[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2184 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  1st Session
                                S. 2184

To amend title 38, United States Code, to improve veterans' health care 
                   benefits, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            December 1, 2017

 Mr. McCain (for himself and Mr. Moran) introduced the following bill; 
which was read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To amend title 38, United States Code, to improve veterans' health care 
                   benefits, 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 Community 
Care and Access Act of 2017''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
       TITLE I--DEVELOPING AN INTEGRATED HIGH-PERFORMING NETWORK

      Subtitle A--Establishing the Veterans Community Care Program

Sec. 101. Establishment of Veterans Community Care Program.
Sec. 102. Strategy regarding the High Performing Integrated Healthcare 
                            Network of the Department.
Sec. 103. Access standards and standards for quality.
            Subtitle B--Forming Partnerships and Agreements

Sec. 111. Continuity of care and existing agreements.
Sec. 112. Authorization of agreements between Department of Veterans 
                            Affairs and non-Department providers.
Sec. 113. Prevention of certain health care providers from providing 
                            non-Department health care services to 
                            veterans.
Sec. 114. Conforming amendments for State veterans homes.
                      Subtitle C--Paying Providers

Sec. 121. Prompt payment to providers.
Sec. 122. Payment rates for community care.
Sec. 123. Authority to pay for authorized care not subject to an 
                            agreement.
             TITLE II--STREAMLINING COMMUNITY CARE PROGRAMS

            Subtitle A--Streamlining Community Care Programs

Sec. 201. Access to walk-in care.
Sec. 202. Veterans Choice Fund flexibility.
Sec. 203. Conforming amendments.
        Subtitle B--Improving Information Sharing With Providers

Sec. 211. Improving information sharing with community providers.
Sec. 212. Establishment of processes to ensure safe opioid prescribing 
                            practices by non-Department of Veterans 
                            Affairs health care providers.
                   Subtitle C--Improving Collections

Sec. 221. Aligning with best practices on collection of health 
                            insurance information.
Sec. 222. Improving authority to collect.
   TITLE III--IMPROVING DEPARTMENT OF VETERANS AFFAIRS CARE DELIVERY

               Subtitle A--Improving Personnel Practices

Sec. 301. Licensure of health care professionals of the Department of 
                            Veterans Affairs providing treatment via 
                            telemedicine.
Sec. 302. Graduate medical education and residency.
Sec. 303. Annual report on awards or bonuses awarded to certain high-
                            level employees of the department of 
                            veterans affairs.
            Subtitle B--Facilities, Construction, and Leases

Sec. 311. Facilitating sharing of medical facilities with other Federal 
                            agencies.
Sec. 312. Review of enhanced use leases.
                  TITLE IV--INNOVATIVE PILOT PROGRAMS

Sec. 401. Pilot program to establish or affiliate with graduate medical 
                            residency programs at facilities operated 
                            by Indian tribes, tribal organizations, and 
                            the Indian Health Service in rural areas.
Sec. 402. Authority for Department of Veterans Affairs Center for 
                            Innovation for Care and Payment.
                   TITLE V--OTHER HEALTH CARE MATTERS

Sec. 501. Authorization of appropriations for health care from 
                            Department of Veterans Affairs.
Sec. 502. Appropriation of amounts for Veterans Choice Program.
Sec. 503. Applicability of Directive of Office of Federal Contract 
                            Compliance Programs.
Sec. 504. Amending statutory requirements for the position of the Chief 
                            Officer of the Readjustment Counseling 
                            Service.
Sec. 505. Authorization of certain major medical facility projects of 
                            the Department of Veterans Affairs.

SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.

    Except as otherwise expressly provided, whenever in this Act an 
amendment or repeal is expressed in terms of an amendment to, or repeal 
of, a section or other provision, the reference shall be considered to 
be made to a section or other provision of title 38, United States 
Code.

       TITLE I--DEVELOPING AN INTEGRATED HIGH-PERFORMING NETWORK

      Subtitle A--Establishing the Veterans Community Care Program

SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY CARE PROGRAM.

    (a) Establishment.--
            (1) In general.--Section 1703 is amended to read as 
        follows:
``Sec. 1703. Veterans Community Care Program
    ``(a) In General.--(1) Subject to the availability of 
appropriations for such purpose and subject to paragraph (4), hospital 
care, medical services, and extended care services under this chapter 
shall be furnished to a covered veteran described in subsection (b) by 
health care providers specified in subsection (c) in accordance with 
this section.
    ``(2) The furnishing of care and services under this section may be 
referred to as the `Veterans Community Care Program'.
    ``(3)(A) In carrying out this section, the Secretary may develop 
categories of certain health care providers specified in subsection (c) 
for the purpose of providing a covered veteran hospital care, medical 
services, and extended care services when the covered veteran does not 
state a preference for a health care provider.
    ``(B) In developing categories of health care providers under 
subparagraph (A), the Secretary shall not--
            ``(i) prioritize or rank such categories in a manner that 
        limits the options a covered veteran may have in selecting a 
        health care provider specified in subsection (c); or
            ``(ii) direct a covered veteran to receive care or services 
        from certain health care providers instead of other health care 
        providers.
    ``(4) In carrying out this section, the Secretary shall not limit 
any hospital care, medical service, extended care service, or class of 
hospital care, medical service, or extended care service that are set 
forth in the Medical Benefits Package of the Department, as modified as 
determined by the Secretary.
    ``(b) Covered Veterans.--For purposes of this section, a covered 
veteran is any veteran who--
            ``(1)(A) is enrolled in the patient enrollment system of 
        the Department established and operated under section 1705 of 
        this title; or
            ``(B) is not enrolled in such system but is otherwise 
        entitled to hospital care, a medical service, or an extended 
        care service under subsection (c)(2) of such section; and
            ``(2)(A) has been furnished hospital care or medical 
        services under this chapter on at least one occasion during the 
        preceding two-year period; or
            ``(B) requested a first-time appointment for hospital care 
        or medical services at a Department facility.
    ``(c) Health Care Providers Specified.--Health care providers 
specified in this subsection are the following:
            ``(1) Any health care provider that is participating in the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.), including any physician furnishing 
        services under such a program.
            ``(2) The Department of Defense.
            ``(3) The Indian Health Service.
            ``(4) 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))).
            ``(5) Any health care provider not otherwise covered under 
        any of paragraphs (1) through (4) that meets criteria 
        established by the Secretary for purposes of this section.
    ``(d) Contracts To Establish Networks of Health Care Providers.--
(1) The Secretary shall enter into consolidated, competitively bid 
contracts, which may be regional contracts, to establish networks of 
non-Department health care providers specified in paragraphs (1) and 
(5) of subsection (c) for contract purposes of--
            ``(A) providing sufficient access to hospital care, medical 
        services, and extended care services under this section;
            ``(B) managing the operations of such health care 
        providers; and
            ``(C) managing the delivery of hospital care, medical 
        services, and extended care services under this section.
    ``(2) The Secretary may terminate a contract with an entity entered 
into under paragraph (1) at such time and upon such notice to the 
entity as the Secretary may specify for purposes of this section.
    ``(3)(A) Whenever the Secretary provides notice to an entity under 
paragraph (2) that the entity is failing to meet contractual 
obligations entered into under paragraph (1), the Secretary shall 
submit to the Committee on Veterans' Affairs of the Senate and the 
Committee on Veterans' Affairs of the House of Representatives a report 
on such failure and the decision of the Secretary to terminate the 
contract under paragraph (2).
    ``(B) Each report submitted under subparagraph (A) shall include 
the following:
            ``(i) An explanation of the reasons for terminating the 
        contract.
            ``(ii) A description of the effect of the failure of the 
        entity to meet contractual obligations and the termination of 
        the contract, including with respect to cost, schedule, and 
        requirements.
            ``(iii) A description of the actions taken by the Secretary 
        to mitigate such failure and termination.
    ``(e) Coordination of Care and Services.--(1) The Secretary shall 
ensure that for each covered veteran seeking care or services under 
this section, a care coordination team is provided by a medical 
facility of the Department.
    ``(2) The Secretary shall ensure that each care coordination team 
provided under this section, with respect to a covered veteran, is 
responsible for the following:
            ``(A) Coordination and management of hospital care, medical 
        services (including telemedicine), and extended care services 
        furnished under this title, including the following:
                    ``(i) Collaboration with the patient aligned care 
                teams (PACT) within the medical facility of the 
                Department; and
                    ``(ii) Coordination within and across Veterans 
                Integrated Service Networks with non-Department health 
                care providers acting under a contract or agreement to 
                furnish hospital care, a medical service, or an 
                extended care service on behalf of the Department and 
                who meets such terms and conditions as the Secretary 
                may require.
            ``(B) Ensure continuity of care for the covered veteran to 
        avoid any delay or lapse in care or services from an action or 
        error of the Department or any individual of the care 
        coordination team of the covered veteran.
            ``(C) Submitting information to the Secretary in 
        furtherance of analysis conducted under section 1730B(a) of 
        this title.
    ``(3) The Secretary shall develop an organizational construct for 
care coordination teams at medical facilities of the Department that 
may include the following individuals:
            ``(A) An employee of the Department who furnishes hospital 
        care, a medical service, or an extended care service at the 
        facility.
            ``(B) A non-Department health care provider acting under a 
        contract or agreement to furnish hospital care, a medical 
        service, or an extended care service on behalf of the 
        Department and who meets such terms and conditions as the 
        Secretary may require.
            ``(C) An employee of the Department or a health care 
        provider described in subparagraph (B) who serves to seamlessly 
        coordinate the delivery of hospital care, medical services, and 
        extended care services to covered veterans.
    ``(f) Eligibility Reform and Conditions That Require Access to 
Community Care.--(1) Subject to the availability of appropriations, the 
Secretary shall furnish hospital care, medical services, and extended 
care services to a covered veteran, at the election of a covered 
veteran, through health care providers specified in subsection (c) as 
follows:
            ``(A) When a medical facility of the Department does not 
        offer the hospital care, medical services, or extended care 
        services the covered veteran requires.
            ``(B) When a medical facility of the Department cannot 
        furnish or schedule an appointment for hospital care, medical 
        services, or extended care services in accordance with access 
        standards established under section 1703B of this title.
            ``(C) When the covered veteran and a referring clinician of 
        the covered veteran agree that furnishing hospital care, 
        medical services, or extended care services through a non-
        Department entity or provider would be in the best medical 
        interest of the covered veteran, after consideration of the 
        standards established under sections 1703B and 1703C of this 
        title or due to a non-clinical reason, compelling circumstance, 
        or other considerations that are in the best medical interest 
        of the covered veteran.
    ``(2) Not later than 120 days after the date of the enactment of 
the Veterans Community Care and Access Act of 2017, the Secretary shall 
submit to the appropriate committees of Congress a report describing 
the guidelines and standards the Secretary intends to use to carry out 
paragraph (1) in accordance with sections 1703B and 1703C of this 
title.
    ``(g) Scheduling Services.--(1) The Secretary shall ensure that 
services are established in order to schedule appointments for hospital 
care, medical services, and extended care services under this chapter.
    ``(2)(A) In carrying out paragraph (1), the Secretary shall 
determine whether services established under such paragraph should 
reside within the respective medical facility of the Department or 
reside with an entity with whom the Secretary enters into a contract 
for such services.
    ``(B) In carrying out subparagraph (A), the Secretary shall assess 
the following:
            ``(i) Whether a medical facility of the Department is 
        currently managing scheduling services and the Secretary 
        determines such medical facility has the capability to continue 
        to manage scheduling.
            ``(ii) Whether a medical facility of the Department has the 
        capacity to manage scheduling services based on the following:
                    ``(I) An initial review of the medical facility to 
                acquire scheduling service responsibilities and the 
                preference of the medical facility to acquire such 
                responsibilities.
                    ``(II) The market area assessment currently 
                underway pursuant to section 1730B(c) of this title.
                    ``(III) The capacity of the medical facility to 
                perform scheduling services that meet standards 
                established under sections 1703B and 1703C of this 
                title.
            ``(iii) Whether one or more contracts were in effect on the 
        day before the date of the enactment of the Veterans Community 
        Care and Access Act of 2017 that include scheduling services, 
        as determined by the Secretary, and may be modified by the 
        Secretary for services under this subsection.
    ``(h) Definitions.--In this section:
            ``(1) 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.
            ``(2) The term `clinician' has the meaning given that term 
        by the Centers for Medicare & Medicaid Services and includes 
        Doctors of Medicine (MD), Doctors of Osteopathy (DO), Doctors 
        of Dental Surgery or Dental Medicine (DMD/DDS), Doctors of 
        Podiatry, Doctors of Optometry, Chiropractors, Physician 
        Assistants (PA), Nurse Practitioners (NP), Clinical Nurse 
        Specialists, Certified Registered Nurse Anesthetists, and such 
        other health professionals as the Secretary may specify for 
        purposes of this section.
            ``(3) The term `medical facility of the Department' 
        includes a medical center, a community-based outpatient clinic, 
        an outpatient clinic, or any other facility of the Department 
        at which hospital care, medical services, or extended care 
        services are furnished.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 17 of such title is amended by striking 
        the item relating to section 1703 and inserting the following 
        new item:

``1703. Veterans Community Care Program.''.
    (b) Regulations.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
promulgate regulations to carry out section 1703 of title 38, United 
States Code, as amended by subsection (a).
    (c) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date that the Secretary promulgates regulations 
under subsection (b).

