S 2344 CPS
102d CONGRESS
2d Session
S.  2344
To improve the provision of health care and other services to veterans by
the Department of Veterans Affairs, and for other purposes.
IN THE SENATE OF THE UNITED STATES
March 11 (legislative day, JANUARY 30), 1992
Mr. CRANSTON (for himself, Mr. SPECTER, Mr. DECONCINI, Mr. ROCKEFELLER,
Mr. DASCHLE, and Mr. AKAKA) introduced, read twice, considered, read the
third time, and passed
A BILL
To improve the provision of health care and other services to veterans by
the Department of Veterans Affairs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,

9252e5c9c71a44169bea86cd5fe474e96d713200ee84c3492d37cc21103643e4

(a) SHORT TITLE- This Act may be cited as the `Veterans Health Care
Amendments Act of 1992'.
(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.
Part A--Post-Traumatic Stress Disorder

c8f31b37c8d6d7dcb0d6e3901e73c25e39ff20af27b6ff0e928af631249874d4

This part may be cited as the `Veterans Post-Traumatic Stress Disorder
Treatment Act of 1992'.

8feb3a869feb03fe8dee900a8f1d1bd80f95f8bbca465837b235f3b55a1b2b80

TITLE I

-MENTAL HEALTH

The Congress finds the following:
(1) Post-traumatic stress disorder (PTSD) is a highly disruptive and
debilitating psychological disorder that can result from exposure to
combat or any other traumatic event outside the range of conventional
human experience.
(2) Post-traumatic stress disorder can have a destructive impact on the
life of a person suffering from the disorder by adversely affecting his or
her behavior, ability to work with, relate to, and communicate with others,
and ability to maintain gainful employment.
(3) In 1980, the American Psychiatric Association officially recognized
PTSD as a diagnosis in its `Diagnostic and Statistical Manual of Mental
Disorders (Third edition)' and identified combat experience as a potential
cause for PTSD.
(4) A Congressionally-mandated study of Vietnam-era veterans, released
in November 1988, regarding the frequency of symptoms of PTSD and other
problems relating to readjustment from combat of such veterans, found that
479,000 male veterans of the Vietnam theater of operations (representing
15.2 percent of all such male veterans) suffered from the full effects of
PTSD and that another 350,000 of such veterans (representing 11.2 percent
of all such male veterans) experienced some symptoms of the PTSD.
(5) That study also found higher incidences of PTSD among Black and Hispanic
male veterans of the Vietnam theater of operations than among all male
veterans of that theater, but did not include data on the incidence of
the disorder among veterans of other ethnic groups.
(6) A large body of evidence indicates that such psychological disorders
related to combat stress as war neurosis, combat fatigue, and the disorder
commonly known as `shell shock' are analogous to PTSD and that thousands
of veterans of combat in World War II and the Korean war experienced and
continue to experience symptoms of such disorders.
(7) That evidence also indicates that veterans of combat in military
operations conducted after the Vietnam era, including operations in Lebanon,
Granada, and Panama, also suffer from symptoms of PTSD.
(8) Although debilitating, PTSD can be treated successfully, and an
individual experiencing the disorder can learn coping skills, including
how to mitigate the effects of the anxiety, depression, anger, guilt,
fear, alienation, and emotional outbursts that he or she experiences.
(9) Early intervention and treatment of acute PTSD can be an important
part of a therapeutic course to prevent long-term chronic PTSD.
(10) The Department of Veterans Affairs has a responsibility to provide
opportunities for treatment of PTSD and other stress-related psychological
problems to the hundreds of thousands of combat veterans who suffer from
PTSD and to conduct outreach activities that provide both actual notice
of the availability of such treatment to those veterans and appropriate
encouragement for such veterans to participate in the treatment.
(11) The Department has made some progress in expanding diagnosis and
treatment programs relating to PTSD.
(12) Through readjustment counseling, specialized inpatient and outpatient
programs, and general psychiatric services offered in its hospitals
and outpatient clinics, the Department has provided needed treatment to
thousands of veterans for PTSD.
(13) Despite such progress the Department can and should be doing much
more to provide treatment to veterans for PTSD and other stress-related
psychological problems and to provide outreach services to make veterans
aware of, and encourage them to participate in, treatment opportunities
available through the Department.
(14) It is in the public interest for the Secretary of Veterans Affairs to
develop a plan that ensures immediate, on-demand treatment opportunities
for the thousands of veterans who suffer from, and need treatment for,
this disruptive, life-threatening disorder.

f625d8bdf674169293771a31ffd59c562d2b3c5a991553ca115d416a30419aef

STRESS DISORDER.
(a) REQUIREMENT TO FURNISH CARE AND SERVICES- (1) Section 1702 is amended--
(A) by inserting `(a)' before `For'; and
(B) by adding at the end the following new subsections:
`(b)(1) A veteran referred to in paragraph (2)(A) who is diagnosed by
a mental health professional designated by the Chief Medical Director
(following an examination of the veteran by such professional) to be
suffering from post-traumatic stress disorder related to service referred
to in such paragraph shall be furnished care and services for such disorder
pursuant to sections 1710(a)(1)(A) and 1712(a)(1)(A) of this title even
though such disorder has not been determined to be service connected.
`(2)(A) A veteran eligible for the care and services referred to in paragraph
(1) is a veteran who, as determined by the Chief Benefits Director, served on
active duty in a theater of combat operations (as defined by the Secretary)
during World War II, the Korean conflict, the Vietnam era, the Persian Gulf
War, or in any other area during a period in which hostilities occurred
in such area.
`(B) In the case of a veteran who is diagnosed as suffering from
post-traumatic stress disorder, the determination of whether the veteran
served on active duty as described in subparagraph (A) shall be made by
the most expeditious means practicable.
`(c) For the purposes of subsection (b) of this section, the term
`hostilities' means an armed conflict in which members of the Armed Forces
are subjected to danger comparable to the danger to which members of the
Armed Forces have been subjected in combat with enemy armed forces during
a period of war, as determined by the Secretary in consultation with the
Secretary of Defense.'.
(2)(A) The heading of such section is amended to read as follows:
`Sec. 1702. Special provisions relating to mental illness disabilities'.
(B) The item relating to such section in the table of sections at the
beginning of chapter 17 is amended to read as follows:
`1702. Special provisions relating to mental illness disabilities.'.
(b) TIMELINESS OF EVALUATION AND VERIFICATION OF STATUS- Section 1712A
is amended--
(1) by redesignating subsection (i) as subsection (j); and
(2) by inserting after subsection (h) the following new subsection (i):
`(i) Whenever a veteran is referred by a center to a Department general
health-care facility for a determination regarding such veteran's
eligibility for care and services under section 1702(b) of this title,
the veteran shall be evaluated for diagnostic purposes within seven days
after the date on which the referral is made.'.

98dd6ffa05cc10172d304e459b470f8b2356f6ebe614e17380833d2073ce854a

Subsection (a) of section 1712A is amended by adding at the end the
following new paragraph:
`(3) Upon the request of any veteran who served on active duty in a
theater of combat operations (as defined by the Secretary) during World
War II or the Korean conflict, the Secretary shall furnish counseling to
such veteran in order to assist the veteran to overcome any psychological
problems associated with such service. The counseling shall include a
general mental and psychological assessment to ascertain whether the
veteran has mental or psychological problems associated with such service.'.

