Text: H.R.5193 — 102nd Congress (1991-1992)All Information (Except Text)

Text available as:

Shown Here:
Enrolled Bill

 
 
--H.R.5193--
H.R.5193
One Hundred Second Congress of the United States of America
AT THE SECOND SESSION
Begun and held at the City of Washington on Friday, the third day of January,
one thousand nine hundred and ninety-two
An Act
To amend title 38, United States Code, to improve health care services
for women veterans, to expand authority for health care sharing agreements
between the Department of Veterans Affairs and the Department of Defense to
revise certain pay authorities that apply to Department of Veterans Affairs
nurses, to improve preventive health services for veterans, to establish
discounts on pharmaceuticals purchased by the Department of Veterans Affairs,
to provide for a Persian Gulf War Veterans Health Registry, and to make
other improvements in the delivery and administration of health care by 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.
  (a) SHORT TITLE- This Act may be cited as the `Veterans Health Care Act
  of 1992'.
  (b) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
TITLE I--WOMEN VETERANS HEALTH PROGRAMS
Sec. 101. Short title.
Sec. 102. Sexual trauma counseling.
Sec. 103. Priority for outpatient care for sexual trauma counseling.
Sec. 104. Commencement of provision of information on services.
Sec. 105. Report on implementation of sexual trauma counseling program.
Sec. 106. Health care services for women.
Sec. 107. Report on health care and research.
Sec. 108. Coordination of services.
Sec. 109. Research relating to women veterans health.
Sec. 110. Population study of women veterans.
TITLE II--HEALTH-CARE SHARING AGREEMENTS BETWEEN DEPARTMENT OF VETERANS
AFFAIRS AND DEPARTMENT OF DEFENSE
Sec. 201. Temporary expansion of authority for sharing agreements.
Sec. 202. Requirement for improvement in services for veterans.
Sec. 203. Expanded sharing agreements with Department of Defense.
Sec. 204. Expiration of authority.
Sec. 205. Consultation with veterans service organizations.
Sec. 206. Annual report.
TITLE III--NURSE PAY
Sec. 301. Revision to nurse pay grade schedule.
Sec. 302. Authority to establish special rates of pay for employees of
facilities located outside the contiguous United States, Alaska, and Hawaii.
Sec. 303. Salary data for nurse anesthetists.
Sec. 304. Rates of pay for transferring nurses.
Sec. 305. Nursing personnel qualification standards.
Sec. 306. Report on pay for chief nurse position.
Sec. 307. Report on pay compression.
Sec. 308. Effective date.
TITLE IV--STATE HOME AMENDMENTS
Sec. 401. Treatment of earnings of veterans under certain rehabilitative
services programs.
Sec. 402. Permanent authority to make grants to States relating to State homes.
Sec. 403. Extension of period for completion of conditionally approved
applications for construction.
Sec. 404. Limited prohibition on obligation of funds for rescinded projects.
Sec. 405. Commencement date for recapture period.
Sec. 406. Commencement date for payment of per diem.
TITLE V--GENERAL HEALTH CARE AND ADMINISTRATION
Subtitle A--General Health
Sec. 501. Contract hospital care for veterans with permanent and total
service-connected disabilities.
Sec. 502. Permanent authority for respite care program.
Sec. 503. Extension of authority to contract with the Veterans Memorial
Medical Center, Republic of the Philippines.
Subtitle B--Preventive Health
Sec. 511. National Center for Preventive Health.
Sec. 512. Annual report on preventive health services.
Sec. 513. Preventive health services.
Sec. 514. Repeal of pilot program.
Subtitle C--Health Care Administration and Personnel
Sec. 521. Geriatric research, education, and clinical centers.
Sec. 522. Extension of authority to waive certain limitations applicable to
receipt of retirement pay by nurses.
Sec. 523. Health professionals education programs.
Sec. 524. Real property at Temple Junior College, Temple, Texas.
Sec. 525. Demonstration project to evaluate installation of telephones for
patient use at Department health-care facilities.
Sec. 526. Use of Tobacco Products in Department Facilities.
TITLE VI--DRUG PRICING AGREEMENTS
Sec. 601. Treatment of prescription drugs procured by Department of Veterans
Affairs or purchased by certain clinics and hospitals.
Sec. 602. Limitations on prices of drugs purchased by certain clinics and
hospitals.
Sec. 603. Limitation on prices of drugs procured by Department of Veterans
Affairs and certain other Federal agencies.
TITLE VII--PERSIAN GULF WAR VETERANS' HEALTH STATUS
Sec. 701. Short title.
Sec. 702. Persian Gulf War Veterans Health Registry.
Sec. 703. Health examinations and counseling for veterans eligible for
inclusion in certain health-related registries.
Sec. 704. Expansion of coverage of Persian Gulf Registry.
Sec. 705. Study by Office of Technology Assessment of Persian Gulf Registry
and Persian Gulf War Veterans Health Registry.
Sec. 706. Agreement with National Academy of Sciences for review of health
consequences of service during the Persian Gulf War.
Sec. 707. Coordination of government activities on health-related research
on the Persian Gulf War.
Sec. 708. Definition.
TITLE VIII--COURT OF VETERANS APPEALS
Sec. 801. Disciplinary procedures for judges of Court of Veterans Appeals.
SEC. 2. 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--WOMEN VETERANS HEALTH PROGRAMS
SEC. 101. SHORT TITLE.
  This title may be cited as the `Women Veterans Health Programs Act of 1992'.
SEC. 102. SEXUAL TRAUMA COUNSELING.
  (a) IN GENERAL- (1) Chapter 17 of title 38, United States Code, is amended
  by adding at the end of subchapter II the following new section:
`Sec. 1720D. Counseling to women veterans for sexual trauma
  `(a)(1) During the period through December 31, 1995, the Secretary may
  provide counseling to a woman veteran who the Secretary determines requires
  such counseling to overcome psychological trauma, which in the judgment of
  a mental health professional employed by the Department, resulted from a
  physical assault of a sexual nature, battery of a sexual nature, or sexual
  harassment which occurred while the veteran was serving on active duty.
  `(2) To be eligible to receive counseling under this subsection, a veteran
  must seek such counseling from the Secretary within two years after the
  date of the veteran's discharge or release from active military, naval,
  or air  service.
  `(3) In furnishing counseling to a veteran under this subsection, the
  Secretary may, during the period through December 31, 1994, provide
  such  counseling pursuant to a contract with a qualified mental health
  professional if (A) in the judgment of a mental health professional
  employed by the Department, the receipt of counseling by that veteran
  in facilities of the Department would be clinically inadvisable, or (B)
  Department facilities are not capable of furnishing such counseling to
  that veteran economically because of geographical inaccessibility.
  `(b) In providing services to a veteran under subsection (a), the period for
  which counseling is provided may not exceed one year from the date of the
  commencement of the furnishing of such counseling to the veteran. However,
  the Secretary may authorize a longer period in any case if, in the judgment
  of the Secretary, a longer period of counseling is required.
  `(c)(1) The Secretary shall give priority to the establishment and operation
  of the program to provide counseling under subsection (a). In the case of
  a veteran eligible for such counseling who requires other care or services
  under this chapter for trauma described in subsection (a)(1), the Secretary
  shall ensure that the veteran is furnished counseling under this section
  in a way that is coordinated with the furnishing of such other care and
  services under this chapter.
  `(2) In establishing a program to provide counseling under subsection (a),
  the Secretary shall--
  `(A) provide for appropriate training of mental health professionals and
  such other health care personnel as the Secretary determines necessary to
  carry out the program effectively;
  `(B) seek to ensure that such counseling is furnished in a setting that
  is therapeutically appropriate, taking into account the circumstances that
  resulted in the need for such counseling; and
  `(C) provide referral services to assist women veterans who are not
  eligible for services under this chapter to obtain those from sources
  outside the Department.
  `(d) The Secretary shall provide information on the counseling available
  to women veterans under this section. Efforts by the Secretary to provide
  such information--
  `(1) may include establishment of an information system involving the use
  of a toll-free telephone number (commonly referred to as an 800 number), and
  `(2) shall include coordination with the Secretary of Defense seeking to
  ensure that women who are being separated from active military, naval,
  or air service are provided appropriate information about programs,
  requirements, and procedures for applying for counseling under this section.
  `(e) In this section, the term `sexual harassment' means repeated,
  unsolicited verbal or physical contact of a sexual nature which is
  threatening in character.'.
  (2) The table of sections at the beginning of chapter 17 is amended by
  inserting after the item relating to section 1720C the following new item:
`1720D. Counseling to women veterans for sexual trauma.'.
  (b) TRANSITION PROVISION- In the case of a veteran who was discharged or
  released from active military, naval, or air service before December 31,
  1991, the two-year period specified in section 1720D(a)(2) of title 38,
  United States Code, as added by subsection (a), shall be treated as ending
  on December 31, 1993.
SEC. 103. PRIORITY FOR OUTPATIENT CARE FOR SEXUAL TRAUMA COUNSELING.
  Section 1712(i)(2) is amended--
  (1) by striking out `or (B)' and inserting in lieu thereof `, (B)'; and
  (2) by inserting before the period at the end thereof the following: `,
  or (C) who is eligible for counseling under section 1720D of this title,
  for the purposes of such counseling'.
SEC. 104. COMMENCEMENT OF PROVISION OF INFORMATION ON SERVICES.
  Not later than 90 days after the date of the enactment of this Act, the
  Secretary of Veterans Affairs shall commence the provision of information on
  the counseling relating to sexual trauma that is available to women veterans
  under section 1720D of title 38, United States Code (as added by section
  102) in accordance with the provisions of subsection (d) of that section.
SEC. 105. REPORT ON IMPLEMENTATION OF SEXUAL TRAUMA COUNSELING PROGRAM.
  Not later than March 31, 1994, the Secretary of Veterans Affairs shall
  submit to the Committees on Veterans' Affairs of the Senate and House of
  Representatives a comprehensive report on the Secretary's actions under
  section 1720D of title 38, United States Code (as added by section 102),
  and on the use made of the authority provided under that section. The
  report shall include the following:
  (1) The numbers of veterans who have received counseling under such
  section, shown by reference to the facility that provided that counseling
  and including the use made of the contract authority under such section.
  (2) The number of veterans who received care or services under chapter
  17 of title 38, United States Code, under the circumstances described
  in subsection (c)(1) of such section and the numbers referred to sources
  outside the Department, shown by reference to the facility that provided
  those services or made those referrals.
  (3) A listing and description of the specific training programs which the
  Secretary has instituted to ensure that the counseling program established
  under such section is carried out effectively.
  (4) A description of the specific efforts taken by the Secretary to
  ensure that the counseling furnished by the Secretary under such section
  is furnished in settings that are therapeutically appropriate, taking into
  account the circumstances that resulted in the need for such counseling.
SEC. 106. HEALTH CARE SERVICES FOR WOMEN.
  (a) GENERAL AUTHORITY- In furnishing hospital care and medical services
  under chapter 17 of title 38, United States Code, the Secretary of Veterans
  Affairs may provide to women the following health care services:
  (1) Papanicolaou tests (pap smears).
  (2) Breast examinations and mammography.
  (3) General reproductive health care, including the management of menopause,
  but not including under this section infertility services, abortions,
  or pregnancy care (including prenatal and delivery care), except for such
  care relating to a pregnancy that is complicated or in which the risks of
  complication are increased by a service-connected condition.
  (b) RESPONSIBILITIES OF DIRECTORS OF FACILITIES- The Secretary shall ensure
  that directors of medical facilities of the Department identify and assess
  opportunities under the authority provided in title II of this Act to (1)
  expand the availability of, and access to, health care services for women
  veterans under sections 1710 and 1712 of title 38, United States Code,
  and (2) provide counseling, care, and services authorized by this title.
SEC. 107. REPORT ON HEALTH CARE AND RESEARCH.
  (a) IN GENERAL- Not later than January 1, 1993, January 1, 1994, and January
  1, 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
  provision of health care services and the conduct of research carried out
  by, or under the jurisdiction of, the Secretary relating to women veterans.