SEC. 102. STRATEGY REGARDING THE HIGH PERFORMING INTEGRATED HEALTHCARE 
              NETWORK OF THE DEPARTMENT.

    (a) In General.--Subchapter III of chapter 17 is amended by 
inserting after section 1730A the following new section:
``Sec. 1730B. Quadrennial Veterans Health Administration review, 
              management of high-performing integrated healthcare 
              network, and market area assessments
    ``(a) Quadrennial Veterans Health Administration Review.--(1) Not 
later than one year after the date of the enactment of the Veterans 
Community Care and Access Act of 2017 and not less frequently than once 
every four years thereafter, the Secretary shall conduct a 
comprehensive examination (to be known as a `quadrennial Veterans 
Health Administration review') of programs and policies of the 
Department regarding the delivery of health care services and the need 
for health care services for veterans in future years.
    ``(2) The Secretary shall designate an individual in a Senior 
Executive Service position (as defined in section 3132(a) of title 5) 
or equivalent as the Director of the High-Performing Integrated 
Healthcare Network of the Department (in this section referred to as 
the `Director') who shall be responsible for carrying out this section 
and advising the Secretary and the Under Secretary for Health on 
matters pertaining to this section.
    ``(3) Each quadrennial Veterans Health Administration review 
conducted under paragraph (1) shall include a strategic plan to meet 
future requirements and demand for hospital care, medical services, and 
extended care services under the laws administered by the Secretary 
that includes a five-year budget forecast for meeting such requirements 
and demand based on the information contained in the market area 
assessments conducted under subsection (c) and such other information 
as the Secretary considers appropriate.
    ``(4) In preparing the quadrennial Veterans Health Administration 
review under paragraph (1), including the strategic plan under 
paragraph (3), the Secretary shall--
            ``(A) consider the access and quality standards established 
        under sections 1703B and 1703C of this title, respectively;
            ``(B) consider the needs of the Department to furnish 
        health care services to veterans based on--
                    ``(i) identified health care services that provide 
                management of health conditions or disorders related to 
                military service for which there is limited experience 
                or access to such health care services from non-
                Department health care providers in the commercial 
                market;
                    ``(ii) the overall health of veterans throughout 
                their lifespan; or
                    ``(iii) such other services as the Secretary 
                determines appropriate;
            ``(C) consult with key stakeholders within the Department, 
        the heads of other Federal agencies, and other relevant 
        governmental and nongovernmental entities, including State, 
        local, and tribal government officials, members of Congress, 
        veterans service organizations, private sector representatives, 
        academics, and other policy experts;
            ``(D) identify emerging issues, trends, problems, and 
        opportunities that could affect health care services furnished 
        under the laws administered by the Secretary;
            ``(E) develop recommendations regarding both short- and 
        long-term priorities for health care services furnished under 
        the laws administered by the Secretary;
            ``(F) compare the Veterans Equitable Resource Allocation 
        (VERA) system to other resource allocation systems or models 
        for the purpose of analyzing the effectiveness of such systems 
        in allocating resources to furnish hospital care, medical 
        services, and extended care services to veterans; and
            ``(G) consider the work of the Center for Innovation for 
        Care and Payment under section 1703F of this title with respect 
        to research, development, and testing payment and service 
        delivery models.
    ``(b) Management of High-Performing Integrated Healthcare 
Network.--(1) The Director shall be responsible for the management, 
design, implementation, and assessment of the high-performing 
integrated healthcare network of the Department.
    ``(2) In managing, designing, implementing, and assessing the high-
performing integrated healthcare network of the Department under this 
subsection, the Director shall be responsible for the following:
            ``(A) Overseeing the transformation and organizational 
        change across the Department to achieve such high-performing 
        integrated healthcare network.
            ``(B) Developing and implementing the quadrennial Veterans 
        Health Administration review and strategic plan under 
        subsection (a).
            ``(C) Overseeing the market area assessments performed 
        under subsection (c).
            ``(D) Developing the capital infrastructure planning and 
        procurement processes, whether minor or major construction 
        projects or leases, in coordination with other offices of the 
        Department.
            ``(E) Developing a multi-year budget process that is 
        capable of forecasting future year budget requirements and 
        projecting the cost of delivering health care services under a 
        high-performing integrated healthcare network.
    ``(3) To ensure that the Director is able to carry out the 
responsibilities under paragraph (2), the Secretary shall ensure that 
coordination and information sharing occurs with other relevant offices 
of the Department, including the following offices:
            ``(A) The Office of Management.
            ``(B) The Office of Acquisition, Logistics and 
        Construction.
            ``(C) The Office of Information and Technology.
    ``(4) In carrying out this subsection, the Director shall confer 
with the Director of the Defense Health Agency and consider best 
practices and recommendations from non-Department entities, including 
entities carrying out market area assessments under subsection (c), 
that have developed plans, implemented systems, or advised other 
healthcare systems.
    ``(5)(A) Not less frequently than once every three months, the 
Secretary or the Director shall brief the appropriate committees of 
Congress on the activities conducted under this subsection.
    ``(B) Each briefing conducted under subparagraph (A) shall include 
the following:
            ``(i) An assessment of any remediation or improvement 
        conducted by the Department with respect to a medical service 
        line of the Department that the Secretary has determined does 
        not meet an access standard or standard for quality established 
        under section 1703B or 1703C of this title, respectively, in 
        providing hospital care, a medical service, or an extended care 
        service, including the following:
                    ``(I) An assessment of the factors that led the 
                Secretary to make such determination.
                    ``(II) An assessment of the medical service line in 
                relation to the market area assessment most recently 
                performed under subsection (c), particularly with 
                respect to how it relates to the demand for the medical 
                service line in the area and by veterans using a 
                medical facility of the Department for such medical 
                service line.
                    ``(III) A plan with specific actions, and the time 
                to complete them, to meet the access standards and 
                standards for quality established under sections 1703B 
                and 1703C of this title, respectively, which shall 
                include consideration of--
                            ``(aa) increasing personnel or temporary 
                        personnel assistance, including mobile 
                        deployment teams;
                            ``(bb) special hiring incentives, including 
                        the Education Debt Reduction Program under 
                        subchapter VII of chapter 76 of this title and 
                        recruitment, relocation, and retention 
                        incentives;
                            ``(cc) using direct hiring authority;
                            ``(dd) providing improved training 
                        opportunities for staff;
                            ``(ee) acquiring improved equipment;
                            ``(ff) making structural modifications to 
                        the facility used by the medical service line;
                            ``(gg) partnering with health care 
                        providers that have the capacity to meet the 
                        demand in the market area and meet access and 
                        quality standards established under sections 
                        1703B and 1703C of this title; and
                            ``(hh) such other actions as the Secretary 
                        considers appropriate.
            ``(ii) An assessment of the progress made by the Department 
        with respect to the responsibilities of the Director under 
        paragraph (2).
    ``(c) Market Area Assessments.--(1) Not less frequently than once 
every four years, the Secretary shall perform market area assessments 
regarding the health care services furnished under the laws 
administered by the Secretary.
    ``(2) Each market area assessment performed under paragraph (1) 
shall include the following:
            ``(A) An assessment of the demand for hospital care, 
        medical services, and extended care services from the 
        Department, disaggregated by geographic market areas that are 
        consistent with industry market areas or boundaries, including 
        the number of requests for such care and services under the 
        laws administered by the Secretary.
            ``(B) An inventory of the health care capacity of the 
        Department across the facilities of the Department.
            ``(C) An assessment of the health care capacity to be 
        provided through contracted community care providers and 
        providers who entered into a provider agreement with the 
        Department under section 1703A of this title, including the 
        number of providers, the geographic location of the providers, 
        and categories or types of health care services provided by the 
        providers.
            ``(D) An assessment obtained from other Federal direct 
        delivery systems of their capacity to provide health care to 
        veterans.
            ``(E) An assessment of the health care capacity of non-
        contracted providers where there is insufficient network 
        supply.
            ``(F) An assessment of the health care capacity of academic 
        affiliates and other collaborations of the Department as it 
        relates to providing health care to veterans.
            ``(G) An assessment of the effects on health care capacity 
        by the access and quality standards established under sections 
        1703B and 1703C of this title, respectively.
            ``(H) The number of appointments for health care services 
        under the laws administered by the Secretary, disaggregated 
        by--
                    ``(i) appointments at facilities of the Department; 
                and
                    ``(ii) appointments with non-Department health care 
                providers.
            ``(I) Analysis of information submitted from care 
        coordination teams under section 1703(e)(2)(D) of this title 
        from each Department medical facility that includes the 
        following:
                    ``(i) An analysis of coordination and management 
                best practices.
                    ``(ii) Satisfaction survey data from the covered 
                veterans from each care coordination team under section 
                1703(e) of this title.
                    ``(iii) Findings and determinations related to the 
                coordination of care under section 1703(e) of this 
                title to assist the Director in the design, 
                implementation, and assessment of the high-performing 
                integrated healthcare network of the Department.
                    ``(iv) A standardized climate survey developed 
                jointly with the Centers for Medicare & Medicaid 
                Services Alliance to Modernize Healthcare (CAMH) for 
                the employees of each medical facility of the 
                Department that compiles data on culture, 
                communication, teamwork, quality of worklife, rewards 
                or recognition, leadership, and productivity.
    ``(3) The Secretary shall submit to the appropriate committees of 
Congress each market area assessment performed under paragraph (1) and 
the complete market area assessment being performed on the day before 
the date of the enactment of the Veterans Community Care and Access Act 
of 2017 in the same form as such assessments are delivered to the 
Secretary.
    ``(4) The Secretary shall use the market area assessments performed 
under paragraph (1) to inform the quadrennial Veterans Health 
Administration review and strategic plan under subsection (a) and to 
determine the capacity of the Department and the capacity of the health 
care provider networks established under section 1703(d) of this title.
    ``(5) The Secretary shall publish the capacity findings and results 
from the market area assessments performed under paragraph (1) with 
respect to the Department and health care provider networks established 
under section 1703(d) of this title on a publicly accessible Internet 
website of the Department.
    ``(d) Department Budget.--The Secretary shall ensure that the 
budget request of the Department for any fiscal year (as submitted with 
the budget of the President under section 1105(a) of title 31) reflects 
the findings of the Secretary with respect to the most recent 
information described in subsection (b)(5) and is consistent with the 
quadrennial Veterans Health Administration review and strategic plan 
under subsection (a).
    ``(e) Appropriate Committees of Congress Defined.--In this section, 
the term `appropriate committees of Congress' means--
            ``(1) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the Senate; and
            ``(2) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the House of Representatives.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 is amended by inserting after the item relating to section 
1730A the following new item:

``1730B. Quadrennial Veterans Health Administration review, management 
                            of high-performing integrated healthcare 
                            network, and market area assessments.''.
    (c) Waiver of Certain Requirements for Market Assessment in 
Progress.--Paragraph (2) of section 1730B(c) of title 38, United States 
Code, as added by subsection (a), shall not apply to a market area 
assessment that was being performed by the Secretary of Veterans 
Affairs on the day before the date of the enactment of this Act.

SEC. 103. ACCESS STANDARDS AND STANDARDS FOR QUALITY.