d0b7ce044c5c0cecb7afa893f84cdc531a155c61d0e990ca3e27afaace4bcec4

SERVICES OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) PLAN FOR TREATMENT AND OUTREACH SERVICES IMPROVEMENT- Not later than
June 1, 1992, the Secretary of Veterans Affairs shall devise and initiate
implementation of a plan--
(1) to increase the availability of treatment of veterans suffering
from post-traumatic stress disorder by the Department of Veterans Affairs
(including treatment provided in inpatient and outpatient programs providing
specialized treatment for PTSD, treatment for PTSD in conjunction with
substance abuse, and treatment in Vet Centers) to levels commensurate with
the needs of veterans suffering from the disorder as a result of active
duty; and
(2) to enhance outreach activities--
(A) to inform combat veterans (including veterans who are members of ethnic
minority groups), the family members of such veterans, and appropriate
State and local health organizations and social service organizations of
the availability of such treatment; and
(B) to provide appropriate encouragement for such veterans to participate
in such treatment.
(b) SPECIAL CONSIDERATIONS- In devising the plan, the Secretary shall
consider--
(1) the level and geographic accessibility of inpatient and outpatient
care for veterans suffering from PTSD across the United States;
(2) the desirability of providing for inpatient PTSD care to be furnished to
such veterans in facilities of the Department that are physically independent
of general psychiatric wards of the medical facilities of the Department; and
(3) the treatment needs of such veterans who are women, of such veterans
who are members of ethnic minorities (including Native Americans, Native
Hawaiians, Asian-Pacific Islanders, and Native Alaskans), and of such
veterans who suffer from substance abuse problems as well as PTSD.
(c) IMPLEMENTATION- In carrying out the plan, the Secretary shall--
(1) prescribe a schedule for the implementation of the plan;
(2) prescribe appropriate criteria for the selection and training of staff
necessary to increase the availability of the treatment and enhance the
outreach activities referred to in subsection (a); and
(3) provide the facilities, personnel, funds, and other resources necessary
to carry out the plan.
(d) DEFINITIONS- For the purposes of this section:
(1) The term `Vet Center' shall have the meaning given the term `center'
in section 1712A(j)(1) of title 38, United States Code (as redesignated
by section 103(b)(1) of this Act).
(2) The term `active duty' shall have the meaning given such term in
section 101(21) of such title.
(3) The term `veteran' shall have the meaning given such term in section
101(2) of such title.

acc8e0e4ea6b2aada36491cbc37989432b40eb9b836c00c06c078196cc4e0426

(a) IN GENERAL- Not later than 90 days after the date of the enactment of
this Act and subject to subsection (b), the Secretary of Veterans Affairs
shall submit to the Committees on Veterans' Affairs of the Senate and House
of Representatives a report on the plan required by section 105. The report
shall contain the following information:
(1) A description of the plan.
(2) What facilities, personnel, funds, and other resources are necessary
to increase the availability of treatment and enhance outreach activities
in accordance with the plan in a manner that does not reduce the existing
capacity of the Department of Veterans Affairs to provide treatment for
other conditions.
(3) A description of the efforts undertaken by the Secretary to make
such resources available for the treatment of veterans for post-traumatic
stress disorder.
(4) An estimate of the availability of community-based residential
treatment of veterans for post-traumatic stress disorder and the impact
of such availability on the increased availability of such treatment by
the Department.
(5) An assessment of the need for, and potential benefit of, making available
scholarships, tuition reimbursement, or other educational assistance to
health-care students and health-care professionals in order to improve
the training and specialization of such individuals in the provision of
such treatment.
(6) A description of the efforts of the Secretary to implement the
recommendations of the Special Committee on Post-Traumatic Stress Disorder
referred to in subsection (b) with respect to--
(A) establishing educational programming that is directed to each of the
various levels of education, training, and experience of the various mental
health professionals involved in the treatment of veterans suffering from
PTSD; and
(B) giving research relating to PTSD a high priority in the allocation
of funds available to the Department in research activities relating to
mental health.
(7) Such other proposals and recommendations as the Secretary considers
appropriate to increase the availability of such treatment.
(b) REPORT ASSISTANCE- In preparing the report referred to in subsection (a),
the Secretary shall consult with the Special Committee on Post-Traumatic
Stress Disorder established pursuant to section 110(b) of the Veterans'
Health Care Act of 1984 (38 U.S.C. 1712A note) and the Secretary's Advisory
Committee on Readjustment of Vietnam  and Other War Veterans.

82d27a29fd9e4dc190337c4060aedd2489571753e79defc5127287c1671d3d80

(a) EVALUATION OF STUDY OF POSTWAR PSYCHOLOGICAL PROBLEMS OF VIETNAM
VETERANS- (1) Not later than January 1, 1993, the Special Committee on
Post-Traumatic Stress Disorder (hereinafter in this section referred to
as the `Special Committee') established pursuant to section 110(b)(1) of
the Veterans' Health Care Act of 1984 (38 U.S.C. 1712A note) shall submit
concurrently to the Secretary of Veterans Affairs and the Committees on
Veterans' Affairs of the Senate and House of Representatives (hereinafter
in this section referred to as the `Committees') a report setting forth
the Special Committee's evaluation of the results of the study required by
section 102 of the Veterans' Health Care Amendments of 1983 (38 U.S.C. 1712A
note). Such report shall include the Special Committee's--
(A) overall evaluation of the conduct, validity, and meaning of the study;
(B) assessment of the capability of the Department of Veterans Affairs
to meet the need for diagnosing and treating veterans for post-traumatic
stress disorder and for other psychological problems in readjusting to
civilian life, as estimated in the results of such study;
(C) evaluation of the Secretary's report on the study; and
(D) recommendations for any further or follow-up research on the matters
addressed in the study.
(2) Not later than 30 days after receiving the Special Committee's report
under paragraph (1), the Secretary shall submit to the Committees any
comments concerning the report that the Secretary considers appropriate.
(b) UPDATES OF REPORTS UNDER SECTION 110(c) OF PUBLIC LAW 98-528- (1)
Not later than January 1 of each of 1993 and 1994, the Special Committee
shall concurrently submit to the Secretary and the Committees a report
containing information updating the reports submitted to the Secretary
under section 110(e) of the Veterans' Health Care Act of 1984, together
with any additional information the Special Committee considers appropriate
regarding the overall efforts of the Department of Veterans Affairs to
meet the needs of veterans with post-traumatic stress disorder and other
psychological problems in readjusting to civilian life.
(2) Not later than 60 days after receiving each of the Special Committee's
reports under paragraph (1), the Secretary shall submit to the Committees
any comments concerning the report that the Secretary considers appropriate.

c38567f718ee4667ca4348e3a8b61290d1804431dee5b45fde3821c055af7f2d

In the documents providing detailed information on the budget for the
Department of Veterans Affairs that the Secretary of Veterans Affairs
submits to the Congress in conjunction with the President's budget submission
for fiscal year 1994 and for fiscal year 1995 pursuant to section 1105 of
title 31, United States Code, the Secretary shall identify the amounts in
the appropriations requests for Department accounts that are estimated to
be obligated for--
(1) the payment of compensation to veterans for disabilities resulting from
post-traumatic stress disorder (hereinafter in this section referred to as
`PTSD') that is service connected;
(2) the treatment of veterans by or at the expense of the Department for
PTSD related to their active-duty service, including specific designation
of funds for the treatment of PTSD--
(A) in PTSD programs designated pursuant to section 110(a)(1) of the
Veterans' Health Care Act of 1984 (38 U.S.C. 1712A note);
(B) in inpatient psychiatric programs and outpatient mental health programs
other than such designated PTSD programs;
(C) in readjustment counseling programs pursuant to 1712A of title 38,
United States Code; and
(D) under contract through non-Department sources furnishing (i) readjustment
counseling services pursuant to section 1712A(e) of such title, (ii)
mental health services pursuant to such section 1712A(e), or (iii) mental
health services pursuant to other authority, and described in the first
annual report submitted pursuant to section 110(e)(1) of the Veterans'
Health Care Act of 1984 as having been proposed by the Special Committee
on Post-Traumatic Stress Disorder;
(3) education, training, and research at--
(A) the National Center on Post-Traumatic Stress Disorder established
under section 110(c) of such Act;
(B) any centers of mental illness research, education, and clinical
activities that may be established at Department medical centers; and
(C) other Department research facilities; and
(4) the operation of the National Center on Post-Traumatic Stress Disorder.