  (b) CONTENTS- The report under subsection (a) shall include the following
  information with respect to the most recent fiscal year before the date
  of the report:
  (1) The number of women veterans who have received services described in
  section 106 of this Act in facilities under the jurisdiction of the Secretary
  (or the Secretary of Defense), shown by reference to the Department facility
  which provided (or, in the case of Department of Defense facilities,
  arranged) those services;
  (2) A description of (A) the services provided at each such facility,
  and (B) the extent to which each such facility relies on contractual
  arrangements under section 1703 or 8153 of title 38, United States Code,
  to furnish care to women veterans in facilities which are not under the
  jurisdiction of the Secretary where the provision of such care is not
  furnished in a medical emergency.
  (3) The steps taken by each such facility to expand the provision of
  services at such facility (or under arrangements with a Department of
  Defense facility) to women veterans.
  (4) A description (as of October 1 of the year preceding the year in which
  the report is submitted) of the status of any research relating to women
  veterans being carried out by or under the jurisdiction of the Secretary,
  including research under section 109 of this Act.
SEC. 108. COORDINATION OF SERVICES.
  The Secretary of Veterans Affairs shall ensure that an official in each
  regional office of the Veterans Health Administration shall serve as a
  coordinator of women's services. The responsibilities of such official
  shall include the following:
  (1) Conducting periodic assessments of the needs for services of women
  veterans within such region.
  (2) Planning to meet such needs.
  (3) Assisting in carrying out the purposes of section 106(b) of this title.
  (4) Coordinating the training of women veterans coordinators who are
  assigned to Department facilities in the region under the jurisdiction of
  such regional coordinator.
  (5) Providing appropriate technical support and guidance to Department
  facilities in that region with respect to outreach activities to women
  veterans.
SEC. 109. RESEARCH RELATING TO WOMEN VETERANS HEALTH.
  (a) INITIATION AND EXPANSION OF RESEARCH- The Secretary of Veterans Affairs,
  in carrying out the Secretary's responsibilities under section 7303 of
  title 38, United States Code, shall foster and encourage the initiation
  and expansion of research relating to the health of veterans who are women.
  (b) AUTHORIZATION OF APPROPRIATIONS- (1) Funds are authorized to be
  appropriated to the Secretary to initiate new studies in accordance with
  subsection (a) as follows:
  (A) For fiscal year 1993, $1,500,000.
  (B) For fiscal year 1994, $2,000,000.
  (C) For fiscal year 1995, $2,500,000.
  (2) Amounts appropriated pursuant to the authorization of appropriations
  in paragraph (1) are in addition to other funds appropriated or otherwise
  made available to the Department of Veterans Affairs for research.
SEC. 110. POPULATION STUDY OF WOMEN VETERANS.
  (a) STUDY- (1) The Secretary, subject to subsection (d), shall conduct
  a study to determine the needs of veterans who are women for health-care
  services. The study shall be based on an appropriate sample of veterans
  who are women.
  (2) Before carrying out the study, the Secretary shall request the advice
  of the Advisory Committee on Women Veterans on the conduct of the study.
  (3) In carrying out the study, the Secretary shall include in the sample
  veterans who are women and members of the Armed Forces serving on active
  duty who are women.
  (b) REPORTS- The Secretary shall submit to the Committees on Veterans
  Affairs of the Senate and House of Representatives reports relating to
  the study as follows:
  (1) Not later than 9 months after the date of the enactment of this Act,
  an interim report describing (A) the information and advice obtained
  by the Secretary from the Advisory Committee on Women Veterans, and (B)
  the status of the study.
  (2) Not later than December 31, 1995, a final report describing the results
  of the study.
  (c) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be appropriated
  to the general operating expenses account of the Department of Veterans
  Affairs $2,000,000 to carry out the purposes of this section. Amounts
  appropriated pursuant to this authorization of appropriations shall be
  available for obligation until expended without fiscal year limitation.
  (d) LIMITATION- No funds may be used to conduct the study described in
  subsection (a) unless expressly provided for in an appropriation Act.
TITLE II--HEALTH-CARE SHARING AGREEMENTS BETWEEN DEPARTMENT OF VETERANS
AFFAIRS AND DEPARTMENT OF DEFENSE
SEC. 201. TEMPORARY EXPANSION OF AUTHORITY FOR SHARING AGREEMENTS.
  The Secretary of Veterans Affairs may enter into an agreement with the
  Secretary of Defense under this section to expand the availability of
  health-care sharing arrangements with the Department of Defense under
  section 8111(c) of title 38, United States Code. Under such an agreement--
  (1) the head of a Department of Veterans Affairs medical facility may enter
  into agreements under section 8111(d) of that title with (A) the head of a
  Department of Defense medical facility, (B) with any other official of the
  Department of Defense responsible for the provision of care under chapter 55
  of title 10, United States Code, to persons who are covered beneficiaries
  under that chapter, in the region of the Department of Veterans Affairs
  medical facility, or (C) with a contractor of the Department of Defense
  responsible for the provision of care under chapter 55 of title 10, United
  States Code, to persons who are covered beneficiaries under that chapter,
  in the region of the Department of Veterans Affairs medical facility; and
  (2) the term `primary beneficiary' shall be treated as including--
  (A) with respect to the Department of Veterans Affairs, any person who is
  described in section 1713 of title 38, United States Code; and
  (B) with respect to the Department of Defense, any person who is a covered
  beneficiary under chapter 55 of title 10, United States Code.
SEC. 202. REQUIREMENT FOR IMPROVEMENT IN SERVICES FOR VETERANS.
  A proposed agreement authorized by section 201 that is entered into by the
  head of a Department of Veterans Affairs medical facility may take effect
  only if the Chief Medical Director finds, and certifies to the Secretary
  of Veterans Affairs, that implementation of the agreement--
  (1) will result in the improvement of services to eligible veterans at
  that facility; and
  (2) will not result in the denial of, or a delay in providing, access to
  care for any veteran at that facility.
SEC. 203. EXPANDED SHARING AGREEMENTS WITH DEPARTMENT OF DEFENSE.
  Under an agreement under section 201, guidelines under section 8111(b)
  of title 38, United States Code, may be modified to provide that,
  notwithstanding any other provision of law, any person who is a covered
  beneficiary under chapter 55 of title 10  and who is furnished care
  or services by a facility of the Department of Veterans Affairs under
  an agreement entered into under section 8111 of that title, or who is
  described in section 1713 of title 38, United States Code, and who is
  furnished care or services by a facility of the Department of Defense,
  may be authorized to receive such care or services--
  (1) without regard to any otherwise applicable requirement for the payment
  of a copayment or deductible; or
  (2) subject to a requirement to pay only part of any such otherwise
  applicable copayment or deductible, as specified in the guidelines.
SEC. 204. EXPIRATION OF AUTHORITY.
  The authority to provide services pursuant to agreements entered into
  under section 201 expires on October 1, 1996.
SEC. 205. CONSULTATION WITH VETERANS SERVICE ORGANIZATIONS.
  In carrying out this title, the Secretary of Veterans Affairs shall consult
  with organizations named in or approved under section 5902 of title 38,
  United States Code.
SEC. 206. ANNUAL REPORT.
  (a) IN GENERAL- For each of fiscal years 1993 through 1996, the Secretary of
  Defense and the Secretary of Veterans Affairs shall include in the annual
  report of the Secretaries under section 8111(f) of title 38, United States
  Code, a description of the Secretaries' implementation of this section.
  (b) ADDITIONAL MATTERS FOR FISCAL YEAR 1996 REPORT- In the report under
  subsection (a) for fiscal year 1996, the Secretaries shall include the
  following:
  (1) An assessment of the effect of agreements entered into under section
  201 on the delivery of health care to eligible veterans.
  (2) An assessment of the cost savings, if any, associated with provision
  of services under such agreements to retired members of the Armed Forces,
  dependents of members or former members of a uniformed service, and
  beneficiaries under section 1713 of title 38, United States Code.
  (3) Any plans for administrative action, and any recommendations for
  legislation, that the Secretaries consider appropriate to include in
  the report.
TITLE III--NURSE PAY
SEC. 301. REVISION TO NURSE PAY GRADE SCHEDULE.
  (a) REVISION- Section 7404(b)(1) is amended in the matter relating to
  `NURSE SCHEDULE' by striking out `Director grade.' and all that follows
  through `Entry grade.' and inserting in lieu thereof the following:
  `Nurse V.
  `Nurse IV.
  `Nurse III.
  `Nurse II.
  `Nurse I.'.
  (b) CONFORMING AMENDMENT- Section 7451(b) of such title is amended by
  striking out `four' and inserting in lieu thereof `five'.
SEC. 302. AUTHORITY TO ESTABLISH SPECIAL RATES OF PAY FOR EMPLOYEES OF
FACILITIES LOCATED OUTSIDE THE CONTIGUOUS UNITED STATES, ALASKA, AND HAWAII.
  Section 7451(a)(3) is amended--
  (1) by striking out `(3) The rates' and inserting in lieu thereof `(3)(A)
  Except as provided in subparagraph (B), the rates'; and
  (2) by adding at the end the following new subparagraph:
  `(B) Under such regulations as the Secretary shall prescribe, the Secretary
  shall establish and adjust the rates of basic pay for covered positions
  at the following health-care facilities in order to provide rates of basic
  pay that enable the Secretary to recruit and retain sufficient numbers of
  health-care personnel in such positions at those facilities:
  `(i) The Veterans Memorial Medical Center in the Republic of the Philippines.
  `(ii) Department of Veterans Affairs health-care facilities located outside
  the contiguous States, Alaska, and Hawaii.'.
SEC. 303. SALARY DATA FOR NURSE ANESTHETISTS.
  Section 7451(d)(3) is amended--
  (1) by redesignating subparagraphs (C) and (D) as subparagraphs (D) and
  (E), respectively; and
  (2) by inserting after subparagraph (B) the following new subparagraph (C):
  `(C)(i) A director of a Department health-care facility may use data on
  the beginning rates of compensation paid to certified registered nurse
  anesthetists who are employed on a salary basis by entities that provide
  anesthesia services through certified registered nurse anesthetists in
  the labor-market area only if the director--
  `(I) has conducted a survey of beginning rates of compensation for certified
  registered nurse anesthetists in the local labor market area of the facility
  under subparagraph (B);
  `(II) has used all available administrative authority with regard to
  collection of survey data; and
  `(III) makes a determination (under regulations prescribed by the Secretary)
  that such survey methods are insufficient to permit the adjustments referred
  to in subparagraph (B) for such nurse anesthetists employed by the facility.
  `(ii) For the purposes of this subparagraph, certified registered nurse
  anesthetists who are so employed by such entities shall be deemed to be
  corresponding health-care professionals to the certified registered nurse
  anesthetists employed by the facility.
  `(iii) The authority of the director to use such additional data under
  this subparagraph with respect to certified registered nurse anesthetists
  expires on April 1, 1995.'.
SEC. 304. RATES OF PAY FOR TRANSFERRING NURSES.
  (a) SAVE-PAY AUTHORITY FOR NURSES TRANSFERRING TO ANOTHER FACILITY- Section
  7452(e) is amended by striking out the period at the end and inserting
  in lieu thereof `, except that in the case of an employee whose transfer
  (other than pursuant to a disciplinary action otherwise authorized by
  law) to another health-care facility is at the request of the Secretary,
  the Secretary may provide that for at least the first year following such
  transfer the employee shall be paid at a rate of basic pay up to the rate
  applicable to such employee before the transfer, if the Secretary determines
  that such rate of pay is necessary to fill the position. Whenever the
  Secretary exercises the authority under the preceding sentence relating
  to the rate of basic pay of a transferred employee, the Secretary shall,
  in the next annual report required under section 7451(g) of this title,
  provide justification for doing so.'.
  (b) CONFORMING AMENDMENT- Section 7451(g) is amended by adding at the end
  the following new paragraph:
  `(9) The justification required by section 7452(e) of this title.'.
SEC. 305. NURSING PERSONNEL QUALIFICATION STANDARDS.
