113 S2450 PCS: Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014
U.S. Senate
2014-06-09
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 to Care through Choice, Accountability, and Transparency Act of 2014
.
(b)
The table of contents for this Act is as follows:Sec. 1. Short title; table of contents.
TITLE I—Improvement of Scheduling System for Health Care Appointments
Sec. 101. Independent assessment of the scheduling of appointments and other health care management
processes of the Department of Veterans Affairs.
Sec. 102. Technology task force on review of scheduling system and software of the Department of
Veterans Affairs.
TITLE II—Training and Hiring of Health Care Staff
Sec. 201. Treatment of staffing shortage and biannual report on staffing of medical facilities of
the Department of Veterans Affairs.
Sec. 202. Clinic management training for managers and health care providers of the Department of
Veterans Affairs.
Sec. 203. Use of unobligated amounts to hire additional health care providers for the Veterans
Health Administration.
TITLE III—Improvement of Access to Care from Non-Department of Veterans Affairs Providers
Sec. 301. Expanded availability of hospital care and medical services for veterans through the use
of contracts.
Sec. 302. Transfer of authority for payments for hospital care, medical services, and other health
care from non-Department providers to the Chief Business Office of the
Veterans Health Administration of the Department.
Sec. 303. Enhancement of collaboration between Department of Veterans Affairs and Indian Health
Service.
Sec. 304. Enhancement of collaboration between Department of Veterans Affairs and Native Hawaiian
health care systems.
Sec. 305. Sense of Congress on prompt payment by Department of Veterans Affairs.
TITLE IV—Health Care Administrative Matters
Sec. 401. Improvement of access of veterans to mobile vet centers of the Department of Veterans
Affairs.
Sec. 402. Commission on construction projects of the Department of Veterans Affairs.
Sec. 403. Commission on Access to Care.
Sec. 404. Improved performance metrics for health care provided by Department of Veterans Affairs.
Sec. 405. Improved transparency concerning health care provided by Department of Veterans Affairs.
Sec. 406. Information for veterans on the credentials of Department of Veterans Affairs physicians.
Sec. 407. Information in annual budget of the President on hospital care and medical services
furnished through expanded use of contracts for such care.
Sec. 408. Prohibition on falsification of data concerning wait times and quality measures at
Department of Veterans Affairs.
Sec. 409. Removal of Senior Executive Service employees of the Department of Veterans Affairs for
performance.
TITLE V—Health Care Related to Sexual Trauma
Sec. 501. Expansion of eligibility for sexual trauma counseling and treatment to veterans on
inactive duty training.
Sec. 502. Provision of counseling and treatment for sexual trauma by the Department of Veterans
Affairs to members of the Armed Forces.
Sec. 503. Reports on military sexual trauma.
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—Veterans Benefits 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.
TITLE VIII—Appropriation and Emergency Designations
Sec. 801. Appropriation of emergency amounts.
Sec. 802. Emergency designations.
<enum>I</enum>
<header>Improvement of Scheduling System for Health Care Appointments</header>
<section id="id6a6895a934b84b5385fc3edfe1baa0ad">
<enum>101.</enum>
<header>Independent assessment of the scheduling of appointments and other health care management processes
of the
Department of Veterans Affairs</header>
<subsection id="idf1321e25b92b45e389492a14c5a694e6">
<enum>(a)</enum>
<header>Independent assessment</header>
<paragraph id="id910de0c5e7214c6da96f4bcaa8d0c07b">
<enum>(1)</enum>
<header>Assessment</header>
<text>Not later than 30 days after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall enter into a
contract with an independent third party to assess the following:</text><subparagraph id="id879DC5E5C8C24DE8BA50A137C6C67009"><enum>(A)</enum><text>The process at each
medical facility of the Department of Veterans Affairs for scheduling
appointments for veterans to receive hospital care, medical services, or
other health care from the Department.</text></subparagraph><subparagraph id="id30443191077A4883AE4B9A7AF688DD5C"><enum>(B)</enum><text>The staffing level and productivity of each medical facility of the Department, including the
following:</text><clause id="id66FBD45DD04044F4A43B92EBED65F0A6"><enum>(i)</enum><text>The case load of each health care provider of the Department.</text></clause><clause id="id868C4B0BDC5E43D3ACE7515A08823D4A"><enum>(ii)</enum><text>The time spent by each health care provider of the Department on matters other than the case load
of such health care provider, including time spent by such health care
provider as follows:</text><subclause id="id7DF437DBBEB34D049D36EE7647461AB8"><enum>(I)</enum><text>At a medical facility that is affiliated with the Department.</text></subclause><subclause id="id534305A1A0784D5896A1C1066CD2D8D0"><enum>(II)</enum><text>Conducting research.</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id9B1370867AB14FB0B958DFDBF07477D1"><enum>(III)</enum><text>Training or overseeing other health care professionals of the Department.</text></subclause></clause></subparagraph><subparagraph id="id77d9f26ec0154ff98a917446e3922a3a"><enum>(C)</enum><text>The organization, processes, and tools used by the Department to support clinical documentation and
the subsequent coding of inpatient services.</text></subparagraph><subparagraph id="idc324f543d7e04f8181c2df133e30b434"><enum>(D)</enum><text>The purchasing, distribution, and use of pharmaceuticals, medical and surgical supplies, and
medical devices by the Department, including the following:</text><clause id="idCADCA5F4E7AE4320AD87396E041C6704"><enum>(i)</enum><text>The prices paid for, standardization of, and use by the Department of the following:</text><subclause id="id027020063A164437ACA5DD6355B90431"><enum>(I)</enum><text>High-cost pharmaceuticals.</text></subclause><subclause id="idDAC651A596C246A2969AAC939A0B7B14"><enum>(II)</enum><text>Medical and surgical supplies.</text></subclause><subclause id="id7E08C95D07F84DE9880243E42500BEB1"><enum>(III)</enum><text>Medical devices.</text></subclause></clause><clause id="idE0EAC8085E5F456193A250665ADBB03A"><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="id7F56D5C23189498EBC7D36EC7B318750"><enum>(iii)</enum><text>The strategy used by the Department to distribute pharmaceuticals, medical and surgical supplies,
and medical devices to Veterans Integrated Service Networks and medical
facilities of the Department.</text></clause></subparagraph><subparagraph id="idC16B89C49A5B45A099F1F6EF19B7651B"><enum>(E)</enum><text>The performance of the Department in paying amounts owed to third parties and collecting amounts
owed to the Department with respect to hospital care, medical services,
and other health care, including any recommendations of the independent
third party as follows:</text><clause id="id72E2CC11F977479A9649C4382712A0CF"><enum>(i)</enum><text>To avoid the payment of penalties to vendors.</text></clause><clause id="id2DA32FBFABA04CD9A592825E228CB77D"><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.</text></clause><clause id="id92003980D42E40E5AB0E97C211F29649"><enum>(iii)</enum><text>To increase the collection of any other amounts owed to the Department.</text></clause></subparagraph></paragraph><paragraph id="id4b5712e1d6af413fa38899bcb59de2aa">
<enum>(2)</enum>
<header>Elements of scheduling assessment</header>
<text>In carrying out the assessment required by paragraph (1)(A), the independent third party shall do
the
following:</text>
<subparagraph id="id32a33058556d45a4b34debcb9a94000e">
<enum>(A)</enum>
<text>Review all training materials pertaining to scheduling of appointments at each medical facility of
the Department.</text>
</subparagraph><subparagraph id="id111e9495ef9544ee82e8c89bf15ad20e">
<enum>(B)</enum>
<text>Assess whether all employees of the Department conducting tasks related to scheduling are properly
trained for conducting such tasks.</text>
</subparagraph><subparagraph id="idc18c52816b3c4b04b990fec0f0f3a8bb">
<enum>(C)</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>
</subparagraph><subparagraph id="idbeb5fa7208674a8c9a5babbe015f3609">
<enum>(D)</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></subparagraph><subparagraph id="ideb0ed99a3aeb4cdab7f443adaedb9f2b"><enum>(E)</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></subparagraph><subparagraph id="id7ff066aee0494cf4bafa22b442477eae"><enum>(F)</enum><text>Assess whether booking templates for each medical facility or clinic of the Department would
improve the process of scheduling such appointments.</text></subparagraph><subparagraph id="id999c482414054e6f8708f68ced10c723">
<enum>(G)</enum>
<text>Recommend any actions to be taken by the Department to improve the process for scheduling
such appointments, including the following:</text>
<clause id="idc5f04ee5fcb343789b7d6f77f0e3a807">
<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>
</clause><clause commented="no" id="id49fb8c4b12fc4a6488cc267444c9efaf">
<enum>(ii)</enum>
<text>Changes in monitoring and assessment conducted by the Department of wait times of veterans for such
appointments.</text>
</clause><clause commented="no" id="id40c36e59598140d298d5044be7918539">
<enum>(iii)</enum>
<text>Changes in the system used to schedule such appointments, including changes to improve how the
Department—</text>
<subclause commented="no" id="idBF9E253FD62547528C6D99BB3EAE27B4">
<enum>(I)</enum>
<text>measures wait times of veterans for such appointments;</text>
</subclause><subclause commented="no" id="idB5328064822B470BA890494CBCEB1D8D">
<enum>(II)</enum>
<text>monitors the availability of health care providers of the Department; and</text>
</subclause><subclause commented="no" id="idD40C991FF21A4F89999B602945F5C749">
<enum>(III)</enum>
<text>provides veterans the ability to schedule such appointments.</text>
</subclause></clause><clause commented="no" id="id16bcaa4379c04f82a28796e2f186ff12">
<enum>(iv)</enum>
<text>Such other actions as the independent third party considers appropriate.</text>
</clause></subparagraph></paragraph><paragraph id="id5fd37e5d06ee48ba9ee7b2ce87f8493e">
<enum>(3)</enum>
<header>Timing</header>
<text>The independent third party carrying out the assessment required by paragraph (1) shall complete
such assessment not later than 180 days after entering into the contract
described in such paragraph.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idDC18B36876C94342ACA08F44AAB2E228"><enum>(b)</enum><header>Report</header><paragraph commented="no" display-inline="no-display-inline" id="idB574D83C57F741EBA87E6143444A8D05"><enum>(1)</enum><header>In general</header><text>Not later than 90 days after the date on which the independent third party completes the assessment
under this section, 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 results of such assessment.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idC13408C5FD284CF7BBF12C9A349BDEA1"><enum>(2)</enum><header>Publication</header><text>Not later than 30 days after submitting the report under 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></section><section commented="no" display-inline="no-display-inline" id="id7121DB60E81940AB9759BB19534478DF"><enum>102.</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="id9F24CE09BBE544B89FD6A5D397A31808"><enum>(a)</enum><header>Task force review</header><paragraph commented="no" display-inline="no-display-inline" id="idD719B15B436B42FC90755E5935B52A42"><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="id55C6DA76083F4D10B874C796B0F84806"><enum>(2)</enum><header>Agreement</header><subparagraph commented="no" display-inline="no-display-inline" id="id6E1519147E2340CCBF6586CE7E2B682B"><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="idBBA05F81DF794BA99704D72BB91A2BE5"><enum>(B)</enum><header>Prohibition on use of funds</header><text>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="idb1c7dc157dd64cdebaef7e1ad3cf99eb"><enum>(b)</enum><header>Report</header><paragraph id="id6C67EFCE679A4BACBADE8B9412AF1779"><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="id98192E68CBEA41A3BED564B55777D76C"><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="idD6DC0B1E32014BB0BF6786FEF9ED48FD"><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="idB8197694D18A46B6B7222669076D6CDC"><enum>(B)</enum><text>A determination as to whether an existing off-the-shelf system would—</text><clause commented="no" display-inline="no-display-inline" id="id96D8CF0AF1094FE2ABCDA072B9140EF0"><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="id8702BD9624D848D59949B8BA87B6D4AC"><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="idD989625BA98D447799941AA9145B0946"><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="id611E645461584E2F9D3DCBEA4B67D3BD"><enum>(c)</enum><header>Implementation of task force recommendations</header><text>Not later than one 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><enum>II</enum><header>Training and Hiring of Health Care Staff</header><section id="id845007E51D4B43EA91EFF2B462D24EBD">
<enum>201.</enum>
<header>Treatment of staffing shortage and biannual report on staffing of medical facilities of the
Department of Veterans Affairs</header>
<subsection id="id736f8737bcba436c81cad06eed0dd97b">
<enum>(a)</enum>
<header>Staffing shortage</header>
<paragraph id="id1D19476AC02F4D30B1891FEA6B25DED5">
<enum>(1)</enum>
<header>In general</header>
<text>Not later than 180 days after the date of the enactment of this Act, and not later than September
