fairs under subsections (c) 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).

(i) REPORT.-Not later than January 1, 2003, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives a report on the operation of this section (including the amendments made by this section). The Secretary shall include in the report

(1) the Secretary's assessment of the experience of the Department under the provisions of this section;

(2) the costs incurred by the Department under the provisions of this section and a comparison of those costs with the Secretary's estimate of the costs that would have been incurred by the Secretary for extended care services if this section had not been enacted; and

(3) the Secretary's recommendations, with respect to the provisions of section 1710A(a) of title 38, United States Code, as added by subsection (a), and with respect to the provisions of section 1701 (10) of such title, as added by subsection (b), as to

(A) whether those provisions should be extended or made permanent; and

(B) what modifications, if any, should be made to those provisions.

SEC. 102. PILOT PROGRAMS RELATING TO LONGTERM CARE.

(a) PILOT PROGRAMS.—The Secretary shall carry out three pilot programs for the purpose of determining the effectiveness of different models of all-inclusive care-delivery in reducing the use of hospital and nursing home care by frail, elderly veterans.

(b) LOCATIONS OF PILOT PROGRAMS.—In selecting locations in which the pilot programs will be carried out, the Secretary may not select more than one location in any given health care region of the Veterans Health Administration.

(c) SCOPE OF SERVICES UNDER PILOT PROGRAMS.-Each of the pilot programs under this section shall be designed to provide participating veterans with integrated, comprehensive services which include the following:

(1) Adult-day health care services on an eighthour per day, five-day per week basis.

(2) Medical services (including primary care, preventive services, and nursing home care, as needed).

(3) Coordination of needed services.

(4) Transportation services.

(5) Home care services.

(6) Respite care.

(d) PROGRAM REQUIREMENTS.-In carrying out the pilot programs under this section, the Secretary shall

(1) employ the use of interdisciplinary caremanagement teams to provide the required array of services;

(2) determine the appropriate number of patients to be enrolled in each program and the criteria for enrollment; and

(3) ensure that funding for each program is based on the complex care category under the resource allocation system (known as the Veterans Equitable Resource Allocation system) established pursuant to section 429 of Public Law 104-204 (110 Stat. 2929).

(e) DESIGN OF PILOT PROGRAMS.-To the maximum extent feasible, the Secretary shall use the following three models in designing the three pilot programs under this section:

(1) Under one of the pilot programs, the Secretary shall provide services directly through facilities and personnel of the Department.

(2) Under one of the pilot programs, the Secretary shall provide services through a combination of

(A) services provided under contract with appropriate public and private entities; and

(B) services provided through facilities and personnel of the Department.

68-036 Book2 D-01--23

(3) Under one of the pilot programs, the Secretary shall arrange for the provision of services through a combination of—

(A) services provided through cooperative arrangements with appropriate public and private entities; and

(B) services provided through facilities and personnel of the Department.

(f) IN-KIND ASSISTANCE.-In providing for the furnishing of services under a contract in carrying out the pilot program described in subsection (e)(2), the Secretary may, subject to reimbursement, provide in-kind assistance (through the services of Department employees and the sharing of other Department resources) to a facility furnishing care to veterans. Such reimbursement may be made by reduction in the charges to the Secretary under such contract. (g) LIMITATION.-In providing for the furnishing of services in carrying out a pilot program described in subsection (e)(2) or (e)(3), the Secretary shall make payment for services only to the extent that payment for such services is not otherwise covered (notwithstanding any provision of title XVIII or XIX of the Social Security Act) by another government or nongovernment entity or program.

(h) DURATION OF PROGRAMS.-The authority of the Secretary to provide services under a pilot program under this section shall cease on the date that is three years after the date of the commencement of that pilot program.

(i) REPORT.—(1) Not later than nine months after the completion of all of the pilot programs under this section, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report on those programs.

(2) The report shall include the following: (A) A description of the implementation and operation of each such program.

(B) An analysis comparing use of institutional care and use of other services among enrollees in each of the pilot programs with the experience of comparable patients who are not enrolled in one of the pilot programs.

(C) An assessment of the satisfaction of participating veterans with each of those programs. (D) An assessment of the health status of participating veterans in each of those programs and of the ability of those veterans to function independently.

(E) An analysis of the costs and benefits under each of those programs.

SEC. 103. PILOT PROGRAM RELATING TO ASSISTED LIVING.

(a) PROGRAM AUTHORITY.—The Secretary may carry out a pilot program for the purpose of determining the feasibility and practicability of enabling eligible veterans to secure needed assisted living services as an alternative to nursing home care.

(b) LOCATION OF PILOT PROGRAM.─The pilot program shall be carried out in a designated health care region of the Department selected by the Secretary for purposes of this section.

(c) SCOPE OF PROGRAM.-In carrying out the pilot program, the Secretary may enter into contracts with appropriate facilities for the provision for a period of up to six months of assisted living services on behalf of eligible veterans in the region where the program is carried out.

(d) ELIGIBLE VETERANS.-A veteran is an eligible veteran for purposes of this section if the veteran

(1) is eligible for placement assistance by the Secretary under section 1730(a) of title 38, United States Code;

(2) is unable to manage routine activities of daily living without supervision and assistance; and

(3) could reasonably be expected to receive ongoing services after the end of the contract period under another government program or through other means.