  (a) REVISION- The Secretary of Veterans Affairs shall conduct a review of the
  qualification standards used for nursing personnel at Department health-care
  facilities and the relationship between those standards and the compression
  of nursing personnel in the existing intermediate and senior grades. Based
  upon that review, the Secretary shall revise those qualification standards--
  (1) to reflect the five grade levels for nursing personnel under the Nurse
  Schedule, as amended by section 301; and
  (2) to reduce the compression of nursing personnel in the existing
  intermediate and senior grades.
  (b) DEADLINE FOR PRESCRIBING STANDARDS- The Secretary shall prescribe revised
  qualification standards for nursing personnel pursuant to subsection (a)
  not later than six months after the date of the enactment of this Act.
  (c) REPORT- The Secretary shall submit to the Committees on Veterans' Affairs
  of the Senate and House of Representatives a report on the Secretary's
  findings and actions under this section. The report shall be submitted
  not later than six months after the date on which revised qualification
  standards for nursing personnel are prescribed pursuant to subsection (b).
SEC. 306. REPORT ON PAY FOR CHIEF NURSE POSITION.
  (a) REVIEW- The Secretary of Veterans Affairs shall conduct a review of--
  (1) the process for determining the rate of basic pay applicable to the Chief
  Nurse position at Department of Veterans Affairs health-care facilities; and
  (2) the relationship between the rate of such basic pay and the rate of
  basic pay applicable to nurses in positions subordinate to the Chief Nurse
  at the respective Department facilities.
The review shall include an assessment of the adequacy of that process in
determining an equitable pay rate for the Chief Nurse position, including
an assessment of the accuracy of data collected in the survey process and
the difficulties in obtaining accurate data.
  (b) REPORT- The Secretary shall submit to the Committees on Veterans'
  Affairs of the Senate and House of Representatives a report on the review
  and assessment conducted under subsection (a). To the extent that the
  review discloses difficulties in obtaining accurate data in the survey
  process with respect to the Chief Nurse position at Department facilities,
  the Secretary shall include in the report recommendations for corrective
  action. The Secretary shall also include in the report (1) a listing of the
  salary differential (expressed as a percentage) between the Chief Nurse
  at a facility and the highest paid nurse (excluding certified registered
  nurse anesthetists) serving in a position subordinate to the Chief Nurse,
  and (2) an analysis of such data. The report shall be submitted not later
  than 12 months after the date of the enactment of this Act.
SEC. 307. REPORT ON PAY COMPRESSION.
  Section 7451(g) (as amended by section 304(b)) is further amended by adding
  at the end the following new paragraph:
  `(10) The number of nurses, shown by facility and by grade, who are on
  pay retention or in the top step of any grade and, with respect to those
  employees, comprehensive information (by facility) as to whether an extension
  of the pay grades was sought for these positions, and with respect to each
  such request for extension, whether such request was granted or denied.'.
SEC. 308. EFFECTIVE DATE.
  The amendments made by sections 301, 302, 303, and 304 shall take effect
  with respect to the first pay period beginning on or after the end of the
  six-month period beginning on the date of the enactment of this Act.
TITLE IV--STATE HOME AMENDMENTS
SEC. 401. TREATMENT OF EARNINGS OF VETERANS UNDER CERTAIN REHABILITATIVE
SERVICES PROGRAMS.
  Subsection (f) of section 1718 is amended to read as follows:
  `(f)(1) The Secretary may not consider any of the matters stated in
  paragraph (2) as a basis for the denial or discontinuance of a rating
  of total disability for purposes of compensation or pension based on the
  veteran's inability to secure or follow a substantially gainful occupation
  as a result of disability.
  `(2) Paragraph (1) applies to the following:
  `(A) A veteran's participation in an activity carried out under this section.
  `(B) A veteran's receipt of a distribution as a result of participation
  in an activity carried out under this section.
  `(C) A veteran's participation in a program of rehabilitative services that
  (i) is provided as part of the veteran's care furnished by a State home and
  (ii) is approved by the Secretary as conforming appropriately to standards
  for activities carried out under this section.
  `(D) A veteran's receipt of payment as a result of participation in a
  program described in subparagraph (C).
  `(3) A distribution of funds made under this section and a payment made to
  a veteran under a program of rehabilitative services described in paragraph
  (2)(C) shall be considered for the purposes of chapter 15 of this title
  to be a donation from a public or private relief or welfare organization.'.
SEC. 402. PERMANENT AUTHORITY TO MAKE GRANTS TO STATES RELATING TO STATE HOMES.
  Section 8133(a) is amended in the first sentence by striking out `through
  September 30, 1992'.
SEC. 403. EXTENSION OF PERIOD FOR COMPLETION OF CONDITIONALLY APPROVED
APPLICATIONS FOR CONSTRUCTION.
  (a) EXTENSION OF PERIOD- Section 8135(b)(6)(A) is amended by striking out
  `90 days' and inserting in lieu thereof `180 days'.
  (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to
  projects that are conditionally approved after September 30, 1992.
SEC. 404. LIMITED PROHIBITION ON OBLIGATION OF FUNDS FOR RESCINDED PROJECTS.
  (a) PROHIBITION- Section 8135(b)(6)(B) is amended by adding at the end the
  following: `In the event the Secretary rescinds conditional approval of
  a project under this subparagraph, the Secretary may not further obligate
  funds for the project during the fiscal year in which the Secretary rescinds
  such approval.'.
  (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to
  rescissions of conditional approval of projects after the date of the
  enactment of this Act.
SEC. 405. COMMENCEMENT DATE FOR RECAPTURE PERIOD.
  (a) COMMENCEMENT DATE- Section 8136 is amended by striking out `If, within
  20 years after completion of any project' and inserting in lieu thereof
  `If, within the 20-year period beginning on the date of the approval by
  the Secretary of the final architectural and engineering inspection of
  any project'.
  (b) TECHNICAL AMENDMENT- Such section is further amended by striking out
  `such facilities cease' and inserting in lieu thereof `the facilities
  covered by the project cease'.
SEC. 406. COMMENCEMENT DATE FOR PAYMENT OF PER DIEM.
  Section 1741 is amended by adding at the end the following new subsection:
  `(e) Subject to section 1743 of this title, the payment of per diem for
  care furnished in a State home facility shall commence on the date of
  the completion of the inspection for recognition of the facility under
  section 1742(a) of this title if the Secretary determines, as a result
  of that inspection, that the State home meets the standards described in
  such section.'.
TITLE V--GENERAL HEALTH CARE AND ADMINISTRATION
Subtitle A--General Health
SEC. 501. CONTRACT HOSPITAL CARE FOR VETERANS WITH PERMANENT AND TOTAL
SERVICE-CONNECTED DISABILITIES.
  Section 1703(a)(1) is amended--
  (1) by striking out `or' at the end of subparagraph (A);
  (2) by striking out the period at the end of subparagraph (B) and inserting
  in lieu thereof `; or'; and
  (3) by adding at the end the following new subparagraph:
  `(C) a disability of a veteran who has a total disability permanent in
  nature from a service-connected disability.'.
SEC. 502. PERMANENT AUTHORITY FOR RESPITE CARE PROGRAM.
  Section 1720B is amended by striking out subsection (c).
SEC. 503. EXTENSION OF AUTHORITY TO CONTRACT WITH THE VETERANS MEMORIAL
MEDICAL CENTER, REPUBLIC OF THE PHILIPPINES.
  Section 1732(a) is amended by striking out `September 30, 1992' and
  inserting in lieu thereof `September 30, 1994'.
Subtitle B--Preventive Health
SEC. 511. NATIONAL CENTER FOR PREVENTIVE HEALTH.
  (a) ESTABLISHMENT- (1) Subchapter II of chapter 73 is amended by adding
  at the end the following new section:
`Sec. 7318. National Center for Preventive Health
  `(a)(1) The Chief Medical Director shall establish and operate in the
  Veterans Health Administration a National Center for Preventive Health
  (hereinafter in this section referred to as the `Center'). The Center
  shall be located at a Department health care facility.
  `(2) The head of the Center is the Director of Preventive Health (hereinafter
  in this section referred to as the `Director').
  `(3) The Chief Medical Director shall provide the Center with such staff and
  other support as may be necessary for the Center to carry out effectively
  its functions under this section.
  `(b) The purposes of the Center are the following:
  `(1) To provide a central office for monitoring and encouraging the
  activities of the Veterans Health Administration with respect to the
  provision, evaluation, and improvement of preventive health services.
  `(2) To promote the expansion and improvement of clinical, research, and
  educational activities of the Veterans Health Administration with respect
  to such services.
  `(c) In carrying out the purposes of the Center, the Director shall do
  the following:
  `(1) Develop and maintain current information on clinical activities of
  the Veterans Health Administration relating to preventive health services,
  including activities relating to--
  `(A) the on-going provision of regularly-furnished services; and
  `(B) patient education and screening programs carried out throughout the
  Administration.
  `(2) Develop and maintain detailed current information on research activities
  of the Veterans Health Administration relating to preventive health services.
  `(3) In order to encourage the effective provision of preventive health
  services by Veterans Health Administration personnel--
  `(A) ensure the dissemination to such personnel of any appropriate
  information on such services that is derived from research carried out by
  the Administration; and
  `(B) acquire and ensure the dissemination to such personnel of any
  appropriate information on research and clinical practices relating to such
  services that are carried out by researchers, clinicians, and educators
  who are not affiliated with the Administration.
  `(4) Facilitate the optimal use of the unique resources of the Department
  for cooperative research into health outcomes by initiating recommendations,
  and responding to requests of the Chief Medical Director and the Director
  of the Medical and Prosthetic Research Service, for such research into
  preventive health services.
  `(5) Provide advisory services to personnel of Department health-care
  facilities with respect to the planning or furnishing of preventive health
  services by such personnel.
  `(d) There is authorized to be appropriated $1,500,000 to the Medical Care
  General and Special Fund of the Department of Veterans Affairs for each
  fiscal year for the purpose of permitting the National Center for Preventive
  Health to carry out research, clinical, educational, and administrative
  activities under this section. Such activities shall be considered to be
  part of the operation of health-care facilities of the Department without
  regard to the location at which such activities are carried out.
  `(e) In this section, the term `preventive health services' has the meaning
  given such term in section 1701(9) of this title.'.
  (2) The table of sections at the beginning of chapter 73 is amended by
  inserting after the item relating section 7317 the following new item:
`7318. National Center for Preventive Health.'.
  (b) DIRECTOR OF CENTER- (1) Subsection (a) of section 7306 is amended--
  (A) by redesignating paragraph (7) as paragraph (8); and
  (B) by inserting after paragraph (6) the following new paragraph (7):
  `(7) The Director of the National Center for Preventive Health, who shall be
  responsible to the Chief Medical Director for the operation of the Center.'.
  (2) Subsection (c) of such section is amended in the second sentence by
  striking out `and (4)' and inserting in lieu thereof `(4), and (7)'.
  (c) SELECTION OF FACILITY AT WHICH CENTER TO BE ESTABLISHED- In order
  to establish the National Center for Preventive Health pursuant to
  section 7318 of title 38, United States Code, as added by subsection (a),
  the Chief Medical Director of the Department of Veterans Affairs shall
  solicit proposals from Department health care facilities to establish
  the center. The Chief Medical Director shall establish such center at the
  facility or facilities which the Chief Medical Director determines, on the
  basis of a review and analysis of such proposals, would most effectively
  carry out the purposes set forth in subsection (b) of such section.
SEC. 512. ANNUAL REPORT ON PREVENTIVE HEALTH SERVICES.
  (a) ANNUAL REPORT- Chapter 17 is amended by inserting after section 1703
  the following new section:
`Sec. 1704. Preventive health services: annual report
  `Not later than October 31 each year, the Secretary shall submit to the
  Committees on Veterans' Affairs of the Senate and House of Representatives
  a report on preventive health services. Each such report shall include
  the following:
  `(1) A description of the programs and activities of the Department with
  respect to preventive health services during the preceding fiscal year,
  including a description of the following:
  `(A) The programs conducted by the Department--
  `(i) to educate veterans with respect to health promotion and disease
  prevention; and
  `(ii) to provide veterans with preventive health screenings and other
  clinical services, with such description setting forth the types of
  resources used by the Department to conduct such screenings and services
  and the number of veterans reached by such screenings and services.
