APPENDIX C [From the Congressional Record, Vol. 130, No. 105, pp. S10109-S10135--Senate, Aug. 8, 1984] VETERANS' ADMINISTRATRON HEALTH CARE AMENDMENTS OF 1984 Mr. STEVENS. Mr. President, I ask that the Chair lay before the Senate Calendar No. 929, S. 2514. The PRESIDING OFFICER. Without objection, it is so ordered. The clerk will state the bill by title. The assistant legislative clerk read as follows: A bill (8. 2514) to amend title 38, United States Code, to enhance the management of Veterans' Administration medical treatment programs by providing for the referral o veterans to non-Veterans' Administration entities and arrangements for additional necessary services, to revise and clarify the authority for the furnishing of care for vet erans suffering from alcohol or drug dependence, to require the Administrator tc establish the position of Associate Director for Post Traumatic Stress Disorder, to require the Administrator to submit a report to Congress regarding programs of the Veterans' Administration providing hospice and respite care to certain veterans, and to authorize the Administrator of Veterans' Affairs to provide telecaption television decoders to totally deaf veterans in certain cases, and for other purposes. The Senate proceeded to consider the bill which had been reported from the Committee on Veterans' Affairs with an amendment to strike out all after the enacting clause and insert in lieu thereof: That (a) this Act may be cited as the "Veterans' Administration Health Care Amendments of 1984". (b) Except as otherwise specifically 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. COORDINATION OF VETERANS' ADMINISTRATIONCOMMUNITY REFERRAL ASSISTANCE AND SERV ICES SEC. 2. (a) Chapter 73 is amended by adding at the end of subchapter 1 the following new section: "8 4120. Coordination of referral assistance and services "In order to improve the provision, and enhance the management, of health-care and health-related services by the Veterans' Administration and other sources to veterans who are eligible for care under chapter 17 of this title, with a special emphasis on veterans who are 65 years of age or older. and who are determined by the Administra tor to be in need of assistance under this section, the Administrator shall designate one organizational unit in each Veterans' Administration health-care facility for the purpose of coordinating the provision of referral assistance, and facilitating and helping to coordinate the provision of such serv ices not at Veterans' Administration expense, to such eligible veterans when such referral is reasonably necessary for the health of such veterans. The Administrator shall carry out this section (1) in a manner consistent (A) with the policy of the United States, set forth in section 409(a) of Public Law 97-306, that the Veterans' Administration shall maintain a comprehensive, nationwide health-care system for the direct provision of quality health-care services to eligible veterana, (B) with the mandate of section 4101(a) of this title that the Depart ment of Medicine and Surgery shall provide a complete medical and hospital service for the medical care and treatment of veterans, and (C) with the United States Govern ment's historic, firm commitment, and moral obligation, as embodied in this title, to provide care for veterans with serviceconnected disabilities, and (2) in conjunetion with local, State, Federal, and private agencies providing and coordinating the provision of services to elderly persons and with other pertinent public and private agencies.". (b) The table of sections at the beginning of chapter 73 is amended by adding after the Item relating to section 4119 the follow ing: "4120. Coordination of referral assistance and services.". ALCOHOL AND DRUG TREATMENT AND SEC. 3. (a) Section 620A is amended(1) by striking out "pilot" in subsection (ax) both places it appears; (2) by striking out "fifth" and inserting in lleu thereof "seventh" and by striking out "pilot" in subsection (ex (3) in subsection (f)- (A) by inserting "(1)" before "Not"; and (B) by inserting before the period "prior to the amendment of this section by the Veterans' Administration Health Care Amendments of 1984"; and (C) by adding at the end of the following new paragraph: "(2) Not later than March 1, 1986, and March 1, 1987, the Administrator shall report to such committees on the findings and recommendations of the Administrator pertaining to the operation of the program authorized by subsection (a) during the preceding fiscal year and shall include in such report information for such year regarding average duration of participation of veter ans, rates of successful rehabilitation, and any changes in average and maximum allowable charges per veteran under contracts entered into by the Veterans' Administration as part of such program."; and (4) adding at the end of the following new subsection: "(h) Not later than 12 months after the date of the enactment of this subsection, the Administrator shall prescribe regulations to provide guidelines for the treatment and rehabilitation of veterans for alcohol or drug dependence or abuse disabilities under this chapter in facilities over which the Administrator has direct jurisdiction. Such guidelines shall include guidance "(1) on the duration of such treatment and rehabilitation under this chapter. taking into account the duration of such treatment and rehabilitation in non-Veterans' Administration programs and identifying specifically duration in detoxification, inpatient-acute care, Inpatient-rehabilita tion and extended care, outpatient care, and followup services; and "(2) on the provision of referral assistance and the development, implementation, and monitoring of individual treatment plans and followup for veterans receiving such care and treatment.". (b) Not later than March 1. 