[Congressional Bills 110th Congress]
[From the U.S. Government Printing Office]
[S. 2162 Enrolled Bill (ENR)]
S.2162
One Hundred Tenth Congress
of the
United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Thursday,
the third day of January, two thousand and eight
An Act
To improve the treatment and services provided by the Department of
Veterans Affairs to veterans with post-traumatic stress disorder and
substance use disorders, 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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(a) Short Title.--This Act may be cited as the ``Veterans' Mental
Health and Other Care Improvements Act of 2008''.
(b) Table of Contents.--The table of contents for this Act is as
follows:

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provided by Department of Veterans Affairs.

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TITLE I

-SUBSTANCE USE DISORDERS AND MENTAL HEALTH CARE

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treatment for veterans of Operation Iraqi Freedom and
Operation Enduring Freedom.

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use of community mental health centers and Indian Health
Service facilities.

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TITLE II

-MENTAL HEALTH RESEARCH

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provide mental health services to families of veterans.

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TITLE III

-ASSISTANCE FOR FAMILIES OF VETERANS

assistance to veterans and their families in cooperation with
Vet Centers.

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treatment in non-Department of Veterans Affairs facilities
until transfer to Department facilities.

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TITLE IV

-HEALTH CARE MATTERS

care needs of veterans in highly rural areas.

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Veterans Affairs to children of Vietnam veterans born with
Spina Bifida.

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TITLE VI

-HOMELESS VETERANS MATTERS

and counseling services for at-risk veterans transitioning
from certain institutions.

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veterans and enhancement of capacity of domiciliary care
programs for female veterans.

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income veteran families in permanent housing.
FACILITY LEASES

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TITLE VII

-AUTHORIZATION OF MEDICAL FACILITY PROJECTS AND MAJOR MEDICAL

medical facility construction projects previously authorized.

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Colorado, to Secretary of Veterans Affairs for construction of
veterans medical facility.

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care services in definition of medical services.

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TITLE VIII

-EXTENSION OF CERTAIN AUTHORITIES

services, and nursing home care to veterans who participated
in certain chemical and biological testing conducted by the
Department of Defense.

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Committee on Care of Severely Chronically Mentally Ill
Veterans.

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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.

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TITLE IX

-OTHER MATTERS

This title is enacted in tribute to Justin Bailey, who, after
returning to the United States from service as a member of the Armed
Forces in Operation Iraqi Freedom, died in a domiciliary facility of
the Department of Veterans Affairs while receiving care for post-
traumatic stress disorder and a substance use disorder.

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Congress makes the following findings:
(1) More than 1,500,000 members of the Armed Forces have been
deployed in Operation Iraqi Freedom and Operation Enduring Freedom.
The 2005 Department of Defense Survey of Health Related Behaviors
Among Active Duty Personnel reports that 23 percent of members of
the Armed Forces on active duty acknowledge a significant problem
with alcohol use disorder, with similar rates of acknowledged
problems with alcohol use disorder among members of the National
Guard.
(2) The effects of substance use disorder are wide ranging,
including significantly increased risk of suicide, exacerbation of
mental and physical health disorders, breakdown of family support,
and increased risk of unemployment and homelessness.
(3) While veterans suffering from mental health conditions,
chronic physical illness, and polytrauma may be at increased risk
for development of a substance use disorder, treatment for these
veterans is complicated by the need to address adequately the
physical and mental symptoms associated with these conditions
through appropriate medical intervention.
(4) While the Veterans Health Administration has dramatically
increased health services for veterans from 1996 through 2006, the
number of veterans receiving specialized substance use disorder
treatment services decreased 18 percent during that time. No
comparable decrease in the national rate of substance use disorder
has been observed during that time.
(5) While some facilities of the Veterans Health Administration
provide exemplary substance use disorder treatment services, the
availability of such treatment services throughout the health care
system of the Veterans Health Administration is inconsistent.
(6) According to a 2006 report by the Government Accountability
Office, the Department of Veterans Affairs significantly reduced
its substance use disorder treatment and rehabilitation services
between 1996 and 2006, and the Fiscal Year 2007 National Mental
Health Program Monitoring System report shows that little progress
has been made in restoring these services to their pre-1996 levels.

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PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall ensure the
provision of such services and treatment to each veteran enrolled in
the health care system of the Department of Veterans Affairs who is in
need of services and treatments for a substance use disorder as
follows:
(1) Screening for substance use disorder in all settings,
including primary care settings.
(2) Short term motivational counseling services.
(3) Marital and family counseling.
(4) Intensive outpatient or residential care services.
(5) Relapse prevention services.
(6) Ongoing aftercare and outpatient counseling services.
(7) Opiate substitution therapy services.
(8) Pharmacological treatments aimed at reducing craving for
drugs and alcohol.
(9) Detoxification and stabilization services.
(10) Coordination with groups providing peer to peer
counseling.
(11) Such other services as the Secretary considers
appropriate.
(b) Provision of Services.--
(1) Allocation of resources for provision of services.--The
Secretary shall ensure that amounts made available for care,
treatment, and services provided under this section are allocated
in such a manner that a full continuum of care, treatment, and
services described in subsection (a) is available to veterans
seeking such care, treatment, or services, without regard to the
location of the residence of any such veterans.
(2) Manner of provision.--The services and treatment described
in subsection (a) may be provided to a veteran described in such
subsection--
(A) at Department of Veterans Affairs medical centers or
clinics;
(B) by referral to other facilities of the Department that
are accessible to such veteran; or
(C) by contract or fee-for-service payments with community-
based organizations for the provision of such services and
treatments.
(c) Alternatives in Case of Services Denied Due to Clinical
Necessity.--If the Secretary denies the provision to a veteran of
services or treatment for a substance use disorder due to clinical
necessity, the Secretary shall provide the veteran such other services
or treatment as are medically appropriate.

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DISORDERS.
(a) In General.--If the Secretary of Veterans Affairs provides a
veteran inpatient or outpatient care for a substance use disorder and a
comorbid mental health disorder, the Secretary shall ensure that
treatment for such disorders is provided concurrently--
(1) through a service provided by a clinician or health
professional who has training and expertise in treatment of
substance use disorders and mental health disorders;
(2) by separate substance use disorder and mental health
disorder treatment services when there is appropriate coordination,
collaboration, and care management between such treatment services;
or
(3) by a team of clinicians with appropriate expertise.
(b) Team of Clinicians With Appropriate Expertise Defined.--In this
section, the term ``team of clinicians with appropriate expertise''
means a team consisting of the following:
(1) Clinicians and health professionals with expertise in
treatment of substance use disorders and mental health disorders
who act in coordination and collaboration with each other.
(2) Such other professionals as the Secretary considers
appropriate for the provision of treatment to veterans for
substance use and mental health disorders.

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TREATMENT FOR VETERANS OF OPERATION IRAQI FREEDOM AND OPERATION
ENDURING FREEDOM.
(a) Findings.--Congress makes the following findings:
(1) Stigma associated with seeking treatment for mental health
disorders has been demonstrated to prevent some veterans from
seeking such treatment at a medical facility operated by the
Department of Defense or the Department of Veterans Affairs.
(2) There is a significant incidence among veterans of post-
deployment mental health problems, especially among members of a
reserve component who return as veterans to civilian life.
(3) Computer-based self-guided training has been demonstrated
to be an effective strategy for supplementing the care of
psychological conditions.
(4) Younger veterans, especially those who served in Operation
Enduring Freedom or Operation Iraqi Freedom, are comfortable with
and proficient at computer-based technology.
(5) Veterans living in rural areas may find access to treatment
for substance use disorder limited.
(6) Self-assessment and treatment options for substance use
disorders through an Internet website may reduce stigma and
provides additional access for individuals seeking care and
treatment for such disorders.
(b) In General.--Not later than October 1, 2009, the Secretary of
Veterans Affairs shall carry out a pilot program to assess the
feasibility and advisability of providing veterans who seek treatment
for substance use disorders access to a computer-based self-assessment,
education, and specified treatment program through a secure Internet
website operated by the Secretary. Participation in the pilot program
shall be available on a voluntary basis for those veterans who have
served in Operation Enduring Freedom or Operation Iraqi Freedom.
(c) Elements of Pilot Program.--
(1) In general.--In carrying out the pilot program under this
section, the Secretary shall ensure that--
(A) access to the Internet website and the programs
available on the website by a veteran (or family member) does
not involuntarily generate an identifiable medical record of
that access by that veteran in any medical database maintained
by the Department of Veterans Affairs;
(B) the Internet website is accessible from remote
locations, especially rural areas; and
(C) the Internet website includes a self-assessment tool
for substance use disorders, self-guided treatment and
educational materials for such disorders, and appropriate
information and materials for family members of veterans.
(2) Consideration of similar projects.--In designing the pilot
program under this section, the Secretary shall consider similar
pilot projects of the Department of Defense for the early diagnosis
and treatment of post-traumatic stress disorder and other mental
health conditions established under section 741 of the John Warner
National Defense Authorization Act of Fiscal Year 2007 (Public Law
109-364; 120 Stat. 2304).
(3) Location of pilot program.--The Secretary shall carry out
the pilot program through those medical centers of the Department
of Veterans Affairs that have established Centers for Excellence
for Substance Abuse Treatment and Education or that have
established a Substance Abuse Program Evaluation and Research
Center.
(4) Contract authority.--The Secretary may enter into contracts
with qualified entities or organizations to carry out the pilot
program required under this section.
(d) Duration of Pilot Program.--The pilot program required by
subsection (a) shall be carried out during the two-year period
beginning on the date of the commencement of the pilot program.
(e) Report.--Not later than six months after the completion of the
pilot program, the Secretary shall submit to Congress a report on the
pilot program, and shall include in that report--an assessment of the
feasibility and advisability of continuing or expanding the pilot
program, of any cost savings or other benefits associated with the
pilot program, and any other recommendations.
(f) Authorization of Appropriations.--There are authorized to be
appropriated to the Secretary of Veterans Affairs $1,500,000 for each
of fiscal years 2010 and 2011 to carry out the pilot program under this
section.

