Veterans' Benefits and Services Act of 1988

(Conference report filed in House, H. Rept. 100-578)

Veterans' Benefits and Services Act of 1988 - Title I: Health-Care Programs - Part A: Benefits - Amends Federal veterans' benefits provisions to require (currently, authorizes) the Administrator of Veterans Affairs to furnish, on an outpatient or ambulatory basis, needed medical services to a veteran for any service-connected disability, or for any disability of a veteran having a service-connected disability rating of 50 percent or more. Requires the Administrator to provide such services to any veteran receiving benefits due to being disabled during treatment or vocational rehabilitation. Repeals provisions authorizing the Administrator to provide necessary home health services to such veterans. Directs the Administrator to furnish (on an outpatient or ambulatory basis) medical services to any veteran who: (1) has a service-connected disability rating of either 30 or 40 percent; and (2) is eligible for hospital care and whose annual income does not exceed the maximum annual rate of pension that would be applicable to the veteran if the veteran were currently eligible for such pension.

Authorizes the Administrator to furnish, on an ambulatory or outpatient basis, needed medical services to any veteran: (1) who is in receipt of increased pension or additional compensation based on the need of regular aid and attendance or by reason of being permanently housebound; (2) who is a former prisoner of war; (3) of the Mexican border period or of World War I; or (4) who is eligible for hospital care under current veterans' benefits provisions. Defines medical services as those reasonably necessary in preparation for hospital admission or to obviate the need of hospital admission. Defines medical services for purposes of veterans who have been furnished hospital, nursing home, or domiciliary care. Prohibits such services from being provided for a period in excess of 12 months after the veteran is discharged from such care. Revises the priority among specified veterans for the receipt of outpatient services. Authorizes the Administrator to furnish such home health services, as part of necessary outpatient or ambulatory services, as deemed necessary or appropriate for the effective and economical treatment of the veterans' disabilities. Authorizes home improvements and structural alterations to be provided as part of such home services as necessary, while specifically limiting the maximum cost of such alterations or improvements.

Limits the eligibility for domiciliary care to veterans who have: (1) incomes at or below the pension aid-and-attendance level; or (2) no adequate means of support.

Revises the definition of "nursing home care" to include nursing care delivered in skilled, intermediate, and combined facilities and to exclude the provision of domiciliary care.

Authorizes the Veterans Administration (VA) to contract, on an inpatient or outpatient basis, for emergency care for veterans who have been placed in community nursing homes at VA expense, and for diagnostic services to determine eligibility for a VA benefit.

Authorizes the VA to furnish medical care outside the United States for the service-connected disability of a veteran who is in Canada, the Philippines, or, at the discretion of the Administrator, elsewhere.

Reduces from six months to 90 days the minimum internment period required for former prisoners of war to be eligible for outpatient dental care.

Repeals the current mandatory requirement for the transition from the provision of veterans' readjustment counseling services in facilities primarily set apart from health-care facilities operated by the VA to the provision of such services primarily through VA-operated facilities. Requires the Administrator, after considering the recommendations of the Chief Medical Director of the VA, to submit to the Congress a national plan which sets forth plans with respect to each veterans center in existence on January 1, 1988, for not less than the next year as to its relocation to another VA facility, movement to another location, or closure, and which includes an evaluation of the ways in which decisions about each center would ensure the continued availability of readjustment counseling to persons eligible and needing such services in the geographical area served by such center. Requires the national plan to also include plans to open any new centers. Prohibits any action from being taken with respect to any existing center prior to receipt of the national plan and for 120 days thereafter. Specifies that, after the national plan is submitted, if the VA wishes to change its plans as to one or more centers, the Administrator must submit a revision of the national plan for centers in accordance with the same type of reporting requirements as apply to the initial plan, and to explain the basis for the changes in the plan. Provides that no action outlined in any such revision may be implemented prior to 60 days after such plan revision. Provides that, once the plan is submitted, action may be taken as to the centers covered in the plan only in the way described in the plan or the plan revision. Prohibits delegation of the Chief Medical Director's responsibility relating to the national plan. Postpones by one year the due date of a report from the Administrator on the effectiveness of the readjustment counseling program in meeting the readjustment needs of the Vietnam-era veterans.

Provides that payments shall be made to eligible veterans traveling to or from a VA facility or other place for the following purposes: (1) scheduled care or examination; (2) outpatient care or admission to an inpatient health-care facility; (3) VA examination, treatment, or care; or (4) vocational rehabilitation. Provides that the following categories of veterans are eligible for such payments: (1) veterans traveling for care in connection with a service-connected disability; (2) veterans with a service-connected disability rated at 30 percent or more; (3) veterans whose annual income does not exceed the maximum annual rate of pension which would be payable if the veterans were eligible for such pension; (4) veterans who are determined by the Administrator to be unable to defray the expenses of such travel; (5) veterans receiving a pension; and (6) veterans traveling for the purpose of a compensation and pension examination.

