<num style="-uslm-dtd:enum" value="I">TITLE I—</num><heading style="-uslm-dtd:header">CARING FOR OUR VETERANS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/s100" styleType="OLC"> <num style="-uslm-dtd:enum" value="100">SEC. 100. </num><heading style="-uslm-dtd:header">SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES CODE. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/s100/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s101">38 U.S.C. 101 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Short Title.—</heading><content style="-uslm-dtd:text">This title may be cited as the “<shortTitle style="-uslm-dtd:quote">Caring for Our Veterans Act of 2018</shortTitle>”.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/s100/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">References to Title 38, United States Code.—</heading><content style="-uslm-dtd:text">Except as otherwise expressly provided, whenever in this title an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of title 38, United States Code.</content> </subsection> </section> <subtitle style="-uslm-dtd:subtitle" identifier="/us/sComp/115/182/tI/stA" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">Subtitle A—</num><heading style="-uslm-dtd:header">Developing an Integrated High-Performing Network </heading> <chapter style="-uslm-dtd:chapter" identifier="/us/sComp/115/182/tI/stA/ch1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">CHAPTER 1—</num><heading style="-uslm-dtd:header">ESTABLISHING COMMUNITY CARE PROGRAMS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s101" styleType="OLC"> <num style="-uslm-dtd:enum" value="101">SEC. 101. </num><heading style="-uslm-dtd:header">ESTABLISHMENT OF VETERANS COMMUNITY CARE PROGRAM. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s101/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment of Program.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Section 1703 is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703">“SEC. 1703. </num><heading style="-uslm-dtd:header">Veterans Community Care Program </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">There is established a program to furnish hospital care, medical services, and extended care services to covered veterans through health care providers specified in subsection (c).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary shall coordinate the furnishing of hospital care, medical services, and extended care services under this section to covered veterans, including coordination of, at a minimum, the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">Ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-Department providers.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Ensuring continuity of care and services.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">Ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">Ensuring that covered veterans do not experience a lapse in care resulting from errors or delays by the Department or its contractors or an unusual or excessive burden in accessing hospital care, medical services, or extended care services.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">A covered veteran may only receive care or services under this section upon the authorization of such care or services by the Secretary.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Covered Veterans.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, a covered veteran is any veteran who—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">is enrolled in the system of annual patient enrollment established and operated under section 1705 of this title; or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">is not enrolled in such system but is otherwise entitled to hospital care, medical services, or extended care services under subsection (c)(2) of such section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Health Care Providers Specified.—</heading><chapeau style="-uslm-dtd:text">Health care providers specified in this subsection are the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd: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.), including any physician furnishing services under such a program.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Department of Defense.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The Indian Health Service.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">Any health care provider not otherwise covered under any of paragraphs (1) through (4) that meets criteria established by the Secretary for purposes of this section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Conditions Under Which Care Is Required To Be Furnished Through Non-Department Providers.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The Secretary shall, subject to the availability of appropriations, furnish hospital care, medical services, and extended care services to a covered veteran through health care providers specified in subsection (c) if—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the Department does not offer the care or services the veteran requires;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Department does not operate a full-service medical facility in the State in which the covered veteran resides;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">the covered veteran was an eligible veteran under section 101(b)(2)(B) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) as of the day before the date of the enactment of the Caring for Our Veterans Act of 2018;</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">continues to reside in a location that would qualify the veteran for eligibility under such section; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><chapeau style="-uslm-dtd:text">either—</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">resides in one of the five States with the lowest population density as determined by data from the 2010 decennial census; or</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="II">“(II) </num><chapeau style="-uslm-dtd:text">resides in a State not described in subclause (I) and—</chapeau> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="aa">“(aa) </num><content style="-uslm-dtd:text">received care or services under this title in the year preceding the enactment of the Caring for Our Veterans Act of 2018; and</content> </item> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="bb">“(bb) </num><content style="-uslm-dtd:text">is seeking care or services within 2 years of the date of the enactment of the Caring for Our Veterans Act of 2018;</content> </item> </subclause> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">the covered veteran has contacted the Department to request care or services and the Department is not able to furnish such care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">the covered veteran and the covered veteran’s referring clinician agree that furnishing care and services through a non-Department entity or provider would be in the best medical interest of the covered veteran based upon criteria developed by the Secretary.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary shall ensure that the criteria developed under paragraph (1)(E) include consideration of the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">The distance between the covered veteran and the facility that provides the hospital care, medical services, or extended care services the veteran needs.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The nature of the hospital care, medical services, or extended care services required.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">The frequency that the hospital care, medical services, or extended care services needs to be furnished.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">The timeliness of available appointments for the hospital care, medical services, or extended care services the veteran needs.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><chapeau style="-uslm-dtd:text">Whether the covered veteran faces an unusual or excessive burden to access hospital care, medical services, or extended care services from the Department medical facility where a covered veteran seeks hospital care, medical services, or extended care services, which shall include consideration of the following:</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">Whether the covered veteran faces an excessive driving distance, geographical challenge, or environmental factor that impedes the access of the covered veteran.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">Whether the hospital care, medical services, or extended care services sought by the veteran is provided by a medical facility of the Department that is reasonably accessible to a covered veteran.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">Whether a medical condition of the covered veteran affects the ability of the covered veteran to travel.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iv">“(iv) </num><content style="-uslm-dtd:text">Whether there is compelling reason, as determined by the Secretary, that the veteran needs to receive hospital care, medical services, or extended care services from a medical facility other than a medical facility of the Department.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="v">“(v) </num><content style="-uslm-dtd:text">Such other considerations as the Secretary considers appropriate.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">If the Secretary has determined that the Department does not offer the care or services the covered veteran requires under subparagraph (A) of paragraph (1), that the Department does not operate a full-service medical facility in the State in which the covered veteran resides under subparagraph (B) of such paragraph, that the covered veteran is described under subparagraph (C) of such paragraph, or that the Department is not able to furnish care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title under subparagraph (D) of such paragraph, the decision to receive hospital care, medical services, or extended care services under such subparagraphs from a health care provider specified in subsection (c) shall be at the election of the veteran.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Conditions Under Which Care Is Authorized To Be Furnished Through Non-Department Providers.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary may furnish hospital care, medical services, or extended care services through a health care provider specified in subsection (c) to a covered veteran served by a medical service line of the Department that the Secretary has determined is not providing care that complies with the standards for quality the Secretary shall establish under section 1703C.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">In carrying out subparagraph (A), the Secretary shall—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">measure timeliness of the medical service line at a facility of the Department when compared with the same medical service line at different Department facilities; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">measure quality at a medical service line of a facility of the Department by comparing it with two or more distinct and appropriate quality measures at non-Department medical service lines.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than three medical service lines described in such subparagraph at any one health care facility of the Department.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than 36 medical service lines nationally described in such subparagraph.</content> </clause> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary may limit the types of hospital care, medical services, or extended care services covered veterans may receive under paragraph (1) in terms of the length of time such care and services will be available, the location at which such care and services will be available, and the clinical care and services that will be available.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Except as provided for in subparagraph (B), the hospital care, medical services, and extended care services authorized under paragraph (1) with respect to a medical service line shall cease when the remediation described in section 1706A with respect to such medical service line is complete.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The Secretary shall ensure continuity and coordination of care for any veteran who elects to receive care or services under paragraph (1) from a health care provider specified in subsection (c) through the completion of an episode of care.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">The Secretary shall publish in the Federal Register, and shall take all reasonable steps to provide direct notice to covered veterans affected under this subsection, at least once each year stating the time period during which such care and services will be available, the location or locations where such care and services will be available, and the clinical services available at each location under this subsection in accordance with regulations the Secretary shall prescribe.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">When the Secretary exercises the authority under paragraph (1), the decision to receive care or services under such paragraph from a health care provider specified in subsection (c) shall be at the election of the covered veteran.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">Review of Decisions.—</heading><content style="-uslm-dtd:text">The review of any decision under subsection (d) or (e) shall be subject to the Department’s clinical appeals process, and such decisions may not be appealed to the Board of Veterans’ Appeals.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><heading style="-uslm-dtd:header">Tiered Network.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">To promote the provision of high-quality and high-value hospital care, medical services, and extended care services under this section, the Secretary may develop a tiered provider network of eligible providers based on criteria established by the Secretary for purposes of this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">In developing a tiered provider network of eligible providers under paragraph (1), the Secretary shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in selecting a health care provider specified in subsection (c) for receipt of hospital care, medical services, or extended care services under this section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h) </num><heading style="-uslm-dtd:header">Contracts To Establish Networks of Health Care Providers.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall enter into consolidated, competitively bid contracts to establish networks of health care providers specified in paragraphs (1) and (5) of subsection (c) for purposes of providing sufficient access to hospital care, medical services, or extended care services under this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary shall, to the extent practicable, ensure that covered veterans are able to make their own appointments using advanced technology.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">To the extent practicable, the Secretary shall be responsible for the scheduling of appointments for hospital care, medical services, and extended care services under this section.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">The Secretary may terminate a contract with an entity entered into under paragraph (1) at such time and upon such notice to the entity as the Secretary may specify for purposes of this section, if the Secretary notifies the appropriate committees of Congress that, at a minimum—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><chapeau style="-uslm-dtd:text">the entity—</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section;</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">failed to comply with the access standards or the standards for quality established by the Secretary;</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="III">“(III) </num><content style="-uslm-dtd:text">is excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a-7 and 1320a-7a);</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="IV">“(IV) </num><content style="-uslm-dtd:text">is identified as an excluded source on the list maintained in the System for Award Management, or any successor system; or</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="V">“(V) </num><content style="-uslm-dtd:text">has been convicted of a felony or other serious offense under Federal or State law and the continued participation of the entity would be detrimental to the best interests of veterans or the Department;</content> </subclause> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">it is reasonable to terminate the contract based on the health care needs of veterans; or</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">it is reasonable to terminate the contract based on coverage provided by contracts or sharing agreements entered into under authorities other than this section.</content> </clause></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Nothing in subparagraph (A) may be construed to restrict the authority of the Secretary to terminate a contract entered into under paragraph (1) under any other provision of law.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><chapeau style="-uslm-dtd:text">Whenever the Secretary provides notice to an entity that the entity is failing to meet contractual obligations entered into under paragraph (1), 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 such failure. Such report shall include the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">An explanation of the reasons for providing such notice.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">A description of the effect of such failure, including with respect to cost, schedule, and requirements.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">A description of the actions taken by the Secretary to mitigate such failure.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">A description of the actions taken by the contractor to address such failure.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">A description of any effect on the community provider market for veterans in the affected area.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary shall instruct each entity awarded a contract under paragraph (1) to recognize and accept, on an interim basis, the credentials and qualifications of health care providers who are authorized to furnish hospital care and medical services to veterans under a community care program of the Department in effect as of the day before the date of the enactment of the Caring for Our Veterans Act of 2018, including under the Patient-Centered Community Care Program and the Veterans Choice Program under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note), as qualified providers under the program established under this section.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">The interim acceptance period under subparagraph (A) shall be determined by the Secretary based on the following criteria:</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">With respect to a health care provider, when the current certification agreement for the health care provider expires.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">Whether the Department has enacted certification and eligibility criteria and regulatory procedures by which non-Department providers will be authorized under this section.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="6">“(6) </num><content style="-uslm-dtd:text">The Secretary shall establish a system or systems for monitoring the quality of care provided to covered veterans through a network under this subsection and for assessing the quality of hospital care, medical services, and extended care services furnished through such network before the renewal of the contract for such network.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i) </num><heading style="-uslm-dtd:header">Payment Rates for Care and Services.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Except as provided in paragraph (2), and to the extent practicable, the rate paid for hospital care, medical services, or extended care services under any provision in this title may not exceed the rate paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (42 U.S.C. 1395x(u))) or a supplier (as defined in section 1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare program under title XI or title XVIII of the Social Security Act (42 U.S.C. 1301 et seq.), including section 1834 of such Act (42 U.S.C. 1395m), for the same care or services.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">A higher rate than the rate paid by the United States as described in paragraph (1) may be negotiated with respect to the furnishing of care or services to a covered veteran who resides in a highly rural area.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">In this paragraph, the term ‘<quotedText style="-uslm-dtd:quote">highly rural area</quotedText>’ means an area located in a county that has fewer than seven individuals residing in that county per square mile.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs shall be followed, except for when another payment agreement, including a contract or provider agreement, is in effect.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">With respect to furnishing hospital care, medical services, or extended care services under this section in a State with an All-Payer Model Agreement under section 1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3)) that became effective on or after January 1, 2014, the Medicare payment rates under paragraph (2)(A) shall be calculated based on the payment rates under such agreement.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">Notwithstanding paragraph (1), the Secretary may incorporate, to the extent practicable, the use of value-based reimbursement models to promote the provision of high-quality care.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="6">“(6) </num><content style="-uslm-dtd:text">With respect to hospital care, medical services, or extended care services for which there is not a rate paid under the Medicare program as described in paragraph (1), the rate paid for such care or services shall be determined by the Secretary.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="j">“(j) </num><heading style="-uslm-dtd:header">Treatment of Other Health Plan Contracts.—</heading><content style="-uslm-dtd:text">In any case in which a covered veteran is furnished hospital care, medical services, or extended care services under this section for a non-service-connected disability described in subsection (a)(2) of section 1729 of this title, the Secretary shall recover or collect reasonable charges for such care or services from a health plan contract described in section 1729 in accordance with such section.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="k">“(k) </num><heading style="-uslm-dtd:header">Payment by Veteran.—</heading><content style="-uslm-dtd:text">A covered veteran shall not pay a greater amount for receiving care or services under this section than the amount the veteran would pay for receiving the same or comparable care or services at a medical facility of the Department or from a health care provider of the Department.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="l">“(l) </num><heading style="-uslm-dtd:header">Transplant Authority for Improved Access.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">In the case of a covered veteran described in paragraph (2), the Secretary shall determine whether to authorize an organ or bone marrow transplant for that covered veteran at a non-Department facility.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">A covered veteran described in this paragraph—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">requires an organ or bone marrow transplant; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">has, in the opinion of the primary care provider of the veteran, a medically compelling reason to travel outside the region of the Organ Procurement and Transplantation Network, established under section 372 of the National Organ Transplantation Act (Public Law 98-507; 42 U.S.C. 274), in which the veteran resides, to receive such transplant.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="m">“(m) </num><heading style="-uslm-dtd:header">Monitoring of Care Provided.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018, and not less frequently than annually thereafter, the Secretary shall submit to appropriate committees of Congress a review of the types and frequency of care sought under subsection (d).</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">The review submitted under subparagraph (A) shall include an assessment of the following:</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">The top 25 percent of types of care and services most frequently provided under subsection (d) due to the Department not offering such care and services.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">The frequency such care and services were sought by covered veterans under this section.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">An analysis of the reasons the Department was unable to provide such care and services.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iv">“(iv) </num><content style="-uslm-dtd:text">Any steps the Department took to provide such care and services at a medical facility of the Department.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="v">“(v) </num><content style="-uslm-dtd:text">The cost of such care and services.</content> </clause> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">In monitoring the hospital care, medical services, and extended care services furnished under this section, the Secretary shall do the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><chapeau style="-uslm-dtd:text">With respect to hospital care, medical services, and extended care services furnished through provider networks established under subsection (i)—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">compile data on the types of hospital care, medical services, and extended care services furnished through such networks and how many patients used each type of care and service;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">identify gaps in hospital care, medical services, or extended care services furnished through such networks;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">identify how such gaps may be fixed through new contracts within such networks or changes in the manner in which hospital care, medical services, or extended care services are furnished through such networks;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iv">“(iv) </num><content style="-uslm-dtd:text">assess the total amounts spent by the Department on hospital care, medical services, and extended care services furnished through such networks;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="v">“(v) </num><content style="-uslm-dtd:text">assess the timeliness of the Department in referring hospital care, medical services, and extended care services to such networks; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="vi">“(vi) </num><chapeau style="-uslm-dtd:text">assess the timeliness of such networks in—</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">accepting referrals; and</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">scheduling and completing appointments.</content> </subclause> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Report the number of medical service lines the Secretary has determined under subsection (e)(1) not to be providing hospital care, medical services, or extended care services that comply with the standards for quality established by the Secretary.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">Assess the use of academic affiliates and centers of excellence of the Department to furnish hospital care, medical services, and extended care services to covered veterans under this section.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">Assess the hospital care, medical services, and extended care services furnished to covered veterans under this section by medical facilities operated by Federal agencies other than the Department.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018 and not less frequently than once each year thereafter, 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 information gathered under paragraph (2).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="n">“(n) </num><heading style="-uslm-dtd:header">Prohibition on Certain Limitations.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall not limit the types of hospital care, medical services, or extended care services covered veterans may receive under this section if it is in the best medical interest of the veteran to receive such hospital care, medical services, or extended care services, as determined by the veteran and the veteran’s health care provider.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">No provision in this section may be construed to alter or modify any other provision of law establishing specific eligibility criteria for certain hospital care, medical services, or extended care services.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="o">“(o) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><chapeau style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">medical service line</quotedText>’ means a clinic within a Department medical center.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 17is amended by striking the item relating to section 1703 and inserting the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703.</designator><label> Veterans Community Care Program.”</label></referenceItem> </toc></quotedContent>.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s101/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703">38 U.S.C. 1703 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Effective Date.—</heading><chapeau style="-uslm-dtd:text">Section 1703 of title 38, United States Code, as amended by subsection (a), shall take effect on the later of—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">the date that is 30 days after the date on which the Secretary of Veterans Affairs submits the report required under section 101(q)(2) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note); or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">the date on which the Secretary promulgates regulations pursuant to subsection (c).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Regulations.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall promulgate regulations to carry out section 1703 of title 38, United States Code, as amended by subsection (a) of this section.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Updates.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">Periodic.—</heading><content style="-uslm-dtd:text">Before promulgating the regulations required under paragraph (1), the Secretary shall provide to the appropriate committees of Congress periodic updates to confirm the progress of the Secretary toward developing such regulations.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">First update.—</heading><content style="-uslm-dtd:text">The first update under subparagraph (A) shall occur no later than 120 days from the date of the enactment of this Act.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><heading style="-uslm-dtd:header">Appropriate committees of congress defined.—</heading><chapeau style="-uslm-dtd:text">In this paragraph, the term “<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>” means—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2/C/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2/C/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s101/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Continuity of Existing Agreements.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Notwithstanding section 1703 of title 38, United States Code, as amended by subsection (a), the Secretary of Veterans Affairs shall continue all contracts, memorandums of understanding, memorandums of agreements, and other arrangements that were in effect on the day before the date of the enactment of this Act between the Department of Veterans Affairs and the American Indian and Alaska Native health care systems as established under the terms of the Department of Veterans Affairs and Indian Health Service Memorandum of Understanding, signed October 1, 2010, the National Reimbursement Agreement, signed December 5, 2012, arrangements under section 405 of the Indian Health Care Improvement Act (25 U.S.C. 1645), and agreements entered into under sections 102 and 103 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Modifications.—</heading><content style="-uslm-dtd:text">Paragraph (1) shall not be construed to prohibit the Secretary and the parties to the contracts, memorandums of understanding, memorandums of agreements, and other arrangements described in such paragraph from making such changes to such contracts, memorandums of understanding, memorandums of agreements, and other arrangements as may be otherwise authorized pursuant to other provisions of law or the terms of the contracts, memorandums of understanding, memorandums of agreements, and other arrangements.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s102" styleType="OLC"> <num style="-uslm-dtd:enum" value="102">SEC. 102. </num><heading style="-uslm-dtd:header">AUTHORIZATION OF AGREEMENTS BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND NON-DEPARTMENT PROVIDERS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s102/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 17 is amended by inserting after section 1703 the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703A">“SEC. 1703A. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703A">38 U.S.C. 1703A</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Agreements with eligible entities or providers; certification processes </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">Agreements Authorized.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">When hospital care, a medical service, or an extended care service required by a veteran who is entitled to such care or service under this chapter is not feasibly available to the veteran from a facility of the Department or through a contract or sharing agreement entered into pursuant to another provision of law, the Secretary may furnish such care or service to such veteran through an agreement under this section with an eligible entity or provider to provide such hospital care, medical service, or extended care service.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">An agreement entered into under this section to provide hospital care, a medical service, or an extended care service shall be known as a ‘<quotedText style="-uslm-dtd:quote">Veterans Care Agreement</quotedText>’.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">For purposes of subparagraph (A), hospital care, a medical service, or an extended care service may be considered not feasibly available to a veteran from a facility of the Department or through a contract or sharing agreement described in such subparagraph when the Secretary determines the veteran’s medical condition, the travel involved, the nature of the care or services required, or a combination of these factors make the use of a facility of the Department or a contract or sharing agreement described in such subparagraph impracticable or inadvisable.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">A Veterans Care Agreement may be entered into by the Secretary or any Department official authorized by the Secretary.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Subject to subparagraph (B), the Secretary shall review each Veterans Care Agreement of material size, as determined by the Secretary or set forth in paragraph (3), for hospital care, a medical service, or an extended care service to determine whether it is feasible and advisable to provide such care or service within a facility of the Department or by contract or sharing agreement entered into pursuant to another provision of law and, if so, take action to do so.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">The Secretary shall review each Veterans Care Agreement of material size that has been in effect for at least 6 months within the first 2 years of its taking effect, and not less frequently than once every 4 years thereafter.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">If a Veterans Care Agreement has not been in effect for at least 6 months by the date of the review required by subparagraph (A), the agreement shall be reviewed during the next cycle required by subparagraph (A), and such review shall serve as its review within the first 2 years of its taking effect for purposes of clause (i).</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">In fiscal year 2019 and in each fiscal year thereafter, in addition to such other Veterans Care Agreements as the Secretary may determine are of material size, a Veterans Care Agreement for the purchase of extended care services that exceeds $5,000,000 annually shall be considered of material size.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">From time to time, the Secretary may publish a notice in the Federal Register to adjust the dollar amount specified in subparagraph (A) to account for changes in the cost of health care based upon recognized health care market surveys and other available data.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Eligible Entities and Providers.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, an eligible entity or provider is—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">any provider of services that has enrolled and entered into a provider agreement under section 1866(a) of the Social Security Act (42 U.S.C. 1395cc(a)) and any physician or other supplier who has enrolled and entered into a participation agreement under section 1842(h) of such Act (42 U.S.C. 1395u(h));</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">any provider participating under a State plan under title XIX of such Act (42 U.S.C. 1396 et seq.);</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">an Aging and Disability Resource Center, an area agency on aging, or a State agency (as defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002));</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)); or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">any entity or provider not described in paragraph (1) or (2) of this subsection that the Secretary determines to be eligible pursuant to the certification process described in subsection (c).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Eligible Entity or Provider Certification Process.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall establish by regulation a process for the certification of eligible entities or providers or recertification of eligible entities or providers under this section. Such a process shall, at a minimum—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">establish deadlines for actions on applications for certification;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">set forth standards for an approval or denial of certification, duration of certification, revocation of an eligible entity or provider’s certification, and recertification of eligible entities or providers;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">require the denial of certification if the Secretary determines the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act (42 U.S.C. 1320a-7 or 1320a-7a) or is currently identified as an excluded source on the System for Award Management Exclusions list described in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">establish procedures for screening eligible entities or providers according to the risk of fraud, waste, and abuse that are similar to the standards under section 1866(j)(2)(B) of the Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 of title 48, Code of Federal Regulations, or successor regulations; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">incorporate and apply the restrictions and penalties set forth in chapter 21 of title 41 and treat this section as a procurement program only for purposes of applying such provisions.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Rates.—</heading><content style="-uslm-dtd:text">To the extent practicable, the rates paid by the Secretary for hospital care, medical services, and extended care services provided under a Veterans Care Agreement shall be in accordance with the rates paid by the United States under section 1703(i) of this title.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Terms of Veterans Care Agreements.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Pursuant to regulations promulgated under subsection (k), the Secretary may define the requirements for providers and entities entering into agreements under this section based upon such factors as the number of patients receiving care or services, the number of employees employed by the entity or provider furnishing such care or services, the amount paid by the Secretary to the provider or entity, or other factors as determined by the Secretary.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">To furnish hospital care, medical services, or extended care services under this section, an eligible entity or provider shall agree—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">to accept payment at the rates established in regulations prescribed under this section;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">that payment by the Secretary under this section on behalf of a veteran to a provider of services or care shall, unless rejected and refunded by the provider within 30 days of receipt, constitute payment in full and extinguish any liability on the part of the veteran for the treatment or care provided, and no provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate this requirement;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">to provide only the care and services authorized by the Department under this section and to obtain the prior written consent of the Department to furnish care or services outside the scope of such authorization;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">to bill the Department in accordance with the methodology outlined in regulations prescribed under this section;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">to not seek to recover or collect from a health plan contract or third party, as those terms are defined in section 1729 of this title, for any care or service that is furnished or paid for by the Department;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="F">“(F) </num><content style="-uslm-dtd:text">to provide medical records to the Department in the time frame and format specified by the Department; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="G">“(G) </num><content style="-uslm-dtd:text">to meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify in regulation.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">Discontinuation or Nonrenewal of a Veterans Care Agreement.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">An eligible entity or provider may discontinue a Veterans Care Agreement at such time and upon such notice to the Secretary as may be provided in regulations prescribed under this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary may discontinue a Veterans Care Agreement with an eligible entity or provider at such time and upon such reasonable notice to the eligible entity or provider as may be specified in regulations prescribed under this section, if an official designated by the Secretary—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">has determined that the eligible entity or provider failed to comply substantially with the provisions of the Veterans Care Agreement, or with the provisions of this section or regulations prescribed under this section;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">has determined the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act (42 U.S.C. 1320a-7 or 1320a-7a) or is identified on the System for Award Management Exclusions list as provided in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">has ascertained that the eligible entity or provider has been convicted of a felony or other serious offense under Federal or State law and determines the eligible entity or provider’s continued participation would be detrimental to the best interests of veterans or the Department; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">has determined that it is reasonable to terminate the agreement based on the health care needs of a veteran.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><heading style="-uslm-dtd:header">Quality of Care.—</heading><content style="-uslm-dtd:text">The Secretary shall establish a system or systems for monitoring the quality of care provided to veterans through Veterans Care Agreements and for assessing the quality of hospital care, medical services, and extended care services furnished by eligible entities and providers before the renewal of Veterans Care Agreements.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h) </num><heading style="-uslm-dtd:header">Disputes.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to Veterans Care Agreements.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Such procedures constitute the eligible entities’ and providers’ exhaustive and exclusive administrative remedies.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under section 1346 of title 28 (known as the ‘<quotedText style="-uslm-dtd:quote">Tucker Act</quotedText>’).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Disputes under this section must pertain to either the scope of authorization under the Veterans Care Agreement or claims for payment subject to the Veterans Care Agreement and are not claims for the purposes of such laws that would otherwise require application of sections 7101 through 7109 of title 41, United States Code.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i) </num><heading style="-uslm-dtd:header">Applicability of Other Provisions of Law.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">A Veterans Care Agreement may be authorized by the Secretary or any Department official authorized by the Secretary, and such action shall not be treated as—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">an award for the purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of care and services; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">a Federal contract for the acquisition of goods or services for purposes of any provision of Federal law governing Federal contracts for the acquisition of goods or services except section 4706(d) of title 41.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Except as provided in the agreement itself, in subparagraph (B), and unless otherwise provided in this section or regulations prescribed pursuant to this section, an eligible entity or provider that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not subject.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">An eligible entity or provider that enters into an agreement under this section is subject to—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">all laws regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Notwithstanding paragraph (2)(B)(i), an eligible entity or provider that enters into an agreement under this section shall not be treated as a Federal contractor or subcontractor for purposes of chapter 67 of title 41 (commonly known as the ‘<quotedText style="-uslm-dtd:quote">McNamara-O’Hara Service Contract Act of 1965</quotedText>’).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="j">“(j) </num><heading style="-uslm-dtd:header">Parity of Treatment.—</heading><content style="-uslm-dtd:text">Eligibility for hospital care, medical services, and extended care services furnished to any veteran pursuant to a Veterans Care Agreement shall be subject to the same terms as though provided in a facility of the Department, and provisions of this chapter applicable to veterans receiving such care and services in a facility of the Department shall apply to veterans treated under this section.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="k">“(k) </num><heading style="-uslm-dtd:header">Rulemaking.—</heading><content style="-uslm-dtd:text">The Secretary shall promulgate regulations to carry out this section.”</content> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s102/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapteris amended by inserting after the item relating to section 1703 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703A.</designator><label> Agreements with eligible entities or providers; certification processes.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s103" styleType="OLC"> <num style="-uslm-dtd:enum" value="103">SEC. 103. </num><heading style="-uslm-dtd:header">CONFORMING AMENDMENTS FOR STATE VETERANS HOMES. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s103/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><chapeau style="-uslm-dtd:text">Section 1745(a) is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s103/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">in paragraph (1), by striking “<quotedText style="-uslm-dtd:quote">(or agreement under section 1720(c)(1) of this title)</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">(or an agreement)</quotedText>”; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s103/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">by adding at the end the following new paragraph:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">An agreement under this section may be authorized by the Secretary or any Department official authorized by the Secretary, and any such action is not an award for purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of hospital care, medical services, and extended care services.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">Except as provided in the agreement itself, in clause (ii), and unless otherwise provided in this section or regulations prescribed pursuant to this section, a State home that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any provision of law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not subject.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><chapeau style="-uslm-dtd:text">A State home that enters into an agreement under this section is subject to—</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">all provisions of law regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties;</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">all provisions of law that protect against employment discrimination or that otherwise ensure equal employment opportunities; and</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="III">“(III) </num><content style="-uslm-dtd:text">all provisions in subchapter V of chapter 17 of this title.</content> </subclause> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">Notwithstanding subparagraph (B)(ii)(I), a State home that enters into an agreement under this section may not be treated as a Federal contractor or subcontractor for purposes of chapter 67 of title 41 (known as the ‘<quotedText style="-uslm-dtd:quote">McNamara-O’Hara Service Contract Act of 1965</quotedText>’).”</content> </clause> </subparagraph> </paragraph></quotedContent>.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s103/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1745">38 U.S.C. 1745 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Effective Date.—</heading><content style="-uslm-dtd:text">The amendment made by subsection (a) shall apply to care provided on or after the effective date of regulations issued by the Secretary of Veterans Affairs to carry out this section.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s104" styleType="OLC"> <num style="-uslm-dtd:enum" value="104">SEC. 104. </num><heading style="-uslm-dtd:header">ACCESS STANDARDS AND STANDARDS FOR QUALITY. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s104/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 17, as amended by section 102, is further amended by inserting after section 1703A the following new sections:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703B">“SEC. 1703B. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703B">38 U.S.C. 1703B</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Access standards </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall establish access standards for furnishing hospital care, medical services, or extended care services to covered veterans for the purposes of section 1703(d).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary shall ensure that the access standards established under paragraph (1) define such categories of care to cover all care and services within the medical benefits package of the Department of Veterans Affairs.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><content style="-uslm-dtd:text">The Secretary shall ensure that the access standards provide covered veterans, employees of the Department, and health care providers in the network established under section 1703(h) with relevant comparative information that is clear, useful, and timely, so that covered veterans can make informed decisions regarding their health care.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><content style="-uslm-dtd:text">The Secretary shall consult with all pertinent Federal entities (including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services), entities in the private sector, and other nongovernmental entities in establishing access standards.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Not later than 270 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report detailing the access standards.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Before submitting the report required under paragraph (1), the Secretary shall provide periodic updates to the appropriate committees of Congress to confirm the Department’s progress towards developing the access standards required by this section.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The first update under subparagraph (A) shall occur no later than 120 days from the date of the enactment of the Caring for Our Veterans Act of 2018.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Not later than 540 days after the date on which the Secretary implements the access standards established under subsection (a), the Secretary shall submit to the appropriate committees of Congress a report detailing the implementation of and compliance with such access standards by Department and non-Department entities or providers.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><chapeau style="-uslm-dtd:text">Not later than 3 years after the date on which the Secretary establishes access standards under subsection (a) and not less frequently than once every 3 years thereafter, the Secretary shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">conduct a review of such standards; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">submit to the appropriate committees of Congress a report on the findings and any modification to the access standards with respect to the review conducted under paragraph (1).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><content style="-uslm-dtd:text">The Secretary shall ensure health care providers specified under section 1703(c) are able to comply with the applicable access standards established by the Secretary.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><content style="-uslm-dtd:text">The Secretary shall publish in the Federal Register and on an internet website of the Department the designated access standards established under this section for purposes of section 1703(d)(1)(D).</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Consistent with paragraphs (1)(D) and (3) of section 1703(d), covered veterans may contact the Department at any time to request a determination regarding whether they are eligible to receive care and services from a non-Department entity or provider based on the Department being unable to furnish such care and services in a manner that complies with the designated access standards established under this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary shall establish a process to review such requests from covered veterans to determine whether—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the requested care is clinically necessary; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Department is able to provide such care in a manner that complies with designated access standards established under this section.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The Secretary shall promptly respond to any such request by a covered veteran.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">covered veterans</quotedText>’ refers to veterans described in section 1703(b) of this title.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703C">“SEC. 1703C. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703C">38 U.S.C. 1703C</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Standards for quality </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall establish standards for quality regarding hospital care, medical services, and extended care services furnished by the Department pursuant to this title, including through non-Department health care providers pursuant to section 1703 of this title.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">In establishing standards for quality under paragraph (1), the Secretary shall consider existing health quality measures that are applied to public and privately sponsored health care systems with the purpose of providing covered veterans relevant comparative information to make informed decisions regarding their health care.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><chapeau style="-uslm-dtd:text">The Secretary shall collect and consider data for purposes of establishing the standards under paragraph (1). Such data collection shall include—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey, a survey of veterans who have used hospital care, medical services, or extended care services furnished by the Veterans Health Administration during the most recent 2-year period to assess the satisfaction of the veterans with service and quality of care; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">datasets that include, at a minimum, elements relating to the following:</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">Timely care.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">Effective care.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">Safety, including, at a minimum, complications, readmissions, and deaths.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iv">“(iv) </num><content style="-uslm-dtd:text">Efficiency.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">The Secretary shall consult with all pertinent Federal entities (including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services), entities in the private sector, and other nongovernmental entities in establishing standards for quality.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Not later than 270 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report detailing the standards for quality.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">Before submitting the report required under subparagraph (A), the Secretary shall provide periodic updates to the appropriate committees of Congress to confirm the Department’s progress towards developing the standards for quality required by this section.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">The first update under clause (i) shall occur no later than 120 days from the date of the enactment of the Caring for Our Veterans Act of 2018.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Publication and Consideration of Public Comments.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Not later than 1 year after the date on which the Secretary establishes standards for quality under subsection (a), the Secretary shall publish the quality rating of medical facilities of the Department in the publicly available Hospital Compare website through the Centers for Medicare & Medicaid Services for the purpose of providing veterans with information that allows them to compare performance measure information among Department and non-Department health care providers.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Not later than 2 years after the date on which the Secretary establishes standards for quality under subsection (a), the Secretary shall consider and solicit public comment on potential changes to the measures used in such standards to ensure that they include the most up-to-date and applicable industry measures for veterans.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">covered veterans</quotedText>’ refers to veterans described in section 1703(b) of this title.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s104/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 17, as amended by section 102, is further amended by inserting after the item relating to section 1703A the following new items:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703B.</designator><label> Access standards.</label></referenceItem> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703C.</designator><label> Standards for quality.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s105" styleType="OLC"> <num style="-uslm-dtd:enum" value="105">SEC. 105. </num><heading style="-uslm-dtd:header">ACCESS TO WALK-IN CARE. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s105/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Chapter 17 is amended by inserting after section 1725 the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1725A">“SEC. 1725A. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1725A">38 U.S.C. 1725A</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Access to walk-in care </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">Procedures To Ensure Access to Walk-In Care.—</heading><content style="-uslm-dtd:text">The Secretary shall develop procedures to ensure that eligible veterans are able to access walk-in care from qualifying non-Department entities or providers.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Eligible Veterans.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, an eligible veteran is any individual who—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">is enrolled in the health care system established under section 1705(a) of this title; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">has received care under this chapter within the 24-month period preceding the furnishing of walk-in care under this section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Qualifying Non-Department Entities or Providers.—</heading><content style="-uslm-dtd:text">For purposes of this section, a qualifying non-Department entity or provider is a non-Department entity or provider that has entered into a contract or other agreement with the Secretary to furnish services under this section.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Federally-Qualified Health Centers.—</heading><content style="-uslm-dtd:text">Whenever practicable, the Secretary may use a Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))) to carry out this section.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Continuity of Care.—</heading><content style="-uslm-dtd:text">The Secretary shall ensure continuity of care for those eligible veterans who receive walk-in care services under this section, including through the establishment of a mechanism to receive medical records from walk-in care providers and provide pertinent patient medical records to providers of walk-in care.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">Copayments.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary may require an eligible veteran to pay the United States a copayment for each episode of hospital care or medical services provided under this section if the eligible veteran would be required to pay a copayment under this title.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">An eligible veteran not required to pay a copayment under this title may access walk-in care without a copayment for the first two visits in a calendar year. For any additional visits, a copayment at an amount determined by the Secretary may be required.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">An eligible veteran required to pay a copayment under this title may be required to pay a regular copayment for the first two walk-in care visits in a calendar year. For any additional visits, a higher copayment at an amount determined by the Secretary may be required.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">After the first two episodes of care furnished to an eligible veteran under this section, the Secretary may adjust the copayment required of the veteran under this subsection based upon the priority group of enrollment of the eligible veteran, the number of episodes of care furnished to the eligible veteran during a year, and other factors the Secretary considers appropriate under this section.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The amount or amounts of the copayments required under this subsection shall be prescribed by the Secretary by rule.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Section 8153(c) of this title shall not apply to this subsection.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><heading style="-uslm-dtd:header">Regulations.—</heading><content style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall promulgate regulations to carry out this section.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h) </num><heading style="-uslm-dtd:header">Walk-In Care Defined.—</heading><content style="-uslm-dtd:text">In this section, the term ‘<quotedText style="-uslm-dtd:quote">walk-in care</quotedText>’ means non-emergent care provided by a qualifying non-Department entity or provider that furnishes episodic care and not longitudinal management of conditions and is otherwise defined through regulations the Secretary shall promulgate.”</content> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s105/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1725A">38 U.S.C. 1725A note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Effective Date.—</heading><content style="-uslm-dtd:text">Section 1725A of title 38, United States Code, as added by subsection (a) shall take effect on the date upon which final regulations implementing such section take effect.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s105/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1725 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1725A.</designator><label> Access to walk-in care.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s106" styleType="OLC"> <num style="-uslm-dtd:enum" value="106">SEC. 106. </num><heading style="-uslm-dtd:header">STRATEGY REGARDING THE DEPARTMENT OF VETERANS AFFAIRS HIGH-PERFORMING INTEGRATED HEALTH CARE NETWORK. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s106/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter II of chapter 73 is amended by inserting after section 7330B the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="7330C">“SEC. 7330C. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7330C">38 U.S.C. 7330C</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Quadrennial Veterans Health Administration revie </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">Market Area Assessments.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Not less frequently than every 4 years, the Secretary of Veterans Affairs shall perform market area assessments regarding the health care services furnished under the laws administered by the Secretary.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">Each market area assessment established under paragraph (1) shall include the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">An assessment of the demand for health care from the Department, disaggregated by geographic market areas as determined by the Secretary, including the number of requests for health care services under the laws administered by the Secretary.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">An inventory of the health care capacity of the Department of Veterans Affairs across the Department’s system of facilities.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">An assessment of the health care capacity to be provided through contracted community care providers and providers who entered into a provider agreement with the Department under section 1703A of title 38, as added by section 102, including the number of providers, the geographic location of the providers, and categories or types of health care services provided by the providers.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">An assessment obtained from other Federal direct delivery systems of their capacity to provide health care to veterans.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">An assessment of the health care capacity of non-contracted providers where there is insufficient network supply.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="F">“(F) </num><content style="-uslm-dtd:text">An assessment of the health care capacity of academic affiliates and other collaborations of the Department as it relates to providing health care to veterans.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="G">“(G) </num><content style="-uslm-dtd:text">An assessment of the effects on health care capacity of the access standards and standards for quality established under sections 1703B and 1703C of this title.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="H">“(H) </num><chapeau style="-uslm-dtd:text">The number of appointments for health care services under the laws administered by the Secretary, disaggregated by—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">appointments at facilities of the Department of Veterans Affairs; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">appointments with non-Department health care providers.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary shall submit to the appropriate committees of Congress the market area assessments established in paragraph (1).</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The Secretary also shall submit to the appropriate committees of Congress the market area assessments completed by or being performed on the day before the date of the enactment of the Caring for Our Veterans Act of 2018.