HR 901 CDS
101st CONGRESS
1st Session
H. R. 901
IN THE SENATE OF THE UNITED STATES
July 11 (legislative day, JANUARY 3), 1989
Received; read twice and referred to the Committee on Veterans' Affairs
October 3 (legislative day, SEPTEMBER 18), 1989
Committee discharged
AN ACT
To amend title 38, United States Code, to improve programs for the recruitment
and retention of health-care personnel of the Department of Veterans Affairs,
to extend certain expiring programs of that Department, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,

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OF SECRETARY.
(a) SHORT TITLE- This Act may be cited as the `Veterans' Health-Care
Programs Amendments of 1989'.
(b) REFERENCES TO TITLE 38- 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.
(c) SECRETARY DEFINED- For purposes of this Act, the term `Secretary'
means the Secretary of Veterans Affairs.

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ASSISTANTS.
(a) IN GENERAL- Section 4107(e) is amended by adding at the end the
following new paragraph:
`(11) For purposes of this subsection, an employee of the Veterans Health
Services and Research Administration who is a licensed practical or
vocational nurse or a nurse assistant shall be treated in the same manner
as a registered nurse.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect
on the later of (1) October 1, 1989, or (2) the date of the enactment of
this Act.

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TITLE I

-PERSONNEL PROVISIONS

EMPLOYEES.
Section 4108 is amended by adding at the end the following new subsection:
`(e) Any provision of this title limiting employment outside of the
Department by an employee of the Department shall not apply to an employee
described in section 4104(3) of this title.'.

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WHO ARE RETIRED MILITARY PERSONNEL.
(a) EXTENSION TO ALL HEALTH-CARE PERSONNEL- Section 4107(i) is amended--
(1) by inserting `, and registered nurse positions,' after `physician
positions'; and
(2) by adding at the end the following new sentence: `The authority of the
Secretary under the preceding sentence with respect to registered-nurse
positions expires on September 30, 1992.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a)(1) shall take
effect on the first day of the first pay period beginning on or after the
later of (1) October 1, 1989, or (2) the date of the enactment of this Act.

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(a) ENHANCED PAY FLEXIBILITY FOR EXTREMELY-DIFFICULT-TO-FILL PHYSICIAN
POSITIONS- Section 4107 is amended by adding at the end the following
new subsection:
`(k) In the case of specific physician positions in a specialty which
the Secretary has determined to be a specialty in which it is extremely
difficult to recruit and retain physicians, the Secretary may waive the
applicability to any such position of--
`(1) the limitations in subsection (d)(3) of this section and section 5308
of title 5; and
`(2) paragraphs (2) and (3) of subsection (g) of this section.'.
(b) EFFECTIVE DATE- Subsection (k) of section 4107 of title 38, United
States Code, shall take effect on the first day of the first pay period
beginning on or after the later of (1) October 1, 1989, or (2) the date
of the enactment of this Act.

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Section 4106 is amended by adding at the end the following new subsection:
`(h)(1) The Secretary may appoint qualified individuals in the competitive
civil service without regard to the provisions of subchapter I of chapter
33 of title 5 (other than sections 3303 and 3328 of such title).
`(2) For purposes of this subsection, an individual shall be considered
to be a qualified individual if the individual--
`(A) has a recognized degree or certificate from an accredited institution
in a health-care profession or occupation; and
`(B) is appointed to and has successfully completed a clinical education
program affiliated with the Department.
`(3) In using the authority provided by this subsection, the Secretary
shall apply the principles of preference for the hiring of veterans and
other persons established in subchapter I of chapter 33 of title 5.'.

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(a) AUTHORITY FOR PROGRAM- Section 4108 is amended by adding after subsection
(e) (as added by section 102) the following new subsection:
`(f)(1) The Secretary may carry out a leave-sharing program for employees
subject to this section who face medical emergencies (either for
themselves or family members). Any such program shall be consistent with
the leave-sharing programs authorized in subchapter III (beginning with
section 6331) and subchapter IV (beginning with section 6361) of chapter
63 of title 5 for employees appointed under title 5.
`(2) The authority to carry out such a program shall terminate on September
30, 1994.'.
(b) EFFECTIVE DATE- Subsection (f) of section 4108 of title 38, United States
Code, as added by subsection (a), shall take effect on October 1, 1989.