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THE VETERANS HEALTH ADMINISTRATION.
(a) Review.--
(1) In general.--Not later than six months after the date of
the enactment of this Act, the Secretary of Veterans Affairs shall,
acting through the Inspector General of the Department of Veterans
Affairs, complete a review of all residential mental health care
facilities, including domiciliary facilities, of the Veterans
Health Administration.
(2) Assessment.--As part of the review required by paragraph
(1), the Secretary, acting through the Inspector General, shall
assess the following:
(A) The availability of care in residential mental health
care facilities in each Veterans Integrated Service Network
(VISN).
(B) The supervision and support provided in the residential
mental health care facilities of the Veterans Health
Administration.
(C) The ratio of staff members at each residential mental
health care facility to patients at such facility.
(D) The appropriateness of rules and procedures for the
prescription and administration of medications to patients in
such residential mental health care facilities.
(E) The protocols at each residential mental health care
facility for handling missed appointments.
(3) Recommendations.--As part of the review required by
paragraph (1), the Secretary, acting through the Inspector General,
shall develop such recommendations as the Secretary considers
appropriate for improvements to residential mental health care
facilities of the Veterans Health Administration and the care
provided in such facilities.
(b) Follow-up Review.--Not later than two years after the date of
the completion of the review required by subsection (a), the Secretary
of Veterans Affairs shall, acting through the Inspector General of the
Department of Veterans Affairs, complete a follow-up review of the
facilities reviewed under subsection (a) to evaluate any improvements
made or problems remaining since the review under subsection (a) was
completed.
(c) Report.--Not later than 90 days after the completion of the
review required by subsection (a), the Secretary of Veterans Affairs
shall submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a
report on the findings of the Secretary with respect to such review.

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AND USE OF COMMUNITY MENTAL HEALTH CENTERS AND INDIAN HEALTH
SERVICE FACILITIES.
(a) Pilot Program Required.--Commencing not later than 180 days
after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall carry out a pilot program to assess the feasability and
advisability of providing to veterans of Operation Iraqi Freedom and
Operation Enduring Freedom, and, in particular, veterans who served in
such operations as a member of the National Guard or Reserve, the
following:
(1) Peer outreach services.
(2) Peer support services provided by licensed providers of
peer support services or veterans who have personal experience with
mental illness.
(3) Readjustment counseling services described in section 1712A
of title 38, United States Code.
(4) Other mental health services.
(b) Provision of Certain Services.--In providing services described
in paragraphs (3) and (4) of subsection (a) under the pilot program to
veterans who reside in rural areas and do not have adequate access
through the Department of Veterans Affairs to the services described in
such paragraphs, the Secretary shall, acting through the Office of
Mental Health Services and the Office of Rural Health, provide such
services as follows:
(1) Through community mental health centers under contracts or
other agreements if entered into by the Secretary of Veterans
Affairs and the Secretary of Health and Human Services for the
provision of such services for purposes of the pilot program.
(2) Through the Indian Health Service, or an Indian tribe or
tribal organization that has entered into an agreement with the
Indian Health Service pursuant to the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), if a memorandum
of understanding is entered into by the Secretary of Veterans
Affairs and the Secretary of Health and Human Services for purposes
of the pilot program.
(3) Through other appropriate entities under contracts or other
agreements entered into by the Secretary of Veterans Affairs for
the provision of such services for purposes of the pilot program.
(c) Duration.--The pilot program shall be carried out during the
three-year period beginning on the date of the commencement of the
pilot program.
(d) Program Locations.--
(1) In general.--The pilot program shall be carried out within
areas selected by the Secretary for the purpose of the pilot
program in at least three Veterans Integrated Service Networks
(VISNs).
(2) Rural geographic locations.--The locations selected shall
be in rural geographic locations that, as determined by the
Secretary, lack access to comprehensive mental health services
through the Department of Veterans Affairs.
(3) Qualified providers.--In selecting locations for the pilot
program, the Secretary shall select locations in which an adequate
number of licensed mental health care providers with credentials
equivalent to those of Department mental health care providers are
available in Indian Health Service facilities, community mental
health centers, and other entities for participation in the pilot
program.
(e) Participation in Program.--Each community mental health center,
facility of the Indian Health Service, or other entity participating in
the pilot program under subsection (b) shall--
(1) provide the services described in paragraphs (3) and (4) of
subsection (a) to eligible veterans, including, to the extent
practicable, telehealth services that link the center or facility
with Department of Veterans Affairs clinicians;
(2) use the clinical practice guidelines of the Veterans Health
Administration or the Department of Defense in the provision of
such services; and
(3) meet such other requirements as the Secretary shall
require.
(f) Compliance With Department Protocols.--Each community mental
health center, facility of the Indian Health Service, or other entity
participating in the pilot program under subsection (b) shall comply
with--
(1) applicable protocols of the Department before incurring any
liability on behalf of the Department for the provision of services
as part of the pilot program; and
(2) access and quality standards of the Department relevant to
the provision of services as part of the pilot program.
(g) Provision of Clinical Information.--Each community mental
health center, facility of the Indian Health Service, or other entity
participating in the pilot program under subsection (b) shall, in a
timely fashion, provide the Secretary with such clinical information on
each veteran for whom such health center or facility provides mental
health services under the pilot program as the Secretary shall require.
(h) Training.--
(1) Training of veterans.--As part of the pilot program, the
Secretary shall carry out a program of training for veterans
described in subsection (a) to provide the services described in
paragraphs (1) and (2) of such subsection.
(2) Training of clinicians.--
(A) In general.--The Secretary shall conduct a training
program for clinicians of community mental health centers,
Indian Health Service facilities, or other entities
participating in the pilot program under subsection (b) to
ensure that such clinicians can provide the services described
in paragraphs (3) and (4) of subsection (a) in a manner that
accounts for factors that are unique to the experiences of
veterans who served on active duty in Operation Iraqi Freedom
or Operation Enduring Freedom (including their combat and
military training experiences).
(B) Participation in training.--Personnel of each community
mental health center, facility of the Indian Health Service, or
other entity participating in the pilot program under
subsection (b) shall participate in the training program
conducted pursuant to subparagraph (A).
(i) Annual Reports.--Each community mental health center, facility
of the Indian Health Service, or other entity participating in the
pilot program under subsection (b) shall submit to the Secretary on an
annual basis a report containing, with respect to the provision of
services under subsection (b) and for the last full calendar year
ending before the submission of such report--
(1) the number of--
(A) veterans served; and
(B) courses of treatment provided; and
(2) demographic information for such services, diagnoses, and
courses of treatment.
(j) Program Evaluation.--
(1) In general.--The Secretary shall, through Department of
Veterans Affairs Mental Health Services investigators and in
collaboration with relevant program offices of the Department,
design and implement a strategy for evaluating the pilot program.
(2) Elements.--The strategy implemented under paragraph (1)
shall assess the impact that contracting with community mental
health centers, the Indian Health Service, and other entities
participating in the pilot program under subsection (b) has on the
following:
(A) Access to mental health care by veterans in need of
such care.
(B) The use of telehealth services by veterans for mental
health care needs.
(C) The quality of mental health care and substance use
disorder treatment services provided to veterans in need of
such care and services.
(D) The coordination of mental health care and other
medical services provided to veterans.
(k) Definitions.--In this section:
(1) The term ``community mental health center'' has the meaning
given such term in section 410.2 of title 42, Code of Federal
Regulations (as in effect on the day before the date of the
enactment of this Act).
(2) The term ``eligible veteran'' means a veteran in need of
mental health services who--
(A) is enrolled in the Department of Veterans Affairs
health care system; and
(B) has received a referral from a health professional of
the Veterans Health Administration to a community mental health
center, a facility of the Indian Health Service, or other
entity for purposes of the pilot program.
(3) The term ``Indian Health Service'' means the organization
established by section 601(a) of the Indian Health Care Improvement
Act (25 U.S.C. 1661(a)).
(l) Authorization of Appropriations.--There is authorized to be
appropriated such sums as may be necessary to carry out the provisions
of this section.

