
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document affected by Public Law 107-135 Section 124]
[CITE: 38USC8110]

 
                      TITLE 38--VETERANS' BENEFITS
 
            PART VI--ACQUISITION AND DISPOSITION OF PROPERTY
 
   CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY 
FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL PROPERTY
 
      SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES
 
Sec. 8110. Operation of medical facilities

    (a)(1) The Secretary shall establish the total number of hospital 
beds and nursing home beds in medical facilities over which the 
Secretary has direct jurisdiction for the care and treatment of eligible 
veterans at not more than 125,000 and not less than 100,000. The 
Secretary shall establish the total number of such beds so as to 
maintain a contingency capacity to assist the Department of Defense in 
time of war or national emergency to care for the casualties of such war 
or national emergency. Of the number of beds authorized pursuant to the 
preceding sentence, the Secretary shall operate and maintain a total of 
not less than 90,000 hospital beds and nursing home beds and shall 
maintain the availability of such additional beds and facilities in 
addition to the operating bed level as the Secretary considers necessary 
for such contingency purposes. The President shall include in the Budget 
transmitted to the Congress for each fiscal year pursuant to section 
1105 of title 31, an amount for medical care and amounts for 
construction sufficient to enable the Department to operate and maintain 
a total of not less than 90,000 hospital and nursing home beds in 
accordance with this paragraph and to maintain the availability of the 
contingency capacity referred to in the second sentence of this 
paragraph. The Secretary shall staff and maintain, in such a manner as 
to ensure the immediate acceptance and timely and complete care of 
patients, sufficient beds and other treatment capacities to accommodate, 
and provide such care to, eligible veterans applying for admission and 
found to be in need of hospital care or medical services.
    (2) The Secretary shall maintain the bed and treatment capacities of 
all Department medical facilities so as to ensure the accessibility and 
availability of such beds and treatment capacities to eligible veterans 
in all States and to minimize delays in admissions and in the provision 
of hospital, nursing home, and domiciliary care, and of medical services 
furnished pursuant to section 1710(a) of this title.
    (3)(A) The Under Secretary for Health shall at the end of each 
fiscal year (i) analyze agencywide admission policies and the records of 
those eligible veterans who apply for hospital care, medical services, 
and nursing home care, but are rejected or not immediately admitted or 
provided such care or services, and (ii) review and make recommendations 
regarding the adequacy of the established operating bed levels, the 
geographic distribution of operating beds, the demographic 
characteristics of the veteran population and the associated need for 
medical care and nursing home facilities and services in each State, and 
the proportion of the total number of operating beds that are hospital 
beds and that are nursing home beds.
    (B) After considering the analyses and recommendations of the Under 
Secretary for Health pursuant to subparagraph (A) of this paragraph for 
any fiscal year, the Secretary shall report to the committees, on or 
before December 1 after the close of such fiscal year, on the results of 
the analysis of the Under Secretary for Health and on the numbers of 
operating beds and level of treatment capacities required to enable the 
Department to carry out the primary function of the Veterans Health 
Administration. The Secretary shall include in each such report 
recommendations for (i) the numbers of operating beds and the level of 
treatment capacities required for the health care of veterans and the 
maintenance of the contingency capacity referred to in paragraph (1) of 
this subsection, and (ii) the appropriate staffing and funds therefor.
    (4)(A) With respect to each law making appropriations for the 
Department for any fiscal year (or any part of a fiscal year), there 
shall be provided to the Department the funded personnel ceiling defined 
in subparagraph (C) of this paragraph and the funds appropriated 
therefor.
    (B) In order to carry out the provisions of subparagraph (A) of this 