(e) REPORT.—(1) Not later than 90 days before the end of the pilot program under this section, the Secretary shall submit to the Committees on

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Veterans' Affairs of the Senate and the House of Representatives a report on the program.

(2) The report under paragraph (1) shall include the following:

(A) A description of the implementation and operation of the program.

(B) An analysis comparing use of institutional care among participants in the program with the experience of comparable patients who are not enrolled in the program.

(C) A comparison of assisted living services provided by the Department through the pilot program with domiciliary care provided by the Department.

(D) The Secretary's recommendations, if any, regarding an extension of the program.

(f) DURATION.-The authority of the Secretary to provide services under the pilot program shall cease on the date that is three years after the date of the commencement of the pilot program.

(g) DEFINITION.-For purposes of this section, the term "assisted living services" means services in a facility that provides room and board and personal care for and supervision of residents as necessary for the health, safety, and welfare of residents.

(h) STANDARDS.-The Secretary may not enter into a contract with a facility under this section unless the facility meets the standards established in regulations prescribed under section 1730 of title 38, United States Code.

Subtitle B-Other Access-to-Care Matters SEC. 111. REIMBURSEMENT FOR EMERGENCY TREATMENT IN NON-DEPARTMENT OF VETERANS AFFAIRS FACILITIES. (a) AUTHORITY TO PROVIDE REIMBURSEMENT.-Chapter 17 is amended by inserting after section 1724 the following new section: "$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 the 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

"(A) the veteran is enrolled in the health care system established under section 1705(a) of this title; and

“(B) the veteran received care under this chapter within the 24-month period preceding the furnishing of such emergency treatment.

"(3) A veteran is personally liable for emergency treatment furnished the veteran in a nonDepartment 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 (determined, in the case of a health-plan contract as defined in subsection (f)(2)(B) or (f)(2)(C), without regard to any requirement or limitation relating to eligibility for care or services from any department or agency of the United States);

"(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 may be made, to include such requirements on requesting reimbursement as the Secretary shall establish; and

"(C) provide that in no event may a payment under that subsection include any amount for which the veteran is not personally liable.

"(2) Subject to paragraph (1), the Secretary may provide reimbursement under this section only after the veteran or the provider of emergency treatment has exhausted without success all claims and remedies reasonably available to the veteran or provider against a third party for payment of such treatment.

"(3) Payment by the Secretary under this section on behalf of a veteran to a provider of emergency treatment shall, unless rejected and refunded by the provider within 30 days of receipt, extinguish any liability on the part of the veteran for that treatment. Neither the absence of a contract or agreement between the Secretary and the provider nor any provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate the requirement in the preceding sentence.

"(d) INDEPENDENT RIGHT OF RECOVERY.—(1) In accordance with regulations prescribed by the Secretary, the United States shall have the independent right to recover any amount paid under this section when, and to the extent that, a third party subsequently makes a payment for the same emergency treatment.

"(2) Any amount paid by the United States to the veteran (or the veteran's personal representative, successor, dependents, or survivors) or to any other person or organization paying for such treatment shall constitute a lien in favor of the United States against any recovery the payee subsequently receives from a third party for the same treatment.

"(3) Any amount paid by the United States to the provider that furnished the veteran's emergency treatment shall constitute a lien against any subsequent amount the provider receives from a third party for the same emergency treatment for which the United States made payment.

"(4) The veteran (or the veteran's personal representative, successor, dependents, or survivors) shall ensure that the Secretary is promptly notified of any payment received from any third party for emergency treatment furnished to the veteran. The veteran (or the veteran's personal representative, successor, dependents, or survivors) shall immediately forward all documents relating to such payment, cooperate with the Secretary in the investigation of such payment, and assist the Secretary in enforcing the United States right to recover any payment made under subsection (c)(3).

"(e) WAIVER.-The Secretary, in the Secretary's discretion, may waive recovery of a payment made to a veteran under this section that is otherwise required by subsection (d)(1) when the Secretary determines that such waiver would be in the best interest of the United States, as defined by regulations prescribed by the Secretary.

“(f) DEFINITIONS.-For purposes of this section:

"(1) The term 'emergency treatment' means medical care or services furnished, in the judgment of the Secretary

"(A) when Department or other Federal facilities are not feasibly available and an attempt to use them beforehand would not be reasonable;

"(B) when such care or services are rendered in a medical emergency of such nature that a prudent layperson reasonably expects that delay in seeking immediate medical attention would be hazardous to life or health; and

"(C) until such time as the veteran can be transferred safely to a Department facility or other Federal facility.

"(2) The term 'health-plan contract' includes any of the following:

"(A) An insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement under which health services for individuals are provided or the expenses of such services are paid.

"(B) An insurance program described in section 1811 of the Social Security Act (42 U.S.C. 1395c) or established by section 1831 of that Act (42 U.S.C. 1395j).

"(C) A State plan for medical assistance approved under title XIX of such Act (42 U.S.C. 1396 et seq.).

"(D) A workers' compensation law or plan described in section 1729(a)(2)(A) of this title.

"(E) A law of a State or political subdivision described in section 1729(a)(2)(B) of this title. "(3) The term 'third party' means any of the following:

"(A) A Federal entity.

"(B) A State or political subdivision of a State.

"(C) An employer or an employer's insurance carrier.

"(D) An automobile accident reparations insurance carrier.

"(E) A person or entity obligated to provide, or to pay the expenses of, health services under a health-plan contract.".