Limits the amount that the Administrator may deduct from payments to a person required to make six or more one-way trips during any month. Prohibits a deduction to be taken from payments made to a person using a special mode of transportation previously authorized. Authorizes the Administrator to waive such deduction in the case of any person for whom the imposition of such deduction would cause severe financial hardship. Directs the Administrator to adjust proportionately the deduction taken whenever the rates of travel expense payments are increased or decreased.

Requires the Administrator, in consultation and coordination with the Secretary of Transportation and veterans' organizations, to take all appropriate steps to facilitate the establishment and maintenance of local transportation networks under which the organization, or individuals who are volunteering their services to the VA, would take responsibility for the transportation of veterans to VA facilities without reimbursement from the VA. Directs the Administrator, no later than six months after the enactment of this Act, to report to the Senate and House Veterans' Affairs Committees (veterans' committees) on the implementation of such requirement.

Part B: Pilot Programs and Reports - Extends through September 30, 1991, the authority to provide adult day health care. Extends to February 1, 1988, and February 1, 1991, the interim and final reporting dates for a study of such program.

Requires the report on the use of all VA contract-care authorities to accompany the VA's annual budget submission to the Congress.

Requires the VA, in order to evaluate the impact on access to VA health-care services for veterans residing in isolated rural areas at least 100 miles from the nearest VA health-care facility, to conduct a two-year pilot program using eight vehicles equipped as mobile clinics and staffed by VA employees to furnish care in isolated rural areas. Authorizes appropriations for FY 1989 and 1990. Requires specified interim reports evaluating such program.

Requires the VA, within a current required report, to provide information to the extent feasible for FY 1986 through 1988 on the number of veterans being treated by the VA for mental illness disabilities on an inpatient basis and the effects of implementation of the VA's new resources allocation methodology on the number of veterans being treated by the VA for mental illness disabilities.

Directs the Administrator to conduct a pilot program to provide care and treatment and rehabilitative services in halfway houses, therapeutic communities, psychiatric residential treatment centers, and other community-based treatment facilities to homeless veterans suffering from chronic mental illness disabilities who are eligible for such care under veterans' benefits eligibility provisions. Authorizes the Administrator to also provide such services to: (1) veterans being furnished hospital or nursing home care by the VA for chronic mental illness disabilities; and (2) veterans with service-connected chronic mental illness disabilities. Outlines criteria for such program and authorizes the Administrator to provide in-kind assistance to facilities being used under such program. Terminates such program on September 30, 1989, and requires a report from the Administrator to the veterans' committees concerning the experiences under such program no later than February 1, 1989. Authorizes appropriations for such program for FY 1988 and 1989. Repeals current contracting authority contained in Federal law.

Directs the Administrator, no later than December 15 of the years 1988 through 1990, to report to the veterans' committees on the activities of the VA during the preceding fiscal year to assist homeless veterans.

Part C: Matters Relating to AIDS - Provides for the confidentiality of medical records that identify persons with acquired immune deficiency syndrome (AIDS), except in specifically described circumstances. Permits physicians or professional counselors to disclose information pertaining to AIDS to a spouse or sexual partner should the physician or counselor believe that the patient will not do so and that such disclosure is necessary to protect the health of the spouse or sexual partner.

Prohibits discrimination in admission to VA facilities for treatment of veterans infected with AIDS.

Provides an AIDS information and training program for VA employees and beneficiaries.

Prohibits any widespread testing program for the presence of HIV (human immunodeficiency virus), unless funds have been specifically appropriated for that purpose. Permits voluntary testing for such virus.

Part D: Other Matters - Adds to the definition of "Veterans' Administration facilities" those public or private non-VA facilities at which the Administrator provides recreational activities for patients receiving VA hospital, nursing home, or domiciliary care.

Permits the VA to authorize the use, for approved purposes, of the VA seal and other official VA symbols and of the name "Veterans Administration" by any person making significant contributions to the VA for support of special recreational activities for the rehabilitation of disabled veterans. Assists veterans' service organizations in providing recreational activities which would further the rehabilitation of disabled veterans, under certain conditions. Allows the VA to accept contributions of funds and other assistance from any appropriate source for the support of such recreational activities for disabled veterans.

Permits the Administrator to exercise authority to prescribe limitations on the furnishing of health-care services by the VA only in times of national emergencies (other than periods of war or armed conflict).

