[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2372 Engrossed Amendment House (EAH)]
<DOC>
In the House of Representatives, U. S.,
May 16, 2018.
Resolved, That the bill from the Senate (S. 2372) entitled ``An Act
to amend title 38, United States Code, to provide outer burial
receptacles for remains buried in National Parks, and for other
purposes.'', do pass with the following
AMENDMENT:
Strike out all after the enacting clause and insert:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``John S. McCain
III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal
Systems and Strengthening Integrated Outside Networks Act of 2018'' or
the ``VA MISSION Act of 2018''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--CARING FOR OUR VETERANS
Sec. 100. Short title; references to title 38, United States Code.
Subtitle A--Developing an Integrated High-Performing Network
Chapter 1--Establishing Community Care Programs
Sec. 101. Establishment of Veterans Community Care Program.
Sec. 102. Authorization of agreements between Department of Veterans
Affairs and non-Department providers.
Sec. 103. Conforming amendments for State veterans homes.
Sec. 104. Access standards and standards for quality.
Sec. 105. Access to walk-in care.
Sec. 106. Strategy regarding the Department of Veterans Affairs High-
Performing Integrated Health Care Network.
Sec. 107. Applicability of Directive of Office of Federal Contract
Compliance Programs.
Sec. 108. Prevention of certain health care providers from providing
non-Department health care services to
veterans.
Sec. 109. Remediation of medical service lines.
Chapter 2--Paying Providers and Improving Collections
Sec. 111. Prompt payment to providers.
Sec. 112. Authority to pay for authorized care not subject to an
agreement.
Sec. 113. Improvement of authority to recover the cost of services
furnished for non-service-connected
disabilities.
Sec. 114. Processing of claims for reimbursement through electronic
interface.
Chapter 3--Education and Training Programs
Sec. 121. Education program on health care options.
Sec. 122. Training program for administration of non-Department of
Veterans Affairs health care.
Sec. 123. Continuing medical education for non-Department medical
professionals.
Chapter 4--Other Matters Relating to Non-Department of Veterans Affairs
Providers
Sec. 131. Establishment of processes to ensure safe opioid prescribing
practices by non-Department of Veterans
Affairs health care providers.
Sec. 132. Improving information sharing with community providers.
Sec. 133. Competency standards for non-Department of Veterans Affairs
health care providers.
Sec. 134. Department of Veterans Affairs participation in national
network of State-based prescription drug
monitoring programs.
Chapter 5--Other Non-Department Health Care Matters
Sec. 141. Plans for Use of Supplemental Appropriations Required.
Sec. 142. Veterans Choice Fund flexibility.
Sec. 143. Sunset of Veterans Choice Program.
Sec. 144. Conforming amendments.
Subtitle B--Improving Department of Veterans Affairs Health Care
Delivery
Sec. 151. Licensure of health care professionals of the Department of
Veterans Affairs providing treatment via
telemedicine.
Sec. 152. Authority for Department of Veterans Affairs Center for
Innovation for Care and Payment.
Sec. 153. Authorization to provide for operations on live donors for
purposes of conducting transplant
procedures for veterans.
Subtitle C--Family Caregivers
Sec. 161. Expansion of family caregiver program of Department of
Veterans Affairs.
Sec. 162. Implementation of information technology system of Department
of Veterans Affairs to assess and improve
the family caregiver program.
Sec. 163. Modifications to annual evaluation report on caregiver
program of Department of Veterans Affairs.
TITLE II--VA ASSET AND INFRASTRUCTURE REVIEW
Subtitle A--Asset and Infrastructure Review
Sec. 201. Short title.
Sec. 202. The Commission.
Sec. 203. Procedure for making recommendations.
Sec. 204. Actions regarding infrastructure and facilities of the
Veterans Health Administration.
Sec. 205. Implementation.
Sec. 206. Department of Veterans Affairs Asset and Infrastructure
Review Account.
Sec. 207. Congressional consideration of Commission report.
Sec. 208. Other matters.
Sec. 209. Definitions.
Subtitle B--Other Infrastructure Matters
Sec. 211. Improvement to training of construction personnel.
Sec. 212. Review of enhanced use leases.
Sec. 213. Assessment of health care furnished by the Department to
veterans who live in the Pacific
territories.
TITLE III--IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS
Sec. 301. Designated scholarships for physicians and dentists under
Department of Veterans Affairs Health
Professional Scholarship Program.
Sec. 302. Increase in maximum amount of debt that may be reduced under
Education Debt Reduction Program of
Department of Veterans Affairs.
Sec. 303. Establishing the Department of Veterans Affairs Specialty
Education Loan Repayment Program.
Sec. 304. Veterans healing veterans medical access and scholarship
program.
Sec. 305. Bonuses for recruitment, relocation, and retention.
Sec. 306. Inclusion of Vet Center employees in Education Debt Reduction
Program of Department of Veterans Affairs.
TITLE IV--HEALTH CARE IN UNDERSERVED AREAS
Sec. 401. Development of criteria for designation of certain medical
facilities of the Department of Veterans
Affairs as underserved facilities and plan
to address problem of underserved
facilities.
Sec. 402. Pilot program to furnish mobile deployment teams to
underserved facilities.
Sec. 403. Pilot program on graduate medical education and residency.
TITLE V--OTHER MATTERS
Sec. 501. Annual report on performance awards and bonuses awarded to
certain high-level employees of the
department.
Sec. 502. Role of podiatrists in Department of Veterans Affairs.
Sec. 503. Definition of major medical facility project.
Sec. 504. Authorization of certain major medical facility projects of
the Department of Veterans Affairs.
Sec. 505. Department of Veterans Affairs personnel transparency.
Sec. 506. Program on establishment of peer specialists in patient
aligned care team settings within medical
centers of Department of Veterans Affairs.
Sec. 507. Department of Veterans Affairs medical scribe pilot program.
Sec. 508. Extension of requirement to collect fees for housing loans
guaranteed by Secretary of Veterans
Affairs.
Sec. 509. Extension of reduction in amount of pension furnished by
Department of Veterans Affairs for certain
veterans covered by Medicaid plans for
services furnished by nursing facilities.
Sec. 510. Appropriation of amounts.
Sec. 511. Technical correction.
Sec. 512. Budgetary effects.
TITLE I--CARING FOR OUR VETERANS
SEC. 100. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES CODE.
(a) Short Title.--This title may be cited as the ``Caring for Our
Veterans Act of 2018''.
(b) References to Title 38, United States Code.--Except as
otherwise expressly provided, whenever in this title 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.
Subtitle A--Developing an Integrated High-Performing Network
CHAPTER 1--ESTABLISHING COMMUNITY CARE PROGRAMS
SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY CARE PROGRAM.
(a) Establishment of Program.--
(1) In general.--Section 1703 is amended to read as
follows:
``Sec. 1703. Veterans Community Care Program
``(a) In General.--(1) There is established a program to furnish
hospital care, medical services, and extended care services to covered
veterans through health care providers specified in subsection (c).
``(2) The Secretary shall coordinate the furnishing of hospital
care, medical services, and extended care services under this section
to covered veterans, including coordination of, at a minimum, the
following:
``(A) Ensuring the scheduling of medical appointments in a
timely manner and the establishment of a mechanism to receive
medical records from non-Department providers.
``(B) Ensuring continuity of care and services.
``(C) Ensuring coordination among regional networks if the
covered veteran accesses care and services in a different
network than the regional network in which the covered veteran
resides.
``(D) Ensuring that covered veterans do not experience a
lapse in care resulting from errors or delays by the Department
or its contractors or an unusual or excessive burden in
accessing hospital care, medical services, or extended care
services.
``(3) A covered veteran may only receive care or services under
this section upon the authorization of such care or services by the
Secretary.
``(b) Covered Veterans.--For purposes of this section, a covered
veteran is any veteran who--
``(1) is enrolled in the system of annual patient
enrollment established and operated under section 1705 of this
title; or
``(2) is not enrolled in such system but is otherwise
entitled to hospital care, medical services, or extended care
services under subsection (c)(2) of such section.
``(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) Conditions Under Which Care Is Required To Be Furnished
Through Non-Department Providers.--(1) The Secretary shall, subject to
the availability of appropriations, furnish hospital care, medical
services, and extended care services to a covered veteran through
health care providers specified in subsection (c) if--
``(A) the Department does not offer the care or services
the veteran requires;
``(B) the Department does not operate a full-service
medical facility in the State in which the covered veteran
resides;
``(C)(i) the covered veteran was an eligible veteran under
section 101(b)(2)(B) of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701
note) as of the day before the date of the enactment of the
Caring for Our Veterans Act of 2018;
``(ii) continues to reside in a location that would qualify
the veteran for eligibility under such section; and
``(iii) either--
``(I) resides in one of the five States with the
lowest population density as determined by data from
the 2010 decennial census; or
``(II) resides in a State not described in
subclause (I) and--
``(aa) received care or services under this
title in the year preceding the enactment of
the Caring for Our Veterans Act of 2018; and
``(bb) is seeking care or services within 2
years of the date of the enactment of the
Caring for Our Veterans Act of 2018;
``(D) the covered veteran has contacted the Department to
request care or services and the Department is not able to
furnish such care or services in a manner that complies with
designated access standards developed by the Secretary under
section 1703B of this title; or
``(E) the covered veteran and the covered veteran's
referring clinician agree that furnishing care and services
through a non-Department entity or provider would be in the
best medical interest of the covered veteran based upon
criteria developed by the Secretary.
``(2) The Secretary shall ensure that the criteria developed under
paragraph (1)(E) include consideration of the following:
``(A) The distance between the covered veteran and the
facility that provides the hospital care, medical services, or
extended care services the veteran needs.
``(B) The nature of the hospital care, medical services, or
extended care services required.
``(C) The frequency that the hospital care, medical
services, or extended care services needs to be furnished.
``(D) The timeliness of available appointments for the
hospital care, medical services, or extended care services the
veteran needs.
``(E) Whether the covered veteran faces an unusual or
excessive burden to access hospital care, medical services, or
extended care services from the Department medical facility
where a covered veteran seeks hospital care, medical services,
or extended care services, which shall include consideration of
the following:
``(i) Whether the covered veteran faces an
excessive driving distance, geographical challenge, or
environmental factor that impedes the access of the
covered veteran.
``(ii) Whether the hospital care, medical services,
or extended care services sought by the veteran is
provided by a medical facility of the Department that
is reasonably accessible to a covered veteran.
``(iii) Whether a medical condition of the covered
veteran affects the ability of the covered veteran to
travel.
``(iv) Whether there is compelling reason, as
determined by the Secretary, that the veteran needs to
receive hospital care, medical services, or extended
care services from a medical facility other than a
medical facility of the Department.
``(v) Such other considerations as the Secretary
considers appropriate.
``(3) If the Secretary has determined that the Department does not
offer the care or services the covered veteran requires under
subparagraph (A) of paragraph (1), that the Department does not operate
a full-service medical facility in the State in which the covered
veteran resides under subparagraph (B) of such paragraph, that the
covered veteran is described under subparagraph (C) of such paragraph,
or that the Department is not able to furnish care or services in a
manner that complies with designated access standards developed by the
Secretary under section 1703B of this title under subparagraph (D) of
such paragraph, the decision to receive hospital care, medical
services, or extended care services under such subparagraphs from a
health care provider specified in subsection (c) shall be at the
election of the veteran.
``(e) Conditions Under Which Care Is Authorized To Be Furnished
Through Non-Department Providers.--(1)(A) The Secretary may furnish
hospital care, medical services, or extended care services through a
health care provider specified in subsection (c) to a covered veteran
served by a medical service line of the Department that the Secretary
has determined is not providing care that complies with the standards
for quality the Secretary shall establish under section 1703C.
``(B) In carrying out subparagraph (A), the Secretary shall--
``(i) measure timeliness of the medical service line at a
facility of the Department when compared with the same medical
service line at different Department facilities; and
``(ii) measure quality at a medical service line of a
facility of the Department by comparing it with two or more
distinct and appropriate quality measures at non-Department
medical service lines.
``(C)(i) The Secretary may not concurrently furnish hospital care,
medical services, or extended care services under subparagraph (A) with
respect to more than three medical service lines described in such
subparagraph at any one health care facility of the Department.
``(ii) The Secretary may not concurrently furnish hospital care,
medical services, or extended care services under subparagraph (A) with
respect to more than 36 medical service lines nationally described in
such subparagraph.
``(2) The Secretary may limit the types of hospital care, medical
services, or extended care services covered veterans may receive under
paragraph (1) in terms of the length of time such care and services
will be available, the location at which such care and services will be
available, and the clinical care and services that will be available.
``(3)(A) Except as provided for in subparagraph (B), the hospital
care, medical services, and extended care services authorized under
paragraph (1) with respect to a medical service line shall cease when
the remediation described in section 1706A with respect to such medical
service line is complete.
``(B) The Secretary shall ensure continuity and coordination of
care for any veteran who elects to receive care or services under
paragraph (1) from a health care provider specified in subsection (c)
through the completion of an episode of care.
``(4) The Secretary shall publish in the Federal Register, and
shall take all reasonable steps to provide direct notice to covered
veterans affected under this subsection, at least once each year
stating the time period during which such care and services will be
available, the location or locations where such care and services will
be available, and the clinical services available at each location
under this subsection in accordance with regulations the Secretary
shall prescribe.
``(5) When the Secretary exercises the authority under paragraph
(1), the decision to receive care or services under such paragraph from
a health care provider specified in subsection (c) shall be at the
election of the covered veteran.
``(f) Review of Decisions.--The review of any decision under
subsection (d) or (e) shall be subject to the Department's clinical
appeals process, and such decisions may not be appealed to the Board of
Veterans' Appeals.
``(g) Tiered Network.--(1) To promote the provision of high-quality
and high-value hospital care, medical services, and extended care
services under this section, the Secretary may develop a tiered
provider network of eligible providers based on criteria established by
the Secretary for purposes of this section.
``(2) In developing a tiered provider network of eligible providers
under paragraph (1), the Secretary shall not prioritize providers in a
tier over providers in any other tier in a manner that limits the
choice of a covered veteran in selecting a health care provider
specified in subsection (c) for receipt of hospital care, medical
services, or extended care services under this section.
``(h) Contracts To Establish Networks of Health Care Providers.--
(1) The Secretary shall enter into consolidated, competitively bid
contracts to establish networks of health care providers specified in
paragraphs (1) and (5) of subsection (c) for purposes of providing
sufficient access to hospital care, medical services, or extended care
services under this section.
``(2)(A) The Secretary shall, to the extent practicable, ensure
that covered veterans are able to make their own appointments using
advanced technology.
``(B) To the extent practicable, the Secretary shall be responsible
for the scheduling of appointments for hospital care, medical services,
and extended care services under this section.
``(3)(A) 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,
if the Secretary notifies the appropriate committees of Congress that,
at a minimum--
``(i) the entity--
``(I) failed to comply substantially with the
provisions of the contract or with the provisions of
this section and the regulations prescribed under this
section;
``(II) failed to comply with the access standards
or the standards for quality established by the
Secretary;
``(III) is excluded from participation in a Federal
health care program (as defined in section 1128B(f) of
the Social Security Act (42 U.S.C. 1320a-7b(f))) under
section 1128 or 1128A of the Social Security Act (42
U.S.C. 1320a-7 and 1320a-7a);
``(IV) is identified as an excluded source on the
list maintained in the System for Award Management, or
any successor system; or
``(V) has been convicted of a felony or other
serious offense under Federal or State law and the
continued participation of the entity would be
detrimental to the best interests of veterans or the
Department;
``(ii) it is reasonable to terminate the contract based on
the health care needs of veterans; or
``(iii) it is reasonable to terminate the contract based on
coverage provided by contracts or sharing agreements entered
into under authorities other than this section.
``(B) Nothing in subparagraph (A) may be construed to restrict the
authority of the Secretary to terminate a contract entered into under
paragraph (1) under any other provision of law.
``(4) Whenever the Secretary provides notice to an entity 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. Such report shall
include the following:
``(A) An explanation of the reasons for providing such
notice.
``(B) A description of the effect of such failure,
including with respect to cost, schedule, and requirements.
``(C) A description of the actions taken by the Secretary
to mitigate such failure.
``(D) A description of the actions taken by the contractor
to address such failure.
``(E) A description of any effect on the community provider
market for veterans in the affected area.
``(5)(A) The Secretary shall instruct each entity awarded a
contract under paragraph (1) to recognize and accept, on an interim
basis, the credentials and qualifications of health care providers who
are authorized to furnish hospital care and medical services to
veterans under a community care program of the Department in effect as
of the day before the date of the enactment of the Caring for Our
Veterans Act of 2018, including under the Patient-Centered Community
Care Program and the Veterans Choice Program under section 101 of the
Veterans Access, Choice, and Accountability Act of 2014 (Public Law
113-146; 38 U.S.C. 1701 note), as qualified providers under the program
established under this section.
``(B) The interim acceptance period under subparagraph (A) shall be
determined by the Secretary based on the following criteria:
``(i) With respect to a health care provider, when the
current certification agreement for the health care provider
expires.
``(ii) Whether the Department has enacted certification and
eligibility criteria and regulatory procedures by which non-
Department providers will be authorized under this section.
``(6) The Secretary shall establish a system or systems for
monitoring the quality of care provided to covered veterans through a
network under this subsection and for assessing the quality of hospital
care, medical services, and extended care services furnished through
such network before the renewal of the contract for such network.
``(i) Payment Rates for Care and Services.--(1) Except as provided
in paragraph (2), and to the extent practicable, the rate paid for
hospital care, medical services, or extended care 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 (42 U.S.C. 1395x(u))) or a supplier (as defined in
section 1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare
program under title XI or title XVIII of the Social Security Act (42
U.S.C. 1301 et seq.), including section 1834 of such Act (42 U.S.C.
1395m), for the same care or services.
``(2)(A) A higher rate than the rate paid by the United States as
described in paragraph (1) may be negotiated with respect to the
furnishing of care or services to a covered veteran who resides in a
highly rural area.
``(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.
``(3) With respect to furnishing care or services under this
section in Alaska, the Alaska Fee Schedule of the Department of
Veterans Affairs shall be followed, except for when another payment
agreement, including a contract or provider agreement, is in effect.
``(4) With respect to furnishing hospital care, medical services,
or extended care 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 paragraph (2)(A) shall be
calculated based on the payment rates under such agreement.
``(5) Notwithstanding paragraph (1), the Secretary may incorporate,
to the extent practicable, the use of value-based reimbursement models
to promote the provision of high-quality care.
``(6) With respect to hospital care, medical services, or extended
care services for which there is not a rate paid under the Medicare
program as described in paragraph (1), the rate paid for such care or
services shall be determined by the Secretary.
``(j) Treatment of Other Health Plan Contracts.--In any case in
which a covered veteran is furnished hospital care, medical services,
or extended care services under this section for a non-service-
connected disability described in subsection (a)(2) of section 1729 of
this title, the Secretary shall recover or collect reasonable charges
for such care or services from a health plan contract described in
section 1729 in accordance with such section.
``(k) Payment by Veteran.--A covered veteran shall not pay a
greater amount for receiving care or services under this section than
the amount the veteran would pay for receiving the same or comparable
care or services at a medical facility of the Department or from a
health care provider of the Department.
``(l) Transplant Authority for Improved Access.--(1) In the case of
a covered veteran described in paragraph (2), the Secretary shall
determine whether to authorize an organ or bone marrow transplant for
that covered veteran at a non-Department facility.
``(2) A covered veteran described in this paragraph--
``(A) requires an organ or bone marrow transplant; and
``(B) has, in the opinion of the primary care provider of
the veteran, a medically compelling reason to travel outside
the region of the Organ Procurement and Transplantation
Network, established under section 372 of the National Organ
Transplantation Act (Public Law 98-507; 42 U.S.C. 274), in
which the veteran resides, to receive such transplant.
``(m) Monitoring of Care Provided.--(1)(A) Not later than 540 days
after the date of the enactment of the Caring for Our Veterans Act of
2018, and not less frequently than annually thereafter, the Secretary
shall submit to appropriate committees of Congress a review of the
types and frequency of care sought under subsection (d).
``(B) The review submitted under subparagraph (A) shall include an
assessment of the following:
``(i) The top 25 percent of types of care and services most
frequently provided under subsection (d) due to the Department
not offering such care and services.
``(ii) The frequency such care and services were sought by
covered veterans under this section.
