[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1526 Introduced in Senate (IS)]
<DOC>
115th CONGRESS
1st Session
S. 1526
To appropriate amounts to the Department of Veterans Affairs to improve
the provision of health care to veterans, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 11, 2017
Mr. Tester (for himself, Mr. King, Mr. Sanders, Mrs. Murray, Mr.
Blumenthal, Mr. Brown, Ms. Baldwin, and Ms. Hirono) introduced the
following bill; which was read twice and referred to the Committee on
Veterans' Affairs
_______________________________________________________________________
A BILL
To appropriate amounts to the Department of Veterans Affairs to improve
the provision of health care to veterans, 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 ``Veterans Access to
Care Act of 2017''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--APPROPRIATION OF AMOUNTS FOR HEALTH CARE FOR VETERANS
Sec. 101. Appropriation of amounts for Veterans Choice Program.
Sec. 102. Appropriation of amounts for health care from Department of
Veterans Affairs.
TITLE II--IMPROVEMENT OF HEALTH CARE FROM DEPARTMENT OF VETERANS
AFFAIRS
Sec. 201. Program to increase number of graduate medical education
residency positions of Department of
Veterans Affairs.
Sec. 202. Expansion of eligibility for participation in and services
provided under family caregiver program of
Department of Veterans Affairs.
Sec. 203. Authorization of certain major medical facility leases of the
Department of Veterans Affairs.
TITLE III--ADMINISTRATION OF HEALTH CARE FROM NON-DEPARTMENT OF
VETERANS AFFAIRS PROVIDERS
Sec. 301. Modification of process through which Department of Veterans
Affairs records obligations for non-
Department care.
Sec. 302. Modification of report on amounts available under Veterans
Choice Program.
TITLE IV--OTHER MATTERS
Sec. 401. Emergency designations.
TITLE I--APPROPRIATION OF AMOUNTS FOR HEALTH CARE FOR VETERANS
SEC. 101. APPROPRIATION OF AMOUNTS FOR VETERANS CHOICE PROGRAM.
(a) In General.--There is authorized to be appropriated, and is
appropriated, to the Secretary of Veterans Affairs, out of any funds in
the Treasury not otherwise appropriated, $4,300,000,000 to be deposited
in the Veterans Choice Fund under section 802 of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note).
(b) Availability of Amounts.--The amount appropriated under
subsection (a) shall be available for obligation or expenditure without
fiscal year limitation.
SEC. 102. APPROPRIATION OF AMOUNTS FOR HEALTH CARE FROM DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--There is authorized to be appropriated, and is
appropriated, to the Secretary of Veterans Affairs, out of any funds in
the Treasury not otherwise appropriated, $4,300,000,000 to carry out
subsection (c).
(b) Availability of Amounts.--The amount appropriated under
subsection (a) shall be available for obligation or expenditure without
fiscal year limitation.
(c) Use of Amounts.--The amount appropriated under subsection (a)
shall be used by the Secretary as follows:
(1) To increase the access of veterans to care as follows:
(A) To hire primary care and specialty care
physicians for employment in the Department of Veterans
Affairs.
(B) To hire other medical staff, including the
following:
(i) Physicians.
(ii) Gynecologists.
(iii) Nurses.
(iv) Social workers.
(v) Mental health professionals.
(vi) Physician assistants.
(vii) Other health care professionals as
the Secretary considers appropriate.
(C) To carry out the following:
(i) Section 7412 of title 38, United States
Code.
(ii) Section 7302(e) of such title.
(iii) Subchapters II and VII of chapter 76
of such title.
(iv) Section 301(b)(2) of the Veterans
Access, Choice, and Accountability Act of 2014
(Public Law 113-146; 38 U.S.C. 7302 note).
(D) To pay for expenses, equipment, and other costs
associated with the hiring of primary care, specialty
care physicians, and other medical staff under
subparagraphs (A), (B), and (C).
(2) To improve the physical infrastructure of the
Department as follows:
(A) To maintain and operate hospitals, nursing
homes, domiciliary facilities, and other facilities of
the Veterans Health Administration.
(B) To enter into contracts or hire temporary
employees to repair, alter, or improve facilities under
the jurisdiction of the Department that are not
otherwise provided for under this paragraph.
(C) To carry out leases for facilities of the
Department.
(D) To carry out minor construction projects of the
Department.
(3) To carry out the program to increase the number of
graduate medical education residency positions of the
Department under section 201.
(4) To carry out the major medical facility leases
authorized under section 203.