1985, and March 1 of each subsequent year, the Administrator of Veterans' Affairs shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report containing a compre hensive survey of the activities during the preceding fiscal year of all Veterans' Administration-operated programs providing treatment and rehabilitation for alcohol or drug dependence or abuse disabilities, Identifying, by facility, the number of beds involved, the number of patients and episodes of care (whether inpatient-acute, inpatient-rehabili tation, inpatient-extended, or outpatient), the specific treatment methodologica employed, average lengths of participation. rates of successful rehabilitation, and staffing levels and standards, together with a na tional summary of such information. The third such report shall also contain information on the effectiveness of such treatment and rehabilitation in light of the regulations prescribed under subsection (h) of section 620A (as added by the amendment made by subsection (ax4) of this section), including information on diagnostic methodologies employed, use of case-management ap proaches and discharge planning, lengths of participation, treatment results, methods used for approving, evaluating, and monitoring the use of non-Veterans' Administration facilities under section 620A, and referral and followup activities for veterans discharged from such programs and such facili ties. (c) The section heading of section 620A and the item relating to such section in the table of sections at the beginning of chapter 17 are each amended by striking out the semicolon and "pilot program". MEDICAL AND REHABILITATIVE DEVICES (1) by redesignating such section as subsection (a), and (2) by adding at the end of the following new subsection: "(b) In order to assist in overcoming the handicap of deafness, the Administrator may provide assistive devices, including tele captioning television decoders, to veterans who are profoundly deaf and entitled to compensation on account of hearing lianpariment.". POST-TRAUMATIC-STRESS DISORDER Sac. 5. (RX1) In order to enhance the Veterans' Administration's capability to diagnose and treat post-traumatic stress disor der (hereinafter in this section referred to aa "PTSD), the Chief Medical Director of the Veterans' Administration shall establish in the Department of Medicine and Surgery a Special Committee on Post Traumatic Stress Disorder (hereinafter in this section referred to as the "Special Committee") and shall appoint qualified employees of the Department to serve on the Special Commit tee. (2) The Special Committee shall assess, and carry out a continuing assessment if, the capacity of the Veterans' Administration to provide diagnosis and treatment to eligible veterans with PTSD and shall advise the Chief Medical Director regarding the development of policies, the provision of guidance, and the coordination of services for the diagnosis and treatment of veterana with PTSD in Inpatient PTSD units, other Inpatient paychiatric programs, outpatient mental health clinics, and readjustment counseling programs of the Veterans' Administration. The Special Committee shall also make recommendations to the Chief Medical Director for guidance regarding appropriate diagnostic and treatment methods and referral for and coordination of followup care and with respect to the evaluation of PTSD treatment programs, the conduct of research concerning such diagnosis and treatment (taking into account the provi sions of subsection (b) of this section), spe cial programs of education and training on PTSD for employees of the Department of Medicine and Surgery and the Department of Veterans' Benefits (also taking into ac count such provisions), the appropriate allo cation of resources for all such activities, and any specific steps that should be taken to improve such diagnosis and treatment and to correct any deficiencies in the oper ations of inpatient PTSD units. (b) The Chief Medical Director of the Veterans Administration shall establish and operate a National Center on PTSD (A) to carry out and promote research into, and the training of health-care and related personnel in, the diagnosis and treatment of veterans with PTSD, and (B) to serve as a resource center for and to promote and to seek to coordinate the exchange of informa tion regarding all research and training activities carried out by the Veterans' Administration, and by other Federal and nonFedceral entities, with respect to PTSD. (cx1xA) Not later than 180 days after the date of the enactment of this Act, the Administrator shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report on the implementation of subsections (a) and (b). (B) The report required by subparagraph (A) shall contain (1) a list of the members of the Special Committee, (1) the assessment of the Chief Medical Director of the Veterans' Administration, after consultation with the Special Committee. regarding the capability of the Veterans Administration to meet the needs of Vietnam veterans, former prisoners of war, and other eligible veterans for inpatient and outpatient PTSD diagnosis and treatment (both through PTSD inpatient treatment units and otherwise) as well as a description of the results of any evaluations that have been made of PTSD inpatient treatment units in existence on the date of the enact ment of this act, (i) the plans of the Special Committee for further assessments for the capability of the Veterans' Administration to diagnose and treat veterans with PTSD, (i) the plans of the Special Committee for further assessments of the capability of the Veterans' Administration to diagnose and treat veterans with PTSD, (iv) the recommendations made by the Special Committee to the Chief Medical Di rector. (v) a description of the steps taken, plans made (and a timetable for their execution), and resources to be applied to implement subsections (a) and (b), and (vi) the assessment of the Administrator of the capacity of the Veterans' Adminstra tion to meet in all geographic areas of the United States the needs described in clause () and any plans and timetable for increas ing that capacity (including the costs of such action). (2) Not later than February 1, 1986, and February 1 of each subsequent year, the Administrator shall submit to the Committees on Veterans' Affairs of the House of Repre sentatives and the Senate a report containing information updating the report or reports submitted under this subsection prior to the submission of such report. REPORT ON VETERANS' ADMINISTRATION PROGRAMS FOR TERMINALLY ILL VETERANS Src. 