    (a) In General.--Subchapter I of chapter 17 is amended by inserting 
after section 1703 the following new sections:
``Sec. 1703B. Access standards
    ``(a) In General.--(1) The Secretary shall establish access 
standards for hospital care, medical services, and extended care 
services furnished by the Department, including through health care 
providers under section 1703 of this title.
    ``(2) The Secretary shall ensure that the hospital care, medical 
services, and extended care services furnished to a veteran by the 
Department, including through health care providers under section 1703 
of this title, is furnished within the access standards established 
under paragraph (1).
    ``(3) The access standards established under paragraph (1) shall 
align with the categories of hospital care, medical services, and 
extended care services set forth under subsection (b) and shall be 
informed by the market area assessments performed under section 
1730B(c) of this title.
    ``(b) Categories of Hospital Care, Medical Services, and Extended 
Care Services Furnished.--The categories of hospital care, medical 
services, and extended care services subject to access standards 
established under subsection (a) are as follows:
            ``(1) Primary care services.
            ``(2) Specialty care services, including services that may 
        require a referral and services that may be considered wellness 
        or preventative care.
            ``(3) Behavioral health services, including mental health 
        and substance abuse disorder treatment.
            ``(4) Urgent care.
            ``(5) Home health services, including services that may be 
        virtual.
            ``(6) Dental services.
            ``(7) As determined by the Secretary, any additional types 
        of services for which the Department or the networks 
        established under section 1703(d) of this title have 
        experienced increased demand according to the market area 
        assessments performed under section 1730B(c) of this title or 
        an increase in access complaints to network health care 
        providers or the Department.
    ``(c) Application.--(1) The Secretary may establish and apply 
access standards under subsection (a) according to the market area 
assessments under section 1730B(c) of this title.
    ``(2) In carrying out section 1703 of this title, the Secretary 
shall apply access standards established under subsection (a) to a 
covered veteran under such section with respect to the residence, as 
defined in section 17.1505 of title 38, Code of Federal Regulations (or 
any successor regulation), of the covered veteran.
    ``(d) Comparative Information.--The Secretary shall ensure that the 
access standards required by subsection (a) provide veterans, employees 
of the Department, and health providers in the Veterans Community Care 
Program established under section 1703 of this title with relevant 
comparative information that is clear, useful, and timely, so that 
veterans can make informed and responsible decisions regarding their 
hospital care, medical services, and extended care services.
    ``(e) Coordination.--The Secretary shall coordinate with the 
Secretary of Defense, and may consult with the Secretary of Health and 
Human Services, the Administrator of the Centers for Medicare & 
Medicaid Services, entities in the private sector, and other 
nongovernmental entities in establishing access standards under 
subsection (a).
    ``(f) Periodic Review.--Not later than two years after the date on 
which the Secretary establishes access standards under this section and 
not less frequently than once every three years thereafter, the 
Secretary shall--
            ``(1) conduct a review of such standards; and
            ``(2) submit to the appropriate committees of Congress a 
        report that includes the following:
                    ``(A) A report on the findings of the Secretary 
                with respect to the review conducted under paragraph 
                (1) and any modification to such standards as the 
                Secretary considers appropriate.
                    ``(B) For each medical service line that the 
                Secretary determined, during the period covered by the 
                report, did not meet a standard established under this 
                section, identification of the leadership team in the 
                facility and the Veterans Integrated Service Network 
                that are responsible for overseeing the progress of the 
                medical service line in meeting such standard.
    ``(g) Publication.--The Secretary shall publish the health care 
access standards established under subsection (a) and any modifications 
to such standards in the Federal Register and on a publicly accessible 
Internet website of the Department.
    ``(h) Appropriate Committees of Congress Defined.--In this section, 
the term `appropriate committees of Congress' means--
            ``(1) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the Senate; and
            ``(2) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the House of Representatives.
``Sec. 1703C. Standards for quality
    ``(a) In General.--(1) The Secretary shall establish standards for 
quality regarding hospital care, medical services, and extended care 
services furnished by the Department, including through health care 
providers under section 1703 of this title.
    ``(2) The Secretary shall ensure that the hospital care, medical 
services, and extended care services furnished to a veteran by the 
Department, including through health care providers under section 1703 
of this title, is furnished within the standards for quality 
established under paragraph (1).
    ``(3) The standards for quality established under paragraph (1) 
shall align with the Department of Defense according to categories of 
hospital care, medical services, and extended care services set forth 
under section 1703B(b) of this title and shall be informed by the 
market area assessments performed under section 1730B(c) of this title.
    ``(4) In establishing standards for quality under paragraph (1), 
the Secretary shall--
            ``(A) conduct a survey of covered veterans described in 
        section 1703(b) of this title through a third party entity to 
        assess the satisfaction of such veterans with service and 
        quality of care; and
            ``(B) collect data sets that include, at a minimum--
                    ``(i) general information;
                    ``(ii) surveys of patients' experiences;
                    ``(iii) timely and effective care;
                    ``(iv) complications;
                    ``(v) readmissions and deaths;
                    ``(vi) use of medical imaging;
                    ``(vii) payment and value of care; and
                    ``(viii) use of telemedicine.
    ``(5) The Secretary shall develop such standards for quality and 
collect data according to health care settings consistent with the 
Department of Defense and the Centers for Medicare & Medicaid Services, 
including, at a minimum, the following:
            ``(A) Inpatient hospitals.
            ``(B) Nursing homes.
            ``(C) Individual health care providers.
            ``(D) Dialysis facilities.
            ``(E) Hospice.
            ``(F) Inpatient rehabilitation facilities.
            ``(G) Long-term care hospitals.
            ``(H) Outpatient facilities.
    ``(6) The standards for quality established under paragraph (1) 
shall be informed by existing health quality measures, such as those 
defined by the HealthCare Effectiveness Data and Information Set, that 
are applied to public and privately sponsored health care systems with 
the purpose of providing veterans relevant comparative information to 
make informed decisions regarding their health care.
    ``(b) Improving and Strengthening Quality Standards.--Not later 
than one year after the date on which the Secretary establishes 
standards under subsection (a), the Secretary shall--
            ``(1) publish the quality rating of medical facilities of 
        the Department on a publicly available Internet website, such 
        as a website of the Centers for Medicare & Medicaid Services, 
        for the purpose of providing veterans with information that 
        allows them to compare performance measure information among 
        Department and community health care providers who provide 
        hospital care, medical services, or extended care services 
        under section 1703 of this title; and
            ``(2) consider and solicit public comment on potential 
        changes to the established quality measures to ensure that they 
        include the most up-to-date and applicable industry measures 
        for veterans.
    ``(c) Coordination.--The Secretary shall coordinate with the 
Secretary of Defense, and may consult with the Secretary of Health and 
Human Services, the Administrator of the Centers for Medicare & 
Medicaid Services, entities in the private sector, and other 
nongovernmental entities in establishing standards for quality under 
this section.
    ``(d) Periodic Review.--Not later than two years after the date on 
which the Secretary establishes standards for quality under this 
section and not less frequently than once every three years thereafter, 
the Secretary shall--
            ``(1) conduct a review of such standards across the 
        Department; and
            ``(2) submit to the appropriate committees of Congress a 
        report that includes the following:
                    ``(A) A report on the findings of the Secretary 
                with respect to the review conducted under paragraph 
                (1) and any modification to such standards as the 
                Secretary considers appropriate.
                    ``(B) For each medical service line that the 
                Secretary determined, during the period covered by the 
                report, did not meet a standard established under this 
                section, identification of the leadership team in the 
                facility and the Veterans Integrated Service Network 
                that are responsible for overseeing the progress of the 
                medical service line in meeting such standard.
    ``(e) Publication.--The Secretary shall publish the health care 
quality standards established under subsection (a) and any 
modifications to such standards in the Federal Register and on a 
publicly accessible Internet website of the Department.
    ``(f) Appropriate Committees of Congress Defined.--In this section, 
the term `appropriate committees of Congress' means--
            ``(1) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the Senate; and
            ``(2) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the House of Representatives.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17, as amended by section 102, is further amended by inserting 
after the item relating to section 1703 the following new items:

``1703B. Access standards.
``1703C. Standards for quality.''.
    (c) Submittal of Access Standards and Standards for Quality.--
            (1) In general.--Not later than July 1, 2018, the Secretary 
        of Veterans Affairs shall submit to the appropriate committees 
        of Congress a report detailing the access standards and 
        standards for quality established under sections 1703B and 
        1703C of title 38, United States Code, respectively, as added 
        by subsection (a).
            (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.

            Subtitle B--Forming Partnerships and Agreements

SEC. 111. CONTINUITY OF CARE AND EXISTING AGREEMENTS.

    (a) In General.--Notwithstanding section 1703 of title 38, United 
States Code, as amended by section 101 of this Act, the Secretary of 
Veterans Affairs shall ensure veterans do not experience a delay or 
lapse in care or services by continuing the following:
            (1) All contracts, memorandums of understanding, and 
        memorandums of agreements that were in effect on the day before 
        the date of the enactment of this Act between the Department of 
        Veterans Affairs and the American Indian and Alaska Native 
        health care systems as established under the auspices of the 
        Department of Veterans Affairs and Indian Health Service 
        Memorandum of Understanding, signed October 1, 2010.
            (2) The National Reimbursement Agreement, signed December 
        5, 2012.
            (3) Agreements that were in effect on the day before the 
        date of the enactment of this Act and entered into under 
        section 101, 102, or 103 of the Veterans Access, Choice, and 
        Accountability Act of 2014 (Public Law 113-146).
            (4) Agreements that were in effect on the day before the 
        date of the enactment of this Act for the purpose of dialysis 
        treatment, only if the contracts or agreements established 
        under section 1703 of title 38, United States Code, as amended 
        by section 101 of this Act, do not stipulate that such 
        treatments be furnished by providers under such contracts or 
        agreements.
    (b) Modifications.--Subsection (a) shall not be construed to 
prohibit the Secretary and the parties to the contracts, agreements, 
memorandums of understanding, and memorandums of agreements described 
in such subsection from making such changes to such contracts, 
agreements, memorandums of understanding, and memorandums of agreements 
as may be otherwise authorized pursuant to other provisions of law or 
the terms of the contracts, agreements, memorandums of understanding, 
and memorandums of agreements.
    (c) Treatment of Existing Contractors.--To the extent practicable, 
the Secretary shall give health care providers who are providing 
hospital care, medical services, or extended care services pursuant to 
a contract with the Secretary under section 1703 of title 38, United 
States Code, as in effect on the day before the date of the enactment 
of this Act, the opportunity to furnish hospital care, medical 
services, or extended care services under such section as amended by 
section 101 of this Act.

SEC. 112. AUTHORIZATION OF AGREEMENTS BETWEEN DEPARTMENT OF VETERANS 
              AFFAIRS AND NON-DEPARTMENT PROVIDERS.