30 each year thereafter, the Inspector General of the Department of
Veterans Affairs shall
determine, and the Secretary of Veterans Affairs shall publish in the
Federal
Register, the five occupations of health care providers of
the Department of Veterans Affairs for which there is the largest staffing
shortage throughout the Department.</text>
</paragraph><paragraph id="idd40bf01feb1a4074b3969ac736d1a897">
<enum>(2)</enum>
<header>Recruitment and appointment</header>
<text>Notwithstanding sections 3304 and 3309 through 3318 of title 5, United States Code, 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 of health care provider, recruit and directly
appoint highly qualified health care providers to serve as health care
providers in that particular occupation for the Department.</text></paragraph><paragraph id="idB6B1CCA22F3A4783AA6E4102F6275A5A">
<enum>(3)</enum>
<header>Priority in Health Professionals Educational Assistance Program to certain
providers</header><text display-inline="yes-display-inline"><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><subparagraph id="idB8FB461042BA4A7BA09D9A8E9AD89B8B"><enum>(A)</enum><text display-inline="yes-display-inline">in subparagraph (A), by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="idDDF77BA9A9F44411A8F1399C3A6AB7C1"><enum>(B)</enum><text>by redesignating subparagraph (B) as subparagraph (C); and</text></subparagraph><subparagraph id="idC17371C1886E4BFC81BAF8E270CAD38A"><enum>(C)</enum><text>by inserting after subparagraph (A) the following new subparagraph (B):</text><quoted-block display-inline="no-display-inline" id="idD7BB28F0D5F4455B856FD81BC9614753" style="OLC"><subparagraph id="idD479686AE0994F90ADE2458BEF36D419" indent="up1"><enum>(B)</enum><text>shall give priority to applicants pursuing a course of education or training towards a career in an
occupation for which the Secretary has, in the most current determination
published in the Federal Register pursuant to section 201(a)(1) of the <short-title>Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014</short-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></subparagraph></paragraph></subsection><subsection id="idb54bc399263b4c519902acd0a501a47e">
<enum>(b)</enum>
<header>Reports</header>
<paragraph id="id140AF7A69B7743C2B13783424476252C">
<enum>(1)</enum>
<header>In general</header>
<text>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
Committee on Veterans’ Affairs of the Senate and the Committee on
Veterans’ Affairs of the House of Representatives a report
assessing the staffing of each medical facility of the Department of
Veterans Affairs.</text>
</paragraph><paragraph id="id608d8fc90dff4ddb810da73325dd5066">
<enum>(2)</enum>
<header>Elements</header>
<text>Each report submitted under paragraph (1) shall include the following:</text>
<subparagraph id="ide6724455ef514835ba82238b1236562a">
<enum>(A)</enum>
<text>The results of a system-wide assessment of all medical facilities of the Department to ensure the
following:</text>
<clause id="id8704b0d44d9441d599d90461c612a7f2">
<enum>(i)</enum>
<text>Appropriate staffing levels for health care providers to meet the goals of the Secretary for timely
access to care for veterans.</text>
</clause><clause id="id3bff526147f64f6983eecb3cb47ddbd9">
<enum>(ii)</enum>
<text>Appropriate staffing levels for support personnel, including clerks.</text>
</clause><clause id="idf3cac2e4d97f4a2cb1b215e3f26c6466">
<enum>(iii)</enum>
<text>Appropriate sizes for clinical panels.</text>
</clause><clause commented="no" id="id30913fd28f9c4c2cae36fa28e9354157">
<enum>(iv)</enum>
<text>Appropriate numbers of full-time staff, or full-time equivalents, dedicated to direct care of
patients.</text>
</clause><clause id="id07e9c842cb434714928d5793152a4056">
<enum>(v)</enum>
<text>Appropriate physical plant space to meet the capacity needs of the Department in that area.</text>
</clause><clause id="id3a224aec119c42e388fabd41309aa9a9">
<enum>(vi)</enum>
<text>Such other factors as the Secretary considers necessary.</text>
</clause></subparagraph><subparagraph id="id4710cdb7168947ef9a42ca77abf7c7c3">
<enum>(B)</enum>
<text>A plan for addressing any issues identified in the assessment described in subparagraph (A),
including a timeline for
addressing such issues.</text>
</subparagraph><subparagraph id="ida704362530d2431c8ffe17f1d8d09ef0">
<enum>(C)</enum>
<text>A list of the current wait times and workload levels for the following clinics in each medical
facility:</text>
<clause id="id1ac85a12d8a34755b031af919aae76aa">
<enum>(i)</enum>
<text>Mental health.</text>
</clause><clause id="ide30d39acaeb942cc8e0a748333d01575">
<enum>(ii)</enum>
<text>Primary care.</text>
</clause><clause id="idaa8ae4c8e74f4388a4dc033e1ee5e05d">
<enum>(iii)</enum>
<text>Gastroenterology.</text>
</clause><clause id="id1653a54744f746dd882e6303ae8b424c">
<enum>(iv)</enum>
<text>Women’s health.</text>
</clause><clause id="id4ce16b087aac42c59ecb8590270331c1">
<enum>(v)</enum>
<text>Such other clinics as the Secretary considers appropriate.</text>
</clause></subparagraph><subparagraph id="id79c4e8739cb245578dd60ab3f39c9202">
<enum>(D)</enum>
<text>A description of the results of the most current determination of the Inspector General under
paragraph (1) of
subsection (a) and a plan to use direct appointment authority under
paragraph (2) of such subsection to fill staffing shortages, including
recommendations for improving the speed at which the credentialing and
privileging process can be
conducted.</text>
</subparagraph><subparagraph id="id14169a75d1e44ca9a8170cf66f0e2511">
<enum>(E)</enum>
<text>The current staffing models of the Department for the following clinics, including recommendations
for
changes to such models:</text>
<clause id="id584491736D564C42A2222D567C06FAB6">
<enum>(i)</enum>
<text>Mental health.</text>
</clause><clause id="id4F94C9095B3241BA823EEB2CDD8E04EF">
<enum>(ii)</enum>
<text>Primary care.</text>
</clause><clause id="idACF985823B7B4EC29378074C9AE40B04">
<enum>(iii)</enum>
<text>Gastroenterology.</text>
</clause><clause id="idD186E1E677FB4AF3A53A2688631A0C4A">
<enum>(iv)</enum>
<text>Women’s health.</text>
</clause><clause id="id6BF865410BFF48B0BCB1CDEC2693AD44">
<enum>(v)</enum>
<text>Such other clinics as the Secretary considers appropriate.</text>
</clause></subparagraph><subparagraph id="idae8732d50b4047d4b5af9ddcf4d2cc27">
<enum>(F)</enum>
<text>A detailed analysis of succession planning at medical facilities of the Department, including the
following:</text>
<clause id="id07ac071d8c3d4a3fa2e4473eb09a5024">
<enum>(i)</enum>
<text>The number of positions in medical facilities throughout the Department that are not filled by a
permanent
employee.</text>
</clause><clause id="idd0200de338ab41da921c538fb8a73a9c">
<enum>(ii)</enum>
<text>The length of time each position described in clause (i) remained vacant or filled by a
temporary or acting employee.</text>
</clause><clause id="ida669d2cca4b747e8aaf267e59fc6f229">
<enum>(iii)</enum>
<text>A description of any barriers to filling the positions described in clause (i).</text>
</clause><clause id="id8e414fa5904549dcb8573c8facff2d85">
<enum>(iv)</enum>
<text>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 id="ida896e0e2f49f4aa4bc9f854133a361f3">
<enum>(v)</enum>
<text>A plan for handling emergency circumstances, such as administrative leave or sudden medical leave
for
senior officials.</text>
</clause></subparagraph><subparagraph id="idE0376FB28F7A41E88EB92D97AB9D3F00"><enum>(G)</enum><text>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 two-year period preceding the submittal of the
report.</text></subparagraph><subparagraph id="id1B678B22BCE9442E8E3C0FDACEEA237E"><enum>(H)</enum><text>Of the health care providers specified in subparagraph (G) who have been removed from their
positions, the following:</text><clause id="idBA7C28411D354521B476362C3726BFAD"><enum>(i)</enum><text>The number of such health care providers who were reassigned to other positions in the Department.</text></clause><clause id="id3DEA277242FC46ACB228DB5B15084669"><enum>(ii)</enum><text>The number of such health care providers who left the Department.</text></clause><clause commented="no" display-inline="no-display-inline" id="id6FCCE4142AF74CD3A10C33937190F803"><enum>(iii)</enum><text>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="idd77269180af94f05bb69b3954a42d5ed">
<enum>202.</enum>
<header>Clinic management training for managers and health care providers of the Department of Veterans
Affairs</header>
<subsection id="idE16A034D360747188A9DD64A016A676E">
<enum>(a)</enum>
<header>Clinic management training program</header>
<paragraph id="id7B07079FC1F6465192FD5F9C704ADE6B"><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 clinic management training program to provide in-person, standardized
education on health care management to all managers of, and health care
providers at, medical facilities of the Department of Veterans Affairs.</text>
</paragraph><paragraph id="idC554C2897742443E9593F701890F7E0F">
<enum>(2)</enum>
<header>Elements</header>
<text>The clinic management training program required by paragraph (1) shall include the following:</text>
<subparagraph id="idbda99d5117af4ec2bf029bb25b634e5c">
<enum>(A)</enum>
<text>Training on how to manage the schedules of health care providers of the Department, including the
following:</text>
<clause id="idAD1CD993CABB485482FF2EB18D4B64FE">
<enum>(i)</enum>
<text>Maintaining such schedules in a manner that allows appointments to be booked at
least eight weeks in advance.</text>
</clause><clause id="idC29A43CD0F1E4A7091C19BF0D6BA710D">
<enum>(ii)</enum>
<text>Proper planning procedures for vacation,
leave, and graduate medical education training schedules.</text>
</clause></subparagraph><subparagraph id="id127398ef8e3f45b39f1eccd7f829f26d">
<enum>(B)</enum>
<text>Training on the appropriate number of appointments that a health care provider should conduct on a
daily basis, based on
specialty.</text>
</subparagraph><subparagraph id="id42a3135b5ba947c19e3e645d781481a8">
<enum>(C)</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>
</subparagraph><subparagraph id="id82d592ffa13c485ba8b30bdbf91e6310">
<enum>(D)</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>
</subparagraph><subparagraph id="id4f956e768f9f4c6bba579556cfabe95a">
<enum>(E)</enum>
<text>Training on how to optimize the use of technology, including the following:</text>
<clause id="idcea39810b3604ca39fb792cc0046eb59">
<enum>(i)</enum>
<text>Telemedicine.</text>
</clause><clause id="ide35e7ce1d5724820b04f961c69cea2aa">
<enum>(ii)</enum>
<text>Electronic mail.</text>
</clause><clause id="id9916805ad4c74a8a963f343508a508be">
<enum>(iii)</enum>
<text>Text messaging.</text>
</clause><clause id="idd75f8e505a3a449191f5c8061f0f1f74">
<enum>(iv)</enum>
<text>Such other technologies as specified by the Secretary.</text>
</clause></subparagraph><subparagraph id="idc4f43267543f41ec9e7c685dbb0e8efe">
<enum>(F)</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></subparagraph></paragraph><paragraph id="id327F368B049D472DABCB2CFD711F19F5"><enum>(3)</enum><header>Sunset</header><text>The clinic management training program required by paragraph (1) shall terminate on the date that
is two years after the date on which the Secretary commences such program.</text></paragraph></subsection><subsection id="id659908F061794F72A34BD82F5B39ADB7"><enum>(b)</enum><header>Training materials</header><paragraph id="idCE61223038474F78BAEFBAE40AED248C"><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 upon the commencement of
employment of such employee:</text><subparagraph id="id1FBE8DD3E54F48279DA547F89E013FD1"><enum>(A)</enum><text>Any manager of a medical facility of the Department.</text></subparagraph><subparagraph id="id3FF49E4C473B421EB0EDC7A76F509919"><enum>(B)</enum><text>Any health care provider at a medical facility of the Department.</text></subparagraph><subparagraph id="idA437A67C895D49FAB646DFBF51C7D627"><enum>(C)</enum><text>Such other employees of the Department as the Secretary considers appropriate.</text></subparagraph></paragraph><paragraph id="id784BC50F4CAA45EC82C39A7548361151"><enum>(2)</enum><header>Update</header><text>The Secretary shall regularly update the training materials required under paragraph (1).</text></paragraph></subsection></section><section id="id8CF69E3348394C47A520396693AF83B7"><enum>203.</enum><header>Use of unobligated amounts to hire additional health care providers for the Veterans Health
Administration</header><subsection id="idF66B2F1EDEE3499FA55F4FB2C931EA03"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">At the end of each of fiscal years 2014 and 2015, all covered amounts shall be made
available to the Secretary of
Veterans Affairs to hire additional health care providers for the Veterans
Health Administration of the Department of Veterans Affairs, or to carry
out any provision of this Act or the amendments made by this Act, and
shall
remain available until expended.</text></subsection><subsection id="idE936823A09CD42DD9AF72BF6BBE7B6A3"><enum>(b)</enum><header>Priority in hiring</header><text display-inline="yes-display-inline">The Secretary shall prioritize hiring additional health care providers under subsection (a) at
medical facilities of the Department and in geographic areas in which the
Secretary identifies the greatest shortage of health care providers.</text></subsection><subsection id="id28628F4816E24B46AB59AF9A579C86E3"><enum>(c)</enum><header>Covered amounts defined</header><text>In this section, the term <term>covered amounts</term> means amounts—</text><paragraph id="id7166A9D4B0E24191A9D74BA4D2C3DB76"><enum>(1)</enum><text>that are made available to the Veterans Health Administration of the Department for an
