Veterans Health Care Amendments Act of 1991

Veterans' Programs Amendments of 1991 - Title I: Health Care - Part A: General Health Care - Increases certain authorized costs for home improvements and structural alterations furnished as part of necessary home health services available to disabled veterans.

Amends the Veterans' Health Care Amendments of 1986 to extend through FY 1992 an annual report requirement under such Act concerning the furnishing of non-service-connected health care to veterans.

Requires the Geriatrics and Gerontology Advisory Committee to submit to the appropriate congressional committees a copy of any report submitted to the Secretary of Veterans Affairs on all appropriate matters of geriatrics and gerontology.

Extends from three to four years the period in which a Department of Veterans Affairs research corporation must be recognized as a tax-exempt entity under the Internal Revenue Code in order to avoid dissolution. Extends through December 31, 1992, the authority of the Department to establish such corporations.

Authorizes the Secretary to enter into agreements for the joint acquisition of medical equipment. Outlines conditions to such joint acquisition, including payment of no more than one half of the purchase price of such equipment by the Secretary, the exchange of use of such equipment between the joint holders, and provision by the institution involved of its share of the purchase price. Authorizes the Secretary to transfer to the other joint holder its interest in the equipment if the Secretary determines that such transfer would be justified by compelling clinical considerations or the economic interest of the Department. Authorizes the Secretary to purchase the interest of the joint holder of such equipment under similar conditions. Authorizes the Secretary to enter into escrow agreements with institutions to facilitate the procurement of medical equipment. Outlines escrow agreement requirements. Requires the Secretary to report on the implementation of such joint acquisition under these provisions.

States that Department quality assurance activities shall be deemed to be part of the operation of hospitals, nursing homes, and domiciliary facilities of the Department, without regard to the location of the duty stations of employees carrying out such activities.

Renames the Prosthetics Service Advisory Committee as the Advisory Committee on Prosthetics and Special-Disabilities Programs and provides that such committee shall operate as if established by law. Requires the Advisory Committee's activities to relate to: (1) prosthetics and special-disabilities programs of the Department; (2) coordination of programs which develop and test prosthetic devices; and (3) the adequacy of funding for such programs within the Department. Requires the Advisory Committee to report to the Secretary and the Senate and House Veterans' Affairs Committees (veterans' committees) on the effectiveness of the prosthetics and special-disabilities programs administered by the Secretary during the preceding fiscal year.

Directs the Secretary to report to the veterans' committees concerning the backlog that occurred in the procurement of prosthetic appliances in FY 1989 and on actions to be taken to prevent a recurrence of backlogs and failures to furnish appliances on a priority basis.

Directs the Secretary to assess all programs developed by facilities of the Department which have been designed to assist homeless veterans and to replicate at other Department facilities those programs which have as a goal the rehabilitation of homeless veterans and have been determined by the Secretary to be successful in achieving such goal through the integration of homeless veterans into the community and the employment of such veterans. Requires the director of each Department medical center or regional benefits office to make an assessment of the needs of homeless veterans living within their area. Requires each such director, in coordination with certain other officials and nongovernmental organizations, to: (1) develop a list of all public and private programs that provide assistance to homeless persons or homeless veterans in the area, as well as a description of such services; and (2) encourage the development of a plan to coordinate the provision of services to homeless veterans among such public and private programs. Directs the Secretary to require each such director to: (1) meet through existing programs and available resources the needs of homeless veterans as identified in the assessment; (2) attempt to inform those homeless veterans whose needs the director cannot meet of other services available in such area. Authorizes the Secretary to accept donations of funds and services for providing one-stop, nonresidential services and mobile support teams and for expanding the medical services available to homeless veterans through the Department.

Amends the Stewart B. McKinney Homeless Assistance Amendments Act of 1988 to extend through FY 1993 the authorization of appropriations to the Department under such Act for the medical care of homeless veterans.

Amends the Veterans' Benefits and Services Act of 1988 to extend through FY 1994 a program available under such Act for homeless mentally ill veterans. Directs the Secretary to report to the veterans' committees on: (1) the assessment program for homeless veterans; and (2) donations of funds and services to the Department for programs for homeless veterans.

Amends the Department of Veterans Affairs and Housing and Urban Development, and Independent Agencies Appropriations Act, 1992 to exempt from Medicaid "best-price" rebate calculations those prices paid by the Department for drugs and biologicals pursuant to purchase contracts entered into with States.

Part B: Mental Health Provisions - Directs the Secretary to conduct a program for furnishing marriage and family counseling services to veterans who were awarded a campaign medal for active-duty service during the Persian Gulf War, reservists who were called or ordered to active duty during such War, and their spouses and children. Authorizes the Secretary to provide marriage and family counseling services that the Secretary determines, based on an assessment by a mental health professional, are necessary for the amelioration of psychological, marital, or familial difficulties resulting from such active-duty service. Outlines provisions concerning the manner in which such services will be furnished, as well as qualifications required of the marriage and family counselors performing such services. Outlines provisions concerning counseling services provided by mental health professionals pursuant to Department contracts, including the length of marriage and counseling services to be performed under the program. Prohibits the same person who performs the counseling needs assessment from furnishing marriage and counseling services under the program, with a waiver of such prohibition under specified circumstances. Directs the Secretary to reimburse the mental health professionals for the reasonable costs of such counseling services. Provides cost recovery provisions. Authorizes appropriations for FY 1992 through 1994. Requires a report from the Secretary to the Congress on services provided under the program.