Increases the per-diem rates payable to State homes for the care of eligible veterans. Authorizes further increases in such rates whenever the Administrator determines that increasing hospital costs warrant such further increases.

Adds mental health research as a specific VA research mission.

Requires the Administrator to convert underused space in facilities in urban areas to 500 domiciliary-care beds, primarily to be used for homeless veterans.

Title II: Health-Care Administration and Personnel Matters - Part A: Administration - Directs the Administrator, no later than 60 days after the enactment of this Act, to take specified action to upgrade and expand certain activities related to health-care quality assurance. Directs the Administrator, no later than 75 days after the enactment of this Act, to report to the veterans' committees on such actions taken.

Revises the statutes of limitations applicable to suits brought by the United States to recover costs of VA health care. Expands immunity from personal liability for VA health-care providers.

Removes a statutory limitation on the authority of the Administrator to settle administrative tort claims under the Federal Tort Claims Act and provides authority to settle claims on the same basis as is currently afforded to U.S. attorneys.

Authorizes the establishment of a nonprofit corporation at each VA medical center at which significant medical research is carried out to provide a funding mechanism for moneys received from other-than-VA appropriations for research projects approved at the medical center. Prohibits any such corporation from being established after September 30, 1991.

Establishes a nursing home revolving fund, with moneys realized from the transfer or sale of certain VA-owned property, for the purpose of construction, alteration, and acquisition of nursing home facilities. Requires expenditures in excess of $2,000,000 to be specifically approved by a jointly-adopted resolution.

Changes from July 1 to August 15 the annual date for establishing a list of approved projects (including projects which have been conditionally approved by the Administrator), in order of priority, for grants to States for the construction of State homes. Requires the VA to rescind approval and deobligate funds for conditionally-approved projects if all requirements have not been met within the time period set by the Administrator.

Part B: Pay and Other Personnel Benefits - Authorizes the Administrator, in order to recruit and retain pharamacists and occupational therapists within the Department of Medicine and Surgery of the VA (the Department), to provide additional pay for nurses who assist such pharmacists and therapists.

Authorizes the Administrator to enter into incentive bonus agreements with registered nurses (both currently employed and those hired in the future) at facilities which are determined to have a significant shortage of registered nurses in any clinical service. Specifies the amount of the bonuses to be paid, which increases with each additional agreed-to year of employment. Establishes pay-back requirements for not fulfilling such additional terms. Authorizes the Administrator to enter into such agreements with individuals in other health professions if there are significant problems with recruiting and retaining employees in such professions.

Provides authority to pay technical medical specialists to be available for on-call duty, in addition to their regular hours of employment, without requiring them to remain on the facility grounds.

Provides authority for premium pay for Saturday duty for nurses on the same basis as current law provides for premium pay for Sunday duty.

Directs the Administrator, within one year after enactment of this Act, to report to the Veterans' Committees on the implementation of the amendments made under part B of this title.

Repeals the current Federal Health Professionals Educational Assistance program. Establishes the Veterans' Administration Health Professionals Educational Assistance Program (the Program). Outlines eligibility and application requirements. Requires the Administrator and each participant in the Program to enter into an agreement whereby the Administrator agrees to provide the participant with a specified amount of educational assistance and employ the individual in the Department, in return for the participant agreeing to successfully complete such educational training and serve full-time in the Department.

Directs the Administrator, as part of such Program, to carry out a program whereby scholarships are provided to Program participants (consisting of the payment of tuition, books, and educational fees) in return for the agreement to complete such program and accept employment with the Department. Outlines the period of obligated service required of such students after graduation and provisions for breach-of-agreement liability of students who fail to complete such courses, or fail to be successfully employed in the Department upon graduation. Provides a formula for the determination of the amount of liability for breach of such agreement.

Directs the Administrator, as part of the Program, to carry out a tuition reimbursement program, providing the same benefits as previously described, for full-time employees already assigned to a VA health-care facility. Outlines application procedures, obligated service requirements, and the formula for the determination of liability for breach of the tuition reimbursement agreement. Requires the Administrator, no later than March 1 annually, to report to the Congress on the Program.

Part C: Personnel Administration - Provides that all matters relating to adverse personnel actions, disciplinary actions, and grievance procedures involving persons appointed to certain medical positions within the Department shall be resolved under Federal provisions applicable to Federal employees generally.

Provides that the following employees shall not be considered VA employees for purposes of any VA personnel ceilings: temporary workers hired only for duties related to the conduct of research projects in the Department who are not paid by the VA or who are paid from funds appropriated to the VA for the research activity.