``(iii) An analysis of the reasons the Department was
unable to provide such care and services.
``(iv) Any steps the Department took to provide such care
and services at a medical facility of the Department.
``(v) The cost of such care and services.
``(2) In monitoring the hospital care, medical services, and
extended care services furnished under this section, the Secretary
shall do the following:
``(A) With respect to hospital care, medical services, and
extended care services furnished through provider networks
established under subsection (i)--
``(i) compile data on the types of hospital care,
medical services, and extended care services furnished
through such networks and how many patients used each
type of care and service;
``(ii) identify gaps in hospital care, medical
services, or extended care services furnished through
such networks;
``(iii) identify how such gaps may be fixed through
new contracts within such networks or changes in the
manner in which hospital care, medical services, or
extended care services are furnished through such
networks;
``(iv) assess the total amounts spent by the
Department on hospital care, medical services, and
extended care services furnished through such networks;
``(v) assess the timeliness of the Department in
referring hospital care, medical services, and extended
care services to such networks; and
``(vi) assess the timeliness of such networks in--
``(I) accepting referrals; and
``(II) scheduling and completing
appointments.
``(B) Report the number of medical service lines the
Secretary has determined under subsection (e)(1) not to be
providing hospital care, medical services, or extended care
services that comply with the standards for quality established
by the Secretary.
``(C) Assess the use of academic affiliates and centers of
excellence of the Department to furnish hospital care, medical
services, and extended care services to covered veterans under
this section.
``(D) Assess the hospital care, medical services, and
extended care services furnished to covered veterans under this
section by medical facilities operated by Federal agencies
other than the Department.
``(3) Not later than 540 days after the date of the enactment of
the Caring for Our Veterans Act of 2018 and not less frequently than
once each year thereafter, the Secretary shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on the information
gathered under paragraph (2).
``(n) Prohibition on Certain Limitations.--(1) The Secretary shall
not limit the types of hospital care, medical services, or extended
care services covered veterans may receive under this section if it is
in the best medical interest of the veteran to receive such hospital
care, medical services, or extended care services, as determined by the
veteran and the veteran's health care provider.
``(2) No provision in this section may be construed to alter or
modify any other provision of law establishing specific eligibility
criteria for certain hospital care, medical services, or extended care
services.
``(o) 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 `medical service line' means a clinic within
a Department medical center.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 17 is amended by striking the item
relating to section 1703 and inserting the following new item:
``1703. Veterans Community Care Program.''.
(b) Effective Date.--Section 1703 of title 38, United States Code,
as amended by subsection (a), shall take effect on the later of--
(1) the date that is 30 days after the date on which the
Secretary of Veterans Affairs submits the report required under
section 101(q)(2) of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701
note); or
(2) the date on which the Secretary promulgates regulations
pursuant to subsection (c).
(c) Regulations.--
(1) In general.--Not later than 1 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) of this
section.
(2) Updates.--
(A) Periodic.--Before promulgating the regulations
required under paragraph (1), the Secretary shall
provide to the appropriate committees of Congress
periodic updates to confirm the progress of the
Secretary toward developing such regulations.
(B) First update.--The first update under
subparagraph (A) shall occur no later than 120 days
from the date of the enactment of this Act.
(C) Appropriate committees of congress defined.--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.
(d) Continuity of Existing Agreements.--
(1) In general.--Notwithstanding section 1703 of title 38,
United States Code, as amended by subsection (a), the Secretary
of Veterans Affairs shall continue all contracts, memorandums
of understanding, memorandums of agreements, and other
arrangements 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 terms of the Department of
Veterans Affairs and Indian Health Service Memorandum of
Understanding, signed October 1, 2010, the National
Reimbursement Agreement, signed December 5, 2012, arrangements
under section 405 of the Indian Health Care Improvement Act (25
U.S.C. 1645), and agreements entered into under sections 102
and 103 of the Veterans Access, Choice, and Accountability Act
of 2014 (Public Law 113-146).
(2) Modifications.--Paragraph (1) shall not be construed to
prohibit the Secretary and the parties to the contracts,
memorandums of understanding, memorandums of agreements, and
other arrangements described in such paragraph from making such
changes to such contracts, memorandums of understanding,
memorandums of agreements, and other arrangements as may be
otherwise authorized pursuant to other provisions of law or the
terms of the contracts, memorandums of understanding,
memorandums of agreements, and other arrangements.
SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DEPARTMENT OF VETERANS
AFFAIRS AND NON-DEPARTMENT PROVIDERS.
(a) In General.--Subchapter I of chapter 17 is 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 required by a veteran who is
entitled to such care or service under this chapter is not feasibly
available to the veteran from a facility of the Department or through a
contract or sharing agreement entered into pursuant to another
provision of law, the Secretary may furnish such care or service to
such veteran through an agreement under this section with an eligible
entity or provider to provide such hospital care, medical service, or
extended care 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 feasibly
available to a veteran from a 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 6 months within the
first 2 years of its taking effect, and not less frequently than once
every 4 years thereafter.
``(ii) If a Veterans Care Agreement has not been in effect for at
least 6 months by the date of the review required by subparagraph (A),
the agreement shall be reviewed during the next cycle required by
subparagraph (A), and such review shall serve as its review within the
first 2 years of its taking effect for purposes of clause (i).
``(3)(A) In fiscal year 2019 and in each fiscal year thereafter, in
addition to such other Veterans Care Agreements as the Secretary may
determine are of material size, a Veterans Care Agreement for the
purchase of extended care services that exceeds $5,000,000 annually
shall be considered of material size.
``(B) From time to time, the Secretary may publish a notice in the
Federal Register to adjust the dollar amount specified in subparagraph
(A) to account for changes in the cost of health care based upon
recognized health care market surveys and other available data.
``(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.);
``(3) an Aging and Disability Resource Center, an area
agency on aging, or a State agency (as defined in section 102
of the Older Americans Act of 1965 (42 U.S.C. 3002));
``(4) a center for independent living (as defined in
section 702 of the Rehabilitation Act of 1973 (29 U.S.C.
796a)); or
``(5) 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 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 section
1703(i) of this title.
``(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 care or service that is furnished
or paid for 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 Agreement.--
(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 Secretary shall establish a system or
systems for 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 shall not be
treated as--
``(A) an award for the purposes of such laws that would
otherwise require the use of competitive procedures for the
furnishing of care and services; or
``(B) a Federal contract for the acquisition of goods or
services for purposes of any provision of Federal law governing
Federal contracts for the acquisition of goods or services
except section 4706(d) of title 41.
``(2)(A) Except as provided in the agreement itself, 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.
``(3) Notwithstanding paragraph (2)(B)(i), an eligible entity or
provider that enters into an agreement under this section shall not be
treated as a Federal contractor or subcontractor for purposes of
chapter 67 of title 41 (commonly known as the `McNamara-O'Hara Service
Contract Act of 1965').
``(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 relating to section
1703 the following new item:
``1703A. Agreements with eligible entities or providers; certification
processes.''.
SEC. 103. 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 the agreement itself, 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;
``(II) all provisions of law that protect against
employment discrimination or that otherwise ensure equal
employment opportunities; and
``(III) all provisions in subchapter V of chapter 17 of
this title.
``(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.
SEC. 104. ACCESS STANDARDS AND STANDARDS FOR QUALITY.
(a) In General.--Subchapter I of chapter 17, as amended by section
102, is further amended by inserting after section 1703A the following
new sections:
``Sec. 1703B. Access standards
``(a)(1) The Secretary shall establish access standards for
furnishing hospital care, medical services, or extended care services
to covered veterans for the purposes of section 1703(d).
``(2) The Secretary shall ensure that the access standards
established under paragraph (1) define such categories of care to cover
all care and services within the medical benefits package of the
Department of Veterans Affairs.
``(b) The Secretary shall ensure that the access standards provide
covered veterans, employees of the Department, and health care
providers in the network established under section 1703(h) with
relevant comparative information that is clear, useful, and timely, so
that covered veterans can make informed decisions regarding their
health care.
``(c) The Secretary shall consult with all pertinent Federal
entities (including the Department of Defense, the Department of Health
and Human Services, and the Centers for Medicare & Medicaid Services),
entities in the private sector, and other nongovernmental entities in
establishing access standards.
``(d)(1) Not later than 270 days after the date of the enactment of
the Caring for Our Veterans Act of 2018, the Secretary shall submit to
the appropriate committees of Congress a report detailing the access
standards.
``(2)(A) Before submitting the report required under paragraph (1),
the Secretary shall provide periodic updates to the appropriate
committees of Congress to confirm the Department's progress towards
developing the access standards required by this section.
``(B) The first update under subparagraph (A) shall occur no later
than 120 days from the date of the enactment of the Caring for Our
Veterans Act of 2018.
``(3) Not later than 540 days after the date on which the Secretary
implements the access standards established under subsection (a), the
Secretary shall submit to the appropriate committees of Congress a
report detailing the implementation of and compliance with such access
standards by Department and non-Department entities or providers.
``(e) Not later than 3 years after the date on which the Secretary
establishes access standards under subsection (a) and not less
frequently than once every 3 years thereafter, the Secretary shall--
``(1) conduct a review of such standards; and
``(2) submit to the appropriate committees of Congress a
report on the findings and any modification to the access
standards with respect to the review conducted under paragraph
(1).
``(f) The Secretary shall ensure health care providers specified
under section 1703(c) are able to comply with the applicable access
standards established by the Secretary.
``(g) The Secretary shall publish in the Federal Register and on an
internet website of the Department the designated access standards
established under this section for purposes of section 1703(d)(1)(D).
``(h)(1) Consistent with paragraphs (1)(D) and (3) of section
1703(d), covered veterans may contact the Department at any time to
request a determination regarding whether they are eligible to receive
care and services from a non-Department entity or provider based on the
Department being unable to furnish such care and services in a manner
that complies with the designated access standards established under
this section.
``(2) The Secretary shall establish a process to review such
requests from covered veterans to determine whether--
``(A) the requested care is clinically necessary; and
``(B) the Department is able to provide such care in a
manner that complies with designated access standards
established under this section.
``(3) The Secretary shall promptly respond to any such request by a
covered veteran.
``(i)(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 `covered veterans' refers to veterans described in
section 1703(b) of this title.
``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 pursuant to this title, including
through non-Department health care providers pursuant to section 1703
of this title.
``(2) In establishing standards for quality under paragraph (1),
the Secretary shall consider existing health quality measures that are
applied to public and privately sponsored health care systems with the
purpose of providing covered veterans relevant comparative information
to make informed decisions regarding their health care.
``(3) The Secretary shall collect and consider data for purposes of
establishing the standards under paragraph (1). Such data collection
shall include--
``(A) after consultation with veterans service
organizations and other key stakeholders on survey development
or modification of an existing survey, a survey of veterans who
have used hospital care, medical services, or extended care
services furnished by the Veterans Health Administration during
the most recent 2-year period to assess the satisfaction of the
veterans with service and quality of care; and
``(B) datasets that include, at a minimum, elements
relating to the following:
``(i) Timely care.
``(ii) Effective care.
``(iii) Safety, including, at a minimum,
complications, readmissions, and deaths.
``(iv) Efficiency.
``(4) The Secretary shall consult with all pertinent Federal
entities (including the Department of Defense, the Department of Health
and Human Services, and the Centers for Medicare & Medicaid Services),
entities in the private sector, and other nongovernmental entities in
establishing standards for quality.
``(5)(A) Not later than 270 days after the date of the enactment of
the Caring for Our Veterans Act of 2018, the Secretary shall submit to
the appropriate committees of Congress a report detailing the standards
for quality.
``(B)(i) Before submitting the report required under subparagraph
(A), the Secretary shall provide periodic updates to the appropriate
committees of Congress to confirm the Department's progress towards
developing the standards for quality required by this section.
``(ii) The first update under clause (i) shall occur no later than
120 days from the date of the enactment of the Caring for Our Veterans
Act of 2018.
``(b) Publication and Consideration of Public Comments.--(1) Not
later than 1 year after the date on which the Secretary establishes
standards for quality under subsection (a), the Secretary shall publish
the quality rating of medical facilities of the Department in the
publicly available Hospital Compare website through 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 non-Department health care providers.
``(2) Not later than 2 years after the date on which the Secretary
establishes standards for quality under subsection (a), the Secretary
shall consider and solicit public comment on potential changes to the
measures used in such standards to ensure that they include the most
up-to-date and applicable industry measures for veterans.
``(c)(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 `covered veterans' refers to veterans described in
section 1703(b) of this title.''.
(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 1703A the following new items:
``1703B. Access standards.
``1703C. Standards for quality.''.
SEC. 105. 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 eligible veterans are able to
access walk-in care from qualifying non-Department entities or
providers.
``(b) Eligible Veterans.--For purposes of this section, an eligible
veteran is any individual who--
``(1) is enrolled in the health care system established
under section 1705(a) of this title; and
``(2) has received care under this chapter within the 24-
month period preceding the furnishing of walk-in care under
this section.
``(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 has entered into a
contract or other agreement with the Secretary to furnish services
under this section.
``(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.--The Secretary shall ensure continuity of
care for those eligible veterans who receive walk-in care services
under this section, including through the establishment of a mechanism
to receive medical records from walk-in care providers and provide
pertinent patient medical records to providers of walk-in care.
``(f) Copayments.--(1)(A) The Secretary may require an eligible
veteran to pay the United States a copayment for each episode of
hospital care or medical services provided under this section if the
eligible veteran would be required to pay a copayment under this title.
``(B) An eligible veteran not required to pay a copayment under
this title may access walk-in care without a copayment for the first
two visits in a calendar year. For any additional visits, a copayment
at an amount determined by the Secretary may be required.
``(C) An eligible veteran required to pay a copayment under this
title may be required to pay a regular copayment for the first two
walk-in care visits in a calendar year. For any additional visits, a
higher copayment at an amount determined by the Secretary may be
required.
``(2) After the first two episodes of care furnished to an eligible
veteran under this section, the Secretary may adjust the copayment
required of the veteran under this subsection based upon the priority
group of enrollment of the eligible veteran, the number of episodes of
care furnished to the eligible 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) Section 8153(c) of this title shall not apply to this
subsection.
``(g) Regulations.--Not later than 1 year after the date of the
enactment of the Caring for Our Veterans Act of 2018, 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-emergent care provided by a qualifying non-Department
entity or provider that furnishes episodic care and not longitudinal
management of conditions and is otherwise defined through regulations
the Secretary shall promulgate.''.
(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 relating to section
1725 the following new item:
``1725A. Access to walk-in care.''.
SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF VETERANS AFFAIRS HIGH-
PERFORMING INTEGRATED HEALTH CARE NETWORK.
(a) In General.--Subchapter II of chapter 73 is amended by
inserting after section 7330B the following new section:
``Sec. 7330C. Quadrennial Veterans Health Administration review
``(a) Market Area Assessments.--(1) Not less frequently than every
4 years, the Secretary of Veterans Affairs shall perform market area
assessments regarding the health care services furnished under the laws
administered by the Secretary.
``(2) Each market area assessment established under paragraph (1)
shall include the following:
``(A) An assessment of the demand for health care from the
Department, disaggregated by geographic market areas as
determined by the Secretary, including the number of requests
for health care services under the laws administered by the
Secretary.
``(B) An inventory of the health care capacity of the
Department of Veterans Affairs across the Department's system
of facilities.
``(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 title 38, as added by section
102, 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
of the access standards and standards for quality established
under sections 1703B and 1703C of this title.
``(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
of Veterans Affairs; and
``(ii) appointments with non-Department health care
providers.
``(3)(A) The Secretary shall submit to the appropriate committees
of Congress the market area assessments established in paragraph (1).
``(B) The Secretary also shall submit to the appropriate committees
of Congress the market area assessments completed by or being performed
on the day before the date of the enactment of the Caring for Our
Veterans Act of 2018.
``(4)(A) The Secretary shall use the market area assessments
established under paragraph (1) to--
``(i) determine the capacity of the health care provider
networks established under section 1703(h) of this title;
``(ii) inform the Department budget, in accordance with
subparagraph (B); and
``(iii) inform and assess the appropriateness of the access
standards established under section 1703B of this title and
standards for quality under section 1703C and to make
recommendations for any changes to such standards.
``(B) The Secretary shall ensure that the Department budget 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 market area assessments under paragraph
(1) and health care utilization data from the Department and non-
Department entities or providers furnishing care and services to
covered veterans as described in section 1703(b).
``(b) Strategic Plan To Meet Health Care Demand.--(1) Not later
than 1 year after the date of the enactment of the Caring for Our
Veterans Act of 2018 and not less frequently than once every 4 years
thereafter, the Secretary shall submit to the appropriate committees of
Congress a strategic plan that specifies a 4-year forecast of--
``(A) the demand for health care from the Department,
disaggregated by geographic area as determined by the
Secretary;
``(B) the health care capacity to be provided at each
medical center of the Department; and
``(C) the health care capacity to be provided through
community care providers.
``(2) In preparing the strategic plan under paragraph (1), the
Secretary shall--
``(A) assess the access standards and standards for quality
established under sections 1703B and 1703C of this title;
``(B) assess the market area assessments established under
subsection (a);
``(C) assess the needs of the Department based on
identified services that provide management of conditions or
disorders related to military service for which there is
limited experience or access in the national market, the
overall health of veterans throughout their lifespan, or other
services as the Secretary determines appropriate;
``(D) 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;
``(E) identify emerging issues, trends, problems, and
opportunities that could affect health care services furnished
under the laws administered by the Secretary;
``(F) develop recommendations regarding both short- and
long-term priorities for health care services furnished under
the laws administered by the Secretary;
``(G) after consultation with veterans service
organizations and other key stakeholders on survey development
or modification of an existing survey, consider a survey of
veterans who have used hospital care, medical services, or
extended care services furnished by the Veterans Health
Administration during the most recent 2-year period to assess
the satisfaction of the veterans with service and quality of
care;
``(H) conduct a comprehensive examination of programs and
policies of the Department regarding the delivery of health
care services and the demand of health care services for
veterans in future years;
``(I) assess the remediation of medical service lines of
the Department as described in section 1706A in conjunction
with the utilization of non-Department entities or providers to
offset remediation; and
``(J) consider such other matters as the Secretary
considers appropriate.
``(c) Responsibilities.--The Secretary shall be responsible for--
``(1) overseeing the transformation and organizational
change across the Department to achieve such high performing
integrated health care network;
``(2) developing the capital infrastructure planning and
procurement processes, whether minor or major construction
projects or leases; and
``(3) 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 health care network.
``(d) 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
such chapter is amended by inserting after the item relating to section
7330B the following new item:
``7330C. Quadrennial Veterans Health Administration review.''.
SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF FEDERAL CONTRACT
COMPLIANCE PROGRAMS.
(a) In General.--Notwithstanding the treatment of certain laws
under subsection (i) of section 1703A of title 38, United States Code,
as added by section 102 of this title, 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 such section 1703A or section 1745 of such title, as
amended by section 103, 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. 108. 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 1 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 1 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 2 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 services--
(1) provided under subchapter I of chapter 17 of title 38,
United States Code, at non-Department facilities (as defined in
section 1701 of such title);
(2) provided under section 101 of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-146; 38
U.S.C. 1701 note);
(3) purchased through the Medical Community Care account of
the Department; or
(4) purchased with amounts deposited in the Veterans Choice
Fund under section 802 of the Veterans Access, Choice, and
Accountability Act of 2014.
SEC. 109. REMEDIATION OF MEDICAL SERVICE LINES.
(a) In General.--Subchapter I of chapter 17 is amended by inserting
after section 1706 the following new section:
``Sec. 1706A. Remediation of medical service lines
``(a) In General.--Not later than 30 days after determining under
section 1703(e)(1) that a medical service line of the Department is
providing hospital care, medical services, or extended care services
that does not comply with the standards for quality established by the
Secretary, the Secretary shall submit to Congress an assessment of the
factors that led the Secretary to make such determination and a plan
with specific actions, and the time to complete them, to be taken to
comply with such standards for quality, including the following:
``(1) Increasing personnel or temporary personnel
assistance, including mobile deployment teams.
``(2) Special hiring incentives, including the Education
Debt Reduction Program under subchapter VII of chapter 76 of
this title and recruitment, relocation, and retention
incentives.
``(3) Utilizing direct hiring authority.
``(4) Providing improved training opportunities for staff.
``(5) Acquiring improved equipment.
``(6) Making structural modifications to the facility used
by the medical service line.
