HR 3230 ENR: Veterans Access, Choice, and Accountability Act of 2014
U.S. House of Representatives
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents
(a)This Act may be cited as the Veterans Access, Choice, and Accountability Act of 2014
.
(b)The table of contents for this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
Title I—Improvement of Access to Care from Non-Department of Veterans Affairs Providers
Sec. 101. Expanded availability of hospital care and medical services for veterans through the use of agreements with non-Department of Veterans Affairs entities.
Sec. 102. Enhancement of collaboration between Department of Veterans Affairs and Indian Health Service.
Sec. 103. Enhancement of collaboration between Department of Veterans Affairs and Native Hawaiian health care systems.
Sec. 104. Reauthorization and modification of pilot program of enhanced contract care authority for health care needs of veterans.
Sec. 105. Prompt payment by Department of Veterans Affairs.
Sec. 106. Transfer of authority for payments for hospital care, medical services, and other health care from non-Department of Veterans Affairs providers to the chief business office of the Veterans Health Administration.
Title II—Health Care Administrative Matters
Sec. 201. Independent assessment of the health care delivery systems and management processes of the Department of Veterans Affairs.
Sec. 202. Commission on Care.
Sec. 203. Technology task force on review of scheduling system and software of the Department of Veterans Affairs.
Sec. 204. Improvement of access of veterans to mobile vet centers and mobile medical centers of the Department of Veterans Affairs.
Sec. 205. Improved performance metrics for health care provided by Department of Veterans Affairs.
Sec. 206. Improved transparency concerning health care provided by Department of Veterans Affairs.
Sec. 207. Information for veterans on the credentials of Department of Veterans Affairs physicians.
Sec. 208. Information in annual budget of the President on hospital care and medical services furnished through expanded use of contracts for such care.
Sec. 209. Prohibition on falsification of data concerning wait times and quality measures at Department of Veterans Affairs.
Title III—Health Care Staffing, Recruitment, and Training Matters
Sec. 301. Treatment of staffing shortage and biennial report on staffing of medical facilities of the Department of Veterans Affairs.
Sec. 302. Extension and modification of certain programs within the Department of Veterans Affairs Health Professionals Educational Assistance Program.
Sec. 303. Clinic management training for employees at medical facilities of the Department of Veterans Affairs.
Title IV—Health Care Related to Sexual Trauma
Sec. 401. Expansion of eligibility for sexual trauma counseling and treatment to veterans on inactive duty training.
Sec. 402. Provision of counseling and treatment for sexual trauma by the Department of Veterans Affairs to members of the Armed Forces.
Sec. 403. Reports on military sexual trauma.
Title V—Other Health Care Matters
Sec. 501. Extension of pilot program on assisted living services for veterans with traumatic brain injury.
Title VI—Major Medical Facility Leases
Sec. 601. Authorization of major medical facility leases.
Sec. 602. Budgetary treatment of Department of Veterans Affairs major medical facilities leases.
Title VII—Other Veterans Matters
Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry Scholarship.
Sec. 702. Approval of courses of education provided by public institutions of higher learning for purposes of All-Volunteer Force Educational Assistance Program and Post-9/11 Educational Assistance conditional on in-State tuition rate for veterans.
Sec. 703. Extension of reduction in amount of pension furnished by Department of Veterans Affairs for certain veterans covered by Medicaid plans for services furnished by nursing facilities.
Sec. 704. Extension of requirement for collection of fees for housing loans guaranteed by Secretary of Veterans Affairs.
Sec. 705. Limitation on awards and bonuses paid to employees of Department of Veterans Affairs.
Sec. 706. Extension of authority to use income information.
Sec. 707. Removal of senior executives of the Department of Veterans Affairs for performance or misconduct.
Title VIII—Other Matters
Sec. 801. Appropriation of amounts.
Sec. 802. Veterans Choice Fund.
Sec. 803. Emergency designations.
2.In this Act:
(1)The term facility of the Department has the meaning given the term facilities of the Department in section 1701 of title 38, United States Code.
(2)The terms hospital care and medical services have the meanings given such terms in section 1701 of title 38, United States Code.
<enum>I</enum><header>Improvement of Access to Care from Non-Department of Veterans Affairs Providers</header>
<section id="H5D0841A0183E49E7B756DF6CED36A042"><enum>101.</enum><header>Expanded availability of hospital care and medical services for veterans through the use of agreements with non-Department of Veterans Affairs entities</header>
<subsection id="HC8EF163AE8C84F96AE92841E4AEC79D5"><enum>(a)</enum><header>Expansion of available care and services</header>
<paragraph id="H0B0824B1748547AB9BBC83AE64BC9E1A"><enum>(1)</enum><header>Furnishing of care</header>
<subparagraph id="H6627D4ABBF904C6A9D578799FEE3355C"><enum>(A)</enum><header>In general</header><text>Hospital care and medical services under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code, shall be furnished to an eligible veteran described in subsection (b), at the election of such veteran, through agreements authorized under subsection (d), or any other law administered by the Secretary of Veterans Affairs, with entities specified in subparagraph (B) for the furnishing of such care and services to veterans.</text></subparagraph>
<subparagraph id="H6A7BD5E0193743379F329EBA603DF2BF"><enum>(B)</enum><header>Entities specified</header><text>The entities specified in this subparagraph are the following:</text>
<clause id="H7F8A015B6AA941D3A5311C98BBBCBF8D"><enum>(i)</enum><text display-inline="yes-display-inline">Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>), including any physician furnishing services under such program.</text></clause>
<clause id="HAB09DD5447F7463DBD6E3A558A75E698"><enum>(ii)</enum><text>Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(l)(2)(B)</external-xref>)).</text></clause>
<clause id="H076204C76F8C4EBF85596528A51FF64F"><enum>(iii)</enum><text>The Department of Defense.</text></clause>
<clause id="H5F47DFBBC9DF4A7D858B2BF9CD38CFCB"><enum>(iv)</enum><text>The Indian Health Service.</text></clause></subparagraph></paragraph>
<paragraph commented="no" id="HEC78CC5F6D63486E9289ABEF326926C1"><enum>(2)</enum><header>Choice of provider</header><text>An eligible veteran who makes an election under subsection (c) to receive hospital care or medical services under this section may select a provider of such care or services from among the entities specified in paragraph (1)(B) that are accessible to the veteran.</text></paragraph>
<paragraph commented="no" id="H98977D2E75FC4861B39126E1CDE03817"><enum>(3)</enum><header>Coordination of care and services</header><text>The Secretary shall coordinate, through the Non-VA Care Coordination Program of the Department of Veterans Affairs, the furnishing of care and services under this section to eligible veterans, including by ensuring that an eligible veteran receives an appointment for such care and services within the wait-time goals of the Veterans Health Administration for the furnishing of hospital care and medical services.</text></paragraph></subsection>
<subsection id="HFF468DD19974479B96950C25C844DAAF"><enum>(b)</enum><header>Eligible veterans</header><text>A veteran is an eligible veteran for purposes of this section if—</text>
<paragraph id="HDB414C7C0DF44C0EAAE46D7DFA72C45D"><enum>(1)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H7FCB8B5BCC294A7AA201238A69C8DCBD"><enum>(A)</enum><text>as of August 1, 2014, the veteran is enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under <external-xref legal-doc="usc" parsable-cite="usc/38/1705">section 1705</external-xref> of title 38, United States Code, including any such veteran who has not received hospital care or medical services from the Department and has contacted the Department seeking an initial appointment from the Department for the receipt of such care or services; or</text></subparagraph>
<subparagraph id="HC8E1A4BFC1C74A158F3EE5FD13C8174A" indent="up1"><enum>(B)</enum><text>the veteran is eligible for hospital care and medical services under section 1710(e)(1)(D) of such title and is a veteran described in section 1710(e)(3) of such title; and</text></subparagraph></paragraph>
<paragraph id="HF5BBE20C4CDC4400B201367BFF4708BF"><enum>(2)</enum><text>the veteran—</text>
<subparagraph id="HBE97FACB50D94D7A902B0E2F3033AA1B"><enum>(A)</enum><text>attempts, or has attempted, to schedule an appointment for the receipt of hospital care or medical services under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code, but is unable to schedule an appointment within the wait-time goals of the Veterans Health Administration for the furnishing of such care or services;</text></subparagraph>
<subparagraph id="H1266FEF455DC42F9BC5925092A1AC561"><enum>(B)</enum><text>resides more than 40 miles from the medical facility of the Department, including a community-based outpatient clinic, that is closest to the residence of the veteran;</text></subparagraph>
<subparagraph id="H03C83FAE168A4E3FB2BBD786A2A223A8"><enum>(C)</enum><text>resides—</text>
<clause id="H60EB347BB5F240EBAF9DCC9E58CD8B9D"><enum>(i)</enum><text>in a State without a medical facility of the Department that provides—</text>
<subclause id="H125A454486B74658A2426F12545644E1"><enum>(I)</enum><text>hospital care;</text></subclause>
<subclause id="H94D46225391340C289ABCB1DB48CDAD9"><enum>(II)</enum><text>emergency medical services; and</text></subclause>
<subclause id="H31EA533068E346D0A5B24444473228B0"><enum>(III)</enum><text>surgical care rated by the Secretary as having a surgical complexity of standard; and</text></subclause></clause>
<clause commented="no" display-inline="no-display-inline" id="HAE21F68703E54F79921F41F688A5D9C6"><enum>(ii)</enum><text>more than 20 miles from a medical facility of the Department described in clause (i); or</text></clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H2DAD53579E32450EB77E9A197624AFDD"><enum>(D)</enum>
<clause commented="no" display-inline="yes-display-inline" id="HDE68997DDBD64DD0A339DA13D41CDB43"><enum>(i)</enum><text>resides in a location, other than a location in Guam, American Samoa, or the Republic of the Philippines, that is 40 miles or less from a medical facility of the Department, including a community-based outpatient clinic; and</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HA9E6BE68FB584DB38F4424A0353C3F74" indent="up1"><enum>(ii)</enum>
<subclause commented="no" display-inline="yes-display-inline" id="H71BDEC4434DF4B4A8DB280890F8D7C07"><enum>(I)</enum><text>is required to travel by air, boat, or ferry to reach each medical facility described in clause (i) that is 40 miles or less from the residence of the veteran; or</text></subclause>
<subclause commented="no" display-inline="no-display-inline" id="H6509CB26D22F4688BC32FC8B6AD81B6F" indent="up1"><enum>(II)</enum><text>faces an unusual or excessive burden in accessing each medical facility described in clause (i) that is 40 miles or less from the residence of the veteran due to geographical challenges, as determined by the Secretary.</text></subclause></clause></subparagraph></paragraph></subsection>
<subsection id="H6B8DDF2DF02F459B844837FAD5988316"><enum>(c)</enum><header>Election and authorization</header>
<paragraph id="H7F7D82CC376E4790AAF4020EC1E18107"><enum>(1)</enum><header>In general</header><text>In the case of an eligible veteran described in subsection (b)(2)(A), the Secretary shall, at the election of the eligible veteran—</text>
<subparagraph id="H5108AA8301CA400E86A5AF96BEED6F8E"><enum>(A)</enum><text>place such eligible veteran on an electronic waiting list described in paragraph (2) for an appointment for hospital care or medical services the veteran has elected to receive under this section; or</text></subparagraph>
<subparagraph id="H560CF90517474726B6DD4D2B4772A1B9"><enum>(B)</enum>
<clause commented="no" display-inline="yes-display-inline" id="H3E1A8E535F4F4ABD9CF4AE24304D0E37"><enum>(i)</enum><text>authorize that such care or services be furnished to the eligible veteran under this section for a period of time specified by the Secretary; and</text></clause>
<clause id="H85153E9877394D868A245FD1619DF9D9" indent="up1"><enum>(ii)</enum><text>notify the eligible veteran by the most effective means available, including electronic communication or notification in writing, describing the care or services the eligible veteran is eligible to receive under this section.</text></clause></subparagraph></paragraph>
<paragraph id="H0D716A472BE543C284C4F93A36493530"><enum>(2)</enum><header>Electronic waiting list</header><text>The electronic waiting list described in this paragraph shall be maintained by the Department and allow access by each eligible veteran via www.myhealth.va.gov or any successor website for the following purposes:</text>
<subparagraph id="H53523FDE0B304D5D88C38651AE366728"><enum>(A)</enum><text>To determine the place of such eligible veteran on the waiting list.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H35310F76C8E04C02827BD758FB88C1A0"><enum>(B)</enum><text>To determine the average length of time an individual spends on the waiting list, disaggregated by medical facility of the Department and type of care or service needed, for purposes of allowing such eligible veteran to make an informed election under paragraph (1).</text></subparagraph></paragraph></subsection>
<subsection commented="no" id="H2090CF2C3C854FC4AD58FF139EDC49E1"><enum>(d)</enum><header>Care and services through agreements</header>
<paragraph commented="no" id="H8BD622AF45C9499DB13FC64ED6CC13F2"><enum>(1)</enum><header>Agreements</header>
<subparagraph commented="no" id="HA79AF8E35B43405C86E90C12A9519481"><enum>(A)</enum><header>In general</header><text>The Secretary shall enter into agreements for furnishing care and services to eligible veterans under this section with entities specified in subsection (a)(1)(B).</text></subparagraph>
<subparagraph commented="no" id="HE5119FAC64A5498B90742F3265246838"><enum>(B)</enum><header>Agreement defined</header><text>In this paragraph, the term <term>agreement</term> includes contracts, intergovernmental agreements, and provider agreements, as appropriate.</text></subparagraph></paragraph>
<paragraph commented="no" id="HB12A2F05E8D347D3AB8ACCC925A0E355"><enum>(2)</enum><header>Rates and reimbursement</header>
<subparagraph commented="no" id="HF3BAD2608BA749FCB8EF97D4F18530CE"><enum>(A)</enum><header>In general</header><text>In entering into an agreement under paragraph (1) with an entity specified in subsection (a)(1)(B), the Secretary shall—</text>
<clause commented="no" id="H669749725F3F46A29CCCF87FD499724F"><enum>(i)</enum><text>negotiate rates for the furnishing of care and services under this section; and</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HA8FB4E79C03242308D22C3A8B9F3CCED"><enum>(ii)</enum><text>reimburse the entity for such care and services at the rates negotiated pursuant to clause (i) as provided in such agreement.</text></clause></subparagraph>
<subparagraph commented="no" id="H1232C02C60F642F4A27C054C2E6734CD"><enum>(B)</enum><header>Limit on rates</header>
<clause commented="no" id="HD6ECEFE6AAEC49D1B6A46C50782145D8"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">Except as provided in clause (ii), rates negotiated under subparagraph (A)(i) shall not be more than the rates paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(u)</external-xref>)) or a supplier (as defined in section 1861(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(d)</external-xref>)) under the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>) for the same care or services.</text></clause>
<clause commented="no" id="HC0F145C9BFAE44439B7E8111173A003F"><enum>(ii)</enum><header>Exception</header>
<subclause commented="no" id="H2FDD7D8DB6544FFC9E6991B1BF49F40E"><enum>(I)</enum><header>In general</header><text>The Secretary may negotiate a rate that is more than the rate paid by the United States as described in clause (i) with respect to the furnishing of care or services under this section to an eligible veteran who resides in a highly rural area.</text></subclause>
<subclause commented="no" id="H3C2C2F91DDE14D1697E5B4DDCA42B01C"><enum>(II)</enum><header>Highly rural area defined</header><text>In this clause, the term <term>highly rural area</term> means an area located in a county that has fewer than seven individuals residing in that county per square mile.</text></subclause></clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H569E7929964A461385D956DC9E192AB3"><enum>(C)</enum><header>Limit on collection</header><text>For the furnishing of care or services pursuant to an agreement under paragraph (1), an entity specified in subsection (a)(1)(B) may not collect any amount that is greater than the rate negotiated pursuant to subparagraph (A)(i).</text></subparagraph></paragraph>
<paragraph commented="no" id="H1DF8D33E64E64F2BAC3A8E5446282655"><enum>(3)</enum><header>Certain procedures</header>
<subparagraph commented="no" id="HD0C94F42B5A64484B9AC4A18856AE794"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">In entering into an agreement under paragraph (1) with an entity described in subparagraph (B), the Secretary may use the procedures, including those procedures relating to reimbursement, available for entering into provider agreements under section 1866(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)</external-xref>) and participation agreements under section 1842(h) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395u">42 U.S.C. 1395u(h)</external-xref>). During the period in which such entity furnishes care or services pursuant to this section, such entity may not be treated as a Federal contractor or subcontractor by the Office of Federal Contract Compliance Programs of the Department of Labor by virtue of furnishing such care or services.</text></subparagraph>
<subparagraph commented="no" id="H33F1AE48E13C4320ABA1C5B7BE06057B"><enum>(B)</enum><header>Entities described</header><text>The entities described in this subparagraph are the following:</text>
<clause commented="no" id="H3FAA02E1875A44B6AA38D8115B5D831C"><enum>(i)</enum><text display-inline="yes-display-inline">In the case of the Medicare program, any provider of services that has entered into a provider agreement under section 1866(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)</external-xref>) and any physician or other supplier who has entered into a participation agreement under section 1842(h) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395u">42 U.S.C. 1395u(h)</external-xref>); and</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HAAA697EF68DE485D8583DD9F6DA41AE7"><enum>(ii)</enum><text>In the case of the Medicaid program, any provider participating under a State plan under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>).</text></clause></subparagraph></paragraph>
<paragraph commented="no" id="H897802051E014915B2BEE1836B4F34CD"><enum>(4)</enum><header>Information on policies and procedures</header><text>The Secretary shall provide to any entity with which the Secretary has entered into an agreement under paragraph (1) the following:</text>
<subparagraph commented="no" id="H37BD42A3ADCE45F792F00BC973999A6E"><enum>(A)</enum><text>Information on applicable policies and procedures for submitting bills or claims for authorized care or services furnished to eligible veterans under this section.</text></subparagraph>
<subparagraph commented="no" id="H18869210F2C74AFFADE6D59A41EA262E"><enum>(B)</enum><text>Access to a telephone hotline maintained by the Department that such entity may call for information on the following:</text>
<clause commented="no" id="H2EE76C39DE514A1CBDCA40CEDC71C19C"><enum>(i)</enum><text>Procedures for furnishing care and services under this section.</text></clause>
<clause commented="no" id="H806E4AF9F20E435DA7E8625903F35664"><enum>(ii)</enum><text>Procedures for submitting bills or claims for authorized care and services furnished to eligible veterans under this section and being reimbursed for furnishing such care and services.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H65A9EB15859943F38704C3C568D6D4AD"><enum>(iii)</enum><text>Whether particular care or services under this section are authorized, and the procedures for authorization of such care or services.</text></clause></subparagraph></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H9BA9D3AC453C4054B42F3EDA6C1632E1"><enum>(e)</enum><header>Other health-Care plan</header>
<paragraph commented="no" display-inline="no-display-inline" id="HCB6A54F6E2844713BC6CA70C77949227"><enum>(1)</enum><header>Submittal of information to Secretary</header><text>Before receiving hospital care or medical services under this section, an eligible veteran shall provide to the Secretary information on any health-care plan described in paragraph (4) under which the eligible veteran is covered.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H8D1125927B9C4935ADD07EAF73F346EC"><enum>(2)</enum><header>Disclosure of information to non-Department entity</header><text>Notwithstanding <external-xref legal-doc="usc" parsable-cite="usc/38/5701">section 5701</external-xref> of title 38, United States Code, for purposes of furnishing hospital care or medical services to an eligible veteran under this section, the Secretary shall disclose to the entity specified in paragraph (1)(B) of subsection (a) with which the Secretary has entered into an agreement described in such subsection—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HD2B77E972772413BB599D18EB7B756D4"><enum>(A)</enum><text>whether the eligible veteran is covered under a health-care plan described in paragraph (4); and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H53F7D37B7D034E48884F02928124442B"><enum>(B)</enum><text>whether the hospital care or medical services sought by the eligible veteran is for a medical condition that is related to a non-service-connected disability described in paragraph (3)(C).</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H0F33702F87C14E7182D5581EFB5D4A05"><enum>(3)</enum><header>Care for which the Department is secondarily responsible</header>
<subparagraph commented="no" display-inline="no-display-inline" id="HD51917CD4B254448B5CB8D6E790CEEE3"><enum>(A)</enum><header>In general</header><text>If an eligible veteran is covered under a health-care plan described in paragraph (4) and receives hospital care or medical services for a non-service-connected disability described in subparagraph (C), such health-care plan shall be primarily responsible for paying for such care or services, to the extent such care or services is covered by such health-care plan, and the Secretary shall be secondarily responsible for paying for such care or services in accordance with subparagraph (B)(ii).</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H465667535C5E48268245C2B69FECDAEF"><enum>(B)</enum><header>Responsibility for costs of care</header><text display-inline="yes-display-inline">In a case in which the Secretary is secondarily responsible for paying for hospital care or medical services as described in subparagraph (A)—</text>
<clause id="HF982E137E2BB4DD6A7B4F0755DBB5BF3" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">the health care provider that furnishes such care or services pursuant to an agreement described in subsection (a) shall be responsible for seeking reimbursement for the cost of such care or services from the health-care plan described in paragraph (4) under which the eligible veteran is covered; and</text></clause>
<clause id="HFDEC8CED34A8422EA0C295B79561B0F7" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">the Secretary shall be responsible for promptly paying only the amount that is not covered by such health-care plan, except that such responsibility for payment may not exceed the rate determined for such care or services pursuant to subsection (d)(2).</text></clause></subparagraph>
<subparagraph commented="no" id="H6DF7FA26043F42E1B82800D3E979189D"><enum>(C)</enum><header>Non-service-connected disability described</header><text>A non-service-connected disability described in this subsection is a non-service-connected disability (as defined in <external-xref legal-doc="usc" parsable-cite="usc/38/101">section 101</external-xref> of title 38, United States Code)—</text>
<clause commented="no" id="H6E4FF29EE9A3415E908BC157FE125DAD"><enum>(i)</enum><text display-inline="yes-display-inline">that is incurred incident to a veteran’s employment and that is covered under a workers’ compensation law or plan that provides for payment for the cost of health care and services provided to the veteran by reason of the disability;</text></clause>
<clause commented="no" id="H6DF691EFF87B428FBB39372571516163"><enum>(ii)</enum><text>that is incurred as the result of a motor vehicle accident to which applies a State law that requires the owners or operators of motor vehicles registered in that State to have in force automobile accident reparations insurance;</text></clause>
<clause commented="no" id="H69945A78B91D465A9AEA17EF4570D8B4"><enum>(iii)</enum><text>that is incurred as the result of a crime of personal violence that occurred in a State, or a political subdivision of a State, in which a person injured as the result of such a crime is entitled to receive health care and services at such State’s or subdivision’s expense for personal injuries suffered as the result of such crime;</text></clause>
<clause commented="no" id="H49CAE2FBCD5248408A3D53A300514680"><enum>(iv)</enum><text>that is incurred by a veteran—</text>
<subclause commented="no" id="H2089D0B7691846F49E88C4955C2F60D0"><enum>(I)</enum><text>who does not have a service-connected disability; and</text></subclause>
<subclause commented="no" id="H679D7EAC589542F58A16E6B33E978331"><enum>(II)</enum><text>who is entitled to care (or payment of the expenses of care) under a health-care plan; or</text></subclause></clause>
<clause commented="no" id="HDD72A11DBD9742B59A44A17D0CBF44E7"><enum>(v)</enum><text>for which care and services are furnished under this section to a veteran who—</text>
<subclause commented="no" id="HF0BF89E4DDC549A69CF1DBD32B30AE19"><enum>(I)</enum><text>has a service-connected disability; and</text></subclause>
<subclause commented="no" id="H6EFD68387794474F859CD7E528EF7E6A"><enum>(II)</enum><text>is entitled to care (or payment of the expenses of care) under a health-care plan.</text></subclause></clause></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H4DAC646DE589476BB8F2E2FF0BC96DEA"><enum>(4)</enum><header>Health-care plan</header><text display-inline="yes-display-inline">A health-care plan described in this paragraph—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HFD444A51B8FA4646B3EFD092B56D34F4"><enum>(A)</enum><text display-inline="yes-display-inline">is an insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement not administered by the Secretary of Veterans Affairs, under which health services for individuals are provided or the expenses of such services are paid; and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HD9417526C0A942BF8C6F43A9F8FB0134"><enum>(B)</enum><text display-inline="yes-display-inline">does not include any such policy, contract, agreement, or similar arrangement pursuant to title XVIII or XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>) or <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/55">chapter 55</external-xref> of title 10, United States Code.</text></subparagraph></paragraph></subsection>