6. (a) Not later than September 30, 1985, the Administrator of Veterans' Affairs shall submit to the Committees on Veter ans Affairs of the House of Representatives and the Senate a report on programs of the Veterans Administration to furnish pallia tive care, supportive counseling, and other medical services to terminally ill veterans and, pursuant to section 601(6XB) of title 38, United States Code, supportive counsel. ing to members of such veterans' families. (b) The report required by subsection (a) shall include (1) a review of Veterans' Administration policies and guidelines on the provision of care, counseling, and services described in subsection (a); (2) a review of the care, counseling, and services furnished, including the treatment modalities used and services furnished by the Veterans' Administration; (3) an analysts and a comparison of the care, counseling, and services furnished with respect to terminally ill veterans in hospice and other Veterans Administration pro- (4) an explanation of how the care, cour (5) a review of any steps taken to arrange for the exchange of information between Veterans' Administration facilities providing the care, counseling, and services described in subsection (a) and non-Veterans' Administration facilities providing similar care, counseling, and services; and (6) proposals for such administrative or legislative action as the Administrator may consider appropriate in light of the information provided in the report. AUTOMOBILE ADAPTIVE EQUIPMENT Sec. 7. (a) Subsection (e) of section 1903 is amended to read as follows "(cx1) An eligible person shall not be enti tled to adaptive equipment under this chapter for more than two autoraobiles or other conveyances (A) at any one time, or (B) except as provided in paragraph (2) of this subsection, in any four-year period. "(2) If, in a case in which the limitation set forth in paragraph (1XB) of this subsection precludes an eligible person from being entitled to adaptive equipment, the Administrator determines that, due to circumstances beyond the control of the eligible person, one of the automobiles or other conveyances for which adaptive equipment was provided in the applicable four-year period is no longer available for the use of such person, the Administrator may, as a matter of discretion and pursuant to regulations which the Administrator shall prescribe,. provide adaptive equipment for such person for an additional automobile or other conveyance during such period.". (bx1) Except as provided in paragraph (2), the amendment made by subsection (a) shall take effect on October 1, 1984. (2) In the case of a person who was provided adaptive equipment under chapter 39 of Uue 38, United States Code, for an automo bile or other conveyance after September 30, 1980, but prior to October 1, 1984, and who has available for use such automobile or other conveyance on the date of the enactment of this Act, the first four year period applicable to such person under subsection (e) of section 1903 of such title (as amended by subsection (a)) shall begin on the most recent date prior to October 1, 1984, on which such individual was provided such equipment DEFINITION OF VIETNAM ERA SEC. 8. Section 101(29) is amended to read as follows: "(29) The term 'Vietnam era' means (A) READJUSTMENT COUNSELING (1) by striking out "and" at the end of (2) by striking out the period at the end of clause (1) and inserting in lieu thereof a semicolon and "and"; and (3) by adding after clause (it) the following: "(if) assessments of whether or not individuals who "(1) are veterans who served on active duty (aa) during World War II or the Korean conflict (with particular emphasis on those who engaged in combat with the enemy), (bb) during any period and who were prisoners of war, or (cc) after May 7, 1975 (with particular emphasis on those "(II) members of the Armed Forces serv The Administrator may submit the assess- (bx1) Not later than 180 days after the date of the enactment of this Act, the Administrator of Veterans' Affairs and the Secretary of Defense shall submit to the ap propriate committees of the Congress & Joint report setting forth (A) their recommendations, taking into so count the extent of the availability of Vet erans' Administration resources to provide readjustment counseling to Vietnam-era veterana, on the appropriateness and desirabil ity of extending eligibility for readjustment counseling under section 612A of Litle 38 United States Code, to individuals who are serving on active duty in the Armed Forces of the United States and (1) who also served on such active duty during the Vietnam era (as defined in section 101(29) of such title (as amended by section 8 of this Act)), or (1) who also served on active duty after May 7, 1975, in an area during a period in which hostilities (as defined in paragraph (2) of this subsection) occurred in such ares: (B) their determinations as to whether, If eligibility for such readjustment counsel ing were so extended, the Veterans' Administration and the Department of Defense would enter into an agreement or agree ments pursuant to which the Department of Defense would reimburse the Veterans Ad ministration for such counseling provided to such individuals while serving on active duty, (II) If so, whether or not such reimbursement would be made without the ne cessity of the Veterans' Administration providing the Department of Defense with the names of the individuals so counseled and, f not, whether or not a requirement that such names be provided would discourage active duty personnel from requesting such serv ices, and (III) the manner and extend to which the Veterans' Administration and the Department of Defense would undertake to carry out outreach activities to inform such Individuals about the availability of such counseling, and (C) any other information, determina tions, or recommendations pertinent to the subject matter of the report that the Administrator and Secretary consider appro priate. (2) For the purpose of paragraph (1), the term "hostilities" means a situation as to which the Administrator, in consultation with the Secretary, finds that members of the Armed Forces in such situation were subjected to