    (a) In General.--Subchapter I of chapter 17, as amended by sections 
101 and 103, is further amended by inserting after section 1703 the 
following new section:
``Sec. 1703A. Agreements with eligible entities or providers; 
              certification processes
    ``(a) Agreements Authorized.--(1)(A) When hospital care, a medical 
service, or an extended care service is not available to a veteran 
described in section 1703(b) of this title from a medical facility of 
the Department or through a contract or sharing agreement entered into 
under this title under an authority other than this section, the 
Secretary may furnish such care or service to such veteran to avoid a 
delay or lapse in such care or service by entering into an agreement 
under this section with a health care provider specified in section 
1703(c) of this title to provide such care or service.
    ``(B) An agreement entered into under this section to provide 
hospital care, a medical service, or an extended care service shall be 
known as a `Veterans Care Agreement'.
    ``(C) For purposes of subparagraph (A), hospital care, a medical 
service, or an extended care service may be considered not available to 
a veteran from a medical facility of the Department or through a 
contract or sharing agreement described in such subparagraph when the 
Secretary determines the veteran's medical condition, the travel 
involved, the nature of the care or services required, or a combination 
of these factors make the use of a facility of the Department or a 
contract or sharing agreement described in such subparagraph 
impracticable or inadvisable.
    ``(D) A Veterans Care Agreement may be entered into by the 
Secretary or any Department official authorized by the Secretary.
    ``(2)(A) Subject to subparagraph (B), the Secretary shall review 
each Veterans Care Agreement of material size, as determined by the 
Secretary or set forth in paragraph (3), for hospital care, a medical 
service, or an extended care service to determine whether it is 
feasible and advisable to provide such care or service within a 
facility of the Department or by contract or sharing agreement entered 
into pursuant to another provision of law and, if so, take action to do 
so.
    ``(B)(i) The Secretary shall review each Veterans Care Agreement of 
material size that has been in effect for at least six months within 
the first two years of its taking effect, and no less frequently than 
once every four years thereafter.
    ``(ii) If a Veterans Care Agreement has not been in effect for at 
least six months by the date of the review required by subparagraph 
(A), the agreement will be reviewed during the next cycle required by 
subparagraph (A), and such review will serve as its review within the 
first two years of its taking effect for purposes of clause (i).
    ``(3) In addition to such other Veterans Care Agreements as the 
Secretary may determine are of material size, each Veterans Care 
Agreement that takes effect after the date of the enactment of the 
Veterans Community Care and Access Act of 2017 shall be considered of 
material size.
    ``(4)(A) The Secretary, and any other Department official 
authorized by the Secretary, may enter into an agreement under this 
section for extended care services only if the Secretary does not 
expect such agreement would result in an obligation of the Department 
that exceeds a rate of $5,000,000 annually.
    ``(B) If the Secretary enters into an agreement with a provider 
under this section and pursuant to the agreement the Department incurs 
an obligation that exceeds an annual rate of, with respect to extended 
care services, the rate set forth in subparagraph (A), and with respect 
to services that are not extended care services, $2,000,000, the 
Secretary shall submit to the appropriate committees of Congress notice 
that such obligation has exceeded such rate and an accounting of the 
cost and need for such agreement if such provider is unable or 
unwilling to enter into a contract or other agreement under section 
1703 of this title.
    ``(C) In this paragraph, the term `appropriate committees of 
Congress' means--
            ``(i) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the Senate; and
            ``(ii) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the House of Representatives.
    ``(b) Eligible Entities and Providers.--For purposes of this 
section, an eligible entity or provider is--
            ``(1) any provider of services that has enrolled and 
        entered into a provider agreement under section 1866(a) of the 
        Social Security Act (42 U.S.C. 1395cc(a)) and any physician or 
        other supplier who has enrolled and entered into a 
        participation agreement under section 1842(h) of such Act (42 
        U.S.C. 1395u(h));
            ``(2) any provider participating under a State plan under 
        title XIX of such Act (42 U.S.C. 1396 et seq.); or
            ``(3) any entity or provider not described in paragraph (1) 
        or (2) of this subsection that the Secretary determines to be 
        eligible pursuant to the certification process described in 
        subsection (c).
    ``(c) Eligible Entity or Provider Certification Process.--The 
Secretary shall establish by regulation a process for the certification 
of eligible entities or providers or recertification of eligible 
entities or providers under this section. Such a process shall, at a 
minimum--
            ``(1) establish deadlines for actions on applications for 
        certification;
            ``(2) set forth standards for an approval or denial of 
        certification, duration of certification, revocation of an 
        eligible entity or provider's certification, and 
        recertification of eligible entities or providers;
            ``(3) require the denial of certification if the Secretary 
        determines the eligible entity or provider is excluded from 
        participation in a Federal health care program under section 
        1128 or section 1128A of the Social Security Act (42 U.S.C. 
        1320a-7 or 1320a-7a) or is currently identified as an excluded 
        source on the System for Award Management Exclusions list 
        described in part 9 of title 48, Code of Federal Regulations, 
        and part 180 of title 2 of such Code, or successor regulations;
            ``(4) establish procedures for screening eligible entities 
        or providers according to the risk of fraud, waste, and abuse 
        that are similar to the standards under section 1866(j)(2)(B) 
        of the Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and 
        section 9.104 and subpart 9.4 of title 48, Code of Federal 
        Regulations, or successor regulations; and
            ``(5) incorporate and apply the restrictions and penalties 
        set forth in chapter 21 of title 41 and treat this section as a 
        procurement program only for purposes of applying such 
        provisions.
    ``(d) Rates.--To the extent practicable, the rates paid by the 
Secretary for hospital care, medical services, and extended care 
services provided under a Veterans Care Agreement shall be in 
accordance with the rates paid by the United States under the Medicare 
program.
    ``(e) Terms of Veterans Care Agreements.--(1) Pursuant to 
regulations promulgated under subsection (k), the Secretary may define 
the requirements for providers and entities entering into agreements 
under this section based upon such factors as the number of patients 
receiving care or services, the number of employees employed by the 
entity or provider furnishing such care or services, the amount paid by 
the Secretary to the provider or entity, or other factors as determined 
by the Secretary.
    ``(2) To furnish hospital care, medical services, or extended care 
services under this section, an eligible entity or provider shall 
agree--
            ``(A) to accept payment at the rates established in 
        regulations prescribed under this section;
            ``(B) that payment by the Secretary under this section on 
        behalf of a veteran to a provider of services or care shall, 
        unless rejected and refunded by the provider within 30 days of 
        receipt, constitute payment in full and extinguish any 
        liability on the part of the veteran for the treatment or care 
        provided, and no provision of a contract, agreement, or 
        assignment to the contrary shall operate to modify, limit, or 
        negate this requirement;
            ``(C) to provide only the care and services authorized by 
        the Department under this section and to obtain the prior 
        written consent of the Department to furnish care or services 
        outside the scope of such authorization;
            ``(D) to bill the Department in accordance with the 
        methodology outlined in regulations prescribed under this 
        section;
            ``(E) to not seek to recover or collect from a health plan 
        contract or third party, as those terms are defined in section 
        1729 of this title, for any service for which payment is made 
        by the Department;
            ``(F) to provide medical records to the Department in the 
        time frame and format specified by the Department; and
            ``(G) to meet such other terms and conditions, including 
        quality of care assurance standards, as the Secretary may 
        specify in regulation.
    ``(f) Discontinuation or Nonrenewal of a Veterans Care 
Agreements.--(1) An eligible entity or provider may discontinue a 
Veterans Care Agreement at such time and upon such notice to the 
Secretary as may be provided in regulations prescribed under this 
section.
    ``(2) The Secretary may discontinue a Veterans Care Agreement with 
an eligible entity or provider at such time and upon such reasonable 
notice to the eligible entity or provider as may be specified in 
regulations prescribed under this section, if an official designated by 
the Secretary--
            ``(A) has determined that the eligible entity or provider 
        failed to comply substantially with the provisions of the 
        Veterans Care Agreement, or with the provisions of this section 
        or regulations prescribed under this section;
            ``(B) has determined the eligible entity or provider is 
        excluded from participation in a Federal health care program 
        under section 1128 or section 1128A of the Social Security Act 
        (42 U.S.C. 1320a-7 or 1320a-7a) or is identified on the System 
        for Award Management Exclusions list as provided in part 9 of 
        title 48, Code of Federal Regulations, and part 180 of title 2 
        of such Code, or successor regulations;
            ``(C) has ascertained that the eligible entity or provider 
        has been convicted of a felony or other serious offense under 
        Federal or State law and determines the eligible entity or 
        provider's continued participation would be detrimental to the 
        best interests of veterans or the Department; or
            ``(D) has determined that it is reasonable to terminate the 
        agreement based on the health care needs of a veteran.
    ``(g) Quality of Care.--The standards for quality established under 
section 1703C of this title shall be applied in monitoring the quality 
of care provided to veterans through Veterans Care Agreements and for 
assessing the quality of hospital care, medical services, and extended 
care services furnished by eligible entities and providers before the 
renewal of Veterans Care Agreements.
    ``(h) Disputes.--(1) The Secretary shall promulgate administrative 
procedures for eligible entities and providers to present all disputes 
arising under or related to Veterans Care Agreements.
    ``(2) Such procedures constitute the eligible entities' and 
providers' exhaustive and exclusive administrative remedies.
    ``(3) Eligible entities or providers must first exhaust such 
administrative procedures before seeking any judicial review under 
section 1346 of title 28 (known as the `Tucker Act').
    ``(4) Disputes under this section must pertain to either the scope 
of authorization under the Veterans Care Agreement or claims for 
payment subject to the Veterans Care Agreement and are not claims for 
the purposes of such laws that would otherwise require application of 
sections 7101 through 7109 of title 41, United States Code.
    ``(i) Applicability of Other Provisions of Law.--(1) A Veterans 
Care Agreement may be authorized by the Secretary or any Department 
official authorized by the Secretary, and such action is not an award 
for the purposes of such laws that would otherwise require the use of 
competitive procedures for furnishing of care and services.
    ``(2)(A) Except as provided in subparagraph (B), and unless 
otherwise provided in this section or regulations prescribed pursuant 
to this section, an eligible entity or provider that enters into an 
agreement under this section is not subject to, in the carrying out of 
the agreement, any law to which providers of services and suppliers 
under the Medicare program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.) are not subject.
    ``(B) An eligible entity or provider that enters into an agreement 
under this section is subject to--
            ``(i) all laws regarding integrity, ethics, or fraud, or 
        that subject a person to civil or criminal penalties; and
            ``(ii) all laws that protect against employment 
        discrimination or that otherwise ensure equal employment 
        opportunities.
    ``(j) Parity of Treatment.--Eligibility for hospital care, medical 
services, and extended care services furnished to any veteran pursuant 
to a Veterans Care Agreement shall be subject to the same terms as 
though provided in a facility of the Department, and provisions of this 
chapter applicable to veterans receiving such care and services in a 
facility of the Department shall apply to veterans treated under this 
section.
    ``(k) Rulemaking.--The Secretary shall promulgate regulations to 
carry out this section.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item related to section 
1703 the following new item:

``1703A. Agreements with eligible entities or providers; certification 
                            processes.''.

SEC. 113. PREVENTION OF CERTAIN HEALTH CARE PROVIDERS FROM PROVIDING 
              NON-DEPARTMENT HEALTH CARE SERVICES TO VETERANS.

    (a) In General.--On and after the date that is one year after the 
date of the enactment of this Act, the Secretary of Veterans Affairs 
shall deny or revoke the eligibility of a health care provider to 
provide non-Department health care services to veterans if the 
Secretary determines that the health care provider--
            (1) was removed from employment with the Department of 
        Veterans Affairs due to conduct that violated a policy of the 
        Department relating to the delivery of safe and appropriate 
        health care; or
            (2) violated the requirements of a medical license of the 
        health care provider that resulted in the loss of such medical 
        license.
    (b) Permissive Action.--On and after the date that is one year 
after the date of the enactment of this Act, the Secretary may deny, 
revoke, or suspend the eligibility of a health care provider to provide 
non-Department health care services if the Secretary determines such 
action is necessary to immediately protect the health, safety, or 
welfare of veterans and the health care provider is under investigation 
by the medical licensing board of a State in which the health care 
provider is licensed or practices.
    (c) Suspension.--The Secretary shall suspend the eligibility of a 
health care provider to provide non-Department health care services to 
veterans if the health care provider is suspended from serving as a 
health care provider of the Department.
    (d) Comptroller General Report.--Not later than two years after the 
date of the enactment of this Act, the Comptroller General of the 
United States shall submit to Congress a report on the implementation 
by the Secretary of this section, including the following:
            (1) The aggregate number of health care providers denied or 
        suspended under this section from participation in providing 
        non-Department health care services.
            (2) An evaluation of any impact on access to health care 
        for patients or staffing shortages in programs of the 
        Department providing non-Department health care services.
            (3) An explanation of the coordination of the Department 
        with the medical licensing boards of States in implementing 
        this section, the amount of involvement of such boards in such 
        implementation, and efforts by the Department to address any 
        concerns raised by such boards with respect to such 
        implementation.
            (4) Such recommendations as the Comptroller General 
        considers appropriate regarding harmonizing eligibility 
        criteria between health care providers of the Department and 
        health care providers eligible to provide non-Department health 
        care services.
    (e) Non-Department Health Care Services Defined.--In this section, 
the term ``non-Department health care services'' means hospital care, 
medical services, and extended care services furnished at non-
Department facilities under chapter 17 of title 38, United States Code.

SEC. 114. CONFORMING AMENDMENTS FOR STATE VETERANS HOMES.

    (a) In General.--Section 1745(a) is amended--
            (1) in paragraph (1), by striking ``(or agreement under 
        section 1720(c)(1) of this title)'' and inserting ``(or an 
        agreement)''; and
            (2) by adding at the end the following new paragraph:
    ``(4)(A) An agreement under this section may be authorized by the 
Secretary or any Department official authorized by the Secretary, and 
any such action is not an award for purposes of such laws that would 
otherwise require the use of competitive procedures for the furnishing 
of hospital care, medical services, and extended care services.
    ``(B)(i) Except as provided in clause (ii), and unless otherwise 
provided in this section or regulations prescribed pursuant to this 
section, a State home that enters into an agreement under this section 
is not subject to, in the carrying out of the agreement, any provision 
of law to which providers of services and suppliers under the Medicare 
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.) are not subject.
    ``(ii) A State home that enters into an agreement under this 
section is subject to--
            ``(I) all provisions of law regarding integrity, ethics, or 
        fraud, or that subject a person to civil or criminal penalties; 
        and
            ``(II) all provisions of law that protect against 
        employment discrimination or that otherwise ensure equal 
        employment opportunities.
    ``(iii) Notwithstanding subparagraph (B)(ii)(I), a State home that 
enters into an agreement under this section may not be treated as a 
Federal contractor or subcontractor for purposes of chapter 67 of title 
41 (known as the `McNamara-O'Hara Service Contract Act of 1965').''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to care provided on or after the effective date of regulations 
issued by the Secretary of Veterans Affairs to carry out this section.

