[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3230 Engrossed Amendment Senate (EAS)]
In the Senate of the United States,
June 11, 2014.
Resolved, That the bill from the House of Representatives (H.R.
3230) entitled ``An Act making continuing appropriations during a
Government shutdown to provide pay and allowances to members of the
reserve components of the Armed Forces who perform inactive-duty
training during such period.'', do pass with the following
AMENDMENTS:
Strike all after the enacting clause, and insert in lieu
thereof:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans' Access
to Care through Choice, Accountability, and Transparency Act of 2014''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH CARE APPOINTMENTS
Sec. 101. Independent assessment of the scheduling of appointments and
other health care management processes of
the Department of Veterans Affairs.
Sec. 102. Technology task force on review of scheduling system and
software of the Department of Veterans
Affairs.
TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF
Sec. 201. Treatment of staffing shortage and biannual report on
staffing of medical facilities of the
Department of Veterans Affairs.
Sec. 202. Clinic management training for managers and health care
providers of the Department of Veterans
Affairs.
Sec. 203. Use of unobligated amounts to hire additional health care
providers for the Veterans Health
Administration.
TITLE III--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF
VETERANS AFFAIRS PROVIDERS
Sec. 301. Expanded availability of hospital care and medical services
for veterans through the use of contracts.
Sec. 302. Transfer of authority for payments for hospital care, medical
services, and other health care from non-
Department providers to the Chief Business
Office of the Veterans Health
Administration of the Department.
Sec. 303. Enhancement of collaboration between Department of Veterans
Affairs and Indian Health Service.
Sec. 304. Enhancement of collaboration between Department of Veterans
Affairs and Native Hawaiian health care
systems.
Sec. 305. Sense of Congress on prompt payment by Department of Veterans
Affairs.
TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS
Sec. 401. Improvement of access of veterans to mobile vet centers of
the Department of Veterans Affairs.
Sec. 402. Commission on construction projects of the Department of
Veterans Affairs.
Sec. 403. Commission on Access to Care.
Sec. 404. Improved performance metrics for health care provided by
Department of Veterans Affairs.
Sec. 405. Improved transparency concerning health care provided by
Department of Veterans Affairs.
Sec. 406. Information for veterans on the credentials of Department of
Veterans Affairs physicians.
Sec. 407. Information in annual budget of the President on hospital
care and medical services furnished through
expanded use of contracts for such care.
Sec. 408. Prohibition on falsification of data concerning wait times
and quality measures at Department of
Veterans Affairs.
Sec. 409. Removal of Senior Executive Service employees of the
Department of Veterans Affairs for
performance.
TITLE V--HEALTH CARE RELATED TO SEXUAL TRAUMA
Sec. 501. Expansion of eligibility for sexual trauma counseling and
treatment to veterans on inactive duty
training.
Sec. 502. Provision of counseling and treatment for sexual trauma by
the Department of Veterans Affairs to
members of the Armed Forces.
Sec. 503. Reports on military sexual trauma.
TITLE VI--MAJOR MEDICAL FACILITY LEASES
Sec. 601. Authorization of major medical facility leases.
Sec. 602. Budgetary treatment of Department of Veterans Affairs major
medical facilities leases.
TITLE VII--VETERANS BENEFITS MATTERS
Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry
Scholarship.
Sec. 702. Approval of courses of education provided by public
institutions of higher learning for
purposes of All-Volunteer Force Educational
Assistance Program and Post-9/11
Educational Assistance conditional on in-
State tuition rate for veterans.
TITLE VIII--APPROPRIATION AND EMERGENCY DESIGNATIONS
Sec. 801. Appropriation of emergency amounts.
Sec. 802. Emergency designations.
TITLE I--IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH CARE APPOINTMENTS
SEC. 101. INDEPENDENT ASSESSMENT OF THE SCHEDULING OF APPOINTMENTS AND
OTHER HEALTH CARE MANAGEMENT PROCESSES OF THE DEPARTMENT
OF VETERANS AFFAIRS.
(a) Independent Assessment.--
(1) Assessment.--Not later than 30 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall enter into a contract with an independent third party to
assess the following:
(A) The process at each medical facility of the
Department of Veterans Affairs for scheduling
appointments for veterans to receive hospital care,
medical services, or other health care from the
Department.
(B) The staffing level and productivity of each
medical facility of the Department, including the
following:
(i) The case load of each health care
provider of the Department.
(ii) The time spent by each health care
provider of the Department on matters other
than the case load of such health care
provider, including time spent by such health
care provider as follows:
(I) At a medical facility that is
affiliated with the Department.
(II) Conducting research.
(III) Training or overseeing other
health care professionals of the
Department.
(C) The organization, processes, and tools used by
the Department to support clinical documentation and
the subsequent coding of inpatient services.
(D) The purchasing, distribution, and use of
pharmaceuticals, medical and surgical supplies, and
medical devices by the Department, including the
following:
(i) The prices paid for, standardization
of, and use by the Department of the following:
(I) High-cost pharmaceuticals.
(II) Medical and surgical supplies.
(III) Medical devices.
(ii) The use by the Department of group
purchasing arrangements to purchase
pharmaceuticals, medical and surgical supplies,
medical devices, and health care related
services.
(iii) The strategy used by the Department
to distribute pharmaceuticals, medical and
surgical supplies, and medical devices to
Veterans Integrated Service Networks and
medical facilities of the Department.
(E) The performance of the Department in paying
amounts owed to third parties and collecting amounts
owed to the Department with respect to hospital care,
medical services, and other health care, including any
recommendations of the independent third party as
follows:
(i) To avoid the payment of penalties to
vendors.
(ii) To increase the collection of amounts
owed to the Department for hospital care,
medical services, or other health care provided
by the Department for which reimbursement from
a third party is authorized.
(iii) To increase the collection of any
other amounts owed to the Department.
(2) Elements of scheduling assessment.--In carrying out the
assessment required by paragraph (1)(A), the independent third
party shall do the following:
(A) Review all training materials pertaining to
scheduling of appointments at each medical facility of
the Department.
(B) Assess whether all employees of the Department
conducting tasks related to scheduling are properly
trained for conducting such tasks.
(C) Assess whether changes in the technology or
system used in scheduling appointments are necessary to
limit access to the system to only those employees that
have been properly trained in conducting such tasks.
(D) Assess whether health care providers of the
Department are making changes to their schedules that
hinder the ability of employees conducting such tasks
to perform such tasks.
(E) Assess whether the establishment of a
centralized call center throughout the Department for
scheduling appointments at medical facilities of the
Department would improve the process of scheduling such
appointments.
(F) Assess whether booking templates for each
medical facility or clinic of the Department would
improve the process of scheduling such appointments.
(G) Recommend any actions to be taken by the
Department to improve the process for scheduling such
appointments, including the following:
(i) Changes in training materials provided
to employees of the Department with respect to
conducting tasks related to scheduling such
appointments.
(ii) Changes in monitoring and assessment
conducted by the Department of wait times of
veterans for such appointments.
(iii) Changes in the system used to
schedule such appointments, including changes
to improve how the Department--
(I) measures wait times of veterans
for such appointments;
(II) monitors the availability of
health care providers of the
Department; and
(III) provides veterans the ability
to schedule such appointments.
(iv) Such other actions as the independent
third party considers appropriate.
(3) Timing.--The independent third party carrying out the
assessment required by paragraph (1) shall complete such
assessment not later than 180 days after entering into the
contract described in such paragraph.
(b) Report.--
(1) In general.--Not later than 90 days after the date on
which the independent third party completes the assessment
under this section, the Secretary shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on
the results of such assessment.
(2) Publication.--Not later than 30 days after submitting
the report under paragraph (1), the Secretary shall publish
such report in the Federal Register and on an Internet website
of the Department accessible to the public.
SEC. 102. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING SYSTEM AND
SOFTWARE OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Task Force Review.--
(1) In general.--The Secretary of Veterans Affairs shall,
through the use of a technology task force, conduct a review of
the needs of the Department of Veterans Affairs with respect to
the scheduling system and scheduling software of the Department
of Veterans Affairs that is used by the Department to schedule
appointments for veterans for hospital care, medical services,
and other health care from the Department.
(2) Agreement.--
(A) In general.--The Secretary shall seek to enter
into an agreement with a technology organization or
technology organizations to carry out the review
required by paragraph (1).
(B) Prohibition on use of funds.--No Federal funds
may be used to assist the technology organization or
technology organizations under subparagraph (A) in
carrying out the review required by paragraph (1).
(b) Report.--
(1) In general.--Not later than 45 days after the date of
the enactment of this Act, the technology task force required
under subsection (a)(1) shall submit to the Secretary, the
Committee on Veterans' Affairs of the Senate, and the Committee
on Veterans' Affairs of the House of Representatives a report
setting forth the findings and recommendations of the
technology task force regarding the needs of the Department
with respect to the scheduling system and scheduling software
of the Department described in such subsection.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) Proposals for specific actions to be taken by
the Department to improve the scheduling system and
scheduling software of the Department described in
subsection (a)(1).
(B) A determination as to whether an existing off-
the-shelf system would--
(i) meet the needs of the Department to
schedule appointments for veterans for hospital
care, medical services, and other health care
from the Department; and
(ii) improve the access of veterans to such
care and services.
(3) Publication.--Not later than 30 days after the receipt
of the report required by paragraph (1), the Secretary shall
publish such report in the Federal Register and on an Internet
website of the Department accessible to the public.
(c) Implementation of Task Force Recommendations.--Not later than
one year after the receipt of the report required by subsection (b)(1),
the Secretary shall implement the recommendations set forth in such
report that the Secretary considers are feasible, advisable, and cost-
effective.
TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF
SEC. 201. TREATMENT OF STAFFING SHORTAGE AND BIANNUAL REPORT ON
STAFFING OF MEDICAL FACILITIES OF THE DEPARTMENT OF
VETERANS AFFAIRS.
(a) Staffing Shortage.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, and not later than September 30 each
year thereafter, the Inspector General of the Department of
Veterans Affairs shall determine, and the Secretary of Veterans
Affairs shall publish in the Federal Register, the five
occupations of health care providers of the Department of
Veterans Affairs for which there is the largest staffing
shortage throughout the Department.