danger from armed conflict comparable to the danger to which members of the Armed Forces have been subject. ed in combat with the enemy during period of war. SECURITY SERVICE PERSONNEL as follows: "0218. Security and law enforcement on property under the jurisdiction of the Veterans' Administration "(aX1) The Administrator, with the concurrence of the Attorney General, shall prescribe regulations to provide for the maintenance of law and order and the protection of persons and property on land and in buildings under the jurisdiction of the Veterans' Administration and not under the control of the Administrator of General Services (hereinafter in this section referred to as Veterans' Administration property')... Such regulations shall prescribe, but need not be limited to “(A) rules for conduct on Veterans' Administration property. "(B) the penalties, within the limits specifled in paragraph (2) of this subsection, for violations of such rules. "(C) policies with respect to the exercise by Veterans Administration security service officers of the enforcement and arrest authorities granted in subsection (b) of this section, "(D) the scope and duration of training that is required for Veterans' Administra. tion security service officers, with particular emphasis on dealing with situations involv. ing patients, and "(E) rules limiting the carrying and use of weapons by Veterans' Administration security service officers. The rules prescribed under clause (A) of this paragraph, together with the penalties for violations thereof, shall be posted conspicuously on such property. "(2) Whoever violates any rule prescribed under paragraph (1XA) of this subsection shall be fined not more than $500 or impris oned not more than six months (or such lesser amount or period of time as the Administrator prescribes in the regulations prescribed under paragraph (1) of this subsection), or both. "(b) The Administrator may designate employees of the Veterans' Administration as Veterans' Administration security service officers. Such officers shall enforce Federal lawa, and the rules prescribed under subeection (aX1XA) of this section, on Veterans' Administration property. Any Veterans' Administration security service officer, subject to any restrictions under the regulations prescribed under subsection (a) of this sec tion, may make an arrest, with or without a warrant, for any offense-on Veterans' Administration property tf (1) such offense occurs in such officer's presence, or (2) such officer has reasonable grounds to believe (A) that the offense constitutes a violation of any law of the United States or of any rule prescribed under subsection (aX1XA) of this section and (B) that the person to be arrested has committed that offense. "(e) With the agreement of the head of the agency concerned, the Administrator may use the facilities and services of Pederal, State, and local law enforcement agencles when it is economical and in the public interest to do so. "(dx1) Notwithstanding subchapter I of chapter 59 of title 5, the Administrator, pursuant to regulations which the Administrator shall prescribe consistent with paragraph (2) of this subsection, may pay allow. ances for the purchase of uniforms to any Veterans' Administration security service officer who is required to wear a prescribed uniform in the performance of official duties "(2) Allowances that the Administrator may pay under paragraph (1) of this subsection shall not exceed "(A) at the time the individual is first employed as a Veterans' Administration securi. ty service officer, $400; and "(B) at the beginning of the first fiscal year that begins after the individual has completed 12 months of service as a Veterans' Administration security service officer and at the beginning of each subsequent fiscal year, $200.". (bX1) The provisions of section 218 of title 38, United States Code, other than clause (2) of subsection (a) of such section, as in effect on the day before the date of the enactment of this Act shall remain in effect until the date on which the Administrator of Veterans' Affairs prescribes the regula tions required to be prescribed by subsection (a) of such section as amended by subsection (a) of this section. (2) The authority of the Administrator to designate officers and employees of the Veterans' Administration to act as special policemen under section 218(ax2) of such title as in effect on the day before the date of the enactment of this Act shall remain in effect until the date on which the Adminis trator first exercises the authority under subsection (b) of section 218 of such title as amended by subsection (a) of this section. (c) The item relating to such section in the table of sections at the beginning of chapter 3 of such title is amended to read as follows "218. Security and law enforcement on property under the jurisdiction of the Veterans Administration.". (d) Section 4107(g) is amended- (A) by striking out "or" in clause (A); (B) by striking out the comma and inserting in lieu thereof a semicolon and "or" in subclause (iv) of clause (B); and (C) by inserting after clause (B) the following new clause: "(C) of employees providing security services, pursuant to section 18 of this title, in buildings under the jurisdiction of the Administrator (and not under the control of the Administrator of General Services) that are used for the purpose of providing health care.": (2) by striking out "health-care" each place it appears in paragraphs (2XA) and (4); and (3) by inserting "or (C)" after "B" in paragraph (4). COMPTROLLER GENERAL REPORT ON MEDICAL PERSONNEL STAFFING LEVELS SEC. 11. Section 5010(aX4XC) is amended to read as follows: "(C) Not later than fifteen days after the expiration of the period for the submission of a certification by the Director of the Office of Management and Budget under subparagraph (B) of this paragraph, the Comptroller General shall submit to the ap propriate committees of the Congress a report stating the Comptroller General's opinion as to whether the Director has com plied with the requirements of such subparagraph in providing such certification and in providing to the Veterans Adminis tration such funded personnel ceiling.". REPORT ON