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">The Secretary shall use the market area assessments established under paragraph (1) to—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">determine the capacity of the health care provider networks established under section 1703(h) of this title;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">inform the Department budget, in accordance with subparagraph (B); and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">inform and assess the appropriateness of the access standards established under section 1703B of this title and standards for quality under section 1703C and to make recommendations for any changes to such standards.</content> </clause></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The Secretary shall ensure that the Department budget for any fiscal year (as submitted with the budget of the President under section 1105(a) of title 31) reflects the findings of the Secretary with respect to the most recent market area assessments under paragraph (1) and health care utilization data from the Department and non-Department entities or providers furnishing care and services to covered veterans as described in section 1703(b).</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Strategic Plan To Meet Health Care Demand.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of the Caring for Our Veterans Act of 2018 and not less frequently than once every 4 years thereafter, the Secretary shall submit to the appropriate committees of Congress a strategic plan that specifies a 4-year forecast of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the demand for health care from the Department, disaggregated by geographic area as determined by the Secretary;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the health care capacity to be provided at each medical center of the Department; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">the health care capacity to be provided through community care providers.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">In preparing the strategic plan under paragraph (1), the Secretary shall—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">assess the access standards and standards for quality established under sections 1703B and 1703C of this title;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">assess the market area assessments established under subsection (a);</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">assess the needs of the Department based on identified services that provide management of conditions or disorders related to military service for which there is limited experience or access in the national market, the overall health of veterans throughout their lifespan, or other services as the Secretary determines appropriate;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">consult with key stakeholders within the Department, the heads of other Federal agencies, and other relevant governmental and nongovernmental entities, including State, local, and tribal government officials, members of Congress, veterans service organizations, private sector representatives, academics, and other policy experts;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">identify emerging issues, trends, problems, and opportunities that could affect health care services furnished under the laws administered by the Secretary;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="F">“(F) </num><content style="-uslm-dtd:text">develop recommendations regarding both short- and long-term priorities for health care services furnished under the laws administered by the Secretary;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="G">“(G) </num><content style="-uslm-dtd:text">after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey, consider a survey of veterans who have used hospital care, medical services, or extended care services furnished by the Veterans Health Administration during the most recent 2-year period to assess the satisfaction of the veterans with service and quality of care;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="H">“(H) </num><content style="-uslm-dtd:text">conduct a comprehensive examination of programs and policies of the Department regarding the delivery of health care services and the demand of health care services for veterans in future years;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">assess the remediation of medical service lines of the Department as described in section 1706A in conjunction with the utilization of non-Department entities or providers to offset remediation; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="J">“(J) </num><content style="-uslm-dtd:text">consider such other matters as the Secretary considers appropriate.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Responsibilities.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall be responsible for—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">overseeing the transformation and organizational change across the Department to achieve such high performing integrated health care network;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">developing the capital infrastructure planning and procurement processes, whether minor or major construction projects or leases; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">developing a multi-year budget process that is capable of forecasting future year budget requirements and projecting the cost of delivering health care services under a high-performing integrated health care network.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Appropriate Committees of Congress Defined.—</heading><chapeau style="-uslm-dtd:text">In this section, the term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s106/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7301">38 U.S.C. 7301</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapteris amended by inserting after the item relating to section 7330B the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“7330C.</designator><label> Quadrennial Veterans Health Administration review.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s107" styleType="OLC"> <num style="-uslm-dtd:enum" value="107">SEC. 107. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703A">38 U.S.C. 1703A note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">APPLICABILITY OF DIRECTIVE OF OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s107/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Notwithstanding the treatment of certain laws under subsection (i) of section 1703A of title 38, United States Code, as added by section 102 of this title, Directive 2014-01 of the Office of Federal Contract Compliance Programs of the Department of Labor (effective as of May 7, 2014) shall apply to any entity entering into an agreement under such section 1703A or section 1745 of such title, as amended by section 103, in the same manner as such directive applies to subcontractors under the TRICARE program for the duration of the moratorium provided under such directive.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s107/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Applicability Period.—</heading><content style="-uslm-dtd:text">The directive described in subsection (a), and the moratorium provided under such directive, shall not be altered or rescinded before May 7, 2019.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s107/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">TRICARE Program Defined.—</heading><content style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">TRICARE program</quotedText>” has the meaning given that term in section 1072 of title 10, United States Code.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s108" styleType="OLC"> <num style="-uslm-dtd:enum" value="108">SEC. 108. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">PREVENTION OF CERTAIN HEALTH CARE PROVIDERS FROM PROVIDING NON-DEPARTMENT HEALTH CARE SERVICES TO VETERANS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s108/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><chapeau style="-uslm-dtd:text">On and after the date that is 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall deny or revoke the eligibility of a health care provider to provide non-Department health care services to veterans if the Secretary determines that the health care provider—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">was removed from employment with the Department of Veterans Affairs due to conduct that violated a policy of the Department relating to the delivery of safe and appropriate health care; or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">violated the requirements of a medical license of the health care provider that resulted in the loss of such medical license.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s108/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Permissive Action.—</heading><content style="-uslm-dtd:text">On and after the date that is 1 year after the date of the enactment of this Act, the Secretary may deny, revoke, or suspend the eligibility of a health care provider to provide non-Department health care services if the Secretary determines such action is necessary to immediately protect the health, safety, or welfare of veterans and the health care provider is under investigation by the medical licensing board of a State in which the health care provider is licensed or practices.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s108/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Suspension.—</heading><content style="-uslm-dtd:text">The Secretary shall suspend the eligibility of a health care provider to provide non-Department health care services to veterans if the health care provider is suspended from serving as a health care provider of the Department.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s108/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Comptroller General Report.—</heading><chapeau style="-uslm-dtd:text">Not later than 2 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the implementation by the Secretary of this section, including the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The aggregate number of health care providers denied or suspended under this section from participation in providing non-Department health care services.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">An evaluation of any impact on access to health care for patients or staffing shortages in programs of the Department providing non-Department health care services.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/d/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">An explanation of the coordination of the Department with the medical licensing boards of States in implementing this section, the amount of involvement of such boards in such implementation, and efforts by the Department to address any concerns raised by such boards with respect to such implementation.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/d/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><content style="-uslm-dtd:text">Such recommendations as the Comptroller General considers appropriate regarding harmonizing eligibility criteria between health care providers of the Department and health care providers eligible to provide non-Department health care services.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s108/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Non-Department Health Care Services Defined.—</heading><chapeau style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">non-Department health care services</quotedText>” means services—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">provided under subchapter I of chapter 17 of title 38, United States Code, at non-Department facilities (as defined in section 1701 of such title);</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note);</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/e/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">purchased through the Medical Community Care account of the Department; or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/e/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><content style="-uslm-dtd:text">purchased with amounts deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s109" styleType="OLC"> <num style="-uslm-dtd:enum" value="109">SEC. 109. </num><heading style="-uslm-dtd:header">REMEDIATION OF MEDICAL SERVICE LINES. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s109/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 17 is amended by inserting after section 1706 the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1706A">“SEC. 1706A. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1706A">38 U.S.C. 1706A</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Remediation of medical service lines </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><chapeau style="-uslm-dtd:text">Not later than 30 days after determining under section 1703(e)(1) that a medical service line of the Department is providing hospital care, medical services, or extended care services that does not comply with the standards for quality established by the Secretary, the Secretary shall submit to Congress an assessment of the factors that led the Secretary to make such determination and a plan with specific actions, and the time to complete them, to be taken to comply with such standards for quality, including the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">Increasing personnel or temporary personnel assistance, including mobile deployment teams.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Special hiring incentives, including the Education Debt Reduction Program under subchapter VII of chapter 76 of this title and recruitment, relocation, and retention incentives.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Utilizing direct hiring authority.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Providing improved training opportunities for staff.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">Acquiring improved equipment.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">“(6) </num><content style="-uslm-dtd:text">Making structural modifications to the facility used by the medical service line.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="7">“(7) </num><content style="-uslm-dtd:text">Such other actions as the Secretary considers appropriate.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Responsible Parties.—</heading><content style="-uslm-dtd:text">In each assessment submitted under subsection (a) with respect to a medical service line, the Secretary shall identify the individuals at the Central Office of the Veterans Health Administration, the facility used by the medical service line, and the central office of the relevant Veterans Integrated Service Network who are responsible for overseeing the progress of that medical service line in complying with the standards for quality established by the Secretary.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Interim Reports.—</heading><content style="-uslm-dtd:text">Not later than 180 days after submitting an assessment under subsection (a) with respect to a medical service line, the Secretary shall submit to Congress a report on the progress of that medical service line in complying with the standards for quality established by the Secretary and any other measures the Secretary will take to assist the medical service line in complying with such standards for quality.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Annual Reports.—</heading><chapeau style="-uslm-dtd:text">Not less frequently than once each year, the Secretary shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">submit to Congress an analysis of the remediation actions and costs of such actions taken with respect to each medical service line with respect to which the Secretary submitted an assessment and plan under paragraph (1) in the preceding year, including an update on the progress of each such medical service line in complying with the standards for quality and timeliness established by the Secretary and any other actions the Secretary is undertaking to assist the medical service line in complying with standards for quality as established by the Secretary; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">publish such analysis on the internet website of the Department.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s109/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1706 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1706A.</designator><label> Remediation of medical service lines.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> </chapter> <chapter style="-uslm-dtd:chapter" identifier="/us/sComp/115/182/tI/stA/ch2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">CHAPTER 2—</num><heading style="-uslm-dtd:header">PAYING PROVIDERS AND IMPROVING COLLECTIONS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch2/s111" styleType="OLC"> <num style="-uslm-dtd:enum" value="111">SEC. 111. </num><heading style="-uslm-dtd:header">PROMPT PAYMENT TO PROVIDERS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s111/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 17 is amended by inserting after section 1703C, as added by section 104 of this title, the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703D">“SEC. 1703D. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703D">38 U.S.C. 1703D</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Prompt payment standard </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Notwithstanding any other provision of this title or of any other provision of law, the Secretary shall pay for hospital care, medical services, or extended care services furnished by health care entities or providers under this chapter within 45 calendar days upon receipt of a clean paper claim or 30 calendar days upon receipt of a clean electronic claim.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">If a claim is denied, the Secretary shall, within 45 calendar days of denial for a paper claim and 30 calendar days of denial for an electronic claim, notify the health care entity or provider of the reason for denying the claim and what, if any, additional information is required to process the claim.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Upon the receipt of the additional information, the Secretary shall ensure that the claim is paid, denied, or otherwise adjudicated within 30 calendar days from the receipt of the requested information.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">This section shall only apply to payments made on an invoice basis and shall not apply to capitation or other forms of periodic payment to entities or providers.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Submittal of Claims by Health Care Entities and Providers.—</heading><content style="-uslm-dtd:text">A health care entity or provider that furnishes hospital care, a medical service, or an extended care service under this chapter shall submit to the Secretary a claim for payment for furnishing the hospital care, medical service, or extended care service not later than 180 days after the date on which the entity or provider furnished the hospital care, medical service, or extended care service.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Fraudulent Claims.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Sections 3729 through 3733 of title 31 shall apply to fraudulent claims for payment submitted to the Secretary by a health care entity or provider under this chapter.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Pursuant to regulations prescribed by the Secretary, the Secretary shall bar a health care entity or provider from furnishing hospital care, medical services, and extended care services under this chapter when the Secretary determines the entity or provider has submitted to the Secretary fraudulent health care claims for payment by the Secretary.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Overdue Claims.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Any claim that has not been denied with notice, made pending with notice, or paid to the health care entity or provider by the Secretary shall be overdue if the notice or payment is not received by the entity provider within the time periods specified in subsection (a).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">If a claim is overdue under this subsection, the Secretary may, under the requirements established by subsection (a) and consistent with the provisions of chapter 39 of title 31 (commonly referred to as the ‘<quotedText style="-uslm-dtd:quote">Prompt Payment Act</quotedText>’), require that interest be paid on clean claims.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Interest paid under subparagraph (A) shall be computed at the rate of interest established by the Secretary of the Treasury under section 3902 of title 31 and published in the Federal Register.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><chapeau style="-uslm-dtd:text">Not less frequently than annually, the Secretary shall submit to Congress a report on payment of overdue claims under this subsection, disaggregated by paper and electronic claims, that includes the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">The amount paid in overdue claims described in this subsection, disaggregated by the amount of the overdue claim and the amount of interest paid on such overdue claim.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The number of such overdue claims and the average number of days late each claim was paid, disaggregated by facility of the Department and Veterans Integrated Service Network region.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Overpayment.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall deduct the amount of any overpayment from payments due a health care entity or provider under this chapter.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Deductions may not be made under this subsection unless the Secretary has made reasonable efforts to notify a health care entity or provider of the right to dispute the existence or amount of such indebtedness and the right to request a compromise of such indebtedness.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The Secretary shall make a determination with respect to any such dispute or request prior to deducting any overpayment unless the time required to make such a determination before making any deductions would jeopardize the Secretary’s ability to recover the full amount of such indebtedness.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">Information and Documentation Required.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall provide to all health care entities and providers participating in a program to furnish hospital care, medical services, or extended care services under this chapter a list of information and documentation that is required to establish a clean claim under this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary shall consult with entities in the health care industry, in the public and private sector, to determine the information and documentation to include in the list under paragraph (1).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">If the Secretary modifies the information and documentation included in the list under paragraph (1), the Secretary shall notify all health care entities and providers described in paragraph (1) not later than 30 days before such modifications take effect.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><heading style="-uslm-dtd:header">Processing of Claims.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">In processing a claim for compensation for hospital care, medical services, or extended care services furnished by a non-Department health care entity or provider under this chapter, the Secretary may act through—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">a non-Department entity that is under contract or agreement for the program established under section 1703(a) of this title; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">a non-Department entity that specializes in such processing for other Federal agency health care systems.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary shall seek to contract with a third party to conduct a review of claims described in paragraph (3) that includes—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">a feasibility assessment to determine the capacity of the Department to process such claims in a timely manner; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">a cost benefit analysis comparing the capacity of the Department to a third party entity capable of processing such claims.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The review required under paragraph (2) shall apply to claims for hospital care, medical services, or extended care services furnished under section 1703 of this Act, as amended by the Caring for Our Veterans Act of 2018, that are processed by the Department.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h) </num><heading style="-uslm-dtd:header">Report on Encounter Data System.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Not later than 90 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report on the feasibility and advisability of adopting a funding mechanism similar to what is utilized by other Federal agencies to allow a contracted entity to act as a fiscal intermediary for the Federal Government to distribute, or pass through, Federal Government funds for certain non-underwritten hospital care, medical services, or extended care services.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary may coordinate with the Department of Defense, the Department of Health and Human Services, and the Department of the Treasury in developing the report required by paragraph (1).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><chapeau style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">clean electronic claim</quotedText>’ means the transmission of data for purposes of payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">clean paper claim</quotedText>’ means a paper claim for payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">fraudulent claims</quotedText>’ means the knowing misrepresentation of a material fact or facts by a health care entity or provider made to induce the Secretary to pay a claim that was not legally payable to that provider.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">health care entity or provider</quotedText>’ includes any non-Department health care entity or provider, but does not include any Federal health care entity or provider.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s111/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapteris amended by inserting after the item relating to section 1703C, as added by section 104 of this title, the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703D.</designator><label> Prompt payment standard.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch2/s112" styleType="OLC"> <num style="-uslm-dtd:enum" value="112">SEC. 112. </num><heading style="-uslm-dtd:header">AUTHORITY TO PAY FOR AUTHORIZED CARE NOT SUBJECT TO AN AGREEMENT. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s112/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter IV of chapter 81 is amended by adding at the end the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="8159">“SEC. 8159. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s8159">38 U.S.C. 8159</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Authority to pay for services authorized but not subject to an agreement </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">If, in the course of furnishing hospital care, a medical service, or an extended care service authorized by the Secretary and pursuant to a contract, agreement, or other arrangement with the Secretary, a provider who is not a party to the contract, agreement, or other arrangement furnishes hospital care, a medical service, or an extended care service that the Secretary considers necessary, the Secretary may compensate the provider for the cost of such care or service.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">New Contracts and Agreements.—</heading><content style="-uslm-dtd:text">The Secretary shall take reasonable efforts to enter into a contract, agreement, or other arrangement with a provider described in subsection (a) to ensure that future care and services authorized by the Secretary and furnished by the provider are subject to such a contract, agreement, or other arrangement.”</content> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s112/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s8101">38 U.S.C. 8101</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapteris amended by inserting after the item relating to section 8158 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“8159.</designator><label> Authority to pay for services authorized but not subject to an agreement.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch2/s113" styleType="OLC"> <num style="-uslm-dtd:enum" value="113">SEC. 113. </num><heading style="-uslm-dtd:header">IMPROVEMENT OF AUTHORITY TO RECOVER THE COST OF SERVICES FURNISHED FOR NON-SERVICE-CONNECTED DISABILITIES. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Broadening Scope of Applicability.—</heading><chapeau style="-uslm-dtd:text">Section 1729 is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">in subsection (a)—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">in paragraph (2)(A)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran’s</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual’s</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><chapeau style="-uslm-dtd:text">in paragraph (3)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">in the matter preceding subparagraph (A), by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">in subparagraph (A), by striking “<quotedText style="-uslm-dtd:quote">the veteran’s</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual’s</quotedText>”;</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><chapeau style="-uslm-dtd:text">in subsection (b)—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">in paragraph (1)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran’s</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual’s</quotedText>”; and</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><chapeau style="-uslm-dtd:text">in paragraph (2)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><chapeau style="-uslm-dtd:text">in subparagraph (A)—</chapeau> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/i/I" styleType="OLC"> <num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </subclause> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/i/II" styleType="OLC"> <num style="-uslm-dtd:enum" value="II">(II) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran’s</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual’s</quotedText>”; and</content> </subclause> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><chapeau style="-uslm-dtd:text">in subparagraph (B)—</chapeau> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/ii/I" styleType="OLC"> <num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">in clause (i), by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </subclause> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/ii/II" styleType="OLC"> <num style="-uslm-dtd:enum" value="II">(II) </num><chapeau style="-uslm-dtd:text">in clause (ii)—</chapeau> <item style="-uslm-dtd:item" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/ii/II/aa" styleType="OLC"> <num style="-uslm-dtd:enum" value="aa">(aa) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </item> <item style="-uslm-dtd:item" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/ii/II/bb" styleType="OLC"> <num style="-uslm-dtd:enum" value="bb">(bb) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran’s</quotedText>” each place it appears and inserting “<quotedText style="-uslm-dtd:quote">the individual’s</quotedText>”;</content> </item> </subclause> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">in subsection (e), by striking “<quotedText style="-uslm-dtd:quote">A veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">An individual</quotedText>”; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><chapeau style="-uslm-dtd:text">in subsection (h)—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">in paragraph (1)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">in the matter preceding subparagraph (A), by striking “<quotedText style="-uslm-dtd:quote">a veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">an individual</quotedText>”;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">in subparagraph (A), by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/A/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">in subparagraph (B), by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><chapeau style="-uslm-dtd:text">in paragraph (2)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">A veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">An individual</quotedText>”;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">a veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">an individual</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/B/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s113/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Modification of Authority.—</heading><content style="-uslm-dtd:text">Subsection (a)(1) of such section is amended by striking “<quotedText style="-uslm-dtd:quote">(1) Subject</quotedText>” and all that follows through the period and inserting the following: “<quotedText style="-uslm-dtd:quote">(1) Subject to the provisions of this section, in any case in which the United States is required by law to furnish or pay for care or services under this chapter for a non-service-connected disability described in paragraph (2) of this subsection, the United States has the right to recover or collect from a third party the reasonable charges of care or services so furnished or paid for to the extent that 132 STAT. 1423 the recipient or provider of the care or services would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished or paid for by a department or agency of the United States.</quotedText>”.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s113/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Modification of Eligible Individuals.—</heading><content style="-uslm-dtd:text">Subparagraph (D) of subsection (a)(2) of such section is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">that is incurred by an individual who is entitled to care (or payment of the expenses of care) under a health-plan contract.”</content> </subparagraph></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch2/s114" styleType="OLC"> <num style="-uslm-dtd:enum" value="114">SEC. 114. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703D">38 U.S.C. 1703D note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">PROCESSING OF CLAIMS FOR REIMBURSEMENT THROUGH ELECTRONIC INTERFACE. </heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs may enter into an agreement with a third-party entity to process, through the use of an electronic interface, claims for reimbursement for health care provided under the laws administered by the Secretary.</content> </section> </chapter> <chapter style="-uslm-dtd:chapter" identifier="/us/sComp/115/182/tI/stA/ch3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">CHAPTER 3—</num><heading style="-uslm-dtd:header">EDUCATION AND TRAINING PROGRAMS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch3/s121" styleType="OLC"> <num style="-uslm-dtd:enum" value="121">SEC. 121. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">EDUCATION PROGRAM ON HEALTH CARE OPTIONS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s121/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall develop and administer an education program that teaches veterans about their health care options through the Department of Veterans Affairs.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">The program under subsection (a) shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">teach veterans about—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">eligibility criteria for care from the Department set forth under sections 1703, as amended by section 101 of this title, and 1710 of title 38, United States Code;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">priority groups for enrollment in the system of annual patient enrollment under section 1705(a) of such title;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">the copayments and other financial obligations, if any, required of certain individuals for certain services; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/1/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">how to utilize the access standards and standards for quality established under sections 1703B and 1703C of such title;</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">teach veterans about the interaction between health insurance (including private insurance, Medicare, Medicaid, the TRICARE program, the Indian Health Service, tribal health programs, and other forms of insurance) and health care from the Department; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">provide veterans with information on what to do when they have a complaint about health care received from the Department (whether about the provider, the Department, or any other type of complaint).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s121/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Accessibility.—</heading><chapeau style="-uslm-dtd:text">In developing the education program under this section, the Secretary shall ensure that materials under such program are accessible—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">to veterans who may not have access to the internet; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">to veterans in a manner that complies with the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s121/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Annual Evaluation and Report.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Evaluation.—</heading><content style="-uslm-dtd:text">The Secretary shall develop a method to evaluate the effectiveness of the education program under this section and evaluate the program using the method not less frequently than once each year.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Report.—</heading><content style="-uslm-dtd:text">Not less frequently than once each year, the Secretary shall submit to Congress a report on the findings of the Secretary with respect to the most recent evaluation conducted by the Secretary under paragraph (1).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s121/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Medicaid.—</heading><content style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">Medicaid</quotedText>” means the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Medicare.—</heading><content style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">Medicare</quotedText>” means the Medicare program under title XVIII of such Act (42 U.S.C. 1395 et seq.).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/e/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Tricare program.—</heading><content style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">TRICARE program</quotedText>” has the meaning given that term in section 1072 of title 10, United States Code.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch3/s122" styleType="OLC"> <num style="-uslm-dtd:enum" value="122">SEC. 122. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">TRAINING PROGRAM FOR ADMINISTRATION OF NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s122/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment of Program.—</heading><chapeau style="-uslm-dtd:text">The Secretary of Veterans Affairs shall develop and implement a training program to train employees and contractors of the Department of Veterans Affairs on how to administer non-Department health care programs, including the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Reimbursement for non-Department emergency room care.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">The Veterans Community Care Program under section 1703 of such title, as amended by section 101.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">Management of prescriptions pursuant to improvements under section 131.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s122/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Annual Evaluation and Report.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">develop a method to evaluate the effectiveness of the training program developed and implemented under subsection (a);</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">evaluate such program not less frequently than once each year; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">not less frequently than once each year, submit to Congress the findings of the Secretary with respect to the most recent evaluation carried out under paragraph (2).</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch3/s123" styleType="OLC"> <num style="-uslm-dtd:enum" value="123">SEC. 123. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">CONTINUING MEDICAL EDUCATION FOR NON-DEPARTMENT MEDICAL PROFESSIONALS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment of Program.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall establish a program to provide continuing medical education material to non-Department medical professionals.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Education provided.—</heading><chapeau style="-uslm-dtd:text">The program established under paragraph (1) shall include education on the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Identifying and treating common mental and physical conditions of veterans and family members of veterans.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The health care system of the Department of Veterans Affairs.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Such other matters as the Secretary considers appropriate.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s123/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Material Provided.—</heading><content style="-uslm-dtd:text">The continuing medical education material provided to non-Department medical professionals under the program established under subsection (a) shall be the same material provided to medical professionals of the Department to ensure that all medical professionals treating veterans have access to the same materials, which supports core competencies throughout the community.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Administration of Program.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">The Secretary shall administer the program established under subsection (a) to participating non-Department medical professionals through an internet website of the Department of Veterans Affairs.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Curriculum and credit provided.—</heading><content style="-uslm-dtd:text">The Secretary shall determine the curriculum of the program and the number of hours of credit to provide to participating non-Department medical professionals for continuing medical education.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Accreditation.—</heading><content style="-uslm-dtd:text">The Secretary shall ensure that the program is accredited in as many States as practicable.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Consistency with existing rules.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall ensure that the program is consistent with the rules and regulations of the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/4/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The medical licensing agency of each State in which the program is accredited.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/4/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Such medical credentialing organizations as the Secretary considers appropriate.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><heading style="-uslm-dtd:header">User cost.—</heading><content style="-uslm-dtd:text">The Secretary shall carry out the program at no cost to participating non-Department medical professionals.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/6" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">(6) </num><heading style="-uslm-dtd:header">Monitoring, evaluation, and report.—</heading><content style="-uslm-dtd:text">The Secretary shall monitor the utilization of the program established under subsection (a), evaluate its effectiveness, and report to Congress on utilization and effectiveness not less frequently than once each year.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s123/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Non-Department Medical Professional Defined.—</heading><content style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">non-Department medical professional</quotedText>” means any individual who is licensed by an appropriate medical authority in the United States and is in good standing, is not an employee of the Department of Veterans Affairs, and provides care to veterans or family members of veterans under the laws administered by the Secretary of Veterans Affairs.</content> </subsection> </section> </chapter> <chapter style="-uslm-dtd:chapter" identifier="/us/sComp/115/182/tI/stA/ch4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">CHAPTER 4—</num><heading style="-uslm-dtd:header">OTHER MATTERS RELATING TO NON-DEPARTMENT OF VETERANS AFFAIRS PROVIDERS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch4/s131" styleType="OLC"> <num style="-uslm-dtd:enum" value="131">SEC. 131. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">ESTABLISHMENT OF PROCESSES TO ENSURE SAFE OPIOID PRESCRIBING PRACTICES BY NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROVIDERS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s131/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Receipt and Review of Guidelines.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall ensure that all covered health care providers are provided a copy of and certify that they have reviewed the evidence-based guidelines for prescribing opioids set forth by the Opioid Safety Initiative of the Department of Veterans Affairs.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s131/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Inclusion of Medical History and Current Medications.—</heading><content style="-uslm-dtd:text">The Secretary shall implement a process to ensure that, if care of a veteran by a covered health care provider is authorized under the laws administered by the Secretary, the document authorizing such care includes the available and relevant medical history of the veteran and a list of all medications prescribed to the veteran as known by the Department.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Submittal of Medical Records and Prescriptions.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">The Secretary shall, consistent with section 1703(a)(2)(A), as amended by section 101 of this title, and section 1703A(e)(2)(F), as added by section 102 of this title, require each covered health care provider to submit medical records of any care or services furnished, including records of any prescriptions for opioids, to the Department in the timeframe and format specified by the Secretary.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Responsibility of department for recording and monitoring.—</heading><chapeau style="-uslm-dtd:text">In carrying out paragraph (1) and upon the receipt by the Department of the medical records described in paragraph (1), the Secretary shall—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">ensure the Department is responsible for the recording of the prescription in the electronic health record of the veteran; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">enable other monitoring of the prescription as outlined in the Opioid Safety Initiative of the Department.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Report.—</heading><content style="-uslm-dtd:text">Not less frequently than annually, 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 evaluating the compliance of covered health care providers with the requirements under this section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Use of Opioid Safety Initiative Guidelines.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">If the Secretary determines that the opioid prescribing practices of a covered health care provider, when treating covered veterans, satisfy a condition described in paragraph (3), the Secretary shall take such action as the Secretary considers appropriate to ensure the safety of all veterans receiving care from that health care provider, including removing or directing the removal of any such health care provider from provider networks or otherwise refusing to authorize care of veterans by such health care provider in any program authorized under the laws administered by the Secretary.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Inclusion in contracts.—</heading><content style="-uslm-dtd:text">The Secretary shall ensure that any contracts, agreements, or other arrangements entered into by the Secretary with third parties involved in administering programs that provide care in the community to veterans under the laws administered by the Secretary specifically grant the authority set forth in paragraph (1) to such third parties and to the Secretary, as the case may be.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Conditions for exclusion or limitation.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall take such action as is considered appropriate under paragraph (1) when the opioid prescribing practices of a covered health care provider when treating covered veterans—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">conflict with or are otherwise inconsistent with the standards of appropriate and safe care;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">violate the requirements of a medical license of the health care provider; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/3/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">may place at risk the veterans receiving health care from the provider.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s131/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Covered Health Care Provider Defined.—</heading><content style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">covered health care provider</quotedText>” means a non-Department of Veterans Affairs health care provider who provides health care to veterans under the laws administered by the Secretary of Veterans Affairs, but does not include a health care provider employed by another agency of the Federal Government.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch4/s132" styleType="OLC"> <num style="-uslm-dtd:enum" value="132">SEC. 132. </num><heading style="-uslm-dtd:header">IMPROVING INFORMATION SHARING WITH COMMUNITY PROVIDERS. </heading><content style="-uslm-dtd:text">Section 7332(b)(2) is amended by striking subparagraph (H) and inserting the following new subparagraphs:<quotedContent style="-uslm-dtd:quoted-block"> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="H">“(H)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">To a non-Department entity (including private entities and other Federal agencies) for purposes of providing health care, including hospital care, medical services, and extended care services, to patients or performing other health care-related activities or functions.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">An entity to which a record is disclosed under this subparagraph may not disclose or use such record for a purpose other than that for which the disclosure was made or as permitted by law.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">To a third party in order to recover or collect reasonable charges for care furnished to, or paid on behalf of, a patient in connection with a non-service connected disability as permitted by section 1729 of this title or for a condition for which recovery is authorized or with respect to which the United States is deemed to be a third party beneficiary under the Act entitled ‘<quotedText style="-uslm-dtd:quote">An Act to provide for the recovery from tortiously liable third persons of the cost of hospital and medical care and treatment furnished by the United States</quotedText>’ (Public Law 87-693; 42 U.S.C. 2651 et seq.; commonly known as the ‘<quotedText style="-uslm-dtd:quote">Federal Medical Care Recovery Act</quotedText>’).”</content> </subparagraph></quotedContent>.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch4/s133" styleType="OLC"> <num style="-uslm-dtd:enum" value="133">SEC. 133. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">COMPETENCY STANDARDS FOR NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROVIDERS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s133/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment of Standards and Requirements.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall establish standards and requirements for the provision of care by non-Department of Veterans Affairs health care providers in clinical areas for which the Department of Veterans Affairs has special expertise, including post-traumatic stress disorder, military sexual trauma-related conditions, and traumatic brain injuries.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s133/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Condition for Eligibility To Furnish Care.—</heading><paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s133/b/1" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Each non-Department of Veterans Affairs health care provider shall, to the extent practicable as determined by the Secretary or otherwise provided for in paragraph (2), meet the standards and requirements established pursuant to subsection (a) before furnishing care pursuant to a contract, agreement, or other arrangement with the Department of Veterans Affairs. Non-Department of Veterans Affairs health care providers furnishing care pursuant to a contract, agreement, or other arrangement shall, to the extent practicable as determined by the Secretary, fulfill training requirements established by the Secretary on how to deliver evidence-based treatments in the clinical areas for which the Department of Veterans Affairs has special expertise.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s133/b/2" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">Each non-Department of Veterans Affairs health care provider who enters into a contract, agreement, or other arrangement after the effective date identified in subsection (c) shall, to the extent practicable, meet the standards and requirements established pursuant to subsection (a) within 6 months of the contract, agreement, or other arrangement taking effect.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s133/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Effective Date.—</heading><content style="-uslm-dtd:text">This section shall take effect on the day that is 1 year after the date of the enactment of this Act.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch4/s134" styleType="OLC"> <num style="-uslm-dtd:enum" value="134">SEC. 134. </num><heading style="-uslm-dtd:header">DEPARTMENT OF VETERANS AFFAIRS PARTICIPATION IN NATIONAL NETWORK OF STATE-BASED PRESCRIPTION DRUG MONITORING PROGRAMS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s134/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Chapter 17 is amended by inserting after section 1730A the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1730B">“SEC. 1730B. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1730B">38 U.S.C. 1730B</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Access to State prescription drug monitoring programs </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">Access to Programs.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Any licensed health care provider or delegate of such a provider shall be considered an authorized recipient or user for the purpose of querying and receiving data from the national network of State-based prescription drug monitoring programs to support the safe and effective prescribing of controlled substances to covered patients.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">Under the authority granted by paragraph (1)—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">licensed health care providers or delegates of such providers shall query such network in accordance with applicable regulations and policies of the Veterans Health Administration; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">notwithstanding any general or specific provision of law, rule, or regulation of a State, no State may restrict the access of licensed health care providers or delegates of such providers from accessing that State’s prescription drug monitoring programs.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">No State shall deny or revoke the license, registration, or certification of a licensed health care provider or delegate who otherwise meets that State’s qualifications for holding the license, registration, or certification on the basis that the licensed health care provider or delegate queried or received data, or attempted to query or receive data, from the national network of State-based prescription drug monitoring programs under this section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Covered Patients.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, a covered patient is a patient who—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">receives a prescription for a controlled substance; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">is not receiving palliative care or enrolled in hospice care.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">controlled substance</quotedText>’ has the meaning given such term in section 102(6) of the Controlled Substances Act (21 U.S.C. 802(6)).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">delegate</quotedText>’ means a person or automated system accessing the national network of State-based prescription monitoring programs at the direction or under the supervision of a licensed health care provider.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">licensed health care provider</quotedText>’ means a health care provider employed by the Department who is licensed, certified, or registered within any State to fill or prescribe medications within the scope of his or her practice as a Department employee.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">national network of State-based prescription monitoring programs</quotedText>’ means an interconnected nation-wide system that facilitates the transfer to State prescription drug monitoring program data across State lines.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">State</quotedText>’ means a State, as defined in section 101(20) of this title, or a political subdivision of a State.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s134/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1730A the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1730B.</designator><label> Access to State prescription drug monitoring programs.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> </chapter> <chapter style="-uslm-dtd:chapter" identifier="/us/sComp/115/182/tI/stA/ch5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">CHAPTER 5—</num><heading style="-uslm-dtd:header">OTHER NON-DEPARTMENT HEALTH CARE MATTERS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch5/s141" styleType="OLC"> <num style="-uslm-dtd:enum" value="141">SEC. 141. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s303">38 U.S.C. 303 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">PLANS FOR USE OF SUPPLEMENTAL APPROPRIATIONS REQUIRED. </heading><content style="-uslm-dtd:text">Whenever the Secretary submits to Congress a request for supplemental appropriations or any other appropriation outside the standard budget process to address a budgetary issue affecting the Department of Veterans Affairs, the Secretary shall, not later than 45 days before the date on which such budgetary issue would start affecting a program or service, submit to Congress a justification for the request, including a plan that details how the Secretary intends to use the requested appropriation and how long the requested appropriation is expected to meet the needs of the Department and certification that the request was made using an updated and sound actuarial analysis.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch5/s142" styleType="OLC"> <num style="-uslm-dtd:enum" value="142">SEC. 142. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">VETERANS CHOICE FUND FLEXIBILITY. </heading><chapeau style="-uslm-dtd:text">Section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch5/s142/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">in subsection (c)—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch5/s142/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">in paragraph (1), by striking “<quotedText style="-uslm-dtd:quote">by paragraph (3)</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">in paragraphs (3) and (4)</quotedText>”; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch5/s142/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">by adding at the end the following new paragraph:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><heading style="-uslm-dtd:header">Permanent authority for other uses.—</heading><content style="-uslm-dtd:text">Beginning on March 1, 2019, amounts remaining in the Veterans Choice Fund may be used to furnish hospital care, medical services, and extended care services to individuals pursuant to chapter 17 of title 38, United States Code, at non-Department facilities, including pursuant to non-Department provider programs other than the program established by section 101. Such amounts shall be available in addition to amounts available in other appropriations accounts for such purposes.”</content> </paragraph></quotedContent>; and</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch5/s142/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">in subsection (d)(1), by striking “<quotedText style="-uslm-dtd:quote">to subsection (c)(3)</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">to paragraphs (3) and (4) of subsection (c)</quotedText>”.</content> </paragraph> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch5/s143" styleType="OLC"> <num style="-uslm-dtd:enum" value="143">SEC. 143. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">SUNSET OF VETERANS CHOICE PROGRAM. </heading><content style="-uslm-dtd:text">Subsection (p) of section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="p">“(p) </num><heading style="-uslm-dtd:header">Authority To Furnish Care and Services.—</heading><content style="-uslm-dtd:text">The Secretary may not use the authority under this section to furnish care and services after the date that is 1 year after the date of the enactment of the Caring for Our Veterans Act of 2018.”</content> </subsection></quotedContent>.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch5/s144" styleType="OLC"> <num style="-uslm-dtd:enum" value="144">SEC. 144. </num><heading style="-uslm-dtd:header">CONFORMING AMENDMENTS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Title 38.—</heading><chapeau style="-uslm-dtd:text">Title 38, United States Code, is amended—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">in section 1712(a)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">in paragraph (3), by striking “<quotedText style="-uslm-dtd:quote">under clause (1), (2), or (5) of section 1703(a) of this title</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">or entered an agreement</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">in paragraph (4)(A), by striking “<quotedText style="-uslm-dtd:quote">under the provisions of this subsection and section 1703 of this title</quotedText>”;</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><chapeau style="-uslm-dtd:text">in section 1712A(e)(1)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">by inserting “<quotedText style="-uslm-dtd:quote">or agreements</quotedText>” after “<quotedText style="-uslm-dtd:quote">contracts</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">(under sections 1703(a)(2) and 1710(a)(1)(B) of this title)</quotedText>”; and</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">in section 2303(a)(2)(B)(i), by striking “<quotedText style="-uslm-dtd:quote">with section 1703</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">with sections 1703A, 8111, and 8153</quotedText>”.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Social security act.—</heading><content style="-uslm-dtd:text">Section 1866(a)(1)(L) of the Social Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by striking “<quotedText style="-uslm-dtd:quote">under section 603</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">under chapter 17</quotedText>”.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Veterans’ benefits improvements act of 1994.—</heading><content style="-uslm-dtd:text">Section 104(a)(4)(A) of the Veterans’ Benefits Improvements Act of 1994 (Public Law 103-446; 38 U.S.C. 1117 note) is amended by striking “<quotedText style="-uslm-dtd:quote">in section 1703</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">in sections 1703A, 8111, and 8153</quotedText>”.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch5/s144/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1712">38 U.S.C. 1712 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Effective Date.—</heading><content style="-uslm-dtd:text">The amendments made by subsection (a) shall take effect on the date described in section 101(b).</content> </subsection> </section> </chapter> </subtitle> <subtitle style="-uslm-dtd:subtitle" identifier="/us/sComp/115/182/tI/stB" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">Subtitle B—</num><heading style="-uslm-dtd:header">Improving Department of Veterans Affairs Health Care Delivery </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stB/s151" styleType="OLC"> <num style="-uslm-dtd:enum" value="151">SEC. 151. </num><heading style="-uslm-dtd:header">LICENSURE OF HEALTH CARE PROFESSIONALS OF THE DEPARTMENT OF VETERANS AFFAIRS PROVIDING TREATMENT VIA TELEMEDICINE. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s151/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Chapter 17 is amended by inserting after section 1730B, as added by section 134, the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1730C">“SEC. 1730C. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1730C">38 U.S.C. 1730C</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Licensure of health care professionals providing treatment via telemedicine </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Notwithstanding any provision of law regarding the licensure of health care professionals, a covered health care professional may practice the health care profession of the health care professional at any location in any State, regardless of where the covered health care professional or the patient is located, if the covered health care professional is using telemedicine to provide treatment to an individual under this chapter.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Covered Health Care Professionals.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, a covered health care professional is any health care professional who—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">is an employee of the Department appointed under the authority under section 7306, 7401, 7405, 7406, or 7408 of this title or title 5;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">is authorized by the Secretary to provide health care under this chapter;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">is required to adhere to all standards for quality relating to the provision of medicine in accordance with applicable policies of the Department; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">has an active, current, full, and unrestricted license, registration, or certification in a State to practice the health care profession of the health care professional.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Property of Federal Government.—</heading><content style="-uslm-dtd:text">Subsection (a) shall apply to a covered health care professional providing treatment to a patient regardless of whether the covered health care professional or patient is located in a facility owned by the Federal Government during such treatment.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Relation to State Law.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The provisions of this section shall supersede any provisions of the law of any State to the extent that such provision of State law are inconsistent with this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">No State shall deny or revoke the license, registration, or certification of a covered health care professional who otherwise meets the qualifications of the State for holding the license, registration, or certification on the basis that the covered health care professional has engaged or intends to engage in activity covered by subsection (a).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Rule of Construction.—</heading><content style="-uslm-dtd:text">Nothing in this section may be construed to remove, limit, or otherwise affect any obligation of a covered health care professional under the Controlled Substances Act (21 U.S.C. 801 et seq.).</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">State Defined.—</heading><content style="-uslm-dtd:text">In this section, the term ‘<quotedText style="-uslm-dtd:quote">State</quotedText>’ means a State, as defined in section 101(20) of this title, or a political subdivision of a State.”</content> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s151/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1730B, as added by section 134, the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1730C.</designator><label> Licensure of health care professionals providing treatment via telemedicine.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s151/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Report on Telemedicine.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stB/s151/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than 1 year after the earlier of the date on which services provided under section 1730B of title 38, United States Code, as added by subsection (a), first occur or regulations are promulgated to carry out such section, 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 effectiveness of the use of telemedicine by the Department of Veterans Affairs.