appropriations account—</text><subparagraph id="idEF30DC7C665E403EA1BBA2657FF5983C"><enum>(A)</enum><text>under
the heading <quote><header-in-text level="appropriations-small" style="OLC">Medical
Services</header-in-text></quote>;</text></subparagraph><subparagraph id="id98659F4E23464B5E9B6048AE0A2B732C"><enum>(B)</enum><text>under the heading <quote><header-in-text level="appropriations-small" style="OLC">Medical
Support and Compliance</header-in-text></quote>; or</text></subparagraph><subparagraph id="idED6CE2DB81D04630BBAEDC687E75F036"><enum>(C)</enum><text>under the heading <quote><header-in-text level="appropriations-small" style="OLC">Medical
Facilities</header-in-text></quote>; and</text></subparagraph></paragraph><paragraph id="id0217F3FA6EAE4D35A877F34377D09334"><enum>(2)</enum><text>that are unobligated at the end of the applicable fiscal year.</text></paragraph></subsection></section><enum>III</enum><header>Improvement of Access to Care from Non-Department of Veterans Affairs Providers</header><section id="idAAA50315EAD04F7B9EBF2B18655A8C07"><enum>301.</enum><header>Expanded availability of hospital care and medical
services for veterans through the use of contracts</header><subsection id="id282466E193B541009FBB97ADA0DD75BB"><enum>(a)</enum><header>Expansion of available care and services</header><paragraph id="idD38CFD4DE35D4489AE74EBA7102ED554"><enum>(1)</enum><header>Furnishing of care</header><subparagraph id="id580CA15D09FA431298E6A09322F2F23C"><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 contracts 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="id65F39978BFC4441B9DD30ED86C5E5532"><enum>(B)</enum><header>Entities specified</header><text>The entities specified in this subparagraph are the following:</text><clause id="id596E08E7CDBA42D6BDEA74F708C2235D"><enum>(i)</enum><text>Any health care provider that is participating in the Medicare
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.).</text></clause><clause id="id765B6655A2784458B3A0A7B3778918AE"><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="idE8D2CE1F3CD043DD932369445CDF03B8"><enum>(iii)</enum><text>The Department of Defense.</text></clause><clause id="idF0D72609FE05499FB75019A2BC7CED8D"><enum>(iv)</enum><text>The Indian Health Service.</text></clause></subparagraph></paragraph><paragraph commented="no" id="idFE19336CBA6C443AA7854F9D2E577CC0"><enum>(2)</enum><header>Choice of provider</header><text>An eligible veteran who elects to receive care and services under this section may select the
provider of
such care and services from among any source of provider of such care and
services through an entity specified in paragraph (1)(B) that is
accessible to the veteran.</text></paragraph><paragraph commented="no" id="idD67D5C6A73AC4D5696A618F93319341B"><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 current wait-time goals
of the Veterans Health Administration for the furnishing of hospital care
and medical services.</text></paragraph></subsection><subsection id="idCE4B056E819D41DAB26957489B896A77"><enum>(b)</enum><header>Eligible veterans</header><text>A veteran is an eligible veteran for purposes of this section if—</text><paragraph id="id7A1B3E173A8C455A951D42C1142B040F"><enum>(1)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id28D7EB9818C945D8BBAAFA75647A24ED"><enum>(A)</enum><text>the veteran is enrolled in the patient enrollment system
of the Department
of Veterans Affairs established and operated under section 1705 of title
38, United States Code; or</text></subparagraph><subparagraph id="idCCF1C2D8AC874B9690140DE1818C4A3F" indent="up1"><enum>(B)</enum><text>the veteran is enrolled in such system, 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;
and</text></subparagraph></paragraph><paragraph id="idA38451CBFCAF42ED884A546AE841DDA3"><enum>(2)</enum><text>the veteran—</text><subparagraph id="id9ED45DFE68444FBA8734ABC2EB821531"><enum>(A)</enum><clause commented="no" display-inline="yes-display-inline" id="id0B37E8B1485C4F2EB66B906640C04C3C"><enum>(i)</enum><text>attempts, or has attempted under paragraph (1)(B), 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 current wait-time goals of the
Veterans Health Administration for the furnishing of such care or
services; and</text></clause><clause id="id309EBA5B7AC148F2A461495620589E13" indent="up1"><enum>(ii)</enum><text>elects, and is authorized, to be furnished such care or services pursuant to subsection (c)(2);</text></clause></subparagraph><subparagraph id="idD6B80AAF1F5948C08BAFE3D291B605A3"><enum>(B)</enum><text>resides more than 40 miles from the nearest medical facility of the Department, including a
community-based outpatient clinic, that is closest to the residence of the
veteran; or</text></subparagraph><subparagraph id="id5B71CCDDF5364420A4BC9891D3A9BB37"><enum>(C)</enum><text>resides—</text><clause id="id51C31E92E45F4FF28232D7C633AA241D"><enum>(i)</enum><text>in a State without a medical facility of the Department that provides—</text><subclause id="idD48160F82DFE44639B0DE2D6115254C4"><enum>(I)</enum><text>hospital care;</text></subclause><subclause id="id830DBEA4155F440D9446E4093B1332B7"><enum>(II)</enum><text>emergency medical services; and</text></subclause><subclause id="id80CC8045F9C6443CA134609EAC9E5A19"><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="idC89E48EE7CC541FBADA0D854CFA26B55"><enum>(ii)</enum><text>more than 20 miles from a medical facility of the Department described in clause (i).</text></clause></subparagraph></paragraph></subsection><subsection id="id131cd16019554349ba90bf58d82178f0"><enum>(c)</enum><header>Election and authorization</header><paragraph id="idB3FE81B209144B63AC6AB11A630A9BEC"><enum>(1)</enum><header>In general</header><text>If the Secretary confirms that an appointment for an eligible veteran described in subsection
(b)(2)(A) 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,
is unavailable within the
current wait-time goals of the Department for the furnishing of such care
or services, the Secretary shall, at the election of the eligible
veteran—</text><subparagraph id="id4C0EC9F902EA40A9943CFF9DA015F866"><enum>(A)</enum><text>place such eligible veteran on an electronic waiting list described in paragraph (2) for such an
appointment; or</text></subparagraph><subparagraph id="id2615DCDCD3FD4819AAD55B1DB71F1B7B"><enum>(B)</enum><clause commented="no" display-inline="yes-display-inline" id="idFFC37C24A90C441F9B62B718E34C0F20"><enum>(i)</enum><text>authorize that such care and services be furnished to the eligible veteran under this section for a
period of time specified by the Secretary; and</text></clause><clause id="id240FFE7CB8FB46CBA393C33AD66B9FD0" indent="up1"><enum>(ii)</enum><text>send a letter to the eligible veteran describing the care and services the eligible veteran is
eligible to
receive under this section.</text></clause></subparagraph></paragraph><paragraph id="id4398FFC10C754D649632AD80B9981D79"><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="id3DA36DE49BE944D18AB094A43ADC3ECA"><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="id4BCC233A04D747D39E38379067EF2181"><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 id="id4F411B9073BA4D52B5BA86D2E5C5DDF2"><enum>(d)</enum><header>Care and services through contracts</header><paragraph id="id708DBCC3C0F540AAA4DB5FE48CE3BC62"><enum>(1)</enum><header>In general</header><text>The Secretary shall enter into contracts with health care providers that are participating in the
Medicare
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) to furnish care and services to eligible veterans under this
section.</text></paragraph><paragraph id="id0F64D43855D04AC2A05AB0BED47AD48A"><enum>(2)</enum><header>Rates and reimbursement</header><subparagraph id="id285D8B8047804E57A3CC8E7823F398F1"><enum>(A)</enum><header>In general</header><text>In entering into a contract under this subsection, the Secretary shall—</text><clause id="id94CC6BEF1ED245E585C17C947DC5692F"><enum>(i)</enum><text>negotiate rates for the furnishing of care and services under this section; and</text></clause><clause id="id366A029A4A734777895C9EABA660E1AA"><enum>(ii)</enum><text>reimburse the health care provider for such care and services at the rates
negotiated pursuant to clause (i) as provided in such contract.</text></clause></subparagraph><subparagraph id="id87EF9231418C4A5DA306EA41ECEF7505"><enum>(B)</enum><header>Limit on rates</header><clause id="id1F629A4559D0401BB05107515F68924D"><enum>(i)</enum><header>In general</header><text>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 (42 U.S.C. 1395 et
seq.) for the same care and services.</text></clause><clause id="idF2201BC059294A3685D7F57B54413926"><enum>(ii)</enum><header>Exception</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 if the Secretary
determines that there is no health care provider that will provide such
care or services to such eligible veteran at the rate required under such
clause—</text><subclause id="id629A91AD71B441189E29811EBF7CDC19"><enum>(I)</enum><text>within the current wait-time goals
of the Veterans Health Administration for the furnishing of such care or
services; and</text></subclause><subclause id="id87B373C682D94AFA8B85AC81AB234E4A"><enum>(II)</enum><text>at a location not more than 40 miles from the residence of such eligible veteran.</text></subclause></clause></subparagraph><subparagraph id="idE8D1650461CC48CFBB52CCDAFA60F775"><enum>(C)</enum><header>Limit on collection</header><text>For the furnishing of care and services pursuant to a contract under this section, a health care
provider may not collect
any amount
that
is greater than the rate negotiated pursuant to subparagraph (A)(i).</text></subparagraph></paragraph><paragraph id="id891E69E3F86149E791171865FC3BD002"><enum>(3)</enum><header>Information on policies and procedures</header><text>The Secretary shall provide to any health care provider with which the Secretary has entered into a
contract under paragraph (1) the following:</text><subparagraph id="idE1EA56D66E824FCDBAA658EA06A6F001"><enum>(A)</enum><text>Information on applicable policies and procedures for submitting bills or
claims for authorized care and services furnished to eligible veterans
under this
section.</text></subparagraph><subparagraph id="id392B49F402444FDA9FBA07A25CAAD179"><enum>(B)</enum><text>Access to a telephone hotline maintained by the Department that such health care provider may call
for information on the following:</text><clause id="idCBC0599B5A8C459DAC5D32042E21FBE1"><enum>(i)</enum><text>Procedures for furnishing care and services under this section.</text></clause><clause id="id760706BD58824883BA08211D6AB4D389"><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 id="id5E1BD6EF0AF144A2B33DB1FCAFD3DB37"><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 id="idD0BCB6EB7FF84AFEA2CD2BB5639D5FEB"><enum>(e)</enum><header>Choice card</header><paragraph id="id9E0A084B932D4144A5D7355557A33587"><enum>(1)</enum><header>In general</header><text>For purposes of receiving care and services under this section, the Secretary shall issue to each
eligible
veteran a card that the eligible
veteran shall present to a health care provider that is eligible to
furnish care and services under this section before receiving such care
and services.</text></paragraph><paragraph id="id78DDDDF4067F4930A4CDA6AAF8F6EFB3"><enum>(2)</enum><header>Name of card</header><text>Each card issued under paragraph (1) shall be known as a <quote>Choice Card</quote>.</text></paragraph><paragraph id="idA55E42770DC94D4D9B7F334B256DA050"><enum>(3)</enum><header>Details of card</header><text>Each Choice Card issued to an eligible veteran under paragraph (1) shall include the following:</text><subparagraph id="id7921E2AFE85D4D94AAC7305B909DE8D8"><enum>(A)</enum><text>The name of the eligible veteran.</text></subparagraph><subparagraph id="id6BA2F8D9BBCB463A8A4D2BF5F807032C"><enum>(B)</enum><text>An identification number for the eligible veteran that is not the social security number of the
eligible veteran.</text></subparagraph><subparagraph id="id88D2ECF2E60D4ACC9940A8E0FE040D16"><enum>(C)</enum><text>The contact information of an appropriate office of the Department for health care providers to
confirm that care and services under
this section are
authorized for the eligible veteran.</text></subparagraph><subparagraph id="idBA648934EDBF4021BA9BF59820ED60E4"><enum>(D)</enum><text>Contact information and other relevant information for the submittal of claims or bills for the
furnishing of care and services under this section.</text></subparagraph><subparagraph id="id7BA7CFFC3FA24646805FA1D3EC8298E4"><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="id9071B3287211440392F4CED268E4A21E"><enum>(4)</enum><header>Information on use of card</header><text>Upon issuing a Choice Card to an eligible veteran, the Secretary shall provide the eligible veteran
with information clearly stating the circumstances under which the veteran
may be
eligible for care and services under this section.</text></paragraph></subsection><subsection id="id2C50470CB0D94675BD845D718F99FB3A"><enum>(f)</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 id="id718677A18A3E4E59840C8B8AAE639126"><enum>(1)</enum><text>When the veteran enrolls in the patient enrollment system of the Department under section
1705 of title 38, United States Code.</text></paragraph><paragraph id="id2396313FC6844E468534ECD7B96ACF88"><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 current wait-time goals of the