FEDERAL GOVERNMENT RESPONSIBIL ITY TO INDIVIDUALS WHO SERVED WITH VOLUNTARY CIVILIAN ORGANIZATIONS IN VIETNAM SEC. 12. (aX1) The purpose of this section is to provide a basis for the executive branch and the Congress to evaluate the question of United States Government responsibility, and alternative approaches, for providing individuals who served for a period of at least thirty days in the Republic of Vietnam during the Vietnam era as employees of voluntary organizations, deter mined by the Administrator of Veterans' Affairs, in consultation with the Secretary of Defense, to be organizations which provided significant assistance to the United States Armed Forces in the Republic of Vietnam during the Vietnam era. with Federal and other benefits and services (including, but not limited to, health care and monetary compensation for disabilities which may be related to exposure to dioxin or be the result of traumatic events), either through the Veterans' Administration or otherwise. and for assisting such individuals in connec tion with disabilities they may have incurred as a result of such service. (2) In order to carry out the purpose stated in paragraph (1), the Administrator. the Secretary of Defense, and the Secretary of Health and Human Services, not later than 180 days after the date of the enact ment of this Act, shall submit to the appropriate committees of the Congress Joint report on the question of United States. Government responsibility and setting forth various alternative approaches (together with comments on the appropriateness and the advantages and disadvantages of each), and any recommendations by such officials for legislative and administrative action with respect thereto, for establishing a program for providing such benefits, services, and assistance to such individuals. (b) For the purpose of this section, the terms "Armed Forces" and "Vietnam era" have the meanings given such terms in sec tion 101(10) and (29) (as amended by section 8 of this Act), respectively, of title 38. United States Code. CONTRACT CARE IN PUERTO RICO AND THE SEC. 13. Section 601(4XCXV) is amended by striking out "September 30, 1984." and inserting in lieu thereof "September 30, 1985.". PAYMENT FOR THERAPEUTIC AND SEC. 14. (a) Notwithstanding any other provision of law, no amount of remunera tion provided to an individual as a partici pant in a therapeutic or rehabilitative activ ity carried out pursuant to section 618 of title 38, United States Code, shall be includ ed in determining annual income for pur poses of payments of pension (as defined in section 101(15) of such title). (bx1) Subsection (a) shall take effect on October 1. 1984, and shall cease to have effect on December 31, 1987. (2XA) In the case of each person who on January 1. 1984, was, or on a subsequent date prior to October 1, 1984, became, a par ticipant in an activity under such section 618 and who either (A) continuously partici pated in such activity from January 1, 1984. or such subsequent date through September 30. 1984, or (B) terminated such participa tion for the purpose of entering into more remunerative employment, the Administrator of Veterans' Affairs shall pay to such person, from funds in the Veterans' Administration compensation and pension account, an amount equal to the amount of pension (as so defined) that such person would have been eligible to receive by reason of subsec tion (a) if it had become effective as of January 1, 1984. (B) This paragraph shall take effect on October 1, 1984. (c) Not later than February 1, 1987, the Administrator of Veterans' Affairs shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report, with respect to fiscal years 1985 and 1986, on the implementation of subsections (a) and (b). Such report shall contain information regarding the numbers of individuals who participated in activities under such section 818, the numbers of such Individuals who are in receipt of Veterans' Administration pension, the costs of exclud ing payments provided for participation in an activity under such section 618 from countable income for Veterans' Administration pension purpose, and the effect of so excluding such payments on the participa tion of veterans in such activities. Such report shall also and shall include any recommendations of the Administration for legislative or administrative action in light of information contained in the report. (d) Section 618 is amended by adding at the end the following new subsection: "(D) Neither a veteran's participation in an activity carried out under this section nor such veteran's receipt of remuneration as a result of such participation shall be consid ered as a basis for the dental or discontinuance of a total disability rating for purposes of compensation or pension based on the veteran's inability to secure or follow a substantially gainful occupation as a result of disability.". 37-524 0-84-42 HEALTH CARE IN REMOTE AREAS SEC. 15. (a) The Congress finds that (1) many veterans with service-connected disabilities and other veterans eligible for certain health-care services from the Veter ans Administration, within the limits of Veterans Administration facilities, reside in areas of the United States that are geographically remote from health-care facili ties over which the Administrator of Veter ans Affairs has direct jurisdiction: (2) for many such veterans such healthcare facilities are geographically inaccessi ble and for many other such veterans the inconvenience of travel to such facilities dis courages them from seeking health-care services from the Veterans' Administration. and (3) a study conducted by the Administrator (bx1) The Administrator shall carry out a study to develop information about veterans who reside in remote areas and are eligible for health-care services from the Veterans' Administration and to develop alternative spproaches that could be adopted to furnish such veterans with such services. In carryIng out the study, the Administrator shall(A) develop. to the maximum feasible extent, statistics on the number of eligible veterans who, during fiscal year 1985 (b) reside less than 50 miles from the nearest Veteran's Administration medical facility. (i) reside between 50 