<subsection id="H18DAA2F198B74E63A6E011B64E7F113E"><enum>(f)</enum><header>Veterans choice card</header>
<paragraph id="H070B1C8A089D4802966A2F72CA228F75"><enum>(1)</enum><header>In general</header><text>For purposes of receiving care and services under this section, the Secretary shall, not later than 90 days after the date of the enactment of this Act, issue to each veteran described in subsection (b)(1) a card that may be presented to a health care provider to facilitate the receipt of care or services under this section.</text></paragraph>
<paragraph id="HF4CC137455BF463FB52AA79BA5D2ADB2"><enum>(2)</enum><header>Name of card</header><text>Each card issued under paragraph (1) shall be known as a <quote>Veterans Choice Card</quote>.</text></paragraph>
<paragraph id="H5BFF1FBE8707405B9B3945231B1FE30D"><enum>(3)</enum><header>Details of card</header><text>Each Veterans Choice Card issued to a veteran under paragraph (1) shall include the following:</text>
<subparagraph id="HE3151272D5EB4BC6A60EE197D0BD4F42"><enum>(A)</enum><text>The name of the veteran.</text></subparagraph>
<subparagraph id="H9829D167C4434920867486A82C041240"><enum>(B)</enum><text>An identification number for the veteran that is not the social security number of the veteran.</text></subparagraph>
<subparagraph id="HF483B0C99E3B4F8B8BF287E23E0D410E"><enum>(C)</enum><text>The contact information of an appropriate office of the Department for health care providers to confirm that care or services under this section are authorized for the veteran.</text></subparagraph>
<subparagraph id="HF7D45BA9342746ADB5FCEFF5B3862C79"><enum>(D)</enum><text>Contact information and other relevant information for the submittal of claims or bills for the furnishing of care or services under this section.</text></subparagraph>
<subparagraph id="H89A6C8697E554D6E9C55BE06A3AD02E5"><enum>(E)</enum><text>The following statement: <quote>This card is for qualifying medical care outside the Department of Veterans Affairs. Please call the Department of Veterans Affairs phone number specified on this card to ensure that treatment has been authorized.</quote>.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H9997DCDEEC4840A999253F47A50554B6"><enum>(4)</enum><header>Information on use of card</header><text>Upon issuing a Veterans Choice Card to a veteran, the Secretary shall provide the veteran with information clearly stating the circumstances under which the veteran may be eligible for care or services under this section.</text></paragraph></subsection>
<subsection id="H9AAC8C01C13344D8B731ABC9A4547629"><enum>(g)</enum><header>Information on availability of care</header><text>The Secretary shall provide information to a veteran about the availability of care and services under this section in the following circumstances:</text>
<paragraph commented="no" id="HF866A88EEE4D49C6887ECECC2CB936A7"><enum>(1)</enum><text>In the case of a veteran described in subsection (b)(1)(B), when the veteran enrolls in the patient enrollment system of the Department under <external-xref legal-doc="usc" parsable-cite="usc/38/1705">section 1705</external-xref> of title 38, United States Code.</text></paragraph>
<paragraph id="HEDD0E97D9799447B9F0780A95E05E2C9"><enum>(2)</enum><text>When the veteran attempts to schedule an appointment for the receipt of hospital care or medical services from the Department but is unable to schedule an appointment within the wait-time goals of the Veterans Health Administration for the furnishing of such care or services.</text></paragraph>
<paragraph id="HEB4D5A19763A45FAB6B7825897C6C683"><enum>(3)</enum><text>When the veteran becomes eligible for hospital care or medical services under this section under subparagraph (B), (C), or (D) of subsection (b)(2).</text></paragraph></subsection>
<subsection id="HDD7C1ADDE09A4FF897A9AE919939F6E3"><enum>(h)</enum><header>Follow-Up care</header><text display-inline="yes-display-inline">In carrying out this section, the Secretary shall ensure that, at the election of an eligible veteran who receives hospital care or medical services from a health care provider in an episode of care under this section, the veteran receives such hospital care and medical services from such health care provider through the completion of the episode of care (but for a period not exceeding 60 days), including all specialty and ancillary services deemed necessary as part of the treatment recommended in the course of such hospital care or medical services.</text></subsection>
<subsection id="H07843ADCC0DE4296A3D43A23721118D3"><enum>(i)</enum><header>Providers</header><text>To be eligible to furnish care or services under this section, a health care provider must—</text>
<paragraph id="H545A7ACBF53643E9820810E2CFCD3F1C"><enum>(1)</enum><text>maintain at least the same or similar credentials and licenses as those credentials and licenses that are required of health care providers of the Department, as determined by the Secretary for purposes of this section; and</text></paragraph>
<paragraph id="H416C09D8923D4219BF2DADFB4368AB32"><enum>(2)</enum><text>submit, not less frequently than once each year during the period in which the Secretary is authorized to carry out this section pursuant to subsection (p), verification of such licenses and credentials maintained by such health care provider.</text></paragraph></subsection>
<subsection id="HBDEA62E417F2439EA7B681C42FED2AC3"><enum>(j)</enum><header>Cost-Sharing</header>
<paragraph id="HAEB623DFC14F428A9203AD19BA6B2482"><enum>(1)</enum><header>In general</header><text>The Secretary shall require an eligible veteran to pay a copayment for the receipt of care or services under this section only if such eligible veteran would be required to pay a copayment for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department pursuant to <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code.</text></paragraph>
<paragraph id="H1370C16C108C452593C9424184B9A73C"><enum>(2)</enum><header>Limitation</header><text>The amount of a copayment charged under paragraph (1) may not exceed the amount of the copayment that would be payable by such eligible veteran for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department pursuant to <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code.</text></paragraph>
<paragraph id="HF85EE09FE20D42438F87CD5754E524F4"><enum>(3)</enum><header>Collection of copayment</header><text>A health care provider that furnishes care or services to an eligible veteran under this section shall collect the copayment required under paragraph (1) from such eligible veteran at the time of furnishing such care or services.</text></paragraph></subsection>
<subsection id="H4407A6203CE24467BAA61698B4C6D71C"><enum>(k)</enum><header>Claims processing system</header>
<paragraph id="H70C332854B12441E9CF604524A86B7CA"><enum>(1)</enum><header>In general</header><text>The Secretary shall provide for an efficient nationwide system for processing and paying bills or claims for authorized care and services furnished to eligible veterans under this section.</text></paragraph>
<paragraph id="HB5FB1EF9BEDA4BC08C099FAFBDB156D6"><enum>(2)</enum><header>Regulations</header><text>Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall prescribe regulations for the implementation of such system.</text></paragraph>
<paragraph id="H62B5DC7C661F452880775D8C90A9050E"><enum>(3)</enum><header>Oversight</header><text>The Chief Business Office of the Veterans Health Administration shall oversee the implementation and maintenance of such system.</text></paragraph>
<paragraph id="HE0EAC52378854026BBB29890236C8D42"><enum>(4)</enum><header>Accuracy of payment</header>
<subparagraph id="HE21DBDAB5B8A443DA2ADF24B05F0217D"><enum>(A)</enum><header>In general</header><text>The Secretary shall ensure that such system meets such goals for accuracy of payment as the Secretary shall specify for purposes of this section.</text></subparagraph>
<subparagraph commented="no" id="HE2B1B2BED20D458E88CB55A11A28553A"><enum>(B)</enum><header>Quarterly report</header>
<clause commented="no" id="HD3322860ED28423D946A47DEBCA1FECA"><enum>(i)</enum><header>In general</header><text>The Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a quarterly report on the accuracy of such system.</text></clause>
<clause commented="no" id="HCB2EF70018324BC6B3941FBD58C34692"><enum>(ii)</enum><header>Elements</header><text>Each report required by clause (i) shall include the following:</text>
<subclause commented="no" id="H9305D7F6098241B6B5CC2F5BBF67D399"><enum>(I)</enum><text>A description of the goals for accuracy for such system specified by the Secretary under subparagraph (A).</text></subclause>
<subclause commented="no" id="H9F50E636B35440ED9DCF035C272883AF"><enum>(II)</enum><text>An assessment of the success of the Department in meeting such goals during the quarter covered by the report.</text></subclause></clause>
<clause id="HB199CA0348F14840A8E60BA92969850A"><enum>(iii)</enum><header>Deadline</header><text>The Secretary shall submit each report required by clause (i) not later than 20 days after the end of the quarter covered by the report.</text></clause></subparagraph></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H58F9A06B948545CA9361D060CD66E093"><enum>(l)</enum><header display-inline="yes-display-inline">Medical records</header>
<paragraph commented="no" display-inline="no-display-inline" id="HE62A132A4F66455AAF0CD309757C1C5B"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall ensure that any health care provider that furnishes care or services under this section to an eligible veteran submits to the Department any medical record related to the care or services provided to such eligible veteran by such health care provider for inclusion in the electronic medical record of such eligible veteran maintained by the Department upon the completion of the provision of such care or services to such eligible veteran.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H905F6ADFD04B4853A182C9286913668D"><enum>(2)</enum><header>Electronic format</header><text>Any medical record submitted to the Department under paragraph (1) shall, to the extent possible, be in an electronic format.</text></paragraph></subsection>
<subsection id="H9120BBB1BF494925A47EED0D9374E753"><enum>(m)</enum><header>Tracking of missed appointments</header><text>The Secretary shall implement a mechanism to track any missed appointments for care or services under this section by eligible veterans to ensure that the Department does not pay for such care or services that were not furnished to an eligible veteran.</text></subsection>
<subsection id="H40342C3B35774C30AF5A03A27FB4E443"><enum>(n)</enum><header>Implementation</header><text>Not later than 90 days after the date of the enactment of this Act, the Secretary shall prescribe interim final regulations on the implementation of this section and publish such regulations in the Federal Register.</text></subsection>
<subsection id="H579C0176D78842AE87253FC7FEEDEC15"><enum>(o)</enum><header>Inspector General report</header><text display-inline="yes-display-inline">Not later than 30 days after the date on which the Secretary determines that 75 percent of the amounts deposited in the Veterans Choice Fund established by section 802 have been exhausted, the Inspector General of the Department shall submit to the Secretary a report on the results of an audit of the care and services furnished under this section to ensure the accuracy and timeliness of payments by the Department for the cost of such care and services, including any findings and recommendations of the Inspector General.</text></subsection>
<subsection id="H001F3D20547A49518DCBB914E7ED2E77"><enum>(p)</enum><header>Authority To furnish care and services</header>
<paragraph id="HE0F16551BEB94426BF764C22CE5F1FD3"><enum>(1)</enum><header>In general</header><text>The Secretary may not use the authority under this section to furnish care and services after the date specified in paragraph (2).</text></paragraph>
<paragraph commented="no" id="H590C06F6CC6F4CF2B712410CC033CC43"><enum>(2)</enum><header>Date specified</header><text>The date specified in this paragraph is the date on which the Secretary has exhausted all amounts deposited in the Veterans Choice Fund established by section 802, or the date that is 3 years after the date of the enactment of this Act, whichever occurs first.</text></paragraph>
<paragraph id="HD573B13913DF4533AC63A52E3C577341"><enum>(3)</enum><header>Publication</header><text>The Secretary shall publish such date in the Federal Register and on an Internet website of the Department available to the public not later than 30 days before such date.</text></paragraph></subsection>
<subsection id="HEBC9418409A74ADFADA27C59F6A7F3C6"><enum>(q)</enum><header>Reports</header>
<paragraph id="H8ED5DB7B5A164D38AD8EE2E526FF382A"><enum>(1)</enum><header>Initial report</header><text>Not later than 90 days after the publication of the interim final regulations under subsection (n), the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the furnishing of care and services under this section that includes the following:</text>
<subparagraph id="HEB7B2D60437A49D097DC3D74098D0668"><enum>(A)</enum><text>The number of eligible veterans who have received care or services under this section.</text></subparagraph>
<subparagraph id="H925E2C7778184047B35D3CAB2A7D5007"><enum>(B)</enum><text>A description of the types of care and services furnished to eligible veterans under this section.</text></subparagraph></paragraph>
<paragraph id="HF07F7090CE1E40448A755F84CF8796B4"><enum>(2)</enum><header>Final report</header><text>Not later than 30 days after the date on which the Secretary determines that 75 percent of the amounts deposited in the Veterans Choice Fund established by section 802 have been exhausted, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the furnishing of care and services under this section that includes the following:</text>
<subparagraph id="H91B63759F13D48B68F222EB29A9CA8A5"><enum>(A)</enum><text>The total number of eligible veterans who have received care or services under this section, disaggregated by—</text>
<clause id="H56A5B3FCB604402B94F8377AF57D47BF"><enum>(i)</enum><text>eligible veterans described in subsection (b)(2)(A);</text></clause>
<clause id="H6C155C2E77924740ADA2F8B726418648"><enum>(ii)</enum><text>eligible veterans described in subsection (b)(2)(B);</text></clause>
<clause id="HF1F8CAF60F38458F939ECAFCE9A094B1"><enum>(iii)</enum><text>eligible veterans described in subsection (b)(2)(C); and</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HD3394C9316004C5F97E9E47310E93C96"><enum>(iv)</enum><text>eligible veterans described in subsection (b)(2)(D).</text></clause></subparagraph>
<subparagraph id="H15C480E157174EFCA22F4D7DE952E48C"><enum>(B)</enum><text>A description of the types of care and services furnished to eligible veterans under this section.</text></subparagraph>
<subparagraph id="H7A328A78BAA1461FA1C654E8CA27807F"><enum>(C)</enum><text>An accounting of the total cost of furnishing care and services to eligible veterans under this section.</text></subparagraph>
<subparagraph id="H3AD0571A0E4A4D7ABD96F74FA042A247"><enum>(D)</enum><text>The results of a survey of eligible veterans who have received care or services under this section on the satisfaction of such eligible veterans with the care or services received by such eligible veterans under this section.</text></subparagraph>
<subparagraph id="HA0AD3793D3DD4F239819C3E7147E20F4"><enum>(E)</enum><text>An assessment of the effect of furnishing care and services under this section on wait times for appointments for the receipt of hospital care and medical services from the Department.</text></subparagraph>
<subparagraph id="H5B733E4780D447DBB2B4A68B047F2399"><enum>(F)</enum><text>An assessment of the feasibility and advisability of continuing furnishing care and services under this section after the termination date specified in subsection (p).</text></subparagraph></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H3DCE38D7363341C794D746B6012BB741"><enum>(r)</enum><header>Rule of construction</header><text>Nothing in this section shall be construed to alter the process of the Department for filling and paying for prescription medications.</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H6B09CDF49A704E96A42F65FCAE933591"><enum>(s)</enum><header>Wait-Time goals of the Veterans Health Administration</header>
<paragraph commented="no" display-inline="no-display-inline" id="H71C6E501B4C54503939846487236927A"><enum>(1)</enum><header>In general</header><text>Except as provided in paragraph (2), in this section, the term <term>wait-time goals of the Veterans Health Administration</term> means not more than 30 days from the date on which a veteran requests an appointment for hospital care or medical services from the Department.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HB65D4B23805540A0B40180ED9F387445"><enum>(2)</enum><header>Alternate goals</header><text>If the Secretary submits to Congress, not later than 60 days after the date of the enactment of this Act, a report stating that the actual wait-time goals of the Veterans Health Administration are different from the wait-time goals specified in paragraph (1)—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H082E0A5BF6D7465AB513AC132036295D"><enum>(A)</enum><text>for purposes of this section, the wait-time goals of the Veterans Health Administration shall be the wait-time goals submitted by the Secretary under this paragraph; and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H6DBEE999744649B394764D41F15FFA22"><enum>(B)</enum><text>the Secretary shall publish such wait-time goals in the Federal Register and on an Internet website of the Department available to the public.</text></subparagraph></paragraph></subsection></section>
<section id="HE5493636732944A4855E1DC8803F0D19"><enum>102.</enum><header>Enhancement of collaboration between Department of Veterans Affairs and Indian Health Service</header>
<subsection id="HF94C14A303A4449E85F5EF6E36BF1CC1"><enum>(a)</enum><header>Outreach to Tribal-Run medical facilities</header><text>The Secretary of Veterans Affairs shall, in consultation with the Director of the Indian Health Service, conduct outreach to each medical facility operated by an Indian tribe or tribal organization through a contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act (<external-xref legal-doc="usc" parsable-cite="usc/25/450">25 U.S.C. 450 et seq.</external-xref>) to raise awareness of the ability of such facilities, Indian tribes, and tribal organizations to enter into agreements with the Department of Veterans Affairs under which the Secretary reimburses such facilities, Indian tribes, or tribal organizations, as the case may be, for health care provided to veterans who are—</text>
<paragraph id="H81CC4BCBF7D74E569C834E1EFEA9CDB9"><enum>(1)</enum><text>eligible for health care at such facilities; and</text></paragraph>
<paragraph id="H1E9D64F314A545088FBD12AD65C722FB"><enum>(2)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="HC52E0D0B0F9C4DE1A5EA99C98F7B1DA6"><enum>(A)</enum><text>enrolled in the patient enrollment system of the Department established and operated under <external-xref legal-doc="usc" parsable-cite="usc/38/1705">section 1705</external-xref> of title 38, United States Code; or</text></subparagraph>
<subparagraph id="H11FB5FD9E6B64EC5B1799FA8F723802B" indent="up1"><enum>(B)</enum><text>eligible for hospital care and medical services pursuant to subsection (c)(2) of such section.</text></subparagraph></paragraph></subsection>
<subsection id="H24552F453CF2431BBEE098D6BAE02D74"><enum>(b)</enum><header>Performance metrics for memorandum of understanding</header><text>The Secretary of Veterans Affairs shall establish performance metrics for assessing the performance by the Department of Veterans Affairs and the Indian Health Service under the memorandum of understanding entitled <quote>Memorandum of Understanding between the Department of Veterans Affairs (VA) and the Indian Health Service (IHS)</quote> in increasing access to health care, improving quality and coordination of health care, promoting effective patient-centered collaboration and partnerships between the Department and the Service, and ensuring health-promotion and disease-prevention services are appropriately funded and available for beneficiaries under both health care systems.</text></subsection>
<subsection id="H510A696ADD614FFD84E7DB00C41279A0"><enum>(c)</enum><header>Report</header><text>Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs and the Director of the Indian Health Service shall jointly submit to Congress a report on the feasibility and advisability of the following:</text>
<paragraph id="H9E0441D538C6464EA36FF96A2CCAA318"><enum>(1)</enum><text>Entering into agreements for the reimbursement by the Secretary of the costs of direct care services provided through organizations receiving amounts pursuant to grants made or contracts entered into under section 503 of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1653">25 U.S.C. 1653</external-xref>) to veterans who are otherwise eligible to receive health care from such organizations.</text></paragraph>
<paragraph id="H24A69834641640F6990F390CFD6437D5"><enum>(2)</enum><text>Including the reimbursement of the costs of direct care services provided to veterans who are not Indians in agreements between the Department and the following:</text>
<subparagraph id="HFCDB81B92D09439EA2895B5541952451"><enum>(A)</enum><text>The Indian Health Service.</text></subparagraph>
<subparagraph id="HDD0F3C4674BA4282981F619B63A96560"><enum>(B)</enum><text>An Indian tribe or tribal organization operating a medical facility through a contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act (<external-xref legal-doc="usc" parsable-cite="usc/25/450">25 U.S.C. 450 et seq.</external-xref>).</text></subparagraph>
<subparagraph id="HB81973F3FEBB4DCDB9BB7E2CA48137B0"><enum>(C)</enum><text>A medical facility of the Indian Health Service.</text></subparagraph></paragraph></subsection>
<subsection id="H5E02900B8D39439582BA488AA0F6AB92"><enum>(d)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="HA6CC67E32CC24A468DF9E05A9148316A"><enum>(1)</enum><header>Indian</header><text>The terms <term>Indian</term> and <term>Indian tribe</term> have the meanings given those terms in section 4 of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1603">25 U.S.C. 1603</external-xref>).</text></paragraph>
<paragraph id="H325F697CBF134D1EA45EB050234DAB93"><enum>(2)</enum><header>Medical facility of the Indian Health Service</header><text>The term <term>medical facility of the Indian Health Service</term> includes a facility operated by an Indian tribe or tribal organization through a contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act (<external-xref legal-doc="usc" parsable-cite="usc/25/450">25 U.S.C. 450 et seq.</external-xref>).</text></paragraph>
<paragraph id="HC5D3A51DC7A644B7A6CE8C7F46E267F6"><enum>(3)</enum><header>Tribal organization</header><text>The term <term>tribal organization</term> has the meaning given the term in section 4 of the Indian Self-Determination and Education Assistance Act (<external-xref legal-doc="usc" parsable-cite="usc/25/450b">25 U.S.C. 450b</external-xref>).</text></paragraph></subsection></section>
<section id="HF740ABCE4EC84AFAB81D5C36FFF70B63"><enum>103.</enum><header>Enhancement of collaboration between Department of Veterans Affairs and Native Hawaiian health care systems</header>
<subsection id="H88F13106EA714FC48C9433F24ECAC30D"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs shall, in consultation with Papa Ola Lokahi and such other organizations involved in the delivery of health care to Native Hawaiians as the Secretary considers appropriate, enter into contracts or agreements with Native Hawaiian health care systems that are in receipt of funds from the Secretary of Health and Human Services pursuant to grants awarded or contracts entered into under section 6(a) of the Native Hawaiian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/42/11705">42 U.S.C. 11705(a)</external-xref>) for the reimbursement of direct care services provided to eligible veterans as specified in such contracts or agreements.</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H916FD8193CB842CBBF585A912208C5BD"><enum>(b)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section, the terms <term>Native Hawaiian</term>, <term>Native Hawaiian health care system</term>, and <term>Papa Ola Lokahi</term> have the meanings given those terms in section 12 of the Native Hawaiian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/42/11711">42 U.S.C. 11711</external-xref>).</text></subsection></section>
<section id="H71C34988183C44F782962A14F8A8CABD"><enum>104.</enum><header>Reauthorization and modification of pilot program of enhanced contract care authority for health care needs of veterans</header><text display-inline="no-display-inline">Section 403 of the Veterans' Mental Health and Other Care Improvements Act of 2008 (<external-xref legal-doc="public-law" parsable-cite="pl/110/387">Public Law 110–387</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1703">38 U.S.C. 1703</external-xref> note) is amended—</text>
<paragraph commented="no" id="H60A402AEC0084EDEB8B685C29CFB93E8"><enum>(1)</enum><text>in subsection (a)—</text>
<subparagraph commented="no" id="H73D1D4E1C4174FECB7315033D3EE0305"><enum>(A)</enum><text>in paragraph (3), by striking <quote>only during the</quote> and all that follows through the period at the end and inserting <quote>only during the period beginning on the date of the commencement of the pilot program under paragraph (2) and ending on the date that is two years after the date of the enactment of the <short-title>Veterans Access, Choice, and Accountability Act of 2014</short-title>.</quote>; and</text></subparagraph>
<subparagraph commented="no" id="HF0BFD05E71BE42D6841558272EA98BFE"><enum>(B)</enum><text>by amending paragraph (4) to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="H6AA9331A83684276823C827AA3F8A4CB" style="OLC">
<paragraph commented="no" id="H61B243A6DE034DE892C01101CB06DCF4"><enum>(4)</enum><header>Program locations</header><text display-inline="yes-display-inline">The Secretary shall carry out the pilot program at locations in the following Veterans Integrated Service Networks (and such other locations as the Secretary considers appropriate):</text>
<subparagraph commented="no" id="HA939E9D779A94E18B47E90041ABB901A"><enum>(A)</enum><text display-inline="yes-display-inline">Veterans Integrated Service Network 1.</text></subparagraph>
<subparagraph commented="no" id="H3CAF319F0DDD4983A6A31EC1CE126709"><enum>(B)</enum><text display-inline="yes-display-inline">Veterans Integrated Service Network 6.</text></subparagraph>
<subparagraph commented="no" id="H070788F266E340D2BD47F7F9383AA162"><enum>(C)</enum><text display-inline="yes-display-inline">Veterans Integrated Service Network 15.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H6DD43A81C5B14C7EAE01CB6879B93EB7"><enum>(D)</enum><text display-inline="yes-display-inline">Veterans Integrated Service Network 18.</text></subparagraph>
<subparagraph commented="no" id="H79A86B90209C45BDBA7A4C0C72211B05"><enum>(E)</enum><text display-inline="yes-display-inline">Veterans Integrated Service Network 19.</text></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph commented="no" id="H69E639C56ED3490C9E1EED3E780BED90"><enum>(2)</enum><text>in subsection (b)(1)(A), by striking <quote>as of the date of the commencement of the pilot program under subsection (a)(2)</quote> and inserting <quote>as of August 1, 2014</quote>;</text></paragraph>
