Veterans Health Care Amendments Act of 1991

Veterans Health Care Amendments Act of 1991 -Title I: Mental Health - Part A: Post-Traumatic Stress Disorder-Veterans Post-Traumatic Stress Disorder Treatment Act of 1991- Directs that a veteran diagnosed by the Department of Veterans Affairs as suffering from post-traumatic stress disorder (PTSD) be furnished care and services for such disorder by the Department, even if such disorder has not been determined to be service-connected. Makes eligible for such care and services a veteran who served on active duty in a theater of combat operations during World War II, the Korean conflict, the Vietnam era, the Persian Gulf War, or in any other area during a period in which hostilities occurred in such area. Requires a veteran who is referred by a Vet Center to a Department general health-care facility for a determination regarding such veteran's eligibility for PTSD care and services to be evaluated for diagnostic purposes within seven days of such referral.

Requires the Secretary of Veterans Affairs, upon request of any eligible veteran, to furnish counseling to assist the veteran in overcoming any psychological problems associated with such service.

Directs the Secretary, no later than December 1, 1991, to devise and initiate a plan to: (1) increase the availability of treatment of veterans suffering from PTSD to levels commensurate with their needs; and (2) enhance outreach activities to inform combat veterans (and their families) of the availability of such treatment and to encourage such veterans to participate in such treatment. Directs the Secretary to report to the Senate and House Veterans' Affairs Committees (veterans' commitees) on the description and implementation of such plan. Directs the Secretary, in preparing such report, to consult with the Special Committee on Post-Traumatic Stress Disorder and the Advisory Committee on Readjustment of Vietnam Veterans.

Directs the Special Committee on Post-Traumatic Stress Disorder (Special Committee) to report concurrently to the Secretary and the veterans' committees setting forth its evaluation of a study required under prior law of postwar psychological problems of Vietnam veterans. Requires the Special Committee in 1992 and 1993 to update certain reports required under prior law relating to PTSD and its treatment.

Directs the Secretary, in the budgetary documents submitted to the Congress in conjunction with the President's budget submission for FY 1993 and 1994, to identify amounts in the appropriations requests for Department accounts that are estimated to be obligated for various purposes relating to the provision of treatment for PTSD.

Directs the Secretary to ensure that there are PTSD units in locations that are readily accessible to veterans residing in rural areas.

Part B: Mental Illness Research and Education - Directs the Secretary, upon the recommendation of the Chief Medical Director (CMD) of the Department, to designate not more than five health-care facilities of the Department as locations for centers of mental illness research, education and clinical activities (especially for service-related conditions) and to establish and operate such centers at such locations. Requires the first such facility to be designated no later than January 1, 1992. Requires the Secretary to ensure the appropriate geographical distribution of such facilities. Prohibits the Secretary from designating any such facility as a mental illness research, education, and clinical center (MIC) unless such facility has an arrangement with an accredited medical school, graduate school of psychology, or nursing school which: (1) provides appropriate education and training in such matters; (2) has the ability to attract appropriate personnel for such research; (3) has a policy-making advisory committee; and (4) has the capability to conduct effective evaluations of the activities at such center. Authorizes appropriations for the operation of the MICs for FY 1992 through 1995. Requires such research to include an appropriate emphasis on the psychological dimension of mental illness and on proposals for furnishing care and treatment to veterans suffering from mental illness. Requires the CMD to ensure that useful information produced by MICs is disseminated through the Veterans Health Administration (VHA). Requires reports during 1993 through 1995 from the Secretary to the veterans' committees on experiences under the MIC program.

Part C: Program of Marriage and Family Counseling for Certain Veterans - Directs the Secretary of Veterans Affairs 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, dependents, and parents. Authorizes the Secretary to provide marriage and family counseling services that the Secretary determines, based on an assessment by a mental-health professional, is 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 the 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 1991 through 1994. Terminates the program at the end of FY 1994. Requires the Secretary to report to the Congress on such program, with recommendations.