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DISORDER AND SUBSTANCE USE DISORDERS.
(a) Program Required.--The Secretary of Veterans Affairs shall,
through the Office of Research and Development, carry out a program of
research into comorbid post-traumatic stress disorder (PTSD) and
substance use disorder.
(b) Discharge Through National Center for Posttraumatic Stress
Disorder.--The research program required by subsection (a) shall be
carried out by the National Center for Posttraumatic Stress Disorder.
In carrying out the program, the Center shall--
(1) develop protocols and goals with respect to research under
the program; and
(2) coordinate research, data collection, and data
dissemination under the program.
(c) Research.--The program of research required by subsection (a)
shall address the following:
(1) Comorbid post-traumatic stress disorder and substance use
disorder.
(2) The systematic integration of treatment for post-traumatic
stress disorder with treatment for substance use disorder.
(3) The development of protocols to evaluate care of veterans
with comorbid post-traumatic stress disorder and substance use
disorder.
(d) Funding.--
(1) Authorization of appropriations.--There is authorized to be
appropriated for the Department of Veterans Affairs for each of
fiscal years 2009 through 2012, $2,000,000 to carry out this
section.
(2) Availability.--Amounts authorized to be appropriated by
paragraph (1) shall be made available to the National Center on
Posttraumatic Stress Disorder for the purpose specified in that
paragraph.
(3) Supplement not supplant.--Any amount made available to the
National Center on Posttraumatic Stress Disorder for a fiscal year
under paragraph (2) is in addition to any other amounts made
available to the National Center on Posttraumatic Stress Disorder
for such year under any other provision of law.

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TRAUMATIC STRESS DISORDER.
Section 110(e)(2) of the Veterans' Health Care Act of 1984 (38
U.S.C. 1712A note; Public Law 98-528) is amended by striking ``through
2008'' and inserting ``through 2012''.

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AFFAIRS TO PROVIDE MENTAL HEALTH SERVICES TO FAMILIES OF
VETERANS.
(a) In General.--Chapter 17 is amended--
(1) in section 1701(5)(B)--
(A) by inserting ``marriage and family counseling,'' after
``professional counseling,''; and
(B) by striking ``as may be essential to'' and inserting
``as the Secretary considers appropriate for''; and
(2) in section 1782--
(A) in subsection (a), by inserting ``marriage and family
counseling,'' after ``professional counseling,''; and
(B) in subsection (b)--
(i) by inserting ``marriage and family counseling,''
after ``professional counseling,''; and
(ii) by striking ``if--'' and all that follows and
inserting a period.
(b) Location.--Paragraph (5) of section 1701 of title 38, United
States Code, shall not be construed to prevent the Secretary of
Veterans Affairs from providing services described in subparagraph (B)
of such paragraph to individuals described in such subparagraph in
centers under section 1712A of such title (commonly referred to as
``Vet Centers''), Department of Veterans Affairs medical centers,
community-based outpatient clinics, or in such other facilities of the
Department of Veterans Affairs as the Secretary considers necessary.

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ASSISTANCE TO VETERANS AND THEIR FAMILIES IN COOPERATION WITH VET
CENTERS.
(a) Pilot Program.--The Secretary of Veterans Affairs shall carry
out, through a non-Department of Veterans Affairs entity, a pilot
program to assess the feasability and advisability of providing
readjustment and transition assistance described in subsection (b) to
veterans and their families in cooperation with centers under section
1712A of title 38, United States Code (commonly referred to as ``Vet
Centers'').
(b) Readjustment and Transition Assistance.--Readjustment and
transition assistance described in this subsection is assistance as
follows:
(1) Readjustment and transition assistance that is preemptive,
proactive, and principle-centered.
(2) Assistance and training for veterans and their families in
coping with the challenges associated with making the transition
from military to civilian life.
(c) Non-Department of Veterans Affairs Entity.--
(1) In general.--The Secretary shall carry out the pilot
program through any for-profit or non-profit organization selected
by the Secretary for purposes of the pilot program that has
demonstrated expertise and experience in the provision of
assistance and training described in subsection (b).
(2) Contract or agreement.--The Secretary shall carry out the
pilot program through a non-Department entity described in
paragraph (1) pursuant to a contract or other agreement entered
into by the Secretary and the entity for purposes of the pilot
program.
(d) Commencement of Pilot Program.--The pilot program shall
commence not later than 180 days after the date of the enactment of
this Act.
(e) Duration of Pilot Program.--The pilot program shall be carried
out during the three-year period beginning on the date of the
commencement of the pilot program, and may be carried out for
additional one-year periods thereafter.
(f) Location of Pilot Program.--
(1) In general.--The Secretary shall provide assistance under
the pilot program in cooperation with 10 centers described in
subsection (a) designated by the Secretary for purposes of the
pilot program.
(2) Designations.--In designating centers described in
subsection (a) for purposes of the pilot program, the Secretary
shall designate centers so as to provide a balanced geographical
representation of such centers throughout the United States,
including the District of Columbia, the Commonwealth of Puerto
Rico, tribal lands, and other territories and possessions of the
United States.
(g) Participation of Centers.--A center described in subsection (a)
that is designated under subsection (f) for participation in the pilot
program shall participate in the pilot program by promoting awareness
of the assistance and training available to veterans and their families
through--
(1) the facilities and other resources of such center;
(2) the non-Department of Veterans Affairs entity selected
pursuant to subsection (c); and
(3) other appropriate mechanisms.
(h) Additional Support.--In carrying out the pilot program, the
Secretary may enter into contracts or other agreements, in addition to
the contract or agreement described in subsection (c), with such other
non-Department of Veterans Affairs entities meeting the requirements of
subsection (c) as the Secretary considers appropriate for purposes of
the pilot program.
(i) Report on Pilot Program.--
(1) Report required.--Not later than three years after the date
of the enactment of this Act, the Secretary shall submit to the
congressional veterans affairs committees a report on the pilot
program.
(2) Elements.--Each report under paragraph (1) shall include
the following:
(A) A description of the activities under the pilot program
as of the date of such report, including the number of veterans
and families provided assistance under the pilot program and
the scope and nature of the assistance so provided.
(B) A current assessment of the effectiveness of the pilot
program.
(C) Any recommendations that the Secretary considers
appropriate for the extension or expansion of the pilot
program.
(3) Congressional veterans affairs committees defined.--In this
subsection, the term ``congressional veterans affairs committees''
means--
(A) the Committees on Veterans' Affairs and Appropriations
of the Senate; and
(B) the Committees on Veterans' Affairs and Appropriations
of the House of Representatives.
(j) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated for the
Department of Veterans Affairs for each of fiscal years 2009
through 2011 $1,000,000 to carry out this section.
(2) Availability.--Amounts authorized to be appropriated by
paragraph (1) shall remain available until expended.

124921c6159179bbe5d87da9013038cd01bece3220c39302f4af44ef44e61f05

(a) Repeal of Requirement To Adjust Amounts Deducted From Payments
or Allowances for Beneficiary Travel.--
(1) In general.--Section 111(c) is amended--
(A) by striking paragraph (5); and
(B) in paragraph (2), by striking ``, except as provided in
paragraph (5) of this subsection,''.
(2) Reinstatement of amount of deduction specified by
statute.--Notwithstanding any adjustment made by the Secretary of
Veterans Affairs under paragraph (5) of section 111(c) of title 38,
United States Code, as such paragraph was in effect before the date
of the enactment of this Act, the amount deducted under paragraph
(1) of such section 111(c) on or after such date shall be the
amount specified in such paragraph.
(b) Determination of Mileage Reimbursement Rate.--Section 111(g) is
amended--
(1) by amending paragraph (1) to read as follows:
``(1) Subject to paragraph (3), in determining the amount of
allowances or reimbursement to be paid under this section, the
Secretary shall use the mileage reimbursement rate for the use of
privately owned vehicles by Government employees on official business
(when a Government vehicle is available), as prescribed by the
Administrator of General Services under section 5707(b) of title 5.'';
(2) by striking paragraphs (3) and (4); and
(3) by inserting after paragraph (2) the following new
paragraph (3):
``(3) Subject to the availability of appropriations, the Secretary
may modify the amount of allowances or reimbursement to be paid under
this section using a mileage reimbursement rate in excess of that
prescribed under paragraph (1).''.
(c) Report.--Not later than 14 months after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a report
containing an estimate of the additional costs incurred by the
Department of Veterans Affairs because of this section, including--
(1) any costs resulting from increased utilization of
healthcare services by veterans eligible for travel allowances or
reimbursements under section 111 of title 38, United States Code;
and
(2) the additional costs that would be incurred by the
Department should the Secretary exercise the authority described in
subsection (g)(3) of such section.
(d) Effective Date.--The amendments made by this section shall
apply with respect to travel expenses incurred after the expiration of
the 90-day period that begins on the date of the enactment of this Act.