d30d324d974d1f987531a6d3279a20468358bce46d15e21b59d1932189f2752a

TREATMENT UNITS.
(a) ACCESSIBILITY OF PTSD TREATMENT UNITS TO VETERANS IN RURAL AREAS- (1)
Subchapter I of chapter 81 is amended by adding at the end the following
new section:
` 8117. Locations of PTSD treatment units
`The Secretary shall to the extent practicable ensure that there are
Department post-traumatic stress disorder treatment units in locations
that are readily accessible to veterans residing in rural areas of the
United States.'.
(2) The table of sections at the beginning of such chapter is amended by
adding after the item relating to section 8116 the following new item:
`8117. Locations of PTSD treatment units.'.
(b) IMPLEMENTATION- In determining where to locate post-traumatic stress
disorder units which may be established after the date of the enactment of
this Act, the Secretary of Veterans Affairs shall give strong consideration
to locations referred to in section 8117 of title 38, United States Code,
as added by subsection (a)(1).
Part B--Mental Illness Research and Education

ebc8d40bc5399d4a2e795d18ffcde84c27bb5f204cf42a91968d3a4b6d5283a6

(a) IN GENERAL- Subchapter II of chapter 73 is amended--
(1) by redesignating sections 7316 and 7317 as sections 7317 and 7318,
respectively; and
(2) by inserting after section 7315 the following new section 7316:
`Sec. 7316. Mental illness research, education, and clinical centers
`(a) The purposes of this section are to facilitate the improvement of
health-care services for eligible veterans suffering from mental illness,
especially service-related conditions, through research, the education
and training of health personnel, and the development of improved models
for the furnishing of clinical services.
`(b)(1) In order to carry out the purposes of this section, the Secretary,
upon the recommendation of the Chief Medical Director and pursuant to
the provisions of this subsection, shall designate not more than five
health-care facilities of the Department as the locations for centers of
mental illness research, education, and clinical activities and (subject
to the appropriation of sufficient funds for such purpose) shall establish
and operate such centers at such locations in accordance with this section.
`(2) The Secretary shall designate at least one facility under paragraph
(1) not later than January 1, 1993.
`(3) In designating facilities as the locations for centers under paragraph
(1), the Secretary, upon the recommendation of the Chief Medical Director,
shall ensure appropriate geographic distribution of such facilities.
`(4) The Secretary may not designate any health-care facility as a
location for a center under paragraph (1) unless the Secretary, upon the
recommendation of the Chief Medical Director, determines that the facility
has (or may reasonably be anticipated to develop)--
`(A) with an accredited medical school which provides education and training
in psychiatry and with which such facility is affiliated, an arrangement
under which residents receive education and training in psychiatry through
regular rotation through such facility so as to provide such residents
with training in the diagnosis and treatment of mental illness;
`(B) with an accredited graduate school of psychology which provides
education and training in clinical or counseling psychology or both and
with which the facility is affiliated, an arrangement under which students
receive education and training in clinical or counseling psychology or
both through regular rotation through such facility so as to provide such
students with training in the diagnosis and treatment of mental illness;
`(C) an arrangement under which nursing, social work, or other allied
health personnel receive training and education in mental health care
through regular rotation through such facility;
`(D) the ability to attract the participation of scientists who are
capable of ingenuity and creativity in research into the causes, treatment,
and prevention of mental illness and into models for furnishing care and
treatment to veterans suffering from mental illness;
`(E) a policymaking advisory committee composed of appropriate mental
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 such center
during the period of the operation of such center; and
`(F) the capability to conduct effectively evaluations of the activities
of such center.
`(c) Activities of clinical and scientific investigation at each center shall
be eligible to compete for the award of funding from amounts appropriated
for the Department of Veterans Affairs medical and prosthetics research
account and shall receive priority in the award of funding from such
account insofar as funds are awarded to projects for mental illness.
`(d) There are authorized to be appropriated for the basic support of the
research and education and training activities of the centers established
pursuant to subsection (b)(1), $3,125,000 for fiscal year 1993 and $6,250,000
for each of the three subsequent fiscal years. The Chief Medical Director
shall allocate to such centers from other funds appropriated generally for
the Department of Veterans Affairs medical care account and medical and
prosthetics research account such amounts as the Chief Medical Director
determines appropriate.
`(e) The Chief Medical Director shall ensure that research activities
carried out through centers established under subsection (b)(1) include
an appropriate emphasis on the psychosocial dimension of mental illness
and on proposals of means of furnishing care and treatment to veterans
suffering from mental illness.
`(f) The Chief Medical Director shall ensure that useful information produced
by the research, education and training, and clinical activities of the
centers established under subsection (b)(1) is disseminated throughout
the Veterans Health Administration through the development of programs
of continuing medical and related education provided through regional
medical education centers under subchapter VI of chapter 74 of this title
and other means.
`(g) The official within the Central Office of the Veterans Health
Administration responsible for mental health and behavioral sciences
matters shall be responsible for the supervision of the operation of the
centers established pursuant to subsection (b)(1).'.
(b) CLERICAL AMENDMENT- The table of sections at the beginning of chapter
73 is amended by striking out the items relating to sections 7316 and 7317
and inserting in lieu thereof the following:
`7316. Mental illness research, education, and clinical centers.
`7317. Malpractice and negligence suits: defense by United States.
`7318. Hazardous research projects: indemnification of contractors.'.
(c) REPORTS- Not later than February 1 of each of 1993, 1994, and 1995,
the Secretary of Veterans Affairs shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a report on
the experience during the prior fiscal year under the centers established
pursuant to section 7316 of title 38, United States Code (as added by
subsection (a)). Each such report shall contain the following:
(1) A description of--
(A) the activities carried out at each center and the funding provided
for such activities;
(B) the advances made at each center in research, education and training,
and clinical activities relating to mental illness in veterans; and
(C) the efforts made by the Chief Medical Director of the Department of
Veterans Affairs pursuant to subsection (e) of such section (as so added)
to disseminate throughout the Veterans Health Administration useful
information derived from such activities.
(2) The Secretary's evaluations of the effectiveness of the centers in
fulfilling the purposes of the centers.
Part C--Program of Marriage and Family Counseling for Certain Veterans