(2) Recruitment and appointment.--Notwithstanding sections
3304 and 3309 through 3318 of title 5, United States Code, the
Secretary may, upon a determination by the Inspector General
under paragraph (1) that there is a staffing shortage
throughout the Department with respect to a particular
occupation of health care provider, recruit and directly
appoint highly qualified health care providers to serve as
health care providers in that particular occupation for the
Department.
(3) Priority in health professionals educational assistance
program to certain providers.--Section 7612(b)(5) of title 38,
United States Code, is amended--
(A) in subparagraph (A), by striking ``and'' at the
end;
(B) by redesignating subparagraph (B) as
subparagraph (C); and
(C) by inserting after subparagraph (A) the
following new subparagraph (B):
``(B) shall give priority to applicants pursuing a course
of education or training towards a career in an occupation for
which the Secretary has, in the most current determination
published in the Federal Register pursuant to section 201(a)(1)
of the Veterans' Access to Care through Choice, Accountability,
and Transparency Act of 2014, determined that there is one of
the largest staffing shortages throughout the Department with
respect to such occupation; and''.
(b) Reports.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, and not later than December 31 of
each even numbered year thereafter until 2024, the Secretary of
Veterans Affairs shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives a report assessing the staffing of
each medical facility of the Department of Veterans Affairs.
(2) Elements.--Each report submitted under paragraph (1)
shall include the following:
(A) The results of a system-wide assessment of all
medical facilities of the Department to ensure the
following:
(i) Appropriate staffing levels for health
care providers to meet the goals of the
Secretary for timely access to care for
veterans.
(ii) Appropriate staffing levels for
support personnel, including clerks.
(iii) Appropriate sizes for clinical
panels.
(iv) Appropriate numbers of full-time
staff, or full-time equivalents, dedicated to
direct care of patients.
(v) Appropriate physical plant space to
meet the capacity needs of the Department in
that area.
(vi) Such other factors as the Secretary
considers necessary.
(B) A plan for addressing any issues identified in
the assessment described in subparagraph (A), including
a timeline for addressing such issues.
(C) A list of the current wait times and workload
levels for the following clinics in each medical
facility:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the Secretary
considers appropriate.
(D) A description of the results of the most
current determination of the Inspector General under
paragraph (1) of subsection (a) and a plan to use
direct appointment authority under paragraph (2) of
such subsection to fill staffing shortages, including
recommendations for improving the speed at which the
credentialing and privileging process can be conducted.
(E) The current staffing models of the Department
for the following clinics, including recommendations
for changes to such models:
(i) Mental health.
(ii) Primary care.
(iii) Gastroenterology.
(iv) Women's health.
(v) Such other clinics as the Secretary
considers appropriate.
(F) A detailed analysis of succession planning at
medical facilities of the Department, including the
following:
(i) The number of positions in medical
facilities throughout the Department that are
not filled by a permanent employee.
(ii) The length of time each position
described in clause (i) remained vacant or
filled by a temporary or acting employee.
(iii) A description of any barriers to
filling the positions described in clause (i).
(iv) A plan for filling any positions that
are vacant or filled by a temporary or acting
employee for more than 180 days.
(v) A plan for handling emergency
circumstances, such as administrative leave or
sudden medical leave for senior officials.
(G) The number of health care providers of the
Department who have been removed from their positions,
have retired, or have left their positions for another
reason, disaggregated by provider type, during the two-
year period preceding the submittal of the report.
(H) Of the health care providers specified in
subparagraph (G) who have been removed from their
positions, the following:
(i) The number of such health care
providers who were reassigned to other
positions in the Department.
(ii) The number of such health care
providers who left the Department.
(iii) The number of such health care
providers who left the Department and were
subsequently rehired by the Department.
SEC. 202. CLINIC MANAGEMENT TRAINING FOR MANAGERS AND HEALTH CARE
PROVIDERS OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Clinic Management Training Program.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall commence a clinic management training program to provide
in-person, standardized education on health care management to
all managers of, and health care providers at, medical
facilities of the Department of Veterans Affairs.
(2) Elements.--The clinic management training program
required by paragraph (1) shall include the following:
(A) Training on how to manage the schedules of
health care providers of the Department, including the
following:
(i) Maintaining such schedules in a manner
that allows appointments to be booked at least
eight weeks in advance.
(ii) Proper planning procedures for
vacation, leave, and graduate medical education
training schedules.
(B) Training on the appropriate number of
appointments that a health care provider should conduct
on a daily basis, based on specialty.
(C) Training on how to determine whether there are
enough available appointment slots to manage demand for
different appointment types and mechanisms for alerting
management of insufficient slots.
(D) Training on how to properly use the appointment
scheduling system of the Department, including any new
scheduling system implemented by the Department.
(E) Training on how to optimize the use of
technology, including the following:
(i) Telemedicine.
(ii) Electronic mail.
(iii) Text messaging.
(iv) Such other technologies as specified
by the Secretary.
(F) Training on how to properly use physical plant
space at medical facilities of the Department to ensure
efficient flow and privacy for patients and staff.
(3) Sunset.--The clinic management training program
required by paragraph (1) shall terminate on the date that is
two years after the date on which the Secretary commences such
program.
(b) Training Materials.--
(1) In general.--After the termination of the clinic
management training program required by subsection (a), the
Secretary shall provide training materials on health care
management to each of the following employees of the Department
upon the commencement of employment of such employee:
(A) Any manager of a medical facility of the
Department.
(B) Any health care provider at a medical facility
of the Department.
(C) Such other employees of the Department as the
Secretary considers appropriate.
(2) Update.--The Secretary shall regularly update the
training materials required under paragraph (1).
SEC. 203. USE OF UNOBLIGATED AMOUNTS TO HIRE ADDITIONAL HEALTH CARE
PROVIDERS FOR THE VETERANS HEALTH ADMINISTRATION.
(a) In General.--At the end of each of fiscal years 2014 and 2015,
all covered amounts shall be made available to the Secretary of
Veterans Affairs to hire additional health care providers for the
Veterans Health Administration of the Department of Veterans Affairs,
or to carry out any provision of this Act or the amendments made by
this Act, and shall remain available until expended.
(b) Priority in Hiring.--The Secretary shall prioritize hiring
additional health care providers under subsection (a) at medical
facilities of the Department and in geographic areas in which the
Secretary identifies the greatest shortage of health care providers.
(c) Covered Amounts Defined.--In this section, the term ``covered
amounts'' means amounts--
(1) that are made available to the Veterans Health
Administration of the Department for an appropriations
account--
(A) under the heading ``medical services'';
(B) under the heading ``medical support and
compliance''; or
(C) under the heading ``medical facilities''; and
(2) that are unobligated at the end of the applicable
fiscal year.
TITLE III--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF
VETERANS AFFAIRS PROVIDERS
SEC. 301. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES
FOR VETERANS THROUGH THE USE OF CONTRACTS.
(a) Expansion of Available Care and Services.--
(1) Furnishing of care.--
(A) In general.--Hospital care and medical services
under chapter 17 of title 38, United States Code, shall
be furnished to an eligible veteran described in
subsection (b), at the election of such veteran,
through contracts authorized under subsection (d), or
any other law administered by the Secretary of Veterans
Affairs, with entities specified in subparagraph (B)
for the furnishing of such care and services to
veterans.
(B) Entities specified.--The entities specified in
this subparagraph are the following:
(i) 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.).
(ii) 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))).
(iii) The Department of Defense.
(iv) The Indian Health Service.
(2) Choice of provider.--An eligible veteran who elects to
receive care and services under this section may select the
provider of such care and services from among any source of
provider of such care and services through an entity specified
in paragraph (1)(B) that is accessible to the veteran.
(3) Coordination of care and services.--The Secretary shall
coordinate, through the Non-VA Care Coordination Program of the
Department of Veterans Affairs, the furnishing of care and
services under this section to eligible veterans, including by
ensuring that an eligible veteran receives an appointment for
such care and services within the current wait-time goals of
the Veterans Health Administration for the furnishing of
hospital care and medical services.
(b) Eligible Veterans.--A veteran is an eligible veteran for
purposes of this section if--
(1)(A) the veteran is enrolled in the patient enrollment
system of the Department of Veterans Affairs established and
operated under section 1705 of title 38, United States Code; or
(B) the veteran is enrolled in such system, has not
received hospital care or medical services from the Department,
and has contacted the Department seeking an initial appointment
from the Department for the receipt of such care or services;
and
(2) the veteran--
(A)(i) attempts, or has attempted under paragraph
(1)(B), to schedule an appointment for the receipt of
hospital care or medical services under chapter 17 of
title 38, United States Code, but is unable to schedule
an appointment within the current wait-time goals of
the Veterans Health Administration for the furnishing
of such care or services; and
(ii) elects, and is authorized, to be furnished
such care or services pursuant to subsection (c)(2);
(B) resides more than 40 miles from the nearest
medical facility of the Department, including a
community-based outpatient clinic, that is closest to
the residence of the veteran; or
(C) resides--
(i) in a State without a medical facility
of the Department that provides--
(I) hospital care;
(II) emergency medical services;
and
(III) surgical care rated by the
Secretary as having a surgical
complexity of standard; and
(ii) more than 20 miles from a medical
facility of the Department described in clause
(i).
(c) Election and Authorization.--
(1) In general.--If the Secretary confirms that an
appointment for an eligible veteran described in subsection
(b)(2)(A) for the receipt of hospital care or medical services
under chapter 17 of title 38, United States Code, is
unavailable within the current wait-time goals of the
Department for the furnishing of such care or services, the
Secretary shall, at the election of the eligible veteran--
(A) place such eligible veteran on an electronic
waiting list described in paragraph (2) for such an
appointment; or
(B)(i) authorize that such care and services be
furnished to the eligible veteran under this section
for a period of time specified by the Secretary; and
(ii) send a letter to the eligible veteran
describing the care and services the eligible veteran
is eligible to receive under this section.
(2) Electronic waiting list.--The electronic waiting list
described in this paragraph shall be maintained by the
Department and allow access by each eligible veteran via
www.myhealth.va.gov or any successor website for the following
purposes:
(A) To determine the place of such eligible veteran
on the waiting list.
(B) To determine the average length of time an
individual spends on the waiting list, disaggregated by
medical facility of the Department and type of care or
service needed, for purposes of allowing such eligible
veteran to make an informed election under paragraph
(1).