miles and 100 miles from the nearest Veteran's Administration medical facility. (D) reside between 100 miles and 200 miles from the nearest Veteran's Adminis tration medical facility, or (iv) reside more than 200 miles from the nearest Veteran's Administration medical facility (B) develop, by each group of residences described in clause (A), statistics on the numbers of eligible veterans who, during such year () utilize Veteran's Administration medical facilities. (i) receive inpatient care in such facilities (including the typical lengths of stay of such veterans in such facilities), (i) receive outpatient care from such fa cilities, or (iv) receive followup health-care services from such facilities; (C) develop such further statistics and gather such additional information as the considers appropriate Administrator carry out the study: and ما (D) develop breakdowns of the statisters described in clauses (A) and (B) with respect to age, service connection, and financial need regarding the applicable veteran popu. lations. (2) Not later than January 1, 1986. the Administrator shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a full report on such study. Such report shall include (A) the statistics and breakdown devel oped and information gathered pursuant to paragraph (1) (B) the Administrator's findings on the extent of the need for the Veteran's AdminIstration to increase health-care services in remote areas; and (C) the Administrator's findings and recommendations regarding the advantages and disadvantages of the Veteran's Adminis tration contracting for and making other ar rangements for the furnishing of healthcare services to eligible veterans in remote areas (3) Not later than July 1. 1986, the Administrator shall submit to such committees a report describing an experimental program that could feasibly be carried out through projects in five remote areas, selected on the basis of the statistics, breakdowns, informa tion, and findings included in the report submitted under paragraph (2), to demonstrate alternative approaches for the Veteran's Administration to furnish health-care services to eligible veterans in remote areas. The report shall also include a description of the health-care services, and a detailed breakdown of the costs for them, that could be furnished under such an experimental program to such veterans in each such ares, along with the recommendations (and the reasons therefor) of the Administrator re garding whether any such projects should be carried out and such recommendations for legislative or administrative action as the Administrator considers appropriate in light of the informaton contained in the report. Amend the title so as to read: “A bill to amend title 38, United States Code, to require the Veterans' Administration to develop guidance for the provision of care to veterans suffering from alcohol or drug dependence, to require the Administrator to establish a Special Committee and a National Center for Post-Traumatic Stress Disorder, to improve the Veterans' Administration ability to protect persons and property on its premises, and to exempt from being counted for pension purposes remuneration received by veterans in certain rehabilitation therepy programs; and for other purposes." AMENDMENT NO. 3462 (Purpose: To delete certain provisions involving entitlement spending: to direct the Administrator of Veterans Affairs to modify the reversionary interest of the United States in certain land previously conveyed to the State of California; to modify the Veterans Administration's State veterans' home matching fund construction grant program to authorize grants for the acquisition of State home facilities; to express the sense of Congress about certain recommendations of the President's Private Sector Survey on Cost Control relating to the Veterans' Adminis tration health care system; to authorize the Administrator to modify rates of basic pay for certain psychologista; to name cerLain Veterans' Administration medical centers; and for other purposes) Mr. STEVENS. Mr. President, I send an amendment to the desk in behalf of Senators SIMPSON and CRANSTON. It is an amendment to the subcommittee substitute. The PRESIDING OFFICER. The amendment will be stated. The assistant legislative clerk read as follows: The Senator from Alaska (Mr. STEVENS) for Mr. SIMPSON, Mr. CRANSTON, Mr. BOSCHWITZ and Mr. WILSON, proposes an amendment numbered 3662. (1) On page 15, line 6, strike out "extended" and insert in lieu thereof "Inpa tient-extended". (2) On page 23, delete lines 14 through 20. (3) Redesignate sections 9 through 13 as sections 8 through 12, respectively. (4) On page 33, lines 15 and 16, strike out "(as amended by section 8 of this Act)". all (5) On page 33, strike out line 22 and all that follows through page 35, line 21. (6) Redesignate section 15 as section 13. (7) At the end of the bill, add the follow Ing new seetions; USE OF CERTAIN LANDS BY THE UNIVERSITY OF CALIFORNIA SEC. 14. (a) Notwithstanding the Act de scribed in subsection (b), the Administrator of Veterans' Affairs shall execute such legal documents as are necessary to permit the use of the real property described in subsec Lion (b) (or any portion of such property) for educational or cultural purposes in addi tion to the use of such property as a re search and medical center and for allied purposes. The Administrator may carry out the preceding sentence subject to such terms and conditions as the Administrator determines are necessary in order to protect interests of the United States. (b) The real property referred to in subsection (a) is the property transferred to the State of Califormis for the use of the Uni versity of California by a quitclaim deed dated December 10, 1948, executed by the Administrator Veterans Affairs under the Act entitled "An Act to authorize the Administrator of Verterans' Affairs to transfer a portion of the Veterans' Adminis tration center at Los Angeles, California, to the State of California for the use of the University California", approved June 19, 1948 (62 Stat. 559), and recorded in the land records of the County of Los Angeles, Callfornia, at page 307 of book 29032. (e) Any document executed to carry