7a3dd0eaa12d28b8c374591d50ed13d5085c9ce304a1ac88e4ea66e952db24dc

(a) REQUIREMENT- Subject, in fiscal years 1993 and 1994, to the availability
of funds appropriated pursuant to the authorization in section 133 of
this Act, the Secretary of Veterans Affairs shall conduct a program to
furnish to the persons referred to in subsection (b) the marriage and
family counseling services referred to in subsection (c). The Secretary
shall commence the program not later than 30 days after the date of the
enactment of this Act. The authority to conduct the program shall expire
at the end of September 30, 1994.
(b) PERSONS ELIGIBLE FOR COUNSELING- The persons eligible to receive
marriage and family counseling services under the program are--
(1) veterans who were awarded a campaign medal for active-duty service
during the Persian Gulf War and the spouses, children, and parents  of
such veterans; and
(2) members of the reserve components who were called or ordered to active
duty during the Persian Gulf War and the spouses, children, and parents
of such members.
(c) COUNSELING SERVICES- Under the program, the Secretary may provide
marriage and family counseling that the Secretary determines, based on an
assessment by a mental-health professional employed by the Department and
designated by the Secretary (or, in an area where no such professional
is available, a mental-health professional designated by the Secretary
and performing services under a contract or fee arrangement with the
Secretary) is necessary for the amelioration of psychological, marital,
or familial difficulties that result from the active duty service referred
to in subsection (b) (1) or (2).
(d) MANNER OF FURNISHING SERVICES- (1) The Secretary shall furnish the
marriage and family counseling services under the program as follows:
(A) By personnel of the Department of Veterans Affairs who are qualified
to provide such counseling services.
(B) By appropriately certified marriage and family counselors employed by
the Department.
(C) By qualified mental health professionals pursuant to contracts with
the Department.
(2) The Secretary shall establish the qualifications required of personnel
under subparagraphs (A) and (C) of paragraph (1) and shall prescribe the
training, experience, and certification required of appropriately certified
marriage and family counselors under subparagraph (B) of such paragraph.
(3) The Secretary may employ counselors to provide marriage and family
counseling under paragraph (1)(B) and shall pay such counselors at the rates
prevailing for such counseling among non-Department health-care professionals
with similar training, experience, and certification in the locality in which
such counselors provide such counseling, as determined by the Secretary.
(e) CONTRACT COUNSELING SERVICES- (1) Subject to paragraphs (2) and
(4), a mental health professional referred to in subsection (d)(1)(C)
may furnish marriage and family counseling services to a person under the
program as follows:
(A) For a period of not more than 15 days beginning on the date of the
commencement of the furnishing of such services to the person.
(B) For a 90-day period beginning on such date if--
(i) the mental health professional submits to the Secretary a treatment
plan with respect to the person not later than 15 days after such date; and
(ii) the plan and assessment made under subsection (a) are approved by an
appropriate mental health professional of the Department designated for
that purpose by the Chief Medical Director.
(C) For an additional 90-day period beginning on the date of the expiration
of the 90-day period referred to in subparagraph (B) (or any subsequent
90-day period) if--
(i) not more than 30 days before the expiration of the 90-day period
referred to in subparagraph (B) (or any subsequent 90-day period), the
mental health professional submits to the Secretary a revised treatment
plan containing a justification of the need of the person for additional
counseling services; and
(ii) the plan is approved in accordance with the provisions of subparagraph
(B)(ii).
(2)(A) A mental health professional referred to in paragraph (1) who
assesses the need of any person for services for the purposes of subsection
(c) may not furnish counseling services to that person.
(B) The Secretary may waive the prohibition referred to in subparagraph
(A) for locations (as determined by the Secretary) in which the Secretary
is unable to obtain the assessment referred to in that subparagraph from
a mental health professional other than the mental health professional
with whom the Secretary enters into contracts under subsection (d)(1)(C)
for the furnishing of counseling services.
(3) The Secretary shall reimburse mental health professionals for the
reasonable cost (as determined by the Secretary) of furnishing counseling
services under paragraph (1).  In the event of the disapproval of a treatment
plan of a person submitted by a mental health professional under paragraph
(1)(B)(i), the Secretary shall reimburse the mental health professional for
the reasonable cost (as so determined) of furnishing counseling services
to the person for the period beginning on the date of the commencement of
such services and ending on the date of the disapproval.
(4) The Secretary may authorize the furnishing of counseling in an individual
case for a period shorter than the 90-day period specified in subparagraph
(B) or (C) of paragraph (1) and, upon further consideration, extend the
shorter period to the full 90 days.
(5)(A) For the purposes of this subsection, the term `treatment plan',
with respect to a person entitled to counseling services under the program,
must include--
(i) an assessment by the mental health professional submitting the plan
of the counseling needs of the person described in the plan on the date
of the submittal of the plan; and
(ii) a description of the counseling services to be furnished to the
person by the mental health professional during the 90-day period covered
by the plan, including the number of counseling sessions proposed as part
of such services.
(B) The Secretary shall prescribe an appropriate form for the treatment plan.
(f) COST RECOVERY- For the purposes of section 1729 of title 38, United
States Code, marriage and family counseling services furnished under the
program shall be deemed to be care and services furnished by the Department
under chapter 17 of such title, and the United States shall be entitled
to recover or collect the reasonable cost of such services in accordance
with that section.

a90235d4f0e6e5e1e09fdfc6b485e32cd67c0e9b7d2452b753a02ff26f591e4b

For the purposes of this part, the terms `veteran', `child', `parent',
`active duty', `reserve component',  `spouse', and `Persian Gulf War'
have the meanings given such terms in section 101(2), (4), (5), (21),
(27), (31), and (33) of title 38, United States Code, respectively.

9550eb61253beb2f999ad64a15e7c91a872379d6b85eb38730aecb48b7bb0d04

There is authorized to be appropriated $10,000,000 for each of fiscal
years 1993 and 1994 to carry out this part.

65b0b80d5e46374b065a09f4cc6913dba4ca3e012be2942f024a4b81279e3b47

(a) INTERIM REPORT- Not later than April 1, 1993, the Secretary shall
submit to Congress a report on the program conducted pursuant to section
131 of this Act. The report shall contain information regarding the persons
furnished counseling services under the program, including--
(1) the number of such persons, stated as a total number and separately
for each eligibility status referred to in section 131(b) of this Act;
(2) the age and gender of such persons;
(3) the manner in which such persons were furnished such services under
the program; and
(4) the number of counseling sessions furnished to such persons.
(d) FINAL REPORT- Not later than January 1, 1994, the Secretary shall
submit to Congress a report on the program. The report shall contain
updates of the information referred to in subsection (a) and a description
and evaluation of the program and shall include such recommendations with
respect to the program as the Secretary considers appropriate.
Part A--General Health

e046108289fc9dcc2bf7e5a0efccefd7f6010860c1da190591ca059c9e0bf356

(a) IN GENERAL- Section 1701(6)(A)(i) is amended by striking out `(except
under the conditions described in section 1712(f)(1)(A)(i) of this title)'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect on
the date on which the Secretary of Veterans Affairs submits to the Committees
on Veterans' Affairs of the Senate and House of Representatives copies of the
Secretary's written determination that implementation of that amendment will
not result in (1) substantial delay, or contribute substantially to delays,
in the furnishing of prosthetic items in connection with the treatment of
disabilities that are service connected (within the meaning of that term
provided in section 101(16) of title 38, United States Code), or (2) the
denial of such items in connection with the treatment of such disabilities.

81cda4a8968cb888afc6dc90849f0112a198053aabf279936654cc198bf3583d

TITLE II

-GENERAL HEALTH CARE

Section 1717(a)(2) is amended--
(1) in subparagraph (A), by striking out `$2,500' and inserting in lieu
thereof `$5,000'; and
(2) in subparagraph (B), by striking out `$600' and inserting in lieu
thereof `$1,200'.