<paragraph id="H4E4CB9D89C5E44868F33D4398BE32599"><enum>(3)</enum><text>by redesignating subsection (h) as subsection (k);</text></paragraph>
<paragraph id="H580483C537894124A5279A7EC96B0E61"><enum>(4)</enum><text>by inserting after subsection (g) the following new subsections:</text>
<quoted-block display-inline="no-display-inline" id="H5A355D62D02B470E9D0C7AB4561136D7" style="OLC">
<subsection id="HFEA9BAF63982445391A26334795B061F"><enum>(h)</enum><header>Appointments</header><text display-inline="yes-display-inline">In carrying out the pilot program under this section, the Secretary shall ensure that medical appointments for covered veterans—</text>
<paragraph id="H6A402872897044D89FCF532F4BCCC6E7"><enum>(1)</enum><text display-inline="yes-display-inline">are scheduled not later than 5 days after the date on which the appointment is requested; and</text></paragraph>
<paragraph id="H3204E3E2A7F24FCAAAEDF7C4F60F9365"><enum>(2)</enum><text display-inline="yes-display-inline">occur not later than 30 days after such date.</text></paragraph></subsection>
<subsection id="H250D772DA2014E6C9917DAB2E273A831"><enum>(i)</enum><header>Outreach</header><text>The Secretary shall ensure that covered veterans are informed about the pilot program under this section.</text></subsection>
<subsection id="H3C94F817BFD74D48A545A6BEEB72DCDF"><enum>(j)</enum><header>Use of existing contracts</header><text>In carrying out the pilot program under this section after the date of the enactment of the <short-title>Veterans Access, Choice, and Accountability Act of 2014</short-title>, the Secretary shall make use of contracts entered into before such date or may enter into new contracts.</text></subsection><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H49FE86812BF948BCA9B6513BE3FEF2B6"><enum>(5)</enum><text display-inline="yes-display-inline">in paragraph (2)(B) of subsection (k), as redesignated by paragraph (3) of this section, by striking the semicolon at the end and inserting <quote>; and</quote>.</text></paragraph></section>
<section commented="no" display-inline="no-display-inline" id="HEE04C08B02BC44159B0188F4E8640B6E"><enum>105.</enum><header>Prompt payment by Department of Veterans Affairs</header>
<subsection commented="no" display-inline="no-display-inline" id="H1404E7EAD49A452B97E89454CFC30B91"><enum>(a)</enum><header>Sense of Congress on prompt payment by Department</header><text display-inline="yes-display-inline">It is the sense of Congress that the Secretary of Veterans Affairs shall comply with <external-xref legal-doc="regulation" parsable-cite="cfr/5/1315">section 1315</external-xref> of title 5, Code of Federal Regulations (commonly known as the <quote>prompt payment rule</quote>), or any corresponding similar regulation or ruling, in paying for health care pursuant to contracts entered into with non-Department of Veterans Affairs providers to provide health care under the laws administered by the Secretary.</text></subsection>
<subsection id="H48B6A1F53A70445CAE8F42CC3FBD4AA1"><enum>(b)</enum><header>Establishment of claims processing system</header>
<paragraph id="HE29A0E9C326A443C974B605E9088FA56"><enum>(1)</enum><header>Claims processing system</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs shall establish and implement a system to process and pay claims for payment for hospital care, medical services, and other health care furnished by non-Department of Veterans Affairs health care providers under the laws administered by the Secretary.</text></paragraph>
<paragraph id="H09AD63E02358406EB3341972572BAB4E"><enum>(2)</enum><header>Compliance with Prompt Payment Act</header><text>The system established and implemented under paragraph (1) shall comply with all requirements of chapter 39, United States Code (commonly referred to as the <quote>Prompt Payment Act</quote>). </text></paragraph></subsection>
<subsection id="H14426307CC314A889555928927BE773C"><enum>(c)</enum><header>Report</header><text>Not later than 1 year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the timeliness of payments by the Secretary for hospital care, medical services, and other health care furnished by non-Department of Veterans Affairs health care providers under the laws administered by the Secretary.</text></subsection>
<subsection id="H44EB57BCEEEA413A951F0612E97C4CDB"><enum>(d)</enum><header>Elements</header><text>The report required by subsection (b) shall include the following:</text>
<paragraph id="HE87E54BF96FB4FB48CB1C7C709ADBC39"><enum>(1)</enum><text>The results of a survey of non-Department health care providers who have submitted claims to the Department for hospital care, medical services, or other health care furnished to veterans for which payment is authorized under the laws administered by the Secretary during the one-year period preceding the submittal of the report, which survey shall include the following:</text>
<subparagraph id="H64219A95D34849DB8AE24DF978DA2A3A"><enum>(A)</enum><text>The amount of time it took for such health care providers, after submitting such claims, to receive payment from the Department for such care or services.</text></subparagraph>
<subparagraph id="HCE564351D067441CAA10CB51868D0435"><enum>(B)</enum><text>A comparison of the amount of time under subparagraph (A) and the amount of time it takes such health care providers to receive payments from the United States for similar care or services provided to the following, if applicable:</text>
<clause id="HED9919C753374827A5C18EA56D985AA9"><enum>(i)</enum><text>Beneficiaries under the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>).</text></clause>
<clause id="H34ED0618D71647609E9F481F2157BB64"><enum>(ii)</enum><text>Covered beneficiaries under the TRICARE program under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/55">chapter 55</external-xref> of title 10, United States Code.</text></clause></subparagraph></paragraph>
<paragraph id="H6811EE153A4C43AB88C81FD6AE016702"><enum>(2)</enum><text>Such recommendations for legislative or administrative action as the Comptroller General considers appropriate.</text></paragraph></subsection>
<subsection id="HECC466FB8D774238A4667F1E93CA1D49"><enum>(e)</enum><header>Survey elements</header><text>In carrying out the survey, the Comptroller General shall seek responses from non-Department health care providers in a manner that ensures that the survey reflects the responses of such providers that—</text>
<paragraph id="HF0E6E8E1FE5B442DB6D31996F036A393"><enum>(1)</enum><text>are located in different geographic areas;</text></paragraph>
<paragraph id="H5E4D8C865BD54332B33E6C84DD4EE652"><enum>(2)</enum><text>furnish a variety of different hospital care, medical services, and other health care; and</text></paragraph>
<paragraph id="HF810ECDBE7A74499A267B5F85BBB93E8"><enum>(3)</enum><text>furnish such care and services in a variety of different types of medical facilities.</text></paragraph></subsection></section>
<section id="HDE759FA7D7844D14A7D87CD82378B4E0"><enum>106.</enum><header>Transfer of authority for payments for hospital care, medical services, and other health care from non-Department of Veterans Affairs providers to the chief business office of the Veterans Health Administration</header>
<subsection id="H54FCE629CB0B4E0BB2CF33BEDAF88709"><enum>(a)</enum><header>Transfer of authority</header>
<paragraph id="H3EE18237705C41B897AF79F167A32EB4"><enum>(1)</enum><header>In general</header><text>Effective as of October 1, 2014, the Secretary of Veterans Affairs shall transfer the authority to pay for hospital care, medical services, and other health care furnished through non-Department of Veterans Affairs providers from—</text>
<subparagraph id="H7F76B6A6508342BD81214958196A9658"><enum>(A)</enum><text>the Veterans Integrated Service Networks and medical centers of the Department of Veterans Affairs, to</text></subparagraph>
<subparagraph id="HDD508160FCFA492AA715A82035FFF259"><enum>(B)</enum><text>the Chief Business Office of the Veterans Health Administration of the Department of Veterans Affairs.</text></subparagraph></paragraph>
<paragraph id="HD763D71C77A64BA493CD1F149D24B48D"><enum>(2)</enum><header>Manner of care</header><text>The Chief Business Office shall work in consultation with the Office of Clinical Operations and Management of the Department to ensure that care and services described in paragraph (1) are provided in a manner that is clinically appropriate and in the best interest of the veterans receiving such care and services.</text></paragraph>
<paragraph id="H756F513D088045A2BF594A40BB1FF261"><enum>(3)</enum><header>No delay in payment</header><text>The transfer of authority under paragraph (1) shall be carried out in a manner that does not delay or impede any payment by the Department for hospital care, medical services, or other health care furnished through a non-Department provider under the laws administered by the Secretary.</text></paragraph></subsection>
<subsection id="HD964291B4BA54B8CBFE41D546AE8A127"><enum>(b)</enum><header>Budget matters</header><text>The budget of the Department of Veterans Affairs for any fiscal year beginning after the date of the enactment of this Act (as submitted to Congress pursuant to <external-xref legal-doc="usc" parsable-cite="usc/31/1105">section 1105(a)</external-xref> of title 31, United States Code) shall specify funds for the payment for hospital care, medical services, and other health care furnished through non-Department of Veterans Affairs providers, including any administrative costs associated with such payment, as funds for the Chief Business Office of the Veterans Health Administration rather than as funds for the Veterans Integrated Service Networks or medical centers of the Department.</text></subsection></section>
<enum>II</enum><header>Health Care Administrative Matters</header>
<section id="HD61D4FE1DED64FE9A3581E4C4CE4DC60"><enum>201.</enum><header>Independent assessment of the health care delivery systems and management processes of the Department of Veterans Affairs</header>
<subsection id="H1D1F5CCEB8D0408589E0E37F66B3EA36"><enum>(a)</enum><header>Independent assessment</header>
<paragraph id="H4A6F0CECC64144808F33F541901D4068"><enum>(1)</enum><header>Assessment</header><text>Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into one or more contracts with a private sector entity or entities described in subsection (b) to conduct an independent assessment of the hospital care, medical services, and other health care furnished in medical facilities of the Department. Such assessment shall address each of the following:</text>
<subparagraph id="HD6FACF02D4CE4F3A854FECC83EF283BA"><enum>(A)</enum><text display-inline="yes-display-inline">Current and projected demographics and unique health care needs of the patient population served by the Department.</text></subparagraph>
<subparagraph id="HBD7846A7580D4FED8F40C5838888EFB6"><enum>(B)</enum><text>Current and projected health care capabilities and resources of the Department, including hospital care, medical services, and other health care furnished by non-Department facilities under contract with the Department, to provide timely and accessible care to veterans.</text></subparagraph>
<subparagraph id="HA7A089AE120F402D9C4D52BB4CEB9BE3"><enum>(C)</enum><text>The authorities and mechanisms under which the Secretary may furnish hospital care, medical services, and other health care at non-Department facilities, including whether the Secretary should have the authority to furnish such care and services at such facilities through the completion of episodes of care.</text></subparagraph>
<subparagraph id="HE5EFBA06C286407BBEF2F39061EA47DB"><enum>(D)</enum><text>The appropriate system-wide access standard applicable to hospital care, medical services, and other health care furnished by and through the Department, including an identification of appropriate access standards for each individual specialty and post-care rehabilitation.</text></subparagraph>
<subparagraph id="HB7B90219FFD4473B8253959B1BFA1558"><enum>(E)</enum><text>The workflow process at each medical facility of the Department for scheduling appointments for veterans to receive hospital care, medical services, or other health care from the Department.</text></subparagraph>
<subparagraph id="H7807C977E3C740FB80A9F4FC016271BF"><enum>(F)</enum><text>The organization, workflow processes, and tools used by the Department to support clinical staffing, access to care, effective length-of-stay management and care transitions, positive patient experience, accurate documentation, and subsequent coding of inpatient services.</text></subparagraph>
<subparagraph commented="no" id="HCD542051E05C4C6984423FF4DD48D77C"><enum>(G)</enum><text>The staffing level at each medical facility of the Department and the productivity of each health care provider at such medical facility, compared with health care industry performance metrics, which may include an assessment of any of the following:</text>
<clause commented="no" id="H0E73D840EEC843FC9C5BEA33A462D689"><enum>(i)</enum><text>The case load of, and number of patients treated by, each health care provider at such medical facility during an average week.</text></clause>
<clause commented="no" id="H919BA75960C54C69A80D826B27B25FC0"><enum>(ii)</enum><text>The time spent by such health care provider on matters other than the case load of such health care provider, including time spent by such health care provider as follows:</text>
<subclause commented="no" id="H422B6DAC405345E2A6660DB7D40F92A2"><enum>(I)</enum><text>At a medical facility that is affiliated with the Department.</text></subclause>
<subclause commented="no" id="HC4C128E9DC3F4620ADE37B3AD29FD563"><enum>(II)</enum><text>Conducting research.</text></subclause>
<subclause commented="no" display-inline="no-display-inline" id="H2F5CDE32E5BF4435A22E4A5A0514310C"><enum>(III)</enum><text>Training or supervising other health care professionals of the Department.</text></subclause></clause></subparagraph>
<subparagraph id="HB960CD17EF5940EA9FA7A358F3B714D0"><enum>(H)</enum><text>The information technology strategies of the Department with respect to furnishing and managing health care, including an identification of any weaknesses and opportunities with respect to the technology used by the Department, especially those strategies with respect to clinical documentation of episodes of hospital care, medical services, and other health care, including any clinical images and associated textual reports, furnished by the Department in Department or non-Department facilities.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HA3E23A8EE08E4197BB8C2FEF3D7C3F05"><enum>(I)</enum><text>Business processes of the Veterans Health Administration, including processes relating to furnishing non-Department health care, insurance identification, third-party revenue collection, and vendor reimbursement, including an identification of mechanisms as follows:</text>
<clause commented="no" id="H7F379A29C55F46FFAB080F9D78C7BBB8"><enum>(i)</enum><text>To avoid the payment of penalties to vendors.</text></clause>
<clause commented="no" id="H53F8D5163D5B4DF3A04A2EC7B1BE0BAB"><enum>(ii)</enum><text>To increase the collection of amounts owed to the Department for hospital care, medical services, or other health care provided by the Department for which reimbursement from a third party is authorized and to ensure that such amounts collected are accurate.</text></clause>
<clause commented="no" id="H804BC9742CB44992B658EF43EE80C1E6"><enum>(iii)</enum><text>To increase the collection of any other amounts owed to the Department with respect to hospital care, medical services, and other health care and to ensure that such amounts collected are accurate.</text></clause>
<clause id="HF22854FAF34D4EC6814FD682D8E98B1D"><enum>(iv)</enum><text>To increase the accuracy and timeliness of Department payments to vendors and providers.</text></clause></subparagraph>
<subparagraph id="HDE1E4AA46D7446AD994B5E8FB46917FF"><enum>(J)</enum><text>The purchasing, distribution, and use of pharmaceuticals, medical and surgical supplies, medical devices, and health care related services by the Department, including the following:</text>
<clause id="H5ED713AD4E7C441DB2C439939CEBCE65"><enum>(i)</enum><text>The prices paid for, standardization of, and use by the Department of the following:</text>
<subclause id="HC20FC8408B9C437B991573163F14A38A"><enum>(I)</enum><text>Pharmaceuticals.</text></subclause>
<subclause id="H5D35FF97CA09425C8E2A085527D33D77"><enum>(II)</enum><text>Medical and surgical supplies.</text></subclause>
<subclause id="H86881846A684450FA77035460AF31A46"><enum>(III)</enum><text>Medical devices.</text></subclause></clause>
<clause id="H6F353400D2EF4F98914CF7F9C60EF980"><enum>(ii)</enum><text>The use by the Department of group purchasing arrangements to purchase pharmaceuticals, medical and surgical supplies, medical devices, and health care related services.</text></clause>
<clause id="H6F0D7F21448447E09B67E3A6FF1A7E4F"><enum>(iii)</enum><text>The strategy and systems used by the Department to distribute pharmaceuticals, medical and surgical supplies, medical devices, and health care related services to Veterans Integrated Service Networks and medical facilities of the Department.</text></clause></subparagraph>
<subparagraph id="H339A0838DC5D4E7399ADAC398F810141"><enum>(K)</enum><text>The process of the Department for carrying out construction and maintenance projects at medical facilities of the Department and the medical facility leasing program of the Department.</text></subparagraph>
<subparagraph id="H7EFA27D601AA40079B26B2CEA1EAE2D0"><enum>(L)</enum><text display-inline="yes-display-inline">The competency of leadership with respect to culture, accountability, reform readiness, leadership development, physician alignment, employee engagement, succession planning, and performance management.</text></subparagraph></paragraph>
<paragraph id="HBFF59352B209463F88FD2900646E8018"><enum>(2)</enum><header>Particular elements of certain assessments</header>
<subparagraph id="HD0FAC0B7C8B54DE690DBAC6A2052593E"><enum>(A)</enum><header>Scheduling assessment</header><text>In carrying out the assessment required by paragraph (1)(E), the private sector entity or entities shall do the following:</text>
<clause id="H394E792C9CC945C7BB1CF2E73A4729E8"><enum>(i)</enum><text>Review all training materials pertaining to scheduling of appointments at each medical facility of the Department.</text></clause>
<clause id="HAA8786853EA94B8D8D6291F9F8555ACB"><enum>(ii)</enum><text>Assess whether all employees of the Department conducting tasks related to scheduling are properly trained for conducting such tasks.</text></clause>
<clause id="HA73D9DB994784B65AE2E98D929D9A757"><enum>(iii)</enum><text>Assess whether changes in the technology or system used in scheduling appointments are necessary to limit access to the system to only those employees that have been properly trained in conducting such tasks.</text></clause>
<clause id="HE5DD4A1F0A004A53A1E80F1F2C537870"><enum>(iv)</enum><text>Assess whether health care providers of the Department are making changes to their schedules that hinder the ability of employees conducting such tasks to perform such tasks.</text></clause>
<clause id="HE2BD850DA6B443779B6A0EE122B891B0"><enum>(v)</enum><text>Assess whether the establishment of a centralized call center throughout the Department for scheduling appointments at medical facilities of the Department would improve the process of scheduling such appointments.</text></clause>
<clause id="H367EBB7FD8014A86990C40A0100E1A03"><enum>(vi)</enum><text>Assess whether booking templates for each medical facility or clinic of the Department would improve the process of scheduling such appointments.</text></clause>
<clause id="H57035D104D104C679E6B54455555E37B"><enum>(vii)</enum><text display-inline="yes-display-inline">Assess any interim technology changes or attempts by Department to internally develop a long-term scheduling solutions with respect to the feasibility and cost effectiveness of such internally developed solutions compared to commercially available solutions.</text></clause>
<clause id="H5405CBABE0C049429AE9DC40EAE753D2"><enum>(viii)</enum><text>Recommend actions, if any, to be taken by the Department to improve the process for scheduling such appointments, including the following:</text>
<subclause id="HD5B0FCB1CE81446180106337870B63B3"><enum>(I)</enum><text>Changes in training materials provided to employees of the Department with respect to conducting tasks related to scheduling such appointments.</text></subclause>
<subclause commented="no" id="H63D37A7DD6714F09BDEC80F959000B1D"><enum>(II)</enum><text>Changes in monitoring and assessment conducted by the Department of wait times of veterans for such appointments.</text></subclause>
<subclause commented="no" id="HFDA4D5DA38AA4D08AFCE60B13F3F63B4"><enum>(III)</enum><text>Changes in the system used to schedule such appointments, including changes to improve how the Department—</text>
<item commented="no" id="HF8B60651C009447990F806ED4E059A40"><enum>(aa)</enum><text>measures wait times of veterans for such appointments;</text></item>
<item commented="no" id="H0CD607CA54F14FBC8AB460105A30AE10"><enum>(bb)</enum><text>monitors the availability of health care providers of the Department; and</text></item>
<item commented="no" id="H0994D5424120453B893A60AF34639831"><enum>(cc)</enum><text>provides veterans the ability to schedule such appointments.</text></item></subclause>
<subclause commented="no" id="H14FD71DEDB174033879CA2BB096BE04D"><enum>(IV)</enum><text>Such other actions as the private sector entity or entities considers appropriate.</text></subclause></clause></subparagraph>
<subparagraph commented="no" id="H432FD06C5ABF498C8C366EAE7F3E92C5"><enum>(B)</enum><header>Medical construction and maintenance project and leasing program assessment</header><text>In carrying out the assessment required by paragraph (1)(K), the private sector entity or entities shall do the following:</text>
<clause id="H011014164D514F12A0EE2B8A6464A4B8"><enum>(i)</enum><text>Review the process of the Department for identifying and designing proposals for construction and maintenance projects at medical facilities of the Department and leases for medical facilities of the Department.</text></clause>
<clause id="HF9A2C5DE3BA843268C176F490BE5BB30"><enum>(ii)</enum><text>Assess the process through which the Department determines the following:</text>
<subclause id="H100C095CD2B0469DBA827D8F40A141F8"><enum>(I)</enum><text>That a construction or maintenance project or lease is necessary with respect to a medical facility or proposed medical facility of the Department.</text></subclause>
<subclause id="H72DF4A3050174E159208315DC01BF661"><enum>(II)</enum><text>The proper size of such medical facility or proposed medical facility with respect to treating veterans in the catchment area of such medical facility or proposed medical facility.</text></subclause></clause>
<clause id="H412EFA1B2E6D4050B8353DBEDC2D8066"><enum>(iii)</enum><text>Assess the management processes of the Department with respect to the capital management programs of the Department, including processes relating to the methodology for construction and design of medical facilities of the Department, the management of projects relating to the construction and design of such facilities, and the activation of such facilities.</text></clause>
<clause id="H740AE4FB2BFE4AB7915E2FCCCC68771C"><enum>(iv)</enum><text>Assess the medical facility leasing program of the Department.</text></clause></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H3BCFF81EBD0F4E5BB3250E8DD397FA44"><enum>(3)</enum><header display-inline="yes-display-inline">Timing</header><text display-inline="yes-display-inline">The private sector entity or entities carrying out the assessment required by paragraph (1) shall complete such assessment not later than 240 days after entering into the contract described in such paragraph.</text></paragraph></subsection>
<subsection id="H0E29E126E1F14FFA82583B8FB13C9489"><enum>(b)</enum><header>Private sector entities described</header><text>A private entity described in this subsection is a private entity that—</text>
<paragraph id="H97F3CDD96AC4472D99CD06C52C9F6E77"><enum>(1)</enum><text>has experience and proven outcomes in optimizing the performance of the health care delivery systems of the Veterans Health Administration and the private sector and in health care management; and</text></paragraph>
<paragraph id="HA5148123DC34459DB5B271CD9605CA8C"><enum>(2)</enum><text>specializes in implementing large-scale organizational and cultural transformations, especially with respect to health care delivery systems.</text></paragraph></subsection>
<subsection id="HC8B953A4CC474B2AB84A7D8C8A51A661"><enum>(c)</enum><header>Program integrator</header>
<paragraph id="H3E3CDA1A746E4AE78EA0D736CCD0A22B"><enum>(1)</enum><header>In general</header><text>If the Secretary enters into contracts with more than one private sector entity under subsection (a), the Secretary shall designate one such entity that is predominately a health care organization as the program integrator.</text></paragraph>
<paragraph id="HC4FC6047E93B42C6A1E3CC7FB72BEAA2"><enum>(2)</enum><header>Responsibilities</header><text>The program integrator designated pursuant to paragraph (1) shall be responsible for coordinating the outcomes of the assessments conducted by the private entities pursuant to such contracts.</text></paragraph></subsection>
<subsection commented="no" id="H13C80311B6614D32AEDACE554F09D5EE"><enum>(d)</enum><header>Report on assessment</header>
<paragraph commented="no" id="H117BC588037C4B8E93301C64DFC03BB1"><enum>(1)</enum><header>In general</header><text>Not later than 60 days after completing the assessment required by subsection (a), the private sector entity or entities carrying out such assessment shall submit to the Secretary of Veterans Affairs, the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the Commission on Care established under section 202 a report on the findings and recommendations of the private sector entity or entities with respect to such assessment.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H7DB46D4AF61E43C89E3A01FF4D4A62BC"><enum>(2)</enum><header>Publication</header><text>Not later than 30 days after receiving the report under paragraph (1), the Secretary shall publish such report in the Federal Register and on an Internet website of the Department of Veterans Affairs that is accessible to the public.</text></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H902761786C234697803A4C684EB23465"><enum>(e)</enum><header>Non-Department facilities defined</header><text>In this section, the term <term>non-Department facilities</term> has the meaning given that term in <external-xref legal-doc="usc" parsable-cite="usc/38/1701">section 1701</external-xref> of title 38, United States Code.</text></subsection></section>
<section id="H1C4350B16B7E406EBCB4A2D3B1E2BF13"><enum>202.</enum><header>Commission on Care</header>
<subsection id="H9AD45BE1276B4387B3213EC60D8B1334"><enum>(a)</enum><header>Establishment of commission</header>
<paragraph id="HDD1C5C8F505E4A1CA2A11F3B2BCD76A0"><enum>(1)</enum><header>In general</header><text>There is established a commission, to be known as the <quote>Commission on Care</quote> (in this section referred to as the <quote>Commission</quote>), to examine the access of veterans to health care from the Department of Veterans Affairs and strategically examine how best to organize the Veterans Health Administration, locate health care resources, and deliver health care to veterans during the 20-year period beginning on the date of the enactment of this Act.</text></paragraph>