out subsection (a) shall provide that the proper ty involved shall revert to the United States if it ceases to be used as a research and med. ical center or for educational or cultural purposes. ACQUISITION OF BUILDINGS FOR STATE HOME SEC. 15. Subchapter III of chapter 81 in amended as follows: (1) Section 5031(e) is amended-(A) by striking out term 'construction' means" and inserting "terms 'constructed and 'construction' refer to"; and (B) by inserting "the acquisition of exist ing buildings for use as domicillary or nurs ing home care facilities," after "home build ings," (2) Section 5032 is amended by inserting "to acquire existing buildings for use as State home facilities for furnishing such care to veterans," after "nursing home care to veterans," and (3) Section 5035(a) is amended-- (A) by striking out "and" at the end of clause (7); and (B) in clause (8), (I) by striking out "sections 276a through 276a-5 of title 40" and inserting in liew thereof "the Act of March 3, 1931 (40 USC. 276a-276a-5)"; and (II) by striking out the period at the end and inserting in lieu thereof a comma and "and"; and (C) by inserting at the end the following new clause: "(9) in the case of a project for acquisition of a facility, reasonable assurance that the estimated total costs of acquisition of the facility and of any expansion, remodeling. and alteration of the acquired facility necessary to meet Veterans' Administration standards shall not be greater than the esti mated cost of constructing an equivalent new facility.". SENSE OF THE CONGRESS REGARDING CERTALE GRACE COMMISSION RECOMMENDATIONS SEc. 16. (a) The Congres makes the fol lowing findings: (1) The Department of Medicine and Bur gery of the Veterans' Administration, estab lished by an Act of the Congress, represents a national commitment by the Government to meet the medical needs of eligible veter ans, especially those who have been disabled as a result of their military service. (2)(A) Section 408(a) of Public Law 97-306 states that it is the policy of the United States that the Veterans Administration "shall maintain a comprehensive, nationwide heath-care system for the direct prot sion of quality health-care services to eligi ble veterans". (B) Section 5010aX1) of title 38, United States Code, requires the Veterans' Adoxinistration to operate and maintain a total of not less than 90,000 hospital and nursing home beds and such additional beds as may be necessary for the Veterans' Administra tion to meet its contingency obligations to assist the Department of Defense in times of war or national emergency in caring for the casualities of such war or national emergency. (3) The President's Private Sector Survey on Cost Control (commonly known as and hereinafter referred to as the "Grace Commission") has recommended that Veterans' Administration hospitals reduce the average length of stay of their inpatients to a level comparable to that found in the private sector; however, many Veterans Administration hospital patients have severe and multiple disabilities requiring extensive treatment. (4) The Grace Commission has recommended that funds for construction of Veterans' Administration hospitals not already under contract be deleted from the Veterans Administration budget, that bids be invited from private hospital management companies to lease hospital facilities to the Veterans' Administration under long-term contracts, and that such facilities be managed by private companies under short-term performance contracts. (5) The Grace Commission has recommended that nursing home construction by the Veterans' Administration be entirely discontinued and that the Veterans' Administration contract for the operation of nursing home care facilities by the private sector. (6) The Grace Commission has recommended that the Veterans' Administration eliminate such number of Veterans' Administration acute care hospital beds as is nee essary to achieve an 80 percent occupancy rate for such beds. some (7) The Grace Commission has recommended that the Veterans' Administration consider converting underutilized acute health-care facilities to extended health-care facilities and phasing out old hospital facilities which may be in need of replacement or significant reconstruction; however, demographic information compiled by the Veterans Administration shows a forthcoming major increased demand on the Veterans' Admininstration from the aging veterans of World War II for acute as well as long term health care. (8) A joint study of the Grace Commission's recommendations conducted by the Congressional Budget Office and the General Accounting Office and submitted to Congress in February 1984, concluded that the potential deficit reductions that might result in 1985 through 1987 from implemen tation of the Grace Commission's recommendations would be much smaller than the three-year savings projected by the Commission. (9) The Congress desires to reassure veterans that the Congress remains firmly com. mitted to an Independent and comprehensive, nationwide health-care system within the Veterans Administration, capable of providing quality care to eligible veterans. (b) In light of the findings made in subsec tion (a), it is the sense of the Congress (1) that the aforementioned recommendations of the President's Private Sector Survey on Cost Control relating to the Veterans' Administration health-care system must be evaluated in light of the national policies described in subsection (a)(2) and in light of the aforementioned factors, and (2) that no action to implement such recommendations should be taken without their policy impli cations having first been given full and careful consideration, after appropriate hearings, by the Committees on Veterans' Af fairs of the House of Representatives and the Senate. AUTHORITY TO ADJUST RATES OF PAY FOR SEC. 17. Section 4104 is amended(1) by inserting "(other than those described in paragraph (3))" after "psychologists" in paragraph (2); and (2) by striking out "Certified" in paragraph (3) and inserting in lieu thereof Clinical or counseling psychologists who hold diplomas as diplomates in psychology from an accrediting authority approved by the Administrator, certified". PROGRAM