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

Bill summaries are authored by CRS.

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House agreed to Senate amendment with amendment (10/06/1992)

Veterans Health Care Act of 1992 - Title I: Women Veterans Health Programs - Women Veterans Health Programs Act of 1992 - Authorizes the Secretary of Veterans Affairs, through December 31, 1995, to provide counseling to a woman veteran whom the Secretary of Health and Human Services determines requires such counseling to overcome psychological trauma which, in the judgment of a mental health professional employed by the Department of Veterans Affairs, resulted from a physical assault, battery, or harassment of a sexual nature which occurred while the veteran was serving on active duty. Requires such a woman veteran to seek such counseling within two years after her date of discharge or release from active duty. Allows the Secretary, through December 31, 1994, to provide such counseling through a contract with a qualified mental health professional under certain conditions. Limits any counseling to a one-year period, unless the Secretary determines that a longer period is required. Requires the Secretary to give priority to the establishment of the women veterans counseling program and to provide information concerning the availability of such services to eligible women veterans. Allows such information to include the establishment of a toll-free telephone number. Requires coordination with the Secretary of Defense for informing newly released women veterans of such program. Provides a priority for such women veterans among veterans receiving outpatient care from the Department. Directs the Secretary to commence the provision of information on the sexual trauma counseling within 90 days after the enactment of this Act. Directs the Secretary to report to the Senate and House Veterans' Affairs Committees (veterans' committees) on actions taken with respect to the counseling program.

Authorizes the Secretary, in furnishing hospital care and medical services to veterans, to provide to women the following health care services: (1) pap smears; (2) breast examinations and mammography; and (3) general reproductive health care, including the management of menopause, but excluding infertility services, abortions, or pregnancy care (with an exception). Requires the Secretary to ensure that directors of Department medical facilities identify and assess the opportunities to: (1) expand the availability of, and access to, health care services for women veterans; and (2) provide the counseling, care, and services authorized under this title.

Directs the Secretary, in 1993 through 1995, to report to the veterans' committees on the provision of health care and the conduct of research carried out by, or under the jurisdiction of, the Secretary relating to women veterans.

Requires the Secretary to ensure that an official in each regional office of the Veterans Health Administration (VHA) of the Department serve as a coordinator of women's services, outlining such coordinator's responsibilities.

Directs the Secretary to foster and encourage the initiation and expansion of research relating to the health of women veterans. Authorizes appropriations.

Directs the Secretary, only with funds expressly so provided in an appropriations Act, to study and report to the veterans' committees on the needs of women veterans for health care services. Authorizes appropriations.

Title II: Health-Care Sharing Agreements Between Department of Veterans Affairs and Department of Defense - Authorizes the Secretary to enter into an agreement with the Secretary of Defense to expand the availability of health-care sharing arrangements with the Department of Defense (DOD). Allows a proposed agreement entered into by the head of a Department medical facility to take effect only if the Chief Medical Director (CMD) of the VHA certifies to the Secretary that implementation of such agreement: (1) will result in the improvement of services to eligible veterans at such facility; and (2) will not result in the denial of, or delay in providing, access to care for any veteran at such facility. Provides that such agreement will pertain to primary beneficiaries of veterans (surviving spouses and natural or adopted children). Allows covered beneficiaries receiving care or services at either a Department or DOD facility to receive such services: (1) without regard to any otherwise applicable copayment or deductible; or (2) subject to a requirement to pay only part of any such copayment or deductible as specified in agreement guidelines. Terminates the authority to provide services under the sharing agreements on October 1, 1996.

Directs the Secretary, in carrying out this title, to consult with specified veterans service organizations.

Directs the Secretaries of Veterans Affairs and Defense, for each of FY 1993 through 1996, to include in a previously required annual report a description of their implementation of this title. Requires additional information to be included in the 1996 report.

Title III: Nurse Pay - Revises the pay schedule for nurses employed in the Department to include pay levels I through V (currently, there are only four such pay grades). Directs the Secretary to establish and adjust the pay rates for covered positions at Department health-care facilities in order to recruit and retain a sufficient number of qualified health-care personnel at Department health-care facilities outside the 50 States.

Outlines conditions under which a director of a Department health care facility may use data concerning the beginning pay for nurse anesthetists in the local market when determining the appropriate starting salary for such nurses. Terminates the authority to use such data on April 1, 1995.

Provides that, in the case of a Department nurse who is transferred to another Department facility at the request of the Secretary, the Secretary may pay, for the first year of such transfer, the rate of basic pay up to the rate applicable to such employee prior to such transfer if necessary to fill that position.

Directs the Secretary to conduct a review of, prescribe revised standards for, and report to the veterans' committees on, the qualifications used for nursing personnel at Department health-care facilities and the relationship between such standards and the compression of nursing personnel in the existing intermediate and senior grades.

Directs the Secretary to review and report to the veterans' committees on: (1) the process for determining the rate of basic pay applicable to the Chief Nurse position at Department health-care facilities; and (2) the relationship between such pay rate and the rate applicable to nurses in subordinate positions.