95b68f37aaed711603445c49c3a15b316fa68bb9da09423c5f7fbf5011f952f6

TREATMENT IN NON-DEPARTMENT OF VETERANS AFFAIRS FACILITIES UNTIL
TRANSFER TO DEPARTMENT FACILITIES.
(a) Certain Veterans Without Service-Connected Disability.--Section
1725 is amended--
(1) in subsection (a)(1), by striking ``may reimburse'' and
inserting ``shall reimburse''; and
(2) in subsection (f)(1), by striking subparagraph (C) and
inserting the following new subparagraph (C):
``(C) until--
``(i) such time as the veteran can be transferred
safely to a Department facility or other Federal facility
and such facility is capable of accepting such transfer; or
``(ii) such time as a Department facility or other
Federal facility accepts such transfer if--
``(I) at the time the veteran could have been
transferred safely to a Department facility or other
Federal facility, no Department facility or other
Federal facility agreed to accept such transfer; and
``(II) the non-Department facility in which such
medical care or services was furnished made and
documented reasonable attempts to transfer the veteran
to a Department facility or other Federal facility.''.
(b) Certain Veterans With Service-Connected Disability.--Section
1728 is amended--
(1) by striking subsection (a) and inserting the following new
subsection (a):
``(a) The Secretary shall, under such regulations as the Secretary
prescribes, reimburse veterans eligible for hospital care or medical
services under this chapter for the customary and usual charges of
emergency treatment (including travel and incidental expenses under the
terms and conditions set forth in section 111 of this title) for which
such veterans have made payment, from sources other than the
Department, where such emergency treatment was rendered to such
veterans in need thereof for any of the following:
``(1) An adjudicated service-connected disability.
``(2) A non-service-connected disability associated with and
held to be aggravating a service-connected disability.
``(3) Any disability of a veteran if the veteran has a total
disability permanent in nature from a service-connected disability.
``(4) Any illness, injury, or dental condition of a veteran
who--
``(A) is a participant in a vocational rehabilitation
program (as defined in section 3101(9) of this title); and
``(B) is medically determined to have been in need of care
or treatment to make possible the veteran's entrance into a
course of training, or prevent interruption of a course of
training, or hasten the return to a course of training which
was interrupted because of such illness, injury, or dental
condition.'';
(2) in subsection (b), by striking ``care or services'' both
places it appears and inserting ``emergency treatment''; and
(3) by adding at the end the following new subsection:
``(c) In this section, the term `emergency treatment' has the
meaning given such term in section 1725(f)(1) of this title.''.

a99fccf97ea084121692c8d1b0a7ca3a58c6cc2502234374bfb53100882f1e23

HEALTH CARE NEEDS OF VETERANS IN HIGHLY RURAL AREAS.
(a) Pilot Program Required.--
(1) In general.--The Secretary of Veterans Affairs shall
conduct a pilot program under which the Secretary provides covered
health services to covered veterans through qualifying non-
Department of Veterans Affairs health care providers.
(2) Commencement.--The Secretary shall commence the conduct of
the pilot program on the date that is 120 days after the date of
the enactment of this Act.
(3) Termination.--A veteran may receive health services under
the pilot program only during the three-year period beginning on
the date of the commencement of the pilot program under paragraph
(2).
(4) Program locations.--The pilot program shall be carried out
within areas selected by the Secretary for the purposes of the
pilot program in at least five Veterans Integrated Service Networks
(VISNs). Of the Veterans Integrated Service Networks so selected--
(A) not less than four such networks shall include at least
three highly rural counties, as determined by the Secretary
upon consideration of the most recent decennial census;
(B) not less than one such network, not including a network
selected under subparagraph (A), shall include only one highly
rural county, as determined by the Secretary upon consideration
of the most recent decennial census;
(C) all such networks shall include area within the borders
of at least four States; and
(D) no such networks shall be participants in the
Healthcare Effectiveness through Resource Optimization pilot
program of the Department of Veterans Affairs.
(b) Covered Veterans.--
(1) In general.--For purposes of the pilot program under this
section, a covered veteran is any highly rural veteran who is--
(A) enrolled in the system of patient enrollment
established under section 1705(a) of title 38, United States
Code, as of the date of the commencement of the pilot program
under subsection (a)(2); or
(B) eligible for health care under section 1710(e)(3)(C) of
title 38, United States Code.
(2) Highly rural veterans.--For purposes of this subsection, a
highly rural veteran is any veteran who--
(A) resides in a location that is--
(i) more than 60 miles driving distance from the
nearest Department health care facility providing primary
care services, if the veteran is seeking such services;
(ii) more than 120 miles driving distance from the
nearest Department health care facility providing acute
hospital care, if the veteran is seeking such care; or
(iii) more than 240 miles driving distance from the
nearest Department health care facility providing tertiary
care, if the veteran is seeking such care; or
(B) in the case of a veteran who resides in a location less
than the distance specified in clause (i), (ii), or (iii) of
subparagraph (A), as applicable, experiences such hardship or
other difficulties in travel to the nearest appropriate
Department health care facility that such travel is not in the
best interest of the veteran, as determined by the Secretary
pursuant to regulations prescribed for purposes of this
subsection.
(c) Covered Health Services.--For purposes of the pilot program
under this section, a covered health service with respect to a covered
veteran is any hospital care, medical service, rehabilitative service,
or preventative health service that is authorized to be provided by the
Secretary to the veteran under chapter 17 of title 38, United States
Code, or any other provision of law.
(d) Qualifying Non-Department Health Care Providers.--For purposes
of the pilot program under this section, an entity or individual is a
qualifying non-Department health care provider of a covered health
service if the Secretary determines that the entity or individual is
qualified to furnish such service to veterans under the pilot program.
(e) Election.--A covered veteran seeking to be provided covered
health services under the pilot program under this section shall submit
to the Secretary an application therefor in such form, and containing
such information as the Secretary shall specify for purposes of the
pilot program.
(f) Provision of Services Through Contract.--The Secretary shall
provide covered health services to veterans under the pilot program
under this section through contracts with qualifying non-Department
health care providers for the provision of such services.
(g) Exchange of Medical Information.--In conducting the pilot
program under this section, the Secretary shall develop and utilize a
functional capability to provide for the exchange of appropriate
medical information between the Department and non-Department health
care providers providing health services under the pilot program.
(h) Reports.--Not later than the 30 days after the end of each year
in which the pilot program under this section is conducted, the
Secretary shall submit to the Committee of Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report which includes--
(1) the assessment of the Secretary of the pilot program during
the preceding year, including its cost, volume, quality, patient
satisfaction, benefit to veterans, and such other findings and
conclusions with respect to pilot program as the Secretary
considers appropriate; and
(2) such recommendations as the Secretary considers appropriate
regarding--
(A) the continuation of the pilot program;
(B) extension of the pilot program to other or all Veterans
Integrated Service Networks of the Department;
(C) making the pilot program permanent.