<paragraph id="H8026568A37F0490FA19BB8E7D5439011"><enum>(2)</enum><header>Membership</header>
<subparagraph id="H32DE99B5C1014B23B14AE2DC72495F85"><enum>(A)</enum><header>Voting members</header><text>The Commission shall be composed of 15 voting members who are appointed as follows:</text>
<clause id="H4B6B94CB15A044CD8A2992D8CA7AA0C1"><enum>(i)</enum><text display-inline="yes-display-inline">Three members appointed by the Speaker of the House of Representatives, at least one of whom shall be a veteran.</text></clause>
<clause id="HE3ABD7731DA846509ABED6E209DEE625"><enum>(ii)</enum><text>Three members appointed by the Minority Leader of the House of Representatives, at least one of whom shall be a veteran.</text></clause>
<clause id="H00B6CA2D94394D91B47ADE879EABCC63"><enum>(iii)</enum><text>Three members appointed by the Majority Leader of the Senate, at least one of whom shall be a veteran.</text></clause>
<clause id="HAFBC6F845D0343DB8C1CEBA2CB8C6922"><enum>(iv)</enum><text>Three members appointed by the Minority Leader of the Senate, at least one of whom shall be a veteran.</text></clause>
<clause id="H1230F976FF254CD48BEEB6742989CEA7"><enum>(v)</enum><text>Three members appointed by the President, at least two of whom shall be veterans.</text></clause></subparagraph>
<subparagraph id="HEF0D2FC41D5C47E4A37BD61D048F0260"><enum>(B)</enum><header>Qualifications</header><text>Of the members appointed under subparagraph (A)—</text>
<clause id="HC2BA2BC6E58743328A123147631AB6AA"><enum>(i)</enum><text>at least one member shall represent an organization recognized by the Secretary of Veterans Affairs for the representation of veterans under <external-xref legal-doc="usc" parsable-cite="usc/38/5902">section 5902</external-xref> of title 38, United States Code;</text></clause>
<clause id="H8CC5A7A929C84A32B87CDFD5CD4A328F"><enum>(ii)</enum><text>at least one member shall have experience as senior management for a private integrated health care system with an annual gross revenue of more than $50,000,000;</text></clause>
<clause id="HC7EF8751794B4103822E5F8C5FABF482"><enum>(iii)</enum><text>at least one member shall be familiar with government health care systems, including those systems of the Department of Defense, the Indian Health Service, and Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(l)(2)(B)</external-xref>));</text></clause>
<clause id="H087858B0F08B40AE86C6F5301F47E189"><enum>(iv)</enum><text>at least one member shall be familiar with the Veterans Health Administration but shall not be currently employed by the Veterans Health Administration; and</text></clause>
<clause id="H4FB174D629D54608805E6C5AF1BF9A59"><enum>(v)</enum><text>at least one member shall be familiar with medical facility construction and leasing projects carried out by government entities and have experience in the building trades, including construction, engineering, and architecture.</text></clause></subparagraph>
<subparagraph id="H72309CE089C24234A82F7BE545F52BF5"><enum>(C)</enum><header>Date</header><text>The appointments of members of the Commission shall be made not later than 1 year after the date of the enactment of this Act.</text></subparagraph></paragraph>
<paragraph id="H56BADA955357437CA3E2D38556B769D0"><enum>(3)</enum><header>Period of appointment</header>
<subparagraph id="H4294F369384F45ACB6E0D4CEFFA641B3"><enum>(A)</enum><header>In general</header><text>Members shall be appointed for the life of the Commission.</text></subparagraph>
<subparagraph id="H9C8F053C09E94ACF8802FF5E2506F816"><enum>(B)</enum><header>Vacancies</header><text>Any vacancy in the Commission shall not affect its powers, but shall be filled in the same manner as the original appointment.</text></subparagraph></paragraph>
<paragraph id="H011A07B4D6F642038F483A821FC69E07"><enum>(4)</enum><header>Initial meeting</header><text>Not later than 15 days after the date on which eight voting members of the Commission have been appointed, the Commission shall hold its first meeting.</text></paragraph>
<paragraph id="H29F47CCCFDC146A5923E067C2F979DF9"><enum>(5)</enum><header>Meetings</header><text>The Commission shall meet at the call of the Chairperson.</text></paragraph>
<paragraph id="H8E1AD51566FE40FAAD4904879B0B1918"><enum>(6)</enum><header>Quorum</header><text>A majority of the members of the Commission shall constitute a quorum, but a lesser number of members may hold hearings.</text></paragraph>
<paragraph id="H7DDA93757B5F46B69E274DBDAB7DD69A"><enum>(7)</enum><header>Chairperson and Vice Chairperson</header><text display-inline="yes-display-inline">The President shall designate a member of the commission to serve as Chairperson of the Commission. The Commission shall select a Vice Chairperson from among its members.</text></paragraph></subsection>
<subsection id="H13F5EB5E4BB045779A6236FC0F516EAA"><enum>(b)</enum><header>Duties of commission</header>
<paragraph id="HE08A36E6E68F4A50A74C718D1577D527"><enum>(1)</enum><header>Evaluation and assessment</header><text>The Commission shall undertake a comprehensive evaluation and assessment of access to health care at the Department of Veterans Affairs.</text></paragraph>
<paragraph id="H50830427C0EB469183F97D2DE0632690"><enum>(2)</enum><header>Matters evaluated and assessed</header><text>In undertaking the comprehensive evaluation and assessment required by paragraph (1), the Commission shall evaluate and assess the results of the assessment conducted by the private sector entity or entities under section 201, including any findings, data, or recommendations included in such assessment.</text></paragraph>
<paragraph id="H387C470CCA0E4E089D83A2056FD6F844"><enum>(3)</enum><header>Reports</header><text>The Commission shall submit to the President, through the Secretary of Veterans Affairs, reports as follows:</text>
<subparagraph id="HDA745C7259C14DA0AE7997B24C595D58"><enum>(A)</enum><text>Not later than 90 days after the date of the initial meeting of the Commission, an interim report on—</text>
<clause id="H19EB5D1E10A0422590E88088E518694F"><enum>(i)</enum><text>the findings of the Commission with respect to the evaluation and assessment required by this subsection; and</text></clause>
<clause id="HFD1D8859842A49F7A8FE87D7C32A80C4"><enum>(ii)</enum><text>such recommendations as the Commission may have for legislative or administrative action to improve access to health care through the Veterans Health Administration.</text></clause></subparagraph>
<subparagraph id="HFE0064FB3FB04ABEB59F28C718689091"><enum>(B)</enum><text>Not later than 180 days after the date of the initial meeting of the Commission, a final report on—</text>
<clause id="HA55E016368B24B13844943D5FFE36439"><enum>(i)</enum><text>the findings of the Commission with respect to the evaluation and assessment required by this subsection; and</text></clause>
<clause id="HA44C2103C3CA4AD4A5B0710349831CB2"><enum>(ii)</enum><text>such recommendations as the Commission may have for legislative or administrative action to improve access to health care through the Veterans Health Administration.</text></clause></subparagraph></paragraph></subsection>
<subsection id="H3B1D18BE6FB74C32BF35A0DE0E426B89"><enum>(c)</enum><header>Powers of the commission</header>
<paragraph id="H5C2C9C007A114410871820552D3274C7"><enum>(1)</enum><header>Hearings</header><text>The Commission may hold such hearings, sit and act at such times and places, take such testimony, and receive such evidence as the Commission considers advisable to carry out this section.</text></paragraph>
<paragraph id="HC92C16B26023463494806D2E701B8AC6"><enum>(2)</enum><header>Information from Federal agencies</header><text>The Commission may secure directly from any Federal agency such information as the Commission considers necessary to carry out this section. Upon request of the Chairperson of the Commission, the head of such agency shall furnish such information to the Commission.</text></paragraph></subsection>
<subsection id="H44EF44E466F041BAA2B79ABE9AE998FC"><enum>(d)</enum><header>Commission personnel matters</header>
<paragraph id="HA3502C89E77241C492E48ED05A90D545"><enum>(1)</enum><header>Compensation of members</header>
<subparagraph id="HAA79FD85F4A5484FA3ABB14ED5E9F21A"><enum>(A)</enum><header>In general</header><text>Each member of the Commission who is not an officer or employee of the Federal Government shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under <external-xref legal-doc="usc" parsable-cite="usc/5/5315">section 5315</external-xref> of title 5, United States Code, for each day (including travel time) during which such member is engaged in the performance of the duties of the Commission.</text></subparagraph>
<subparagraph id="HA89F72299F5F459DAB14DBBF68925825"><enum>(B)</enum><header>Officers or employees of the United States</header><text>All members of the Commission who are officers or employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States.</text></subparagraph></paragraph>
<paragraph id="HFD81AAF712254B3EAA4E3CD17967F414"><enum>(2)</enum><header>Travel expenses</header><text>The members of the Commission shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/57">chapter 57</external-xref> of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Commission.</text></paragraph>
<paragraph id="H67D4A3518B034DE6A903B6CFFFB8A970"><enum>(3)</enum><header>Staff</header>
<subparagraph id="HCBC77F28114940379E46D792D67A2169"><enum>(A)</enum><header>In general</header><text>The Chairperson of the Commission may, without regard to the civil service laws and regulations, appoint and terminate an executive director and such other additional personnel as may be necessary to enable the Commission to perform its duties. The employment of an executive director shall be subject to confirmation by the Commission.</text></subparagraph>
<subparagraph id="HF785F1EE601247D2BB002AC6DBC13322"><enum>(B)</enum><header>Compensation</header><text>The Chairperson of the Commission may fix the compensation of the executive director and other personnel without regard to chapter 51 and subchapter III of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/53">chapter 53</external-xref> of title 5, United States Code, relating to classification of positions and General Schedule pay rates, except that the rate of pay for the executive director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of such title.</text></subparagraph></paragraph>
<paragraph id="H9B0249CD7E554BBF9EECF4FB803337EA"><enum>(4)</enum><header>Detail of government employees</header><text>Any Federal Government employee may be detailed to the Commission without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege.</text></paragraph>
<paragraph id="H728B0CB2D14646F49EBF15DF3A7CEBF3"><enum>(5)</enum><header>Procurement of temporary and intermittent services</header><text>The Chairperson of the Commission may procure temporary and intermittent services under <external-xref legal-doc="usc" parsable-cite="usc/5/3109">section 3109(b)</external-xref> of title 5, United States Code, at rates for individuals that do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title.</text></paragraph></subsection>
<subsection id="H92D58F94E11C4133940E999F091152E5"><enum>(e)</enum><header>Termination of the commission</header><text display-inline="yes-display-inline">The Commission shall terminate 30 days after the date on which the Commission submits the report under subsection (b)(3)(B).</text></subsection>
<subsection id="HE40B95EEDC4D47328F1E4FDD93150C86"><enum>(f)</enum><header>Funding</header><text>The Secretary of Veterans Affairs shall make available to the Commission from amounts appropriated or otherwise made available to the Secretary such amounts as the Secretary and the Chairperson of the Commission jointly consider appropriate for the Commission to perform its duties under this section.</text></subsection>
<subsection id="HC43E580484CC426A8C17D3B208FB485B"><enum>(g)</enum><header>Executive action</header>
<paragraph id="H7128D96B21414F2180661740EF9CC1AA"><enum>(1)</enum><header>Action on recommendations</header><text>The President shall require the Secretary of Veterans Affairs and such other heads of relevant Federal departments and agencies to implement each recommendation set forth in a report submitted under subsection (b)(3) that the President—</text>
<subparagraph id="HEC32AA62EDD94135B2DC44192FE070C6"><enum>(A)</enum><text>considers feasible and advisable; and</text></subparagraph>
<subparagraph id="H0A6527EAEF6B4A36ACC01D5C980DF318"><enum>(B)</enum><text>determines can be implemented without further legislative action.</text></subparagraph></paragraph>
<paragraph id="HF63C76438CEF4382AD6F42035F972B3A"><enum>(2)</enum><header>Reports</header><text>Not later than 60 days after the date on which the President receives a report under subsection (b)(3), the President shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives and such other committees of Congress as the President considers appropriate a report setting forth the following:</text>
<subparagraph id="H27DF15457A7F4F32B7C8B1D9B389A255"><enum>(A)</enum><text>An assessment of the feasibility and advisability of each recommendation contained in the report received by the President.</text></subparagraph>
<subparagraph id="HE6C79E64F67F431186452A3B008A6BA6"><enum>(B)</enum><text>For each recommendation assessed as feasible and advisable under subparagraph (A) the following:</text>
<clause id="H8E2FA4B257844241ADF14EFB22778ACC"><enum>(i)</enum><text>Whether such recommendation requires legislative action.</text></clause>
<clause id="H27870973034149808A8E0B28E5BB6800"><enum>(ii)</enum><text>If such recommendation requires legislative action, a recommendation concerning such legislative action.</text></clause>
<clause id="H57EB570B72814261BD5C1AAB41DF77BF"><enum>(iii)</enum><text>A description of any administrative action already taken to carry out such recommendation.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H40076F11C18D4B458DAD2D77643F6AC4"><enum>(iv)</enum><text>A description of any administrative action the President intends to be taken to carry out such recommendation and by whom.</text></clause></subparagraph></paragraph></subsection></section>
<section commented="no" display-inline="no-display-inline" id="H8F6E815A7B5E4AE6A1098A021CF6A50D"><enum>203.</enum><header>Technology task force on review of scheduling system and software of the Department of Veterans Affairs</header>
<subsection commented="no" display-inline="no-display-inline" id="H30F5A8F16EB34EE1811FCA4297FFD4E8"><enum>(a)</enum><header>Task force review</header>
<paragraph commented="no" display-inline="no-display-inline" id="HFA61A1A92BA84B85B4F6BA6CAAE62B91"><enum>(1)</enum><header>In general</header><text>The Secretary of Veterans Affairs shall, through the use of a technology task force, conduct a review of the needs of the Department of Veterans Affairs with respect to the scheduling system and scheduling software of the Department of Veterans Affairs that is used by the Department to schedule appointments for veterans for hospital care, medical services, and other health care from the Department.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H24D64D4433EA47C48958A4E4F5D380DE"><enum>(2)</enum><header>Agreement</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H84ECAC3AEB0D485593C10BB6317986CE"><enum>(A)</enum><header>In general</header><text>The Secretary shall seek to enter into an agreement with a technology organization or technology organizations to carry out the review required by paragraph (1).</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H0AA6757E88BE4FFD99DC0C016867AEA8"><enum>(B)</enum><header>Prohibition on use of funds</header><text>Notwithstanding any other provision of law, no Federal funds may be used to assist the technology organization or technology organizations under subparagraph (A) in carrying out the review required by paragraph (1).</text></subparagraph></paragraph></subsection>
<subsection id="H8702DD4E54A14781ABD5DE3C8429356A"><enum>(b)</enum><header>Report</header>
<paragraph id="H791F7D2688BC4C948E208A7723DA3018"><enum>(1)</enum><header>In general</header><text>Not later than 45 days after the date of the enactment of this Act, the technology task force required under subsection (a)(1) shall submit to the Secretary, the Committee on Veterans' Affairs of the Senate, and the Committee on Veterans' Affairs of the House of Representatives a report setting forth the findings and recommendations of the technology task force regarding the needs of the Department with respect to the scheduling system and scheduling software of the Department described in such subsection.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HAB901F711DD24D918264366689CC08AA"><enum>(2)</enum><header>Elements</header><text>The report required by paragraph (1) shall include the following:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HA57506ABB8224555A70A8B53A8CBA128"><enum>(A)</enum><text>Proposals for specific actions to be taken by the Department to improve the scheduling system and scheduling software of the Department described in subsection (a)(1).</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H54C2AEAE56F445C9BCC667BA7703A20C"><enum>(B)</enum><text>A determination as to whether one or more existing off-the-shelf systems would—</text>
<clause commented="no" display-inline="no-display-inline" id="HFF489C3C50A04C36960B93B6A6293853"><enum>(i)</enum><text>meet the needs of the Department to schedule appointments for veterans for hospital care, medical services, and other health care from the Department; and</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H4B1182F5BA694E10A9D79530F45FB60C"><enum>(ii)</enum><text>improve the access of veterans to such care and services.</text></clause></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HBC4F860F5AD14F4CBB7F112C08D5CB70"><enum>(3)</enum><header>Publication</header><text>Not later than 30 days after the receipt of the report required by paragraph (1), the Secretary shall publish such report in the Federal Register and on an Internet website of the Department accessible to the public.</text></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H5625543B73664EE3B141CBA15D4EC8C2"><enum>(c)</enum><header>Implementation of task force recommendations</header><text>Not later than 1 year after the receipt of the report required by subsection (b)(1), the Secretary shall implement the recommendations set forth in such report that the Secretary considers are feasible, advisable, and cost effective.</text></subsection></section>
<section id="HFA6267052AEB46C6B2F1B4DBB3942119"><enum>204.</enum><header>Improvement of access of veterans to mobile vet centers and mobile medical centers of the Department of Veterans Affairs</header>
<subsection id="H0F33BA89719740849705C51545AB27E7"><enum>(a)</enum><header>Improvement of access</header>
<paragraph id="HF4BB3B611A6A4F939102C0970C60D0A7"><enum>(1)</enum><header>In general</header><text>The Secretary of Veterans Affairs shall improve the access of veterans to telemedicine and other health care through the use of mobile vet centers and mobile medical centers of the Department of Veterans Affairs by providing standardized requirements for the operation of such centers.</text></paragraph>
<paragraph id="H07A5B6B53BA945C38AF3A509E51DF69C"><enum>(2)</enum><header>Requirements</header><text>The standardized requirements required by paragraph (1) shall include the following:</text>
<subparagraph id="H72E4FF0BB15A43718E3C8F87C15C8FDD"><enum>(A)</enum><text>The number of days each mobile vet center and mobile medical center of the Department is expected to travel per year.</text></subparagraph>
<subparagraph id="H31FFCE8FE1FD43D5A30D3288401C639C"><enum>(B)</enum><text>The number of locations each center is expected to visit per year.</text></subparagraph>
<subparagraph id="H462B5D4F03A347B196992809D7CBE53B"><enum>(C)</enum><text>The number of appointments each center is expected to conduct per year.</text></subparagraph>
<subparagraph id="HC02A3E9A155E4FF79EBED283326E5519"><enum>(D)</enum><text>The method and timing of notifications given by each center to individuals in the area to which the center is traveling, including notifications informing veterans of the availability to schedule appointments at the center.</text></subparagraph></paragraph>
<paragraph id="HF494720EAA3C45F6BDF3228FB18F0D04"><enum>(3)</enum><header>Use of telemedicine</header><text>The Secretary shall ensure that each mobile vet center and mobile medical center of the Department has the capability to provide telemedicine services.</text></paragraph></subsection>
<subsection id="HCF5B27F3F3E8454887C18F64CA0A0274"><enum>(b)</enum><header>Reports</header>
<paragraph id="HA00CD4A17B07403CAECD7B154EF40A00"><enum>(1)</enum><header>In general</header><text>Not later than 1 year after the date of the enactment of this Act, and not later than September 30 each year thereafter, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on access to health care through the use of mobile vet centers and mobile medical centers of the Department that includes statistics on each of the requirements set forth in subsection (a)(2) for the year covered by the report.</text></paragraph>
<paragraph id="H0A2D09C1A26E4A0FADD1170153B7F63B"><enum>(2)</enum><header>Elements</header><text>Each report required by paragraph (1) shall include the following:</text>
<subparagraph id="HB22E5C43CBD94F99901305DE9F8317D0"><enum>(A)</enum><text>A description of the use of mobile vet centers and mobile medical centers to provide telemedicine services to veterans during the year preceding the submittal of the report, including the following:</text>
<clause id="H55501507665349BF8F4AF76D6001FFC9"><enum>(i)</enum><text>The number of days each mobile vet center and mobile medical center was open to provide such services.</text></clause>
<clause id="H52681DE402D0489BB514D6F978BC7087"><enum>(ii)</enum><text>The number of days each center traveled to a location other than the headquarters of the center to provide such services.</text></clause>
<clause id="HF3D2BF0C45BA488295DCAEA298435DEC"><enum>(iii)</enum><text>The number of appointments each center conducted to provide such services on average per month and in total during such year.</text></clause></subparagraph>
<subparagraph id="HA751C8DACEBA4CFF9EE84E7279B3E55E"><enum>(B)</enum><text>An analysis of the effectiveness of using mobile vet centers and mobile medical centers to provide health care services to veterans through the use of telemedicine.</text></subparagraph>
<subparagraph id="H9D4D498CCA1442808AC909CBBBB72671"><enum>(C)</enum><text>Any recommendations for an increase in the number of mobile vet centers and mobile medical centers of the Department.</text></subparagraph>
<subparagraph id="H1CA80A55DAFA4858B0D916FFE3C1998A"><enum>(D)</enum><text>Any recommendations for an increase in the telemedicine capabilities of each mobile vet center and mobile medical center.</text></subparagraph>
<subparagraph id="H6F75C65742774D96A258BB876A57CC41"><enum>(E)</enum><text>The feasibility and advisability of using temporary health care providers, including locum tenens, to provide direct health care services to veterans at mobile vet centers and mobile medical centers.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H82A83929123645F7A65F72C4255E896B"><enum>(F)</enum><text>Such other recommendations on improvement of the use of mobile vet centers and mobile medical centers by the Department as the Secretary considers appropriate.</text></subparagraph></paragraph></subsection></section>
<section id="H6134EEBFBB594C90847D01462030CA9D"><enum>205.</enum><header>Improved performance metrics for health care provided by Department of Veterans Affairs</header>
<subsection id="H3D23E71EFBA54B21A03095E7C7B5FED2"><enum>(a)</enum><header>Prohibition on use of scheduling and wait-Time metrics in determination of performance awards</header><text>The Secretary of Veterans Affairs shall ensure that scheduling and wait-time metrics or goals are not used as factors in determining the performance of the following employees for purposes of determining whether to pay performance awards to such employees:</text>
<paragraph id="HB2FFA1BA68AA42FEB1A1E62E59D1D0C8"><enum>(1)</enum><text>Directors, associate directors, assistant directors, deputy directors, chiefs of staff, and clinical leads of medical centers of the Department of Veterans Affairs.</text></paragraph>
<paragraph id="H5DB05D91629541CD9C4A67C47DCB399E"><enum>(2)</enum><text>Directors, assistant directors, and quality management officers of Veterans Integrated Service Networks of the Department of Veterans Affairs.</text></paragraph></subsection>
<subsection id="HEA9D6CEF0C184151A61B7814E5F6FB43"><enum>(b)</enum><header>Modification of performance plans</header>
<paragraph id="HF2B8D45EB3634A9897AD5FFA7B1C8EA3"><enum>(1)</enum><header>In general</header><text>Not later than 30 days after the date of the enactment of this Act, the Secretary shall modify the performance plans of the directors of the medical centers of the Department and the directors of the Veterans Integrated Service Networks to ensure that such plans are based on the quality of care received by veterans at the health care facilities under the jurisdictions of such directors.</text></paragraph>
<paragraph id="HB5EF558D6A8A4C6884AA741E1E8238D2"><enum>(2)</enum><header>Factors</header><text>In modifying performance plans under paragraph (1), the Secretary shall ensure that assessment of the quality of care provided at health care facilities under the jurisdiction of a director described in paragraph (1) includes consideration of the following:</text>
<subparagraph id="H8A964B63993B41DA8C41CEB1D29EE174"><enum>(A)</enum><text>Recent reviews by the Joint Commission (formerly known as the <quote>Joint Commission on Accreditation of Healthcare Organizations</quote>) of such facilities.</text></subparagraph>
<subparagraph id="HD7B570EFD25E4E89B68C5547B53DDD57"><enum>(B)</enum><text>The number and nature of recommendations concerning such facilities by the Inspector General of the Department in reviews conducted through the Combined Assessment Program, in the reviews by the Inspector General of community-based outpatient clinics and primary care clinics, and in reviews conducted through the Office of Healthcare Inspections during the two most recently completed fiscal years.</text></subparagraph>
<subparagraph id="H286FDBD065BE46E291AD679C56C4A9E8"><enum>(C)</enum><text>The number of recommendations described in subparagraph (B) that the Inspector General of the Department determines have not been carried out satisfactorily with respect to such facilities.</text></subparagraph>
<subparagraph id="H08991CC689E54E7D9E6D5606F1C3076E"><enum>(D)</enum><text>Reviews of such facilities by the Commission on Accreditation of Rehabilitation Facilities.</text></subparagraph>
<subparagraph id="HB3838C1000C045B3BD3525993C43103D"><enum>(E)</enum><text>The number and outcomes of administrative investigation boards, root cause analyses, and peer reviews conducted at such facilities during the fiscal year for which the assessment is being conducted.</text></subparagraph>
<subparagraph id="HE202DF6587FF443C9647847C1551B259"><enum>(F)</enum><text>The effectiveness of any remedial actions or plans resulting from any Inspector General recommendations in the reviews and analyses described in subparagraphs (A) through (E).</text></subparagraph></paragraph>