ee54270ada4dec006b155cd50c7a77ae60f9b36e51362117e178151ddacecc13

(a) ASSESSMENT AND PLAN- (1)(A) The Secretary of Veterans Affairs shall
require the director of each medical center or the director of each regional
benefits office to make an assessment of the needs of homeless veterans
living within the area served by the director of the medical center concerned
or the region of the director of the region concerned, as the case may be.
(B) Each assessment shall identify the needs of homeless veterans with
respect to the following areas:
(i) Health care.
(ii) Education and training.
(iii) Employment.
(iv) Shelter.
(v) Counseling.
(vi) Outreach services.
(C) Each assessment shall also indicate the extent to which the needs
referred to in clauses (i) through (vi) of subparagraph (B) are being
met adequately by the programs of the Department of Veterans Affairs,
of other departments and agencies of the Federal Government, of State and
local governments, and of nongovernmental organizations.
(D) Each assessment shall be made in consultation with all facilities of
the Department of Veterans Affairs serving veterans in the appropriate
service area and with community-based organizations that have experience
working with homeless persons in that area.
(E) Each assessment shall be carried out in accordance with uniform
procedures and guidelines prescribed by the Secretary.
(2)(A) The director of each medical center shall develop a plan for each
of fiscal years 1993, 1994, and 1995 for the provision of outreach services
and other services to meet the needs that are identified in the assessment
referred to in paragraph (1)(B) on the part of homeless veterans in the
area served by the medical center concerned. The director of each medical
center shall develop such plans in consultation with the director of the
appropriate regional benefits office, the heads of other facilities of the
Department of Veterans Affairs, and the Director for Veterans' Employment
and Training within the State concerned.
(B) Each plan developed pursuant to subparagraph (A) shall--
(i) describe the actions to be taken by the Department of Veterans Affairs
to meet, directly or otherwise, those needs of homeless veterans that are
identified in the assessment referred to in paragraph (1) as not being
adequately met by existing programs; and
(ii) provide that the director of the medical center concerned or other
official of the Department of Veterans Affairs will take appropriate action
to meet those needs, to the maximum extent practicable, through existing
programs and available resources.
(C) The director of each medical center shall coordinate the development
of the plan for the area served by the medical center concerned with
other programs of the Department of Veterans Affairs, other departments
and agencies of the Federal Government, State and local governments,
and community-based organizations and other private entities that provide
services to homeless persons.
(D) Each plan shall include a list of all public and private programs that
provide assistance to homeless persons or homeless veterans in the area
concerned and shall describe the services offered by those programs.
(3) The director of each medical center shall be responsible for carrying
out the plan developed with respect to the area served by that medical
center. In carrying out such plan, the director shall take appropriate
actions to seek to inform each homeless veteran, and each veteran who is at
risk of becoming homeless (as determined by the director), of the services
available to the veteran within the area served by the medical center.
(4) The director of each medical center shall disseminate to other
departments and agencies of the Federal Government, all State and local
governments, and all private entities that provide services to homeless
persons or homeless veterans within the area served by the medical center
information regarding the services provided to homeless veterans by the
medical center or other facility of the Department of Veterans Affairs.
(b) PILOT PROGRAM FOR PROVIDING DOMICILIARY CARE FOR HOMELESS VETERANS- (1)
The Secretary shall conduct a pilot program to determine the effectiveness
of providing, through existing community-based organizations, domiciliary
care (including medical services) to homeless veterans eligible for such
care from the Department of Veterans Affairs under other provisions of
law. In carrying out the program, the Secretary may enter into contracts
with community-based organizations that have demonstrated effectiveness in
providing relevant services to homeless persons. The Secretary shall conduct
the program at not more than 15 locations throughout the United States.
(2) In entering into contracts under this section, the Secretary shall
give preference to community-based organizations that offer the most
comprehensive care and services to homeless individuals, particularly
services that meet needs identified in the assessments referred to in
subsection (a)(1) as not being adequately met by existing programs.
(3) There is authorized to be appropriated to carry out this subsection
$1,500,000 for each of fiscal years 1992, 1993, 1994, and 1995.
(4) If the Secretary determines that the pilot program conducted pursuant
to paragraph (1) is meeting effectively the domiciliary care needs of
homeless veterans and that additional funds are needed for that program,
the Secretary may transfer funds appropriated to carry out section 801
of the Stewart B. McKinney Homeless Assistance Amendments Act of 1988
(Public Law 100-628; 102 Stat. 3257), as amended by subsection (e), to
the account available to carry out the pilot program provided for in this
subsection, except that no amount may be transferred in any fiscal year
that would reduce the amount available for expenditure under such section
801 below an amount equal to the amount expended under that section in
the preceding fiscal year. Funds transferred under this paragraph shall
be available for the same period for which originally appropriated.
(c) AUTHORITY TO ACCEPT DONATIONS FOR CERTAIN PROGRAMS- The Secretary
may accept donations of funds and services for the purposes of providing
one-stop, non-residential services and mobile support teams and for expanding
the medical services to homeless veterans eligible for such services from
the Department of Veterans Affairs.
(d) DEFINITIONS- As used in subsections (a), (b), and (c):
(1) The term `medical center' means a medical center of the Department of
Veterans Affairs.
(2) The term `regional benefits office' means a regional benefits office
of the Department of Veterans Affairs.
(3) The term `veteran' has the same meaning given such term by section
101(2) of title 38, United States Code.
(4) The term `homeless' has the same meaning given such term by section
103(a), as limited by section 103(c), of the Stewart B. McKinney Homeless
Assistance Act (Public Law 100-77; 101 Stat. 485).
(e) EXTENSION OF CERTAIN PROGRAMS FOR HOMELESS VETERANS- (1) Section 801
of the Stewart B. McKinney Homeless Assistance Amendments Act of 1988
(Public Law 100-628; 102 Stat. 3257) is amended--
(A) by striking out subsection (a) and inserting in lieu thereof the
following:
`(a) AUTHORIZATION OF APPROPRIATIONS- There is hereby authorized to
be appropriated to the Department of Veterans Affairs $30,000,000 for
each of the fiscal years 1989 and 1990; $50,000,000 for fiscal year
1991; $57,500,000 for fiscal year 1992; and $65,000,000 for fiscal year
1993. Funds appropriated pursuant to this section shall be in addition
to any funds appropriated pursuant to any other authorizations (whether
definite or indefinite) for such fiscal years.';
(B) in subsection (b)--
(i) by inserting `(1)' after `DOMICILIARY CARE- ';
(ii) by striking out `50 percent' and inserting in lieu thereof `the
amounts specified in paragraph (2)';
(iii) by redesignating clauses (1) and (2) as clauses (A) and (B),
respectively; and
(iv) by adding at the end the following new paragraph:
`(2) The amounts available for the purposes referred to in paragraph (1)
are as follows:
`(A) For fiscal year 1989, $15,000,000.
`(B) For fiscal year 1990, $15,000,000.
`(C) For fiscal year 1991, $20,000,000.
`(D) For fiscal year 1992, $22,500,000.
`(E) For fiscal year 1993, $25,000,000.'; and
(C) in subsection (c)--
(i) by inserting `(1)' after `HOMELESS VETERANS- ';
(ii) by striking out `50 percent' and inserting in lieu thereof `the
amounts specified in paragraph (2)'; and
(iii) by adding at the end the following new paragraph:
`(2) The amounts available for the purposes referred to in paragraph (1)
are as follows:
`(A) For fiscal year 1989, $15,000,000.
`(B) For fiscal year 1990, $15,000,000.
`(C) For fiscal year 1991, $30,000,000.
`(D) For fiscal year 1992, $35,000,000.
`(E) For fiscal year 1993, $40,000,000.'.
(2) EXTENSION OF PROGRAM FOR MENTALLY ILL HOMELESS VETERANS- Section 115(d)
of the Veterans' Benefits and Services Act of 1988 (38 U.S.C. 1712 note)
is amended by striking out `1992' and inserting in lieu thereof `1994'.
(f) REPORT- Not later than February 1, 1994, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs of the Senate
and House of Representatives a report containing an evaluation of the
programs referred to in subsections (a), (b), and (c).

5809d5c6e2e6c36e9c2d1a03e80f526d9e10e57603e4a01d232189a3c1460e9f

Section 113(b) of the Veterans' Benefits and Services Act of 1988 (38
U.S.C. 1712 note) is amended--
(1) by striking out `and 1990' and inserting in lieu thereof a comma and
`1990, 1991, 1992, and 1993'; and
(2) by adding at the end the following new sentence: `Funds appropriated
to carry out the pilot program authorized by this section shall remain
available until expended.'.

134108926d98d3af31cde041fe78e055879e2eb5e532d5815135a7c991190707

(a) ESTABLISHING OF ADVISORY COMMITTEE- Chapter 5 is amended by adding at
the end of subchapter III the following new section:
`Sec. 543. Advisory Committee on Prosthetics and Special-Disabilities Programs
`(a)(1) The Secretary shall establish an advisory committee to be known
as the Advisory Committee on Prosthetics and Special-Disabilities Programs
(hereinafter in this section referred to as the `Committee').
`(2) The members of the Committee shall be appointed by the Secretary and
shall include--
`(A) appropriate representatives of veterans who use prosthetic devices;
`(B) individuals who are recognized experts in the fields of prosthetics
engineering;
`(C) individuals engaged in prosthetics research;
`(D) individuals engaged in rehabilitative medicine;
`(E) individuals engaged in the clinical treatment of individuals who are
users of prosthetic devices;
`(F) individuals engaged in clinical treatment in the Department's
special-disabilities programs; and
`(G) such other individuals with pertinent expertise or experience as the
Secretary may determine appropriate.
`(3) The Committee may also include, as ex officio members, individuals
appointed from the Department.
`(4) The Secretary shall determine the total number, terms of service, and
pay and allowances of members of the Committee appointed by the Secretary,
except that the term of office of any such member may not exceed three years.
`(b)(1) It shall be the function of the Committee to advise the Secretary
and the Chief Medical Director on all matters related to--
`(A) prosthetics and special-disabilities programs administered by the
Secretary;
`(B) the coordination of programs of the Department for the development
and testing of, and for information exchange regarding, prosthetic devices;
`(C) the coordination of Department and non-Department programs that
involve the development and testing of prosthetic devices; and
`(D) the adequacy of funding for the prosthetics and special-disabilities
programs of the Department.
`(2) The Secretary shall, on a regular basis, consult with and seek
the advice of the Committee on the matters described in paragraph (1)
of this subsection.
`(c) Not later than June 15 of 1993, 1994, and 1995, the Committee shall
submit to the Secretary and the Committees on Veterans Affairs' of the
Senate and House of Representatives a report on the effectiveness of the
prosthetics and special-disabilities programs administered by the Secretary
during the preceding fiscal year. Not more than 30 days after the date on
which any such report is received by the Secretary, the Secretary shall
submit a report to such committees commenting on the report of the Committee.
`(d) As used in this section, the term `special-disabilities programs'
includes all programs administered by the Secretary for spinal-cord-injured
veterans, blind veterans, veterans who have lost or lost the use of
extremities, hearing-impaired veterans, and other veterans with serious
incapacities in terms of daily life functions.'.
(b) CLERICAL AMENDMENT- The table of sections at the beginning of chapter
5 is amended by adding after the item relating to section 542 the following:
`543. Advisory Committee on Prosthetics and Special-Disabilities Programs.'.

