[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4242 Reported in House (RH)]

<DOC>





                                                 Union Calendar No. 444
115th CONGRESS
  2d Session
                                H. R. 4242

                          [Report No. 115-585]

To amend title 38, United States Code, to establish a permanent VA Care 
           in the Community Program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 3, 2017

  Mr. Roe of Tennessee (for himself, Mr. Coffman, Mr. Wenstrup, Mrs. 
 Radewagen, Mr. Bost, Mr. Poliquin, Mr. Arrington, Mr. Rutherford, Mr. 
Higgins of Louisiana, Mr. Bergman, Mr. Banks of Indiana, Miss Gonzalez-
Colon of Puerto Rico, Mr. Bilirakis, Mr. Dunn, Mr. Walz, Ms. Kuster of 
New Hampshire, Miss Rice of New York, Mr. Correa, Mr. Sablan, Ms. Esty 
of Connecticut, Mr. Peters, Mr. O'Rourke, Mr. Takano, and Ms. Brownley 
of California) introduced the following bill; which was referred to the 
                     Committee on Veterans' Affairs

                             March 5, 2018

 Additional sponsors: Mr. Emmer, Mr. Stewart, Mr. Messer, Mr. Hudson, 
            Mr. Johnson of Ohio, and Mr. Webster of Florida

                             March 5, 2018

  Reported with an amendment, committed to the Committee of the Whole 
       House on the State of the Union, and ordered to be printed
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]
    [For text of introduced bill, see copy of bill as introduced on 
                           November 3, 2017]


_______________________________________________________________________

                                 A BILL


 
To amend title 38, United States Code, to establish a permanent VA Care 
           in the Community Program, and for other purposes.


 


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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``VA Care in the 
Community Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

  TITLE I--IMPROVED ACCESS FOR VETERANS TO NON-DEPARTMENT OF VETERANS 
                          AFFAIRS MEDICAL CARE

Sec. 101. Assignment of veterans to primary care providers.
Sec. 102. Establishment of VA Care in the Community Program.
Sec. 103. Veterans Care Agreements.
Sec. 104. Modification of authority to enter into agreements with State 
                            homes to provide nursing home care.
Sec. 105. Department of Veterans Affairs electronic interface for 
                            processing of medical claims.
Sec. 106. Funding for VA Care in the Community Program.
Sec. 107. Termination of certain provisions authorizing medical care to 
                            veterans through non-Department of Veterans 
                            Affairs providers.
Sec. 108. Implementation and transition.
Sec. 109. Transplant procedures with live donors and related services.

                 TITLE II--OTHER ADMINISTRATIVE MATTERS

Sec. 201. Reimbursement for emergency ambulance services.
Sec. 202. Improvement of care coordination for veterans through 
                            exchange of certain medical records.
Sec. 203. Elimination of copayment offset.
Sec. 204. Use of Department of Veterans Affairs Medical Care 
                            Collections Fund for certain improvements 
                            in collections.
Sec. 205. Department of Veterans Affairs health care productivity 
                            improvement.
Sec. 206. Licensure of health care professionals of the Department of 
                            Veterans Affairs providing treatment via 
                            telemedicine.
Sec. 207. Establishment of processes to ensure safe opioid prescribing 
                            practices by non-Department of Veterans 
                            Affairs health care providers.
Sec. 208. Assessment of health care furnished by the Department to 
                            veterans who live in the territories.
Sec. 209. Oversight and accountability of financial processes of 
                            Department of Veterans Affairs.
Sec. 210. Authority for Department of Veterans Affairs Center for 
                            Innovation for Care and Payment.

          TITLE III--IMPROVEMENTS TO RECRUITMENT OF PHYSICIANS

Sec. 301. Designated scholarships for physicians and dentists under 
                            Department of Veterans Affairs Health 
                            Professional Scholarship Program.
Sec. 302. Establishment of Department of Veterans Affairs Specialty 
                            Education Loan Repayment Program.
Sec. 303. Veterans healing veterans medical access and scholarship 
                            program.

  TITLE I--IMPROVED ACCESS FOR VETERANS TO NON-DEPARTMENT OF VETERANS 
                          AFFAIRS MEDICAL CARE

SEC. 101. ASSIGNMENT OF VETERANS TO PRIMARY CARE PROVIDERS.

    Section 1706 of title 38, United States Code, is amended by adding 
at the end the following new subsection:
    ``(d)(1) Except as provided in section 1703A of this title, in 
furnishing primary care under this chapter, the Secretary shall assign 
each eligible veteran to--
            ``(A) a patient-aligned care team of the Department; or
            ``(B) a dedicated primary care provider of the Department 
        as a part of any other model of providing consistent primary 
        care determined appropriate by the Secretary.
    ``(2) Each patient-aligned care team of the Department shall 
consist of a team of health care professionals of the Department who--
            ``(A) provide to each eligible veteran comprehensive 
        primary care in partnership with the veteran; and
            ``(B) manage and coordinate comprehensive hospital care and 
        medical services consistent with the goals of care agreed upon 
        by the veteran and team.
    ``(3) The Secretary shall ensure that an eligible veteran is not 
simultaneously assigned to more than one patient-aligned care team or 
dedicated primary care provider under this subsection at a single 
location, including by establishing procedures in the event a primary 
care provider retires or is otherwise no longer able to treat the 
veteran. In the case of an eligible veteran who resides in more than 
one location, the Secretary may assign such veteran to a patient-
aligned care team or dedicated primary care provider at each such 
location.
    ``(4) The term `eligible veteran' means a veteran who--
            ``(A) is enrolled in the patient enrollment system of the 
        Department established and operated under section 1705(a) of 
        this title; and
            ``(B) has--
                    ``(i) been furnished hospital care or medical 
                services at or through a Department facility on at 
                least one occasion during the two-year period preceding 
                the date of the determination of eligibility; or
                    ``(ii) requested a first-time appointment for 
                hospital care or medical services at a Department 
                facility.''.

SEC. 102. ESTABLISHMENT OF VA CARE IN THE COMMUNITY PROGRAM.