Veterans Health Administration for delivery of such care or services.</text></paragraph></subsection><subsection id="id5F654DA79A3D41F7A37280CC180ED772"><enum>(g)</enum><header>Providers</header><text>To be eligible to furnish care and services under this section, a health care provider must—</text><paragraph id="id207AFFBA0CA445EE817FE94ABF807E53"><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="id8F76E4D223844C4FB42D3AF216CED8F9"><enum>(2)</enum><text>submit, not less frequently than once each year, verification of such licenses and credentials
maintained by such health care provider.</text></paragraph></subsection><subsection id="id6A871A2F97BE4BC0AAEDA9F7581ED315"><enum>(h)</enum><header>Cost-sharing</header><paragraph id="idFE6A59E42B11496AA0BA3361E09946FA"><enum>(1)</enum><header>In general</header><text>The Secretary shall require an eligible veteran to pay a copayment to the Department for
the receipt of care and services under this section only if such eligible
veteran would be required to pay such copayment for the receipt of such
care
and services at a
medical facility of the Department.</text></paragraph><paragraph id="id5F44F351FDAC4E7C80045515920FAA17"><enum>(2)</enum><header>Limitation</header><text>The copayment required under paragraph (1) shall not be greater than the copayment required of such
eligible veteran by the Department for the receipt of such
care
and services at a
medical facility of the Department.</text></paragraph></subsection><subsection id="idEEEB269DACC74423A84E5F9DC6D6646C"><enum>(i)</enum><header>Claims processing system</header><paragraph id="id085D7B7D7F48485987D4B993437AF041"><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="id716E65738D9D4316930ECE94B11C8E53"><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="idA99F7699CBB946C0A67E3A029716C833"><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="id3B35FDF05D5A4797A93CD96B53C8C9A3"><enum>(4)</enum><header>Accuracy of payment</header><subparagraph id="id858EE47459EE42E3B37841C230E92D11"><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 id="id45A81D78A50B454DA17D87EEDF4F530D"><enum>(B)</enum><header>Annual report</header><clause id="id43FE95DE0721455C9B3FC0BCAA5DDB2F"><enum>(i)</enum><header>In general</header><text>Not later than one year after the date of the enactment of this Act, and annually thereafter until
the termination date specified in 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 goals for accuracy of such system.</text></clause><clause id="idA85D3EAE47E54A859E2869486A4B8483"><enum>(ii)</enum><header>Elements</header><text>Each report required by clause (i) shall include the following:</text><subclause id="id30C68C677C154F87B7B0098386172A38"><enum>(I)</enum><text>A description of the goals for accuracy for such system specified
by the Secretary under subparagraph (A).</text></subclause><subclause id="id4C11A9FF51DD4CCE8F0DE8AAD1F6D5CC"><enum>(II)</enum><text>An assessment of the success of the Department in meeting such goals during the year preceding the
submittal of the report.</text></subclause></clause></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id37a68deea2524b22a50133a059f6ce1d"><enum>(j)</enum><header display-inline="yes-display-inline">Medical records</header><text display-inline="yes-display-inline">The Secretary shall ensure that
any health care provider that furnishes care and services under this
section to an eligible veteran submits to the Department any
medical record related to the care and 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 and services to such eligible veteran.</text></subsection><subsection id="idA4DB5733BB45402DBBE97750CB948838"><enum>(k)</enum><header>Tracking of missed appointments</header><text>The Secretary shall implement a mechanism to track any missed appointments for care and services
under this section by eligible veterans to ensure that the Department does
not pay for such care and services that were not furnished to an eligible
veteran.</text></subsection><subsection id="idFA30FCF8AEFF4FDDB0B394AFD3C7F729"><enum>(l)</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="id7AD0900654EE4D299FDBEFE4BA7CB33F"><enum>(m)</enum><header>Inspector General report</header><text display-inline="yes-display-inline">Not later than 540 days after the publication of the interim final regulations under subsection
(l), 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="idD9065318EC9D416C91F1B8E93FDEF911"><enum>(n)</enum><header>Termination</header><text>The requirement of the Secretary to furnish care and services under this section terminates on the
date that is two years after the date on which the Secretary publishes the
interim final regulations under subsection (l).</text></subsection><subsection id="id5D015C11E9E7482D886FA79DC949841F"><enum>(o)</enum><header>Reports</header><paragraph id="id464F39DBF64E4074BED451E91E3065FA"><enum>(1)</enum><header>Initial report</header><text>Not later than 90 days after the publication of the interim final regulations under subsection
(l), 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="id4A6EE41B694646A2BEC813430ABC6836"><enum>(A)</enum><text>The number of eligible veterans who have received care and services under this section.</text></subparagraph><subparagraph id="id17CCB4461BF64164B46EB5013FD19F94"><enum>(B)</enum><text>A description of the type of care and services furnished to eligible veterans under this section.</text></subparagraph></paragraph><paragraph id="id14DC5C6FF70C4F128042B03A810AF439"><enum>(2)</enum><header>Final report</header><text>Not later than 540 days after the publication of the interim final regulations under subsection
(l), 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="id837A48654F484500A14BA03AEC65F9D0"><enum>(A)</enum><text>The total number of eligible veterans who have received care and services under this section,
disaggregated by—</text><clause id="idBDEB5C62BEC1415F951E386CD46A17B4"><enum>(i)</enum><text>eligible veterans described in subsection (b)(2)(A); and</text></clause><clause id="id9E3C42371F3A44FDA9208862343E2C6F"><enum>(ii)</enum><text>eligible veterans described in subsection (b)(2)(B).</text></clause></subparagraph><subparagraph id="id5C2BB52E71F745D78C693E57148353F8"><enum>(B)</enum><text>A description of the type of care and services furnished to eligible veterans under this section.</text></subparagraph><subparagraph id="id610BA80B9E5E453991AB388631A01D0A"><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="id3F314D06A86F447DB2DBC2FDFB53080F"><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="idAB3EA3970FFD4CA6B001CFB3798E54B2"><enum>(E)</enum><text>An assessment of the effect of furnishing care and services under this section on wait times for an
appointment for the receipt of hospital care and medical services from the
Department.</text></subparagraph><subparagraph id="id640A2E5D0A3144BD831D2AE0B8ECF339"><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 (n).</text></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id2157D041824A40FA82DC5D0D34E0E0CD"><enum>(p)</enum><header>Rules of construction</header><paragraph commented="no" display-inline="no-display-inline" id="id30A3832E003F475881877F9A75B95FFA"><enum>(1)</enum><header>No modification of contracts</header><text>Nothing in this section shall be construed to require the Secretary to renegotiate contracts for
the furnishing of hospital care or medical services to veterans entered
into by the Department before the date of the enactment of this Act.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id6F84909CF320417AA0A839345357F88A"><enum>(2)</enum><header>Filling and paying for prescription medications</header><text>Nothing in this section shall be construed to alter the process of the Department for filling and
paying for prescription medications.</text></paragraph></subsection></section><section id="idcb5f241a336a43cea45cdaf866d0f63b">
<enum>302.</enum>
<header>Transfer of authority for payments for hospital care, medical services, and other health care from
non-Department providers to the Chief
Business Office of the Veterans Health Administration of the Department</header>
<subsection id="idd17c1717bb4643febb763a598c6b3f87">
<enum>(a)</enum>
<header>Transfer of authority</header>
<paragraph id="idD437654D4D4F40EAAE32DB75D688E653">
<enum>(1)</enum>
<header>In general</header>
<text>Effective on October 1, 2014, the Secretary of Veterans Affairs shall transfer the authority to pay
for hospital care, medical services, and other health care through
non-Department providers to the Chief Business Office of the Veterans
Health Administration of the Department of Veterans Affairs from the
Veterans Integrated Service Networks and medical centers of the Department
of Veterans Affairs.</text>
</paragraph><paragraph id="id43DBD04F274644E296EC38BC3CA03B4D"><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 of Veterans Affairs to ensure that care and
services described in paragraph (1) are provided in a manner that is
clinically appropriate and effective.</text></paragraph><paragraph id="id76945C2EFB944D039A508991AFC385C1">
<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 provided through a
non-Department provider under the laws administered by the Secretary.</text>
</paragraph></subsection><subsection id="idD0BCE1F5E8414D34851B4941C1FF171F">
<enum>(b)</enum>
<header>Budgetary effect</header>
<text>The Secretary shall, for each fiscal year that begins after the date of the enactment of this Act—</text>
<paragraph id="idB257DD5FB740425FAC5BEE57A3E846C9">
<enum>(1)</enum>
<text>include in the budget for the Chief Business Office of the Veterans Health Administration amounts
to pay for hospital care, medical services, and other health care provided
through non-Department providers, including any amounts necessary to carry
out the transfer of authority to pay for such care and services under
subsection (a), including any increase in staff; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id6245E17BC31E483DAE59441742F153C0"><enum>(2)</enum><text>not include in the budget of each
Veterans Integrated Service Network and medical center of the Department
amounts to pay for such care and services.</text></paragraph></subsection></section><section id="id9FCF35F8915A44A19552554020D7FA09">
<enum>303.</enum>
<header>Enhancement of collaboration between Department of Veterans Affairs and Indian Health Service</header>
<subsection id="idC1E94CB3D24E4E63AE0093EF44AF1282">
<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 eligible for health care at such
facilities.</text>
</subsection><subsection id="id6CF7AAC0E9B6433CBEBE15F51AB800FD">
<enum>(b)</enum>
<header>Metrics for memorandum of understanding performance</header>
<text>The Secretary of Veterans Affairs shall implement 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="id145E7D29B94C4B3FA28A5BC1B820CEFF">
<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="id3CB52EEC4D9642EAA226F5EA05FD8C9D">
<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 (25
U.S.C. 1653) to veterans who are otherwise eligible to receive health care
from such organizations.</text>
</paragraph><paragraph id="id52CFB76C00A04FCA8AFC3AC15D0471AA">
<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="id189D503844374F6C830B400086C8917C"><enum>(A)</enum><text>The Indian Health Service.</text>
</subparagraph><subparagraph id="idBEF3924AC4424C9F876D72291E743135"><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="id53DC946107414F1F9D3CDEC3D4A34FF4"><enum>(C)</enum><text>A medical facility of the Indian Health Service.</text></subparagraph></paragraph></subsection><subsection id="id8738FD39F92D468A97C5EC0F4B6E8453">
<enum>(d)</enum>
<header>Definitions</header>
<text>In this section:</text>
<paragraph id="id91C8E6E3B07545B39C9EAE3D4590A05D">
<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 (25
U.S.C. 1603).</text>
</paragraph><paragraph id="id3E405D97D88C439F8763D91CCE852340">
<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="idF995AF6D928245FF8B674FEE855C4B3D">
<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="id9d8674cce378477b898e9a27e7dfb626"><enum>304.</enum><header>Enhancement of collaboration between Department of Veterans Affairs and Native Hawaiian health care
systems</header><subsection id="id30EF22924ADD4A29932D585DE6F126D1"><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="id6573E598CA8C4FBFB0E7506882EEC70F"><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="id04676BFE7E6649D1AB2F802E2ECB51CD"><enum>305.</enum><header>Sense of Congress on prompt payment by Department of Veterans Affairs</header><text display-inline="no-display-inline">It is the sense of Congress that the Secretary of Veterans Affairs shall comply with section 1315
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></section><enum>IV</enum><header>Health Care Administrative Matters</header><section id="ide0e609da34344ecfb5c96a31ee6b5186">
<enum>401.</enum>
<header>Improvement of access of veterans to mobile vet centers of the Department of Veterans Affairs</header>
<subsection id="id692116af513b4cd485ad7fd5e0ba432e">
<enum>(a)</enum>
<header>Improvement of access</header>
<paragraph id="id65E3E9249CF04336B1ADFD13461B6158">
<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 of the Department of
Veterans Affairs by providing standardized requirements for the operation
of such centers.</text>
</paragraph><paragraph id="id2baa567cae6249d0b90bf17ee6231c26">
<enum>(2)</enum>
<header>Requirements</header>
<text>The standardized requirements required by paragraph (1) shall include the following:</text>
<subparagraph id="ideb029586973e495db551fc1216fddb19">
<enum>(A)</enum>
<text>The number of days each mobile vet center of the Department is expected to travel per year.</text>
</subparagraph><subparagraph id="idc2955ef085374597aae2f45989ec43dc">
<enum>(B)</enum>
<text>The number of locations each center is expected to visit per year.</text>
</subparagraph><subparagraph id="id04e69c73651a44c497b7ec001b4a9ece">
<enum>(C)</enum>