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">The report required by paragraph (1) shall include an assessment of the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The satisfaction of veterans with telemedicine furnished by the Department.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The satisfaction of health care providers in providing telemedicine furnished by the Department.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><chapeau style="-uslm-dtd:text">The effect of telemedicine furnished by the Department on the following:</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">The ability of veterans to access health care, whether from the Department or from non-Department health care providers.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">The frequency of use by veterans of telemedicine.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">The productivity of health care providers.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C/iv" styleType="OLC"> <num style="-uslm-dtd:enum" value="iv">(iv) </num><content style="-uslm-dtd:text">Wait times for an appointment for the receipt of health care from the Department.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C/v" styleType="OLC"> <num style="-uslm-dtd:enum" value="v">(v) </num><content style="-uslm-dtd:text">The use by veterans of in-person services at Department facilities and non-Department facilities.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">The types of appointments for the receipt of telemedicine furnished by the Department that were provided during the 1-year period preceding the submittal of the report.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">The number of appointments for the receipt of telemedicine furnished by the Department that were requested during such period, disaggregated by medical facility.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/F" styleType="OLC"> <num style="-uslm-dtd:enum" value="F">(F) </num><content style="-uslm-dtd:text">Savings by the Department, if any, including travel costs, from furnishing health care through the use of telemedicine during such period.</content> </subparagraph> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stB/s152" styleType="OLC"> <num style="-uslm-dtd:enum" value="152">SEC. 152. </num><heading style="-uslm-dtd:header">AUTHORITY FOR DEPARTMENT OF VETERANS AFFAIRS CENTER FOR INNOVATION FOR CARE AND PAYMENT. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s152/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 17, as amended by this title, is further amended by inserting after section 1703D, as added by section 111, the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703E">“SEC. 1703E. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703E">38 U.S.C. 1703E</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Center for Innovation for Care and Payment </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">There is established within the Department a Center for Innovation for Care and Payment (in this section referred to as the ‘<quotedText style="-uslm-dtd:quote">Center</quotedText>’).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary, acting through the Center, may carry out such pilot programs the Secretary determines to be appropriate to develop innovative approaches to testing payment and service delivery models in order to reduce expenditures while preserving or enhancing the quality of care furnished by the Department.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><chapeau style="-uslm-dtd:text">The Secretary, acting through the Center, shall test payment and service delivery models to determine whether such models—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">improve access to, and quality, timeliness, and patient satisfaction of care and services; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">create cost savings for the Department.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary shall test a model in a location where the Secretary determines that the model will addresses deficits in care (including poor clinical outcomes or potentially avoidable expenditures) for a defined population.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The Secretary shall focus on models the Secretary expects to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits under this chapter.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">The models selected may include those described in section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)).</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5) </num><chapeau style="-uslm-dtd:text">In selecting a model for testing, the Secretary may consider, in addition to other factors identified in this subsection, the following factors:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">Whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and preferences of individuals receiving benefits under this chapter.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Whether the model places the individual receiving benefits under this chapter (including family members and other caregivers of such individual) at the center of the care team of such individual.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">Whether the model uses technology or new systems to coordinate care over time and across settings.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">Whether the model demonstrates effective linkage with other public sector payers, private sector payers, or statewide payment models.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="6">“(6)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Models tested under this section may not be designed in such a way that would allow the United States to recover or collect reasonable charges from a Federal health care program for care or services furnished by the Secretary to a veteran under pilot programs carried out under this section.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">In this paragraph, the term ‘<quotedText style="-uslm-dtd:quote">Federal health care program</quotedText>’ means—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">an insurance program described in section 1811 of the Social Security Act (42 U.S.C. 1395c) or established by section 1831 of such Act (42 U.S.C. 1395j);</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">a State plan for medical assistance approved under title XIX of such Act (42 U.S.C. 1396 et seq.); or</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">a TRICARE program operated under sections 1075, 1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Duration.—</heading><content style="-uslm-dtd:text">Each pilot program carried out by the Secretary under this section shall terminate no later than 5 years after the date of the commencement of the pilot program.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Location.—</heading><content style="-uslm-dtd:text">The Secretary shall ensure that each pilot program carried out under this section occurs in an area or areas appropriate for the intended purposes of the pilot program. To the extent practicable, the Secretary shall ensure that the pilot programs are located in geographically diverse areas of the United States.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Budget.—</heading><chapeau style="-uslm-dtd:text">Funding for each pilot program carried out by the Secretary under this section shall come from appropriations—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">provided in advance in appropriations acts for the Veterans Health Administration; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">provided for information technology systems.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Notice.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">publish information about each pilot program under this section in the Federal Register; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">take reasonable actions to provide direct notice to veterans eligible to participate in such pilot programs.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">Waiver of Authorities.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Subject to reporting under paragraph (2) and approval under paragraph (3), in implementing a pilot program under this section, the Secretary may waive such requirements in subchapters I, II, and III of this chapter as the Secretary determines necessary solely for the purposes of carrying out this section with respect to testing models described in subsection (a).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">Before waiving any authority under paragraph (1), the Secretary shall submit to the Speaker of the House of Representatives, the minority leader of the House of Representatives, the majority leader of the Senate, the minority leader of the Senate, and each standing committee with jurisdiction under the rules of the Senate and of the House of Representatives to report a bill to amend the provision or provisions of law that would be waived by the Department, a report on a request for waiver that describes in detail the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">The specific authorities to be waived under the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The standard or standards to be used in the pilot program in lieu of the waived authorities.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">The reasons for such waiver or waivers.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">A description of the metric or metrics the Secretary will use to determine the effect of the waiver or waivers upon the access to and quality, timeliness, or patient satisfaction of care and services furnished through the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">The anticipated cost savings, if any, of the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="F">“(F) </num><content style="-uslm-dtd:text">The schedule for interim reports on the pilot program describing the results of the pilot program so far and the feasibility and advisability of continuing the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="G">“(G) </num><content style="-uslm-dtd:text">The schedule for the termination of the pilot program and the submission of a final report on the pilot program describing the result of the pilot program and the feasibility and advisability of making the pilot program permanent.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="H">“(H) </num><content style="-uslm-dtd:text">The estimated budget of the pilot program.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Upon receipt of a report submitted under paragraph (2), each House of Congress shall provide copies of the report to the chairman and ranking member of each standing committee with jurisdiction under the rules of the House of Representatives or the Senate to report a bill to amend the provision or provisions of law that would be waived by the Department under this subsection.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The waiver requested by the Secretary under paragraph (2) shall be considered approved under this paragraph if there is enacted into law a joint resolution approving such request in its entirety.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><chapeau style="-uslm-dtd:text">For purposes of this paragraph, the term ‘<quotedText style="-uslm-dtd:quote">joint resolution</quotedText>’ means only a joint resolution which is introduced within the period of five legislative days beginning on the date on which the Secretary transmits the report to the Congress under such paragraph (2), and—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">which does not have a preamble; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">the matter after the resolving clause of which is as follows: ‘<quotedText style="-uslm-dtd:quote">that Congress approves the request for a waiver under section 1703E(f) of title 38, United States Code, as submitted by the Secretary on ___</quotedText>’, the blank space being filled with the appropriate date.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">Any committee of the House of Representatives to which a joint resolution is referred shall report it to the House without amendment not later than 15 legislative days after the date of introduction thereof. If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">It shall be in order at any time after the third legislative day after each committee authorized to consider a joint resolution has reported or has been discharged from consideration of a joint resolution, to move to proceed to consider the joint resolution in the House. All points of order against the motion are waived. Such a motion shall not be in order after the House has disposed of a motion to proceed on a joint resolution addressing a particular submission. The previous question shall be considered as ordered on the motion to its adoption without intervening motion. The motion shall not be debatable. A motion to reconsider the vote by which the motion is disposed of shall not be in order.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">The joint resolution shall be considered as read. All points of order against the joint resolution and against its consideration are waived. The previous question shall be considered as ordered on the joint resolution to its passage without intervening motion except two hours of debate equally divided and controlled by the proponent and an opponent. A motion to reconsider the vote on passage of the joint resolution shall not be in order.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">A joint resolution introduced in the Senate shall be referred to the Committee on Veterans’ Affairs.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">Any committee of the Senate to which a joint resolution is referred shall report it to the Senate without amendment not later than 15 session days after the date of introduction of a joint resolution described in paragraph (C). If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution and the joint resolution shall be placed on the calendar.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii)</num><subclause style="-uslm-dtd:subclause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">Notwithstanding Rule XXII of the Standing Rules of the Senate, it is in order at any time after the third session day on which the Committee on Veterans’ Affairs has reported or has been discharged from consideration of a joint resolution described in paragraph (C) (even though a previous motion to the same effect has been disagreed to) to move to proceed to the consideration of the joint resolution, and all points of order against the joint resolution (and against consideration of the joint resolution) are waived. The motion to proceed is not debatable. The motion is not subject to a motion to postpone. A motion to reconsider the vote by which the motion is agreed to or disagreed to shall not be in order. If a motion to proceed to the consideration of the resolution is agreed to, the joint resolution shall remain the unfinished business until disposed of.</content></subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">Consideration of the joint resolution, and on all debatable motions and appeals in connection therewith, shall be limited to not more than two hours, which shall be divided equally between the majority and minority leaders or their designees. A motion further to limit debate is in order and not debatable. An amendment to, or a motion to postpone, or a motion to proceed to the consideration of other business, or a motion to recommit the joint resolution is not in order.</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="III">“(III) </num><content style="-uslm-dtd:text">If the Senate has voted to proceed to a joint resolution, the vote on passage of the joint resolution shall occur immediately following the conclusion of consideration of the joint resolution, and a single quorum call at the conclusion of the debate if requested in accordance with the rules of the Senate.</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="IV">“(IV) </num><content style="-uslm-dtd:text">Appeals from the decisions of the Chair relating to the application of the rules of the Senate, as the case may be, to the procedure relating to a joint resolution shall be decided without debate.</content> </subclause> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="F">“(F) </num><content style="-uslm-dtd:text">A joint resolution considered pursuant to this paragraph shall not be subject to amendment in either the House of Representatives or the Senate.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="G">“(G)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><chapeau style="-uslm-dtd:text">If, before the passage by one House of the joint resolution of that House, that House receives the joint resolution from the other House, then the following procedures shall apply:</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">The joint resolution of the other House shall not be referred to a committee.</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><chapeau style="-uslm-dtd:text">With respect to the joint resolution of the House receiving the joint resolution—</chapeau> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="aa">“(aa) </num><content style="-uslm-dtd:text">the procedure in that House shall be the same as if no joint resolution had been received from the other House; but</content> </item> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="bb">“(bb) </num><content style="-uslm-dtd:text">the vote on passage shall be on the joint resolution of the other House.</content> </item> </subclause></clause> <clause style="-uslm-dtd:clause" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">If the Senate fails to introduce or consider a joint resolution under this paragraph, the joint resolution of the House shall be entitled to expedited floor procedures under this subparagraph.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">If, following passage of the joint resolution in the Senate, the Senate then receives the companion measure from the House of Representatives, the companion measure shall not be debatable.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="H">“(H) </num><chapeau style="-uslm-dtd:text">This subparagraph is enacted by Congress—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">as an exercise of the rulemaking power of the Senate and House of Representatives, respectively, and as such it is deemed a part of the rules of each House, respectively, but applicable only with respect to the procedure to be followed in that House in the case of a joint resolution, and it supersedes other rules only to the extent that it is inconsistent with such rules; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">with full recognition of the constitutional right of either House to change the rules (so far as relating to the procedure of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><heading style="-uslm-dtd:header">Limitations.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary may not carry out more than 10 pilot programs concurrently.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Subject to subparagraph (B), the Secretary may not expend more than $50,000,000 in any fiscal year from amounts under subsection (d).</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">The Secretary may expend more than the amount in subparagraph (A) if—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">the Secretary determines that the additional expenditure is necessary to carry out pilot programs under this section;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">the Secretary submits to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report setting forth the amount of the additional expenditure and a justification for the additional expenditure; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">the Chairmen of the Committees on Veterans’ Affairs of the Senate and the House of Representatives transmit to the Secretary a letter approving of the additional expenditure.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The waiver provisions in subsection (f) shall not apply unless the Secretary, in accordance with the requirements in subsection (f), submits the first proposal for a pilot program not later than 18 months after the date of the enactment of the Caring for Our Veterans Act of 2018.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Notwithstanding section 502 of this title, decisions by the Secretary under this section shall, consistent with section 511 of this title, be final and conclusive and may not be reviewed by any other official or by any court, whether by an action in the nature of mandamus or otherwise.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">If the Secretary determines that a pilot program is not improving the quality of care or producing cost savings, the Secretary shall—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">propose a modification to the pilot program in the interim report that shall also be considered a report under subsection (f)(2) and shall be subject to the terms and conditions of subsection (f)(2); or</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">terminate such pilot program not later than 30 days after submitting the interim report to Congress.</content> </clause></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">If the Secretary terminates a pilot program under subparagraph (A)(ii), for purposes of subparagraphs (F) and (G) of subsection (f)(2), such interim report will also serve as the final report for that pilot program.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h) </num><heading style="-uslm-dtd:header">Evaluation and Reporting Requirements.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The Secretary shall conduct an evaluation of each model tested, which shall include, at a minimum, an analysis of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the quality of care furnished under the model, including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the Secretary; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the changes in spending by reason of that model.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary shall make the results of each evaluation under this subsection available to the public in a timely fashion and may establish requirements for other entities participating in the testing of models under this section to collect and report information that the Secretary determines is necessary to monitor and evaluate such models.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i) </num><heading style="-uslm-dtd:header">Coordination and Advice.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall obtain advice from the Under Secretary for Health and the Special Medical Advisory Group established pursuant to section 7312 of this title in the development and implementation of any pilot program operated under this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">In carrying out the duties under this section, the Secretary shall consult representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management. The Secretary shall use appropriate mechanisms to seek input from interested parties.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="j">“(j) </num><heading style="-uslm-dtd:header">Expansion of Successful Pilot Programs.—</heading><chapeau style="-uslm-dtd:text">Taking into account the evaluation under subsection (f), the Secretary may, through rulemaking, expand (including implementation on a nationwide basis) the duration and the scope of a model that is being tested under subsection (a) to the extent determined appropriate by the Secretary, if—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><chapeau style="-uslm-dtd:text">the Secretary determines that such expansion is expected to—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">reduce spending without reducing the quality of care; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">improve the quality of patient care without increasing spending; and</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits for individuals receiving benefits under this chapter.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s152/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Conforming Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapter, as amended by this title, is further amended by inserting after the item relating to section 1703D the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703E.</designator><label> Center for Innovation for Care and Payment.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stB/s153" styleType="OLC"> <num style="-uslm-dtd:enum" value="153">SEC. 153. </num><heading style="-uslm-dtd:header">AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE DONORS FOR PURPOSES OF CONDUCTING TRANSPLANT PROCEDURES FOR VETERANS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s153/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter VIII of chapter 17 is amended by adding at the end the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1788">“SEC. 1788. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1788">38 U.S.C. 1788</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Transplant procedures with live donors and related services </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subject to subsections (b) and (c), in a case in which a veteran is eligible for a transplant procedure from the Department, the Secretary may provide for an operation on a live donor to carry out such procedure for such veteran, notwithstanding that the live donor may not be eligible for health care from the Department.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Other Services.—</heading><content style="-uslm-dtd:text">Subject to the availability of appropriations for such purpose, the Secretary shall furnish to a live donor any care or services before and after conducting the transplant procedure under subsection (a) that may be required in connection with such procedure.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Use of Non-Department Facilities.—</heading><content style="-uslm-dtd:text">In carrying out this section, the Secretary may provide for the operation described in subsection (a) on a live donor and furnish to the live donor the care and services described in subsection (b) at a non-Department facility pursuant to an agreement entered into by the Secretary under this chapter. The live donor shall be deemed to be an individual eligible for hospital care and medical services at a non-Department facility pursuant to such an agreement solely for the purposes of receiving such operation, care, and services at the non-Department facility.”</content> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s153/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 17is amended by inserting after the item relating to section 1787 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1788.</designator><label> Transplant procedures with live donors and related services.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> </subtitle> <subtitle style="-uslm-dtd:subtitle" identifier="/us/sComp/115/182/tI/stC" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">Subtitle C—</num><heading style="-uslm-dtd:header">Family Caregivers </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stC/s161" styleType="OLC"> <num style="-uslm-dtd:enum" value="161">SEC. 161. </num><heading style="-uslm-dtd:header">EXPANSION OF FAMILY CAREGIVER PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s161/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Family Caregiver Program.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Expansion of eligibility.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Subparagraph (B) of subsection (a)(2) of section 1720G is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">for assistance provided under this subsection—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">before the date on which the Secretary submits to Congress a certification that the Department has fully implemented the information technology system required by section 162(a) of the Caring for Our Veterans Act of 2018, has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><chapeau style="-uslm-dtd:text">during the 2-year period beginning on the date on which the Secretary submitted to Congress the certification described in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service—</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">on or before May 7, 1975; or</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">on or after September 11, 2001; or</content> </subclause> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">after the date that is 2 years after the date on which the Secretary submits to Congress the certification described in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service; and”</content> </clause> </subparagraph></quotedContent>.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1720G">38 U.S.C. 1720G note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Publication in federal register.—</heading><content style="-uslm-dtd:text">Not later than 30 days after the date on which the Secretary of Veterans Affairs submits to Congress the certification described in subsection (a)(2)(B)(i) of section 1720G of such title, as amended by subparagraph (A) of this paragraph, the Secretary shall publish the date specified in such subsection in the Federal Register.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Expansion of needed services in eligibility criteria.—</heading><chapeau style="-uslm-dtd:text">Subsection (a)(2)(C) of such section is amended—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">in clause (ii), by striking “<quotedText style="-uslm-dtd:quote">; or</quotedText>” and inserting a semicolon;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">by redesignating clause (iii) as clause (iv); and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">by inserting after clause (ii) the following new clause (iii):<quotedContent style="-uslm-dtd:quoted-block"> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text"> a need for regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired; or”</content> </subsection></quotedContent>.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Expansion of services provided.—</heading><chapeau style="-uslm-dtd:text">Subsection (a)(3)(A)(ii) of such section is amended—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">in subclause (IV), by striking “<quotedText style="-uslm-dtd:quote">; and</quotedText>” and inserting a semicolon;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">in subclause (V), by striking the period at the end and inserting “<quotedText style="-uslm-dtd:quote">; and</quotedText>”; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/3/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">by adding at the end the following new subclause:<quotedContent style="-uslm-dtd:quoted-block"> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="VI">“(VI) </num><chapeau style="-uslm-dtd:text">through the use of contracts with, or the provision of grants to, public or private entities—</chapeau> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="aa">“(aa) </num><content style="-uslm-dtd:text">financial planning services relating to the needs of injured veterans and their caregivers; and</content> </item> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="bb">“(bb) </num><content style="-uslm-dtd:text">legal services, including legal advice and consultation, relating to the needs of injured veterans and their caregivers.”</content> </item> </subclause></quotedContent>.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Modification of stipend calculation.—</heading><chapeau style="-uslm-dtd:text">Subsection (a)(3)(C) of such section is amended—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/4/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">by redesignating clause (iii) as clause (iv); and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/4/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">by inserting after clause (ii) the following new clause (iii):<quotedContent style="-uslm-dtd:quoted-block"> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease3"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><chapeau style="-uslm-dtd:text">In determining the amount and degree of personal care services provided under clause (i) with respect to an eligible veteran whose need for personal care services is based in whole or in part on a need for supervision or protection under paragraph (2)(C)(ii) or regular instruction or supervision under paragraph (2)(C)(iii), the Secretary shall take into account the following:</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">The assessment by the family caregiver of the needs and limitations of the veteran.</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">The extent to which the veteran can function safely and independently in the absence of such supervision, protection, or instruction.</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="III">“(III) </num><content style="-uslm-dtd:text">The amount of time required for the family caregiver to provide such supervision, protection, or instruction to the veteran.”</content> </subclause> </clause></quotedContent>.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><heading style="-uslm-dtd:header">Periodic evaluation of need for certain services.—</heading><content style="-uslm-dtd:text">Subsection (a)(3) of such section is amended by adding at the end the following new subparagraph:<quotedContent style="-uslm-dtd:quoted-block"> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">In providing instruction, preparation, and training under subparagraph (A)(i)(I) and technical support under subparagraph (A)(i)(II) to each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph (6), the Secretary shall periodically evaluate the needs of the eligible veteran and the skills of the family caregiver of such veteran to determine if additional instruction, preparation, training, or technical support under those subparagraphs is necessary.”</content> </subparagraph></quotedContent>.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/6" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">(6) </num><heading style="-uslm-dtd:header">Use of primary care teams.—</heading><content style="-uslm-dtd:text">Subsection (a)(5) of such section is amended, in the matter preceding subparagraph (A), by inserting “<quotedText style="-uslm-dtd:quote">(in collaboration with the primary care team for the eligible veteran to the maximum extent practicable)</quotedText>” after “<quotedText style="-uslm-dtd:quote">evaluate</quotedText>”.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/7" styleType="OLC"> <num style="-uslm-dtd:enum" value="7">(7) </num><heading style="-uslm-dtd:header">Assistance for family caregivers.—</heading><content style="-uslm-dtd:text">Subsection (a) of such section is amended by adding at the end the following new paragraph:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="11">“(11)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">In providing assistance under this subsection to family caregivers of eligible veterans, the Secretary may enter into contracts, provider agreements, and memoranda of understanding with Federal agencies, States, and private, nonprofit, and other entities to provide such assistance to such family caregivers.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The Secretary may provide assistance under this paragraph only if such assistance is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the Department.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">The Secretary may provide fair compensation to Federal agencies, States, and other entities that provide assistance under this paragraph.”</content> </subparagraph> </paragraph></quotedContent>.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s161/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Modification of Definition of Personal Care Services.—</heading><chapeau style="-uslm-dtd:text">Subsection (d)(4) of such section is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">in subparagraph (A), by striking “<quotedText style="-uslm-dtd:quote">independent</quotedText>”;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">by redesignating subparagraph (B) as subparagraph (D); and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">by inserting after subparagraph (A) the following new subparagraphs:<quotedContent style="-uslm-dtd:quoted-block"> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Supervision or protection based on symptoms or residuals of neurological or other impairment or injury.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">Regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired.”</content> </subparagraph></quotedContent>.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stC/s162" styleType="OLC"> <num style="-uslm-dtd:enum" value="162">SEC. 162. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1720G">38 U.S.C. 1720G note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">IMPLEMENTATION OF INFORMATION TECHNOLOGY SYSTEM OF DEPARTMENT OF VETERANS AFFAIRS TO ASSESS AND IMPROVE THE FAMILY CAREGIVER PROGRAM. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s162/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Implementation of New System.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than October 1, 2018, the Secretary of Veterans Affairs shall implement an information technology system that fully supports the Program and allows for data assessment and comprehensive monitoring of the Program.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Elements of system.—</heading><chapeau style="-uslm-dtd:text">The information technology system required to be implemented under paragraph (1) shall include the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The ability to easily retrieve data that will allow all aspects of the Program (at the medical center and aggregate levels) and the workload trends for the Program to be assessed and comprehensively monitored.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The ability to manage data with respect to a number of caregivers that is more than the number of caregivers that the Secretary expects to apply for the Program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/a/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">The ability to integrate the system with other relevant information technology systems of the Veterans Health Administration.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s162/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Assessment of Program.—</heading><content style="-uslm-dtd:text">Not later than 180 days after implementing the system described in subsection (a), the Secretary shall, through the Under Secretary for Health, use data from the system and other relevant data to conduct an assessment of how key aspects of the Program are structured and carried out.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s162/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Ongoing Monitoring of and Modifications to Program.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Monitoring.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall use the system implemented under subsection (a) to monitor and assess the workload of the Program, including monitoring and assessment of data on—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/c/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">the status of applications, appeals, and home visits in connection with the Program; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/c/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">the use by caregivers participating in the Program of other support services under the Program such as respite care.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Modifications.—</heading><content style="-uslm-dtd:text">Based on the monitoring and assessment conducted under paragraph (1), the Secretary shall identify and implement such modifications to the Program as the Secretary considers necessary to ensure the Program is functioning as intended and providing veterans and caregivers participating in the Program with services in a timely manner.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s162/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Reports.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Initial report.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><chapeau style="-uslm-dtd:text">Not later than 90 days after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the Comptroller General of the United States a report that includes—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/1/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">the status of the planning, development, and deployment of the system required to be implemented under subsection (a), including any changes in the timeline for the implementation of the system; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/1/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">an assessment of the needs of family caregivers of veterans described in subparagraph (B), the resources needed for the inclusion of such family caregivers in the Program, and such changes to the Program as the Secretary considers necessary to ensure the successful expansion of the Program to include such family caregivers.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Veterans described.—</heading><content style="-uslm-dtd:text">Veterans described in this subparagraph are veterans who are eligible for the Program under clause (ii) or (iii) of section 1720G(a)(2)(B) of title 38, United States Code, as amended by section 161(a)(1) of this title, solely due to a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service before September 11, 2001.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Notification by comptroller general.—</heading><chapeau style="-uslm-dtd:text">The Comptroller General shall review the report submitted under paragraph (1) and notify the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives with respect to the progress of the Secretary in—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">fully implementing the system required under subsection (a); and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">implementing a process for using such system to monitor and assess the Program under subsection (c)(1) and modify the Program as considered necessary under subsection (c)(2).</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/d/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Final report.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than October 1, 2019, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the Comptroller General a report on the implementation of subsections (a) through (c).</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">The report required by subparagraph (A) shall include the following:</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/3/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">A certification by the Secretary that the information technology system described in subsection (a) has been implemented.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/3/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">A description of how the Secretary has implemented such system.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/3/B/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">A description of the modifications to the Program, if any, that were identified and implemented under subsection (c)(2).</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/3/B/iv" styleType="OLC"> <num style="-uslm-dtd:enum" value="iv">(iv) </num><content style="-uslm-dtd:text">A description of how the Secretary is using such system to monitor the workload of the Program.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s162/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Active military, naval, or air service.—</heading><content style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">active military, naval, or air service</quotedText>” has the meaning given that term in section 101 of title 38, United States Code.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Program.—</heading><content style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">Program</quotedText>” means the program of comprehensive assistance for family caregivers under section 1720G(a) of title 38, United States Code, as amended by section 161 of this title.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stC/s163" styleType="OLC"> <num style="-uslm-dtd:enum" value="163">SEC. 163. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1720G">38 U.S.C. 1720G note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">MODIFICATIONS TO ANNUAL EVALUATION REPORT ON CAREGIVER PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s163/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Barriers to Care and Services.—</heading><content style="-uslm-dtd:text">Subparagraph (A)(iv) of section 101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111-163; 38 U.S.C. 1720G note) is amended by inserting “<quotedText style="-uslm-dtd:quote">, including a description of any barriers to accessing and receiving care and services under such programs</quotedText>” before the semicolon.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s163/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Sufficiency of Training for Family Caregiver Program.—</heading><chapeau style="-uslm-dtd:text">Subparagraph (B) of such section is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s163/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">in clause (i), by striking “<quotedText style="-uslm-dtd:quote">; and</quotedText>” and inserting a semicolon;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s163/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">in clause (ii), by striking the period at the end and inserting “<quotedText style="-uslm-dtd:quote">; and</quotedText>”; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s163/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">by adding at the end the following new clause:<quotedContent style="-uslm-dtd:quoted-block"> <clause style="-uslm-dtd:clause" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">an evaluation of the sufficiency and consistency of the training provided to family caregivers under such program in preparing family caregivers to provide care to veterans under such program.”</content> </clause></quotedContent>.</content> </paragraph> </subsection> </section> </subtitle>

AN ACTTo establish a permanent community care program for veterans, to establish a commission for the purpose of making recommendations regarding the modernization or realignment of facilities of the Veterans Health Administration, to improve construction of the Department of Veterans Affairs, to make certain improvements in the laws administered by the Secretary of Veterans Affairs relating to the home loan program of the Department of Veterans Affairs, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) [38 U.S.C. 101 note] Short Title.—This Act may be cited as the “John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018” or the “VA MISSION Act of 2018”. (b) Table of Contents.—The table of contents for this Act is as follows: Sec. 123. Continuing medical education for non-Department medical professionals. Chapter 4—Other Matters Relating to Non-Department of Veterans Affairs Providers Sec. 131. Establishment of processes to ensure safe opioid prescribing practices by non-Department of Veterans Affairs health care providers. Sec. 132. Improving information sharing with community providers. Sec. 133. Competency standards for non-Department of Veterans Affairs health care providers. Sec. 134. Department of Veterans Affairs participation in national network of State-based prescription drug monitoring programs. Chapter 5—Other Non-Department Health Care Matters Sec. 141. Plans for Use of Supplemental Appropriations Required. Sec. 142. Veterans Choice Fund flexibility. Sec. 143. Sunset of Veterans Choice Program. Sec. 144. Conforming amendments. Subtitle B—Improving Department of Veterans Affairs Health Care Delivery Sec. 151. Licensure of health care professionals of the Department of Veterans Affairs providing treatment via telemedicine. Sec. 152. Authority for Department of Veterans Affairs Center for Innovation for Care and Payment. Sec. 153. Authorization to provide for operations on live donors for purposes of conducting transplant procedures for veterans. Subtitle C—Family Caregivers Sec. 161. Expansion of family caregiver program of Department of Veterans Affairs. Sec. 162. Implementation of information technology system of Department of Veterans Affairs to assess and improve the family caregiver program. Sec. 163. Modifications to annual evaluation report on caregiver program of Department of Veterans Affairs. TITLE II—VA ASSET AND INFRASTRUCTURE REVIEW Subtitle A—Asset and Infrastructure Review Sec. 201. Short title. Sec. 202. The Commission. Sec. 203. Procedure for making recommendations. Sec. 204. Actions regarding infrastructure and facilities of the Veterans Health Administration. Sec. 205. Implementation. Sec. 206. Department of Veterans Affairs Asset and Infrastructure Review Account. Sec. 207. Congressional consideration of Commission report. Sec. 208. Other matters. Sec. 209. Definitions. Subtitle B—Other Infrastructure Matters Sec. 211. Improvement to training of construction personnel. Sec. 212. Review of enhanced use leases. Sec. 213. Assessment of health care furnished by the Department to veterans who live in the Pacific territories. TITLE III—IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS Sec. 301. Designated scholarships for physicians and dentists under Department of Veterans Affairs Health Professional Scholarship Program. Sec. 302. Increase in maximum amount of debt that may be reduced under Education Debt Reduction Program of Department of Veterans Affairs. Sec. 303. Establishing the Department of Veterans Affairs Specialty Education Loan Repayment Program. Sec. 304. Veterans healing veterans medical access and scholarship program. Sec. 305. Bonuses for recruitment, relocation, and retention. Sec. 306. Inclusion of Vet Center employees in Education Debt Reduction Program of Department of Veterans Affairs. TITLE IV—HEALTH CARE IN UNDERSERVED AREAS Sec. 401. Development of criteria for designation of certain medical facilities of the Department of Veterans Affairs as underserved facilities and plan to address problem of underserved facilities. Sec. 402. Pilot program to furnish mobile deployment teams to underserved facilities. Sec. 403. Pilot program on graduate medical education and residency. TITLE V—OTHER MATTERS Sec. 501. Annual report on performance awards and bonuses awarded to certain high-level employees of the department. Sec. 502. Role of podiatrists in Department of Veterans Affairs. Sec. 503. Definition of major medical facility project. Sec. 504. Authorization of certain major medical facility projects of the Department of Veterans Affairs. Sec. 505. Department of Veterans Affairs personnel transparency. Sec. 506. Program on establishment of peer specialists in patient aligned care team settings within medical centers of Department of Veterans Affairs. Sec. 507. Department of Veterans Affairs medical scribe pilot program. Sec. 508. Extension of requirement to collect fees for housing loans guaranteed by Secretary of Veterans Affairs. Sec. 509. Extension of reduction in amount of pension furnished by Department of Veterans Affairs for certain veterans covered by Medicaid plans for services furnished by nursing facilities. Sec. 510. Appropriation of amounts. Sec. 511. Technical correction. Sec. 512. Budgetary effects. Sec. 1. Short title; table of contents. TITLE I—CARING FOR OUR VETERANS Sec. 100. Short title; references to title 38, United States Code. Subtitle A—Developing an Integrated High-Performing Network Chapter 1—Establishing Community Care Programs Sec. 101. Establishment of Veterans Community Care Program. Sec. 102. Authorization of agreements between Department of Veterans Affairs and non-Department providers. Sec. 103. Conforming amendments for State veterans homes. Sec. 104. Access standards and standards for quality. Sec. 105. Access to walk-in care. Sec. 106. Strategy regarding the Department of Veterans Affairs High-Performing Integrated Health Care Network. Sec. 107. Applicability of Directive of Office of Federal Contract Compliance Programs. Sec. 108. Prevention of certain health care providers from providing non-Department health care services to veterans. Sec. 109. Remediation of medical service lines. Chapter 2—Paying Providers and Improving Collections Sec. 111. Prompt payment to providers. Sec. 112. Authority to pay for authorized care not subject to an agreement. Sec. 113. Improvement of authority to recover the cost of services furnished for non-service-connected disabilities. Sec. 114. Processing of claims for reimbursement through electronic interface. Chapter 3—Education and Training Programs Sec. 121. Education program on health care options. Sec. 122. Training program for administration of non-Department of Veterans Affairs health care.

<num style="-uslm-dtd:enum" value="I">TITLE I—</num><heading style="-uslm-dtd:header">CARING FOR OUR VETERANS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/s100" styleType="OLC"> <num style="-uslm-dtd:enum" value="100">SEC. 100. </num><heading style="-uslm-dtd:header">SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES CODE. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/s100/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s101">38 U.S.C. 101 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Short Title.—</heading><content style="-uslm-dtd:text">This title may be cited as the “<shortTitle style="-uslm-dtd:quote">Caring for Our Veterans Act of 2018</shortTitle>”.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/s100/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">References to Title 38, United States Code.—</heading><content style="-uslm-dtd:text">Except as otherwise expressly provided, whenever in this title an amendment or repeal is expressed in terms of an amendment to, or repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of title 38, United States Code.</content> </subsection> </section> <subtitle style="-uslm-dtd:subtitle" identifier="/us/sComp/115/182/tI/stA" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">Subtitle A—</num><heading style="-uslm-dtd:header">Developing an Integrated High-Performing Network </heading> <chapter style="-uslm-dtd:chapter" identifier="/us/sComp/115/182/tI/stA/ch1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">CHAPTER 1—</num><heading style="-uslm-dtd:header">ESTABLISHING COMMUNITY CARE PROGRAMS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s101" styleType="OLC"> <num style="-uslm-dtd:enum" value="101">SEC. 101. </num><heading style="-uslm-dtd:header">ESTABLISHMENT OF VETERANS COMMUNITY CARE PROGRAM. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s101/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment of Program.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Section 1703 is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703">“SEC. 1703. </num><heading style="-uslm-dtd:header">Veterans Community Care Program </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">There is established a program to furnish hospital care, medical services, and extended care services to covered veterans through health care providers specified in subsection (c).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary shall coordinate the furnishing of hospital care, medical services, and extended care services under this section to covered veterans, including coordination of, at a minimum, the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">Ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-Department providers.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Ensuring continuity of care and services.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">Ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">Ensuring that covered veterans do not experience a lapse in care resulting from errors or delays by the Department or its contractors or an unusual or excessive burden in accessing hospital care, medical services, or extended care services.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">A covered veteran may only receive care or services under this section upon the authorization of such care or services by the Secretary.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Covered Veterans.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, a covered veteran is any veteran who—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">is enrolled in the system of annual patient enrollment established and operated under section 1705 of this title; or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">is not enrolled in such system but is otherwise entitled to hospital care, medical services, or extended care services under subsection (c)(2) of such section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Health Care Providers Specified.—</heading><chapeau style="-uslm-dtd:text">Health care providers specified in this subsection are the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd: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.), including any physician furnishing services under such a program.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Department of Defense.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The Indian Health Service.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">Any health care provider not otherwise covered under any of paragraphs (1) through (4) that meets criteria established by the Secretary for purposes of this section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Conditions Under Which Care Is Required To Be Furnished Through Non-Department Providers.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The Secretary shall, subject to the availability of appropriations, furnish hospital care, medical services, and extended care services to a covered veteran through health care providers specified in subsection (c) if—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the Department does not offer the care or services the veteran requires;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Department does not operate a full-service medical facility in the State in which the covered veteran resides;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">the covered veteran was an eligible veteran under section 101(b)(2)(B) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) as of the day before the date of the enactment of the Caring for Our Veterans Act of 2018;</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">continues to reside in a location that would qualify the veteran for eligibility under such section; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><chapeau style="-uslm-dtd:text">either—</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">resides in one of the five States with the lowest population density as determined by data from the 2010 decennial census; or</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="II">“(II) </num><chapeau style="-uslm-dtd:text">resides in a State not described in subclause (I) and—</chapeau> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="aa">“(aa) </num><content style="-uslm-dtd:text">received care or services under this title in the year preceding the enactment of the Caring for Our Veterans Act of 2018; and</content> </item> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="bb">“(bb) </num><content style="-uslm-dtd:text">is seeking care or services within 2 years of the date of the enactment of the Caring for Our Veterans Act of 2018;</content> </item> </subclause> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">the covered veteran has contacted the Department to request care or services and the Department is not able to furnish such care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">the covered veteran and the covered veteran’s referring clinician agree that furnishing care and services through a non-Department entity or provider would be in the best medical interest of the covered veteran based upon criteria developed by the Secretary.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary shall ensure that the criteria developed under paragraph (1)(E) include consideration of the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">The distance between the covered veteran and the facility that provides the hospital care, medical services, or extended care services the veteran needs.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The nature of the hospital care, medical services, or extended care services required.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">The frequency that the hospital care, medical services, or extended care services needs to be furnished.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">The timeliness of available appointments for the hospital care, medical services, or extended care services the veteran needs.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><chapeau style="-uslm-dtd:text">Whether the covered veteran faces an unusual or excessive burden to access hospital care, medical services, or extended care services from the Department medical facility where a covered veteran seeks hospital care, medical services, or extended care services, which shall include consideration of the following:</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">Whether the covered veteran faces an excessive driving distance, geographical challenge, or environmental factor that impedes the access of the covered veteran.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">Whether the hospital care, medical services, or extended care services sought by the veteran is provided by a medical facility of the Department that is reasonably accessible to a covered veteran.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">Whether a medical condition of the covered veteran affects the ability of the covered veteran to travel.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iv">“(iv) </num><content style="-uslm-dtd:text">Whether there is compelling reason, as determined by the Secretary, that the veteran needs to receive hospital care, medical services, or extended care services from a medical facility other than a medical facility of the Department.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="v">“(v) </num><content style="-uslm-dtd:text">Such other considerations as the Secretary considers appropriate.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">If the Secretary has determined that the Department does not offer the care or services the covered veteran requires under subparagraph (A) of paragraph (1), that the Department does not operate a full-service medical facility in the State in which the covered veteran resides under subparagraph (B) of such paragraph, that the covered veteran is described under subparagraph (C) of such paragraph, or that the Department is not able to furnish care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title under subparagraph (D) of such paragraph, the decision to receive hospital care, medical services, or extended care services under such subparagraphs from a health care provider specified in subsection (c) shall be at the election of the veteran.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Conditions Under Which Care Is Authorized To Be Furnished Through Non-Department Providers.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary may furnish hospital care, medical services, or extended care services through a health care provider specified in subsection (c) to a covered veteran served by a medical service line of the Department that the Secretary has determined is not providing care that complies with the standards for quality the Secretary shall establish under section 1703C.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">In carrying out subparagraph (A), the Secretary shall—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">measure timeliness of the medical service line at a facility of the Department when compared with the same medical service line at different Department facilities; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">measure quality at a medical service line of a facility of the Department by comparing it with two or more distinct and appropriate quality measures at non-Department medical service lines.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than three medical service lines described in such subparagraph at any one health care facility of the Department.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than 36 medical service lines nationally described in such subparagraph.</content> </clause> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary may limit the types of hospital care, medical services, or extended care services covered veterans may receive under paragraph (1) in terms of the length of time such care and services will be available, the location at which such care and services will be available, and the clinical care and services that will be available.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Except as provided for in subparagraph (B), the hospital care, medical services, and extended care services authorized under paragraph (1) with respect to a medical service line shall cease when the remediation described in section 1706A with respect to such medical service line is complete.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The Secretary shall ensure continuity and coordination of care for any veteran who elects to receive care or services under paragraph (1) from a health care provider specified in subsection (c) through the completion of an episode of care.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">The Secretary shall publish in the Federal Register, and shall take all reasonable steps to provide direct notice to covered veterans affected under this subsection, at least once each year stating the time period during which such care and services will be available, the location or locations where such care and services will be available, and the clinical services available at each location under this subsection in accordance with regulations the Secretary shall prescribe.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">When the Secretary exercises the authority under paragraph (1), the decision to receive care or services under such paragraph from a health care provider specified in subsection (c) shall be at the election of the covered veteran.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">Review of Decisions.—</heading><content style="-uslm-dtd:text">The review of any decision under subsection (d) or (e) shall be subject to the Department’s clinical appeals process, and such decisions may not be appealed to the Board of Veterans’ Appeals.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><heading style="-uslm-dtd:header">Tiered Network.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">To promote the provision of high-quality and high-value hospital care, medical services, and extended care services under this section, the Secretary may develop a tiered provider network of eligible providers based on criteria established by the Secretary for purposes of this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">In developing a tiered provider network of eligible providers under paragraph (1), the Secretary shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in selecting a health care provider specified in subsection (c) for receipt of hospital care, medical services, or extended care services under this section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h) </num><heading style="-uslm-dtd:header">Contracts To Establish Networks of Health Care Providers.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall enter into consolidated, competitively bid contracts to establish networks of health care providers specified in paragraphs (1) and (5) of subsection (c) for purposes of providing sufficient access to hospital care, medical services, or extended care services under this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary shall, to the extent practicable, ensure that covered veterans are able to make their own appointments using advanced technology.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">To the extent practicable, the Secretary shall be responsible for the scheduling of appointments for hospital care, medical services, and extended care services under this section.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">The Secretary may terminate a contract with an entity entered into under paragraph (1) at such time and upon such notice to the entity as the Secretary may specify for purposes of this section, if the Secretary notifies the appropriate committees of Congress that, at a minimum—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><chapeau style="-uslm-dtd:text">the entity—</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section;</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">failed to comply with the access standards or the standards for quality established by the Secretary;</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="III">“(III) </num><content style="-uslm-dtd:text">is excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a-7 and 1320a-7a);</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="IV">“(IV) </num><content style="-uslm-dtd:text">is identified as an excluded source on the list maintained in the System for Award Management, or any successor system; or</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="V">“(V) </num><content style="-uslm-dtd:text">has been convicted of a felony or other serious offense under Federal or State law and the continued participation of the entity would be detrimental to the best interests of veterans or the Department;</content> </subclause> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">it is reasonable to terminate the contract based on the health care needs of veterans; or</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">it is reasonable to terminate the contract based on coverage provided by contracts or sharing agreements entered into under authorities other than this section.</content> </clause></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Nothing in subparagraph (A) may be construed to restrict the authority of the Secretary to terminate a contract entered into under paragraph (1) under any other provision of law.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><chapeau style="-uslm-dtd:text">Whenever the Secretary provides notice to an entity that the entity is failing to meet contractual obligations entered into under paragraph (1), 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 such failure. Such report shall include the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">An explanation of the reasons for providing such notice.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">A description of the effect of such failure, including with respect to cost, schedule, and requirements.