ee0589ea8781a265ad1a894c1c0038c74cea814cda7d0cee428b559bd9020c8e

(a) In General.--Subchapter II of chapter 73 is amended by adding
at the end the following new section:
``Sec. 7330A. Epilepsy centers of excellence
``(a) Establishment of Centers.--(1) Not later than 120 days after
the date of the enactment of the Veterans' Mental Health and Other Care
Improvements Act of 2008, the Secretary shall designate at least four
but not more than six Department health care facilities as locations
for epilepsy centers of excellence for the Department.
``(2) Of the facilities designated under paragraph (1), not less
than two shall be centers designated under section 7327 of this title.
``(3) Of the facilities designated under paragraph (1), not less
than two shall be facilities that are not centers designated under
section 7327 of this title.
``(4) Subject to the availability of appropriations for such
purpose, the Secretary shall establish and operate an epilepsy center
of excellence at each location designated under paragraph (1).
``(b) Designation of Facilities.--(1) In designating locations for
epilepsy centers of excellence under subsection (a), the Secretary
shall solicit proposals from Department health care facilities seeking
designation as a location for an epilepsy center of excellence.
``(2) The Secretary may not designate a facility as a location for
an epilepsy center of excellence under subsection (a) unless the peer
review panel established under subsection (c) has determined under that
subsection that the proposal submitted by such facility seeking
designation as a location for an epilepsy center of excellence is among
those proposals that meet the highest competitive standards of
scientific and clinical merit.
``(3) In choosing from among the facilities meeting the
requirements of paragraph (2), the Secretary shall also consider
appropriate geographic distribution when designating the epilepsy
centers of excellence under subsection (a).
``(c) Peer Review Panel.--(1) The Under Secretary for Health shall
establish a peer review panel to assess the scientific and clinical
merit of proposals that are submitted to the Secretary for the
designation of epilepsy centers of excellence under this section.
``(2)(A) The membership of the peer review panel shall consist of
experts on epilepsy, including post-traumatic epilepsy.
``(B) Members of the peer review panel shall serve for a period of
no longer than two years, except as specified in subparagraph (C).
``(C) Of the members first appointed to the panel, one half shall
be appointed for a period of three years and one half shall be
appointed for a period of two years, as designated by the Under
Secretary at the time of appointment.
``(3) The peer review panel shall review each proposal submitted to
the panel by the Under Secretary for Health and shall submit its views
on the relative scientific and clinical merit of each such proposal to
the Under Secretary.
``(4) The peer review panel shall, in conjunction with the national
coordinator designated under subsection (e), conduct regular
evaluations of each epilepsy center of excellence established and
operated under subsection (a) to ensure compliance with the
requirements of this section.
``(5) The peer review panel shall not be subject to the Federal
Advisory Committee Act.
``(d) Epilepsy Center of Excellence Defined.--In this section, the
term `epilepsy center of excellence' means a health care facility that
has (or in the foreseeable future can develop) the necessary capacity
to function as a center of excellence in research, education, and
clinical care activities in the diagnosis and treatment of epilepsy and
has (or may reasonably be anticipated to develop) each of the
following:
``(1) An affiliation with an accredited medical school that
provides education and training in neurology, including an
arrangement with such school under which medical residents receive
education and training in the diagnosis and treatment of epilepsy
(including neurosurgery).
``(2) The ability to attract the participation of scientists
who are capable of ingenuity and creativity in health care research
efforts.
``(3) An advisory committee composed of veterans and
appropriate health care and research representatives of the
facility and of the affiliated school or schools to advise the
directors of such facility and such center on policy matters
pertaining to the activities of the center during the period of the
operation of such center.
``(4) The capability to conduct effectively evaluations of the
activities of such center.
``(5) The capability to assist in the expansion of the
Department's use of information systems and databases to improve
the quality and delivery of care for veterans enrolled within the
Department's health care system.
``(6) The capability to assist in the expansion of the
Department telehealth program to develop, transmit, monitor, and
review neurological diagnostic tests.
``(7) The ability to perform epilepsy research, education, and
clinical care activities in collaboration with Department medical
facilities that have centers for research, education, and clinical
care activities on complex multi-trauma associated with combat
injuries established under section 7327 of this title.
``(e) National Coordinator for Epilepsy Programs.--(1) To assist
the Secretary and the Under Secretary for Health in carrying out this
section, the Secretary shall designate an individual in the Veterans
Health Administration to act as a national coordinator for epilepsy
programs of the Veterans Health Administration.
``(2) The duties of the national coordinator for epilepsy programs
shall include the following:
``(A) To supervise the operation of the centers established
pursuant to this section.
``(B) To coordinate and support the national consortium of
providers with interest in treating epilepsy at Department health
care facilities lacking such centers in order to ensure better
access to state-of-the-art diagnosis, research, clinical care, and
education for traumatic brain injury and epilepsy throughout the
health care system of the Department.
``(C) To conduct, in conjunction with the peer review panel
established under subsection (c), regular evaluations of the
epilepsy centers of excellence to ensure compliance  with the
requirements of this section.
``(D) To coordinate (as part of an integrated national system)
education, clinical care, and research activities within all
facilities with an epilepsy center of excellence.
``(E) To develop jointly a national consortium of providers
with interest in treating epilepsy at Department health care
facilities lacking an epilepsy center of excellence in order to
ensure better access to state-of-the-art diagnosis, research,
clinical care, and education for traumatic brain injury and
epilepsy throughout the health care system of the Department. Such
consortium should include a designated epilepsy referral clinic in
each Veterans Integrated Service Network.
``(3) In carrying out duties under this subsection, the national
coordinator for epilepsy programs shall report to the official of the
Veterans Health Administration responsible for neurology.
``(f) Authorization of Appropriations.--(1) There are authorized to
be appropriated $6,000,000 for each of fiscal years 2009 through 2013
for the support of the clinical care, research, and education
activities of the epilepsy centers of excellence established and
operated pursuant to subsection (a)(2).
``(2) There are authorized to be appropriated for each fiscal year
after fiscal year 2013 such sums as may be necessary for the support of
the clinical care, research, and education activities of the epilepsy
centers of excellence established and operated pursuant to subsection
(a)(2).
``(3) The Secretary shall ensure that funds for such centers are
designated for the first three years of operation as a special purpose
program for which funds are not allocated through the Veterans
Equitable Resource Allocation system.
``(4) In addition to amounts authorized to be appropriated under
paragraphs (1) and (2) for a fiscal year, the Under Secretary for
Health shall allocate to such centers from other funds appropriated
generally for the Department medical services account and medical and
prosthetics research account, as appropriate, such amounts as the Under
Secretary for Health determines appropriate.
``(5) In addition to amounts authorized to be appropriated under
paragraphs (1) and (2) for a fiscal year, there are authorized to be
appropriated such sums as may be necessary to fund the national
coordinator established by subsection (e).''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 73 is amended by inserting after the item relating to section
7330 the following new item:
``7330A. Epilepsy centers of excellence.''.

c7bbe7138f3156940f98e28b8947ab9459c76c460cb384dfedade7c82e92446c

APPOINTEES.
(a) In General.--Section 7402(b) is amended--
(1) by redesignating the paragraph (11) relating to other
health care positions as paragraph (14); and
(2) by inserting after paragraph (12) the following new
paragraph (13):
``(13) Peer Specialist.--To be eligible to be appointed to a peer
specialist position, a person must--
``(A) be a veteran who has recovered or is recovering from a
mental health condition; and
``(B) be certified by--
``(i) a not-for-profit entity engaged in peer specialist
training as having met such criteria as the Secretary shall
establish for a peer specialist position; or
``(ii) a State as having satisfied relevant State
requirements for a peer specialist position.''.
(b) Peer Specialist Training.--Section 7402 is amended by adding at
the end the following new subsection:
``(g) The Secretary may enter into contracts with not-for-profit
entities to provide--
``(1) peer specialist training to veterans; and
``(2) certification for veterans under subsection
(b)(13)(B)(i).''.

5b9eea70d1980d5ea71bf111080889ae34f28f063cc4b7593be60e6e6ea700c5

(a) Establishment of Centers.--Chapter 17 is amended by inserting
after section 1729A the following new section:
``Sec. 1729B. Consolidated patient accounting centers
``(a) In General.--Not later than five years after the date of the
enactment of this section, the Secretary of Veterans Affairs shall
establish not more than seven consolidated patient accounting centers
for conducting industry-modeled regionalized billing and collection
activities of the Department.
``(b) Functions.--The centers shall carry out the following
functions:
``(1) Reengineer and integrate all business processes of the
revenue cycle of the Department.
``(2) Standardize and coordinate all activities of the
Department related to the revenue cycle for all health care
services furnished to veterans for non-service-connected medical
conditions.
``(3) Apply commercial industry standards for measures of
access, timeliness, and performance metrics with respect to revenue
enhancement of the Department.
``(4) Apply other requirements with respect to such revenue
cycle improvement as the Secretary may specify.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1729A the following:
``1729B. Consolidated patient accounting centers.''.

ae2478411ae85af47fc7abf64f2f1268d394c82f66b43f481fecf31d517b38f7

HIV TESTING PROGRAM.
Section 124 of the Veterans' Benefits and Services Act of 1988
(title I of Public Law 100-322, as amended; 38 U.S.C. 7333 note) is
repealed.

15036a16bcfa209ff0b798e893b7e653cf4dd6e63f37e5cdd5a8f760d6907133

VETERANS AFFAIRS TO CHILDREN OF VIETNAM VETERANS BORN WITH SPINA
BIFIDA.
(a) Provision of Comprehensive Health Care.--Section 1803(a) is
amended by striking ``such health care as the Secretary determines is
needed by the child for the spina bifida or any disability that is
associated with such condition'' and inserting ``health care under this
section''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to care furnished after the date of the enactment of
this Act.

b9f3df52157041af51407389abcdcf469abd190ec9b82c77ea5ebf7ede521b49

RECEIVING HOSPICE CARE.
Section 1710 is amended--
(1) in subsection (f)(1), by inserting ``(except if such care
constitutes hospice care)'' after ``nursing home care''; and
(2) in subsection (g)(1), by inserting ``(except if such care
constitutes hospice care)'' after ``medical services''.

5a9d7a01a09d78448d05d96a7655d31d7579c1c551d9c3257423126909cc757d

(a) Comprehensive Policy Required.--Not later than October 1, 2009,
the Secretary of Veterans Affairs shall develop and implement a
comprehensive policy on the management of pain experienced by veterans
enrolled for health care services provided by the Department of
Veterans Affairs.
(b) Scope of Policy.--The policy required by subsection (a) shall
cover each of the following:
(1) The Department-wide management of acute and chronic pain
experienced by veterans.
(2) The standard of care for pain management to be used
throughout the Department.
(3) The consistent application of pain assessments to be used
throughout the Department.
(4) The assurance of prompt and appropriate pain care treatment
and management by the Department, system-wide, when medically
necessary.
(5) Department programs of research related to acute and
chronic pain suffered by veterans, including pain attributable to
central and peripheral nervous system damage characteristic of
injuries incurred in modern warfare.
(6) Department programs of pain care education and training for
health care personnel of the Department.
(7) Department programs of patient education for veterans
suffering from acute or chronic pain and their families.
(c) Updates.--The Secretary shall revise the policy required by
subsection (a) on a periodic basis in accordance with experience and
evolving best practice guidelines.
(d) Consultation.--The Secretary shall develop the policy required
by subsection (a), and revise such policy under subsection (c), in
consultation with veterans service organizations and organizations with
expertise in the assessment, diagnosis, treatment, and management of
pain.
(e) Annual Report.--
(1) In general.--Not later than 180 days after the date of the
completion and initial implementation of the policy required by
subsection (a) and on October 1 of every fiscal year thereafter
through fiscal year 2018, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on the
implementation of the policy required by subsection (a).
(2) Contents.--The report required by paragraph (1) shall
include the following:
(A) A description of the policy developed and implemented
under subsection (a) and any revisions to such policy under
subsection (c).
(B) A description of the performance measures used to
determine the effectiveness of such policy in improving pain
care for veterans system-wide.
(C) An assessment of the adequacy of Department pain
management services based on a survey of patients managed in
Department clinics.
(D) An assessment of the research projects of the
Department relevant to the treatment of the types of acute and
chronic pain suffered by veterans.
(E) An assessment of the training provided to Department
health care personnel with respect to the diagnosis, treatment,
and management of acute and chronic pain.
(F) An assessment of the patient pain care education
programs of the Department.
(f) Veterans Service Organization Defined.--In this section, the
term ``veterans service organization'' means any organization
recognized by the Secretary for the representation of veterans under
section 5902 of title 38, United States Code.

b1b5cf08ec1e645e451b5d910e56f72976e8b3f36c7d0a0d15d1001e1a573f69

TITLE V

-PAIN CARE

COMPREHENSIVE SERVICE PROGRAMS.
Section 2013 is amended by striking ``$130,000,000'' and inserting
``$150,000,000''.