(d) Care and Services Through Contracts.--
(1) In general.--The Secretary shall enter into contracts
with health care providers that are participating in the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) to furnish care and services to
eligible veterans under this section.
(2) Rates and reimbursement.--
(A) In general.--In entering into a contract under
this subsection, the Secretary shall--
(i) negotiate rates for the furnishing of
care and services under this section; and
(ii) reimburse the health care provider for
such care and services at the rates negotiated
pursuant to clause (i) as provided in such
contract.
(B) Limit on rates.--
(i) In general.--Except as provided in
clause (ii), rates negotiated under
subparagraph (A)(i) shall not be more than the
rates paid by the United States to a provider
of services (as defined in section 1861(u) of
the Social Security Act (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 XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.)
for the same care and services.
(ii) Exception.--The Secretary may
negotiate a rate that is more than the rate
paid by the United States as described in
clause (i) with respect to the furnishing of
care or services under this section to an
eligible veteran if the Secretary determines
that there is no health care provider that will
provide such care or services to such eligible
veteran at the rate required under such
clause--
(I) within the current wait-time
goals of the Veterans Health
Administration for the furnishing of
such care or services; and
(II) at a location not more than 40
miles from the residence of such
eligible veteran.
(C) Limit on collection.--For the furnishing of
care and services pursuant to a contract under this
section, a health care provider may not collect any
amount that is greater than the rate negotiated
pursuant to subparagraph (A)(i).
(3) Information on policies and procedures.--The Secretary
shall provide to any health care provider with which the
Secretary has entered into a contract under paragraph (1) the
following:
(A) Information on applicable policies and
procedures for submitting bills or claims for
authorized care and services furnished to eligible
veterans under this section.
(B) Access to a telephone hotline maintained by the
Department that such health care provider may call for
information on the following:
(i) Procedures for furnishing care and
services under this section.
(ii) Procedures for submitting bills or
claims for authorized care and services
furnished to eligible veterans under this
section and being reimbursed for furnishing
such care and services.
(iii) Whether particular care or services
under this section are authorized, and the
procedures for authorization of such care or
services.
(e) Choice Card.--
(1) In general.--For purposes of receiving care and
services under this section, the Secretary shall issue to each
eligible veteran a card that the eligible veteran shall present
to a health care provider that is eligible to furnish care and
services under this section before receiving such care and
services.
(2) Name of card.--Each card issued under paragraph (1)
shall be known as a ``Choice Card''.
(3) Details of card.--Each Choice Card issued to an
eligible veteran under paragraph (1) shall include the
following:
(A) The name of the eligible veteran.
(B) An identification number for the eligible
veteran that is not the social security number of the
eligible veteran.
(C) The contact information of an appropriate
office of the Department for health care providers to
confirm that care and services under this section are
authorized for the eligible veteran.
(D) Contact information and other relevant
information for the submittal of claims or bills for
the furnishing of care and services under this section.
(E) The following statement: ``This card is for
qualifying medical care outside the Department of
Veterans Affairs. Please call the Department of
Veterans Affairs phone number specified on this card to
ensure that treatment has been authorized.''.
(4) Information on use of card.--Upon issuing a Choice Card
to an eligible veteran, the Secretary shall provide the
eligible veteran with information clearly stating the
circumstances under which the veteran may be eligible for care
and services under this section.
(f) Information on Availability of Care.--The Secretary shall
provide information to a veteran about the availability of care and
services under this section in the following circumstances:
(1) When the veteran enrolls in the patient enrollment
system of the Department under section 1705 of title 38, United
States Code.
(2) When the veteran attempts to schedule an appointment
for the receipt of hospital care or medical services from the
Department but is unable to schedule an appointment within the
current wait-time goals of the Veterans Health Administration
for delivery of such care or services.
(g) Providers.--To be eligible to furnish care and services under
this section, a health care provider must--
(1) maintain at least the same or similar credentials and
licenses as those credentials and licenses that are required of
health care providers of the Department, as determined by the
Secretary for purposes of this section; and
(2) submit, not less frequently than once each year,
verification of such licenses and credentials maintained by
such health care provider.
(h) Cost-sharing.--
(1) In general.--The Secretary shall require an eligible
veteran to pay a copayment to the Department for the receipt of
care and services under this section only if such eligible
veteran would be required to pay such copayment for the receipt
of such care and services at a medical facility of the
Department.
(2) Limitation.--The copayment required under paragraph (1)
shall not be greater than the copayment required of such
eligible veteran by the Department for the receipt of such care
and services at a medical facility of the Department.
(i) Claims Processing System.--
(1) In general.--The Secretary shall provide for an
efficient nationwide system for processing and paying bills or
claims for authorized care and services furnished to eligible
veterans under this section.
(2) Regulations.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall prescribe regulations for the implementation of such
system.
(3) Oversight.--The Chief Business Office of the Veterans
Health Administration shall oversee the implementation and
maintenance of such system.
(4) Accuracy of payment.--
(A) In general.--The Secretary shall ensure that
such system meets such goals for accuracy of payment as
the Secretary shall specify for purposes of this
section.
(B) Annual report.--
(i) In general.--Not later than one year
after the date of the enactment of this Act,
and annually thereafter until the termination
date specified in subsection (n), the Secretary
shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on
Veterans' Affairs of the House of
Representatives a report on the goals for
accuracy of such system.
(ii) Elements.--Each report required by
clause (i) shall include the following:
(I) A description of the goals for
accuracy for such system specified by
the Secretary under subparagraph (A).
(II) An assessment of the success
of the Department in meeting such goals
during the year preceding the submittal
of the report.
(j) Medical Records.--The Secretary shall ensure that any health
care provider that furnishes care and services under this section to an
eligible veteran submits to the Department any medical record related
to the care and services provided to such eligible veteran by such
health care provider for inclusion in the electronic medical record of
such eligible veteran maintained by the Department upon the completion
of the provision of such care and services to such eligible veteran.
(k) Tracking of Missed Appointments.--The Secretary shall implement
a mechanism to track any missed appointments for care and services
under this section by eligible veterans to ensure that the Department
does not pay for such care and services that were not furnished to an
eligible veteran.
(l) Implementation.--Not later than 90 days after the date of the
enactment of this Act, the Secretary shall prescribe interim final
regulations on the implementation of this section and publish such
regulations in the Federal Register.
(m) Inspector General Report.--Not later than 540 days after the
publication of the interim final regulations under subsection (l), the
Inspector General of the Department shall submit to the Secretary a
report on the results of an audit of the care and services furnished
under this section to ensure the accuracy and timeliness of payments by
the Department for the cost of such care and services, including any
findings and recommendations of the Inspector General.
(n) Termination.--The requirement of the Secretary to furnish care
and services under this section terminates on the date that is two
years after the date on which the Secretary publishes the interim final
regulations under subsection (l).
(o) Reports.--
(1) Initial report.--Not later than 90 days after the
publication of the interim final regulations under subsection
(l), the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives a report on the furnishing of care
and services under this section that includes the following:
(A) The number of eligible veterans who have
received care and services under this section.
(B) A description of the type of care and services
furnished to eligible veterans under this section.
(2) Final report.--Not later than 540 days after the
publication of the interim final regulations under subsection
(l), the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives a report on the furnishing of care
and services under this section that includes the following:
(A) The total number of eligible veterans who have
received care and services under this section,
disaggregated by--
(i) eligible veterans described in
subsection (b)(2)(A); and
(ii) eligible veterans described in
subsection (b)(2)(B).
(B) A description of the type of care and services
furnished to eligible veterans under this section.
(C) An accounting of the total cost of furnishing
care and services to eligible veterans under this
section.
(D) The results of a survey of eligible veterans
who have received care or services under this section
on the satisfaction of such eligible veterans with the
care or services received by such eligible veterans
under this section.
(E) An assessment of the effect of furnishing care
and services under this section on wait times for an
appointment for the receipt of hospital care and
medical services from the Department.
(F) An assessment of the feasibility and
advisability of continuing furnishing care and services
under this section after the termination date specified
in subsection (n).
(p) Rules of Construction.--
(1) No modification of contracts.--Nothing in this section
shall be construed to require the Secretary to renegotiate
contracts for the furnishing of hospital care or medical
services to veterans entered into by the Department before the
date of the enactment of this Act.
(2) Filling and paying for prescription medications.--
Nothing in this section shall be construed to alter the process
of the Department for filling and paying for prescription
medications.
SEC. 302. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL CARE, MEDICAL
SERVICES, AND OTHER HEALTH CARE FROM NON-DEPARTMENT
PROVIDERS TO THE CHIEF BUSINESS OFFICE OF THE VETERANS
HEALTH ADMINISTRATION OF THE DEPARTMENT.
(a) Transfer of Authority.--
(1) In general.--Effective on October 1, 2014, the
Secretary of Veterans Affairs shall transfer the authority to
pay for hospital care, medical services, and other health care
through non-Department providers to the Chief Business Office
of the Veterans Health Administration of the Department of
Veterans Affairs from the Veterans Integrated Service Networks
and medical centers of the Department of Veterans Affairs.
(2) Manner of care.--The Chief Business Office shall work
in consultation with the Office of Clinical Operations and
Management of the Department of Veterans Affairs to ensure that
care and services described in paragraph (1) are provided in a
manner that is clinically appropriate and effective.
(3) No delay in payment.--The transfer of authority under
paragraph (1) shall be carried out in a manner that does not
delay or impede any payment by the Department for hospital
care, medical services, or other health care provided through a
non-Department provider under the laws administered by the
Secretary.
(b) Budgetary Effect.--The Secretary shall, for each fiscal year
that begins after the date of the enactment of this Act--
(1) include in the budget for the Chief Business Office of
the Veterans Health Administration amounts to pay for hospital
care, medical services, and other health care provided through
non-Department providers, including any amounts necessary to
carry out the transfer of authority to pay for such care and
services under subsection (a), including any increase in staff;
and
(2) not include in the budget of each Veterans Integrated
Service Network and medical center of the Department amounts to
pay for such care and services.
SEC. 303. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS
AFFAIRS AND INDIAN HEALTH SERVICE.