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">A description of the actions taken by the Secretary to mitigate such failure.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">A description of the actions taken by the contractor to address such failure.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">A description of any effect on the community provider market for veterans in the affected area.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary shall instruct each entity awarded a contract under paragraph (1) to recognize and accept, on an interim basis, the credentials and qualifications of health care providers who are authorized to furnish hospital care and medical services to veterans under a community care program of the Department in effect as of the day before the date of the enactment of the Caring for Our Veterans Act of 2018, including under the Patient-Centered Community Care Program and the Veterans Choice Program under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note), as qualified providers under the program established under this section.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">The interim acceptance period under subparagraph (A) shall be determined by the Secretary based on the following criteria:</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">With respect to a health care provider, when the current certification agreement for the health care provider expires.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">Whether the Department has enacted certification and eligibility criteria and regulatory procedures by which non-Department providers will be authorized under this section.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="6">“(6) </num><content style="-uslm-dtd:text">The Secretary shall establish a system or systems for monitoring the quality of care provided to covered veterans through a network under this subsection and for assessing the quality of hospital care, medical services, and extended care services furnished through such network before the renewal of the contract for such network.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i) </num><heading style="-uslm-dtd:header">Payment Rates for Care and Services.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Except as provided in paragraph (2), and to the extent practicable, the rate paid for hospital care, medical services, or extended care services under any provision in this title may not exceed the rate paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (42 U.S.C. 1395x(u))) or a supplier (as defined in section 1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare program under title XI or title XVIII of the Social Security Act (42 U.S.C. 1301 et seq.), including section 1834 of such Act (42 U.S.C. 1395m), for the same care or services.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">A higher rate than the rate paid by the United States as described in paragraph (1) may be negotiated with respect to the furnishing of care or services to a covered veteran who resides in a highly rural area.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">In this paragraph, the term ‘<quotedText style="-uslm-dtd:quote">highly rural area</quotedText>’ means an area located in a county that has fewer than seven individuals residing in that county per square mile.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs shall be followed, except for when another payment agreement, including a contract or provider agreement, is in effect.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">With respect to furnishing hospital care, medical services, or extended care services under this section in a State with an All-Payer Model Agreement under section 1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3)) that became effective on or after January 1, 2014, the Medicare payment rates under paragraph (2)(A) shall be calculated based on the payment rates under such agreement.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">Notwithstanding paragraph (1), the Secretary may incorporate, to the extent practicable, the use of value-based reimbursement models to promote the provision of high-quality care.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="6">“(6) </num><content style="-uslm-dtd:text">With respect to hospital care, medical services, or extended care services for which there is not a rate paid under the Medicare program as described in paragraph (1), the rate paid for such care or services shall be determined by the Secretary.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="j">“(j) </num><heading style="-uslm-dtd:header">Treatment of Other Health Plan Contracts.—</heading><content style="-uslm-dtd:text">In any case in which a covered veteran is furnished hospital care, medical services, or extended care services under this section for a non-service-connected disability described in subsection (a)(2) of section 1729 of this title, the Secretary shall recover or collect reasonable charges for such care or services from a health plan contract described in section 1729 in accordance with such section.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="k">“(k) </num><heading style="-uslm-dtd:header">Payment by Veteran.—</heading><content style="-uslm-dtd:text">A covered veteran shall not pay a greater amount for receiving care or services under this section than the amount the veteran would pay for receiving the same or comparable care or services at a medical facility of the Department or from a health care provider of the Department.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="l">“(l) </num><heading style="-uslm-dtd:header">Transplant Authority for Improved Access.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">In the case of a covered veteran described in paragraph (2), the Secretary shall determine whether to authorize an organ or bone marrow transplant for that covered veteran at a non-Department facility.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">A covered veteran described in this paragraph—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">requires an organ or bone marrow transplant; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">has, in the opinion of the primary care provider of the veteran, a medically compelling reason to travel outside the region of the Organ Procurement and Transplantation Network, established under section 372 of the National Organ Transplantation Act (Public Law 98-507; 42 U.S.C. 274), in which the veteran resides, to receive such transplant.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="m">“(m) </num><heading style="-uslm-dtd:header">Monitoring of Care Provided.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018, and not less frequently than annually thereafter, the Secretary shall submit to appropriate committees of Congress a review of the types and frequency of care sought under subsection (d).</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">The review submitted under subparagraph (A) shall include an assessment of the following:</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">The top 25 percent of types of care and services most frequently provided under subsection (d) due to the Department not offering such care and services.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">The frequency such care and services were sought by covered veterans under this section.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">An analysis of the reasons the Department was unable to provide such care and services.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iv">“(iv) </num><content style="-uslm-dtd:text">Any steps the Department took to provide such care and services at a medical facility of the Department.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="v">“(v) </num><content style="-uslm-dtd:text">The cost of such care and services.</content> </clause> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">In monitoring the hospital care, medical services, and extended care services furnished under this section, the Secretary shall do the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><chapeau style="-uslm-dtd:text">With respect to hospital care, medical services, and extended care services furnished through provider networks established under subsection (i)—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">compile data on the types of hospital care, medical services, and extended care services furnished through such networks and how many patients used each type of care and service;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">identify gaps in hospital care, medical services, or extended care services furnished through such networks;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">identify how such gaps may be fixed through new contracts within such networks or changes in the manner in which hospital care, medical services, or extended care services are furnished through such networks;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iv">“(iv) </num><content style="-uslm-dtd:text">assess the total amounts spent by the Department on hospital care, medical services, and extended care services furnished through such networks;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="v">“(v) </num><content style="-uslm-dtd:text">assess the timeliness of the Department in referring hospital care, medical services, and extended care services to such networks; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="vi">“(vi) </num><chapeau style="-uslm-dtd:text">assess the timeliness of such networks in—</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">accepting referrals; and</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">scheduling and completing appointments.</content> </subclause> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Report the number of medical service lines the Secretary has determined under subsection (e)(1) not to be providing hospital care, medical services, or extended care services that comply with the standards for quality established by the Secretary.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">Assess the use of academic affiliates and centers of excellence of the Department to furnish hospital care, medical services, and extended care services to covered veterans under this section.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">Assess the hospital care, medical services, and extended care services furnished to covered veterans under this section by medical facilities operated by Federal agencies other than the Department.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018 and not less frequently than once each year thereafter, 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 information gathered under paragraph (2).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="n">“(n) </num><heading style="-uslm-dtd:header">Prohibition on Certain Limitations.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall not limit the types of hospital care, medical services, or extended care services covered veterans may receive under this section if it is in the best medical interest of the veteran to receive such hospital care, medical services, or extended care services, as determined by the veteran and the veteran’s health care provider.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">No provision in this section may be construed to alter or modify any other provision of law establishing specific eligibility criteria for certain hospital care, medical services, or extended care services.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="o">“(o) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><chapeau style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">medical service line</quotedText>’ means a clinic within a Department medical center.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 17is amended by striking the item relating to section 1703 and inserting the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703.</designator><label> Veterans Community Care Program.”</label></referenceItem> </toc></quotedContent>.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s101/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703">38 U.S.C. 1703 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Effective Date.—</heading><chapeau style="-uslm-dtd:text">Section 1703 of title 38, United States Code, as amended by subsection (a), shall take effect on the later of—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">the date that is 30 days after the date on which the Secretary of Veterans Affairs submits the report required under section 101(q)(2) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note); or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">the date on which the Secretary promulgates regulations pursuant to subsection (c).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Regulations.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall promulgate regulations to carry out section 1703 of title 38, United States Code, as amended by subsection (a) of this section.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Updates.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">Periodic.—</heading><content style="-uslm-dtd:text">Before promulgating the regulations required under paragraph (1), the Secretary shall provide to the appropriate committees of Congress periodic updates to confirm the progress of the Secretary toward developing such regulations.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">First update.—</heading><content style="-uslm-dtd:text">The first update under subparagraph (A) shall occur no later than 120 days from the date of the enactment of this Act.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><heading style="-uslm-dtd:header">Appropriate committees of congress defined.—</heading><chapeau style="-uslm-dtd:text">In this paragraph, the term “<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>” means—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2/C/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch1/s101/c/2/C/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s101/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Continuity of Existing Agreements.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Notwithstanding section 1703 of title 38, United States Code, as amended by subsection (a), the Secretary of Veterans Affairs shall continue all contracts, memorandums of understanding, memorandums of agreements, and other arrangements that were in effect on the day before the date of the enactment of this Act between the Department of Veterans Affairs and the American Indian and Alaska Native health care systems as established under the terms of the Department of Veterans Affairs and Indian Health Service Memorandum of Understanding, signed October 1, 2010, the National Reimbursement Agreement, signed December 5, 2012, arrangements under section 405 of the Indian Health Care Improvement Act (25 U.S.C. 1645), and agreements entered into under sections 102 and 103 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s101/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Modifications.—</heading><content style="-uslm-dtd:text">Paragraph (1) shall not be construed to prohibit the Secretary and the parties to the contracts, memorandums of understanding, memorandums of agreements, and other arrangements described in such paragraph from making such changes to such contracts, memorandums of understanding, memorandums of agreements, and other arrangements as may be otherwise authorized pursuant to other provisions of law or the terms of the contracts, memorandums of understanding, memorandums of agreements, and other arrangements.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s102" styleType="OLC"> <num style="-uslm-dtd:enum" value="102">SEC. 102. </num><heading style="-uslm-dtd:header">AUTHORIZATION OF AGREEMENTS BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND NON-DEPARTMENT PROVIDERS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s102/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 17 is amended by inserting after section 1703 the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703A">“SEC. 1703A. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703A">38 U.S.C. 1703A</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Agreements with eligible entities or providers; certification processes </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">Agreements Authorized.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">When hospital care, a medical service, or an extended care service required by a veteran who is entitled to such care or service under this chapter is not feasibly available to the veteran from a facility of the Department or through a contract or sharing agreement entered into pursuant to another provision of law, the Secretary may furnish such care or service to such veteran through an agreement under this section with an eligible entity or provider to provide such hospital care, medical service, or extended care service.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">An agreement entered into under this section to provide hospital care, a medical service, or an extended care service shall be known as a ‘<quotedText style="-uslm-dtd:quote">Veterans Care Agreement</quotedText>’.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">For purposes of subparagraph (A), hospital care, a medical service, or an extended care service may be considered not feasibly available to a veteran from a facility of the Department or through a contract or sharing agreement described in such subparagraph when the Secretary determines the veteran’s medical condition, the travel involved, the nature of the care or services required, or a combination of these factors make the use of a facility of the Department or a contract or sharing agreement described in such subparagraph impracticable or inadvisable.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">A Veterans Care Agreement may be entered into by the Secretary or any Department official authorized by the Secretary.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Subject to subparagraph (B), the Secretary shall review each Veterans Care Agreement of material size, as determined by the Secretary or set forth in paragraph (3), for hospital care, a medical service, or an extended care service to determine whether it is feasible and advisable to provide such care or service within a facility of the Department or by contract or sharing agreement entered into pursuant to another provision of law and, if so, take action to do so.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">The Secretary shall review each Veterans Care Agreement of material size that has been in effect for at least 6 months within the first 2 years of its taking effect, and not less frequently than once every 4 years thereafter.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">If a Veterans Care Agreement has not been in effect for at least 6 months by the date of the review required by subparagraph (A), the agreement shall be reviewed during the next cycle required by subparagraph (A), and such review shall serve as its review within the first 2 years of its taking effect for purposes of clause (i).</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">In fiscal year 2019 and in each fiscal year thereafter, in addition to such other Veterans Care Agreements as the Secretary may determine are of material size, a Veterans Care Agreement for the purchase of extended care services that exceeds $5,000,000 annually shall be considered of material size.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">From time to time, the Secretary may publish a notice in the Federal Register to adjust the dollar amount specified in subparagraph (A) to account for changes in the cost of health care based upon recognized health care market surveys and other available data.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Eligible Entities and Providers.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, an eligible entity or provider is—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">any provider of services that has enrolled and entered into a provider agreement under section 1866(a) of the Social Security Act (42 U.S.C. 1395cc(a)) and any physician or other supplier who has enrolled and entered into a participation agreement under section 1842(h) of such Act (42 U.S.C. 1395u(h));</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">any provider participating under a State plan under title XIX of such Act (42 U.S.C. 1396 et seq.);</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">an Aging and Disability Resource Center, an area agency on aging, or a State agency (as defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002));</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)); or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">any entity or provider not described in paragraph (1) or (2) of this subsection that the Secretary determines to be eligible pursuant to the certification process described in subsection (c).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Eligible Entity or Provider Certification Process.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall establish by regulation a process for the certification of eligible entities or providers or recertification of eligible entities or providers under this section. Such a process shall, at a minimum—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">establish deadlines for actions on applications for certification;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">set forth standards for an approval or denial of certification, duration of certification, revocation of an eligible entity or provider’s certification, and recertification of eligible entities or providers;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">require the denial of certification if the Secretary determines the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act (42 U.S.C. 1320a-7 or 1320a-7a) or is currently identified as an excluded source on the System for Award Management Exclusions list described in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">establish procedures for screening eligible entities or providers according to the risk of fraud, waste, and abuse that are similar to the standards under section 1866(j)(2)(B) of the Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 of title 48, Code of Federal Regulations, or successor regulations; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">incorporate and apply the restrictions and penalties set forth in chapter 21 of title 41 and treat this section as a procurement program only for purposes of applying such provisions.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Rates.—</heading><content style="-uslm-dtd:text">To the extent practicable, the rates paid by the Secretary for hospital care, medical services, and extended care services provided under a Veterans Care Agreement shall be in accordance with the rates paid by the United States under section 1703(i) of this title.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Terms of Veterans Care Agreements.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Pursuant to regulations promulgated under subsection (k), the Secretary may define the requirements for providers and entities entering into agreements under this section based upon such factors as the number of patients receiving care or services, the number of employees employed by the entity or provider furnishing such care or services, the amount paid by the Secretary to the provider or entity, or other factors as determined by the Secretary.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">To furnish hospital care, medical services, or extended care services under this section, an eligible entity or provider shall agree—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">to accept payment at the rates established in regulations prescribed under this section;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">that payment by the Secretary under this section on behalf of a veteran to a provider of services or care shall, unless rejected and refunded by the provider within 30 days of receipt, constitute payment in full and extinguish any liability on the part of the veteran for the treatment or care provided, and no provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate this requirement;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">to provide only the care and services authorized by the Department under this section and to obtain the prior written consent of the Department to furnish care or services outside the scope of such authorization;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">to bill the Department in accordance with the methodology outlined in regulations prescribed under this section;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">to not seek to recover or collect from a health plan contract or third party, as those terms are defined in section 1729 of this title, for any care or service that is furnished or paid for by the Department;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="F">“(F) </num><content style="-uslm-dtd:text">to provide medical records to the Department in the time frame and format specified by the Department; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="G">“(G) </num><content style="-uslm-dtd:text">to meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify in regulation.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">Discontinuation or Nonrenewal of a Veterans Care Agreement.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">An eligible entity or provider may discontinue a Veterans Care Agreement at such time and upon such notice to the Secretary as may be provided in regulations prescribed under this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary may discontinue a Veterans Care Agreement with an eligible entity or provider at such time and upon such reasonable notice to the eligible entity or provider as may be specified in regulations prescribed under this section, if an official designated by the Secretary—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">has determined that the eligible entity or provider failed to comply substantially with the provisions of the Veterans Care Agreement, or with the provisions of this section or regulations prescribed under this section;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">has determined the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act (42 U.S.C. 1320a-7 or 1320a-7a) or is identified on the System for Award Management Exclusions list as provided in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">has ascertained that the eligible entity or provider has been convicted of a felony or other serious offense under Federal or State law and determines the eligible entity or provider’s continued participation would be detrimental to the best interests of veterans or the Department; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">has determined that it is reasonable to terminate the agreement based on the health care needs of a veteran.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><heading style="-uslm-dtd:header">Quality of Care.—</heading><content style="-uslm-dtd:text">The Secretary shall establish a system or systems for monitoring the quality of care provided to veterans through Veterans Care Agreements and for assessing the quality of hospital care, medical services, and extended care services furnished by eligible entities and providers before the renewal of Veterans Care Agreements.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h) </num><heading style="-uslm-dtd:header">Disputes.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to Veterans Care Agreements.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Such procedures constitute the eligible entities’ and providers’ exhaustive and exclusive administrative remedies.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under section 1346 of title 28 (known as the ‘<quotedText style="-uslm-dtd:quote">Tucker Act</quotedText>’).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Disputes under this section must pertain to either the scope of authorization under the Veterans Care Agreement or claims for payment subject to the Veterans Care Agreement and are not claims for the purposes of such laws that would otherwise require application of sections 7101 through 7109 of title 41, United States Code.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i) </num><heading style="-uslm-dtd:header">Applicability of Other Provisions of Law.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">A Veterans Care Agreement may be authorized by the Secretary or any Department official authorized by the Secretary, and such action shall not be treated as—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">an award for the purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of care and services; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">a Federal contract for the acquisition of goods or services for purposes of any provision of Federal law governing Federal contracts for the acquisition of goods or services except section 4706(d) of title 41.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Except as provided in the agreement itself, in subparagraph (B), and unless otherwise provided in this section or regulations prescribed pursuant to this section, an eligible entity or provider that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not subject.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">An eligible entity or provider that enters into an agreement under this section is subject to—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">all laws regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Notwithstanding paragraph (2)(B)(i), an eligible entity or provider that enters into an agreement under this section shall not be treated as a Federal contractor or subcontractor for purposes of chapter 67 of title 41 (commonly known as the ‘<quotedText style="-uslm-dtd:quote">McNamara-O’Hara Service Contract Act of 1965</quotedText>’).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="j">“(j) </num><heading style="-uslm-dtd:header">Parity of Treatment.—</heading><content style="-uslm-dtd:text">Eligibility for hospital care, medical services, and extended care services furnished to any veteran pursuant to a Veterans Care Agreement shall be subject to the same terms as though provided in a facility of the Department, and provisions of this chapter applicable to veterans receiving such care and services in a facility of the Department shall apply to veterans treated under this section.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="k">“(k) </num><heading style="-uslm-dtd:header">Rulemaking.—</heading><content style="-uslm-dtd:text">The Secretary shall promulgate regulations to carry out this section.”</content> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s102/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapteris amended by inserting after the item relating to section 1703 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703A.</designator><label> Agreements with eligible entities or providers; certification processes.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s103" styleType="OLC"> <num style="-uslm-dtd:enum" value="103">SEC. 103. </num><heading style="-uslm-dtd:header">CONFORMING AMENDMENTS FOR STATE VETERANS HOMES. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s103/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><chapeau style="-uslm-dtd:text">Section 1745(a) is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s103/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">in paragraph (1), by striking “<quotedText style="-uslm-dtd:quote">(or agreement under section 1720(c)(1) of this title)</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">(or an agreement)</quotedText>”; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s103/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">by adding at the end the following new paragraph:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">An agreement under this section may be authorized by the Secretary or any Department official authorized by the Secretary, and any such action is not an award for purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of hospital care, medical services, and extended care services.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">Except as provided in the agreement itself, in clause (ii), and unless otherwise provided in this section or regulations prescribed pursuant to this section, a State home that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any provision of law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not subject.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><chapeau style="-uslm-dtd:text">A State home that enters into an agreement under this section is subject to—</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">all provisions of law regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties;</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">all provisions of law that protect against employment discrimination or that otherwise ensure equal employment opportunities; and</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="III">“(III) </num><content style="-uslm-dtd:text">all provisions in subchapter V of chapter 17 of this title.</content> </subclause> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">Notwithstanding subparagraph (B)(ii)(I), a State home that enters into an agreement under this section may not be treated as a Federal contractor or subcontractor for purposes of chapter 67 of title 41 (known as the ‘<quotedText style="-uslm-dtd:quote">McNamara-O’Hara Service Contract Act of 1965</quotedText>’).”</content> </clause> </subparagraph> </paragraph></quotedContent>.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s103/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1745">38 U.S.C. 1745 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Effective Date.—</heading><content style="-uslm-dtd:text">The amendment made by subsection (a) shall apply to care provided on or after the effective date of regulations issued by the Secretary of Veterans Affairs to carry out this section.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s104" styleType="OLC"> <num style="-uslm-dtd:enum" value="104">SEC. 104. </num><heading style="-uslm-dtd:header">ACCESS STANDARDS AND STANDARDS FOR QUALITY. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s104/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 17, as amended by section 102, is further amended by inserting after section 1703A the following new sections:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703B">“SEC. 1703B. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703B">38 U.S.C. 1703B</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Access standards </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall establish access standards for furnishing hospital care, medical services, or extended care services to covered veterans for the purposes of section 1703(d).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary shall ensure that the access standards established under paragraph (1) define such categories of care to cover all care and services within the medical benefits package of the Department of Veterans Affairs.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><content style="-uslm-dtd:text">The Secretary shall ensure that the access standards provide covered veterans, employees of the Department, and health care providers in the network established under section 1703(h) with relevant comparative information that is clear, useful, and timely, so that covered veterans can make informed decisions regarding their health care.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><content style="-uslm-dtd:text">The Secretary shall consult with all pertinent Federal entities (including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services), entities in the private sector, and other nongovernmental entities in establishing access standards.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Not later than 270 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report detailing the access standards.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Before submitting the report required under paragraph (1), the Secretary shall provide periodic updates to the appropriate committees of Congress to confirm the Department’s progress towards developing the access standards required by this section.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The first update under subparagraph (A) shall occur no later than 120 days from the date of the enactment of the Caring for Our Veterans Act of 2018.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Not later than 540 days after the date on which the Secretary implements the access standards established under subsection (a), the Secretary shall submit to the appropriate committees of Congress a report detailing the implementation of and compliance with such access standards by Department and non-Department entities or providers.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><chapeau style="-uslm-dtd:text">Not later than 3 years after the date on which the Secretary establishes access standards under subsection (a) and not less frequently than once every 3 years thereafter, the Secretary shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">conduct a review of such standards; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">submit to the appropriate committees of Congress a report on the findings and any modification to the access standards with respect to the review conducted under paragraph (1).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><content style="-uslm-dtd:text">The Secretary shall ensure health care providers specified under section 1703(c) are able to comply with the applicable access standards established by the Secretary.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><content style="-uslm-dtd:text">The Secretary shall publish in the Federal Register and on an internet website of the Department the designated access standards established under this section for purposes of section 1703(d)(1)(D).</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Consistent with paragraphs (1)(D) and (3) of section 1703(d), covered veterans may contact the Department at any time to request a determination regarding whether they are eligible to receive care and services from a non-Department entity or provider based on the Department being unable to furnish such care and services in a manner that complies with the designated access standards established under this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary shall establish a process to review such requests from covered veterans to determine whether—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the requested care is clinically necessary; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Department is able to provide such care in a manner that complies with designated access standards established under this section.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The Secretary shall promptly respond to any such request by a covered veteran.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">covered veterans</quotedText>’ refers to veterans described in section 1703(b) of this title.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703C">“SEC. 1703C. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703C">38 U.S.C. 1703C</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Standards for quality </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall establish standards for quality regarding hospital care, medical services, and extended care services furnished by the Department pursuant to this title, including through non-Department health care providers pursuant to section 1703 of this title.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">In establishing standards for quality under paragraph (1), the Secretary shall consider existing health quality measures that are applied to public and privately sponsored health care systems with the purpose of providing covered veterans relevant comparative information to make informed decisions regarding their health care.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><chapeau style="-uslm-dtd:text">The Secretary shall collect and consider data for purposes of establishing the standards under paragraph (1). Such data collection shall include—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey, a survey of veterans who have used hospital care, medical services, or extended care services furnished by the Veterans Health Administration during the most recent 2-year period to assess the satisfaction of the veterans with service and quality of care; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">datasets that include, at a minimum, elements relating to the following:</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">Timely care.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">Effective care.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">Safety, including, at a minimum, complications, readmissions, and deaths.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iv">“(iv) </num><content style="-uslm-dtd:text">Efficiency.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">The Secretary shall consult with all pertinent Federal entities (including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services), entities in the private sector, and other nongovernmental entities in establishing standards for quality.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Not later than 270 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report detailing the standards for quality.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">Before submitting the report required under subparagraph (A), the Secretary shall provide periodic updates to the appropriate committees of Congress to confirm the Department’s progress towards developing the standards for quality required by this section.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">The first update under clause (i) shall occur no later than 120 days from the date of the enactment of the Caring for Our Veterans Act of 2018.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Publication and Consideration of Public Comments.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Not later than 1 year after the date on which the Secretary establishes standards for quality under subsection (a), the Secretary shall publish the quality rating of medical facilities of the Department in the publicly available Hospital Compare website through the Centers for Medicare & Medicaid Services for the purpose of providing veterans with information that allows them to compare performance measure information among Department and non-Department health care providers.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Not later than 2 years after the date on which the Secretary establishes standards for quality under subsection (a), the Secretary shall consider and solicit public comment on potential changes to the measures used in such standards to ensure that they include the most up-to-date and applicable industry measures for veterans.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">covered veterans</quotedText>’ refers to veterans described in section 1703(b) of this title.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s104/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 17, as amended by section 102, is further amended by inserting after the item relating to section 1703A the following new items:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703B.</designator><label> Access standards.</label></referenceItem> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703C.</designator><label> Standards for quality.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s105" styleType="OLC"> <num style="-uslm-dtd:enum" value="105">SEC. 105. </num><heading style="-uslm-dtd:header">ACCESS TO WALK-IN CARE. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s105/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Chapter 17 is amended by inserting after section 1725 the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1725A">“SEC. 1725A. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1725A">38 U.S.C. 1725A</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Access to walk-in care </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">Procedures To Ensure Access to Walk-In Care.—</heading><content style="-uslm-dtd:text">The Secretary shall develop procedures to ensure that eligible veterans are able to access walk-in care from qualifying non-Department entities or providers.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Eligible Veterans.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, an eligible veteran is any individual who—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">is enrolled in the health care system established under section 1705(a) of this title; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">has received care under this chapter within the 24-month period preceding the furnishing of walk-in care under this section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Qualifying Non-Department Entities or Providers.—</heading><content style="-uslm-dtd:text">For purposes of this section, a qualifying non-Department entity or provider is a non-Department entity or provider that has entered into a contract or other agreement with the Secretary to furnish services under this section.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Federally-Qualified Health Centers.—</heading><content style="-uslm-dtd:text">Whenever practicable, the Secretary may use a Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))) to carry out this section.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Continuity of Care.—</heading><content style="-uslm-dtd:text">The Secretary shall ensure continuity of care for those eligible veterans who receive walk-in care services under this section, including through the establishment of a mechanism to receive medical records from walk-in care providers and provide pertinent patient medical records to providers of walk-in care.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">Copayments.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary may require an eligible veteran to pay the United States a copayment for each episode of hospital care or medical services provided under this section if the eligible veteran would be required to pay a copayment under this title.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">An eligible veteran not required to pay a copayment under this title may access walk-in care without a copayment for the first two visits in a calendar year. For any additional visits, a copayment at an amount determined by the Secretary may be required.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">An eligible veteran required to pay a copayment under this title may be required to pay a regular copayment for the first two walk-in care visits in a calendar year. For any additional visits, a higher copayment at an amount determined by the Secretary may be required.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">After the first two episodes of care furnished to an eligible veteran under this section, the Secretary may adjust the copayment required of the veteran under this subsection based upon the priority group of enrollment of the eligible veteran, the number of episodes of care furnished to the eligible veteran during a year, and other factors the Secretary considers appropriate under this section.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The amount or amounts of the copayments required under this subsection shall be prescribed by the Secretary by rule.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Section 8153(c) of this title shall not apply to this subsection.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><heading style="-uslm-dtd:header">Regulations.—</heading><content style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall promulgate regulations to carry out this section.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h) </num><heading style="-uslm-dtd:header">Walk-In Care Defined.—</heading><content style="-uslm-dtd:text">In this section, the term ‘<quotedText style="-uslm-dtd:quote">walk-in care</quotedText>’ means non-emergent care provided by a qualifying non-Department entity or provider that furnishes episodic care and not longitudinal management of conditions and is otherwise defined through regulations the Secretary shall promulgate.”</content> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s105/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1725A">38 U.S.C. 1725A note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Effective Date.—</heading><content style="-uslm-dtd:text">Section 1725A of title 38, United States Code, as added by subsection (a) shall take effect on the date upon which final regulations implementing such section take effect.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s105/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1725 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1725A.</designator><label> Access to walk-in care.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s106" styleType="OLC"> <num style="-uslm-dtd:enum" value="106">SEC. 106. </num><heading style="-uslm-dtd:header">STRATEGY REGARDING THE DEPARTMENT OF VETERANS AFFAIRS HIGH-PERFORMING INTEGRATED HEALTH CARE NETWORK. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s106/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter II of chapter 73 is amended by inserting after section 7330B the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="7330C">“SEC. 7330C. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7330C">38 U.S.C. 7330C</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Quadrennial Veterans Health Administration revie </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">Market Area Assessments.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Not less frequently than every 4 years, the Secretary of Veterans Affairs shall perform market area assessments regarding the health care services furnished under the laws administered by the Secretary.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">Each market area assessment established under paragraph (1) shall include the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">An assessment of the demand for health care from the Department, disaggregated by geographic market areas as determined by the Secretary, including the number of requests for health care services under the laws administered by the Secretary.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">An inventory of the health care capacity of the Department of Veterans Affairs across the Department’s system of facilities.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">An assessment of the health care capacity to be provided through contracted community care providers and providers who entered into a provider agreement with the Department under section 1703A of title 38, as added by section 102, including the number of providers, the geographic location of the providers, and categories or types of health care services provided by the providers.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">An assessment obtained from other Federal direct delivery systems of their capacity to provide health care to veterans.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">An assessment of the health care capacity of non-contracted providers where there is insufficient network supply.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="F">“(F) </num><content style="-uslm-dtd:text">An assessment of the health care capacity of academic affiliates and other collaborations of the Department as it relates to providing health care to veterans.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="G">“(G) </num><content style="-uslm-dtd:text">An assessment of the effects on health care capacity of the access standards and standards for quality established under sections 1703B and 1703C of this title.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="H">“(H) </num><chapeau style="-uslm-dtd:text">The number of appointments for health care services under the laws administered by the Secretary, disaggregated by—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">appointments at facilities of the Department of Veterans Affairs; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">appointments with non-Department health care providers.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary shall submit to the appropriate committees of Congress the market area assessments established in paragraph (1).</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The Secretary also shall submit to the appropriate committees of Congress the market area assessments completed by or being performed on the day before the date of the enactment of the Caring for Our Veterans Act of 2018.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">The Secretary shall use the market area assessments established under paragraph (1) to—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">determine the capacity of the health care provider networks established under section 1703(h) of this title;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">inform the Department budget, in accordance with subparagraph (B); and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">inform and assess the appropriateness of the access standards established under section 1703B of this title and standards for quality under section 1703C and to make recommendations for any changes to such standards.</content> </clause></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The Secretary shall ensure that the Department budget for any fiscal year (as submitted with the budget of the President under section 1105(a) of title 31) reflects the findings of the Secretary with respect to the most recent market area assessments under paragraph (1) and health care utilization data from the Department and non-Department entities or providers furnishing care and services to covered veterans as described in section 1703(b).</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Strategic Plan To Meet Health Care Demand.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of the Caring for Our Veterans Act of 2018 and not less frequently than once every 4 years thereafter, the Secretary shall submit to the appropriate committees of Congress a strategic plan that specifies a 4-year forecast of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the demand for health care from the Department, disaggregated by geographic area as determined by the Secretary;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the health care capacity to be provided at each medical center of the Department; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">the health care capacity to be provided through community care providers.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">In preparing the strategic plan under paragraph (1), the Secretary shall—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">assess the access standards and standards for quality established under sections 1703B and 1703C of this title;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">assess the market area assessments established under subsection (a);</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">assess the needs of the Department based on identified services that provide management of conditions or disorders related to military service for which there is limited experience or access in the national market, the overall health of veterans throughout their lifespan, or other services as the Secretary determines appropriate;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">consult with key stakeholders within the Department, the heads of other Federal agencies, and other relevant governmental and nongovernmental entities, including State, local, and tribal government officials, members of Congress, veterans service organizations, private sector representatives, academics, and other policy experts;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">identify emerging issues, trends, problems, and opportunities that could affect health care services furnished under the laws administered by the Secretary;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="F">“(F) </num><content style="-uslm-dtd:text">develop recommendations regarding both short- and long-term priorities for health care services furnished under the laws administered by the Secretary;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="G">“(G) </num><content style="-uslm-dtd:text">after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey, consider a survey of veterans who have used hospital care, medical services, or extended care services furnished by the Veterans Health Administration during the most recent 2-year period to assess the satisfaction of the veterans with service and quality of care;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="H">“(H) </num><content style="-uslm-dtd:text">conduct a comprehensive examination of programs and policies of the Department regarding the delivery of health care services and the demand of health care services for veterans in future years;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">assess the remediation of medical service lines of the Department as described in section 1706A in conjunction with the utilization of non-Department entities or providers to offset remediation; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="J">“(J) </num><content style="-uslm-dtd:text">consider such other matters as the Secretary considers appropriate.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Responsibilities.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall be responsible for—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">overseeing the transformation and organizational change across the Department to achieve such high performing integrated health care network;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">developing the capital infrastructure planning and procurement processes, whether minor or major construction projects or leases; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">developing a multi-year budget process that is capable of forecasting future year budget requirements and projecting the cost of delivering health care services under a high-performing integrated health care network.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Appropriate Committees of Congress Defined.—</heading><chapeau style="-uslm-dtd:text">In this section, the term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s106/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7301">38 U.S.C. 7301</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapteris amended by inserting after the item relating to section 7330B the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“7330C.</designator><label> Quadrennial Veterans Health Administration review.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s107" styleType="OLC"> <num style="-uslm-dtd:enum" value="107">SEC. 107. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703A">38 U.S.C. 1703A note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">APPLICABILITY OF DIRECTIVE OF OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s107/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Notwithstanding the treatment of certain laws under subsection (i) of section 1703A of title 38, United States Code, as added by section 102 of this title, Directive 2014-01 of the Office of Federal Contract Compliance Programs of the Department of Labor (effective as of May 7, 2014) shall apply to any entity entering into an agreement under such section 1703A or section 1745 of such title, as amended by section 103, in the same manner as such directive applies to subcontractors under the TRICARE program for the duration of the moratorium provided under such directive.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s107/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Applicability Period.—</heading><content style="-uslm-dtd:text">The directive described in subsection (a), and the moratorium provided under such directive, shall not be altered or rescinded before May 7, 2019.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s107/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">TRICARE Program Defined.—</heading><content style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">TRICARE program</quotedText>” has the meaning given that term in section 1072 of title 10, United States Code.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s108" styleType="OLC"> <num style="-uslm-dtd:enum" value="108">SEC. 108. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">PREVENTION OF CERTAIN HEALTH CARE PROVIDERS FROM PROVIDING NON-DEPARTMENT HEALTH CARE SERVICES TO VETERANS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s108/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><chapeau style="-uslm-dtd:text">On and after the date that is 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall deny or revoke the eligibility of a health care provider to provide non-Department health care services to veterans if the Secretary determines that the health care provider—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">was removed from employment with the Department of Veterans Affairs due to conduct that violated a policy of the Department relating to the delivery of safe and appropriate health care; or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">violated the requirements of a medical license of the health care provider that resulted in the loss of such medical license.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s108/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Permissive Action.—</heading><content style="-uslm-dtd:text">On and after the date that is 1 year after the date of the enactment of this Act, the Secretary may deny, revoke, or suspend the eligibility of a health care provider to provide non-Department health care services if the Secretary determines such action is necessary to immediately protect the health, safety, or welfare of veterans and the health care provider is under investigation by the medical licensing board of a State in which the health care provider is licensed or practices.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s108/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Suspension.—</heading><content style="-uslm-dtd:text">The Secretary shall suspend the eligibility of a health care provider to provide non-Department health care services to veterans if the health care provider is suspended from serving as a health care provider of the Department.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s108/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Comptroller General Report.—</heading><chapeau style="-uslm-dtd:text">Not later than 2 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the implementation by the Secretary of this section, including the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The aggregate number of health care providers denied or suspended under this section from participation in providing non-Department health care services.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">An evaluation of any impact on access to health care for patients or staffing shortages in programs of the Department providing non-Department health care services.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/d/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">An explanation of the coordination of the Department with the medical licensing boards of States in implementing this section, the amount of involvement of such boards in such implementation, and efforts by the Department to address any concerns raised by such boards with respect to such implementation.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/d/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><content style="-uslm-dtd:text">Such recommendations as the Comptroller General considers appropriate regarding harmonizing eligibility criteria between health care providers of the Department and health care providers eligible to provide non-Department health care services.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s108/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Non-Department Health Care Services Defined.—</heading><chapeau style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">non-Department health care services</quotedText>” means services—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">provided under subchapter I of chapter 17 of title 38, United States Code, at non-Department facilities (as defined in section 1701 of such title);</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note);</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/e/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">purchased through the Medical Community Care account of the Department; or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch1/s108/e/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><content style="-uslm-dtd:text">purchased with amounts deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch1/s109" styleType="OLC"> <num style="-uslm-dtd:enum" value="109">SEC. 109. </num><heading style="-uslm-dtd:header">REMEDIATION OF MEDICAL SERVICE LINES. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s109/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 17 is amended by inserting after section 1706 the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1706A">“SEC. 1706A. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1706A">38 U.S.C. 1706A</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Remediation of medical service lines </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><chapeau style="-uslm-dtd:text">Not later than 30 days after determining under section 1703(e)(1) that a medical service line of the Department is providing hospital care, medical services, or extended care services that does not comply with the standards for quality established by the Secretary, the Secretary shall submit to Congress an assessment of the factors that led the Secretary to make such determination and a plan with specific actions, and the time to complete them, to be taken to comply with such standards for quality, including the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">Increasing personnel or temporary personnel assistance, including mobile deployment teams.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Special hiring incentives, including the Education Debt Reduction Program under subchapter VII of chapter 76 of this title and recruitment, relocation, and retention incentives.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Utilizing direct hiring authority.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Providing improved training opportunities for staff.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">Acquiring improved equipment.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">“(6) </num><content style="-uslm-dtd:text">Making structural modifications to the facility used by the medical service line.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="7">“(7) </num><content style="-uslm-dtd:text">Such other actions as the Secretary considers appropriate.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Responsible Parties.—</heading><content style="-uslm-dtd:text">In each assessment submitted under subsection (a) with respect to a medical service line, the Secretary shall identify the individuals at the Central Office of the Veterans Health Administration, the facility used by the medical service line, and the central office of the relevant Veterans Integrated Service Network who are responsible for overseeing the progress of that medical service line in complying with the standards for quality established by the Secretary.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Interim Reports.—</heading><content style="-uslm-dtd:text">Not later than 180 days after submitting an assessment under subsection (a) with respect to a medical service line, the Secretary shall submit to Congress a report on the progress of that medical service line in complying with the standards for quality established by the Secretary and any other measures the Secretary will take to assist the medical service line in complying with such standards for quality.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Annual Reports.—</heading><chapeau style="-uslm-dtd:text">Not less frequently than once each year, the Secretary shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">submit to Congress an analysis of the remediation actions and costs of such actions taken with respect to each medical service line with respect to which the Secretary submitted an assessment and plan under paragraph (1) in the preceding year, including an update on the progress of each such medical service line in complying with the standards for quality and timeliness established by the Secretary and any other actions the Secretary is undertaking to assist the medical service line in complying with standards for quality as established by the Secretary; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">publish such analysis on the internet website of the Department.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch1/s109/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1706 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1706A.</designator><label> Remediation of medical service lines.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> </chapter> <chapter style="-uslm-dtd:chapter" identifier="/us/sComp/115/182/tI/stA/ch2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">CHAPTER 2—</num><heading style="-uslm-dtd:header">PAYING PROVIDERS AND IMPROVING COLLECTIONS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch2/s111" styleType="OLC"> <num style="-uslm-dtd:enum" value="111">SEC. 111. </num><heading style="-uslm-dtd:header">PROMPT PAYMENT TO PROVIDERS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s111/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 17 is amended by inserting after section 1703C, as added by section 104 of this title, the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703D">“SEC. 1703D. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703D">38 U.S.C. 1703D</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Prompt payment standard </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Notwithstanding any other provision of this title or of any other provision of law, the Secretary shall pay for hospital care, medical services, or extended care services furnished by health care entities or providers under this chapter within 45 calendar days upon receipt of a clean paper claim or 30 calendar days upon receipt of a clean electronic claim.