  `(B) The means by which the Secretary addressed the specific preventive
  health services needs of particular groups of veterans (including veterans
  with service-connected disabilities, elderly veterans, low-income veterans,
  women veterans, institutionalized veterans, and veterans who are at risk
  for mental illness).
  `(C) The manner in which the provision of such services was coordinated
  with the activities of the Medical and Prosthetic Research Service of the
  Department and the National Center for Preventive Health.
  `(D) The manner in which the provision of such services was integrated
  into training programs of the Department, including initial and continuing
  medical training of medical students, residents, and Department staff.
  `(E) The manner in which the Department participated in cooperative
  preventive health efforts with other governmental and private entities
  (including State and local health promotion offices and not-for-profit
  organizations).
  `(F) The specific research carried out by the Department with respect
  to the long-term relationships among screening activities, treatment,
  and morbidity and mortality outcomes.
  `(G) The cost effectiveness of such programs and activities, including an
  explanation of the means by which the costs and benefits (including the
  quality of life of veterans who participate in such programs and activities)
  of such programs and activities are measured.
  `(2) A specific description of research activities on preventive health
  services carried out during that period using employees, funds, equipment,
  office space, or other support services of the Department, with such
  description setting forth--
  `(A) the source of funds for those activities;
  `(B) the articles or publications (including the authors of the articles
  and publications) in which those activities are described;
  `(C) the Federal, State, or local governmental entity or private entity,
  if any, with which such activities were carried out; and
  `(D) the clinical, research, or staff education projects for which funding
  applications were submitted (including the source of the funds applied for)
  and upon which a decision is pending or was denied.
  `(3) An accounting of the expenditure of funds during that period by the
  National Center for Preventive Health under section 7318 of this title.'.
  (b) CLERICAL AMENDMENT- The table of sections at the beginning of such
  chapter is amended by inserting after the item relating to section 1703
  the following new item:
`1704. Preventive health services: annual report.'.
SEC. 513. PREVENTIVE HEALTH SERVICES.
  (a) IN GENERAL- The text of section 1762 is transferred to the end of
  section 1701, redesignated as paragraph (9), and amended--
  (1) by striking out `For the purposes of this subchapter, the term
  `preventive health-care services' means' and inserting in lieu thereof
  `The term `preventive health services' means'; and
  (2) by redesignating paragraphs (1), (2), (3), (4), (5), (6), (7), (8),
  (9), (10), and (11) as subparagraphs (A), (B), (C), (D), (E), (F), (G),
  (H), (I), (J), and (K), respectively.
  (b) CONFORMING AMENDMENT- Section 1701(6)(A)(i) is amended by striking out
  `preventive health-care services as defined in section 1762 of this title,'
  and inserting in lieu thereof `preventive health services,'.
SEC. 514. REPEAL OF PILOT PROGRAM.
  (a) REPEAL- Subchapter VII of chapter 17 is repealed.
  (b) CLERICAL AMENDMENT- The table of sections at the beginning of chapter 17
  is amended by striking out the items relating to subchapter VII (including
  the items relating to the sections of that subchapter).
Subtitle C--Health Care Administration and Personnel
SEC. 521. GERIATRIC RESEARCH, EDUCATION, AND CLINICAL CENTERS.
  Section 7314 is amended--
  (1) in subsection (c), by inserting after `unless' in the matter preceding
  paragraph (1) the following: `the peer review panel established under
  subsection (d) has determined under that subsection that the proposal
  submitted by such facility as a location for a new center under subsection
  (a) is among those proposals which have met the highest competitive
  standards of scientific and clinical merit, and';
  (2) by redesignating subsections (d), (e), and (f) as subsections (e),
  (f), and (g), respectively; and
  (3) by inserting after subsection (c) the following new subsection (d):
  `(d)(1) In order to provide advice to assist the Chief Medical Director
  and the Secretary to carry out their responsibilities under this section,
  the Assistant Chief Medical Director described in section 7306(b)(3) of this
  title shall establish a panel to assess the scientific and clinical merit
  of proposals that are submitted to the Secretary for the establishment of
  new centers under this section.
  `(2) The membership of the panel shall consist of experts in the fields of
  geriatric and gerontological research, education, and clinical care. Members
  of the panel shall serve as consultants to the Department for a period of
  no longer than six months.
  `(3) The panel shall review each proposal submitted to the panel by the
  Assistant Chief Medical Director and shall submit its views on the relative
  scientific and clinical merit of each such proposal to the Assistant Chief
  Medical Director.
  `(4) The panel shall not be subject to the Federal Advisory Committee Act.'.
SEC. 522. EXTENSION OF AUTHORITY TO WAIVE CERTAIN LIMITATIONS APPLICABLE TO
RECEIPT OF RETIREMENT PAY BY NURSES.
  Section 7426(c) is amended by striking out `September 30, 1992' and
  inserting in lieu thereof `December 31, 1994'.
SEC. 523. HEALTH PROFESSIONALS EDUCATION PROGRAMS.
  (a) EXTENSION OF HEALTH SCHOLARSHIP PROGRAM- Section 7618 is amended by
  striking out `September 30, 1992' and inserting in lieu thereof `December
  31, 1995'.
  (b) HEALTH PROFESSIONALS- Notwithstanding any other provision of law,
  the Secretary of Veterans Affairs may not provide payments to health-care
  professional employees of the Department of Veterans Affairs for payment
  of tuition loans.
SEC. 524. REAL PROPERTY AT TEMPLE JUNIOR COLLEGE, TEMPLE, TEXAS.
  (a) REMOVAL OF RESTRICTIONS ON USE OF PREVIOUSLY CONVEYED LAND-  Subject
  to subsection (b), the Secretary of Veterans Affairs shall release all
  restrictions and conditions (including a right of reverter) imposed in a
  quitclaim deed executed by the Administrator of Veterans Affairs on March
  8, 1968, pursuant to Public Law 90-197 (81 Stat. 582; December 14, 1967),
  in which the United States, acting through the Administrator of Veterans
  Affairs, conveyed a tract of land consisting of 73 acres, more or less,
  to Temple Junior College, Temple, Texas.
  (b) REQUIREMENT FOR PAYMENT- Subsection (a) shall be effective upon the
  payment to the Secretary of Veterans Affairs of such monetary consideration
  as the Secretary determines to be appropriate. Any amount received by the
  Secretary pursuant to this subsection shall be deposited in the general
  fund of the Treasury.
  (c) EXECUTION OF LEGAL INSTRUMENTS- The Secretary of Veterans Affairs
  shall execute such legal documents as necessary to carry out subsection
  (a). The Secretary may include in such legal documents such terms,
  conditions, reservations, easements, and restrictions (other than those
  released pursuant to subsection (a)) as the Secretary considers necessary
  to protect the interest of the United States.
SEC. 525. DEMONSTRATION PROJECT TO EVALUATE INSTALLATION OF TELEPHONES FOR
PATIENT USE AT DEPARTMENT HEALTH-CARE FACILITIES.
  (a) DEMONSTRATION PROJECT- The Secretary of Veterans Affairs shall carry
  out a demonstration project to evaluate--
  (1) the feasibility and desirability of (A) providing telephone service
  in patient rooms in Department of Veterans Affairs health-care facilities
  which do not currently provide such service, and (B) the use of telephones
  by the patients of such health-care facilities; and
  (2) the relative feasibility and cost-effectiveness of a variety of options
  for providing such service.
  (b) PROJECT ACTIVITIES- (1) In carrying out the demonstration project under
  this section, the Secretary shall, at an appropriate number (as determined
  by the Secretary) of health care facilities, provide patients reasonable
  access to telephone service in patients' rooms to the extent feasible,
  and subject to paragraph (2).
  (2) The Secretary shall ensure that patients who use such telephones bear
  financial responsibility for the cost of any long-distance telephone calls
  made during such use.
  (c) PROJECT EVALUATION- In carrying out the evaluation under subsection
  (a), the Secretary shall determine--
  (1) the cost of the installation, use, and maintenance of such telephones,
  including--
  (A) the amount of any savings which accrue to the facility by reason of
  such installation and use (including the amount of any savings that may
  result from any decrease in the amount of assistance in using telephones
  that the staff of the facility would otherwise provide to patients); and
  (B) any costs that result from providing special telephones or other special
  equipment to facilitate the use of telephones by disabled veterans; and
  (2) the effect of the use of such telephones on the therapeutic course of
  veterans who receive care at the facility; and
  (3) the relative feasibility and cost effectiveness of a range of options
  for providing access to telephone service, including--
  (A) the expenditure of appropriated funds;
  (B) the receipt of donated funds, equipment, and services; and
  (C) the procuring of equipment and services by the Veterans Canteen Service.
  (d) REPORT- Not later than September 30, 1994, the Secretary shall submit
  to the Committees on Veterans' Affairs of the Senate and the House of
  Representatives a report on the demonstration project. The report shall
  contain the following:
  (1) The determinations of the Secretary under sub- section (c).
  (2) An assessment by the Secretary of the feasibility and desirability
  of providing telephones for patients in other health-care facilities of
  the Department.
  (3) The experience of the Secretary in using, and an assessment by
  the Secretary of the feasibility and cost effectiveness of, alternative
  arrangements to the expenditure of appropriated funds for securing telephone
  service for patients in health-care facilities of the Department.
  (4) Any additional information and recommendations with respect to the
  provision and use of patient telephones at Department health-care facilities
  as the Secretary considers appropriate.
SEC. 526. USE OF TOBACCO PRODUCTS IN DEPARTMENT FACILITIES.
  (a) IN GENERAL- The Secretary of Veterans Affairs shall take appropriate
  actions to ensure that, consistent with medical requirements and limitations,
  each facility of the Department described in subsection (b)--
  (1) establishes and maintains--
  (A) a suitable indoor area in which patients or residents may smoke and
  which is ventilated in a manner that, to the maximum extent feasible,
  prevents smoke from entering other areas of the facility; or
  (B) an area in a building that--
  (i) is detached from the facility;
  (ii) is accessible to patients or residents of the facility; and
  (iii) has appropriate heating and air conditioning; and
  (2) provides access to an area established and maintained under paragraph
  (1), consistent with medical requirements and limitations, for patients
  or residents of the facility who are receiving care or services and who
  desire to smoke tobacco products.
  (b) COVERED FACILITIES- A Department facility referred to in subsection
  (a) is any Department of Veterans Affairs medical center, nursing home,
  or domiciliary care facility.
  (c) REPORTS- (1) Not later than 180 days after the date of the enactment
  of this Act, the Comptroller General shall submit to the Committees on
  Veterans' Affairs of the Senate and House of Representatives a report on
  the feasibility of the establishment and maintenance of areas for smoking
  in Department facilities under this section. The report shall include
  information on--
  (A) the cost of, and a proposed schedule for, the establishment of such
  an area at each Department facility covered by this section;
  (B) the extent to which the ventilating system of each facility is
  adequate to ensure that use of the area for smoking does not result in
  health problems for other patients or residents of the facility; and
  (C) the effect of the establishment and maintenance of an area for smoking
  in each facility on the accreditation score issued for the facility by
  the Joint Commission on the Accreditation of Health Organizations.
  (2) Not later than 120 days after the effective date of this section,
  the Secretary shall submit to the committees referred to in paragraph (1)
  a report on the implementation of this section. The report shall include
  a description of the actions taken at each covered facility to ensure
  compliance with this section.
  (d) EFFECTIVE DATE- The requirement to establish and maintain areas for
  smoking under subsection (a) shall take effect 60 days after the date on
  which the Comptroller General submits to the committees referred to in
  subsection (c)(1) that report required under that subsection.
TITLE VI--DRUG PRICING AGREEMENTS
SEC. 601. TREATMENT OF PRESCRIPTION DRUGS PROCURED BY DEPARTMENT OF VETERANS
AFFAIRS OR PURCHASED BY CERTAIN CLINICS AND HOSPITALS.