(d) Report.--
(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 appropriate committees of Congress a report
on how the Secretary has obligated the amount appropriated
under subsection (a) as of the date of the submittal of the
report.
(2) Appropriate committees of congress defined.--In this
subsection, the term ``appropriate committees of Congress''
means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
(e) Funding Plan.--The Secretary shall submit to Congress a funding
plan describing how the Secretary intends to use the amount
appropriated under subsection (a).
TITLE II--IMPROVEMENT OF HEALTH CARE FROM DEPARTMENT OF VETERANS
AFFAIRS
SEC. 201. PROGRAM TO INCREASE NUMBER OF GRADUATE MEDICAL EDUCATION
RESIDENCY POSITIONS OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall conduct a
program to increase the number of graduate medical education residency
positions at covered facilities by not more than 1,500 positions
through the payment of educational assistance to participants in the
program.
(b) Application.--To participate in the program under this section,
an individual shall submit to the Secretary an application for such
participation together with an agreement described in subsection (d)
under which the individual agrees to serve a period of obligated
service in the Veterans Health Administration as provided in the
agreement in return for payment of educational assistance as provided
in the agreement.
(c) Approval by Secretary.--
(1) In general.--An individual becomes a participant in the
program under this section upon the approval by the Secretary
of the application of the individual and the acceptance by the
Secretary of an agreement described in subsection (d) with
respect to the individual.
(2) Notification.--Upon the approval by the Secretary under
paragraph (1) of the participation of an individual in the
program and the acceptance of an agreement described in
subsection (d), the Secretary shall promptly notify the
individual in writing of that approval and acceptance.
(d) Agreement.--An agreement between the Secretary and a
participant in the program under this section shall be in writing and
shall be signed by the participant containing such terms as the
Secretary may specify.
(e) Conditions for Medical Residency.--The Secretary may prescribe
the conditions of employment of individuals participating in a medical
residency under the program under this section, including necessary
training, and the customary amount and terms of pay for such
individuals during the period of such employment and training as a
medical resident.
(f) Obligated Service.--
(1) In general.--Each participant in the program under this
section shall serve as a full-time employee of the Department
of Veterans Affairs for a period of obligated service provided
in the agreement entered into by the participant under
subsection (d).
(2) Practice area.--Service by a participant under
paragraph (1) shall be in the full-time clinical practice of
the profession of the participant or in another health care
position in an assignment or location determined by the
Secretary.
(3) Notification.--Not later than 60 days before the date
of the beginning of the period of obligated service of a
participant, the Secretary shall notify the participant of that
date.
(g) Breach of Agreement; Liability.--
(1) Liquidated damages for failure to accept payment.--
(A) In general.--A participant in the program under
this section (other than a participant described in
paragraph (2)) who fails to accept payment, or
instructs the covered facility at which the participant
is a medical resident not to accept payment, in whole
or in part, of educational assistance under the
agreement entered into under subsection (d) shall be
liable to the United States for liquidated damages in
the amount of $1,500.
(B) Treatment of other obligations.--Liability for
liquidated damages under subparagraph (A) is in
addition to any period of obligated service or other
obligation or liability under the agreement entered
into under subsection (d).
(2) Liability for certain breaches.--
(A) In general.--A participant in the program under
this section shall be liable to the United States for
the amount that has been paid to or on behalf of the
participant under the agreement if any of the following
occurs:
(i) The participant is dismissed from
serving as a medical resident at a covered
facility for disciplinary reasons.
(ii) The participant voluntarily terminates
service as a medical resident at a covered
facility before completion of such service.
(iii) The participant loses his or her
license, registration, or certification to
practice his or her health care profession in a
State.
(B) Treatment of period of obligated service.--
Liability under subparagraph (A) is in lieu of any
period of obligated service under the agreement entered
into under subsection (d).
(3) Liability for failing to complete period of service.--
(A) In general.--If a participant in the program
under this section breaches the agreement under
subsection (d) by failing (for any reason) to complete
the period of obligated service of the participant, the
United States shall be entitled to recover from the
participant an amount determined in accordance with the
following formula: A = 3F(t - s/t).
(B) Formula variables.--In the formula specified in
subparagraph (A):
(i) ``A'' is the amount the United States
is entitled to recover from the participant.
(ii) ``F'' is the sum of--
(I) the amounts paid under this
section to or on behalf of the
participant; and
(II) the interest on such amounts
which would be payable if at the time
the amounts were paid they were loans
bearing interest at the maximum legal
prevailing rate, as determined by the
Treasurer of the United States.
(iii) ``t'' is the total number of months
in the period of obligated service of the
participant.