<paragraph id="H95684A9800DB4918B0704F54D4F9E183"><enum>(3)</enum><header>Additional leadership positions</header><text>To the degree practicable, the Secretary shall assess the performance of other employees of the Department in leadership positions at Department medical centers, including associate directors, assistant directors, deputy directors, chiefs of staff, and clinical leads, and in Veterans Integrated Service Networks, including assistant directors and quality management officers, using factors and criteria similar to those used in the performance plans modified under paragraph (1).</text></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HC4D42AE0A4CB47218C3607E247DE3275"><enum>(c)</enum><header display-inline="yes-display-inline">Removal of certain performance goals</header><text display-inline="yes-display-inline">For each fiscal year that begins after the date of the enactment of this Act, the Secretary shall not include in the performance goals of any employee of a Veterans Integrated Service Network or medical center of the Department any performance goal that might disincentivize the payment of Department amounts to provide hospital care, medical services, or other health care through a non-Department provider.</text></subsection></section>
<section id="H81067F2FAD93461E82778B074F0B7A9F"><enum>206.</enum><header>Improved transparency concerning health care provided by Department of Veterans Affairs</header>
<subsection id="H80AFD513765C46019E534E1C3AC2E057"><enum>(a)</enum><header>Publication of wait times</header><text display-inline="yes-display-inline">Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall publish in the Federal Register, and on a publicly accessible Internet website of each medical center of the Department of Veterans Affairs, the wait-times for the scheduling of an appointment in each Department facility by a veteran for the receipt of primary care, specialty care, and hospital care and medical services based on the general severity of the condition of the veteran. Whenever the wait-times for the scheduling of such an appointment changes, the Secretary shall publish the revised wait-times—</text>
<paragraph commented="no" display-inline="no-display-inline" id="HD75ECA50BCDA451AB4AFD4AEC590763A"><enum>(1)</enum><text>on a publicly accessible Internet website of each medical center of the Department by not later than 30 days after such change; and</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H1CE82F9AAF36475FB521A5A6745B2233"><enum>(2)</enum><text>in the Federal Register by not later than 90 days after such change.</text></paragraph></subsection>
<subsection id="H0C68E1A2B424472CADC529E33A55092D"><enum>(b)</enum><header>Publicly available database of patient safety, quality of care, and outcome measures</header>
<paragraph id="H6E771A6EAAD641B2B5F0C980B9EA3996"><enum>(1)</enum><header>In general</header><text>Not later than 180 days after the date of the enactment of this Act, the Secretary shall develop and make available to the public a comprehensive database containing all applicable patient safety, quality of care, and outcome measures for health care provided by the Department that are tracked by the Secretary.</text></paragraph>
<paragraph id="HB7E7B8B4F2DC481885932E7C0AEE2DF2"><enum>(2)</enum><header>Update frequency</header><text>The Secretary shall update the database required by paragraph (1) not less frequently than once each year.</text></paragraph>
<paragraph id="HE4BB236A7D2F47649C74CB73B6BE244C"><enum>(3)</enum><header>Unavailable measures</header><text>For all measures that the Secretary would otherwise publish in the database required by paragraph (1) but has not done so because such measures are not available, the Secretary shall publish notice in the database of the reason for such unavailability and a timeline for making such measures available in the database.</text></paragraph>
<paragraph id="HD8DCD775107C4065B1FFCD2573BC9F76"><enum>(4)</enum><header>Accessibility</header><text>The Secretary shall ensure that the database required by paragraph (1) is accessible to the public through the primary Internet website of the Department and through each primary Internet website of a Department medical center.</text></paragraph></subsection>
<subsection id="H1411B2D328ED4F8C9F7ABFA7DCCD52B3"><enum>(c)</enum><header>Hospital Compare website of Department of Health and Human Services</header>
<paragraph id="H4E8B0021310E41C5AE29DCCB57772C16"><enum>(1)</enum><header>Agreement required</header><text>Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into an agreement with the Secretary of Health and Human Services for the provision by the Secretary of Veterans Affairs of such information as the Secretary of Health and Human Services may require to report and make publicly available patient quality and outcome information concerning Department of Veterans Affairs medical centers through the Hospital Compare Internet website of the Department of Health and Human Services or any successor Internet website.</text></paragraph>
<paragraph id="HD94C0A07DED749D59FB96B74B2973F86"><enum>(2)</enum><header>Information provided</header><text>The information provided by the Secretary of Veterans Affairs to the Secretary of Health and Human Services under paragraph (1) shall include the following:</text>
<subparagraph id="H72EA0784BFE746F68E61BF56328DE534"><enum>(A)</enum><text>Measures of timely and effective health care.</text></subparagraph>
<subparagraph id="H09A989944E5D41BB9E3A8BBA5C9D4DF0"><enum>(B)</enum><text>Measures of readmissions, complications of death, including with respect to 30-day mortality rates and 30-day readmission rates, surgical complication measures, and health care related infection measures.</text></subparagraph>
<subparagraph id="H89B0FDC2AB264229BF551EDA7455C44E"><enum>(C)</enum><text>Survey data of patient experiences, including the Hospital Consumer Assessment of Healthcare Providers and Systems or any similar successor survey developed by the Department of Health and Human Services.</text></subparagraph>
<subparagraph id="H6CCC6134F94449B7841E9EA613CDEB78"><enum>(D)</enum><text>Any other measures required of or reported with respect to hospitals participating in the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>).</text></subparagraph></paragraph>
<paragraph id="HD21463CB7ADF4829A6BBA516C6C12600"><enum>(3)</enum><header>Unavailable information</header><text>For any applicable metric collected by the Department of Veterans Affairs or required to be provided under paragraph (2) and withheld from or unavailable in the Hospital Compare Internet website or any successor Internet website, the Secretary of Veterans Affairs shall publish a notice on such Internet website stating the reason why such metric was withheld from public disclosure and a timeline for making such metric available, if applicable.</text></paragraph></subsection>
<subsection id="HE6394C9CD9404109803FE6FF946FE72E"><enum>(d)</enum><header>Comptroller General review of publicly available safety and quality metrics</header><text>Not later than 3 years after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a review of the safety and quality metrics made publicly available by the Secretary of Veterans Affairs under this section to assess the degree to which the Secretary is complying with the provisions of this section.</text></subsection></section>
<section id="H0C71FAA080F64A8B99F6E3713277E5D3"><enum>207.</enum><header>Information for veterans on the credentials of Department of Veterans Affairs physicians</header>
<subsection id="H8271AFC8E55A4399B5709134F663CFF5"><enum>(a)</enum><header>Improvement of <quote>Our Doctors</quote> Internet website links</header>
<paragraph id="HAFC5424283774042BCDCD88A885565ED"><enum>(1)</enum><header>Availability through Department of Veterans Affairs homepage</header><text>A link to the <quote>Our Doctors</quote> health care providers database of the Department of Veterans Affairs, or any successor database, shall be available on and through the homepage of the Internet website of the Department that is accessible to the public.</text></paragraph>
<paragraph id="H6244469BD6924987A6C5C366BD6B41BF"><enum>(2)</enum><header>Information on location of residency training</header><text>The Internet website of the Department that is accessible to the public shall include under the link to the <quote>Our Doctors</quote> health care providers database of the Department, or any successor database, the name of the facility at which each licensed physician of the Department underwent residency training.</text></paragraph>
<paragraph id="H8312944A187B4B499BB644E79F05D80F"><enum>(3)</enum><header>Information on physicians at particular facilities</header><text>The <quote>Our Doctors</quote> health care providers database of the Department, or any successor database, shall identify whether each licensed physician of the Department is a physician in residency.</text></paragraph></subsection>
<subsection id="HD8A236C07F1C4018A9DFEA67B2D07FCB"><enum>(b)</enum><header>Information on credentials of physicians for veterans undergoing surgical procedures</header>
<paragraph id="H17B689F4845F419C86283159CCC223BD"><enum>(1)</enum><header>In general</header><text>Each veteran who is undergoing a surgical procedure by or through the Department shall be provided information described in paragraph (2) with respect to the surgeon to be performing such procedure at such time in advance of the procedure as is appropriate to permit such veteran to evaluate such information.</text></paragraph>
<paragraph id="HAF7B86F765524059BE9F6C728E2694F3"><enum>(2)</enum><header>Information described</header><text>The information described in this paragraph with respect to a surgeon described in paragraph (1) is as follows:</text>
<subparagraph id="HD3C4BF9FE4FF44DDAB7694E27BFD86A8"><enum>(A)</enum><text>The education and training of the surgeon.</text></subparagraph>
<subparagraph id="H338C6E0169864DDD868E0C41DFC6F821"><enum>(B)</enum><text>The licensure, registration, and certification of the surgeon by the State or national entity responsible for such licensure, registration, or certification.</text></subparagraph></paragraph>
<paragraph id="H6867CCEF6B8741838FDCBBE4FDC47AED"><enum>(3)</enum><header>Other individuals</header><text>If a veteran is unable to evaluate the information provided under paragraph (1) due to the health or mental competence of the veteran, such information shall be provided to an individual acting on behalf of the veteran.</text></paragraph></subsection>
<subsection id="H35DD234264D84ADE80859106DC9AC11D"><enum>(c)</enum><header>Comptroller General report and plan</header>
<paragraph id="HF04747E8DE6E454B87139ECBBFA23383"><enum>(1)</enum><header>Report</header><text>Not later than 2 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report setting forth an assessment by the Comptroller General of the following:</text>
<subparagraph id="H4C1FC96AD21D42B99E07ABBAAC262D1C"><enum>(A)</enum><text>The manner in which contractors under the Patient-Centered Community Care initiative of the Department perform oversight of the credentials of physicians within the networks of such contractors under the initiative.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H44C383E69D5E4C50A4C09CAD37361607"><enum>(B)</enum><text>The oversight by the Department of the contracts under the Patient-Centered Community Care initiative.</text></subparagraph>
<subparagraph id="H79FFF08E38F440B5848FB68FD1BB6A32"><enum>(C)</enum><text>The verification by the Department of the credentials and licenses of health care providers furnishing hospital care and medical services under section 101.</text></subparagraph></paragraph>
<paragraph id="HFAFDDD4A94E44EDA9D2F404424BEFA5C"><enum>(2)</enum><header>Plan</header>
<subparagraph id="HD69F6290328C4D64841550277C379EC3"><enum>(A)</enum><header>In general</header><text>Not later than 30 days after the submittal of the report under paragraph (1), the Secretary shall submit to the Comptroller General, the Committee on Veterans' Affairs of the Senate, and the Committee on Veterans' Affairs of the House of Representatives a plan to address any findings and recommendations of the Comptroller General included in such report.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H596E709DEF3D4712B3651A4514A36512"><enum>(B)</enum><header>Implementation</header><text>Not later than 90 days after the submittal of the report under paragraph (1), the Secretary shall carry out such plan.</text></subparagraph></paragraph></subsection></section>
<section id="H8CC2E7034D1442A88A04CD711F3B7C38"><enum>208.</enum><header>Information in annual budget of the President on hospital care and medical services furnished through expanded use of contracts for such care</header><text display-inline="no-display-inline">The materials on the Department of Veterans Affairs in the budget of the President for a fiscal year, as submitted to Congress pursuant to <external-xref legal-doc="usc" parsable-cite="usc/31/1105">section 1105(a)</external-xref> of title 31, United States Code, shall set forth the following:</text>
<paragraph id="HD366B34891484D6F88E53AD914775918"><enum>(1)</enum><text>The number of veterans who received hospital care and medical services under section 101 during the fiscal year preceding the fiscal year in which such budget is submitted.</text></paragraph>
<paragraph id="H1C1FB4589B264BF1BE47CAAC66CBED4D"><enum>(2)</enum><text>The amount expended by the Department on furnishing care and services under such section during the fiscal year preceding the fiscal year in which such budget is submitted.</text></paragraph>
<paragraph id="HDE31C69B175644BDAD76FE1AD3E57693"><enum>(3)</enum><text>The amount requested in such budget for the costs of furnishing care and services under such section during the fiscal year covered by such budget, set forth in aggregate and by amounts for each account for which amounts are so requested.</text></paragraph>
<paragraph id="H437B279A0EB64E72B5E8368E1BE7F40F"><enum>(4)</enum><text>The number of veterans that the Department estimates will receive hospital care and medical services under such section during the fiscal years covered by the budget submission.</text></paragraph>
<paragraph id="H96F93E3377474905B130AA248D61DF30"><enum>(5)</enum><text>The number of employees of the Department on paid administrative leave at any point during the fiscal year preceding the fiscal year in which such budget is submitted.</text></paragraph></section>
<section commented="no" display-inline="no-display-inline" id="HB15E5F618B724D8C91E2D33A3ABB5957"><enum>209.</enum><header>Prohibition on falsification of data concerning wait times and quality measures at Department of Veterans Affairs</header><text display-inline="no-display-inline">Not later than 60 days after the date of the enactment of this Act, and in accordance with title 5, United States Code, the Secretary of Veterans Affairs shall establish policies whereby any employee of the Department of Veterans Affairs who knowingly submits false data concerning wait times for health care or quality measures with respect to health care to another employee of the Department or knowingly requires another employee of the Department to submit false data concerning such wait times or quality measures to another employee of the Department is subject to a penalty the Secretary considers appropriate after notice and an opportunity for a hearing, including civil penalties, unpaid suspensions, or termination.</text></section>
<enum>III</enum><header>Health Care Staffing, Recruitment, and Training Matters</header>
<section commented="no" display-inline="no-display-inline" id="HF172427CE09B4BD9AB0419EE59D54422"><enum>301.</enum><header display-inline="yes-display-inline">Treatment of staffing shortage and biennial report on staffing of medical facilities of the Department of Veterans Affairs</header>
<subsection commented="no" display-inline="no-display-inline" id="HEBB206249785409B865F367C46A53066"><enum>(a)</enum><header display-inline="yes-display-inline">Staffing shortages</header>
<paragraph id="HC6C182D5CFBC450FBC2F0579B4099763"><enum>(1)</enum><header>In general</header><text>Subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/74">chapter 74</external-xref> of title 38, United States Code, is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H54E340F82ADE40449498B0D80524A60C" style="USC">
<section id="H22490110545B47759E54CC01866B069E"><enum>7412.</enum><header>Annual determination of staffing shortages; recruitment and appointment for needed occupations</header>
<subsection id="H3811AF84991B453A872EC72C5EEB4E60"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than September 30 of each year, the Inspector General of the Department shall determine, and the Secretary shall publish in the Federal Register, the five occupations of personnel of this title of the Department covered under section 7401 of this title for which there are the largest staffing shortages throughout the Department as calculated over the five-year period preceding the determination.</text></subsection>
<subsection id="H3B9C275012734B6491534CEC7C5603AB"><enum>(b)</enum><header>Recruitment and appointment</header><text>Notwithstanding sections 3304 and 3309 through 3318 of title 5, the Secretary may, upon a determination by the Inspector General under paragraph (1) that there is a staffing shortage throughout the Department with respect to a particular occupation, recruit and directly appoint, during the fiscal year after the fiscal year during which such determination is made, qualified personnel to serve in that particular occupation for the Department.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HCB98F8E5B2444B9CA0007CED365E81CA"><enum>(2)</enum><header display-inline="yes-display-inline">Clerical amendment</header><text display-inline="yes-display-inline">The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7411 the following new item:</text>
<quoted-block display-inline="no-display-inline" id="HD4239FBD356D4E299C9F3E661CFAD512" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="section">7412. Annual determination of staffing shortages; recruitment and appointment for needed occupations.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H9BB212DAA90C434AAAE0DC4C68198A53"><enum>(3)</enum><header display-inline="yes-display-inline">Deadline for first determination</header><text display-inline="yes-display-inline">Notwithstanding the deadline under <external-xref legal-doc="usc" parsable-cite="usc/38/7412">section 7412</external-xref> of title 38, United States Code, as added by paragraph (1), for the annual determination of staffing shortages in the Veterans Health Administration, the Inspector General of the Department of Veterans Affairs shall make the first determination required under such section, and the Secretary of Veterans Affairs shall publish in the Federal Register such determination, by not later than the date that is 180 days after the date of the enactment of this Act.</text></paragraph></subsection>
<subsection id="HCEC91373FFFE47BD8746F163DBBFC6CB"><enum>(b)</enum><header>Increase of graduate medical education residency positions</header>
<paragraph id="HFC410767304F4595950F4D057BD39AF0"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/38/7302">Section 7302</external-xref> of title 38, United States Code, is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H9DA331F2FC64453FB25F515F08015DA6" style="OLC">
<subsection id="H18B948FC545044D2A004F6AA87CD29F2"><enum>(e)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="HACF847C762EF4191A9F7A2873E0666CE"><enum>(1)</enum><text>In carrying out this section, the Secretary shall establish medical residency programs, or ensure that already established medical residency programs have a sufficient number of residency positions, at any medical facility of the Department that the Secretary determines—</text>
<subparagraph id="H1F1C2AA0A7FD45D1BF4B4E271B153975" indent="up1"><enum>(A)</enum><text>is experiencing a shortage of physicians; and</text></subparagraph>
<subparagraph id="H3FBFA34E577940C6A23D988AC71B86A9" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">is located in a community that is designated as a health professional shortage area (as defined in section 332 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254e">42 U.S.C. 254e</external-xref>)).</text></subparagraph></paragraph>
<paragraph id="H4EF120DBC76545628F69C59D7107D350" indent="up1"><enum>(2)</enum><text>In carrying out paragraph (1), the Secretary shall—</text>
<subparagraph id="H1D82B194FB634DF089C32664FFCA2C13"><enum>(A)</enum><text>allocate the residency positions under such paragraph among occupations included in the most current determination published in the Federal Register pursuant to <external-xref legal-doc="usc" parsable-cite="usc/38/7412">section 7412(a)</external-xref> of this title; and</text></subparagraph>
<subparagraph id="HEFE5E51940ED4C6CB4DBF86D6EC3A26A"><enum>(B)</enum><text>give priority to residency positions and programs in primary care, mental health, and any other specialty the Secretary determines appropriate.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph id="H45B654918782418B9F1F7C46E87B651A"><enum>(2)</enum><header>Five-year increase</header>
<subparagraph id="H6189AA3BAB4E4BF0970CF046E15A459E"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">In carrying out <external-xref legal-doc="usc" parsable-cite="usc/38/7302">section 7302(e)</external-xref> of title 38, United States Code, as added by paragraph (1), during the 5-year period beginning on the day that is 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall increase the number of graduate medical education residency positions at medical facilities of the Department by up to 1,500 positions.</text></subparagraph>
<subparagraph id="H223E16DA17C04875881AE3DF62756901"><enum>(B)</enum><header>Priority</header><text display-inline="yes-display-inline">In increasing the number of graduate medical education residency positions at medical facilities of the Department under subparagraph (A), the Secretary shall give priority to medical facilities that—</text>
<clause id="HA926DA310800491EA8AEEAF7E897B56E"><enum>(i)</enum><text>as of the date of the enactment of this Act, do not have a medical residency program; and</text></clause>
<clause id="H36A4D8E7C49A45C69B9F60B22223B240"><enum>(ii)</enum><text>are located in a community that has a high concentration of veterans.</text></clause></subparagraph></paragraph>
<paragraph id="H906010C2247944F79A84392DA2CA5665"><enum>(3)</enum><header>Report</header>
<subparagraph id="H1D3C6E6166F8492793A7091F29C60848"><enum>(A)</enum><header>In general</header><text>Not later than 60 days after the date of the enactment of this Act, and not later than October 1 each year thereafter until 2019, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on graduate medical education residency positions at medical facilities of the Department.</text></subparagraph>
<subparagraph id="H845E7693F9FA442A8ED415ED86B4CD5E"><enum>(B)</enum><header>Elements</header><text>Each report required by subparagraph (A) shall include the following:</text>
<clause id="HC51FAD2CCAC245D4BFC30FB6FA563E46"><enum>(i)</enum><text>For the year preceding the submittal of the report, the number of graduate medical education residency positions at medical facilities of the Department as follows:</text>
<subclause id="H73D605BE567C49A2B17CCCCB81EEF4FD"><enum>(I)</enum><text>That were filled.</text></subclause>
<subclause id="HD7322B6CE6F44A9C9E11C4CE3076B8B8"><enum>(II)</enum><text>That were not filled.</text></subclause>
<subclause id="H3A602C4223D746569C6CBBADE08B81B7"><enum>(III)</enum><text>That the Department anticipated filling.</text></subclause></clause>
<clause id="H2A147E3BF8A04BBBB3D0E16B19D55077"><enum>(ii)</enum><text>With respect to each graduate medical education residency position specified in clause (i)—</text>
<subclause id="H7707F93C46424125B88243AC0A623805"><enum>(I)</enum><text>the geographic location of each such position; and</text></subclause>
<subclause id="H238F6AAA896C46B38981F4A01F7A8CEA"><enum>(II)</enum><text>if such position was filled, the academic affiliation of the medical resident that filled such position.</text></subclause></clause>
<clause id="H8C4065CE05FF4CAC80FF121DD1A0B76D"><enum>(iii)</enum><text>The policy at each medical facility of the Department with respect to the ratio of medical residents to staff supervising medical residents.</text></clause>
<clause id="HEA4EE3370EBF42198844E8A1513B3EA7"><enum>(iv)</enum><text>During the 1-year period preceding the submittal of the report, the number of individuals who declined an offer from the Department to serve as a medical resident at a medical facility of the Department and the reason why each such individual declined such offer.</text></clause>
<clause id="HCBF3E0D7767A413FAACACDAD227743A8"><enum>(v)</enum><text>During the 1-year period preceding the submittal of the report, a description of—</text>
<subclause id="H1AAFF04FE0C249129586843DE805DC97"><enum>(I)</enum><text>challenges, if any, faced by the Department in filling graduate medical education residency positions at medical facilities of the Department; and</text></subclause>
<subclause id="H2672419546D24A549517B19E456CEA72"><enum>(II)</enum><text>actions, if any, taken by the Department to address such challenges.</text></subclause></clause>
<clause id="H044FD147BC234EC3965C19E4870315D5"><enum>(vi)</enum><text>A description of efforts of the Department, as of the date of the submittal of the report, to recruit and retain medical residents to work for the Veterans Health Administration as full-time employees.</text></clause></subparagraph></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H8DADED9C16844EBA88AC9E222514AD3A"><enum>(c)</enum><header display-inline="yes-display-inline">Priority in Scholarship Program of Health Professionals Educational Assistance Program to certain providers</header><text><external-xref legal-doc="usc" parsable-cite="usc/38/7612">Section 7612(b)(5)</external-xref> of title 38, United States Code, is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="H871AC45DF43D474082EF7AF4727F11B2"><enum>(1)</enum><text display-inline="yes-display-inline">in subparagraph (A), by striking <quote>and</quote> at the end;</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HECF1372819094B16B882C03929647841"><enum>(2)</enum><text display-inline="yes-display-inline">by redesignating subparagraph (B) as subparagraph (C); and</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H77D4E9A8C5AD4C7FA64D252D582A13B4"><enum>(3)</enum><text display-inline="yes-display-inline">by inserting after subparagraph (A) the following new subparagraph (B):</text>
<quoted-block display-inline="no-display-inline" id="H381F63F30A0A4969B96DF030B47AB740" style="USC">
<subparagraph id="H994A0CC676E74E849B330A9022FF3AC3" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">shall give priority to applicants pursuing a course of education or training toward a career in an occupation for which the Inspector General of the Department has, in the most current determination published in the Federal Register pursuant to section 7412(a) of this title, determined that there is one of the largest staffing shortages throughout the Department with respect to such occupation; and</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H80A7C392AF3B45A18931394D8D9A5DAB"><enum>(d)</enum><header display-inline="yes-display-inline">Reports</header>