  (a) EXCLUSION OF PRICES FROM CALCULATION OF BEST PRICES FOR MEDICAID
  REBATE AGREEMENTS- Section 1927(c)(1)(C) of the Social Security Act (42
  U.S.C. 1396r-8(c)(1)(C)) is amended by striking `(excluding' and inserting
  `(excluding any prices charged on or after October 1, 1992, to the Indian
  Health Service, the Department of Veterans Affairs, a State home receiving
  funds under section 1741 of title 38, United States Code, the Department
  of Defense, the Public Health Service, or a covered entity described in
  subsection (a)(5)(B), any prices charged under the Federal Supply Schedule
  of the General Services Administration, or any prices used under a State
  pharmaceutical assistance program, and excluding'.
  (b) AGREEMENTS REQUIRED TO RECEIVE PAYMENT-
  (1) IN GENERAL- The first sentence of section 1927(a)(1) of such Act
  (42 U.S.C. 1396r-8(a)(1)) is amended by striking `manufacturer).' and
  inserting `manufacturer), and must meet the requirements of paragraph
  (5) (with respect to drugs purchased by a covered entity on or after the
  first day of the first month that begins after the date of the enactment
  of title VI of the Veterans Health Care Act of 1992) and paragraph (6).'.
  (2) AGREEMENTS DESCRIBED- Section 1927(a) of such Act (42 U.S.C. 1396r-8(a))
  is amended by adding at the end the following new paragraphs:
  `(5) LIMITATION ON PRICES OF DRUGS PURCHASED BY COVERED ENTITIES-
  `(A) AGREEMENT WITH SECRETARY- A manufacturer meets the requirements of
  this paragraph if the manufacturer has entered into an agreement with
  the Secretary that meets the requirements of section 340B of the Public
  Health Service Act with respect to covered outpatient drugs purchased by
  a covered entity on or after the first day of the first month that begins
  after the date of the enactment of this paragraph.
  `(B) COVERED ENTITY DEFINED- In this subsection, the term `covered entity'
  means an entity described in section 340B(a)(4) of the Public Health
  Service Act.
  `(C) ESTABLISHMENT OF ALTERNATIVE MECHANISM TO ENSURE AGAINST DUPLICATE
  DISCOUNTS OR REBATES- If the Secretary does not establish a mechanism under
  section 340B(a)(5)(A) of the Public Health Service Act within 12 months
  of the date of the enactment of such section, the following requirements
  shall apply:
  `(i) ENTITIES- Each covered entity shall inform the single State agency
  under section 1902(a)(5) when it is seeking reimbursement from the State
  plan for medical assistance described in section 1905(a)(12) with respect
  to a unit of any covered outpatient drug which is subject to an agreement
  under section 340B(a) of such Act.
  `(ii) STATE AGENCY- Each such single State agency shall provide a means
  by which a covered entity shall indicate on any drug reimbursement claims
  form (or format, where electronic claims management is used) that a unit of
  the drug that is the subject of the form is subject to an agreement under
  section 340B of such Act, and not submit to any manufacturer a claim for
  a rebate payment under subsection (b) with respect to such a drug.
  `(D) EFFECT OF SUBSEQUENT AMENDMENTS- In determining whether an agreement
  under subparagraph (A) meets the requirements of section 340B of the
  Public Health Service Act, the Secretary shall not take into account any
  amendments to such section that are enacted after the enactment of title
  VI of the Veterans Health Care Act of 1992.
  `(E) DETERMINATION OF COMPLIANCE- A manufacturer is deemed to meet the
  requirements of this paragraph if the manufacturer establishes to the
  satisfaction of the Secretary that the manufacturer would comply (and
  has offered to comply) with the provisions of section 340B of the Public
  Health Service Act (as in effect immediately after the enactment of this
  paragraph) and would have entered into an agreement under such section
  (as such section was in effect at such time), but for a legislative change
  in such section after the date of the enactment of this paragraph.
  `(6) REQUIREMENTS RELATING TO MASTER AGREEMENTS FOR DRUGS PROCURED BY
  DEPARTMENT OF VETERANS AFFAIRS AND CERTAIN OTHER FEDERAL AGENCIES-
  `(A) IN GENERAL- A manufacturer meets the requirements of this paragraph if
  the manufacturer complies with the provisions of section 8126 of title 38,
  United States Code, including the requirement of entering into a master
  agreement with the Secretary of Veterans Affairs under such section.
  `(B) EFFECT OF SUBSEQUENT AMENDMENTS- In determining whether a master
  agreement described in subparagraph (A) meets the requirements of section
  8126 of title 38, United States Code, the Secretary shall not take into
  account any amendments to such section that are enacted after the enactment
  of title VI of the Veterans Health Care Act of 1992.
  `(C) DETERMINATION OF COMPLIANCE- A manufacturer is deemed to meet the
  requirements of this paragraph if the manufacturer establishes to the
  satisfaction of the Secretary that the manufacturer would comply (and
  has offered to comply) with the provisions of section 8126 of title 38,
  United States Code (as in effect immediately after the enactment of this
  paragraph) and would have entered into an agreement under such section
  (as such section was in effect at such time), but for a legislative change
  in such section after the date of the enactment of this paragraph.'.
  (3) CONFIDENTIALITY OF INFORMATION- Section 1927(b)(3)(D) of such Act
  (42 U.S.C. 1396r-8(b)(3)(D)) is amended--
  (A) by striking `this paragraph' and inserting `this paragraph or under an
  agreement with the Secretary of Veterans Affairs described in subsection
  (a)(6)(A)(ii)';
  (B) by striking `Secretary' each place it appears and inserting `Secretary
  or the Secretary of Veterans Affairs'; and
  (C) by striking `except' and all that follows through the period and
  inserting: `except--
  `(i) as the Secretary determines to be necessary to carry out this section,
  `(ii) to permit the Comptroller General to review the information provided,
  and
  `(iii) to permit the Director of the Congressional Budget Office to review
  the information provided.'.
  (4) TERMINATION OF REBATE AGREEMENTS- Section 1927(b)(4)(B) of such Act
  (42 U.S.C. 1396r-8(b)(4)(B)) is amended--
  (i) in clause (ii), by striking `such period' and inserting `the calendar
  quarter beginning at least 60 days',
  (ii) in clause (ii), by striking `of the notice' and all through `the
  agreement).' and inserting `the manufacturer provides notice to the
  Secretary.', and
  (iii) by adding at the end the following new clauses:
  `(iv) NOTICE TO STATES- In the case of a termination under this subparagraph,
  the Secretary shall provide notice of such termination to the States within
  not less than 30 days before the effective date of such termination.
  `(v) APPLICATION TO TERMINATIONS OF OTHER AGREEMENTS- The provisions of
  this subparagraph shall apply to the terminations of agreements described
  in section 340B(a)(1) of the Public Health Service Act and master agreements
  described in section 8126(a) of title 38, United States Code.'.
  (c) BUDGET NEUTRALITY ADJUSTMENT- Section 1927(c)(1)(B) of the Social
  Security Act (42 U.S.C. 1396r-8(c)(1)(B)) is amended--
  (1) by striking `January 1, 1993,' and inserting `October 1, 1992,';
  (2) by striking `and' at the end of clause (i); and
  (3) by striking clause (ii) and inserting the following:
  `(ii) for quarters (or other periods) beginning after September 30, 1992,
  and before January 1, 1994, the greater of--
  `(I) 15.7 percent of the average manufacturer price for the drug, or
  `(II) the difference between the average manufacturer price for the drug
  and the best price (as defined in subparagraph (C)) for such quarter
  (or period) for such drug;
  `(iii) for quarters (or other periods) beginning after December 31, 1993,
  and before January 1, 1995, the greater of--
  `(I) 15.4 percent of the average manufacturer price for the drug, or
  `(II) the difference between the average manufacturer price for the drug
  and the best price (as defined in subparagraph (C)) for such quarter
  (or period) for such drug;
  `(iv) for quarters (or other periods) beginning after December 31, 1994,
  and before January 1, 1996, the greater of--
  `(I) 15.2 percent of the average manufacturer price for the drug, or
  `(II) the difference between the average manufacturer price for the drug
  and the best price (as defined in subparagraph (C)) for such quarter
  (or period) for such drug; and
  `(v) for quarters (or other periods) beginning after December 31, 1995,
  the greater of--
  `(I) 15.1 percent of the average manufacturer price for the drug, or
  `(II) the difference between the average manufacturer price for the drug
  and the best price (as defined in subparagraph (C)) for such quarter
  (or period) for such drug.'.
  (d) REPORTS ON BEST PRICE CHANGES AND PAYMENT OF REBATES-
  (1) IN GENERAL- Not later than 90 days after the expiration of each calendar
  quarter that begins on or after October 1, 1992, and ends on or before
  December 31, 1995, the Secretary of Health and Human Services shall submit
  a report to Congress that contains the following information relating to
  prescription drugs dispensed in the quarter (subject to paragraph (2)):
  (A) With respect to single source drugs and innovator multiple source
  drugs (as such terms are defined in section 1927(k)(7) of the Social
  Security Act)--
  (i) the percentage of such drugs whose best price (as reported to the
  Secretary under section 1927(b) of the Social Security Act) increased
  compared to the best price during the previous calendar quarter, and
  the amount of expenditures under State plans under title XIX of such Act
  attributable to such drugs;
  (ii) the percentage of such drugs whose best price (as so reported)
  decreased compared to the best price during the previous calendar quarter,
  and the amount of expenditures under State plans under title XIX of such
  Act attributable to such drugs;
  (iii) the percentage of such drugs whose best price (as so reported)
  was the same as the best price during the previous calendar quarter, and
  the amount of expenditures under State plans under title XIX of such Act
  attributable to such drugs;
  (iv) the median and mean percentage increase (or decrease) in the best
  price of such single source drugs (as so reported) compared to the best
  price during the previous calendar quarter, unweighted and weighted (in
  the case of the mean percentage increase or decrease) by the dollar volume
  of drugs dispensed;
  (v) the median and mean percentage increase (or decrease) in the best price
  of such innovator multiple source drugs (as so reported) compared to the
  best price during the previous calendar quarter, unweighted and weighted
  (in the case of the mean percentage increase or decrease) by the dollar
  volume of drugs dispensed; and
  (vi) the median and mean percentage increase (or decrease) in the best price
  of all such drugs (as so reported) compared to the best price during the
  previous calendar quarter, unweighted and weighted (in the case of the mean
  percentage increase or decrease) by the dollar volume of drugs dispensed.
  (B) With respect to all drugs for which manufacturers are required to pay
  rebates under section 1927(c) of the Social Security Act, the Secretary's
  estimate, on a State-by-State and a national aggregate basis, of--
  (i) the total amount of all rebates paid under such section during the
  quarter, broken down by the portions of such total amount attributable to
  rebates described in paragraphs (1), (2), and (3) of such section;
  (ii) the percentages of such total amount attributable to rebates described
  in paragraphs (1), (2), and (3) of such section; and
  (iii) the amount of the portion of such total amount attributable to
  the rebate described in paragraph (1) of such section that is solely
  attributable to the application of subclause (II) of clause (i), (ii),
  (iii), (iv), or (v) of such paragraph.
  (2) LIMITATION ON DRUGS SUBJECT TO REPORT- No report submitted under
  paragraph (1) shall include any information relating to any prescription
  drug unless the Secretary finds that expenditures for the drug are
  significant expenditures under the medicaid program. In the previous
  sentence, expenditures for a drug are `significant' if the drug was one
  of the 1,000 drugs for which the greatest amount of the Federal financial
  assistance attributable to prescription drugs was paid under section 1903(a)
  of the Social Security Act during calendar year 1991.
  (3) SPECIAL RULE FOR INITIAL REPORT- For purposes of the first report
  required to be submitted under paragraph (1)--
  (A) the Secretary shall submit the report not later than May 1, 1993; and
  (B) the information contained in the report shall include information on
  prescription drugs dispensed during each calendar quarter that began on
  or after January 1, 1991, and ended on or before December 31, 1992.