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">If a claim is denied, the Secretary shall, within 45 calendar days of denial for a paper claim and 30 calendar days of denial for an electronic claim, notify the health care entity or provider of the reason for denying the claim and what, if any, additional information is required to process the claim.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Upon the receipt of the additional information, the Secretary shall ensure that the claim is paid, denied, or otherwise adjudicated within 30 calendar days from the receipt of the requested information.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">This section shall only apply to payments made on an invoice basis and shall not apply to capitation or other forms of periodic payment to entities or providers.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Submittal of Claims by Health Care Entities and Providers.—</heading><content style="-uslm-dtd:text">A health care entity or provider that furnishes hospital care, a medical service, or an extended care service under this chapter shall submit to the Secretary a claim for payment for furnishing the hospital care, medical service, or extended care service not later than 180 days after the date on which the entity or provider furnished the hospital care, medical service, or extended care service.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Fraudulent Claims.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Sections 3729 through 3733 of title 31 shall apply to fraudulent claims for payment submitted to the Secretary by a health care entity or provider under this chapter.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Pursuant to regulations prescribed by the Secretary, the Secretary shall bar a health care entity or provider from furnishing hospital care, medical services, and extended care services under this chapter when the Secretary determines the entity or provider has submitted to the Secretary fraudulent health care claims for payment by the Secretary.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Overdue Claims.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Any claim that has not been denied with notice, made pending with notice, or paid to the health care entity or provider by the Secretary shall be overdue if the notice or payment is not received by the entity provider within the time periods specified in subsection (a).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">If a claim is overdue under this subsection, the Secretary may, under the requirements established by subsection (a) and consistent with the provisions of chapter 39 of title 31 (commonly referred to as the ‘<quotedText style="-uslm-dtd:quote">Prompt Payment Act</quotedText>’), require that interest be paid on clean claims.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Interest paid under subparagraph (A) shall be computed at the rate of interest established by the Secretary of the Treasury under section 3902 of title 31 and published in the Federal Register.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><chapeau style="-uslm-dtd:text">Not less frequently than annually, the Secretary shall submit to Congress a report on payment of overdue claims under this subsection, disaggregated by paper and electronic claims, that includes the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">The amount paid in overdue claims described in this subsection, disaggregated by the amount of the overdue claim and the amount of interest paid on such overdue claim.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The number of such overdue claims and the average number of days late each claim was paid, disaggregated by facility of the Department and Veterans Integrated Service Network region.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Overpayment.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall deduct the amount of any overpayment from payments due a health care entity or provider under this chapter.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Deductions may not be made under this subsection unless the Secretary has made reasonable efforts to notify a health care entity or provider of the right to dispute the existence or amount of such indebtedness and the right to request a compromise of such indebtedness.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The Secretary shall make a determination with respect to any such dispute or request prior to deducting any overpayment unless the time required to make such a determination before making any deductions would jeopardize the Secretary’s ability to recover the full amount of such indebtedness.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">Information and Documentation Required.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall provide to all health care entities and providers participating in a program to furnish hospital care, medical services, or extended care services under this chapter a list of information and documentation that is required to establish a clean claim under this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary shall consult with entities in the health care industry, in the public and private sector, to determine the information and documentation to include in the list under paragraph (1).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">If the Secretary modifies the information and documentation included in the list under paragraph (1), the Secretary shall notify all health care entities and providers described in paragraph (1) not later than 30 days before such modifications take effect.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><heading style="-uslm-dtd:header">Processing of Claims.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">In processing a claim for compensation for hospital care, medical services, or extended care services furnished by a non-Department health care entity or provider under this chapter, the Secretary may act through—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">a non-Department entity that is under contract or agreement for the program established under section 1703(a) of this title; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">a non-Department entity that specializes in such processing for other Federal agency health care systems.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary shall seek to contract with a third party to conduct a review of claims described in paragraph (3) that includes—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">a feasibility assessment to determine the capacity of the Department to process such claims in a timely manner; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">a cost benefit analysis comparing the capacity of the Department to a third party entity capable of processing such claims.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The review required under paragraph (2) shall apply to claims for hospital care, medical services, or extended care services furnished under section 1703 of this Act, as amended by the Caring for Our Veterans Act of 2018, that are processed by the Department.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h) </num><heading style="-uslm-dtd:header">Report on Encounter Data System.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Not later than 90 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report on the feasibility and advisability of adopting a funding mechanism similar to what is utilized by other Federal agencies to allow a contracted entity to act as a fiscal intermediary for the Federal Government to distribute, or pass through, Federal Government funds for certain non-underwritten hospital care, medical services, or extended care services.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary may coordinate with the Department of Defense, the Department of Health and Human Services, and the Department of the Treasury in developing the report required by paragraph (1).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><chapeau style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">clean electronic claim</quotedText>’ means the transmission of data for purposes of payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">clean paper claim</quotedText>’ means a paper claim for payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">fraudulent claims</quotedText>’ means the knowing misrepresentation of a material fact or facts by a health care entity or provider made to induce the Secretary to pay a claim that was not legally payable to that provider.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">health care entity or provider</quotedText>’ includes any non-Department health care entity or provider, but does not include any Federal health care entity or provider.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s111/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapteris amended by inserting after the item relating to section 1703C, as added by section 104 of this title, the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703D.</designator><label> Prompt payment standard.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch2/s112" styleType="OLC"> <num style="-uslm-dtd:enum" value="112">SEC. 112. </num><heading style="-uslm-dtd:header">AUTHORITY TO PAY FOR AUTHORIZED CARE NOT SUBJECT TO AN AGREEMENT. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s112/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter IV of chapter 81 is amended by adding at the end the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="8159">“SEC. 8159. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s8159">38 U.S.C. 8159</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Authority to pay for services authorized but not subject to an agreement </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">If, in the course of furnishing hospital care, a medical service, or an extended care service authorized by the Secretary and pursuant to a contract, agreement, or other arrangement with the Secretary, a provider who is not a party to the contract, agreement, or other arrangement furnishes hospital care, a medical service, or an extended care service that the Secretary considers necessary, the Secretary may compensate the provider for the cost of such care or service.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">New Contracts and Agreements.—</heading><content style="-uslm-dtd:text">The Secretary shall take reasonable efforts to enter into a contract, agreement, or other arrangement with a provider described in subsection (a) to ensure that future care and services authorized by the Secretary and furnished by the provider are subject to such a contract, agreement, or other arrangement.”</content> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s112/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s8101">38 U.S.C. 8101</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapteris amended by inserting after the item relating to section 8158 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“8159.</designator><label> Authority to pay for services authorized but not subject to an agreement.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch2/s113" styleType="OLC"> <num style="-uslm-dtd:enum" value="113">SEC. 113. </num><heading style="-uslm-dtd:header">IMPROVEMENT OF AUTHORITY TO RECOVER THE COST OF SERVICES FURNISHED FOR NON-SERVICE-CONNECTED DISABILITIES. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Broadening Scope of Applicability.—</heading><chapeau style="-uslm-dtd:text">Section 1729 is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">in subsection (a)—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">in paragraph (2)(A)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran’s</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual’s</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><chapeau style="-uslm-dtd:text">in paragraph (3)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">in the matter preceding subparagraph (A), by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/1/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">in subparagraph (A), by striking “<quotedText style="-uslm-dtd:quote">the veteran’s</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual’s</quotedText>”;</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><chapeau style="-uslm-dtd:text">in subsection (b)—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">in paragraph (1)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran’s</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual’s</quotedText>”; and</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><chapeau style="-uslm-dtd:text">in paragraph (2)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><chapeau style="-uslm-dtd:text">in subparagraph (A)—</chapeau> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/i/I" styleType="OLC"> <num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </subclause> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/i/II" styleType="OLC"> <num style="-uslm-dtd:enum" value="II">(II) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran’s</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual’s</quotedText>”; and</content> </subclause> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><chapeau style="-uslm-dtd:text">in subparagraph (B)—</chapeau> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/ii/I" styleType="OLC"> <num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">in clause (i), by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </subclause> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/ii/II" styleType="OLC"> <num style="-uslm-dtd:enum" value="II">(II) </num><chapeau style="-uslm-dtd:text">in clause (ii)—</chapeau> <item style="-uslm-dtd:item" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/ii/II/aa" styleType="OLC"> <num style="-uslm-dtd:enum" value="aa">(aa) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </item> <item style="-uslm-dtd:item" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/2/B/ii/II/bb" styleType="OLC"> <num style="-uslm-dtd:enum" value="bb">(bb) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran’s</quotedText>” each place it appears and inserting “<quotedText style="-uslm-dtd:quote">the individual’s</quotedText>”;</content> </item> </subclause> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">in subsection (e), by striking “<quotedText style="-uslm-dtd:quote">A veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">An individual</quotedText>”; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><chapeau style="-uslm-dtd:text">in subsection (h)—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">in paragraph (1)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">in the matter preceding subparagraph (A), by striking “<quotedText style="-uslm-dtd:quote">a veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">an individual</quotedText>”;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">in subparagraph (A), by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/A/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">in subparagraph (B), by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”; and</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><chapeau style="-uslm-dtd:text">in paragraph (2)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">A veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">An individual</quotedText>”;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">a veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">an individual</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch2/s113/a/4/B/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">the veteran</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the individual</quotedText>”.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s113/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Modification of Authority.—</heading><content style="-uslm-dtd:text">Subsection (a)(1) of such section is amended by striking “<quotedText style="-uslm-dtd:quote">(1) Subject</quotedText>” and all that follows through the period and inserting the following: “<quotedText style="-uslm-dtd:quote">(1) Subject to the provisions of this section, in any case in which the United States is required by law to furnish or pay for care or services under this chapter for a non-service-connected disability described in paragraph (2) of this subsection, the United States has the right to recover or collect from a third party the reasonable charges of care or services so furnished or paid for to the extent that 132 STAT. 1423 the recipient or provider of the care or services would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished or paid for by a department or agency of the United States.</quotedText>”.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch2/s113/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Modification of Eligible Individuals.—</heading><content style="-uslm-dtd:text">Subparagraph (D) of subsection (a)(2) of such section is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">that is incurred by an individual who is entitled to care (or payment of the expenses of care) under a health-plan contract.”</content> </subparagraph></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch2/s114" styleType="OLC"> <num style="-uslm-dtd:enum" value="114">SEC. 114. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703D">38 U.S.C. 1703D note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">PROCESSING OF CLAIMS FOR REIMBURSEMENT THROUGH ELECTRONIC INTERFACE. </heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs may enter into an agreement with a third-party entity to process, through the use of an electronic interface, claims for reimbursement for health care provided under the laws administered by the Secretary.</content> </section> </chapter> <chapter style="-uslm-dtd:chapter" identifier="/us/sComp/115/182/tI/stA/ch3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">CHAPTER 3—</num><heading style="-uslm-dtd:header">EDUCATION AND TRAINING PROGRAMS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch3/s121" styleType="OLC"> <num style="-uslm-dtd:enum" value="121">SEC. 121. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">EDUCATION PROGRAM ON HEALTH CARE OPTIONS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s121/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall develop and administer an education program that teaches veterans about their health care options through the Department of Veterans Affairs.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">The program under subsection (a) shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">teach veterans about—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">eligibility criteria for care from the Department set forth under sections 1703, as amended by section 101 of this title, and 1710 of title 38, United States Code;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">priority groups for enrollment in the system of annual patient enrollment under section 1705(a) of such title;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">the copayments and other financial obligations, if any, required of certain individuals for certain services; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/1/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">how to utilize the access standards and standards for quality established under sections 1703B and 1703C of such title;</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">teach veterans about the interaction between health insurance (including private insurance, Medicare, Medicaid, the TRICARE program, the Indian Health Service, tribal health programs, and other forms of insurance) and health care from the Department; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">provide veterans with information on what to do when they have a complaint about health care received from the Department (whether about the provider, the Department, or any other type of complaint).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s121/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Accessibility.—</heading><chapeau style="-uslm-dtd:text">In developing the education program under this section, the Secretary shall ensure that materials under such program are accessible—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">to veterans who may not have access to the internet; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">to veterans in a manner that complies with the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s121/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Annual Evaluation and Report.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Evaluation.—</heading><content style="-uslm-dtd:text">The Secretary shall develop a method to evaluate the effectiveness of the education program under this section and evaluate the program using the method not less frequently than once each year.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Report.—</heading><content style="-uslm-dtd:text">Not less frequently than once each year, the Secretary shall submit to Congress a report on the findings of the Secretary with respect to the most recent evaluation conducted by the Secretary under paragraph (1).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s121/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Medicaid.—</heading><content style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">Medicaid</quotedText>” means the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Medicare.—</heading><content style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">Medicare</quotedText>” means the Medicare program under title XVIII of such Act (42 U.S.C. 1395 et seq.).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s121/e/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Tricare program.—</heading><content style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">TRICARE program</quotedText>” has the meaning given that term in section 1072 of title 10, United States Code.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch3/s122" styleType="OLC"> <num style="-uslm-dtd:enum" value="122">SEC. 122. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">TRAINING PROGRAM FOR ADMINISTRATION OF NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s122/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment of Program.—</heading><chapeau style="-uslm-dtd:text">The Secretary of Veterans Affairs shall develop and implement a training program to train employees and contractors of the Department of Veterans Affairs on how to administer non-Department health care programs, including the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Reimbursement for non-Department emergency room care.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">The Veterans Community Care Program under section 1703 of such title, as amended by section 101.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">Management of prescriptions pursuant to improvements under section 131.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s122/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Annual Evaluation and Report.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">develop a method to evaluate the effectiveness of the training program developed and implemented under subsection (a);</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">evaluate such program not less frequently than once each year; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s122/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">not less frequently than once each year, submit to Congress the findings of the Secretary with respect to the most recent evaluation carried out under paragraph (2).</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch3/s123" styleType="OLC"> <num style="-uslm-dtd:enum" value="123">SEC. 123. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">CONTINUING MEDICAL EDUCATION FOR NON-DEPARTMENT MEDICAL PROFESSIONALS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment of Program.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall establish a program to provide continuing medical education material to non-Department medical professionals.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Education provided.—</heading><chapeau style="-uslm-dtd:text">The program established under paragraph (1) shall include education on the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Identifying and treating common mental and physical conditions of veterans and family members of veterans.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The health care system of the Department of Veterans Affairs.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/a/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Such other matters as the Secretary considers appropriate.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s123/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Material Provided.—</heading><content style="-uslm-dtd:text">The continuing medical education material provided to non-Department medical professionals under the program established under subsection (a) shall be the same material provided to medical professionals of the Department to ensure that all medical professionals treating veterans have access to the same materials, which supports core competencies throughout the community.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Administration of Program.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">The Secretary shall administer the program established under subsection (a) to participating non-Department medical professionals through an internet website of the Department of Veterans Affairs.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Curriculum and credit provided.—</heading><content style="-uslm-dtd:text">The Secretary shall determine the curriculum of the program and the number of hours of credit to provide to participating non-Department medical professionals for continuing medical education.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Accreditation.—</heading><content style="-uslm-dtd:text">The Secretary shall ensure that the program is accredited in as many States as practicable.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Consistency with existing rules.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall ensure that the program is consistent with the rules and regulations of the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/4/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The medical licensing agency of each State in which the program is accredited.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/4/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Such medical credentialing organizations as the Secretary considers appropriate.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><heading style="-uslm-dtd:header">User cost.—</heading><content style="-uslm-dtd:text">The Secretary shall carry out the program at no cost to participating non-Department medical professionals.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch3/s123/c/6" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">(6) </num><heading style="-uslm-dtd:header">Monitoring, evaluation, and report.—</heading><content style="-uslm-dtd:text">The Secretary shall monitor the utilization of the program established under subsection (a), evaluate its effectiveness, and report to Congress on utilization and effectiveness not less frequently than once each year.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch3/s123/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Non-Department Medical Professional Defined.—</heading><content style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">non-Department medical professional</quotedText>” means any individual who is licensed by an appropriate medical authority in the United States and is in good standing, is not an employee of the Department of Veterans Affairs, and provides care to veterans or family members of veterans under the laws administered by the Secretary of Veterans Affairs.</content> </subsection> </section> </chapter> <chapter style="-uslm-dtd:chapter" identifier="/us/sComp/115/182/tI/stA/ch4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">CHAPTER 4—</num><heading style="-uslm-dtd:header">OTHER MATTERS RELATING TO NON-DEPARTMENT OF VETERANS AFFAIRS PROVIDERS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch4/s131" styleType="OLC"> <num style="-uslm-dtd:enum" value="131">SEC. 131. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">ESTABLISHMENT OF PROCESSES TO ENSURE SAFE OPIOID PRESCRIBING PRACTICES BY NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROVIDERS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s131/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Receipt and Review of Guidelines.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall ensure that all covered health care providers are provided a copy of and certify that they have reviewed the evidence-based guidelines for prescribing opioids set forth by the Opioid Safety Initiative of the Department of Veterans Affairs.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s131/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Inclusion of Medical History and Current Medications.—</heading><content style="-uslm-dtd:text">The Secretary shall implement a process to ensure that, if care of a veteran by a covered health care provider is authorized under the laws administered by the Secretary, the document authorizing such care includes the available and relevant medical history of the veteran and a list of all medications prescribed to the veteran as known by the Department.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Submittal of Medical Records and Prescriptions.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">The Secretary shall, consistent with section 1703(a)(2)(A), as amended by section 101 of this title, and section 1703A(e)(2)(F), as added by section 102 of this title, require each covered health care provider to submit medical records of any care or services furnished, including records of any prescriptions for opioids, to the Department in the timeframe and format specified by the Secretary.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Responsibility of department for recording and monitoring.—</heading><chapeau style="-uslm-dtd:text">In carrying out paragraph (1) and upon the receipt by the Department of the medical records described in paragraph (1), the Secretary shall—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">ensure the Department is responsible for the recording of the prescription in the electronic health record of the veteran; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">enable other monitoring of the prescription as outlined in the Opioid Safety Initiative of the Department.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/c/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Report.—</heading><content style="-uslm-dtd:text">Not less frequently than annually, 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 evaluating the compliance of covered health care providers with the requirements under this section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Use of Opioid Safety Initiative Guidelines.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">If the Secretary determines that the opioid prescribing practices of a covered health care provider, when treating covered veterans, satisfy a condition described in paragraph (3), the Secretary shall take such action as the Secretary considers appropriate to ensure the safety of all veterans receiving care from that health care provider, including removing or directing the removal of any such health care provider from provider networks or otherwise refusing to authorize care of veterans by such health care provider in any program authorized under the laws administered by the Secretary.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Inclusion in contracts.—</heading><content style="-uslm-dtd:text">The Secretary shall ensure that any contracts, agreements, or other arrangements entered into by the Secretary with third parties involved in administering programs that provide care in the community to veterans under the laws administered by the Secretary specifically grant the authority set forth in paragraph (1) to such third parties and to the Secretary, as the case may be.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Conditions for exclusion or limitation.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall take such action as is considered appropriate under paragraph (1) when the opioid prescribing practices of a covered health care provider when treating covered veterans—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">conflict with or are otherwise inconsistent with the standards of appropriate and safe care;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">violate the requirements of a medical license of the health care provider; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch4/s131/d/3/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">may place at risk the veterans receiving health care from the provider.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s131/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Covered Health Care Provider Defined.—</heading><content style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">covered health care provider</quotedText>” means a non-Department of Veterans Affairs health care provider who provides health care to veterans under the laws administered by the Secretary of Veterans Affairs, but does not include a health care provider employed by another agency of the Federal Government.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch4/s132" styleType="OLC"> <num style="-uslm-dtd:enum" value="132">SEC. 132. </num><heading style="-uslm-dtd:header">IMPROVING INFORMATION SHARING WITH COMMUNITY PROVIDERS. </heading><content style="-uslm-dtd:text">Section 7332(b)(2) is amended by striking subparagraph (H) and inserting the following new subparagraphs:<quotedContent style="-uslm-dtd:quoted-block"> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="H">“(H)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">To a non-Department entity (including private entities and other Federal agencies) for purposes of providing health care, including hospital care, medical services, and extended care services, to patients or performing other health care-related activities or functions.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">An entity to which a record is disclosed under this subparagraph may not disclose or use such record for a purpose other than that for which the disclosure was made or as permitted by law.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">To a third party in order to recover or collect reasonable charges for care furnished to, or paid on behalf of, a patient in connection with a non-service connected disability as permitted by section 1729 of this title or for a condition for which recovery is authorized or with respect to which the United States is deemed to be a third party beneficiary under the Act entitled ‘<quotedText style="-uslm-dtd:quote">An Act to provide for the recovery from tortiously liable third persons of the cost of hospital and medical care and treatment furnished by the United States</quotedText>’ (Public Law 87-693; 42 U.S.C. 2651 et seq.; commonly known as the ‘<quotedText style="-uslm-dtd:quote">Federal Medical Care Recovery Act</quotedText>’).”</content> </subparagraph></quotedContent>.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch4/s133" styleType="OLC"> <num style="-uslm-dtd:enum" value="133">SEC. 133. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">COMPETENCY STANDARDS FOR NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROVIDERS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s133/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment of Standards and Requirements.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall establish standards and requirements for the provision of care by non-Department of Veterans Affairs health care providers in clinical areas for which the Department of Veterans Affairs has special expertise, including post-traumatic stress disorder, military sexual trauma-related conditions, and traumatic brain injuries.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s133/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Condition for Eligibility To Furnish Care.—</heading><paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s133/b/1" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Each non-Department of Veterans Affairs health care provider shall, to the extent practicable as determined by the Secretary or otherwise provided for in paragraph (2), meet the standards and requirements established pursuant to subsection (a) before furnishing care pursuant to a contract, agreement, or other arrangement with the Department of Veterans Affairs. Non-Department of Veterans Affairs health care providers furnishing care pursuant to a contract, agreement, or other arrangement shall, to the extent practicable as determined by the Secretary, fulfill training requirements established by the Secretary on how to deliver evidence-based treatments in the clinical areas for which the Department of Veterans Affairs has special expertise.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch4/s133/b/2" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">Each non-Department of Veterans Affairs health care provider who enters into a contract, agreement, or other arrangement after the effective date identified in subsection (c) shall, to the extent practicable, meet the standards and requirements established pursuant to subsection (a) within 6 months of the contract, agreement, or other arrangement taking effect.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s133/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Effective Date.—</heading><content style="-uslm-dtd:text">This section shall take effect on the day that is 1 year after the date of the enactment of this Act.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch4/s134" styleType="OLC"> <num style="-uslm-dtd:enum" value="134">SEC. 134. </num><heading style="-uslm-dtd:header">DEPARTMENT OF VETERANS AFFAIRS PARTICIPATION IN NATIONAL NETWORK OF STATE-BASED PRESCRIPTION DRUG MONITORING PROGRAMS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s134/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Chapter 17 is amended by inserting after section 1730A the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1730B">“SEC. 1730B. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1730B">38 U.S.C. 1730B</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Access to State prescription drug monitoring programs </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">Access to Programs.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Any licensed health care provider or delegate of such a provider shall be considered an authorized recipient or user for the purpose of querying and receiving data from the national network of State-based prescription drug monitoring programs to support the safe and effective prescribing of controlled substances to covered patients.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">Under the authority granted by paragraph (1)—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">licensed health care providers or delegates of such providers shall query such network in accordance with applicable regulations and policies of the Veterans Health Administration; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">notwithstanding any general or specific provision of law, rule, or regulation of a State, no State may restrict the access of licensed health care providers or delegates of such providers from accessing that State’s prescription drug monitoring programs.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">No State shall deny or revoke the license, registration, or certification of a licensed health care provider or delegate who otherwise meets that State’s qualifications for holding the license, registration, or certification on the basis that the licensed health care provider or delegate queried or received data, or attempted to query or receive data, from the national network of State-based prescription drug monitoring programs under this section.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Covered Patients.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, a covered patient is a patient who—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">receives a prescription for a controlled substance; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">is not receiving palliative care or enrolled in hospice care.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">controlled substance</quotedText>’ has the meaning given such term in section 102(6) of the Controlled Substances Act (21 U.S.C. 802(6)).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">delegate</quotedText>’ means a person or automated system accessing the national network of State-based prescription monitoring programs at the direction or under the supervision of a licensed health care provider.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">licensed health care provider</quotedText>’ means a health care provider employed by the Department who is licensed, certified, or registered within any State to fill or prescribe medications within the scope of his or her practice as a Department employee.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">national network of State-based prescription monitoring programs</quotedText>’ means an interconnected nation-wide system that facilitates the transfer to State prescription drug monitoring program data across State lines.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">“(5) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">State</quotedText>’ means a State, as defined in section 101(20) of this title, or a political subdivision of a State.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch4/s134/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1730A the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1730B.</designator><label> Access to State prescription drug monitoring programs.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> </chapter> <chapter style="-uslm-dtd:chapter" identifier="/us/sComp/115/182/tI/stA/ch5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">CHAPTER 5—</num><heading style="-uslm-dtd:header">OTHER NON-DEPARTMENT HEALTH CARE MATTERS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch5/s141" styleType="OLC"> <num style="-uslm-dtd:enum" value="141">SEC. 141. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s303">38 U.S.C. 303 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">PLANS FOR USE OF SUPPLEMENTAL APPROPRIATIONS REQUIRED. </heading><content style="-uslm-dtd:text">Whenever the Secretary submits to Congress a request for supplemental appropriations or any other appropriation outside the standard budget process to address a budgetary issue affecting the Department of Veterans Affairs, the Secretary shall, not later than 45 days before the date on which such budgetary issue would start affecting a program or service, submit to Congress a justification for the request, including a plan that details how the Secretary intends to use the requested appropriation and how long the requested appropriation is expected to meet the needs of the Department and certification that the request was made using an updated and sound actuarial analysis.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch5/s142" styleType="OLC"> <num style="-uslm-dtd:enum" value="142">SEC. 142. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">VETERANS CHOICE FUND FLEXIBILITY. </heading><chapeau style="-uslm-dtd:text">Section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch5/s142/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">in subsection (c)—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch5/s142/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">in paragraph (1), by striking “<quotedText style="-uslm-dtd:quote">by paragraph (3)</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">in paragraphs (3) and (4)</quotedText>”; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch5/s142/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">by adding at the end the following new paragraph:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><heading style="-uslm-dtd:header">Permanent authority for other uses.—</heading><content style="-uslm-dtd:text">Beginning on March 1, 2019, amounts remaining in the Veterans Choice Fund may be used to furnish hospital care, medical services, and extended care services to individuals pursuant to chapter 17 of title 38, United States Code, at non-Department facilities, including pursuant to non-Department provider programs other than the program established by section 101. Such amounts shall be available in addition to amounts available in other appropriations accounts for such purposes.”</content> </paragraph></quotedContent>; and</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch5/s142/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">in subsection (d)(1), by striking “<quotedText style="-uslm-dtd:quote">to subsection (c)(3)</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">to paragraphs (3) and (4) of subsection (c)</quotedText>”.</content> </paragraph> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch5/s143" styleType="OLC"> <num style="-uslm-dtd:enum" value="143">SEC. 143. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">SUNSET OF VETERANS CHOICE PROGRAM. </heading><content style="-uslm-dtd:text">Subsection (p) of section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="p">“(p) </num><heading style="-uslm-dtd:header">Authority To Furnish Care and Services.—</heading><content style="-uslm-dtd:text">The Secretary may not use the authority under this section to furnish care and services after the date that is 1 year after the date of the enactment of the Caring for Our Veterans Act of 2018.”</content> </subsection></quotedContent>.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stA/ch5/s144" styleType="OLC"> <num style="-uslm-dtd:enum" value="144">SEC. 144. </num><heading style="-uslm-dtd:header">CONFORMING AMENDMENTS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Title 38.—</heading><chapeau style="-uslm-dtd:text">Title 38, United States Code, is amended—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">in section 1712(a)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">in paragraph (3), by striking “<quotedText style="-uslm-dtd:quote">under clause (1), (2), or (5) of section 1703(a) of this title</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">or entered an agreement</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">in paragraph (4)(A), by striking “<quotedText style="-uslm-dtd:quote">under the provisions of this subsection and section 1703 of this title</quotedText>”;</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><chapeau style="-uslm-dtd:text">in section 1712A(e)(1)—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">by inserting “<quotedText style="-uslm-dtd:quote">or agreements</quotedText>” after “<quotedText style="-uslm-dtd:quote">contracts</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">(under sections 1703(a)(2) and 1710(a)(1)(B) of this title)</quotedText>”; and</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">in section 2303(a)(2)(B)(i), by striking “<quotedText style="-uslm-dtd:quote">with section 1703</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">with sections 1703A, 8111, and 8153</quotedText>”.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Social security act.—</heading><content style="-uslm-dtd:text">Section 1866(a)(1)(L) of the Social Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by striking “<quotedText style="-uslm-dtd:quote">under section 603</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">under chapter 17</quotedText>”.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stA/ch5/s144/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Veterans’ benefits improvements act of 1994.—</heading><content style="-uslm-dtd:text">Section 104(a)(4)(A) of the Veterans’ Benefits Improvements Act of 1994 (Public Law 103-446; 38 U.S.C. 1117 note) is amended by striking “<quotedText style="-uslm-dtd:quote">in section 1703</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">in sections 1703A, 8111, and 8153</quotedText>”.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stA/ch5/s144/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1712">38 U.S.C. 1712 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Effective Date.—</heading><content style="-uslm-dtd:text">The amendments made by subsection (a) shall take effect on the date described in section 101(b).</content> </subsection> </section> </chapter> </subtitle> <subtitle style="-uslm-dtd:subtitle" identifier="/us/sComp/115/182/tI/stB" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">Subtitle B—</num><heading style="-uslm-dtd:header">Improving Department of Veterans Affairs Health Care Delivery </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stB/s151" styleType="OLC"> <num style="-uslm-dtd:enum" value="151">SEC. 151. </num><heading style="-uslm-dtd:header">LICENSURE OF HEALTH CARE PROFESSIONALS OF THE DEPARTMENT OF VETERANS AFFAIRS PROVIDING TREATMENT VIA TELEMEDICINE. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s151/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Chapter 17 is amended by inserting after section 1730B, as added by section 134, the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1730C">“SEC. 1730C. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1730C">38 U.S.C. 1730C</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Licensure of health care professionals providing treatment via telemedicine </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Notwithstanding any provision of law regarding the licensure of health care professionals, a covered health care professional may practice the health care profession of the health care professional at any location in any State, regardless of where the covered health care professional or the patient is located, if the covered health care professional is using telemedicine to provide treatment to an individual under this chapter.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Covered Health Care Professionals.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, a covered health care professional is any health care professional who—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">is an employee of the Department appointed under the authority under section 7306, 7401, 7405, 7406, or 7408 of this title or title 5;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">is authorized by the Secretary to provide health care under this chapter;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">is required to adhere to all standards for quality relating to the provision of medicine in accordance with applicable policies of the Department; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">has an active, current, full, and unrestricted license, registration, or certification in a State to practice the health care profession of the health care professional.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Property of Federal Government.—</heading><content style="-uslm-dtd:text">Subsection (a) shall apply to a covered health care professional providing treatment to a patient regardless of whether the covered health care professional or patient is located in a facility owned by the Federal Government during such treatment.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Relation to State Law.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The provisions of this section shall supersede any provisions of the law of any State to the extent that such provision of State law are inconsistent with this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">No State shall deny or revoke the license, registration, or certification of a covered health care professional who otherwise meets the qualifications of the State for holding the license, registration, or certification on the basis that the covered health care professional has engaged or intends to engage in activity covered by subsection (a).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Rule of Construction.—</heading><content style="-uslm-dtd:text">Nothing in this section may be construed to remove, limit, or otherwise affect any obligation of a covered health care professional under the Controlled Substances Act (21 U.S.C. 801 et seq.).</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">State Defined.—</heading><content style="-uslm-dtd:text">In this section, the term ‘<quotedText style="-uslm-dtd:quote">State</quotedText>’ means a State, as defined in section 101(20) of this title, or a political subdivision of a State.”</content> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s151/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1730B, as added by section 134, the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1730C.</designator><label> Licensure of health care professionals providing treatment via telemedicine.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s151/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Report on Telemedicine.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stB/s151/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than 1 year after the earlier of the date on which services provided under section 1730B of title 38, United States Code, as added by subsection (a), first occur or regulations are promulgated to carry out such section, 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 effectiveness of the use of telemedicine by the Department of Veterans Affairs.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">The report required by paragraph (1) shall include an assessment of the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The satisfaction of veterans with telemedicine furnished by the Department.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The satisfaction of health care providers in providing telemedicine furnished by the Department.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><chapeau style="-uslm-dtd:text">The effect of telemedicine furnished by the Department on the following:</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">The ability of veterans to access health care, whether from the Department or from non-Department health care providers.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">The frequency of use by veterans of telemedicine.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">The productivity of health care providers.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C/iv" styleType="OLC"> <num style="-uslm-dtd:enum" value="iv">(iv) </num><content style="-uslm-dtd:text">Wait times for an appointment for the receipt of health care from the Department.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stB/s151/c/2/C/v" styleType="OLC"> <num style="-uslm-dtd:enum" value="v">(v) </num><content style="-uslm-dtd:text">The use by veterans of in-person services at Department facilities and non-Department facilities.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">The types of appointments for the receipt of telemedicine furnished by the Department that were provided during the 1-year period preceding the submittal of the report.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">The number of appointments for the receipt of telemedicine furnished by the Department that were requested during such period, disaggregated by medical facility.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stB/s151/c/2/F" styleType="OLC"> <num style="-uslm-dtd:enum" value="F">(F) </num><content style="-uslm-dtd:text">Savings by the Department, if any, including travel costs, from furnishing health care through the use of telemedicine during such period.</content> </subparagraph> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stB/s152" styleType="OLC"> <num style="-uslm-dtd:enum" value="152">SEC. 152. </num><heading style="-uslm-dtd:header">AUTHORITY FOR DEPARTMENT OF VETERANS AFFAIRS CENTER FOR INNOVATION FOR CARE AND PAYMENT. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s152/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 17, as amended by this title, is further amended by inserting after section 1703D, as added by section 111, the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1703E">“SEC. 1703E. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1703E">38 U.S.C. 1703E</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Center for Innovation for Care and Payment </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">There is established within the Department a Center for Innovation for Care and Payment (in this section referred to as the ‘<quotedText style="-uslm-dtd:quote">Center</quotedText>’).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary, acting through the Center, may carry out such pilot programs the Secretary determines to be appropriate to develop innovative approaches to testing payment and service delivery models in order to reduce expenditures while preserving or enhancing the quality of care furnished by the Department.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><chapeau style="-uslm-dtd:text">The Secretary, acting through the Center, shall test payment and service delivery models to determine whether such models—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">improve access to, and quality, timeliness, and patient satisfaction of care and services; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">create cost savings for the Department.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary shall test a model in a location where the Secretary determines that the model will addresses deficits in care (including poor clinical outcomes or potentially avoidable expenditures) for a defined population.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The Secretary shall focus on models the Secretary expects to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits under this chapter.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">The models selected may include those described in section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)).</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5) </num><chapeau style="-uslm-dtd:text">In selecting a model for testing, the Secretary may consider, in addition to other factors identified in this subsection, the following factors:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">Whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and preferences of individuals receiving benefits under this chapter.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Whether the model places the individual receiving benefits under this chapter (including family members and other caregivers of such individual) at the center of the care team of such individual.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">Whether the model uses technology or new systems to coordinate care over time and across settings.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">Whether the model demonstrates effective linkage with other public sector payers, private sector payers, or statewide payment models.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="6">“(6)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Models tested under this section may not be designed in such a way that would allow the United States to recover or collect reasonable charges from a Federal health care program for care or services furnished by the Secretary to a veteran under pilot programs carried out under this section.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">In this paragraph, the term ‘<quotedText style="-uslm-dtd:quote">Federal health care program</quotedText>’ means—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">an insurance program described in section 1811 of the Social Security Act (42 U.S.C. 1395c) or established by section 1831 of such Act (42 U.S.C. 1395j);</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">a State plan for medical assistance approved under title XIX of such Act (42 U.S.C. 1396 et seq.); or</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">a TRICARE program operated under sections 1075, 1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Duration.—</heading><content style="-uslm-dtd:text">Each pilot program carried out by the Secretary under this section shall terminate no later than 5 years after the date of the commencement of the pilot program.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Location.—</heading><content style="-uslm-dtd:text">The Secretary shall ensure that each pilot program carried out under this section occurs in an area or areas appropriate for the intended purposes of the pilot program. To the extent practicable, the Secretary shall ensure that the pilot programs are located in geographically diverse areas of the United States.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">“(d) </num><heading style="-uslm-dtd:header">Budget.—</heading><chapeau style="-uslm-dtd:text">Funding for each pilot program carried out by the Secretary under this section shall come from appropriations—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">provided in advance in appropriations acts for the Veterans Health Administration; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">provided for information technology systems.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">“(e) </num><heading style="-uslm-dtd:header">Notice.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">publish information about each pilot program under this section in the Federal Register; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">take reasonable actions to provide direct notice to veterans eligible to participate in such pilot programs.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">“(f) </num><heading style="-uslm-dtd:header">Waiver of Authorities.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Subject to reporting under paragraph (2) and approval under paragraph (3), in implementing a pilot program under this section, the Secretary may waive such requirements in subchapters I, II, and III of this chapter as the Secretary determines necessary solely for the purposes of carrying out this section with respect to testing models described in subsection (a).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">Before waiving any authority under paragraph (1), the Secretary shall submit to the Speaker of the House of Representatives, the minority leader of the House of Representatives, the majority leader of the Senate, the minority leader of the Senate, and each standing committee with jurisdiction under the rules of the Senate and of the House of Representatives to report a bill to amend the provision or provisions of law that would be waived by the Department, a report on a request for waiver that describes in detail the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">The specific authorities to be waived under the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The standard or standards to be used in the pilot program in lieu of the waived authorities.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">The reasons for such waiver or waivers.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">A description of the metric or metrics the Secretary will use to determine the effect of the waiver or waivers upon the access to and quality, timeliness, or patient satisfaction of care and services furnished through the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">The anticipated cost savings, if any, of the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="F">“(F) </num><content style="-uslm-dtd:text">The schedule for interim reports on the pilot program describing the results of the pilot program so far and the feasibility and advisability of continuing the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="G">“(G) </num><content style="-uslm-dtd:text">The schedule for the termination of the pilot program and the submission of a final report on the pilot program describing the result of the pilot program and the feasibility and advisability of making the pilot program permanent.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="H">“(H) </num><content style="-uslm-dtd:text">The estimated budget of the pilot program.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Upon receipt of a report submitted under paragraph (2), each House of Congress shall provide copies of the report to the chairman and ranking member of each standing committee with jurisdiction under the rules of the House of Representatives or the Senate to report a bill to amend the provision or provisions of law that would be waived by the Department under this subsection.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The waiver requested by the Secretary under paragraph (2) shall be considered approved under this paragraph if there is enacted into law a joint resolution approving such request in its entirety.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><chapeau style="-uslm-dtd:text">For purposes of this paragraph, the term ‘<quotedText style="-uslm-dtd:quote">joint resolution</quotedText>’ means only a joint resolution which is introduced within the period of five legislative days beginning on the date on which the Secretary transmits the report to the Congress under such paragraph (2), and—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">which does not have a preamble; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">the matter after the resolving clause of which is as follows: ‘<quotedText style="-uslm-dtd:quote">that Congress approves the request for a waiver under section 1703E(f) of title 38, United States Code, as submitted by the Secretary on ___</quotedText>’, the blank space being filled with the appropriate date.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">Any committee of the House of Representatives to which a joint resolution is referred shall report it to the House without amendment not later than 15 legislative days after the date of introduction thereof. If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">It shall be in order at any time after the third legislative day after each committee authorized to consider a joint resolution has reported or has been discharged from consideration of a joint resolution, to move to proceed to consider the joint resolution in the House. All points of order against the motion are waived. Such a motion shall not be in order after the House has disposed of a motion to proceed on a joint resolution addressing a particular submission. The previous question shall be considered as ordered on the motion to its adoption without intervening motion. The motion shall not be debatable. A motion to reconsider the vote by which the motion is disposed of shall not be in order.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">The joint resolution shall be considered as read. All points of order against the joint resolution and against its consideration are waived. The previous question shall be considered as ordered on the joint resolution to its passage without intervening motion except two hours of debate equally divided and controlled by the proponent and an opponent. A motion to reconsider the vote on passage of the joint resolution shall not be in order.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">A joint resolution introduced in the Senate shall be referred to the Committee on Veterans’ Affairs.</content></clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">Any committee of the Senate to which a joint resolution is referred shall report it to the Senate without amendment not later than 15 session days after the date of introduction of a joint resolution described in paragraph (C). If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution and the joint resolution shall be placed on the calendar.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii)</num><subclause style="-uslm-dtd:subclause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">Notwithstanding Rule XXII of the Standing Rules of the Senate, it is in order at any time after the third session day on which the Committee on Veterans’ Affairs has reported or has been discharged from consideration of a joint resolution described in paragraph (C) (even though a previous motion to the same effect has been disagreed to) to move to proceed to the consideration of the joint resolution, and all points of order against the joint resolution (and against consideration of the joint resolution) are waived. The motion to proceed is not debatable. The motion is not subject to a motion to postpone. A motion to reconsider the vote by which the motion is agreed to or disagreed to shall not be in order. If a motion to proceed to the consideration of the resolution is agreed to, the joint resolution shall remain the unfinished business until disposed of.</content></subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">Consideration of the joint resolution, and on all debatable motions and appeals in connection therewith, shall be limited to not more than two hours, which shall be divided equally between the majority and minority leaders or their designees. A motion further to limit debate is in order and not debatable. An amendment to, or a motion to postpone, or a motion to proceed to the consideration of other business, or a motion to recommit the joint resolution is not in order.</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="III">“(III) </num><content style="-uslm-dtd:text">If the Senate has voted to proceed to a joint resolution, the vote on passage of the joint resolution shall occur immediately following the conclusion of consideration of the joint resolution, and a single quorum call at the conclusion of the debate if requested in accordance with the rules of the Senate.</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="IV">“(IV) </num><content style="-uslm-dtd:text">Appeals from the decisions of the Chair relating to the application of the rules of the Senate, as the case may be, to the procedure relating to a joint resolution shall be decided without debate.</content> </subclause> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="F">“(F) </num><content style="-uslm-dtd:text">A joint resolution considered pursuant to this paragraph shall not be subject to amendment in either the House of Representatives or the Senate.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="G">“(G)</num><clause style="-uslm-dtd:clause" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="i">(i) </num><chapeau style="-uslm-dtd:text">If, before the passage by one House of the joint resolution of that House, that House receives the joint resolution from the other House, then the following procedures shall apply:</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">The joint resolution of the other House shall not be referred to a committee.