518d1abd29ace6d9a0c404658c8a99663ebe8d23340d643baf1fd83591bb31fe

PROCREATION.
(a) DEFINITION OF `MEDICAL SERVICES'- Clause (A) of section 1701(6),
as amended by section 201 of this Act, is further amended to read as follows:
`(A)(i) surgical services, (ii) services to achieve pregnancy in a veteran
or a veteran's spouse when such services are necessary to overcome a
service-connected disability impairing a veteran's procreative ability (but
only if such services are furnished by contract, except for services which
the Chief Medical Director determines that Department of Veterans Affairs
facilities are fully capable of furnishing in a cost-effective manner),
(iii) dental services and appliances as described in sections 1710 and
1712 of this title, (iv) optometric and podiatric services, (v) (in the
case of a person otherwise receiving care or services under this chapter)
preventive health-care services as defined in section 1762 of this title,
(vi) wheelchairs, artificial limbs, trusses and similar appliances, special
clothing made necessary by the wearing of prosthetic appliances, and such
other supplies or services as the Secretary determines to be reasonable
and necessary, and (vii) travel and incidental expenses pursuant to the
provisions of section 111 of this title; and'.
(b) ADVISORY COMMITTEE- The Chief Medical Director of the Department of
Veterans Affairs shall appoint an advisory committee to advise the Chief
Medical Director on the exercise of authority to furnish services described
in subclause (ii) of section 1701(6)(A) of title 38, United States Code,
as added by subsection (a). Section 14 of the Federal Advisory Committee
Act (5 U.S.C. App.) shall not apply to the advisory committee appointed
under this subsection.

f01bab1899b66df38e2e6eaeaf97da44f1200c31c0f4287e689beaae3a4ae3fd

(a) EXTENSION OF PILOT PROGRAM- Section 1763(a)(1) is amended to read
as follows:
`(a)(1) In order to carry out the purpose of this subchapter, the Secretary
shall, through fiscal year 1996--
`(A) furnish annually at least two preventive health-care services that
the Secretary determines to be feasible and appropriate to any veteran
being furnished care or services under section 1710(a)(1) or 1712(a)
(1) or (2) of this title; and
`(B) implement annually at each Department of Veterans Affairs health-care
facility a major preventive health-care and health-promotion initiative
for such veterans.'.
(b) LIMIT ON EXPENDITURES- Section 1763(c) is amended--
(1) by striking out `or' after `1983,'; and
(2) by striking out the period at the end and inserting in lieu thereof `,
more than $16,000,000 in fiscal year 1992, more than $17,000,000 in fiscal
year 1993, more than $18,000,000 in fiscal year 1994, more than $19,000,000
in fiscal year 1995, or more than $20,000,000 in fiscal year 1996.'.
(c) DIRECTOR OF PREVENTIVE HEALTH-CARE AND HEALTH-PROMOTION PROGRAMS-
Section 1763 is amended by adding at the end the following new subsection:
`(d)(1) The Chief Medical Director shall designate an official in the
Veterans Health Administration to act as the Director of Preventive
Health-Care and Health-Promotion Programs.
`(2) The Director of Preventive Health-Care and Health-Promotion Programs
shall prepare guidance regarding, and be responsible for coordinating,
evaluating, and advising the Chief Medical Director on, all activities
carried out under this subchapter.'.
(d) REPORTS- Section 1764 is amended to read as follows:
`(a) The Secretary shall submit to the Committees on Veterans' Affairs of
the Senate and House of Representatives--
`(1) not later than February 1, 1994, an interim report on the experience
under the program provided for by this subchapter; and
`(2) not later than February 1, 1996, a final report on the experience
under the program.
`(b) Each report submitted pursuant to subsection (a) of this section
shall include, with respect to the experience under the program through
September 30 of the year preceding the deadline for submission of such
report specified in subsection (a)--
`(1) a description of the types of services that have been furnished
pursuant to section 1763(a)(1)(A) of this title and the number of veterans
who received such services;
`(2) a description of the preventive health-care and health-promotion
initiatives that were implemented pursuant to section 1763(a)(1)(B)
of this title and the number of veterans who have been served through
such initiatives;
`(3) a description of the types of preventive health-care services that
have been furnished pursuant to sections 1710 and 1712 of this title and
the number of veterans who received such services;
`(4) a description of activities conducted pursuant to section 1763(a)(2)
of this title;
`(5) an assessment of the results of the program; and
`(6) any plans for administrative action, and any recommendations for
legislation, that the Secretary considers appropriate.'.
(e) CONFORMING AND CLARIFYING AMENDMENTS- (1) Section 1761(1) is amended
by striking out `, including veterans with service-connected disabilities'
and all that follows through `disability under this chapter,'.
(2) Clauses (1) and (2) of section 1762 are amended to read as follows:
`(1) periodic medical examinations (including screenings for high blood
pressure, glaucoma, colorectal cancer, and cholesterol) and dental
examinations; and
`(2) patient health education (including education about nutrition, stress
management, physical fitness, and smoking cessation);'.

5fe32cc4add5078a40081f45ca0a30459291f30bcd371408525f6a07387232d0

(a) AUTHORITY TO PROVIDE ASSISTIVE DOGS- Section 1714 is amended by adding
at the end the following new subsection:
`(c)(1) The Secretary may provide--
`(A) a service dog to a quadriplegic veteran who has a service-connected
disability; and
`(B) a signal dog to a veteran who has a service-connected hearing impairment
and is in need of the assistance of such a dog.
`(2) The Secretary may pay travel and incidental expenses to veterans
referred to in paragraph (1), under the terms and conditions set forth
in section 111 of this title, for travel to and from such veteran's homes
that are incurred in becoming adjusted to the service dogs and signal dogs
referred to in such paragraph.
`(3) For the purposes of this subsection:
`(A) The term `service dog' means a dog trained to assist quadriplegic
individuals in the performance of daily living tasks.
`(B) The term `signal dog' means a dog trained to provide hearing assistance
to deaf persons.'.
(b) TECHNICAL CORRECTIONS- Section 1714(b) is amended by striking out
`(under the terms and conditions set forth in section 111 of this title)
to and from their homes and' and inserting in lieu thereof `, under the
terms and conditions set forth in section 111 of this title, for travel
to and from such veteran's homes that are'.

3510d4ad150a2ba37db4cc00e551683e8e348063d780e13a51383bb3b91906f0

Not later than July 15, 1992, the Secretary of Veterans Affairs shall
submit to the Committees on Veterans' Affairs of the Senate and House of
Representatives a report containing--
(1) the Secretary's evaluation of the reasons for the backlog that occurred
in the procurement of prosthetic appliances in fiscal year 1989, and
for the failure to furnish prosthetic appliances in accordance with the
priority established in section 1712(i) of title 38, United States Code; and
(2) a description of the actions that the Secretary has taken and plans
to take to prevent a recurrence of--
(A) the failure to furnish prosthetic appliances in accordance with such
priority, including a schedule for any such planned actions; and
(B) the accumulation of a significant backlog in the procurement of
prosthetic appliances.