Authorizes the VA to waive licensure and internship requirements for certain medical personnel as follows: (1) State licensure or registration requirements, as appropriate, for practical or vocational nurses or physical therapists if they are to be employed in either research or academic work and are to have no direct patient-care responsibilities, or if they are to be employed in a country other than the United States if their license is in the country in which they are to work; and (2) the requirement for a one-year internship for psychologists if they are to be employed in research or academic work and are to have no direct patient-care responsibilities.

Requires that the chief of the nursing service at each VA health-care facility be included in each policymaking committee at that facility.

Part D: Reports - Directs the Administrator to conduct a study on: (1) the effects of pay and other personnel management practices of the VA's Department of Medicine and Surgery on the ability of the VA to recruit and retain qualified individuals to provide direct patient-care services in VA health-care facilities; and (2) the effects that flexible employment benefits programs would have on the recruitment and retention of such employees. Outlines other matters to be determined as part of such study, and requires the Administrator, no later than one year after the enactment of this Act, to report to the veterans' committees on the results of the study.

Directs the Administrator, no later than August 1, 1988, to report to the veterans' committees concerning the VA's activities designed to promote increased efforts by affiliated institutions in: (1) training health-care professionals to care for older patients; and (2) research into the aging process and diseases and disabilities associated with aging.

Title III: Veterans' Benefits - Part A: Benefits Based on Service-Connected Disabilities - Increases the following veterans' compensation benefits available for service-disabled veterans: (1) the specially-adapted housing allowance; (2) the automobile assistance allowance; and (3) the service-connected death burial allowance.

Part B: Compensation-Related Provisions - Revises the definition of "former prisoner of war" for purposes of increasing eligibility benefits for such ex-prisoners. Expands the list of diseases which may be presumed to be service-connected if suffered by former prisoners-of-war to include peripheral neuropathy, irritable bowel syndrome, and peptic ulcers. Adds to the list of service-connected chronic diseases the disease of lupus erythematosus.

Restores to a limited number of beneficiaries Social-Security-equivalent benefits paid by the VA to certain veterans' survivors who were omitted from the restoration of such benefits in 1982.

Part C: Education Provisions - Revises provisions concerning the hour measurement of courses qualifying for VA-approved laboratory instruction. Revises provisions concerning certain compliance surveys conducted by the Administrator to assure certain educational compliance by veterans enrolled in educational programs.

Part D: Insurance Provisions - Amends Federal veterans' life insurance provisions to authorize the Administrator to increase periodically the amount of monthly annuity payments to beneficiaries under the following policies: (1) National Service Life Insurance; (2) Veterans' Special Life Insurance; (3) Veterans Reopened Insurance; and (4) United States Government Life Insurance. Prohibits any State from imposing taxes on any premiums paid under a Serviceman's Group Life Insurance or under a Veterans' Mortgage Life Insurance program, authorizing the Administrator to administer such program directly. Revises such program in the areas of the initial amount of mortgage protection life insurance originally provided to veterans under such program, the premiums collected on policies under the program, and the amount of insurance in force at any time under the program. Discontinues the policy of insurance previously in effect under such program.

Part E: Memorial Affairs - Authorizes the Administrator to provide for flat grave markers in certain cases at national cemeteries.

Authorizes the Administrator to make contributions to local authorities for road improvements or traffic controls determined essential to ensure safe ingress to and egress from national cemeteries.

Repeals a provision prohibiting any State from receiving an amount of VA veterans' cemetery construction grants exceeding 20 percent of the total amount appropriated for such grants in any fiscal year.

Authorizes the Administrator to provide grave liners for any grave in a cemetery within the National Cemetery System in which remains are interred in a casket.

Establishes in the Treasury the Foreign Currency Fluctuations, American Battle Monuments Commission, Account to be used to pay the costs of salaries and expenses that exceed appropriated amounts due to fluctuations in the foreign exchange rate as it affects the American Battle Monuments Commission budget. Outlines administrative provisions concerning funding for such Account. Directs the Commission to report to the appropriate congressional committees concerning certain transfers made under the Account. Authorizes appropriations to fund such Account.

Directs the Administrator, no later than six months after enactment of this Act, to enter into an agreement with the State of Arizona that: (1) provides for the conveyance to the United States of all title and interest to the Arizona Veterans Memorial Cemetery; and (2) commits the State to provide to the VA funding necessary to supplement Federal funding so that the level of operation and maintenance of such cemetery can be maintained for three years. Provides that such cemetery, after acceptance by the Administrator, shall become part of the National Cemetery System. Limits the expenditures authorized to be made by the Administrator during the three-year period for operation and maintenance. Authorizes the Administrator to accept gifts and bequests for the purpose of the operation, maintenance, or improvement of such cemetery. Directs the Administrator to provide for the use of flat grave markers for interments at such cemetery.