    (a) Establishment of Program.--
            (1) In general.--Chapter 17 of title 38, United States 
        Code, is amended by inserting after section 1703 the following 
        new section:
``Sec. 1703A. VA Care in the Community Program
    ``(a) Program.--(1) Subject to the availability of appropriations 
for such purpose, hospital care, medical services, and extended care 
services under this chapter shall be furnished to an eligible veteran 
through contracts or agreements authorized under subsection (d), or 
contracts or agreements, including national contracts or agreements, 
authorized under section 8153 of this title or any other provision of 
law administered by the Secretary, with network providers for the 
furnishing of such care and services to veterans.
    ``(2) Subject to subsection (b), an eligible veteran may select a 
provider of such care or services from among network providers.
    ``(3) The Secretary shall coordinate the furnishing of care and 
services under this section to eligible veterans.
    ``(4)(A) In carrying out this section, the Secretary shall 
establish regional networks of network providers. The Secretary shall 
determine, and may modify, such regions based on the capacity and 
market assessments of Veterans Integrated Service Networks conducted 
under subsection (k) or upon recognized need.
    ``(B) The Secretary may enter into one or more contracts for the 
purposes of managing the operations of the regional networks and for 
the delivery of care pursuant to this section.
    ``(C) The Secretary shall--
            ``(i) verify upon enrollment, and annually thereafter, that 
        network providers have not been excluded from participation in 
        other federally funded health care programs; and
            ``(ii) submit to the Committees on Veterans' Affairs of the 
        House of Representatives and the Senate an annual report on the 
        results of such verifications.
    ``(b) Primary and Specialty Care.--(1)(A) If the Secretary is 
unable to assign an eligible veteran to a patient-aligned care team or 
dedicated primary care provider under section 1706(d) of this title 
because the Secretary determines such a care team or provider at a 
Department facility is not available--
            ``(i) the Secretary shall consult with the veteran 
        regarding available primary care providers from among network 
        providers that are located in the regional network in which the 
        veteran resides or a regional network that is adjacent to the 
        regional network in which the veteran resides; and
            ``(ii) the veteran may select one of the available primary 
        care providers to serve as the dedicated primary care provider 
        of the veteran.
    ``(B) In determining whether a patient-aligned care team or 
dedicated provider under section 1706(d) of this title is available for 
assignment to a veteran, the Secretary shall take into consideration 
each of the following:
            ``(i) Whether the veteran faces an unusual or excessive 
        burden in accessing such patient-aligned care team or dedicated 
        provider at a medical facility of the Department including with 
        respect to--
                    ``(I) geographical challenges;
                    ``(II) environmental factors, including roads that 
                are not accessible to the general public, traffic, or 
                hazardous weather;
                    ``(III) a medical condition of the veteran; or
                    ``(IV) such other factors as determined by the 
                Secretary.
            ``(ii) Whether the veteran reasonably believes that the 
        assignment of a particular care team or provider to the veteran 
        would detrimentally affect the patient-provider relationship 
        and result in sub-optimal care to the veteran.
            ``(iii) Whether the panel size of the care team or provider 
        is at such a number that it would result in difficulty for the 
        veteran in accessing timely care or in sub-optimal care to the 
        veteran.
            ``(iv) Whether the veteran resides in a State where the 
        Department does not operated a full-service medical facility.
    ``(C) If the Secretary determines that a patient-aligned care team 
or dedicated primary care provider at a Department facility has become 
available for assignment to an eligible veteran who had been assigned 
to a network provider under subparagraph (A), the Secretary shall 
provide the veteran with the option of reassignment to the team or 
provider at the Department facility.
    ``(D) In the case of an eligible veteran who is assigned to a 
network provider under subparagraph (A), the Secretary shall reevaluate 
such assignment not earlier than one year after a veteran makes a 
selection under subparagraph (A)(ii), and on an annual basis 
thereafter, to--
            ``(i) determine whether the Secretary is able to assign to 
        the veteran a patient-aligned care team or dedicated primary 
        care provider under section 1706(d) of this title; and
            ``(ii) in consultation with and upon approval of the 
        veteran, make such assignment if able.
    ``(2)(A)(i) Except as provided in clause (ii), the Secretary may 
only furnish specialty hospital care, medical services, or extended 
care services to an eligible veteran under this section pursuant to a 
referral for such specialty care or services made by the primary care 
provider of the veteran.
    ``(ii) The Secretary may designate specialties which shall be 
exempt from the requirement under clause (i).
    ``(B) The Secretary shall determine whether to furnish specialty 
hospital care, medical services, or extended care services to an 
eligible veteran pursuant to subparagraph (A)--
            ``(i) at a medical facility of the Department that is 
        within a reasonable distance of the residence of the veteran, 
        as determined by the Secretary;
            ``(ii) by a network provider that, to the greatest extent 
        practicable, is located in the regional network in which the 
        veteran resides or a regional network that is adjacent to the 
        regional network in which the veteran resides; or
            ``(iii) pursuant to an agreement described in subparagraph 
        (C).
    ``(C) An agreement described in this subparagraph is an agreement 
entered into by the Secretary with a network provider under which--
            ``(i) specialty hospital care, medical services, or 
        extended care services are furnished to an eligible veteran 
        pursuant to subparagraph (A)--
                    ``(I) at a medical facility of the Department by a 
                network provider possessing the appropriate 
                credentials, as determined by the Secretary; or
                    ``(II) at a facility of a network provider by a 
                health care provider of the Department; and
            ``(ii) such specialty care or services are so furnished 
        either--
                    ``(I) in accordance with this section with respect 
                to fees and payments for care and services furnished 
                under subsection (a); or
                    ``(II) at no cost to the United States.
    ``(D) In making the determination under subparagraph (B), the 
Secretary shall give priority to medical facilities and health care 
providers of the Department but shall take into account--
            ``(i) whether the veteran faces an unusual or excessive 
        burden in accessing such specialty hospital care, medical 
        services, or extended care services at a medical facility of 
        the Department, including with respect to--
                    ``(I) geographical challenges;
                    ``(II) environmental factors, such as roads that 
                are not accessible to the general public, traffic, or 
                hazardous weather;
                    ``(III) a medical condition of the veteran; or
                    ``(IV) such other factors as determined by the 
                Secretary;
            ``(ii) whether the primary care provider of the veteran 
        recommends that such specialty hospital care, medical services, 
        or extended care services should be furnished by a network 
        provider;
            ``(iii) whether the veteran resides in a State where the 
        Department does not operate a full-service medical facility; 
        and
            ``(iv) in the case of a veteran who requires an organ or 
        bone marrow transplant, whether the veteran has, in the opinion 
        of the primary care provider of the veteran, a medically 
        compelling reason to travel outside the region of the Organ 
        Procurement and Transplantation Network, established under 
        section 372 of the National Organ Transplantation Act (Public 
        Law 98-507; 42 U.S.C. 274), in which the veteran resides, to 
        receive such transplant.
    ``(E) The Secretary shall ensure that each medical facility of the 
Department processes referrals for specialty hospital care, medical 
services, or extended care services in a standardized manner, including 
with respect to the organization of the program office responsible for 
such referrals.
    ``(F) In carrying out this section, the Secretary shall establish a 
process to review any disagreement between an eligible veteran and the 
Department, or between an eligible veteran and a health care provider 
of the Department, regarding the eligibility of the veteran to receive 
care or services from a network provider under this section or the 
assignment of a primary care provider of the Department to the veteran. 
In reviewing a disagreement under such process with respect to the 
availability of and assignment to a patient aligned care team or 
dedicated primary care provider, the Secretary may give deference to 
the veteran with respect to any determination under subsection 
(b)(1)(B)(ii).
    ``(G)(i) The Secretary shall develop procedures to ensure that 
assigning a veteran to a patient-aligned care team or dedicated primary 
care provider under subparagraph (A), (C), or (D) does not adversely 
affect the continuity or quality of care for the veteran during the 
transition.
    ``(ii) Procedures under clause (i) shall provide for--
            ``(I) the appointment of a contact in the Department for 
        the veteran who shall provide information to the veteran and 
        resolve issues regarding the transition;
            ``(II) the transfer of relevant medical records;
            ``(III) coordination of care between providers;
            ``(IV) the continued treatment of chronic or current 
        episodes of care (by means including medication, subspecialty 
        care, and ancillary services); and
            ``(V) any other action the Secretary determines is 
        necessary.
    ``(c) Episodes of Care.--(1) The Secretary shall ensure that, at 
the election of an eligible veteran who receives hospital care, medical 
services, or extended care services from a network provider in an 
episode of care under this section, the veteran receives such care or 
services from that network provider, another network provider selected 
by the veteran, or a health care provider of the Department, through 
the completion of the episode of care, including all specialty and 
ancillary services determined necessary by the provider as part of the 
treatment recommended in the course of such care or services. In making 
such determination with respect to necessary specialty and ancillary 
services provided by a network provider, the network provider shall 
consult with the Secretary, acting through the program office of the 
appropriate medical facility.
    ``(2) In cases of episodes of care that the Secretary determines 
case management to be appropriate, the Secretary shall provide case 
management to an eligible veteran who receives hospital care, medical 
services, or extended care services from a network provider for such 
episodes of care. The Secretary may provide such case management 
through the Veterans Health Administration or through an entity that 
manages the operations of the regional networks pursuant to subsection 
(a)(4)(B).
    ``(d) Care and Services Through Contracts and Agreements.--(1) The 
Secretary shall enter into contracts or agreements, including national 
contracts or agreements for, but not limited to, dialysis, for 
furnishing care and services to eligible veterans under this section 
with network providers.
    ``(2)(A) In entering into a contract or agreement under paragraph 
(1) with a network provider, the Secretary shall--
            ``(i) negotiate rates for the furnishing of care and 
        services under this section; and
            ``(ii) reimburse the provider for such care and services at 
        the rates negotiated pursuant to clause (i) as provided in such 
        contract or agreement.
    ``(B)(i) Except as provided in paragraph (3), 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 or services.
    ``(ii) In determining the rates under the Medicare Program under 
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for 
purposes of clause (i), in the case of care or services furnished by a 
provider of services with respect to which such rates are determined 
under a fee schedule to which the area wage index under section 
1886(d)(3)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(E)) 
applies, such area wage index so applied to such provider of services 
may not be less than 1.00.
    ``(C) In carrying out paragraph (2), the Secretary may incorporate 
the use of value-based reimbursement models to promote the provision of 
high-quality care.
    ``(3)(A) With respect to the furnishing of care or services under 
this section to an eligible veteran who resides in a highly rural area 
(as defined under the rural-urban commuting area codes developed by the 
Secretary of Agriculture and the Secretary of Health and Human 
Services), the Secretary of Veterans Affairs may negotiate a rate that 
is more than the rate paid by the United States as described in 
paragraph (2)(B).
    ``(B) With respect to furnishing care or services under this 
section in Alaska, the Alaska Fee Schedule of the Department of 
Veterans Affairs will be followed, except for when another payment 
agreement, including a contract or provider agreement, is in place.
    ``(C) With respect to furnishing care or services under this 
section in a State with an All-Payer Model Agreement under the Social 
Security Act that became effective on or after January 1, 2014, the 
Medicare payment rates under paragraph (2)(B) shall be calculated based 
on the payment rates under such agreement, or any such successor 
agreement.
    ``(D) With respect to furnishing care or services under this 
section in a location in which the Secretary determines that adjusting 
the rate paid by the United States as described in paragraph (2)(B) is 
appropriate, the Secretary may negotiate such an adjusted rate.
    ``(E) With respect to furnishing care or services under this 
section in a location or in a situation in which an exception to the 
rates paid by the United States 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 applies, the Secretary may follow such exception.
    ``(F) With respect to furnishing care or services under this 
section for care or services not covered under the Medicare Program 
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), 
the Secretary shall establish a schedule of fees for such care or 
services.
    ``(G) With respect to furnishing care or services under this 
section pursuant to an agreement with a tribal or Federal entity, the 
Secretary may negotiate a rate that is more than the rate paid by the 
United States as described in paragraph (2)(B).
    ``(4) For the furnishing of care or services pursuant to a contract 
or agreement under paragraph (1), a network provider may not collect 
any amount that is greater than the rate negotiated pursuant to 
paragraph (2)(A).
    ``(5)(A) If, in the course of an episode of care under this 
section, any part of care or services is furnished by a medical 
provider who is not a network provider, the Secretary may compensate 
such provider for furnishing such care or services.
    ``(B) The Secretary shall make reasonable efforts to enter into a 
contract or agreement under this section with any provider who is 
compensated pursuant to subparagraph (A).
    ``(e) Prompt Payment Standard.--(1) The Secretary shall ensure that 
claims for payments for hospital care, medical services, or extended 
care services furnished under this section are processed in accordance 
with this subsection, regardless of whether such claims are--
            ``(A) made by a network provider to the Secretary;
            ``(B) made by a network provider to a regional network 
        operated by a contractor pursuant to subsection (a)(4)(B); or
            ``(C) made by such a regional network to the Secretary.
    ``(2) A covered claimant that seeks payment for hospital care, 
medical services, or extended care services furnished under this 
section shall submit to the covered payer a claim for payment not later 
than--
            ``(A) with respect to a claim by a network provider, 180 
        days after the date on which the network provider furnishes 
        such care or services; or
            ``(B) with respect to a claim by a regional network 
        operated by a contractor, 180 days after the date on which the 
        contractor pays the network provider for furnishing such care 
        or services.
    ``(3) Notwithstanding chapter 39 of title 31 or any other provision 
of law, the covered payer shall pay a covered claimant for hospital 
care, medical services, or extended care services furnished under this 
section--
            ``(A) in the case of a clean claim submitted to the covered 
        payer on paper, not later than 45 calendar days after receiving 
        the claim; or
            ``(B) in the case of a clean claim submitted to the covered 
        payer electronically, not later than 30 calendar days after 
        receiving the claim.
    ``(4)(A) If the covered payer denies a claim submitted by a covered 
claimant under paragraph (1), the covered payer shall notify the 