``(7) Such other actions as the Secretary considers
appropriate.
``(b) Responsible Parties.--In each assessment submitted under
subsection (a) with respect to a medical service line, the Secretary
shall identify the individuals at the Central Office of the Veterans
Health Administration, the facility used by the medical service line,
and the central office of the relevant Veterans Integrated Service
Network who are responsible for overseeing the progress of that medical
service line in complying with the standards for quality established by
the Secretary.
``(c) Interim Reports.--Not later than 180 days after submitting an
assessment under subsection (a) with respect to a medical service line,
the Secretary shall submit to Congress a report on the progress of that
medical service line in complying with the standards for quality
established by the Secretary and any other measures the Secretary will
take to assist the medical service line in complying with such
standards for quality.
``(d) Annual Reports.--Not less frequently than once each year, the
Secretary shall--
``(1) submit to Congress an analysis of the remediation
actions and costs of such actions taken with respect to each
medical service line with respect to which the Secretary
submitted an assessment and plan under paragraph (1) in the
preceding year, including an update on the progress of each
such medical service line in complying with the standards for
quality and timeliness established by the Secretary and any
other actions the Secretary is undertaking to assist the
medical service line in complying with standards for quality as
established by the Secretary; and
``(2) publish such analysis on the internet website of the
Department.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
1706 the following new item:
``1706A. Remediation of medical service lines.''.
CHAPTER 2--PAYING PROVIDERS AND IMPROVING COLLECTIONS
SEC. 111. PROMPT PAYMENT TO PROVIDERS.
(a) In General.--Subchapter I of chapter 17 is amended by inserting
after section 1703C, as added by section 104 of this title, 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, a medical
service, or an extended care service under this chapter shall submit to
the Secretary a claim for payment for furnishing the hospital care,
medical service, or extended care service not later than 180 days after
the date on which the entity or provider furnished the hospital care,
medical service, or extended care service.
``(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 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.
``(3) Not less frequently than annually, the Secretary shall submit
to Congress a report on payment of overdue claims under this
subsection, disaggregated by paper and electronic claims, that includes
the following:
``(A) The amount paid in overdue claims described in this
subsection, disaggregated by the amount of the overdue claim
and the amount of interest paid on such overdue claim.
``(B) The number of such overdue claims and the average
number of days late each claim was paid, disaggregated by
facility of the Department and Veterans Integrated Service
Network region.
``(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.--(1) In processing a claim for
compensation for hospital care, medical services, or extended care
services furnished by a non-Department health care entity or provider
under this chapter, the Secretary may act through--
``(A) a non-Department entity that is under contract or
agreement for the program established under section 1703(a) of
this title; or
``(B) a non-Department entity that specializes in such
processing for other Federal agency health care systems.
``(2) The Secretary shall seek to contract with a third party to
conduct a review of claims described in paragraph (3) that includes--
``(A) a feasibility assessment to determine the capacity of
the Department to process such claims in a timely manner; and
``(B) a cost benefit analysis comparing the capacity of the
Department to a third party entity capable of processing such
claims.
``(3) The review required under paragraph (2) shall apply to claims
for hospital care, medical services, or extended care services
furnished under section 1703 of this Act, as amended by the Caring for
Our Veterans Act of 2018, that are processed by the Department.
``(h) Report on Encounter Data System.--(1) Not later than 90 days
after the date of the enactment of the Caring for Our Veterans Act of
2018, 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 knowing
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.
``(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 relating to section
1703C, as added by section 104 of this title, the following new item:
``1703D. Prompt payment standard.''.
SEC. 112. 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 who 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) 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.''.
(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.''.
SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE COST OF SERVICES
FURNISHED FOR NON-SERVICE-CONNECTED DISABILITIES.
(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) Modification of Authority.--Subsection (a)(1) of such section
is amended 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.''.
(c) Modification of Eligible Individuals.--Subparagraph (D) of
subsection (a)(2) of such section is amended 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.''.
SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT THROUGH ELECTRONIC
INTERFACE.
The Secretary of Veterans Affairs may enter into an agreement with
a third-party entity to process, through the use of an electronic
interface, claims for reimbursement for health care provided under the
laws administered by the Secretary.
CHAPTER 3--EDUCATION AND TRAINING PROGRAMS
SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OPTIONS.
(a) In General.--The Secretary of Veterans Affairs shall develop
and administer an education program that teaches veterans about their
health care options through the Department of Veterans Affairs.
(b) Elements.--The program under subsection (a) shall--
(1) teach veterans about--
(A) eligibility criteria for care from the
Department set forth under sections 1703, as amended by
section 101 of this title, and 1710 of title 38, United
States Code;
(B) priority groups for enrollment in the system of
annual patient enrollment under section 1705(a) of such
title;
(C) the copayments and other financial obligations,
if any, required of certain individuals for certain
services; and
(D) how to utilize the access standards and
standards for quality established under sections 1703B
and 1703C of such title;
(2) teach veterans about the interaction between health
insurance (including private insurance, Medicare, Medicaid, the
TRICARE program, the Indian Health Service, tribal health
programs, and other forms of insurance) and health care from
the Department; and
(3) provide veterans with information on what to do when
they have a complaint about health care received from the
Department (whether about the provider, the Department, or any
other type of complaint).
(c) Accessibility.--In developing the education program under this
section, the Secretary shall ensure that materials under such program
are accessible--
(1) to veterans who may not have access to the internet;
and
(2) to veterans in a manner that complies with the
Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et
seq.).
(d) Annual Evaluation and Report.--
(1) Evaluation.--The Secretary shall develop a method to
evaluate the effectiveness of the education program under this
section and evaluate the program using the method not less
frequently than once each year.
(2) Report.--Not less frequently than once each year, the
Secretary shall submit to Congress a report on the findings of
the Secretary with respect to the most recent evaluation
conducted by the Secretary under paragraph (1).
(e) Definitions.--In this section:
(1) Medicaid.--The term ``Medicaid'' means the Medicaid
program under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.).
(2) Medicare.--The term ``Medicare'' means the Medicare
program under title XVIII of such Act (42 U.S.C. 1395 et seq.).
(3) Tricare program.--The term ``TRICARE program'' has the
meaning given that term in section 1072 of title 10, United
States Code.
SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF NON-DEPARTMENT OF
VETERANS AFFAIRS HEALTH CARE.
(a) Establishment of Program.--The Secretary of Veterans Affairs
shall develop and implement a training program to train employees and
contractors of the Department of Veterans Affairs on how to administer
non-Department health care programs, including the following:
(1) Reimbursement for non-Department emergency room care.
(2) The Veterans Community Care Program under section 1703
of such title, as amended by section 101.
(3) Management of prescriptions pursuant to improvements
under section 131.
(b) Annual Evaluation and Report.--The Secretary shall--
(1) develop a method to evaluate the effectiveness of the
training program developed and implemented under subsection
(a);
(2) evaluate such program not less frequently than once
each year; and
(3) not less frequently than once each year, submit to
Congress the findings of the Secretary with respect to the most
recent evaluation carried out under paragraph (2).
SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DEPARTMENT MEDICAL
PROFESSIONALS.
(a) Establishment of Program.--
(1) In general.--The Secretary of Veterans Affairs shall
establish a program to provide continuing medical education
material to non-Department medical professionals.
(2) Education provided.--The program established under
paragraph (1) shall include education on the following:
(A) Identifying and treating common mental and
physical conditions of veterans and family members of
veterans.
(B) The health care system of the Department of
Veterans Affairs.
(C) Such other matters as the Secretary considers
appropriate.
(b) Material Provided.--The continuing medical education material
provided to non-Department medical professionals under the program
established under subsection (a) shall be the same material provided to
medical professionals of the Department to ensure that all medical
professionals treating veterans have access to the same materials,
which supports core competencies throughout the community.
(c) Administration of Program.--
(1) In general.--The Secretary shall administer the program
established under subsection (a) to participating non-
Department medical professionals through an internet website of
the Department of Veterans Affairs.
(2) Curriculum and credit provided.--The Secretary shall
determine the curriculum of the program and the number of hours
of credit to provide to participating non-Department medical
professionals for continuing medical education.
(3) Accreditation.--The Secretary shall ensure that the
program is accredited in as many States as practicable.
(4) Consistency with existing rules.--The Secretary shall
ensure that the program is consistent with the rules and
regulations of the following:
(A) The medical licensing agency of each State in
which the program is accredited.
(B) Such medical credentialing organizations as the
Secretary considers appropriate.
(5) User cost.--The Secretary shall carry out the program
at no cost to participating non-Department medical
professionals.
(6) Monitoring, evaluation, and report.--The Secretary
shall monitor the utilization of the program established under
subsection (a), evaluate its effectiveness, and report to
Congress on utilization and effectiveness not less frequently
than once each year.
(d) Non-Department Medical Professional Defined.--In this section,
the term ``non-Department medical professional'' means any individual
who is licensed by an appropriate medical authority in the United
States and is in good standing, is not an employee of the Department of
Veterans Affairs, and provides care to veterans or family members of
veterans under the laws administered by the Secretary of Veterans
Affairs.
CHAPTER 4--OTHER MATTERS RELATING TO NON-DEPARTMENT OF VETERANS AFFAIRS
PROVIDERS
SEC. 131. 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.
(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 available and relevant medical history of the veteran and
a list of all medications prescribed to the veteran as known by the
Department.
(c) Submittal of Medical Records and Prescriptions.--
(1) In general.--The Secretary shall, consistent with
section 1703(a)(2)(A), as amended by section 101 of this title,
and section 1703A(e)(2)(F), as added by section 102 of this
title, require each covered health care provider to submit
medical records of any care or services furnished, including
records of any prescriptions for opioids, to the Department in
the timeframe and format specified by the Secretary.
(2) Responsibility of department for recording and
monitoring.--In carrying out paragraph (1) and upon the receipt
by the Department of the medical records described in paragraph
(1), the Secretary shall--
(A) ensure the Department is responsible for the
recording of the prescription in the electronic health
record of the veteran; and
(B) enable other monitoring of the prescription as
outlined in the Opioid Safety Initiative of the
Department.
(3) Report.--Not less frequently than annually, 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
section.
(d) Use of Opioid Safety Initiative Guidelines.--
(1) In general.--If the Secretary determines that the
opioid prescribing practices of a covered health care provider,
when treating covered veterans, satisfy a condition described
in paragraph (3), the Secretary shall take such action as the
Secretary 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, agreements, or other arrangements 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 Secretary, as the case may be.
(3) Conditions for exclusion or limitation.--The Secretary
shall take such action as is considered appropriate under
paragraph (1) when the opioid prescribing practices of a
covered health care provider when treating covered veterans--
(A) conflict with or are otherwise inconsistent
with the standards of appropriate and safe care;
(B) violate the requirements of a medical license
of the health care provider; or
(C) may place at risk the veterans receiving health
care from the provider.
(e) 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, but does not include a health care provider employed by
another agency of the Federal Government.
SEC. 132. 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 or performing other health
care-related activities or functions.
``(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 or as
permitted by law.
``(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. 133. COMPETENCY STANDARDS FOR NON-DEPARTMENT OF VETERANS AFFAIRS
HEALTH CARE PROVIDERS.
(a) Establishment of Standards and Requirements.--The Secretary of
Veterans Affairs shall establish standards and requirements for the
provision of care by non-Department of Veterans Affairs health care
providers in clinical areas for which the Department of Veterans
Affairs has special expertise, including post-traumatic stress
disorder, military sexual trauma-related conditions, and traumatic
brain injuries.
(b) Condition for Eligibility To Furnish Care.--(1) Each non-
Department of Veterans Affairs health care provider shall, to the
extent practicable as determined by the Secretary or otherwise provided
for in paragraph (2), meet the standards and requirements established
pursuant to subsection (a) before furnishing care pursuant to a
contract, agreement, or other arrangement with the Department of
Veterans Affairs. Non-Department of Veterans Affairs health care
providers furnishing care pursuant to a contract, agreement, or other
arrangement shall, to the extent practicable as determined by the
Secretary, fulfill training requirements established by the Secretary
on how to deliver evidence-based treatments in the clinical areas for
which the Department of Veterans Affairs has special expertise.
(2) Each non-Department of Veterans Affairs health care provider
who enters into a contract, agreement, or other arrangement after the
effective date identified in subsection (c) shall, to the extent
practicable, meet the standards and requirements established pursuant
to subsection (a) within 6 months of the contract, agreement, or other
arrangement taking effect.
(c) Effective Date.--This section shall take effect on the day that
is 1 year after the date of the enactment of this Act.
SEC. 134. DEPARTMENT OF VETERANS AFFAIRS PARTICIPATION IN NATIONAL
NETWORK OF STATE-BASED PRESCRIPTION DRUG MONITORING
PROGRAMS.
(a) In General.--Chapter 17 is amended by inserting after section
1730A the following new section:
``Sec. 1730B. Access to State prescription drug monitoring programs
``(a) Access to Programs.--(1) Any licensed health care provider or
delegate of such a provider shall be considered an authorized recipient
or user for the purpose of querying and receiving data from the
national network of State-based prescription drug monitoring programs
to support the safe and effective prescribing of controlled substances
to covered patients.
``(2) Under the authority granted by paragraph (1)--
``(A) licensed health care providers or delegates of such
providers shall query such network in accordance with
applicable regulations and policies of the Veterans Health
Administration; and
``(B) notwithstanding any general or specific provision of
law, rule, or regulation of a State, no State may restrict the
access of licensed health care providers or delegates of such
providers from accessing that State's prescription drug
monitoring programs.
``(3) No State shall deny or revoke the license, registration, or
certification of a licensed health care provider or delegate who
otherwise meets that State's qualifications for holding the license,
registration, or certification on the basis that the licensed health
care provider or delegate queried or received data, or attempted to
query or receive data, from the national network of State-based
prescription drug monitoring programs under this section.
``(b) Covered Patients.--For purposes of this section, a covered
patient is a patient who--
``(1) receives a prescription for a controlled substance;
and
``(2) is not receiving palliative care or enrolled in
hospice care.
``(c) Definitions.--In this section:
``(1) The term `controlled substance' has the meaning given
such term in section 102(6) of the Controlled Substances Act
(21 U.S.C. 802(6)).
``(2) The term `delegate' means a person or automated
system accessing the national network of State-based
prescription monitoring programs at the direction or under the
supervision of a licensed health care provider.
``(3) The term `licensed health care provider' means a
health care provider employed by the Department who is
licensed, certified, or registered within any State to fill or
prescribe medications within the scope of his or her practice
as a Department employee.
``(4) The term `national network of State-based
prescription monitoring programs' means an interconnected
nation-wide system that facilitates the transfer to State
prescription drug monitoring program data across State lines.
``(5) The term `State' means a State, as defined in section
101(20) of this title, or a political subdivision of a
State.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item
relating to section 1730A the following new item:
``1730B. Access to State prescription drug monitoring programs.''.
CHAPTER 5--OTHER NON-DEPARTMENT HEALTH CARE MATTERS
SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIATIONS REQUIRED.
Whenever the Secretary submits to Congress a request for
supplemental appropriations or any other appropriation outside the
standard budget process to address a budgetary issue affecting the
Department of Veterans Affairs, the Secretary shall, not later than 45
days before the date on which such budgetary issue would start
affecting a program or service, submit to Congress a justification for
the request, including a plan that details how the Secretary intends to
use the requested appropriation and how long the requested
appropriation is expected to meet the needs of the Department and
certification that the request was made using an updated and sound
actuarial analysis.
SEC. 142. 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 on
March 1, 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,
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. 143. SUNSET OF VETERANS CHOICE PROGRAM.
Subsection (p) of section 101 of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is
amended to read as follows:
``(p) Authority To Furnish Care and Services.--The Secretary may
not use the authority under this section to furnish care and services
after the date that is 1 year after the date of the enactment of the
Caring for Our Veterans Act of 2018.''.
SEC. 144. 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 603'' 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).
Subtitle B--Improving Department of Veterans Affairs Health Care
Delivery
SEC. 151. LICENSURE OF HEALTH CARE PROFESSIONALS OF THE DEPARTMENT OF
VETERANS AFFAIRS PROVIDING TREATMENT VIA TELEMEDICINE.
(a) In General.--Chapter 17 is amended by inserting after section
1730B, as added by section 134, 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 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 the
authority under section 7306, 7401, 7405, 7406, or 7408 of this
title or title 5;
``(2) is authorized by the Secretary to provide health care
under this chapter;
``(3) is required to adhere to all 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.).
``(f) State Defined.--In this section, the term `State' means a
State, as defined in section 101(20) of this title, or a political
subdivision of a State.''.
(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 134, the following new
item:
``1730C. Licensure of health care professionals providing treatment via
telemedicine.''.
(c) Report on Telemedicine.--
(1) In general.--Not later than 1 year after the earlier of
the date on which services provided under section 1730B 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 1-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. 152. AUTHORITY FOR DEPARTMENT OF VETERANS AFFAIRS CENTER FOR
INNOVATION FOR CARE AND PAYMENT.
(a) In General.--Subchapter I of chapter 17, as amended by this
title, is further amended by inserting after section 1703D, as added by
section 111, the following new section:
``Sec. 1703E. Center for Innovation for Care and Payment
``(a) In General.--(1) There is established within the Department a
Center for Innovation for Care and Payment (in this section referred to
as the `Center').
``(2) The Secretary, acting through the Center, may carry out such
pilot programs the Secretary determines to be appropriate to develop
innovative approaches to testing payment and service delivery models in
order to reduce expenditures while preserving or enhancing the quality
of care furnished by the Department.
``(3) The Secretary, acting through the Center, shall test payment
and service delivery models to determine whether such models--
``(A) improve access to, and quality, timeliness, and
patient satisfaction of care and services; and
``(B) create cost savings for the Department.
``(4)(A) The Secretary shall test a model in a location where the
Secretary determines that the model will addresses deficits in care
(including poor clinical outcomes or potentially avoidable
expenditures) for a defined population.
``(B) The Secretary shall focus on models the Secretary expects to
reduce program costs while preserving or enhancing the quality of care
received by individuals receiving benefits under this chapter.
``(C) The models selected may include those described in section
1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)).
``(5) In selecting a model for testing, the Secretary may consider,
in addition to other factors identified in this subsection, the
following factors:
``(A) Whether the model includes a regular process for
monitoring and updating patient care plans in a manner that is
consistent with the needs and preferences of individuals
receiving benefits under this chapter.
``(B) Whether the model places the individual receiving
benefits under this chapter (including family members and other
caregivers of such individual) at the center of the care team
of such individual.
``(C) Whether the model uses technology or new systems to
coordinate care over time and across settings.
``(D) Whether the model demonstrates effective linkage with
other public sector payers, private sector payers, or statewide
payment models.
``(6)(A) Models tested under this section may not be designed in
such a way that would allow the United States to recover or collect
reasonable charges from a Federal health care program for care or
services furnished by the Secretary to a veteran under pilot programs
carried out under this section.
``(B) In this paragraph, the term `Federal health care program'
means--
``(i) an insurance program described in section 1811 of the
Social Security Act (42 U.S.C. 1395c) or established by section
1831 of such Act (42 U.S.C. 1395j);
``(ii) a State plan for medical assistance approved under
title XIX of such Act (42 U.S.C. 1396 et seq.); or
``(iii) a TRICARE program operated under sections 1075,
1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.
``(b) Duration.--Each pilot program carried out by the Secretary
under this section shall terminate no later than 5 years after the date
of the commencement of the pilot program.
``(c) Location.--The Secretary shall ensure that each pilot program
carried out under this section occurs in an area or areas appropriate
for the intended purposes of the pilot program. To the extent
practicable, the Secretary shall ensure that the pilot programs are
located in geographically diverse areas of the United States.
``(d) Budget.--Funding for each pilot program carried out by the
Secretary under this section shall come from appropriations--
``(1) provided in advance in appropriations acts for the
Veterans Health Administration; and
``(2) provided for information technology systems.
``(e) Notice.--The Secretary shall--
``(1) publish information about each pilot program under
this section in the Federal Register; and
``(2) take reasonable actions to provide direct notice to
veterans eligible to participate in such pilot programs.
``(f) Waiver of Authorities.--(1) Subject to reporting under
paragraph (2) and approval under paragraph (3), in implementing a pilot
program under this section, the Secretary may waive such requirements
in subchapters I, II, and III of this chapter as the Secretary
determines necessary solely for the purposes of carrying out this
section with respect to testing models described in subsection (a).