(a) Outreach to Tribal-Run Medical Facilities.--The Secretary of
Veterans Affairs shall, in consultation with the Director of the Indian
Health Service, conduct outreach to each medical facility operated by
an Indian tribe or tribal organization through a contract or compact
with the Indian Health Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.) to raise awareness of
the ability of such facilities, Indian tribes, and tribal organizations
to enter into agreements with the Department of Veterans Affairs under
which the Secretary reimburses such facilities, Indian tribes, or
tribal organizations, as the case may be, for health care provided to
veterans eligible for health care at such facilities.
(b) Metrics for Memorandum of Understanding Performance.--The
Secretary of Veterans Affairs shall implement performance metrics for
assessing the performance by the Department of Veterans Affairs and the
Indian Health Service under the memorandum of understanding entitled
``Memorandum of Understanding between the Department of Veterans
Affairs (VA) and the Indian Health Service (IHS)'' in increasing access
to health care, improving quality and coordination of health care,
promoting effective patient-centered collaboration and partnerships
between the Department and the Service, and ensuring health-promotion
and disease-prevention services are appropriately funded and available
for beneficiaries under both health care systems.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs and the
Director of the Indian Health Service shall jointly submit to Congress
a report on the feasibility and advisability of the following:
(1) Entering into agreements for the reimbursement by the
Secretary of the costs of direct care services provided through
organizations receiving amounts pursuant to grants made or
contracts entered into under section 503 of the Indian Health
Care Improvement Act (25 U.S.C. 1653) to veterans who are
otherwise eligible to receive health care from such
organizations.
(2) Including the reimbursement of the costs of direct care
services provided to veterans who are not Indians in agreements
between the Department and the following:
(A) The Indian Health Service.
(B) An Indian tribe or tribal organization
operating a medical facility through a contract or
compact with the Indian Health Service under the Indian
Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.).
(C) A medical facility of the Indian Health
Service.
(d) Definitions.--In this section:
(1) Indian.--The terms ``Indian'' and ``Indian tribe'' have
the meanings given those terms in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603).
(2) Medical facility of the indian health service.--The
term ``medical facility of the Indian Health Service'' includes
a facility operated by an Indian tribe or tribal organization
through a contract or compact with the Indian Health Service
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.).
(3) Tribal organization.--The term ``tribal organization''
has the meaning given the term in section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450b).
SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF VETERANS
AFFAIRS AND NATIVE HAWAIIAN HEALTH CARE SYSTEMS.
(a) In General.--The Secretary of Veterans Affairs shall, in
consultation with Papa Ola Lokahi and such other organizations involved
in the delivery of health care to Native Hawaiians as the Secretary
considers appropriate, enter into contracts or agreements with Native
Hawaiian health care systems that are in receipt of funds from the
Secretary of Health and Human Services pursuant to grants awarded or
contracts entered into under section 6(a) of the Native Hawaiian Health
Care Improvement Act (42 U.S.C. 11705(a)) for the reimbursement of
direct care services provided to eligible veterans as specified in such
contracts or agreements.
(b) Definitions.--In this section, the terms ``Native Hawaiian'',
``Native Hawaiian health care system'', and ``Papa Ola Lokahi'' have
the meanings given those terms in section 12 of the Native Hawaiian
Health Care Improvement Act (42 U.S.C. 11711).
SEC. 305. SENSE OF CONGRESS ON PROMPT PAYMENT BY DEPARTMENT OF VETERANS
AFFAIRS.
It is the sense of Congress that the Secretary of Veterans Affairs
shall comply with section 1315 of title 5, Code of Federal Regulations
(commonly known as the ``prompt payment rule''), or any corresponding
similar regulation or ruling, in paying for health care pursuant to
contracts entered into with non-Department of Veterans Affairs
providers to provide health care under the laws administered by the
Secretary.
TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS
SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET CENTERS OF
THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Improvement of Access.--
(1) In general.--The Secretary of Veterans Affairs shall
improve the access of veterans to telemedicine and other health
care through the use of mobile vet centers of the Department of
Veterans Affairs by providing standardized requirements for the
operation of such centers.
(2) Requirements.--The standardized requirements required
by paragraph (1) shall include the following:
(A) The number of days each mobile vet center of
the Department is expected to travel per year.
(B) The number of locations each center is expected
to visit per year.
(C) The number of appointments each center is
expected to conduct per year.
(D) The method and timing of notifications given by
each center to individuals in the area to which such
center is traveling, including notifications informing
veterans of the availability to schedule appointments
at the center.
(3) Use of telemedicine.--The Secretary shall ensure that
each mobile vet center of the Department has the capability to
provide telemedicine services.
(b) Reports.--Not later than one year after the date of the
enactment of this Act, and not later than September 30 each year
thereafter, the Secretary of Veterans Affairs shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on the
following:
(1) The use of mobile vet centers to provide telemedicine
services to veterans during the year preceding the submittal of
the report, including the following:
(A) The number of days each mobile vet center was
open to provide such services.
(B) The number of days each mobile vet center
traveled to a location other than the headquarters of
the mobile vet center to provide such services.
(C) The number of appointments each center
conducted to provide such services on average per month
and in total during such year.
(2) An analysis of the effectiveness of using mobile vet
centers to provide health care services to veterans through the
use of telemedicine.
(3) Any recommendations for an increase in the number of
mobile vet centers of the Department.
(4) Any recommendations for an increase in the telemedicine
capabilities of each mobile vet center.
(5) The feasibility and advisability of using temporary
health care providers, including locum tenens, to provide
direct health care services to veterans at mobile vet centers.
(6) Such other recommendations on improvement of the use of
mobile vet centers by the Department as the Secretary considers
appropriate.
SEC. 402. COMMISSION ON CONSTRUCTION PROJECTS OF THE DEPARTMENT OF
VETERANS AFFAIRS.
(a) Establishment of Commission.--
(1) Establishment.--There is established an Independent
Commission on Department of Veterans Affairs Construction
Projects (in this section referred to as the ``Commission'').
(2) Membership.--
(A) Voting members.--The Commission shall be
composed of 10 voting members as follows:
(i) Three members to be appointed by the
President from among members of the National
Academy of Engineering who are nominated under
subparagraph (B).
(ii) Three members to be appointed by the
President from among members of the National
Institute of Building Sciences who are
nominated under subparagraph (B).
(iii) Four members to be appointed by the
President from among veterans enrolled in the
patient enrollment system of the Department of
Veterans Affairs under section 1705 of title
38, United States Code, who are nominated under
subparagraph (B).
(B) Nomination of voting members.--The majority
leader of the Senate, the minority leader of the
Senate, the speaker of the House of Representatives,
and the minority leader of the House of Representatives
shall jointly nominate not less than 24 individuals to
be considered by the President for appointment under
subparagraph (A).
(C) Nonvoting members.--The Commission shall be
composed of the following nonvoting members:
(i) The Comptroller General of the United
States, or designee.
(ii) The Secretary of Veterans Affairs, or
designee.
(iii) The Inspector General of the
Department of Veterans Affairs, or designee.
(D) Date of appointment of members.--The
appointments of the members of the Commission under
subparagraph (A) shall be made not later than 14 days
after the date of the enactment of this Act.
(3) Period of appointment; vacancies.--Members shall be
appointed for the life of the Commission. Any vacancy in the
Commission shall not affect its powers, but shall be filled in
the same manner as the original appointment.
(4) Initial meeting.--Not later than five days after the
date on which all members of the Commission have been
appointed, the Commission shall hold its first meeting.
(5) Meetings.--The Commission shall meet at the call of the
Chairperson.
(6) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold hearings.
(7) Chairperson and vice chairperson.--The Commission shall
select a Chairperson and Vice Chairperson from among its
members.
(b) Duties of Commission.--
(1) Review.--The Commission shall review current
construction and maintenance projects and the medical facility
leasing program of the Department of Veterans Affairs to
identify any problems experienced by the Department in carrying
out such projects and program.
(2) Reports.--
(A) Commission report.--Not later than 120 days
after the date of the enactment of this Act, the
Commission shall submit to the Secretary of Veterans
Affairs, the Committee on Veterans' Affairs of the
Senate, and the Committee on Veterans' Affairs of the
House of Representatives a report setting forth
recommendations, if any, for improving the manner in
which the Secretary carries out the projects and
program specified in paragraph (1).
(B) Department report.--Not later than 60 days
after the submittal of the report under subparagraph
(A), the Secretary of Veterans Affairs shall submit to
the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives a report on the feasibility and
advisability of implementing the recommendations of the
Commission, if any, included in the report submitted
under such subparagraph, including a timeline for the
implementation of such recommendations.
(c) Powers of Commission.--
(1) Hearings.--The Commission may hold such hearings, sit
and act at such times and places, take such testimony, and
receive such evidence as the Commission considers advisable to
carry out this section.
(2) Information from federal agencies.--The Commission may
secure directly from any Federal agency such information as the
Commission considers necessary to carry out this section. Upon
request of the Chairperson of the Commission, the head of such
agency shall furnish such information to the Commission.
(d) Commission Personnel Matters.--
(1) Compensation of members.--Each member of the Commission
who is not an officer or employee of the Federal Government
shall be compensated at a rate equal to the daily equivalent of
the annual rate of basic pay prescribed for level IV of the
Executive Schedule under section 5315 of title 5, United States
Code, for each day (including travel time) during which such
member is engaged in the performance of the duties of the
Commission. All members of the Commission who are officers or
employees of the United States shall serve without compensation
in addition to that received for their services as officers or
employees of the United States.
(2) Travel expenses.--The members of the Commission shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of business
in the performance of services for the Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission
may, without regard to the civil service laws and
regulations, appoint and terminate an executive
director and such other additional personnel as may be
necessary to enable the Commission to perform its
duties. The employment of an executive director shall
be subject to confirmation by the Commission.
(B) Compensation.--The Chairperson of the
Commission may fix the compensation of the executive
director and other personnel without regard to chapter
51 and subchapter III of chapter 53 of title 5, United
States Code, relating to classification of positions
and General Schedule pay rates, except that the rate of
pay for the executive director and other personnel may
not exceed the rate payable for level V of the
Executive Schedule under section 5316 of such title.
(4) Detail of government employees.--Any Federal Government
employee may be detailed to the Commission without
reimbursement, and such detail shall be without interruption or
loss of civil service status or privilege.