<text>The number of appointments each center is expected to conduct per year.</text>
</subparagraph><subparagraph id="id84ebc9e373714c6f82634c9aa7335f29">
<enum>(D)</enum>
<text>The method and timing of notifications given by each center to individuals in the area to which
such center is traveling, including notifications informing veterans of
the availability to schedule appointments at the center.</text>
</subparagraph></paragraph><paragraph id="id6a049ddafd3a424b9f8661b8b6812c50">
<enum>(3)</enum>
<header>Use of telemedicine</header>
<text>The Secretary shall ensure that each mobile vet center of the Department has the capability to
provide telemedicine services.</text>
</paragraph></subsection><subsection id="idcb965e8ff8ce4011a0e6ebae06332ae6">
<enum>(b)</enum>
<header>Reports</header>
<text>Not later than one 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 the
following:</text>
<paragraph id="id5ead4e86f7644b209aa1a30ce5f5c142">
<enum>(1)</enum>
<text>The use of mobile vet centers to provide telemedicine services to veterans during the year
preceding the submittal of the report, including the following:</text>
<subparagraph id="id88DE9E15F76D4FAE9F2EAEFB29E940A0">
<enum>(A)</enum>
<text>The number of days each mobile vet center was open to provide such services.</text>
</subparagraph><subparagraph id="idB31304C50259449299B69CA748193AC4">
<enum>(B)</enum>
<text>The number of days each mobile vet center traveled to a location other than the headquarters of the
mobile vet center to provide such services.</text>
</subparagraph><subparagraph id="id1443DF792CE949DFA3756DC38422050C">
<enum>(C)</enum>
<text>The number of appointments each center conducted to provide such services on average per month and
in total during such year.</text>
</subparagraph></paragraph><paragraph id="id4f5ea3a614dd42c1908950b23fe4c6e9">
<enum>(2)</enum>
<text>An analysis of the effectiveness of using mobile vet centers to provide health care services to
veterans through the use of telemedicine.</text>
</paragraph><paragraph id="id0aadddc2bbd84dc4896586d4f796306b">
<enum>(3)</enum>
<text>Any recommendations for an increase in the number of mobile vet centers of the Department.</text>
</paragraph><paragraph id="id7f7abbf2ab1449b3bff6409106a40763">
<enum>(4)</enum>
<text>Any recommendations for an increase in the telemedicine capabilities of each mobile vet center.</text>
</paragraph><paragraph id="ida4d8437e9bbf4b80a4ee604c63e602d9">
<enum>(5)</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.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idad10abd2985b47f2bd9a12411404f7c7">
<enum>(6)</enum>
<text>Such other recommendations on improvement of the use of mobile vet centers by the Department as the
Secretary considers appropriate.</text></paragraph></subsection></section><section id="idCDCA6A018396465886640BE49264F0F5">
<enum>402.</enum>
<header>Commission on construction projects of the Department of Veterans Affairs</header>
<subsection id="ID56F26CD6FBE944EA93712D08EBBE89D4">
<enum>(a)</enum>
<header>Establishment of commission</header>
<paragraph id="ID9F36EA019CFD43CA8D682B0BC84633EF">
<enum>(1)</enum>
<header>Establishment</header>
<text>There is established an Independent Commission on Department of Veterans Affairs Construction
Projects (in this section referred to as the <quote>Commission</quote>).</text>
</paragraph><paragraph id="ID6A592491DD5E438FB033D04272120D24">
<enum>(2)</enum>
<header>Membership</header>
<subparagraph id="ID0B2C8C10439843EDB075747AB2C196CC">
<enum>(A)</enum>
<header>Voting members</header>
<text>The Commission shall be composed of 10 voting members as follows:</text><clause id="ID67CFD5F721E645AE89404D197DFAA134">
<enum>(i)</enum>
<text>Three members to be appointed by the President from among members of the National Academy of
Engineering who are nominated under subparagraph (B).</text>
</clause><clause id="id2F96E5993E6445D899B25B02ACFAD19E"><enum>(ii)</enum><text>Three members to be appointed by the President from among members of the National Institute of
Building
Sciences who are nominated under subparagraph (B).</text></clause><clause id="id203630942C3C4DB6AA630BB18A328649"><enum>(iii)</enum><text>Four members to be appointed by the President from among veterans enrolled in the patient
enrollment
system of the Department of Veterans Affairs under section 1705 of title
38, United States Code, who are nominated under subparagraph (B).</text></clause></subparagraph><subparagraph id="id9ECB0D41B47E4DBB9EF1C8D43F841EF5">
<enum>(B)</enum>
<header>Nomination of voting members</header>
<text>The majority leader of the Senate, the minority leader of the Senate, the speaker of the House of
Representatives, and the minority leader of the House of Representatives
shall jointly nominate not less than 24 individuals to be considered by
the President for appointment under subparagraph (A).</text></subparagraph><subparagraph id="id36066AED1D3D4F0B860C9339E45FAC21">
<enum>(C)</enum>
<header>Nonvoting members</header>
<text>The Commission shall be composed of the following nonvoting members:</text>
<clause id="id444253CF243040CDA62865DE178D95F9"><enum>(i)</enum><text>The Comptroller General of the United States, or designee.</text></clause><clause id="id1DFDD552E75643FE86FD08F9378BB541"><enum>(ii)</enum><text>The Secretary of Veterans Affairs, or designee.</text></clause><clause id="idAD3E43E37E744B8C9F22696404F0A18F">
<enum>(iii)</enum>
<text>The Inspector General of the Department of Veterans Affairs, or designee.</text>
</clause></subparagraph><subparagraph commented="no" id="ID7122D83211FF4465AAD1E3E201D774C3">
<enum>(D)</enum>
<header>Date of appointment of members</header>
<text>The appointments of the members of the Commission under
subparagraph (A) shall be made not later
than 14 days after the date of the enactment of this Act.</text>
</subparagraph></paragraph><paragraph commented="no" id="IDB4CDEF3B42ED4C0CAE1CCAB6B0EF1C42">
<enum>(3)</enum>
<header>Period of appointment; vacancies</header>
<text>Members shall be appointed for the life of the Commission. Any vacancy in the Commission shall not
affect its powers, but shall be filled in the same manner as the original
appointment.</text>
</paragraph><paragraph commented="no" id="IDDDE5A648F8EA47948DFD7AED58D91E2A">
<enum>(4)</enum>
<header>Initial meeting</header>
<text>Not later than five days after the date on which all members of the Commission have been appointed,
the
Commission shall hold its first meeting.</text>
</paragraph><paragraph commented="no" id="ID0ECCB1F0E51847F8945FA1902DA20BF5">
<enum>(5)</enum>
<header>Meetings</header>
<text>The Commission shall meet at the call of the Chairperson.</text>
</paragraph><paragraph commented="no" id="ID1693DFD5501647F49A65A1A3368919FC">
<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 commented="no" id="ID4FED0A1CED9D4258886D9DACB0FC8370">
<enum>(7)</enum>
<header>Chairperson and vice chairperson</header>
<text>The Commission shall select a Chairperson and Vice Chairperson from among its members.</text>
</paragraph></subsection><subsection id="ID259A7A661C3949B785B22185785AECC2">
<enum>(b)</enum>
<header>Duties of commission</header>
<paragraph id="idE5A169CC69AE4173B66F944EDA5B914E">
<enum>(1)</enum>
<header>Review</header>
<text>The Commission shall review current construction and maintenance projects and the medical facility
leasing
program of the Department of Veterans Affairs to identify any problems
experienced by the Department in carrying out such projects and program.</text>
</paragraph><paragraph id="idC9CF32682756496F9664D30BB93CF190">
<enum>(2)</enum>
<header>Reports</header>
<subparagraph id="id860E9CFA10FF435CB837ABFFD220570C"><enum>(A)</enum><header>Commission report</header><text>Not later than 120 days after the date of the enactment of this Act, the Commission shall submit to
the Secretary of Veterans Affairs, the Committee on Veterans' Affairs of
the Senate, and the Committee on Veterans' Affairs of the House of
Representatives a report setting forth recommendations, if any, for
improving the manner in which the Secretary carries out the projects and
program specified in paragraph (1).</text></subparagraph><subparagraph id="id677C5B7927164EE4B7C8D5BEAFC76EA7"><enum>(B)</enum><header>Department report</header><text>Not later than 60 days after the submittal of the report under subparagraph (A), 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 feasibility and advisability of
implementing the recommendations of the Commission, if any, included in
the report submitted under such subparagraph, including a timeline for the
implementation of such recommendations.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="ID74156D0F025F4F2F8385B03BFCB9216A">
<enum>(c)</enum>
<header>Powers of commission</header>
<paragraph commented="no" id="ID702F0A5C44754537816EAC4CAF3D12A9">
<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 commented="no" id="ID887F1AF5135A43938A70866E5CA5046E">
<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 commented="no" id="IDE1D4C35B84A9419386ECE15783B4CDF7">
<enum>(d)</enum>
<header>Commission personnel matters</header>
<paragraph commented="no" id="IDDBD53C21509D47C98A217B083F4AD4EC">
<enum>(1)</enum>
<header>Compensation of members</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 section
5315 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. 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>
</paragraph><paragraph commented="no" id="ID1179DD9A0A7D4FCDA271C283AC67C62C">
<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 commented="no" id="ID10D69ECE240145F1BFDAC737CC0BBF7D">
<enum>(3)</enum>
<header>Staff</header>
<subparagraph commented="no" id="IDEEFC75CB2B454D92B36EFA5653A525F0">
<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 commented="no" id="IDE4E58C0C6C7D4E42B46A4DF413EF166C">
<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 commented="no" id="ID591F8DD90C4F4240BF5617F5D66B9BA0">
<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 commented="no" id="ID3287C6AFC6FA4DEE95E40AB4E7829734">
<enum>(5)</enum>
<header>Procurement of temporary and intermittent services</header>
<text>The Chairperson of the Commission may procure temporary and intermittent services under section
3109(b)
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 commented="no" id="IDF9F07993A3D8499993B5AA3005D801B9">
<enum>(e)</enum>
<header>Termination of commission</header>
<text display-inline="yes-display-inline">The Commission shall terminate 30 days after the date on which the Commission submits its report
under subsection (b)(2)(A).</text>
</subsection></section><section id="id2592D01CF6AD41FABA3D63784329F632"><enum>403.</enum><header>Commission on Access to Care</header><subsection id="id219713C9069046DB816F0AD4CC852B4F"><enum>(a)</enum><header>Establishment of commission</header><paragraph id="idF543FC2DEC6740078812D06E1EE92AB1"><enum>(1)</enum><header>In general</header><text>There is established the Commission on Access to Care (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 10- to 20-year period beginning on the date of the
enactment of this Act.</text></paragraph><paragraph id="id4FE1FCE412984BDD8B302FFC3563911B"><enum>(2)</enum><header>Membership</header><subparagraph id="id4DBDBEC805714B4E9CD61986A1A252A9"><enum>(A)</enum><header>Voting members</header><text>The Commission shall be composed of 10 voting members who are appointed by the President as
follows:</text><clause id="id701DCAE87F654C36808A49179A79F7B5"><enum>(i)</enum><text>At least two members who 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="id35C7337DC96847FCA1DC34CAA8F621D9"><enum>(ii)</enum><text>At least one member from among persons who 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="id62ED7356209E41FF8E88FE94F1BE4265"><enum>(iii)</enum><text>At least one member from among persons who are 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="idE88FD32AA4104642943A1963BA4B25A6"><enum>(iv)</enum><text>At least two members from among persons who are familiar with the Veterans Health Administration
but are not current employees of the Veterans Health Administration.</text></clause><clause id="idC23C2CE9E1144D44990AE44F5F5E99AB"><enum>(v)</enum><text>At least two members from among persons who are veterans or eligible for hospital care, medical
services, or other health care under the laws administered by the
Secretary of Veterans Affairs.</text></clause></subparagraph><subparagraph id="id4C7C7B9DC16249FE98AC74D56AB211B2"><enum>(B)</enum><header>Nonvoting members</header><clause id="idBB233700CD4146E1884812DBB90B0826"><enum>(i)</enum><header>In general</header><text>In addition to members appointed under subparagraph (A), the Commission shall be composed of
10 nonvoting members who are appointed by the President as follows:</text><subclause id="id60B13937427B46609FB36C72DD5CF3D5"><enum>(I)</enum><text>At least two members who 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></subclause><subclause id="id261DBC740E554C3B96B79E2E56355BD5"><enum>(II)</enum><text>At least one member from among persons who have experience as senior management for a private
integrated health care system with an annual gross revenue of more than
$50,000,000.</text></subclause><subclause id="id60E77165DB714486809A091736FD43ED"><enum>(III)</enum><text>At least one member from among persons who are 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></subclause><subclause id="id117638148B004152A2B8BEAB21B14B83"><enum>(IV)</enum><text>At least two members from among persons who are familiar with the Veterans Health Administration
but are not current employees of the Veterans Health Administration.</text></subclause><subclause id="idE813E79E0F524252B967231EF8F5C914"><enum>(V)</enum><text>At least two members from among persons who are veterans or eligible for hospital care, medical
