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H.R. 2116 (enr) To amend title 38, United States Code, to establish a program of [Enrolled bill] ...


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106th CONGRESS

  1st Session

                               H. R. 2116

_______________________________________________________________________

                                 AN ACT

   To amend title 38, United States Code, to establish a program of 
 extended care services for veterans and to make other improvements in 
      health care programs of the Department of Veterans Affairs.
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
106th CONGRESS
  1st Session
                                H. R. 2116

_______________________________________________________________________

                                 AN ACT


 
   To amend title 38, United States Code, to establish a program of 
 extended care services for veterans and to make other improvements in 
      health care programs of the Department of Veterans Affairs.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS; REFERENCES TO TITLE 38, 
              UNITED STATES CODE.

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

Sec. 1. Short title; table of contents; references to title 38, United 
                            States Code.
                        TITLE I--ACCESS TO CARE

Sec. 101. Extended care services.
Sec. 102. Reimbursement for emergency treatment.
Sec. 103. Eligibility for care of combat-injured veterans.
Sec. 104. Access to care for military retirees.
Sec. 105. Benefits for persons disabled by participation in compensated 
                            work therapy program.
Sec. 106. Pilot program of medical care for certain dependents of 
                            enrolled veterans.
Sec. 107. Enhanced services program at designated medical centers.
Sec. 108. Counseling and treatment for veterans who have experienced 
                            sexual trauma.
                    TITLE II--PROGRAM ADMINISTRATION

Sec. 201. Medical care collections.
Sec. 202. Health Services Improvement Fund.
Sec. 203. Veterans Tobacco Trust Fund.
Sec. 204. Authority to accept funds for education and training.
Sec. 205. Extension and revision of certain authorities.
Sec. 206. State Home grant program.
Sec. 207. Expansion of enhanced-use lease authority.
Sec. 208. Ineligibility for employment by Veterans Health 
                            Administration of health care professionals 
                            who have lost license to practice in one 
                            jurisdiction while still licensed in 
                            another jurisdiction.
                        TITLE III--MISCELLANEOUS

Sec. 301. Review of proposed changes to operation of medical 
                            facilities.
Sec. 302. Patient services at Department facilities.
Sec. 303. Report on assisted living services.
Sec. 304. Chiropractic treatment.
Sec. 305. Designation of hospital bed replacement building at Ioannis 
                            A. Lougaris Department of Veterans Affairs 
                            Medical Center, Reno, Nevada.
             TITLE IV--CONSTRUCTION AND FACILITIES MATTERS

Sec. 401. Authorization of major medical facility projects.
Sec. 402. Authorization of major medical facility leases.
Sec. 403. Authorization of appropriations.
    (c) References to Title 38, United States Code.--Except as 
otherwise expressly provided, whenever in this Act an amendment or 
repeal is expressed in terms of an amendment to, or repeal of, a 
section or other provision, the reference shall be considered to be 
made to a section or other provision of title 38, United States Code.

                        TITLE I--ACCESS TO CARE

SEC. 101. EXTENDED CARE SERVICES.