covered claimant of the reason for denying the claim and the additional 
information, if any, that may be required to process the claim--
            ``(i) in the case of a clean claim submitted to the covered 
        payer on paper, not later than 45 calendar days after receiving 
        the claim; or
            ``(ii) in the case of a clean claim submitted to the 
        covered payer electronically, not later than 30 calendar days 
        after receiving the claim.
    ``(B) Upon receipt by the covered payer of additional information 
specified under subparagraph (A) relating to a claim, the covered payer 
shall pay, deny, or otherwise adjudicate the claim, as appropriate, not 
later than 30 calendar days after receiving such information.
    ``(5)(A) If the covered payer has not paid a covered claimant or 
denied a clean claim for payment by the covered claimant under this 
subsection during the appropriate period specified in this subsection, 
such clean claim shall be considered overdue.
    ``(B) If a clean claim for payment by a covered claimant is 
considered overdue under subparagraph (A), in addition to the amount 
the covered payer owes the covered claimant under the claim, the 
covered payer shall owe the covered claimant an interest penalty amount 
that shall--
            ``(i) be prorated daily;
            ``(ii) accrue from the date the payment was overdue;
            ``(iii) be payable at the time the claim is paid; and
            ``(iv) be computed at the rate of interest established by 
        the Secretary of the Treasury, and published in the Federal 
        Register, for interest payments under subsections (a)(1) and 
        (b) of section 7109 of title 41 that is in effect at the time 
        the covered payer accrues the obligation to pay the interest 
        penalty amount.
    ``(6)(A) If the covered payer overpays a covered claimant for 
hospital care, medical services, or extended care services furnished 
under this section--
            ``(i) the covered payer shall deduct the amount of any 
        overpayment from payments due to the covered claimant after the 
        date of such overpayment; or
            ``(ii) if the covered payer determines that there are no 
        such payments due after the date of the overpayment, the 
        covered claimant shall refund the amount of such overpayment 
        not later than 30 days after such determination.
    ``(B)(i) Before deducting any amount from a payment to a covered 
claimant under subparagraph (A), the covered payer shall ensure that 
the covered claimant is provided an opportunity--
            ``(I) to dispute the existence or amount of any overpayment 
        owed to the covered payer; and
            ``(II) to request a compromise with respect to any such 
        overpayment.
    ``(ii) The covered payer may not make any deduction from a payment 
to a covered claimant under subparagraph (A) unless the covered payer 
has made reasonable efforts to notify the covered claimant of the 
rights of the covered claimant under subclauses (I) and (II) of clause 
(i).
    ``(iii) Upon receiving a dispute under subclause (I) of clause (i) 
or a request under subclause (II) of such clause, the covered payer 
shall make a determination with respect to such dispute or request 
before making any deduction under subparagraph (A) unless the time 
required to make such a determination would jeopardize the ability of 
the covered payer to recover the full amount owed to the covered payer.
    ``(7) Notwithstanding any other provision of law, the Secretary 
may, except in the case of a fraudulent claim, false claim, or 
misrepresented claim, compromise any claim of an amount owed to the 
United States under this section.
    ``(8) This subsection shall apply only to payments made on a claims 
basis and not to capitation or other forms of periodic payments to 
network providers.
    ``(9) A network provider that provides hospital care, medical 
services, or extended care services to an eligible veteran under this 
section may not seek any payment for such care or services from the 
eligible veteran.
    ``(10) With respect to making a payment for hospital care or 
medical services furnished to an eligible veteran by a network provider 
under this section--
            ``(A) the Secretary may not require receipt by the veteran 
        or the Department of a medical record under subsection (g) 
        detailing such care or services before a covered payer makes a 
        payment for such care or services; and
            ``(B) the Secretary may require that the network provider 
        attests to such care or services so provided before a covered 
        payer makes a payment for such care or services.
    ``(f) Cost-Sharing.--(1) The Secretary shall require an eligible 
veteran to pay a copayment for the receipt of care or services under 
this section only if such eligible veteran would be required to pay a 
copayment for the receipt of such care or services at a medical 
facility of the Department or from a health care provider of the 
Department under this chapter.
    ``(2) The amount of a copayment charged under paragraph (1) may not 
exceed the amount of the copayment that would be payable by such 
eligible veteran for the receipt of such care or services at a medical 
facility of the Department or from a health care provider of the 
Department under this chapter.
    ``(3) In any case in which an eligible veteran is furnished 
hospital care or medical services under this section for a non-service-
connected disability described in subsection (a)(2) of section 1729 of 
this title, the Secretary shall recover or collect reasonable charges 
for such care or services from a health-plan contract described in 
section 1705A in accordance with such section 1729.
    ``(g) Medical Records.--(1) The Secretary shall ensure that any 
network provider that furnishes care or services under this section to 
an eligible veteran--
            ``(A) upon the request of the veteran, provides to the 
        veteran the medical records related to such care or services; 
        and
            ``(B) upon the completion of the provision of such care or 
        services to such veteran, provides to the Department the 
        medical records for the veteran furnished care or services 
        under this section in a timeframe and format specified by the 
        Secretary for purposes of this section, except the Secretary 
        may not require that any payment by the Secretary to the 
        eligible provider be contingent on such provision of medical 
        records.
    ``(2) To the extent practicable, the Secretary shall submit to a 
network provider that furnishes care or services under this section to 
an eligible veteran the medical records of such eligible veteran that 
are maintained by the Department and are relevant to such care or 
services.
    ``(3) To the extent practicable, the Secretary shall--
            ``(A) ensure that the medical records shared under 
        paragraphs (1) and (2) are shared in an electronic format 
        accessible by network providers and the Department through an 
        Internet website; and
            ``(B) provide to network providers access to the electronic 
        patient health record system of the Department, or successor 
        system, for the purpose of furnishing care or services under 
        this section.
    ``(h) Use of Card.--The Secretary shall ensure that the veteran 
health identification card, or such successor identification card, 
includes sufficient information to act as an identification card for an 
eligible entity or other non-Department facility. The Secretary may not 
use any amounts made available to the Secretary to issue separate 
identification cards solely for the purpose of carrying out this 
section.
    ``(i) Prescription Medications.--(1) With respect to requirements 
relating to the licensing or credentialing of a network provider, the 
Secretary shall ensure that the network provider is able to submit 
prescriptions for pharmaceutical agents on the formulary of the 
Department to pharmacies of the Department in a manner that is 
substantially similar to the manner in which the network provider 
submits prescriptions to retail pharmacies.
    ``(2) Nothing in this section shall be construed to affect the 
process of the Department for filling and paying for prescription 
medications.
    ``(j) Quality of Care.--In carrying out this section, the Secretary 
shall use the quality of care standards set forth or used by the 
Centers for Medicare & Medicaid Services or other quality of care 
standards, as determined by the Secretary.
    ``(k) Capacity and Commercial Market Assessments.--(1) On a 
periodic basis, but not less often than once every three years, the 
Secretary shall conduct an assessment of the capacity of each Veterans 
Integrated Service Network and medical facility of the Department to 
furnish care or services under this chapter. Each such assessment 
shall--
            ``(A) identify gaps in furnishing such care or services at 
        such Veterans Integrated Service Network or medical facility;
            ``(B) identify how such gaps can be filled by--
                    ``(i) entering into contracts or agreements with 
                network providers under this section or with entities 
                under other provisions of law;
                    ``(ii) making changes in the way such care and 
                services are furnished at such Veterans Integrated 
                Service Network or medical facility, including but not 
                limited to--
                            ``(I) extending hours of operation;
                            ``(II) adding personnel; or
                            ``(III) expanding space through 
                        construction, leasing, or sharing of health 
                        care facilities; and
                    ``(iii) the building or realignment of Department 
                resources or personnel;
            ``(C) forecast, based on future projections and historical 
        trends, both the short- and long-term demand in furnishing care 
        or services at such Veterans Integrated Service Network or 
        medical facility and assess how such demand affects the needs 
        to use such network providers;
            ``(D) include a commercial health care market assessment of 
        designated catchment areas in the United States conducted by a 
        nongovernmental entity; and
            ``(E) consider the unique ability of the Federal Government 
        to retain a presence in an area otherwise devoid of commercial 
        health care providers or from which such providers are at a 
        risk of leaving.
    ``(2) The Secretary shall submit each assessment under paragraph 
(1) to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate and shall make each such assessment 
publicly available.
    ``(l) Allocation of Funds.--The Secretary shall develop a plan for 
the allocation of funds in the Medical Community Care account.
    ``(m) Reports on Rates.--Not later than December 31, 2019, and 
annually thereafter during each of the subsequent three years, the 
Secretary shall submit to the Committees on Veterans' Affairs of the 
House of Representatives and the Senate a report detailing, for the 
fiscal year preceding the fiscal year during which the report is 
submitted, the rates paid by the Secretary for hospital care, medical 
services, or extended care services under this section that, pursuant 
to subsection (d)(3), are more than the rates described in subsection 
(d)(2)(B) for the same care or services.
    ``(n) Definitions.--In this section:
            ``(1) The term `clean claim' means a claim submitted--
                    ``(A) to the covered payer by a covered claimant 
                for purposes of payment by the covered payer of 
                expenses for hospital care or medical services 
                furnished under this section;
                    ``(B) that contains substantially all of the 
                required elements necessary for accurate adjudication, 
                without requiring additional information from the 
                network provider; and
                    ``(C) in such a nationally recognized format as may 
                be prescribed by the Secretary for purposes of paying 
                claims for hospital care or medical services furnished 
                under this section.
            ``(2) The term `covered claimant' means--
                    ``(A) a network provider that submits a claim to 
                the Secretary for purposes of payment by the Secretary 
                of expenses for hospital care or medical services 
                furnished under this section; or
                    ``(B) a regional network operated by a contractor 
                pursuant to subsection (a)(4)(B) that submits a claim 
                to the Secretary for purposes of reimbursement for a 
                payment made by the contractor to a network provider 
                for hospital care or medical services furnished under 
                this section.
            ``(3) The term `covered payer' means--
                    ``(A) a regional network operated by a contractor 
                pursuant to subsection (a)(4)(B) with respect to a 
                claim made by a network provider to the contractor for 
                purposes of payment by the contractor of expenses for 
                hospital care or medical services furnished under this 
                section; or
                    ``(B) the Secretary with respect to--
                            ``(i) a claim made by a network provider to 
                        the Secretary for purposes of payment by the 
                        Secretary of expenses for hospital care or 
                        medical services furnished under this section; 
                        and
                            ``(ii) a claim made by a regional network 
                        operated by a contractor pursuant to subsection 
                        (a)(4)(B) for purposes of reimbursement for a 
                        payment described by subparagraph (A).
            ``(4) The term `eligible veteran' means a veteran who--
                    ``(A) is enrolled in the patient enrollment system 
                of the Department established and operated under 
                section 1705(a) of this title; and
                    ``(B) has--
                            ``(i) been furnished hospital care or 
                        medical services at or through a Department 
                        facility on at least one occasion during the 
                        two-year period preceding the date of the 
                        determination of eligibility; or
                            ``(ii) requested a first-time appointment 
                        for hospital care or medical services at a 
                        Department facility.
            ``(5) The term `fraudulent claim' means a claim by a 
        network provider for reimbursement under this section that 
        includes an intentional and deliberate misrepresentation of a 
        material fact or facts that is intended to induce the Secretary 
        to pay an amount that was not legally owed to the provider.''.
            (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. VA Care in the Community Program.''.
    (b) Conforming Amendments.--The Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113-146) is amended--
            (1) in section 101(p)(1) (38 U.S.C. 1701 note), by 
        inserting before the period at the end the following: ``or the 
        date on which the Secretary certifies to the Committees on 
        Veterans' Affairs of the House of Representatives and the 
        Senate that the Secretary is fully implementing section 1703A 
        of title 38, United States Code, whichever occurs first''; and
            (2) in section 208(1), by striking ``section 101'' and 
        inserting ``section 1703A of title 38, United States Code''.
    (c) Definitions.--Section 1701 of title 38, United States Code, is 
amended by adding at the end the following new paragraphs:
            ``(11) The term `network provider' means any of the 
        following health care providers that have entered into a 
        contract or agreement under which the provider agrees to 
        furnish care and services to eligible veterans under section 
        1703A of this title:
                    ``(A) Any health care provider or supplier that is 
                participating in the Medicare Program under title XVIII 
                of the Social Security Act (42 U.S.C. 1395 et seq.), 
                including any physician furnishing services under such 
                program.
                    ``(B) Any provider of items and services receiving 
                payment under a State plan under title XIX of such Act 
                (42 U.S.C. 1396 et seq.) or a waiver of such a plan.
                    ``(C) 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))).
                    ``(D) The Department of Defense.
                    ``(E) The Indian Health Service.
                    ``(F) Any health care provider that is an academic 
                affiliate of the Department.
                    ``(G) Any health care provider not otherwise 
                covered under any of subparagraphs (A) through (F) that 
                meets criteria established by the Secretary for 
                purposes of such section.
            ``(12) The term `VA Care in the Community Program' means 
        the program under which the Secretary furnishes hospital care 
        or medical services to veterans through network providers 
        pursuant to section 1703A of this title.''.
    (d) Transition of Provision of Care.--This Act, and the amendments 
made by this Act, may not be construed to affect the obligations of the 
Secretary of Veterans Affairs under contracts and agreements for the 
provision of hospital care, medical services, and extended care 
services entered into before the date of the enactment of this Act at 
the terms and rates contained in such contracts and agreements.