3e33a309d030a9b30195e34ccdcb1820e388d40f8ffd2b620938d84ab62f3ea0

REFERRAL AND COUNSELING SERVICES FOR AT-RISK VETERANS
TRANSITIONING FROM CERTAIN INSTITUTIONS.
(a) Program Authority.--Subsection (a) of section 2023 is amended
by striking ``a demonstration program for the purpose of determining
the costs and benefits of providing'' and inserting ``a program of''.
(b) Scope of Program.--Subsection (b) of such section is amended--
(1) by striking ``Demonstration'' in the subsection heading;
(2) by striking ``demonstration''; and
(3) by striking ``in at least six locations'' and inserting
``in at least 12 locations''.
(c) Extension of Authority.--Subsection (d) of such section is
amended by striking ``shall cease'' and all that follows and inserting
``shall cease on September 30, 2012.''.
(d) Conforming Amendments.--
(1) Subsection (c)(1) of such section is amended by striking
``demonstration''.
(2) The heading of such section is amended to read as follows:
``Sec. 2023. Referral and counseling services: veterans at risk of
homelessness who are transitioning from certain institutions''.
(3) Section 2022(f)(2)(C) of such title is amended by striking
``demonstration''.
(e) Clerical Amendment.--The table of sections at the beginning of
chapter 20 is amended by striking the item relating to section 2023 and
inserting the following:
``2023. Referral and counseling services: veterans at risk of
homelessness who are transitioning from certain
institutions.''.

5171c70f6663d946a67d4ad7220c492febe415723ae407b72e991c4cb5adf683

VETERANS AND ENHANCEMENT OF CAPACITY OF DOMICILIARY CARE PROGRAMS
FOR FEMALE VETERANS.
Subsection (b) of section 2043 is amended to read as follows:
``(b) Enhancement of Capacity of Domiciliary Care Programs for
Female Veterans.--The Secretary shall take appropriate actions to
ensure that the domiciliary care programs of the Department are
adequate, with respect to capacity and with respect to safety, to meet
the needs of veterans who are women.''.

f056124011b0c56e5e2475849fce06da0036010d51112c4d848aa7d49b042fe3

LOW-INCOME VETERAN FAMILIES IN PERMANENT HOUSING.
(a) Purpose.--The purpose of this section is to facilitate the
provision of supportive services for very low-income veteran families
in permanent housing.
(b) Financial Assistance.--
(1) In general.--Subchapter V of chapter 20 is amended by
adding at the end the following new section:
``Sec. 2044. Financial assistance for supportive services for very low-
income veteran families in permanent housing
``(a) Distribution of Financial Assistance.--(1) The Secretary
shall provide financial assistance to eligible entities approved under
this section to provide and coordinate the provision of supportive
services described in subsection (b) for very low-income veteran
families occupying permanent housing.
``(2) Financial assistance under this section shall consist of
grants for each such family for which an approved eligible entity is
providing or coordinating the provision of supportive services.
``(3)(A) The Secretary shall provide such grants to each eligible
entity that is providing or coordinating the provision of supportive
services.
``(B) The Secretary is authorized to establish intervals of payment
for the administration of such grants and establish a maximum amount to
be awarded, in accordance with the services being provided and their
duration.
``(4) In providing financial assistance under paragraph (1), the
Secretary shall give preference to entities providing or coordinating
the provision of supportive services for very low-income veteran
families who are transitioning from homelessness to permanent housing.
``(5) The Secretary shall ensure that, to the extent practicable,
financial assistance under this subsection is equitably distributed
across geographic regions, including rural communities and tribal
lands.
``(6) Each entity receiving financial assistance under this section
to provide supportive services to a very low-income veteran family
shall notify that family that such services are being paid for, in
whole or in part, by the Department.
``(7) The Secretary may require entities receiving financial
assistance under this section to submit a report to the Secretary that
describes the projects carried out with such financial assistance.
``(b) Supportive Services.--The supportive services referred to in
subsection (a) are the following:
``(1) Services provided by an eligible entity or a
subcontractor of an eligible entity that address the needs of very
low-income veteran families occupying permanent housing,
including--
``(A) outreach services;
``(B) case management services;
``(C) assistance in obtaining any benefits from the
Department which the veteran may be eligible to receive,
including, but not limited to, vocational and rehabilitation
counseling, employment and training service, educational
assistance, and health care services; and
``(D) assistance in obtaining and coordinating the
provision of other public benefits provided in federal, State,
or local agencies, or any organization defined in subsection
(f), including--
``(i) health care services (including obtaining health
insurance);
``(ii) daily living services;
``(iii) personal financial planning;
``(iv) transportation services;
``(v) income support services;
``(vi) fiduciary and representative payee services;
``(vii) legal services to assist the veteran family
with issues that interfere with the family's ability to
obtain or retain housing or supportive services;
``(viii) child care;
``(ix) housing counseling; and
``(x) other services necessary for maintaining
independent living.
``(2) Services described in paragraph (1) that are delivered to
very low-income veteran families who are homeless and who are
scheduled to become residents of permanent housing within 90 days
pending the location or development of housing suitable for
permanent housing.
``(3) Services described in paragraph (1) for very low-income
veteran families who have voluntarily chosen to seek other housing
after a period of tenancy in permanent housing, that are provided,
for a period of 90 days after such families exit permanent housing
or until such families commence receipt of other housing services
adequate to meet their current needs, but only to the extent that
services under this paragraph are designed to support such families
in their choice to transition into housing that is responsive to
their individual needs and preferences.
``(c) Application for Financial Assistance.--(1) An eligible entity
seeking financial assistance under subsection (a) shall submit to the
Secretary an application therefor in such form, in such manner, and
containing such commitments and information as the Secretary determines
to be necessary to carry out this section.
``(2) Each application submitted by an eligible entity under
paragraph (1) shall contain--
``(A) a description of the supportive services proposed to be
provided by the eligible entity and the identified needs for those
services;
``(B) a description of the types of very low-income veteran
families proposed to be provided such services;
``(C) an estimate of the number of very low-income veteran
families proposed to be provided such services;
``(D) evidence of the experience of the eligible entity in
providing supportive services to very low-income veteran families;
and
``(E) a description of the managerial capacity of the eligible
entity--
``(i) to coordinate the provision of supportive services
with the provision of permanent housing by the eligible entity
or by other organizations;
``(ii) to assess continuously the needs of very low-income
veteran families for supportive services;
``(iii) to coordinate the provision of supportive services
with the services of the Department;
``(iv) to tailor supportive services to the needs of very
low-income veteran families; and
``(v) to seek continuously new sources of assistance to
ensure the long-term provision of supportive services to very
low-income veteran families.
``(3) The Secretary shall establish criteria for the selection of
eligible entities to be provided financial assistance under this
section.
``(d) Technical Assistance.--(1) The Secretary shall provide
training and technical assistance to participating eligible entities
regarding the planning, development, and provision of supportive
services to very low-income veteran families occupying permanent
housing, through the Technical Assistance grants program in section
2064 of this title.
``(2) The Secretary may provide the training described in paragraph
(1) directly or through grants or contracts with appropriate public or
nonprofit private entities.
``(e) Funding.--(1) From amounts appropriated to the Department for
Medical Services, there shall be available to carry out subsection (a),
(b), and (c) amounts as follows:
``(A) $15,000,000 for fiscal year 2009.
``(B) $20,000,000 for fiscal year 2010.
``(C) $25,000,000 for fiscal year 2011.
``(2) Not more than $750,000 may be available under paragraph (1)
in any fiscal year to provide technical assistance under subsection
(d).
``(3) There is authorized to be appropriated $1,000,000 for each of
the fiscal year 2009 through 2011 to carry out the provisions of
subsection (d).
``(f) Definitions.--In this section:
``(1) The term `consumer cooperative' has the meaning given
such term in section 202 of the Housing Act of 1959 (12 U.S.C.
1701q).
``(2) The term `eligible entity' means--
``(A) a private nonprofit organization; or
``(B) a consumer cooperative.
``(3) The term `homeless' has the meaning given that term in
section 103 of the McKinney-Vento Homeless Assistance Act (42
U.S.C. 11302).
``(4) The term `permanent housing' means community-based
housing without a designated length of stay.
``(5) The term `private nonprofit organization' means any of
the following:
``(A) Any incorporated private institution or foundation--
``(i) no part of the net earnings of which inures to
the benefit of any member, founder, contributor, or
individual;
``(ii) which has a governing board that is responsible
for the operation of the supportive services provided under
this section; and
``(iii) which is approved by the Secretary as to
financial responsibility.
``(B) A for-profit limited partnership, the sole general
partner of which is an organization meeting the requirements of
clauses (i), (ii), and (iii) of subparagraph (A).
``(C) A corporation wholly owned and controlled by an
organization meeting the requirements of clauses (i), (ii), and
(iii) of subparagraph (A).
``(D) A tribally designated housing entity (as defined in
section 4 of the Native American Housing Assistance and Self-
Determination Act of 1996 (25 U.S.C. 4103)).
``(6)(A) Subject to subparagraphs (B) and (C), the term `very
low-income veteran family' means a veteran family whose income does
not exceed 50 percent of the median income for an area specified by
the Secretary for purposes of this section, as determined by the
Secretary in accordance with this paragraph.
``(B) The Secretary shall make appropriate adjustments to the
income requirement under subparagraph (A) based on family size.
``(C) The Secretary may establish an income ceiling higher or
lower than 50 percent of the median income for an area if the
Secretary determines that such variations are necessary because the
area has unusually high or low construction costs, fair market
rents (as determined under section 8 of the United States Housing
Act of 1937 (42 U.S.C. 1437f)), or family incomes.
``(7) The term `veteran family' includes a veteran who is a
single person and a family in which the head of household or the
spouse of the head of household is a veteran.''.
(2) Clerical amendment.--The table of sections at the beginning
of chapter 20 is amended by inserting after the item relating to
section 2043 the following new item:
``2044. Financial assistance for supportive services for very low-income
veteran families in permanent housing.''.
(c) Study of Effectiveness of Permanent Housing Program.--
(1) In general.--For fiscal years 2009 and 2010, the Secretary
shall conduct a study of the effectiveness of the permanent housing
program under section 2044 of title 38, United States Code, as
added by subsection (b), in meeting the needs of very low-income
veteran families, as that term is defined in that section.
(2) Comparison.--In the study required by paragraph (1), the
Secretary shall compare the results of the program referred to in
that subsection with other programs of the Department of Veterans
Affairs dedicated to the delivery of housing and services to
veterans.
(3) Criteria.--In making the comparison required in paragraph
(2), the Secretary shall examine the following:
(A) The satisfaction of veterans targeted by the programs
described in paragraph (2).
(B) The health status of such veterans.
(C) The housing provided such veterans under such programs.
(D) The degree to which such veterans are encouraged to
productive activity by such programs.
(4) Report.--Not later than March 31, 2011, the Secretary shall
submit to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives a
report on the results of the study required by paragraph (1).
FACILITY LEASES