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(a) RESPITE CARE- Section 620B(c) is repealed.
(b) STATE HOME GRANT AUTHORITY- Section 5033(a) is amended by striking out
`September 30, 1989' and inserting in lieu thereof `September 30, 1992'.
(c) HOMELESS VETERANS- Section 115(d) of the Veterans' Benefits and Services
Act of 1988 (Public Law 100-322; 102 Stat. 501) is amended by striking out
`September 30, 1989' and inserting in lieu thereof `September 30, 1992'.
(d) ANNUAL REPORT ON MEANS TEST FOR FURNISHING NON-SERVICE-CONNECTED HEALTH
CARE- Section 19011(e)(1) of the Veterans' Health Care Amendments of 1986
(title XIX of Public Law 99-272; 100 Stat. 379) is amended by striking out
`and 1988' and inserting in lieu thereof `, 1988, 1989, 1990, and 1991'.
(e) ANNUAL REPORT ON PTSD- Section 110(e)(2) of the Veterans' Health Care
Act of 1984 (Public Law 98-528; 98 Stat. 2693) is amended by striking out
`three' and inserting in lieu thereof `six'.

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TITLE II

-HEALTH PROGRAM AMENDMENTS

Section 9 of the Veterans' Home Loan Program Improvements and Property
Rehabilitation Act of 1987 (38 U.S.C. 1820 note; 101 Stat. 1320) is amended--
(1) in subsection (a)(3)(B)(i), by striking out `solely as a shelter'
and inserting in lieu thereof `as a shelter or as transitional housing';
(2) by redesignating subsections (c) and (d) as subsections (d) and (e),
respectively;
(3) by inserting after subsection (b) the following new subsection:
`(c) VETERANS PARTICIPATING IN COMPENSATED WORK THERAPY PROGRAM- (1) To
assist veterans who are participants in a compensated work therapy program
authorized under section 618 of title 38, United States Code, the Secretary
of Veterans Affairs may convey to persons described in paragraph (2) real
property and improvements described in subsection (a)(2) for an amount
not less than 75 percent of the fair market value of such real property
and improvements.
`(2) The Secretary may convey such property to persons who enter into an
agreement with the Secretary to employ veterans who are participants in
a compensated work therapy program authorized under such section 618.
`(3) The Secretary may include appropriate enforcement provisions in any
agreement described in paragraph (2), including provision for reasonable
liquidated damages.'; and
(4) in subsection (d), as redesignated by paragraph (2), by striking out
`subsections (a) and (b)' and inserting in lieu thereof `this section'.