(5) Procurement of temporary and intermittent services.--
The Chairperson of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5, United
States Code, at rates for individuals that do not exceed the
daily equivalent of the annual rate of basic pay prescribed for
level V of the Executive Schedule under section 5316 of such
title.
(e) Termination of Commission.--The Commission shall terminate 30
days after the date on which the Commission submits its report under
subsection (b)(2)(A).
SEC. 403. COMMISSION ON ACCESS TO CARE.
(a) Establishment of Commission.--
(1) In general.--There is established the Commission on
Access to Care (in this section referred to as the
``Commission'') to examine the access of veterans to health
care from the Department of Veterans Affairs and strategically
examine how best to organize the Veterans Health
Administration, locate health care resources, and deliver
health care to veterans during the 10- to 20-year period
beginning on the date of the enactment of this Act.
(2) Membership.--
(A) Voting members.--The Commission shall be
composed of 10 voting members who are appointed by the
President as follows:
(i) At least two members who represent an
organization recognized by the Secretary of
Veterans Affairs for the representation of
veterans under section 5902 of title 38, United
States Code.
(ii) At least one member from among persons
who have experience as senior management for a
private integrated health care system with an
annual gross revenue of more than $50,000,000.
(iii) At least one member from among
persons who are familiar with government health
care systems, including those systems of the
Department of Defense, the Indian Health
Service, and Federally-qualified health centers
(as defined in section 1905(l)(2)(B) of the
Social Security Act (42 U.S.C.
1396d(l)(2)(B))).
(iv) At least two members from among
persons who are familiar with the Veterans
Health Administration but are not current
employees of the Veterans Health
Administration.
(v) At least two members from among persons
who are veterans or eligible for hospital care,
medical services, or other health care under
the laws administered by the Secretary of
Veterans Affairs.
(B) Nonvoting members.--
(i) In general.--In addition to members
appointed under subparagraph (A), the
Commission shall be composed of 10 nonvoting
members who are appointed by the President as
follows:
(I) At least two members who
represent an organization recognized by
the Secretary of Veterans Affairs for
the representation of veterans under
section 5902 of title 38, United States
Code.
(II) At least one member from among
persons who have experience as senior
management for a private integrated
health care system with an annual gross
revenue of more than $50,000,000.
(III) At least one member from
among persons who are familiar with
government health care systems,
including those systems of the
Department of Defense, the Indian
Health Service, and Federally-qualified
health centers (as defined in section
1905(l)(2)(B) of the Social Security
Act (42 U.S.C. 1396d(l)(2)(B))).
(IV) At least two members from
among persons who are familiar with the
Veterans Health Administration but are
not current employees of the Veterans
Health Administration.
(V) At least two members from among
persons who are veterans or eligible
for hospital care, medical services, or
other health care under the laws
administered by the Secretary of
Veterans Affairs.
(ii) Additional nonvoting members.--In
addition to members appointed under
subparagraph (A) and clause (i), the Commission
shall be composed of the following nonvoting
members:
(I) The Comptroller General of the
United States, or designee.
(II) The Inspector General of the
Department of Veterans Affairs, or
designee.
(C) Date.--The appointments of members of the
Commission shall be made not later than 60 days after
the date of the enactment of this Act.
(3) Period of appointment; vacancies.--Members shall be
appointed for the life of the Commission. Any vacancy in the
Commission shall not affect its powers, but shall be filled in
the same manner as the original appointment.
(4) Initial meeting.--Not later than 15 days after the date
on which seven voting members of the Commission have been
appointed, the Commission shall hold its first meeting.
(5) Meetings.--The Commission shall meet at the call of the
Chairperson.
(6) Quorum.--A majority of the members of the Commission
shall constitute a quorum, but a lesser number of members may
hold hearings.
(7) Chairperson and vice chairperson.--The Commission shall
select a Chairperson and Vice Chairperson from among its
members.
(b) Duties of Commission.--
(1) Evaluation and assessment.--The Commission shall
undertake a comprehensive evaluation and assessment of access
to health care at the Department of Veterans Affairs.
(2) Matters evaluated and assessed.--The matters evaluated
and assessed by the Commission shall include the following:
(A) The appropriateness of current standards of the
Department of Veterans Affairs concerning access to
health care.
(B) The measurement of such standards.
(C) The appropriateness of performance standards
and incentives in relation to standards described in
subparagraph (A).
(D) Staffing levels throughout the Veterans Health
Administration and whether they are sufficient to meet
current demand for health care from the Administration.
(E) The results of the assessment conducted by an
independent third party under section 101(a), including
any data or recommendations included in such
assessment.
(3) Reports.--The Commission shall submit to the President,
through the Secretary of Veterans Affairs, reports as follows:
(A) Not later than 90 days after the date of the
initial meeting of the Commission, an interim report
on--
(i) the findings of the Commission with
respect to the evaluation and assessment
required by this subsection; and
(ii) such recommendations as the Commission
may have for legislative or administrative
action to improve access to health care through
the Veterans Health Administration.
(B) Not later than 180 days after the date of the
initial meeting of the Commission, a final report on--
(i) the findings of the Commission with
respect to the evaluation and assessment
required by this subsection; and
(ii) such recommendations as the Commission
may have for legislative or administrative
action to improve access to health care through
the Veterans Health Administration.
(c) Powers of the Commission.--
(1) Hearings.--The Commission may hold such hearings, sit
and act at such times and places, take such testimony, and
receive such evidence as the Commission considers advisable to
carry out this section.
(2) Information from federal agencies.--The Commission may
secure directly from any Federal department or agency such
information as the Commission considers necessary to carry out
this section. Upon request of the Chairperson of the
Commission, the head of such department or agency shall furnish
such information to the Commission.
(d) Commission Personnel Matters.--
(1) Compensation of members.--Each member of the Commission
who is not an officer or employee of the Federal Government
shall be compensated at a rate equal to the daily equivalent of
the annual rate of basic pay prescribed for level IV of the
Executive Schedule under section 5315 of title 5, United States
Code, for each day (including travel time) during which such
member is engaged in the performance of the duties of the
Commission. All members of the Commission who are officers or
employees of the United States shall serve without compensation
in addition to that received for their services as officers or
employees of the United States.
(2) Travel expenses.--The members of the Commission shall
be allowed travel expenses, including per diem in lieu of
subsistence, at rates authorized for employees of agencies
under subchapter I of chapter 57 of title 5, United States
Code, while away from their homes or regular places of business
in the performance of services for the Commission.
(3) Staff.--
(A) In general.--The Chairperson of the Commission
may, without regard to the civil service laws and
regulations, appoint and terminate an executive
director and such other additional personnel as may be
necessary to enable the Commission to perform its
duties. The employment of an executive director shall
be subject to confirmation by the Commission.
(B) Compensation.--The Chairperson of the
Commission may fix the compensation of the executive
director and other personnel without regard to chapter
51 and subchapter III of chapter 53 of title 5, United
States Code, relating to classification of positions
and General Schedule pay rates, except that the rate of
pay for the executive director and other personnel may
not exceed the rate payable for level V of the
Executive Schedule under section 5316 of such title.
(4) Detail of government employees.--Any Federal Government
employee may be detailed to the Commission without
reimbursement, and such detail shall be without interruption or
loss of civil service status or privilege.
(5) Procurement of temporary and intermittent services.--
The Chairperson of the Commission may procure temporary and
intermittent services under section 3109(b) of title 5, United
States Code, at rates for individuals that do not exceed the
daily equivalent of the annual rate of basic pay prescribed for
level V of the Executive Schedule under section 5316 of such
title.
(e) Termination of the Commission.--The Commission shall terminate
30 days after the date on which the Commission submits its report under
subsection (b)(3)(B).
(f) Funding.--The Secretary of Veterans Affairs shall make
available to the Commission from amounts appropriated or otherwise made
available to the Secretary such amounts as the Secretary and the
Chairperson of the Commission jointly consider appropriate for the
Commission to perform its duties under this section.
(g) Executive Action.--
(1) Action on recommendations.--The President shall require
the Secretary of Veterans Affairs and such other heads of
relevant Federal departments and agencies to implement each
recommendation set forth in a report submitted under subsection
(b)(3) that the President--
(A) considers feasible and advisable; and
(B) determines can be implemented without further
legislative action.
(2) Reports.--Not later than 60 days after the date on
which the President receives a report under subsection (b)(3),
the President shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives and such other committees of
Congress as the President considers appropriate a report
setting forth the following:
(A) An assessment of the feasibility and
advisability of each recommendation contained in the
report received by the President.
(B) For each recommendation assessed as feasible
and advisable under subparagraph (A) the following:
(i) Whether such recommendation requires
legislative action.
(ii) If such recommendation requires
legislative action, a recommendation concerning
such legislative action.
(iii) A description of any administrative
action already taken to carry out such
recommendation.
(iv) A description of any administrative
action the President intends to be taken to
carry out such recommendation and by whom.
SEC. 404. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE PROVIDED BY
DEPARTMENT OF VETERANS AFFAIRS.
(a) Prohibition on Use of Scheduling and Wait-time Metrics in
Determination of Performance Awards.--The Secretary of Veterans Affairs
shall ensure that scheduling and wait-time metrics or goals are not
used as factors in determining the performance of the following
employees for purposes of determining whether to pay performance awards
to such employees:
(1) Directors, associate directors, assistant directors,
deputy directors, chiefs of staff, and clinical leads of
medical centers of the Department of Veterans Affairs.
(2) Directors, assistant directors, and quality management
officers of Veterans Integrated Service Networks of the
Department of Veterans Affairs.
(b) Modification of Performance Plans.--
(1) In general.--Not later than 30 days after the date of
the enactment of this Act, the Secretary shall modify the
performance plans of the directors of the medical centers of
the Department and the directors of the Veterans Integrated
Service Networks to ensure that such plans are based on the
quality of care received by veterans at the health care
facilities under the jurisdictions of such directors.
(2) Factors.--In modifying performance plans under
paragraph (1), the Secretary shall ensure that assessment of
the quality of care provided at health care facilities under
the jurisdiction of a director described in paragraph (1)
includes consideration of the following:
(A) Recent reviews by the Joint Commission
(formerly known as the ``Joint Commission on
Accreditation of Healthcare Organizations'') of such
facilities.