    (a) Requirement To Provide Extended Care Services.--(1) Chapter 17 
is amended by inserting after section 1710 the following new section:
``Sec. 1710A. Extended care services
    ``(a) The Secretary (subject to section 1710(a)(4) of this title 
and subsection (c) of this section) shall operate and maintain a 
program to provide extended care services to eligible veterans in 
accordance with this section. Such services shall include the 
following:
            ``(1) Geriatric evaluation.
            ``(2) Nursing home care (A) in facilities operated by the 
        Secretary, and (B) in community-based facilities through 
        contracts under section 1720 of this title.
            ``(3) Domiciliary services under section 1710(b) of this 
        title.
            ``(4) Adult day health care under section 1720(f) of this 
        title.
            ``(5) Such other noninstitutional alternatives to nursing 
        home care, including those described in section 1720C of this 
        title, as the Secretary considers reasonable and appropriate.
            ``(6) Respite care under section 1720B of this title.
    ``(b)(1) In carrying out subsection (a), the Secretary shall 
provide extended care services which the Secretary determines are 
needed (A) to any veteran in need of such care for a service-connected 
disability, and (B) to any veteran who is in need of such care and who 
has a service-connected disability rated at 50 percent or more.
    ``(2) The Secretary, in making placements for nursing home care in 
Department facilities, shall give highest priority to veterans (A) who 
are in need of such care for a service-connected disability, or (B) who 
have a service-connected disability rated at 50 percent or more. The 
Secretary shall ensure that a veteran described in this subsection who 
continues to need nursing home care shall not after placement in a 
Department nursing home be transferred from the facility without the 
consent of the veteran, or, in the event the veteran cannot provide 
informed consent, the representative of the veteran.
    ``(c)(1) The Secretary, in carrying out subsection (a), shall 
prescribe regulations governing the priorities for the provision of 
nursing home care in Department facilities so as to ensure that 
priority for such care is given (A) for patient rehabilitation, (B) for 
clinically complex patient populations, and (C) for patients for whom 
there are not other suitable placement options.
    ``(2) The Secretary may not furnish extended care services for a 
non-service-connected disability other than in the case of a veteran 
who has a service-connected disability rated at 50 percent or more 
unless the veteran agrees to pay to the United States a copayment for 
extended care services of more than 21 days in any year.
    ``(d)(1) A veteran who is furnished extended care services under 
this chapter and who is required under subsection (c)(2) to pay an 
amount to the United States in order to be furnished such services 
shall be liable to the United States for that amount.
    ``(2) In implementing subsection (c)(2), the Secretary shall 
develop a methodology for establishing the amount of the copayment for 
which a veteran described in subsection (c) is liable. That methodology 
shall provide for--
            ``(A) establishing a maximum monthly copayment (based on 
        all income and assets of the veteran and the spouse of such 
        veteran);
            ``(B) protecting the spouse of a veteran from financial 
        hardship by not counting all of the income and assets of the 
        veteran and spouse (in the case of a spouse who resides in the 
        community) as available for determining the copayment 
        obligation; and
            ``(C) allowing the veteran to retain a monthly personal 
        allowance.
    ``(e)(1) There is established in the Treasury of the United States 
a revolving fund known as the Department of Veterans Affairs Extended 
Care Fund (hereinafter in this section referred to as the `fund'). 
Amounts in the fund shall be available, without fiscal year limitation 
and without further appropriation, exclusively for the purpose of 
providing extended care services under subsection (a).
    ``(2) All amounts received by the Department under this section 
shall be deposited in or credited to the fund.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1710 the 
following new item:

``1710A. Requirement to provide extended care.''.
    (b) Requirement To Increase Extended Care Services.--(1) Not later 
than January 1, 2000, the Secretary of Veterans Affairs shall develop 
and begin to implement a plan for carrying out the recommendation of 
the Federal Advisory Committee on the Future of Long-Term Care to 
increase, above the level of extended care services which were provided 
as of September 30, 1998--
            (A) the options and services for home and community-based 
        care for eligible veterans; and
            (B) the percentage of the Department of Veterans Affairs 
        medical care budget dedicated to such care.
    (2) The Secretary shall ensure that the staffing and level of 
extended care services provided by the Secretary nationally in 
facilities operated by the Secretary during any fiscal year is not less 
than the level of such services provided nationally in facilities 
operated by the Secretary during fiscal year 1998.
    (c) Adult Day Health Care.--Section 1720(f)(1)(A) is amended to 
read as follows:
    ``(f)(1)(A) The Secretary may furnish adult day health care 
services to a veteran enrolled under section 1705(a) of this title who 
would otherwise require nursing home care.''
    (d) Respite Care Program.--Section 1720B is amended--
            (1) in subsection (a), by striking ``eligible'' and 
        inserting ``enrolled'';
            (2) in subsection (b)--
                    (A) by striking ``the term `respite care' means 
                hospital or nursing home care'' and inserting ``the 
                term `respite care services' means care and services'';
                    (B) by striking ``is'' at the beginning of each of 
                paragraphs (1), (2), and (3) and inserting ``are''; and
                    (C) by striking ``in a Department facility'' in 
                paragraph (2); and
            (3) by adding at the end the following new subsection:
    ``(c) In furnishing respite care services, the Secretary may enter 
into contract arrangements.''.
    (e) Conforming Amendments.--Section 1710 is amended--
            (1) in subsection (a)(1), by striking ``may furnish nursing 
        home care,''; and
            (2) in subsection (a)(4), by inserting ``, and the 
        requirement in section 1710A of this title that the Secretary 
        provide a program of extended care services,'' after ``medical 
        services''.
    (f) State Homes.--Section 1741(a)(2) is amended by striking ``adult 
day health care in a State home'' and inserting ``extended care 
services described in any of paragraphs (4) through (6) of section 
1710A(a) of this title under a program administered by a State home''.
    (g) Effective Date.--(1) Except as provided in paragraph (2), the 
amendments made by this section shall take effect on the date of the 
enactment of this Act.
    (2) Subsection (c)(2) of section 1710A(a) of title 38, United 
States Code (as added by subsection (a)), shall take effect on the 
effective date of regulations prescribed by the Secretary of Veterans 
Affairs under subsections (c)(2) and (d) of such section. The Secretary 
shall publish the effective date of such regulations in the Federal 
Register.
    (3) The provisions of section 1710(f) of title 38, United States 
Code, shall not apply to any day of nursing home care on or after the 
effective date of regulations under paragraph (2).

SEC. 102. REIMBURSEMENT FOR EMERGENCY TREATMENT.

    (a) Authority To Provide Reimbursement.--Chapter 17 is amended by 
inserting after section 1724 the following new section:
``Sec. 1725. Reimbursement for emergency treatment
    ``(a) General Authority.--(1) Subject to subsections (c) and (d), 
the Secretary may reimburse a veteran described in subsection (b) for 
the reasonable value of emergency treatment furnished the veteran in a 
non-Department facility.
    ``(2) In any case in which reimbursement is authorized under 
subsection (a)(1), the Secretary, in the Secretary's discretion, may, 
in lieu of reimbursing the veteran, make payment of the reasonable 
value of the furnished emergency treatment directly--
            ``(A) to a hospital or other health care provider that 
        furnished the treatment; or
            ``(B) to the person or organization that paid for such 
        treatment on behalf of such veteran.
    ``(b) Eligibility.--(1) A veteran referred to in subsection (a)(1) 
is an individual who is an active Department health-care participant 
who is personally liable for emergency treatment furnished the veteran 
in a non-Department facility.
    ``(2) A veteran is an active Department health-care participant if 
the veteran--
            ``(A) is described in any of paragraphs (1) through (6) of 
        section 1705(a) of this title;
            ``(B) is enrolled in the health care system established 
        under such section; and
            ``(C) received care under this chapter within the 12-month 
        period preceding the furnishing of such emergency treatment.
    ``(3) A veteran is personally liable for emergency treatment 
furnished the veteran in a non-Department facility if the veteran--
            ``(A) is financially liable to the provider of emergency 
        treatment for that treatment;
            ``(B) has no entitlement to care or services under a 
        health-plan contract;
            ``(C) has no other contractual or legal recourse against a 
        third party that would, in whole or in part, extinguish such 
        liability to the provider; and
            ``(D) is not eligible for reimbursement for medical care or 
        services under section 1728 of this title.
    ``(c) Limitations on Reimbursement.--(1) The Secretary, in 
accordance with regulations prescribed by the Secretary, shall--
            ``(A) establish the maximum amount payable under subsection 
        (a);
            ``(B) delineate the circumstances under which such payments 

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