SEC. 103. VETERANS CARE AGREEMENTS.

    (a) In General.--Subchapter I of chapter 17 of title 38, United 
States Code, is further amended by inserting after section 1703A, as 
added by section 102, the following new section:
``Sec. 1703B. Veterans Care Agreements with non-network providers
    ``(a) Veterans Care Agreements.--(1) In addition to furnishing 
hospital care, medical services, or extended care services under this 
chapter at facilities of the Department or under contracts or 
agreements entered into pursuant to section 1703A of this title or any 
other provision of law other than this section, the Secretary may 
furnish such care and services to eligible veterans through the use of 
agreements, to be known as `Veterans Care Agreements', entered into 
under this section by the Secretary with eligible non-network 
providers.
    ``(2) The Secretary may enter into a Veterans Care Agreement under 
this section with an eligible non-network provider if the Secretary 
determines that--
            ``(A) the provision of the hospital care, medical services, 
        or extended care services at a Department facility is 
        impracticable or inadvisable because of the medical condition 
        of the veteran, the travel involved, or the nature of the care 
        or services required, or a combination of such factors; and
            ``(B) such care or services are not available to be 
        furnished by a non-Department health care provider under a 
        contract or agreement entered into pursuant to a provision of 
        law other than this section.
    ``(3)(A) In accordance with subparagraphs (C) and (D), the 
Secretary shall review each Veterans Care Agreement with a non-network 
provider to determine whether it is practical or advisable to, instead 
of carrying out such agreement--
            ``(i) provide at a Department facility the hospital care, 
        medical services, or extended care services covered by such 
        agreement; or
            ``(ii) enter into an agreement with the provider under 
        section 1703A of this title to provide such care or services.
    ``(B) If the Secretary determines pursuant to a review of a 
Veterans Care Agreement under subparagraph (A) that it is practical or 
advisable to provide hospital care, medical services, or extended care 
services at a Department facility, or enter into an agreement under 
section 1703A of this title to provide such care or services, as the 
case may be, the Secretary--
            ``(i) may not renew the Veterans Care Agreement; and
            ``(ii) shall take such actions as are necessary to 
        implement such determination.
    ``(C) This paragraph shall apply with respect to Veterans Care 
Agreements entered into with a non-network provider whose gross annual 
revenue, as determined under subsection (b)(1), exceeds--
            ``(i) $3,000,000, in the case of a provider that furnishes 
        homemaker or home health aide services; or
            ``(ii) $1,000,000, in the case of any other provider.
    ``(D) The Secretary shall conduct each review of a Veterans Care 
Agreement under subparagraph (A) as follows:
            ``(i) Once during the 18-month period beginning on the date 
        that is six months after date on which the agreement is entered 
        into.
            ``(ii) Not less than once during each four-year period 
        beginning on the date on which the review under subparagraph 
        (A) is conducted.
    ``(b) Eligible Non-Network Providers.--A provider of hospital care, 
medical services, or extended care services is eligible to enter into a 
Veterans Care Agreement under this section if the Secretary determines 
that the provider meets the following criteria:
            ``(1) The gross annual revenue of the provider under 
        contracts or agreements entered into with the Secretary in the 
        year preceding the year in which the provider enters into the 
        Veterans Care Agreement does not exceed--
                    ``(A) $5,000,000 (as adjusted in a manner similar 
                to amounts adjusted pursuant to section 5312 of this 
                title), in the case of a provider that furnishes 
                homemaker or home health aide services; or
                    ``(B) $2,000,000 (as so adjusted), in the case of 
                any other provider.
            ``(2) The provider is not a network provider and does not 
        otherwise provide hospital care, medical services, or extended 
        care services to patients pursuant to a contract entered into 
        with the Department.
            ``(3) The provider is--
                    ``(A) a provider of services that has enrolled and 
                entered into a provider agreement under section 1866(a) 
                of the Social Security Act (42 U.S.C. 1395cc(a));
                    ``(B) a physician or supplier that has enrolled and 
                entered into a participation agreement under section 
                1842(h) of such Act (42 U.S.C. 1395u(h));
                    ``(C) a provider of items and services receiving 
                payment under a State plan under title XIX of such Act 
                (42 U.S.C. 1396 et seq.) or a waiver of such a plan;
                    ``(D) an Aging and Disability Resource Center, an 
                area agency on aging, or a State agency (as defined in 
                section 102 of the Older Americans Act of 1965 (42 
                U.S.C. 3002)); or
                    ``(E) a center for independent living (as defined 
                in section 702 of the Rehabilitation Act of 1973 (29 
                U.S.C. 796a)).
            ``(4) The provider is certified pursuant to the process 
        established under subsection (c)(1).
            ``(5) Any additional criteria determined appropriate by the 
        Secretary.
    ``(c) Provider Certification.--(1) The Secretary shall establish a 
process for the certification of eligible providers to enter into 
Veterans Care Agreements under this section that shall, at a minimum, 
set forth the following:
            ``(A) Procedures for the submission of applications for 
        certification and deadlines for actions taken by the Secretary 
        with respect to such applications.
            ``(B) Standards and procedures for the approval and denial 
        of certifications and the revocation of certifications.
            ``(C) Procedures for assessing eligible providers based on 
        the risk of fraud, waste, and abuse of such providers similar 
        to the level of screening under section 1866(j)(2)(B) of the 
        Social Security Act (42 U.S.C. 1395(j)(2)(B)) and the standards 
        set forth under section 9.104 of title 48, Code of Federal 
        Regulations, or any successor regulation.
            ``(D) Requirement for denial or revocation of certification 
        if the Secretary determines that the otherwise eligible 
        provider is--
                    ``(i) excluded from participation in a Federal 
                health care program (as defined in section 1128B(f) of 
                the Social Security Act (42 U.S.C. 1320a-7b(f))) under 
                section 1128 or 1128A of the Social Security Act (42 
                U.S.C. 1320a-7 and 1320a-7a); or
                    ``(ii) identified as an excluded source on the list 
                maintained in the System for Award Management, or any 
                successor system.
            ``(E) Procedures by which a provider whose certification is 
        denied or revoked under the procedures established under this 
        subsection will be identified as an excluded source on the list 
        maintained in the System for Award Management, or successor 
        system, if the Secretary determines that such exclusion is 
        appropriate.
    ``(2) To the extent practicable, the Secretary shall establish the 
procedures under paragraph (1) in a manner that takes into account any 
certification process administered by another department or agency of 
the Federal Government that an eligible provider has completed by 
reason of being a provider described in any of subparagraphs (A) 
through (E) of subsection (b)(4).
    ``(3) The Secretary shall--
            ``(A) verify upon enrollment, and annually thereafter, that 
        eligible providers have not been excluded from participation in 
        other federally funded health care programs; and
            ``(B) submit to the Committees on Veterans' Affairs of the 
        House of Representatives and the Senate an annual report on the 
        results of such verifications.
    ``(d) Terms of Agreements.--Subsections (d), (e), (f), and (g) of 
section 1703A of this title shall apply with respect to a Veterans Care 
Agreement in the same manner such subsections apply to contracts and 
agreements entered into under such section.
    ``(e) Exclusion of Certain Federal Contracting Provisions.--(1) 
Notwithstanding any other provision of law, the Secretary may enter 
into a Veterans Care Agreement using procedures other than competitive 
procedures.
    ``(2)(A) Except as provided in subparagraph (B) and unless 
otherwise provided in this section, an eligible non-network provider 
that enters into a Veterans Care Agreement under this section is not 
subject to, in the carrying out of the agreement, any provision of law 
that providers of services and suppliers under the original Medicare 
fee-for-service program under parts A and B of 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.) are not subject 
to.
    ``(B) In addition to the provisions of laws covered by subparagraph 
(A), an eligible non-network provider shall be subject to the following 
provisions of law:
            ``(i) Any applicable law regarding integrity, ethics, or 
        fraud, or that subject a person to civil or criminal penalties.
            ``(ii) Section 1352 of title 31, except for the filing 
        requirements under subsection (b) of such section.
            ``(iii) Section 4705 or 4712 of title 41, and any other 
        applicable law regarding the protection of whistleblowers.
            ``(iv) Section 4706(d) of title 41.
            ``(v) Title VII of the Civil Rights Act of 1964 (42 U.S.C. 
        2000e et seq.) to the same extent as such title applies with 
        respect to the eligible non-network provider in providing care 
        or services through an agreement or arrangement other than 
        under a Veterans Care Agreement.
    ``(f) Termination of a Veterans Care Agreement.--(1) An eligible 
non-network provider may terminate a Veterans Care Agreement with the 
Secretary under this section at such time and upon such notice to the 
Secretary as the Secretary may specify for purposes of this section.
    ``(2) The Secretary may terminate a Veterans Care Agreement with an 
eligible non-network provider under this section at such time and upon 
such notice to the provider as the Secretary may specify for the 
purposes of this section, if the Secretary determines necessary.
    ``(g) Disputes.--(1) The Secretary shall establish administrative 
procedures for providers with which the Secretary has entered into a 
Veterans Care Agreement to present any dispute arising under or related 
to the agreement.
    ``(2) Before using any dispute resolution mechanism under chapter 
71 of title 41 with respect to a dispute arising under a Veterans Care 
Agreement under this section, a provider must first exhaust the 
administrative procedures established by the Secretary under paragraph 
(1).
    ``(h) Authority To Pay for Other Authorized Services.--(1) If, in 
the course of an episode of care for which hospital care, medical 
services, or extended care services are furnished to an eligible 
veteran pursuant to a Veterans Care Agreement, any part of such care or 
services is furnished by a medical provider who is not an eligible non-
network provider or a network provider, the Secretary may compensate 
such provider for furnishing such care or services.
    ``(2) The Secretary shall make reasonable efforts to enter into a 
Veterans Care Agreement with any provider who is compensated pursuant 
to paragraph (1).
    ``(i) Annual Reports.--(1) Not later than December 31 of the year 
following the fiscal year in which the Secretary first enters into a 
Veterans Care Agreement under this section, and each year thereafter, 
the Secretary shall submit to the appropriate congressional committees 
an annual report that includes a list of all Veterans Care Agreements 
entered into as of the date of the report.
    ``(2) The requirement to submit a report under paragraph (1) shall 
terminate on the date that is five years after the date of the 
enactment of this section.
    ``(j) Quality of Care.--In carrying out this section, the Secretary 
shall use the quality of care standards set forth or used by the 
Centers for Medicare & Medicaid Services or other quality of care 
standards, as determined by the Secretary.
    ``(k) Delegation.--The Secretary may delegate the authority to 
enter into or terminate a Veterans Care Agreement to an official of the 
Department at a level not below the Director of a Veterans Integrated 
Service Network or the Director of a Network Contracting Office.
    ``(l) Definitions.--In this section:
            ``(1) The term `appropriate congressional committees' 
        means--
                    ``(A) the Committees on Veterans' Affairs of the 
                House of Representatives and the Senate; and
                    ``(B) the Committees on Appropriations of the House 
                of Representatives and the Senate.
            ``(2) The term `eligible veteran' has the meaning given 
        such term in section 1703A(m) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1703A, as added by section 102, the following new item:

``1703B. Veterans Care Agreements with non-network providers.''.

SEC. 104. MODIFICATION OF AUTHORITY TO ENTER INTO AGREEMENTS WITH STATE 
              HOMES TO PROVIDE NURSING HOME CARE.

    (a) Use of Agreements.--
            (1) In general.--Paragraph (1) of section 1745(a) of title 
        38, United States Code, is amended, in the matter preceding 
        subparagraph (A), by striking ``a contract (or agreement under 
        section 1720(c)(1) of this title)'' and inserting ``an 
        agreement''.
            (2) Payment.--Paragraph (2) of such section is amended by 
        striking ``contract (or agreement)'' each place it appears and 
        inserting ``agreement''.
    (b) Treatment of Certain Laws.--Such section is amended by adding 
at the end the following new paragraph:
    ``(4)(A) An agreement under this section may be entered into 
without regard to any law that would require the Secretary to use 
competitive procedures in selecting the party with which to enter into 
the agreement.
    ``(B)(i) Except as provided in clause (ii) and unless otherwise 
provided in this section or in regulations prescribed pursuant to this 
section, a State home that enters into an agreement under this section 
is not subject to, in the carrying out of the agreement, any law to 
which providers of services and suppliers are not subject under the 
original Medicare fee-for-service program under parts A and B of 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.).
    ``(ii) The exclusion under clause (i) does not apply to laws 
regarding integrity, ethics, fraud, or that subject a person to civil 
or criminal penalties.
    ``(C) Title VII of the Civil Rights Act of 1964 (42 U.S.C. 2000e et 
seq.) shall apply with respect to a State home that enters into an 
agreement under this section to the same extent as such title applies 
with respect to the State home in providing care or services through an 
agreement or arrangement other than under this section.''.
    (c) Effective Date.--
            (1) In general.--The amendments made by this section shall 
        apply to agreements entered into under section 1745 of such 
        title on and after the date on which the regulations prescribed 
        by the Secretary of Veterans Affairs to implement such 
        amendments take effect.
            (2) Publication.--The Secretary shall publish the date 
        described in paragraph (1) in the Federal Register not later 
        than 30 days before such date.

SEC. 105. DEPARTMENT OF VETERANS AFFAIRS ELECTRONIC INTERFACE FOR 
              PROCESSING OF MEDICAL CLAIMS.

    (a) Electronic Interface.--Not later than the implementation date 
specified in section 108(a), the Chief Information Officer of the 
Department of Veterans Affairs shall ensure that the information 
technology system used by the Department to receive, process, and pay 
claims under the VA Care in the Community Program established in 
section 1703A of title 38, United States Code, as added by section 102, 
and under Veterans Care Agreements established in section 1703B of such 
title, as added by section 103, includes the following:
            (1) A function through which a covered non-Department 
        health care provider may submit all required data and 
        supporting information required for claims reimbursement 
        through electronic data interchanges.
            (2) An ability to automatically adjudicate claims.
            (3) A centralized claims database that is accessible 
        nationwide.
            (4) Integration with the relevant eligibility and 
        authorization information technology systems of the Department.
            (5) Ability for a covered non-Department health care 
        provider to ascertain the status of a pending claim submitted 
        by the provider, receive information regarding missing 
        documentation or discrepancies that may impede claim processing 
        timelines or result in rejection, and receive notification when 
        such claim is accepted for reimbursement or rejected.
            (6) A claim review system similar to that used by the 
        Centers for Medicare & Medicaid Services, as of the date of the 
        enactment of this Act, including the use of contractors to 
        perform audits through data analytics, to determine the 
        appropriateness and accuracy of claims of providers and to 
        ensure program integrity and oversight.
    (b) Security and Privacy.--The Chief Information Officer shall also 
ensure that the information technology system covered under subsection 
(a) meets the following criteria:
            (1) Such system shall be developed and implemented in 
        compliance with all applicable laws, regulations and Federal 
        Government standards regarding information security, privacy, 
        and accessibility.
            (2) Such system shall provide for the elicitation, 
        analysis, and prioritization of functional and nonfunctional 
        information security and privacy requirements for such system, 
        including security and privacy services and architectural 
        requirements relating to security and privacy based on a 
        thorough risk assessment of all reasonably anticipated cyber 
        and noncyber threats to the security and privacy of electronic 
        protected health information made available through such 
        interface.
            (3) Such system shall provide for the elicitation, 
        analysis, and prioritization of secure development requirements 
        relating to such system.
            (4) Such system shall provide assurance that the 
        prioritized information security and privacy requirements of 
        such system--
                    (A) are correctly implemented in the design and 
                implementation of such system through the systems 
                development lifecycle; and
                    (B) satisfy the information objectives of such 
                system relating to security and privacy throughout the 
                systems development lifecycle.
    (c) Contract Authority.--The Chief Information Officer may enter 
into a contract for purposes of carrying out this section.
    (d) Definitions.--In this section:
            (1) The term ``electronic protected health information'' 
        has the meaning given that term in section 160.103 of title 45, 
        Code of Federal Regulations, as in effect on the date of the 
        enactment of this Act.
            (2) The term ``covered non-Department health care 
        provider'' means--
                    (A) a network provider (as defined by section 
                1701(11) of title 38, United States Code, as added by 
                section 102);
                    (B) a non-network provider with which the Secretary 
                has entered into a Veterans Care Agreement under 
                section 1703B of such title, as added by section 103; 
                or
                    (C) any other non-Department eligible provider or 
                non-Department health care provider that furnishes 
                hospital care or medical services pursuant to chapter 
                17 of such title.
            (3) The term ``secure development requirements'' means, 
        with respect to the information technology system established 
        under subsection (a), activities that are required to be 
        completed during the system development lifecycle of such 
        interface, such as secure coding principles and test 
        methodologies.
            (4) The term ``VA Care in the Community Program'' has the 
        meaning given that term in section 1701(12) of title 38, United 
        States Code, as added by section 102.

SEC. 106. FUNDING FOR VA CARE IN THE COMMUNITY PROGRAM.