paragraph, the Director of the Office of Management and Budget shall, 
with respect to each such law (i) provide to the Department for the 
fiscal year (or part of a fiscal year) concerned such funded personnel 
ceiling and the funds necessary to achieve such ceiling, and (ii) submit 
to the appropriate committees of the Congress and to the Comptroller 
General of the United States certification that the Director has so 
provided such ceiling. Not later than the thirtieth day after the 
enactment of such a law or, in the event of the enactment of such a law 
more than thirty days prior to the fiscal year for which such law makes 
such appropriations, not later than the tenth day of such fiscal year, 
the certification required in the first sentence of this subparagraph 
shall be submitted, together with a report containing complete 
information on the personnel ceiling that the Director has provided to 
the Department for the employees described in subparagraph (C) of this 
paragraph.
    (C) For the purposes of this paragraph, the term ``funded personnel 
ceiling'' means, with respect to any fiscal year (or part of a fiscal 
year), the authorization by the Director of the Office of Management and 
Budget to employ (under the appropriation accounts for medical care, 
medical and prosthetic research, and medical administration and 
miscellaneous operating expenses) not less than the number of employees 
for the employment of which appropriations have been made for such 
fiscal year (or part of a fiscal year).
    (5) Notwithstanding any other provision of this title or of any 
other law, funds appropriated for the Department under the appropriation 
accounts for medical care, medical and prosthetic research, and medical 
administration and miscellaneous operating expenses may not be used for, 
and no employee compensated from such funds may carry out any activity 
in connection with, the conduct of any study comparing the cost of the 
provision by private contractors with the cost of the provision by the 
Department of commercial or industrial products and services for the 
Veterans Health Administration unless such funds have been specifically 
appropriated for that purpose.
    (6)(A) Temporary research personnel of the Veterans Health 
Administration shall be excluded from any ceiling on full-time 
equivalent employees of the Department or any other personnel ceiling 
otherwise applicable to employees of the Department.
    (B) For purposes of subparagraph (A) of this paragraph, the term 
``temporary research personnel'' means personnel who are employed in the 
Veterans Health Administration in other than a career appointment for 
work on a research activity and who are not paid by the Department or 
are paid from funds appropriated to the Department to support such 
activity.
    (b) When the Secretary determines, in accordance with regulations 
which the Secretary shall prescribe, that a Department facility serves a 
substantial number of veterans with limited English-speaking ability, 
the Secretary shall establish and implement procedures, upon the 
recommendation of the Under Secretary for Health, to ensure the 
identification of sufficient numbers of individuals on such facility's 
staff who are fluent in both the language most appropriate to such 
veterans and in English and whose responsibilities shall include 
providing guidance to such veterans and to appropriate Department staff 
members with respect to cultural sensitivities and bridging linguistic 
and cultural differences.
    (c) The Secretary shall include in the materials submitted to 
Congress each year in support of the budget of the Department for the 
next fiscal year a report on activities and proposals involving 
contracting for performance by contractor personnel of work previously 
performed by Department employees. The report shall--
        (1) identify those specific activities that are currently 
    performed at a Department facility by more than 10 Department 
    employees which the Secretary proposes to study for possible 
    contracting involving conversion from performance by Department 
    employees to performance by employees of a contractor; and
        (2) identify those specific activities that have been contracted 
    for performance by contractor employees during the prior fiscal year 
    (shown by location, subject, scope of contracts, and savings) and 
    shall describe the effect of such contracts on the quality of 
    delivery of health services during such year.