``(2) Before waiving any authority under paragraph (1), the
Secretary shall submit to the Speaker of the House of Representatives,
the minority leader of the House of Representatives, the majority
leader of the Senate, the minority leader of the Senate, and each
standing committee with jurisdiction under the rules of the Senate and
of the House of Representatives to report a bill to amend the provision
or provisions of law that would be waived by the Department, a report
on a request for waiver that describes in detail the following:
``(A) The specific authorities to be waived under the pilot
program.
``(B) The standard or standards to be used in the pilot
program in lieu of the waived authorities.
``(C) The reasons for such waiver or waivers.
``(D) A description of the metric or metrics the Secretary
will use to determine the effect of the waiver or waivers upon
the access to and quality, timeliness, or patient satisfaction
of care and services furnished through the pilot program.
``(E) The anticipated cost savings, if any, of the pilot
program.
``(F) The schedule for interim reports on the pilot program
describing the results of the pilot program so far and the
feasibility and advisability of continuing the pilot program.
``(G) The schedule for the termination of the pilot program
and the submission of a final report on the pilot program
describing the result of the pilot program and the feasibility
and advisability of making the pilot program permanent.
``(H) The estimated budget of the pilot program.
``(3)(A) Upon receipt of a report submitted under paragraph (2),
each House of Congress shall provide copies of the report to the
chairman and ranking member of each standing committee with
jurisdiction under the rules of the House of Representatives or the
Senate to report a bill to amend the provision or provisions of law
that would be waived by the Department under this subsection.
``(B) The waiver requested by the Secretary under paragraph (2)
shall be considered approved under this paragraph if there is enacted
into law a joint resolution approving such request in its entirety.
``(C) For purposes of this paragraph, the term `joint resolution'
means only a joint resolution which is introduced within the period of
five legislative days beginning on the date on which the Secretary
transmits the report to the Congress under such paragraph (2), and--
``(i) which does not have a preamble; and
``(ii) the matter after the resolving clause of which is as
follows: `that Congress approves the request for a waiver under
section 1703E(f) of title 38, United States Code, as submitted
by the Secretary on ___', the blank space being filled with the
appropriate date.
``(D)(i) Any committee of the House of Representatives to which a
joint resolution is referred shall report it to the House without
amendment not later than 15 legislative days after the date of
introduction thereof. If a committee fails to report the joint
resolution within that period, the committee shall be discharged from
further consideration of the joint resolution.
``(ii) It shall be in order at any time after the third legislative
day after each committee authorized to consider a joint resolution has
reported or has been discharged from consideration of a joint
resolution, to move to proceed to consider the joint resolution in the
House. All points of order against the motion are waived. Such a motion
shall not be in order after the House has disposed of a motion to
proceed on a joint resolution addressing a particular submission. The
previous question shall be considered as ordered on the motion to its
adoption without intervening motion. The motion shall not be debatable.
A motion to reconsider the vote by which the motion is disposed of
shall not be in order.
``(iii) The joint resolution shall be considered as read. All
points of order against the joint resolution and against its
consideration are waived. The previous question shall be considered as
ordered on the joint resolution to its passage without intervening
motion except two hours of debate equally divided and controlled by the
proponent and an opponent. A motion to reconsider the vote on passage
of the joint resolution shall not be in order.
``(E)(i) A joint resolution introduced in the Senate shall be
referred to the Committee on Veterans' Affairs.
``(ii) Any committee of the Senate to which a joint resolution is
referred shall report it to the Senate without amendment not later than
15 session days after the date of introduction of a joint resolution
described in paragraph (C). If a committee fails to report the joint
resolution within that period, the committee shall be discharged from
further consideration of the joint resolution and the joint resolution
shall be placed on the calendar.
``(iii)(I) Notwithstanding Rule XXII of the Standing Rules of the
Senate, it is in order at any time after the third session day on which
the Committee on Veterans' Affairs has reported or has been discharged
from consideration of a joint resolution described in paragraph (C)
(even though a previous motion to the same effect has been disagreed
to) to move to proceed to the consideration of the joint resolution,
and all points of order against the joint resolution (and against
consideration of the joint resolution) are waived. The motion to
proceed is not debatable. The motion is not subject to a motion to
postpone. A motion to reconsider the vote by which the motion is agreed
to or disagreed to shall not be in order. If a motion to proceed to the
consideration of the resolution is agreed to, the joint resolution
shall remain the unfinished business until disposed of.
``(II) Consideration of the joint resolution, and on all debatable
motions and appeals in connection therewith, shall be limited to not
more than two hours, which shall be divided equally between the
majority and minority leaders or their designees. A motion further to
limit debate is in order and not debatable. An amendment to, or a
motion to postpone, or a motion to proceed to the consideration of
other business, or a motion to recommit the joint resolution is not in
order.
``(III) If the Senate has voted to proceed to a joint resolution,
the vote on passage of the joint resolution shall occur immediately
following the conclusion of consideration of the joint resolution, and
a single quorum call at the conclusion of the debate if requested in
accordance with the rules of the Senate.
``(IV) Appeals from the decisions of the Chair relating to the
application of the rules of the Senate, as the case may be, to the
procedure relating to a joint resolution shall be decided without
debate.
``(F) A joint resolution considered pursuant to this paragraph
shall not be subject to amendment in either the House of
Representatives or the Senate.
``(G)(i) If, before the passage by one House of the joint
resolution of that House, that House receives the joint resolution from
the other House, then the following procedures shall apply:
``(I) The joint resolution of the other House shall not be
referred to a committee.
``(II) With respect to the joint resolution of the House
receiving the joint resolution--
``(aa) the procedure in that House shall be
the same as if no joint resolution had been
received from the other House; but
``(bb) the vote on passage shall be on the
joint resolution of the other House.
``(ii) If the Senate fails to introduce or consider a joint
resolution under this paragraph, the joint resolution of the
House shall be entitled to expedited floor procedures under
this subparagraph.
``(iii) If, following passage of the joint resolution in
the Senate, the Senate then receives the companion measure from
the House of Representatives, the companion measure shall not
be debatable.
``(H) This subparagraph is enacted by Congress--
``(i) as an exercise of the rulemaking power of the Senate
and House of Representatives, respectively, and as such it is
deemed a part of the rules of each House, respectively, but
applicable only with respect to the procedure to be followed in
that House in the case of a joint resolution, and it supersedes
other rules only to the extent that it is inconsistent with
such rules; and
``(ii) with full recognition of the constitutional right of
either House to change the rules (so far as relating to the
procedure 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.
``(g) Limitations.--(1) The Secretary may not carry out more than
10 pilot programs concurrently.
``(2)(A) Subject to subparagraph (B), the Secretary may not expend
more than $50,000,000 in any fiscal year from amounts under subsection
(d).
``(B) The Secretary may expend more than the amount in subparagraph
(A) if--
``(i) the Secretary determines that the additional
expenditure is necessary to carry out pilot programs under this
section;
``(ii) the Secretary submits to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a report
setting forth the amount of the additional expenditure and a
justification for the additional expenditure; and
``(iii) the Chairmen of the Committees on Veterans' Affairs
of the Senate and the House of Representatives transmit to the
Secretary a letter approving of the additional expenditure.
``(3) The waiver provisions in subsection (f) shall not apply
unless the Secretary, in accordance with the requirements in subsection
(f), submits the first proposal for a pilot program not later than 18
months after the date of the enactment of the Caring for Our Veterans
Act of 2018.
``(4) 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.
``(5)(A) If the Secretary determines that a 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) and shall be subject to the terms and
conditions of subsection (f)(2); or
``(ii) terminate such pilot program not later than 30 days
after submitting the interim report to Congress.
``(B) If the Secretary terminates a pilot program under
subparagraph (A)(ii), for purposes of subparagraphs (F) and (G) of
subsection (f)(2), 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 Advice.--(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
individuals receiving benefits under this chapter.''.
(b) Conforming Amendment.--The table of sections at the beginning
of such chapter, as amended by this title, is further amended by
inserting after the item relating to section 1703D the following new
item:
``1703E. Center for Innovation for Care and Payment.''.
SEC. 153. AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE DONORS FOR
PURPOSES OF CONDUCTING TRANSPLANT PROCEDURES FOR
VETERANS.
(a) In General.--Subchapter VIII of chapter 17 is amended by adding
at the end the following new section:
``Sec. 1788. Transplant procedures with live donors and related
services
``(a) In General.--Subject to subsections (b) and (c), in a case in
which a veteran is eligible for a transplant procedure from the
Department, the Secretary may provide for an operation on a live donor
to carry out such procedure for such veteran, notwithstanding that the
live donor may not be eligible for health care from the Department.
``(b) Other Services.--Subject to the availability of
appropriations for such purpose, the Secretary shall furnish to a live
donor any care or services before and after conducting the transplant
procedure under subsection (a) that may be required in connection with
such procedure.
``(c) Use of Non-Department Facilities.--In carrying out this
section, the Secretary may provide for the operation described in
subsection (a) on a live donor and furnish to the live donor the care
and services described in subsection (b) at a non-Department facility
pursuant to an agreement entered into by the Secretary under this
chapter. The live donor shall be deemed to be an individual eligible
for hospital care and medical services at a non-Department facility
pursuant to such an agreement solely for the purposes of receiving such
operation, care, and services at the non-Department facility.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 is amended by inserting after the item relating to section
1787 the following new item:
``1788. Transplant procedures with live donors and related services.''.
Subtitle C--Family Caregivers
SEC. 161. EXPANSION OF FAMILY CAREGIVER PROGRAM OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) Family Caregiver Program.--
(1) Expansion of eligibility.--
(A) In general.--Subparagraph (B) of subsection
(a)(2) of section 1720G is amended to read as follows:
``(B) for assistance provided under this subsection--
``(i) before the date on which the Secretary
submits to Congress a certification that the Department
has fully implemented the information technology system
required by section 162(a) of the Caring for Our
Veterans Act of 2018, has a serious injury (including
traumatic brain injury, psychological trauma, or other
mental disorder) incurred or aggravated in the line of
duty in the active military, naval, or air service on
or after September 11, 2001;
``(ii) during the 2-year period beginning on the
date on which the Secretary submitted to Congress the
certification described in clause (i), has a serious
injury (including traumatic brain injury, psychological
trauma, or other mental disorder) incurred or
aggravated in the line of duty in the active military,
naval, or air service--
``(I) on or before May 7, 1975; or
``(II) on or after September 11, 2001; or
``(iii) after the date that is 2 years after the
date on which the Secretary submits to Congress the
certification described in clause (i), has a serious
injury (including traumatic brain injury, psychological
trauma, or other mental disorder) incurred or
aggravated in the line of duty in the active military,
naval, or air service; and''.
(B) Publication in federal register.--Not later
than 30 days after the date on which the Secretary of
Veterans Affairs submits to Congress the certification
described in subsection (a)(2)(B)(i) of section 1720G
of such title, as amended by subparagraph (A) of this
paragraph, the Secretary shall publish the date
specified in such subsection in the Federal Register.
(2) Expansion of needed services in eligibility criteria.--
Subsection (a)(2)(C) of such section is amended--
(A) in clause (ii), by striking ``; or'' and
inserting a semicolon;
(B) by redesignating clause (iii) as clause (iv);
and
(C) by inserting after clause (ii) the following
new clause (iii):
``(iii) a need for regular or extensive instruction
or supervision without which the ability of the veteran
to function in daily life would be seriously impaired;
or''.
(3) Expansion of services provided.--Subsection
(a)(3)(A)(ii) of such section is amended--
(A) in subclause (IV), by striking ``; and'' and
inserting a semicolon;
(B) in subclause (V), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new
subclause:
``(VI) through the use of contracts with, or the
provision of grants to, public or private entities--
``(aa) financial planning services relating
to the needs of injured veterans and their
caregivers; and
``(bb) legal services, including legal
advice and consultation, relating to the needs
of injured veterans and their caregivers.''.
(4) Modification of stipend calculation.--Subsection
(a)(3)(C) of such section is amended--
(A) by redesignating clause (iii) as clause (iv);
and
(B) by inserting after clause (ii) the following
new clause (iii):
``(iii) In determining the amount and degree of personal care
services provided under clause (i) with respect to an eligible veteran
whose need for personal care services is based in whole or in part on a
need for supervision or protection under paragraph (2)(C)(ii) or
regular instruction or supervision under paragraph (2)(C)(iii), the
Secretary shall take into account the following:
``(I) The assessment by the family caregiver of the needs
and limitations of the veteran.
``(II) The extent to which the veteran can function safely
and independently in the absence of such supervision,
protection, or instruction.
``(III) The amount of time required for the family
caregiver to provide such supervision, protection, or
instruction to the veteran.''.
(5) Periodic evaluation of need for certain services.--
Subsection (a)(3) of such section is amended by adding at the
end the following new subparagraph:
``(D) In providing instruction, preparation, and training under
subparagraph (A)(i)(I) and technical support under subparagraph
(A)(i)(II) to each family caregiver who is approved as a provider of
personal care services for an eligible veteran under paragraph (6), the
Secretary shall periodically evaluate the needs of the eligible veteran
and the skills of the family caregiver of such veteran to determine if
additional instruction, preparation, training, or technical support
under those subparagraphs is necessary.''.
(6) Use of primary care teams.--Subsection (a)(5) of such
section is amended, in the matter preceding subparagraph (A),
by inserting ``(in collaboration with the primary care team for
the eligible veteran to the maximum extent practicable)'' after
``evaluate''.
(7) Assistance for family caregivers.--Subsection (a) of
such section is amended by adding at the end the following new
paragraph:
``(11)(A) In providing assistance under this subsection to family
caregivers of eligible veterans, the Secretary may enter into
contracts, provider agreements, and memoranda of understanding with
Federal agencies, States, and private, nonprofit, and other entities to
provide such assistance to such family caregivers.
``(B) The Secretary may provide assistance under this paragraph
only if such assistance is reasonably accessible to the family
caregiver and is substantially equivalent or better in quality to
similar services provided by the Department.
``(C) The Secretary may provide fair compensation to Federal
agencies, States, and other entities that provide assistance under this
paragraph.''.
(b) Modification of Definition of Personal Care Services.--
Subsection (d)(4) of such section is amended--
(1) in subparagraph (A), by striking ``independent'';
(2) by redesignating subparagraph (B) as subparagraph (D);
and
(3) by inserting after subparagraph (A) the following new
subparagraphs:
``(B) Supervision or protection based on symptoms
or residuals of neurological or other impairment or
injury.
``(C) Regular or extensive instruction or
supervision without which the ability of the veteran to
function in daily life would be seriously impaired.''.
SEC. 162. IMPLEMENTATION OF INFORMATION TECHNOLOGY SYSTEM OF DEPARTMENT
OF VETERANS AFFAIRS TO ASSESS AND IMPROVE THE FAMILY
CAREGIVER PROGRAM.
(a) Implementation of New System.--
(1) In general.--Not later than October 1, 2018, the
Secretary of Veterans Affairs shall implement an information
technology system that fully supports the Program and allows
for data assessment and comprehensive monitoring of the
Program.
(2) Elements of system.--The information technology system
required to be implemented under paragraph (1) shall include
the following:
(A) The ability to easily retrieve data that will
allow all aspects of the Program (at the medical center
and aggregate levels) and the workload trends for the
Program to be assessed and comprehensively monitored.
(B) The ability to manage data with respect to a
number of caregivers that is more than the number of
caregivers that the Secretary expects to apply for the
Program.
(C) The ability to integrate the system with other
relevant information technology systems of the Veterans
Health Administration.
(b) Assessment of Program.--Not later than 180 days after
implementing the system described in subsection (a), the Secretary
shall, through the Under Secretary for Health, use data from the system
and other relevant data to conduct an assessment of how key aspects of
the Program are structured and carried out.
(c) Ongoing Monitoring of and Modifications to Program.--
(1) Monitoring.--The Secretary shall use the system
implemented under subsection (a) to monitor and assess the
workload of the Program, including monitoring and assessment of
data on--
(A) the status of applications, appeals, and home
visits in connection with the Program; and
(B) the use by caregivers participating in the
Program of other support services under the Program
such as respite care.
(2) Modifications.--Based on the monitoring and assessment
conducted under paragraph (1), the Secretary shall identify and
implement such modifications to the Program as the Secretary
considers necessary to ensure the Program is functioning as
intended and providing veterans and caregivers participating in
the Program with services in a timely manner.
(d) Reports.--
(1) Initial report.--
(A) In general.--Not later than 90 days after the
date of the enactment of this Act, the Secretary shall
submit to the Committee on Veterans' Affairs of the
Senate, the Committee on Veterans' Affairs of the House
of Representatives, and the Comptroller General of the
United States a report that includes--
(i) the status of the planning,
development, and deployment of the system
required to be implemented under subsection
(a), including any changes in the timeline for
the implementation of the system; and
(ii) an assessment of the needs of family
caregivers of veterans described in
subparagraph (B), the resources needed for the
inclusion of such family caregivers in the
Program, and such changes to the Program as the
Secretary considers necessary to ensure the
successful expansion of the Program to include
such family caregivers.
(B) Veterans described.--Veterans described in this
subparagraph are veterans who are eligible for the
Program under clause (ii) or (iii) of section
1720G(a)(2)(B) of title 38, United States Code, as
amended by section 161(a)(1) of this title, solely due
to a serious injury (including traumatic brain injury,
psychological trauma, or other mental disorder)
incurred or aggravated in the line of duty in the
active military, naval, or air service before September
11, 2001.
(2) Notification by comptroller general.--The Comptroller
General shall review the report submitted under paragraph (1)
and notify the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives with respect to the progress of the Secretary
in--
(A) fully implementing the system required under
subsection (a); and
(B) implementing a process for using such system to
monitor and assess the Program under subsection (c)(1)
and modify the Program as considered necessary under
subsection (c)(2).
(3) Final report.--
(A) In general.--Not later than October 1, 2019,
the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate, the Committee on
Veterans' Affairs of the House of Representatives, and
the Comptroller General a report on the implementation
of subsections (a) through (c).
(B) Elements.--The report required by subparagraph
(A) shall include the following:
(i) A certification by the Secretary that
the information technology system described in
subsection (a) has been implemented.
(ii) A description of how the Secretary has
implemented such system.
(iii) A description of the modifications to
the Program, if any, that were identified and
implemented under subsection (c)(2).
(iv) A description of how the Secretary is
using such system to monitor the workload of
the Program.
(e) Definitions.--In this section:
(1) Active military, naval, or air service.--The term
``active military, naval, or air service'' has the meaning
given that term in section 101 of title 38, United States Code.
(2) Program.--The term ``Program'' means the program of
comprehensive assistance for family caregivers under section
1720G(a) of title 38, United States Code, as amended by section
161 of this title.
SEC. 163. MODIFICATIONS TO ANNUAL EVALUATION REPORT ON CAREGIVER
PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Barriers to Care and Services.--Subparagraph (A)(iv) of section
101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of
2010 (Public Law 111-163; 38 U.S.C. 1720G note) is amended by inserting
``, including a description of any barriers to accessing and receiving
care and services under such programs'' before the semicolon.
(b) Sufficiency of Training for Family Caregiver Program.--
Subparagraph (B) of such section is amended--
(1) in clause (i), by striking ``; and'' and inserting a
semicolon;
(2) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) an evaluation of the sufficiency
and consistency of the training provided to
family caregivers under such program in
preparing family caregivers to provide care to
veterans under such program.''.
TITLE II--VA ASSET AND INFRASTRUCTURE REVIEW
Subtitle A--Asset and Infrastructure Review
SEC. 201. SHORT TITLE.
This subtitle may be cited as the ``VA Asset and Infrastructure
Review Act of 2018''.
SEC. 202. THE COMMISSION.
(a) Establishment.--There is established an independent commission
to be known as the ``Asset and Infrastructure Review Commission'' (in
this subtitle referred to as the ``Commission'').
(b) Duties.--The Commission shall carry out the duties specified
for it in this subtitle.
(c) Appointment.--
(1) In general.--
(A) Appointment.--The Commission shall be composed
of nine members appointed by the President, by and with
the advice and consent of the Senate.
(B) Transmission of nominations.--The President
shall transmit to the Senate the nominations for
appointment to the Commission not later than May 31,
2021.
(2) Consultation in selection process.--In selecting
individuals for nominations for appointments to the Commission,
the President shall consult with--
(A) the Speaker of the House of Representatives;
(B) the majority leader of the Senate;
(C) the minority leader of the House of
Representatives;
(D) the minority leader of the Senate; and
(E) congressionally chartered, membership based
veterans service organizations concerning the
appointment of three members.