Directs the Secretary to include, in a currently required report, information as to: (1) the number of nurses, by facility and pay grade, on pay retention or in the top step of any grade; and (2) whether an extension of such pay grades was sought and granted or denied.

Title IV: State Home Amendments - Prohibits a veteran's participation in a program of rehabilitative services that is provided as part of a veteran's care furnished by a State home and approved by the Secretary as conforming to applicable standards from being considered a basis for the denial or discontinuance of a rating of total disability for purposes of compensation or pension. Includes a veterans's receipt of a payment or distribution of funds as a result of participation in such activities within such prohibition.

Makes permanent (currently terminates on September 30, 1992) the authority of the Secretary to make grants to States for the construction of State home facilities for veterans.

Extends from 90 to 180 days the time period for a State to meet all necessary grant requirements relating to the construction of State veterans' homes after receiving the Secretary's conditional approval for such construction. Prohibits the Secretary from obligating any further funds for a grant after rescinding a conditional approval.

Revises the determination of the commencement of the 20-year period following such a construction project after which, if the building is no longer used for approved purposes, the Secretary may recapture certain project costs.

Provides for the determination of the commencement date for the payment of per diem funds to State homes for care furnished to veterans.

Title V: General Health Care and Administration - Subtitle A: General Health - Authorizes the Department to contract with non-Department health care facilities for the treatment of a disability of a veteran who suffers from a permanent service-connected disability.

Makes permanent (currently expires September 30, 1992) the authority of certain veterans to receive respite care.

Extends through FY 1994 the Secretary's authority to contract with the Veterans Memorial Medical Center, Philippines, for the care and treatment of U.S. veterans.

Subtitle B: Preventive Health - Directs the CMD to operate in the VHA a National Center for Preventive Health. Designates the Director of Preventive Health as the head of the Center.

Requires the Center to: (1) provide a central office for monitoring and encouraging the activities of the VHA with respect to the provision, evaluation, and improvement of preventive health services; and (2) promote the expansion and improvement of clinical, research, and educational activities of the VHA with respect to such services. Authorizes appropriations to the Medical Care General and Special Fund of the Department for each fiscal year for activities of the Center. Outlines provisions concerning the selection of the facility at which the Center is to be established.

Directs the Secretary to report annually to the veterans' committees on preventive health services conducted by the Department. Requires a fund expenditures accounting to be included in each such report.

Repeals current provisions of Federal law with respect to a preventive health-care service pilot program.

Subtitle C: Health Care Administration and Personnel - Directs the Assistant CMD to establish a review panel to assess the scientific and clinical merit of proposals submitted to the Secretary for the establishment at Department health-care facilities of geriatric research, education, and clinical centers. Prohibits the Secretary from designating a facility for such a center unless the review panel has determined that such facility has met the highest competitive standards of scientific and clinical merit. Exempts the panel from provisions of the Federal Advisory Committee Act.

Extends through December 31, 1994, the authority to waive certain limitations applicable to the receipt of retirement pay by nurses.

Extends through December 31, 1995, the authority of the Secretary to furnish scholarships to new participants in the Health Professionals Scholarship Program. Prohibits the Secretary from paying Department health-care employees for the payment of tuition loans.

Directs the Secretary to release all restrictions and conditions imposed in a quitclaim deed executed previously by the former Administrator of Veterans Affairs with respect to a tract of land at Temple Junior College, Temple, Texas. Requires a monetary consideration to be paid before such release.

Directs the Secretary to carry out a demonstration project to evaluate the feasibility of providing individual telephone service in patient rooms in Department health care facilities which currently do not provide such service. Requires patients to bear the cost of any long-distance calls. Requires an evaluation report to the veterans' committees by the Secretary.

Directs the Secretary to ensure that, to the extent consistent with medical requirements and limitations, each Department health care facility establishes and maintains a suitable indoor area for patient and resident smoking and provides access to such area for the patients and residents. Requires various reports concerning the effectiveness of such program.

Title VI: Drug Pricing Agreements - Amends title XIX (Medicaid) of the Social Security Act to exclude the prices charged on or after October 1, 1992, for prescription drugs purchased by the Department, DOD, a State veterans' home receiving certain grant funds, the Indian and Public Health Services, or certain federally funded clinics and public or private nonprofit hospitals from the calculation of best price procurement for purposes of application of Medicaid rebate agreements.

Requires an agreement between the Secretary of Health and Human Services (HHS) and a covered drug manufacturer limiting the purchase price of drugs procured by covered entities (the federally-funded clinics and public or private nonprofit hospitals referred to above).

Provides that if the HHS Secretary does not establish a certain mechanism under the Public Health Service Act below: (1) each covered entity must inform the applicable State agency when it seeks reimbursement under Medicaid for covered drugs subject to an agreement (described below); and (2) such State agency must provide a means by which the entity must indicate on any claims form that the drug is subject to such agreement, and not submit to any manufacturer a claim for a rebate payment under Medicaid.

Outlines requirements relating to master agreements for drugs procured by the Department and certain other Federal agencies.