<paragraph commented="no" display-inline="no-display-inline" id="H24F4EF6F564E4644988DD90735B696D6"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Not later than 180 days after the date of the enactment of this Act, and not later than December 31 of each even-numbered year thereafter until 2024, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report assessing the staffing of each medical facility of the Department.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H8464B607BD524D0F93D0C4F366D21306"><enum>(2)</enum><header display-inline="yes-display-inline">Elements</header><text display-inline="yes-display-inline">Each report submitted under paragraph (1) shall include the following:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HABE214558182437389466735F57327E5"><enum>(A)</enum><text display-inline="yes-display-inline">The results of a system-wide assessment of all medical facilities of the Department to ensure the following:</text>
<clause commented="no" display-inline="no-display-inline" id="H20B6782AFB804EC495FE3BAE7EFA4B27"><enum>(i)</enum><text display-inline="yes-display-inline">Appropriate staffing levels for health care professionals to meet the goals of the Secretary for timely access to care for veterans.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H51D9EF58ECA34054BB621C1689B64317"><enum>(ii)</enum><text display-inline="yes-display-inline">Appropriate staffing levels for support personnel, including clerks.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HDF4ACC3EE5A44A88952EAC1D10B8B609"><enum>(iii)</enum><text display-inline="yes-display-inline">Appropriate sizes for clinical panels.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HD653553D09DE456FAF92DBB882A8C122"><enum>(iv)</enum><text display-inline="yes-display-inline">Appropriate numbers of full-time staff, or full-time equivalents, dedicated to direct care of patients.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HFEB6DF0093FE40C7B5695399CBE19BB4"><enum>(v)</enum><text display-inline="yes-display-inline">Appropriate physical plant space to meet the capacity needs of the Department in that area.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H1A6185D4DB344E2D9DA640F3A55F0F96"><enum>(vi)</enum><text display-inline="yes-display-inline">Such other factors as the Secretary considers necessary.</text></clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H33B09464993341E1A6D41A70897226A7"><enum>(B)</enum><text display-inline="yes-display-inline">A plan for addressing any issues identified in the assessment described in subparagraph (A), including a timeline for addressing such issues.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H97C5D1E8BF064F54BB1E1996BE27056F"><enum>(C)</enum><text display-inline="yes-display-inline">A list of the current wait times and workload levels for the following clinics in each medical facility:</text>
<clause commented="no" display-inline="no-display-inline" id="H65FF315B52E642F2AC578222AF833006"><enum>(i)</enum><text display-inline="yes-display-inline">Mental health.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H840C7EB66A5F45E98BD33F23049B5A7D"><enum>(ii)</enum><text display-inline="yes-display-inline">Primary care.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HD4B880C6487A4024A4996276C21B4B05"><enum>(iii)</enum><text display-inline="yes-display-inline">Gastroenterology.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H12ABC6EDE81E4BDCBF230CB8A3D1E811"><enum>(iv)</enum><text display-inline="yes-display-inline">Women’s health.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H82F3C8D0DFB04F328A747038D9699A72"><enum>(v)</enum><text display-inline="yes-display-inline">Such other clinics as the Secretary considers appropriate.</text></clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HCAD89FB55A5443BE9B16FFDE9F0C7372"><enum>(D)</enum><text display-inline="yes-display-inline">A description of the results of the most current determination of the Inspector General under subsection (a) of <external-xref legal-doc="usc" parsable-cite="usc/38/7412">section 7412</external-xref> of title 38, United States Code, as added by subsection (a)(1) of this section, and a plan to use direct appointment authority under subsection (b) of such section 7412 to fill staffing shortages, including recommendations for improving the speed at which the credentialing and privileging process can be conducted.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HBD4FED323A594FA99F2275F66A871234"><enum>(E)</enum><text display-inline="yes-display-inline">The current staffing models of the Department for the following clinics, including recommendations for changes to such models:</text>
<clause commented="no" display-inline="no-display-inline" id="H70AA9C50C8AA457587B6D768F0212D46"><enum>(i)</enum><text display-inline="yes-display-inline">Mental health.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H74C4B56FBC034D49861F3A4A8CC9C1FD"><enum>(ii)</enum><text display-inline="yes-display-inline">Primary care.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HBFFC80D8EDF9446EB61540551F91555C"><enum>(iii)</enum><text display-inline="yes-display-inline">Gastroenterology.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H5027C5635C0F4E9289BFC516C49386E4"><enum>(iv)</enum><text display-inline="yes-display-inline">Women’s health.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HE4C2D928A1B444A5B70766419B1A9134"><enum>(v)</enum><text display-inline="yes-display-inline">Such other clinics as the Secretary considers appropriate.</text></clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HB836B731AF9443998D03606856E1F217"><enum>(F)</enum><text display-inline="yes-display-inline">A detailed analysis of succession planning at medical facilities of the Department, including the following:</text>
<clause commented="no" display-inline="no-display-inline" id="H2BF2F24EE3B640E7B7AF4DE3623BCA8B"><enum>(i)</enum><text display-inline="yes-display-inline">The number of positions in medical facilities throughout the Department that are not filled by a permanent employee.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H8336F8B5EA8D48CDB104E6DFB094FF79"><enum>(ii)</enum><text display-inline="yes-display-inline">The length of time each position described in clause (i) remained vacant or filled by a temporary or acting employee.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H9C631C797CFD456196056D368ED28C99"><enum>(iii)</enum><text display-inline="yes-display-inline">A description of any barriers to filling the positions described in clause (i).</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H2CA30A1EEA764B91A1DB8BFB924FE396"><enum>(iv)</enum><text display-inline="yes-display-inline">A plan for filling any positions that are vacant or filled by a temporary or acting employee for more than 180 days.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H83F18CC6C6C745D898135D9EE469D920"><enum>(v)</enum><text display-inline="yes-display-inline">A plan for handling emergency circumstances, such as administrative leave or sudden medical leave for senior officials.</text></clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HC19A7023DFF94943A98C4D71F9854133"><enum>(G)</enum><text display-inline="yes-display-inline">The number of health care providers of the Department who have been removed from their positions, have retired, or have left their positions for another reason, disaggregated by provider type, during the 2-year period preceding the submittal of the report.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H5FED1B9CF7584619A95CA99F1673AA95"><enum>(H)</enum><text display-inline="yes-display-inline">Of the health care providers specified in subparagraph (G) who have been removed from their positions, the following:</text>
<clause commented="no" display-inline="no-display-inline" id="H3D2D337FE7F6411EB42768CFA40CFDC1"><enum>(i)</enum><text display-inline="yes-display-inline">The number of such health care providers who were reassigned to other positions in the Department.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HFA331C49196C4418ACEB32C6A523F6F8"><enum>(ii)</enum><text display-inline="yes-display-inline">The number of such health care providers who left the Department.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H0D63173F8EC74FC6A27DC1F7BE9597A0"><enum>(iii)</enum><text display-inline="yes-display-inline">The number of such health care providers who left the Department and were subsequently rehired by the Department.</text></clause></subparagraph></paragraph></subsection></section>
<section id="H69901CBDE516444B9510AD9E1282CA81"><enum>302.</enum><header>Extension and modification of certain programs within the Department of Veterans Affairs Health Professionals Educational Assistance Program</header>
<subsection id="HEF668272D90A44EAA5BED7C6E464DFEC"><enum>(a)</enum><header>Extension of Scholarship Program</header><text><external-xref legal-doc="usc" parsable-cite="usc/38/7619">Section 7619</external-xref> of title 38, United States Code, is amended by striking <quote>December 31, 2014</quote> and inserting <quote>December 31, 2019</quote>.</text></subsection>
<subsection id="HF23CC4EF90AB4DA8884C87412AC34D68"><enum>(b)</enum><header>Modification of Education Debt Reduction Program</header>
<paragraph id="H5C4980F98F4341C38792C95D994C888D"><enum>(1)</enum><header>Modification of amount and duration of eligibility</header><text>Paragraph (1) of section 7683(d) of such title is amended—</text>
<subparagraph id="HA5078428569643FEA00F5C7D155560C9"><enum>(A)</enum><text>by striking <quote>$60,000</quote> and inserting <quote>$120,000</quote>; and</text></subparagraph>
<subparagraph id="H082DDA1B30DB4B69AC464728A531A255"><enum>(B)</enum><text>by striking <quote>$12,000 of such payments</quote> and all that follows through the period at the end and inserting <quote>$24,000 of such payments may be made in each year of participation in the Program</quote>.</text></subparagraph></paragraph>
<paragraph id="HB070DF95DD4B424E96A82E083FFF486F"><enum>(2)</enum><header>Elimination of limitation</header>
<subparagraph id="HB15A09CD4E374E0D8CFCE72DF84FAD24"><enum>(A)</enum><header>In general</header><text>Such section is further amended—</text>
<clause id="H81DC1D50BAFB4C778F1677165E3EC513"><enum>(i)</enum><text>by striking paragraph (2);</text></clause>
<clause id="H68D367BB797E450FB0D7955754B186FF"><enum>(ii)</enum><text>by redesignating paragraph (3) as paragraph (2); and</text></clause>
<clause id="H39163BF72EBF488191FBF3E5E9839B4D"><enum>(iii)</enum><text>in paragraph (2), as redesignated by clause (ii), by striking <quote>paragraphs (1) and (2)</quote> and inserting <quote>paragraph (1)</quote>.</text></clause></subparagraph>
<subparagraph id="H20B4617CB4314E719C64BCF157A7CD3C"><enum>(B)</enum><header>Conforming amendment</header><text>Paragraph (1) of such section, as amended by paragraph (1), is further amended by striking <quote>Subject to paragraph (2), the amount</quote> and inserting <quote>The amount</quote>.</text></subparagraph></paragraph></subsection></section>
<section id="H5E268BDAE9964643AEFAA108CBF02953"><enum>303.</enum><header>Clinic management training for employees at medical facilities of the Department of Veterans Affairs</header>
<subsection id="HC73922B76AAE4CB2ABBC2CA920DFE746"><enum>(a)</enum><header>Clinic management training program</header>
<paragraph id="H8D54F28FA4394D77A8018EC725E611FB"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall commence a role-specific clinic management training program to provide in-person, standardized education on systems and processes for health care practice management and scheduling to all appropriate employees, as determined by the Secretary, at medical facilities of the Department.</text></paragraph>
<paragraph id="HB827F2CEF49F48EEA9071781F4F6ABC3"><enum>(2)</enum><header>Elements</header>
<subparagraph id="H0E2EC3CE81CD4FD4A098FF9B01810B8E"><enum>(A)</enum><header>In general</header><text>The clinic management training program required by paragraph (1) shall include the following:</text>
<clause id="H645FB5BB5CC840B988214A7889031E4E"><enum>(i)</enum><text>Training on how to manage the schedules of health care providers of the Department, including the following:</text>
<subclause id="H4055A2E487E847329FC4494277DF4928"><enum>(I)</enum><text>Maintaining such schedules in a manner that allows appointments to be booked at least eight weeks in advance.</text></subclause>
<subclause id="H1ECD7A42AF45436DA12FE34292E5710F"><enum>(II)</enum><text>Proper planning procedures for vacation, leave, and graduate medical education training schedules.</text></subclause></clause>
<clause id="H041CCBA0C957413999F1FC9443060606"><enum>(ii)</enum><text>Training on the appropriate number of appointments that a health care provider should conduct on a daily basis, based on specialty.</text></clause>
<clause id="HBFBEFC45931042B99C278F248309D669"><enum>(iii)</enum><text>Training on how to determine whether there are enough available appointment slots to manage demand for different appointment types and mechanisms for alerting management of insufficient slots.</text></clause>
<clause id="H942F013916E9450AB226294664C9C49A"><enum>(iv)</enum><text>Training on how to properly use the appointment scheduling system of the Department, including any new scheduling system implemented by the Department.</text></clause>
<clause id="H527FCAEEE2B54FE486694D413C909B2D"><enum>(v)</enum><text>Training on how to optimize the use of technology, including the following:</text>
<subclause id="H91F649D216F64BA385CDD24C07FBA052"><enum>(I)</enum><text>Telemedicine.</text></subclause>
<subclause id="H7FD0354058644D099BA4A1281C5FB6FB"><enum>(II)</enum><text>Electronic mail.</text></subclause>
<subclause id="HF53D5E06BF714D19ACADFBD1324D226B"><enum>(III)</enum><text>Text messaging.</text></subclause>
<subclause id="H711716E5123B4D879E4BE29E583CAEC2"><enum>(IV)</enum><text>Such other technologies as specified by the Secretary.</text></subclause></clause>
<clause id="H37D2918BC81C4129A51C823FAD544DE8"><enum>(vi)</enum><text>Training on how to properly use physical plant space at medical facilities of the Department to ensure efficient flow and privacy for patients and staff.</text></clause></subparagraph>
<subparagraph id="H457B97D5B6884612BEA11A57D458A0D5"><enum>(B)</enum><header>Role-specific</header><text>The Secretary shall ensure that each employee of the Department included in the clinic management training program required by paragraph (1) receives education under such program that is relevant to the responsibilities of such employee.</text></subparagraph></paragraph>
<paragraph id="HA46E8D223DFA4F498B22E54D586A02B3"><enum>(3)</enum><header>Sunset</header><text>The clinic management training program required by paragraph (1) shall terminate on the date that is 2 years after the date on which the Secretary commences such program.</text></paragraph></subsection>
<subsection id="H2E0C335DA802443EB5FB840ADC78DDEC"><enum>(b)</enum><header>Training materials</header>
<paragraph id="HA872A4E397404A40A3D96C3E28622EDB"><enum>(1)</enum><header>In general</header><text>After the termination of the clinic management training program required by subsection (a), the Secretary shall provide training materials on health care management to each of the following employees of the Department that are relevant to the position and responsibilities of such employee upon the commencement of employment of such employee:</text>
<subparagraph id="HAAF7CC508CBB4A2CB2BB10B71FDCF9A7"><enum>(A)</enum><text>Any manager of a medical facility of the Department.</text></subparagraph>
<subparagraph id="H92926564248C48BB9B12D2C41FAA37A6"><enum>(B)</enum><text>Any health care provider at a medical facility of the Department.</text></subparagraph>
<subparagraph id="H67A987D2725140379997A7F2C151BE57"><enum>(C)</enum><text>Such other employees of the Department as the Secretary considers appropriate.</text></subparagraph></paragraph>
<paragraph id="H6660BABA2D0842399F34E5D83099AF90"><enum>(2)</enum><header>Update</header><text>The Secretary shall regularly update the training materials required under paragraph (1).</text></paragraph></subsection></section>
<enum>IV</enum><header>Health Care Related to Sexual Trauma</header>
<section id="H036B13AC808F412FB2B46EE2EB97E61B"><enum>401.</enum><header>Expansion of eligibility for sexual trauma counseling and treatment to veterans on inactive duty training</header><text display-inline="no-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/38/1720D">Section 1720D(a)(1)</external-xref> of title 38, United States Code, is amended by striking <quote>or active duty for training</quote> and inserting <quote>, active duty for training, or inactive duty training</quote>.</text></section>
<section id="HE49223F533BD407B8C91C92403D9465D"><enum>402.</enum><header>Provision of counseling and treatment for sexual trauma by the Department of Veterans Affairs to members of the Armed Forces</header>
<subsection id="HDA08930C79294445A29136640C6A7204"><enum>(a)</enum><header>Expansion of coverage to members of the Armed Forces</header><text>Subsection (a) of <external-xref legal-doc="usc" parsable-cite="usc/38/1720D">section 1720D</external-xref> of title 38, United States Code, is amended—</text>
<paragraph id="H34CE530971EB41E493ED54AACB9331C8"><enum>(1)</enum><text>by redesignating paragraph (2) as paragraph (3);</text></paragraph>
<paragraph id="HC92F2B2B91404905937B522EF378B598"><enum>(2)</enum><text>by inserting after paragraph (1) the following new paragraph (2):</text>
<quoted-block display-inline="no-display-inline" id="H35BC7FF6F7D343ABBE8E368112A0CEF8" style="OLC">
<paragraph id="H4647B10571004C83A5D8DF0FDA4DB5BF" indent="up1"><enum>(2)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H6BDF2F847D3B48CE945601895B814B3E"><enum>(A)</enum><text>In operating the program required by paragraph (1), the Secretary may, in consultation with the Secretary of Defense, provide counseling and care and services to members of the Armed Forces (including members of the National Guard and Reserves) on active duty to overcome psychological trauma described in that paragraph.</text></subparagraph>
<subparagraph id="HA5A607C8E22E443F85D6FEC77BDE4AFD" indent="up1"><enum>(B)</enum><text>A member described in subparagraph (A) shall not be required to obtain a referral before receiving counseling and care and services under this paragraph.</text></subparagraph></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph>
<paragraph id="H36C085AABE344F2FA0CAF68D52835300"><enum>(3)</enum><text>in paragraph (3), as redesignated by paragraph (1)—</text>
<subparagraph id="H1F261AB341F646C79C8A0C0CFEED2E4E"><enum>(A)</enum><text>by striking <quote>a veteran</quote> and inserting <quote>an individual</quote>; and</text></subparagraph>
<subparagraph id="H8A69800FBA8549E0B7CC24640CA65745"><enum>(B)</enum><text>by striking <quote>that veteran</quote> each place it appears and inserting <quote>that individual</quote>.</text></subparagraph></paragraph></subsection>
<subsection id="H1B48B6997DCA4FA1BBA84172EF3A1C9E"><enum>(b)</enum><header>Information to members on availability of counseling and services</header><text>Subsection (c) of such section is amended—</text>
<paragraph id="H7E21FA5D26624E659D0375DFCBA8465A"><enum>(1)</enum><text>by striking <quote>to veterans</quote> each place it appears; and</text></paragraph>
<paragraph id="H2C1AE6910AA3482C8D6AEB2DE8510CC0"><enum>(2)</enum><text>in paragraph (3), by inserting <quote>members of the Armed Forces and</quote> before <quote>individuals</quote>.</text></paragraph></subsection>
<subsection id="H8073A8B412ED40A98358006083A1C7E2"><enum>(c)</enum><header>Inclusion of members in reports on counseling and services</header><text>Subsection (e) of such section is amended—</text>
<paragraph id="HD70C6264B34249D9BC21556B35D06391"><enum>(1)</enum><text>in the matter preceding paragraph (1), by striking <quote>to veterans</quote>;</text></paragraph>
<paragraph id="H8D3F5E105D294938A67560638DAF0C5D"><enum>(2)</enum><text>in paragraph (2)—</text>
<subparagraph id="HBF34A0BD491D4613AA7176E802B98E05"><enum>(A)</enum><text>by striking <quote>women veterans</quote> and inserting <quote>individuals</quote>; and</text></subparagraph>
<subparagraph id="HF905206275FD4B7BBB3ABED07E42AA29"><enum>(B)</enum><text>by striking <quote>training under subsection (d).</quote> and inserting “training under subsection (d), disaggregated by—</text>
<quoted-block display-inline="no-display-inline" id="H5AF39D8593BB41E293293B3FC41A1721" style="OLC">
<subparagraph id="H78DDC05C5CAB4F0EBCB7A917690E7E5F"><enum>(A)</enum><text>veterans;</text></subparagraph>
<subparagraph id="H2831907E1C1642A993344A3C97C89284"><enum>(B)</enum><text>members of the Armed Forces (including members of the National Guard and Reserves) on active duty; and</text></subparagraph>
<subparagraph id="H4CC612BA865F4D869AE805001B205CE5"><enum>(C)</enum><text>for each of subparagraphs (A) and (B)—</text>
<clause id="H7E4B4C72E6F84A0C8833812B9984F41A"><enum>(i)</enum><text>men; and</text></clause>
<clause id="H2D867A5B8FFA4BC188EBE90CCC890472"><enum>(ii)</enum><text>women.</text></clause></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="HF3A1B12CBAB14BAEA6A39EB77A6FF79A"><enum>(3)</enum><text>in paragraph (4), by striking <quote>veterans</quote> and inserting <quote>individuals</quote>; and</text></paragraph>
<paragraph id="HE98D12EE161244FBAA29A7C4FCA94651"><enum>(4)</enum><text>in paragraph (5)—</text>
<subparagraph id="H18D7CCCB17824E76A1DE5DC2D7F6858C"><enum>(A)</enum><text>by striking <quote>women veterans</quote> and inserting <quote>individuals</quote>; and</text></subparagraph>
<subparagraph id="H32836C13259D49FCAFBA9C41FCD228CC"><enum>(B)</enum><text>by inserting <quote>, including specific recommendations for individuals specified in subparagraphs (A), (B), and (C) of paragraph (2)</quote> before the period at the end.</text></subparagraph></paragraph></subsection>
<subsection id="H4D9241FEFB5540CF96F4819E26AE938F"><enum>(d)</enum><header>Effective date</header><text>The amendments made by this section shall take effect on the date that is 1 year after the date of the enactment of this Act.</text></subsection></section>
<section commented="no" display-inline="no-display-inline" id="H777D5F6A0BF740CD9D3401574A23AA98"><enum>403.</enum><header>Reports on military sexual trauma</header>
<subsection id="H040E9D3C89E84447BA1AE8AF9F3108A2"><enum>(a)</enum><header>Report on services available for military sexual trauma in the Department of Veterans Affairs</header><text>Not later than 630 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the treatment and services available from the Department of Veterans Affairs for male veterans who experience military sexual trauma compared to such treatment and services available to female veterans who experience military sexual trauma.</text></subsection>
<subsection id="HBD47D69A61C34E40A0A87A8BB00D9A1F"><enum>(b)</enum><header>Reports on transition of military sexual trauma treatment from Department of Defense to Department of Veterans Affairs</header><text>Not later than 630 days after the date of the enactment of this Act, and annually thereafter for 5 years, the Department of Veterans Affairs-Department of Defense Joint Executive Committee established by <external-xref legal-doc="usc" parsable-cite="usc/38/320">section 320(a)</external-xref> of title 38, United States Code, shall submit to the appropriate committees of Congress a report on military sexual trauma that includes the following:</text>
<paragraph id="HE53BEAB3CA5C494AA77F9EF91F5E7481"><enum>(1)</enum><text>The processes and procedures utilized by the Department of Veterans Affairs and the Department of Defense to facilitate transition of treatment of individuals who have experienced military sexual trauma from treatment provided by the Department of Defense to treatment provided by the Department of Veterans Affairs.</text></paragraph>
<paragraph id="HEEE11EBF6071443FBB12E85877662AA4"><enum>(2)</enum><text>A description and assessment of the collaboration between the Department of Veterans Affairs and the Department of Defense in assisting veterans in filing claims for disabilities related to military sexual trauma, including permitting veterans access to information and evidence necessary to develop or support such claims.</text></paragraph></subsection>
<subsection id="H7484C942BE3C433B97D7AA0C3A5900BB"><enum>(c)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="HBEBF5619DF8A4DC2A62E98FD98D1A5D6"><enum>(1)</enum><header>Appropriate committees of congress</header><text>The term <term>appropriate committees of Congress</term> means—</text>
<subparagraph id="HE782753F96AD4999AAE6C631700897E6"><enum>(A)</enum><text>the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate; and</text></subparagraph>
<subparagraph id="H09C679A516C44245B3FF266CE061AD4B"><enum>(B)</enum><text>the Committee on Veterans’ Affairs and the Committee on Armed Services of the House of Representatives.</text></subparagraph></paragraph>
<paragraph id="HD5B93D0E161E42E1BCFED4F98E242772"><enum>(2)</enum><header>Military sexual trauma</header><text>The term <term>military sexual trauma</term> means psychological trauma, which in the judgment of a mental health professional employed by the Department, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the veteran was serving on active duty, active duty for training, or inactive duty training.</text></paragraph>
<paragraph id="HBF6E234A02284B01BC22475165ABA0B8"><enum>(3)</enum><header>Sexual harassment</header><text>The term <term>sexual harassment</term> means repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HE8622DCA6018430CBA554B47FA7A5A11"><enum>(4)</enum><header>Sexual trauma</header><text>The term <term>sexual trauma</term> shall have the meaning given that term by the Secretary of Veterans Affairs for purposes of this section.</text></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HCED50E04722545058288292818430166"><enum>(d)</enum><header>Effective date</header><text>This section shall take effect on the date that is 270 days after the date of the enactment of this Act.</text></subsection></section>
<enum>V</enum><header>Other Health Care Matters</header>
<section id="H71345C90480942AC9800E14D8B3364A6"><enum>501.</enum><header>Extension of pilot program on assisted living services for veterans with traumatic brain injury</header>
<subsection id="H052421A3274D4E639E370D1B851B0BC8"><enum>(a)</enum><header>In general</header><text>Section 1705 of the National Defense Authorization Act for Fiscal Year 2008 (<external-xref legal-doc="public-law" parsable-cite="pl/110/181">Public Law 110–181</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1710C">38 U.S.C. 1710C</external-xref> note) is amended by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="H4AB5FC68D1894E94B329AF488E63366C" style="OLC">
<subsection id="H040F8D3E1B954C6E869BBAD87D20168C"><enum>(g)</enum><header>Termination</header><text>The pilot program shall terminate on October 6, 2017.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H08C690EE9D4C4615B5E9AB83A6B4394E"><enum>(b)</enum><header>Conforming amendment</header><text>Subsection (a) of such section is amended by striking <quote>five-year</quote>.</text></subsection></section>
<enum>VI</enum><header>Major Medical Facility Leases</header>
<section id="HFFB52DC5910B46338E901A5EF9DC11E6"><enum>601.</enum><header>Authorization of major medical facility leases</header>
<subsection id="H6EBB9CFE2E5445D393CB15CAF58D3E1B"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs may carry out the following major medical facility leases at the locations specified, and in an amount for each lease not to exceed the amount shown for such location (not including any estimated cancellation costs):</text>
<paragraph id="HE9747648D1444AC8AC319F8E3B34940E"><enum>(1)</enum><text>For a clinical research and pharmacy coordinating center, Albuquerque, New Mexico, an amount not to exceed $9,560,000.</text></paragraph>
<paragraph id="H8CE5B044E28A4C5A807AA25839976BE5"><enum>(2)</enum><text>For a community-based outpatient clinic, Brick, New Jersey, an amount not to exceed $7,280,000.</text></paragraph>