    (d) The Secretary may not in any fiscal year close more than 50 
percent of the beds within a bed section (of 20 or more beds) of a 
Department medical center unless the Secretary first submits to the 
Committees on Veterans' Affairs of the Senate and the House of 
Representatives a report providing a justification for the closure. No 
action to carry out such closure may be taken after the submission of 
such report until the end of the 21-day period beginning on the date of 
the submission of the report.
    (e) The Secretary shall submit to the Committees on Veterans' 
Affairs of the Senate and the House of Representatives, not later than 
January 20 of each year, a report documenting by network for the 
preceding fiscal year the following:
        (1) The number of medical service and surgical service beds, 
    respectively, that were closed during that fiscal year and, for each 
    such closure, a description of the changes in delivery of services 
    that allowed such closure to occur.
        (2) The number of nursing home beds that were the subject of a 
    mission change during that fiscal year and the nature of each such 
    mission change.

    (f) For purposes of this section:
        (1) The term ``closure'', with respect to beds in a medical 
    center, means ceasing to provide staffing for, and to operate, those 
    beds. Such term includes converting the provision of such bed care 
    from care in a Department facility to care under contract 
    arrangements.
        (2) The term ``bed section'', with respect to a medical center, 
    means psychiatric beds (including beds for treatment of substance 
    abuse and post-traumatic stress disorder), intermediate, neurology, 
    and rehabilitation medicine beds, extended care (other than nursing 
    home) beds, and domiciliary beds.
        (3) The term ``justification'', with respect to closure of beds, 
    means a written report that includes the following:
            (A) An explanation of the reasons for the determination that 
        the closure is appropriate and advisable.
            (B) A description of the changes in the functions to be 
        carried out and the means by which such care and services would 
        continue to be provided to eligible veterans.
            (C) A description of the anticipated effects of the closure 
        on veterans and on their access to care.

(Added Pub. L. 96-22, title III, Sec. 301(a), June 13, 1979, 93 Stat. 
59, Sec. 5010; amended Pub. L. 96-151, title III, Sec. 301(a), Dec. 20, 
1979, 93 Stat. 1095; Pub. L. 97-66, title VI, Sec. 601(b), Oct. 17, 
1981, 95 Stat. 1033; Pub. L. 97-72, title I, Sec. 108, Nov. 3, 1981, 95 
Stat. 1053; Pub. L. 97-306, title IV, Sec. 409(b), Oct. 14, 1982, 96 
Stat. 1446; Pub. L. 97-452, Sec. 2(e)(4), Jan. 12, 1983, 96 Stat. 2479; 
Pub. L. 98-160, title VII, Sec. 702(19), Nov. 21, 1983, 97 Stat. 1010; 
Pub. L. 98-528, title I, Sec. 102, Oct. 19, 1984, 98 Stat. 2688; Pub. L. 
99-576, title VII, Sec. 702(15), Oct. 28, 1986, 100 Stat. 3302; Pub. L. 
100-322, title II, Sec. 222(a), title IV, Sec. 401(a), May 20, 1988, 102 
Stat. 531, 543; renumbered Sec. 8110 and amended Pub. L. 102-40, title 
IV, Sec. 402(b)(1), (d)(1), May 7, 1991, 105 Stat. 238, 239; Pub. L. 
102-83, Secs. 4(a)(3), (4), (b)(1), (2)(E), 5(c)(1), Aug. 6, 1991, 105 
Stat. 404-406; Pub. L. 102-405, title III, Sec. 302(c)(1), Oct. 9, 1992, 
106 Stat. 1984; Pub. L. 103-446, title XI, Sec. 1103, title XII, 
Sec. 1201(b)(1), (d)(17), (g)(7), Nov. 2, 1994, 108 Stat. 4681, 4682, 
4684, 4687; Pub. L. 104-66, title I, Sec. 1141(c), Dec. 21, 1995, 109 
Stat. 726; Pub. L. 104-262, title I, Sec. 101(e)(4), title III, 
Sec. 305, Oct. 9, 1996, 110 Stat. 3181, 3194; Pub. L. 106-117, title 
III, Sec. 301, Nov. 30, 1999, 113 Stat. 1571.)


                            Prior Provisions

    Provisions similar to those comprising this section were contained 
in former section 5001(a)(2), (3), (h) of this title prior to the 
general revision of this subchapter by Pub. L. 96-22.