Directs the Secretary, in carrying out medical research and awarding grants, to assign a high priority to the conduct of research on mental illness, including research regarding post-traumatic stress disorder (PTSD), PTSD in association with substance abuse, and the treatment of those disorders.

Directs the Special Committee on Post-Traumatic Stress Disorder to concurrently submit to the Secretary and the veterans' committees a report updating earlier required reports with respect to the overall efforts of the Department to meet the needs of veterans with PTSD and other psychological problems in adjusting to civilian life.

Requires the Secretary to develop a plan to: (1) ensure that veterans suffering from PTSD related to active duty are provided appropriate treatment and rehabilitative services for such condition in a timely manner; (2) expand and improve the services available to such veterans; (3) eliminate waiting lists for inpatient treatment and other modes of treatment for PTSD; (4) enhance outreach activities to inform veterans of the availability of treatment for PTSD; and (5) ensure that there are Department PTSD treatment units in locations readily accessible to veterans residing in rural areas. Outlines factors to be considered by the Secretary in the development of such plan, including the number of veterans suffering from PTSD, the number likely to seek treatment, the level and accessibility of inpatient and outpatient care available for such purpose, and the treatment needs of such veterans who are women or ethnic minorities. Requires a report on the plan developed.

Title II: Health-Care Personnel - Prohibits the increase in basic pay authorized for certain Department health-care personnel furnishing direct care to patients or providing services incidental to such care from exceeding by two times (currently, only exceeding) the amount by which the maximum for such pay grade exceeds the minimum for such grade.

Requires a minimum two-year service requirement in the Department for graduates of the Department of Veterans Affairs Health Professional Scholarship Program.

Authorizes the Secretary to purchase promotional items of nominal value for recruitment purposes.

Requires that a physician or dentist who was employed in the Veterans Health Administration of the Department on July 13, 1991, and who was being paid special pay for no special pay factors other than primary, full-time, length of service, or specialty or board certification shall continue to be paid special pay at an annual rate no lower than the rate paid on such date. Provides a transitional provision with respect to physicians and dentists employed on July 14, 1991, who were ready and willing to enter into a special pay agreement before the enactment of such Act.

Authorizes the Department to appoint and pay nonphysician directors of clinical support services within the Veterans Health Administration of the Department.

Title III: Life Insurance Programs - Amends Federal provisions concerning National Service Life Insurance to authorize an additional $10,000 in supplemental service-disabled veterans' insurance for those veterans who qualify for a waiver of payment of premiums under National Service Life Insurance due to being totally disabled. Outlines application procedures. Prohibits the waiver of premiums for the supplemental life insurance granted.

Increases from $40,000 to $90,000 the maximum amount of Veterans' Mortgage Life Insurance available to veterans who have received a specially-adapted housing grant.

Title IV: Compensation and Pension - Provides that, for purposes of the sequestration baseline under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), the amount by which each rate of veterans' compensation is increased shall be assumed to be rounded to the nearest whole dollar.

Limits to $90 the monthly pension payable to a veteran with no spouse or child or to a surviving spouse who has no child during any period that a nursing facility furnishes such person with services covered under title XIX (Medicaid) of the Social Security Act.

Amends the Right to Financial Privacy Act of 1978 to state that information protection provisions of such Act shall not apply to the disclosure by a financial institution of the name and address of any customer to the Department where such disclosure is necessary, and such information is used solely for, the administration of Department compensation and pension benefits. Allows the Secretary to make such a request when such information: (1) is necessary for administration purposes; and (2) cannot be secured by a reasonable search of records and information of the Department. Requires the Secretary to include a certification of such determinations in each request presented to a financial institution.

Title V: Miscellaneous - Extends through March 31, 1994, the authority to maintain a Department regional office in the Philippines.

Reestablishes the Advisory Committee on Native-American Veterans as formerly established (and since terminated) under the Veterans' Health-Care Amendments of 1986. Incorporates the establishment provisions of such Act into this reestablishment. Requires 1993 and 1994 reports from the Advisory Committee regarding the needs of Native American veterans and whether and to what extent those needs are being met by the Department. Directs the Secretary to transmit such reports, together with comments, to the veterans' committees.

Extends through December 31, 1992: (1) the temporary Departmental program for trial work periods and voluntary vocational rehabilitation for veterans receiving compensation at the rate paid to totally disabled veterans; (2) the temporary program of vocational training for certain veterans' pension recipients; and (3) the protection of a pension-receiving veteran's Departmental health care eligibility if pension entitlement is lost as a result of work income received after undergoing vocational training.

Prohibits funds from being appropriated for any fiscal year, and prohibits the Secretary from obligating or expending funds, for any major medical facility project or lease unless funds have been specifically authorized by law. Defines a "major medical facility lease" as a lease having an average annual rental amount of more than $300,000 (currently, $500,000).

Redesignates within the Department the positions of the Chief Medical Director and the Chief Benefits Director as the Under Secretary for Health and the Under Secretary for Benefits, respectively.