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(a) AUTHORIZED SOURCES FOR PROVISION OF THERAPEUTIC WORK- (1) Subsection
(b)(1) of section 618 is amended by striking out `contractual arrangements
with private industry or other sources outside the Veterans' Administration'
and inserting in lieu thereof `a contract or other arrangement with any
appropriate source (whether or not an element of the Department of Veterans
Affairs or of any other Federal entity)'.
(2) Subsection (c)(1) of such section is amended by striking out
`carrying out the provisions of' and inserting in lieu thereof `furnishing
rehabilitative services authorized in'.
(b) AUTHORITY TO ESTABLISH AND OPERATE THERAPEUTIC AND REHABILITATIVE
ACTIVITIES TRANSITIONAL HOUSING- (1) The Secretary may carry out a
demonstration program of transitional housing in accordance with this
subsection. Under that program, the Secretary may purchase, lease, or
otherwise acquire residential housing and may operate each residence
acquired under this subsection as transitional housing for veterans
described in paragraph (2).
(2) The veterans for whom transitional housing may be provided under this
subsection are veterans--
(A) who are furnishing services to the Department of Veterans Affairs
under subsection (a) of section 618 of title 38, United States Code; or
(B) who are furnished therapeutic work pursuant to subsection (b) of
that section.
(3) The Secretary may use such procurement procedures for the purchase,
lease, or other acquisition of residential housing for purposes of this
subsection as the Secretary considers appropriate to expedite the opening
and operation of transitional housing and to protect the interests of the
United States.
(4) A residence may be operated as transitional housing for veterans
described in paragraph (2) under the following conditions:
(A) Only veterans described in such paragraph and a house manager may
reside in such residence.
(B) Each resident, other than the house manager, shall pay rent for the
period of residence in such housing.
(C) In the establishment and operation of housing under this subsection, the
Secretary shall consult with appropriate representatives of the community in
which the housing is established and shall comply with zoning requirements,
building permit requirements, and other similar requirements applicable
to other real property used for similar purposes in the community.
(D) The residence shall meet State and community fire and safety
requirements applicable to other real property used for similar purposes
in the community in which the transitional housing is located, but fire
and safety requirements applicable to buildings of the Federal Government
shall not apply to such property.
(5) The Secretary shall prescribe the qualifications for house managers
for transitional housing operated under this subsection. The Secretary
may provide for free room and subsistence for house managers in addition
to or instead of payment of a fee for such services.
(6) The Secretary may operate as transitional housing under this subsection--
(A) any suitable residential property acquired by the Secretary as the
result of a default on a loan made, guaranteed, or insured under chapter
37 of title 38, United States Code; and
(B) any other suitable residential property purchased, leased, or otherwise
acquired by the Secretary.
(7)(A) In the case of the purchase of any property referred to in paragraph
(6)(A), the Secretary shall transfer from the Special Therapeutic and
Rehabilitation Activities Fund to the Loan Guaranty Revolving Fund the
amount equal to the amount that the Secretary would charge for the sale of
such property to a nonprofit organization or a State for use as a shelter
for homeless veterans.
(B) In the case of any residential property purchased by the Secretary
of Veterans Affairs from the Department of Housing and Urban Development
under this section, the amount charged by the Secretary of Housing and
Urban Development for that property may not exceed the amount that the
Secretary of Housing and Urban Development would charge for the sale of
such property to a nonprofit organization or a State for use as a shelter
for homeless persons.
(8) Subject to the authority, direction, and control of the Secretary, the
Chief Medical Director shall be responsible for the management, maintenance,
and disposition of property acquired for the purpose of this subsection.
(9) The Secretary shall prescribe--
(A) a procedure for establishing reasonable rental rates for persons
residing in transitional housing; and
(B) appropriate limits on the period for which such persons may reside in
transitional housing.
(10) The Secretary may dispose of any property acquired for the purpose
of this subsection. The proceeds of any such disposal shall be credited
to the Special Therapeutic and Rehabilitation Activities Fund.
(c) AVAILABILITY OF THE SPECIAL THERAPEUTIC AND REHABILITATION ACTIVITIES
FUND FOR COMPENSATED WORK THERAPY COMMUNITIES- Section 618(c) is amended--
(1) in paragraph (1), by inserting `and for the purpose of carrying out
section 203 of the Veterans' Health-Care Programs Amendments of 1989'
before the period at the end of the first sentence; and
(2) in paragraph (2)--
(A) by inserting `and all funds received by the Department as rent under
section 203 of the Veterans' Health-Care Programs Amendments of 1989'
in the first sentence after `paragraph (2) of such subsection,'; and
(B) by adding at the end the following new sentence: `The Secretary may
also distribute out of the fund such amounts as may be necessary for the
acquisition, management, maintenance, and disposition of real property
for the purpose of carrying out such section 203.'.
(d) REPORT- After the program under this subsection has been in effect for
three years, the Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives a report on the
operation of the program. The Secretary shall include in the report
such recommendations for continuation or expansion of the program as the
Secretary considers appropriate.

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(a) CONFORMITY WITH ELIGIBILITY FOR INPATIENT CARE- Section 612(a)
is amended--
(1) in paragraph (1), by striking out `determines are needed--' and all
that follows in that paragraph and inserting in lieu thereof `determines
are needed to any veteran who is eligible for hospital care under section
610(a)(1) of this title, subject to the same limitations as apply under
subparagraphs (A) through (I) of that section with respect to eligibility
for hospital care under that section.';
(2) by striking out paragraphs (2) and (3);
(3) by redesignating paragraph (4) as paragraph (2) and in that paragraph
striking out `paragraph (5)' and inserting in lieu thereof `paragraph (3)';
(4) by redesignating paragraph (5) as paragraph (3) and in that paragraph
striking out `paragraph (4)' and inserting in lieu thereof `paragraph
(2)'; and
(5) by redesignating paragraph (6) as paragraph (4).
(b) EFFECTIVE DATE- The amendments made by subsection (a) shall take effect
on October 1, 1989.

