“(5) review any investigation conducted by the Medical Inspector General of the Department of Medicine and Surgery of any adverse incident or incidents occurring during the course of furnishing health-care services in a Veterans' Administration facility or facilities and make such recommendations for additional action to such Medical Inspector General as the Assistant Inspector General considers appropriate;

"(6) monitor and analyze the collection and analysis of quality assurance and risk management information by the Department of Medicine and Surgery (including information relating to medical malpractice claims), review such quality assurance and risk management information in order to identify data that is not collected and should be collected, and monitor the analysis by the Department of Medicine and Surgery of trends in the provision of health-care services by such Department;

"(7) make to the Inspector General such recommendations for corrective action on health-care matters as the Assistant Inspector General considers appropriate; and

"(8) monitor the implementation of recommendations for corrective action made to the Administrator by the Inspector General on health-care matters. "(f) The Inspector General of the Veterans' Administration, in addition to preparing and submitting the reports required by the Inspector General Act of 1978 (5 U.S.C. App. 3), shall submit to the Administrator and the Committee on Veterans' Affairs of the Senate and the House of Representatives, not later than February 1 of each year, a report containing

"(1) a discussion of the activities undertaken by the Assistant Inspector General for Health Care Quality Assurance Review during the fiscal year preceding the fiscal year in which the report is submitted, including

"(A) the findings and conclusions resulting from such activities;

"(B) the recommendations made (on the basis of such activities) by the Inspector General to the Administrator for corrective action in the activities of the Department of Medicine and Surgery; and

"(C) any corrective actions taken with respect to those recommendations; and

"(2) a discussion of the activities undertaken by the Assistant Inspector General for Health Care Quality Assurance Review to monitor the activities of the Medical Inspector General of the Department of Medicine and Surgery during the fiscal year preceding the fiscal year in which the report is submitted, including

"(A) the findings of the Inspector General of the Veterans' Administration and the Assistant Inspector General on the activities of the Medical Inspector General during such preceding fiscal year;

"(B) the recommendations, if any, made by the Inspector General of the Veterans' Administration to the Chief Medical Director or the Administrator on the basis of such monitoring activities, including any recommendations for remedial or disciplinary actions as a result of such activities; and "(C) an assessment of the extent to which the Inspector General has been effective during such preceding fiscal year in bringing about such recommended remedial and disciplinary actions.

"(g) The rate of pay for the position of Assistant Inspector General for Health Care Quality Assurance Review shall be the same rate of pay established for the positions of the other Assistant Inspectors General of the Veterans' Administration.".

(2) The table of sections at the beginning of such chapter is amended by adding at the end the following:

"SUBCHAPTER V-OTHER VETERANS' ADMINISTRATION OFFICES

"250. Assistant Inspector General for Health Care Quality Assurance Review.".

(b) RESOURCES FOR MONITORING QUALITY ASSURANCE PROGRAM. -Section 4151(e)(2) is amended by inserting "to the Assistant Inspector General for Health Care Quality Assurance Review" after "qualifications)".

TITLE III-VIETNAM VETERANS' READJUSTMENT COUNSELING

PROGRAMS

SEC. 301. READJUSTMENT COUNSELING PROGRAM IMPROVEMENTS.

(a) Section 612A is amended

(1) in subsection (a)—

(A) by inserting "(1)" before "Upon";

(B) by amending the first sentence of paragraph (1) (as redesignated by clause (A) of this section) to read as follows:

"Upon the request of—

“(A) any veteran who served on active duty during the Vietnam era, or

"(B) any veteran who served on active duty after May 7, 1975, in an area during a period in which hostilities (as defined in paragraph (3) of this subsection) occurred in such area,

the Administrator shall furnish counseling to assist such veteran in readjusting to civilian life."; and

(C) by adding at the end the following new paragraphs:

“(2) Upon the request of (A) any veteran who served on active duty during World War II or the Korean conflict, or (B) any person who is serving on active duty and who served on active duty during either of the periods described in clause (A) or (B) of the first sentence of paragraph (1) of this subsection, the Administrator may furnish counseling to such veteran or person in overcoming any psychological problems associated with such veteran's or person's service during such period. In furnishing counseling under clause (A) of the first sentence of this paragraph, the Administrator shall place particular emphasis on the needs of those who engaged in combat with the enemy. Such counseling shall include a general mental and psychological assessment to ascertain whether such veteran or person has mental or psychological problems associated with such veteran's or person's active military, naval, or air service.