                               Amendments

    1999--Subsecs. (d) to (f). Pub. L. 106-117 added subsecs. (d) to 
(f).
    1996--Subsec. (a)(2). Pub. L. 104-262, Sec. 101(e)(4), substituted 
``section 1710(a)'' for ``section 1712''.
    Subsec. (c). Pub. L. 104-262, Sec. 305, amended subsec. (c) 
generally, substituting provisions consisting of an introductory par. 
and pars. (1) and (2), relating to reports on activities and proposals 
involving contracting for performance by contractor personnel of work 
previously performed by Department employees for provisions consisting 
of pars. (1) to (9), relating to conversion of activities at health-care 
facilities from those performed by Federal employees to those performed 
by Government contractors.
    1995--Subsec. (a)(4). Pub. L. 104-66 substituted ``subparagraph 
(C)'' for ``subparagraph (D)'' in subpars. (A) and (B), redesignated 
subpar. (D) as (C), and struck out former subpar. (C) which read as 
follows: ``Whenever the Director of the Office of Management and Budget 
is required to submit a certification under subparagraph (B) of this 
paragraph, the Comptroller General shall submit to the appropriate 
committees of the Congress a report stating the Comptroller General's 
opinion as to whether the Director has complied with the requirements of 
that subparagraph. The Comptroller General shall submit the report not 
later than fifteen days after the end of the period specified in such 
subparagraph for the Director to submit the certification.''
    1994--Subsec. (a)(3)(B), (5), (6). Pub. L. 103-446, Sec. 1201(b)(1), 
substituted ``Veterans Health Administration'' for ``Department of 
Medicine and Surgery'' wherever appearing.
    Subsec. (c)(3)(B). Pub. L. 103-446, Sec. 1201(d)(17), substituted 
``section 513 or 7409'' for ``section 213 or 4117''.
    Subsec. (c)(7). Pub. L. 103-446, Sec. 1201(g)(7), which provided for 
striking out obsolete or executed provisions and directed the amendment 
of subsec. (c) by striking out par. (7), was not executed because of the 
prior amendment of subsec. (c) by Pub. L. 103-446, Sec. 1103. See below.
    Pub. L. 103-446, Sec. 1103, added par. (7) and struck out former 
par. (7) which read as follows: ``Not later than February 1, 1984, and 
February 1 of each of the five succeeding years, the Secretary shall 
submit a written report to Congress describing the extent to which 
activities at Department health-care facilities were performed by 
contractors during the preceding fiscal year and the actual cost savings 
resulting from such contracts.''
    Subsec. (c)(8), (9). Pub. L. 103-446, Sec. 1103, added pars. (8) and 
(9).
    1992--Subsecs. (a)(3), (b), (c)(1), (3)(B). Pub. L. 102-405 
substituted ``Under Secretary for Health'' for ``Chief Medical 
Director'' wherever appearing.
    1991--Pub. L. 102-40, Sec. 402(b)(1), renumbered section 5010 of 
this title as this section.
    Subsec. (a). Pub. L. 102-83, Sec. 5(c)(1), substituted ``1712'' for 
``612'' in par. (2).
    Pub. L. 102-83, Sec. 4(b)(1), (2)(E), substituted ``Secretary'' for 
``Administrator'' wherever appearing.
    Pub. L. 102-83, Sec. 4(a)(3), (4), substituted ``Department'' for 
``Veterans' Administration'' wherever appearing.
    Subsec. (b). Pub. L. 102-83, Sec. 4(b)(1), (2)(E), substituted 
``Secretary'' for ``Administrator'' wherever appearing.
    Pub. L. 102-83, Sec. 4(a)(3), (4), substituted ``Department'' for 
``Veterans' Administration'' in two places.
    Subsec. (c). Pub. L. 102-83, Sec. 4(b)(1), (2)(E), substituted 
``Secretary'' for ``Administrator'' and ``Secretary's'' for 
``Administrator's'' wherever appearing.
    Pub. L. 102-83, Sec. 4(a)(3), (4), substituted ``Department'' for 
``Veterans' Administration'' wherever appearing.
    Pub. L. 102-40, Sec. 402(d)(1), substituted ``8111, 8111A, or 8153'' 
for ``5011, 5011A, or 5053'' in par. (3)(A).
    1988--Subsec. (a)(6). Pub. L. 100-322, Sec. 222(a), added par. (6).
    Subsec. (c)(2). Pub. L. 100-322, Sec. 401(a), inserted ``responsive 
bids are received from at least two responsible, financially autonomous 
bidders and'' after ``only if''.
    1986--Subsec. (a)(1). Pub. L. 99-576 substituted ``125,000 and not 
less than 100,000'' for ``one hundred and twenty-five thousand and not 
less than one hundred thousand'' and ``90,000'' for ``ninety thousand'' 
in two places.
    1984--Subsec. (a)(4)(C). Pub. L. 98-528 substituted provision 
requiring the Comptroller General to submit a report stating the 
Comptroller General's opinion as to whether the Director has complied 
with subpar. (B) not later than fifteen days after end of period 
specified in that subparagraph for Director to submit required 
certification for provision which had required the Comptroller General 
to submit a report stating the Comptroller General's opinion as to 