                      Subtitle C--Paying Providers

SEC. 121. PROMPT PAYMENT TO PROVIDERS.

    (a) In General.--Subchapter I of chapter 17 is amended by inserting 
after section 1703C, as added by section 103 of this Act, the following 
new section:
``Sec. 1703D. Prompt payment standard
    ``(a) In General.--(1) Notwithstanding any other provision of this 
title or of any other provision of law, the Secretary shall pay for 
hospital care, medical services, or extended care services furnished by 
health care entities or providers under this chapter within 45 calendar 
days upon receipt of a clean paper claim or 30 calendar days upon 
receipt of a clean electronic claim.
    ``(2) If a claim is denied, the Secretary shall, within 45 calendar 
days of denial for a paper claim and 30 calendar days of denial for an 
electronic claim, notify the health care entity or provider of the 
reason for denying the claim and what, if any, additional information 
is required to process the claim.
    ``(3) Upon the receipt of the additional information, the Secretary 
shall ensure that the claim is paid, denied, or otherwise adjudicated 
within 30 calendar days from the receipt of the requested information.
    ``(4) This section shall only apply to payments made on an invoice 
basis and shall not apply to capitation or other forms of periodic 
payment to entities or providers.
    ``(b) Submittal of Claims by Health Care Entities and Providers.--A 
health care entity or provider that furnishes hospital care, medical 
services, or extended care services under this chapter shall submit to 
the Secretary a claim for payment for furnishing the care or services 
not later than 180 days after the date on which the entity or provider 
furnished the care or services.
    ``(c) Fraudulent Claims.--(1) Sections 3729 through 3733 of title 
31 shall apply to fraudulent claims for payment submitted to the 
Secretary by a health care entity or provider under this chapter.
    ``(2) Pursuant to regulations prescribed by the Secretary, the 
Secretary shall bar a health care entity or provider from furnishing 
hospital care, medical services, and extended care services under this 
chapter when the Secretary determines the entity or provider has 
submitted to the Secretary fraudulent health care claims for payment by 
the Secretary.
    ``(d) Overdue Claims.--(1) Any claim that has not been denied with 
notice, made pending with notice, or paid to the health care entity or 
provider by the Secretary shall be overdue if the notice or payment is 
not received by the entity or provider within the time periods 
specified in subsection (a).
    ``(2)(A) If a claim is overdue under this subsection, the Secretary 
may, under the requirements established by subsection (a) and 
consistent with the provisions of chapter 39 of title 31 (commonly 
referred to as the `Prompt Payment Act'), require that interest be paid 
on clean claims.
    ``(B) Interest paid under subparagraph (A) shall be computed at the 
rate of interest established by the Secretary of the Treasury under 
section 3902 of title 31 and published in the Federal Register.
    ``(e) Overpayment.--(1) The Secretary shall deduct the amount of 
any overpayment from payments due a health care entity or provider 
under this chapter.
    ``(2) Deductions may not be made under this subsection unless the 
Secretary has made reasonable efforts to notify a health care entity or 
provider of the right to dispute the existence or amount of such 
indebtedness and the right to request a compromise of such 
indebtedness.
    ``(3) The Secretary shall make a determination with respect to any 
such dispute or request prior to deducting any overpayment unless the 
time required to make such a determination before making any deductions 
would jeopardize the Secretary's ability to recover the full amount of 
such indebtedness.
    ``(f) Information and Documentation Required.--(1) The Secretary 
shall provide to all health care entities and providers participating 
in a program to furnish hospital care, medical services, or extended 
care services under this chapter a list of information and 
documentation that is required to establish a clean claim under this 
section.
    ``(2) The Secretary shall consult with entities in the health care 
industry, in the public and private sector, to determine the 
information and documentation to include in the list under paragraph 
(1).
    ``(3) If the Secretary modifies the information and documentation 
included in the list under paragraph (1), the Secretary shall notify 
all health care entities and providers described in paragraph (1) not 
later than 30 days before such modifications take effect.
    ``(g) Processing of Claims.--In processing a claim for compensation 
for hospital care, medical services, or extended care services 
furnished by a health care entity or provider under this chapter, the 
Secretary shall act through--
            ``(1) a non-Department entity that is under contract or 
        agreement for the program established under section 1703(a) of 
        this title; or
            ``(2) a non-Department entity that specializes in such 
        processing for other Federal agency health care systems.
    ``(h) Report on Encounter Data System.--(1) Not later than 90 days 
after the date of the enactment of the Veterans Community Care and 
Access Act of 2017, the Secretary shall submit to the appropriate 
committees of Congress a report on the feasibility and advisability of 
adopting a funding mechanism similar to what is utilized by other 
Federal agencies to allow a contracted entity to act as a fiscal 
intermediary for the Federal Government to distribute, or pass through, 
Federal Government funds for certain non-underwritten hospital care, 
medical services, or extended care services.
    ``(2) The Secretary may coordinate with the Department of Defense, 
the Department of Health and Human Services, and the Department of the 
Treasury in developing the report required by paragraph (1).
    ``(i) Definitions.--In this section:
            ``(1) 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.
            ``(2) The term `clean electronic claim' means the 
        transmission of data for purposes of payment of covered health 
        care expenses that is submitted to the Secretary which contains 
        substantially all of the required data elements necessary for 
        accurate adjudication, without obtaining additional information 
        from the entity or provider that furnished the care or service, 
        submitted in such format as prescribed by the Secretary in 
        regulations for the purpose of paying claims for care or 
        services.
            ``(3) The term `clean paper claim' means a paper claim for 
        payment of covered health care expenses that is submitted to 
        the Secretary which contains substantially all of the required 
        data elements necessary for accurate adjudication, without 
        obtaining additional information from the entity or provider 
        that furnished the care or service, submitted in such format as 
        prescribed by the Secretary in regulations for the purpose of 
        paying claims for care or services.
            ``(4) The term `fraudulent claims' means the intentional 
        and deliberate misrepresentation of a material fact or facts by 
        a health care entity or provider made to induce the Secretary 
        to pay a claim that was not legally payable to that provider. 
        This term, as used in this section, shall not include a good 
        faith interpretation by a health care entity or provider of 
        utilization, medical necessity, coding, and billing 
        requirements of the Secretary.
            ``(5) The term `health care entity or provider' includes 
        any non-Department health care entity or provider, but does not 
        include any Federal health care entity or provider.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item related to section 
1703C, as added by section 103 of this Act, the following new item:

``1703D. Prompt payment standard.''.

SEC. 122. PAYMENT RATES FOR COMMUNITY CARE.

    (a) In General.--Subchapter I of chapter 17, as amended by section 
121 of this Act, is further amended by inserting after section 1703D 
the following new section:
``Sec. 1703E. Payment rates for community care
    ``(a) In General.--Except as provided in subsection (b), and to the 
extent practicable, the rate paid for hospital care or medical services 
under any provision in this title may not exceed the rate paid by the 
United States to a provider of services (as defined in section 1861(u) 
of the Social Security Act (1395x(u))) or a supplier (as defined in 
section 1861 (d) of such Act (42 U.S.C. 1395x(d))) under the Medicare 
program under title XI or title XVIII of the Social Security Act (42 
U.S.C. 1301 et seq. and 1395 et seq.) for the same care or services, 
including rates adjusted for critical access hospitals under section 
1834(g) of such Act (42 U.S.C. 1395m(g)).
    ``(b) Exception.--(1)(A) A higher rate than the rate paid by the 
United States as described in subsection (a) may be negotiated with 
respect to the furnishing of care or services to a veteran described in 
section 1703(b) of this title who resides in a highly rural area or in 
a market area where the availability of care or services is limited and 
a higher rate of pay may be required.
    ``(B) In this paragraph, the term `highly rural area' means an area 
located in a county that has fewer than seven individuals residing in 
that county per square mile.
    ``(2) With respect to furnishing care or services under this 
section in Alaska, the Alaska Fee Schedule of the Department of 
Veterans Affairs shall be followed, except for when another payment 
agreement, including a contract, provider agreement or Veterans Care 
Agreement, is in place.
    ``(3) With respect to furnishing care or services under this 
section in a State with an All-Payer Model Agreement under section 
1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3)) that 
became effective on or after January 1, 2014, the Medicare payment 
rates under subparagraph (A) shall be calculated based on the payment 
rates under such agreement.
    ``(c) Value-Based Reimbursement.--Notwithstanding subsection (a), 
the Secretary shall incorporate, to the greatest extent practicable, 
the use of value-based reimbursement models to promote the provision of 
high quality care.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1703D, as added by section 121 of this Act, the following new item:

``1703E. Payment Rates for Community Care.''.

SEC. 123. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT SUBJECT TO AN 
              AGREEMENT.

    (a) In General.--Subchapter IV of chapter 81 is amended by adding 
at the end the following new section:
``Sec. 8159. Authority to pay for services authorized but not subject 
              to an agreement
    ``(a) In General.--If, in the course of furnishing hospital care, a 
medical service, or an extended care service authorized by the 
Secretary and pursuant to a contract, agreement, or other arrangement 
with the Secretary, a provider that is not a party to the contract, 
agreement, or other arrangement furnishes hospital care, a medical 
service, or an extended care service that the Secretary considers 
necessary, the Secretary may compensate the provider for the cost of 
such care or service.
    ``(b) Reports on Use of Authority.--Whenever the Secretary 
compensates a provider under subsection (a) for the furnishing of 
hospital care, a medical service, or an extended care service, the care 
coordination team that coordinated the furnishing of such care or 
service under section 1703(e)(1) of this title shall--
            ``(1) submit to the appropriate committees of Congress a 
        report on the furnishing of such care; and
            ``(2) analyze the future demand for such care or service 
        from such provider.
    ``(c) New Contracts and Agreements.--The Secretary shall take 
reasonable efforts to enter into a contract, agreement, or other 
arrangement with a provider described in subsection (a) to ensure that 
future care and services authorized by the Secretary and furnished by 
the provider are subject to such a contract, agreement, or other 
arrangement.
    ``(d) Definitions.--In this section:
            ``(1) 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.
            ``(2) The terms `hospital care' and `medical service' have 
        the meanings given such terms in section 1701 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 
8158 the following new item:

``8159. Authority to pay for services authorized but not subject to an 
                            agreement.''.

             TITLE II--STREAMLINING COMMUNITY CARE PROGRAMS

            Subtitle A--Streamlining Community Care Programs

SEC. 201. ACCESS TO WALK-IN CARE.

