[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 3401 Introduced in Senate (IS)]

<DOC>






114th CONGRESS
  2d Session
                                S. 3401

 To amend title 38, United States Code, to consolidate and expand the 
provision of health care to veterans through non-Department of Veterans 
         Affairs health care providers, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 27, 2016

   Mr. Crapo introduced the following bill; which was read twice and 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To amend title 38, United States Code, to consolidate and expand the 
provision of health care to veterans through non-Department of Veterans 
         Affairs health care providers, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Improving Veterans Care in the 
Community Act of 2016''.

SEC. 2. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) the Department of Veterans Affairs should remain the 
        primary means by which eligible veterans access health care;
            (2) the Veterans Health Administration needs a simple tool 
        by which it can send veterans into the community to receive 
        health care when appropriate; and
            (3) it is appropriate to send veterans into the community 
        for health care when--
                    (A) it is in the best medical interest of the 
                veteran;
                    (B) the veteran does not have access to a medical 
                facility of the Department without an undue travel 
                burden;
                    (C) the nearest medical facility of the Department 
                does not provide the service the veteran needs and the 
                veteran faces an undue travel burden to receive the 
                service from another medical facility of the 
                Department; or
                    (D) the Secretary of Veterans Affairs determines 
                that it is appropriate.

SEC. 3. ESTABLISHMENT OF CARE IN THE COMMUNITY PROGRAM OF DEPARTMENT OF 
              VETERANS AFFAIRS TO CONSOLIDATE AND EXPAND THE PROVISION 
              OF HEALTH CARE TO VETERANS THROUGH NON-DEPARTMENT OF 
              VETERANS AFFAIRS PROVIDERS.