</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><chapeau style="-uslm-dtd:text">With respect to the joint resolution of the House receiving the joint resolution—</chapeau> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="aa">“(aa) </num><content style="-uslm-dtd:text">the procedure in that House shall be the same as if no joint resolution had been received from the other House; but</content> </item> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="bb">“(bb) </num><content style="-uslm-dtd:text">the vote on passage shall be on the joint resolution of the other House.</content> </item> </subclause></clause> <clause style="-uslm-dtd:clause" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">If the Senate fails to introduce or consider a joint resolution under this paragraph, the joint resolution of the House shall be entitled to expedited floor procedures under this subparagraph.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">If, following passage of the joint resolution in the Senate, the Senate then receives the companion measure from the House of Representatives, the companion measure shall not be debatable.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="H">“(H) </num><chapeau style="-uslm-dtd:text">This subparagraph is enacted by Congress—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">as an exercise of the rulemaking power of the Senate and House of Representatives, respectively, and as such it is deemed a part of the rules of each House, respectively, but applicable only with respect to the procedure to be followed in that House in the case of a joint resolution, and it supersedes other rules only to the extent that it is inconsistent with such rules; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">with full recognition of the constitutional right of either House to change the rules (so far as relating to the procedure of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g) </num><heading style="-uslm-dtd:header">Limitations.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary may not carry out more than 10 pilot programs concurrently.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Subject to subparagraph (B), the Secretary may not expend more than $50,000,000 in any fiscal year from amounts under subsection (d).</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">The Secretary may expend more than the amount in subparagraph (A) if—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">the Secretary determines that the additional expenditure is necessary to carry out pilot programs under this section;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">the Secretary submits to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report setting forth the amount of the additional expenditure and a justification for the additional expenditure; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">the Chairmen of the Committees on Veterans’ Affairs of the Senate and the House of Representatives transmit to the Secretary a letter approving of the additional expenditure.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The waiver provisions in subsection (f) shall not apply unless the Secretary, in accordance with the requirements in subsection (f), submits the first proposal for a pilot program not later than 18 months after the date of the enactment of the Caring for Our Veterans Act of 2018.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Notwithstanding section 502 of this title, decisions by the Secretary under this section shall, consistent with section 511 of this title, be final and conclusive and may not be reviewed by any other official or by any court, whether by an action in the nature of mandamus or otherwise.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">If the Secretary determines that a pilot program is not improving the quality of care or producing cost savings, the Secretary shall—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">propose a modification to the pilot program in the interim report that shall also be considered a report under subsection (f)(2) and shall be subject to the terms and conditions of subsection (f)(2); or</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">terminate such pilot program not later than 30 days after submitting the interim report to Congress.</content> </clause></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">If the Secretary terminates a pilot program under subparagraph (A)(ii), for purposes of subparagraphs (F) and (G) of subsection (f)(2), such interim report will also serve as the final report for that pilot program.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">“(h) </num><heading style="-uslm-dtd:header">Evaluation and Reporting Requirements.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The Secretary shall conduct an evaluation of each model tested, which shall include, at a minimum, an analysis of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">the quality of care furnished under the model, including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the Secretary; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">the changes in spending by reason of that model.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The Secretary shall make the results of each evaluation under this subsection available to the public in a timely fashion and may establish requirements for other entities participating in the testing of models under this section to collect and report information that the Secretary determines is necessary to monitor and evaluate such models.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i) </num><heading style="-uslm-dtd:header">Coordination and Advice.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The Secretary shall obtain advice from the Under Secretary for Health and the Special Medical Advisory Group established pursuant to section 7312 of this title in the development and implementation of any pilot program operated under this section.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">In carrying out the duties under this section, the Secretary shall consult representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management. The Secretary shall use appropriate mechanisms to seek input from interested parties.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="j">“(j) </num><heading style="-uslm-dtd:header">Expansion of Successful Pilot Programs.—</heading><chapeau style="-uslm-dtd:text">Taking into account the evaluation under subsection (f), the Secretary may, through rulemaking, expand (including implementation on a nationwide basis) the duration and the scope of a model that is being tested under subsection (a) to the extent determined appropriate by the Secretary, if—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><chapeau style="-uslm-dtd:text">the Secretary determines that such expansion is expected to—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">reduce spending without reducing the quality of care; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">improve the quality of patient care without increasing spending; and</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits for individuals receiving benefits under this chapter.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s152/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Conforming Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapter, as amended by this title, is further amended by inserting after the item relating to section 1703D the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1703E.</designator><label> Center for Innovation for Care and Payment.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stB/s153" styleType="OLC"> <num style="-uslm-dtd:enum" value="153">SEC. 153. </num><heading style="-uslm-dtd:header">AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE DONORS FOR PURPOSES OF CONDUCTING TRANSPLANT PROCEDURES FOR VETERANS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s153/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subchapter VIII of chapter 17 is amended by adding at the end the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="1788">“SEC. 1788. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1788">38 U.S.C. 1788</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Transplant procedures with live donors and related services </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Subject to subsections (b) and (c), in a case in which a veteran is eligible for a transplant procedure from the Department, the Secretary may provide for an operation on a live donor to carry out such procedure for such veteran, notwithstanding that the live donor may not be eligible for health care from the Department.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Other Services.—</heading><content style="-uslm-dtd:text">Subject to the availability of appropriations for such purpose, the Secretary shall furnish to a live donor any care or services before and after conducting the transplant procedure under subsection (a) that may be required in connection with such procedure.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Use of Non-Department Facilities.—</heading><content style="-uslm-dtd:text">In carrying out this section, the Secretary may provide for the operation described in subsection (a) on a live donor and furnish to the live donor the care and services described in subsection (b) at a non-Department facility pursuant to an agreement entered into by the Secretary under this chapter. The live donor shall be deemed to be an individual eligible for hospital care and medical services at a non-Department facility pursuant to such an agreement solely for the purposes of receiving such operation, care, and services at the non-Department facility.”</content> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stB/s153/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 17is amended by inserting after the item relating to section 1787 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“1788.</designator><label> Transplant procedures with live donors and related services.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> </subtitle> <subtitle style="-uslm-dtd:subtitle" identifier="/us/sComp/115/182/tI/stC" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">Subtitle C—</num><heading style="-uslm-dtd:header">Family Caregivers </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stC/s161" styleType="OLC"> <num style="-uslm-dtd:enum" value="161">SEC. 161. </num><heading style="-uslm-dtd:header">EXPANSION OF FAMILY CAREGIVER PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s161/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Family Caregiver Program.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Expansion of eligibility.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Subparagraph (B) of subsection (a)(2) of section 1720G is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">for assistance provided under this subsection—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">before the date on which the Secretary submits to Congress a certification that the Department has fully implemented the information technology system required by section 162(a) of the Caring for Our Veterans Act of 2018, has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001;</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><chapeau style="-uslm-dtd:text">during the 2-year period beginning on the date on which the Secretary submitted to Congress the certification described in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service—</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">on or before May 7, 1975; or</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">on or after September 11, 2001; or</content> </subclause> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">after the date that is 2 years after the date on which the Secretary submits to Congress the certification described in clause (i), has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service; and”</content> </clause> </subparagraph></quotedContent>.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1720G">38 U.S.C. 1720G note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Publication in federal register.—</heading><content style="-uslm-dtd:text">Not later than 30 days after the date on which the Secretary of Veterans Affairs submits to Congress the certification described in subsection (a)(2)(B)(i) of section 1720G of such title, as amended by subparagraph (A) of this paragraph, the Secretary shall publish the date specified in such subsection in the Federal Register.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Expansion of needed services in eligibility criteria.—</heading><chapeau style="-uslm-dtd:text">Subsection (a)(2)(C) of such section is amended—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">in clause (ii), by striking “<quotedText style="-uslm-dtd:quote">; or</quotedText>” and inserting a semicolon;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">by redesignating clause (iii) as clause (iv); and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">by inserting after clause (ii) the following new clause (iii):<quotedContent style="-uslm-dtd:quoted-block"> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text"> a need for regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired; or”</content> </subsection></quotedContent>.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Expansion of services provided.—</heading><chapeau style="-uslm-dtd:text">Subsection (a)(3)(A)(ii) of such section is amended—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">in subclause (IV), by striking “<quotedText style="-uslm-dtd:quote">; and</quotedText>” and inserting a semicolon;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">in subclause (V), by striking the period at the end and inserting “<quotedText style="-uslm-dtd:quote">; and</quotedText>”; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/3/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">by adding at the end the following new subclause:<quotedContent style="-uslm-dtd:quoted-block"> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="VI">“(VI) </num><chapeau style="-uslm-dtd:text">through the use of contracts with, or the provision of grants to, public or private entities—</chapeau> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="aa">“(aa) </num><content style="-uslm-dtd:text">financial planning services relating to the needs of injured veterans and their caregivers; and</content> </item> <item style="-uslm-dtd:item" styleType="OLC"> <num style="-uslm-dtd:enum" value="bb">“(bb) </num><content style="-uslm-dtd:text">legal services, including legal advice and consultation, relating to the needs of injured veterans and their caregivers.”</content> </item> </subclause></quotedContent>.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Modification of stipend calculation.—</heading><chapeau style="-uslm-dtd:text">Subsection (a)(3)(C) of such section is amended—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/4/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">by redesignating clause (iii) as clause (iv); and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s161/a/4/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">by inserting after clause (ii) the following new clause (iii):<quotedContent style="-uslm-dtd:quoted-block"> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease3"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><chapeau style="-uslm-dtd:text">In determining the amount and degree of personal care services provided under clause (i) with respect to an eligible veteran whose need for personal care services is based in whole or in part on a need for supervision or protection under paragraph (2)(C)(ii) or regular instruction or supervision under paragraph (2)(C)(iii), the Secretary shall take into account the following:</chapeau> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="I">“(I) </num><content style="-uslm-dtd:text">The assessment by the family caregiver of the needs and limitations of the veteran.</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="II">“(II) </num><content style="-uslm-dtd:text">The extent to which the veteran can function safely and independently in the absence of such supervision, protection, or instruction.</content> </subclause> <subclause style="-uslm-dtd:subclause" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="III">“(III) </num><content style="-uslm-dtd:text">The amount of time required for the family caregiver to provide such supervision, protection, or instruction to the veteran.”</content> </subclause> </clause></quotedContent>.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><heading style="-uslm-dtd:header">Periodic evaluation of need for certain services.—</heading><content style="-uslm-dtd:text">Subsection (a)(3) of such section is amended by adding at the end the following new subparagraph:<quotedContent style="-uslm-dtd:quoted-block"> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease2"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">In providing instruction, preparation, and training under subparagraph (A)(i)(I) and technical support under subparagraph (A)(i)(II) to each family caregiver who is approved as a provider of personal care services for an eligible veteran under paragraph (6), the Secretary shall periodically evaluate the needs of the eligible veteran and the skills of the family caregiver of such veteran to determine if additional instruction, preparation, training, or technical support under those subparagraphs is necessary.”</content> </subparagraph></quotedContent>.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/6" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">(6) </num><heading style="-uslm-dtd:header">Use of primary care teams.—</heading><content style="-uslm-dtd:text">Subsection (a)(5) of such section is amended, in the matter preceding subparagraph (A), by inserting “<quotedText style="-uslm-dtd:quote">(in collaboration with the primary care team for the eligible veteran to the maximum extent practicable)</quotedText>” after “<quotedText style="-uslm-dtd:quote">evaluate</quotedText>”.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/a/7" styleType="OLC"> <num style="-uslm-dtd:enum" value="7">(7) </num><heading style="-uslm-dtd:header">Assistance for family caregivers.—</heading><content style="-uslm-dtd:text">Subsection (a) of such section is amended by adding at the end the following new paragraph:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="11">“(11)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">In providing assistance under this subsection to family caregivers of eligible veterans, the Secretary may enter into contracts, provider agreements, and memoranda of understanding with Federal agencies, States, and private, nonprofit, and other entities to provide such assistance to such family caregivers.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The Secretary may provide assistance under this paragraph only if such assistance is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the Department.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">The Secretary may provide fair compensation to Federal agencies, States, and other entities that provide assistance under this paragraph.”</content> </subparagraph> </paragraph></quotedContent>.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s161/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Modification of Definition of Personal Care Services.—</heading><chapeau style="-uslm-dtd:text">Subsection (d)(4) of such section is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">in subparagraph (A), by striking “<quotedText style="-uslm-dtd:quote">independent</quotedText>”;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">by redesignating subparagraph (B) as subparagraph (D); and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s161/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">by inserting after subparagraph (A) the following new subparagraphs:<quotedContent style="-uslm-dtd:quoted-block"> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">Supervision or protection based on symptoms or residuals of neurological or other impairment or injury.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">Regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired.”</content> </subparagraph></quotedContent>.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stC/s162" styleType="OLC"> <num style="-uslm-dtd:enum" value="162">SEC. 162. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1720G">38 U.S.C. 1720G note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">IMPLEMENTATION OF INFORMATION TECHNOLOGY SYSTEM OF DEPARTMENT OF VETERANS AFFAIRS TO ASSESS AND IMPROVE THE FAMILY CAREGIVER PROGRAM. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s162/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Implementation of New System.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than October 1, 2018, the Secretary of Veterans Affairs shall implement an information technology system that fully supports the Program and allows for data assessment and comprehensive monitoring of the Program.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Elements of system.—</heading><chapeau style="-uslm-dtd:text">The information technology system required to be implemented under paragraph (1) shall include the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The ability to easily retrieve data that will allow all aspects of the Program (at the medical center and aggregate levels) and the workload trends for the Program to be assessed and comprehensively monitored.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The ability to manage data with respect to a number of caregivers that is more than the number of caregivers that the Secretary expects to apply for the Program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/a/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">The ability to integrate the system with other relevant information technology systems of the Veterans Health Administration.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s162/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Assessment of Program.—</heading><content style="-uslm-dtd:text">Not later than 180 days after implementing the system described in subsection (a), the Secretary shall, through the Under Secretary for Health, use data from the system and other relevant data to conduct an assessment of how key aspects of the Program are structured and carried out.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s162/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Ongoing Monitoring of and Modifications to Program.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Monitoring.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall use the system implemented under subsection (a) to monitor and assess the workload of the Program, including monitoring and assessment of data on—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/c/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">the status of applications, appeals, and home visits in connection with the Program; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/c/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">the use by caregivers participating in the Program of other support services under the Program such as respite care.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Modifications.—</heading><content style="-uslm-dtd:text">Based on the monitoring and assessment conducted under paragraph (1), the Secretary shall identify and implement such modifications to the Program as the Secretary considers necessary to ensure the Program is functioning as intended and providing veterans and caregivers participating in the Program with services in a timely manner.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s162/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Reports.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Initial report.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><chapeau style="-uslm-dtd:text">Not later than 90 days after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the Comptroller General of the United States a report that includes—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/1/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">the status of the planning, development, and deployment of the system required to be implemented under subsection (a), including any changes in the timeline for the implementation of the system; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/1/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">an assessment of the needs of family caregivers of veterans described in subparagraph (B), the resources needed for the inclusion of such family caregivers in the Program, and such changes to the Program as the Secretary considers necessary to ensure the successful expansion of the Program to include such family caregivers.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Veterans described.—</heading><content style="-uslm-dtd:text">Veterans described in this subparagraph are veterans who are eligible for the Program under clause (ii) or (iii) of section 1720G(a)(2)(B) of title 38, United States Code, as amended by section 161(a)(1) of this title, solely due to a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service before September 11, 2001.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Notification by comptroller general.—</heading><chapeau style="-uslm-dtd:text">The Comptroller General shall review the report submitted under paragraph (1) and notify the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives with respect to the progress of the Secretary in—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">fully implementing the system required under subsection (a); and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">implementing a process for using such system to monitor and assess the Program under subsection (c)(1) and modify the Program as considered necessary under subsection (c)(2).</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/d/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Final report.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than October 1, 2019, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate, the Committee on Veterans’ Affairs of the House of Representatives, and the Comptroller General a report on the implementation of subsections (a) through (c).</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tI/stC/s162/d/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">The report required by subparagraph (A) shall include the following:</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/3/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">A certification by the Secretary that the information technology system described in subsection (a) has been implemented.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/3/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">A description of how the Secretary has implemented such system.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/3/B/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">A description of the modifications to the Program, if any, that were identified and implemented under subsection (c)(2).</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tI/stC/s162/d/3/B/iv" styleType="OLC"> <num style="-uslm-dtd:enum" value="iv">(iv) </num><content style="-uslm-dtd:text">A description of how the Secretary is using such system to monitor the workload of the Program.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s162/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Active military, naval, or air service.—</heading><content style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">active military, naval, or air service</quotedText>” has the meaning given that term in section 101 of title 38, United States Code.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s162/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Program.—</heading><content style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">Program</quotedText>” means the program of comprehensive assistance for family caregivers under section 1720G(a) of title 38, United States Code, as amended by section 161 of this title.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tI/stC/s163" styleType="OLC"> <num style="-uslm-dtd:enum" value="163">SEC. 163. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1720G">38 U.S.C. 1720G note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">MODIFICATIONS TO ANNUAL EVALUATION REPORT ON CAREGIVER PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s163/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Barriers to Care and Services.—</heading><content style="-uslm-dtd:text">Subparagraph (A)(iv) of section 101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111-163; 38 U.S.C. 1720G note) is amended by inserting “<quotedText style="-uslm-dtd:quote">, including a description of any barriers to accessing and receiving care and services under such programs</quotedText>” before the semicolon.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tI/stC/s163/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Sufficiency of Training for Family Caregiver Program.—</heading><chapeau style="-uslm-dtd:text">Subparagraph (B) of such section is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s163/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">in clause (i), by striking “<quotedText style="-uslm-dtd:quote">; and</quotedText>” and inserting a semicolon;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s163/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">in clause (ii), by striking the period at the end and inserting “<quotedText style="-uslm-dtd:quote">; and</quotedText>”; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tI/stC/s163/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">by adding at the end the following new clause:<quotedContent style="-uslm-dtd:quoted-block"> <clause style="-uslm-dtd:clause" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">“(iii) </num><content style="-uslm-dtd:text">an evaluation of the sufficiency and consistency of the training provided to family caregivers under such program in preparing family caregivers to provide care to veterans under such program.”</content> </clause></quotedContent>.</content> </paragraph> </subsection> </section> </subtitle> <num style="-uslm-dtd:enum" value="II">TITLE II—</num><heading style="-uslm-dtd:header">VA ASSET AND INFRASTRUCTURE REVIEW </heading> <subtitle style="-uslm-dtd:subtitle" identifier="/us/sComp/115/182/tII/stA" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">Subtitle A—</num><heading style="-uslm-dtd:header">Asset and Infrastructure Review </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stA/s201" styleType="OLC"> <num style="-uslm-dtd:enum" value="201">SEC. 201. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s8122">38 U.S.C. 8122 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">SHORT TITLE. </heading><content style="-uslm-dtd:text">This subtitle may be cited as the “<shortTitle style="-uslm-dtd:quote">VA Asset and Infrastructure Review Act of 2018</shortTitle>”.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stA/s202" styleType="OLC"> <num style="-uslm-dtd:enum" value="202">SEC. 202. </num><heading style="-uslm-dtd:header">THE COMMISSION. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment.—</heading><content style="-uslm-dtd:text">There is established an independent commission to be known as the “<quotedText style="-uslm-dtd:quote">Asset and Infrastructure Review Commission</quotedText>” (in this subtitle referred to as the “<quotedText style="-uslm-dtd:quote">Commission</quotedText>”).</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Duties.—</heading><content style="-uslm-dtd:text">The Commission shall carry out the duties specified for it in this subtitle.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Appointment.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">Appointment.—</heading><content style="-uslm-dtd:text">The Commission shall be composed of nine members appointed by the President, by and with the advice and consent of the Senate.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Transmission of nominations.—</heading><content style="-uslm-dtd:text">The President shall transmit to the Senate the nominations for appointment to the Commission not later than May 31, 2021.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Consultation in selection process.—</heading><chapeau style="-uslm-dtd:text">In selecting individuals for nominations for appointments to the Commission, the President shall consult with—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">the Speaker of the House of Representatives;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">the majority leader of the Senate;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">the minority leader of the House of Representatives;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/2/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">the minority leader of the Senate; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/2/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">congressionally chartered, membership based veterans service organizations concerning the appointment of three members.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/c/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Designation of chair.—</heading><content style="-uslm-dtd:text">At the time the President nominates individuals for appointment to the Commission under paragraph (1)(B), the President shall designate one such individual who shall serve as Chair of the Commission and one such individual who shall serve as Vice Chair of the Commission.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/c/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Member representation.—</heading><chapeau style="-uslm-dtd:text">In nominating individuals under this subsection, the President shall ensure that—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/4/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">veterans, reflecting current demographics of veterans enrolled in the system of annual patient enrollment under section 1705 of title 38, United States Code, are adequately represented in the membership of the Commission;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/4/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">at least one member of the Commission has experience working for a private integrated health care system that has annual gross revenues of more than $50,000,000;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/4/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">at least one member has experience as a senior manager for an entity specified in clause (ii), (iii), or (iv) of section 101(a)(1)(B) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note);</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/4/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><chapeau style="-uslm-dtd:text">at least one member—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s202/c/4/D/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">has experience with capital asset management for the Federal Government; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s202/c/4/D/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">is familiar with trades related to building and real property, including construction, engineering, architecture, leasing, and strategic partnerships; and</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/c/4/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">at least three members represent congressionally chartered, membership-based, veterans service organizations.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Meetings.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">The Commission shall meet only during calendar years 2022 and 2023.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Public nature of meetings and proceedings.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/d/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">Public meetings.—</heading><content style="-uslm-dtd:text">Each meeting of the Commission shall be open to the public.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/d/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Open participation.—</heading><content style="-uslm-dtd:text">All the proceedings, information, and deliberations of the Commission shall be available for review by the public.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Vacancies.—</heading><content style="-uslm-dtd:text">A vacancy in the Commission shall be filled in the same manner as the original appointment, but the individual appointed to fill the vacancy shall serve only for the unexpired portion of the term for which the individual’s predecessor was appointed.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/f" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">(f) </num><heading style="-uslm-dtd:header">Pay.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/f/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Members of the Commission shall serve without pay.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/f/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Officers or employees of the united states.—</heading><content style="-uslm-dtd:text">Each member of the Commission who is an officer or employee of the United States shall serve without compensation in addition to that received for service as an officer or employee of the United States.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/f/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Travel expenses.—</heading><content style="-uslm-dtd:text">Members shall receive travel expenses, including per diem in lieu of subsistence, in accordance with sections 5702 and 5703 of title 5, United States Code.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/g" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">(g) </num><heading style="-uslm-dtd:header">Director of Staff.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/g/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Appointment.—</heading><chapeau style="-uslm-dtd:text">The Commission shall appoint a Director who—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/g/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">has not served as an employee of the Department of Veterans Affairs during the 1-year period preceding the date of such appointment; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/g/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">is not otherwise barred or prohibited from serving as Director under Federal ethics laws and regulations, by reason of post-employment conflict of interest.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/g/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Rate of pay.—</heading><content style="-uslm-dtd:text">The Director shall be paid at the rate of basic pay payable for level IV of the Executive Schedule under section 5315 of title 5, United States Code.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/h" styleType="OLC"> <num style="-uslm-dtd:enum" value="h">(h) </num><heading style="-uslm-dtd:header">Staff.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/h/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Pay of personnel.—</heading><content style="-uslm-dtd:text">Subject to paragraphs (2) and (3), the Director, with the approval of the Commission, may appoint and fix the pay of additional personnel.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/h/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Exemption from certain requirements.—</heading><content style="-uslm-dtd:text">The Director may make such appointments without regard to the provisions of title 5, United States Code, governing appointments in the competitive service, and any personnel so appointed may be paid without regard to the provisions of chapter 51 and subchapter III of chapter 53 of that title relating to classification and General Schedule pay rates, except that an individual so appointed may not receive pay in excess of the annual rate of basic pay payable for GS-15 of the General Schedule.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/h/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Detailees.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/h/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">Limitation on number.—</heading><content style="-uslm-dtd:text">Not more than two-thirds of the personnel employed by or detailed to the Commission may be on detail from the Department of Veterans Affairs.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/h/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Professional analysts.—</heading><content style="-uslm-dtd:text">Not more than half of the professional analysts of the Commission staff may be persons detailed from the Department of Veterans Affairs to the Commission.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s202/h/3/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><heading style="-uslm-dtd:header">Prohibition on detail of certain personnel.—</heading><content style="-uslm-dtd:text">A person may not be detailed from the Department of Veterans Affairs to the Commission if, within 6 months before the detail is to begin, that person participated personally and substantially in any matter within the Department of Veterans Affairs concerning the preparation of recommendations regarding facilities of the Veterans Health Administration.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/h/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Authority to request detailed personnel.—</heading><content style="-uslm-dtd:text">Subject to paragraph (3), the head of any Federal department or agency, upon the request of the Director, may detail any of the personnel of that department or agency to the Commission to assist the Commission in carrying out its duties under this subtitle.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/h/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><heading style="-uslm-dtd:header">Information from federal agencies.—</heading><content style="-uslm-dtd:text">The Commission may secure directly from any Federal agency such information the Commission considers necessary to carry out this subtitle. Upon request of the Chair, the head of such agency shall furnish such information to the Commission.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><heading style="-uslm-dtd:header">Other Authority.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/i/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Temporary and intermittent services.—</heading><content style="-uslm-dtd:text">The Commission may procure by contract, to the extent funds are available, the temporary or intermittent services of experts or consultants pursuant to section 3109 of title 5, United States Code.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/i/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Leasing and acquisition of property.—</heading><content style="-uslm-dtd:text">To the extent funds are available, the Commission may lease real property and acquire personal property either of its own accord or in consultation with the General Services Administration.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/j" styleType="OLC"> <num style="-uslm-dtd:enum" value="j">(j) </num><heading style="-uslm-dtd:header">Termination.—</heading><content style="-uslm-dtd:text">The Commission shall terminate on December 31, 2023.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s202/k" styleType="OLC"> <num style="-uslm-dtd:enum" value="k">(k) </num><heading style="-uslm-dtd:header">Prohibition Against Restricting Communications.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/k/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Except as provided in paragraph (2), no person may restrict an employee of the Department of Veterans Affairs in communicating with the Commission.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s202/k/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Unlawful communications.—</heading><content style="-uslm-dtd:text">Paragraph (1) does not apply to a communication that is unlawful.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stA/s203" styleType="OLC"> <num style="-uslm-dtd:enum" value="203">SEC. 203. </num><heading style="-uslm-dtd:header">PROCEDURE FOR MAKING RECOMMENDATIONS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s203/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Selection Criteria.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Publication.—</heading><content style="-uslm-dtd:text">The Secretary shall, not later than February 1, 2021, and after consulting with veterans service organizations, publish in the Federal Register and transmit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives the criteria proposed to be used by the Department of Veterans Affairs in assessing and making recommendations regarding the modernization or realignment of facilities of the Veterans Health Administration under this subtitle. Such criteria shall include the preferences of veterans regarding health care furnished by the Department.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Public comment.—</heading><content style="-uslm-dtd:text">The Secretary shall provide an opportunity for public comment on the proposed criteria under paragraph (1) for a period of at least 90 days and shall include notice of that opportunity in the publication required under such paragraph.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Publication of final criteria.—</heading><content style="-uslm-dtd:text">The Secretary shall, not later than May 31, 2021, publish in the Federal Register and transmit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives the final criteria to be used in making recommendations regarding the closure, modernization, or realignment of facilities of the Veterans Health Administration under this subtitle.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s203/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Recommendations of the Secretary.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Publication in federal register.—</heading><content style="-uslm-dtd:text">The Secretary shall, not later than January 31, 2022, and after consulting with veterans service organizations, publish in the Federal Register and transmit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives and to the Commission a report detailing the recommendations regarding the modernization or realignment of facilities of the Veterans Health Administration on the basis of the final criteria referred to in subsection (a)(2) that are applicable.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Factors for consideration.—</heading><chapeau style="-uslm-dtd:text">In making recommendations under this subsection, the Secretary shall consider each of the following factors:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The degree to which any health care delivery or other site for providing services to veterans reflect the metrics of the Department of Veterans Affairs regarding market area health system planning.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The provision of effective and efficient access to high-quality health care and services for veterans.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">The extent to which the real property that no longer meets the needs of the Federal Government could be reconfigured, repurposed, consolidated, realigned, exchanged, outleased, replaced, sold, or disposed.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">The need of the Veterans Health Administration to acquire infrastructure or facilities that will be used for the provision of health care and services to veterans.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">The extent to which the operating and maintenance costs are reduced through consolidating, colocating, and reconfiguring space, and through realizing other operational efficiencies.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/F" styleType="OLC"> <num style="-uslm-dtd:enum" value="F">(F) </num><content style="-uslm-dtd:text">The extent and timing of potential costs and savings, including the number of years such costs or savings will be incurred, beginning with the date of completion of the proposed recommendation.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/G" styleType="OLC"> <num style="-uslm-dtd:enum" value="G">(G) </num><content style="-uslm-dtd:text">The extent to which the real property aligns with the mission of the Department of Veterans Affairs.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/H" styleType="OLC"> <num style="-uslm-dtd:enum" value="H">(H) </num><content style="-uslm-dtd:text">The extent to which any action would impact other missions of the Department (including education, research, or emergency preparedness).</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/I" styleType="OLC"> <num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">Local stakeholder inputs and any factors identified through public field hearings.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/J" styleType="OLC"> <num style="-uslm-dtd:enum" value="J">(J) </num><content style="-uslm-dtd:text">The assessments under paragraph (3)..</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/K" styleType="OLC"> <num style="-uslm-dtd:enum" value="K">(K) </num><content style="-uslm-dtd:text">The extent to which the Veterans Health Administration has appropriately staffed the medical facility, including determinations whether there has been insufficient resource allocation or deliberate understaffing.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/2/L" styleType="OLC"> <num style="-uslm-dtd:enum" value="L">(L) </num><content style="-uslm-dtd:text">Any other such factors the Secretary determines appropriate.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Capacity and commercial market assessments.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">Assessments.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall assess the capacity of each Veterans Integrated Service Network and medical facility of the Department to furnish hospital care or medical services to veterans under chapter 17 of title 38, United States Code. Each such assessment shall—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">identify gaps in furnishing such care or services at such Veterans Integrated Service Network or medical facility;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><chapeau style="-uslm-dtd:text">identify how such gaps can be filled by—</chapeau> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/ii/I" styleType="OLC"> <num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">entering into contracts or agreements with network providers under this section or with entities under other provisions of law;</content> </subclause> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/ii/II" styleType="OLC"> <num style="-uslm-dtd:enum" value="II">(II) </num><chapeau style="-uslm-dtd:text">making changes in the way such care and services are furnished at such Veterans Integrated Service Network or medical facility, including—</chapeau> <item style="-uslm-dtd:item" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/ii/II/aa" styleType="OLC"> <num style="-uslm-dtd:enum" value="aa">(aa) </num><content style="-uslm-dtd:text">extending hours of operation;</content> </item> <item style="-uslm-dtd:item" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/ii/II/bb" styleType="OLC"> <num style="-uslm-dtd:enum" value="bb">(bb) </num><content style="-uslm-dtd:text">adding personnel; or</content> </item> <item style="-uslm-dtd:item" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/ii/II/cc" styleType="OLC"> <num style="-uslm-dtd:enum" value="cc">(cc) </num><content style="-uslm-dtd:text">expanding space through the construction, leasing, or sharing of health care facilities; and</content> </item> </subclause> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/ii/III" styleType="OLC"> <num style="-uslm-dtd:enum" value="III">(III) </num><content style="-uslm-dtd:text">the building or realignment of Department resources or personnel;</content> </subclause> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">forecast, based on future projections and historical trends, both the short- and long-term demand in furnishing care or services at such Veterans Integrated Service Network or medical facility and assess how such demand affects the needs to use such network providers;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/iv" styleType="OLC"> <num style="-uslm-dtd:enum" value="iv">(iv) </num><content style="-uslm-dtd:text">include a commercial health care market assessment of designated catchment areas in the United States conducted by a non-governmental entity; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/b/3/A/v" styleType="OLC"> <num style="-uslm-dtd:enum" value="v">(v) </num><content style="-uslm-dtd:text">consider the unique ability of the Federal Government to retain a presence in an area otherwise devoid of commercial health care providers or from which such providers are at risk of leaving.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Consultation.—</heading><content style="-uslm-dtd:text">In carrying out the assessments under subparagraph (A), the Secretary shall consult with veterans service organizations and veterans served by each such Veterans Integrated Service Network and medical facility.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/3/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><heading style="-uslm-dtd:header">Submittal.—</heading><content style="-uslm-dtd:text">The Secretary shall submit such assessments to the Committees on Veterans’ Affairs of the House of Representatives and the Senate with the recommendations of the Secretary under this subsection and make the assessments publicly available.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/b/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Summary of selection process.—</heading><content style="-uslm-dtd:text">The Secretary shall include, with the list of recommendations published and transmitted pursuant to paragraph (1), a summary of the selection process that resulted in the recommendation for each facility of the Veterans Health Administration, including a justification for each recommendation. The Secretary shall transmit the matters referred to in the preceding sentence not later than 7 days after the date of the transmittal to the Committees on Veterans’ Affairs of the Senate and the House of Representatives and the Commission of the report referred to in paragraph (1).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/b/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><heading style="-uslm-dtd:header">Treatment of facilities.—</heading><content style="-uslm-dtd:text">In assessing facilities of the Veterans Health Administration, the Secretary shall consider all such facilities equally without regard to whether the facility has been previously considered or proposed for reuse, closure, modernization, or realignment by the Department of Veterans Affairs.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/b/6" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">(6) </num><heading style="-uslm-dtd:header">Availability of information to congress.—</heading><content style="-uslm-dtd:text">In addition to making all information used by the Secretary to prepare the recommendations under this subsection available to Congress (including any committee or Member of Congress), the Secretary shall also make such information available to the Commission and the Comptroller General of the United States.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/b/7" styleType="OLC"> <num style="-uslm-dtd:enum" value="7">(7) </num><heading style="-uslm-dtd:header">Certification of accuracy.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/7/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Each person referred to in subparagraph (B), when submitting information to the Secretary or the Commission concerning the modernization or realignment of a facility of the Veterans Health Administration, shall certify that such information is accurate and complete to the best of that person’s knowledge and belief.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/b/7/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Covered persons.—</heading><chapeau style="-uslm-dtd:text">Subparagraph (A) applies to the following persons:</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/b/7/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">Each Under Secretary of the Department of Veterans Affairs.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/b/7/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">Each director of a Veterans Integrated Service Network.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/b/7/B/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">Each director of a medical center of the Department of Veterans Affairs.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/b/7/B/iv" styleType="OLC"> <num style="-uslm-dtd:enum" value="iv">(iv) </num><content style="-uslm-dtd:text">Each director of a program office of the Department of Veterans Affairs.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/b/7/B/v" styleType="OLC"> <num style="-uslm-dtd:enum" value="v">(v) </num><content style="-uslm-dtd:text">Each person who is in a position the duties of which include personal and substantial involvement in the preparation and submission of information and recommendations concerning the modernization or realignment of facilities of the Veterans Health Administration.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s203/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Review and Recommendations by the Commission.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Public hearings.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/c/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">After receiving the recommendations from the Secretary pursuant to subsection (b), the Commission shall conduct public hearings on the recommendations.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/c/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Locations.—</heading><content style="-uslm-dtd:text">The Commission shall conduct public hearings in regions affected by a recommendation of the Secretary to close a facility of the Veterans Health Administration. To the greatest extent practicable, the Commission shall conduct public hearings in regions affected by a recommendation of the Secretary to modernize or realign such a facility.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/c/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><heading style="-uslm-dtd:header">Required witnesses.—</heading><chapeau style="-uslm-dtd:text">Witnesses at each public hearing shall include at a minimum—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/c/1/C/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><chapeau style="-uslm-dtd:text">a veteran—</chapeau> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tII/stA/s203/c/1/C/i/I" styleType="OLC"> <num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">enrolled under section 1705 of title 38, United States Code; and</content> </subclause> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tII/stA/s203/c/1/C/i/II" styleType="OLC"> <num style="-uslm-dtd:enum" value="II">(II) </num><content style="-uslm-dtd:text">identified by a local veterans service organization; and</content> </subclause> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/c/1/C/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">a local elected official.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Transmittal to president.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">The Commission shall, not later than January 31, 2023, transmit to the President a report containing the Commission’s findings and conclusions based on a review and analysis of the recommendations made by the Secretary, together with the Commission’s recommendations, for modernizations and realignments of facilities of the Veterans Health Administration.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Authority to make changes to recommendations.—</heading><chapeau style="-uslm-dtd:text">Subject to subparagraph (C), in making its recommendations, the Commission may change any recommendation made by the Secretary if the Commission—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/c/2/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">determines that the Secretary deviated substantially from the final criteria referred to in subsection (a)(2) in making such recommendation;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/c/2/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">determines that the change is consistent with the final criteria referred to in subsection (a)(2);</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/c/2/B/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">publishes a notice of the proposed change in the Federal Register not less than 45 days before transmitting its recommendations to the President pursuant to subparagraph (A); and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s203/c/2/B/iv" styleType="OLC"> <num style="-uslm-dtd:enum" value="iv">(iv) </num><content style="-uslm-dtd:text">conducts public hearings on the proposed change.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/c/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Justification for changes.—</heading><content style="-uslm-dtd:text">The Commission shall explain and justify in its report submitted to the President pursuant to paragraph (2) any recommendation made by the Commission that is different from the recommendations made by the Secretary pursuant to subsection (b). The Commission shall transmit a copy of such report to the Committees on Veterans’ Affairs of the Senate and the House of Representatives on the same date on which it transmits its recommendations to the President under paragraph (2).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/c/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Provision of information to congress.—</heading><content style="-uslm-dtd:text">After the Commission transmits its report to the President, the Commission shall promptly provide, upon request, to any Member of Congress, information used by the Commission in making its recommendations.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s203/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Review by the President.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Report.—</heading><content style="-uslm-dtd:text">The President shall, not later than February 15, 2023, transmit to the Commission and to the Congress a report containing the President’s approval or disapproval of the Commission’s recommendations.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Presidential approval.—</heading><content style="-uslm-dtd:text">If the President approves all the recommendations of the Commission, the President shall transmit a copy of such recommendations to the Congress, together with a certification of such approval.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/d/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Presidential disapproval.—</heading><chapeau style="-uslm-dtd:text">If the President disapproves the recommendations of the Commission, in whole or in part, the President shall transmit to the Commission and the Congress, not later than March 1, 2023, the reasons for that disapproval. The Commission, after consideration of the President’s reasons for disapproval, shall then transmit to the President, not later than March 15, 2023, a report containing—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/d/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">the Commission’s findings and conclusions based on a review and analysis of those reasons for disapproval provided by the President; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s203/d/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">recommendations that the Commission determines are appropriate for modernizations and realignments of facilities of the Veterans Health Administration.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/d/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Transmittal of recommendations to congress.—</heading><content style="-uslm-dtd:text">If the President approves all recommendations of the Commission transmitted to the President under paragraph (3), the President shall transmit a copy of such recommendations to the Congress, together with a certification of such approval.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s203/d/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><heading style="-uslm-dtd:header">Failure to transmit.—</heading><content style="-uslm-dtd:text">If the President does not transmit to the Congress an approval and certification described in paragraph (2) or (4) by March 30, 2023, the process by which facilities of the Veterans Health Administration may be selected for modernization or realignment under this subtitle shall be terminated.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stA/s204" styleType="OLC"> <num style="-uslm-dtd:enum" value="204">SEC. 204. </num><heading style="-uslm-dtd:header">ACTIONS REGARDING INFRASTRUCTURE AND FACILITIES OF THE VETERANS HEALTH ADMINISTRATION. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s204/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><chapeau style="-uslm-dtd:text">Subject to subsection (b), the Secretary shall begin to implement the recommended modernizations and realignments in the report under section 203(d) not later than 3 years after the date on which the President transmits such report to Congress. In any fiscal year, such implementation includes—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s204/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">the planning of modernizations and realignments of facilities of the Veterans Health Administration as recommended in such report; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s204/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">providing detailed information on the budget for such modernizations or realignments in documents submitted to Congress by the Secretary in support of the President’s budget for that fiscal year.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s204/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Congressional Disapproval.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s204/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><chapeau style="-uslm-dtd:text">The Secretary may not carry out any modernization or realignment recommended by the Commission in a report transmitted from the President pursuant to section 203(d) if a joint resolution is enacted, in accordance with the provisions of section 207, disapproving such recommendations of the Commission before the earlier of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s204/b/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">the end of the 45-day period beginning on the date on which the President transmits such report; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s204/b/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">the adjournment of Congress sine die for the session during which such report is transmitted.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s204/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Computation of period.—</heading><content style="-uslm-dtd:text">For purposes of paragraph (1) and subsections (a) and (c) of section 207, the days on which either House of Congress is not in session because of an adjournment of more than three days to a day certain shall be excluded in the computation of a period.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stA/s205" styleType="OLC"> <num style="-uslm-dtd:enum" value="205">SEC. 205. </num><heading style="-uslm-dtd:header">IMPLEMENTATION.—. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s205/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Modernizing and realigning facilities.—</heading><chapeau style="-uslm-dtd:text">In modernizing or realigning any facility of the Veterans Health Administration under this subtitle, the Secretary may—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/a/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">take such actions as may be necessary to modernize or realign any such facility, including the alteration of such facilities, the acquisition of such land, the leasing or construction of such replacement facilities, the disposition of such land or facilities, the performance of such activities, and the conduct of such advance planning and design as may be required to transfer functions from a facility of the Veterans Health Administration to another such facility, and may use for such purpose funds in the Account or funds appropriated to the Department of Veterans Affairs for such purposes;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/a/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">carry out activities for the purposes of environmental mitigation, abatement, or restoration at any such facility, and shall use for such purposes funds in the Account;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/a/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">reimburse other Federal agencies for actions performed at the request of the Secretary with respect to any such closure or realignment, and may use for such purpose funds in the Account or funds appropriated to the Department of Veterans Affairs and available for such purpose; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/a/1/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">exercise the authority of the Secretary under subchapter V of chapter 81 of title 38, United States Code.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Environmental restoration; historic preservation.—</heading><chapeau style="-uslm-dtd:text">In carrying out any closure or realignment under this subtitle, the Secretary, with regards to any property made excess to the needs of the Department of Veterans Affairs as a result of such closure or realignment, shall carry out, as soon as possible with funds available for such purpose, any of the following for which the Secretary is responsible:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Environmental mitigation.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Environmental abatement.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/a/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Environmental restoration.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/a/2/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">Compliance with historic preservation requirements.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s205/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Management and Disposal of Property.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Existing disposal authorities.