(3) Designation of chair.--At the time the President
nominates individuals for appointment to the Commission under
paragraph (1)(B), the President shall designate one such
individual who shall serve as Chair of the Commission and one
such individual who shall serve as Vice Chair of the
Commission.
(4) Member representation.--In nominating individuals under
this subsection, the President shall ensure that--
(A) veterans, reflecting current demographics of
veterans enrolled in the system of annual patient
enrollment under section 1705 of title 38, United
States Code, are adequately represented in the
membership of the Commission;
(B) at least one member of the Commission has
experience working for a private integrated health care
system that has annual gross revenues of more than
$50,000,000;
(C) at least one member has experience as a senior
manager for an entity specified in clause (ii), (iii),
or (iv) of section 101(a)(1)(B) of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-
146; 38 U.S.C. 1701 note);
(D) at least one member--
(i) has experience with capital asset
management for the Federal Government; and
(ii) is familiar with trades related to
building and real property, including
construction, engineering, architecture,
leasing, and strategic partnerships; and
(E) at least three members represent
congressionally chartered, membership-based, veterans
service organizations.
(d) Meetings.--
(1) In general.--The Commission shall meet only during
calendar years 2022 and 2023.
(2) Public nature of meetings and proceedings.--
(A) Public meetings.--Each meeting of the
Commission shall be open to the public.
(B) Open participation.--All the proceedings,
information, and deliberations of the Commission shall
be available for review by the public.
(e) Vacancies.--A vacancy in the Commission shall be filled in the
same manner as the original appointment, but the individual appointed
to fill the vacancy shall serve only for the unexpired portion of the
term for which the individual's predecessor was appointed.
(f) Pay.--
(1) In general.--Members of the Commission shall serve
without pay.
(2) Officers or employees of the united states.--Each
member of the Commission who is an officer or employee of the
United States shall serve without compensation in addition to
that received for service as an officer or employee of the
United States.
(3) Travel expenses.--Members shall receive travel
expenses, including per diem in lieu of subsistence, in
accordance with sections 5702 and 5703 of title 5, United
States Code.
(g) Director of Staff.--
(1) Appointment.--The Commission shall appoint a Director
who--
(A) has not served as an employee of the Department
of Veterans Affairs during the 1-year period preceding
the date of such appointment; and
(B) is not otherwise barred or prohibited from
serving as Director under Federal ethics laws and
regulations, by reason of post-employment conflict of
interest.
(2) Rate of pay.--The Director shall be paid at the rate of
basic pay payable for level IV of the Executive Schedule under
section 5315 of title 5, United States Code.
(h) Staff.--
(1) Pay of personnel.--Subject to paragraphs (2) and (3),
the Director, with the approval of the Commission, may appoint
and fix the pay of additional personnel.
(2) Exemption from certain requirements.--The Director may
make such appointments without regard to the provisions of
title 5, United States Code, governing appointments in the
competitive service, and any personnel so appointed may be paid
without regard to the provisions of chapter 51 and subchapter
III of chapter 53 of that title relating to classification and
General Schedule pay rates, except that an individual so
appointed may not receive pay in excess of the annual rate of
basic pay payable for GS-15 of the General Schedule.
(3) Detailees.--
(A) Limitation on number.--Not more than two-thirds
of the personnel employed by or detailed to the
Commission may be on detail from the Department of
Veterans Affairs.
(B) Professional analysts.--Not more than half of
the professional analysts of the Commission staff may
be persons detailed from the Department of Veterans
Affairs to the Commission.
(C) Prohibition on detail of certain personnel.--A
person may not be detailed from the Department of
Veterans Affairs to the Commission if, within 6 months
before the detail is to begin, that person participated
personally and substantially in any matter within the
Department of Veterans Affairs concerning the
preparation of recommendations regarding facilities of
the Veterans Health Administration.
(4) Authority to request detailed personnel.--Subject to
paragraph (3), the head of any Federal department or agency,
upon the request of the Director, may detail any of the
personnel of that department or agency to the Commission to
assist the Commission in carrying out its duties under this
subtitle.
(5) Information from federal agencies.--The Commission may
secure directly from any Federal agency such information the
Commission considers necessary to carry out this subtitle. Upon
request of the Chair, the head of such agency shall furnish
such information to the Commission.
(i) Other Authority.--
(1) Temporary and intermittent services.--The Commission
may procure by contract, to the extent funds are available, the
temporary or intermittent services of experts or consultants
pursuant to section 3109 of title 5, United States Code.
(2) Leasing and acquisition of property.--To the extent
funds are available, the Commission may lease real property and
acquire personal property either of its own accord or in
consultation with the General Services Administration.
(j) Termination.--The Commission shall terminate on December 31,
2023.
(k) Prohibition Against Restricting Communications.--
(1) In general.--Except as provided in paragraph (2), no
person may restrict an employee of the Department of Veterans
Affairs in communicating with the Commission.
(2) Unlawful communications.--Paragraph (1) does not apply
to a communication that is unlawful.
SEC. 203. PROCEDURE FOR MAKING RECOMMENDATIONS.
(a) Selection Criteria.--
(1) Publication.--The Secretary shall, not later than
February 1, 2021, and after consulting with veterans service
organizations, publish in the Federal Register and transmit to
the Committees on Veterans' Affairs of the Senate and the House
of Representatives the criteria proposed to be used by the
Department of Veterans Affairs in assessing and making
recommendations regarding the modernization or realignment of
facilities of the Veterans Health Administration under this
subtitle. Such criteria shall include the preferences of
veterans regarding health care furnished by the Department.
(2) Public comment.--The Secretary shall provide an
opportunity for public comment on the proposed criteria under
paragraph (1) for a period of at least 90 days and shall
include notice of that opportunity in the publication required
under such paragraph.
(3) Publication of final criteria.--The Secretary shall,
not later than May 31, 2021, publish in the Federal Register
and transmit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives the final criteria to
be used in making recommendations regarding the closure,
modernization, or realignment of facilities of the Veterans
Health Administration under this subtitle.
(b) Recommendations of the Secretary.--
(1) Publication in federal register.--The Secretary shall,
not later than January 31, 2022, and after consulting with
veterans service organizations, publish in the Federal Register
and transmit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives and to the Commission a
report detailing the recommendations regarding the
modernization or realignment of facilities of the Veterans
Health Administration on the basis of the final criteria
referred to in subsection (a)(2) that are applicable.
(2) Factors for consideration.--In making recommendations
under this subsection, the Secretary shall consider each of the
following factors:
(A) The degree to which any health care delivery or
other site for providing services to veterans reflect
the metrics of the Department of Veterans Affairs
regarding market area health system planning.
(B) The provision of effective and efficient access
to high-quality health care and services for veterans.
(C) The extent to which the real property that no
longer meets the needs of the Federal Government could
be reconfigured, repurposed, consolidated, realigned,
exchanged, outleased, replaced, sold, or disposed.
(D) The need of the Veterans Health Administration
to acquire infrastructure or facilities that will be
used for the provision of health care and services to
veterans.
(E) The extent to which the operating and
maintenance costs are reduced through consolidating,
colocating, and reconfiguring space, and through
realizing other operational efficiencies.
(F) The extent and timing of potential costs and
savings, including the number of years such costs or
savings will be incurred, beginning with the date of
completion of the proposed recommendation.
(G) The extent to which the real property aligns
with the mission of the Department of Veterans Affairs.
(H) The extent to which any action would impact
other missions of the Department (including education,
research, or emergency preparedness).
(I) Local stakeholder inputs and any factors
identified through public field hearings.
(J) The assessments under paragraph (3).
(K) The extent to which the Veterans Health
Administration has appropriately staffed the medical
facility, including determinations whether there has
been insufficient resource allocation or deliberate
understaffing.
(L) Any other such factors the Secretary determines
appropriate.
(3) Capacity and commercial market assessments.--
(A) Assessments.--The Secretary shall assess the
capacity of each Veterans Integrated Service Network
and medical facility of the Department to furnish
hospital care or medical services to veterans under
chapter 17 of title 38, United States Code. Each such
assessment shall--
(i) identify gaps in furnishing such care
or services at such Veterans Integrated Service
Network or medical facility;
(ii) identify how such gaps can be filled
by--
(I) entering into contracts or
agreements with network providers under
this section or with entities under
other provisions of law;
(II) making changes in the way such
care and services are furnished at such
Veterans Integrated Service Network or
medical facility, including--
(aa) extending hours of
operation;
(bb) adding personnel; or
(cc) expanding space
through the construction,
leasing, or sharing of health
care facilities; and
(III) the building or realignment
of Department resources or personnel;
(iii) forecast, based on future projections
and historical trends, both the short- and
long-term demand in furnishing care or services
at such Veterans Integrated Service Network or
medical facility and assess how such demand
affects the needs to use such network
providers;
(iv) include a commercial health care
market assessment of designated catchment areas
in the United States conducted by a non-
governmental entity; and
(v) consider the unique ability of the
Federal Government to retain a presence in an
area otherwise devoid of commercial health care
providers or from which such providers are at
risk of leaving.
(B) Consultation.--In carrying out the assessments
under subparagraph (A), the Secretary shall consult
with veterans service organizations and veterans served
by each such Veterans Integrated Service Network and
medical facility.
(C) Submittal.--The Secretary shall submit such
assessments to the Committees on Veterans' Affairs of
the House of Representatives and the Senate with the
recommendations of the Secretary under this subsection
and make the assessments publicly available.
(4) Summary of selection process.--The Secretary shall
include, with the list of recommendations published and
transmitted pursuant to paragraph (1), a summary of the
selection process that resulted in the recommendation for each
facility of the Veterans Health Administration, including a
justification for each recommendation. The Secretary shall
transmit the matters referred to in the preceding sentence not
later than 7 days after the date of the transmittal to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives and the Commission of the report referred to in
paragraph (1).
(5) Treatment of facilities.--In assessing facilities of
the Veterans Health Administration, the Secretary shall
consider all such facilities equally without regard to whether
the facility has been previously considered or proposed for
reuse, closure, modernization, or realignment by the Department
of Veterans Affairs.
(6) Availability of information to congress.--In addition
to making all information used by the Secretary to prepare the
recommendations under this subsection available to Congress
(including any committee or Member of Congress), the Secretary
shall also make such information available to the Commission
and the Comptroller General of the United States.
(7) Certification of accuracy.--
(A) In general.--Each person referred to in
subparagraph (B), when submitting information to the
Secretary or the Commission concerning the
modernization or realignment of a facility of the
Veterans Health Administration, shall certify that such
information is accurate and complete to the best of
that person's knowledge and belief.
(B) Covered persons.--Subparagraph (A) applies to
the following persons:
(i) Each Under Secretary of the Department
of Veterans Affairs.
(ii) Each director of a Veterans Integrated
Service Network.
(iii) Each director of a medical center of
the Department of Veterans Affairs.
(iv) Each director of a program office of
the Department of Veterans Affairs.
(v) Each person who is in a position the
duties of which include personal and
substantial involvement in the preparation and
submission of information and recommendations
concerning the modernization or realignment of
facilities of the Veterans Health
Administration.
(c) Review and Recommendations by the Commission.--
(1) Public hearings.--
(A) In general.--After receiving the
recommendations from the Secretary pursuant to
subsection (b), the Commission shall conduct public
hearings on the recommendations.
(B) Locations.--The Commission shall conduct public
hearings in regions affected by a recommendation of the
Secretary to close a facility of the Veterans Health
Administration. To the greatest extent practicable, the
Commission shall conduct public hearings in regions
affected by a recommendation of the Secretary to
modernize or realign such a facility.
(C) Required witnesses.--Witnesses at each public
hearing shall include at a minimum--
(i) a veteran--
(I) enrolled under section 1705 of
title 38, United States Code; and
(II) identified by a local veterans
service organization; and
(ii) a local elected official.
(2) Transmittal to president.--
(A) In general.--The Commission shall, not later
than January 31, 2023, transmit to the President a
report containing the Commission's findings and
conclusions based on a review and analysis of the
recommendations made by the Secretary, together with
the Commission's recommendations, for modernizations
and realignments of facilities of the Veterans Health
Administration.
(B) Authority to make changes to recommendations.--
Subject to subparagraph (C), in making its
recommendations, the Commission may change any
recommendation made by the Secretary if the
Commission--
(i) determines that the Secretary deviated
substantially from the final criteria referred
to in subsection (a)(2) in making such
recommendation;
(ii) determines that the change is
consistent with the final criteria referred to
in subsection (a)(2);
(iii) publishes a notice of the proposed
change in the Federal Register not less than 45
days before transmitting its recommendations to
the President pursuant to subparagraph (A); and
(iv) conducts public hearings on the
proposed change.
(3) Justification for changes.--The Commission shall
explain and justify in its report submitted to the President
pursuant to paragraph (2) any recommendation made by the
Commission that is different from the recommendations made by
the Secretary pursuant to subsection (b). The Commission shall
transmit a copy of such report to the Committees on Veterans'
Affairs of the Senate and the House of Representatives on the
same date on which it transmits its recommendations to the
President under paragraph (2).
(4) Provision of information to congress.--After the
Commission transmits its report to the President, the
Commission shall promptly provide, upon request, to any Member
of Congress, information used by the Commission in making its
recommendations.
(d) Review by the President.--
(1) Report.--The President shall, not later than February
15, 2023, transmit to the Commission and to the Congress a
report containing the President's approval or disapproval of
the Commission's recommendations.
(2) Presidential approval.--If the President approves all
the recommendations of the Commission, the President shall
transmit a copy of such recommendations to the Congress,
together with a certification of such approval.
(3) Presidential disapproval.--If the President disapproves
the recommendations of the Commission, in whole or in part, the
President shall transmit to the Commission and the Congress,
not later than March 1, 2023, the reasons for that disapproval.
The Commission, after consideration of the President's reasons
for disapproval, shall then transmit to the President, not
later than March 15, 2023, a report containing--
(A) the Commission's findings and conclusions based
on a review and analysis of those reasons for
disapproval provided by the President; and
(B) recommendations that the Commission determines
are appropriate for modernizations and realignments of
facilities of the Veterans Health Administration.
(4) Transmittal of recommendations to congress.--If the
President approves all recommendations of the Commission
transmitted to the President under paragraph (3), the President
shall transmit a copy of such recommendations to the Congress,
together with a certification of such approval.
(5) Failure to transmit.--If the President does not
transmit to the Congress an approval and certification
described in paragraph (2) or (4) by March 30, 2023, the
process by which facilities of the Veterans Health
Administration may be selected for modernization or realignment
under this subtitle shall be terminated.
SEC. 204. ACTIONS REGARDING INFRASTRUCTURE AND FACILITIES OF THE
VETERANS HEALTH ADMINISTRATION.
(a) In General.--Subject to subsection (b), the Secretary shall
begin to implement the recommended modernizations and realignments in
the report under section 203(d) not later than 3 years after the date
on which the President transmits such report to Congress. In any fiscal
year, such implementation includes--
(1) the planning of modernizations and realignments of
facilities of the Veterans Health Administration as recommended
in such report; and
(2) providing detailed information on the budget for such
modernizations or realignments in documents submitted to
Congress by the Secretary in support of the President's budget
for that fiscal year.
(b) Congressional Disapproval.--
(1) In general.--The Secretary may not carry out any
modernization or realignment recommended by the Commission in a
report transmitted from the President pursuant to section
203(d) if a joint resolution is enacted, in accordance with the
provisions of section 207, disapproving such recommendations of
the Commission before the earlier of--
(A) the end of the 45-day period beginning on the
date on which the President transmits such report; or
(B) the adjournment of Congress sine die for the
session during which such report is transmitted.
(2) Computation of period.--For purposes of paragraph (1)
and subsections (a) and (c) of section 207, the days on which
either House of Congress is not in session because of an
adjournment of more than three days to a day certain shall be
excluded in the computation of a period.
SEC. 205. IMPLEMENTATION.
(a) In General.--
(1) Modernizing and realigning facilities.--In modernizing
or realigning any facility of the Veterans Health
Administration under this subtitle, the Secretary may--
(A) take such actions as may be necessary to
modernize or realign any such facility, including the
alteration of such facilities, the acquisition of such
land, the leasing or construction of such replacement
facilities, the disposition of such land or facilities,
the performance of such activities, and the conduct of
such advance planning and design as may be required to
transfer functions from a facility of the Veterans
Health Administration to another such facility, and may
use for such purpose funds in the Account or funds
appropriated to the Department of Veterans Affairs for
such purposes;
(B) carry out activities for the purposes of
environmental mitigation, abatement, or restoration at
any such facility, and shall use for such purposes
funds in the Account;
(C) reimburse other Federal agencies for actions
performed at the request of the Secretary with respect
to any such closure or realignment, and may use for
such purpose funds in the Account or funds appropriated
to the Department of Veterans Affairs and available for
such purpose; and
(D) exercise the authority of the Secretary under
subchapter V of chapter 81 of title 38, United States
Code.
(2) Environmental restoration; historic preservation.--In
carrying out any closure or realignment under this subtitle,
the Secretary, with regards to any property made excess to the
needs of the Department of Veterans Affairs as a result of such
closure or realignment, shall carry out, as soon as possible
with funds available for such purpose, any of the following for
which the Secretary is responsible:
(A) Environmental mitigation.
(B) Environmental abatement.
(C) Environmental restoration.
(D) Compliance with historic preservation
requirements.
(b) Management and Disposal of Property.--
(1) Existing disposal authorities.--To transfer or dispose
of surplus real property or infrastructure located at any
facility of the Veterans Health Administration that is
modernized or realigned under this title, the Secretary may
exercise the authorities of the Secretary under subchapters I
and II of chapter 81 of title 38, United States Code, or the
authorities delegated to the Secretary by the Administrator of
General Services under subchapter III of chapter 5 of title 40,
United States Code.
(2) Effects on local communities.--
(A) Consultation with state and local government.--
Before any action may be taken with respect to the
disposal of any surplus real property or infrastructure
located at any facility of the Veterans Health
Administration to be closed or realigned under this
subtitle, the Secretary of Veterans Affairs shall
consult with the Governor of the State and the heads of
the local governments concerned for the purpose of
considering any plan for the use of such property by
the local community concerned.
(B) Treatment of roads.--If infrastructure or a
facility of the Veterans Health Administration to be
closed or realigned under this subtitle includes a road
used for public access through, into, or around the
facility, the Secretary--
(i) shall consult with the Government of
the State and the heads of the local
governments concerned for the purpose of
considering the continued availability of the
road for public use after the recommended
action is complete; and
(ii) may exercise the authority of the
Secretary under section 8108 of title 38,
United States Code.
(3) Leases; cercla.--
(A) Lease authority.--
(i) Transfer to redevelopment authority for
lease.--The Secretary may transfer title to a
facility of the Veterans Health Administration
approved for closure or realignment under this
subtitle (including property at a facility of
the Veterans Health Administration approved for
realignment which will be retained by the
Department of Veterans Affairs or another
Federal agency after realignment) to the
redevelopment authority for the facility if the
redevelopment authority agrees to lease,
directly upon transfer, one or more portions of
the property transferred under this
subparagraph to the Secretary or to the head of
another department or agency of the Federal
Government.
(ii) Term of lease.--A lease under clause
(i) shall be for a term of not to exceed 50
years, but may provide for options for renewal
or extension of the term by the department or
agency concerned.
(iii) Limitation.--A lease under clause (i)
may not require rental payments by the United
States.
(iv) Treatment of remaindered lease
terms.--A lease under clause (i) shall include
a provision specifying that if the department
or agency concerned ceases requiring the use of
the leased property before the expiration of
the term of the lease, the remainder of the
lease term may be satisfied by the same or
another department or agency of the Federal
Government using the property for a use similar
to the use under the lease. Exercise of the
authority provided by this clause shall be made
in consultation with the redevelopment
authority concerned.
(v) Facility services.--Notwithstanding
clause (iii), if a lease under clause (i)
involves a substantial portion of the facility,
the department or agency concerned may obtain
facility services for the leased property and
common area maintenance from the redevelopment
authority or the redevelopment authority's
assignee as a provision of the lease. The
facility services and common area maintenance
shall be provided at a rate no higher than the
rate charged to non-Federal tenants of the
transferred property. Facility services and
common area maintenance covered by the lease
shall not include--
(I) municipal services that a State
or local government is required by law
to provide to all landowners in its
jurisdiction without direct charge; or
(II) firefighting or security-guard
functions.