(b) CONFORMING AMENDMENTS.-(1) Section 1729 A(b) is amended—

(A) by redesignating paragraphs (5) and (6) as paragraphs (6) and (7), respectively; and

(B) by inserting after paragraph (4) the following new paragraph:

"(5) Section 1725 of this title.".

(2) The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1724 the following new item:

"1725. Reimbursement for emergency treatment.".

(c) EFFECTIVE DATE.-The amendments made by this section shall take effect 180 days after the date of the enactment of this Act.

(d) IMPLEMENTATION REPORTS.-The Secretary shall include with the budget justification materials submitted to Congress in support of the Department of Veterans Affairs budget for fiscal year 2002 and for fiscal year 2003 a report on the implementation of section 1725 of title 38, United States Code, as added by subsection (a). Each such report shall include information on the experience of the Department under that section and the costs incurred, and expected to be incurred, under that section. SEC. 112. ELIGIBILITY FOR CARE OF COMBAT-INJURED VETERANS.

Chapter 17 is amended

(1) in section 1710(a)(2)(D), by inserting "or who was awarded the Purple Heart" after "former prisoner of war"; and

(2) in section 1705(a)(3), by inserting "or who were awarded the Purple Heart" after "former prisoners of war".

SEC. 113. ACCESS TO CARE FOR TRICARE-ELIGIBLE MILITARY RETIREES.

(a) INTERAGENCY AGREEMENT.-(1) The Secretary of Defense shall enter into an agreement (characterized as a memorandum of understanding or otherwise) with the Secretary of Veterans Affairs with respect to the provision of medical care by the Secretary of Veterans Affairs to eligible military retirees in accordance with the provisions of subsection (c). That agreement shall include provisions for reimbursement of the Secretary of Veterans Affairs by the Secretary of Defense for medical care provided by the Secretary of Veterans Affairs to an eligible military retiree and may include such other provisions with respect to the terms and conditions of such care as may be agreed upon by the two Secretaries.

(2) Reimbursement under the agreement under paragraph (1) shall be in accordance with rates agreed upon by the Secretary of Defense and

the Secretary of Veterans Affairs. Such reimbursement may be made by the Secretary of Defense or by the appropriate TRICARE Managed Care Support contractor, as determined in accordance with that agreement.

(3) In entering into the agreement under paragraph (1), particularly with respect to determination of the rates of reimbursement under paragraph (2), the Secretary of Defense shall consult with TRICARE Managed Care Support contractors.

(4) The Secretary of Veterans Affairs may not enter into an agreement under paragraph (1) for the provision of care in accordance with the provisions of subsection (c) with respect to any geographic service area, or a part of any such area, of the Veterans Health Administration unless

(A) in the judgment of that Secretary, the Department of Veterans Affairs will recover the costs of providing such care to eligible military retirees; and

(B) that Secretary has certified and documented, with respect to any geographic service area in which the Secretary proposes to provide care in accordance with the provisions of subsection (c), that such geographic service area, or designated part of any such area, has adequate capacity (consistent with the requirements in section 1705(b)(1) of title 38, United States Code, that care to enrollees shall be timely and acceptable in quality) to provide such care.

(5) The agreement under paragraph (1) shall be entered into by the Secretaries not later than nine months after the date of the enactment of this Act. If the Secretaries are unable to reach agreement, they shall jointly report, by that date or within 30 days thereafter, to the Committees on Armed Services and the Committees on Veterans' Affairs of the Senate and House of Representatives on the reasons for their inability to reach an agreement and their mutually agreed plan for removing any impediments to final agreement.

(b)

DEPOSITING OF REIMBURSEMENTS.— Amounts received by the Secretary of Veterans Affairs under the agreement under subsection (a) shall be deposited in the Department of Veterans Affairs Health Services Improvement Fund established under section 1729B of title 38, United States Code, as added by section 202.

(c) COPAYMENT REQUIREMENT.-The provisions of subsections (f)(1) and (g)(1) of section 1710 of title 38, United States Code, shall not apply in the case of an eligible military retiree who is covered by the agreement under subsection (a).

(d) PHASED IMPLEMENTATION.-(1) The Secretary of Defense shall include in each TRICARE contract entered into after the date of the enactment of this Act provisions to implement the agreement under subsection (a).

(2) The provisions of the agreement under subsection (a)(2) and the provisions of subsection (c) shall apply to the furnishing of medical care by the Secretary of Veterans Affairs in any area of the United States only if that area is covered by a TRICARE contract that was entered into after the date of the enactment of this Act.

(e) ELIGIBLE MILITARY RETIREES.-For purposes of this section, an eligible military retiree is a member of the Army, Navy, Air Force, or Marine Corps who—

(1) has retired from active military, naval, or air service;

(2) is eligible for care under the TRICARE program established by the Secretary of Defense; (3) has enrolled for care under section 1705 of title 38, United States Code; and

(4) is not described in paragraph (1) or (2) of section 1710(a) of such title.

SEC. 114. TREATMENT AND SERVICES FOR DRUG OR ALCOHOL DEPENDENCY.

(a) AUTHORITY TO PROVIDE TREATMENT AND SERVICES FOR MEMBERS ON ACTIVE DUTY.-Section 1720A(c) is amended in the first sentence of paragraph (1)—

(1) by striking "may not be transferred" and inserting "may be transferred"; and

(2) by striking "unless such transfer is during the last thirty days of such member's enlistment or tour of duty".