(B) The number and nature of recommendations
concerning such facilities by the Inspector General of
the Department in reviews conducted through the
Combined Assessment Program (CAP), in the reviews by
the Inspector General of community based outpatient
clinics and primary care clinics, and in reviews
conducted through the Office of Healthcare Inspections
during the two most recently completed fiscal years.
(C) The number of recommendations described in
subparagraph (B) that the Inspector General of the
Department determines have not been carried out
satisfactorily with respect to such facilities.
(D) Reviews of such facilities by the Commission on
Accreditation of Rehabilitation Facilities.
(E) The number and outcomes of administrative
investigation boards, root cause analysis, and peer
reviews conducted at such facilities during the fiscal
year for which the assessment is being conducted.
(F) The effectiveness of any remedial actions or
plans resulting from any Inspector General
recommendations in the reviews and analyses described
in subparagraphs (A) through (E).
(3) Additional leadership positions.--To the degree
practicable, the Secretary shall assess the performance of
other employees of the Department in leadership positions at
Department medical centers, including associate directors,
assistant directors, deputy directors, chiefs of staff, and
clinical leads, and in Veterans Integrated Service Networks,
including assistant directors and quality management officers,
using factors and criteria similar to those used in the
performance plans modified under paragraph (1).
(c) Removal of Certain Performance Goals.--For each fiscal year
that begins after the date of the enactment of this Act, the Secretary
shall not include in the performance goals of any employee of a
Veterans Integrated Service Network or medical center of the Department
any performance goal that might disincentivize the payment of
Department amounts to provide hospital care, medical services, or other
health care through a non-Department provider.
SEC. 405. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE PROVIDED BY
DEPARTMENT OF VETERANS AFFAIRS.
(a) Publication of Wait Times.--
(1) Goals.--
(A) Initial.--Not later than 90 days after the date
of the enactment of this Act, the Secretary of Veterans
Affairs shall publish in the Federal Register, and on
an Internet website accessible to the public of each
medical center of the Department of Veterans Affairs,
the wait-time goals of the Department for the
scheduling of an appointment by a veteran for the
receipt of health care from the Department.
(B) Subsequent changes.--
(i) In general.--If the Secretary modifies
the wait-time goals described in subparagraph
(A), the Secretary shall publish the new wait-
times goals--
(I) on an Internet website
accessible to the public of each
medical center of the Department not
later than 30 days after such
modification; and
(II) in the Federal Register not
later than 90 days after such
modification.
(ii) Effective date.--Any modification
under clause (i) shall take effect on the date
of publication in the Federal Register.
(C) Goals described.--Wait-time goals published
under this paragraph shall include goals for primary
care appointments, specialty care appointments, and
appointments based on the general severity of the
condition of the veteran.
(2) Wait times at medical centers of the department.--Not
later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall publish on an
Internet website accessible to the public of each medical
center of the Department the current wait time for an
appointment for primary care and specialty care at the medical
center.
(b) Publicly Available Database of Patient Safety, Quality of Care,
and Outcome Measures.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall develop and make
available to the public a comprehensive database containing all
applicable patient safety, quality of care, and outcome
measures for health care provided by the Department that are
tracked by the Secretary.
(2) Update frequency.--The Secretary shall update the
database required by paragraph (1) not less frequently than
once each year.
(3) Unavailable measures.--For all measures that the
Secretary would otherwise publish in the database required by
paragraph (1) but has not done so because such measures are not
available, the Secretary shall publish notice in the database
of the reason for such unavailability and a timeline for making
such measures available in the database.
(4) Accessibility.--The Secretary shall ensure that the
database required by paragraph (1) is accessible to the public
through the primary Internet website of the Department and
through each primary Internet website of a Department medical
center.
(c) Hospital Compare Website of Department of Health and Human
Services.--
(1) Agreement required.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall enter into an agreement with the Secretary of
Health and Human Services for the provision by the Secretary of
Veterans Affairs of such information as the Secretary of Health
and Human Services may require to report and make publicly
available patient quality and outcome information concerning
Department of Veterans Affairs medical centers through the
Hospital Compare Internet website of the Department of Health
and Human Services or any successor Internet website.
(2) Information provided.--The information provided by the
Secretary of Veterans Affairs to the Secretary of Health and
Human Services under paragraph (1) shall include the following:
(A) Measures of timely and effective health care.
(B) Measures of readmissions, complications of
death, including with respect to 30-day mortality rates
and 30-day readmission rates, surgical complication
measures, and health care related infection measures.
(C) Survey data of patient experiences, including
the Hospital Consumer Assessment of Healthcare
Providers and Systems or any similar successor survey
developed by the Department of Health and Human
Services.
(D) Any other measures required of or reported with
respect to hospitals participating in the Medicare
program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.).
(3) Unavailable information.--For any applicable metric
collected by the Department of Veterans Affairs or required to
be provided under paragraph (2) and withheld from or
unavailable in the Hospital Compare Internet website, the
Secretary of Veterans Affairs shall publish a notice in the
Federal Register stating the reason why such metric was
withheld from public disclosure and a timeline for making such
metric available, if applicable.
(d) Comptroller General Review of Publicly Available Safety and
Quality Metrics.--Not later than three years after the date of the
enactment of this Act, the Comptroller General of the United States
shall conduct a review of the safety and quality metrics made publicly
available by the Secretary of Veterans Affairs under this section to
assess the degree to which the Secretary is complying with the
provisions of this section.
SEC. 406. INFORMATION FOR VETERANS ON THE CREDENTIALS OF DEPARTMENT OF
VETERANS AFFAIRS PHYSICIANS.
(a) Improvement of ``Our Providers'' Internet Website Links.--
(1) Availability through department of veterans affairs
homepage.--A link to the ``Our Providers'' health care
providers database of the Department of Veterans Affairs, or
any successor database, shall be available on and through the
homepage of the Internet website of the Department that is
accessible to the public.
(2) Information on location of residency training.--The
Internet website of the Department that is accessible to the
public shall include under the link to the ``Our Providers''
health care providers database of the Department, or any
successor database, the location of residency training of each
licensed physician of the Department.
(3) Information on physicians at particular facilities.--
The ``Our Providers'' health care providers database of the
Department, or any successor database, shall identify whether
each licensed physician of the Department is a physician in
residency.
(b) Information on Credentials of Physicians for Veterans
Undergoing Surgical Procedures.--
(1) In general.--Each veteran who is undergoing a surgical
procedure by or through the Department shall be provided
information on the credentials of the surgeon to be performing
such procedure at such time in advance of the procedure as is
appropriate to permit such veteran to evaluate such
information.
(2) Other individuals.--If a veteran is unable to evaluate
the information provided under paragraph (1) due to the health
or mental competence of the veteran, such information shall be
provided to an individual acting on behalf of the veteran.
(c) Comptroller General Report and Plan.--
(1) Report.--Not later than two years after the date of the
enactment of this Act, the Comptroller General of the United
States shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House
of Representatives a report setting forth an assessment by the
Comptroller General of the following:
(A) The manner in which contractors under the
Patient-Centered Community Care initiative of the
Department perform oversight of the credentials of
physicians within the networks of such contractors
under the initiative.
(B) The oversight by the Department of the
contracts under the Patient-Centered Community Care
initiative.
(C) The verification by the Department of the
credentials and licenses of health care providers
furnishing hospital care and medical services under
section 301.
(2) Plan.--
(A) In general.--Not later than 30 days after the
submittal of the report under paragraph (1), the
Secretary shall--
(i) submit to the Comptroller General, the
Committee on Veterans' Affairs of the Senate,
and the Committee on Veterans' Affairs of the
House of Representatives a plan to address any
findings and recommendations of the Comptroller
General included in such report; and
(ii) submit to the Committee on Veterans'
Affairs of the Senate and the Committee on
Veterans' Affairs of the House of
Representatives a request for additional
amounts, if any, that may be necessary to carry
out such plan.
(B) Implementation.--Not later than 90 days after
the submittal of the report under paragraph (1), the
Secretary shall carry out such plan.
SEC. 407. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON HOSPITAL
CARE AND MEDICAL SERVICES FURNISHED THROUGH EXPANDED USE
OF CONTRACTS FOR SUCH CARE.
The materials on the Department of Veterans Affairs in the budget
of the President for a fiscal year, as submitted to Congress pursuant
to section 1105(a) of title 31, United States Code, shall set forth the
following:
(1) The number of veterans who received hospital care and
medical services under section 301 during the fiscal year
preceding the fiscal year in which such budget is submitted.
(2) The amount expended by the Department on furnishing
care and services under such section during the fiscal year
preceding the fiscal year in which such budget is submitted.
(3) The amount requested in such budget for the costs of
furnishing care and services under such section during the
fiscal year covered by such budget, set forth in aggregate and
by amounts for each account for which amounts are so requested.
(4) The number of veterans that the Department estimates
will receive hospital care and medical services under such
section during the fiscal years covered by the budget
submission.
(5) The number of employees of the Department on paid
administrative leave at any point during the fiscal year
preceding the fiscal year in which such budget is submitted.
SEC. 408. PROHIBITION ON FALSIFICATION OF DATA CONCERNING WAIT TIMES
AND QUALITY MEASURES AT DEPARTMENT OF VETERANS AFFAIRS.
Not later than 60 days after the date of the enactment of this Act,
and in accordance with title 5, United States Code, the Secretary of
Veterans Affairs shall establish policies whereby any employee of the
Department of Veterans Affairs who knowingly submits false data
concerning wait times for health care or quality measures with respect
to health care to another employee of the Department or knowingly
requires another employee of the Department to submit false data
concerning such wait times or quality measures to another employee of
the Department is subject to a penalty the Secretary considers
appropriate after notice and an opportunity for a hearing, including
civil penalties, unpaid suspensions, or termination.
SEC. 409. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOYEES OF THE
DEPARTMENT OF VETERANS AFFAIRS FOR PERFORMANCE.
(a) Removal or Transfer.--
(1) In general.--Chapter 7 of title 38, United States Code,
is amended by adding at the end the following new section:
``Sec. 713. Senior Executive Service: removal based on performance
``(a) In General.--The Secretary may remove any individual from the
Senior Executive Service if the Secretary determines the performance of
the individual warrants such removal. If the Secretary so removes such
an individual, the Secretary may--
``(1) remove the individual from the civil service (as
defined in section 2101 of title 5); or
``(2) transfer the individual to a General Schedule
position at any grade of the General Schedule for which the
individual is qualified and that the Secretary determines is
appropriate.