—</heading><content style="-uslm-dtd:text">To transfer or dispose of surplus real property or infrastructure located at any facility of the Veterans Health Administration that is modernized or realigned under this title, the Secretary may exercise the authorities of the Secretary under subchapters I and II of chapter 81 of title 38, United States Code, or the authorities delegated to the Secretary by the Administrator of General Services under subchapter III of chapter 5 of title 40, United States Code.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Effects on local communities.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/b/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">Consultation with state and local government.—</heading><content style="-uslm-dtd:text">Before any action may be taken with respect to the disposal of any surplus real property or infrastructure located at any facility of the Veterans Health Administration to be closed or realigned under this subtitle, the Secretary of Veterans Affairs shall consult with the Governor of the State and the heads of the local governments concerned for the purpose of considering any plan for the use of such property by the local community concerned.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/b/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Treatment of roads.—</heading><chapeau style="-uslm-dtd:text">If infrastructure or a facility of the Veterans Health Administration to be closed or realigned under this subtitle includes a road used for public access through, into, or around the facility, the Secretary—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/b/2/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">shall consult with the Government of the State and the heads of the local governments concerned for the purpose of considering the continued availability of the road for public use after the recommended action is complete; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/b/2/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">may exercise the authority of the Secretary under section 8108 of title 38, United States Code.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Leases; cercla.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/b/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">Lease authority.—</heading> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/b/3/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><heading style="-uslm-dtd:header">Transfer to redevelopment authority for lease.—</heading><content style="-uslm-dtd:text">The Secretary may transfer title to a facility of the Veterans Health Administration approved for closure or realignment under this subtitle (including property at a facility of the Veterans Health Administration approved for realignment which will be retained by the Department of Veterans Affairs or another Federal agency after realignment) to the redevelopment authority for the facility if the redevelopment authority agrees to lease, directly upon transfer, one or more portions of the property transferred under this subparagraph to the Secretary or to the head of another department or agency of the Federal Government.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/b/3/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><heading style="-uslm-dtd:header">Term of lease.—</heading><content style="-uslm-dtd:text">A lease under clause (i) shall be for a term of not to exceed 50 years, but may provide for options for renewal or extension of the term by the department or agency concerned.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/b/3/A/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><heading style="-uslm-dtd:header">Limitation.—</heading><content style="-uslm-dtd:text">A lease under clause (i) may not require rental payments by the United States.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/b/3/A/iv" styleType="OLC"> <num style="-uslm-dtd:enum" value="iv">(iv) </num><heading style="-uslm-dtd:header">Treatment of remaindered lease terms.—</heading><content style="-uslm-dtd:text">A lease under clause (i) shall include a provision specifying that if the department or agency concerned ceases requiring the use of the leased property before the expiration of the term of the lease, the remainder of the lease term may be satisfied by the same or another department or agency of the Federal Government using the property for a use similar to the use under the lease. Exercise of the authority provided by this clause shall be made in consultation with the redevelopment authority concerned.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/b/3/A/v" styleType="OLC"> <num style="-uslm-dtd:enum" value="v">(v) </num><heading style="-uslm-dtd:header">Facility services.—</heading><chapeau style="-uslm-dtd:text">Notwithstanding clause (iii), if a lease under clause (i) involves a substantial portion of the facility, the department or agency concerned may obtain facility services for the leased property and common area maintenance from the redevelopment authority or the redevelopment authority’s assignee as a provision of the lease. The facility services and common area maintenance shall be provided at a rate no higher than the rate charged to non-Federal tenants of the transferred property. Facility services and common area maintenance covered by the lease shall not include—</chapeau> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tII/stA/s205/b/3/A/v/I" styleType="OLC"> <num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">municipal services that a State or local government is required by law to provide to all landowners in its jurisdiction without direct charge; or</content> </subclause> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tII/stA/s205/b/3/A/v/II" styleType="OLC"> <num style="-uslm-dtd:enum" value="II">(II) </num><content style="-uslm-dtd:text">firefighting or security-guard functions.</content> </subclause> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/b/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Application of cercla.—</heading><content style="-uslm-dtd:text">The provisions of section 120(h) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9620(h)) shall apply to any transfer of real property under this paragraph.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/b/3/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><heading style="-uslm-dtd:header">Additional terms and conditions.—</heading><content style="-uslm-dtd:text">The Secretary may require any additional terms and conditions in connection with a transfer under this paragraph as such Secretary considers appropriate to protect the interests of the United States.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/b/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Application of mckinney-vento homeless assistance act.—</heading><content style="-uslm-dtd:text">Nothing in this subtitle shall limit or otherwise affect the application of the provisions of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11301 et seq.) to facilities of the Veterans Health Administration closed under this subtitle.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s205/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Applicability of National Environmental Policy Act of 1969.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">The provisions of the National Environmental Policy Act of 1969 (42 U.S.C. 4321 et seq.) shall not apply to the actions of the President, the Commission, and, except as provided in paragraph (2), the Department of Veterans Affairs in carrying out this subtitle.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Department of veterans affairs.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">Covered activities.—</heading><chapeau style="-uslm-dtd:text">The provisions of the National Environmental Policy Act of 1969 shall apply to actions of the Department of Veterans Affairs under this subtitle—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/c/2/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">during the process of property disposal; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/c/2/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">during the process of relocating functions from a facility of the Veterans Health Administration being closed or realigned to another facility after the receiving facility has been selected but before the functions are relocated.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Other activities.—</heading><chapeau style="-uslm-dtd:text">In applying the provisions of the National Environmental Policy Act of 1969 to the processes referred to in subparagraph (A), the Secretary shall not have to consider—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/c/2/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">the need for closing or realigning the facility of the Veterans Health Administration as recommended by the Commission;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/c/2/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">the need for transferring functions to any facility of the Veterans Health Administration which has been selected as the receiving facility; or</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s205/c/2/B/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">facilities of the Veterans Health Administration alternative to those recommended or selected.</content> </clause> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s205/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Waiver.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Restrictions on use of funds.—</heading><content style="-uslm-dtd:text">The Secretary may close or realign facilities of the Veterans Health Administration under this subtitle without regard to any provision of law restricting the use of funds for closing or realigning facilities of the Veterans Health Administration included in any appropriation or authorization Act.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Restrictions on authorities.—</heading><content style="-uslm-dtd:text">The Secretary may close or realign facilities of the Veterans Health Administration under this subtitle without regard to the restrictions of section 8110 of title 38, United States Code.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s205/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Transfer Authority in Connection With Payment of Environmental Remediation Costs.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/e/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">Transfer by deed.—</heading><content style="-uslm-dtd:text">Subject to paragraph (2) of this subsection and section 120(h) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9620(h)), the Secretary may enter into an agreement to transfer by deed a facility of the Veterans Health Administration with any person who agrees to perform all environmental restoration, waste management, and environmental compliance activities that are required for the property or facilities under Federal and State laws, administrative decisions, agreements (including schedules and milestones), and concurrences.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/e/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Additional terms or conditions.—</heading><content style="-uslm-dtd:text">The Secretary may require any additional terms and conditions in connection with an agreement authorized by subparagraph (A) as the Secretary considers appropriate to protect the interests of the United States.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Limitation.—</heading><chapeau style="-uslm-dtd:text">A transfer of a facility of the Veterans Health Administration may be made under paragraph (1) only if the Secretary certifies to Congress that—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/e/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">the costs of all environmental restoration, waste management, and environmental compliance activities otherwise to be paid by the Secretary with respect to the facility of the Veterans Health Administration are equal to or greater than the fair market value of the property or facilities to be transferred, as determined by the Secretary; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/e/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">if such costs are lower than the fair market value of the facility of the Veterans Health Administration, the recipient of such transfer agrees to pay the difference between the fair market value and such costs.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/e/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Payment by the secretary for certain transfers.—</heading><chapeau style="-uslm-dtd:text">In the case of a facility of the Veterans Health Administration covered by a certification under paragraph (2)(A), the Secretary may pay the recipient of such facility an amount equal to the lesser of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/e/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">the amount by which the costs incurred by the recipient of the facility of the Veterans Health Administration for all environmental restoration, waste, management, and environmental compliance activities with respect to such facility exceed the fair market value of such property as specified in such certification; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s205/e/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">the amount by which the costs (as determined by the Secretary) that would otherwise have been incurred by the Secretary for such restoration, management, and activities with respect to such facility of the Veterans Health Administration exceed the fair market value of property as so specified.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/e/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Disclosure.—</heading><content style="-uslm-dtd:text">As part of an agreement under paragraph (1), the Secretary shall disclose to the person to whom the facility of the Veterans Health Administration will be transferred any information of the Secretary regarding the environmental restoration, waste management, and environmental compliance activities described in paragraph (1) that relate to the facility of the Veterans Health Administration. The Secretary shall provide such information before entering into the agreement.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s205/e/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><heading style="-uslm-dtd:header">Applicability of certain environmental laws.—</heading><content style="-uslm-dtd:text">Nothing in this subsection shall be construed to modify, alter, or amend the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9601 et seq.) or the Solid Waste Disposal Act (42 U.S.C. 6901 et seq.).</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stA/s206" styleType="OLC"> <num style="-uslm-dtd:enum" value="206">SEC. 206. </num><heading style="-uslm-dtd:header">DEPARTMENT OF VETERANS AFFAIRS ASSET AND INFRASTRUCTURE REVIEW ACCOUNT. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s206/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment.—</heading><content style="-uslm-dtd:text">There is hereby established in the ledgers of the Treasury an account to be known as the “<quotedText style="-uslm-dtd:quote">Department of Veterans Affairs Asset and Infrastructure Review Account</quotedText>” which shall be administered by the Secretary as a single account.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s206/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Credits to Account.—</heading><chapeau style="-uslm-dtd:text">There shall be credited to the Account the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s206/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Funds authorized for and appropriated to the Account.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s206/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">Proceeds received from the lease, transfer, or disposal of any property at a facility of the Veterans Health Administration closed or realigned under this subtitle.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s206/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Use of Account.—</heading><chapeau style="-uslm-dtd:text">The Secretary may use the funds in the Account only for the following purposes:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s206/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">To carry out this subtitle.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s206/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">To cover property management and disposal costs incurred at facilities of the Veterans Health Administration closed, modernized, or realigned under this subtitle.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s206/c/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">To cover costs associated with supervision, inspection, overhead, engineering, and design of construction projects undertaken under this subtitle, and subsequent claims, if any, related to such activities.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s206/c/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><content style="-uslm-dtd:text">Other purposes that the Secretary determines support the mission and operations of the Department of Veterans Affairs.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s206/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Consolidated Budget Justification Display for Account.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s206/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Consolidated budget information required.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall establish a consolidated budget justification display in support of the Account that for each fiscal year—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s206/d/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">details the amount and nature of credits to, and expenditures from, the Account during the preceding fiscal year;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s206/d/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">separately details the environmental remediation costs associated with facility of the Veterans Health Administration for which a budget request is made;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s206/d/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">specifies the transfers into the Account and the purposes for which these transferred funds will be further obligated, to include caretaker and environment remediation costs associated with each facility of the Veterans Health Administration; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s206/d/1/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">details any intra-budget activity transfers within the Account that exceeded $1,000,000 during the preceding fiscal year or that are proposed for the next fiscal year and will exceed $1,000,000.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s206/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Submission.—</heading><content style="-uslm-dtd:text">The Secretary shall include the information required by paragraph (1) in the materials that the Secretary submits to Congress in support of the budget for a fiscal year submitted by the President pursuant to section 1105 of title 31, United States Code.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s206/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Closure of Account; Treatment of Remaining Funds.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s206/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Closure.—</heading><content style="-uslm-dtd:text">The Account shall be closed at the time and in the manner provided for appropriation accounts under section 1555 of title 31, United States Code, except that unobligated funds which remain in the Account upon closure shall be held by the Secretary of the Treasury until transferred to the Secretary of Veterans Affairs by law after the Committees on Veterans’ Affairs of the Senate and the House of Representatives receive the final report transmitted under paragraph (2).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s206/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Final report.—</heading><chapeau style="-uslm-dtd:text">No later than 60 days after the closure of the Account under paragraph (1), the Secretary shall transmit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives and the Committees on Appropriations of the House of Representatives and the Senate a report containing an accounting of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s206/e/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">all the funds credited to and expended from the Account or otherwise expended under this subtitle; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s206/e/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">any funds remaining in the Account.</content> </subparagraph> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stA/s207" styleType="OLC"> <num style="-uslm-dtd:enum" value="207">SEC. 207. </num><heading style="-uslm-dtd:header">CONGRESSIONAL CONSIDERATION OF COMMISSION REPORT. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s207/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Disapproval Resolution.—</heading><chapeau style="-uslm-dtd:text">For purposes of this subtitle, the term “<quotedText style="-uslm-dtd:quote">joint resolution</quotedText>” means only a joint resolution which is introduced within the 5-day period beginning on the date on which the President transmits the report to the Congress under section 203(d), and—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">which does not have a preamble;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">the matter after the resolving clause of which is as follows: “<quotedText style="-uslm-dtd:quote">that Congress disapproves the recommendations of the VHA Asset and Infrastructure Review Commission as submitted by the President on ___</quotedText>”, the blank space being filled with the appropriate date; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">the title of which is as follows: “<quotedText style="-uslm-dtd:quote">Joint resolution disapproving the recommendations of the VHA Asset and Infrastructure Review Commission.</quotedText>”.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s207/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Consideration in the House of Representatives.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Reporting and discharge.—</heading><content style="-uslm-dtd:text">Any committee of the House of Representatives to which a joint resolution is referred shall report it to the House without amendment not later than 15 legislative days after the date of introduction thereof. If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Proceeding to consideration.—</heading><content style="-uslm-dtd:text">It shall be in order at any time after the third legislative day after each committee authorized to consider a joint resolution has reported or has been discharged from consideration of a joint resolution, to move to proceed to consider the joint resolution in the House. All points of order against the motion are waived. Such a motion shall not be in order after the House has disposed of a motion to proceed on a joint resolution addressing a particular submission. The previous question shall be considered as ordered on the motion to its adoption without intervening motion. The motion shall not be debatable. A motion to reconsider the vote by which the motion is disposed of shall not be in order.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Consideration.—</heading><content style="-uslm-dtd:text">The joint resolution shall be considered as read. All points of order against the joint resolution and against its consideration are waived. The previous question shall be considered as ordered on the joint resolution to its passage without intervening motion except 2 hours of debate equally divided and controlled by the proponent and an opponent. A motion to reconsider the vote on passage of the joint resolution shall not be in order.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s207/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Consideration in the Senate.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Referral.—</heading><content style="-uslm-dtd:text">A joint resolution introduced in the Senate shall be referred to the Committee on Veterans’ Affairs.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Reporting and discharge.—</heading><content style="-uslm-dtd:text">Any committee of the Senate to which a joint resolution is referred shall report it to the Senate without amendment not later than 15 session days after the date of introduction of a joint resolution described in subsection (a). If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution and the joint resolution shall be placed on the calendar.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/c/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Floor consideration.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s207/c/3/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Notwithstanding Rule XXII of the Standing Rules of the Senate, it is in order at any time after the third session day on which the Committee on Veterans’ Affairs has reported or has been discharged from consideration of a joint resolution described in subsection (a) (even though a previous motion to the same effect has been disagreed to) to move to proceed to the consideration of the joint resolution, and all points of order against the joint resolution (and against consideration of the joint resolution) are waived. The motion to proceed is not debatable. The motion is not subject to a motion to postpone. A motion to reconsider the vote by which the motion is agreed to or disagreed to shall not be in order. If a motion to proceed to the consideration of the resolution is agreed to, the joint resolution shall remain the unfinished business until disposed of.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s207/c/3/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Consideration.—</heading><content style="-uslm-dtd:text">Consideration of the joint resolution, and on all debatable motions and appeals in connection therewith, shall be limited to not more than 2 hours, which shall be divided equally between the majority and minority leaders or their designees. A motion further to limit debate is in order and not debatable. An amendment to, or a motion to postpone, or a motion to proceed to the consideration of other business, or a motion to recommit the joint resolution is not in order.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s207/c/3/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><heading style="-uslm-dtd:header">Vote on passage.—</heading><content style="-uslm-dtd:text">If the Senate has voted to proceed to a joint resolution, the vote on passage of the joint resolution shall occur immediately following the conclusion of consideration of the joint resolution, and a single quorum call at the conclusion of the debate if requested in accordance with the rules of the Senate.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s207/c/3/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><heading style="-uslm-dtd:header">Rulings of the chair on procedure.—</heading><content style="-uslm-dtd:text">Appeals from the decisions of the Chair relating to the application of the rules of the Senate, as the case may be, to the procedure relating to a joint resolution shall be decided without debate.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s207/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Amendment Not in Order.—</heading><content style="-uslm-dtd:text">A joint resolution of disapproval considered pursuant to this section shall not be subject to amendment in either the House of Representatives or the Senate.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s207/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Coordination With Action by Other House.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><chapeau style="-uslm-dtd:text">If, before the passage by one House of the joint resolution of that House, that House receives the joint resolution from the other House, then the following procedures shall apply:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s207/e/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The joint resolution of the other House shall not be referred to a committee.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s207/e/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><chapeau style="-uslm-dtd:text">With respect to the joint resolution of the House receiving the joint resolution—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s207/e/1/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">the procedure in that House shall be the same as if no joint resolution had been received from the other House; but</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s207/e/1/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">the vote on passage shall be on the joint resolution of the other House.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Treatment of joint resolution of other house.—</heading><content style="-uslm-dtd:text">If the Senate fails to introduce or consider a joint resolution under this section, the joint resolution of the House shall be entitled to expedited floor procedures under this section.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/e/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Treatment of companion measures.—</heading><content style="-uslm-dtd:text">If, following passage of the joint resolution in the Senate, the Senate then receives the companion measure from the House of Representatives, the companion measure shall not be debatable.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s207/f" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">(f) </num><heading style="-uslm-dtd:header">Rules of the House of Representatives and Senate.—</heading><chapeau style="-uslm-dtd:text">This section is enacted by Congress—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/f/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">as an exercise of the rulemaking power of the Senate and House of Representatives, respectively, and as such it is deemed a part of the rules of each House, respectively, but applicable only with respect to the procedure to be followed in that House in the case of a joint resolution, and it supersedes other rules only to the extent that it is inconsistent with such rules; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s207/f/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">with full recognition of the constitutional right of either House to change the rules (so far as relating to the procedure of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stA/s208" styleType="OLC"> <num style="-uslm-dtd:enum" value="208">SEC. 208. </num><heading style="-uslm-dtd:header">OTHER MATTERS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s208/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Online Publication of Communications.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s208/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than 24 hours after the transmission or receipt of any communication under this subtitle that is transmitted or received by a party specified in paragraph (2), the Secretary of Veterans Affairs shall publish such communication online.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s208/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Parties specified.—</heading><chapeau style="-uslm-dtd:text">The parties specified under this paragraph are the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s208/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary of Veterans Affairs.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s208/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The Commission.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s208/a/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">The President.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s208/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Continuation of Existing Construction Projects and Planning.—</heading><chapeau style="-uslm-dtd:text">During activities that the Commission, President, or Congress carry out under this subtitle, the Secretary of Veterans Affairs may not stop, solely because of such activities—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s208/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">a construction or leasing project of the Veterans Health Administration;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s208/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">long term planning regarding infrastructure and assets of the Veterans Health Administration; or</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s208/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">budgetary processes for the Veterans Health Administration.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stA/s208/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Recommendations for Future Asset Reviews.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs may, after consulting with veterans service organizations, include in budget submissions the Secretary submits after the termination of the Commission recommendations for future such commissions or other capital asset realignment and management processes.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stA/s209" styleType="OLC" role="definitions"> <num style="-uslm-dtd:enum" value="209">SEC. 209. </num><heading style="-uslm-dtd:header">DEFINITIONS. </heading><chapeau style="-uslm-dtd:text">In this subtitle:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">Account</term>” means the Department of Veterans Affairs Asset and Infrastructure Review Account established by section 206(a).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">Commission</term>” means the Commission established by section 202.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">date of approval</term>”, with respect to a modernization or realignment of a facility of the Veterans Health Administration, means the date on which the authority of Congress to disapprove a recommendation of modernization or realignment, as the case may be, of such facility under this subtitle expires.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><chapeau style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">facility of the Veterans Health Administration</term>”—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s209/4/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">means any land, building, structure, or infrastructure (including any medical center, nursing home, domiciliary facility, outpatient clinic, center that provides readjustment counseling, or leased facility) that is—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s209/4/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">under the jurisdiction of the Department of Veterans Affairs;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s209/4/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">under the control of the Veterans Health Administration; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s209/4/A/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">not under the control of the General Services Administration; or</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s209/4/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><chapeau style="-uslm-dtd:text">with respect to a colocated facility of the Department of Veterans Affairs, includes any land, building, or structure—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s209/4/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">under the jurisdiction of the Department of Veterans Affairs;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s209/4/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">under the control of another administration of the Department of Veterans Affairs; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tII/stA/s209/4/B/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">not under the control of the General Services Administration.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><content style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">infrastructure</term>” means improvements to land other than buildings or structures.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/6" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">(6) </num><chapeau style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">modernization</term>” includes—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s209/6/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">any action, including closure, required to align the form and function of a facility of the Veterans Health Administration to the provision of modern day health care, including utilities and environmental control systems;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s209/6/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">the construction, purchase, lease, or sharing of a facility of the Veterans Health Administration; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s209/6/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">realignments, disposals, exchanges, collaborations between the Department of Veterans Affairs and other Federal entities, and strategic collaborations between the Department and non-Federal entities, including tribal organizations.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/7" styleType="OLC"> <num style="-uslm-dtd:enum" value="7">(7) </num><chapeau style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">realignment</term>”, with respect to a facility of the Veterans Health Administration, includes—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s209/7/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">any action that changes the numbers of or relocates services, functions, and personnel positions;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s209/7/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">disposals or exchanges between the Department of Veterans Affairs and other Federal entities, including the Department of Defense; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s209/7/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">strategic collaborations between the Department of Veterans Affairs and non-Federal entities, including tribal organizations.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/8" styleType="OLC"> <num style="-uslm-dtd:enum" value="8">(8) </num><content style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">redevelopment authority</term>”, in the case of a facility of the Veterans Health Administration closed or modernized under this subtitle, means any entity (including an entity established by a State or local government) recognized by the Secretary of Veterans Affairs as the entity responsible for developing the redevelopment plan with respect to the facility or for directing the implementation of such plan.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/9" styleType="OLC"> <num style="-uslm-dtd:enum" value="9">(9) </num><chapeau style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">redevelopment plan</term>” in the case of a facility of the Veterans Health Administration to be closed or realigned under this subtitle, means a plan that—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s209/9/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">is agreed to by the local redevelopment authority with respect to the facility; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stA/s209/9/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">provides for the reuse or redevelopment of the real property and personal property of the facility that is available for such reuse and redevelopment as a result of the closure or realignment of the facility.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/10" styleType="OLC"> <num style="-uslm-dtd:enum" value="10">(10) </num><content style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">Secretary</term>” means the Secretary of Veterans Affairs.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stA/s209/11" styleType="OLC"> <num style="-uslm-dtd:enum" value="11">(11) </num><content style="-uslm-dtd:text">The term “<term style="-uslm-dtd:quote">tribal organization</term>” has the meaning given such term in section 3765 of title 38, United States Code.</content> </paragraph> </section> </subtitle> <subtitle style="-uslm-dtd:subtitle" identifier="/us/sComp/115/182/tII/stB" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">Subtitle B—</num><heading style="-uslm-dtd:header">Other Infrastructure Matters </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stB/s211" styleType="OLC"> <num style="-uslm-dtd:enum" value="211">SEC. 211. </num><heading style="-uslm-dtd:header">IMPROVEMENT TO TRAINING OF CONSTRUCTION PERSONNEL. </heading><content style="-uslm-dtd:text">Subsection (g) of section 8103 of title 38, United States Code, is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">“(g)</num><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Not later than September 30 of the fiscal year following the fiscal year during which the VA Asset and Infrastructure Review Act of 2018 is enacted, the Secretary shall implement the covered training curriculum and the covered certification program.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">In designing and implementing the covered training curriculum and the covered certification program under paragraph (1), the Secretary shall use as models existing training curricula and certification programs that have been established under chapter 87 of title 10, United States Code, as determined relevant by the Secretary.</content> </subparagraph></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The Secretary may develop the training curriculum under paragraph (1)(A) in a manner that provides such training in any combination of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">training provided in person;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">training provided over an internet website; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">training provided by another department or agency of the Federal Government.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><chapeau style="-uslm-dtd:text">The Secretary may develop the certification program under paragraph (1)(A) in a manner that uses—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">one level of certification; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">more than one level of certification, as determined appropriate by the Secretary with respect to the level of certification for different grades of the General Schedule.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">The Secretary may enter into a contract with an appropriate entity to provide the covered training curriculum and the covered certification program under paragraph (1)(A).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="5">“(5)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Not later than September 30 of the second fiscal year following the fiscal year during which the VA Asset and Infrastructure Review Act of 2018 is enacted, the Secretary shall ensure that the majority of employees subject to the covered certification program achieve the certification or the appropriate level of certification pursuant to paragraph (3), as the case may be.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">After carrying out subparagraph (A), the Secretary shall ensure that each employee subject to the covered certification program achieves the certification or the appropriate level of certification pursuant to paragraph (3), as the case may be, as quickly as practicable.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="6">“(6) </num><chapeau style="-uslm-dtd:text">In this subsection:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">covered certification program</quotedText>’ means, with respect to employees of the Department of Veterans Affairs who are members of occupational series relating to construction or facilities management, or employees of the Department who award or administer contracts for major construction, minor construction, or nonrecurring maintenance, including as contract specialists or contracting officers’ representatives, a program to certify knowledge and skills relating to construction or facilities management and to ensure that such employees maintain adequate expertise relating to industry standards and best practices for the acquisition of design and construction services.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">covered training curriculum</quotedText>’ means, with respect to employees specified in subparagraph (A), a training curriculum relating to construction or facilities management.”</content> </subparagraph> </paragraph> </subsection></quotedContent>.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stB/s212" styleType="OLC"> <num style="-uslm-dtd:enum" value="212">SEC. 212. </num><heading style="-uslm-dtd:header">REVIEW OF ENHANCED USE LEASES. </heading><content style="-uslm-dtd:text">Section 8162(b)(6) is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="6">“(6) </num><content style="-uslm-dtd:text">The Office of Management and Budget shall review each enhanced-use lease before the lease goes into effect to determine whether the lease is in compliance with paragraph (5).”</content> </paragraph></quotedContent>.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tII/stB/s213" styleType="OLC"> <num style="-uslm-dtd:enum" value="213">SEC. 213. </num><heading style="-uslm-dtd:header">ASSESSMENT OF HEALTH CARE FURNISHED BY THE DEPARTMENT TO VETERANS WHO LIVE IN THE PACIFIC TERRITORIES. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stB/s213/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report regarding health care furnished by the Department of Veterans Affairs to veterans who live in the Pacific territories.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stB/s213/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">The report under subsection (a) shall include assessments of the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stB/s213/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The ability of the Department to furnish to veterans who live in the Pacific territories the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stB/s213/b/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Hospital care.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stB/s213/b/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Medical services.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stB/s213/b/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Mental health services.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tII/stB/s213/b/1/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">Geriatric services.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tII/stB/s213/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">The feasibility of establishing a community-based outpatient clinic of the Department in any Pacific territory that does not contain such a facility.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tII/stB/s213/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Definition.—</heading><content style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">Pacific territories</quotedText>” means American Samoa, Guam, and the Northern Mariana Islands.</content> </subsection> </section> </subtitle> <num style="-uslm-dtd:enum" value="III">TITLE III—</num><heading style="-uslm-dtd:header">IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tIII/s301" styleType="OLC"> <num style="-uslm-dtd:enum" value="301">SEC. 301. </num><heading style="-uslm-dtd:header">DESIGNATED SCHOLARSHIPS FOR PHYSICIANS AND DENTISTS UNDER DEPARTMENT OF VETERANS AFFAIRS HEALTH PROFESSIONAL SCHOLARSHIP PROGRAM. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s301/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Scholarships for Physicians and Dentists.—</heading><content style="-uslm-dtd:text">Section 7612(b) of title 38, United States Code, is amended by adding at the end the following new paragraph:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="6">“(6)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Of the scholarships awarded under this subchapter, the Secretary shall ensure that not less than 50 scholarships are awarded each year to individuals who are accepted for enrollment or enrolled (as described in section 7602 of this title) in a program of education or training leading to employment as a physician or dentist until such date as the Secretary determines that the staffing shortage of physicians and dentists in the Department is less than 500.</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">After such date, the Secretary shall ensure that of the scholarships awarded under this subchapter, a number of scholarships is awarded each year to individuals referred to in subparagraph (A) in an amount equal to not less than ten percent of the staffing shortage of physicians and dentists in the Department, as determined by the Secretary.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><chapeau style="-uslm-dtd:text">Notwithstanding subsection (c)(1), the agreement between the Secretary and a participant in the Scholarship Program who receives a scholarship pursuant to this paragraph shall provide the following:</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">The Secretary’s agreement to provide the participant with a scholarship under this subchapter for a specified number (from two to four) of school years during which the participant is pursuing a course of education or training leading to employment as a physician or dentist.</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">The participant’s agreement to serve as a full-time employee in the Veterans Health Administration for a period of time (hereinafter in this subchapter referred to as the ‘<quotedText style="-uslm-dtd:quote">period of obligated service</quotedText>’) of 18 months for each school year or part thereof for which the participant was provided a scholarship under the Scholarship Program.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text">In providing scholarships pursuant to this paragraph, the Secretary may provide a preference for applicants who are veterans.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="E">“(E) </num><content style="-uslm-dtd:text">On an annual basis, the Secretary shall provide to appropriate educational institutions informational material about the availability of scholarships under this paragraph.”</content> </subparagraph> </paragraph></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s301/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Breach of Agreement.—</heading><chapeau style="-uslm-dtd:text">Section 7617 of such title is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s301/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">by redesignating paragraphs (4) and (5) as paragraphs (5) and (6), respectively; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s301/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">by inserting after paragraph (3) the following new paragraph (4):<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">In the case of a participant who is enrolled in a program or education or training leading to employment as a physician, the participant fails to successfully complete post-graduate training leading to eligibility for board certification in a specialty.”</content> </paragraph></quotedContent>.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s301/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Extension of Program.—</heading><content style="-uslm-dtd:text">Section 7619 of such title is amended by striking “<quotedText style="-uslm-dtd:quote">December 31, 2019</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">December 31, 2033</quotedText>”.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tIII/s302" styleType="OLC"> <num style="-uslm-dtd:enum" value="302">SEC. 302. </num><heading style="-uslm-dtd:header">INCREASE IN MAXIMUM AMOUNT OF DEBT THAT MAY BE REDUCED UNDER EDUCATION DEBT REDUCTION PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s302/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Increase in Amount.—</heading><chapeau style="-uslm-dtd:text">Section 7683(d)(1) is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s302/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">$120,000</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">$200,000</quotedText>”; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s302/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">$24,000</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">$40,000</quotedText>”.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s302/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Study.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s302/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><chapeau style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s302/b/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">conduct a study on the demand for education debt reduction under subchapter VII of chapter 76 of title 38, United States Code; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s302/b/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">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 findings of the Secretary with respect to the study carried out under subparagraph (A).</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s302/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Considerations.—</heading><chapeau style="-uslm-dtd:text">In carrying out the study required by paragraph (1)(A), the Secretary shall consider the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s302/b/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The total number of vacancies within the Veterans Health Administration whose applicants are eligible to participate in the Education Debt Reduction Program pursuant to section 7682(a) of such title.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s302/b/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The types of medical professionals in greatest demand in the United States.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s302/b/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Projections by the Secretary of the numbers and types of medical professions that meet the needs of veterans.</content> </subparagraph> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tIII/s303" styleType="OLC"> <num style="-uslm-dtd:enum" value="303">SEC. 303. </num><heading style="-uslm-dtd:header">ESTABLISHING THE DEPARTMENT OF VETERANS AFFAIRS SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s303/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7691">38 U.S.C. 7691</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Chapter 76 of title 38, United States Code, is amended by insertingafter subchapter VII the following new subchapter:<quotedContent style="-uslm-dtd:quoted-block"> <subchapter style="-uslm-dtd:subchapter"> <num style="-uslm-dtd:enum" value="VIII">“SUBCHAPTER VIII—</num><heading style="-uslm-dtd:header">SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM </heading> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="7691">“SEC. 7691. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7691">38 U.S.C. 7691</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Establishment </heading><content style="-uslm-dtd:text">As part of the Educational Assistance Program, the Secretary may carry out a student loan repayment program under section 5379 of title 5. The program shall be known as the Department of Veterans Affairs Specialty Education Loan Repayment Program (in this chapter referred to as the ‘<quotedText style="-uslm-dtd:quote">Specialty Education Loan Repayment Program</quotedText>’).</content> </section> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="7692">“SEC. 7692. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7692">38 U.S.C. 7692</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Purpose </heading><content style="-uslm-dtd:text">The purpose of the Specialty Education Loan Repayment Program is to assist, through the establishment of an incentive program for certain individuals employed in the Veterans Health Administration, in meeting the staffing needs of the Veterans Health Administration for physicians in medical specialties for which the Secretary determines recruitment or retention of qualified personnel is difficult.</content> </section> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="7693">“SEC. 7693. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7693">38 U.S.C. 7693</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Eligibility; preferences; covered costs </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">Eligibility.—</heading><chapeau style="-uslm-dtd:text">An individual is eligible to participate in the Specialty Education Loan Repayment Program if the individual—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">is hired under section 7401 of this title to work in an occupation described in section 7692 of this title;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">owes any amount of principal or interest under a loan, the proceeds of which were used by or on behalf of that individual to pay costs relating to a course of education or training which led to a degree that qualified the individual for the position referred to in paragraph (1); and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><chapeau style="-uslm-dtd:text">is—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">recently graduated from an accredited medical or osteopathic school and matched to an accredited residency program in a medical specialty described in section 7692 of this title; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">a physician in training in a medical specialty described in section 7692 of this title with more than 2 years remaining in such training.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Preferences.—</heading><chapeau style="-uslm-dtd:text">In selecting individuals for participation in the Specialty Education Loan Repayment Program under this subchapter, the Secretary may give preference to the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><chapeau style="-uslm-dtd:text">Individuals who are, or will be, participating in residency programs in health care facilities—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">located in rural areas;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">operated by Indian tribes, tribal organizations, or the Indian Health Service; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text">affiliated with underserved health care facilities of the Department.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Veterans.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Covered Costs.—</heading><chapeau style="-uslm-dtd:text">For purposes of subsection (a)(2), costs relating to a course of education or training include—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">tuition expenses;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">all other reasonable educational expenses, including expenses for fees, books, equipment, and laboratory expenses; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">reasonable living expenses.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="7694">“SEC. 7694. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7694">38 U.S.C. 7694</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Specialty education loan repayment </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Payments under the Specialty Education Loan Repayment Program shall consist of payments for the principal and interest on loans described in section 7682(a)(2) of this title for individuals selected to participate in the Program to the holders of such loans.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Frequency of Payment.—</heading><content style="-uslm-dtd:text">The Secretary shall make payments for any given participant in the Specialty Education Loan Repayment Program on a schedule determined appropriate by the Secretary.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Maximum Amount; Waiver.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The amount of payments made for a participant under the Specialty Education Loan Repayment Program may not exceed $160,000 over a total of 4 years of participation in the Program, of which not more than $40,000 of such payments may be made in each year of participation in the Program.</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2)</num><subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The Secretary may waive the limitations under paragraph (1) in the case of a participant described in subparagraph (B). In the case of such a waiver, the total amount of payments payable to or for that participant is the total amount of the principal and the interest on the participant’s loans referred to in subsection (a).</content></subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text">A participant described in this subparagraph is a participant in the Program who the Secretary determines serves in a position for which there is a shortage of qualified employees by reason of either the location or the requirements of the position.</content> </subparagraph> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="7695">“SEC. 7695. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7695">38 U.S.C. 7695</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Choice of location </heading><content style="-uslm-dtd:text">Each participant in the Specialty Education Loan Repayment Program who completes residency may select, from a list of medical facilities of the Veterans Health Administration provided by the Secretary, at which such facility the participant will work in a medical specialty described in section 7692 of this title.</content> </section> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="7696">“SEC. 7696. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7696">38 U.S.C. 7696</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Term of obligated service </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><chapeau style="-uslm-dtd:text">In addition to any requirements under section 5379(c) of title 5, a participant in the Specialty Education Loan Repayment Program must agree, in writing and before the Secretary may make any payment to or for the participant, to—</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">obtain a license to practice medicine in a State;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">successfully complete post-graduate training leading to eligibility for board certification in a specialty;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">serve as a full-time clinical practice employee of the Veterans Health Administration for 12 months for every $40,000 in such benefits that the employee receives, but in no case for fewer than 24 months; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">except as provided in subsection (b), to begin such service as a full-time practice employee by not later than 60 days after completing a residency.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Fellowship.—</heading><content style="-uslm-dtd:text">In the case of a participant who receives an accredited fellowship in a medical specialty other than a medical specialty described in section 7692 of this title, the Secretary, on written request of the participant, may delay the term of obligated service under subsection (a) for the participant until after the participant completes the fellowship, but in no case later than 60 days after completion of such fellowship.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Penalty.—</heading><paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="inline"><num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">An employee who does not complete a period of obligated service under this section shall owe the Federal Government an amount determined in accordance with the following formula: <i style="-uslm-dtd:italic">A = B </i>× ((T − S) ÷ T)).</content></paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">In the formula in paragraph (1):</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text"> ‘<quotedText style="-uslm-dtd:quote">A</quotedText>’ is the amount the employee owes the Federal Government.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="B">“(B) </num><content style="-uslm-dtd:text"> ‘<quotedText style="-uslm-dtd:quote">B</quotedText>’ is the sum of all payments to or for the participant under the Specialty Education Loan Repayment Program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="C">“(C) </num><content style="-uslm-dtd:text"> ‘<quotedText style="-uslm-dtd:quote">T</quotedText>’ is the number of months in the period of obligated service of the employee.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="D">“(D) </num><content style="-uslm-dtd:text"> ‘<quotedText style="-uslm-dtd:quote">S</quotedText>’ is the number of whole months of such period of obligated service served by the employee.</content> </subparagraph> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="7697">“SEC. 7697. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7697">38 U.S.C. 7697</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Relationship to Educational Assistance Program </heading><content style="-uslm-dtd:text">Assistance under the Specialty Education Loan Repayment Program may be in addition to other assistance available to individuals under the Educational Assistance Program.”</content> </section> </subchapter></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s303/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Conforming and Technical Amendments.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s303/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Conforming amendments.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s303/b/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">Section 7601(a) of title 38, United States Code, is amended—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tIII/s303/b/1/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">in paragraph (4), by striking “<quotedText style="-uslm-dtd:quote">and</quotedText>”;</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tIII/s303/b/1/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">in paragraph (5), by striking the period and inserting “<quotedText style="-uslm-dtd:quote">; and</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tIII/s303/b/1/A/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">by adding at the end the following new paragraph:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">“(6) </num><content style="-uslm-dtd:text">the specialty education loan repayment program provided for in subchapter VIII of this chapter.”</content> </paragraph></quotedContent>.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s303/b/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Section 7603(a)(1) of title 38, United States Code, is amended by striking “<quotedText style="-uslm-dtd:quote">or VI</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">VI, or VIII</quotedText>”.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s303/b/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Section 7604 of title 38, United States Code, is amended by striking “<quotedText style="-uslm-dtd:quote">or VI</quotedText>” each place it appears and inserting “<quotedText style="-uslm-dtd:quote">VI, or VIII</quotedText>”.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s303/b/1/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><chapeau style="-uslm-dtd:text">Section 7631 of title 38, United States Code, is amended—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tIII/s303/b/1/D/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><chapeau style="-uslm-dtd:text">in subsection (a)(1)—</chapeau> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tIII/s303/b/1/D/i/I" styleType="OLC"> <num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">and</quotedText>” after “<quotedText style="-uslm-dtd:quote">scholarship amount,</quotedText>”; and</content> </subclause> <subclause style="-uslm-dtd:subclause" identifier="/us/sComp/115/182/tIII/s303/b/1/D/i/II" styleType="OLC"> <num style="-uslm-dtd:enum" value="II">(II) </num><content style="-uslm-dtd:text">by inserting “<quotedText style="-uslm-dtd:quote">, and the maximum specialty education loan repayment amount</quotedText>” after “<quotedText style="-uslm-dtd:quote">reduction payments amount</quotedText>”; and</content> </subclause> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tIII/s303/b/1/D/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">in subsection (b) by adding at the end the following new paragraph:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="7">“(7) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">specialty education loan repayment amount</quotedText>’ means the maximum amount of specialty education loan repayment payments payable to or for a participant in the Department of Veterans Affairs Specialty Education Loan Repayment Program under subchapter VIII of this chapter, as specified in section 7694(c)(1) of this title and as previously adjusted (if at all) in accordance with this section.”</content> </paragraph></quotedContent>.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s303/b/1/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><chapeau style="-uslm-dtd:text">Section 7632 of title 38, United States Code, is amended—</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tIII/s303/b/1/E/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">in paragraph (1), by striking “<quotedText style="-uslm-dtd:quote">and the Education Debt Reduction Program</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">the Education Debt Reduction Program, and the Specialty Education Loan Repayment Program</quotedText>”; and</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tIII/s303/b/1/E/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">in paragraph (4), by striking “<quotedText style="-uslm-dtd:quote">and per participant in the Education Debt Reduction Program</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">per participant in the Education Debt Reduction Program, and per participant in the Specialty Education Loan Repayment Program</quotedText>”.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s303/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7601">38 U.S.C. 7601</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Table of sections.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 76 of such title is amended by inserting after the items relating to subchapter VII the following:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="subchapter" class="centered"><designator>“subchapter viii—</designator><label>specialty education loan repayment program</label></referenceItem> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“7691.</designator><label> Establishment.