5849636fc00cd94d1f1faa56a01d22f42f357f6ca86be744128bee942fffea22

HOSPITAL OR DOMICILIARY CARE.
(a) IN GENERAL- Section 1715 is repealed.
(b) CLERICAL AMENDMENT- The table of sections at the beginning of chapter
17 is amended by striking out the item relating to section 1715.

f24b406ac8aded3233b66a7e433cfcf1866ec5c20985647d3c5a672488194a25

INCONSISTENCIES IN CERTAIN VETERANS BENEFITS LAWS.
(a) REQUIREMENT TO ESTABLISH TASK FORCE- The Secretary of Veterans Affairs
shall establish a task force to recommend policies and legislation for the
elimination of inconsistencies among provisions of law relating to veterans'
eligibility for certain health-care benefits.
(b) COMPOSITION OF TASK FORCE- The task force shall be composed of the
following:
(1) Employees of the Department of Veterans Affairs involved in the
administration of programs affected by the inconsistencies in law referred
to in subsection (a).
(2) Representatives of organizations concerned with the administration of
such programs, as determined by the Secretary.
(c) RESPONSIBILITIES OF TASK FORCE- The task force shall--
(1) identify inconsistencies among sections 1701(6), 1712, 1714, 1717,
and 1719 of title 38, United States Code, and the implementation of such
sections;
(2) after consultation with appropriate representatives of veterans, develop
policy recommendations and legislative proposals for the elimination of
any such inconsistencies; and
(3) not later than the date specified by the Secretary, submit to the
Secretary a report containing (A) descriptions of the inconsistencies
identified by the task force, (B) the policies and legislative proposals
recommended by the task force for the elimination of such inconsistencies,
and (C) the reasons for each such recommendation.
(d) ACTION BY THE SECRETARY- The Secretary shall--
(1) review the report submitted by the task force; and
(2) either (A) approve the recommendations for legislation contained in the
report, or (B) with respect to any such recommendations that the Secretary
does not approve, recommend, or decline to recommend, alternative legislative
proposals that the Secretary considers appropriate for the elimination of
the inconsistencies identified by the task force.
(e) SUBMISSION OF RECOMMENDATIONS TO CONGRESS- Not later than 180 days after
the date of the enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and House of Representatives--
(1) the report submitted to the Secretary by the task force; and
(2) a report containing--
(A) any legislation recommended by the Secretary for the elimination of
the inconsistencies identified by the task force;
(B) an analysis of any legislation recommended by the Secretary; and
(C) the reasons for any differences between any legislation recommended
by the Secretary and the legislation recommended by the task force.

7689a6fdf92c20079bc37d3c1a9df80a475efc0594769945c40886e3f6ec10d1

SERVICES.
Section 1712(a)(1) is amended--
(1) at the end of clause (B), by striking out `and';
(2) at the end of clause (C), by striking out the period and inserting in
lieu thereof `; and'; and
(3) by adding at the end thereof the following new clause:
`(D) to any former prisoner of war for any disability.'.

64f7b1e3c3e7b889612975154df83e01cb7ecb44dc1e84b92f931ef0b1d2a203

(a) REQUIREMENT FOR PILOT PROGRAM- During fiscal years 1992, 1993, 1994,
and 1995, the Secretary of Veterans Affairs shall conduct a pilot program
under which the Secretary shall--
(1) furnish assistive monkeys to quadriplegic veterans who have
service-connected disabilities rated 50 percent or more; and
(2) facilitate the furnishing of assistive monkeys to other quadriplegic
veterans.
(b) SELECTION OF VETERAN-PARTICIPANTS- (1) In determining whether to furnish
an assistive monkey to a veteran, or to facilitate the furnishing of an
assistive monkey to a veteran, under the pilot program, the Secretary shall
(A) consider the extent to which the veteran needs and can benefit from
the assistance of the monkey, and (B) provide a preference for veterans
who have service-connected quadriplegia.
(2) The Secretary shall approve a veteran for participation in the pilot
program only upon the Secretary's determination that the veteran is
well-suited for--
(A) carrying out the responsibilities involved in the care of the monkey; and
(B) effectively using the monkey for assistance in performing the veteran's
daily living tasks.
(c) ADMINISTRATIVE MATTERS- (1) The Secretary is authorized to enter into
contracts for the furnishing of assistive monkeys under subsection (a). Under
such contracts the Secretary may make advance payments for the furnishing
of the monkeys before receipt of the monkeys and may either reimburse the
provider of such monkeys for the costs of training the monkeys or, subject
to such terms and conditions as the Secretary determines are necessary to
protect the interests of the Government, make advance payments for such
costs before the costs are incurred.
(2) Ownership of an assistive monkey furnished to a veteran under the
pilot program shall be determined in accordance with a contract between
the provider of the monkey and the veteran.
(3) The Secretary shall provide for the protection of the welfare of
assistive monkeys furnished veterans under the pilot program.
(d) EVALUATION AND REPORT- (1) The Secretary shall evaluate the conduct
of the pilot program, the nature and extent of the benefit to veterans
furnished assistive monkeys under the program (including any benefits
related to employment), the costs and cost-effectiveness of furnishing such
monkeys to quadriplegic veterans, and the effects of such program on the
recruitment and retention of paid primary caregivers for veterans receiving
monkeys and on the morale of unpaid primary caregivers for such veterans.
(2) Not later than February 1, 1995, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and House of Representatives a
report on the experience under the pilot program. The report shall contain--
(A) the results of the evaluation carried out under paragraph (1), including
descriptions of the procedures and criteria used to select veterans to
receive assistive monkeys, the nature and extent of the benefit that the
veterans received from the assistance of such monkeys, and the amounts
and types of costs incurred by the Department of Veterans Affairs in the
conduct of the program;
(B) the Secretary's views on the relationship between the furnishing of an
assistive monkey to a veteran and the payment to a veteran of (i) an aid
and attendance allowance under section 1114(r) of title 38, United States
Code, or (ii) an annual rate of pension under section 1521 of such title
based on the veteran's need of regular aid and attendance; and
(C) any recommendations that the Secretary considers appropriate regarding
whether the pilot program should be continued or whether the authority to
furnish assistive monkeys to quadriplegic veterans should be made permanent.
(e) EVALUATION OF PRIVATE ASSISTIVE MONKEY PLACEMENT PROGRAMS- Before
furnishing assistive monkeys to veterans under the pilot program, the Chief
Medical Director of the Department of Veterans Affairs shall provide for the
conduct of an independent evaluation of the way that assistive monkeys would
be treated during training and placement under the pilot program. The Chief
Medical Director shall ensure that the person or organization performing
the evaluation consults with representatives of appropriate animal welfare
organizations prior to conducting the evaluation.
(f) DEFINITIONS- For the purposes of this section--
(1) the terms `veterans' and `service-connected' have the meanings given
those terms in paragraphs (2) and (16), respectively, of section 101 of
title 38, United States Code; and
(2) the term `assistive monkey' means a monkey that is specially trained to
assist in the performance of daily living tasks for quadriplegic individuals.
Part B--Health-Care Personnel

e36ccd7a5403c36e04d3c22b06aa945ae02f4bd1ddb2b36e851d03400686843c

Section 7454(b) is amended by striking out `or occupational therapists,'
and inserting in lieu thereof `occupational therapists, or any other
health-care personnel furnishing direct care to patients or providing
services incident to the furnishing of direct care to patients,'.

b67bf723da4e7eb073e436faa5915d9eef94c85381b131fc49bf3fbc949b969c

Section 7455(c) is amended--
(1) by inserting `(1)' after `(c)';
(2) by inserting `by two times' after `exceed' the first place it appears;
and
(3) by inserting at the end the following new paragraph:
`(2) Whenever the amount of an increase under subsection (a)(1) results in
a rate of basic pay for a position being equal to or greater than the amount
that is 94 percent of the maximum amount permitted under paragraph (1), the
Secretary shall promptly notify the Committees on Veterans' Affairs of the
Senate and House of Representatives of the increase and the amount thereof.'.