(B) Application of cercla.--The provisions of
section 120(h) of the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980 (42
U.S.C. 9620(h)) shall apply to any transfer of real
property under this paragraph.
(C) Additional terms and conditions.--The Secretary
may require any additional terms and conditions in
connection with a transfer under this paragraph as such
Secretary considers appropriate to protect the
interests of the United States.
(4) Application of mckinney-vento homeless assistance
act.--Nothing in this subtitle shall limit or otherwise affect
the application of the provisions of the McKinney-Vento
Homeless Assistance Act (42 U.S.C. 11301 et seq.) to facilities
of the Veterans Health Administration closed under this
subtitle.
(c) Applicability of National Environmental Policy Act of 1969.--
(1) In general.--The provisions of the National
Environmental Policy Act of 1969 (42 U.S.C. 4321 et seq.) shall
not apply to the actions of the President, the Commission, and,
except as provided in paragraph (2), the Department of Veterans
Affairs in carrying out this subtitle.
(2) Department of veterans affairs.--
(A) Covered activities.--The provisions of the
National Environmental Policy Act of 1969 shall apply
to actions of the Department of Veterans Affairs under
this subtitle--
(i) during the process of property
disposal; and
(ii) during the process of relocating
functions from a facility of the Veterans
Health Administration being closed or realigned
to another facility after the receiving
facility has been selected but before the
functions are relocated.
(B) Other activities.--In applying the provisions
of the National Environmental Policy Act of 1969 to the
processes referred to in subparagraph (A), the
Secretary shall not have to consider--
(i) the need for closing or realigning the
facility of the Veterans Health Administration
as recommended by the Commission;
(ii) the need for transferring functions to
any facility of the Veterans Health
Administration which has been selected as the
receiving facility; or
(iii) facilities of the Veterans Health
Administration alternative to those recommended
or selected.
(d) Waiver.--
(1) Restrictions on use of funds.--The Secretary may close
or realign facilities of the Veterans Health Administration
under this subtitle without regard to any provision of law
restricting the use of funds for closing or realigning
facilities of the Veterans Health Administration included in
any appropriation or authorization Act.
(2) Restrictions on authorities.--The Secretary may close
or realign facilities of the Veterans Health Administration
under this subtitle without regard to the restrictions of
section 8110 of title 38, United States Code.
(e) Transfer Authority in Connection With Payment of Environmental
Remediation Costs.--
(1) In general.--
(A) Transfer by deed.--Subject to paragraph (2) of
this subsection and section 120(h) of the Comprehensive
Environmental Response, Compensation, and Liability Act
of 1980 (42 U.S.C. 9620(h)), the Secretary may enter
into an agreement to transfer by deed a facility of the
Veterans Health Administration with any person who
agrees to perform all environmental restoration, waste
management, and environmental compliance activities
that are required for the property or facilities under
Federal and State laws, administrative decisions,
agreements (including schedules and milestones), and
concurrences.
(B) Additional terms or conditions.--The Secretary
may require any additional terms and conditions in
connection with an agreement authorized by subparagraph
(A) as the Secretary considers appropriate to protect
the interests of the United States.
(2) Limitation.--A transfer of a facility of the Veterans
Health Administration may be made under paragraph (1) only if
the Secretary certifies to Congress that--
(A) the costs of all environmental restoration,
waste management, and environmental compliance
activities otherwise to be paid by the Secretary with
respect to the facility of the Veterans Health
Administration are equal to or greater than the fair
market value of the property or facilities to be
transferred, as determined by the Secretary; or
(B) if such costs are lower than the fair market
value of the facility of the Veterans Health
Administration, the recipient of such transfer agrees
to pay the difference between the fair market value and
such costs.
(3) Payment by the secretary for certain transfers.--In the
case of a facility of the Veterans Health Administration
covered by a certification under paragraph (2)(A), the
Secretary may pay the recipient of such facility an amount
equal to the lesser of--
(A) the amount by which the costs incurred by the
recipient of the facility of the Veterans Health
Administration for all environmental restoration,
waste, management, and environmental compliance
activities with respect to such facility exceed the
fair market value of such property as specified in such
certification; or
(B) the amount by which the costs (as determined by
the Secretary) that would otherwise have been incurred
by the Secretary for such restoration, management, and
activities with respect to such facility of the
Veterans Health Administration exceed the fair market
value of property as so specified.
(4) Disclosure.--As part of an agreement under paragraph
(1), the Secretary shall disclose to the person to whom the
facility of the Veterans Health Administration will be
transferred any information of the Secretary regarding the
environmental restoration, waste management, and environmental
compliance activities described in paragraph (1) that relate to
the facility of the Veterans Health Administration. The
Secretary shall provide such information before entering into
the agreement.
(5) Applicability of certain environmental laws.--Nothing
in this subsection shall be construed to modify, alter, or
amend the Comprehensive Environmental Response, Compensation,
and Liability Act of 1980 (42 U.S.C. 9601 et seq.) or the Solid
Waste Disposal Act (42 U.S.C. 6901 et seq.).
SEC. 206. DEPARTMENT OF VETERANS AFFAIRS ASSET AND INFRASTRUCTURE
REVIEW ACCOUNT.
(a) Establishment.--There is hereby established in the ledgers of
the Treasury an account to be known as the ``Department of Veterans
Affairs Asset and Infrastructure Review Account'' which shall be
administered by the Secretary as a single account.
(b) Credits to Account.--There shall be credited to the Account the
following:
(1) Funds authorized for and appropriated to the Account.
(2) Proceeds received from the lease, transfer, or disposal
of any property at a facility of the Veterans Health
Administration closed or realigned under this subtitle.
(c) Use of Account.--The Secretary may use the funds in the Account
only for the following purposes:
(1) To carry out this subtitle.
(2) To cover property management and disposal costs
incurred at facilities of the Veterans Health Administration
closed, modernized, or realigned under this subtitle.
(3) To cover costs associated with supervision, inspection,
overhead, engineering, and design of construction projects
undertaken under this subtitle, and subsequent claims, if any,
related to such activities.
(4) Other purposes that the Secretary determines support
the mission and operations of the Department of Veterans
Affairs.
(d) Consolidated Budget Justification Display for Account.--
(1) Consolidated budget information required.--The
Secretary shall establish a consolidated budget justification
display in support of the Account that for each fiscal year--
(A) details the amount and nature of credits to,
and expenditures from, the Account during the preceding
fiscal year;
(B) separately details the environmental
remediation costs associated with facility of the
Veterans Health Administration for which a budget
request is made;
(C) specifies the transfers into the Account and
the purposes for which these transferred funds will be
further obligated, to include caretaker and environment
remediation costs associated with each facility of the
Veterans Health Administration; and
(D) details any intra-budget activity transfers
within the Account that exceeded $1,000,000 during the
preceding fiscal year or that are proposed for the next
fiscal year and will exceed $1,000,000.
(2) Submission.--The Secretary shall include the
information required by paragraph (1) in the materials that the
Secretary submits to Congress in support of the budget for a
fiscal year submitted by the President pursuant to section 1105
of title 31, United States Code.
(e) Closure of Account; Treatment of Remaining Funds.--
(1) Closure.--The Account shall be closed at the time and
in the manner provided for appropriation accounts under section
1555 of title 31, United States Code, except that unobligated
funds which remain in the Account upon closure shall be held by
the Secretary of the Treasury until transferred to the
Secretary of Veterans Affairs by law after the Committees on
Veterans' Affairs of the Senate and the House of
Representatives receive the final report transmitted under
paragraph (2).
(2) Final report.--No later than 60 days after the closure
of the Account under paragraph (1), the Secretary shall
transmit to the Committees on Veterans' Affairs of the Senate
and the House of Representatives and the Committees on
Appropriations of the House of Representatives and the Senate a
report containing an accounting of--
(A) all the funds credited to and expended from the
Account or otherwise expended under this subtitle; and
(B) any funds remaining in the Account.
SEC. 207. CONGRESSIONAL CONSIDERATION OF COMMISSION REPORT.
(a) Disapproval Resolution.--For purposes of this subtitle, the
term ``joint resolution'' means only a joint resolution which is
introduced within the 5-day period beginning on the date on which the
President transmits the report to the Congress under section 203(d),
and--
(1) which does not have a preamble;
(2) the matter after the resolving clause of which is as
follows: ``that Congress disapproves the recommendations of the
VHA Asset and Infrastructure Review Commission as submitted by
the President on ___'', the blank space being filled with the
appropriate date; and
(3) the title of which is as follows: ``Joint resolution
disapproving the recommendations of the VHA Asset and
Infrastructure Review Commission.''.
(b) Consideration in the House of Representatives.--
(1) Reporting and discharge.--Any committee of the House of
Representatives to which a joint resolution is referred shall
report it to the House without amendment not later than 15
legislative days after the date of introduction thereof. If a
committee fails to report the joint resolution within that
period, the committee shall be discharged from further
consideration of the joint resolution.
(2) Proceeding to consideration.--It shall be in order at
any time after the third legislative day after each committee
authorized to consider a joint resolution has reported or has
been discharged from consideration of a joint resolution, to
move to proceed to consider the joint resolution in the House.
All points of order against the motion are waived. Such a
motion shall not be in order after the House has disposed of a
motion to proceed on a joint resolution addressing a particular
submission. The previous question shall be considered as
ordered on the motion to its adoption without intervening
motion. The motion shall not be debatable. A motion to
reconsider the vote by which the motion is disposed of shall
not be in order.
(3) Consideration.--The joint resolution shall be
considered as read. All points of order against the joint
resolution and against its consideration are waived. The
previous question shall be considered as ordered on the joint
resolution to its passage without intervening motion except 2
hours of debate equally divided and controlled by the proponent
and an opponent. A motion to reconsider the vote on passage of
the joint resolution shall not be in order.
(c) Consideration in the Senate.--
(1) Referral.--A joint resolution introduced in the Senate
shall be referred to the Committee on Veterans' Affairs.
(2) Reporting and discharge.--Any committee of the Senate
to which a joint resolution is referred shall report it to the
Senate without amendment not later than 15 session days after
the date of introduction of a joint resolution described in
subsection (a). If a committee fails to report the joint
resolution within that period, the committee shall be
discharged from further consideration of the joint resolution
and the joint resolution shall be placed on the calendar.
(3) Floor consideration.--
(A) In general.--Notwithstanding Rule XXII of the
Standing Rules of the Senate, it is in order at any
time after the third session day on which the Committee
on Veterans' Affairs has reported or has been
discharged from consideration of a joint resolution
described in subsection (a) (even though a previous
motion to the same effect has been disagreed to) to
move to proceed to the consideration of the joint
resolution, and all points of order against the joint
resolution (and against consideration of the joint
resolution) are waived. The motion to proceed is not
debatable. The motion is not subject to a motion to
postpone. A motion to reconsider the vote by which the
motion is agreed to or disagreed to shall not be in
order. If a motion to proceed to the consideration of
the resolution is agreed to, the joint resolution shall
remain the unfinished business until disposed of.
(B) Consideration.--Consideration of the joint
resolution, and on all debatable motions and appeals in
connection therewith, shall be limited to not more than
2 hours, which shall be divided equally between the
majority and minority leaders or their designees. A
motion further to limit debate is in order and not
debatable. An amendment to, or a motion to postpone, or
a motion to proceed to the consideration of other
business, or a motion to recommit the joint resolution
is not in order.
(C) Vote on passage.--If the Senate has voted to
proceed to a joint resolution, the vote on passage of
the joint resolution shall occur immediately following
the conclusion of consideration of the joint
resolution, and a single quorum call at the conclusion
of the debate if requested in accordance with the rules
of the Senate.
(D) Rulings of the chair on procedure.--Appeals
from the decisions of the Chair relating to the
application of the rules of the Senate, as the case may
be, to the procedure relating to a joint resolution
shall be decided without debate.
(d) Amendment Not in Order.--A joint resolution of disapproval
considered pursuant to this section shall not be subject to amendment
in either the House of Representatives or the Senate.
(e) Coordination With Action by Other House.--
(1) In general.--If, before the passage by one House of the
joint resolution of that House, that House receives the joint
resolution from the other House, then the following procedures
shall apply:
(A) The joint resolution of the other House shall
not be referred to a committee.
(B) With respect to the joint resolution of the
House receiving the joint resolution--
(i) the procedure in that House shall be
the same as if no joint resolution had been
received from the other House; but
(ii) the vote on passage shall be on the
joint resolution of the other House.
(2) Treatment of joint resolution of other house.--If the
Senate fails to introduce or consider a joint resolution under
this section, the joint resolution of the House shall be
entitled to expedited floor procedures under this section.
(3) Treatment of companion measures.--If, following passage
of the joint resolution in the Senate, the Senate then receives
the companion measure from the House of Representatives, the
companion measure shall not be debatable.
(f) Rules of the House of Representatives and Senate.--This section
is enacted by Congress--
(1) as an exercise of the rulemaking power of the Senate
and House of Representatives, respectively, and as such it is
deemed a part of the rules of each House, respectively, but
applicable only with respect to the procedure to be followed in
that House in the case of a joint resolution, and it supersedes
other rules only to the extent that it is inconsistent with
such rules; and
(2) with full recognition of the constitutional right of
either House to change the rules (so far as relating to the
procedure 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.
SEC. 208. OTHER MATTERS.
(a) Online Publication of Communications.--
(1) In general.--Not later than 24 hours after the
transmission or receipt of any communication under this
subtitle that is transmitted or received by a party specified
in paragraph (2), the Secretary of Veterans Affairs shall
publish such communication online.
(2) Parties specified.--The parties specified under this
paragraph are the following:
(A) The Secretary of Veterans Affairs.
(B) The Commission.
(C) The President.
(b) Continuation of Existing Construction Projects and Planning.--
During activities that the Commission, President, or Congress carry out
under this subtitle, the Secretary of Veterans Affairs may not stop,
solely because of such activities--
(1) a construction or leasing project of the Veterans
Health Administration;
(2) long term planning regarding infrastructure and assets
of the Veterans Health Administration; or
(3) budgetary processes for the Veterans Health
Administration.
(c) Recommendations for Future Asset Reviews.--The Secretary of
Veterans Affairs may, after consulting with veterans service
organizations, include in budget submissions the Secretary submits
after the termination of the Commission recommendations for future such
commissions or other capital asset realignment and management
processes.
SEC. 209. DEFINITIONS.
In this subtitle:
(1) The term ``Account'' means the Department of Veterans
Affairs Asset and Infrastructure Review Account established by
section 206(a).
(2) The term ``Commission'' means the Commission
established by section 202.
(3) The term ``date of approval'', with respect to a
modernization or realignment of a facility of the Veterans
Health Administration, means the date on which the authority of
Congress to disapprove a recommendation of modernization or
realignment, as the case may be, of such facility under this
subtitle expires.
(4) The term ``facility of the Veterans Health
Administration''--
(A) means any land, building, structure, or
infrastructure (including any medical center, nursing
home, domiciliary facility, outpatient clinic, center
that provides readjustment counseling, or leased
facility) that is--
(i) under the jurisdiction of the
Department of Veterans Affairs;
(ii) under the control of the Veterans
Health Administration; and
(iii) not under the control of the General
Services Administration; or
(B) with respect to a colocated facility of the
Department of Veterans Affairs, includes any land,
building, or structure--
(i) under the jurisdiction of the
Department of Veterans Affairs;
(ii) under the control of another
administration of the Department of Veterans
Affairs; and
(iii) not under the control of the General
Services Administration.
(5) The term ``infrastructure'' means improvements to land
other than buildings or structures.
(6) The term ``modernization'' includes--
(A) any action, including closure, required to
align the form and function of a facility of the
Veterans Health Administration to the provision of
modern day health care, including utilities and
environmental control systems;
(B) the construction, purchase, lease, or sharing
of a facility of the Veterans Health Administration;
and
(C) realignments, disposals, exchanges,
collaborations between the Department of Veterans
Affairs and other Federal entities, and strategic
collaborations between the Department and non-Federal
entities, including tribal organizations.
(7) The term ``realignment'', with respect to a facility of
the Veterans Health Administration, includes--
(A) any action that changes the numbers of or
relocates services, functions, and personnel positions;
(B) disposals or exchanges between the Department
of Veterans Affairs and other Federal entities,
including the Department of Defense; and
(C) strategic collaborations between the Department
of Veterans Affairs and non-Federal entities, including
tribal organizations.
(8) The term ``redevelopment authority'', in the case of a
facility of the Veterans Health Administration closed or
modernized under this subtitle, means any entity (including an
entity established by a State or local government) recognized
by the Secretary of Veterans Affairs as the entity responsible
for developing the redevelopment plan with respect to the
facility or for directing the implementation of such plan.
(9) The term ``redevelopment plan'' in the case of a
facility of the Veterans Health Administration to be closed or
realigned under this subtitle, means a plan that--
(A) is agreed to by the local redevelopment
authority with respect to the facility; and
(B) provides for the reuse or redevelopment of the
real property and personal property of the facility
that is available for such reuse and redevelopment as a
result of the closure or realignment of the facility.
(10) The term ``Secretary'' means the Secretary of Veterans
Affairs.
(11) The term ``tribal organization'' has the meaning given
such term in section 3765 of title 38, United States Code.
Subtitle B--Other Infrastructure Matters
SEC. 211. IMPROVEMENT TO TRAINING OF CONSTRUCTION PERSONNEL.
Subsection (g) of section 8103 of title 38, United States Code, is
amended to read as follows:
``(g)(1)(A) Not later than September 30 of the fiscal year
following the fiscal year during which the VA Asset and Infrastructure
Review Act of 2018 is enacted, the Secretary shall implement the
covered training curriculum and the covered certification program.
``(B) In designing and implementing the covered training curriculum
and the covered certification program under paragraph (1), the
Secretary shall use as models existing training curricula and
certification programs that have been established under chapter 87 of
title 10, United States Code, as determined relevant by the Secretary.
``(2) The Secretary may develop the training curriculum under
paragraph (1)(A) in a manner that provides such training in any
combination of--
``(A) training provided in person;
``(B) training provided over an internet website; or
``(C) training provided by another department or agency of
the Federal Government.
``(3) The Secretary may develop the certification program under
paragraph (1)(A) in a manner that uses--
``(A) one level of certification; or
``(B) more than one level of certification, as determined
appropriate by the Secretary with respect to the level of
certification for different grades of the General Schedule.
``(4) The Secretary may enter into a contract with an appropriate
entity to provide the covered training curriculum and the covered
certification program under paragraph (1)(A).
``(5)(A) Not later than September 30 of the second fiscal year
following the fiscal year during which the VA Asset and Infrastructure
Review Act of 2018 is enacted, the Secretary shall ensure that the
majority of employees subject to the covered certification program
achieve the certification or the appropriate level of certification
pursuant to paragraph (3), as the case may be.
``(B) After carrying out subparagraph (A), the Secretary shall
ensure that each employee subject to the covered certification program
achieves the certification or the appropriate level of certification
pursuant to paragraph (3), as the case may be, as quickly as
practicable.
``(6) In this subsection:
``(A) The term `covered certification program' means, with
respect to employees of the Department of Veterans Affairs who
are members of occupational series relating to construction or
facilities management, or employees of the Department who award
or administer contracts for major construction, minor
construction, or nonrecurring maintenance, including as
contract specialists or contracting officers' representatives,
a program to certify knowledge and skills relating to
construction or facilities management and to ensure that such
employees maintain adequate expertise relating to industry
standards and best practices for the acquisition of design and
construction services.
``(B) The term `covered training curriculum' means, with
respect to employees specified in subparagraph (A), a training
curriculum relating to construction or facilities
management.''.
SEC. 212. REVIEW OF ENHANCED USE LEASES.
Section 8162(b)(6) is amended to read as follows:
``(6) The Office of Management and Budget shall review each
enhanced-use lease before the lease goes into effect to determine
whether the lease is in compliance with paragraph (5).''.
SEC. 213. ASSESSMENT OF HEALTH CARE FURNISHED BY THE DEPARTMENT TO
VETERANS WHO LIVE IN THE PACIFIC TERRITORIES.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the Committees on Veterans' Affairs of the Senate and the House of
Representatives a report regarding health care furnished by the
Department of Veterans Affairs to veterans who live in the Pacific
territories.
