The President has ordered a detailed review of all existing advisory committees. Therefore, until that effort is complete, we cannot support provisions which would establish additional advisory committees.

Section 7 would require that we prepare and submit to this committee, and its counterpart in the House, a plan for converting all Vet Centers into Vietnam Veteran Resource Centers. The plan must contain a timetable for this effort.

Several years ago, at the direction of Congress, VA undertook a pilot program in several Vet Centers to provide additional services to those eligible for readjustment counseling. These resource centers provide benefits counseling, employment counseling, training and placement; help for substance abuse disabilities; and general coordination of benefits. VA has continued funding the original ten resource center sites which participated in the pilot program between 1986 and 1988.

Although there may be merit in expanding the resource center program to all Vet Centers, to do so would require the use of funds now devoted to other VA programs. At this time, we are not prepared to argue that such expansion would have a higher priority than many other valuable programs competing for available funds. Section 8 of the bill would direct that we carry out a new twoyear pilot program to provide veterans with outpatient medical services at Vet Centers. The bill directs that we identify 12 to 15 Vet Centers in diverse locations to serve as sites for furnishing veterans with varying degrees of outpatient care. Those eligible for services would be service-connected veterans rated at least 30-percent disabled or who seek care for their service-connected disability, very low income nonservice-connected veterans, and a few others including former POWs and World War I veterans. At five sites, we would have to provide a minimum of 20 hours per week of "basic ambulatory services." Finally, a minimum of two sites would have to provide at least 120 hours per week of physician services. The bill also calls for a report to Congress at the conclusion of the pilot program.

In our view, providing basic health care services in Vet Centers would fundamentally change the unique nature of these facilities. Much of the success these entities have experienced over the last 14 years can be attributed to the fact that they are not outpatient clinics providing routine medical services. Veterans can go to Vet Centers without feeling that they are patients seeking medical care. Rather, the centers are places where veterans who have suffered the psychological ravages of war can find assistance from counselors who often have had similar experiences to those of the veteran. A large proportion of counselors in Vet Centers are themselves Vietnam veterans. We believe that to introduce basic outpatient health care services into the mix of services now provided by Vet Centers could compromise the continued success of those facilities.

The Department operates many independent outpatient clinics. We know that such clinics work, and do not believe this pilot program would furnish us with particularly valuable information. In addition, we already have the authority which would permit us to furnish outpatient services through Vet Centers. Indeed, in six

places Vet Centers are located side-by-side with clinics providing outpatient care. However, those are unique situations that have occurred in Hawaii and the Caribbean to overcome unusual access to care problems. The facilities are carefully tailored to make certain that the Vet Center maintains its nature as a counseling center, not a medical clinic.

Finally, implementation of this proposal would require diversion of funds from existing VA programs. It would likely require shifting current VA personnel from existing outpatient settings into Vet Centers. In some instances, Vet Centers would likely have to be relocated to obtain sufficient space to provide required services. We do not believe this pilot program would be an effective use of these

resources.

We estimate that the cost to the Department of enacting S. 1226 would be as follows (dollars in thousands):

The office of Management and Budget advises that there is no objection from the standpoint of the Administration's program to the submission of this report on S. 1226 to the Congress.

Sincerely yours,

JESSE BROWN, Secretary.

CHANGES IN EXISTING LAW MADE BY S. 1226 AS REPORTED

In compliance with paragraph 12 of rule XXVI of the Standing Rules of the Senate, changes in existing law made by the bill, as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, existing law in which no change is proposed is shown in roman):

TITLE 38-UNITED STATES CODE

PART II-GENERAL BENEFITS

CHAPTER 17-HOSPITAL, NURSING HOME,
DOMICILIARY, AND MEDICAL CARE

SUBCHAPTER II-HOSPITAL, NURSING HOME OR DOMICILIARY CARE AND MEDICAL

TREATMENT

1710. Eligibility for hospital, nursing home, and domiciliary care

1712C. Advisory Committee on Veteran Readjustment Counseling

Subchapter II Hospital, Nursing Home or Domiciliary Care and Medical Treatment

§ 1712A. Eligibility for readjustment counseling and related mental health services

(a)(1)(A) Upon the request of any veteran who served on active [duty during the Vietnam era,] military, naval, or air service in a theater of combat operations (as determined by the Secretary) during a period of war or in any other area during a period in which such hostilities (as defined in subparagraph (B) of this paragraph) occurred in such area, the Secretary [shall, within the limits of Department facilities,] shall furnish counseling to such veteran to assist such veteran in readjusting to civilian life. [Such counseling shall include a general mental and psychological assessment to ascertain whether such veteran haws mental or psychological problems associated with readjustment] Upon the request of any veteran other than a veteran described in the preceding sentence, the Secretary shall, within the limits of Department facilities, furnish counseling to such veteran to assist such veteran in readjusting to civilian life.

[(2)(A) The Secretary shall furnish counseling as described in paragraph (1), upon request, to any veteran who served on active duty after May 7, 1975, in an area at a time during which hostilities occurred in such area.]