Title II: General Health Care - Part A: General Health - Authorizes the furnishing of prosthetic devices and certain other medical items as part of outpatient care when necessary either to obviate the need for hospital admission or in preparation for such. Requires the Secretary, in order for such authority to become effective, to determine that its implementation would not result in a substantial delay in furnishing such items in connection with the treatment of service-connected disabilities or in the denial of such items in connection with such treatment.

Increases the amount authorized to be expended per veteran for improvements and structural alterations necessary to assure the continuation of treatment for a disability or to provide access to the home or to lavatory and sanitary facilities.

Directs the Secretary to require the directors of Department medical centers or regional benefits offices to assess the needs of homeless veterans living within their service areas, including the needs of such veterans with respect to health care, education and training, employment, shelter, counseling, and outreach services. Requires each assessment to indicate the extent to which such needs are being adequately met by programs of the Department and other Federal, State, and local governments and agencies, as well as nongovernmental organizations. Requires each such director to develop a plan for each of FY 1992 through 1994 for the provision of outreach and other services to meet veterans' needs. Requires the coordination of such plans with other Federal, non-Federal, and private plans and programs with respect to the provision of services to homeless persons. Requires each director to carry out such plan and to disseminate to all other appropriate entities information regarding the services provided to homeless veterans by the medical facility or benefits office.

Directs the Secretary to conduct a pilot program to determine the effectiveness of providing, through existing community-based organizations, domiciliary care to homeless veterans eligible for such care from the Department under other provisions of law. Requires the pilot program to be conducted at not more than 15 locations throughout the United States. Authorizes the Secretary to enter into contracts with community-based organizations to provide services under such program, giving preference to those that offer the most comprehensive care and services to homeless individuals and those not being adequately met by existing programs. Authorizes the transfer of certain other funds for continuing pilot programs, with certain transfer limitations. 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 eligible homeless veterans. Amends the Stewart B. McKinney Homeless Assistance Amendments Act of 1988 to extend through FY 1993 the authorization of appropriations and the provision of certain programs for homeless veterans provided under such Act.

Amends the Veterans' Benefits and Services Act of 1988 to extend through FY 1994 a program under such Act with regard to certain services for mentally ill homeless veterans.

Requires the Secretary to report to the veterans' committees an evaluation of: (1) assessments and plans by medical center and benefits office directors with respect to homeless veterans; (2) the pilot program for the provision of domiciliary care to homeless veterans; and (3) the acceptance of gifts and services to provide nonresidential services and mobile support teams for expanding the medical services available to homeless veterans.

Amends the Veterans' Benefits and Services Act of 1988 to extend through FY 1993 the authorization of appropriations for a pilot program which provides mobile health-care clinics for veterans residing in isolated rural areas.

Directs the Secretary to establish the Advisory Committee on Prosthetics and Special-Disabilities Programs to advise the Secretary on: (1) all matters related to 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 veterans' committees annually in 1992 through 1995 on the effectiveness of the prosthetics and special-disabilities programs administered by the Secretary during the preceding fiscal year.

Expands the definition of "medical services," for purposes of veterans' benefits provisions, to include services to overcome a service-connected disability impairing a veteran's ability to achieve procreation. Directs the CMD to appoint an advisory committee to advise the CMD on the exercise of authority to furnish such procreative-assistive services.

Authorizes the Secretary, through FY 1996, to: (1) furnish annually at least two preventive health-care services that the Secretary determines are feasible and appropriate for any veteran being furnished hospital, nursing home, or domiciliary care or medical treatment under current veterans' benefits provisions; and (2) implement annually at each Department health-care facility a major preventive health-care and health-promotion initiative for such veterans. Limits the yearly expenditures for such activities. Requires the CMD to designate an official in the VHA to act as the Director of Preventive Health-Care and Health-Promotion Programs. Requires the Secretary to report on February 1 of 1994 and 1996 on interim and final experiences under the programs.

Authorizes the Secretary to provide: (1) a service dog to a quadriplegic veteran who has a service-connected disability; and (2) a signal dog to a veteran who has a service-connected hearing impairment. Authorizes the payment of travel and incidental expenses to veterans for travel incurred in becoming adjusted to such service or signal dog.

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.

Repeals the authority of the Department to furnish tobacco products to veterans receiving hospital or domiciliary care through the Department.