whether the Director has complied with the requirements of any law 
making appropriations for the Veterans' Administration for any fiscal 
year or any part thereof regarding funded personnel ceilings not later 
than forty-fifth day after enactment of each such law.
    1983--Subsec. (a)(1). Pub. L. 97-452 substituted ``section 1105 of 
title 31'' for ``section 201(a) of the Budget and Accounting Act, 1921 
(31 U.S.C. 11(a))''.
    Subsec. (c)(2)(B). Pub. L. 98-160 substituted ``quantity and 
quality'' for ``quantity or quality''.
    1982--Subsec. (c). Pub. L. 97-306 added subsec. (c).
    1981--Subsec. (a)(1). Pub. L. 97-72, Sec. 108(a)(1), struck out 
provision authorizing the Administrator, subject to the approval of the 
President to establish and operate not less than 125,000 hospital beds 
in medical facilities over which the Administrator has direct 
jurisdiction for the care and treatment of eligible veterans and 
substituted therefor provisions directing the Administrator to establish 
a total number of hospital beds and nursing home beds in medical 
facilities over which the Administrator has direct jurisdiction for the 
care and treatment of eligible veterans at not more than one hundred and 
twenty-five thousand and not less than one hundred thousand, and 
provided that the Administrator establish the total number of such beds 
so as to maintain a contingency capacity to assist the Department of 
Defense in time of war or national emergency to care for the casualties 
of such war or national emergency, that of the number of beds authorized 
pursuant to the preceding sentence, the Administrator operate and 
maintain a total of not less than ninety thousand hospital beds and 
nursing home beds and maintain the availability of such additional beds 
and facilities in addition to the operating bed level as the 
Administrator considers necessary for such contingency purposes, and 
that the President include in the Budget transmitted to the Congress for 
each fiscal year pursuant to section 201(a) of the Budget and Accounting 
Act, 1921 (31 U.S.C. 11(a)), an amount for medical care and amounts for 
construction.
    Subsec. (a)(3). Pub. L. 97-72, Sec. 108(a)(2), struck out provision 
requiring that the Chief Medical Director periodically analyze 
agencywide admission policies and the records of those eligible veterans 
who apply for hospital care and medical services and annually advise 
each committee of the results and the added requirements which those 
results indicate and substituted therefor provisions that the Chief 
Medical Director, at the end of each fiscal year, (i) analyze agencywide 
admission policies and the records of those eligible veterans who apply 
for hospital care, medical services and nursing home care, but are 
rejected or not immediately admitted or provided such care or services, 
and (ii) review and made recommendations regarding the adequacy of the 
established operating bed levels, the geographic distribution of 
operating beds, the demographic characteristics of the veteran 
population and the associated need for medical care and nursing home 
facilities and services in each State, and the proportion of the total 
number of operating beds that are hospital beds and that are nursing 
home beds, and that, after considering the analyses and recommendations 
of the Chief Medical Director pursuant to subparagraph (A) of this 
paragraph for any fiscal year, the Administrator report to the 
committees, on or before December 1 after the close of such fiscal year, 
on the results of the analysis of the Chief Medical Director and on the 
required number of beds and the level of treatment capacities required.
    Subsec. (a)(4)(A). Pub. L. 97-66, Sec. 601(b)(1)(A), inserted ``for 
any fiscal year (or any part of a fiscal year)'' after ``With respect to 
each law making appropriations for the Veterans' Administration''.
    Subsec. (a)(4)(B). Pub. L. 97-66, Sec. 601(b)(1)(B), inserted ``(or 
part of a fiscal year)'' after ``provide to the Veterans' Administration 
for the fiscal year''.
    Subsec. (a)(4)(D). Pub. L. 97-66, Sec. 601(b)(1)(B), inserted ``(or 
part of a fiscal year)'' after ``fiscal year'' in two places.
    Subsec. (a)(5). Pub. L. 97-66, Sec. 601(b)(2), added par. (5).
    Subsecs. (b), (c). Pub. L. 97-72, Sec. 108(b), redesignated subsec. 
(c) as (b). Former subsec. (b), authorizing the Administrator to 
establish, subject to the approval of the President, not less than 
twelve thousand beds during fiscal year 1980, and during each fiscal 
year thereafter, for the furnishing of nursing home care to eligible 
veterans in facilities over which the Administrator has direct 
jurisdiction, was struck out.
    1979--Subsec. (a)(4). Pub. L. 96-151 added par. (4).


