to make.
I want to extend a special thanks to Congresswoman Lois Capps for
introducing H.R. 1435. This bill raised the Committee's awareness of
the need for a round-the-clock telephone crisis and referral service.
We intend to have the VA investigate its current resources and
recommend a strategy for enhancing its current capabilities.
This measure contains a charter for a new Commission on VA Nursing.
As we know, the nursing profession, inside and outside of VA has
changed and VA must be prepared to be an ``employer of choice'' in the
future. This Commission can give expert advise on where VA must
position itself now and in the future to attract the best nurses
available to treat our veterans. In addition, it contains provisions
from S. 1188, and its companion introduced in the House by Tom Udall,
H.R. 3017. These provisions will provide additional opportunities for
VA to recruit and retain nurses--an invaluable component of its health
care staff.
The Health Care Programs Enhancement Act is a strong measure and I
urge my colleagues to support the bill.
Mr. EVANS. Mr. Speaker, I yield back the balance of my time.

{time} 2310

Mr. SMITH of New Jersey. Mr. Speaker, I have no further requests for
time, and I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Terry). The question is on the motion
offered by the gentleman from New Jersey (Mr. Smith) that the House
suspend the rules and pass the bill, H.R. 3447.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the bill was passed.
A motion to reconsider was laid on the table.

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