    (a) Establishment of Program.--
            (1) In general.--Subchapter I of chapter 17 of title 38, 
        United States Code, is amended by inserting after section 1703 
        the following new section:
``Sec. 1703A. Care in the Community Program
    ``(a) In General.--(1) There is established a consolidated program 
to furnish care and services specified in subsection (e) to veterans 
through individuals and entities specified in subsection (c), including 
through the use of contracts or agreements entered into under this 
section to furnish such care and services. Such program may be referred 
to as the `Care in the Community Program'.
    ``(b) Requirement To Receive Care.--To receive care or services 
under this section, a veteran must be enrolled in the patient 
enrollment system of the Department established and operated under 
section 1705 of this title.
    ``(c) Individuals and Entities Specified.--Individuals and entities 
specified in this paragraph are the following:
            ``(1) 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.) or the Medicaid program under title 
        XIX of such Act (42 U.S.C. 1396 et seq.), including any 
        physician furnishing services under such a program.
            ``(2) The Department of Defense, including pursuant to 
        agreements entered into under section 8111 of this title.
            ``(3) The Indian Health Service.
            ``(4) Institutions affiliated with the Department under 
        section 7302 of this title.
            ``(5) Providers of care under the Alaska Native Health Care 
        System.
            ``(6) 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))).
            ``(7) Any individual or entity with which the Secretary has 
        entered into a contract or agreement under section 8153 of this 
        title.
            ``(8) Any other individual or entity that meets criteria 
        established by the Secretary for purposes of this section.
    ``(d) Eligibility for Certain Services.--(1)(A) A veteran is 
eligible for hospital care and medical services under subsection (e)(9) 
if--
            ``(i) the veteran does not live within 40 miles of a 
        medical facility of the Department, including a community-based 
        outpatient clinic;
            ``(ii) the veteran requires care or services that are not 
        available at any medical facility of the Department, including 
        a community-based outpatient clinic, within 40 miles from the 
        residence of the veteran;
            ``(iii) the veteran resides--
                    ``(I) in a State without a medical facility of the 
                Department that provides--
                            ``(aa) hospital care;
                            ``(bb) emergency medical services; and
                            ``(cc) 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 subclause (I);
            ``(iv) the veteran--
                    ``(I) resides in a location, other than a location 
                in Guam, American Samoa, or the Republic of the 
                Philippines, that is within 40 miles of a medical 
                facility of the Department, including a community-based 
                outpatient clinic; and
                    ``(II)(aa) is required to travel by air, boat, or 
                ferry to reach each medical facility described in 
                subclause (I) that is within 40 miles of the residence 
                of the veteran; or
                    ``(bb) faces an unusual or excessive burden in 
                traveling to such a medical facility of the Department 
                based on--
                            ``(AA) geographical challenges;
                            ``(BB) environmental factors, such as roads 
                        that are not accessible to the general public, 
                        traffic, or hazardous weather;
                            ``(CC) a medical condition that impacts the 
                        ability to travel; or
                            ``(DD) other factors, as determined by the 
                        Secretary;
            ``(v) the veteran would be required to wait longer than a 
        period specified by the Secretary to receive hospital care or 
        medical services from the Department; or
            ``(vi) a health care provider of the Department determines 
        that it is in the medical interest of the veteran to access 
        hospital care or medical services outside of the Department.
    ``(B) Any distance specified under subparagraph (A) shall be 
calculated based on distance traveled.
    ``(C) The period specified by the Secretary under subparagraph 
(A)(v) shall be 30 days unless the Secretary--
            ``(i) prescribes regulations specifying a different period, 
        which may include a different period for each area of specialty 
        care; and
            ``(ii) publishes such different period or periods in the 
        Federal Register and on an Internet Web site of the Department.
    ``(D) Veterans who meet eligibility criteria set forth under the 
pilot program under section 403 of the Veterans' Mental Health and 
Other Care Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703 
note) (commonly known as `Project Arch'), as in effect on the day 
before the termination of such program, are eligible for care and 
services under subsection (e)(9).
    ``(2)(A) A veteran is eligible for reimbursement for emergency 
treatment furnished under subsection (e)(15) at a non-Department 
facility--
            ``(i) if the veteran is an active Department health-care 
        participant who is personally liable for emergency treatment 
        furnished the veteran in a non-Department facility, for any 
        emergency treatment furnished such veteran; or
            ``(ii) if the treatment was for--
                    ``(I) an adjudicated service-connected disability;
                    ``(II) a non-service-connected disability 
                associated with and held to be aggravating a service-
                connected disability;
                    ``(III) any disability of a veteran if the veteran 
                has a total disability permanent in nature from a 
                service-connected disability; or
                    ``(IV) any illness, injury, or dental condition of 
                a veteran who--
                            ``(aa) is a participant in a vocational 
                        rehabilitation program (as defined in section 
                        3101(9) of this title); and
                            ``(bb) is medically determined to have been 
                        in need of care or treatment to make possible 
                        the veteran's entrance into a course of 
                        training, or prevent interruption of a course 
                        of training, or hasten the return to a course 
                        of training which was interrupted because of 
                        such illness, injury, or dental condition.
    ``(B) A veteran is an active Department health-care participant if 
the veteran received care under this chapter within the 24-month period 
preceding the furnishing of such emergency treatment.
    ``(C) A veteran is personally liable for emergency treatment 
furnished the veteran in a non-Department facility if the veteran--
            ``(i) is financially liable to the provider of emergency 
        treatment for that treatment;
            ``(ii) has no entitlement to care or services under a 
        health-plan contract (determined, in the case of a health-plan 
        contract as defined in subsection (j)(2)(B) or (j)(2)(C), 
        without regard to any requirement or limitation relating to 
        eligibility for care or services from any department or agency 
        of the United States); and
            ``(iii) has no other contractual or legal recourse against 
        a third party that would, in whole, extinguish such liability 
        to the provider.
    ``(e) Care and Services.--Care and services specified in this 
subsection are the following:
            ``(1) Hospital care or medical services furnished to a 
        veteran for the treatment of--
                    ``(A) a service-connected disability;
                    ``(B) a disability for which a veteran was 
                discharged or released from the active military, naval, 
                or air service; or
                    ``(C) a disability of a veteran who has a total 
                disability permanent in nature from a service-connected 
                disability.
            ``(2) Medical services for the treatment of any disability 
        of--
                    ``(A) a veteran described in section 1710(a)(1)(B) 
                of this title;
                    ``(B) a veteran who--
                            ``(i) has been furnished hospital care, 
                        nursing home care, domiciliary care, or medical 
                        services; and
                            ``(ii) requires medical services to 
                        complete treatment incident to such care or 
                        services; or
                    ``(C) a veteran described in section 1710(a)(2)(E) 
                of this title, or a veteran who is in receipt of 
                increased pension, or additional compensation or 
                allowances based on the need of regular aid and 
                attendance or by reason of being permanently housebound 
                (or who, but for the receipt of retired pay, would be 
                in receipt of such pension, compensation, or 
                allowance), if the Secretary has determined, based on 
                an examination by a physician employed by the 
                Department (or, in areas where no such physician is 
                available, by a physician carrying out such function 
                under a contract or fee arrangement), that the medical 
                condition of such veteran precludes appropriate 
                treatment in Department facilities.
            ``(3) Hospital care or medical services in a non-Department 
        facility for the treatment of medical emergencies which pose a 
        serious threat to the life or health of a veteran receiving 
        medical services in a Department facility or nursing home care 
        under section 1720 of this title until such time following the 
        furnishing of care in the non-Department facility as the 