``(b) Notice to Congress.--Not later than 30 days after removing or
transferring an individual from the Senior Executive Service under
subsection (a), the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives notice in
writing of such removal or transfer and the reason for such removal or
transfer.
``(c) Procedure.--(1) The procedures under section 7543 of title 5
shall not apply to a removal or transfer under this section.
``(2)(A) Subject to subparagraph (B), any removal or transfer under
subsection (a) may be appealed to the Merit Systems Protection Board
under section 7701 of title 5.
``(B) An appeal under subparagraph (A) of a removal or transfer may
only be made if such appeal is made not later than 7 days after the
date of such removal or transfer.
``(d) Expedited Review by Merit Systems Protection Board.--(1) The
Merit Systems Protection Board shall expedite any appeal under section
7701 of title 5 of a removal or transfer under subsection (a) and, in
any such case, shall issue a decision not later than 21 days after the
date of the appeal.
``(2) In any case in which the Merit Systems Protection Board
determines that it cannot issue a decision in accordance with the 21-
day requirement under paragraph (1), the Merit Systems Protection Board
shall submit to Congress a report that explains the reason why the
Merit Systems Protection Board is unable to issue a decision in
accordance with such requirement in such case.
``(3) There is authorized to be appropriated such sums as may be
necessary for the Merit Systems Protection Board to expedite appeals
under paragraph (1).
``(4) The Merit Systems Protection Board may not stay any personnel
action taken under this section.
``(5) A person who appeals under section 7701 of title 5 a removal
under subsection (a)(1) may not receive any pay, awards, bonuses,
incentives, allowances, differentials, student loan repayments, special
payments, or benefits from the Secretary until the Merit Systems
Protection Board has made a final decision on such appeal.
``(6) A decision made by the Merit Systems Protection Board with
respect to a removal or transfer under subsection (a) shall not be
subject to any further appeal.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by adding at the end the
following new item:
``713. Senior Executive Service: removal based on performance.''.
(b) Establishment of Expedited Review Process.--
(1) In general.--Not later than 30 days after the date of
the enactment of this Act, the Merit Systems Protection Board
shall establish and put into effect a process to conduct
expedited reviews in accordance with section 713(d) of title
38, United States Code.
(2) Inapplicability of certain regulations.--Section
1201.22 of title 5, Code of Federal Regulations, as in effect
on the day before the date of the enactment of this Act, shall
not apply to expedited reviews carried out under section 713(d)
of title 38, United States Code.
(3) Report by merit systems protection board.--Not later
than 30 days after the date of the enactment of this Act, the
Merit Systems Protection Board shall submit to Congress a
report on the actions the Board plans to take to conduct
expedited reviews under section 713(d) of title 38, United
States Code, as added by subsection (a). Such report shall
include a description of the resources the Board determines
will be necessary to conduct such reviews and a description of
whether any resources will be necessary to conduct such reviews
that were not available to the Board on the day before the date
of the enactment of this Act.
(c) Temporary Exemption From Certain Limitation on Initiation of
Removal From Senior Executive Service.--During the 120-day period
beginning on the date of the enactment of this Act, an action to remove
an individual from the Senior Executive Service at the Department of
Veterans Affairs pursuant to section 713 of title 38, United States
Code, as added by subsection (a), or section 7543 of title 5, United
States Code, may be initiated, notwithstanding section 3592(b) of title
5, United States Code, or any other provision of law.
(d) Construction.--Nothing in this section or section 713 of title
38, United States Code, as added by subsection (a), shall be construed
to apply to an appeal of a removal, transfer, or other personnel action
that was pending before the date of the enactment of this Act.
TITLE V--HEALTH CARE RELATED TO SEXUAL TRAUMA
SEC. 501. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA COUNSELING AND
TREATMENT TO VETERANS ON INACTIVE DUTY TRAINING.
Section 1720D(a)(1) of title 38, United States Code, is amended by
striking ``or active duty for training'' and inserting ``, active duty
for training, or inactive duty training''.
SEC. 502. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL TRAUMA BY
THE DEPARTMENT OF VETERANS AFFAIRS TO MEMBERS OF THE
ARMED FORCES.
(a) Expansion of Coverage to Members of the Armed Forces.--
Subsection (a) of section 1720D of title 38, United States Code, is
amended--
(1) by redesignating paragraph (2) as paragraph (3);
(2) by inserting after paragraph (1) the following new
paragraph (2):
``(2)(A) In operating the program required by paragraph (1), the
Secretary may, in consultation with the Secretary of Defense, provide
counseling and care and services to members of the Armed Forces
(including members of the National Guard and Reserves) on active duty
to overcome psychological trauma described in that paragraph.
``(B) A member described in subparagraph (A) shall not be required
to obtain a referral before receiving counseling and care and services
under this paragraph.''; and
(3) in paragraph (3), as predesignated by paragraph (1)--
(A) by striking ``a veteran'' and inserting ``an
individual''; and
(B) by striking ``that veteran'' each place it
appears and inserting ``that individual''.
(b) Information to Members on Availability of Counseling and
Services.--Subsection (c) of such section is amended--
(1) by striking ``to veterans'' each place it appears; and
(2) in paragraph (3), by inserting ``members of the Armed
Forces and'' before ``individuals''.
(c) Inclusion of Members in Reports on Counseling and Services.--
Subsection (e) of such section is amended--
(1) in the matter preceding paragraph (1), by striking ``to
veterans'';
(2) in paragraph (2)--
(A) by striking ``women veterans'' and inserting
``individuals''; and
(B) by striking ``training under subsection (d).''
and inserting ``training under subsection (d),
desegregated by--
``(A) veterans;
``(B) members of the Armed Forces (including
members of the National Guard and Reserves) on active
duty; and
``(C) for each of subparagraphs (A) and (B)--
``(i) men; and
``(ii) women.'';
(3) in paragraph (4), by striking ``veterans'' and
inserting ``individuals''; and
(4) in paragraph (5)--
(A) by striking ``women veterans'' and inserting
``individuals'' ; and
(B) by inserting ``, including specific
recommendations for individuals specified in
subparagraphs (A), (B), and (C) of paragraph (2)''
before the period at the end.
(d) Effective Date.--The amendments made by this section shall take
effect on the date that is one year after the date of the enactment of
this Act.
SEC. 503. REPORTS ON MILITARY SEXUAL TRAUMA.
(a) Report on Services Available for Military Sexual Trauma in the
Department of Veterans Affairs.--Not later than 630 days after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
submit to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives a report
on the treatment and services available from the Department of Veterans
Affairs for male veterans who experience military sexual trauma
compared to such treatment and services available to female veterans
who experience military sexual trauma.
(b) Reports on Transition of Military Sexual Trauma Treatment From
Department of Defense to Department of Veterans Affairs.--Not later
than 630 days after the date of the enactment of this Act, and annually
thereafter for five years, the Department of Veterans Affairs-
Department of Defense Joint Executive Committee established by section
320(a) of title 38, United States Code, shall submit to the appropriate
committees of Congress a report on military sexual trauma that includes
the following:
(1) The processes and procedures utilized by the Department
of Veterans Affairs and the Department of Defense to facilitate
transition of treatment of individuals who have experienced
military sexual trauma from treatment provided by the
Department of Defense to treatment provided by the Department
of Veterans Affairs.
(2) A description and assessment of the collaboration
between the Department of Veterans Affairs and the Department
of Defense in assisting veterans in filing claims for
disabilities related to military sexual trauma, including
permitting veterans access to information and evidence
necessary to develop or support such claims.
(c) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Committee on Armed Services of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Armed Services of the House of
Representatives.
(2) Military sexual trauma.--The term ``military sexual
trauma'' means psychological trauma, which in the judgment of a
mental health professional employed by the Department, resulted
from a physical assault of a sexual nature, battery of a sexual
nature, or sexual harassment which occurred while the veteran
was serving on active duty or active duty for training.
(3) Sexual harassment.--The term ``sexual harassment''
means repeated, unsolicited verbal or physical contact of a
sexual nature which is threatening in character.
(4) Sexual trauma.--The term ``sexual trauma'' shall have
the meaning given that term by the Secretary of Veterans
Affairs for purposes of this section.
(d) Effective Date.--This section shall take effect on the date
that is 270 days after the date of the enactment of this Act.
TITLE VI--MAJOR MEDICAL FACILITY LEASES
SEC. 601. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.
The Secretary of Veterans Affairs may carry out the following major
medical facility leases at the locations specified, and in an amount
for each lease not to exceed the amount shown for such location (not
including any estimated cancellation costs):
(1) For a clinical research and pharmacy coordinating
center, Albuquerque, New Mexico, an amount not to exceed
$9,560,000.
(2) For a community-based outpatient clinic, Brick, New
Jersey, an amount not to exceed $7,280,000.
(3) For a new primary care and dental clinic annex,
Charleston, South Carolina, an amount not to exceed $7,070,250.
(4) For the Cobb County community-based Outpatient Clinic,
Cobb County, Georgia, an amount not to exceed $6,409,000.
(5) For the Leeward Outpatient Healthcare Access Center,
Honolulu, Hawaii, including a co-located clinic with the
Department of Defense and the co-location of the Honolulu
Regional Office of the Veterans Benefits Administration and the
Capel Vet Center of the Department of Veterans Affairs, an
amount not to exceed $15,887,370.
(6) For a community-based outpatient clinic, Johnson
County, Kansas, an amount not to exceed $2,263,000.
(7) For a replacement community-based outpatient clinic,
Lafayette, Louisiana, an amount not to exceed $2,996,000.
(8) For a community-based outpatient clinic, Lake Charles,
Louisiana, an amount not to exceed $2,626,000.
(9) For outpatient clinic consolidation, New Port Riche,
Florida, an amount not to exceed $11,927,000.
(10) For an outpatient clinic, Pence, Puerto Rico, an
amount not to exceed $11,535,000.
(11) For lease consolidation, San Antonio, Texas, an amount
not to exceed $19,426,000.