  (e) EFFECTIVE DATE- The amendments made by this section shall apply with
  respect to payments to State plans under title XIX of the Social Security
  Act for calendar quarters (or periods) beginning on or after January 1,
  1993 (without regard to whether or not regulations to carry out such
  amendments have been promulgated by such date).
SEC. 602. LIMITATIONS ON PRICES OF DRUGS PURCHASED BY CERTAIN CLINICS AND
HOSPITALS.
  (a) IN GENERAL- Part D of title III of the Public Health Service Act is
  amended by adding the following subpart:
`Subpart VII--Drug Pricing Agreements
`LIMITATION ON PRICES OF DRUGS PURCHASED BY COVERED ENTITIES
  `SEC. 340B. (a) REQUIREMENTS FOR AGREEMENT WITH SECRETARY-
  `(1) IN GENERAL- The Secretary shall enter into an agreement with each
  manufacturer of covered drugs under which the amount required to be paid
  (taking into account any rebate or discount, as provided by the Secretary) to
  the manufacturer for covered drugs (other than drugs described in paragraph
  (3)) purchased by a covered entity on or after the first day of the first
  month that begins after the date of the enactment of this section, does not
  exceed an amount equal to the average manufacturer price for the drug under
  title XIX of the Social Security Act in the preceding calendar quarter,
  reduced by the rebate percentage described in paragraph (2).
  `(2) REBATE PERCENTAGE DEFINED-
  `(A) IN GENERAL- For a covered outpatient drug purchased in a calendar
  quarter, the `rebate percentage' is the amount (expressed as a percentage)
  equal to--
  `(i) the average total rebate required under section 1927(c) of the Social
  Security Act with respect to the drug (for a unit of the dosage form and
  strength involved) during the preceding calendar quarter; divided by
  `(ii) the average manufacturer price for such a unit of the drug during
  such quarter.
  `(B) OVER THE COUNTER DRUGS-
  `(i) IN GENERAL- For purposes of subparagraph (A), in the case of over
  the counter drugs, the `rebate percentage' shall be determined as if the
  rebate required under section 1927(c) of the Social Security Act is based
  on the applicable percentage provided under section 1927(c)(4) of such Act.
  `(ii) DEFINITION- The term `over the counter drug' means a drug that may
  be sold without a prescription and which is prescribed by a physician
  (or other persons authorized to prescribe such drug under State law).
  `(3) DRUGS PROVIDED UNDER STATE MEDICAID PLANS- Drugs described in this
  paragraph are drugs purchased by the entity for which payment is made by
  the State under the State plan for medical assistance under title XIX of
  the Social Security Act.
  `(4) COVERED ENTITY DEFINED- In this section, the term `covered entity'
  means an entity that meets the requirements described in paragraph (5)
  and is one of the following:
  `(A) A Federally-qualified health center (as defined in section 1905(l)(2)(B)
  of the Social Security Act).
  `(B) An entity receiving a grant under section 340A.
  `(C) A family planning project receiving a grant or contract under
  section 1001.
  `(D) An entity receiving a grant under subpart II of part C of title XXVI
  (relating to categorical grants for outpatient early intervention services
  for HIV disease).
  `(E) A State-operated AIDS drug purchasing assistance program receiving
  financial assistance under title XXVI.
  `(F) A black lung clinic receiving funds under section 427(a) of the Black
  Lung Benefits Act.
  `(G) A comprehensive hemophilia diagnostic treatment center receiving a
  grant under section 501(a)(2) of the Social Security Act.
  `(H) A Native Hawaiian Health Center receiving funds under the Native
  Hawaiian Health Care Act of 1988.
  `(I) An urban Indian organization receiving funds under title V of the
  Indian Health Care Improvement Act.
  `(J) Any entity receiving assistance under title XXVI (other than a State
  or unit of local government or an entity described in subparagraph (D)), but
  only if the entity is certified by the Secretary pursuant to paragraph (7).
  `(K) An entity receiving funds under section 318 (relating to treatment of
  sexually transmitted diseases) or section 317(j)(2) (relating to treatment
  of tuberculosis) through a State or unit of local government, but only if
  the entity is certified by the Secretary pursuant to paragraph (7).
  `(L) A subsection (d) hospital (as defined in section 1886(d)(1)(B) of
  the Social Security Act) that--
  `(i) is owned or operated by a unit of State or local government, is a public
  or private non-profit corporation which is formally granted governmental
  powers by a unit of State or local government, or is a private non-profit
  hospital which has a contract with a State or local government to provide
  health care services to low income individuals who are not entitled to
  benefits under title XVIII of the Social Security Act or eligible for
  assistance under the State plan under this title;
  `(ii) for the most recent cost reporting period that ended before the
  calendar quarter involved, had a disproportionate share adjustment percentage
  (as determined under section 1886(d)(5)(F) of the Social Security Act)
  greater than 11.75 percent or was described in section 1886(d)(5)(F)(i)(II)
  of such Act; and
  `(iii) does not obtain covered outpatient drugs through a group purchasing
  organization or other group purchasing arrangement.
  `(5) REQUIREMENTS FOR COVERED ENTITIES-
  `(A) PROHIBITING DUPLICATE DISCOUNTS OR REBATES-
  `(i) IN GENERAL- A covered entity shall not request payment under title
  XIX of the Social Security Act for medical assistance described in section
  1905(a)(12) of such Act with respect to a drug that is subject to an
  agreement under this section if the drug is subject to the payment of a
  rebate to the State under section 1927 of such Act.
  `(ii) ESTABLISHMENT OF MECHANISM- The Secretary shall establish a mechanism
  to ensure that covered entities comply with clause (i). If the Secretary does
  not establish a mechanism within 12 months under the previous sentence, the
  requirements of section 1927(a)(5)(C) of the Social Security Act shall apply.
  `(B) PROHIBITING RESALE OF DRUGS- With respect to any covered outpatient
  drug that is subject to an agreement under this subsection, a covered
  entity shall not resell or otherwise transfer the drug to a person who is
  not a patient of the entity.
  `(C) AUDITING- A covered entity shall permit the Secretary and the
  manufacturer of a covered outpatient drug that is subject to an agreement
  under this subsection with the entity (acting in accordance with procedures
  established by the Secretary relating to the number, duration, and scope
  of audits) to audit at the Secretary's or the manufacturer's expense the
  records of the entity that directly pertain to the entity's compliance
  with the requirements described in subparagraphs (A) or (B) with respect
  to drugs of the manufacturer.
  `(D) ADDITIONAL SANCTION FOR NONCOMPLIANCE- If the Secretary finds, after
  notice and hearing, that a covered entity is in violation of a requirement
  described in subparagraphs (A) or (B), the covered entity shall be liable
  to the manufacturer of the covered outpatient drug that is the subject of
  the violation in an amount equal to the reduction in the price of the drug
  (as described in subparagraph (A)) provided under the agreement between
  the entity and the manufacturer under this paragraph.
  `(6) TREATMENT OF DISTINCT UNITS OF HOSPITALS- In the case of a covered
  entity that is a distinct part of a hospital, the hospital shall not be
  considered a covered entity under this paragraph unless the hospital is
  otherwise a covered entity under this subsection.
  `(7) CERTIFICATION OF CERTAIN COVERED ENTITIES-
  `(A) DEVELOPMENT OF PROCESS- Not later than 60 days after the date of
  enactment of this subsection, the Secretary shall develop and implement a
  process for the certification of entities described in subparagraphs (J)
  and (K) of paragraph (4).
  `(B) INCLUSION OF PURCHASE INFORMATION- The process developed under
  subparagraph (A) shall include a requirement that an entity applying for
  certification under this paragraph submit information to the Secretary
  concerning the amount such entity expended for covered outpatient drugs
  in the preceding year so as to assist the Secretary in evaluating the
  validity of the entity's subsequent purchases of covered outpatient drugs
  at discounted prices.
  `(C) CRITERIA- The Secretary shall make available to all manufacturers of
  covered outpatient drugs a description of the criteria for certification
  under this paragraph.
  `(D) LIST OF PURCHASERS AND DISPENSERS- The certification process developed
  by the Secretary under subparagraph (A) shall include procedures under
  which each State shall, not later than 30 days after the submission of
  the descriptions under subparagraph (C), prepare and submit a report to
  the Secretary that contains a list of entities described in subparagraphs
  (J) and (K) of paragraph (4) that are located in the State.
  `(E) RECERTIFICATION- The Secretary shall require the recertification of
  entities certified pursuant to this paragraph on a not more frequent than
  annual basis, and shall require that such entities submit information
  to the Secretary to permit the Secretary to evaluate the validity of
  subsequent purchases by such entities in the same manner as that required
  under subparagraph (B).
  `(8) DEVELOPMENT OF PRIME VENDOR PROGRAM- The Secretary shall establish a
  prime vendor program under which covered entities may enter into contracts
  with prime vendors for the distribution of covered outpatient drugs. If a
  covered entity obtains drugs directly from a manufacturer, the manufacturer
  shall be responsible for the costs of distribution.
  `(9) NOTICE TO MANUFACTURERS- The Secretary shall notify manufacturers of
  covered outpatient drugs and single State agencies under section 1902(a)(5)
  of the Social Security Act of the identities of covered entities under
  this paragraph, and of entities that no longer meet the requirements of
  paragraph (5) or that are no longer certified pursuant to paragraph (7).
  `(10) NO PROHIBITION ON LARGER DISCOUNT- Nothing in this subsection shall
  prohibit a manufacturer from charging a price for a drug that is lower
  than the maximum price that may be charged under paragraph (1).
  `(b) OTHER DEFINITIONS- In this section, the terms `average manufacturer
  price', `covered outpatient drug', and `manufacturer' have the meaning
  given such terms in section 1927(k) of the Social Security Act.
  `(c) REFERENCES TO SOCIAL SECURITY ACT- Any reference in this section to
  a provision of the Social Security Act shall be deemed to be a reference
  to the provision as in effect on the date of the enactment of this section.
  `(d) COMPLIANCE WITH REQUIREMENTS- A manufacturer is deemed to meet the
  requirements of subsection (a) if the manufacturer establishes to the
  satisfaction of the Secretary that the manufacturer would comply (and
  has offered to comply) with the provisions of this section (as in effect
  immediately after the enactment of the Veterans Health Care Act of 1992),
  as applied by the Secretary, and would have entered into an agreement
  under this section (as such section was in effect at such time), but for
  a legislative change in this section (or the application of this section)
  after the date of the enactment of such Act.'.
  (b) STUDY OF TREATMENT OF CERTAIN CLINICS AS COVERED ENTITIES ELIGIBLE
  FOR PRESCRIPTION DRUG DISCOUNTS-
  (1) STUDY- The Secretary of Health and Human Services shall conduct a study
  of the feasibility and desirability of including entities described in
  paragraph (3) as covered entities eligible for limitations on the prices
  of covered outpatient drugs under section 340B(a) of the Public Health
  Service Act (as added by subsection (a)).
  (2) REPORT- Not later than 1 year after the date of the enactment of this
  Act, the Secretary shall submit a report to Congress on the study conducted
  under paragraph (1), and shall include in the report--
  (A) a description of the entities that are the subject of the study;
  (B) an analysis of the extent to which such entities procure prescription
  drugs; and
  (C) an analysis of the impact of the inclusion of such entities as covered
  entities under section 340B(a) of the Public Health Service Act on the
  quality of care provided to and the health status of the patients of
  such entities.
  (3) ENTITIES DESCRIBED- An entity described in this paragraph is an entity--
  (A) receiving funds from a State for the provision of mental health or
  substance abuse treatment services under subparts I or II of part B of
  title XIX of the Public Health Service Act or under title V of such Act; or
  (B) receiving funds from a State under title V of the Social Security Act
  for the provision of maternal and child health services that are furnished on
  an outpatient basis (other than an entity described in section 340B(a)(4)(G)
  of the Public Health Service Act).
SEC. 603. LIMITATION ON PRICES OF DRUGS PROCURED BY DEPARTMENT OF VETERANS
AFFAIRS AND CERTAIN OTHER FEDERAL AGENCIES.