        veteran can be safely transferred to a Department facility.
            ``(4) Hospital care for women veterans.
            ``(5) Hospital care, or medical services that will obviate 
        the need for hospital admission, for veterans in a State (other 
        than the Commonwealth of Puerto Rico) not contiguous to the 
        contiguous States, except that the annually determined hospital 
        patient load and incidence of the furnishing of medical 
        services to veterans hospitalized or treated at the expense of 
        the Department in Government and non-Department facilities in 
        each such noncontiguous State shall be consistent with the 
        patient load or incidence of the furnishing of medical services 
        for veterans hospitalized or treated by the Department within 
        the 48 contiguous States and the Commonwealth of Puerto Rico.
            ``(6) Diagnostic services necessary for determination of 
        eligibility for, or of the appropriate course of treatment in 
        connection with, furnishing medical services at independent 
        Department outpatient clinics to obviate the need for hospital 
        admission.
            ``(7) Outpatient dental services and treatment, and related 
        dental appliances, for a veteran described in section 
        1712(a)(1)(F) of this title.
            ``(8) Diagnostic services (on an inpatient or outpatient 
        basis) for observation or examination of a person to determine 
        eligibility for a benefit or service under laws administered by 
        the Secretary.
            ``(9) Hospital care and medical services for veterans 
        described in subsection (d)(1).
            ``(10) Hospital care and medical services, including 
        counseling and related mental health services under section 
        1712A, for veterans meeting eligibility criteria for such care 
        and services under the Patient-Centered Community Care program 
        of the Department, as in effect on the day before the effective 
        date under section 3(j)(2) of the `Improving Veterans Care in 
        the Community Act of 2016'.
            ``(11) Hospital care and medical services for veterans at 
        medical facilities of the Indian Health Service or under the 
        Tribal Health Program pursuant to sharing agreements entered 
        into between the Department and the Indian Health Service, 
        Indian tribes, or tribal organizations.
            ``(12) Hospital care and medical services for veterans at 
        medical facilities of the Department of Defense pursuant to 
        sharing agreements entered into between the Department of 
        Veterans Affairs and the Department of Defense.
            ``(13) Hospital care and medical services for veterans at 
        other non-Department facilities pursuant to sharing agreements 
        entered into between the Department of Veterans Affairs and 
        such facilities.
            ``(14) Hospital care and medical services for veterans at 
        institutions affiliated with the Department under section 7302 
        of this title pursuant to contracts entered into with such 
        institutions.
            ``(15) Reimbursement for payment made by veterans described 
        in subsection (d)(2), or on behalf of such veterans, for 
        emergency treatment furnished such veterans in non-Department 
        facilities.
    ``(f) Referral for Services.--(1) Except as provided in paragraph 
(2), a veteran is required to obtain a referral from a primary care 
provider of the Department to receive specialty care services under 
this section. Any such referral shall be reviewed by the director of 
the medical facility at which the primary care physician is located.
    ``(2)(A) A veteran described in any of clauses (i) through (v) of 
subsection (d)(1)(A) is not required to obtain a referral for specialty 
care services furnished under subsection (e)(9).
    ``(B) In the case of a veteran described in subparagraph (A), the 
Secretary, through the Non-VA Care Coordination Program of the 
Department, shall notify the primary care provider of the veteran of 
the specialty care appointment and ensure that the primary care 
provider receives materials from the specialty care provider necessary 
to update the medical record of the veteran as appropriate.
    ``(g) Payment Rates.--(1) Subject to paragraph (2), the Secretary 
shall establish uniform rates for payment or reimbursement for care and 
services under this section.
    ``(2) In entering into contracts or agreements under this section 
with individuals and entities specified in subsection (c), the 
Secretary shall--
            ``(A) negotiate rates for the furnishing of care and 
        services under this section; and
            ``(B) reimburse the individual or entity for such care and 
        services at the rates negotiated pursuant to subparagraph (A) 
        as provided in such contract or agreement.
    ``(3)(A) Except as provided in subparagraph (B), rates negotiated 
under paragraph (2)(A) 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 or services.
    ``(B)(i) The Secretary may negotiate a rate that is more than the 
rate paid by the United States as described in subparagraph (A) with 
respect to the furnishing of care or services under this section to a 
veteran who resides in a highly rural area.
    ``(ii) With respect to furnishing care or services under this 
section in Alaska, the Alaska Fee Schedule of the Department of 
Veterans Affairs shall be followed, except for when another payment 
agreement, including a contract or provider agreement, is in place.
    ``(iii) With respect to furnishing care or services under this 
section in a State with an All-Payer Model Agreement under section 
1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3)) that 
became effective on January 1, 2014, the Medicare payment rates under 
subparagraph (A) shall be calculated based on the payment rates under 
such agreement.
    ``(iv) In this subparagraph, the term `highly rural area' means an 
area located in a county that has fewer than seven individuals residing 
in that county per square mile.
    ``(h) Administration.--(1) Except as provided in paragraph (2), the 
Secretary shall be responsible for administering the Care in the 
Community Program through the Non-VA Care Coordination Program of the 
Department.
    ``(2) The Non-VA Care Coordination Program, through each medical 
center of the Department, shall be responsible for handling the day-to-
day administration of the Care in the Community Program, including 
finding providers, scheduling appointments, paying providers, and 
disseminating information to providers.
    ``(i) Outreach.--The Non-VA Care Coordination Program, through each 
medical center of the Department, shall be responsible for conducting 
outreach to health care providers and veterans located in the area 
covered by the medical center regarding care and services available 
under the Care in the Community Program.
    ``(j) Definitions.--In this section:
            ``(1) The term `emergency treatment' means medical care or 
        services furnished, in the judgment of the Secretary--
                    ``(A) when Department or other Federal facilities 
                are not feasibly available and an attempt to use them 
                beforehand would not be reasonable;
                    ``(B) when such care or services are rendered in a 
                medical emergency of such nature that a prudent 
                layperson reasonably expects that delay in seeking 
                immediate medical attention would be hazardous to life 
                or health; and
                    ``(C) until--
                            ``(i) such time as the veteran can be 
                        transferred safely to a Department facility or 
                        other Federal facility and such facility is 
                        capable of accepting such transfer; or
                            ``(ii) such time as a Department facility 
                        or other Federal facility accepts such transfer 
                        if--
                                    ``(I) at the time the veteran could 
                                have been transferred safely to a 
                                Department facility or other Federal 
                                facility, no Department facility or 
                                other Federal facility agreed to accept 
                                such transfer; and
                                    ``(II) the non-Department facility 
                                in which such medical care or services 
                                was furnished made and documented 
                                reasonable attempts to transfer the 
                                veteran to a Department facility or 
                                other Federal facility.
            ``(2) The term `health-plan contract' includes any of the 
        following:
                    ``(A) An insurance policy or contract, medical or 
                hospital service agreement, membership or subscription 
                contract, or similar arrangement under which health 
                services for individuals are provided or the expenses 
                of such services are paid.
                    ``(B) An insurance program described in section 
                1811 of the Social Security Act (42 U.S.C. 1395c) or 
                established by section 1831 of that Act (42 U.S.C. 
                1395j).
                    ``(C) A State plan for medical assistance approved 
                under title XIX of such Act (42 U.S.C. 1396 et seq.).
                    ``(D) A workers' compensation law or plan described 
                in section 1729(a)(2)(A) of this title.
            ``(3) The term `third party' means any of the following:
                    ``(A) A Federal entity.
                    ``(B) A State or political subdivision of a State.
                    ``(C) An employer or an employer's insurance 
                carrier.
                    ``(D) An automobile accident reparations insurance 
                carrier.
                    ``(E) A person or entity obligated to provide, or 
                to pay the expenses of, health services under a health-
                plan contract.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 17 of such title is amended by inserting 
        after the item relating to section 1703 the following new item:

``1703A. Care in the Community Program.''.
    (b) Implementation.--
            (1) Initial implementation.--
                    (A) In general.--Except as provided in subparagraph 
                (B), during the one-year period beginning on the 
                effective date specified in subsection (j)(1), the 
                Secretary of Veterans Affairs shall implement the Care 
                in the Community Program under section 1703A of title 
                38, United States Code, as added by subsection (a), by 
                prioritizing the use of such Program in areas where 
                there are medical facilities of the Department that are 
                experiencing issues with quality of care or lack of 
                capacity.
                    (B) Exception for reimbursement for emergency 
                care.--Reimbursement for payment made by veterans, or 
                on behalf of such veterans, for emergency treatment 
                furnished such veterans in non-Department facilities 
                under section 1703A(e)(15) of such title, as so added, 
                shall be implemented in all areas on and after the 
                effective date specified in subsection (j)(1).
            (2) Full implementation.--
                    (A) In general.--On and after the end of the one-
                year period described in paragraph (1)(A), the 
                Secretary shall implement the Care in the Community 
                Program under section 1703A of such title, as so added, 
                in all areas.
                    (B) Report.--If the Secretary is unable to 
                implement the Care in the Community Program under 
                section 1703A of such title, as so added, in all areas 
                as of the date that is two years after the date of the 
                enactment of this Act, the Secretary shall submit to 
                Congress a report on why the Secretary is unable to 
                implement such program in all areas.
    (c) Funding.--Amounts required to carry out the Care in the 
Community Program under section 1703A of title 38, United States Code, 
as added by subsection (a), shall be derived from the Medical Services 
account of the Department of Veterans Affairs or the Veterans Choice 
Fund under section 802 of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note), 
as amended by section 4 of this Act.
    (d) Treatment of Other Programs, Contracts, and Agreements.--
            (1) In general.--Any contract, sharing agreement, or other 
        agreement entered into under any provision of law that 
        authorizes individuals eligible for health care from the 
        Department of Veterans Affairs to receive such care at 
        facilities that are not facilities of the Department of 
        Veterans Affairs shall be administered under the Care in the 
        Community Program under section 1703A of title 38, United 
        States Code, as added by subsection (a), on and after the 
        effective date specified in subsection (j)(2).
            (2) Treatment of patient-centered community care program.--
        On and after the effective date specified in subsection (j)(2), 
        the Secretary of Veterans Affairs may not carry out the 
        Patient-Centered Community Care program of the Department of 
        Veterans Affairs (commonly known as ``PC3'') and shall ensure 
        that beneficiaries under such program are able to receive care 
        under the Care in the Community Program under section 1703A of 
        title 38, United States Code, as added by subsection (a).
    (e) Patient Advocacy.--Section 7309A of title 38, United States 
Code, is amended--
            (1) by redesignating subsections (e) and (f) as subsections 
        (f) and (g), respectively;
            (2) by inserting after subsection (d) the following new 
        subsection (e):
    ``(e) Education on Non-Department Care.--The Director shall develop 
and administer a program of education on the Care in the Community 
Program under section 1703A of this title that ensures veterans 
understand--
            ``(1) how the Care in the Community Program works;
            ``(2) how veterans become eligible for the Care in the 
        Community Program; and
            ``(3) all issues regarding payment for care under the Care 
        in the Community Program, including when the Department is the 
        primary payer and when the Department is not the primary payer 
        and the veteran may have to pay out of pocket.''.
    (f) Extension of Existing Program.--Subsection (p) of section 101 
of the Veterans Access, Choice, and Accountability Act of 2014 (Public 
Law 113-146; 38 U.S.C. 1701 note) is amended to read as follows:
    ``(p) Authority To Furnish Care and Services.--The Secretary may 
not use the authority under this section to furnish care and services 
after the date on which the Secretary submits to Congress the 
certification described in section 3(j)(2) of the Improving Veterans 
Care in the Community Act of 2016.''.
    (g) Report on Administrators of Choice Program.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Comptroller General of the 
        United States shall submit to Congress a report on 
        administrators used by the Department of Veterans Affairs to 
        administer section 101 of the Veterans Access, Choice, and 
        Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 
        note).
            (2) Elements.--The report required by paragraph (1) shall 
        include the following:
                    (A) An assessment of the performance of 
                administrators, including--
                            (i) an examination of the ability of 
                        administrators to schedule appointments, 
                        reimburse providers in a timely manner, and 
                        meet the performance standards established by 
                        their contract with the Department of Veterans 
                        Affairs; and
                            (ii) an assessment of the satisfaction of 
                        veterans with the work of administrators.
                    (B) An assessment of the overlap of the work of 
                administrators with the work of employees of the 
                Department, especially employees at medical centers and 
                community-based outpatient clinics and employees of the 
                Non-VA Care Coordination Program.
                    (C) An assessment of the resources needed by the 
                Department to function without administrators in 
                implementing the Care in the Community Program under 
                section 1703A of title 38, United States Code, as added 
                by subsection (a).
    (h) Repeal of Superseded Authority for Contracts for Care in Non-
Department Facilities.--
            (1) In general.--Section 1703 of title 38, United States 
        Code, is repealed.
            (2) Conforming amendments.--
                    (A) Dental care.--Section 1712(a) of such title is 
                amended--
                            (i) in paragraph (3), by striking ``under 
                        clause (1), (2), or (5) of section 1703(a) of 
                        this title'' and inserting ``under section 
                        1703A of this title''; and
                            (ii) in paragraph (4)(A), in the first 
                        sentence, by striking ``section 1703 of this 
                        title'' each place it appears and inserting 
                        ``section 1703A of this title''.
                    (B) Readjustment counseling.--Section 1712A(e)(1) 
                of such title is amended by striking ``sections 
                1703(a)(2) and 1710(a)(1)(B)'' and inserting ``sections 
                1703A and 1710(a)(1)(B)''.
                    (C) Death in department facility.--Section 
                2303(a)(2)(B)(i) of such title is amended by striking 
                ``in accordance with section 1703'' and inserting 
                ``under section 1703A''.
                    (D) Medicare provider agreements.--Section 
                1866(a)(1)(L) of the Social Security Act (42 U.S.C. 
                1395cc(a)(1)(L)) is amended by striking ``under section 
                1703 of title 38'' and inserting ``under section 1703A 
                of title 38''.
    (i) Repeal of Superseded Authority for Emergency Treatment 
Reimbursement.--
            (1) Non-service connected.--
                    (A) In general.--Section 1725 of such title is 
                repealed.
                    (B) Conforming amendments.--
                            (i) Medical care collections fund.--Section 
                        1729A(b) of such title is amended--
                                    (I) by striking paragraph (5); and
                                    (II) by redesignating paragraphs 
                                (6) through (10) as paragraphs (5) 
                                through (9), respectively.
                            (ii) Medical care for survivors and 
                        dependents.--Section 1781(a)(4) of such title 
                        is amended by striking ``section 1725(f)'' and 
                        inserting ``section 1703(j)''.
                            (iii) Health care for family members of 
                        veterans stationed at camp lejeune, north 
                        carolina.--Section 1787(b)(3) of such title is 
                        amended by striking ``section 1725(f)'' and 
                        inserting ``section 1703(j)''.
            (2) Service connected.--Section 1728 of such title is 
        repealed.
    (j) Effective Dates.--
            (1) Community care program.--The amendments made by 
        subsections (a), (d), and (i) shall take effect on the date 
        that is one year after the date of the enactment of this Act.
            (2) Repeal of superseded authority.--
                    (A) In general.--The amendments made by subsection 
                (h) shall take effect on the date on which the 
                Secretary of Veterans Affairs certifies to Congress 
                that the Secretary is fully implementing the Care in 
                the Community Program under section 1703A of title 38, 
                United States Code, as added by subsection (a).
                    (B) Publication.--The Secretary shall publish the 
                date specified in subparagraph (A) in the Federal 
                Register not later than 90 days before such date.