<paragraph id="H5A41EA6966CE46798E0A3FF36CEB3DAB"><enum>(3)</enum><text>For a new primary care and dental clinic annex, Charleston, South Carolina, an amount not to exceed $7,070,250.</text></paragraph>
<paragraph id="HDEBF2D8CEF60416092F57E650254A1EC"><enum>(4)</enum><text>For a community-based outpatient clinic, Cobb County, Georgia, an amount not to exceed $6,409,000.</text></paragraph>
<paragraph id="H3410BB007009431CAE12E9CB5ADCAAB9"><enum>(5)</enum><text>For the Leeward Outpatient Healthcare Access Center, Honolulu, Hawaii, including a co-located clinic with the Department of Defense and the co-location of the Honolulu Regional Office of the Veterans Benefits Administration and the Kapolei Vet Center of the Department of Veterans Affairs, an amount not to exceed $15,887,370.</text></paragraph>
<paragraph id="H54F07DED2EAD4876B87496FBB461CA72"><enum>(6)</enum><text>For a community-based outpatient clinic, Johnson County, Kansas, an amount not to exceed $2,263,000.</text></paragraph>
<paragraph id="H288D7DFDAD5F45D19D70329F319D2C23"><enum>(7)</enum><text>For a replacement community-based outpatient clinic, Lafayette, Louisiana, an amount not to exceed $2,996,000.</text></paragraph>
<paragraph id="H8B2A48D35F3240A2897F62F49853A63D"><enum>(8)</enum><text>For a community-based outpatient clinic, Lake Charles, Louisiana, an amount not to exceed $2,626,000.</text></paragraph>
<paragraph id="H55187EF2E789440F9F18B4035F814AAE"><enum>(9)</enum><text>For outpatient clinic consolidation, New Port Richey, Florida, an amount not to exceed $11,927,000.</text></paragraph>
<paragraph id="H0C1597F587DA41739FA4954666412F4F"><enum>(10)</enum><text>For an outpatient clinic, Ponce, Puerto Rico, an amount not to exceed $11,535,000.</text></paragraph>
<paragraph id="H18427A2601094628AC972E2892C4411E"><enum>(11)</enum><text>For lease consolidation, San Antonio, Texas, an amount not to exceed $19,426,000.</text></paragraph>
<paragraph id="H7959336EBD19448A8C3684FB84701953"><enum>(12)</enum><text>For a community-based outpatient clinic, San Diego, California, an amount not to exceed $11,946,100.</text></paragraph>
<paragraph id="H6F4987A90A024E8DAB037845CD824E28"><enum>(13)</enum><text>For an outpatient clinic, Tyler, Texas, an amount not to exceed $4,327,000.</text></paragraph>
<paragraph id="HDE4E8BCD82DD4205B8F467D62D8CAA8B"><enum>(14)</enum><text>For the Errera Community Care Center, West Haven, Connecticut, an amount not to exceed $4,883,000.</text></paragraph>
<paragraph id="H134B5B78F4D145F9B68E22809F97F6C2"><enum>(15)</enum><text>For the Worcester Community-Based Outpatient Clinic, Worcester, Massachusetts, an amount not to exceed $4,855,000.</text></paragraph>
<paragraph id="H3D1A18DE6235440AB6B355FBD270E9FF"><enum>(16)</enum><text>For the expansion of a community-based outpatient clinic, Cape Girardeau, Missouri, an amount not to exceed $4,232,060.</text></paragraph>
<paragraph id="H531559A8EC224756820B01F46406824E"><enum>(17)</enum><text>For a multispecialty clinic, Chattanooga, Tennessee, an amount not to exceed $7,069,000.</text></paragraph>
<paragraph id="H744DEEE3849E4A0BB04027E57AFCF114"><enum>(18)</enum><text>For the expansion of a community-based outpatient clinic, Chico, California, an amount not to exceed $4,534,000.</text></paragraph>
<paragraph id="H48E384D9B23B4986A719F933BF3D879B"><enum>(19)</enum><text>For a community-based outpatient clinic, Chula Vista, California, an amount not to exceed $3,714,000.</text></paragraph>
<paragraph id="HC3B77566DE8E458F8BE2F340180E7D5F"><enum>(20)</enum><text>For a new research lease, Hines, Illinois, an amount not to exceed $22,032,000.</text></paragraph>
<paragraph id="HBF07278E4F2B4B17A958572B3031F247"><enum>(21)</enum><text>For a replacement research lease, Houston, Texas, an amount not to exceed $6,142,000.</text></paragraph>
<paragraph id="HAC2F12E37008417B821498755D09A3E4"><enum>(22)</enum><text>For a community-based outpatient clinic, Lincoln, Nebraska, an amount not to exceed $7,178,400.</text></paragraph>
<paragraph id="H30BA572D209E45F79C26FE1F7A11FC55"><enum>(23)</enum><text>For a community-based outpatient clinic, Lubbock, Texas, an amount not to exceed $8,554,000.</text></paragraph>
<paragraph id="HE2928E07F65D47D1976FC120B0E20678"><enum>(24)</enum><text>For a community-based outpatient clinic consolidation, Myrtle Beach, South Carolina, an amount not to exceed $8,022,000.</text></paragraph>
<paragraph id="H9E1785780FC5431F92F7C2F396490670"><enum>(25)</enum><text>For a community-based outpatient clinic, Phoenix, Arizona, an amount not to exceed $20,757,000.</text></paragraph>
<paragraph id="HE22DF1FCD8CD4F878CFD807C29DB9B5C"><enum>(26)</enum><text>For the expansion of a community-based outpatient clinic, Redding, California, an amount not to exceed $8,154,000.</text></paragraph>
<paragraph id="H7A3F762DEE1F4898BA7A4C08AE1D268E"><enum>(27)</enum><text>For the expansion of a community-based outpatient clinic, Tulsa, Oklahoma, an amount not to exceed $13,269,200.</text></paragraph></subsection>
<subsection id="H7A92BC308ADC4756AB67D559DAD89181"><enum>(b)</enum><header>Requirements for clinic in Tulsa</header>
<paragraph id="H170C59D7281B476DA219DC7F86F78171"><enum>(1)</enum><header>In general</header><text>In carrying out the expansion of the community-based outpatient clinic in Tulsa, Oklahoma, authorized by subsection (a)(27), the Secretary of Veterans Affairs shall ensure that such clinic satisfies the following requirements:</text>
<subparagraph id="H8F9C866E67374A4580002EBB1DD0DBE5"><enum>(A)</enum><text>Consist of not more than 140,000 gross square feet.</text></subparagraph>
<subparagraph id="H8D6D78C5173D41B093A5D81B23DACA8C"><enum>(B)</enum><text>Have an annual cost per square foot of not more than the average market rate in Tulsa, Oklahoma, for an equivalent medical facility plus 20 percent.</text></subparagraph>
<subparagraph id="HBFD2D61B64D14EB5B9679AFAEFBD09B8"><enum>(C)</enum><text>Satisfy the mandate of the Department of Veterans Affairs to provide veterans in Oklahoma with access to quality and efficient care.</text></subparagraph>
<subparagraph id="HBDCEEC4C973E4CA7AAD8F85D6EC50364"><enum>(D)</enum><text>Expand clinical capacity in the region in which the clinic is located in a cost efficient manner based upon regional cost comparisons, taking into account the needs of current veterans and the potential demand by veterans for care in the future.</text></subparagraph>
<subparagraph id="HFB5D9C4196474F4BA4336A61D424BE84"><enum>(E)</enum><text>Be the most cost effective option for the Department as predicted over a 30-year life cycle for such clinic.</text></subparagraph></paragraph>
<paragraph id="H3EB5E88428D54AD9BB8914CC510013B3"><enum>(2)</enum><header>Cost effective determination</header>
<subparagraph id="HBC098413D5AA45F3A72E19B24B505F57"><enum>(A)</enum><header>In general</header><text>If the Secretary determines that the most cost effective option over a 30-year life cycle would be to purchase or construct a facility in Tulsa, Oklahoma, instead of entering into a major medical facility lease in such location as authorized by subsection (a)(27), the Secretary shall not enter into such lease.</text></subparagraph>
<subparagraph id="H7F479DE22111452B9BEB85ED672BDD42"><enum>(B)</enum><header>Major medical facility project</header><text>If the Secretary makes the determination described in subparagraph (A), the Secretary may request authority for a major medical facility project in Tulsa, Oklahoma, from Congress pursuant to <external-xref legal-doc="usc" parsable-cite="usc/38/8104">section 8104(b)</external-xref> of title 38, United States Code.</text></subparagraph>
<subparagraph id="H3ACBE02616494591B2537DE4B1C67B15"><enum>(C)</enum><header>Cost-benefit analysis</header><text>If the Secretary requests authority for the major medical facility project described in subparagraph (B), not later than 90 days after making the determination described in subparagraph (A), the Secretary shall submit to Congress a detailed cost-benefit analysis of such major medical facility project.</text></subparagraph></paragraph></subsection></section>
<section id="H50D8130E3F214207A4E6D81FDB9E6819"><enum>602.</enum><header>Budgetary treatment of Department of Veterans Affairs major medical facilities leases</header>
<subsection id="HD04599594183460EA62C1F14763C3E25"><enum>(a)</enum><header>Findings</header><text>Congress finds the following:</text>
<paragraph id="HCF1932664C5D424BB03B034092F5246B"><enum>(1)</enum><text>Title 31, United States Code, requires the Department of Veterans Affairs to record the full cost of its contractual obligation against funds available at the time a contract is executed.</text></paragraph>
<paragraph id="HA9BC170DD2E44532939AA87072778033"><enum>(2)</enum><text>Office of Management and Budget Circular A–11 provides guidance to agencies in meeting the statutory requirements under title 31, United States Code, with respect to leases.</text></paragraph>
<paragraph id="H20DDC86C5849420DA6398600CC8E25C3"><enum>(3)</enum><text>For operating leases, Office of Management and Budget Circular A–11 requires the Department of Veterans Affairs to record up-front budget authority in an <quote>amount equal to total payments under the full term of the lease or [an] amount sufficient to cover first year lease payments plus cancellation costs</quote>.</text></paragraph></subsection>
<subsection id="HAAFE5AE2517B4C73B9DB4902B0D6970A"><enum>(b)</enum><header>Requirement for obligation of full cost</header>
<paragraph id="H772FDE65325B4B48B1721469213DE108"><enum>(1)</enum><header>In general</header><text>Subject to the availability of appropriations provided in advance, in exercising the authority of the Secretary of Veterans Affairs to enter into leases provided in this Act, the Secretary shall record, pursuant to <external-xref legal-doc="usc" parsable-cite="usc/31/1501">section 1501</external-xref> of title 31, United States Code, as the full cost of the contractual obligation at the time a contract is executed either—</text>
<subparagraph id="HF46A5F0D6E15429D99224BF18B738268"><enum>(A)</enum><text>an amount equal to total payments under the full term of the lease; or</text></subparagraph>
<subparagraph id="H86DC5333662B4A57B36430C85085F5C2"><enum>(B)</enum><text>if the lease specifies payments to be made in the event the lease is terminated before its full term, an amount sufficient to cover the first year lease payments plus the specified cancellation costs.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H2BC31A765C894E759B1B65440CEC74C4"><enum>(2)</enum><header>Self-insuring authority</header><text>The requirements of paragraph (1) may be satisfied through the use of the self-insuring authority identified in title 40, United States Code, consistent with Office of Management and Budget Circular A–11.</text></paragraph></subsection>
<subsection id="HFB904DA46A54495D9884103A47514967"><enum>(c)</enum><header>Transparency</header>
<paragraph id="HA90A7A74F20C421D8C8147DE32BFE45B"><enum>(1)</enum><header>Compliance</header><text>Subsection (b) of <external-xref legal-doc="usc" parsable-cite="usc/38/8104">section 8104</external-xref> of title 38, United States Code, is amended by adding at the end the following new paragraph:</text>
<quoted-block id="HCF0DB7B0106A40FB8F07A3C837E2E79D" style="OLC">
<paragraph id="H4490E46F43FB48A498E2E5086369C7BD"><enum>(7)</enum><text>In the case of a prospectus proposing funding for a major medical facility lease, a detailed analysis of how the lease is expected to comply with Office of Management and Budget Circular A–11 and <external-xref legal-doc="usc" parsable-cite="usc/31/1341">section 1341</external-xref> of title 31 (commonly referred to as the <quote>Anti-Deficiency Act</quote>). Any such analysis shall include—</text>
<subparagraph id="H4958703545394876B1CA2EB2F90FDAE6"><enum>(A)</enum><text>an analysis of the classification of the lease as a <quote>lease-purchase</quote>, <quote>capital lease</quote>, or <quote>operating lease</quote> as those terms are defined in Office of Management and Budget Circular A–11;</text></subparagraph>
<subparagraph id="H95878FFB3FB34DAABBA6307847D2EFFC"><enum>(B)</enum><text>an analysis of the obligation of budgetary resources associated with the lease; and</text></subparagraph>
<subparagraph id="H24084D69CBF44BAABAE8467164FC4AEE"><enum>(C)</enum><text>an analysis of the methodology used in determining the asset cost, fair market value, and cancellation costs of the lease.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph id="H17BC42C7B04947B88C18B87148C10120"><enum>(2)</enum><header>Submittal to Congress</header><text>Such section 8104 is further amended by adding at the end the following new subsection:</text>
<quoted-block id="HDB129213D72B453DA02C4F0BA8E02A5B" style="OLC">
<subsection id="H6B6E0D989EEC48F1A8072308688A3DF4"><enum>(h)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="H3965C46805964AC38ED4443053957781"><enum>(1)</enum><text display-inline="yes-display-inline">Not less than 30 days before entering into a major medical facility lease, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives—</text>
<subparagraph id="HC4B7F7B6BC564FAC97BC181C504AE6A0" indent="up1"><enum>(A)</enum><text>notice of the Secretary’s intention to enter into the lease;</text></subparagraph>
<subparagraph id="H4CF37CFA525A4458AA5F3CCF01449E06" indent="up1"><enum>(B)</enum><text>a detailed summary of the proposed lease;</text></subparagraph>
<subparagraph id="HC6FDFAA8CEDD40C784E3D5F99951FC37" indent="up1"><enum>(C)</enum><text>a description and analysis of any differences between the prospectus submitted pursuant to subsection (b) and the proposed lease; and</text></subparagraph>
<subparagraph id="HC292F4A103F74C4B828E77757A57D16C" indent="up1"><enum>(D)</enum><text display-inline="yes-display-inline">a scoring analysis demonstrating that the proposed lease fully complies with Office of Management and Budget Circular A–11.</text></subparagraph></paragraph>
<paragraph id="H8C308B9532304ECEB8FE8D7F9EA6DC50" indent="up1"><enum>(2)</enum><text>Each committee described in paragraph (1) shall ensure that any information submitted to the committee under such paragraph is treated by the committee with the same level of confidentiality as is required by law of the Secretary and subject to the same statutory penalties for unauthorized disclosure or use as the Secretary.</text></paragraph>
<paragraph id="HEE1C5E42B63D45B0A0487026A6F08F5E" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">Not more than 30 days after entering into a major medical facility lease, the Secretary shall submit to each committee described in paragraph (1) a report on any material differences between the lease that was entered into and the proposed lease described under such paragraph, including how the lease that was entered into changes the previously submitted scoring analysis described in subparagraph (D) of such paragraph.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HF1A52F61E1F44424851A68A5D206B9FE"><enum>(d)</enum><header>Rule of construction</header><text>Nothing in this section, or the amendments made by this section, shall be construed to in any way relieve the Department of Veterans Affairs from any statutory or regulatory obligations or requirements existing prior to the enactment of this section and such amendments.</text></subsection></section>
<enum>VII</enum><header>Other Veterans Matters</header>
<section id="H594951A857E14CACA58C8C16386A78FC"><enum>701.</enum><header>Expansion of Marine Gunnery Sergeant John David Fry Scholarship</header>
<subsection id="H25883B7B87EC4F4F818EF46A6DAF29EF"><enum>(a)</enum><header>Expansion of entitlement</header><text display-inline="yes-display-inline">Subsection (b)(9) of <external-xref legal-doc="usc" parsable-cite="usc/38/3311">section 3311</external-xref> of title 38, United States Code, is amended by inserting <quote>or spouse</quote> after <quote>child</quote>.</text></subsection>
<subsection id="HF29019C54BC9450FB27C3E50E7629806"><enum>(b)</enum><header>Limitation and election on certain benefits</header><text>Subsection (f) of such section is amended—</text>
<paragraph id="H4F7D63EC12E747E6B907E39F83BD57A5"><enum>(1)</enum><text>by redesignating paragraph (2) as paragraph (4); and</text></paragraph>
<paragraph id="H99C5FA24A6BF452F98002E4F9B29CAC5"><enum>(2)</enum><text>by inserting after paragraph (1) the following new paragraphs:</text>
<quoted-block display-inline="no-display-inline" id="H40A56892E9C84BE49C721E6A65F822A6" style="OLC">
<paragraph id="H1B8AEF3310D541DFA79F3B4037D7D049"><enum>(2)</enum><header>Limitation</header><text>The entitlement of an individual to assistance under subsection (a) pursuant to paragraph (9) of subsection (b) because the individual was a spouse of a person described in such paragraph shall expire on the earlier of—</text>
<subparagraph id="H35C5E263089E40F1B5DCC72E8587274B"><enum>(A)</enum><text>the date that is 15 years after the date on which the person died; or</text></subparagraph>
<subparagraph id="H7CF799687088455AB4DB576348CAD43F"><enum>(B)</enum><text>the date on which the individual remarries.</text></subparagraph></paragraph>
<paragraph id="H9AEE29F180F547C78757E264E521031D"><enum>(3)</enum><header>Election on receipt of certain benefits</header><text>A surviving spouse entitled to assistance under subsection (a) pursuant to paragraph (9) of subsection (b) who is also entitled to educational assistance under chapter 35 of this title may not receive assistance under both this section and such chapter, but shall make an irrevocable election (in such form and manner as the Secretary may prescribe) under which section or chapter to receive educational assistance.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection id="HDA388B8D260B458288E45226F408E295"><enum>(c)</enum><header>Conforming amendment</header><text>Section 3321(b)(4) of such title is amended—</text>
<paragraph id="H1CBA8C6CD9CD4DE98138F5B5F1FBC0CB"><enum>(1)</enum><text>by striking <quote>an individual</quote> and inserting <quote>a child</quote>; and</text></paragraph>
<paragraph id="H6A3CC89EB2024331AA72774AEFB44B3B"><enum>(2)</enum><text>by striking <quote>such individual’s</quote> each time it appears and inserting <quote>such child’s</quote>.</text></paragraph></subsection>
<subsection id="H2635653B93EE49C5BA76EB2A5D5196F6"><enum>(d)</enum><header>Effective date</header><text>The amendments made by this section shall apply with respect to a quarter, semester, or term, as applicable, commencing on or after January 1, 2015.</text></subsection></section>
<section id="H93161456111C460FAE8393A1CE3E4012"><enum>702.</enum><header>Approval of courses of education provided by public institutions of higher learning for purposes of All-Volunteer Force Educational Assistance Program and Post-9/11 Educational Assistance conditional on in-State tuition rate for veterans</header>
<subsection id="HFF08F68F4106434586E33FBA5953253F"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/38/3679">Section 3679</external-xref> of title 38, United States Code, is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H241FBFEBFB6B4137B1728FD401F275B9" style="USC">
<subsection id="H11EC0F0D107348A98C4C2D60BD874B19"><enum>(c)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="HD440C34D026F46EEAB1E755058DC1F63"><enum>(1)</enum><text display-inline="yes-display-inline">Notwithstanding any other provision of this chapter and subject to paragraphs (3) through (6), the Secretary shall disapprove a course of education provided by a public institution of higher learning to a covered individual pursuing a course of education with educational assistance under chapter 30 or 33 of this title while living in the State in which the public institution of higher learning is located if the institution charges tuition and fees for that course for the covered individual at a rate that is higher than the rate the institution charges for tuition and fees for that course for residents of the State in which the institution is located, regardless of the covered individual’s State of residence.</text></paragraph>
<paragraph id="H7CCEF21783EA466EAEACA1E766170530" indent="up1"><enum>(2)</enum><text>For purposes of this subsection, a covered individual is any individual as follows:</text>
<subparagraph id="H0846E714B7B1403991BB8A452E492408"><enum>(A)</enum><text>A veteran who was discharged or released from a period of not fewer than 90 days of service in the active military, naval, or air service less than three years before the date of enrollment in the course concerned.</text></subparagraph>
<subparagraph id="H65D90C3C1F9346889698E44B99502810"><enum>(B)</enum><text>An individual who is entitled to assistance under <external-xref legal-doc="usc" parsable-cite="usc/38/3311">section 3311(b)(9)</external-xref> or <external-xref legal-doc="usc" parsable-cite="usc/38/3319">3319</external-xref> of this title by virtue of such individual's relationship to a veteran described in subparagraph (A).</text></subparagraph></paragraph>
<paragraph id="HF5BB8DD5ACDE452DBF534415FF7B5655" indent="up1"><enum>(3)</enum><text>If after enrollment in a course of education that is subject to disapproval under paragraph (1) by reason of paragraph (2)(A) or (2)(B) a covered individual pursues one or more courses of education at the same public institution of higher learning while remaining continuously enrolled (other than during regularly scheduled breaks between courses, semesters or terms) at that institution of higher learning, any course so pursued by the covered individual at that institution of higher learning while so continuously enrolled shall also be subject to disapproval under paragraph (1).</text></paragraph>
<paragraph id="HE7BE6B2E7CB247048F8A10A0FEA9AB31" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">It shall not be grounds to disapprove a course of education under paragraph (1) if a public institution of higher learning requires a covered individual pursuing a course of education at the institution to demonstrate an intent, by means other than satisfying a physical presence requirement, to establish residency in the State in which the institution is located, or to satisfy other requirements not relating to the establishment of residency, in order to be charged tuition and fees for that course at a rate that is equal to or less than the rate the institution charges for tuition and fees for that course for residents of the State.</text></paragraph>
<paragraph id="H1603BA8AB3D0404EA866C078EB791E2A" indent="up1"><enum>(5)</enum><text>The Secretary may waive such requirements of paragraph (1) as the Secretary considers appropriate.</text></paragraph>
<paragraph id="H1CC35C80310B4962992F4820A27B0CA4" indent="up1"><enum>(6)</enum><text display-inline="yes-display-inline">Disapproval under paragraph (1) shall apply only with respect to educational assistance under chapters 30 and 33 of this title.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HAB462D1B87074A86B02CCE8C8B981B53"><enum>(b)</enum><header>Effective date</header><text display-inline="yes-display-inline">Subsection (c) of <external-xref legal-doc="usc" parsable-cite="usc/38/3679">section 3679</external-xref> of title 38, United States Code (as added by subsection (a) of this section), shall apply with respect to educational assistance provided for pursuit of a program of education during a quarter, semester, or term, as applicable, that begins after July 1, 2015.</text></subsection></section>
<section commented="no" display-inline="no-display-inline" id="HC2D742775B9D480E99F7F9D874045E3B"><enum>703.</enum><header display-inline="yes-display-inline">Extension of reduction in amount of pension furnished by Department of Veterans Affairs for certain veterans covered by Medicaid plans for services furnished by nursing facilities</header><text display-inline="no-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/38/5503">Section 5503(d)(7)</external-xref> of title 38, United States Code, is amended by striking <quote>November 30, 2016</quote> and inserting <quote>September 30, 2024</quote>.</text></section>
<section id="HB5B7194E407D444991A4FC0D9F57F61D"><enum>704.</enum><header>Extension of requirement for collection of fees for housing loans guaranteed by Secretary of Veterans Affairs</header><text display-inline="no-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/38/3729">Section 3729(b)(2)</external-xref> of title 38, United States Code, is amended—</text>
<paragraph id="H0F58E1853D394EDFADEA67E8732EF112"><enum>(1)</enum><text>in subparagraph (A)—</text>
<subparagraph id="HAF5A9A869E0F4B96AF22D1F6BE38AB6B"><enum>(A)</enum><text>in clause (iii), by striking <quote>October 1, 2017</quote> and inserting <quote>September 30, 2024</quote>; and</text></subparagraph>
<subparagraph id="H0A25D15DF1124EAC941CEBBDF767E25E"><enum>(B)</enum><text>in clause (iv), by striking <quote>October 1, 2017</quote> and inserting <quote>September 30, 2024</quote>;</text></subparagraph></paragraph>
<paragraph id="H2BF75615E4F541309FEE3F0978DF4032"><enum>(2)</enum><text>in subparagraph (B)—</text>
<subparagraph display-inline="no-display-inline" id="H58820B66664549C593DA77677514BD03"><enum>(A)</enum><text>in clause (i), by striking <quote>October 1, 2017</quote> and inserting <quote>September 30, 2024</quote>; and</text></subparagraph>
<subparagraph id="H11F74CB9C8DE4E4CBAF5ABEC39869BAC"><enum>(B)</enum><text>in clause (ii), by striking <quote>October 1, 2017</quote> and inserting <quote>September 30, 2024</quote>;</text></subparagraph></paragraph>
<paragraph id="HD83D4531318746ECB408987CA9236060"><enum>(3)</enum><text>in subparagraph (C)—</text>
<subparagraph id="HF659BD5E0C4341D7B28A09C066C6C6F5"><enum>(A)</enum><text>in clause (i), by striking <quote>October 1, 2017</quote> and inserting <quote>September 30, 2024</quote>; and</text></subparagraph>
<subparagraph id="H481D4FA254E94DD484A3610BAFF166DC"><enum>(B)</enum><text>in clause (ii), by striking <quote>October 1, 2017</quote> and inserting <quote>September 30, 2024</quote>; and</text></subparagraph></paragraph>
<paragraph id="H4A4A2178235642BF82FDCFC292B7654F"><enum>(4)</enum><text>in subparagraph (D)—</text>
<subparagraph id="H50C38438EF0D4190A815B1103CC703AE"><enum>(A)</enum><text>in clause (i), by striking <quote>October 1, 2017</quote> and inserting <quote>September 30, 2024</quote>; and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H3DE254A96D8A4D45B1D5C11554182D9D"><enum>(B)</enum><text display-inline="yes-display-inline">in clause (ii), by striking <quote>October 1, 2017</quote> and inserting <quote>September 30, 2024</quote>.</text></subparagraph></paragraph></section>
<section commented="no" display-inline="no-display-inline" id="H8341E813FD5B4B24B94D9BD9E24DB56E"><enum>705.</enum><header display-inline="yes-display-inline">Limitation on awards and bonuses paid to employees of Department of Veterans Affairs</header><text display-inline="no-display-inline">In each of fiscal years 2015 through 2024, the Secretary of Veterans Affairs shall ensure that the aggregate amount of awards and bonuses paid by the Secretary in a fiscal year under chapter 45 or 53 of title 5, United States Code, or any other awards or bonuses authorized under such title does not exceed $360,000,000.</text></section>
<section commented="no" display-inline="no-display-inline" id="HCF273E5105354E4E94AA4A16A9FB3C4D"><enum>706.</enum><header>Extension of authority to use income information</header><text display-inline="no-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/38/5317">Section 5317(g)</external-xref> of title 38, United States Code, is amended by striking <quote>September 30, 2016</quote> and inserting <quote>September 30, 2024</quote>.</text></section>