    (a) In General.--All amounts required to carry out the VA Care in 
the Community Program and Veterans Care Agreements under section 1703B 
of title 38, United States Code, shall be derived from the Veterans 
Health Administration, Medical Community Care account.
    (b) Transfer of Amounts.--
            (1) In general.--Any unobligated amounts in the Veterans 
        Choice Fund under section 802 of the Veterans Access, Choice, 
        and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 
        1701 note) shall be transferred to the Veterans Health 
        Administration, Medical Community Care account on the later of 
        the following dates:
                    (A) The date that is one year after the date of the 
                enactment of this Act.
                    (B) The date on which the Secretary of Veterans 
                Affairs submits to the Committees on Veterans' Affairs 
                of the Senate and the House of Representatives the 
                certification required by section 107(c).
            (2) Conforming repeal.--
                    (A) In general.--Effective immediately following 
                the transfer of amounts under paragraph (1), section 
                802 of the Veterans Access, Choice, and Accountability 
                Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) 
                is repealed.
                    (B) Conforming amendment.--Section 4003 of the 
                Surface Transportation and Veterans Health Care Choice 
                Improvement Act of 2015 (Public Law 114-41; 38 U.S.C. 
                1701 note) is amended by striking ``for non-Department 
                provider programs (as defined in section 2(d))'' and 
                all that follows through ``1802)'' and inserting the 
                following: ``for the VA Care in the Community Program 
                (as defined in section 1701(12) of title 38, United 
                States Code) and Veterans Care Agreements under section 
                1703B of title 38, United States Code''.
    (c) VA Care in the Community Program Defined.--In this section, the 
term ``VA Care in the Community Program'' has the meaning given that 
term in section 1701(12) of title 38, United States Code, as added by 
section 102.

SEC. 107. TERMINATION OF CERTAIN PROVISIONS AUTHORIZING MEDICAL CARE TO 
              VETERANS THROUGH NON-DEPARTMENT OF VETERANS AFFAIRS 
              PROVIDERS.

    (a) Termination of Authority To Contract for Care in Non-Department 
Facilities.--
            (1) In general.--Section 603of title 38, United States 
        Code, is amended by adding at the end the following new 
        subsection:
    ``(e) The authority of the Secretary to carry out this section 
terminates on the date on which the Secretary certifies to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate that the Secretary is fully implementing section 1703A of this 
title.''.
            (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 the VA Care 
                        in the Community Program''; and
                            (ii) in paragraph (4)(A), in the first 
                        sentence--
                                    (I) by striking ``and section 1703 
                                of this title'' and inserting ``and the 
                                VA Care in the Community Program (with 
                                respect to such a year beginning on or 
                                after the date on which the Secretary 
                                commences implementation of the VA Care 
                                in the Community Program)''; and
                                    (II) by striking ``in section 1703 
                                of this title'' and inserting ``under 
                                the VA Care in the Community Program''.
                    (B) Readjustment counseling.--Section 1712A(e)(1) 
                of such title is amended by striking ``(under sections 
                1703(a)(2) and 1710(a)(1)(B) of this title)'' and 
                inserting ``(under the VA Care in the Community 
                Program)''.
                    (C) Death in department facility.--Section 
                2303(a)(2)(B)(i) of such title is amended by striking 
                ``in accordance with section 1703 of this title'' and 
                inserting ``under the VA Care in the Community 
                Program''.
                    (D) Medicare provider agreements.--Section 
                1866(a)(1)(L) of the Social Security Act (42 U.S.C. 
                1395cc(a)(1)(L)) is amended--
                            (i) by striking ``under section 1703 of 
                        title 38'' and inserting ``under the VA Care in 
                        the Community Program (as defined in section 
                        1701(12) of title 38, United States Code)''; 
                        and
                            (ii) by striking ``such section'' and 
                        inserting ``such program''.
    (b) Repeal of Authority To Contract for Scarce Medical 
Specialists.--
            (1) In general.--Section 7409 of title 38, United States 
        Code, is repealed.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 74 of such title is amended by striking 
        the item relating to section 7409.
    (c) Effective Date.--The amendments made by subsections (a) and (b) 
shall take effect on the date on which the Secretary certifies to the 
Committees on Veterans' Affairs of the House of Representatives and the 
Senate that the Secretary is fully implementing section 1703A of title 
38, United States Code, as added by section 102.

SEC. 108. IMPLEMENTATION AND TRANSITION.

    (a) Implementation.--The Secretary of Veterans Affairs shall 
commence the implementation of section 1703A of title 38, United States 
Code, as added by section 102, and section 1703B of such title, as 
added by section 103, and shall make the transfer under section 106(b), 
by not later than one year after the date of the enactment of this Act. 
The Secretary shall prescribe interim final regulations to implement 
such sections and publish such regulations in the Federal Register.
    (b) Training.--Before commencing the implementation of sections 
1703A and 1703B of title 38, United States Code, as added by sections 
102 and 103, respectively, the Secretary of Veterans Affairs shall--
            (1) certify to the Committees on Veterans' Affairs of the 
        House of Representatives and the Senate that--
                    (A) each network provider (as defined by section 
                1701(11) of title 38, United States Code) and eligible 
                non-network provider that furnishes care or services 
                under such section 1703A or section 1703B is trained to 
                furnish such care or services under such sections; and
                    (B) each employee of the Department that refers, 
                authorizes, or coordinates such care or services is 
                trained to carry out such sections; and
            (2) establish standard, written guidance for network 
        providers, non-Department health care providers, and any non-
        Department administrative entities acting on behalf of such 
        providers, with respect to the policies and procedures for 
        furnishing care or services under such sections.

SEC. 109. TRANSPLANT PROCEDURES WITH LIVE DONORS AND RELATED SERVICES.

    (a) In General.--Subchapter I of chapter 17 of title 38, United 
States Code, is further amended by inserting after section 1703B, as 
added by section 103, the following new section:
``Sec. 1703C. Transplant procedures with live donors and related 
              services
    ``(a) In General.--Subject to subsections (b) and (c), in a case in 
which a veteran is eligible for a transplant procedure from the 
Department, the Secretary may provide for an operation on a live donor 
to carry out such procedure for such veteran, notwithstanding that the 
live donor may not be eligible for health care from the Department.
    ``(b) Other Services.--Subject to the availability of 
appropriations for such purpose, the Secretary shall furnish to a live 
donor any care or services before and after conducting the transplant 
procedure under subsection (a) that may be required in connection with 
such procedure.
    ``(c) Use of Non-Department Facilities.--(1) In carrying out this 
subsection, the Secretary may provide for the operation described in 
subsection (a) on a live donor and furnish to the live donor the care 
and services described in subsection (b) at a non-Department facility 
pursuant to an agreement entered into by the Secretary under this 
section. The live donor shall be deemed to be an individual eligible 
for hospital care and medical services at a non-Department facility 
pursuant to such an agreement solely for the purposes of receiving such 
operation, care, and services at the non-Department facility.
    ``(2) The Secretary may only provide for an operation at a non-
Department of Veterans Affairs transplant center pursuant to paragraph 
(1) if the center is in compliance with regulations prescribed by the 
Centers for Medicare & Medicaid Services applicable to transplant 
centers.''.
    (b) Clerical Amendment.--The table of section at the beginning of 
such chapter is further amended by inserting after the item relating to 
section 1703B, as added by section 103, the following new item:

``1703C. Transplant procedures with live donors and related 
                            services.''.

                 TITLE II--OTHER ADMINISTRATIVE MATTERS

SEC. 201. REIMBURSEMENT FOR EMERGENCY AMBULANCE SERVICES.

    (a) In General.--Section 1725(c) of title 38, United States Code, 
is amended by adding at the end the following new paragraph:
    ``(5) In delineating the circumstances under which reimbursement 
may be made under this section for ambulance services for an 
individual, the Secretary shall treat such services as emergency 
services for which reimbursement may be made under this section if the 
Secretary determines that--
            ``(A) the request for ambulance services was made as a 
        result of the sudden onset of a medical condition of such a 
        nature that a prudent layperson who possesses an average 
        knowledge of health and medicine--
                    ``(i) would have reasonably expected that a delay 
                in seeking immediate medical attention would have been 
                hazardous to the life or health of the individual; or
                    ``(ii) could reasonably expect the absence of 
                immediate medical attention to result in placing the 
                health of the individual in serious jeopardy, the 
                serious impairment of bodily functions, or the serious 
                dysfunction of any bodily organ or part; and
            ``(B) the individual is transported to the most appropriate 
        medical facility capable of treating such medical condition.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act and shall apply 
with respect to ambulance services provided on or after January 1, 
2019.

SEC. 202. IMPROVEMENT OF CARE COORDINATION FOR VETERANS THROUGH 
              EXCHANGE OF CERTAIN MEDICAL RECORDS.

    Section 7332(b) of title 38, United States Code, is amended--
            (1) in paragraph (2), by adding at the end the following 
        new subparagraphs:
                    ``(I) To a public or private health care provider 
                in order to provide treatment or health care to a 
                shared patient.
                    ``(J) To a third party in order to recover or 
                collect reasonable charges for care furnished to a 
                veteran for a non-service-connected disability pursuant 
                to section 1729 of this title or section 1 of Public 
                Law 87-693 (42 U.S.C. 2651).''; and
            (2) by adding at the end the following new paragraph:
    ``(4) Nothing in this section shall be construed to authorize any 
provision of records in violation of relevant health record privacy 
laws, including the Health Insurance Portability and Accountability Act 
of 1996 (Public Law 104-191).''.

SEC. 203. ELIMINATION OF COPAYMENT OFFSET.

    (a) In General.--Section 1729(a) of title 38, United States Code, 
is amended by adding at the end the following new paragraph:
            ``(4) Notwithstanding any other provision of law, any 
        amount that the United States may collect or recover under this 
        section shall not affect any copayment amount a veteran is 
        otherwise obligated to pay under this chapter.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act and apply with 
respect to a copayment obligation that arises on or after the date of 
the enactment of this Act.

SEC. 204. USE OF DEPARTMENT OF VETERANS AFFAIRS MEDICAL CARE 
              COLLECTIONS FUND FOR CERTAIN IMPROVEMENTS IN COLLECTIONS.

    Section 1729A(c)(1)(B) of title 38, United States Code, is amended 
by inserting ``(including with respect to automatic data processing or 
information technology improvements)'' after ``collection''.

SEC. 205. DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PRODUCTIVITY 
              IMPROVEMENT.

    (a) In General.--Subchapter I of chapter 17 of title 38, United 
States Code, is further amended by inserting after section 1705A the 
following new section:
``Sec. 1705B. Management of health care: productivity
    ``(a) Relative Value Unit Tracking.--The Secretary shall track 
relative value units for all Department providers.
    ``(b) Clinical Procedure Coding Training.--The Secretary shall 
require all Department providers to attend training on clinical 
procedure coding.
    ``(c) Performance Standards.--(1) The Secretary shall establish for 
each Department facility--
            ``(A) in accordance with paragraph (2), standardized 
        performance standards based on nationally recognized relative 
        value unit production standards applicable to each specific 
        profession in order to evaluate clinical productivity at the 
        provider and facility level;
            ``(B) remediation plans to address low clinical 
        productivity and clinical inefficiency; and
            ``(C) an ongoing process to systematically review the 
        content, implementation, and outcome of the plans developed 
        under subparagraph (B).
    ``(2) In establishing the performance standards under paragraph 
(1)(A), the Secretary may--
            ``(A) incorporate values-based productivity models; and
            ``(B) take into account non-clinical duties, including with 
        respect to training and research.
    ``(d) Definitions.--In this section:
            ``(1) The term `Department provider' means an employee of 
        the Department whose primary responsibilities include 
        furnishing hospital care or medical services, including a 
        physician, a dentist, an optometrist, a podiatrist, a 
        chiropractor, an advanced practice registered nurse, and a 
        physician's assistant acting as an independent provider.
            ``(2) The term `relative value unit' means a unit for 
        measuring workload by determining the time, mental effort and 
        judgment, technical skill, physical effort, and stress involved 
        in delivering a procedure.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is further amended by inserting after the item relating to 
section 1705A the following new item:

``1705B. Management of health care: productivity.''.
    (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 implementation of section 1705B of title 38, United States Code, 
as added by subsection (a). Such report shall include, for each 
professional category of Department providers, the relative value unit 
of such category of providers at the national, Veterans Integrated 
Service Network, and facility levels.

SEC. 206. LICENSURE OF HEALTH CARE PROFESSIONALS OF THE DEPARTMENT OF 
              VETERANS AFFAIRS PROVIDING TREATMENT VIA TELEMEDICINE.