88d1fa4f12bdc151b0f829795d4f7c028574ba126b298df85dd31e777b6fd9de

Notwithstanding any other provision of law, the Secretary of Veterans
Affairs, not later than 90 days after the date of the enactment of this
Act, shall utilize the authority provided in section 7455 of title
38, United States Code, to increase the rates of pay for clinical or
counseling psychologists who hold diplomas as diplomates in psychology
from an accredited authority recognized by the Secretary unless the
Chief Medical Director of the Department of Veterans Affairs determines
that such psychologists are not needed to furnish appropriate quality of
psychological services for veterans. The amount by which such rate of pay
shall be increased shall be the amount determined by the Secretary, upon
the recommendation of the Chief Medical Director, to be necessary to make
the pay for such psychologists competitive with the pay of psychologists
with the same qualifications and credentials serving in non-Department
of Veterans Affairs capacities comparable to the Department capacities in
which the Department psychologists are serving.

7f0a104e542313abacc43427b06ab47591c1e9e0a18879ac167471cdaaa452af

(a) ASSESSMENTS OF EMPLOYEE NEEDS FOR CHILD-CARE SERVICES- (1) In order to
provide for adequate planning for the availability of child-care services
for children of Department of Veterans Affairs employees, the Secretary of
Veterans Affairs shall require the director of each Department of Veterans
Affairs medical center and regional office to--
(A) assess the needs of such employees for child-care services; and
(B) submit an annual report to the Secretary containing--
(i) the director's findings relating to the needs of such employees for
such services and the extent to which such services are available to meet
such needs, and
(ii) a proposal (including a schedule) for meeting fully any unmet needs or,
if the director determines that it is impracticable to meet such needs fully,
a detailed explanation of the reasons for such determination and a proposal
(including a schedule) for meeting as many of such needs as is practicable.
(2) In making the assessment referred to in paragraph (1), the director
shall consult with appropriate representatives of the employees at the
center or office.
(3) The annual report referred to in this subsection shall be submitted
not later than March 1 of each year.
(b) TECHNICAL AMENDMENT- Subsection (b) of section 7809 is amended by
striking out `of this section' in the final sentence.

c15e31213d250bc6c81e54c0d85713019f9829dd2334ce6666d384fb80bc4ae2

CERTIFICATION.
(a) FULL-TIME PHYSICIANS AND DENTISTS- Section 7437(e)(1)(C) is amended
by striking out `only for the special pay' and all that follows through
the period and inserting in lieu thereof `for no special pay factors
other than primary, full-time, length of service, and specialty or board
certification.'.
(b) PART-TIME PHYSICIANS AND DENTISTS- Section 7437(e)(2)(C) is amended
by striking out `only for the special pay' and all that follows through
the period and inserting in lieu thereof `for no special pay factors
other than primary, full-time, length of service, and specialty or board
certification.'.
(c) EFFECTIVE DATE- The amendments made by this section shall take effect
as if enacted with the amendment made by section 102 of the Department
of Veterans Affairs Health-Care Personnel Act of 1991 (Public Law 102-40;
105 Stat. 187).
(d) AVAILABILITY OF FUNDS- Expenses incurred for periods before October 1,
1991, by reason of the enactment of the amendments made by subsections
(a) and (b) may be charged to fiscal year 1992 appropriations for the
same purpose.

5babe40b9dd603d9f4c4b973dbd2b38fbbacacae96edb4211b1663d9b9925be2

CHIEF MEDICAL DIRECTOR.
Section 7306(a) is amended--
(1) by redesignating paragraph (7) as paragraph (8); and
(2) by inserting after paragraph (6) the following new paragraph (7):
`(7) Such directors of such other professional or auxiliary services as may
be appointed to suit the needs of the Department, who shall be responsible to
the Chief Medical Director for the operation of their respective services.'.

25cbf6d7996e3a2f47ae74852787dee6726c05af2a0c076c8721c93eec701d90

SCHEDULE.
Section 7404(b)(2) is amended in the first sentence by inserting `, or
comparable position' before the period.

64f673c1bbec5f14e1fb075f1d1c87a28b6d31e2fc2c7e37bba88040fa9f058c

VETERANS.
(a) ESTABLISHMENT- Effective June 1, 1992, the Advisory Committee on
Native-American Veterans established by section 19032 of the Veterans'
Health-Care Amendments of 1986 (title XIX of Public Law 99-272; 100
Stat. 388) is reestablished.
(b) INCORPORATION OF PROVISIONS OF PRIOR LAW- Subsections (b) through
(e) and (g) of section 19032 of the Veterans' Health-Care Amendments of
1986 shall apply to the Advisory Committee on Native-American Veterans
reestablished by subsection (a).
(c) REPORTS- (1) Not later than December 31, 1992, and December 31, 1993,
the Committee shall submit to the Secretary of Veterans Affairs a report
containing the findings and any recommendations of the Committee regarding
the matters described in section 19032(b) of the Veterans' Health-Care
Amendments of 1986 that were examined and evaluated by the Committee during
the fiscal year preceding the fiscal year in which the report is submitted.
(2) Not later than 60 days after receiving each such report, the Secretary
shall transmit to the Committees on Veterans' Affairs of the Senate and
House of Representatives a copy of the report, together with any comments
and recommendations concerning the report that the Secretary considers
appropriate.
(d) TERMINATION- The Committee shall expire 90 days after the date on which
the second report is transmitted by the Committee pursuant to subsection (c).

60a6fb164aef6b09e9174325edbcc12e09213d3d61627b3ee8189d36ad0b4cbc

TITLE III

-MINORITY AFFAIRS

(a) IN GENERAL- Section 5904(c) is amended--
(1) by inserting `(A)' after `(c)(1)';
(2) by redesignating paragraph (2) as subparagraph (B);
(3) in subparagraph (B) (as so redesignated), by striking out `paragraph
(1)' and inserting in lieu thereof `subparagraph (A)'; and
(4) by adding at the end the following new paragraph:
`(2) The provisions of this subsection shall apply only to cases involving
a claim for benefits submitted by any person applying for benefits under
the laws administered by the Department, and such provisions shall not
apply in cases in which the Government is proceeding against a person to
collect an indebtedness or in which other attorneys' fee statutes apply.'.
(b) APPLICATION OF PROHIBITION- Section 3404(c) of title 38, United States
Code, as in effect on November 17, 1988, shall apply only to cases involving
a claim for benefits submitted by any person applying for benefits under the
laws administered by the Department and shall not apply in cases in which
the Government is proceeding against a person to collect an indebtedness
or in which other attorneys' fee statutes apply.

79fedc947126415d06bc2a221a9bb55c39370beff762a6d86c996779c177dd91

TITLE IV

-MISCELLANEOUS

UNITED STATES.
(a) AUTHORIZATION- The director of each national cemetery is authorized
to display a POW/MIA flag on a flagstaff at that cemetery. In determining
whether to display a POW/MIA flag at the cemetery, the director is authorized
and urged to consult with appropriate representatives of local civic and
veterans' organizations having an interest in the activities of the cemetery.
(b) PROHIBITION- No officer or other employee of the Federal Government
may obligate appropriated funds for the purpose of purchasing a POW/MIA
flag for display at a national cemetery.
(c) DEFINITIONS- In this section:
(1) The term `national cemetery' means any cemetery in the National Cemetery
System referred to in section 1000 of title 38, United States Code.
(2) The term `POW/MIA flag' means the flag designated as the National League
of Families POW/MIA flag pursuant to section 2 of the Joint Resolution
designating September 21, 1990, as `National POW/MIA Recognition Day',
and recognizing the National League of Families POW/MIA flag (Public Law
101-355; 104 Stat. 416).
(3) The term `flagstaff' means any flagstaff at a national cemetery,
including the main flagstaff of the cemetery.

082c5950c1d630d69dd7d647583c88db39edc3e1fd398d262a245e1550f2c8de

Veterans' Medical Programs Amendments of 1992

Other Sections

TITLE I

TITLE II

TITLE III

TITLE IV

Want the full experience?