                    Effective Date of 1988 Amendment

    Section 222(b) of Pub. L. 100-322 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply with respect 
to fiscal years after fiscal year 1987.''
    Section 401(b) of Pub. L. 100-322 provided that: ``The amendment 
made by subsection (a) [amending this section] shall apply only with 
respect to the awarding of contracts under solicitations issued after 
the date of the enactment of this Act [May 20, 1988].''


                    Effective Date of 1981 Amendment

    Amendment by section 601(b)(1) of Pub. L. 97-66 effective Oct. 1, 
1981, see section 701(b)(4) of Pub. L. 97-66, set out as a note under 
section 1114 of this title.
    Amendment by section 601(b)(2) of Pub. L. 97-66 effective Oct. 17, 
1981, see section 701(b)(1) of Pub. L. 97-66, set out as a note under 
section 1114 of this title.


                    Effective Date of 1979 Amendment

    Section 301(b) of Pub. L. 96-151 provided that: ``The amendment made 
by subsection (a) [amending this section] shall take effect with respect 
to Public Law 96-103 [Nov. 5, 1979, 93 Stat. 771], but, with respect to 
such Public Law, the certification and report required by subparagraph 
(B) of paragraph (4) of section 5010 [now 8110] of title 38, United 
States Code (as added by such amendment), and the report required by 
subparagraph (C) of such paragraph (as added by such amendment) shall be 
submitted to the appropriate committees of the Congress not later than 
January 15, 1980, and February 1, 1980, respectively.''


         Conversion of Underused Space to Domiciliary-Care Beds

    Section 136 of Pub. L. 100-322 directed Administrator, not later 
than June 1, 1988, to convert underused space located in facilities 
under jurisdiction of Administrator in urban areas with significant 
numbers of homeless veterans into 500 domiciliary-care beds to be used 
for care of veterans in need of domiciliary care, primarily homeless 
veterans.


          Policy of Comprehensive Veterans' Health-Care System

    Section 409(a) of Pub. L. 97-306 provided that: ``It is the policy 
of the United States that the Veterans' Administration--
        ``(1) shall maintain a comprehensive, nationwide health-care 
    system for the direct provision of quality health-care services to 
    eligible veterans; and
        ``(2) shall operate such system through cost-effective means 
    that are consistent with carrying out fully the functions of the 
    Department of Medicine and Surgery of the Veterans' Administration 
    under title 38, United States Code.''

                  Section Referred to in Other Sections

    This section is referred to in sections 8103, 8111 of this title.