(b) Elements.--The report under subsection (a) shall include
assessments of the following:
(1) The ability of the Department to furnish to veterans
who live in the Pacific territories the following:
(A) Hospital care.
(B) Medical services.
(C) Mental health services.
(D) Geriatric services.
(2) The feasibility of establishing a community-based
outpatient clinic of the Department in any Pacific territory
that does not contain such a facility.
(c) Definition.--In this section, the term ``Pacific territories''
means American Samoa, Guam, and the Northern Mariana Islands.
TITLE III--IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS
SEC. 301. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS AND DENTISTS UNDER
DEPARTMENT OF VETERANS AFFAIRS HEALTH PROFESSIONAL
SCHOLARSHIP PROGRAM.
(a) Scholarships for Physicians and Dentists.--Section 7612(b) of
title 38, United States Code, is amended by adding at the end the
following new paragraph:
``(6)(A) Of the scholarships awarded under this subchapter, the
Secretary shall ensure that not less than 50 scholarships are awarded
each year to individuals who are accepted for enrollment or enrolled
(as described in section 7602 of this title) in a program of education
or training leading to employment as a physician or dentist until such
date as the Secretary determines that the staffing shortage of
physicians and dentists in the Department is less than 500.
``(B) After such date, the Secretary shall ensure that of the
scholarships awarded under this subchapter, a number of scholarships is
awarded each year to individuals referred to in subparagraph (A) in an
amount equal to not less than ten percent of the staffing shortage of
physicians and dentists in the Department, as determined by the
Secretary.
``(C) Notwithstanding subsection (c)(1), the agreement between the
Secretary and a participant in the Scholarship Program who receives a
scholarship pursuant to this paragraph shall provide the following:
``(i) The Secretary's agreement to provide the participant
with a scholarship under this subchapter for a specified number
(from two to four) of school years during which the participant
is pursuing a course of education or training leading to
employment as a physician or dentist.
``(ii) The participant's agreement to serve as a full-time
employee in the Veterans Health Administration for a period of
time (hereinafter in this subchapter referred to as the `period
of obligated service') of 18 months for each school year or
part thereof for which the participant was provided a
scholarship under the Scholarship Program.
``(D) In providing scholarships pursuant to this paragraph, the
Secretary may provide a preference for applicants who are veterans.
``(E) On an annual basis, the Secretary shall provide to
appropriate educational institutions informational material about the
availability of scholarships under this paragraph.''.
(b) Breach of Agreement.--Section 7617 of such title is amended--
(1) by redesignating paragraphs (4) and (5) as paragraphs
(5) and (6), respectively; and
(2) by inserting after paragraph (3) the following new
paragraph (4):
``(4) In the case of a participant who is enrolled in a
program or education or training leading to employment as a
physician, the participant fails to successfully complete post-
graduate training leading to eligibility for board
certification in a specialty.''.
(c) Extension of Program.--Section 7619 of such title is amended by
striking ``December 31, 2019'' and inserting ``December 31, 2033''.
SEC. 302. INCREASE IN MAXIMUM AMOUNT OF DEBT THAT MAY BE REDUCED UNDER
EDUCATION DEBT REDUCTION PROGRAM OF DEPARTMENT OF
VETERANS AFFAIRS.
(a) Increase in Amount.--Section 7683(d)(1) is amended--
(1) by striking ``$120,000'' and inserting ``$200,000'';
and
(2) by striking ``$24,000'' and inserting ``$40,000''.
(b) Study.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) conduct a study on the demand for education
debt reduction under subchapter VII of chapter 76 of
title 38, United States Code; and
(B) 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 findings
of the Secretary with respect to the study carried out
under subparagraph (A).
(2) Considerations.--In carrying out the study required by
paragraph (1)(A), the Secretary shall consider the following:
(A) The total number of vacancies within the
Veterans Health Administration whose applicants are
eligible to participate in the Education Debt Reduction
Program pursuant to section 7682(a) of such title.
(B) The types of medical professionals in greatest
demand in the United States.
(C) Projections by the Secretary of the numbers and
types of medical professions that meet the needs of
veterans.
SEC. 303. ESTABLISHING THE DEPARTMENT OF VETERANS AFFAIRS SPECIALTY
EDUCATION LOAN REPAYMENT PROGRAM.
(a) In General.--Chapter 76 of title 38, United States Code, is
amended by inserting after subchapter VII the following new subchapter:
``SUBCHAPTER VIII--SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM
``Sec. 7691. Establishment
``As part of the Educational Assistance Program, the Secretary may
carry out a student loan repayment program under section 5379 of title
5. The program shall be known as the Department of Veterans Affairs
Specialty Education Loan Repayment Program (in this chapter referred to
as the `Specialty Education Loan Repayment Program').
``Sec. 7692. Purpose
``The purpose of the Specialty Education Loan Repayment Program is
to assist, through the establishment of an incentive program for
certain individuals employed in the Veterans Health Administration, in
meeting the staffing needs of the Veterans Health Administration for
physicians in medical specialties for which the Secretary determines
recruitment or retention of qualified personnel is difficult.
``Sec. 7693. Eligibility; preferences; covered costs
``(a) Eligibility.--An individual is eligible to participate in the
Specialty Education Loan Repayment Program if the individual--
``(1) is hired under section 7401 of this title to work in
an occupation described in section 7692 of this title;
``(2) owes any amount of principal or interest under a
loan, the proceeds of which were used by or on behalf of that
individual to pay costs relating to a course of education or
training which led to a degree that qualified the individual
for the position referred to in paragraph (1); and
``(3) is--
``(A) recently graduated from an accredited medical
or osteopathic school and matched to an accredited
residency program in a medical specialty described in
section 7692 of this title; or
``(B) a physician in training in a medical
specialty described in section 7692 of this title with
more than 2 years remaining in such training.
``(b) Preferences.--In selecting individuals for participation in
the Specialty Education Loan Repayment Program under this subchapter,
the Secretary may give preference to the following:
``(1) Individuals who are, or will be, participating in
residency programs in health care facilities--
``(A) located in rural areas;
``(B) operated by Indian tribes, tribal
organizations, or the Indian Health Service; or
``(C) affiliated with underserved health care
facilities of the Department.
``(2) Veterans.
``(c) Covered Costs.--For purposes of subsection (a)(2), costs
relating to a course of education or training include--
``(1) tuition expenses;
``(2) all other reasonable educational expenses, including
expenses for fees, books, equipment, and laboratory expenses;
and
``(3) reasonable living expenses.
``Sec. 7694. Specialty education loan repayment
``(a) In General.--Payments under the Specialty Education Loan
Repayment Program shall consist of payments for the principal and
interest on loans described in section 7682(a)(2) of this title for
individuals selected to participate in the Program to the holders of
such loans.
``(b) Frequency of Payment.--The Secretary shall make payments for
any given participant in the Specialty Education Loan Repayment Program
on a schedule determined appropriate by the Secretary.
``(c) Maximum Amount; Waiver.--(1) The amount of payments made for
a participant under the Specialty Education Loan Repayment Program may
not exceed $160,000 over a total of 4 years of participation in the
Program, of which not more than $40,000 of such payments may be made in
each year of participation in the Program.
``(2)(A) The Secretary may waive the limitations under paragraph
(1) in the case of a participant described in subparagraph (B). In the
case of such a waiver, the total amount of payments payable to or for
that participant is the total amount of the principal and the interest
on the participant's loans referred to in subsection (a).
``(B) A participant described in this subparagraph is a participant
in the Program who the Secretary determines serves in a position for
which there is a shortage of qualified employees by reason of either
the location or the requirements of the position.
``Sec. 7695. Choice of location
``Each participant in the Specialty Education Loan Repayment
Program who completes residency may select, from a list of medical
facilities of the Veterans Health Administration provided by the
Secretary, at which such facility the participant will work in a
medical specialty described in section 7692 of this title.
``Sec. 7696. Term of obligated service
``(a) In General.--In addition to any requirements under section
5379(c) of title 5, a participant in the Specialty Education Loan
Repayment Program must agree, in writing and before the Secretary may
make any payment to or for the participant, to--
``(1) obtain a license to practice medicine in a State;
``(2) successfully complete post-graduate training leading
to eligibility for board certification in a specialty;
``(3) serve as a full-time clinical practice employee of
the Veterans Health Administration for 12 months for every
$40,000 in such benefits that the employee receives, but in no
case for fewer than 24 months; and
``(4) except as provided in subsection (b), to begin such
service as a full-time practice employee by not later than 60
days after completing a residency.
``(b) Fellowship.--In the case of a participant who receives an
accredited fellowship in a medical specialty other than a medical
specialty described in section 7692 of this title, the Secretary, on
written request of the participant, may delay the term of obligated
service under subsection (a) for the participant until after the
participant completes the fellowship, but in no case later than 60 days
after completion of such fellowship.
``(c) Penalty.--(1) An employee who does not complete a period of
obligated service under this section shall owe the Federal Government
an amount determined in accordance with the following formula: A = B
x ((T - S) <divide> T)).
``(2) In the formula in paragraph (1):
``(A) `A' is the amount the employee owes the Federal
Government.
``(B) `B' is the sum of all payments to or for the
participant under the Specialty Education Loan Repayment
Program.
``(C) `T' is the number of months in the period of
obligated service of the employee.
``(D) `S' is the number of whole months of such period of
obligated service served by the employee.
``Sec. 7697. Relationship to Educational Assistance Program
``Assistance under the Specialty Education Loan Repayment Program
may be in addition to other assistance available to individuals under
the Educational Assistance Program.''.
(b) Conforming and Technical Amendments.--
(1) Conforming amendments.--
(A) Section 7601(a) of title 38, United States
Code, is amended--
(i) in paragraph (4), by striking ``and'';
(ii) in paragraph (5), by striking the
period and inserting ``; and''; and
(iii) by adding at the end the following
new paragraph:
``(6) the specialty education loan repayment program
provided for in subchapter VIII of this chapter.''.
(B) Section 7603(a)(1) of title 38, United States
Code, is amended by striking ``or VI'' and inserting
``VI, or VIII''.
(C) Section 7604 of title 38, United States Code,
is amended by striking ``or VI'' each place it appears
and inserting ``VI, or VIII''.
(D) Section 7631 of title 38, United States Code,
is amended--
(i) in subsection (a)(1)--
(I) by striking ``and'' after
``scholarship amount,''; and
(II) by inserting ``, and the
maximum specialty education loan
repayment amount'' after ``reduction
payments amount''; and
(ii) in subsection (b) by adding at the end
the following new paragraph:
``(7) The term `specialty education loan repayment amount' means
the maximum amount of specialty education loan repayment payments
payable to or for a participant in the Department of Veterans Affairs
Specialty Education Loan Repayment Program under subchapter VIII of
this chapter, as specified in section 7694(c)(1) of this title and as
previously adjusted (if at all) in accordance with this section.''.
(E) Section 7632 of title 38, United States Code,
is amended--
(i) in paragraph (1), by striking ``and the
Education Debt Reduction Program'' and
inserting ``the Education Debt Reduction
Program, and the Specialty Education Loan
Repayment Program''; and
(ii) in paragraph (4), by striking ``and
per participant in the Education Debt Reduction
Program'' and inserting ``per participant in
the Education Debt Reduction Program, and per
participant in the Specialty Education Loan
Repayment Program''.
(2) Table of sections.--The table of sections at the
beginning of chapter 76 of such title is amended by inserting
after the items relating to subchapter VII the following:
``subchapter viii--specialty education loan repayment program
``7691. Establishment.
``7692. Purpose.
``7693. Eligibility; preferences; covered costs.
``7694. Specialty education loan repayment.
``7695. Choice of location.
``7696. Term of obligated service.
``7697. Relationship to Educational Assistance Program.''.
(c) Needs of the VHA.--In making determinations each year under
section 7692 of title 38, United States Code, as enacted by subsection
(a), the Secretary of Veterans Affairs shall consider the anticipated
needs of the Veterans Health Administration during the period 2 to 6
years in the future.
(d) Preference.--In granting preference under section 7693 of title
38, United States Code, as enacted by subsection (a), the Secretary of
Veterans Affairs shall determine whether a facility of the Department
is underserved based on the criteria developed under section 401 of
this Act.
(e) Offer Deadline.--In the case of an applicant who applies before
receiving a residency match and whom the Secretary of Veterans Affairs
selects for participation in the Specialty Education Loan Repayment
Program established by subsection (a), the Secretary shall offer
participation to the applicant not later than 28 days after--
(1) the applicant matches with a residency in a medical
specialty described in section 7692 of title 38, United States
Code, as enacted by subsection (a); and
(2) such match is published.
(f) Publicity.--The Secretary of Veterans Affairs shall take such
steps as the Secretary determines are appropriate to publicize the
Specialty Education Loan Repayment Program established under subchapter
VIII of chapter 76 of title 38, United States Code, as enacted by
subsection (a).
SEC. 304. VETERANS HEALING VETERANS MEDICAL ACCESS AND SCHOLARSHIP
PROGRAM.
(a) Establishment.--The Secretary of Veterans Affairs, acting
through the Office of Academic Affiliations of the Department of
Veterans Affairs, shall carry out a pilot program under which the
Secretary shall provide funding for the medical education of a total of
18 eligible veterans. Such funding shall be provided for two veterans
enrolled in each covered medical schools in accordance with this
section.
(b) Eligible Veterans.--To be eligible to receive funding for
medical education under this section, a veteran shall--
(1) have been discharged from the Armed Forces not more
than 10 years before the date of application for admission to a
covered medical school;
(2) not be entitled to educational assistance under chapter
30, 31, 32, 33, 34, or 35 of title 38, United States Code, or
chapter 1606 or 1607 of title 10, United States Code;
(3) apply for admission to a covered medical school for the
entering class of 2019;
(4) indicate on such application for admission that the
veteran would like to be considered for an award of funding
under this section;
(5) meet the minimum admissions criteria for the covered
medical school to which the veteran applies; and
(6) enter into an agreement described in subsection (e).
(c) Award of Funding.--
(1) In general.--Each covered medical school that opts to
participate in the program under this section shall reserve two
seats in the entering class of 2019 for eligible veterans who
receive funding under such program. Such funding shall be
awarded to the two eligible veterans with the highest
admissions rankings for such class at such school.
(2) Amount of funding.--Each eligible veteran who receives
funding under this section shall receive an amount equal to the
actual cost of--
(A) tuition at the covered medical school at which
the veteran enrolls for 4 years;
(B) books, fees, and technical equipment;
(C) fees associated with the National Residency
Match Program;
(D) two away rotations performed during the fourth
year at a Department of Veterans Affairs medical
facility; and
(E) a monthly stipend for the 4-year period during
which the veteran is enrolled in medical school in an
amount to be determined by the Secretary.
(3) Distribution of funding.--In the event that two or more
eligible veterans do not apply for admission at one of the
covered medical schools for the entering class of 2019, the
Secretary shall distribute the available funding to eligible
veterans who applied for admission at other covered medical
schools.
(d) Agreement.--
(1) Terms of agreement.--Each eligible veteran who accepts
funding for medical education under this section shall enter
into an agreement with the Secretary that provides that the
veteran agrees--
(A) to maintain enrollment and attendance in the
medical school;
(B) while enrolled in such medical school, to
maintain an acceptable level of academic standing (as
determined by the medical school under regulations
prescribed by the Secretary);
(C) to complete post-graduate training leading to
eligibility for board certification in a speciality
applicable to the Department of Veterans Affairs, as
determined by the Secretary;
(D) after completion of medical school, to obtain a
license to practice medicine in a State; and
(E) after completion of medical school and post-
graduate training, to serve as a full-time clinical
practice employee in the Veterans Health Administration
for a period of 4 years.
(2) Breach of agreement.--If an eligible veteran who
accepts funding under this section breaches the terms of the
agreement described in paragraph (1), the United States shall
be entitled to recover damages in an amount equal to the total
amount of such funding received by the veteran.
(e) Rule of Construction.--Nothing in this section shall be
construed to prevent any covered medical school from accepting more
than two eligible veterans for the entering class of 2019.
(f) Report to Congress.--Not later than December 31, 2020, and
annually thereafter for the subsequent 3 years, the Secretary shall
submit to Congress a report on the pilot program under this section.
Such report shall include the evaluation of the Secretary of the
success of the pilot program, including the number of veterans who
received funding under the program who matriculated and an evaluation
of the academic progress of such veterans.
(g) Covered Medical Schools.--In this section, the term ``covered
medical school'' means any of the following:
(1) The Teague-Cranston medical schools, consisting of--
(A) Texas A&M College of Medicine;
(B) Quillen College of Medicine at East Tennessee
State University;
(C) Boonshoft School of Medicine at Wright State
University;
(D) Joan C. Edwards School of Medicine at Marshall
University; and
(E) University of South Carolina School of
Medicine.
(2) Charles R Drew University of Medicine and Science.
(3) Howard University College of Medicine.
(4) Meharry Medical College.
(5) Morehouse School of Medicine.
SEC. 305. BONUSES FOR RECRUITMENT, RELOCATION, AND RETENTION.
Section 705(a) of the Veterans Access, Choice, and Accountability
Act of 2014 (Public Law 113-146; 38 U.S.C. 703 note) is amended--
(1) in paragraph (1), by striking ``$230,000,000'' and
inserting ``$250,000,000, of which not less than $20,000,000
shall be for recruitment, relocation, and retention bonuses'';
and
(2) in paragraph (2), by striking ``$225,000,000'' and
inserting ``$290,000,000, of which not less than $20,000,000
shall be for recruitment, relocation, and retention bonuses''.
SEC. 306. INCLUSION OF VET CENTER EMPLOYEES IN EDUCATION DEBT REDUCTION
PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall ensure
that clinical staff working at Vet Centers are eligible to participate
in the Education Debt Reduction Program of the Department of Veterans
Affairs under subchapter VII of chapter 76 of title 38, United States
Code.
(b) Report.--Not later than 1 year after the date of the enactment
of this Act, the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report on the number of participants in the
Education Debt Reduction Program of the Department under such
subchapter who work at Vet Centers.
(c) Vet Center Defined.--In this section, the term ``Vet Center''
has the meaning given that term in section 1712A(h) of title 38, United
States Code.
TITLE IV--HEALTH CARE IN UNDERSERVED AREAS
SEC. 401. DEVELOPMENT OF CRITERIA FOR DESIGNATION OF CERTAIN MEDICAL
FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS AS
UNDERSERVED FACILITIES AND PLAN TO ADDRESS PROBLEM OF
UNDERSERVED FACILITIES.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall develop
criteria to designate medical centers, ambulatory care facilities, and
community based outpatient clinics of the Department of Veterans
Affairs as underserved facilities.
(b) Consideration.--Criteria developed under subsection (a) shall
include consideration of the following with respect to a facility:
(1) The ratio of veterans to health care providers of the
Department of Veterans Affairs for a standardized geographic
area surrounding the facility, including a separate ratio for
general practitioners and specialists.
(2) The range of clinical specialties covered by such
providers in such area.
(3) Whether the local community is medically underserved.
(4) The type, number, and age of open consults.
(5) Whether the facility is meeting the wait-time goals of
the Department.
(6) Such other criteria as the Secretary considers
important in determining which facilities are not adequately
serving area veterans.
(c) Analysis of Facilities.--Not less frequently than annually,
directors of Veterans Integrated Service Networks of the Department
shall perform an analysis to determine which facilities within that
Veterans Integrated Service Network qualify as underserved facilities
pursuant to criteria developed under subsection (a).
(d) Annual Plan To Address Underserved Facilities.--
(1) Plan required.--Not later than 1 year after the date of
the enactment of this Act and not less frequently than once
each year, the Secretary shall submit to Congress a plan to
address the problem of underserved facilities of the
Department, as designated pursuant to criteria developed under
subsection (a).
(2) Contents.--Each plan submitted under paragraph (1)
shall address the following:
(A) Increasing personnel or temporary personnel
assistance, including mobile deployment teams furnished
under section 407 of this Act.
(B) Providing special hiring incentives, including
under the Education Debt Reduction Program under
subchapter VII of chapter 76 of title 38, United States
Code, and recruitment, relocation, and retention
incentives.
(C) Using direct hiring authority.
(D) Improving training opportunities for staff.
(E) Such other actions as the Secretary considers
appropriate.
SEC. 402. PILOT PROGRAM TO FURNISH MOBILE DEPLOYMENT TEAMS TO
UNDERSERVED FACILITIES.