“(3) For the purposes of subparagraph (1)(B) of this subsection, the term 'hostilities' means a situation in which members of the Armed Forces were, as determined by the Administrator in consultation with the Secretary of Defense, subjected to danger from armed conflict comparable to the danger to which members of the Armed Forces have been subjected in battle with the enemy during a period of war.";

(2) in subsection (d)—

(A) by inserting "(1)" before "The"; and

(B) by adding at the end the following new paragraph:

“(2)(A) Any individual who has satisfactorily completed 2 years of substantially continuous employment in the program established to carry out this section under a time-limited appointment and who is so employed on the ninetieth day after the date of the enactment of this paragraph shall be converted by the Administrator to career-conditional or career employment. Such conversion shall be accomplished not later than (i) 30 days after the date on which such 2-year period has expired, or (ii) 120 days after the date of the enactment of this paragraph, whichever is the later. An employee converted under this paragraph shall automatically acquire a competitive status.

"(B) Not later than 15 days after an individual becomes entitled to conversion under subparagraph (A) of this paragraph, the Administrator shall notify such individual of such entitlement and the timetable for such employee's conversion.";

(3) in subsection (g)—

(A) by amending paragraph (1) to read as follows: "(1A) No Vet Center in existence on July 1, 1987, may be closed or relocated to another location unless the Chief Medical Director

“(i) determines, in accordance with subparagraph (B) of this paragraph and pursuant to regulations prescribed by the Chief Medical Director, that such closure or relocation will not result in any diminution in the continuing availability and effective furnishing of readjustment counseling services to persons entitled to and needing such services in the geographic area served by such Vet Center, and so certifies in the notification described in clause (iii) of this subparagraph;

"(ii) in the case of such a relocation, certifies in such notification that the requirements of subparagraph (C) of this paragraph will be met; and

"(iii) provides to the Committees on Veterans' Affairs of the Senate and the House of Representatives at least 60 days prior to any such closure or relocation a notification thereof, including a description of the results of the consideration given to the factors specified in subparagraph (B) of this paragraph. "(B) In making a determination under clause (i) of subparagraph (A) of this paragraph, the Chief Medical Director shall give full consideration to

"(i) the distribution of Vietnam-era veterans in the geographical area served by the existing Vet Center and the relationships between the location of such Vet Center and the general Veterans' Administration facility and such distribu

"(ii) the distance between the existing Vet Center and the general Veterans' Administration facility;

"(iii) the acceptability of the proposed closure or relocation to (I) the staff of both the existing Vet Center and the general Veterans' Administration facility, (II) representatives of veterans' service organizations located in the geographic area served by the existing Vet Center, and (III) individual veterans who are being furnished services at the existing Vet Center;

“(iv) the availability of other entities, such as State, local, or private outreach facilities, which provide assistance to Vietnam-era veterans in the area served by the existing Vet Center;

"(v) the availability of transportation to, and parking at, the existing Vet Center and the general Veterans' Administration facility;

"(vi) the availability, cost, and suitability of the space at the general Veterans' Administration facility, including the opportunity to establish a direct entry into the area where readjustment counseling services would be furnished and the suitability of the environment where such services would be furnished; "(vii) a comparison of the recurring non-personnel costs of providing readjustment counseling to the same estimated number of veterans at the existing Vet Center and the general Veterans' Administration facility;

"(viii) the impact of the proposed closure or relocation on the program at the existing Vet Center pursuant to which eligible veterans are furnished readjustment counseling services by private facilities under a contract with the Veterans' Administration; and

"(ix) the workload trends over the prior 2 fiscal years at the existing Vet Center; and

"(x) such other factors, specified in the regulations prescribed under subparagraph (A)(i) of this paragraph, as the Chief Medical Director determines are relevant to making the determination described in such subparagraph (A)(i). "(C)(i) Except as provided in division (ii) of this subparagraph, in the case of a relocation of a Vet Center to a general Veterans' Administration facility, not less than the average annual budget and personnel ceiling provided to such Vet Center in each of the 3 fiscal years prior to such relocation (calculated on an annualized basis for any year in which a Vet Center was not operational for an entire year) will remain available to furnish readjustment counseling services for 2 full fiscal years following such relocation.