SEC. 4. AUTHORIZATION OF USE OF CERTAIN AMOUNTS APPROPRIATED TO THE 
              VETERANS CHOICE FUND FOR OTHER NON-DEPARTMENT OF VETERANS 
              AFFAIRS CARE.

    Section 802 of the Veterans Access, Choice, and Accountability Act 
of 2014 (Public Law 113-146; 128 Stat. 1801) is amended--
            (1) in subsection (c)--
                    (A) in paragraph (1)--
                            (i) by striking ``Except as provided by 
                        paragraph (3), any'' and inserting ``Any''; and
                            (ii) by striking ``by the Secretary of 
                        Veterans Affairs'' and all that following 
                        through the period at the end and inserting 
                        ``by the Secretary of Veterans Affairs--
                    ``(A) to carry out section 101, including, subject 
                to paragraph (2), any administrative requirements of 
                such section;
                    ``(B) to furnish health care to individuals under 
                chapter 17 of title 38, United States Code, at non-
                Department facilities, including pursuant to non-
                Department provider programs other than the program 
                under section 101; and
                    ``(C) to furnish disability examinations conducted 
                by health care providers that are not health care 
                providers of the Department of Veterans Affairs.''; and
                    (B) by striking paragraph (3) and inserting the 
                following new paragraphs:
            ``(3) Treatment of amounts.--Amounts made available to the 
        Secretary under this section shall be in addition to amounts 
        made available to the Secretary in the Medical Services account 
        of the Department of Veterans Affairs.
            ``(4) Definitions.--In this subsection:
                    ``(A) The term `non-Department facilities' has the 
                meaning given that term in section 1701 of title 38, 
                United States Code.
                    ``(B) The term `non-Department provider programs' 
                has the meaning given that term in section 4002(d) of 
                the VA Budget and Choice Improvement Act (Public Law 
                114-41; 129 Stat. 462).''; and
            (2) in subsection (d)(1), by striking ``only for the 
        program'' and all that follows through the period at the end 
        and inserting ``only for the purposes specified in subsection 
        (c)(1).''.