</label></referenceItem> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“7692.</designator><label> Purpose.</label></referenceItem> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“7693.</designator><label> Eligibility; preferences; covered costs.</label></referenceItem> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“7694.</designator><label> Specialty education loan repayment.</label></referenceItem> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“7695.</designator><label> Choice of location.</label></referenceItem> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“7696.</designator><label> Term of obligated service.</label></referenceItem> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“7697.</designator><label> Relationship to Educational Assistance Program.”</label></referenceItem> </toc></quotedContent>.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s303/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7692">38 U.S.C. 7692 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Needs of the VHA.—</heading><content style="-uslm-dtd:text">In making determinations each year under section 7692 of title 38, United States Code, as enacted by subsection (a), the Secretary of Veterans Affairs shall consider the anticipated needs of the Veterans Health Administration during the period 2 to 6 years in the future.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s303/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7693">38 U.S.C. 7693 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Preference.—</heading><content style="-uslm-dtd:text">In granting preference under section 7693 of title 38, United States Code, as enacted by subsection (a), the Secretary of Veterans Affairs shall determine whether a facility of the Department is underserved based on the criteria developed under section 401 of this Act.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s303/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7691">38 U.S.C. 7691 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Offer Deadline.—</heading><chapeau style="-uslm-dtd:text">In the case of an applicant who applies before receiving a residency match and whom the Secretary of Veterans Affairs selects for participation in the Specialty Education Loan Repayment Program established by subsection (a), the Secretary shall offer participation to the applicant not later than 28 days after—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s303/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">the applicant matches with a residency in a medical specialty described in section 7692 of title 38, United States Code, as enacted by subsection (a); and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s303/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">such match is published.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s303/f" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">(f) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7691">38 U.S.C. 7691 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Publicity.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall take such steps as the Secretary determines are appropriate to publicize the Specialty Education Loan Repayment Program established under subchapter VIII of chapter 76 of title 38, United States Code, as enacted by subsection (a).</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tIII/s304" styleType="OLC"> <num style="-uslm-dtd:enum" value="304">SEC. 304. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7601">38 U.S.C. 7601 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">VETERANS HEALING VETERANS MEDICAL ACCESS AND SCHOLARSHIP PROGRAM. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s304/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs, acting through the Office of Academic Affiliations of the Department of Veterans Affairs, shall carry out a pilot program under which the Secretary shall provide funding for the medical education of a total of 18 eligible veterans. Such funding shall be provided for two veterans enrolled in each covered medical schools in accordance with this section.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s304/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Eligible Veterans.—</heading><chapeau style="-uslm-dtd:text">To be eligible to receive funding for medical education under this section, a veteran shall—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">have been discharged from the Armed Forces not more than 10 years before the date of application for admission to a covered medical school;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">not be entitled to educational assistance under chapter 30, 31, 32, 33, 34, or 35 of title 38, United States Code, or chapter 1606 or 1607 of title 10, United States Code;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">apply for admission to a covered medical school for the entering class of 2019;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/b/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><content style="-uslm-dtd:text">indicate on such application for admission that the veteran would like to be considered for an award of funding under this section;</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/b/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><content style="-uslm-dtd:text">meet the minimum admissions criteria for the covered medical school to which the veteran applies; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/b/6" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">(6) </num><content style="-uslm-dtd:text">enter into an agreement described in subsection (e).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s304/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Award of Funding.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Each covered medical school that opts to participate in the program under this section shall reserve two seats in the entering class of 2019 for eligible veterans who receive funding under such program. Such funding shall be awarded to the two eligible veterans with the highest admissions rankings for such class at such school.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Amount of funding.—</heading><chapeau style="-uslm-dtd:text">Each eligible veteran who receives funding under this section shall receive an amount equal to the actual cost of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">tuition at the covered medical school at which the veteran enrolls for 4 years;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">books, fees, and technical equipment;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/c/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">fees associated with the National Residency Match Program;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/c/2/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">two away rotations performed during the fourth year at a Department of Veterans Affairs medical facility; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/c/2/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">a monthly stipend for the 4-year period during which the veteran is enrolled in medical school in an amount to be determined by the Secretary.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/c/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Distribution of funding.—</heading><content style="-uslm-dtd:text">In the event that two or more eligible veterans do not apply for admission at one of the covered medical schools for the entering class of 2019, the Secretary shall distribute the available funding to eligible veterans who applied for admission at other covered medical schools.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s304/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Agreement.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Terms of agreement.—</heading><chapeau style="-uslm-dtd:text">Each eligible veteran who accepts funding for medical education under this section shall enter into an agreement with the Secretary that provides that the veteran agrees—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/d/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">to maintain enrollment and attendance in the medical school;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/d/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">while enrolled in such medical school, to maintain an acceptable level of academic standing (as determined by the medical school under regulations prescribed by the Secretary);</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/d/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">to complete post-graduate training leading to eligibility for board certification in a speciality applicable to the Department of Veterans Affairs, as determined by the Secretary;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/d/1/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">after completion of medical school, to obtain a license to practice medicine in a State; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/d/1/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">after completion of medical school and post-graduate training, to serve as a full-time clinical practice employee in the Veterans Health Administration for a period of 4 years.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7611">38 U.S.C. 7611 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Breach of agreement.—</heading><content style="-uslm-dtd:text">If an eligible veteran who accepts funding under this section breaches the terms of the agreement described in paragraph (1), the United States shall be entitled to recover damages in an amount equal to the total amount of such funding received by the veteran.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s304/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Rule of Construction.—</heading><content style="-uslm-dtd:text">Nothing in this section shall be construed to prevent any covered medical school from accepting more than two eligible veterans for the entering class of 2019.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s304/f" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">(f) </num><heading style="-uslm-dtd:header">Report to Congress.—</heading><content style="-uslm-dtd:text">Not later than December 31, 2020, and annually thereafter for the subsequent 3 years, the Secretary shall submit to Congress a report on the pilot program under this section. Such report shall include the evaluation of the Secretary of the success of the pilot program, including the number of veterans who received funding under the program who matriculated and an evaluation of the academic progress of such veterans.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s304/g" styleType="OLC"> <num style="-uslm-dtd:enum" value="g">(g) </num><heading style="-uslm-dtd:header">Covered Medical Schools.—</heading><chapeau style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">covered medical school</quotedText>” means any of the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/g/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The Teague-Cranston medical schools, consisting of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/g/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Texas A&M College of Medicine;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/g/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Quillen College of Medicine at East Tennessee State University;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/g/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Boonshoft School of Medicine at Wright State University;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/g/1/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">Joan C. Edwards School of Medicine at Marshall University; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIII/s304/g/1/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">University of South Carolina School of Medicine.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/g/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">Charles R Drew University of Medicine and Science.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/g/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">Howard University College of Medicine.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/g/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><content style="-uslm-dtd:text">Meharry Medical College.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s304/g/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><content style="-uslm-dtd:text">Morehouse School of Medicine.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tIII/s305" styleType="OLC"> <num style="-uslm-dtd:enum" value="305">SEC. 305. </num><heading style="-uslm-dtd:header">BONUSES FOR RECRUITMENT, RELOCATION, AND RETENTION. </heading><chapeau style="-uslm-dtd:text">Section 705(a) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 703 note) is amended—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s305/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">in paragraph (1), by striking “<quotedText style="-uslm-dtd:quote">$230,000,000</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">$250,000,000, of which not less than $20,000,000 shall be for recruitment, relocation, and retention bonuses</quotedText>”; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIII/s305/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">in paragraph (2), by striking “<quotedText style="-uslm-dtd:quote">$225,000,000</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">$290,000,000, of which not less than $20,000,000 shall be for recruitment, relocation, and retention bonuses</quotedText>”.</content> </paragraph> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tIII/s306" styleType="OLC"> <num style="-uslm-dtd:enum" value="306">SEC. 306. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7682">38 U.S.C. 7682 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">INCLUSION OF VET CENTER EMPLOYEES IN EDUCATION DEBT REDUCTION PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s306/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall ensure that clinical staff working at Vet Centers are eligible to participate in the Education Debt Reduction Program of the Department of Veterans Affairs under subchapter VII of chapter 76 of title 38, United States Code.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s306/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Report.—</heading><content style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of this Act, 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 number of participants in the Education Debt Reduction Program of the Department under such subchapter who work at Vet Centers.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIII/s306/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Vet Center Defined.—</heading><content style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">Vet Center</quotedText>” has the meaning given that term in section 1712A(h) of title 38, United States Code.</content> </subsection> </section> <num style="-uslm-dtd:enum" value="IV">TITLE IV—</num><heading style="-uslm-dtd:header">HEALTH CARE IN UNDERSERVED AREAS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tIV/s401" styleType="OLC"> <num style="-uslm-dtd:enum" value="401">SEC. 401. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s8110">38 U.S.C. 8110 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">DEVELOPMENT OF CRITERIA FOR DESIGNATION OF CERTAIN MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS AS UNDERSERVED FACILITIES AND PLAN TO ADDRESS PROBLEM OF UNDERSERVED FACILITIES. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s401/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop criteria to designate medical centers, ambulatory care facilities, and community based outpatient clinics of the Department of Veterans Affairs as underserved facilities.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s401/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Consideration.—</heading><chapeau style="-uslm-dtd:text">Criteria developed under subsection (a) shall include consideration of the following with respect to a facility:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s401/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The ratio of veterans to health care providers of the Department of Veterans Affairs for a standardized geographic area surrounding the facility, including a separate ratio for general practitioners and specialists.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s401/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">The range of clinical specialties covered by such providers in such area.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s401/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">Whether the local community is medically underserved.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s401/b/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><content style="-uslm-dtd:text">The type, number, and age of open consults.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s401/b/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><content style="-uslm-dtd:text">Whether the facility is meeting the wait-time goals of the Department.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s401/b/6" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">(6) </num><content style="-uslm-dtd:text">Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s401/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Analysis of Facilities.—</heading><content style="-uslm-dtd:text">Not less frequently than annually, directors of Veterans Integrated Service Networks of the Department shall perform an analysis to determine which facilities within that Veterans Integrated Service Network qualify as underserved facilities pursuant to criteria developed under subsection (a).</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s401/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Annual Plan To Address Underserved Facilities.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s401/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Plan required.—</heading><content style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of this Act and not less frequently than once each year, the Secretary shall submit to Congress a plan to address the problem of underserved facilities of the Department, as designated pursuant to criteria developed under subsection (a).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s401/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Contents.—</heading><chapeau style="-uslm-dtd:text">Each plan submitted under paragraph (1) shall address the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s401/d/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Increasing personnel or temporary personnel assistance, including mobile deployment teams furnished under section 407 of this Act.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s401/d/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Providing special hiring incentives, including under the Education Debt Reduction Program under subchapter VII of chapter 76 of title 38, United States Code, and recruitment, relocation, and retention incentives.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s401/d/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Using direct hiring authority.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s401/d/2/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">Improving training opportunities for staff.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s401/d/2/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">Such other actions as the Secretary considers appropriate.</content> </subparagraph> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tIV/s402" styleType="OLC"> <num style="-uslm-dtd:enum" value="402">SEC. 402. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s8110">38 U.S.C. 8110 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">PILOT PROGRAM TO FURNISH MOBILE DEPLOYMENT TEAMS TO UNDERSERVED FACILITIES. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s402/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall carry out a pilot program to furnish mobile deployment teams of medical personnel to underserved facilities.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s402/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">In furnishing mobile deployment teams under subsection (a), the Secretary shall consider the following elements:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s402/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">The medical positions of greatest need at underserved facilities.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s402/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">The size and composition of teams to be deployed.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s402/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">Such other elements as the Secretary considers necessary for effective oversight of the program established under subsection (a).</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s402/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Use of Annual Analysis.—</heading><content style="-uslm-dtd:text">The Secretary shall use the results of the annual analysis conducted under section 401(c) of this Act to form mobile deployment teams under subsection (a) that are composed of the most needed medical personnel for underserved facilities.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s402/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Reporting.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s402/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Progress report.—</heading><content style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit a report to Congress on the implementation of the pilot program under this section.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s402/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Final report.—</heading><chapeau style="-uslm-dtd:text">Not later than the termination of the pilot program under this section, the Secretary shall submit a final report to Congress that contains the recommendations of the Secretary regarding the feasibility and advisability of—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s402/d/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">extending or expanding the pilot program; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s402/d/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">making the pilot program (or any aspect thereof) permanent.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s402/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Duration.—</heading><content style="-uslm-dtd:text">The pilot program under this section shall terminate 3 years after the date of the enactment of this Act.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s402/f" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">(f) </num><heading style="-uslm-dtd:header">Underserved Facility Defined.—</heading><content style="-uslm-dtd:text">In this section, the term “<quotedText style="-uslm-dtd:quote">underserved facility</quotedText>” means a medical center, ambulatory care facility, or community based outpatient clinic of the Department of Veterans Affairs designated by the Secretary of Veterans Affairs as underserved pursuant to criteria developed under section 401 of this Act.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tIV/s403" styleType="OLC"> <num style="-uslm-dtd:enum" value="403">SEC. 403. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7302">38 U.S.C. 7302 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">PILOT PROGRAM ON GRADUATE MEDICAL EDUCATION AND RESIDENCY. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s403/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Establishment.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Subject to paragraph (5), the Secretary of Veterans Affairs shall establish a pilot program to establish medical residency positions authorized under section 7302 of title 38, United States Code, at covered facilities.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Covered facilities.—</heading><chapeau style="-uslm-dtd:text">For purposes of this section, a covered facility is any of the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">A health care facility of the Department of Veterans Affairs.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">A health care facility operated by an Indian tribe or a tribal organization, as those terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">A health care facility operated by the Indian Health Service.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/2/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">A Federally-qualified health center, as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B)).</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/2/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">A health care facility operated by the Department of Defense.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/2/F" styleType="OLC"> <num style="-uslm-dtd:enum" value="F">(F) </num><content style="-uslm-dtd:text">Such other health care facility as the Secretary considers appropriate for purposes of this section.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Agreements.—</heading><content style="-uslm-dtd:text">To carry out the pilot program under this section, the Secretary may enter into agreements with entities that operate covered facilities in which the Secretary places residents under paragraph (1).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/a/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Parameters for location, affiliate sponsor, and duration.—</heading><chapeau style="-uslm-dtd:text">When determining in which covered facilities to place residents under paragraph (1), the Secretary shall consider the extent to which there is a clinical need for providers in an area, as determined by the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/4/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The ratio of veterans to health care providers of the Department for a standardized geographic area surrounding a facility, including a separate ratio for general practitioners and specialists.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/4/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The range of clinical specialties of providers in standardized geographic areas surrounding a facility.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/4/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Whether the specialty of a provider is included in the most recent staffing shortage determination of the Department under section 7412 of title 38, United States Code.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/4/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">Whether the local community is designated by the Secretary of Veterans Affairs as underserved pursuant to criteria developed under section 401 of this Act.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/4/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">Whether the facility is located in a community that is designated by the Secretary of Health and Human Services as a health professional shortage area under section 332 of the Public Health Service Act (42 U.S.C. 254e).</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/4/F" styleType="OLC"> <num style="-uslm-dtd:enum" value="F">(F) </num><content style="-uslm-dtd:text">Whether the facility is located in a rural or remote area.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/4/G" styleType="OLC"> <num style="-uslm-dtd:enum" value="G">(G) </num><content style="-uslm-dtd:text">Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/a/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><heading style="-uslm-dtd:header">Priority in placements.—</heading><chapeau style="-uslm-dtd:text">During the pilot program under this section, the Secretary shall place no fewer than 100 residents in covered facilities—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/5/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">operated by the Indian Health Service;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/5/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">operated by an Indian tribe;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/5/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">operated by a tribal organization; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/a/5/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">located in communities designated by the Secretary as underserved pursuant to criteria developed under section 401 of this Act.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/a/6" styleType="OLC"> <num style="-uslm-dtd:enum" value="6">(6) </num><heading style="-uslm-dtd:header">Stipends and benefits.—</heading><content style="-uslm-dtd:text">The Secretary may pay stipends and provide benefits for residents in positions under paragraph (1), regardless of whether they have been assigned in a Department facility.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s403/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Reimbursement.—</heading><chapeau style="-uslm-dtd:text">If a covered facility establishes a new residency program in which the Secretary places a resident under the pilot program, the Secretary shall reimburse that covered facility for costs of the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Curriculum development.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">Recruitment and retention of faculty.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">Accreditation of the program by the Accreditation Council for Graduate Medical Education.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/b/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><content style="-uslm-dtd:text">The portion of faculty salaries attributable to duties under an agreement subsection (a)(3).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/b/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><content style="-uslm-dtd:text">Expenses relating to educating a resident under the pilot program.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s403/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Reporting.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than 1 year after the date of the enactment of this Act and not less frequently than once each year thereafter until the termination of the pilot program, the Secretary shall submit to Congress a report on the implementation of the pilot program.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tIV/s403/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">Each report submitted under paragraph (1) shall include the following with regard to the immediately preceding year, and in comparison to the year immediately preceding that year:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The number of veterans who received care from residents under the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The number of veterans who received care from each resident per position described in subsection (a)(1) under the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">The number of veterans who received care from residents under the pilot program expressed as a percentage of all individuals who received care from such residents.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">The number of clinical appointments for veterans conducted by each resident under the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/E" styleType="OLC"> <num style="-uslm-dtd:enum" value="E">(E) </num><content style="-uslm-dtd:text">The number of clinical appointments for veterans conducted by residents per position described in subsection (a)(1) under the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/F" styleType="OLC"> <num style="-uslm-dtd:enum" value="F">(F) </num><content style="-uslm-dtd:text">The number of clinical appointments for veterans expressed as a percentage of all clinical appointments conducted by residents under the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/G" styleType="OLC"> <num style="-uslm-dtd:enum" value="G">(G) </num><content style="-uslm-dtd:text">The number of positions described in subsection (a)(1) at each covered facility under the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/H" styleType="OLC"> <num style="-uslm-dtd:enum" value="H">(H) </num><content style="-uslm-dtd:text">For each position described in subsection (a)(1) in a residency program affiliated with a health care facility of the Department, the time a resident under the pilot program spent training at that facility of the Department, expressed as a percentage of the total training time for that resident position.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/I" styleType="OLC"> <num style="-uslm-dtd:enum" value="I">(I) </num><content style="-uslm-dtd:text">For each residency program affiliated with a health care facility of the Department, the time all residents under the pilot program spent training at that facility of the Department, expressed as a percentage of the total training time for those residents.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/J" styleType="OLC"> <num style="-uslm-dtd:enum" value="J">(J) </num><content style="-uslm-dtd:text">The time that all residents under the pilot program who are assigned to programs affiliated with health care facilities of the Department spent training at facilities of the Department, expressed as a percentage of the total training time for those residents.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/K" styleType="OLC"> <num style="-uslm-dtd:enum" value="K">(K) </num><content style="-uslm-dtd:text">The cost to the Department of Veterans Affairs under the pilot program in the year immediately preceding the report and since the beginning of the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/L" styleType="OLC"> <num style="-uslm-dtd:enum" value="L">(L) </num><content style="-uslm-dtd:text">The cost to the Department of Veterans Affairs per resident placed under the pilot program at each covered facility.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/M" styleType="OLC"> <num style="-uslm-dtd:enum" value="M">(M) </num><content style="-uslm-dtd:text">The number of residents under the pilot program hired by the Secretary to work in the Veterans Health Administration after completion of residency in the year immediately preceding the report and since the beginning of the pilot program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tIV/s403/c/2/N" styleType="OLC"> <num style="-uslm-dtd:enum" value="N">(N) </num><content style="-uslm-dtd:text">The medical specialties pursued by residents under the pilot program.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tIV/s403/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Duration.—</heading><content style="-uslm-dtd:text">The pilot program under this section shall terminate on August 7, 2031.</content> </subsection> </section> <num style="-uslm-dtd:enum" value="V">TITLE V—</num><heading style="-uslm-dtd:header">OTHER MATTERS </heading> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s501" styleType="OLC"> <num style="-uslm-dtd:enum" value="501">SEC. 501. </num><heading style="-uslm-dtd:header">ANNUAL REPORT ON PERFORMANCE AWARDS AND BONUSES AWARDED TO CERTAIN HIGH-LEVEL EMPLOYEES OF THE DEPARTMENT. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s501/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">Chapter 7 of title 38, United States Code, is amended by adding at the end the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="726">“SEC. 726. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s726">38 U.S.C. 726</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Annual report on performance awards and bonuses awarded to certain high-level employees </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">In General.—</heading><chapeau style="-uslm-dtd:text">Not later than 100 days after the end of each fiscal year, the Secretary shall submit to the appropriate committees of Congress a report that contains, for the most recent fiscal year ending before the submittal of the report, a description of all performance awards or bonuses awarded to each of the following:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">Regional Office Director of the Department.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">Director of a Medical Center of the Department.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">Director of a Veterans Integrated Service Network.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">“(4) </num><content style="-uslm-dtd:text">Senior executive of the Department.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">Each report submitted under subsection (a) shall include the following with respect to each performance award or bonus awarded to an individual described in such subsection:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">The amount of each award or bonus.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><content style="-uslm-dtd:text">The job title of the individual awarded the award or bonus.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The location where the individual awarded the award or bonus works.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">“(c) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">“(1) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">appropriate committees of Congress</quotedText>’ means the Committees on Veterans’ Affairs and Appropriations of the Senate and House of Representatives.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">“(2) </num><chapeau style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">senior executive</quotedText>’ means—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">“(A) </num><content style="-uslm-dtd:text">a career appointee; or</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">“(B) </num><chapeau style="-uslm-dtd:text">an individual—</chapeau> <clause style="-uslm-dtd:clause" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">“(i) </num><content style="-uslm-dtd:text">in an administrative or executive position; and</content> </clause> <clause style="-uslm-dtd:clause" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">“(ii) </num><content style="-uslm-dtd:text">appointed under section 7306(a) or section 7401(1) of this title.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">The term ‘<quotedText style="-uslm-dtd:quote">career appointee</quotedText>’ has the meaning given that term in section 3132(a) of title 5, United States Code.”</content> </paragraph> </subsection> </section></quotedContent>.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s501/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s701">38 U.S.C. 701</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical Amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 725 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“726.</designator><label> Annual report on performance awards and bonuses awarded to certain high-level employees.”</label></referenceItem> </toc></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s502" styleType="OLC"> <num style="-uslm-dtd:enum" value="502">SEC. 502. </num><heading style="-uslm-dtd:header">ROLE OF PODIATRISTS IN DEPARTMENT OF VETERANS AFFAIRS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s502/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Inclusion as Physician.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s502/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Subchapter I of chapter 74 is amended by adding at the end the following new section:<quotedContent style="-uslm-dtd:quoted-block"> <section style="-uslm-dtd:section" styleType="OLC"> <num style="-uslm-dtd:enum" value="7413">“SEC. 7413. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7413">38 U.S.C. 7413</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Treatment of podiatrists; clinical oversight standards </heading> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">“(a) </num><heading style="-uslm-dtd:header">Podiatrists.—</heading><content style="-uslm-dtd:text">Except as provided by subsection (b), a doctor of podiatric medicine who is appointed as a podiatrist under section 7401(1) of this title is eligible for any supervisory position in the Veterans Health Administration to the same degree that a physician appointed under such section is eligible for the position.</content> </subsection> <subsection style="-uslm-dtd:subsection" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">“(b) </num><heading style="-uslm-dtd:header">Establishment of Clinical Oversight Standards.—</heading><content style="-uslm-dtd:text">The Secretary, in consultation with appropriate stakeholders, shall establish standards to ensure that specialists appointed in the Veterans Health Administration to supervisory positions do not provide direct clinical oversight for purposes of peer review or practice evaluation for providers of other clinical specialties.”</content> </subsection> </section></quotedContent>.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s502/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7401">38 U.S.C. 7401</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Clerical amendment.—</heading><content style="-uslm-dtd:text">The table of sections at the beginning of chapter 74 is amended by inserting after the item relating to section 7412 the following new item:<quotedContent style="-uslm-dtd:quoted-block"> <toc style="-uslm-dtd:toc"> <referenceItem style="-uslm-dtd:toc-entry" role="section"><designator>“7413.</designator><label> Treatment of podiatrists; clinical oversight standards.”</label></referenceItem> </toc></quotedContent>.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s502/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Modification and Clarification of Pay Grade.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s502/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Grade.—</heading><chapeau style="-uslm-dtd:text">The list in section 7404(b) of such title is amended—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s502/b/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">PHYSICIAN AND DENTIST SCHEDULE</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">PHYSICIAN AND SURGEON (MD/DO), PODIATRIC SURGEON (DPM), AND DENTIST AND ORAL SURGEON (DDS, DMD) SCHEDULE</quotedText>”;</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s502/b/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">Physician grade</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">Physician and surgeon grade</quotedText>”; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s502/b/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">by striking “<quotedText style="-uslm-dtd:quote">PODIATRIST, CHIROPRACTOR, AND</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">CHIROPRACTOR AND</quotedText>”.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s502/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s7404">38 U.S.C. 7404 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">Application.—</heading><content style="-uslm-dtd:text">The amendments made by paragraph (1) shall apply with respect to a pay period of the Department of Veterans Affairs beginning on or after the date that is 30 days after the date of the enactment of this Act.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s503" styleType="OLC"> <num style="-uslm-dtd:enum" value="503">SEC. 503. </num><heading style="-uslm-dtd:header">DEFINITION OF MAJOR MEDICAL FACILITY PROJECT. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s503/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Modification of Definition of Medical Facility.—</heading><content style="-uslm-dtd:text">Section 8101(3) is amended by striking “<quotedText style="-uslm-dtd:quote">Secretary</quotedText>” and all that follows through “<quotedText style="-uslm-dtd:quote">nursing home,</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">Secretary, or as otherwise authorized by law, for the provision of health-care services (including hospital, outpatient clinic, nursing home,</quotedText>”.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s503/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Modification of Definition of Major Medical Facility Project.—</heading><content style="-uslm-dtd:text">Paragraph (3) of section 8104(a) is amended to read as follows:<quotedContent style="-uslm-dtd:quoted-block"> <paragraph style="-uslm-dtd:paragraph" styleType="OLC" class="leftIndentDecrease1"> <num style="-uslm-dtd:enum" value="3">“(3) </num><content style="-uslm-dtd:text">For purposes of this subsection, the term ‘<quotedText style="-uslm-dtd:quote">major medical facility project</quotedText>’ means a project for the construction, alteration, or acquisition of a medical facility involving a total expenditure of more than $20,000,000, but such term does not include an acquisition by exchange, nonrecurring maintenance projects of the Department, or the construction, alteration, or acquisition of a shared Federal medical facility for which the Department’s estimated share of the project costs does not exceed $20,000,000.”</content> </paragraph></quotedContent>.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s504" styleType="OLC"> <num style="-uslm-dtd:enum" value="504">SEC. 504. </num><heading style="-uslm-dtd:header">AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY PROJECTS OF THE DEPARTMENT OF VETERANS AFFAIRS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s504/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Authorization.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs may carry out the following major medical facility project, to be carried out in an amount not to exceed the amount specified for that project: Construction of the new East Bay Community Based Outpatient Clinic and all associated site work, utilities, parking, and landscaping, construction of the Central Valley Engineering and Logistics support facility, and enhanced flood plain mitigation at the Central Valley and East Bay Community Based Outpatient Clinics as part of the realignment of medical facilities in Livermore, California, in an amount not to exceed $117,300,000.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s504/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Authorization of Appropriations for Construction.—</heading><content style="-uslm-dtd:text">There is authorized to be appropriated to the Secretary of Veterans Affairs for fiscal year 2018 or the year in which funds are appropriated for the Construction, Major Projects account, $117,300,000 for the project authorized in subsection (a).</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s504/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Submittal of Information.—</heading><chapeau style="-uslm-dtd:text">Not later than 90 days after the date of the enactment of this Act, for the project authorized in subsection (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 the following information:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s504/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">A line item accounting of expenditures relating to construction management carried out by the Department of Veterans Affairs for such project.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s504/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">The future amounts that are budgeted to be obligated for construction management carried out by the Department for such project.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s504/c/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">A justification for the expenditures described in paragraph (1) and the future amounts described in paragraph (2).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s504/c/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><content style="-uslm-dtd:text">Any agreement entered into by the Secretary regarding a non-Department of Veterans Affairs Federal entity providing management services relating to such project, including reimbursement agreements and the costs to the Department for such services.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s505" styleType="OLC"> <num style="-uslm-dtd:enum" value="505">SEC. 505. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s301">38 U.S.C. 301 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">DEPARTMENT OF VETERANS AFFAIRS PERSONNEL TRANSPARENCY. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s505/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Publication of Staffing and Vacancies.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s505/a/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Website required.—</heading><chapeau style="-uslm-dtd:text">Subject to paragraph (2) and not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall make publicly available on an Internet website of the Department of Veterans Affairs the following information, which shall, subject to subparagraph (D), be displayed by departmental component or, in the case of information relating to Veterans Health Administration positions, by medical facility:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s505/a/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">The number of personnel encumbering positions.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s505/a/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">The number of accessions and separation actions processed during the quarter preceding the date of the publication of the information.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s505/a/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">The number of vacancies, by occupation.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s505/a/1/D" styleType="OLC"> <num style="-uslm-dtd:enum" value="D">(D) </num><content style="-uslm-dtd:text">The percentage of new hires for the Department who were hired within the time-to-hire target of the Office of Personnel Management, disaggregated by administration.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s505/a/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Exceptions.—</heading><content style="-uslm-dtd:text">The Secretary may withhold from publication under paragraph (1) information relating to law enforcement, information security, or such positions in the Department that the Secretary determines to be sensitive.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s505/a/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><heading style="-uslm-dtd:header">Update of information.—</heading><content style="-uslm-dtd:text">The Secretary shall update the information on the website required under paragraph (1) on a quarterly basis.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s505/a/4" styleType="OLC"> <num style="-uslm-dtd:enum" value="4">(4) </num><heading style="-uslm-dtd:header">Treatment of contractor positions.—</heading><content style="-uslm-dtd:text">Any Department of Veterans Affairs position that is filled with a contractor may not be treated as a Department position for purposes of the information required to be published under paragraph (1).</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s505/a/5" styleType="OLC"> <num style="-uslm-dtd:enum" value="5">(5) </num><heading style="-uslm-dtd:header">Inspector general review.—</heading><content style="-uslm-dtd:text">On a semi-annual basis, the Inspector General of the Department shall review the administration of the website required under paragraph (1) and make recommendations relating to the improvement of such administration.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s505/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Report to Congress.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall submit to Congress an annual report on the steps the Department is taking to achieve full staffing capacity. Each such report shall include the amount of additional funds necessary to enable the Department to reach full staffing capacity.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s506" styleType="OLC"> <num style="-uslm-dtd:enum" value="506">SEC. 506. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">PROGRAM ON ESTABLISHMENT OF PEER SPECIALISTS IN PATIENT ALIGNED CARE TEAM SETTINGS WITHIN MEDICAL CENTERS OF DEPARTMENT OF VETERANS AFFAIRS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s506/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Program Required.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall carry out a program to establish not fewer than two peer specialists in patient aligned care teams at medical centers of the Department of Veterans Affairs to promote the use and integration of services for mental health, substance use disorder, and behavioral health in a primary care setting.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s506/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Timeframe for Establishment of Program.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall carry out the program at medical centers of the Department as follows:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s506/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">Not later than May 31, 2019, at not fewer than 15 medical centers of the Department.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s506/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">Not later than May 31, 2020, at not fewer than 30 medical centers of the Department.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s506/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Selection of Locations.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s506/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">In general.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall select medical centers for the program as follows:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s506/c/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Not fewer than five shall be medical centers of the Department that are designated by the Secretary as polytrauma centers.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s506/c/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Not fewer than 10 shall be medical centers of the Department that are not designated by the Secretary as polytrauma centers.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s506/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Considerations.—</heading><chapeau style="-uslm-dtd:text">In selecting medical centers for the program under paragraph (1), the Secretary shall consider the feasibility and advisability of selecting medical centers in the following areas:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s506/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Rural areas and other areas that are underserved by the Department.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s506/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Areas that are not in close proximity to an active duty military installation.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s506/c/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Areas representing different geographic locations, such as census tracts established by the Bureau of the Census.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s506/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Gender-Specific Services.—</heading><chapeau style="-uslm-dtd:text">In carrying out the program at each location selected under subsection (c), the Secretary shall ensure that—</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s506/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">the needs of female veterans are specifically considered and addressed; and</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s506/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">female peer specialists are made available to female veterans who are treated at each location.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s506/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Engagement With Community Providers.—</heading><content style="-uslm-dtd:text">At each location selected under subsection (c), the Secretary shall consider ways in which peer specialists can conduct outreach to health care providers in the community who are known to be serving veterans to engage with those providers and veterans served by those providers.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s506/f" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">(f) </num><heading style="-uslm-dtd:header">Reports.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s506/f/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Periodic reports.—</heading> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s506/f/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><heading style="-uslm-dtd:header">In general.—</heading><content style="-uslm-dtd:text">Not later than 180 days after the date of the enactment of this Act, and not less frequently than once every 180 days thereafter until the Secretary determines that the program is being carried out at the last location to be selected under subsection (c), the Secretary shall submit to Congress a report on the program.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s506/f/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><heading style="-uslm-dtd:header">Elements.—</heading><chapeau style="-uslm-dtd:text">Each report required by subparagraph (A) shall, with respect to the 180-day period preceding the submittal of the report, include the following:</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tV/s506/f/1/B/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">The findings and conclusions of the Secretary with respect to the program.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tV/s506/f/1/B/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">An assessment of the benefits of the program to veterans and family members of veterans.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tV/s506/f/1/B/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">An assessment of the effectiveness of peer specialists in engaging under subsection (e) with health care providers in the community and veterans served by those providers.</content> </clause> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s506/f/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Final report.—</heading><content style="-uslm-dtd:text">Not later than 180 days after the Secretary determines that the program is being carried out at the last location to be selected under subsection (c), the Secretary shall submit to Congress a report detailing the recommendations of the Secretary as to the feasibility and advisability of expanding the program to additional locations.</content> </paragraph> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s507" styleType="OLC"> <num style="-uslm-dtd:enum" value="507">SEC. 507. </num><editorialNote style="-uslm-dtd:usc-reference" role="uscRef"><b>[</b><ref href="/us/usc/t38/s1701">38 U.S.C. 1701 note</ref><b>]</b> </editorialNote><heading style="-uslm-dtd:header">DEPARTMENT OF VETERANS AFFAIRS MEDICAL SCRIBE PILOT PROGRAM. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s507/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">In General.—</heading><content style="-uslm-dtd:text">The Secretary of Veterans Affairs shall carry out a 2-year pilot program under which the Secretary shall increase the use of medical scribes at Department of Veterans Affairs medical centers.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s507/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Locations.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall carry out the pilot program at the 10 medical centers of the Department as follows:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s507/b/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><content style="-uslm-dtd:text">At least four such medical centers located in rural areas.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s507/b/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">At least four such medical centers located in urban areas.</content> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s507/b/3" styleType="OLC"> <num style="-uslm-dtd:enum" value="3">(3) </num><content style="-uslm-dtd:text">Two such medical centers located in areas with need for increased access or increased efficiency, as determine by the Secretary.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s507/c" styleType="OLC"> <num style="-uslm-dtd:enum" value="c">(c) </num><heading style="-uslm-dtd:header">Medical Scribes.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s507/c/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Hiring.—</heading><chapeau style="-uslm-dtd:text">Under the pilot program the Secretary shall—</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s507/c/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">hire 20 new Department of Veterans Affairs term employees as medical scribes; and</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s507/c/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">seek to enter into contracts with appropriate entities for the employment of 20 additional medical scribes.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s507/c/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Distribution.—</heading><chapeau style="-uslm-dtd:text">The Secretary shall assign four medical scribes to each of the 10 medical centers of the Department where the Secretary carries out the pilot program as follows:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s507/c/2/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Two scribes shall be assigned to each of two physicians.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s507/c/2/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Thirty percent of the scribes shall be employed in the provision of emergency care.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s507/c/2/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Seventy percent of the scribes shall be employed in the provision of speciality care in specialties with the longest patient wait times or lowest efficiency ratings, as determined by the Secretary.</content> </subparagraph> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s507/d" styleType="OLC"> <num style="-uslm-dtd:enum" value="d">(d) </num><heading style="-uslm-dtd:header">Reports.—</heading> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s507/d/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><heading style="-uslm-dtd:header">Reports to congress.—</heading><chapeau style="-uslm-dtd:text">Not later than 180 days after the commencement of the pilot program required under this section, and every 180 days thereafter for the duration of the pilot program, the Secretary of Veterans Affairs shall submit to Congress a report on the pilot program. Each such report shall include each of the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s507/d/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><chapeau style="-uslm-dtd:text">A separate analysis of each the following with respect to medical scribes employed by the Department of Veterans Affairs and medical scribes performing Department of Veterans Affairs functions under a contract:</chapeau> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tV/s507/d/1/A/i" styleType="OLC"> <num style="-uslm-dtd:enum" value="i">(i) </num><content style="-uslm-dtd:text">Provider efficiency.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tV/s507/d/1/A/ii" styleType="OLC"> <num style="-uslm-dtd:enum" value="ii">(ii) </num><content style="-uslm-dtd:text">Patient satisfaction.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tV/s507/d/1/A/iii" styleType="OLC"> <num style="-uslm-dtd:enum" value="iii">(iii) </num><content style="-uslm-dtd:text">Average wait time.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tV/s507/d/1/A/iv" styleType="OLC"> <num style="-uslm-dtd:enum" value="iv">(iv) </num><content style="-uslm-dtd:text">The number of patients seen per day by each physician or practitioner.</content> </clause> <clause style="-uslm-dtd:clause" identifier="/us/sComp/115/182/tV/s507/d/1/A/v" styleType="OLC"> <num style="-uslm-dtd:enum" value="v">(v) </num><content style="-uslm-dtd:text">The amount of time required to hire and train an employee to perform medical scribe functions under the pilot program.</content> </clause> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s507/d/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Metrics and data for analyzing the effects of the pilot program, including an evaluation of the each of the elements under clauses (i) through (iv) of subparagraph (A) at medical centers who employed scribes under the pilot program for an appropriate period preceding the hiring of such scribes.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s507/d/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><heading style="-uslm-dtd:header">Comptroller general report.—</heading><content style="-uslm-dtd:text">Not later than 90 days after the termination of the pilot program under this section, the Comptroller General of the United States shall submit to Congress a report on the pilot program. Such report shall include a comparison of the pilot program with similar programs carried out in the private sector.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s507/e" styleType="OLC"> <num style="-uslm-dtd:enum" value="e">(e) </num><heading style="-uslm-dtd:header">Definitions.—</heading><chapeau style="-uslm-dtd:text">In this section:</chapeau> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s507/e/1" styleType="OLC"> <num style="-uslm-dtd:enum" value="1">(1) </num><chapeau style="-uslm-dtd:text">The term “<quotedText style="-uslm-dtd:quote">medical scribe</quotedText>” means an unlicensed individual hired to enter information into the electronic health record or chart at the direction of a physician or licensed independent practitioner whose responsibilities include the following:</chapeau> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s507/e/1/A" styleType="OLC"> <num style="-uslm-dtd:enum" value="A">(A) </num><content style="-uslm-dtd:text">Assisting the physician or practitioner in navigating the electronic health record.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s507/e/1/B" styleType="OLC"> <num style="-uslm-dtd:enum" value="B">(B) </num><content style="-uslm-dtd:text">Responding to various messages as directed by the physician or practitioner.</content> </subparagraph> <subparagraph style="-uslm-dtd:subparagraph" identifier="/us/sComp/115/182/tV/s507/e/1/C" styleType="OLC"> <num style="-uslm-dtd:enum" value="C">(C) </num><content style="-uslm-dtd:text">Entering information into the electronic health record, as directed by the physician or practitioner.</content> </subparagraph> </paragraph> <paragraph style="-uslm-dtd:paragraph" identifier="/us/sComp/115/182/tV/s507/e/2" styleType="OLC"> <num style="-uslm-dtd:enum" value="2">(2) </num><content style="-uslm-dtd:text">The terms “<quotedText style="-uslm-dtd:quote">urban</quotedText>” and “<quotedText style="-uslm-dtd:quote">rural</quotedText>” have the meanings given such terms under the rural-urban commuting codes developed by the Secretary of Agriculture and the Secretary of Health and Human Services.</content> </paragraph> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s507/f" styleType="OLC"> <num style="-uslm-dtd:enum" value="f">(f) </num><heading style="-uslm-dtd:header">Funding.—</heading><content style="-uslm-dtd:text">The pilot program under this section shall be carried out using amounts otherwise authorized to be appropriated for the Department of Veterans Affairs. No additional amounts are authorized to be appropriated to carry out such program.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s508" styleType="OLC"> <num style="-uslm-dtd:enum" value="508">SEC. 508. </num><heading style="-uslm-dtd:header">EXTENSION OF REQUIREMENT TO COLLECT FEES FOR HOUSING LOANS GUARANTEED BY SECRETARY OF VETERANS AFFAIRS. </heading><content style="-uslm-dtd:text">Section 3729(b)(2) of title 38, United States Code, is amended by striking “<quotedText style="-uslm-dtd:quote">2027</quotedText>” each place it appears and inserting “<quotedText style="-uslm-dtd:quote">2028</quotedText>”.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s509" styleType="OLC"> <num style="-uslm-dtd:enum" value="509">SEC. 509. </num><heading style="-uslm-dtd:header">EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN VETERANS COVERED BY MEDICAID PLANS FOR SERVICES FURNISHED BY NURSING FACILITIES. </heading><content style="-uslm-dtd:text">Section 5503(d)(7) of title 38, United States Code, is amended by striking “<quotedText style="-uslm-dtd:quote">September 30, 2027</quotedText>” and inserting “<quotedText style="-uslm-dtd:quote">September 30, 2028</quotedText>”.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s510" styleType="OLC"> <num style="-uslm-dtd:enum" value="510">SEC. 510. </num><heading style="-uslm-dtd:header">APPROPRIATION OF AMOUNTS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s510/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Veterans Choice Program.—</heading><content style="-uslm-dtd:text">There is authorized to be appropriated, and is appropriated, to the Secretary of Veterans Affairs, out of any funds in the Treasury not otherwise appropriated, $5,200,000,000 to be deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note).</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s510/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Availability of Amounts.—</heading><content style="-uslm-dtd:text">The amounts appropriated under subsection (a) shall be available for obligation or expenditure without fiscal year limitation.</content> </subsection> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s511" styleType="OLC"> <num style="-uslm-dtd:enum" value="511">SEC. 511. </num><heading style="-uslm-dtd:header">TECHNICAL CORRECTION. </heading><content style="-uslm-dtd:text">Section 1712I of title 38, United States Code, is redesignated as section 1720I of such title.</content> </section> <section style="-uslm-dtd:section" identifier="/us/sComp/115/182/tV/s512" styleType="OLC"> <num style="-uslm-dtd:enum" value="512">SEC. 512. </num><heading style="-uslm-dtd:header">BUDGETARY EFFECTS. </heading> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s512/a" styleType="OLC"> <num style="-uslm-dtd:enum" value="a">(a) </num><heading style="-uslm-dtd:header">Statutory Pay-As-You-Go Scorecards.—</heading><content style="-uslm-dtd:text">The budgetary effects of this Act shall not be entered on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.</content> </subsection> <subsection style="-uslm-dtd:subsection" identifier="/us/sComp/115/182/tV/s512/b" styleType="OLC"> <num style="-uslm-dtd:enum" value="b">(b) </num><heading style="-uslm-dtd:header">Senate PAYGO Scorecards.—</heading><content style="-uslm-dtd:text">The budgetary effects of this Act shall not be entered on any PAYGO scorecard maintained for purposes of section 4106 of H. Con. Res. 71 (115th Congress).</content> </subsection> </section>