    (a) In General.--Chapter 17 of title 38, United States Code, is 
further amended by inserting after section 1730A the following new 
section:
``Sec. 1730B. Licensure of health care professionals providing 
              treatment via telemedicine
    ``(a) In General.--Notwithstanding any provision of law regarding 
the licensure of health care professionals, a covered health care 
professional may practice the health care profession of the health care 
professional at any location in any State, regardless of where the 
covered health care professional or the patient is located, if the 
covered health care professional is using telemedicine to provide 
treatment to an individual under this chapter.
    ``(b) Property of Federal Government.--Subsection (a) shall apply 
to a covered health care professional providing treatment to a patient 
regardless of whether the covered health care professional or patient 
is located in a facility owned by the Federal Government during such 
treatment.
    ``(c) Construction.--Nothing in this section may be construed to 
remove, limit, or otherwise affect any obligation of a covered health 
care professional under the Controlled Substances Act (21 U.S.C. 801 et 
seq.).
    ``(d) Covered Health Care Professional Defined.--In this section, 
the term `covered health care professional' means a health care 
professional who--
            ``(1) is an employee of the Department appointed under the 
        authority under section 7306, 7401, 7405, 7406, or 7408 of this 
        title, or title 5;
            ``(2) is authorized by the Secretary to provide health care 
        under this chapter;
            ``(3) is required to adhere to all quality standards 
        relating to the provision of telemedicine in accordance with 
        applicable policies of the Department; and
            ``(4) has an active, current, full, and unrestricted 
        license, registration, or certification in a State to practice 
        the health care profession of the health care professional.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is further amended by inserting after the item 
relating to section 1730A the following new item:

``1730B. Licensure of health care professionals providing treatment via 
                            telemedicine.''.
    (c) Report on Telemedicine.--
            (1) In general.--Not later than one year 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 effectiveness of the use of 
        telemedicine by the Department of Veterans Affairs.
            (2) Elements.--The report required by paragraph (1) shall 
        include an assessment of the following:
                    (A) The satisfaction of veterans with telemedicine 
                furnished by the Department.
                    (B) The satisfaction of health care providers in 
                providing telemedicine furnished by the Department.
                    (C) The effect of telemedicine furnished by the 
                Department on the following:
                            (i) The ability of veterans to access 
                        health care, whether from the Department or 
                        from non-Department health care providers.
                            (ii) The frequency of use by veterans of 
                        telemedicine.
                            (iii) The productivity of health care 
                        providers.
                            (iv) Wait times for an appointment for the 
                        receipt of health care from the Department.
                            (v) The reduction, if any, in the use by 
                        veterans of in-person services at Department 
                        facilities and non-Department facilities.
                    (D) The types of appointments for the receipt of 
                telemedicine furnished by the Department that were 
                provided during the one-year period preceding the 
                submittal of the report.
                    (E) The number of appointments for the receipt of 
                telemedicine furnished by the Department that were 
                requested during such period, disaggregated by Veterans 
                Integrated Service Network.
                    (F) Savings by the Department, if any, including 
                travel costs, of furnishing health care through the use 
                of telemedicine during such period.

SEC. 207. ESTABLISHMENT OF PROCESSES TO ENSURE SAFE OPIOID PRESCRIBING 
              PRACTICES BY NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH 
              CARE PROVIDERS.

    (a) Receipt and Review of Guidelines.--The Secretary of Veterans 
Affairs shall ensure that all covered health care providers are 
provided a copy of and certify that they have reviewed the evidence-
based guidelines for prescribing opioids set forth by the Opioid Safety 
Initiative of the Department of Veterans Affairs under sections 
911(a)(2) and 912(c) of the Jason Simcakoski Memorial and Promise Act 
(Public Law 114-198; 38 U.S.C. 1701 note) before first providing care 
under the laws administered by the Secretary and at any time when those 
guidelines are modified thereafter.
    (b) Inclusion of Medical History and Current Medications.--The 
Secretary shall implement a process to ensure that, if care of a 
veteran by a covered health care provider is authorized under the laws 
administered by the Secretary, the document authorizing such care 
includes the relevant medical history of the veteran and a list of all 
medications prescribed to the veteran.
    (c) Submittal of Prescriptions.--
            (1) In general.--Except as provided in paragraph (3), the 
        Secretary shall require, to the maximum extent practicable, 
        each covered health care provider to submit prescriptions for 
        opioids--
                    (A) to the Department for prior authorization for 
                the prescribing of a limited amount of opioids under 
                contracts the Department has with retail pharmacies; or
                    (B) directly to a pharmacy of the Department for 
                the dispensing of such prescription.
            (2) Department responsibility.--In carrying out paragraph 
        (1), upon receipt by the Department of a prescription for 
        opioids for a veteran under the laws administered by the 
        Secretary, the Secretary shall--
                    (A) record such prescription in the electronic 
                health record of the veteran; and
                    (B) monitor such prescription as outlined in the 
                Opioid Safety Initiative of the Department.
            (3) Exception.--
                    (A) In general.--A covered health care provider is 
                not required under paragraph (1)(B) to submit an opioid 
                prescription directly to a pharmacy of the Department 
                if--
                            (i) the health care provider determines 
                        that there is an immediate medical need for the 
                        prescription, including an urgent or emergent 
                        prescription or a prescription dispensed as 
                        part of an opioid treatment program that 
                        provides office-based medications; and
                            (ii)(I) following an inquiry into the 
                        matter, a pharmacy of the Department notifies 
                        the health care provider that it cannot fill 
                        the prescription in a timely manner; or
                            (II) the health care provider determines 
                        that the requirement under paragraph (1)(B) 
                        would impose an undue hardship on the veteran, 
                        including with respect to travel distances, as 
                        determined by the Secretary.
                    (B) Notification to department.--If a covered 
                health care provider uses an exception under 
                subparagraph (A) with respect to an opioid prescription 
                for a veteran, the health care provider shall, on the 
                same day the prescription is written, submit to the 
                Secretary for inclusion in the electronic health record 
                of the veteran a notice, in such form as the Secretary 
                may establish, providing information about the 
                prescription and describing the reason for the 
                exception.
                    (C) Report.--
                            (i) In general.--Not less frequently than 
                        quarterly, the Secretary shall submit to the 
                        Committee on Veterans' Affairs of the Senate 
                        and the Committee on Veterans' Affairs of the 
                        House of Representatives a report evaluating 
                        the compliance of covered health care providers 
                        with the requirements under this paragraph and 
                        setting forth data on the use by health care 
                        providers of exceptions under subparagraph (A) 
                        and notices under subparagraph (B).
                            (ii) Elements.--Each report required by 
                        clause (i) shall include the following with 
                        respect to the quarter covered by the report:
                                    (I) The number of exceptions used 
                                under subparagraph (A) and notices 
                                received under subparagraph (B).
                                    (II) The rate of compliance by the 
                                Department with the requirement under 
                                subparagraph (B) to include such 
                                notices in the health records of 
                                veterans.
                                    (III) The identification of any 
                                covered health care providers that, 
                                based on criteria prescribed the 
                                Secretary, are determined by the 
                                Secretary to be statistical outliers 
                                regarding the use of exceptions under 
                                subparagraph (A).
    (d) Use of Opioid Safety Initiative Guidelines.--
            (1) In general.--If a director of a medical center of the 
        Department or a Veterans Integrated Service Network determines 
        that the opioid prescribing practices of a covered health care 
        provider conflicts with or is otherwise inconsistent with the 
        standards of appropriate and safe care, as that term is used in 
        section 913(d) of the Jason Simcakoski Memorial and Promise Act 
        (Public Law 114-198; 38 U.S.C. 1701 note), the director shall 
        take such action as the director considers appropriate to 
        ensure the safety of all veterans receiving care from that 
        health care provider, including removing or directing the 
        removal of any such health care provider from provider networks 
        or otherwise refusing to authorize care of veterans by such 
        health care provider in any program authorized under the laws 
        administered by the Secretary.
            (2) Inclusion in contracts.--The Secretary shall ensure 
        that any contracts entered into by the Secretary with third 
        parties involved in administering programs that provide care in 
        the community to veterans under the laws administered by the 
        Secretary specifically grant the authority set forth in 
        paragraph (1) to such third parties and to the directors 
        described in that paragraph, as the case may be.
    (e) Denial or Revocation of Eligibility of Non-Department 
Providers.--The Secretary shall deny or revoke the eligibility of a 
non-Department health care provider to provide health care to veterans 
under the laws administered by the Secretary if the Secretary 
determines that the opioid prescribing practices of the provider--
            (1) violate the requirements of a medical license of the 
        health care provider; or
            (2) detract from the ability of the health care provider to 
        deliver safe and appropriate health care.
    (f) Covered Health Care Provider Defined.--In this section, the 
term ``covered health care provider'' means a non-Department of 
Veterans Affairs health care provider who provides health care to 
veterans under the laws administered by the Secretary of Veterans 
Affairs.

SEC. 208. ASSESSMENT OF HEALTH CARE FURNISHED BY THE DEPARTMENT TO 
              VETERANS WHO LIVE IN THE TERRITORIES.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to the Committees on Veterans' Affairs of the Senate and the House of 
Representatives a report regarding health care furnished by the 
Department of Veterans Affairs to veterans who live in the territories.
    (b) Elements.--The report under subsection (a) shall include 
assessments of the following:
            (1) The ability of the Department to furnish to veterans 
        who live in the territories the following:
                    (A) Hospital care.
                    (B) Medical services.
                    (C) Mental health services.
                    (D) Geriatric services.
            (2) The feasibility of establishing a medical facility of 
        the Department in any territory that does not contain such a 
        facility.
    (c) Definition.--In this section, the term ``territories'' means 
the Northern Mariana Islands, Puerto Rico, American Samoa, Guam, and 
the Virgin Islands.

SEC. 209. OVERSIGHT AND ACCOUNTABILITY OF FINANCIAL PROCESSES OF 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) Sense of Congress.--It is the sense of Congress that--
            (1) the normal budget process for the Department of 
        Veterans Affairs should be grounded in sound actuarial analysis 
        based on accurate demand forecasting;
            (2) the regular budget process for the Department should be 
        the norm;
            (3) supplemental requests for appropriations should be used 
        sparingly and for unforeseen demand or natural occurrences; and
            (4) upon receipt of the financial audit of the Office of 
        Inspector General of the Department, the Committee on Veterans' 
        Affairs of the Senate and the Committee on Veterans' Affairs of 
        the House of Representatives shall give due consideration to 
        the report, including by holding hearings as appropriate
    (b) Plans for Use of Supplemental Appropriations Required.--
Whenever the Secretary submits to address a budgetary issue affecting 
the Department of Veterans Affairs to Congress a request for 
supplemental appropriations or any other appropriation when the request 
is submitted outside the standard budget process, the Secretary shall, 
not later than 45 days before the date on which such budgetary issue 
would start affecting a program or service, submit to Congress a 
justification for the request, including a plan that details how the 
Secretary intends to use the requested appropriation and how long the 
requested appropriation is expected to meet the needs of the Department 
and certification that the request was made using an updated and sound 
actuarial analysis.
    (c) Annual Attestation Regarding Financial Projections.--Concurrent 
with the President's annual budget request submitted to Congress under 
section 1105 of title 31, United States Code, for fiscal year 2019 and 
each fiscal year thereafter, the Chief Financial Officer of the 
Department of Veterans Affairs shall submit to the Committee on 
Veterans' Affairs of the Senate and the Committee on Veterans' Affairs 
of the House of Representatives the following:
            (1) A statement of assurance that financial projections 
        included in such budget or the supporting materials submitted 
        along with such budget for the Department of Veterans Affairs 
        are sufficient to provide benefits and services under laws 
        administered by the Secretary of Veterans Affairs.
            (2) A certification of the Chief Financial Officer's 
        responsibility for internal financial controls of the 
        Department.
            (3) An attestation that the Chief Financial Officer has 
        collaborated sufficiently with the financial officers of the 
        facilities and components of the Department to be confident in 
        such financial projections.

SEC. 210. AUTHORITY FOR DEPARTMENT OF VETERANS AFFAIRS CENTER FOR 
              INNOVATION FOR CARE AND PAYMENT.