SEC. 5. INTERDISCIPLINARY PANEL ON DEVELOPMENT OF CLINICAL APPEALS 
              PROCESS FOR THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall establish 
an interdisciplinary panel to assist the Secretary in developing a new 
clinical appeals process for resolving disputes regarding health care 
furnished under the laws administered by the Secretary of Veterans 
Affairs, including health care furnished under the Care in the 
Community Program under section 1703A of title 38, United States Code, 
as added by section 3(a).
    (b) Duties.--The duties of the interdisciplinary panel established 
under subsection (a) are the following:
            (1) To create one process throughout the Veterans Health 
        Administration for resolving clinical disputes.
            (2) To ensure that such process provides veterans with the 
        ability to have an external review at his or her discretion.
            (3) To ensure that such process is as comprehensive and 
        fair as processes provided by private health insurers and other 
        Federal agencies.
    (c) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
on the activities of the interdisciplinary panel under this section.

SEC. 6. COMPTROLLER GENERAL REPORTS ON THE DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) Report on Clinical Operations of Veterans Health 
Administration.--Not later than one year after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to Congress a report on the clinical operations of the 
Veterans Health Administration that includes an assessment of the 
following:
            (1) How such clinical operations can be enhanced.
            (2) What the Secretary of Veterans Affairs can do to ensure 
        that highly trained clinical staff of the Department of 
        Veterans Affairs are able to perform at the top of their 
        license and are not performing tasks that should be done by 
        support staff.
            (3) What the Secretary can do to improve the hiring, 
        retaining, and training of medical support assistants of the 
        Department.
    (b) Report on Travel Benefits Program of Department.--Not later 
than one year after the date of the enactment of this Act, the 
Comptroller General shall submit to Congress a report on the travel 
benefits program of the Department under sections 111 and 111A of title 
38, United States Code, that includes an assessment of the following:
            (1) How such program can be improved to ensure that 
        veterans are reimbursed for travel in a timely manner.
            (2) What the Secretary can do to speed up the reimbursement 
        process while protecting against fraud, waste, and abuse.
            (3) Whether there should be changes made to eligibility for 
        such program.
    (c) Report on Office of Congressional and Legislative Affairs of 
Department.--Not later than one year after the date of the enactment of 
this Act, the Comptroller General shall submit to Congress a report on 
the structure and management of the Office of Congressional and 
Legislative Affairs of the Department, including an assessment of what 
the Secretary can do to enable the Office to provide more timely, 
complete responses to requests from Congress.
    (d) Report on Payment for Non-Department Care.--Not later than one 
year after the date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report on payment by the Department 
for health care furnished to veterans through non-Department health 
care providers, including an assessment of the following:
            (1) When the Department should be the primary payer for 
        such care and when the Department should be the secondary payer 
        for such care.
            (2) How payment by the Department for such care should 
        function with coverage under private insurance, coverage under 
        the Medicare program, and other health coverage options.

SEC. 7. ESTABLISHMENT OF PAYMENT AND ACCESS COMMISSION FOR VETERANS 
              HEALTH ADMINISTRATION.