services, or other health care under the laws administered by the
Secretary of Veterans Affairs.</text></subclause></clause><clause id="id67FD3877FF6840E7AEA07BADEAECFF14"><enum>(ii)</enum><header>Additional nonvoting members</header><text>In addition to members appointed under subparagraph (A) and clause (i), the Commission shall be
composed of the following nonvoting members:</text><subclause id="idE38E8208642B43088AB896392C395624">
<enum>(I)</enum>
<text>The Comptroller General of the United States, or designee.</text>
</subclause><subclause commented="no" display-inline="no-display-inline" id="id1A7CCE5098BC4187B0A6CBB9359E5444"><enum>(II)</enum><text>The Inspector General of the Department of Veterans Affairs, or designee.</text></subclause></clause></subparagraph><subparagraph id="id4781BFA8331842269F8919D7126F6560"><enum>(C)</enum><header>Date</header><text>The appointments of members of the Commission shall be made not later than 60 days after the date
of the enactment of this Act.</text></subparagraph></paragraph><paragraph id="id4B5E820E7FE745689A8628B05E8EDEF5"><enum>(3)</enum><header>Period of appointment; vacancies</header><text>Members shall be appointed for the life of the Commission. Any vacancy in the Commission shall not
affect its powers, but shall be filled in the same manner as the original
appointment.</text></paragraph><paragraph id="id3D93BC953AD949B39A0EE5D994AF24DA"><enum>(4)</enum><header>Initial meeting</header><text>Not later than 15 days after the date on which seven voting members of the Commission have been
appointed, the Commission shall hold its first meeting.</text></paragraph><paragraph id="id215ECAA13CFB40F69322B37B4A2D4B05"><enum>(5)</enum><header>Meetings</header><text>The Commission shall meet at the call of the Chairperson.</text></paragraph><paragraph id="id45C6B352F94C4224A842A4CE0D62B159"><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="id0CD857AE9A57496A9CD822441CA7B761"><enum>(7)</enum><header>Chairperson and Vice Chairperson</header><text>The Commission shall select a Chairperson and Vice Chairperson from among its members.</text></paragraph></subsection><subsection id="id2F9D157D1A4645B0BDAEAA77C5138B69"><enum>(b)</enum><header>Duties of commission</header><paragraph id="idB38FE0268E2444D28CDC91350434E8B9"><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="idAE19C169E0C8449BAD5AD17A268B1317"><enum>(2)</enum><header>Matters evaluated and assessed</header><text>The matters evaluated and assessed by the Commission shall include the following:</text><subparagraph id="idB0C4EB0C9D1F44B485D82E9E4DF6EACF"><enum>(A)</enum><text>The appropriateness of current standards of the Department of Veterans Affairs concerning access to
health care.</text></subparagraph><subparagraph id="id7827A85E63F34A4C945DDE815CBA1D7C"><enum>(B)</enum><text>The measurement of such standards.</text></subparagraph><subparagraph id="id6E48884E3E894AD09B56D2A587A162C2"><enum>(C)</enum><text>The appropriateness of performance standards and incentives in relation to standards described in
subparagraph (A).</text></subparagraph><subparagraph id="id67928E64E2F3472CB9A79C1A1180B598"><enum>(D)</enum><text>Staffing levels throughout the Veterans Health Administration and whether they are sufficient to
meet current demand for health care from the Administration.</text></subparagraph><subparagraph id="idE2A977DE1174430A98D87C8A3809C5B4"><enum>(E)</enum><text>The results of the assessment conducted by an independent third party under section 101(a),
including any data or recommendations included in such assessment.</text></subparagraph></paragraph><paragraph id="idF4A58323276D43ED8C261CB6F8BFAB38"><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="id08A6CA2F4ADA47BA956AC546D0869258"><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="id0C8984DA9AA0419DAE2B328BA8D96916"><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="id670C0004C8BC4AA5B7C8B58FAD7B2CDA"><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="idF4508FDA87D54D5B9C80BF2E126F5B71"><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="idE8BD2E22D7B94113B6208932DCE3D098"><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="idB2CAD4BBC71E498897CFAA63A64924A9"><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="IDBF35816E08534CFC835DB84FCD77111A"><enum>(c)</enum><header>Powers of the
commission</header>
<paragraph id="ID78DA905C4EAE49B0AF74CB57183B6E1A"><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="ID575D757C021D4B048F3625D80002BDAA"><enum>(2)</enum><header>Information
from Federal agencies</header><text>The Commission may secure directly from any
Federal department or 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 department or agency shall furnish such
information to the Commission.</text>
</paragraph></subsection><subsection id="ID5B2226B82D614F6AA60C08533C1FED30"><enum>(d)</enum><header>Commission
personnel matters</header>
<paragraph id="IDF9E4CF3EA6AC4F01B81923D97C022F5A"><enum>(1)</enum><header>Compensation of
members</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. 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>
</paragraph><paragraph id="ID8AB9CAB7544542CBBCD32562861B7980"><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="ID771CB422D4684EF88424586CBA7942C6"><enum>(3)</enum><header>Staff</header>
<subparagraph id="ID99AD8891AD904A7EBF3A1D3EE5A99435"><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="IDB23DD631FF0E49B589B943F8049F018B"><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 chapter
53 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="IDA9D71553FE6B470ABBF61FBF5DCE8D94"><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="IDD761928855434025A0BC6D8D636885FE"><enum>(5)</enum><header>Procurement of
temporary and intermittent services</header><text>The Chairperson of the
Commission may procure temporary and intermittent services under section
3109(b) 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="ID8E18677BEB06432BA5DE4BCFA806C638"><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 its
report under subsection (b)(3)(B).</text>
</subsection><subsection id="id8851F0971DED4D1A9C9709D1C88B7943"><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="id3B38A4074D9B4A73822080C40888D787"><enum>(g)</enum><header>Executive action</header><paragraph id="id9A3A0077F8A34E57B261417D7D053717"><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="id3EE37FA7D46046DD80F7424E96412C5F"><enum>(A)</enum><text>considers feasible and advisable; and</text></subparagraph><subparagraph id="idCF8A0D7FD5D24A1594F186BF32CB7C4A"><enum>(B)</enum><text>determines can be implemented without further legislative action.</text></subparagraph></paragraph><paragraph id="id4D241784CAE7451683906D910BE1C8B9"><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="id6EDB869D6A2E48108B55174C3279AF70"><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="id934BD7A7375B4020A889EC759AE5323F"><enum>(B)</enum><text>For each recommendation assessed as feasible and advisable under subparagraph (A) the following:</text><clause id="id8DE9516843C34FD3A9E882FA2A6505BF"><enum>(i)</enum><text>Whether such recommendation requires legislative action.</text></clause><clause id="id037CFEFFB0904C68AA2BC553BC949135"><enum>(ii)</enum><text>If such recommendation requires legislative action, a recommendation concerning such legislative
action.</text></clause><clause id="idC0B79EE388464FCD9067A014EC5AB00F"><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="idA3B623F6404D47318CBBBD4910DB70E6"><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 id="idA33E7FEBDC16459E8003B567CAB88562"><enum>404.</enum><header>Improved performance metrics for health care provided by Department of Veterans Affairs</header><subsection id="idF318B183F8E24A768CC55E231ED542E8"><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="id55C7ABB50C8F47CDA06D9F72F86E546F"><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="id506229E07D634F5785E93122B2E1B57B"><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="id0B831DC5A28849068D603069E47EEC05"><enum>(b)</enum><header>Modification of performance plans</header><paragraph id="id128B6FA933434C2CAD5638BE6BB5B9D8"><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="id955FA626CDE048A5B72FD66B07585161"><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="id1e2899d9a0d444428fa4e747fac01782"><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="id2c80f8b4028840e49fe27818e8dd695a"><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
(CAP), 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="id85b361a3622347e5b1bc77d20718dce7"><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="idb1ff590d69214bd9aab9fee117eab5a9"><enum>(D)</enum><text>Reviews of such facilities by the Commission on Accreditation of Rehabilitation Facilities.</text></subparagraph><subparagraph id="idb53e43f118ad4a008c88a82b6e2ae1ac"><enum>(E)</enum><text>The number and outcomes of administrative investigation boards, root cause analysis, and peer
reviews conducted at such facilities during
the fiscal year for which the assessment is being conducted.</text></subparagraph><subparagraph id="id733fbb56bc1b45a3a18288caf073ff75"><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="id1B47C2B98A8F4070B41AACEC02B748BD"><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="id2C266483F445408CA171EAC0407614C4"><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="id97403FDA69D44209B92064A86C1C27CC"><enum>405.</enum><header>Improved transparency concerning health care provided by Department of Veterans Affairs</header><subsection id="id60B73750F2C84709B0A4D026FECAC30E"><enum>(a)</enum><header>Publication of wait times</header><paragraph id="id28B42BBE17EF423E9F06729BC973C875"><enum>(1)</enum><header>Goals</header><subparagraph id="id7A05FAF9B97C4B25AE25859C06DF3E29"><enum>(A)</enum><header>Initial</header><text>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
an Internet website accessible to the public of each medical center of the
Department of
Veterans Affairs, the wait-time goals of the Department for the scheduling
of an appointment by a veteran for the receipt
of health care from the Department.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idFF35295B5AD94579BC9C87DDEAF29217"><enum>(B)</enum><header>Subsequent changes</header><clause commented="no" display-inline="no-display-inline" id="id5D4FB9BEB59C4B9C889D17C15646DDCA"><enum>(i)</enum><header>In general</header><text>If the Secretary modifies the wait-time goals described in subparagraph (A), the Secretary shall
publish the new wait-times goals—</text><subclause commented="no" display-inline="no-display-inline" id="id7E8DC16B6E8E47F8B5E15A09E92608E6"><enum>(I)</enum><text>on
an Internet website accessible to the public of each medical center of the
Department not later than 30 days after such modification; and</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id9BA45F6E1BC44BAB8028D4CE87487A89"><enum>(II)</enum><text>in the Federal Register not later than 90
days after such modification.</text></subclause></clause><clause commented="no" display-inline="no-display-inline" id="id4CCBC1431A1A42A3A597A3382A182424"><enum>(ii)</enum><header>Effective date</header><text>Any modification under clause (i) shall take effect on the date of publication in the Federal
Register.</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id98929BC372FE43D3AE993F7AF6F998C7"><enum>(C)</enum><header>Goals described</header><text>Wait-time goals published under this paragraph shall include goals for primary care appointments,
specialty care appointments, and appointments based on the
general severity of the condition of the veteran.</text></subparagraph></paragraph><paragraph id="idA9F84F8A7B8140DBA451DA5DD4269431"><enum>(2)</enum><header>Wait times at medical centers of the Department</header><text>Not later than one year after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall publish on
an Internet website accessible to the public of each medical center of the
Department the current wait time for an appointment for primary care and
specialty care at the medical
center.</text></paragraph></subsection><subsection id="id50CD3D26D8CB459789AD1052365CDFFC"><enum>(b)</enum><header>Publicly available database of patient safety, quality of care, and outcome measures</header><paragraph id="id790706F63AC94F56B34D50DF052FF537"><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="id40CD39CFC86948F9AE7FE6A19235EB35"><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="id600C08C2E41C444EA6A1BD82B1D7FC90"><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="id9DD76344E3F8491BB7945AED6E6D84C3"><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="id610B396424BC465499C2AEDD4FB56C47"><enum>(c)</enum><header>Hospital Compare website of Department of Health and Human Services</header><paragraph id="id23CECB26AB7848AA8AAC904DE4B34153"><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="id8743217BA85B446CB2AEFF02455DA66A"><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="id7342a113a6d34399a962ddd23a720f43"><enum>(A)</enum><text>Measures of timely and effective health care.</text></subparagraph><subparagraph id="id371a0609a7694e2b851d5f0d7ea25b24"><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="id42890a28799441f2aeb14fa175f97fa1"><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="id30496AB1B1D94277835B4A3776FA1062"><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 (42 U.S.C. 1395 et
seq.).</text></subparagraph></paragraph><paragraph id="id0e5af4ce999f4975a0de77ee6b8f36bf"><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, the Secretary of