(b) CONFORMING AMENDMENT.-The first sentence of paragraph (2) of that section is amended by striking "during the last thirty days of such person's enlistment period or tour of duty".

SEC. 115. COUNSELING AND TREATMENT FOR VETERANS WHO HAVE EXPERIENCED SEXUAL TRAUMA.

(a) EXTENSION OF PERIOD OF PROGRAM.-Subsection (a) of section 1720D is amended—

(1) in paragraph (1), by striking "December 31, 2001" and inserting "December 31, 2004"; and

(2) in paragraph (3), by striking "December 31, 2001" and inserting "December 31, 2004".

(b) MANDATORY NATURE OF PROGRAM.—(1) Subsection (a)(1) of such section is further amended by striking "may provide counseling to a veteran who the Secretary determines requires such counseling" and inserting "shall operate a program under which the Secretary provides counseling and appropriate care and services to veterans who the Secretary determines require such counseling and care and services".

(2) Subsection (a) of such section is further amended

(A) by striking paragraph (2); and

(B) by redesignating paragraph (3) (as amended by subsection (a)(2)) as paragraph (2).

(c) OUTREACH EFFORTS.-Subsection (c) of such section is amended

(1) by inserting "and treatment" in the first sentence and in paragraph (2) after "counseling":

(2) by striking "and" at the end of paragraph (1);

(3) by redesignating paragraph (2) as paragraph (3); and

(4) by inserting after paragraph (1) the following new paragraph (2):

"(2) shall ensure that information about the counseling and treatment available to veterans under this section

"(A) is revised and updated as appropriate; "(B) is made available and visibly posted at appropriate facilities of the Department; and "(C) is made available through appropriate public information services; and".

(d) REPORT ON IMPLEMENTATION OF OUTREACH ACTIVITIES.-Not later than six months after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives a report on the Secretary's implementation of paragraph (2) of section 1720D(c) of title 38, United States Code, as added by subsection (c). Such report shall include examples of the documents and other means of communication developed for compliance with that paragraph.

(e) STUDY OF EXPANDING ELIGIBILITY FOR COUNSELING AND TREATMENT.-(1) The Secretary of Veterans Affairs, in consultation with the Secretary of Defense, shall conduct a study to determine

(A) the extent to which former members of the reserve components of the Armed Forces experienced physical assault of a sexual nature or battery of a sexual nature while serving on active duty for training;

(B) the extent to which such former members have sought counseling from the Department of Veterans Affairs relating to those incidents; and

(C) the additional resources that, in the judgment of the Secretary, would be required to meet the projected need of those former members for such counseling.

(2) Not later than 16 months after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives a report on the results of the study conducted under paragraph (1).

(f) OVERSIGHT OF OUTREACH ACTIVITIES.-Not later than 14 months after the date of the enactment of this Act, the Secretary of Veterans Af

fairs and the Secretary of Defense shall submit to the appropriate congressional committees a joint report describing in detail the collaborative efforts of the Department of Veterans Affairs and the Department of Defense to ensure that members of the Armed Forces, upon separation from active military, naval, or air service, are provided appropriate and current information about programs of the Department of Veterans Affairs to provide counseling and treatment for sexual trauma that may have been experienced by those members while in the active military, naval, or air service, including information about eligibility requirements for, and procedures for applying for, such counseling and treatment. The report shall include proposed recommendations from both the Secretary of Veterans Affairs and the Secretary of Defense for the improvement of their collaborative efforts to provide such information.

(g) REPORT ON IMPLEMENTATION OF SEXUAL TRAUMA TREATMENT PROGRAM.-Not later than 14 months 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 a report on the use made of the authority provided under section 1720D of title 38, United States Code, as amended by this section. The report shall include the following with respect to activities under that section since the enactment of this Act:

(1) The number of veterans who have received counseling under that section.

(2) The number of veterans who have been referred to non-Department mental health facilities and providers in connection with sexual trauma counseling and treatment.

SEC. 116. SPECIALIZED MENTAL HEALTH SERVICES.

(a) IMPROVEMENT TO SPECIALIZED MENTAL HEALTH SERVICES.-The Secretary, in furtherance of the responsibilities of the Secretary under section 1706(b) of title 38, United States Code, shall carry out a program to expand and improve the provision of specialized mental health services to veterans. The Secretary shall establish the program in consultation with the Committee on Care of Severely Chronically Mentally Ill Veterans established pursuant to section 7321 of title 38, United States Code.

(b) COVERED PROGRAMS.—For purposes of this section, the term "specialized mental health services" includes programs relating to— (1) the treatment of post-traumatic stress disorder; and

(2) substance use disorders.

(c) FUNDING.-(1) In carrying out the program described in subsection (a), the Secretary shall identify, from funds available to the Department for medical care, an amount of not less than $15,000,000 to be available to carry out the program and to be allocated to facilities of the Department pursuant to subsection (d).

(2) In identifying available amounts pursuant to paragraph (1), the Secretary shall ensure that, after the allocation of those funds under subsection (d), the total expenditure for programs relating to (A) the treatment of post-traumatic stress disorder, and (B) substance use disorders is not less than $15,000,000 in excess of the baseline amount.

(3) For purposes of paragraph (2), the baseline amount is the amount of the total expenditures on such programs for the most recent fiscal year for which final expenditure amounts are known, adjusted to reflect any subsequent increase in applicable costs to deliver such services in the Veterans Health Administration, as determined by the Committee on Care of Severely Chronically Mentally Ill Veterans.