Directs the Secretary to establish a task force to recommend policies and legislation for the elimination of inconsistencies among provisions of law relating to veterans' eligibility for certain health-care benefits. Requires the Secretary to review the report of the task force and either approve of its recommendations, make recommendations in lieu of such recommendations, or a combination of both and report thereon to the veterans' committees.

Makes former prisoners of war eligible for outpatient medical services through the Department for any disability.

Directs the Secretary, during FY 1992 through 1995, to conduct a pilot program to furnish assistive monkeys to quadriplegic veterans who have service-connected disabilities rated at 50 percent or more. Directs the Secretary to: (1) consider the extent to which the veteran needs and can benefit from the assistance of the monkey; and (2) provide a preference for veterans who have service-connected quadriplegia. Requires a receiving veteran to be well-suited for caring for such monkey and for effectively using the monkey for the provision of assistance in performing daily living tasks. Outlines administrative matters, including the making of contracts for the furnishing of such assistive monkeys. Requires the Secretary to evaluate and report to the veterans' committees on the pilot program. Requires the CMD, before furnishing such assistive monkeys under the pilot program, to provide for the conduct of an independent evaluation of the way that assistive monkeys would be treated during training and placement under the pilot program. Requires consultation with appropriate animal welfare organizations.

Extends through December 31, 1992: (1) the temporary Departmental program for trial work periods and voluntary vocational rehabilitation evaluations 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.

Exempts from Medicaid "best-price" rebate calculations prices paid by the Department for drugs and biologicals pursuant to purchase contracts entered into with States.

Part B: Health-Care Personnel - Authorizes the provision of increased pay to any Department health-care personnel furnishing direct care to patients or providing incidental services on the same basis as pay is currently provided for nurses within the Department. Prohibits such added pay from exceeding by two times (currently, only exceeding) the amount by which the maximum for such pay grade exceeds the minimum for such grade.

Directs the Secretary to increase the rates of pay for clinical or counseling psychologists who hold diplomas in psychology from an accredited authority recognized by the Secretary, unless the CMD determines that such psychologists are not needed to furnish the appropriate quality of psychological services for veterans. Makes such increase an amount needed to make their pay competitive with the pay of psychologists in comparable positions in a non-Department facility.

Directs the Secretary to require the director of each Department medical facility and regional office to: (1) assess the needs of employees of such facility or office for child-care services; and (2) report annually to the Secretary on their findings, including a proposal to meet such needs.

Includes board certification pay within certain other categories of special pay under Federal provisions guaranteeing that full and part-time physicians and dentists receiving special pay will continue to receive special pay of at least such amount after changes made to special pay provisions under the Department of Veterans Affairs Health-Care Personnel Act of 1991. Provides a transitional provision for such revised special pay provisions with respect to physicians or dentists employed as of July 14, 1991, who were about 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, as opposed to payment under a Federal employees' schedule.

Title III: Minority Affairs - Amends the Department of Veterans Affairs Act to include within the functions of the Assistant Secretaries established under such Act the review and assessment of the effects of policies, regulations, programs, and activities of the Department on minority veterans and the coordinating and monitoring of policies facilitating access by such minority veterans to benefits and services provided through the Department. Defines "minority veterans" as veterans who are black, women, Native American, Hispanic-American, Asian-American, or Pacific-Islander-American.

Reestablishes the Advisory Committee on Native-American Veterans as established under the Veterans' Health-Care Amendments of 1986. Requires the Advisory Committee to report to the Secretary, who in turn shall report to the veterans' committees, on findings and recommendations with respect to the needs of Native American veterans, including American Indians and Alaska Natives. Terminates such Advisory Committee 90 days after its second report.

Title IV: Miscellaneous - States that the prohibition on the payment of attorneys' fees in connection with VA benefits proceedings applies only where the individual is applying for such benefits, and not when the Government is proceeding against a person to collect an indebtedness or in cases in which other attorneys' fees statutes apply.

Authorizes the director of each national cemetery to display a prisoner of war/missing in action flag on a flagstaff at that cemetery. Prohibits any officer or employee of the Government from obligating appropriated funds for the purchase of such a flag at a national cemetery.