588bfcf8b76fd336a915f31c5ddff8a63b0f908ed05339c34c5625fcc79f50e9

PROJECTS.
The Secretary of Veterans Affairs may carry out the following major
medical facility projects in fiscal year 2009 in the amount specified
for each project:
(1) Seismic corrections, Building 2, at the Department of
Veterans Affairs Palo Alto Health Care System, Palo Alto Division
Palo Alto, California, in an amount not to exceed $54,000,000.
(2) Construction of a polytrauma healthcare and rehabilitation
center at the Department of Veterans Affairs Medical Center, San
Antonio, Texas, in an amount not to exceed $66,000,000.
(3) Seismic corrections, Building 1, at the Department of
Veterans Affairs Medical Center, San Juan, Puerto Rico, in an
amount not to exceed $225,900,000.

dbbc495841187987142a886400ca94f5b7d44df10ef9d9173249536220e45190

MEDICAL FACILITY CONSTRUCTION PROJECTS PREVIOUSLY AUTHORIZED.
(a) Modification of Major Medical Facility Authorizations.--Section
801(a) of the Veterans Benefits, Health Care, and Information
Technology Act of 2006 (Public Law 109-461) is amended--
(1) in paragraph (1)--
(A) by striking ``$300,000,000'' and inserting
``$625,000,000''; and
(B) by striking the second sentence; and
(2) in paragraph (3), by striking ``$98,000,000'' and inserting
``$568,400,000''.
(b) Modification of Authorization for Certain Major Medical
Facility Construction Projects Previously Authorized in Connection With
Capital Asset Realignment Initiative.--
(1) Correction of patient privacy deficiencies at the
department of veterans affairs medical center, gainesville,
florida.--Paragraph (5) of section 802 of the Veterans Benefits,
Health Care, and Information Technology Act of 2006 (Public Law
109-461) is amended by striking ``$85,200,000'' and inserting
``$136,700,000''.
(2) Construction of a new medical center facility at the
department of veterans affairs medical center, las vegas, nevada.--
Paragraph (7) of such section is amended by striking
``$406,000,000'' and inserting ``$600,400,000''.
(3) Construction of a new outpatient clinic, lee county,
florida.--Paragraph (8) of such section is amended--
(A) by striking ``ambulatory'' and all that follows through
``purchase,'' and inserting ``outpatient clinic in''; and
(B) by striking ``$65,100,000'' and inserting
``$131,800,000''.
(4) Construction of a new medical center facility, orlando,
florida.--Paragraph (11) of such section is amended by striking
``$377,700,000'' and inserting ``$656,800,000''.
(5) Consolidation of campuses at the university drive and h.
john heinz iii divisions, pittsburgh, pennsylvania.--Paragraph (12)
of such section is amended by striking ``$189,205,000'' and
inserting ``$295,600,000''.

18098d369c197f41f2134eb1336b69ae4a6e291dfd5fcb0caa6ef636518e3523

LEASES.
The Secretary of Veterans Affairs may carry out the following major
medical facility leases in fiscal year 2009 at the locations specified,
and in an amount for each lease not to exceed the amount shown for such
location:
(1) For an outpatient clinic, Brandon, Florida, $4,326,000.
(2) For an outpatient clinic, Colorado Springs, Colorado,
$10,300,000.
(3) For an outpatient clinic, Eugene, Oregon, $5,826,000.
(4) For the expansion of an outpatient clinic, Green Bay,
Wisconsin, $5,891,000.
(5) For an outpatient clinic, Greenville, South Carolina,
$3,731,000.
(6) For an outpatient clinic, Mansfield, Ohio, $2,212,000.
(7) For an outpatient clinic, Mayaguez, Puerto Rico,
$6,276,000.
(8) For an outpatient clinic, Mesa, Arizona, $5,106,000.
(9) For interim research space, Palo Alto, California,
$8,636,000.
(10) For the expansion of an outpatient clinic, Savannah,
Georgia, $3,168,000.
(11) For an outpatient clinic, Sun City, Arizona, $2,295,000.
(12) For a primary care annex, Tampa, Florida, $8,652,000.
(13) For an outpatient clinic, Peoria, Illinois, $3,600,000.

681b4ce592662ea256d7377a23ef0c4eebd76ab6f5f2e51edae89c1121e444f1

(a) Authorization of Appropriations for Fiscal Year 2009 Major
Medical Facility Projects.--There is authorized to be appropriated for
the Secretary of Veterans Affairs for fiscal year 2009 for the
Construction, Major Projects, account--
(1) $345,900,000 for the projects authorized in section 701;
and
(2) $1,493,495,000 for the increased amounts authorized for
projects whose authorizations are modified by section 702.
(b) Authorization For Appropriations For Fiscal Year 2009 Major
Medical Facility Leases.--There is authorized to be appropriated for
the Secretary of Veterans Affairs for fiscal year 2009 for the Medical
Facilities account, $70,019,000, for the leases authorized in section
703.

4545293600f1e232193c8274efc9658e11085e53f9f3dcd48b7f3f2ab5ca258a

REQUIRING CONGRESSIONAL APPROVAL.
Section 8104(a)(3)(B) is amended by striking ``$600,000'' and
inserting ``$1,000,000''.