(d) ALLOCATION OF FUNDS TO DEPARTMENT FACILITIES.-The Secretary shall allocate funds identified pursuant to subsection (c)(1) to individual medical facilities of the Department as the Secretary determines appropriate based upon proposals submitted by those facilities for the use of those funds for improvements to specialized mental health services.

(e) REPORT.-Not later than 12 months 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 a report describing the implementation of this section. The Secretary shall include in the report information on the allocation of funds to facilities of the Department under the program and a description of the improvements made with those funds to specialized mental health services for veterans.

TITLE II-MEDICAL PROGRAM
ADMINISTRATION

SEC. 201. MEDICAL CARE COLLECTIONS.

(a) LIMITED AUTHORITY TO SET COPAYMENTS.-Section 1722A is amended—

(1) by redesignating subsections (b) and (c) as subsections (c) and (d), respectively;

(2) by inserting after subsection (a) the following new subsection (b):

"(b) The Secretary, pursuant to regulations which the Secretary shall prescribe, may

"(1) increase the copayment amount in effect under subsection (a); and

"(2) establish a maximum monthly and a maximum annual pharmaceutical copayment amount under subsection (a) for veterans who have multiple outpatient prescriptions."; and

(3) in subsection (c), as redesignated by paragraph (1)

(A) by striking "this section" and inserting "subsection (a)"; and

(B) by adding at the end the following new sentence: "Amounts collected through use of the authority under subsection (b) shall be deposited in the Department of Veterans Affairs Health Services Improvement Fund.".

(b) OUTPATIENT TREATMENT.-Section 1710(g) is amended

(1) in paragraph (1), by striking "the amount determined under paragraph (2) of this subsection" and inserting "in the case of each outpatient visit the applicable amount or amounts established by the Secretary by regulation"; and

(2) in paragraph (2), by striking all after "for an amount" and inserting "which the Secretary shall establish by regulation.".

SEC. 202. HEALTH SERVICES IMPROVEMENT FUND.

(a) ESTABLISHMENT OF FUND.-Chapter 17 is amended by inserting after section 1729A the following new section:

"$1729B. Health Services Improvement Fund

"(a) There is established in the Treasury of the United States a fund to be known as the Department of Veterans Affairs Health Services Improvement Fund.

"(b) Amounts received or collected after the date of the enactment of this section under any of the following provisions of law shall be deposited in the fund:

"(1) Section 1713A of this title. "(2) Section 1722A(b) of this title. "(3) Section 8165(a) of this title. "(4) Section 113 of the Veterans Millennium Health Care and Benefits Act.

"(c) Amounts in the fund are hereby available, without fiscal year limitation, to the Secretary for the purposes stated in subparagraphs (A) and (B) of section 1729A(c)(1) of this title.

"(d) The Secretary shall allocate amounts in the fund in the same manner as applies under subsection (d) of section 1729A of this title with respect to amounts made available from the fund under that section.".

(b) CLERICAL AMENDMENT.-The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1729 A the following new item:

"1729B. Health Services Improvement Fund.". SEC. 203. ALLOCATION TO HEALTH CARE FACILITIES OF AMOUNTS MADE AVAILABLE FROM MEDICAL CARE COLLECTIONS FUND.

Section 1729A(d) is amended—

(1) by striking “(1)";

(2) by striking "each designated health care region" and inserting "each Department health care facility":

(3) by striking "each region" and inserting "each facility";

(4) by striking "such region" both places it appears and inserting "such facility"; and (5) by striking paragraph (2).

SEC. 204. AUTHORITY TO ACCEPT FUNDS FOR EDUCATION AND TRAINING.

(a) ESTABLISHMENT OF NONPROFIT CORPORATIONS AT MEDICAL CENTERS.-Section 7361(a) is amended

(1) by inserting "and education" after "research"; and

(2) by adding at the end the following: "Such a corporation may be established to facilitate either research or education or both research and education.".

(b) PURPOSE OF CORPORATIONS.-Section 7362 is amended

(1) in the first sentence

(A) by inserting "(a)" before "Any corporation"; and

(B) by inserting "and education and training as described in sections 7302, 7471, 8154, and 1701(6)(B) of this title" after "of this title"; (2) in the second sentence

(A) by inserting "or education" after "research"; and

(B) by striking "that purpose" and inserting "these purposes"; and

(3) by adding at the end the following new subsection:

"(b) For purposes of this section, the term 'education and training' means the following:

"(1) In the case of employees of the Veterans Health Administration, such term means workrelated instruction or other learning experiences to

"(A) improve performance of current duties; "(B) assist employees in maintaining or gaining specialized proficiencies; and

"(C) expand understanding of advances and changes in patient care, technology, and health care administration.

Such term includes (in the case of such employees) education and training conducted as part of a residency or other program designed to prepare an individual for an occupation or profession.

"(2) In the case of veterans under the care of the Veterans Health Administration, such term means instruction or other learning experiences related to improving and maintaining the health of veterans to patients and to the families and guardians of patients.".

(c) BOARD OF DIRECTORS.-Section 7363(a) is amended

(1) in subsection (a)(1), by striking all after "medical center, and" and inserting "as appropriate, the assistant chief of staff for research for the medical center and the assistant chief of staff for education for the medical center, or, in the case of a facility at which such positions do not exist, those officials who are responsible for carrying out the responsibilities of the medical center director, chief of staff, and, as appropriate, the assistant chief of staff for research and the assistant chief of staff for education; and":

(2) in subsection (a)(2), by inserting "or education, as appropriate" after "research"; and

(3) in subsection (c), by inserting "or education" after "research".