  (a) AGREEMENTS WITH SECRETARY OF VETERANS AFFAIRS- (1) Subchapter II of
  chapter 81 is amended by adding at the end the following new section:
`Sec. 8126. Limitation on prices of drugs procured by Department and certain
other Federal agencies
  `(a) Each manufacturer of covered drugs shall enter into a master agreement
  with the Secretary under which--
  `(1) beginning January 1, 1993, the manufacturer shall make available
  for procurement on the Federal Supply Schedule of the General Services
  Administration each covered drug of the manufacturer;
  `(2) with respect to each covered drug of the manufacturer procured by a
  Federal agency described in subsection (b) on or after January 1, 1993,
  that is purchased under depot contracting systems or listed on the Federal
  Supply Schedule, the manufacturer has entered into and has in effect a
  pharmaceutical pricing agreement with the Secretary (or the Federal agency
  involved, if the Secretary delegates to the Federal agency the authority
  to enter into such a pharmaceutical pricing agreement) under which the
  price charged during the one-year period beginning on the date on which
  the agreement takes effect may not exceed 76 percent of the non-Federal
  average manufacturer price (less the amount of any additional discount
  required under subsection (c)) during the one-year period ending one month
  before such date (or, in the case of a covered drug for which sufficient
  data for determining the non-Federal average manufacturer price during
  such period are not available, during such period preceding such date as
  the Secretary considers appropriate), except that such price may nominally
  exceed such amount if found by the Secretary to be in the best interests
  of the Department or such Federal agencies;
  `(3) with respect to each covered drug of the manufacturer procured by
  a State home receiving funds under section 1741 of this title, the price
  charged may not exceed the price charged under the Federal Supply Schedule
  at the time the drug is procured; and
  `(4) unless the manufacturer meets the requirements of paragraphs (1),
  (2), and (3), the manufacturer may not receive payment for the purchase
  of drugs or biologicals from--
  `(A) a State plan under title XIX of the Social Security Act, except as
  authorized under section 1927(a)(3) of such Act,
  `(B) any Federal agency described in subsection (b), or
  `(C) any entity that receives funds under the Public Health Service Act.
  `(b) The Federal agencies described in this subsection are as follows:
  `(1) The Department.
  `(2) The Department of Defense.
  `(3) The Public Health Service, including the Indian Health Service.
  `(c) With respect to any covered drug the price of which is determined in
  accordance with a pharmaceutical pricing agreement entered into pursuant to
  subsection (a)(2), for calendar quarters beginning on or after January 1,
  1993, the manufacturer shall provide a discount in an amount equal to the
  amount by which the change in non-Federal price exceeds the amount equal to--
  `(1) the non-Federal average manufacturer price of the drug during the
  3-month period that ends one year before the last day of the month preceding
  the month during which the contract for the covered drug goes into effect
  (or, in the case of a covered drug for which sufficient data for determining
  the non-Federal average manufacturer price during such period is not
  available, during such period preceding the month during which the contract
  goes into effect as the Secretary considers appropriate); increased by
  `(2) the percentage increase in the Consumer Price Index for all urban
  consumers (U.S. city average) between the last month of the period described
  in paragraph (1) and the last month preceding the month during which the
  contract goes into effect for which Consumer Price Index data is available.
  `(d) In the case of a covered drug of a manufacturer that has entered
  into a multi-year contract with the Secretary under subsection (a)(2)
  for the procurement of the drug--
  `(1) during any one-year period that follows the first year for which the
  contract is in effect, the price charged may not exceed the price charged
  during the preceding one-year period, increased by the percentage increase
  in the Consumer Price Index for all urban consumers (U.S. city average)
  between the last months of such one-year periods for which Consumer Price
  Index data is available; and
  `(2) in applying subsection (c) to determine the amount of the discount
  provided with respect to the drug during a year that follows the first year
  for which the contract is in effect, any reference in such subsection to
  `the month during which the contract goes into effect' shall be considered
  a reference to the first month of such following year.
  `(e)(1) The manufacturer of any covered drug the price of which is determined
  in accordance with a pharmaceutical pricing agreement entered into pursuant
  to subsection (a)(2) shall--
  `(A) not later than 30 days after the first day of the last quarter that
  begins before the agreement takes effect (or, in the case of an agreement
  that takes effect on January 1, 1993, not later than 30 days after the date
  of the enactment of this section), report to the Secretary the non-Federal
  average manufacturer price for the drug during the 1-year period that ends
  on the last day of the previous quarter; and
  `(B) not later than 30 days after the last day of each quarter for which
  the agreement is in effect, report to the Secretary the non-Federal average
  manufacturer price for the drug during such quarter.
  `(2) The provisions of subparagraphs (B) and (C) of section 1927(b)(3)
  of the Social Security Act shall apply to drugs described in paragraph (1)
  and the Secretary in the same manner as such provisions apply to covered
  outpatient drugs and the Secretary of Health and Human Services under such
  subparagraphs, except that references in such subparagraphs to prices or
  information reported or required under `subparagraph (A)' shall be deemed
  to refer to information reported under paragraph (1).
  `(3) In order to determine the accuracy of a drug price that is reported
  to the Secretary under paragraph (1), the Secretary may audit the relevant
  records of the manufacturer or of any wholesaler that distributes the drug,
  and may delegate the authority to audit such records to the appropriate
  Federal agency described in subsection (b).
  `(4) Any information contained in a report submitted to the Secretary under
  paragraph (1) or obtained by the Secretary through any audit conducted
  under paragraph (3) shall remain confidential, except as the Secretary
  determines necessary to carry out this section and to permit the Comptroller
  General and the Director of the Congressional Budget Office to review the
  information provided.
  `(f) The Secretary shall supply to the Secretary of Health and Human
  Services--
  `(1) upon the execution or termination of any master agreement, the name
  of the manufacturer, and
  `(2) on a quarterly basis, a list of manufacturers who have entered into
  master agreements under this section, and
  `(g)(1) Any reference in this section to a provision of the Social Security
  Act shall be deemed to be a reference to the provision as in effect on
  the date of the enactment of this section.
  `(2) A manufacturer is deemed to meet the requirements of subsection
  (a) if the manufacturer establishes to the satisfaction of the Secretary
  that the manufacturer would comply (and has offered to comply) with the
  provisions of this section (as in effect immediately after the enactment of
  this section), and would have entered into an agreement under this section
  (as such section was in effect at such time), but for a legislative change
  in this section after the date of the enactment of this section.
  `(h) In this section:
  `(1) The term `change in non-Federal price' means, with respect to a covered
  drug that is subject to an agreement under this section, an amount equal to--
  `(A) the non-Federal average manufacturer price of the drug during the
  3-month period that ends with the month preceding the month during which
  a contract goes into effect (or, in the case of a covered drug for which
  sufficient data for determining the non-Federal average manufacturer price
  during such period is not available, during such period as the Secretary
  considers appropriate); minus
  `(B) the non-Federal average manufacturer price of the drug during the
  3-month period that ends one year before the end of the period described in
  subparagraph (A) (or, in the case of a covered drug for which sufficient
  data for determining the non-Federal average manufacturer price during
  such period is not available, during such period preceding the period
  described in subparagraph (A) as the Secretary considers appropriate).
  `(2) The term `covered drug' means--
  `(A) a drug described in section 1927(k)(7)(A)(ii) of the Social Security
  Act, or that would be described in such section but for the application
  of the first sentence of section 1927(k)(3) of such Act;
  `(B) a drug described in section 1927(k)(7)(A)(iv) of the Social Security
  Act, or that would be described in such section but for the application
  of the first sentence of section 1927(k)(3) of such Act;
  `(C) any biological product identified under section 600.3 of title 21,
  Code of Federal Regulations; or
  `(D) insulin certified under section 506 of the Federal Food, Drug, and
  Cosmetic Act.
  `(3) The term `depot' means a centralized commodity management system through
  which covered drugs procured by an agency of the Federal Government are--
  `(A) received, stored, and delivered through--
  `(i) a federally owned and operated warehouse system, or
  `(ii) a commercial entity operating under contract with such agency; or
  `(B) delivered directly from the commercial source to the entity using
  such covered drugs.
  `(4) The term `manufacturer' means any entity which is engaged in--
  `(A) the production, preparation, propagation, compounding, conversion,
  or processing of prescription drug products, either directly or indirectly
  by extraction from substances of natural origin, or independently by means
  of chemical synthesis, or by a combination of extraction and chemical
  synthesis, or
  `(B) in the packaging, repackaging, labeling, relabeling, or distribution
  of prescription drug products.
Such term does not include a wholesale distributor of drugs or a retail
pharmacy licensed under State law.
  `(5) The term `non-Federal average manufacturer price' means, with respect
  to a covered drug and a period of time (as determined by the Secretary),
  the weighted average price of a single form and dosage unit of the drug
  that is paid by wholesalers in the United States to the manufacturer,
  taking into account any cash discounts or similar price reductions during
  that period, but not taking into account--
  `(A) any prices paid by the Federal Government; or
  `(B) any prices found by the Secretary to be merely nominal in amount.
  `(6) The term `weighted average price' means, with respect to a covered drug
  and a period of time (as determined by the Secretary) an amount equal to--
  `(A) the sum of the products of the average price per package unit of
  each quantity of the drug sold during the period and the number of package
  units of the drug sold during the period; divided by
  `(B) the total number of package units of the drug sold during the period.'.
  (2) The table of sections at the beginning of such chapter is amended by
  inserting after the item relating to section 8125 the following new item:
`8126. Limitation on prices of drugs procured by Department.'.
TITLE VII--PERSIAN GULF WAR VETERANS' HEALTH STATUS
SEC. 701. SHORT TITLE.
  This title may be cited as the `Persian Gulf War Veterans' Health Status
  Act'.
SEC. 702. PERSIAN GULF WAR VETERANS HEALTH REGISTRY.
  (a) ESTABLISHMENT OF REGISTRY- The Secretary of Veterans Affairs shall
  establish and maintain a special record to be known as the `Persian Gulf War
  Veterans Health Registry' (in this section referred to as the `Registry').
  (b) CONTENTS OF REGISTRY- Except as provided in subsection (c), the Registry
  shall include the following information:
  (1) A list containing the name of each individual who served as a member
  of the Armed Forces in the Persian Gulf theater of operations during the
  Persian Gulf War and who--
  (A) applies for care or services from the Department of Veterans Affairs
  under chapter 17 of title 38, United States Code;
  (B) files a claim for compensation under chapter 11 of such title on the
  basis of any disability which may be associated with such service;
  (C) dies and is survived by a spouse, child, or parent who files a claim
  for dependency and indemnity compensation under chapter 13 of such title
  on the basis of such service;
  (D) requests from the Department a health examination under section 703; or
  (E) receives from the Department of Defense a health examination similar
  to the health examination referred to in subparagraph (D) and requests
  inclusion in the Registry.
  (2) Relevant medical data relating to the health status of, and other
  information that the Secretary considers relevant and appropriate with
  respect to, each individual described in paragraph (1) who--
  (A) grants to the Secretary permission to include such information in the
  Registry; or
  (B) at the time the individual is listed in the Registry, is deceased.
  (c) INDIVIDUALS SUBMITTING CLAIMS OR MAKING REQUESTS BEFORE DATE
  OF ENACTMENT- If in the case of an individual described in subsection
  (b)(1) the application, claim, or request referred to in such subsection
  was submitted, filed, or made, before the date of the enactment of this
  Act, the Secretary shall, to the extent feasible, include in the Registry
  such individual's name and the data and information, if any, described in
  subsection (b)(2) relating to the individual.
  (d) DEPARTMENT OF DEFENSE INFORMATION- The Secretary of Defense shall
  furnish to the Secretary of Veterans Affairs such information maintained
  by the Department of Defense as the Secretary of Veterans Affairs considers
  necessary to establish and maintain the Registry.