GUIDE ON ALZHEIMER'S DISEASE SEC. 18. Not later than 180 days after the date of the enactment of this Act, the Administrator shall disseminate to appropriate Veterans' Administration medical facilities and submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a program guide to clarify Veter ans' Administration policy regarding the authorization and provision of treatment, including diagnosis, information, outpatient services, hospital care, and nursing home care, of veterans who are eligible for serv ices under title 38, United States Code, and who are suffering from Alzheimer's disease and related neurological diseases. NAMING OF VETERANS' ADMINISTRATION SEC. 19. (a) The Veterans' Administration Medical Center in Murfreesboro, Tennessee, shall after the date of the enactment of this Act be known and designated as the "Ser geant Alvin C. York Veterans' Administra tion Medical Center". Any reference to such medical center in any law, regulation, map. document, record, or other paper of the United States shall after such date be deemed to be a reference to the Sergeant Alvin C. York Veterans' Administration Medical Center. (b) The Veterans Administration Medical Center in Milwaukee, Wisconsin, shall after the date of the enactment of this Act be known and designated as the "Clement J. Zablocki Veterans' Administration Medical Center". Any reference to such medical center in any law, regulation, map, document, record, or other paper of the United States shall after such date be deemed to be a reference to the Clement J. Zablocki Vet. erans' Administration Medical Center. Mr. STEVENS. I ask adoption of the Simpson-Cranston amendment. The PRESIDING OFFICER. The question is on agreeing to the amendment. The amendment (No. 3662) was agreed to. Mr. SIMPSON. Mr. President, I rise to express my strong support of S. 2514, the proposed "Veterans' Administration Health Care Amendments of 1984," which was approved unanimously by the Committee on Veterans' Affairs on May 9. The provisions of the bill are designed to maintain and improve the quality and efficiency of health-care services provided by the Veterans' Administration to eligible veterans. I believe the committee bill is fair and reasonable and I would urge that my colleagues Join me in assuring its passage. The committee intends that the committee bill would enhance the VA's capability to ensure that eligible veterans with certain complex health-care needs are provided with the most appropriate kinds and levels of care and that such care is provided in a coordinated fashion. The committee bill would also enhance the VA's health-care planning prodesses by examining the demand for certain kinds of health in health-related services. INTRODUCTION On March 30, 1984, as chairman of the Senate Committee on Veterans' Affairs, I introduced S. 2514. As introduced, S. 2514 would have, first, required the Administrator of Veterans' Affairs to designate one office at each VA health-care facility to coordinate and arrange for certain health and health-related services in local communities at no expense to the Veterans' Administration; second, required the Administrator to issue regulations re lated to the care for veterans suffering from alcohol or drug dependence; third, provided the Administrator with specific authority to provide assistive devices for certain hearing impaired veterans, including telecaptioning television decoders; fourth, directed the Administrator to establish the position of Associate Director for Post-Traumatic Stress Disorder (PTSD); and fifth, directed the Administrator to submit a report to Congress regarding VA hospice and respite programs for terminally ill and chronically ill veterans. On January 24, 1984, I introduced S. 2210. As introduced, S. 2210 would have revised and clarified the eligibility of certain disabled veterans for automobile adaptive equipment. On April 11, 1984, the committee held a hearing on these bills and a number of other measures and, on May 9, 1984, the committee met in open session and voted to report favorably S. 2514, with an amendment in the nature of a committee substitute and a title amendment. S. 2514 as reported consists of provisions derived with modifications from S. 2514, S. 2210, S. 2269, amendment No. 2850 to S. 2269, and S. 2278. HIGHLIGHTS OF S. 2514 AS REPORTED S. 2514, which I will refer to as the committee bill, contains 14 provisions that would enhance the Veterans' Administration's ability to provide high quality health care services to our Nation's veterans in an efficient manner. The committee bill would require the Administrator of Veterans' Affairs to designate one organizational unit in each VA medical facility to help coordinate referrals and facilitate the provision of services not at VA expense when such services are necessary to promote the health of veter ans. The committee bill would also extend for 2 years the VA's present discretionary authority to contract with halfway houses and other community-based facilities for the treatment and rehabilitation of veterans with alcohol or drug abuse or dependency disabilities. It would require the Administrator to prescribe regulations providing guidelines for VA operated treatment and rehabilitation programs for veter ans with alcohol or drug dependency or abuse disabilities. It would provide the Administrator with specific discretionary authority to provide hearing impairment assistive devices, including telecaptioning television decorders, to veterans who are profoundly deaf and who are entitled to disability compensation for a hearing impairment. It would require the VA to establish a Special Committee for Post-Traumatic Stress Disorder (PTSD) to assist the Chief Medical Director in developing policies, providing guidance, and coordinating the provision of services for the treatment of veterans with PTSD. It would require the VA to establish a National Center on PTSD to carry out research and training of health care personnel and to coordinate the exchange of information regarding PTSD among all VA and other Federal programs engaged in PTSD research and training activities. It would require the VA to report to Congress on its programs to furnish palliative care |