5e523a34b6172761beac0bfd01aa7fa4570ca44c3ae8f1266e238ac041d5e97f

COLORADO, TO SECRETARY OF VETERANS AFFAIRS FOR CONSTRUCTION OF
VETERANS MEDICAL FACILITY.
Section 410 of title IV of division I of the Consolidated
Appropriations Act, 2008 (Public Law 110-161; 121 Stat. 2276) is
amended to read as follows:
``SEC. 410. CONVEYANCE OF CERTAIN NON-FEDERAL LAND.
``(a) Definitions.--In this section:
``(1) City.--The term `City' means the City of Aurora,
Colorado.
``(2) Deed.--The term `deed' means the quitclaim deed--
``(A) conveyed to the City by the Secretary (acting through
the Director of the National Park Service); and
``(B) dated May 24, 1999.
``(3) Non-federal land.--The term `non-Federal land' means--
``(A) parcel I of the former United States Army Garrison
Fitzsimons, Adams County, Colorado, as more specifically
described in the deed; and
``(B) the parcel of land described in the deed.
``(4) Secretary.--The term `Secretary' means the Secretary of
the Interior.
``(b) Duty of Secretary.--To allow the City to convey by donation
to the United States the non-Federal land to be used by the Secretary
of Veterans Affairs for the construction of a veterans medical
facility, not later than 60 days after the date of enactment of this
section, the Secretary shall execute each instrument that is necessary
to release all rights, conditions, and restrictions retained by the
United States in and to the non-Federal land conveyed in the deed.''.

aa9cdb1153514869314f112494e7467d5bbfc6978d9706f8b50cff57dd224c2c

Not later than 60 days after the date of the enactment of this Act,
the Secretary of Veterans Affairs shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the progress of the
Secretary in complying with section 312A of title 38, United States
Code.

eec8190b0600e9e2e2567ba5de96007fe1dcf17b2e07cd033cf825d28787bb60

(a) Annual Report Required.--Subchapter I of chapter 81 is amended
by adding at the end the following new section:
``Sec. 8119. Annual report on outpatient clinics
``(a) Annual Report Required.--The Secretary shall submit to the
committees an annual report on community-based outpatient clinics and
other outpatient clinics of the Department. The report shall be
submitted each year not later than the date on which the budget for the
next fiscal year is submitted to the Congress under section 1105 of
title 31.
``(b) Contents of Report.--Each report required under subsection
(a) shall include the following:
``(1) A list of each community-based outpatient clinic and
other outpatient clinic of the Department, and for each such
clinic, the type of clinic, location, size, number of health
professionals employed by the clinic, workload, whether the clinic
is leased or constructed and operated by the Secretary, and the
annual cost of operating the clinic.
``(2) A list of community-based outpatient clinics and other
outpatient clinics that the Secretary opened during the fiscal year
preceding the fiscal year during which the report is submitted and
a list of clinics the Secretary proposes opening during the fiscal
year during which the report is submitted and the subsequent fiscal
year, together with the cost of activating each such clinic and the
information required to be provided under paragraph (1) for each
such clinic and proposed clinic.
``(3) A list of proposed community-based outpatient clinics and
other outpatient clinics that are, as of the date of the submission
of the report, under review by the National Review Panel and a list
of possible locations for future clinics identified in the
Department's strategic planning process, including any identified
locations in rural and underserved areas.
``(4) A prioritized list of sites of care identified by the
Secretary that the Secretary could establish without carrying out
construction or entering into a lease, including--
``(A) any such sites that could be expanded by hiring
additional staff or allocating staff to Federal facilities or
facilities operating in collaboration with the Federal
Government; and
``(B) any sites established, or able to be established,
under sections 8111 and 8153 of this title.''.
(b) Deadline for First Annual Report.--The Secretary of Veterans
Affairs shall submit the first report required under section 8119(a) of
title 38, United States Code, as added by subsection (a), by not later
than 90 days after the date of the enactment of this Act.
(c) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by adding at the end of the items relating to
subchapter I the following new item:
``8119. Annual report on outpatient clinics.''.

468d04d81e883c3296851043f1e4d04856d03442591c2c1b0a28c46c7f67f2ff

CENTER, TAMPA, FLORIDA.
The spinal cord injury center located at the James A. Haley
Department of Veterans Affairs Medical Center in Tampa, Florida, shall
after the date of the enactment of this Act be known and designated as
the ``Michael Bilirakis Department of Veterans Affairs Spinal Cord
Injury Center''. Any reference to such center in any law, regulation,
map, document, record, or other paper of the United States shall be
considered to be a reference to the ``Michael Bilirakis Department of
Veterans Affairs Spinal Cord Injury Center''.

999bf5410ba56fbac762b9becaeca43a09edf9daace2ee59144f75e6c4a8911e

EXTENDED CARE SERVICES IN DEFINITION OF MEDICAL SERVICES.
Section 1701 is amended--
(1) by striking paragraph (10); and
(2) in paragraph (6)--
(A) by redesignating subparagraphs (E) and (F) as
subparagraphs (F) and (G), respectively; and
(B) by inserting after subparagraph (D) the following new
subparagraph (E):
``(E) Noninstitutional extended care services, including
alternatives to institutional extended care that the Secretary
may furnish directly, by contract, or through provision of case
management by another provider or payer.''.

a410ee2d36babef3864b1b09301acc98665c0223e467a76dd5a6b0122d549736

Section 1703(d)(4) is amended by striking ``September 30, 2008''
and inserting ``September 30, 2013''.

bf4ce4b33ada45a5866759f3b7fb389309bd0fcd6fc7dde93568ceb7ea2146ff

MEDICAL SERVICES, AND NURSING HOME CARE TO VETERANS WHO
PARTICIPATED IN CERTAIN CHEMICAL AND BIOLOGICAL TESTING CONDUCTED
BY THE DEPARTMENT OF DEFENSE.
(a) Permanent Authority.--Subsection (e)(3) of section 1710 is
amended--
(1) in subparagraph (B), by inserting ``and'' after the
semicolon;
(2) in subparagraph (C), by striking ``; and'' and inserting a
period; and
(3) by striking subparagraph (D).
(b) Conforming Amendment.--Subsection (e)(1)(E) of such section is
amended by striking ``paragraphs (2) and (3)'' and inserting
``paragraph (2)''.

bbef8fd1d959f1149616253205240b9dfad0211602c1d23e781c1ce3e64877ff

(a) Health Care Copayments.--Section 1710(f)(2)(B) is amended by
striking ``September 30, 2008'' and inserting ``September 30, 2010''.
(b) Medical Care Cost Recovery.--Section 1729(a)(2)(E) is amended
by striking ``October 1, 2008'' and inserting ``October 1, 2010''.

14f4ae157f13d3df404e3823f54c26ecc421233d81fa29cf0f081e94111e1a9f

Section 1710A(d) is amended by striking ``December 31, 2008'' and
inserting ``December 31, 2013''.

81bdc89fc5eb4ab540748eb6ebd873b60c79b52d9373f105d509287bf6aa8f66

(a) Repeal.--Chapter 73 is amended by striking section 7368.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by striking the item relating to section 7368.

77f201bf94022a7da16d2985bcd7aa622c4b08d989401bc15ac0ba3b9a52b64b

COMMITTEE ON CARE OF SEVERELY CHRONICALLY MENTALLY ILL VETERANS.
Section 7321(d)(2) is amended by striking ``through 2008'' and
inserting ``through 2012''.

65dff1b5e8ccf28f6f314e2fe12905ede072a98218626fee168a24b9e0054ce9

ADVISORY COMMITTEE.
Section 542(c)(1) is amended by striking ``through 2008''.

0425f40b373ad79da5e3266784014824b1363c6ff7ba92536549cca6ae56e382

ASSISTANCE SERVICES.
Section 214 of the Veterans Benefits, Health Care, and Information
Technology Act of 2006 (Public Law 109-461; 38 U.S.C. 1710B note) is
amended--
(1) in subsection (b), by striking ``two-year period'' and
inserting ``three-year period''; and
(2) in subsection (d), by striking ``fiscal years 2007 and
2008'' and inserting ``fiscal years 2007 through 2009''.

b6d7201651fcbbc900be20d96f0262b360e54231bed4ee9134f34f2f8da12f07

(a) Title 38.--Title 38, United States Code, is amended--
(1) in section 1712A--
(A) by striking subsection (g);
(B) by redesignating subsections (d) through (i) as
subsections (c) through (f), respectively; and
(C) in subsection (f), as so redesignated, by striking
``(including a Resource Center designated under subsection
(h)(3)(A) of this section)'';
(2) in section 2065(b)(3)(C), by striking ``)'';
(3) in the table of sections at the beginning of chapter 36, by
striking the item relating to section 3684A and inserting the
following new item:
``3684A. Procedures relating to computer matching program.'';
(4) in section 4110(c)(1), by striking ``15'' and inserting
``16'';
(5) in the table of sections at the beginning of chapter 51, by
striking the item relating to section 5121 and inserting the
following new item:
``5121. Payment of certain accrued benefits upon death of a
beneficiary.'';
(6) in section 7458(b)(2), by striking ``pro rated'' and
inserting ``pro-rated'';
(7) in section 8117(a)(1), by striking ``such such'' and
inserting ``such''; and
(8) in each of sections 1708(d), 7314(f), 7320(j)(2),
7325(i)(2), and 7328(i)(2), by striking ``medical care account''
and inserting ``medical services account''.
(b) Veterans Benefits, Health Care, and Information Technology Act
of 2006.--Section 807(e) of the Veterans Benefits, Health Care, and
Information Technology Act of 2006 (Public Law 109-461) is amended by
striking ``Medical Care'' each place it appears and inserting ``Medical
Facilities''.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.

eb21e6c8386aa2652fe34e90460d365fbc168f341e821929096c7afa9d0b558f

Veterans' Mental Health and Other Care Improvements Act of 2008

Other Sections