  (e) RELATION TO DEPARTMENT OF DEFENSE REGISTRY- The Secretary of Veterans
  Affairs, in consultation with the Secretary of Defense, shall ensure that
  information is collected and maintained in the Registry in a manner that
  permits effective and efficient cross-reference between the Registry
  and the registry established under section 734 of the National Defense
  Authorization Act for Fiscal Years 1992 and 1993 (Public Law 102-190;
  105 Stat. 1411; 10 U.S.C. 1074 note), as amended by section 704.
  (f) ONGOING OUTREACH TO INDIVIDUALS LISTED IN REGISTRY- The Secretary of
  Veterans Affairs shall, from time to time, notify individuals listed in the
  Registry of significant developments in research on the health consequences
  of military service in the Persian Gulf theater of operations during the
  Persian Gulf War.
SEC. 703. HEALTH EXAMINATIONS AND COUNSELING FOR VETERANS ELIGIBLE FOR
INCLUSION IN CERTAIN HEALTH-RELATED REGISTRIES.
  (a) IN GENERAL- (1) The Secretary of Veterans Affairs--
  (A) shall, upon the request of a veteran described in subsection (b)(1),
  provide the veteran with a health examination and consultation and counseling
  with respect to the results of the examination; and
  (B) may, upon the request of a veteran described in subsection (b)(2),
  provide the veteran with such an examination and such consultation and
  counseling.
  (2) The Secretary shall carry out appropriate outreach activities with
  respect to the provision of any health examinations and consultation and
  counseling services under paragraph (1).
  (b) COVERED VETERANS- (1) In accordance with subsection (a)(1)(A), the
  Secretary shall provide an examination, consultation, and counseling under
  that subsection to any veteran who is eligible for listing or inclusion
  in the Persian Gulf War Veterans Health Registry established by section 702.
  (2) In accordance with subsection (a)(1)(B), the Secretary may provide an
  examination, consultation, and counseling under that subsection to any
  veteran who is eligible for listing or inclusion in any other similar
  health-related registry administered by the Secretary.
SEC. 704. EXPANSION OF COVERAGE OF PERSIAN GULF REGISTRY.
  (a) IN GENERAL- Subsections (a) and (b) of section 734 of the National
  Defense Authorization Act for Fiscal Years 1992 and 1993 (Public Law 102-190;
  105 Stat. 1411; 10 U.S.C. 1074 note) are amended to read as follows:
  `(a) ESTABLISHMENT OF REGISTRY- The Secretary of Defense shall establish and
  maintain a special record (in this section referred to as the `Registry')
  relating to the following members of the Armed Forces:
  `(1) Members who, as determined by the Secretary, were exposed to the fumes
  of burning oil in the Operation Desert Storm theater of operations during
  the Persian Gulf conflict.
  `(2) Any other members who served in the Operation Desert Storm theater
  of operations during the Persian Gulf conflict.
  `(b) CONTENTS OF REGISTRY- (1) The Registry shall include--
  `(A) with respect to each class of members referred to in each of paragraphs
  (1) and (2) of subsection (a)--
  `(i) a list containing each such member's name and other relevant identifying
  information with respect to the member; and
  `(ii) to the extent that data are available and inclusion of the data
  is feasible, a description of the circumstances of the member's service
  during the Persian Gulf conflict, including the locations in the Operation
  Desert Storm theater of operations in which such service occurred and the
  atmospheric and other environmental circumstances in such locations at
  the time of such service; and
  `(B) with respect to the members referred to in subsection (a)(1), a
  description of the circumstances of each exposure of each such member to
  the fumes of burning oil as described in such subsection (a)(1), including
  the length of time of the exposure.
  `(2) The Secretary shall establish the Registry with the advice of an
  independent scientific organization.'.
  (b) CONFORMING AMENDMENTS- (1) Subsection (c)(1) of such section is amended
  by striking out `subsection (a)' and inserting in lieu thereof `subsection
  (a)(1)'.
  (2) Subsection (d) of such section is amended by inserting `pursuant to
  subsection (a)(1)' after `Registry'.
SEC. 705. STUDY BY OFFICE OF TECHNOLOGY ASSESSMENT OF PERSIAN GULF REGISTRY
AND PERSIAN GULF WAR VETERANS HEALTH REGISTRY.
  (a) STUDY- The Director of the Office of Technology Assessment shall,
  in a manner consistent with the Technology Assessment Act of 1972 (2
  U.S.C. 472(d)), assess--
  (1) the potential utility of each of the Persian Gulf Registry and the
  Persian Gulf War Veterans Health Registry for scientific study and assessment
  of the intermediate and long-term health consequences of military service
  in the Persian Gulf theater of operations during the Persian Gulf War;
  (2) the extent to which each registry meets the requirements of the
  provisions of law under which the registry is established;
  (3) the extent to which data contained in each registry--
  (A) are maintained in a manner that ensures permanent preservation and
  facilitates the effective, efficient retrieval of information that is
  potentially relevant to the scientific study of the intermediate and
  long-term health consequences of military service in the Persian Gulf
  theater of operations during the Persian Gulf War; and
  (B) would be useful for scientific study regarding such health consequences;
  (4) the adequacy of any plans to update each of the registries;
  (5) the extent to which the Department of Defense or the Department
  of Veterans Affairs, as the case may be, is assembling and maintaining
  information on the Persian Gulf theater of operations (including information
  on troop locations and atmospheric and weather conditions) in a manner that
  facilitates the usefulness of, maintenance of, and retrieval of information
  from, the applicable registry; and
  (6) the adequacy and compatibility of protocols for the health examinations
  and counseling provided under section 703 and health examinations provided
  by the Department of Defense to members of the Armed Forces for the purpose
  of assessing the health status of members of the Armed Forces who served
  in the Persian Gulf theater of operations during the Persian Gulf War.
  (b) ACCESS TO INFORMATION- The Secretary of Veterans Affairs and the
  Secretary of Defense shall provide the Director with access to such
  records and information under the jurisdiction of each such secretary as
  the Director determines necessary to permit the Director to carry out the
  study required under this section.
  (c) REPORTS- The Director shall--
  (1) not later than 270 days after the date of the enactment of this Act,
  submit to Congress a report on the results of the assessment carried out
  under this section of the Persian Gulf Registry and health-examination
  protocols; and
  (2) not later than 15 months after such date, submit to Congress a report
  on the results of the assessment carried out under this section of the
  Persian Gulf War Veterans Health Registry.
  (d) DEFINITIONS- For the purposes of this section:
  (1) The term `Persian Gulf Registry' means the registry established under
  section 734 of the National Defense Authorization Act for Fiscal Years
  1992 and 1993 (Public Law 102-190; 105 Stat. 1411; 10 U.S.C. 1074 note),
  as amended by section 704.
  (2) The term `Persian Gulf War Veterans Health Registry' means the Persian
  Gulf War Veterans Health Registry established under section 702.
SEC. 706. AGREEMENT WITH NATIONAL ACADEMY OF SCIENCES FOR REVIEW OF HEALTH
CONSEQUENCES OF SERVICE DURING THE PERSIAN GULF WAR.
  (a) AGREEMENT- (1) The Secretary of Veterans Affairs and Secretary of Defense
  jointly shall seek to enter into an agreement with the National Academy
  of Sciences for the Medical Follow-Up Agency (MFUA) of the Institute of
  Medicine of the Academy to review existing scientific, medical, and other
  information on the health consequences of military service in the Persian
  Gulf theater of operations during the Persian Gulf War.
  (2) The agreement shall require MFUA to provide members of veterans
  organizations and members of the scientific community (including the Director
  of the Office of Technology Assessment) with the opportunity to comment
  on the method or methods MFUA proposes to use in conducting the review.
  (3) The agreement shall permit MFUA, in conducting the review, to examine and
  evaluate medical records of individuals who are included in the registries
  referred to in section 705(d) for purposes that MFUA considers appropriate,
  including the purpose of identifying illnesses of those individuals.
  (4) The Secretary of Veterans Affairs and the Secretary of Defense shall
  seek to enter into the agreement under this section not later than 180
  days after the date of the enactment of this Act.
  (b) REPORT- (1) The agreement under this section shall require the National
  Academy of Sciences to submit to the committees and secretaries referred
  to in paragraph (2) a report on the results of the review carried out
  under the agreement. Such report shall contain the following:
  (A) An assessment of the effectiveness of actions taken by the Secretary
  of Veterans Affairs and the Secretary of Defense to collect and maintain
  information that is potentially useful for assessing the health consequences
  of the military service referred to in subsection (a).
  (B) Recommendations on means of improving the collection and maintenance
  of such information.
  (C) Recommendations on whether there is sound scientific basis for an
  epidemiological study or studies on the health consequences of such service,
  and if the recommendation is that there is sound scientific basis for such
  a study or studies, the nature of the study or studies.
  (2) The committees and secretaries referred to in paragraph (1) are the
  following:
  (A) The Committees on Veterans' Affairs of the Senate and House of
  Representatives.
  (B) The Committees on Armed Services of the Senate and House of
  Representatives.
  (C) The Secretary of Veterans Affairs.
  (D) The Secretary of Defense.
  (c) FUNDING- (1) The Secretary of Veterans Affairs and the Secretary of
  Defense shall make available up to a total of $500,000 in fiscal year
  1993, from funds available to the Department of Veterans Affairs and the
  Department of Defense in that fiscal year, to carry out the review. Any
  amounts provided by the two departments shall be provided in equal amounts.
  (2) If the Secretary of Veterans Affairs and the Secretary of Defense
  enter into an agreement under subsection (a) with the National Academy
  of Sciences--
  (A) the Secretary of Veterans Affairs shall make available $250,000 in each
  of fiscal years 1994 through 2003, from amounts available to the Department
  of Veterans Affairs in each such fiscal year, to the National Academy of
  Sciences for the general purposes of conducting epidemiological research
  with respect to military and veterans populations; and
  (B) the Secretary of Defense shall make available $250,000 in each of
  fiscal years 1994 through 2003, from amounts available to the Department of
  Defense in each such fiscal year, to the National Academy of Sciences for
  the purposes of carrying out the research referred to in subparagraph (A).
SEC. 707. COORDINATION OF GOVERNMENT ACTIVITIES ON HEALTH-RELATED RESEARCH
ON THE PERSIAN GULF WAR.
  (a) DESIGNATION OF COORDINATING ORGANIZATION- The President shall designate,
  and may redesignate from time to time, the head of an appropriate department
  or agency of the Federal Government to coordinate all research activities
  undertaken or funded by the Executive Branch of the Federal Government on
  the health consequences of military service in the Persian Gulf theater
  of operations during the Persian Gulf War.
  (b) REPORT- Not later than March 1 of each year, the head of the department
  or agency designated under subsection (a) shall submit to the Committees
  on Veterans' Affairs of the Senate and House of Representatives a report
  on the status and results of all such research activities undertaken or
  by the Executive Branch of the Federal Government during the previous year.
SEC. 708. DEFINITION.
  For the purposes of this title, the term `Persian Gulf War' has the meaning
  given such term in section 101(33) of title 38, United States Code.
TITLE VIII--COURT OF VETERANS APPEALS
SEC. 801. DISCIPLINARY PROCEDURES FOR JUDGES OF COURT OF VETERANS APPEALS.
  Section 7253(g) is amended--
  (1) by inserting `(1)' after `(g)'; and
  (2) by adding at the end the following:
  `(2) The provisions of paragraphs (7) through (15) of section 372(c) of
  title 28, regarding referral or certification to, and petition for review
  in, the Judicial Conference of the United States and action thereon,
  shall apply to the exercise by the Court of the powers of a judicial
  council under paragraph (1) of this subsection. The grounds for removal
  from office specified in subsection (f)(1) shall provide a basis for a
  determination pursuant to paragraph (7) or (8) of section 372(c) of title
  28, and certification and transmittal by the Conference shall be made to
  the President for consideration under subsection (f).
  `(3)(A) In conducting hearings pursuant to paragraph (1), the Court may
  exercise the authority provided under section 1821 of title 28 to pay the
  fees and allowances described in that section.
  `(B) The Court shall have the power provided under section 372(c)(16) of
  title 28 to award reimbursement for the reasonable expenses described in
  that section. Reimbursements under this subparagraph shall be made from
  funds appropriated to the Court.'.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.