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(a) PROGRAM- (1) The Secretary shall carry out a program for the
establishment of an improved system for the administration and collection
of fees and other amounts payable to the United States under Department
of Veterans Affairs receipts programs.
(2) For purposes of this section, the term `Department of Veterans Affairs
receipts programs' means provisions of law administered by the Veterans
Health Services and Research Administration under the title 38, United
States Code, for the collection of fees and other amounts payable to the
United States, including the provisions relating to--
(A) fees charged to third parties;
(B) amounts recoverable by the United States under section 629 of title 38,
United States Code; and
(C) amounts payable as first-party medical copayments authorized in
such title.
(b) AUTOMATED PROGRAM FOR BILLING AND COLLECTION- (1) As part of the
system established under subsection (a), the Secretary shall provide for
the development of an automated program to carry out billing and collection
of fees and other amounts. The automated program shall have the capability
to process each Department of Veterans Affairs receipts program listed in
subparagraphs (A) through (C) of subsection (a)(2).
(2) In developing the billing and collection program required by paragraph
(1), the Secretary shall use services of the private sector to the maximum
extent feasible.
(3) Not later than January 31, 1992, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and House of Representatives
a report on the operation of this subsection during fiscal years 1990 and
1991. The report shall be based on a study, to be done in consultation with
the Comptroller General of the United States, comparing the experience in
carrying out this subsection through the use of employees of the Department
at not more than 20 medical centers with the experience in carrying out
this subsection through the use of contractor services at not more than
20 medical centers.
(c) ALLOCATION OF AMOUNTS COLLECTED- (1) The Secretary shall defray
costs of administering the automated program, including the costs of any
contract under the program, from amounts received by the Secretary through
the program.
(2) Of amounts collected or recovered by the Secretary for any fiscal
year under the Department of Veterans Affairs receipts programs listed in
subparagraphs (A) through (C) of subsection (a)(2) that remain after costs
are defrayed pursuant to paragraph (1), the Secretary shall cover into the
general fund of the Treasury as miscellaneous receipts an amount equal
to the amount which was estimated by the Congressional Budget Office in
February 1989 to be the total amount which would be recovered or collected
for fiscal year 1990 under those receipts programs (assuming this section
had not been enacted).
(3) Of amounts collected or recovered by the Secretary for any fiscal
year under the Department of Veterans Affairs receipts programs listed in
subparagraphs (A) through (C) of subsection (a)(2) that remain after costs
are defrayed pursuant to paragraph (1) and the requirement of paragraph
(2) has been met, the Secretary shall allocate remaining amounts as follows:
(A) 50 percent shall be credited to the Medical Care Account of the
Department of Veterans Affairs.
(B) 50 percent shall be credited to the Nursing Home Revolving Fund of
the Department.
(4) The Secretary shall prescribe regulations for the allocation to the
medical centers of the Department of amounts credited to the Medical Care
Account of the Department under paragraph (3). Those regulations shall be
designed to provide incentives to directors of medical centers to increase
the recovery and collection of amounts owed to the United States under
programs listed in subsection (a)(2) that are attributable to health care
and services furnished at their medical centers and, in the case of medical
centers at which such recovery and collection has been at above average
levels, to maintain and increase such levels.
(d) NURSING HOME REVOLVING FUND- Section 5016 is amended--
(1) by striking out `realized from a transfer pursuant to' in subsection
(a)(1) and inserting in lieu thereof `referred to in section 629 (g)(3)
and; and
(2) by striking out `may be made only as' in subsection (b)(1) and inserting
in lieu thereof `shall be made subject to such limitations as are'.
(e) EFFECTIVE DATE- This section shall apply with respect to funds collected
or recovered after September 30, 1989.

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TITLE III

-HEALTH-CARE MANAGEMENT

AGREEMENTS.
Section 5011(g)(5) is amended by inserting after `title 10' the following:
`or a dependent (as defined in section 1072(2) of such title) who is
eligible for care under section 1076 of such title'.