    (a) In General.--Subchapter I of chapter 17, as amended by section 
103, is further amended by inserting after section 1703C, as added by 
section 109, the following new section:
``Sec. 1703D. Center for Innovation for Care and Payment
    ``(a) In General.--(1) There is established within the Department a 
Center for Innovation for Care and Payment (in this section referred to 
as the `Center').
    ``(2) The Secretary, acting through the Center, may carry out such 
pilot programs the Secretary determines to be appropriate to develop 
innovative approaches to testing payment and service delivery models in 
order to reduce expenditures while preserving or enhancing the quality 
of care furnished by the Department.
    ``(3) The Secretary, acting through the Center, shall test payment 
and service delivery models to determine whether such models--
            ``(A) improve access to, and quality, timeliness, and 
        patient satisfaction of care and services; and
            ``(B) create cost savings for the Department.
    ``(4)(A) The Secretary shall test a model in a location where the 
Secretary determines that the model will addresses deficits in care 
(including poor clinical outcomes or potentially avoidable 
expenditures) for a defined population.
    ``(B) The Secretary shall focus on models the Secretary expects to 
reduce program costs while preserving or enhancing the quality of care 
received by individuals receiving benefits under this chapter.
    ``(C) The models selected may include those described in section 
1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)).
    ``(5) In selecting a model for testing, the Secretary may consider, 
in addition to other factors identified in this subsection, the 
following factors:
            ``(A) Whether the model includes a regular process for 
        monitoring and updating patient care plans in a manner that is 
        consistent with the needs and preferences of individuals 
        receiving benefits under this chapter.
            ``(B) Whether the model places the individual receiving 
        benefits under this chapter at the center of the care team 
        (including family members and other caregivers) of such 
        individual.
            ``(C) Whether the model uses technology or new systems to 
        coordinate care over time and across settings.
            ``(D) Whether the model demonstrates effective linkage with 
        other public sector payers, private sector payers, or statewide 
        payment models.
    ``(6)(A) Models tested under this section may not be designed in 
such a way that would allow the United States to recover or collect 
reasonable charges from a Federal health care program for care or 
services furnished by the Secretary to a veteran under pilot programs 
carried out under this section.
    ``(B) In this paragraph, the term `Federal health care program' 
means--
            ``(i) an insurance program described in section 1811 of the 
        Social Security Act (42 U.S.C. 1395c) or established by section 
        1831 of such Act (42 U.S.C. 1395j); or
            ``(ii) a State plan for medical assistance approved under 
        title XIX of such Act (42 U.S.C. 1396 et seq.); or
            ``(iii) a TRICARE program operated under sections 1075, 
        1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.
    ``(b) Duration.--Each pilot program carried out by the Secretary 
under this section shall terminate no later than five years after the 
date of the commencement of the pilot program.
    ``(c) Location.--The Secretary shall ensure that each pilot program 
carried out under this section occurs in an area or areas appropriate 
for the intended purposes of the pilot program.
    ``(d) Budget.--Funding for each pilot program carried out by the 
Secretary under this section shall come from appropriations--
            ``(1) provided in advance in appropriations acts for the 
        Veterans Health Administration; and
            ``(2) provided for information technology systems.
    ``(e) Notice.--The Secretary shall--
            ``(1) publish information about each pilot program under 
        this section in the Federal Register; and
            ``(2) take reasonable actions to provide direct notice to 
        veterans eligible to participate in such pilot programs.
    ``(f) Waiver of Authorities.--(1) Subject to reporting under 
paragraph (2) and approval under paragraph (3), in implementing a pilot 
program under this section, the Secretary may waive such requirements 
in subchapters I, II, and III of this chapter as the Secretary 
determines necessary solely for the purposes of carrying out this 
section with respect to testing models described in subsection (a).
    ``(2) Before waiving any authority under paragraph (1), the 
Secretary shall submit a report to the Speaker of the House of 
Representatives, the minority leader of the House of Representatives, 
the majority leader of the Senate, the minority leader of the Senate, 
and each standing committee with jurisdiction under the rules of the 
Senate and of the House of Representatives to report a bill to amend 
the provision or provisions of law that would be waived by the 
Department describing in detail the following:
            ``(A) The specific authorities to be waived under the pilot 
        program.
            ``(B) The standard or standards to be used in the pilot 
        program in lieu of the waived authorities.
            ``(C) The reasons for such waiver or waivers.
            ``(D) A description of the metric or metrics the Secretary 
        will use to determine the effect of the waiver or waivers upon 
        the access to and quality, timeliness, or patient satisfaction 
        of care and services furnished through the pilot program.
            ``(E) The anticipated cost savings, if any, of the pilot 
        program.
            ``(F) The schedule for interim reports on the pilot program 
        describing the results of the pilot program so far and the 
        feasibility and advisability of continuing the pilot program.
            ``(G) The schedule for the termination of the pilot program 
        and the submission of a final report on the pilot program 
        describing the result of the pilot program and the feasibility 
        and advisability of making the pilot program permanent.
            ``(H) The estimated budget of the pilot program.
    ``(3)(A) Upon receipt of a report submitted under paragraph (2), 
each House of Congress shall provide copies of the report to the 
chairman and ranking member of each standing committee with 
jurisdiction under the rules of the House of Representatives or the 
Senate to report a bill to amend the provision or provisions of law 
that would be waived by the Department under this subsection.
    ``(B)(i) The waiver requested by the Secretary under paragraph (2) 
shall be considered approved under this paragraph if there is enacted 
into law a bill or joint resolution approving such request in its 
entirety. Such bill or joint resolution shall be passed by recorded 
vote to reflect the vote of each member of Congress thereon.
    ``(ii) The provisions of this paragraph are enacted by Congress--
            ``(I) as an exercise of the rulemaking power of the Senate 
        and the House of Representatives and as such shall be 
        considered as part of the rules of each House of Congress, and 
        shall supersede other rules only to the extent that they are 
        inconsistent therewith; and
            ``(II) with full recognition of the constitutional right of 
        either House of Congress to change the rules (so far as they 
        relate to the procedures of that House) at any time, in the 
        same manner, and to the same extent as in the case of any other 
        rule of that House.
    ``(C) During the 60-calendar-day period beginning on the date on 
which the Secretary submits the report described in paragraph (2) to 
Congress, it shall be in order as a matter of highest privilege in each 
House of Congress to consider a bill or joint resolution, if offered by 
the majority leader of such House (or a designee), approving such 
request in its entirety.
    ``(g) Limitations.--(1) The waiver provisions in subsection (f) 
shall not apply unless the Secretary, in accordance with the 
requirements in subsection (f), submits the first proposal for a pilot 
program not later than 18 months after the date of the enactment of the 
VA Care in the Community Act.
    ``(2) Notwithstanding section 502 of this title, decisions by the 
Secretary under this section shall, consistent with section 511 of this 
title, be final and conclusive and may not be reviewed by any other 
official or by any court, whether by an action in the nature of 
mandamus or otherwise.
    ``(3)(A) If the Secretary determines that the pilot program is not 
improving the quality of care or producing cost savings, the Secretary 
shall--
            ``(i) propose a modification to the pilot program in the 
        interim report that shall also be considered a report under 
        subsection (f)(2)(A) and shall be subject to the terms and 
        conditions of subsection (f)(2); or
            ``(ii) terminate such pilot program not later than 30 days 
        after submitting the interim report to Congress.
    ``(B) If the Secretary terminates the pilot program under 
subparagraph (A)(ii), for purposes of clauses (vi) and (vii) of 
subsection (f)(2)(A), such interim report will also serve as the final 
report for that pilot program.
    ``(h) Evaluation and Reporting Requirements.--(1) The Secretary 
shall conduct an evaluation of each model tested, which shall include, 
at a minimum, an analysis of--
            ``(A) the quality of care furnished under the model, 
        including the measurement of patient-level outcomes and 
        patient-centeredness criteria determined appropriate by the 
        Secretary; and
            ``(B) the changes in spending by reason of that model.
    ``(2) The Secretary shall make the results of each evaluation under 
this subsection available to the public in a timely fashion and may 
establish requirements for other entities participating in the testing 
of models under this section to collect and report information that the 
Secretary determines is necessary to monitor and evaluate such models.
    ``(i) Coordination and Consultation.--(1) The Secretary shall 
consult with the Under Secretary for Health and the Special Medical 
Advisory Group established pursuant to section 7312 of this title in 
the development and implementation of any pilot program operated under 
this section.
    ``(2) In carrying out the duties under this section, the Secretary 
shall consult representatives of relevant Federal agencies, and 
clinical and analytical experts with expertise in medicine and health 
care management. The Secretary shall use appropriate mechanisms to seek 
input from interested parties.
    ``(j) Expansion of Successful Pilot Programs.--Taking into account 
the evaluation under subsection (f), the Secretary may, through 
rulemaking, expand (including implementation on a nationwide basis) the 
duration and the scope of a model that is being tested under subsection 
(a) to the extent determined appropriate by the Secretary, if--
            ``(1) the Secretary determines that such expansion is 
        expected to--
                    ``(A) reduce spending without reducing the quality 
                of care; or
                    ``(B) improve the quality of patient care without 
                increasing spending; and
            ``(2) the Secretary determines that such expansion would 
        not deny or limit the coverage or provision of benefits for 
        individuals receiving benefits under this chapter.''.
    (b) Conforming Amendment.--The table of sections at the beginning 
of such chapter, as amended by section 109, is further amended by 
inserting after the item relating to section 1703C the following new 
item:

``1703D. Center for Innovation for Care and Payment.''.

          TITLE III--IMPROVEMENTS TO RECRUITMENT OF PHYSICIANS

SEC. 301. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS AND DENTISTS UNDER 
              DEPARTMENT OF VETERANS AFFAIRS HEALTH PROFESSIONAL 
              SCHOLARSHIP PROGRAM.

    (a) Scholarships for Physicians and Dentists.--Section 7612(b) of 
title 38, United States Code, is amended by adding at the end the 
following new paragraph:
    ``(6)(A) Of the scholarships awarded under this subchapter, the 
Secretary shall ensure that not less than 50 scholarships are awarded 
each year to individuals who are accepted for enrollment or enrolled 
(as described in section 7602 of this title) in a program of education 
or training leading to employment as a physician or dentist until such 
date as the Secretary determines that the staffing shortage of 
physicians and dentists in the Department is less than 500.
    ``(B) After such date, the Secretary shall ensure that of the 
scholarships awarded under this subchapter, a number of scholarships is 
awarded each year to individuals referred to in subparagraph (A) in an 
amount equal to not less than ten percent of the staffing shortage of 
physicians and dentists in the Department, as determined by the 
Secretary.
    ``(C) Notwithstanding subsection (c)(1), the agreement between the 
Secretary and a participant in the Scholarship Program who receives a 
scholarship pursuant to this paragraph shall provide the following:
            ``(i) The Secretary's agreement to provide the participant 
        with a scholarship under this subchapter for a specified number 
        (from two to four) of school years during which the participant 
        is pursuing a course of education or training leading to 
        employment as a physician or dentist.
            ``(ii) The participant's agreement to serve as a full-time 
        employee in the Veterans Health Administration for a period of 
        time (hereinafter in this subchapter referred to as the `period 
        of obligated service') of 18 months for each school year or 
        part thereof for which the participant was provided a 
        scholarship under the Scholarship Program.
    ``(D) In providing scholarships pursuant to this paragraph, the 
Secretary may provide a preference for applicants who are veterans.
    ``(E) On an annual basis, the Secretary shall provide to 
appropriate educational institutions informational material about the 
availability of scholarships under this paragraph.''.
    (b) Breach of Agreement.--Section 7617(b) of such title is 
amended--
            (1) by redesignating paragraphs (4) and (5) as paragraphs 
        (5) and (6), respectively; and
            (2) by inserting after paragraph (3) the following new 
        paragraph (4):
            ``(4) In the case of a participant who is enrolled in a 
        program or education or training leading to employment as a 
        physician, the participant fails to successfully complete post-
        graduate training leading to eligibility for board 
        certification in a specialty.''.
    (c) Extension of Program.--Section 7619 of such title is amended by 
striking ``December 31, 2019'' and inserting ``December 31, 2033''.

SEC. 302. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS SPECIALTY 
              EDUCATION LOAN REPAYMENT PROGRAM.