    (a) In General.--Chapter 17 is amended by inserting after section 
1725 the following new section:
``Sec. 1725A. Access to walk-in care
    ``(a) Procedures To Ensure Access to Walk-In Care.--The Secretary 
shall develop procedures to ensure that covered veterans are able to 
access walk-in care from qualifying non-Department entities or 
providers.
    ``(b) Covered Veterans.--For purposes of this section, a covered 
veteran is any veteran described in section 1703(b) of this title.
    ``(c) Qualifying Non-Department Entities or Providers.--For 
purposes of this section, a qualifying non-Department entity or 
provider is a non-Department entity or provider that--
            ``(1) has entered into a contract or other agreement with 
        the Secretary to furnish services under this section; or
            ``(2) entered into an agreement with the Secretary that was 
        in effect on the day before the date of the enactment of the 
        Veterans Community Care and Access Act of 2017 to furnish walk-
        in care.
    ``(d) Federally-Qualified Health Centers.--Whenever practicable, 
the Secretary may use a Federally-qualified health center (as defined 
in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
1396d(l)(2)(B))) to carry out this section.
    ``(e) Continuity of Care.--(1) The Secretary shall ensure 
continuity of care for each covered veteran who receives a walk-in care 
service under this section through the care coordination team provided 
such covered veteran under section 1703(e)(1) of this title.
    ``(2) The Secretary shall inform and educate covered veterans on 
procedures to utilize and access walk-in care under this section.
    ``(3) The Secretary shall develop a mechanism to coordinate with 
qualifying non-Department entities or providers through the care 
coordination teams provided under section 1703(e)(1) of this title that 
includes the use of medical records from walk-in care providers to 
accurately represent access to care, health needs of the covered 
veterans, and to monitor conditions of covered veterans.
    ``(f) Copayments.--(1) The Secretary shall require each covered 
veteran to pay the United States a copayment for each episode of walk-
in care provided under this section, except if the episode of walk-in 
care for the covered veteran is related to a service-connected 
disability of the covered veteran.
    ``(2) The Secretary may adjust the copayment required of a covered 
veteran under this subsection based upon the priority group of 
enrollment of the veteran, the number of episodes of care furnished to 
a covered veteran during a year, and other factors the Secretary 
considers appropriate under this section.
    ``(3) The amount or amounts of the copayments required under this 
subsection shall be prescribed by the Secretary by rule.
    ``(4) Copayments required by this subsection shall apply 
notwithstanding any other provision of law that would allow the 
Secretary to offset a covered veteran's copayment obligation with 
amounts recovered from a third party under section 1729 of this title.
    ``(g) Regulations.--Not later than one year after the date of the 
enactment of the Veterans Community Care and Access Act of 2017, the 
Secretary shall promulgate regulations to carry out this section.
    ``(h) Walk-In Care Defined.--In this section, the term `walk-in 
care' means non-urgent, non-emergent, convenience care provided by a 
qualifying non-Department entity or provider that furnishes episodic 
care and not longitudinal management of conditions and certain services 
as defined through contracts or agreements described in subsection (c) 
or regulations the Secretary shall prescribe for purposes of this 
section.''.
    (b) Effective Date.--Section 1725A of title 38, United States Code, 
as added by subsection (a) shall take effect on the date upon which 
final regulations implementing such section take effect.
    (c) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item related to section 
1725 the following new item:

``Sec. 1725A. Access to walk-in care.''.

SEC. 202. VETERANS CHOICE FUND FLEXIBILITY.

    Section 802 of the Veterans Access, Choice, and Accountability Act 
of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended--
            (1) in subsection (c)--
                    (A) in paragraph (1), by striking ``by paragraph 
                (3)'' and inserting ``in paragraphs (3) and (4)''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(4) Permanent authority for other uses.--Beginning in 
        fiscal year 2019, amounts remaining in the Veterans Choice Fund 
        may be used to furnish hospital care, medical services, and 
        extended care services to individuals pursuant to chapter 17 of 
        title 38, United States Code, at non-Department facilities or 
        through non-Department providers at Department facilities, 
        including pursuant to non-Department provider programs other 
        than the program established by section 101. Such amounts shall 
        be available in addition to amounts available in other 
        appropriations accounts for such purposes.''; and
            (2) in subsection (d)(1), by striking ``to subsection 
        (c)(3)'' and inserting ``to paragraphs (3) and (4) of 
        subsection (c)''.

SEC. 203. CONFORMING AMENDMENTS.

    (a) In General.--
            (1) Title 38.--Title 38, United States Code, is amended--
                    (A) in section 1712(a)--
                            (i) in paragraph (3), by striking ``under 
                        clause (1), (2), or (5) of section 1703(a) of 
                        this title'' and inserting ``or entered an 
                        agreement''; and
                            (ii) in paragraph (4)(A), by striking 
                        ``under the provisions of this subsection and 
                        section 1703 of this title'';
                    (B) in section 1712A(e)(1)--
                            (i) by inserting ``or agreements'' after 
                        ``contracts''; and
                            (ii) by striking ``(under sections 
                        1703(a)(2) and 1710(a)(1)(B) of this title)''; 
                        and
                    (C) in section 2303(a)(2)(B)(i), by striking ``with 
                section 1703'' and inserting ``with sections 1703A, 
                8111, and 8153''.
            (2) Social security act.--Section 1866(a)(1)(L) of the 
        Social Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by 
        striking ``under section 1703'' and inserting ``under chapter 
        17''.
            (3) Veterans' benefits improvements act of 1994.--Section 
        104(a)(4)(A) of the Veterans' Benefits Improvements Act of 1994 
        (Public Law 103-446; 38 U.S.C. 1117 note) is amended by 
        striking ``in section 1703'' and inserting ``in sections 1703A, 
        8111, and 8153''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date described in section 101(b)(2).

        Subtitle B--Improving Information Sharing With Providers

SEC. 211. IMPROVING INFORMATION SHARING WITH COMMUNITY PROVIDERS.

    Section 7332(b)(2) is amended by striking subparagraph (H) and 
inserting the following new subparagraphs:
            ``(H)(i) To a non-Department entity (including private 
        entities and other Federal agencies) for purposes of providing 
        health care, including hospital care, medical services, and 
        extended care services, to patients.
            ``(ii) An entity to which a record is disclosed under this 
        subparagraph may not disclose or use such record for a purpose 
        other than that for which the disclosure was made.
            ``(I) To a third party in order to recover or collect 
        reasonable charges for care furnished to, or paid on behalf of, 
        a patient in connection with a non-service connected disability 
        as permitted by section 1729 of this title or for a condition 
        for which recovery is authorized or with respect to which the 
        United States is deemed to be a third party beneficiary under 
        the Act entitled `An Act to provide for the recovery from 
        tortiously liable third persons of the cost of hospital and 
        medical care and treatment furnished by the United States' 
        (Public Law 87-693; 42 U.S.C. 2651 et seq.; commonly known as 
        the `Federal Medical Care Recovery Act').''.

SEC. 212. 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.

                   Subtitle C--Improving Collections

SEC. 221. ALIGNING WITH BEST PRACTICES ON COLLECTION OF HEALTH 
              INSURANCE INFORMATION.

    Section 1705A is amended--
            (1) in subsection (a)(1), by striking ``Any individual'' 
        and all that follows through ``covered.'' and inserting the 
        following: ``Any individual who applies for or seeks hospital 
        care or medical services under this chapter shall, at the time 
        of such application, or otherwise when requested by the 
        Secretary, furnish the Secretary with such current information 
        as the Secretary may require to identify any health-plan 
        contract, as defined in subsection (i)(l) of section 1729, 
        under which such individual is covered, to include, as 
        applicable, the name, address, and telephone number of such 
        health-plan contract; the name of the policy holder, if 
        coverage under a health-plan contract is in the name of a 
        person other than such individual; the plan identification 
        number; and the group code of the plans.''; and
            (2) in subsection (c)--
                    (A) by striking ``The Secretary'' and inserting 
                ``(1) Except as provided in paragraph (2), the 
                Secretary''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(2) The Secretary may charge an individual who does not provide 
the information required by subsection (a) reasonable charges for the 
provision of such care and services.''.

SEC. 222. IMPROVING AUTHORITY TO COLLECT.

    (a) Broadening Scope of Applicability.--Section 1729 is amended--
            (1) in subsection (a)--
                    (A) in paragraph (2)(A)--
                            (i) by striking ``the veteran's'' and 
                        inserting ``the individual's''; and
                            (ii) by striking ``the veteran'' and 
                        inserting ``the individual''; and
                    (B) in paragraph (3)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``the veteran'' and inserting 
                        ``the individual''; and
                            (ii) in subparagraph (A), by striking ``the 
                        veteran's'' and inserting ``the individual's'';
            (2) in subsection (b)--
                    (A) in paragraph (1)--
                            (i) by striking ``the veteran'' and 
                        inserting ``the individual''; and
                            (ii) by striking ``the veteran's'' and 
                        inserting ``the individual's''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A)--
                                    (I) by striking ``the veteran'' and 
                                inserting ``the individual''; and
                                    (II) by striking ``the veteran's'' 
                                and inserting ``the individual's''; and
                            (ii) in subparagraph (B)--
                                    (I) in clause (i), by striking 
                                ``the veteran'' and inserting ``the 
                                individual''; and
                                    (II) in clause (ii)--
                                            (aa) by striking ``the 
                                        veteran'' and inserting ``the 
                                        individual''; and
                                            (bb) by striking ``the 
                                        veteran's'' each place it 
                                        appears and inserting ``the 
                                        individual's'';
            (3) in subsection (e), by striking ``A veteran'' and 
        inserting ``An individual''; and
            (4) in subsection (h)--
                    (A) in paragraph (1)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``a veteran'' and inserting 
                        ``an individual'';
                            (ii) in subparagraph (A), by striking ``the 
                        veteran'' and inserting ``the individual''; and
                            (iii) in subparagraph (B), by striking 
                        ``the veteran'' and inserting ``the 
                        individual''; and
                    (B) in paragraph (2)--
                            (i) by striking ``A veteran'' and inserting 
                        ``An individual'';
                            (ii) by striking ``a veteran'' and 
                        inserting ``an individual''; and
                            (iii) by striking ``the veteran'' and 
                        inserting ``the individual''.
    (b) Additional Amendments.--Such section is further amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking ``(1) Subject'' 
                and all that follows through the period and inserting 
                the following: ``(1) Subject to the provisions of this 
                section, in any case in which the United States is 
                required by law to furnish or pay for care or services 
                under this chapter for a non-service-connected 
                disability described in paragraph (2) of this 
                subsection, the United States has the right to recover 
                or collect from a third party the reasonable charges of 
                care or services so furnished or paid for to the extent 
                that the recipient or provider of the care or services 
                would be eligible to receive payment for such care or 
                services from such third party if the care or services 
                had not been furnished or paid for by a department or 
                agency of the United States.'';
                    (B) in paragraph (2)--
                            (i) in subparagraph (C), by striking the 
                        semicolon and inserting ``; or'';
                            (ii) by amending subparagraph (D) to read 
                        as follows:
            ``(D) that is incurred by an individual who is entitled to 
        care (or payment of the expenses of care) under a health-plan 
        contract.''; and
                            (iii) by striking subparagraph (E); and
                    (C) by adding at the end the following new 
                paragraph:
    ``(4) In the case of a health-plan contract where the United States 
has a right to recover or collect reasonable charges, the Secretary 
shall collect from a veteran or responsible individual any copayment or 
cost-share required under this chapter.'';
            (2) in subsection (b), by adding at the end the following 
        new paragraph:
    ``(3)(A) The obligation of the third party to pay is not dependent 
upon an individual executing an assignment of benefits to the United 
States, nor is the obligation to pay dependent upon any other 
submission by the beneficiary to the third party, including any claim 
or appeal.
    ``(B) In any case in which the Secretary makes a claim, appeal, 
representation, or other filing under the authority of this chapter, 
any procedural requirement in any third-party plan for the beneficiary 
of such plan to make the claim, appeal, representation, or other filing 
is deemed to be satisfied.''; and
            (3) in subsection (f)--
                    (A) by inserting ``(1)'' before ``No law''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(2) The absence of a participating provider agreement, Veterans 
Care Agreement, or other contractual arrangement with a third party 
described in subsection (i)(3)(D) shall not operate to prevent, or 
reduce the amount of, any such recovery or collection by the United 
States. For purposes of this section, the Department shall recover or 
collect as if it were a participating provider.''; and
    (c) Definitions.--Subsection (i) of such section is amended to read 
as follows:
    ``(i) In this section:
            ``(1) The term `health-plan contract' includes any of the 
        following:
                    ``(A) An insurance policy or contract including any 
                health maintenance organization, preferred provider 
                organization, point of service organization, 
                accountable care organization, or any other type of 
                health insurance policy or contract, medical or 
                hospital service agreement, membership or subscription 
                contract, or similar arrangement under which hospital 
                care or medical services for individuals are provided 
                or the expenses of such services are paid.
                    ``(B) A workers' compensation law or plan.
            ``(2) The term `payment' includes reimbursement and 
        indemnification.
            ``(3) The term `third party' means any of the following:
                    ``(A) A State or political subdivision of a State.
                    ``(B) An employer or an employer's insurance 
                carrier.
                    ``(C) An automobile accident reparations or 
                liability insurance carrier.
                    ``(D) A person or entity obligated to provide, or 
                to pay the expenses of, health services under a health-
                plan contract.
            ``(4) The term `reasonable charges' shall include the 
        following:
                    ``(A) For hospital care or medical services 
                furnished by the Department, charges established in 
                accordance with this section.
                    ``(B) For hospital care or medical services paid 
                for under subparagraphs (A) and (B) of subsection 
                (a)(2), the amount paid to a non-Department entity or 
                provider.''.

   TITLE III--IMPROVING DEPARTMENT OF VETERANS AFFAIRS CARE DELIVERY

               Subtitle A--Improving Personnel Practices

SEC. 301. LICENSURE OF HEALTH CARE PROFESSIONALS OF THE DEPARTMENT OF 
              VETERANS AFFAIRS PROVIDING TREATMENT VIA TELEMEDICINE.