"(ii) In the event that the Chief Medical Director determines at the end of the first full fiscal year following such relocation that the demand for services at the relocated Vet Center's current location, when compared with the demand for services at such Vet Center's prior location, does not then justify the budget and personnel ceiling levels described in division (i) of this subparagraph, the Chief Medical Director may, as an exception to such division, reduce such levels to such levels needed to meet such demand and the estimated future demand for such services if (I) the Chief Medical Director determines that relocation of the Vet Center to a location away from the general Veterans' Administration facility is highly unlikely to result in a demand sufficient to justify the levels initially provided, and (II) the Chief Medical Director promptly notifies the Committees on Veterans' Affairs of the Senate and the House of Representatives of such determinations and the bases therefor.

"(D)(i)(I) Any proposed closure or relocation during any fiscal year after fiscal year 1988 of more than 10 percent of the Vet Centers in existence on July 1, 1987, shall be deemed to be an administrative reorganization for the purposes of section 210(b)(2) of this title.

"(II) Not more than 5 percent of the Vet Centers (including relocated Vet Centers) in existence on July 1, 1987, may be closed or relocated to a general Veterans' Administration facility prior to October 1, 1988.

"(ii)(I) Except as provided in subdivision (II) of this division, in the event of a proposed administrative reorganization as described in division (i) of this subparagraph, the Administrator, at the time specified in subparagraph (A) of such section 210(b)(2), shall submit, in lieu of a report containing a detailed plan and justification, a notification as described in subparagraph (A)(iii) of this paragraph including information as to each Vet Center or relocated Vet Center that is proposed to be closed or relocated and a justification of such proposed administrative reorganization in light of the contents of the report required to be submitted by paragraph (2) of this subsection, particularly the contents of such report in response to the requirement in the second sentence of subparagraph (A) of such paragraph.

“(II) In the event of a proposed administrative reorganization as described in division (i) of this subparagraph which is proposed to take effect in fiscal year 1989, the

Administrator may delay submitting the notification described in subdivision (I) of this division until the date on which the report required by subsection (g)(2) of this section is submitted or to April 1, 1988, whichever is the earlier.

"(E) For the purposes of this paragraph

"(i) the term 'general Veterans' Administration facility' means a Veterans' Administration facility which is not a Vet Center and at which readjustment counseling would be furnished in a particular geographic area upon the closure or relocation of a Vet Center; and

"(ii) the term 'relocated Vet Center' means a Vet Center that has been relocation to a general Veterans' Administration facility.";

(B) in paragraph (2)—

(i) in subparagraph (A)—

(I) by striking out "April 1, 1987" and inserting in lieu thereof "April 1, 1988"; and

(II) by striking out "(or" and all that follows through “available)";

(ii) in subparagraph (B)—

(I) by striking out in clause (i) "a program" and all that follows through "health-care facilities" and inserting in lieu thereof "Vet Centers"; and

(II) in clause (ii) by striking out “paragraph (1) of"; and

(C) by striking out paragraphs (3) and (4);

(4) by redesignating subsection (h) as subsection (i);

(5) by inserting after subsection (g), the following new subsection:

"(h)(1) The Administrator may provide to eligible veterans at Vet Centers, in addition to furnishing readjustment counseling services under this section, other services (including counseling with respect to, and assistance in applying for, all benefits and services under laws administered by the Veterans' Administration for which such veterans may be eligible) that the Administrator is authorized to furnish such

veterans.

"(2) The Administrator may assign such personnel and other resources as are necessary to provide such additional services under this subsection and are otherwise available to the Administrator for such purpose."; and

(6) by adding at the end the following new subsection (j):

"(j) For the purposes of this section:

“(1) The term 'Vet Centers' mean facilities (including Centers) which are operated by the Veterans' Administration for the provision of services under this section and which (except in the cases of 'relocated Vet Centers' (as that term is defined in subsection (g)(1) of this section)) are situated apart from Veterans' Administration general health-care facilities.

"(2) The term 'Veterans' Administration general health-care facilities' means health-care facilities which are operated by the Veterans' Administration for the furnishing of health-care services under this chapter, not limited to services provided through the programs established under this section.".