(B) For the purposes of subparagraph (A) of this paragraph, the term "hostilities" means an armed conflict in which the members of the Armed Forces are subjected to danger comparable to the danger to which members of the Armed Forces have been subjected in combat with enemy armed forces during a period of war, as determined by the Secretary in consultation with the Secretary of Defense.

(2) The counseling referred to in paragraph (1) shall include a general mental and psychological assessment to ascertain whether such veteran has mental or psychological problems associated with readjustment to civilian life.

*

[(c) Upon receipt of a request for counseling under this section from any individual who has been discharged or released from active military, naval, or air service but who is not eligible for such counseling, the Secretary shall—

[(1) provide referral services to assist such individual, to the maximum extent practicable, in obtaining mental health care and services from sources outside the Department; and

[(2) if pertinent, advise such individual of such individual's rights to apply to the appropriate military, naval, or air service and the Department for review of such individual's discharge or release from such service.]

(c)(1) The Secretary shall provide the counseling services de scribed in section 1701 (6)(B)(ii) of this title to the surviving parents,

spouse, and children of any member of the Armed Forces who is killed during service on active military, naval, or air service in a theater of combat operations (as determined by the Secretary of Defense) during a period of war or in any other area during a period in which hostilities (as defined in subsection (a)(1)(B) of this section) occurred in such area.

(2) The Secretary may, within the limits of Department facilities, provide the counseling services referred to in paragraph (1) to the surviving parents, spouse, and children of any member of the Armed Forces who dies while serving on active duty or from a condition (as determined by the Secretary) incurred in or aggravated by such service.

(e)(1) In furnishing counseling and related mental health services under subsections [(a) and (b)] (a), (b), and (c) of this section, the Secretary shall have available the same authority to enter into contracts with private facilities that is available to the Secretary (under sections 1712(a)(1)(B) and 1703(a)(2) of this title) in furnishing medical services to veterans suffering from total service-connected disabilities.

(2) Before furnishing counseling or related mental health services described in subsections [(a) and (b)] (a), (b), and (c) of this section through a contract facility, as authorized by this subsection, the Secretary shall approve (in accordance with criteria which the Secretary shall prescribe by regulation) the quality and effectiveness of the program operated by such facility for the purpose for which the counseling or services are to be furnished.

$1712C. Advisory Committee on Veteran Readjustment Counseling

(a)(1) There is in the Department the Advisory Committee on Veteran Readjustment Counseling (hereinafter in the section referred to as the "Committee”).

(2) The Committee shall consist of not more than 18 members appointed by the Secretary from among veterans

(A) who have demonstrated significant civic or professional achievement; and

(B) who have experience with the provision of veterans benefits and services by the Department.

(3) The Secretary shall seek to ensure that members appointed to the Committee include persons from a wide variety of geographic areas and ethnic backgrounds, persons from veterans service organizations, and women.

(4) The Secretary shall determine the terms of service and pay and allowances of the members of the Committee, except that a term of service may not exceed 2 years. The Secretary may reappoint any member for additional terms of service.

(b)(1) The Secretary shall, on a regular basis, consult with and seek the advice of the Committee with respect to the provision by the Department of benefits and services to veterans in order to assist veterans in the readjustment to civilian life.

(2)(A) In providing advice to the Secretary under this subsection, the Committee shall

(i) assemble and review information relating to the needs of veterans in readjusting to civilian life;

(ii) provide information relating to the nature and character of psychological problems arising from military service;

(iii) provide an on-going assessment of the effectiveness of the policies, organizational structures, and services of the Department in assisting veterans in readjusting to civilian life; and

(iv) provide on-going advice on the most appropriate means of responding to the readjustment needs of future veterans. (B) In carrying out its specific duties under subparagraph (A), the Committee shall take into special account veterans of the Vietnam era, and the readjustment needs of such veterans.

(c)(1) Not later than March 31 of each year, the Committee shall submit to the Secretary a report on the programs and activities of the Department that relate to the readjustment of veterans to civilian life. Each such report shall include_

(A) an assessment of the needs of veterans with respect to readjustment to civilian life;

(B) a review of the programs and activities of the Department designed to meet such needs; and

(C) such recommendations (including recommendations for administrative and legislative action) as the Committee considers appropriate.

(2) Not later than 90 days after the receipt of each report under paragraph (1), the Secretary shall transmit to the Committees on Veterans' Affairs of the Senate and House of Representatives a copy of the report, together with any comments and recommendations concerning the report that the Secretary considers appropriate.

(3) The Committee may also submit to the Secretary such other reports and recommendations as the Committee considers appropriate.

(4) The Secretary shall submit with each annual report submitted to the Congress pursuant to section 529 of this title a summary of all reports and recommendations of the Committee submitted to the Secretary since the previous annual report of the Secretary submitted pursuant to that section.

(d)(1) Except as provided in paragraph (2), the provisions of the Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the activities of the Committee under this section.

(2) Section 14 of such Act shall not apply to the Committee.