    (a) In General.--Chapter 17, as amended by section 102, is further 
amended by adding at the end the following new section:
``Sec. 1730C. 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 in a 
State 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) Covered Health Care Professionals.--For purposes of this 
section, a covered health care professional is any health care 
professional who--
            ``(1) is an employee of the Department appointed under 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 standards for quality 
        relating to the provision of medicine 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.
    ``(c) 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.
    ``(d) Relation to State Law.--(1) The provisions of this section 
shall supersede any provisions of the law of any State to the extent 
that such provision of State law are inconsistent with this section.
    ``(2) No State shall deny or revoke the license, registration, or 
certification of a covered health care professional who otherwise meets 
the qualifications of the State for holding the license, registration, 
or certification on the basis that the covered health care professional 
has engaged or intends to engage in activity covered by subsection (a).
    ``(e) Rule of 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.).''.
    (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 1730B, as added by section 102, the following new 
item:

``1730C. Licensure of health care professionals providing treatment via 
                            telemedicine.''.
    (c) Report on Telemedicine.--
            (1) In general.--Not later than one year after the earlier 
        of the date on which services provided under section 1730C of 
        title 38, United States Code, as added by subsection (a), first 
        occur or regulations are promulgated to carry out such section, 
        the Secretary of Veterans Affairs shall submit to the Committee 
        on Veterans' Affairs of the Senate and the Committee on 
        Veterans' Affairs of the House of Representatives a report on 
        the effectiveness of the use of telemedicine by the Department 
        of Veterans Affairs.
            (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 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 medical 
                facility.
                    (F) Savings by the Department, if any, including 
                travel costs, from furnishing health care through the 
                use of telemedicine during such period.

SEC. 302. GRADUATE MEDICAL EDUCATION AND RESIDENCY.

    (a) Increase in Number of Graduate Medical Education Residency 
Positions.--
            (1) In general.--The Secretary of Veterans Affairs shall 
        increase the number of graduate medical education residency 
        positions at covered facilities by not fewer than 1,500 
        positions in the 10-year period beginning on the date of the 
        enactment of this Act.
            (2) Covered facilities.--For purposes of this section, a 
        covered facility is any of the following:
                    (A) A facility of the Department of Veterans 
                Affairs.
                    (B) 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).
                    (C) A facility operated by the Indian Health 
                Service.
                    (D) 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)).
                    (E) A community health center.
                    (F) A facility operated by the Department of 
                Defense.
                    (G) Such other health care facility as the 
                Secretary considers appropriate for purposes of this 
                section.
            (3) Stipends and benefits.--The Secretary may pay stipends 
        and provide benefits for residents in positions under paragraph 
        (1), regardless of whether they have been assigned in a 
        Department facility.
            (4) Parameters for location, affiliate sponsor, and 
        duration.--When determining characteristics of residency 
        positions under paragraph (1), the Secretary shall consider the 
        extent to which there is a clinical need for providers, as 
        determined by the market area assessment most recently 
        performed under section 1730B(c) of title 38, United States 
        Code, as added by section 102.
            (5) Parameters for types of specialties.--When determining 
        the types of specialties to be included in residency positions 
        under paragraph (1), the Secretary shall consider the 
        following:
                    (A) The types of specialties that improve the 
                quality and coverage of medical services provided to 
                veterans.
                    (B) The range of clinical specialties covered by 
                providers in standardized geographic areas surrounding 
                facilities.
                    (C) Whether the specialty is included in the most 
                recent staffing shortage determination of the 
                Department under section 7412 of title 38, United 
                States Code.
                    (D) The most recent market area assessment 
                performed under section 1730B(c) of title 38, United 
                States Code, as added by section 102.
    (b) Application To Participate.--To participate as a resident in 
one of the positions increased under subsection (a)(1), an individual 
shall submit to the Secretary an application therefor together with an 
agreement described in subsection (d) under which the participant 
agrees to serve a period of obligated service in the Veterans Health 
Administration as provided in the agreement in return for payment of 
stipend and benefit support as provided in the agreement.
    (c) Selection.--
            (1) In general.--An individual becomes a participant in a 
        residency program under this section upon the Secretary's 
        approval of the individual's application under subsection (b) 
        and the Secretary's acceptance of the agreement under 
        subsection (d) (if required).
            (2) Notice.--Upon the Secretary's approval of an 
        individual's participation in the program under paragraph (1), 
        the Secretary shall promptly notify the individual of that 
        approval. Such notice shall be in writing.
    (d) Agreement.--
            (1) In general.--An agreement between the Secretary and a 
        resident in a position under subsection (a)(1) shall be in 
        writing and shall be signed by the resident containing such 
        terms as the Secretary may specify.
            (2) Requirements.--The agreement must specify the terms of 
        the service obligation resulting from participating as a 
        resident under this section, including by requiring a service 
        obligation equal to the number of years of stipend and benefit 
        support.
    (e) Conditions of Employment.--The Secretary may prescribe the 
conditions of employment of persons appointed to positions under 
subsection (a)(1), including necessary training, and the customary 
amount and terms of pay for such positions during the period of such 
employment and training.
    (f) Obligated Service.--
            (1) In general.--Each person appointed to a position under 
        subsection (a)(1) shall provide service as a full-time employee 
        of the Department for the period of obligated service provided 
        in the agreement of the participant entered into under 
        subsection (d). Such service shall be provided in the full-time 
        clinical practice of such participant's profession or in 
        another health-care position in an assignment or location 
        determined by the Secretary.
            (2) Commencement date.--Not later than 60 days before the 
        date on which a person commences serving in a position under 
        subsection (a)(1), the Secretary shall notify the person of 
        such date. Such date shall be the first day of the person's 
        period of obligated service.
    (g) Breach of Agreement: Liability.--
            (1) Penalty.--A person appointed under this section to a 
        position under subsection (a)(1) (other than a person who is 
        liable under paragraph (2)) who fails to accept payment, or 
        instructs the educational institution in which the person is 
        enrolled not to accept payment, in whole or in part, for a 
        residency under the agreement entered into under subsection (d) 
        of this title shall be liable to the United States for 
        liquidated damages in the amount of $1,500. Such liability is 
        in addition to any period of obligated service or other 
        obligation or liability under the agreement.
            (2) Liability.--
                    (A) In general.--A person appointed to a position 
                under subsection (a)(1) shall be liable to the United 
                States for the amount which has been paid to or on 
                behalf of the person under the agreement if any of the 
                following occurs:
                            (i) The person is dismissed from the 
                        position for disciplinary reasons.
                            (ii) The person voluntarily terminates the 
                        residency before the completion of such course 
                        of training.
                            (iii) The person loses the person's 
                        license, registration, or certification to 
                        practice the person's health care profession in 
                        a State.
                    (B) Liability supplants service obligation.--
                Liability under this paragraph is in lieu of any 
                service obligation arising under the person's agreement 
                under subsection (d).
    (h) Recovery.--
            (1) In general.--If a person breaches the person's 
        agreement under subsection (d) by failing (for any reason) to 
        complete such person's period of obligated service, the United 
        States shall be entitled to recover from the person an amount 
        equal to the product of--
                    (A) three;
                    (B) the sum of--
                            (i) the amounts paid under this section to 
                        or on behalf of the person; and
                            (ii) the interest on such amounts that 
                        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; and
                    (C) the quotient of--
                            (i) the difference between--
                                    (I) the total number of months in 
                                the person's period of obligated 
                                service; and
                                    (II) the number of months of such 
                                period served by the person; and
                            (ii) the total number of months in the 
                        person's period of obligated service.
            (2) Period of recovery.--Any amount which the United States 
        is entitled to recover under this subsection shall be paid to 
        the United States not later than the date that is one year 
        after the date of the breach of the agreement.
    (i) Annual Report.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act and not less frequently than once 
        each year thereafter, the Secretary shall submit to the 
        appropriate committees of Congress a report on the 
        implementation of this section during the previous year.
            (2) Contents.--Each report submitted under paragraph (1) 
        shall include, for the period covered by the report, the 
        following:
                    (A) The number of positions described in subsection 
                (a) that were filled.
                    (B) The location of each such position.
                    (C) The academic affiliate associated with each 
                such position.
                    (D) A description of the challenges faced in 
                filling the positions described in subsection (a) and 
                the actions the Secretary has taken to address such 
                challenges.
            (3) 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.

SEC. 303. ANNUAL REPORT ON AWARDS OR BONUSES AWARDED TO CERTAIN HIGH-
              LEVEL EMPLOYEES OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Chapter 7 is amended by adding at the end the 
following new section:
``Sec. 726. Annual report on awards to certain high-level employees
    ``(a) In General.--Not later than 30 days after the end of each 
fiscal year, the Secretary shall submit to the appropriate committees 
of Congress a report that contains, for the most recent fiscal year 
ending before the submittal of the report, a description of the 
performance awards and bonuses awarded to Regional Office Directors of 
the Department, Directors of Medical Centers of the Department, and 
Directors of Veterans Integrated Service Networks.
    ``(b) Elements.--Each report submitted under subsection (a) shall 
include the following with respect to each award or bonus awarded to an 
individual described in such subsection:
            ``(1) The type of award or bonus, specifically those 
        awarded for performance or on the basis of recruitment, 
        relocation and retention as the case may be.
            ``(2) The amount of each award or bonus.
            ``(3) The job title of the individual awarded the award or 
        bonus.
            ``(4) The location where the individual awarded the award 
        or bonus works.
    ``(c) Appropriate Committees of Congress.--In this section, the 
term `appropriate committees of Congress' means--
            ``(1) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the Senate; and
            ``(2) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the House of Representatives.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 7 of such title is amended by inserting after the item relating 
to section 725 the following new item:

``726. Annual report on awards to certain high-level employees.''.

            Subtitle B--Facilities, Construction, and Leases

SEC. 311. FACILITATING SHARING OF MEDICAL FACILITIES WITH OTHER FEDERAL 
              AGENCIES.

    (a) Construction or Lease of Shared Facility.--
            (1) In general.--Subchapter I of chapter 81 is amended by 
        inserting after section 8111A the following new section:
``Sec. 8111B. Authority to plan, design, construct, or lease a shared 
              medical facility
    ``(a) In General.--(1) The Secretary may enter into agreements with 
other Federal agencies for the planning, designing, constructing, or 
leasing shared medical facilities with the goal of improving access to, 
and quality and cost effectiveness of, health care provided by the 
Department and other Federal agencies.
    ``(2) Facilities planned, designed, constructed, or leased under 
paragraph (1) shall be managed by the Director of the High-Performing 
Integrated Healthcare Network of the Department designated under 
section 1730B(a) of this title.
    ``(b) Transfer of Amounts to Other Federal Agencies.--(1) The 
Secretary may transfer to another Federal agency amounts appropriated 
to the Department for `Construction, Minor Projects' for use for the 
planning, design, or construction of a shared medical facility if the 
estimated share of the project costs to be borne by the Department does 
not exceed the threshold for a major medical facility construction 
project under section 8104(a)(3)(A) of this title.
    ``(2) The Secretary may transfer to another Federal agency amounts 
appropriated to the Department for `Construction, Major Projects' for 
use for the planning, design, or construction of a shared medical 
facility if--
            ``(A) the estimated share of the project costs to be borne 
        by the Department is more than the threshold for a major 
        medical facility construction project under subsection 
        (a)(3)(A) of section 8104 of this title; and
            ``(B) the requirements for such a project under such 
        section have been met.
    ``(3) The Secretary may transfer to another Federal agency amounts 
appropriated to the applicable appropriations account of the Department 
for the purpose of leasing space for a shared medical facility if the 
estimated share of the lease costs to be borne by the Department does 
not exceed the threshold for a major medical facility lease under 
section 8104(a)(3)(B) of this title.
    ``(c) Transfer of Amounts to Department.--(1) Amounts transferred 
to the Department by another Federal agency for the necessary expenses 
of planning, designing, or constructing a shared medical facility for 
which the estimated share of the project costs to be borne by the 
Department does not exceed the threshold for a major medical facility 
project under section 8104(a)(3)(A) of this title may be deposited in 
the `Construction, Minor Projects' account of the Department and used 
for such necessary expenses.
    ``(2) Amounts transferred to the Department by another Federal 
agency for the necessary expenses of planning, designing, or 
constructing a shared medical facility for which the estimated share of 
the project costs to be borne by the Department is more than the 
threshold for a major medical facility project under section 
8104(a)(3)(A) of this title may be deposited in the `Construction, 
Major Projects' account of the Department and used for such necessary 
expenses if the requirements for such project under section 8104 of 
this title have been met.
    ``(3) Amounts transferred to the Department by another Federal 
agency for the purpose of leasing space for a shared medical facility 
may be credited to the applicable appropriations account of the 
Department and shall be available without fiscal year limitation.
    ``(4) Amounts transferred under paragraphs (1) and (2) shall be 
available for the same time period as amounts in the account to which 
those amounts are transferred.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of such chapter is amended by inserting after the 
        item relating to section 8111A the following new item:

``8111B. Authority to plan, design, construct, or lease a shared 
                            medical facility.''
    (b) Modification of Definition of Medical Facility.--Paragraph (3) 
of section 8101 is amended to read as follows:
            ``(3) The term `medical facility' means any facility or 
        part thereof that is, or will be, under the jurisdiction of the 
        Secretary, or as otherwise designated by law, for the provision 
        of healthcare services (including hospital care, outpatient 
        care, nursing home care, domiciliary care, or medical 
        services), including any necessary building and auxiliary 
        structure, garage, parking facility, mechanical equipment, 
        trackage facilities leading thereto, abutting sidewalks, 
        accommodations for attending personnel, and recreation 
        facilities associated therewith.''.