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(a) LIST OF BENEFICIARIES- The Secretary shall compile an accurate and
complete list of individuals eligible as of October 1, 1989, for benefits
under section 613 of title 38, United States Code. Such list shall be
compiled not later than October 1, 1989, and shall be maintained and
periodically updated thereafter. The Secretary may pay benefits under that
section only to persons whose names are included on the list.
(b) PROGRAM REVIEW- Not later than October 1, 1989, the Secretary shall
establish a procedure for the periodic review of the need for, the cost
effectiveness of, and the appropriateness of the provision of health care
by the Secretary under section 613 of such title.
(c) INSPECTOR GENERAL REVIEW- Not later than December 1, 1989, the Inspector
General of the Department of Veterans Affairs shall submit to the Committees
on Veterans' Affairs of the Senate and House of Representatives a report
on the compliance of the Secretary with subsections (a) and (b). If the
report indicates that the Secretary is not in compliance with either such
subsection, the Secretary shall promptly submit to those committees a
report explaining the reason for any such noncompliance and the plans of
the Secretary to correct the deficiency.
(d) STUDY OF ALTERNATIVES- (1) The Secretary shall carry out a study
of alternative methods for providing for the costs of health care which
are currently provided under section 613 of such title. In carrying out
the study, the Secretary shall consider methods which would result in a
substantially unchanged cost to the United States while providing improved
health benefits at lower costs to beneficiaries.
(2) The Secretary shall submit a report on the results of the study to
Congress not later than one year after the date of the enactment of this Act.
(3) There is authorized to be appropriated the sum of $500,000 to carry
out the study under this subsection.

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(a) LIMITATION ON EMPLOYMENT- Section 4203 is amended by adding at the
end the following new subsection:
`(c) A contract or other agreement may not be made by or on behalf of
the Service for performance by an individual not directly employed by the
United States of any activity otherwise performed by an individual employed
by the United States who is compensated with nonappropriated funds.'.
(b) INDEPENDENT STATUS WITHIN THE DEPARTMENT OF VETERANS AFFAIRS- Section
4208 is amended--
(1) by striking out `It is the purpose of this chapter that, under' and
inserting in lieu thereof `Under the'; and
(2) by adding at the end the following: `The head of the Service may not
be required to report to or be supervised by any official of the Department
other than the Secretary and Deputy Secretary.'.

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(a) RESCISSION OF REGULATION- The amendment to Veterans' Administration
medical regulations relating to the use of community nursing home care
facilities that was effective as of May 23, 1988, and which is further
described in subsection (b) is hereby rescinded, and the provisions of
regulations replaced by such regulations described in subsection (b)
are hereby restored.
(b) REGULATION DESCRIBED- Subsection (a) applies to the amendment to
title 38 of the Code of Federal Regulations section 17.51a published in
the Federal Register on April 21, 1988 (53 Fed. Reg. 13120).

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Section 5023 is amended--
(1) by inserting `(a)' before `The Administrator'; and
(2) by adding at the end the following:
`(b) The Secretary shall develop standards, based on the number of eligible
veterans seeking prosthetic and sensory aids services from the Department
at a medical facility, for the staffing of medical facilities of the
Department to provide for--
`(1) the assignment of sufficient numbers of qualified disabled prosthetic
representatives at each medical center; and
`(2) the operation of prosthetic and sensory aids services at each medical
facility with an active prosthetic patient load.
`(c) The Secretary shall carry out a program for the training and continuing
education of prosthetic representatives, orthotists, prosthetists, and
other health care professionals involved in providing and prescribing
prosthetic services.
`(d) Not later than February 1 of each year, the Secretary shall submit
to the Committees on Veterans' Affairs of the Senate and House of
Representatives a report on the funding and operation of the prosthetics
program of the Department. Each such report shall include the following:
`(1) A description and analysis, by medical center, of the duration of
time between the date on which each order for prosthetic services was
placed by an eligible veteran during the period of time covered by the
report and the date on which such service was delivered. Such analysis
shall include a statement of the following:
`(A) A list of facilities at which the duration of time exceeded 5 days
in any case.
`(B) The number of orders, shown by facility, for which the duration of
time was more than five days and the actual amount of time elapsed in
filling each such order.
`(C) The total dollar amount of orders for which the duration of time was
more than five days.
`(D) The reasons for the duration of time for delivering services in
accordance with such orders being in excess of five days.
`(2) A statement of the number of medical facilities at which qualified
disabled prosthetic representatives are employed and the number of medical
centers operating Prosthetic and Sensory Aids Services.
`(3) A description of the training provided to prosthetic representatives,
orthotists, prosthetists, and other health care professionals involved in
providing and prescribing prosthetic services.
`(4) A description of the actions taken during the period covered by the
report to expedite the purchases of prosthetic appliances.'.
Passed the House of Representatives June 27, 1989.
Attest:
DONNALD K. ANDERSON,
Clerk.

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Veterans' Health-Care Programs Amendments of 1989 — HR. 901

Other Sections

TITLE I

TITLE II

TITLE III

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