    (a) In General.--Chapter 76 of title 38, United States Code, is 
amended by inserting after subchapter VII the following new subchapter:

     ``SUBCHAPTER VIII--SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM

``Sec. 7691. Establishment
    ``As part of the Educational Assistance Program, the Secretary may 
carry out a student loan repayment program under section 5379 of title 
5. The program shall be known as the Department of Veterans Affairs 
Specialty Education Loan Repayment Program (in this chapter referred to 
as the `Specialty Education Loan Repayment Program').
``Sec. 7692. Purpose
    ``The purpose of the Specialty Education Loan Repayment Program is 
to assist, through the establishment of an incentive program for 
certain individuals employed in the Veterans Health Administration, in 
meeting the staffing needs of the Veterans Health Administration for 
physicians in medical specialties for which the Secretary determines 
recruitment or retention of qualified personnel is difficult.
``Sec. 7693. Eligibility; preference; covered costs
    ``(a) Eligibility.--An individual is eligible to participate in the 
Specialty Education Loan Repayment Program if the individual--
            ``(1) is hired under section 7401 of this title to work in 
        an occupation described in section 7692 of this title;
            ``(2) owes any amount of principal or interest under a 
        loan, the proceeds of which were used by or on behalf of that 
        individual to pay costs relating to a course of education or 
        training which led to a degree that qualified the individual 
        for the position referred to in paragraph (1); and
            ``(3) is--
                    ``(A) recently graduated from an accredited medical 
                or osteopathic school and matched to an accredited 
                residency program in a medical specialty described in 
                section 7692 of this title; or
                    ``(B) a physician in training in a medical 
                specialty described in section 7692 of this title with 
                more than two years remaining in such training.
    ``(b) Preference for Veterans.--In selecting individuals for 
participation in the Specialty Education Loan Repayment Program under 
this subchapter, the Secretary may give preference to veterans.
    ``(c) Covered Costs.--For purposes of subsection (a)(2), costs 
relating to a course of education or training include--
            ``(1) tuition expenses;
            ``(2) all other reasonable educational expenses, including 
        expenses for fees, books, equipment, and laboratory expenses; 
        and
            ``(3) reasonable living expenses.
``Sec. 7694. Specialty education loan repayment
    ``(a) In General.--Payments under the Specialty Education Loan 
Repayment Program shall consist of payments for the principal and 
interest on loans described in section 7682(a)(2) of this title for 
individuals selected to participate in the Program to the holders of 
such loans.
    ``(b) Frequency of Payment.--The Secretary shall make payments for 
any given participant in the Specialty Education Loan Repayment Program 
on a schedule determined appropriate by the Secretary.
    ``(c) Maximum Amount; Waiver.--(1) The amount of payments made for 
a participant under the Specialty Education Loan Repayment Program may 
not exceed $160,000 over a total of four years of participation in the 
Program, of which not more than $40,000 of such payments may be made in 
each year of participation in the Program.
    ``(2)(A) The Secretary may waive the limitations under paragraph 
(1) in the case of a participant described in subparagraph (B). In the 
case of such a waiver, the total amount of payments payable to or for 
that participant is the total amount of the principal and the interest 
on the participant's loans referred to in subsection (a).
    ``(B) A participant described in this subparagraph is a participant 
in the Program who the Secretary determines serves in a position for 
which there is a shortage of qualified employees by reason of either 
the location or the requirements of the position.
``Sec. 7695. Choice of location
    ``Each participant in the Specialty Education Loan Repayment 
Program who completes residency may select, from a list of medical 
facilities of the Veterans Health Administration provided by the 
Secretary, at which such facility the participant will work in a 
medical specialty described in section 7692 of this title.
``Sec. 7696. Term of obligated service
    ``(a) In General.--In addition to any requirements under section 
5379(c) of title 5, a participant in the Specialty Education Loan 
Repayment Program must agree, in writing and before the Secretary may 
make any payment to or for the participant, to--
            ``(1) obtain a license to practice medicine in a State;
            ``(2) successfully complete post-graduate training leading 
        to eligibility for board certification in a specialty;
            ``(3) serve as a full-time clinical practice employee of 
        the Veterans Health Administration for 12 months for every 
        $40,000 in such benefits that the employee receives, but in no 
        case for fewer than 24 months; and
            ``(4) except as provided in subsection (b), to begin such 
        service as a full-time practice employee by not later than 60 
        days after completing a residency.
    ``(b) Fellowship.--In the case of a participant who receives an 
accredited fellowship in a medical specialty other than a medical 
specialty described in section 7692 of this title, the Secretary, on 
written request of the participant, may delay the term of obligated 
service under subsection (a) for the participant until after the 
participant completes the fellowship, but in no case later than 60 days 
after completion of such fellowship.
    ``(c) Penalty.--(1) An employee who does not complete a period of 
obligated service under this section shall owe the Federal Government 
an amount determined in accordance with the following formula: 
A=B x ((T-S)<divide>T)) .
    ``(2) In the formula in paragraph (1):
            ``(A) `A' is the amount the employee owes the Federal 
        Government.
            ``(B) `B' is the sum of all payments to or for the 
        participant under the Specialty Education Loan Repayment 
        Program.
            ``(C) `T' is the number of months in the period of 
        obligated service of the employee.
            ``(D) `S' is the number of whole months of such period of 
        obligated service served by the employee.
``Sec. 7697. Relationship to Educational Assistance Program
    ``Assistance under the Specialty Education Loan Repayment Program 
may be in addition to other assistance available to individuals under 
the Educational Assistance Program.''.
    (b) Conforming and Technical Amendments.--
            (1) Conforming amendments.--
                    (A) Section 7601(a) of title 38, United States 
                Code, is amended--
                            (i) in paragraph (4), by striking ``and'';
                            (ii) in paragraph (5), by striking the 
                        period and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new paragraph:
            ``(6) the specialty education loan repayment program 
        provided for in subchapter VIII of this chapter.''.
                    (B) Section 7603(a)(1) of title 38, United States 
                Code, is amended by striking ``or VI'' and inserting 
                ``VI, or VIII''.
                    (C) Section 7604 of title 38, United States Code, 
                is amended by striking ``or VI'' each place it appears 
                and inserting ``VI, or VIII''.
                    (D) Section 7631 of title 38, United States Code, 
                is amended--
                            (i) in subsection (a)(1)--
                                    (I) by striking ``and'' after 
                                ``scholarship amount,''; and
                                    (II) by inserting ``, and the 
                                maximum specialty education loan 
                                repayment amount'' after ``reduction 
                                payments amount''; and
                            (ii) in subsection (b) by adding at the end 
                        the following new paragraph:
    ``(7) The term `specialty education loan repayment amount' means 
the maximum amount of specialty education loan repayment payments 
payable to or for a participant in the Department of Veterans Affairs 
Specialty Education Loan Repayment Program under subchapter VIII of 
this chapter, as specified in section 7694(c)(1) of this title and as 
previously adjusted (if at all) in accordance with this section.''.
                    (E) Section 7632 of title 38, United States Code, 
                is amended--
                            (i) in paragraph (1), by striking ``and the 
                        Education Debt Reduction Program'' and 
                        inserting ``the Education Debt Reduction 
                        Program, and the Specialty Education Loan 
                        Repayment Program''; and
                            (ii) in paragraph (4), by striking ``and 
                        per participant in the Education Debt Reduction 
                        Program'' and inserting ``per participant in 
                        the Education Debt Reduction Program, and per 
                        participant in the Specialty Education Loan 
                        Repayment Program''.
            (2) Table of sections.--The table of sections at the 
        beginning of chapter 76 of such title is amended by inserting 
        after the items relating to subchapter VII the following:

      ``subchapter viii--specialty education loan repayment program

``7691. Establishment.
``7692. Purpose.
``7693. Eligibility; preference; covered costs.
``7694. Specialty education loan repayment.
``7695. Choice of location.
``7696. Term of obligated service.
``7697. Relationship to Educational Assistance Program.''.
    (c) Needs of the VHA.--In making determinations each year under 
section 7692 of title 38, United States Code, as enacted by subsection 
(a), the Secretary of Veterans Affairs shall consider the anticipated 
needs of the Veterans Health Administration during the period two to 
six years in the future.
    (d) Offer Deadline.--In the case of an applicant who applies before 
receiving a residency match and whom the Secretary of Veterans Affairs 
selects for participation in the Specialty Education Loan Repayment 
Program established by subsection (a), the Secretary shall offer 
participation to the applicant not later than 28 days after--
            (1) the applicant matches with a residency in a medical 
        specialty described in section 7692 of title 38, United States 
        Code, as enacted by subsection (a); and
            (2) such match is published.
    (e) Publicity.--The Secretary of Veterans Affairs shall take such 
steps as the Secretary determines are appropriate to publicize the 
Specialty Education Loan Repayment Program established under subchapter 
VIII of chapter 76 of title 38, United States Code, as enacted by 
subsection (a).

SEC. 303. VETERANS HEALING VETERANS MEDICAL ACCESS AND SCHOLARSHIP 
              PROGRAM.

    (a) Establishment.--The Secretary of Veterans Affairs, acting 
through the Office of Academic Affiliations of the Department of 
Veterans Affairs, shall carry out a pilot program under which the 
Secretary shall provide funding for the medical education of a total of 
18 eligible veterans. Such funding shall be provided for two veterans 
enrolled in each covered medical schools in accordance with this 
section.
    (b) Eligible Veterans.--To be eligible to receive funding for 
medical education under this section, a veteran shall--
            (1) have been discharged from the Armed Forces not more 
        than ten years before the date of application for admission to 
        a covered medical school;
            (2) not be entitled to educational assistance under chapter 
        30, 31, 32, 33, 34, or 35 of title 38, United States Code, or 
        chapter 1606 or 1607 of title 10, United States Code;
            (3) apply for admission to a covered medical school for the 
        entering class of 2019;
            (4) indicate on such application for admission that the 
        veteran would like to be considered for an award of funding 
        under this section;
            (5) meet the minimum admissions criteria for the covered 
        medical school to which the veteran applies; and
            (6) enter into an agreement described in subsection (e).
    (c) Award of Funding.--
            (1) In general.--Each covered medical school that opts to 
        participate in the program under this section shall reserve two 
        seats in the entering class of 2019 for eligible veterans who 
        receive funding under such program. Such funding shall be 
        awarded to the two eligible veterans with the highest 
        admissions rankings for such class at such school.
            (2) Amount of funding.--Each eligible veteran who receives 
        funding under this section shall receive an amount equal to the 
        actual cost of--
                    (A) tuition at the covered medical school at which 
                the veteran enrolls for four years;
                    (B) books, fees, and technical equipment;
                    (C) fees associated with the National Residency 
                Match Program;
                    (D) two away rotations performed during the fourth 
                year at a Department of Veterans Affairs medical 
                facility; and
                    (E) a monthly stipend for the four-year period 
                during which the veteran is enrolled in medical school 
                in an amount to be determined by the Secretary.
            (3) Distribution of funding.--In the event that two or more 
        eligible veterans do not apply for admission at one of the 
        covered medical schools for the entering class of 2019, the 
        Secretary shall distribute the available funding to eligible 
        veterans who applied for admission at other covered medical 
        schools.
    (d) Agreement.--
            (1) Terms of agreement.--Each eligible veteran who accepts 
        funding for medical education under this section shall enter 
        into an agreement with the Secretary that provides that the 
        veteran agrees--
                    (A) to maintain enrollment and attendance in the 
                medical school;
                    (B) while enrolled in such medical school, to 
                maintain an acceptable level of academic standing (as 
                determined by the medical school under regulations 
                prescribed by the Secretary);
                    (C) to complete post-graduate training leading to 
                eligibility for board certification in a speciality 
                applicable to the Department of Veterans Affairs, as 
                determined by the Secretary;
                    (D) after completion of medical school, to obtain a 
                license to practice medicine in a State; and
                    (E) after completion of medical school and post-
                graduate training, to serve as a full-time clinical 
                practice employee in the Veterans Health Administration 
                for a period of four years.
            (2) Breach of agreement.--If an eligible veteran who 
        accepts funding under this section breaches the terms of the 
        agreement described in paragraph (1), the United States shall 
        be entitled to recover damages in an amount equal to the total 
        amount of such funding received by the veteran.
    (e) Rule of Construction.--Nothing in this section shall be 
construed to prevent any covered medical school from accepting more 
than two eligible veterans for the entering class of 2019.
    (f) Report to Congress.--Not later than December 31, 2020, and 
annually thereafter for the subsequent three years, the Secretary shall 
submit to Congress a report on the pilot program under this section. 
Such report shall include the evaluation of the Secretary of the 
success of the pilot program, including the number of veterans who 
received funding under the program who matriculated and an evaluation 
of the academic progress of such veterans.
    (g) Covered Medical Schools.--In this section, the term ``covered 
medical school'' means any of the following.
            (1) The Teague-Cranston medical schools, consisting of--
                    (A) Texas A&M College of Medicine;
                    (B) Quillen College of Medicine at East Tennessee 
                State University;
                    (C) Boonshoft School of Medicine at Wright State 
                University;
                    (D) Joan C. Edwards School of Medicine at Marshall 
                University; and
                    (E) University of South Carolina School of 
                Medicine.
            (2) Charles R Drew University of Medicine and Science.
            (3) Howard University College of Medicine.
            (4) Meharry Medical College.
            (5) Morehouse School of Medicine.
                                                 Union Calendar No. 444

115th CONGRESS

  2d Session

                               H. R. 4242

                          [Report No. 115-585]

_______________________________________________________________________

                                 A BILL

To amend title 38, United States Code, to establish a permanent VA Care 
           in the Community Program, and for other purposes.

_______________________________________________________________________

                             March 5, 2018

  Reported with an amendment, committed to the Committee of the Whole 
       House on the State of the Union, and ordered to be printed