SEC. 312. REVIEW OF ENHANCED USE LEASES.

    Section 8162 is amended--
            (1) in subsection (a), by amending paragraph (2) to read as 
        follows:
    ``(2) With respect to enhanced-use leases entered into on or after 
the date of enactment of the Veterans Community Care and Access Act of 
2017, the Secretary may enter into an enhanced-use lease only if the 
Secretary determines that--
            ``(A) the lease will not be inconsistent with and will not 
        adversely affect the mission of the Department; and
            ``(B)(i) the lease will enhance the use of the property; or
            ``(ii) the leased property will provide supportive housing 
        as defined in section 8161 of this title.''; and
            (2) in subsection (b), by amending paragraph (6) to read as 
        follows:
    ``(6) The Director of the Office of Management and Budget shall 
review each such enhanced-use lease prior to execution for compliance 
with paragraph (5) of this subsection.''.

                  TITLE IV--INNOVATIVE PILOT PROGRAMS

SEC. 401. PILOT PROGRAM TO ESTABLISH OR AFFILIATE WITH GRADUATE MEDICAL 
              RESIDENCY PROGRAMS AT FACILITIES OPERATED BY INDIAN 
              TRIBES, TRIBAL ORGANIZATIONS, AND THE INDIAN HEALTH 
              SERVICE IN RURAL AREAS.

    (a) Pilot Program Required.--The Secretary of Veterans Affairs, in 
consultation with the Director of the Indian Health Service, shall 
carry out a pilot program--
            (1) to establish graduate medical education residency 
        training programs at covered facilities; or
            (2) to affiliate with established programs described in 
        paragraph (1).
    (b) Covered Facilities.--For purposes of the pilot program, a 
covered facility is any facility--
            (1) described in subparagraph (B) or (C) of section 
        302(a)(2); and
            (2) located in a rural or remote area, as determined by the 
        Secretary and the Director of the Indian Health Service.
    (c) Locations.--
            (1) In general.--The Secretary shall carry out the pilot 
        program at not more than five covered facilities that have been 
        selected by the Secretary for purposes of the pilot program.
            (2) Criteria.--The Secretary shall establish criteria for 
        selecting covered facilities under paragraph (1).
    (d) Duration.--The Secretary shall carry out the pilot program 
during the eight-year period beginning on the date that is 180 days 
after the date of the enactment of this Act.
    (e) Reimbursement of Costs.--The Secretary shall reimburse each 
covered facility participating in the pilot program for the following 
costs associated with the pilot program:
            (1) Curriculum development.
            (2) Recruitment, training, supervision, and retention of 
        residents and faculty.
            (3) Accreditation of programs of education under the pilot 
        program by the Accreditation Council for Graduate Medical 
        Education (ACGME) or the American Osteopathic Association 
        (AOA).
            (4) The portion of faculty salaries attributable to 
        activities relating to carrying out the pilot program.
            (5) Payment for expenses relating to providing medical 
        education under the pilot program.
            (6) Stipends and benefits.
    (f) Period of Obligated Service.--
            (1) In general.--The Secretary shall enter into an 
        agreement with each individual who participates in the pilot 
        program under which such individual agrees to serve under the 
        same terms as established under section 302.
            (2) Loan repayment.--During the period of obligated service 
        of an individual under paragraph (1), the individual--
                    (A) shall be deemed to be an eligible individual 
                under subsection (b) of section 108 of the Indian 
                Health Care Improvement Act (25 U.S.C. 1616a) for 
                purposes of participation in the Indian Health Service 
                Loan Repayment Program under such section during the 
                portion of such period that the individual serves at a 
                covered facility; and
                    (B) shall be deemed to be an eligible individual 
                under section 7682(a) of title 38, United States Code, 
                for purposes of participation in the Department of 
                Veterans Affairs Education Debt Reduction Program under 
                subchapter VII of chapter 76 of such title during the 
                portion of such period that the individual serves at a 
                facility of the Department.
            (3) Concurrent service.--Any period of obligated service 
        required of an individual under paragraph (1) shall be served--
                    (A) with respect to service at a covered facility, 
                concurrently with any period of obligated service 
                required of the individual by the Indian Health 
                Service; and
                    (B) with respect to service at a facility of the 
                Department of Veterans Affairs, concurrently with any 
                period of obligated service required of the individual 
                by the Department.
    (g) Treatment of Participants.--A residency position into which a 
participant in the pilot program is placed as part of the pilot program 
shall be considered a position referred to in section 302(a)(1) for 
purposes of the limitation on number of new positions authorized under 
such section.
    (h) Report.--Not later than three years before the date on which 
the pilot program terminates, the Secretary of Veterans Affairs shall 
submit to the Committee on Veterans' Affairs of the Senate and the 
Committee on Veterans' Affairs of the House of Representatives a report 
on the feasibility and advisability of--
            (1) expanding the pilot program to additional locations; 
        and
            (2) making the pilot program or any aspect of the pilot 
        program permanent.

SEC. 402. 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 
122, is further amended by inserting after section 1703E, as added by 
section 122, the following new section:
``Sec. 1703F. 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 as appropriate to develop new, innovative approaches to 
testing payment and service delivery models 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 improve 
the access to and quality, timeliness, and patient satisfaction of such 
care and services, as well as the cost savings associated with such 
models.
    ``(4)(A) The Secretary shall test models where the Secretary 
determines that there is evidence that the model addresses a defined 
population for which there are deficits care leading to poor clinical 
outcomes or potentially avoidable expenditures.
    ``(B) The Secretary shall focus on models expected 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 models for testing, the Secretary may consider 
the following additional 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 applicable 
        individuals.
            ``(B) Whether the model places the applicable individual, 
        including family members and other caregivers of the applicable 
        individual, at the center of the care team of the applicable 
        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 veterans 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.--Pilot programs carried out by the Secretary under 
this section shall terminate no later than five years after their 
commencement.
    ``(c) Location.--The Secretary shall ensure that pilot programs 
carried out under this section occur in different areas that are 
appropriate for the intended purposes of the pilot program.
    ``(d) Budget.--Funding for pilot programs carried out by the 
Secretary under this section will be derived from appropriations 
provided in advance in appropriations Acts for the Veterans Health 
Administration and from appropriations provided for information 
technology systems.
    ``(e) Notice.--The Secretary shall publish information about such 
pilot programs in the Federal Register, and shall take reasonable 
actions to provide direct notice to veterans eligible to participate in 
a pilot program operated under this section.
    ``(f) Waiver of Authorities.--(1) Subject to reporting under 
paragraph (2) and approval under paragraph (3), in implementing the 
pilot programs under this section, the Secretary may waive such 
requirements in subchapters I, II, and III of this chapter as may be 
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 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 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 the 
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, 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 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 be available unless the Secretary submits the first proposal, 
in accordance with the requirements in subsection (f), for a pilot 
program within 18 months of the date of the enactment of the Veterans 
Community Care and Access Act of 2017.
    ``(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 within 30 days of 
        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 
obtain advice from the Under Secretary for Health and the Special 
Medical Advisory Group established pursuant to section 7312 of this 
title in the development and implementation of any pilot program 
operated under this section.
    ``(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 
        applicable individuals.''.
    (b) Conforming Amendment.--The table of sections at the beginning 
of such chapter, as amended by section 122, is further amended by 
inserting after the item relating to section 1703E the following new 
item:

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

                   TITLE V--OTHER HEALTH CARE MATTERS

SEC. 501. AUTHORIZATION OF APPROPRIATIONS FOR HEALTH CARE FROM 
              DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--There is authorized to be appropriated to the 
Secretary of Veterans Affairs such amounts as may be necessary to carry 
out the purposes set forth in subsection (b).
    (b) Use of Amounts.--The purposes set forth in this subsection are 
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) Nurses.
                            (iii) Social workers.
                            (iv) Mental health professionals.
                            (v) Physician assistants.
                            (vi) 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 sections 303 and 401.
    (c) Funding Plan and Report.--
            (1) In general.--Not later than 180 days after the date on 
        which amounts are appropriated to the Department pursuant to 
        the authorization in subsection (a), the Secretary of Veterans 
        Affairs shall submit to the appropriate committees of Congress 
        a funding plan and report on how the Secretary intends to 
        obligate the amounts so appropriated and how it relates to the 
        quadrennial Veterans Health Administration review and strategic 
        plan under section 1730B(a) of title 38, United States Code, as 
        added by section 102.
            (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.

SEC. 502. 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, $4,000,000,000 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.--The amount appropriated under subsection (a) 
shall remain available until expended pursuant to section 802(c)(4) of 
the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 
113-146; 38 U.S.C. 1701 note) as added by section 202.

SEC. 503. APPLICABILITY OF DIRECTIVE OF OFFICE OF FEDERAL CONTRACT 
              COMPLIANCE PROGRAMS.

    (a) In General.--Directive 2014-01 of the Office of Federal 
Contract Compliance Programs of the Department of Labor (effective as 
of May 7, 2014) shall apply to any entity entering into an agreement 
under section 1703A or section 1745 of title 38, United States Code, as 
amended by sections 112 and 114, respectively, in the same manner as 
such directive applies to subcontractors under the TRICARE program for 
the duration of the moratorium provided under such directive.
    (b) Applicability Period.--The directive described in subsection 
(a), and the moratorium provided under such directive, shall not be 
altered or rescinded before May 7, 2019.
    (c) TRICARE Program Defined.--In this section, the term ``TRICARE 
program'' has the meaning given that term in section 1072 of title 10, 
United States Code.

SEC. 504. AMENDING STATUTORY REQUIREMENTS FOR THE POSITION OF THE CHIEF 
              OFFICER OF THE READJUSTMENT COUNSELING SERVICE.

    Section 7309(b)(2) is amended--
            (1) in subparagraph (B), by striking ``in the Readjustment 
        Counseling Service''; and
            (2) in subparagraph (C), by striking ``in the Readjustment 
        Counseling Service''.

SEC. 505. AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY PROJECTS OF 
              THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) Authorization.--The Secretary of Veterans Affairs may carry out 
the following major medical facility project, to be carried out in an 
amount not to exceed the amount specified for that project: Realignment 
of medical facilities in Livermore, California, in an amount not to 
exceed $117,300,000.
    (b) Authorization of Appropriations for Construction.--There is 
authorized to be appropriated to the Secretary of Veterans Affairs for 
fiscal year 2018 or the year in which funds are appropriated for the 
Construction, Major Projects account, $117,300,000 for the project 
authorized in subsection (a).
    (c) Submittal of Information.--Not later than 90 days after the 
date of the enactment of this Act, for the project authorized in 
section (a), the Secretary of Veterans Affairs shall submit to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives the following 
information:
            (1) A line item accounting of expenditures relating to 
        construction management carried out by the Department of 
        Veterans Affairs for such project.
            (2) The future amounts that are budgeted to be obligated 
        for construction management carried out by the Department for 
        such project.
            (3) A justification for the expenditures described in 
        paragraph (1) and the future amounts described in paragraph 
        (2).
            (4) Any agreement entered into by the Secretary regarding 
        the Army Corps of Engineers providing services relating to such 
        project, including reimbursement agreements and the costs to 
        the Department of Veterans Affairs for such services.
                                 <all>