Revises provisions respecting rebate agreement termination.

Provides a new determination of the basic Medicaid rebate for single source and innovator multiple source drugs for specified calendar quarters beginning after September 30, 1992.

Directs the HHS Secretary to report to the Congress specified information relating to Medicaid best price changes and rebate payments. Prohibits such reports from containing information on any prescription drug unless the HHS Secretary finds that expenditures for the drug are significant expenditures under the Medicaid drug purchase and rebate program.

Amends the Public Health Service Act to require an agreement between the HHS Secretary and a covered drug manufacturer limiting the purchase price of drugs procured by covered entities (the federally-funded clinics and public and private nonprofit hospitals referred to above).

Requires covered entities, in order to receive reduced prices, to: (1) take certain steps to avoid duplicative discounts or rebates; (2) refrain from reselling such purchased drug to a person who is not a patient of such entity; and (3) permit audits of records in order to determine agreement compliance. Makes covered entities liable to the manufacturer for the full amount of any reduced price if the HHS Secretary determines agreement noncompliance on the entity's part.

Requires the HHS Secretary to: (1) establish a mechanism to ensure that covered entities comply with item (1) in the list above; (2) develop a process for the certification of certain covered entities; (3) establish a prime vendor program under which covered entities may enter into contracts with prime vendors for the distribution of covered outpatient drugs; and (4) notify covered drug manufacturers and single State agencies of the identities of covered entities.

Requires the HHS Secretary to study and report to the Congress on whether to include certain clinics as covered entities eligible for prescription drug discounts.

Amends Federal veterans' benefits law to require agreements between the Secretary and covered drug manufacturers limiting the purchase price of drugs procured by the Department and certain other Federal agencies. Provides for additional discounts for covered drugs purchased under the depot contracting system or listed on the Federal Supply Schedule. Requires certain manufacturer reports to the Secretary on drug prices. Authorizes the Secretary to audit relevant manufacturer or wholesaler records. Requires the Secretary to supply to the HHS Secretary the name of the manufacturer upon the execution or termination of any master agreement and, on a quarterly basis, a list of manufacturers who have entered into such agreements.

Title VII: Persian Gulf War Veterans' Health Status - Persian Gulf War (War) Veterans' Health Status Act - Directs the Secretary to establish and maintain a Persian Gulf War Veterans Health Registry. Requires the Secretary of Defense to furnish necessary information. Requires the Registry information to be collected and maintained so as to enable easy cross-reference with a DOD registry previously established under the National Defense Authorization Act for Fiscal Years 1992 and 1993. Directs the Secretary to notify individuals in the Registry from time to time on significant developments in research on the health consequences of military service during the War.

Directs the Secretary to provide a health examination, consultation, and counseling to any veterans eligible for listing or inclusion in the Registry. Authorizes the Secretary to provide such examination, consultation, and counseling to any veteran eligible for listing or inclusion in any other similar health-related registry administered by the Secretary.

Amends the National Defense Authorization Act for Fiscal Years 1992 and 1993 to direct the Secretary of Defense to establish a special record for members of the armed forces who served in Operation Desert Storm during the War or who were exposed to the fumes of burning oil there. Requires such Secretary to establish such record with the advice of an independent scientific organization.

Requires the Director of the Office of Technology Assessment to undertake a study making certain assessments with respect to the Registry and its utility and effectiveness in serving the needs of members serving in the War. Directs each Secretary to provide the Director with access to required information in carrying out such study. Requires reports to the Congress by the Director.

Directs each Secretary to jointly seek to enter into an agreement with the Medical Follow-Up Agency (MFUA) of the National Academy of Sciences to review existing medical, scientific, and other information on the health consequences of military service in the Persian Gulf theater during such War. Permits MFUA, in conducting the review, to examine and evaluate the medical records of individuals included in the Registry and special record in order to identify illnesses. Requires such agreement to be entered into within 180 days after enactment of this Act. Requires the Academy to report to each Secretary and specified congressional committees on the results of the review carried out under the joint agreement. Requires each Secretary to provide amounts from their respective Department's FY 1993 funding to carry out the review. Provides that, if an agreement is reached with the Academy, each Secretary shall provide the Academy with funds in each of fiscal years 1994 through 2003 for conducting epidemiological research with respect to military and veteran populations.

Directs the President to designate (with authorized redesignation from time to time) the head of an appropriate Federal department or agency to coordinate all research activities undertaken by the executive branch on the health consequences of military service in the Persian Gulf theater of operations during such War. Requires the department or agency head so chosen to report annually to the veterans' committees on the status and results of all such research activities during the previous year.

Title VIII: Court of Veterans Appeals - Provides that Federal provisions relating to the bringing of a complaint alleging prejudicial judicial misconduct shall apply to the exercise by the Court of Veterans Appeals of its judicial powers. Authorizes the Court, in the conduct of hearings concerning judicial complaints, to pay appropriate per diem and fee expenses of witnesses. Empowers the Court to award reimbursement for the reasonable expenses incurred by a judge or magistrate during an investigation.