(d) APPROVAL OF EXPENDITURES.-Section 7364 is amended by adding at the end the following new subsection:

"(c)(1) A corporation established under this subchapter may not spend funds for an education activity unless the activity is approved in accordance with procedures prescribed by the Under Secretary for Health.

"(2) The Under Secretary for Health shall prescribe policies and procedures to guide the expenditure of funds by corporations under paragraph (1) consistent with the purpose of such corporations as flexible funding mechanisms.".

(e) ACCOUNTABILITY AND OVERSIGHT.-Section 7366(d) is amended

(1) in paragraph (2)(B), by inserting "for research and the amount received from governmental entities for education" after "entities";

(2) in paragraph (2)(C), by inserting "for research and the amount received from all other sources for education" after "sources";

(3) in paragraph (2)(D), by striking "the" and inserting "a";

(4) in paragraph (3)(A), by striking "and" and inserting ", the amount expended for salary for education staff, and the amount expended";

(5) in paragraph (3)(B), by inserting "and the amount expended for direct support of education" after "research"; and

(6) by adding at the end the following new paragraph:

"(4) The amount expended by each corporation during the year for travel conducted in conjunction with research and the amount expended for travel in conjunction with education.".

SEC. 205. EXTENSION OF CERTAIN AUTHORITIES. (a) READJUSTMENT COUNSELING.-Section 1712A(a)(1)(B)(ii) is amended by striking "January 1, 2000" and inserting "January 1, 2004".

(b) NEWSLETTER ON MEDICAL CARE FOR PERSIAN GULF VETERANS.-Section 105(b)(2) of the Persian Gulf War Veterans' Benefits Act (title I of Public Law 103-446; 108 Stat. 4659; 38 U.S.C. 1117 note) is amended by striking "December 31, 1999" and inserting “December 31, 2003".

(c) EVALUATION OF HEALTH OF SPOUSES AND CHILDREN OF PERSIAN GULF VETERANS.-Section 107(b) of that Act is amended by striking "December 31, 1999" and inserting "December 31, 2003".

SEC. 206. REESTABLISHMENT OF COMMITTEE ON POST-TRAUMATIC STRESS DIS

ORDER.

Section 110 of the Veterans' Health Care Act of 1984 (38 U.S.C. 1712A note) is amended(1) by striking "Chief Medical Director" each place it appears and inserting "Under Secretary for Health":

(2) by striking "Veterans' Administration" each place it appears (other than in subsection (a)(1)) and inserting "Department";

(3) by striking "Veterans' Administration" in subsection (a)(1) and inserting "Department of Veterans Affairs";

(4) by striking "Department of Medicine and Surgery" each place it appears and inserting "Veterans Health Administration”;

(5) by striking "section 612A" in subsection (a)(2) and inserting "section 1712A";

(6) by striking "Department" in the second sentence of subsection (b)(1) and inserting "Veterans Health Administration”;

(7) by striking "Department of Veterans' Benefits" in subsection (b)(4)(E) and inserting "Veterans Benefits Administration";

(8) in subsection (e)(1), by striking "Not later than March 1, 1985, the Administrator” and inserting "Not later than March 1, 2000, the Secretary"; and

(9) in subsection (e)(2)—

(A) by striking "Not later than February 1, 1986" and inserting "Not later than February 1, 2001":

(B) by striking "Administrator" and inserting "Secretary"; and

(C) by striking "before the submission of such report" and inserting "since the enactment of the Veterans Millennium Health Care and Benefits Act".

SEC. 207. STATE HOME GRANT PROGRAM.

(a) GENERAL REGULATIONS.-Section 8134 is amended

(1) by redesignating subsection (b) as subsection (c);

(2) by striking the matter in subsection (a) preceding paragraph (2) and inserting the following:

"(a)(1) The Secretary shall prescribe regulations for the purposes of this subchapter.

"(2) In those regulations, the Secretary shall prescribe for each State the number of nursing home and domiciliary beds for which assistance under this subchapter may be furnished. Such regulations shall be based on projected demand for such care 10 years after the date of the en

actment of the Veterans Millennium Health Care and Benefits Act by veterans who at such time are 65 years of age or older and who reside in that State. In determining such projected demand, the Secretary shall take into account travel distances for veterans and their families.

"(3)(A) In those regulations, the Secretary shall establish criteria under which the Secretary shall determine, with respect to an application for assistance under this subchapter for a project described in subparagraph (B) which is from a State that has a need for additional beds as determined under subsections (a)(2) and (d)(1), whether the need for such beds is most aptly characterized as great, significant, or limited. Such criteria shall take into account the availability of beds already operated by the Secretary and other providers which appropriately serve the needs which the State proposes to meet with its application.

"(B) This paragraph applies to a project for the construction or acquisition of a new State home facility, a project to increase the number of beds available at a State home facility, and a project to replace beds at a State home facility.

"(4) The Secretary shall review and, as necessary, revise regulations prescribed under paragraphs (2) and (3) not less often than every four years.