(iv) ``s'' is the number of months of such
period served by the participant.
(4) Payment deadline.--Any amount of damages that the
United States is entitled to recover under this subsection
shall be paid to the United States within the one-year period
beginning on the date of the breach of the agreement under
subsection (d).
(h) Covered Facilities Defined.--In this section, the term
``covered facilities'' means any of the following:
(1) A Department facility.
(2) A facility operated by an Indian tribe or a tribal
organization, as those terms are defined in section 4 of the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 5304).
(3) A facility operated by the Indian Health Service.
(4) A Federally-qualified health center, as defined in
section 1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B)).
(5) A community health center.
(6) A facility operated by the Department of Defense.
(7) Any other health care facility designated by the
Secretary of Veterans Affairs.
SEC. 202. EXPANSION OF ELIGIBILITY FOR PARTICIPATION IN AND SERVICES
PROVIDED UNDER FAMILY CAREGIVER PROGRAM OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) Family Caregiver Program.--
(1) Expansion of eligibility.--Subsection (a)(2)(B) of
section 1720G of title 38, United States Code, is amended by
striking ``on or after September 11, 2001''.
(2) Clarification of eligibility for illness.--Such
subsection is further amended by inserting ``or illness'' after
``serious injury''.
(3) Expansion of needed services in eligibility criteria.--
Subsection (a)(2)(C) of such section is amended--
(A) in clause (ii), by striking ``; or'' and
inserting a semicolon;
(B) by redesignating clause (iii) as clause (iv);
and
(C) by inserting after clause (ii) the following
new clause (iii):
``(iii) a need for regular or extensive instruction
or supervision without which the ability of the veteran
to function in daily life would be seriously impaired;
or''.
(4) Expansion of services provided.--Subsection
(a)(3)(A)(ii) of such section is amended--
(A) in subclause (IV), by striking ``; and'' and
inserting a semicolon;
(B) in subclause (V), by striking the period at the
end and inserting a semicolon; and
(C) by adding at the end the following new
subclauses:
``(VI) child care services or a monthly stipend for
such services if such services are not readily
available from the Department;
``(VII) financial planning services relating to the
needs of injured and ill veterans and their caregivers;
and
``(VIII) legal services, including legal advice and
consultation, relating to the needs of injured and ill
veterans and their caregivers.''.
(5) Expansion of respite care provided.--Subsection
(a)(3)(B) of such section is amended by striking ``shall be''
and all that follows through the period at the end and
inserting ``shall--
``(i) be medically and age-appropriate;
``(ii) include in-home care; and
``(iii) include peer-oriented group activities.''.
(6) Modification of stipend calculation.--Subsection
(a)(3)(C) of such section is amended--
(A) by redesignating clause (iii) as clause (iv);
and
(B) by inserting after clause (ii) the following
new clause (iii):
``(iii) In determining the amount and degree of personal care
services provided under clause (i) with respect to an eligible veteran
whose need for personal care services is based in whole or in part on a
need for supervision or protection under paragraph (2)(C)(ii) or
regular or extensive instruction or supervision under paragraph
(2)(C)(iii), the Secretary shall take into account the following:
``(I) The assessment by the family caregiver of the needs
and limitations of the veteran.
``(II) The extent to which the veteran can function safely
and independently in the absence of such supervision,
protection, or instruction.
``(III) The amount of time required for the family
caregiver to provide such supervision, protection, or
instruction to the veteran.''.
(7) Periodic evaluation of need for certain services.--
Subsection (a)(3) of such section is amended by adding at the
end the following new subparagraph:
``(D) In providing instruction, preparation, and training under
subparagraph (A)(i)(I) and technical support under subparagraph
(A)(i)(II) to each family caregiver who is approved as a provider of
personal care services for an eligible veteran under paragraph (6), the
Secretary shall periodically evaluate the needs of the eligible veteran
and the skills of the family caregiver of such veteran to determine if
additional instruction, preparation, training, or technical support
under those subparagraphs is necessary.''.
(8) Use of primary care teams.--Subsection (a)(5) of such
section is amended, in the matter preceding subparagraph (A),
by inserting ``(in collaboration with the primary care team for
the eligible veteran to the maximum extent practicable)'' after
``evaluate''.