    (a) Establishment.--Subchapter II of chapter 73 of title 38, United 
States Code, is amended by inserting after section 7330A the following 
new section:
``Sec. 7330B. Payment and Access Commission
    ``(a) Establishment.--There is established in the Veterans Health 
Administration a Payment and Access Commission (in this section 
referred to as the `VHAPAC').
    ``(b) Membership.--(1) The VHAPAC shall be composed of 17 members 
appointed by the Comptroller General of the United States.
    ``(2)(A) The membership of VHAPAC shall include the following:
            ``(i) Veterans who have received care from the Veterans 
        Health Administration.
            ``(ii) Individuals with national recognition for their 
        expertise with respect to--
                    ``(I) Federal health programs;
                    ``(II) health finance and economics;
                    ``(III) actuarial science;
                    ``(IV) health plans and integrated delivery 
                systems;
                    ``(V) reimbursement for health care; or
                    ``(VI) health information technology.
            ``(iii) Providers of health services, public health, and 
        other related fields.
            ``(iv) Physicians and other health professionals.
            ``(v) Individuals with expertise in the delivery of health 
        services.
    ``(B) Members of the VHAPAC shall be appointed in a manner to 
provide a mix of different professions, broad geographic 
representation, and a balance between urban and rural representation.
    ``(C) Members described in clauses (iv) and (v) of subparagraph (A) 
shall include representatives of veterans, including veterans with 
disabilities, and caregivers.
    ``(D) Individuals who are directly involved in the provision, or 
management of the delivery, of items and services furnished by the 
Department shall not constitute a majority of the membership of the 
VHAPAC.
    ``(E) The Comptroller General of the United States shall establish 
a system for public disclosure by members of the VHAPAC of financial 
and other potential conflicts of interest relating to such members.
    ``(F) Members of the VHAPAC shall be treated as employees of 
Congress for purposes of applying title I of the Ethics in Government 
Act of 1978 (5 U.S.C. App.).
    ``(3)(A) The terms of members of the VHAPAC shall be for three 
years except that the Comptroller General of the United States shall 
designate staggered terms for the members first appointed.
    ``(B) Any member appointed to fill a vacancy occurring before the 
expiration of the term for which the member's predecessor was appointed 
shall be appointed only for the remainder of that term. A member may 
serve after the expiration of that member's term until a successor has 
taken office. A vacancy in the VHAPAC shall be filled in the manner in 
which the original appointment was made.
    ``(4)(A) While serving on the business of the VHAPAC (including 
travel time), a member of the VHAPAC shall be entitled to compensation 
at the per diem equivalent of the rate provided for level IV of the 
Executive Schedule under section 5315 of title 5.
    ``(B) While serving on the business of the VHAPAC (including travel 
time) away from home and the member's regular place of business, a 
member may be allowed travel expenses, as authorized by the Chairman of 
the VHAPAC.
    ``(5) The Comptroller General of the United States shall designate 
a Chairman and Vice Chairman of the VHAPAC, at the time of appointment 
of each such individual as a member of the VHAPAC, for the term of 
appointment of such individual, except that in the case of vacancy of 
the Chairmanship or Vice Chairmanship, the Comptroller General may 
designate another member for the remainder of the term of the Chairman 
or Vice Chairman, as the case may be.
    ``(6) The VHAPAC shall meet at the call of the Chairman.
    ``(c) Duties.--(1) The VHAPAC shall--
            ``(A) review policies of the Veterans Health Administration 
        affecting access of veterans to health care, including topics 
        affected by the Care in the Community Program under section 
        1703A of this title;
            ``(B) make recommendations to Congress, the Secretary, and 
        States concerning such access policies; and
            ``(C) by not later than March 15 of each year (beginning 
        with 2018), submit to Congress a report containing--
                    ``(i) the results of reviews conducted under 
                subparagraph (A);
                    ``(ii) recommendations made under subparagraph (B); 
                and
                    ``(iii) an examination of the implications of 
                changes in health care delivery in the United States 
                and in the market for health care services on health 
                care furnished under the laws administered by the 
                Secretary.
    ``(2) Specifically, the VHAPAC shall review and assess the 
following:
            ``(A) Payment policies regarding payment by the Secretary 
        for health care furnished under the laws administered by the 
        Secretary by non-Department providers, including--
                    ``(i) the factors affecting expenditures for the 
                efficient provision of items and services in different 
                sectors, including the process for updating payments to 
                medical, dental, and health professionals, hospitals, 
                residential and long-term care providers, providers of 
                home and community based services, Federally-qualified 
                health centers and rural health clinics (as defined in 
                section 1905(l) of the Social Security Act (42 U.S.C. 
                1396d(l))), managed care entities, and providers of 
                other covered items and services;
                    ``(ii) payment methodologies; and
                    ``(iii) the relationship of such factors and 
                methodologies to access and quality of care for 
                veterans receiving care under the laws administered by 
                the Secretary (including how such factors and 
                methodologies enable such veterans to obtain the 
                services for which they are eligible, affect provider 
                supply, and affect providers that serve a 
                disproportionate share of low-income and other 
                vulnerable populations).
            ``(B) Eligibility policies for receiving care under the 
        laws administered by the Secretary, including the Care in the 
        Community Program under section 1703A of this title.
            ``(C) Enrollment and retention processes for receiving care 
        under the laws administered by the Secretary.
            ``(D) Policies of the Department relating to the quality of 
        care furnished under the laws administered by the Secretary.
            ``(E) The effect of payment policies described in 
        subparagraph (A), especially under the Care in the Community 
        Program under section 1703A of this title, on access to items 
        and services for veterans and the implications of changes in 
        health care delivery in the United States and in the general 
        market for health care items and services on such payment 
        policies.
            ``(F) The interaction of policies of the Department, 
        including under the Care in the Community Program, with the 
        Medicaid and Medicare programs, private insurance, and other 
        forms of health care coverage such as the TRICARE program (as 
        defined in section 1072 of title 10), including with respect to 
        how such interactions affect access to services, payments, and 
        dual eligible individuals.
            ``(G) The effect of policies of the Department on access to 
        covered items and services, including policies relating to 
        transportation and preventive, acute, and long-term services 
        and supports.
    ``(3) The VHAPAC shall--
            ``(A) review national data regarding health care furnished 
        under the laws administered by the Secretary; and
            ``(B) submit reports and recommendations to Congress and 