"(b) The Secretary shall prescribe the following by regulation:";

(3) by redesignating paragraphs (2) and (3) of subsection (b), as designated by paragraph (2), as paragraphs (1) and (2);

(4) in subsection (c), as redesignated by paragraph (1), by striking "subsection (a)(3)" and inserting "subsection (b)(2)”; and

(5) by adding at the end the following new subsection:

“(d)(1) In prescribing regulations to carry out this subchapter, the Secretary shall provide that in the case of a State that seeks assistance under this subchapter for a project described in subsection (a)(3)(B), the determination of the unmet need for beds for State homes in that State shall be reduced by the number of beds in all previous applications submitted by that State under this subchapter, including beds which have not been recognized by the Secretary under section 1741 of this title.

"(2)(A) Financial assistance under this subchapter for a renovation project may only be provided for a project for which the total cost of construction is in excess of $400,000 (as adjusted from time to time in such regulations to reflect changes in costs of construction).

"(B) For purposes of this paragraph, a renovation project is a project to remodel or alter existing buildings for which financial assistance under this subchapter may be provided and does not include maintenance and repair work which is the responsibility of the State.".

(b) APPLICATIONS WITH RESPECT ΤΟ PROJECTS.-Section 8135 is amended

(1) in subsection (a)—

(A) by striking "set forth-" in the matter preceding paragraph (1) and inserting "set forth the following:";

(B) by capitalizing the first letter of the first word in each of paragraphs (1) through (9);

(C) by striking the comma at the end of each of paragraphs (1) through (7) and inserting a period; and

(D) by striking ", and" at the end of paragraph (8) and inserting a period;

(2) by redesignating subsections (b), (c), (d), and (e) as subsections (c), (d), (e), and (f), respectively;

(3) by inserting after subsection (a) the following new subsection (b):

"(b)(1) Any State seeking to receive assistance under this subchapter for a project that would involve construction or acquisition of either nursing home or domiciliary facilities shall include with its application under subsection (a) the following:

"(A) Documentation (i) that the site for the project is in reasonable proximity to a sufficient concentration and population of veterans who

are 65 years of age and older, and (ii) that there is a reasonable basis to conclude that the facilities when complete will be fully occupied.

"(B) A financial plan for the first three years of operation of such facilities.

"(C) A five-year capital plan for the State home program for that State.

"(2) Failure to provide adequate documentation under paragraph (1)(A) or to provide an adequate financial plan under paragraph (1)(B) shall be a basis for disapproving the application."; and

(4) in subsection (c), as redesignated by paragraph (2)—

(A) in paragraph (1), by striking "for a grant under subsection (a) of this section" in the matter preceding subparagraph (A) and inserting "under subsection (a) for financial assistance under this subchapter";

(B) in paragraph (2)—

(i) by striking "the construction or acquisition of" in subparagraph (A); and

(ii) by striking subparagraphs (B), (C), and (D) and inserting the following:

"(B) An application from a State for a project at an existing facility to remedy a condition or conditions that have been cited by an accrediting institution, by the Secretary, or by a local licensing or approving body of the State as being threatening to the lives or safety of the patients in the facility.

"(C) An application from a State that has not previously applied for award of a grant under this subchapter for construction or acquisition of a State nursing home.

“(D) An application for construction or acquisition of a nursing home or domiciliary from a State that the Secretary determines, in accordance with regulations under this subchapter, has a great need for the beds to be established at such home or facility.

"(E) An application from a State for renovations to a State home facility other than renovations described in subparagraph (B).

“(F) An application for construction or acquisition of a nursing home or domiciliary from a State that the Secretary determines, in accordance with regulations under this subchapter, has a significant need for the beds to be established at such home or facility.

"(G) An application that meets other criteria as the Secretary determines appropriate and has established in regulations.

"(H) An application for construction or acquisition of a nursing home or domiciliary from a State that the Secretary determines, in accordance with regulations under this subchapter, has a limited need for the beds to be established at such home or facility."; and

(C) in paragraph (3), by striking subparagraph (A) and inserting the following:

“(A) may not accord any priority to a project for the construction or acquisition of a hospital; and".

(c) TRANSITION.-(1) The provisions of sections 8134 and 8135 of title 38, United States Code, as in effect on November 10, 1999, shall continue in effect after that date with respect to applications described in section 8135(b)(2)(A) of such title, as in effect on that date, that are identified in paragraph (2) (and to projects and grants pursuant to those applications). The Secretary shall accord priority among those applications in the order listed in paragraph (2).

(2) Applications covered by paragraph (1) are the following:

(A) Any application for a fiscal year 1999 priority one project.

(B) Any application for a fiscal year 2000 priority one project that was submitted by a State that (i) did not receive grant funds from amounts appropriated for fiscal year 1999 under the State home grant program, and (ii) does not have any fiscal year 1999 priority one projects. (3) For purposes of this subsection

(A) the term "fiscal year 1999 priority one project" means a project on the list of approved projects established by the Secretary on October 29, 1998, under section 8135(b)(4) of title 38,

United States Code, as in effect on that date that (pursuant to section 8135(b)(2)(A) of that title) is in the grouping of projects on that list designated as Priority Group 1;

(B) the term "fiscal year 2000 priority one project" means a project on the list of approved projects established by the Secretary on November 3, 1999, under section 8135(b)(4) of title 38, United States Code, as in effect on that date that (pursuant to section 8135(b)(2)(A) of that title) is in the grouping of projects on that list designated as Priority Group 1; and

(C) the term "State home grant program” means the grant program under subchapter III of chapter 81 of title 38, United States Code.