Title IV: Veterans Administration Management and Administration - Part A: Procurement Policy - Requires that there be at least two responsible, financially autonomous bidders before medical center support services may be contracted under Federal procurement procedures.

Directs the Administrator, no later than October 1, 1989, to develop and fully implement a plan for the cost-effective purchase of medical and pharmaceutical items on an agencywide basis. Outlines the requirements necessary for other-than-agencywide procurement of such items (for example, the product is not available on a national basis, a particular product is necessary for the effective furnishing of health-care services or the conduct of a research or education program, or an emergency situation exists.) Prohibits more than 20 percent of all such medical and pharmaceutical items procured by the VA in any fiscal year (measured by cost) from being procured under local contracts. Authorizes the Administrator to raise such percentage to 30 percent, under specified circumstances, while not counting emergency procurement under such limitations. Requires the director of each VA medical center, not later than December 1 annually, to submit to the Administrator a list containing items obtained under local procurement. Directs the Administrator, no later than February 1 annually, to report to the veterans' committees on his or her experience in carrying out these provisions during the previous fiscal year.

Authorizes the Administrator to enter into multiyear contracts for the procurement of supplies or services for VA health-care facilities under certain conditions (basically, when it is economically feasible to do so). Outlines certain other terms and conditions relating to such multiyear contracts (concerning the availability of appropriations and funding). Defines terms for purposes of such contracts.

Part B: General Administrative and Financial Matters - Directs the Secretary of the Treasury to return to the VA special therapeutic and rehabilitation activities fund and the veterans' canteen service revolving fund amounts sequestered under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act). Exempts from sequestration under such Act vocational training benefits for service-connected disabled veterans and educational benefits for dependents and survivors of service-connected disabled veterans.

Authorizes the Administrator to operate child care centers at VA medical centers for the children of VA employees on a fee basis sufficient to cover all the costs of operation other than the costs of services provided by the Administrator. Requires the Administrator to provide space in existing VA facilities for such centers, as well as custodial services and utilities.

Amends the Veterans' Health-Care Amendments of 1986 to expand the Advisory Committee on Native American Veterans to include Native Hawaiians (previously excluded from representation on such Committee). Extends until February 1, 1989, the duration of such Committee. Deletes a provision requiring any remaining balance in the Veterans' Canteen Service revolving fund at the end of a fiscal year to be returned into the Treasury as miscellaneous receipts. Exempts employees of the Veterans' Canteen Service from being counted as employees for purposes of personnel ceilings applied to the VA.

Revises Federal provisions concerning basic entitlement eligibility requirements for veterans' housing loans. Includes the following veterans as eligible for such loans: (1) veterans who served on active-duty at any time during World War II, the Korean conflict, or the Vietnam era and whose total service was for 90 days or more; (2) each veteran who was discharged or released from active-duty after December 15, 1940, for a service-connected disability; (3) each veteran who served after July 25, 1947, for a period of more than 180 days and was discharged or released under conditions other than dishonorable; or (4) a veteran who has served more than 180 days in active-duty status and continues on active duty without a service break. Reorganizes certain Federal provisions relating to various veterans' benefits.

Part C: Real Property - Prohibits the transfer to another Federal agency or to a State of any interest in real property owned by the United States and administered by the VA which has a value estimated at more than $50,000 unless the proposed transfer was described in the budget submitted to the Congress for that fiscal year and the VA receives compensation equal to the fair market value of the property. Provides for the deposit in a nursing home revolving fund of proceeds received from such transfers.

Prohibits the Administrator from declaring as excess to the needs of the VA, or disposing of, lands and improvements at the VA medical centers in West Los Angeles and Sepulveda, California.

Provides that no appropriation for any fiscal year may be made for a major medical facility unless the appropriation measure specifies the amount to be appropriated for that project or lease and the project or lease has been approved in a resolution adopted by the veterans' committee or each body of the Congress. Requires the Administrator to provide the veterans' committees with 30-days' notice when cost variations of more than ten percent occur with respect to a project so approved.

Directs the Administrator to enter into an agreement with the Secretary of Labor for the use by the Secretary of 20.6 acres of land in the city of Minot, North Dakota, formerly used by the Air Force. Provides conditions to such transfer, including that the Secretary selects and utilizes such property as a Job Corps Center for the duration of the lease agreement. Maintains such property under the jurisdiction of the VA.

Redesignates the Veterans' Administration Medical Center in Shreveport, Louisiana, as the Overton Brooks Veterans' Administration Medical Center.