Veterans Affairs shall publish a notice in the Federal Register 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="id4552193D09894F4AA2393BC2BA6505A9"><enum>(d)</enum><header>Comptroller General review of publicly available safety and quality metrics</header><text>Not later than three 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="id46F6E77275E14ED2856B954F3D40BACF"><enum>406.</enum><header>Information for veterans on the credentials of Department of Veterans Affairs physicians</header><subsection id="id990CF825C9254ED18DBACF8DAAE7D8BB"><enum>(a)</enum><header>Improvement of <quote>Our Providers</quote> Internet website links</header><paragraph id="id080872A4675C428184E41BC9A98178B0"><enum>(1)</enum><header>Availability through Department of Veterans Affairs homepage</header><text>A link to the <quote>Our Providers</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="id35E097E25F1147479173A33D4874BAD2"><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 Providers</quote> health care providers database of the Department, or any successor database, the location of
residency training of each
licensed physician of the Department.</text></paragraph><paragraph id="id3EE881B9B5D7488BB93BA8AD6D9F5A51"><enum>(3)</enum><header>Information on physicians at particular facilities</header><text>The <quote>Our Providers</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="id3B5314CA57FC48BBB4A15ECF834DDD54"><enum>(b)</enum><header>Information on credentials of physicians for veterans undergoing surgical procedures</header><paragraph id="idEE738732D99246D0AD39CF8157C15CE4"><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 on the credentials of
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="id64589A2812B8494AA961C1091B754D3E"><enum>(2)</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="idB5E4504B21A44243B5E09F51C651EBF5"><enum>(c)</enum><header>Comptroller General report and plan</header><paragraph id="id89ACE85018D14DAEB6D4E5C2D1967F74"><enum>(1)</enum><header>Report</header><text>Not later than two 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="id857EE59FE5F6467EBDC521BD7995A731"><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="id968D367127B043B18643BF9CDB4610B5"><enum>(B)</enum><text>The oversight by the Department of the contracts under the Patient-Centered Community Care
initiative.</text></subparagraph><subparagraph id="id312a81f663ac4b6b8da6aa0b8b0a622e"><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 301.</text></subparagraph></paragraph><paragraph id="id86E70DD706A04F8AA4B1E9913449E979"><enum>(2)</enum><header>Plan</header><subparagraph id="id31A440736BB34DA1870610F5F2C50B1D"><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—</text><clause id="id3BFF60F919C540FFB648962FD566F74B"><enum>(i)</enum><text>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; and</text></clause><clause id="id71EB55EE79B646BCBDB81298CF1CF9F1"><enum>(ii)</enum><text>submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a request for additional amounts, if any,
that may be necessary to carry out such plan.</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idC2DD2480D06643B997409D3927EA1CF2"><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="idBE4E829F22B2404CA66BB679CE36A9F0"><enum>407.</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="id2F369F7B2AA7410FA80E8562BE88D9FE"><enum>(1)</enum><text>The number of veterans who received hospital care and medical services under section 301
during
the fiscal year
preceding the fiscal year in which such budget is submitted.</text></paragraph><paragraph id="id460ECA5CA5D94FCC9DD42394D489173B"><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="idD26E68587E2B4C41A30E64371317FE97"><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="iddd516d94906c4e7f8a32fbb3b3e9cfc0"><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="id53543372882b4183a74dd8f0868665c4"><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="idFBBD3D01F492415987E4E73D8C1328C7"><enum>408.</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><section id="idB9051417F36D4533A382B03BD3C9AC85">
<enum>409.</enum>
<header>Removal of Senior Executive Service employees of the Department of Veterans Affairs for performance</header>
<subsection id="id552E12DC279A4E938961143ABE762D1D">
<enum>(a)</enum>
<header>Removal or transfer</header>
<paragraph id="idE8EFAB82E4034B67854D63898CA50776"><enum>(1)</enum><header>In general</header><text><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="HB1186D1EE916489E83C4B1B4B9E7B0F0" style="USC">
<section id="H3008F43E14D94C02A5584C029CD335D2">
<enum>713.</enum>
<header>Senior Executive Service: removal based on performance</header>
<subsection display-inline="no-display-inline" id="H2A2D2DFD3FE444658A4230E3675482FB">
<enum>(a)</enum>
<header>In general</header>
<text>The Secretary may remove any individual from the Senior
Executive Service if the Secretary determines the performance of the
individual warrants such removal. If the Secretary so removes such an
individual, the Secretary may—</text>
<paragraph id="HE080BF4AB0C345F5B619080CDEA13089">
<enum>(1)</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>
</paragraph><paragraph id="H8369896E6BAE4492949AB00464B83AA9">
<enum>(2)</enum>
<text>transfer the individual 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>
</paragraph></subsection><subsection id="HE09D5FDF93B2428FA8630F4A03FF912F">
<enum>(b)</enum>
<header>Notice to Congress</header>
<text>Not later than 30 days after removing or transferring an individual from the Senior Executive
Service 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 id="id1f4544f7885043d7847b3bc6b20828ba"><enum>(c)</enum><header>Procedure</header><paragraph commented="no" display-inline="yes-display-inline" id="id5EB1F39B11BA412E99C80A92300AC910"><enum>(1)</enum><text>The procedures under <external-xref legal-doc="usc" parsable-cite="usc/5/7543">section 7543</external-xref> of title 5 shall not apply to a removal or transfer under this
section.</text></paragraph><paragraph id="id702B0ECF00954446891D813EB09F4342" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idD83A9D5C63094B3BBCE23E97C560ADF1"><enum>(A)</enum><text>Subject to subparagraph (B), 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 id="id44E9995DADF2416A9C8743065B964625" indent="up1"><enum>(B)</enum><text>An appeal under subparagraph (A) of a removal or transfer may only be made if such appeal is made
not later than 7 days after the date of such removal or
transfer.</text></subparagraph></paragraph></subsection><subsection id="id2423595DEBA44D2AA66F98C222A85629"><enum>(d)</enum><header>Expedited review by Merit Systems Protection Board</header><paragraph commented="no" display-inline="yes-display-inline" id="id47395F958BA0405681335D9C21C31191"><enum>(1)</enum><text>The Merit Systems Protection Board shall expedite any appeal under <external-xref legal-doc="usc" parsable-cite="usc/5/7701">section 7701</external-xref> of title 5 of a
removal or transfer under subsection (a) and, in any such case, shall
issue a decision
not later than 21 days after the date of the appeal.</text></paragraph><paragraph id="id8374B01A9AF64FA2B10DCEAE5FE58A55" indent="up1"><enum>(2)</enum><text>In any case in which the Merit Systems Protection Board determines that it cannot issue a decision
in accordance with the 21-day requirement under paragraph (1), the Merit
Systems Protection Board shall submit to Congress a report that explains
the reason why the Merit Systems Protection Board is unable to issue a
decision in accordance with such requirement in such case.</text></paragraph><paragraph id="id6684A0B613AE468086BB2F6016E2CA12" indent="up1"><enum>(3)</enum><text>There is authorized to be appropriated such sums as may be necessary for the Merit Systems
Protection Board to expedite appeals under paragraph (1).</text></paragraph><paragraph id="idB42879F5245E4483BDC3E1B842B4BF3E" indent="up1"><enum>(4)</enum><text>The Merit Systems Protection Board may not stay any personnel action taken under this section.</text></paragraph><paragraph id="id0DBBAE9225F94F019C218D8DEF8EDC17" indent="up1"><enum>(5)</enum><text>A person who appeals under <external-xref legal-doc="usc" parsable-cite="usc/5/7701">section 7701</external-xref> of title 5 a removal under subsection (a)(1) may
not receive any pay, awards, bonuses, incentives, allowances,
differentials, student loan repayments, special payments, or benefits from
the Secretary until the
Merit Systems Protection Board has made a final decision on such appeal.</text></paragraph><paragraph id="id6038A7B358AD425FB6C263BBF6BF13DE" indent="up1"><enum>(6)</enum><text>A decision made by the Merit Systems Protection Board with respect to a removal or transfer under
subsection (a) shall not be subject to any further appeal.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HB6C8922F9C9745F5A286634A17636BED">
<enum>(2)</enum>
<header>Clerical amendment</header>
<text>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="HD71C2700F91F44FB95783586834A2A12" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="section">713. Senior Executive Service: removal based on performance.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="idA753AB597C0F40F2945778C6A7C1025C"><enum>(b)</enum><header>Establishment of expedited review process</header><paragraph id="idDFA773E6085C44F9A1E6BFD0895D0A0C"><enum>(1)</enum><header>In general</header><text>Not later than 30 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 id="id7A696D4D61ED4CC888576C3D143D6E80"><enum>(2)</enum><header>Inapplicability of certain regulations</header><text><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="id0EB01ADA78EF48DC999AF693DADE3CF5"><enum>(3)</enum><header>Report by Merit Systems Protection Board</header><text>Not later than 30 days after the date of the enactment of this Act, the Merit Systems Protection
Board shall submit to Congress 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 id="id4086CDD486E749509E1B650760019352"><enum>(c)</enum><header>Temporary exemption from certain limitation on initiation of removal from Senior Executive Service</header><text>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/38/713">section 713</external-xref> of title 38, United States Code,
as added by subsection (a), or <external-xref legal-doc="usc" parsable-cite="usc/5/7543">section 7543</external-xref> of title 5, United States
Code, may be initiated, notwithstanding <external-xref legal-doc="usc" parsable-cite="usc/5/3592">section 3592(b)</external-xref> of title 5, United
States Code, or any other provision of law.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="idAE9F18523F1343758C9D8B4A33229C91"><enum>(d)</enum><header>Construction</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>
</subsection></section>
<enum>V</enum>
<header>Health Care Related to Sexual Trauma</header>
<section id="id65C8AD353F394E44871AE4547C71C81D">
<enum>501.</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="id9644CB67D3464550B8385AC2775A8CC7">
<enum>502.</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="id379FE8D8E16C48ADA67E4872DD0BEB8A">
<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="id23477BDAE1214F7E9B6FFF5D20BA9C5B">
<enum>(1)</enum>
<text>by redesignating paragraph (2) as paragraph (3);</text>
</paragraph><paragraph id="id7CCE4863851A449A93CE8D82CE3AFE5F">
<enum>(2)</enum>
<text>by inserting after paragraph (1) the following new paragraph (2):</text>
<quoted-block display-inline="no-display-inline" id="id74BC7FD3BA4D49FF9102677F60CB79D0" style="OLC">
<paragraph id="id48B2AA141F224B919A01438F0435AA19" indent="up1">
<enum>(2)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="id03E1755E208D44B3929FBAB5BB3D5D7B"><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="idDB6537B13EE047D392F108A13B93692C" 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="id6B5039667F5F42A0831B50A4C6025D9E">
<enum>(3)</enum>
<text>in paragraph (3), as redesignated by paragraph (1)—</text>
<subparagraph id="idEA6982A8841D429E979648A872A9156B">
<enum>(A)</enum>
<text>by striking <quote>a veteran</quote> and inserting <quote>an individual</quote>; and</text>
</subparagraph><subparagraph id="idDCDD58842BF7473089ADE3DC948D07A1">
<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="idD48240CB1B9143C7B04A99D56C929ECD">
<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="id66CA0D03E7D448B2BD8034A3F6027CCF">
<enum>(1)</enum>
<text>by striking <quote>to veterans</quote> each place it appears; and</text>
</paragraph><paragraph id="idAFFDD5CF93E341718CE181AF459D9AC0">
<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="id4E7D2E599DF341A09F4261E451CF42AA">
<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="id75B080FAF99B47E1812D6C028A8DA283">
<enum>(1)</enum>
<text>in the matter preceding paragraph (1), by striking <quote>to veterans</quote>;</text>
</paragraph><paragraph id="id1A10AE56E75F43439F20ED61D9E69F42">
<enum>(2)</enum>
<text>in paragraph (2)—</text>
<subparagraph id="id3E45364BFBF74F45B9C0829945B5477A">
<enum>(A)</enum>
<text>by striking <quote>women veterans</quote> and inserting <quote>individuals</quote>; and</text>
</subparagraph><subparagraph id="id415839B622694369930B6C8314C6FD69">
<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="id1E13CB72FD794E2AB374E365E80C6703" style="OLC">
<subparagraph id="id857AA19C7E0249188D2EDC9DE5083F32">
<enum>(A)</enum>
<text>veterans;</text>
</subparagraph><subparagraph id="idA59DB2A245AD4E398C31CDE0A42ABECB">
<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="id975B33A20D584E429FEAD2829447D921">
<enum>(C)</enum>
<text>for each of subparagraphs (A) and (B)—</text>
<clause id="idF7D2DCD6C20B41159DFB11B1EF0271BD">
<enum>(i)</enum>
<text>men; and</text>
</clause><clause id="id7AE2C7394739462B8D3507EED79C8492">
<enum>(ii)</enum>
<text>women.</text>
</clause></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="idD51DC3DDD56F4BC2A6176139D53BE83F">