(12) For a community-based outpatient clinic, San Diego,
California, an amount not to exceed $11,946,100.
(13) For an outpatient clinic, Tyler, Texas, an amount not
to exceed $4,327,000.
(14) For the Arere Community Care Center, West Haven,
Connecticut, an amount not to exceed $4,883,000.
(15) For the Worcester community-based Outpatient Clinic,
Worcester, Massachusetts, an amount not to exceed $4,855,000.
(16) For the expansion of a community-based outpatient
clinic, Cape Girardeau, Missouri, an amount not to exceed
$4,232,060.
(17) For a multi specialty clinic, Chattanooga, Tennessee,
an amount not to exceed $7,069,000.
(18) For the expansion of a community-based outpatient
clinic, Chico, California, an amount not to exceed $4,534,000.
(19) For a community-based outpatient clinic, Chula Vista,
California, an amount not to exceed $3,714,000.
(20) For a new research lease, Haines, Illinois, an amount
not to exceed $22,032,000.
(21) For a replacement research lease, Houston, Texas, an
amount not to exceed $6,142,000.
(22) For a community-based outpatient clinic, Lincoln,
Nebraska, an amount not to exceed $7,178,400.
(23) For a community-based outpatient clinic, Lubbock,
Texas, an amount not to exceed $8,554,000.
(24) For a community-based outpatient clinic consolidation,
Myrtle Beach, South Carolina, an amount not to exceed
$8,022,000.
(25) For a community-based outpatient clinic, Phoenix,
Arizona, an amount not to exceed $20,757,000.
(26) For the expansion of a community-based outpatient
clinic, Redding, California, an amount not to exceed
$8,154,000.
SEC. 602. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS MAJOR
MEDICAL FACILITIES LEASES.
(a) Findings.--Congress finds the following:
(1) Title 31, United States Code, requires the Department
of Veterans Affairs to record the full cost of its contractual
obligation against funds available at the time a contract is
executed.
(2) Office of Management and Budget Circular A-11 provides
guidance to agencies in meeting the statutory requirements
under title 31, United States Code, with respect to leases.
(3) For operating leases, Office of Management and Budget
Circular A-11 requires the Department of Veterans Affairs to
record up-front budget authority in an ``amount equal to total
payments under the full term of the lease or [an] amount
sufficient to cover first year lease payments plus cancellation
costs''.
(b) Requirement for Obligation of Full Cost.--
(1) In general.--Subject to the availability of
appropriations provided in advance, in exercising the authority
of the Secretary of Veterans Affairs to enter into leases
provided in this Act, the Secretary shall record, pursuant to
section 1501 of title 31, United States Code, as the full cost
of the contractual obligation at the time a contract is
executed either--
(A) an amount equal to total payments under the
full term of the lease; or
(B) if the lease specifies payments to be made in
the event the lease is terminated before its full term,
an amount sufficient to cover the first year lease
payments plus the specified cancellation costs.
(2) Self-insuring authority.--The requirements of paragraph
(1) may be satisfied through the use of a self-insuring
authority consistent with Office of Management and Budget
Circular A-11.
(c) Transparency.--
(1) Compliance.--Subsection (b) of section 8104 of title
38, United States Code, is amended by adding at the end the
following new paragraph:
``(7) In the case of a prospectus proposing funding for a
major medical facility lease, a detailed analysis of how the
lease is expected to comply with Office of Management and
Budget Circular A-11 and section 1341 of title 31 (commonly
referred to as the `Anti-Deficiency Act'). Any such analysis
shall include--
``(A) an analysis of the classification of the
lease as a `lease-purchase', `capital lease', or
`operating lease' as those terms are defined in Office
of Management and Budget Circular A-11;
``(B) an analysis of the obligation of budgetary
resources associated with the lease; and
``(C) an analysis of the methodology used in
determining the asset cost, fair market value, and
cancellation costs of the lease.''.
(2) Submittal to congress.--Such section 8104 is further
amended by adding at the end the following new subsection:
``(h)(1) Not less than 30 days before entering into a major medical
facility lease, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House of Representatives--
``(A) notice of the Secretary's intention to enter into the
lease;
``(B) a detailed summary of the proposed lease;
``(C) a description and analysis of any differences between
the prospectus submitted pursuant to subsection (b) and the
proposed lease; and
``(D) a scoring analysis demonstrating that the proposed
lease fully complies with Office of Management and Budget
Circular A-11.
``(2) Each committee described in paragraph (1) shall ensure that
any information submitted to the committee under such paragraph is
treated by the committee with the same level of confidentiality as is
required by law of the Secretary and subject to the same statutory
penalties for unauthorized disclosure or use as the Secretary.
``(3) Not more than 30 days after entering into a major medical
facility lease, the Secretary shall submit to each committee described
in paragraph (1) a report on any material differences between the lease
that was entered into and the proposed lease described under such
paragraph, including how the lease that was entered into changes the
previously submitted scoring analysis described in subparagraph (D) of
such paragraph.''.
(d) Rule of Construction.--Nothing in this section, or the
amendments made by this section, shall be construed to in any way
relieve the Department of Veterans Affairs from any statutory or
regulatory obligations or requirements existing prior to the enactment
of this section and such amendments.
TITLE VII--VETERANS BENEFITS MATTERS
SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY
SCHOLARSHIP.
(a) Expansion of Entitlement.--Subsection (b)(9) of section 3311 of
title 38, United States Code, is amended by inserting ``or spouse''
after ``child''.
(b) Limitation and Election on Certain Benefits.--Subsection (f) of
such section is amended--
(1) by redesignating paragraph (2) as paragraph (4); and
(2) by inserting after paragraph (1) the following new
paragraphs:
``(2) Limitation.--The entitlement of an individual to
assistance under subsection (a) pursuant to paragraph (9) of
subsection (b) because the individual was a spouse of a person
described in such paragraph shall expire on the earlier of--
``(A) the date that is 15 years after the date on
which the person died; and
``(B) the date on which the individual remarries.
``(3) Election on receipt of certain benefits.--A surviving
spouse entitled to assistance under subsection (a) pursuant to
paragraph (9) of subsection (b) who is also entitled to
educational assistance under chapter 35 of this title may not
receive assistance under both this section and such chapter,
but shall make an irrevocable election (in such form and manner
as the Secretary may prescribe) under which section or chapter
to receive educational assistance.''.
(c) Conforming Amendment.--Section 3321(b)(4) of such title is
amended--
(1) by striking ``an individual'' and inserting ``a
child''; and
(2) by striking ``such individual's'' each time it appears
and inserting ``such child's''.
SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC
INSTITUTIONS OF HIGHER LEARNING FOR PURPOSES OF ALL-
VOLUNTEER FORCE EDUCATIONAL ASSISTANCE PROGRAM AND POST-
9/11 EDUCATIONAL ASSISTANCE CONDITIONAL ON IN-STATE
TUITION RATE FOR VETERANS.
(a) In General.--Section 3679 of title 38, United States Code, is
amended by adding at the end the following new subsection:
``(c)(1) Notwithstanding any other provision of this chapter and
subject to paragraphs (3) through (6), the Secretary shall disapprove a
course of education provided by a public institution of higher learning
to a covered individual pursuing a course of education with educational
assistance under chapter 30 or 33 of this title while living in the
State in which the public institution of higher learning is located if
the institution charges tuition and fees for that course for the
covered individual at a rate that is higher than the rate the
institution charges for tuition and fees for that course for residents
of the State in which the institution is located, regardless of the
covered individual's State of residence.
``(2) For purposes of this subsection, a covered individual is any
individual as follows:
``(A) A veteran who was discharged or released from a
period of not fewer than 90 days of service in the active
military, naval, or air service less than three years before
the date of enrollment in the course concerned.
``(B) An individual who is entitled to assistance under
section 3311(b)(9) or 3319 of this title by virtue of such
individual's relationship to a veteran described in
subparagraph (A).
``(3) If after enrollment in a course of education that is subject
to disapproval under paragraph (1) by reason of paragraph (2)(A) or
(2)(B) a covered individual pursues one or more courses of education at
the same public institution of higher learning while remaining
continuously enrolled (other than during regularly scheduled breaks
between courses, semesters or terms) at that institution of higher
learning, any course so pursued by the covered individual at that
institution of higher learning while so continuously enrolled shall
also be subject to disapproval under paragraph (1).
``(4) It shall not be grounds to disapprove a course of education
under paragraph (1) if a public institution of higher learning requires
a covered individual pursuing a course of education at the institution
to demonstrate an intent, by means other than satisfying a physical
presence requirement, to establish residency in the State in which the
institution is located, or to satisfy other requirements not relating
to the establishment of residency, in order to be charged tuition and
fees for that course at a rate that is equal to or less than the rate
the institution charges for tuition and fees for that course for
residents of the State.
``(5) The Secretary may waive such requirements of paragraph (1) as
the Secretary considers appropriate.
``(6) Disapproval under paragraph (1) shall apply only with respect
to educational assistance under chapters 30 and 33 of this title.''.
(b) Effective Date.--Subsection (c) of section 3679 of title 38,
United States Code (as added by subsection (a) of this section), shall
apply with respect to educational assistance provided for pursuit of
programs of education during academic terms that begin after July 1,
2015, through courses of education that commence on or after that date.
TITLE VIII--APPROPRIATION AND EMERGENCY DESIGNATIONS
SEC. 801. APPROPRIATION OF EMERGENCY AMOUNTS.
There is authorized to be appropriated, and is appropriated, to the
Secretary of Veterans Affairs, out of any funds in the Treasury not
otherwise appropriated, for fiscal years 2014, 2015, and 2016, such
sums as may be necessary to carry out this Act.
SEC. 802. EMERGENCY DESIGNATIONS.
(a) In General.--This Act is designated as an emergency requirement
pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 2010 (2
U.S.C. 933(g)).
(b) Designation in Senate.--In the Senate, this Act is designated
as an emergency requirement pursuant to section 403(a) of S. Con. Res.
13 (111th Congress), the concurrent resolution on the budget for fiscal
year 2010.
Amend the title so as to read: ``To improve the access of
veterans to medical services from the Department of Veterans
Affairs, and for other purposes.''
Attest:
Secretary.
113th CONGRESS
2d Session
H.R. 3230
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AMENDMENTS