(9) Eligibility of and assistance for family caregivers.--
Subsection (a) of such section is amended by adding at the end
the following new paragraphs:
``(11) Notwithstanding any other provision of this subsection, a
family caregiver of an eligible veteran who is eligible under paragraph
(2) solely because of a serious injury or illness (including traumatic
brain injury, psychological trauma, or other mental disorder) incurred
or aggravated in the line of duty in the active military, naval, or air
service before September 11, 2001, is eligible for assistance under
this subsection as follows:
``(A) Not earlier than October 1, 2018, if the family
caregiver would merit a monthly personal caregiver stipend
under paragraph (3)(A)(ii)(V) in an amount that is in the
highest tier specified in the schedule established by the
Secretary under paragraph (3)(C)(i).
``(B) Not earlier than October 1, 2020, if the family
caregiver would merit such a stipend in an amount that is in
the middle tier specified in such schedule.
``(C) Not earlier than October 1, 2022, if the family
caregiver would merit such a stipend in an amount that is in
the lowest tier specified in such schedule.
``(12)(A) In providing assistance under this subsection to family
caregivers of eligible veterans, the Secretary may enter into
contracts, provider agreements, and memoranda of understanding with
Federal agencies, States, and private, nonprofit, and other entities to
provide such assistance to such family caregivers.
``(B) The Secretary may provide assistance under this paragraph
only if such assistance is reasonably accessible to the family
caregiver and is substantially equivalent or better in quality to
similar services provided by the Department.
``(C) The Secretary may provide fair compensation to Federal
agencies, States, and other entities that provide assistance under this
paragraph.''.
(b) Termination of General Caregiver Support Program.--
(1) In general.--Subsection (b) of such section is amended
by adding at the end the following new paragraph:
``(6) The authority of the Secretary to provide support services
for caregivers of covered veterans under this subsection shall
terminate on October 1, 2022.''.
(2) Continuation of certain assistance.--The Secretary of
Veterans Affairs shall ensure that any activities carried out
under subsection (b) of such section on September 30, 2022, are
continued under subsection (a) of such section on and after
October 1, 2022.
(c) Modification of Definition of Family Member.--Subparagraph (B)
of subsection (d)(3) of such section is amended to read as follows:
``(B) is not a member of the family of the veteran
and does not provide care to the veteran on a
professional basis.''.
(d) Modification of Definition of Personal Care Services.--
Subsection (d)(4) of such section is amended--
(1) in subparagraph (A), by striking ``independent'';
(2) by redesignating subparagraph (B) as subparagraph (D);
and
(3) by inserting after subparagraph (A) the following new
subparagraphs:
``(B) Supervision or protection based on symptoms
or residuals of neurological or other impairment or
injury.
``(C) Regular or extensive instruction or
supervision without which the ability of the veteran to
function in daily life would be seriously impaired.''.
(e) Annual Evaluation Report.--Paragraph (2) of section 101(c) of
the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public
Law 111-163; 38 U.S.C. 1720G note) is amended to read as follows:
``(2) Contents.--Each report required by paragraph (1)
after the date of the enactment of the Veterans Choice Act of
2017 shall include the following with respect to the program of
comprehensive assistance for family caregivers required by
subsection (a)(1) of such section 1720G:
``(A) The number of family caregivers that received
assistance under such program.
``(B) The cost to the Department of providing
assistance under such program.
``(C) A description of the outcomes achieved by,
and any measurable benefits of, carrying out such
program.
``(D) An assessment of the effectiveness and the
efficiency of the implementation of such program,
including a description of any barriers to accessing
and receiving care and services under such program.
``(E) A description of the outreach activities
carried out by the Secretary under such program.
``(F) An assessment of the manner in which
resources are expended by the Secretary under such
program, particularly with respect to the provision of
monthly personal caregiver stipends under subsection
(a)(3)(A)(ii)(V) of such section 1720G.
``(G) An evaluation of the sufficiency and
consistency of the training provided to family
caregivers under such program in preparing family
caregivers to provide care to veterans under such
program.
``(H) Such recommendations, including
recommendations for legislative or administrative
action, as the Secretary considers appropriate in light
of carrying out such program.''.
SEC. 203. AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY LEASES OF THE
DEPARTMENT OF VETERANS AFFAIRS.
The Secretary of Veterans Affairs may carry out the following major
medical facility leases at the locations specified and in an amount for
each lease not to exceed the amount specified for such location (not
including any estimated cancellation costs):
(1) For an outpatient clinic, Ann Arbor, Michigan, an
amount not to exceed $4,247,000.
(2) For an outpatient mental health clinic, Birmingham,
Alabama, an amount not to exceed $6,649,000.
(3) For research space, Boston, Massachusetts, an amount
not to exceed $6,224,000.
(4) For research space, Charleston, South Carolina, an
amount not to exceed $7,274,000.