<enum>(3)</enum>
<text>in paragraph (4), by striking <quote>veterans</quote> and inserting <quote>individuals</quote>; and</text>
</paragraph><paragraph id="idB91323F29AEB44BFA0488BB80D514250">
<enum>(4)</enum>
<text>in paragraph (5)—</text>
<subparagraph id="idD054A00C08E0418B81A8CF8F8B775899">
<enum>(A)</enum>
<text>by striking <quote>women veterans</quote> and inserting <quote>individuals</quote> ; and</text>
</subparagraph><subparagraph id="idF4EB46B904164933A12E0A1C172E4F34">
<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="id660A89BBBA2247CB8F0DA5D992CB48A2">
<enum>(d)</enum>
<header>Effective date</header>
<text>The amendments made by this section shall take effect on the date that is one year after the date
of the enactment of this Act.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="idFB70DFC6ABED4FAEA48003B0A75E4CA3"><enum>503.</enum><header>Reports on military sexual trauma</header><subsection id="idA1516EA0A055455BA90634C06C74DFA6">
<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="id627A3B06980847CBBC81BA7CC87B43DD">
<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
five 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="idEC896E3A2CF74978B7A47FFBF307EDE7">
<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="id1490D28EEE6D48CD8C945926A23DADE5">
<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="id2EDE6ED9D0224DB4B70FC9DE8816FE03">
<enum>(c)</enum>
<header>Definitions</header>
<text>In this section:</text>
<paragraph id="id6C1BDA06D5A7412C8FFA23FBC4359892">
<enum>(1)</enum>
<header>Appropriate committees of congress</header>
<text>The term <term>appropriate committees of Congress</term> means—</text>
<subparagraph id="idDFEC58934262419197D7697D065D8CE6">
<enum>(A)</enum>
<text>the Committee on Veterans’ Affairs and the Committee on Armed Services of the Senate; and</text>
</subparagraph><subparagraph id="id1DD3AB86C1F641CDA7700A30DEAB8D17">
<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="id49E8CFE2CE2A43628AA48B704005F517">
<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 or active duty for training.</text>
</paragraph><paragraph id="id6781AEC8D92D4E7E84BE9962FA2C005D">
<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="id335DF9478406483E96891736B63D28C5">
<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="idCDC39F7A822B45219FA565456AC15AA9"><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>VI</enum>
<header>Major Medical Facility Leases</header>
<section id="H70CD4F9FB7F94C30A373510D629755E4">
<enum>601.</enum>
<header>Authorization of major medical facility leases</header>
<text display-inline="no-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="HFF370C873E1F43EC8BC40193F7E322FA">
<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="H2ABC8F142A4C4F7DB6579440DDCBFCAB">
<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="HD7C963AB9C92483185C3EE8881FDB372">
<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="H90A80C9114A44D148A499B6D7FF23DBB">
<enum>(4)</enum>
<text>For the Cobb County community-based Outpatient Clinic, Cobb County, Georgia, an amount not to
exceed $6,409,000.</text>
</paragraph><paragraph id="H6D75CDEBEE0B47DAAB4C3FECFB9CDF8D">
<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="H255B937CF1CC4E5F9AFC6BD4D0721CD4">
<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="H7D4B99FEED0047D0BD3394CA70DA8BF1">
<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="H43751530A0784F7980AD5EDD2743AE8E">
<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="H27CF493A25AE42DD83E0E59692612F72">
<enum>(9)</enum>
<text>For outpatient clinic consolidation, New Port Richey, Florida, an amount not to exceed $11,927,000.</text>
</paragraph><paragraph id="HA8FBC79A2245451093E50AF4FAE6EC9E">
<enum>(10)</enum>
<text>For an outpatient clinic, Ponce, Puerto Rico, an amount not to exceed $11,535,000.</text>
</paragraph><paragraph id="H17C78ADD6577488C97F955212EEB6B93">
<enum>(11)</enum>
<text>For lease consolidation, San Antonio, Texas, an amount not to exceed $19,426,000.</text>
</paragraph><paragraph id="HF95A0A1089D6486DBD807FAC3E4C6476">
<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="HD5693F9186414798AF6CA473E6129488">
<enum>(13)</enum>
<text>For an outpatient clinic, Tyler, Texas, an amount not to exceed $4,327,000.</text>
</paragraph><paragraph id="H968AED4F1F60450DB4A67619D1F30472">
<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="H5AB4D60B8BF842BBB2575CF4F51B2C56">
<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="HED0EC9721D9049D3B44372FFCA243FA8">
<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="HCA73DF651D014A9BA27A3F74EACDF6A4">
<enum>(17)</enum>
<text>For a multispecialty clinic, Chattanooga, Tennessee, an amount not to exceed $7,069,000.</text>
</paragraph><paragraph id="H448BAAE0E6A04FC59415F88DC00F1353">
<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="H78478DE94E9A4AA090428164C4534E7E">
<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="H5F14DCD27FC9412CB358E90155D6E37D">
<enum>(20)</enum>
<text>For a new research lease, Hines, Illinois, an amount not to exceed $22,032,000.</text>
</paragraph><paragraph id="HDFD7ABCB2AED4E89B69B9F6D11930D8F">
<enum>(21)</enum>
<text>For a replacement research lease, Houston, Texas, an amount not to exceed $6,142,000.</text>
</paragraph><paragraph id="HE42C28C04764492CBC1ECFB4C0D96298">
<enum>(22)</enum>
<text>For a community-based outpatient clinic, Lincoln, Nebraska, an amount not to exceed $7,178,400.</text>
</paragraph><paragraph id="H033992D19C3340DC8074A8F8A33BA683">
<enum>(23)</enum>
<text>For a community-based outpatient clinic, Lubbock, Texas, an amount not to exceed $8,554,000.</text>
</paragraph><paragraph id="HCC2BBB361F824D6DB2722FE465157D94">
<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="H8C503A2EAAA74DA184778B1F6A189C61">
<enum>(25)</enum>
<text>For a community-based outpatient clinic, Phoenix, Arizona, an amount not to exceed $20,757,000.</text>
</paragraph><paragraph id="H36094DD15F0747209A35D143FD1C62CF">
<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></section><section id="H8C65AB4E60374435A2FC4D7CCAEC0A2D">
<enum>602.</enum>
<header>Budgetary treatment of Department of Veterans Affairs major medical facilities leases</header>
<subsection id="H08FF7AC375114907ABE7189A045C266D">
<enum>(a)</enum>
<header>Findings</header>
<text>Congress finds the following:</text>
<paragraph id="HC4E0F08BBFE7417694304255D0741011">
<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="HD92D5E1DF18C40DA986A493D8311260C">
<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="H0FF5402F8C6E4036AB2B9888B5CE06D5">
<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="H4D9AB046B35943238966A7AB7674ABEF">
<enum>(b)</enum>
<header>Requirement for obligation of full cost</header>
<paragraph id="idE5DE99CDB76F430C9C8D12C2FBC6EA02"><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="H880B5F8B723143BEB5B261B53A20576F">
<enum>(A)</enum>
<text>an amount equal to total payments under the full term of the lease; or</text>
</subparagraph><subparagraph id="HE1967F9C9B5A4C9886B1109BCD7644D4">
<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 id="id6BAEE38AF8EA4061AC818EAB19DAEAB3"><enum>(2)</enum><header>Self-insuring authority</header><text>The requirements of paragraph (1) may be satisfied through the use of a self-insuring authority
consistent with Office of Management and Budget Circular A–11.</text></paragraph></subsection><subsection id="HB026F80B9ECF46889610930F87ED40B5">
<enum>(c)</enum>
<header>Transparency</header>
<paragraph id="HEE55C5A6F4F24320B44B67C0C4191DCC">
<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="H94CF07D9C69641F89952B6649C679E36" style="OLC">
<paragraph id="H0F7822D7F9DE4B44AEF9B432E28BE79A">
<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="H95601E44261242E2A6E9433BC203D6A7">
<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="H95C4964309B745DDAE7C7B106BDF9470">
<enum>(B)</enum>
<text>an analysis of the obligation of budgetary resources associated with the lease; and</text>
</subparagraph><subparagraph id="HAEFF2E465296438286BEFCB7A02E2E4B">
<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="H47485FE558D1467EA9C78D00BBF08BD8">
<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="HD0FFA55A52CD4755A27498BAA11B414B" style="OLC">
<subsection id="H493963BDCB09441193F72EF0FA83DC84">
<enum>(h)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="H87439FBF41B344BA8ADCD4F72DF0A127"><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="H45DC397BAB494CD7942BE923F3D68452" indent="up1">
<enum>(A)</enum>
<text>notice of the Secretary’s intention to enter into the lease;</text>
</subparagraph><subparagraph id="H5663F934A904485491E032C47CE8ABAB" indent="up1">
<enum>(B)</enum>
<text>a detailed summary of the proposed lease;</text>
</subparagraph><subparagraph id="H5810C32AC8AB481EA822A796246866D1" 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="H7439104A12C54467AA3259C017917CD3" 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="H440EAE1B977C41AE856571677AAB219C" 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="H6A68100E838447319788A2FDA722EED6" 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="HDB84537B5D8942418E23F4EC6D686F13">
<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>Veterans Benefits Matters</header><section id="idEFC02D645D7B49EA9A77CBD3D6DFD7B0">
<enum>701.</enum>
<header>Expansion of Marine Gunnery Sergeant John David Fry Scholarship</header>
<subsection id="id3071D96EE64B489CBEFCDB99A209EE13">
<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="id97098BF767904F3F8A162A460FC0471D">
<enum>(b)</enum>
<header>Limitation and election on certain benefits</header>
<text>Subsection (f) of such section is amended—</text>
<paragraph id="id37603DBA56F64A71A9FF1DBD622E1485">
<enum>(1)</enum>
<text>by redesignating paragraph (2) as paragraph (4); and</text>
</paragraph><paragraph id="idD84AFFA5340D469CB103F18B51863299">
<enum>(2)</enum>
<text>by inserting after paragraph (1) the following new paragraphs:</text>
<quoted-block display-inline="no-display-inline" id="id43435579A08D41DB92A7FD258F283F2C" style="OLC">
<paragraph id="id94C130353AAB4362AA0D25F52D449060">
<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="id8CEE4EC8B0D6412082AA8EC5F36F2F43">
<enum>(A)</enum>
<text>the date that is 15 years after the date on which the person died; and</text>
</subparagraph><subparagraph id="idAB2AE1130688497E9E20540AC5E974BC">
<enum>(B)</enum>
<text>the date on which the individual remarries.</text>
</subparagraph></paragraph><paragraph id="id0468681E4BBB40A0AFD9146DDFC6E5B2">
<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="id6b639f4b9d5147f5b15ea9567d2c6ad6">
<enum>(c)</enum>
<header>Conforming amendment</header>
<text>Section 3321(b)(4) of such title is amended—</text>
<paragraph id="id45F1FA22F840475C95E625374E1F7B17">
<enum>(1)</enum>
<text>by striking <quote>an individual</quote> and inserting <quote>a child</quote>; and</text>
</paragraph><paragraph id="idF6B0F214BBEB400495DB6984D0D5D304">
<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></section><section id="id2B1208546B2D447D8036BEE59E8B98CC">
<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="ida43bed06-7d7e-43ad-a9ac-91e44290a92b">
<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="id8fa039ab-5a58-4b43-b5d8-6a0b0e617c25" style="USC">
<subsection id="id1a96d044-499e-4845-ae6f-3dd0e6644459">
<enum>(c)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="id0e580d9d-8055-4f93-afe4-04268e20f8da"><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="idd83b5276-4c79-433e-b4cb-02af945470cc" indent="up1">
<enum>(2)</enum>
<text>For purposes of this subsection, a covered individual is any individual as follows:</text>
<subparagraph id="idfa0ae80c-97f4-43f3-8492-b2647b0b69b1">
<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="idb81fda3a-a20c-4cba-8a85-d0e31f393fb0">
<enum>(B)</enum>
<text>An individual who is entitled to assistance under section 3311(b)(9) or 3319 of this title by
virtue of such individual's relationship to a veteran described in
subparagraph (A).</text>
</subparagraph></paragraph><paragraph id="id3F1C2BC077994A0F891B8C480BEE97ED" 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="id521e0f17-ec2f-4ea1-b6bb-3e5d972a7d24" 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="iddb30fa98-7072-4200-909e-ad27eeb0871e" indent="up1">
<enum>(5)</enum>
<text>The Secretary may waive such requirements of paragraph (1) as the Secretary considers appropriate.</text>
</paragraph><paragraph id="idd05c439d-5f2e-4b64-bd81-8d82125afb8f" 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="id81fa8c4e-447f-4d34-8792-0911afa278dc"><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 programs of education during academic terms that begin after
July 1, 2015, through courses of education that commence on or after that
date.</text></subsection></section><enum>VIII</enum><header>Appropriation and Emergency Designations</header><section commented="no" display-inline="no-display-inline" id="id235709e566fd4d78a81882e3e3745b35" section-type="subsequent-section"><enum>801.</enum><header display-inline="yes-display-inline">Appropriation of emergency amounts</header><text display-inline="no-display-inline">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, for fiscal
years 2014, 2015, and 2016, such sums as
may be necessary to carry out this Act.</text></section><section id="id61AE1671567E4BF8B667A104782DECE0"><enum>802.</enum><header>Emergency designations</header><subsection id="id2EE02956079D47309E778F7367287A6B"><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="id1bbf541770b342538ff4d92c699fe58f"><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>
June 10, 2014Read the second time and placed on the calendar