(b) Not later than 150 days after the date of the enactment of this Act, the Administrator of Veterans' Affairs shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives a report on the implementation of the amendment made by subsection (a)(2)(B). Such report shall include information on the number of employees employed under a time-limited appointment on the date 90 days after such date of enactment, the number, assignment, and duty station of those converted to career-conditional or career employment by the date 120 days after such enactment date, and the plans and timetable for accomplishing the conversion of other such employees.

SEC. 302. POSTPONEMENT OF REPORT DUE DATE.

Section 102(b) of the Veterans' Health Care Amendments of 1983 (Public Law 98160; 97 Stat. 994) is amended by striking out "October 1, 1986" and inserting in lieu thereof "October 1, 1987".

SEC. 303. PROHIBITION ON DELEGATION OF AUTHORITY.

The functions and authorities assigned to the Chief Medical Director of the Veterans' Administration by any provision of this title or any amendment made by this title may not be delegated to or exercised by any other official.

Amend the title so as to read:

To amend title 38, United States Code, to restore beneficiary travel payments to certain individuals in connection with travel to and from Veterans' Administration facilities, to establish the Office of Medical Inspector General, and the position of

Assistant Chief Medical Director for Quality Assurance, in the Office of the Chief Medical Director of the Veterans' Administration and the position of Assistant Inspector General for Health Care Quality Assurance Review in the Office of the Inspector General of the Veterans' Administration, and to eliminate the requirement for a transition under which community-based Vet Centers would be moved to Veterans' Administration medical facilities and provide standards and procedures for any closure or relocations of Vet Centers; and for other purposes.

INTRODUCTION

S. 1464 was introduced on July 1, 1987, by the Chairman of the Committee, Senator Alan Cranston, and cosponsored by the Ranking Minority Member, Frank H. Murkowski, Committee Members Spark M. Matsunaga, Dennis DeConcini, John D. Rockefeller IV, Bob Graham, and Robert T. Stafford, and Senators Daniel P. Moynihan, Howell T. Heflin, Jeff Bingaman, Christopher J. Dodd, Thomas A. Daschle, Terry Sanford, Lawton Chiles, William S. Cohen, Daniel J. Evans, and Charles E. Grassley. Joining later as cosponsors were Committee Members Strom Thurmond and Arlen Specter and Senators William V. Roth, Jr., Chic Hecht, Thad Cochran, Max Baucus, Richard C. Shelby, Quentin N. Burdick,_Bill Bradley, David Pryor, Brock Adams, Patrick J. Leahy, Albert Gore, Jr., Paul S. Trible, Jr., John F. Kerry, John Melcher, Daniel D. Inouye, and Paul Simon. As introduced, S. 1464 would have provided for the payment of beneficiary travel reimbursements-payments generally made to certain veterans to defray the expenses of their travel to Veterans' Administration health-care facilities-to certain service-connected disabled veterans and low-income veterans, and would have provided for a deductible of $3.75 per one-way trip from such reimbursements, except that a maximum total of $22.50 in deductibles would have been required of certain frequent users of VA care, and no deductible would have been required in connection with special-mode or emergency transportation.

On June 26, 1987, S. 1443 and S. 1444 were introduced as complementary measures. S. 1443, introduced by Chairman Cranston and cosponsored by Ranking Minority Membert Murkowski and Committee Members Matsunaga, DeConcini, Graham, and Simpson, would have provided for the upgrading within the VA's Department of Medicine and Surgery (DM&S) of the medical investigation, quality-assurance, and risk-management programs and operations by establishing an autonomous Office of the Medical Inspector General (MIG), with specified staffing and direct accountability to the Chief Medical Director, which would be charged with investigating reports of inadequate quality of care, and by establishing an Assistant Chief Medical Director for Quality Assurance. S. 1444, introduced by Senator Murkowski and cosponsored by Senator Cranston and Committee Members Specter, Simpson, Thurmond, Matsunaga, DeConcini, and Graham, would have upgraded the monitoring by the VA's independent Inspector General of DM&S's quality assurance, risk management, and inspection activities by establishing a new Assistant Inspector General for Health Care Quality Assurance Review with a specified minimum staffing level and a statutory functional statement.

On July 15, 1987, Chairman Cranston introduced S. 1501 with the cosponsorship of Committee members Senators Matsunaga, DeConcini, MItchell, Rockefeller and Graham, and Senators Dodd,