(d) EFFECTIVE DATE FOR INITIAL REGULATIONS. The Secretary shall prescribe the initial regulations under subsection (a) of section 8134 of title 38, United States Code, as added by subsection (a), not later than April 30, 2000. SEC. 208. EXPANSION OF ENHANCED-USE LEASE AUTHORITY.

(a) AUTHORITY.-Section 8162(a)(2) is amended

(1) by striking "only if the Secretary" and inserting "only if—

"(A) the Secretary";

(2) by redesignating subparagraphs (A), (B), and (C) as clauses (i), (ii), and (iii), respectively, and realigning those clauses so as to be four ems from the left margin;

(3) by striking the period at the end of clause (iii), as so redesignated, and inserting "; or"; and

(4) by adding at the end the following:

"(B) the Secretary determines that the implementation of a business plan proposed by the Under Secretary for Health for applying the consideration under such a lease to the provision of medical care and services would result in a demonstrable improvement of services to eligible veterans in the geographic service-delivery area within which the property is located.".

(b) TERM OF ENHANCED-USE LEASE.-Section 8162(b) is amended

(1) in paragraph (2), by striking "may not exceed-" and all that follows and inserting "may not exceed 75 years."; and

(2) by striking paragraph (4) and inserting the following:

"(4) The terms of an enhanced-use lease may provide for the Secretary to—

“(A) obtain facilities, space, or services on the leased property; and

"(B) use minor construction funds for capital contribution payments.".

(c) DESIGNATION OF PROPERTY PROPOSED TO BE LEASED.—(1) Subsection (b) of section 8163 is amended

(A) by striking "include-" and inserting "include the following:";

(B) by capitalizing the first letter of the first word of each of paragraphs (1), (2), (3), (4), and (5);

(C) by striking the semicolon at the end of paragraphs (1), (2), and (3) and inserting a period; and

(D) by striking subparagraphs (A), (B), and (C) of paragraph (4) and inserting the following: "(A) would

"(i) contribute in a cost-effective manner to the mission of the Department;

“(ii) not be inconsistent with the mission of the Department;

"(iii) not adversely affect the mission of the Department; and

"(iv) affect services to veterans; or

"(B) would result in a demonstrable improvement of services to eligible veterans in the geographic service-delivery area within which the property is located.".

(2) Subparagraph (E) of subsection (c)(1) of that section is amended by striking clauses (i), (ii), and (iii) and inserting the following: "“(i) would—

“(I) contribute in a cost-effective manner to the mission of the Department;

"(II) not be inconsistent with the mission of the Department;

"(III) not adversely affect the mission of the Department; and

"(IV) affect services to veterans; or

"(ii) would result in a demonstrable improvement of services to eligible veterans in the geographic service-delivery area within which the property is located.".

(d) USE OF PROCEEDS.-Section 8165(a) is amended by striking paragraph (1) and inserting the following:

"(a)(1) Funds received by the Department under an enhanced-use lease and remaining after any deduction from those funds under subsection (b) shall be deposited in the Department of Veterans Affairs Health Services Improvement Fund established under section 1729B of this title.".

(e) EXTENSION OF AUTHORITY.-Section 8169 is amended by striking "December 31, 2001" and inserting "December 31, 2011".

(f) TRAINING AND OUTREACH REGARDING AUTHORITY.-The Secretary shall take appropriate actions to provide training and outreach to personnel at Department medical centers regarding the enhanced-use lease authority under subchapter V of chapter 81 of title 38, United States Code. The training and outreach shall address methods of approaching potential lessees in the medical or commercial sectors regarding the possibility of entering into leases under that authority and other appropriate matters.

(g) INDEPENDENT ANALYSIS OF OPPORTUNITIES FOR USE OF AUTHORITY.-(1) The Secretary shall take appropriate actions to secure from an appropriate entity (or entities) independent of the Department an analysis (or analyses) of opportunities for the use of the enhanced-use lease authority under subchapter V of chapter 81 of title 38, United States Code.

(2) An analysis under paragraph (1) shall include

(A) a survey of facilities of the Department for purposes of identifying Department property that presents an opportunity for lease under the enhanced-use lease authority;

(B) an assessment of the feasibility of entering into enhanced-use leases under that authority in the case of any property identified under subparagraph (A) as presenting an opportunity for such lease; and

(C) an assessment of the resources required at the Department facilities concerned, and at the Department Central Office, in order to facilitate the entering into of enhanced-used leases in the case of property so identified.

(3) If as a result of a survey under paragraph (2)(A) an entity carrying out an analysis under this subsection determines that a particular Department property presents no opportunities for lease under the enhanced-use lease authority, the analysis shall include the entity's explanation of that determination.

(4) If as a result of such a survey an entity carrying out an analysis under this subsection determines that certain Department property presents an opportunity for lease under the enhanced-use lease authority, the analysis shall include a single integrated business plan, developed by the entity, that addresses the strategy and resources necessary to implement the plan for all property determined to present an opportunity for such lease.

SEC. 209. 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.

Section 7402 is amended by adding at the end the following new subsection:

"(f) A person may not be employed in a position under subsection (b) (other than under paragraph (4) of that subsection) if—

"(1) the person is or has been licensed, registered, or certified (as applicable to such position) in more than one State; and

"(2) either

"(A) any of those States has terminated such license, registration, or certification for cause;

or