        the Secretary, including recommendations that do not require 
        changes in law.
    ``(4)(A) The VHAPAC shall create an early-warning system to 
identify provider shortage areas, as well as other factors that 
adversely affect, or have the potential to adversely affect, access to 
care by, or the health care status of, veterans eligible for health 
care under the laws administered by the Secretary.
    ``(B) The VHAPAC shall include in the annual report required under 
paragraph (1)(C) a description of all areas and factors identified 
under subparagraph (A) with respect to the period addressed in the 
report.
    ``(5)(A) If the Secretary submits to Congress (or a committee of 
Congress) a report that is required by law and that relates to policies 
relating to access to health care under the laws administered by the 
Secretary, including with respect to payment policies for non-
Department providers, the Secretary shall transmit a copy of the report 
to the VHAPAC. The VHAPAC shall review the report and, not later than 
180 days after the date of submittal by the Secretary of the report to 
Congress, shall submit to the appropriate committees of Congress and 
the Secretary written comments on such report. Such comments may 
include such recommendations as the VHAPAC determines appropriate.
    ``(B) The VHAPAC shall review regulations of the Department 
relating to the provision of health care and may comment through 
submission of a report to the appropriate committees of Congress and 
the Secretary on any such regulations that affect access, quality, or 
efficiency of health care under the laws administered by the Secretary.
    ``(6)(A) The VHAPAC shall consult periodically with the chairmen 
and ranking minority members of the appropriate committees of Congress 
regarding the agenda of the VHAPAC and progress towards achieving that 
agenda.
    ``(B) The VHAPAC may conduct additional reviews and submit 
additional reports to the appropriate committees of Congress from time 
to time on such topics relating to the policies and programs of the 
Veterans Health Administration as may be requested by the chairmen and 
ranking minority members of such committees and as the VHAPAC 
determines appropriate.
    ``(7) The VHAPAC shall transmit to the Secretary a copy of each 
report submitted under this subsection and shall make such reports 
available to the public.
    ``(8) With respect to each recommendation contained in a report 
submitted under paragraph (1)(C), each member of the VHAPAC shall vote 
on the recommendation, and the VHAPAC shall include, by member, the 
results of that vote in the report containing the recommendation.
    ``(9) Before making any recommendations under this section, the 
VHAPAC shall examine the budget consequences of such recommendations, 
directly or through consultation with appropriate expert entities, and 
shall submit with any recommendations a report on the consequences to 
the Federal Government of the recommendations.
    ``(10)(A) The VHAPAC shall consult with the Medicare Payment 
Advisory Commission established under section 1805 of the Social 
Security Act (42 U.S.C. 1395b-6) in carrying out its duties under this 
section, as the VHAPAC determines appropriate.
    ``(B) The VHAPAC and the Medicare Payment Advisory Commission shall 
have access to deliberations and records of the other such entity, 
respectively, upon the request of the other such entity.
    ``(11) The VHAPAC shall regularly consult with veterans service 
organizations in carrying out its duties under this section, including 
with respect to developing processes for carrying out such duties, and 
shall ensure that input from veterans service organizations is taken 
into account and represented in recommendations and reports prepared by 
the VHAPAC.
    ``(12) The authority of the VHAPAC to make recommendations under 
this section shall not affect, or be considered to duplicate, the 
authority of the Secretary to carry out Federal responsibilities with 
respect to programs of the Veterans Health Administration.
    ``(13) In this subsection:
            ``(A) The term `appropriate committees of Congress' means 
        the Committee on Veterans' Affairs of the Senate and the 
        Committee on Veterans' Affairs of the House of Representatives.
            ``(B) The term `veterans service organization' means an 
        organization recognized by the Secretary for the representation 
        of veterans under section 5902 of this title.
    ``(d) Personnel.--(1) Subject to such review as the Comptroller 
General of the United States determines necessary to assure the 
efficient administration of the VHAPAC, the VHAPAC may--
            ``(A) employ and fix the compensation of an Executive 
        Director (subject to the approval of the Comptroller General) 
        and such other personnel as may be necessary to carry out the 
        duties of the VHAPAC (without regard to the provisions of title 
        5 governing appointments in the competitive service);
            ``(B) seek such assistance and support as may be required 
        in the performance of the duties of the VHAPAC from appropriate 
        Federal and State departments and agencies;
            ``(C) enter into contracts or make other arrangements as 
        may be necessary for the conduct of the work of the VHAPAC 
        (without regard to section 6101 of title 41);
            ``(D) make advance, progress, and other payments which 
        relate to the work of the VHAPAC;
            ``(E) provide transportation and subsistence for persons 
        serving without compensation; and
            ``(F) prescribe such rules and regulations as the VHAPAC 
        determines necessary with respect to the internal organization 
        and operation of the VHAPAC.
            ``(2)(A) For purposes of pay (other than pay of members of 
        the VHAPAC) and employment benefits, rights, and privileges, 
        all personnel of the VHAPAC shall be treated as if they were 
        employees of the United States Senate.
            ``(B) Physicians serving as personnel of the VHAPAC may be 
        provided a physician comparability allowance by the VHAPAC in 
        the same manner as Government physicians may be provided such 
        an allowance by an agency under section 5948 of title 5, and 
        for such purpose subsection (i) of such section shall apply to 
        the VHAPAC in the same manner as it applies to the Tennessee 
        Valley Authority.
    ``(e) Powers.--(1) The VHAPAC may secure directly from any Federal 
agency information in the possession of that agency necessary to enable 
the VHAPAC to carry out this section. Upon request of the Chairman, the 
head of that agency shall furnish that information to the VHAPAC on an 
agreed upon schedule.
    ``(2) In order to carry out its functions, the VHAPAC shall--
            ``(A) if possible, use existing information, both published 
        and unpublished, collected and assessed either by personnel of 
        the VHAPAC or under other arrangements made in accordance with 
        this section;
            ``(B) carry out, or award grants or contracts for, original 
        research and experimentation if existing information is 
        inadequate; and
            ``(C) adopt procedures allowing any interested party to 
        submit information for use by the VHAPAC in making reports and 
        recommendations.
    ``(3) The Comptroller General of the United States shall have 
unrestricted access to all deliberations, records, and nonproprietary 
data of the VHAPAC, immediately upon request.
    ``(4) The VHAPAC shall be subject to periodic audit by the 
Comptroller General.
    ``(f) Funding.--The VHAPAC shall submit requests for appropriations 
in the same manner as the Comptroller General of the United States 
submits requests for appropriations, but amounts appropriated for the 
VHAPAC shall be separate from amounts appropriated for the Comptroller 
General.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 73 of such title is amended by inserting after the item 
relating to section 7330A the following new item:

``7330B. Payment and Access Commission.''.
                                 <all>