(5) For an outpatient clinic, Corpus Christi, Texas, an
amount not to exceed $6,556,000.
(6) For an outpatient clinic, Daytona Beach, Florida, an
amount not to exceed $12,198,000.
(7) For Chief Business Office Purchased Care office space,
Denver, Colorado, an amount not to exceed $14,784,000.
(8) For an outpatient clinic, Fredericksburg, Virginia, an
amount not to exceed $45,015,000.
(9) For an outpatient clinic, Gainesville, Florida, an
amount not to exceed $7,891,000.
(10) For an outpatient mental health clinic, Gainesville,
Florida, an amount not to exceed $4,320,000.
(11) For an outpatient clinic, Hampton Roads, Virginia, an
amount not to exceed $18,141,000.
(12) For a replacement outpatient clinic, Indianapolis,
Indiana, an amount not to exceed $7,876,000.
(13) For a replacement outpatient clinic, Jacksonville,
Florida, an amount not to exceed $18,623,000.
(14) For an outpatient clinic, Missoula, Montana, an amount
not to exceed $6,942,000.
(15) For an outpatient mental health clinic, Northern
Colorado, Colorado, an amount not to exceed $8,904,000.
(16) For an outpatient clinic, Ocala, Florida, an amount
not to exceed $5,026,000.
(17) For an outpatient clinic, Oxnard, California, an
amount not to exceed $5,274,000.
(18) For an outpatient clinic, Pike County, Georgia, an
amount not to exceed $5,565,000.
(19) For a replacement outpatient clinic, Pittsburgh,
Pennsylvania, an amount not to exceed $6,247,000.
(20) For an outpatient clinic, Portland, Maine, an amount
not to exceed $6,808,000.
(21) For an outpatient clinic, Raleigh, North Carolina, an
amount not to exceed $21,870,000.
(22) For a replacement outpatient clinic, phase II,
Rochester, New York, an amount not to exceed $3,645,000.
(23) For research space, San Diego, California, an amount
not to exceed $4,852,000.
(24) For an outpatient clinic, Santa Rosa, California, an
amount not to exceed $6,922,000.
(25) For a replacement mental health clinic, Tampa,
Florida, an amount not to exceed $13,387,000.
(26) For a replacement outpatient clinic, Lakeland, Tampa,
Florida, an amount not to exceed $10,760,000.
(27) For a replacement outpatient clinic, Terre Haute,
Indiana, an amount not to exceed $4,102,000.
TITLE III--ADMINISTRATION OF HEALTH CARE FROM NON-DEPARTMENT OF
VETERANS AFFAIRS PROVIDERS
SEC. 301. MODIFICATION OF PROCESS THROUGH WHICH DEPARTMENT OF VETERANS
AFFAIRS RECORDS OBLIGATIONS FOR NON-DEPARTMENT CARE.
(a) In General.--Subchapter III of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1730B. Recording obligations for care at non-Department
facilities
``Notwithstanding sections 1341(a)(1) and 1501 of title 31, the
Secretary may record as an obligation of the United States Government
amounts owed for hospital care or medical services furnished under this
chapter at non-Department facilities on the date on which a claim by a
health care provider for payment is approved rather than on the date
that the hospital care or medical services are authorized by the
Secretary.''.
(b) 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 1730A the following new item:
``1730B. Recording obligations for care at non-Department
facilities.''.
SEC. 302. MODIFICATION OF REPORT ON AMOUNTS AVAILABLE UNDER VETERANS
CHOICE PROGRAM.
Section 101(q)(2) of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is
amended--
(1) in the matter preceding subparagraph (A), by striking
``30 days'' and inserting ``14 days'';
(2) by redesignating subparagraph (F) as subparagraph (H);
and
(3) by inserting after subparagraph (E) the following new
subparagraphs:
``(F) An assessment of the rate at which amounts
deposited in the Veterans Choice Fund have been
exhausted during the 90-day period preceding the
submittal of the report, including an identification of
any major factors that are causing amounts to be
exhausted quickly or slowly.
``(G) An estimate of when amounts in the Veterans
Choice Fund will be completely exhausted.''.
TITLE IV--OTHER MATTERS
SEC. 401. EMERGENCY DESIGNATIONS.
(a) In General.--This Act is designated as an emergency requirement
pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 2010 (2
U.S.C. 933(g)).
(b) Designation in Senate.--In the Senate, this Act is designated
as an emergency requirement pursuant to section 403(a) of S. Con. Res.
13 (111th Congress), the concurrent resolution on the budget for fiscal
year 2010.
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