(a) In General.--The Secretary of Veterans Affairs shall carry out
a pilot program to furnish mobile deployment teams of medical personnel
to underserved facilities.
(b) Elements.--In furnishing mobile deployment teams under
subsection (a), the Secretary shall consider the following elements:
(1) The medical positions of greatest need at underserved
facilities.
(2) The size and composition of teams to be deployed.
(3) Such other elements as the Secretary considers
necessary for effective oversight of the program established
under subsection (a).
(c) Use of Annual Analysis.--The Secretary shall use the results of
the annual analysis conducted under section 401(c) of this Act to form
mobile deployment teams under subsection (a) that are composed of the
most needed medical personnel for underserved facilities.
(d) Reporting.--
(1) Progress report.--Not later than 1 year after the date
of the enactment of this Act, the Secretary shall submit a
report to Congress on the implementation of the pilot program
under this section.
(2) Final report.--Not later than the termination of the
pilot program under this section, the Secretary shall submit a
final report to Congress that contains the recommendations of
the Secretary regarding the feasibility and advisability of--
(A) extending or expanding the pilot program; and
(B) making the pilot program (or any aspect
thereof) permanent.
(e) Duration.--The pilot program under this section shall terminate
3 years after the date of the enactment of this Act.
(f) Underserved Facility Defined.--In this section, the term
``underserved facility'' means a medical center, ambulatory care
facility, or community based outpatient clinic of the Department of
Veterans Affairs designated by the Secretary of Veterans Affairs as
underserved pursuant to criteria developed under section 401 of this
Act.
SEC. 403. PILOT PROGRAM ON GRADUATE MEDICAL EDUCATION AND RESIDENCY.
(a) Establishment.--
(1) In general.--Subject to paragraph (5), the Secretary of
Veterans Affairs shall establish a pilot program to establish
medical residency positions authorized under section 301(b)(2)
of the Veterans Access, Choice, and Accountability Act of 2014
(Public Law 113-146; 38 U.S.C. 7302 note) at covered
facilities.
(2) Covered facilities.--For purposes of this section, a
covered facility is any of the following:
(A) A health care facility of the Department of
Veterans Affairs.
(B) A health care 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 health care 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 health care facility operated by the
Department of Defense.
(F) Such other health care facility as the
Secretary considers appropriate for purposes of this
section.
(3) Agreements.--To carry out the pilot program under this
section, the Secretary may enter into agreements with entities
that operate covered facilities in which the Secretary places
residents under paragraph (1).
(4) Parameters for location, affiliate sponsor, and
duration.--When determining in which covered facilities to
place residents under paragraph (1), the Secretary shall
consider the extent to which there is a clinical need for
providers in an area, as determined by the following:
(A) The ratio of veterans to health care providers
of the Department for a standardized geographic area
surrounding a facility, including a separate ratio for
general practitioners and specialists.
(B) The range of clinical specialties of providers
in standardized geographic areas surrounding a
facility.
(C) Whether the specialty of a provider is included
in the most recent staffing shortage determination of
the Department under section 7412 of title 38, United
States Code.
(D) Whether the local community is designated by
the Secretary of Veterans Affairs as underserved
pursuant to criteria developed under section 401 of
this Act.
(E) Whether the facility is located in a community
that is designated by the Secretary of Health and Human
Services as a health professional shortage area under
section 332 of the Public Health Service Act (42 U.S.C.
254e).
(F) Whether the facility is located in a rural or
remote area.
(G) Such other criteria as the Secretary considers
important in determining which facilities are not
adequately serving area veterans.
(5) Priority in placements.--During the pilot program under
this section, the Secretary shall place no fewer than 100
residents in covered facilities--
(A) operated by the Indian Health Service;
(B) operated by an Indian tribe;
(C) operated by a tribal organization; or
(D) located in communities designated by the
Secretary as underserved pursuant to criteria developed
under section 401 of this Act.
(6) 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.
(b) Reimbursement.--If a covered facility establishes a new
residency program in which the Secretary places a resident under the
pilot program, the Secretary shall reimburse that covered facility for
costs of the following:
(1) Curriculum development.
(2) Recruitment and retention of faculty.
(3) Accreditation of the program by the Accreditation
Council for Graduate Medical Education.
(4) The portion of faculty salaries attributable to duties
under an agreement subsection (a)(3).
(5) Expenses relating to educating a resident under the
pilot program.
(c) Reporting.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act and not less frequently than once
each year thereafter until the termination of the pilot
program, the Secretary shall submit to Congress a report on the
implementation of the pilot program.
(2) Elements.--Each report submitted under paragraph (1)
shall include the following with regard to the immediately
preceding year, and in comparison to the year immediately
preceding that year:
(A) The number of veterans who received care from
residents under the pilot program.
(B) The number of veterans who received care from
each resident per position described in subsection
(a)(1) under the pilot program.
(C) The number of veterans who received care from
residents under the pilot program expressed as a
percentage of all individuals who received care from
such residents.
(D) The number of clinical appointments for
veterans conducted by each resident under the pilot
program.
(E) The number of clinical appointments for
veterans conducted by residents per position described
in subsection (a)(1) under the pilot program.
(F) The number of clinical appointments for
veterans expressed as a percentage of all clinical
appointments conducted by residents under the pilot
program.
(G) The number of positions described in subsection
(a)(1) at each covered facility under the pilot
program.
(H) For each position described in subsection
(a)(1) in a residency program affiliated with a health
care facility of the Department, the time a resident
under the pilot program spent training at that facility
of the Department, expressed as a percentage of the
total training time for that resident position.
(I) For each residency program affiliated with a
health care facility of the Department, the time all
residents under the pilot program spent training at
that facility of the Department, expressed as a
percentage of the total training time for those
residents.
(J) The time that all residents under the pilot
program who are assigned to programs affiliated with
health care facilities of the Department spent training
at facilities of the Department, expressed as a
percentage of the total training time for those
residents.
(K) The cost to the Department of Veterans Affairs
under the pilot program in the year immediately
preceding the report and since the beginning of the
pilot program.
(L) The cost to the Department of Veterans Affairs
per resident placed under the pilot program at each
covered facility.
(M) The number of residents under the pilot program
hired by the Secretary to work in the Veterans Health
Administration after completion of residency in the
year immediately preceding the report and since the
beginning of the pilot program.
(N) The medical specialties pursued by residents
under the pilot program.
(d) Duration.--The pilot program under this section shall terminate
on August 7, 2024.
TITLE V--OTHER MATTERS
SEC. 501. ANNUAL REPORT ON PERFORMANCE AWARDS AND BONUSES AWARDED TO
CERTAIN HIGH-LEVEL EMPLOYEES OF THE DEPARTMENT.
(a) In General.--Chapter 7 of title 38, United States Code, is
amended by adding at the end the following new section:
``Sec. 726. Annual report on performance awards and bonuses awarded to
certain high-level employees
``(a) In General.--Not later than 100 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 all
performance awards or bonuses awarded to each of the following:
``(1) Regional Office Director of the Department.
``(2) Director of a Medical Center of the Department.
``(3) Director of a Veterans Integrated Service Network.
``(4) Senior executive of the Department.
``(b) Elements.--Each report submitted under subsection (a) shall
include the following with respect to each performance award or bonus
awarded to an individual described in such subsection:
``(1) The amount of each award or bonus.
``(2) The job title of the individual awarded the award or
bonus.
``(3) The location where the individual awarded the award
or bonus works.
``(c) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means
the Committees on Veterans' Affairs and Appropriations of the
Senate and House of Representatives.
``(2) The term `senior executive' means--
``(A) a career appointee; or
``(B) an individual--
``(i) in an administrative or executive
position; and
``(ii) appointed under section 7306(a) or
section 7401(1) of this title.
``(3) The term `career appointee' has the meaning given
that term in section 3132(a) of title 5, United States Code.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
725 the following new item:
``726. Annual report on performance awards and bonuses awarded to
certain high-level employees.''.
SEC. 502. ROLE OF PODIATRISTS IN DEPARTMENT OF VETERANS AFFAIRS.
(a) Inclusion as Physician.--
(1) In general.--Subchapter I of chapter 74 is amended by
adding at the end the following new section:
``Sec. 7413. Treatment of podiatrists; clinical oversight standards
``(a) Podiatrists.--Except as provided by subsection (b), a doctor
of podiatric medicine who is appointed as a podiatrist under section
7401(1) of this title is eligible for any supervisory position in the
Veterans Health Administration to the same degree that a physician
appointed under such section is eligible for the position.
``(b) Establishment of Clinical Oversight Standards.--The
Secretary, in consultation with appropriate stakeholders, shall
establish standards to ensure that specialists appointed in the
Veterans Health Administration to supervisory positions do not provide
direct clinical oversight for purposes of peer review or practice
evaluation for providers of other clinical specialties.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 74 is amended by inserting after the item
relating to section 7412 the following new item:
``7413. Treatment of podiatrists; clinical oversight standards.''.
(b) Modification and Clarification of Pay Grade.--
(1) Grade.--The list in section 7404(b) of such title is
amended--
(A) by striking ``PHYSICIAN AND DENTIST SCHEDULE''
and inserting ``PHYSICIAN AND SURGEON (MD/DO),
PODIATRIC SURGEON (DPM), AND DENTIST AND ORAL SURGEON
(DDS, DMD) SCHEDULE'';
(B) by striking ``Physician grade'' and inserting
``Physician and surgeon grade''; and
(C) by striking ``PODIATRIST, CHIROPRACTOR, AND''
and inserting ``CHIROPRACTOR AND''.
(2) Application.--The amendments made by paragraph (1)
shall apply with respect to a pay period of the Department of
Veterans Affairs beginning on or after the date that is 30 days
after the date of the enactment of this Act.
SEC. 503. DEFINITION OF MAJOR MEDICAL FACILITY PROJECT.
(a) Modification of Definition of Medical Facility.--Section
8101(3) is amended by striking ``Secretary'' and all that follows
through ``nursing home,'' and inserting ``Secretary, or as otherwise
authorized by law, for the provision of health-care services (including
hospital, outpatient clinic, nursing home,''.
(b) Modification of Definition of Major Medical Facility Project.--
Paragraph (3) of section 8104(a) is amended to read as follows:
``(3) For purposes of this subsection, the term `major medical
facility project' means a project for the construction, alteration, or
acquisition of a medical facility involving a total expenditure of more
than $20,000,000, but such term does not include an acquisition by
exchange, nonrecurring maintenance projects of the Department, or the
construction, alteration, or acquisition of a shared Federal medical
facility for which the Department's estimated share of the project
costs does not exceed $20,000,000.''.
SEC. 504. 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:
Construction of the new East Bay Community Based Outpatient Clinic and
all associated site work, utilities, parking, and landscaping,
construction of the Central Valley Engineering and Logistics support
facility, and enhanced flood plain mitigation at the Central Valley and
East Bay Community Based Outpatient Clinics as part of the 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
subsection (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 a
non-Department of Veterans Affairs Federal entity providing
management services relating to such project, including
reimbursement agreements and the costs to the Department for
such services.
SEC. 505. DEPARTMENT OF VETERANS AFFAIRS PERSONNEL TRANSPARENCY.
(a) Publication of Staffing and Vacancies.--
(1) Website required.--Subject to paragraph (2) and not
later than 90 days after the date of the enactment of this Act,
the Secretary of Veterans Affairs shall make publicly available
on an Internet website of the Department of Veterans Affairs
the following information, which shall, subject to subparagraph
(D), be displayed by departmental component or, in the case of
information relating to Veterans Health Administration
positions, by medical facility:
(A) The number of personnel encumbering positions.
(B) The number of accessions and separation actions
processed during the quarter preceding the date of the
publication of the information.
(C) The number of vacancies, by occupation.
(D) The percentage of new hires for the Department
who were hired within the time-to-hire target of the
Office of Personnel Management, disaggregated by
administration.
(2) Exceptions.--The Secretary may withhold from
publication under paragraph (1) information relating to law
enforcement, information security, or such positions in the
Department that the Secretary determines to be sensitive.
(3) Update of information.--The Secretary shall update the
information on the website required under paragraph (1) on a
quarterly basis.
(4) Treatment of contractor positions.--Any Department of
Veterans Affairs position that is filled with a contractor may
not be treated as a Department position for purposes of the
information required to be published under paragraph (1).
(5) Inspector general review.--On a semi-annual basis, the
Inspector General of the Department shall review the
administration of the website required under paragraph (1) and
make recommendations relating to the improvement of such
administration.
(b) Report to Congress.--The Secretary of Veterans Affairs shall
submit to Congress an annual report on the steps the Department is
taking to achieve full staffing capacity. Each such report shall
include the amount of additional funds necessary to enable the
Department to reach full staffing capacity.
SEC. 506. PROGRAM ON ESTABLISHMENT OF PEER SPECIALISTS IN PATIENT
ALIGNED CARE TEAM SETTINGS WITHIN MEDICAL CENTERS OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) Program Required.--The Secretary of Veterans Affairs shall
carry out a program to establish not fewer than two peer specialists in
patient aligned care teams at medical centers of the Department of
Veterans Affairs to promote the use and integration of services for
mental health, substance use disorder, and behavioral health in a
primary care setting.
(b) Timeframe for Establishment of Program.--The Secretary shall
carry out the program at medical centers of the Department as follows:
(1) Not later than May 31, 2019, at not fewer than 15
medical centers of the Department.
(2) Not later than May 31, 2020, at not fewer than 30
medical centers of the Department.
(c) Selection of Locations.--
(1) In general.--The Secretary shall select medical centers
for the program as follows:
(A) Not fewer than five shall be medical centers of
the Department that are designated by the Secretary as
polytrauma centers.
(B) Not fewer than 10 shall be medical centers of
the Department that are not designated by the Secretary
as polytrauma centers.
(2) Considerations.--In selecting medical centers for the
program under paragraph (1), the Secretary shall consider the
feasibility and advisability of selecting medical centers in
the following areas:
(A) Rural areas and other areas that are
underserved by the Department.
(B) Areas that are not in close proximity to an
active duty military installation.
(C) Areas representing different geographic
locations, such as census tracts established by the
Bureau of the Census.
(d) Gender-Specific Services.--In carrying out the program at each
location selected under subsection (c), the Secretary shall ensure
that--
(1) the needs of female veterans are specifically
considered and addressed; and
(2) female peer specialists are made available to female
veterans who are treated at each location.
(e) Engagement With Community Providers.--At each location selected
under subsection (c), the Secretary shall consider ways in which peer
specialists can conduct outreach to health care providers in the
community who are known to be serving veterans to engage with those
providers and veterans served by those providers.
(f) Reports.--
(1) Periodic reports.--
(A) In general.--Not later than 180 days after the
date of the enactment of this Act, and not less
frequently than once every 180 days thereafter until
the Secretary determines that the program is being
carried out at the last location to be selected under
subsection (c), the Secretary shall submit to Congress
a report on the program.
(B) Elements.--Each report required by subparagraph
(A) shall, with respect to the 180-day period preceding
the submittal of the report, include the following:
(i) The findings and conclusions of the
Secretary with respect to the program.
(ii) An assessment of the benefits of the
program to veterans and family members of
veterans.
(iii) An assessment of the effectiveness of
peer specialists in engaging under subsection
(e) with health care providers in the community
and veterans served by those providers.
(2) Final report.--Not later than 180 days after the
Secretary determines that the program is being carried out at
the last location to be selected under subsection (c), the
Secretary shall submit to Congress a report detailing the
recommendations of the Secretary as to the feasibility and
advisability of expanding the program to additional locations.
SEC. 507. DEPARTMENT OF VETERANS AFFAIRS MEDICAL SCRIBE PILOT PROGRAM.
(a) In General.--The Secretary of Veterans Affairs shall carry out
a 2-year pilot program under which the Secretary shall increase the use
of medical scribes at Department of Veterans Affairs medical centers.
(b) Locations.--The Secretary shall carry out the pilot program at
the 10 medical centers of the Department as follows:
(1) At least four such medical centers located in rural
areas.
(2) At least four such medical centers located in urban
areas.
(3) Two such medical centers located in areas with need for
increased access or increased efficiency, as determine by the
Secretary.
(c) Medical Scribes.--
(1) Hiring.--Under the pilot program the Secretary shall--
(A) hire 20 new Department of Veterans Affairs term
employees as medical scribes; and
(B) seek to enter into contracts with appropriate
entities for the employment of 20 additional medical
scribes.
(2) Distribution.--The Secretary shall assign four medical
scribes to each of the 10 medical centers of the Department
where the Secretary carries out the pilot program as follows:
(A) Two scribes shall be assigned to each of two
physicians.
(B) Thirty percent of the scribes shall be employed
in the provision of emergency care.
(C) Seventy percent of the scribes shall be
employed in the provision of speciality care in
specialties with the longest patient wait times or
lowest efficiency ratings, as determined by the
Secretary.
(d) Reports.--
(1) Reports to congress.--Not later than 180 days after the
commencement of the pilot program required under this section,
and every 180 days thereafter for the duration of the pilot
program, the Secretary of Veterans Affairs shall submit to
Congress a report on the pilot program. Each such report shall
include each of the following:
(A) A separate analysis of each the following with
respect to medical scribes employed by the Department
of Veterans Affairs and medical scribes performing
Department of Veterans Affairs functions under a
contract:
(i) Provider efficiency.
(ii) Patient satisfaction.
(iii) Average wait time.
(iv) The number of patients seen per day by
each physician or practitioner.
(v) The amount of time required to hire and
train an employee to perform medical scribe
functions under the pilot program.
(B) Metrics and data for analyzing the effects of
the pilot program, including an evaluation of the each
of the elements under clauses (i) through (iv) of
subparagraph (A) at medical centers who employed
scribes under the pilot program for an appropriate
period preceding the hiring of such scribes.
(2) Comptroller general report.--Not later than 90 days
after the termination of the pilot program under this section,
the Comptroller General of the United States shall submit to
Congress a report on the pilot program. Such report shall
include a comparison of the pilot program with similar programs
carried out in the private sector.
(e) Definitions.--In this section:
(1) The term ``medical scribe'' means an unlicensed
individual hired to enter information into the electronic
health record or chart at the direction of a physician or
licensed independent practitioner whose responsibilities
include the following:
(A) Assisting the physician or practitioner in
navigating the electronic health record.
(B) Responding to various messages as directed by
the physician or practitioner.
(C) Entering information into the electronic health
record, as directed by the physician or practitioner.
(2) The terms ``urban'' and ``rural'' have the meanings
given such terms under the rural-urban commuting codes
developed by the Secretary of Agriculture and the Secretary of
Health and Human Services.
(f) Funding.--The pilot program under this section shall be carried
out using amounts otherwise authorized to be appropriated for the
Department of Veterans Affairs. No additional amounts are authorized to
be appropriated to carry out such program.
SEC. 508. EXTENSION OF REQUIREMENT TO COLLECT FEES FOR HOUSING LOANS
GUARANTEED BY SECRETARY OF VETERANS AFFAIRS.
Section 3729(b)(2) of title 38, United States Code, is amended by
striking ``2027'' each place it appears and inserting ``2028''.
SEC. 509. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY
DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN VETERANS
COVERED BY MEDICAID PLANS FOR SERVICES FURNISHED BY
NURSING FACILITIES.
Section 5503(d)(7) of title 38, United States Code, is amended by
striking ``September 30, 2027'' and inserting ``September 30, 2028''.
SEC. 510. APPROPRIATION OF AMOUNTS.
(a) Veterans Choice Program.--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,
$5,200,000,000 to be deposited in the Veterans Choice Fund under
section 802 of the Veterans Access, Choice, and Accountability Act of
2014 (Public Law 113-146; 38 U.S.C. 1701 note).
(b) Availability of Amounts.--The amounts appropriated under
subsection (a) shall be available for obligation or expenditure without
fiscal year limitation.
SEC. 511. TECHNICAL CORRECTION.
Section 1712I of title 38, United States Code, is redesignated as
section 1720I of such title.
SEC. 512. BUDGETARY EFFECTS.
(a) Statutory Pay-As-You-Go Scorecards.--The budgetary effects of
this Act shall not be entered on either PAYGO scorecard maintained
pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.
(b) Senate PAYGO Scorecards.--The budgetary effects of this Act
shall not be entered on any PAYGO scorecard maintained for purposes of
section 4106 of H. Con. Res. 71 (115th Congress).
Attest:
Clerk.
115th CONGRESS
2d Session
S. 2372
_______________________________________________________________________
AMENDMENT