<section commented="no" display-inline="no-display-inline" id="H79D5C149E95D477ABA447300022BE2E9"><enum>707.</enum><header display-inline="yes-display-inline">Removal of senior executives of the Department of Veterans Affairs for performance or misconduct</header>
<subsection commented="no" display-inline="no-display-inline" id="H48F17FB2205A487183F0B1C68B5F2CBD"><enum>(a)</enum><header display-inline="yes-display-inline">Removal or transfer</header>
<paragraph commented="no" display-inline="no-display-inline" id="HF8D87F9232554C779E91F49C285C31DB"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/7">Chapter 7</external-xref> of title 38, United States Code, is amended by adding at the end the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H01AB3AAC55254192BE74F3628A12B858" style="USC">
<section commented="no" display-inline="no-display-inline" id="HADEC370CE1FB41C1833232BBF47AC645" section-type="subsequent-section"><enum>713.</enum><header display-inline="yes-display-inline">Senior executives: removal based on performance or misconduct</header>
<subsection commented="no" display-inline="no-display-inline" id="H536F9E535B2D417F9C62450DF73643E6"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H70BA814B2E3C4B9793F75AC38E56924C"><enum>(1)</enum><text>The Secretary may remove an individual employed in a senior executive position at the Department of Veterans Affairs from the senior executive position if the Secretary determines the performance or misconduct of the individual warrants such removal. If the Secretary so removes such an individual, the Secretary may—</text>
<subparagraph commented="no" id="H72F7BB70740D4A24AD0A7861B4BDA085" indent="up1"><enum>(A)</enum><text>remove the individual from the civil service (as defined in <external-xref legal-doc="usc" parsable-cite="usc/5/2101">section 2101</external-xref> of title 5); or</text></subparagraph>
<subparagraph id="H02A5A060F6834D12A8646CA2D1A70098" indent="up1"><enum>(B)</enum><text>in the case of an individual described in paragraph (2), transfer the individual from the senior executive position to a General Schedule position at any grade of the General Schedule for which the individual is qualified and that the Secretary determines is appropriate.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HB3BE15963052425198636F4E8891C970" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">An individual described in this paragraph is an individual who—</text>
<subparagraph commented="no" id="H9332770844AD4BDF90A6C24AFCFD6EE2"><enum>(A)</enum><text>previously occupied a permanent position within the competitive service (as that term is defined in <external-xref legal-doc="usc" parsable-cite="usc/5/2102">section 2102</external-xref> of title 5);</text></subparagraph>
<subparagraph commented="no" id="H43092FFDF9DC4B70B2E7B4CC563D0054"><enum>(B)</enum><text>previously occupied a permanent position within the excepted service (as that term is defined in <external-xref legal-doc="usc" parsable-cite="usc/5/2103">section 2103</external-xref> of title 5); or</text></subparagraph>
<subparagraph commented="no" id="H0B417E48D7C0412EA1DDDFF0A20A9BCF"><enum>(C)</enum><text>prior to employment in a senior executive position at the Department of Veterans Affairs, did not occupy any position within the Federal Government.</text></subparagraph></paragraph></subsection>
<subsection id="HC665F2B74CCC4BEDB41F0A23569F00CE"><enum>(b)</enum><header>Pay of transferred individual</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H9DA15DF104564B1FAD78B056F544140A"><enum>(1)</enum><text>Notwithstanding any other provision of law, including the requirements of <external-xref legal-doc="usc" parsable-cite="usc/5/3594">section 3594</external-xref> of title 5, any individual transferred to a General Schedule position under subsection (a)(2) shall, beginning on the date of such transfer, receive the annual rate of pay applicable to such position.</text></paragraph>
<paragraph id="HAD7010717B3C438B98F287DE192595D8" indent="up1"><enum>(2)</enum><text>An individual so transferred may not be placed on administrative leave or any other category of paid leave during the period during which an appeal (if any) under this section is ongoing, and may only receive pay if the individual reports for duty. If an individual so transferred does not report for duty, such individual shall not receive pay or other benefits pursuant to subsection (e)(5).</text></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H2A52344547A5475B996916DDBF34E854"><enum>(c)</enum><header display-inline="yes-display-inline">Notice to Congress</header><text display-inline="yes-display-inline">Not later than 30 days after removing or transferring an individual from a senior executive position under subsection (a), the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives notice in writing of such removal or transfer and the reason for such removal or transfer.</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HB749A41340CD4808A461A714E802249E"><enum>(d)</enum><header display-inline="yes-display-inline">Procedure</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H648AF1A2FFB444749001DD1C285101F6"><enum>(1)</enum><text display-inline="yes-display-inline">The procedures under <external-xref legal-doc="usc" parsable-cite="usc/5/7543">section 7543(b)</external-xref> of title 5 shall not apply to a removal or transfer under this section.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H99CF94E79FC74E14AAC86D3C98D450E3" indent="up1"><enum>(2)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="HB951B454A0924BC0A7961C01C6F3A6A6"><enum>(A)</enum><text display-inline="yes-display-inline">Subject to subparagraph (B) and subsection (e), any removal or transfer under subsection (a) may be appealed to the Merit Systems Protection Board under <external-xref legal-doc="usc" parsable-cite="usc/5/7701">section 7701</external-xref> of title 5.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H84B984D4A5CF40BDB8D3DB26D7186669" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">An appeal under subparagraph (A) of a removal or transfer may only be made if such appeal is made not later than seven days after the date of such removal or transfer.</text></subparagraph></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H17F32232B57147BA86BBC021A5481410"><enum>(e)</enum><header display-inline="yes-display-inline">Expedited review by administrative judge</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H95581F2CB86441A68D31D34202752191"><enum>(1)</enum><text display-inline="yes-display-inline">Upon receipt of an appeal under subsection (d)(2)(A), the Merit Systems Protection Board shall refer such appeal to an administrative judge pursuant to <external-xref legal-doc="usc" parsable-cite="usc/5/7701">section 7701(b)(1)</external-xref> of title 5. The administrative judge shall expedite any such appeal under such section and, in any such case, shall issue a decision not later than 21 days after the date of the appeal.</text></paragraph>
<paragraph commented="no" id="HFC3E67F85CD34FEA8748F594D4AA4323" indent="up1"><enum>(2)</enum><text>Notwithstanding any other provision of law, including <external-xref legal-doc="usc" parsable-cite="usc/5/7703">section 7703</external-xref> of title 5, the decision of an administrative judge under paragraph (1) shall be final and shall not be subject to any further appeal.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HFCBB4015E98C440DA2524C0D49DD0F25" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">In any case in which the administrative judge cannot issue a decision in accordance with the 21-day requirement under paragraph (1), the removal or transfer is final. In such a case, the Merit Systems Protection Board shall, within 14 days after the date that such removal or transfer is final, submit to Congress and the Committees on Veterans’ Affairs of the Senate and House of Representatives a report that explains the reasons why a decision was not issued in accordance with such requirement.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H1C1B13C6E3A144F0A9508CEA1F21F1D0" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">The Merit Systems Protection Board or administrative judge may not stay any removal or transfer under this section.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H613B9562900B4902B866D968B0867FC6" indent="up1"><enum>(5)</enum><text display-inline="yes-display-inline">During the period beginning on the date on which an individual appeals a removal from the civil service under subsection (d) and ending on the date that the administrative judge issues a final decision on such appeal, such individual may not receive any pay, awards, bonuses, incentives, allowances, differentials, student loan repayments, special payments, or benefits.</text></paragraph>
<paragraph id="H68E51B9E73E248EBAA4F8C83C6616844" indent="up1"><enum>(6)</enum><text>To the maximum extent practicable, the Secretary shall provide to the Merit Systems Protection Board, and to any administrative judge to whom an appeal under this section is referred, such information and assistance as may be necessary to ensure an appeal under this subsection is expedited.</text></paragraph></subsection>
<subsection id="HB3F320B857DA4D2DB81EA6687C3AAF9A"><enum>(f)</enum><header>Relation to title 5</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HEE9DC744AAEA4B3981A5D3961D4E3E4E"><enum>(1)</enum><text>The authority provided by this section is in addition to the authority provided by section 3592 or subchapter V of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/75">chapter 75</external-xref> of title 5.</text></paragraph>
<paragraph id="H01439DBA913443149548476421E6499A" indent="up1"><enum>(2)</enum><text><external-xref legal-doc="usc" parsable-cite="usc/5/3592">Section 3592(b)(1)</external-xref> of title 5 does not apply to an action to remove or transfer an individual under this section.</text></paragraph></subsection>
<subsection id="H97631041F08343D79B53E2F71BC7873C"><enum>(g)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H163AD50BFCD74D54ACC9EA72FC6BC5BD"><enum>(1)</enum><text>The term <term>individual</term> means—</text>
<subparagraph id="HE61EBFAAEE7544A3855E924F2791FB2D"><enum>(A)</enum><text>a career appointee (as that term is defined in <external-xref legal-doc="usc" parsable-cite="usc/5/3132">section 3132(a)(4)</external-xref> of title 5); or</text></subparagraph>
<subparagraph id="HD9FF3B4E46A849708D2C6586E45CD724"><enum>(B)</enum><text display-inline="yes-display-inline">any individual who occupies an administrative or executive position and who was appointed under section 7306(a) or section 7401(1) of this title.</text></subparagraph></paragraph>
<paragraph id="HED1ECCFAEBF24B799FCA20EEC216A53B"><enum>(2)</enum><text display-inline="yes-display-inline">The term <term>misconduct</term> includes neglect of duty, malfeasance, or failure to accept a directed reassignment or to accompany a position in a transfer of function.</text></paragraph>
<paragraph id="HE4A74D59106A4611B66146FE1E459E0A"><enum>(3)</enum><text>The term <term>senior executive position</term> means—</text>
<subparagraph id="H12E56D52AD914BE6B07405FFF34C0693"><enum>(A)</enum><text display-inline="yes-display-inline">with respect to a career appointee (as that term is defined in <external-xref legal-doc="usc" parsable-cite="usc/5/3132">section 3132(a)(4)</external-xref> of title 5), a Senior Executive Service position (as such term is defined in <external-xref legal-doc="usc" parsable-cite="usc/5/3132">section 3132(a)(2)</external-xref> of title 5); and</text></subparagraph>
<subparagraph id="H0261295C9165436D927CE7AC0A2A0D2D"><enum>(B)</enum><text display-inline="yes-display-inline">with respect to an individual appointed under section 7306(a) or section 7401(1) of this title, an administrative or executive position.</text></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HF82A89253F1844B8BD8C8695F6FBDE4B"><enum>(2)</enum><header display-inline="yes-display-inline">Clerical amendment</header><text display-inline="yes-display-inline">The table of sections at the beginning of such chapter is amended by adding at the end the following new item:</text>
<quoted-block display-inline="no-display-inline" id="H9F10CE413F6249C6ACE5230AFCEA6809" style="USC">
<toc regeneration="no-regeneration">
<toc-entry bold="off" level="section">713. Senior executives: removal based on performance or misconduct.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HD1BD4A5203DB4CA7882511619438E556"><enum>(b)</enum><header display-inline="yes-display-inline">Establishment of expedited review process</header>
<paragraph commented="no" display-inline="no-display-inline" id="HAFF8FA6B8E45402CA7D35EDB08B887AA"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Not later than 14 days after the date of the enactment of this Act, the Merit Systems Protection Board shall establish and put into effect a process to conduct expedited reviews in accordance with <external-xref legal-doc="usc" parsable-cite="usc/38/713">section 713(d)</external-xref> of title 38, United States Code.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H8F66A63CFA054E13BA7BD0B35C909CE4"><enum>(2)</enum><header display-inline="yes-display-inline">Inapplicability of certain regulations</header><text display-inline="yes-display-inline"><external-xref legal-doc="regulation" parsable-cite="cfr/5/1201.22">Section 1201.22</external-xref> of title 5, Code of Federal Regulations, as in effect on the day before the date of the enactment of this Act, shall not apply to expedited reviews carried out under <external-xref legal-doc="usc" parsable-cite="usc/38/713">section 713(d)</external-xref> of title 38, United States Code.</text></paragraph>
<paragraph id="H45E9BECA324D4E7EAC134E7C22388179"><enum>(3)</enum><header>Waiver</header><text>The Merit Systems Protection Board may waive any other regulation in order to provide for the expedited review required under <external-xref legal-doc="usc" parsable-cite="usc/38/713">section 713(d)</external-xref> of title 38, United States Code.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H6F0498357607407D9BE1A67C2223EEC3"><enum>(4)</enum><header display-inline="yes-display-inline">Report by Merit Systems Protection Board</header><text display-inline="yes-display-inline">Not later than 14 days after the date of the enactment of this Act, the Merit Systems Protection Board shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on the actions the Board plans to take to conduct expedited reviews under <external-xref legal-doc="usc" parsable-cite="usc/38/713">section 713(d)</external-xref> of title 38, United States Code, as added by subsection (a). Such report shall include a description of the resources the Board determines will be necessary to conduct such reviews and a description of whether any resources will be necessary to conduct such reviews that were not available to the Board on the day before the date of the enactment of this Act.</text></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H6F13E99323B04080B5124E536F954432"><enum>(c)</enum><header display-inline="yes-display-inline">Temporary exemption from certain limitation on initiation of removal from Senior Executive Service</header><text display-inline="yes-display-inline">During the 120-day period beginning on the date of the enactment of this Act, an action to remove an individual from the Senior Executive Service at the Department of Veterans Affairs pursuant to <external-xref legal-doc="usc" parsable-cite="usc/5/7543">section 7543</external-xref> of title 5, United States Code, may be initiated, notwithstanding section 3592(b) of such title, or any other provision of law.</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H3814F9A7AD264F0FA96CFF87EF54D501"><enum>(d)</enum><header display-inline="yes-display-inline">Construction</header>
<paragraph id="HEF27461BD31B409281A50BB01DB7B899"><enum>(1)</enum><header>In general</header><text>Nothing in this section or <external-xref legal-doc="usc" parsable-cite="usc/38/713">section 713</external-xref> of title 38, United States Code, as added by subsection (a), shall be construed to apply to an appeal of a removal, transfer, or other personnel action that was pending before the date of the enactment of this Act.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H79275B53545F4734B46275D3F39ED164"><enum>(2)</enum><header>Relation to title 5</header><text>With respect to the removal or transfer of an individual (as that term is defined in such section 713) employed at the Department of Veterans Affairs, the authority provided by such section 713 is in addition to the authority provided by section 3592 or subchapter V of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/75">chapter 75</external-xref> of title 5, United States Code.</text></paragraph></subsection></section>
<enum>VIII</enum><header>Other Matters</header>
<section id="HAB0758BE17AC44CDA1F7D6BFFE87C00C"><enum>801.</enum><header>Appropriation of amounts</header>
<subsection id="H006297F79E084046A1D7C4043C66F6F8"><enum>(a)</enum><header>In general</header><text>There is authorized to be appropriated, and is appropriated, to the Secretary of Veterans Affairs, out of any funds in the Treasury not otherwise appropriated $5,000,000,000 to carry out subsection (b). Such funds shall be available for obligation or expenditure without fiscal year limitation.</text></subsection>
<subsection id="HAB9A2E283EAD4087BA0A8E8719951089"><enum>(b)</enum><header>Use of amounts</header><text>The amount appropriated under subsection (a) shall be used by the Secretary as follows:</text>
<paragraph id="H514E8B0E377E4145AB6FC484B5F702A6"><enum>(1)</enum><text>To increase the access of veterans to care as follows:</text>
<subparagraph id="H2252E07F97324BBFAB28A3181FAB59D1"><enum>(A)</enum><text>To hire primary care and specialty care physicians for employment in the Department of Veterans Affairs.</text></subparagraph>
<subparagraph id="H76DEF19E70C8469BABF13B7150323F38"><enum>(B)</enum><text>To hire other medical staff, including the following:</text>
<clause id="H99757F65A930470DBAB513C6875F09D9"><enum>(i)</enum><text>Physicians.</text></clause>
<clause id="H77060B0ED69144729E6B62AE176F9A91"><enum>(ii)</enum><text>Nurses.</text></clause>
<clause id="H3858A04876524171BD6AE69DDA168010"><enum>(iii)</enum><text>Social workers.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="HF5E2B9660E3B47D280E6FBE19ED3C435"><enum>(iv)</enum><text>Mental health professionals.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H6B81FFAFBD7C4194B3D1EAF29D00DD05"><enum>(v)</enum><text>Other health care professionals as the Secretary considers appropriate.</text></clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H4354621E44624554896C82E41A7CA4DE"><enum>(C)</enum><text>To carry out sections 301 and 302, including the amendments made by such sections.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HFFC26FA76D8F4934A9A134C32FDAFBC0"><enum>(D)</enum><text>To pay for expenses, equipment, and other costs associated with the hiring of primary care, specialty care physicians, and other medical staff under subparagraphs (A), (B), and (C).</text></subparagraph></paragraph>
<paragraph commented="no" id="H7E6981102D18406FA12C7654A66C345E"><enum>(2)</enum><text>To improve the physical infrastructure of the Department as follows:</text>
<subparagraph commented="no" id="HDEE843F30A684C7AB067C58012928069"><enum>(A)</enum><text>To maintain and operate hospitals, nursing homes, domiciliary facilities, and other facilities of the Veterans Health Administration.</text></subparagraph>
<subparagraph commented="no" id="HA68AEDFA8BC9429F9C5289BAB1A55C1A"><enum>(B)</enum><text>To enter into contracts or hire temporary employees to repair, alter, or improve facilities under the jurisdiction of the Department that are not otherwise provided for under this paragraph.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HB9276E826F084B9A81B7D06631FAE798"><enum>(C)</enum><text>To carry out leases for facilities of the Department.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HD52C0194986346CBB0F66AA7B68CE0AA"><enum>(D)</enum><text>To carry out minor construction projects of the Department.</text></subparagraph></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H74052F9232954362A9FC2307A74F9F26"><enum>(c)</enum><header>Availability</header><text>The amount appropriated under subsection (a) shall remain available until expended.</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HFA43D2F5BF3C4AC0BC69E133AB02923F"><enum>(d)</enum><header>Report</header>
<paragraph commented="no" display-inline="no-display-inline" id="H2DA4C884D8274436BEF12CCDE3413423"><enum>(1)</enum><header>In general</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report on how the Secretary has obligated the amounts appropriated under subsection (a) as of the date of the submittal of the report.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HF3EB5463C5BF47F1ADFC66D86CCAC545"><enum>(2)</enum><header>Appropriate committees of Congress defined</header><text>In this subsection, the term <term>appropriate committees of Congress</term> means—</text>
<subparagraph id="H03D6AE3877A84F7A92F72C081E8F6127"><enum>(A)</enum><text>the Committee on Veterans' Affairs and the Committee on Appropriations of the Senate; and</text></subparagraph>
<subparagraph id="H9CBC1157363B4B8DAB41E62082C6787A"><enum>(B)</enum><text>the Committee on Veterans' Affairs and the Committee on Appropriations of the House of Representatives.</text></subparagraph></paragraph></subsection>
<subsection id="HD9D5A85D7E8C4077A11B6895980B59BB"><enum>(e)</enum><header>Funding plan</header><text>The Secretary shall submit to Congress a funding plan describing how the Secretary intends to use the amounts provided under subsection (a).</text></subsection></section>
<section commented="no" display-inline="no-display-inline" id="H8E55D1A5C435480C8B8D788205E089D9"><enum>802.</enum><header>Veterans Choice Fund</header>
<subsection commented="no" display-inline="no-display-inline" id="H06EE8D79E2154C32BA0837F7D189D9C0"><enum>(a)</enum><header>In general</header><text>There is established in the Treasury of the United States a fund to be known as the Veterans Choice Fund.</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HFD7A42A1DBFE4F7BBF71B4C76D80BD98"><enum>(b)</enum><header>Administration of fund</header><text>The Secretary of Veterans Affairs shall administer the Veterans Choice Fund established by subsection (a).</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H33CDF01E3D7C43DB95B3870EC433AC12"><enum>(c)</enum><header>Use of amounts</header>
<paragraph commented="no" id="HD24312D366FB493EB7C5E01336C19869"><enum>(1)</enum><header>In general</header><text>Any amounts deposited in the Veteran Choice Fund shall be used by the Secretary of Veterans Affairs to carry out section 101, including, subject to paragraph (2), any administrative requirements of such section.</text></paragraph>
<paragraph commented="no" id="H4E5EB5A656094D0D8EC6CF13993119EC"><enum>(2)</enum><header>Amount for administrative requirements</header>
<subparagraph commented="no" id="H028C3C9D9A6149ABAF2C851BBB1766B0"><enum>(A)</enum><header>Limitation</header><text display-inline="yes-display-inline">Except as provided by subparagraph (B), of the amounts deposited in the Veterans Choice Fund, not more than $300,000,000 may be used for administrative requirements to carry out section 101.</text></subparagraph>
<subparagraph commented="no" id="HEAC22CBC5CB54467A9519A804301332B"><enum>(B)</enum><header>Increase</header><text>The Secretary may increase the amount set forth in subparagraph (A) with respect to the amounts used for administrative requirements if—</text>
<clause commented="no" id="H3637DCB5E2CE4AD1BF7959751FF5C583"><enum>(i)</enum><text>the Secretary determines that the amount of such increase is necessary to carry out section 101;</text></clause>
<clause commented="no" id="H00FA897F534A44FBBCA65AFB2BA6F67A"><enum>(ii)</enum><text>the Secretary submits to the Committees on Veterans’ Affairs and Appropriations of the House of Representatives and the Committees on Veterans’ Affairs and Appropriations of the Senate a report described in subparagraph (C); and</text></clause>
<clause commented="no" id="HEFD9A924CA5543AEBD7C0C4F92ADBBFD"><enum>(iii)</enum><text>a period of 60 days has elapsed following the date on which the Secretary submits the report under clause (ii).</text></clause></subparagraph>
<subparagraph commented="no" id="HD7BFB4CDBF754CBB88DCC0EF97895240"><enum>(C)</enum><header>Report</header><text>A report described in this subparagraph is a report that contains the following:</text>
<clause commented="no" id="H2D7C9FE4056F4E58B12576E176B7B938"><enum>(i)</enum><text display-inline="yes-display-inline">A notification of the amount of the increase that the Secretary determines necessary under subparagraph (B)(i).</text></clause>
<clause commented="no" id="HC77908798FED4A63853877E876DA84EC"><enum>(ii)</enum><text>The justifications for such increased amount.</text></clause>
<clause commented="no" id="HCD314444AD0E485399B589619204B8A9"><enum>(iii)</enum><text>The administrative requirements that the Secretary will carry out using such increased amount.</text></clause></subparagraph></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H823D648CC2004D58B228FDE0EC6871C9"><enum>(d)</enum><header>Appropriation and deposit of amounts</header>
<paragraph commented="no" display-inline="no-display-inline" id="HBC4EFADD56324BBAA28D968D38117679"><enum>(1)</enum><header>In general</header><text>There is authorized to be appropriated, and is appropriated, to the Secretary of Veterans Affairs, out of any funds in the Treasury not otherwise appropriated $10,000,000,000 to be deposited in the Veterans Choice Fund established by subsection (a). Such funds shall be available for obligation or expenditure without fiscal year limitation, and only for the program created under section 101.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H23C0C60572AF4ED28C56814A14642B42"><enum>(2)</enum><header>Availability</header><text>The amount appropriated under paragraph (1) shall remain available until expended.</text></paragraph></subsection>
<subsection id="H11F88402B8B14F0997B8B3C149D882F1"><enum>(e)</enum><header>Sense of Congress</header><text display-inline="yes-display-inline">It is the sense of Congress that the Veterans Choice Fund is a supplement to but distinct from the Department of Veterans Affairs’ current and expected level of non-Department care currently part of Department’s medical care budget. Congress expects that the Department will maintain at least its existing obligations of non-Department care programs in addition to but distinct from the Veterans Choice Fund for each of fiscal years 2015 through 2017.</text></subsection></section>
<section id="H7EBAC16668D745999E6B646AE823BAE9"><enum>803.</enum><header>Emergency designations</header>
<subsection id="HDE920FAA1C17409294AAC7E15A8C29F0"><enum>(a)</enum><header>In general</header><text>This Act is designated as an emergency requirement pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 2010 (<external-xref legal-doc="usc" parsable-cite="usc/2/933">2 U.S.C. 933(g)</external-xref>).</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HDC8CD0EC1B274B67AE1DCADCCA4CC469"><enum>(b)</enum><header>Designation in Senate</header><text display-inline="yes-display-inline">In the Senate, this Act is designated as an emergency requirement pursuant to section 403(a) of S. Con. Res. 13 (111th Congress), the concurrent resolution on the budget for fiscal year 2010.</text></subsection></section>
Speaker of the House of Representatives.Vice President of the United States and President of the Senate.