115 S2372 EAH: John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018
U.S. Senate
2018-05-16
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
115th CONGRESS2d Session
In the House of Representatives, U. S.,
May 16, 2018
AMENDMENT:
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 Strike out all after the enacting clause and insert:
1.Short title; table of contents
(a)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)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.
<enum>I</enum><header>Caring for our Veterans</header>
<section id="HAA7B1AADF25848D997A3E9C9BD509B5A" section-type="subsequent-section"><enum>100.</enum><header>Short title; references to title 38, United States Code</header>
<subsection id="HCD7360EC6E054ED7B97B22E5B42ED4BB"><enum>(a)</enum><header>Short title</header><text display-inline="yes-display-inline">This title may be cited as the <quote><short-title>Caring for Our Veterans Act of 2018</short-title></quote>.</text></subsection> <subsection id="H08C3DD11B3AE43C3A832A1768529559B"><enum>(b)</enum><header>References to title 38, United States Code</header><text>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.</text></subsection></section>
<subtitle id="H853EF59D943B41BE895ED535314D3640" style="OLC"><enum>A</enum><header>Developing an Integrated High-Performing Network</header>
<chapter id="H57FF4932D963474CBEDA3F849996DE5F" style="OLC"><enum>1</enum><header>Establishing Community Care Programs</header>
<section id="H7601288E964346DEBFF0C43987F2A174"><enum>101.</enum><header>Establishment of Veterans Community Care Program</header>
<subsection id="HF129C31076CB433AA4F78B457898FD92"><enum>(a)</enum><header>Establishment of program</header>
<paragraph id="H720D5C9330674106B4A66CB188127628"><enum>(1)</enum><header>In general</header><text><external-xref legal-doc="usc" parsable-cite="usc/38/1703">Section 1703</external-xref> is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H8FFF37090291476783415AB2EA8AD73F" style="USC"> <section id="H3F529EF22AB3461581A51546D2D65C04"><enum>1703.</enum><header>Veterans Community Care Program</header> <subsection id="H298CE92B3D3449DB9BB28A5F5E01A30D"><enum>(a)</enum><header>In general</header> <paragraph commented="no" display-inline="yes-display-inline" id="H27861D9C098B4D4389FAF4178518245A"><enum>(1)</enum><text>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).</text></paragraph>
<paragraph id="HFA45B21BFEEC42DAB4149D5A6DAD9367" indent="up1"><enum>(2)</enum><text>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:</text> <subparagraph id="H862D5E9F1C174ADBB3C95750D40F18F4"><enum>(A)</enum><text>Ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-Department providers.</text></subparagraph>
<subparagraph id="H6273776CCE584CC682AC70F6B72FBD46"><enum>(B)</enum><text>Ensuring continuity of care and services.</text></subparagraph> <subparagraph id="H359FD2112645474D9C6AD6A5548735E7"><enum>(C)</enum><text>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.</text></subparagraph>
<subparagraph id="HAA66A9F395B341E1B044FEE2E76D7354"><enum>(D)</enum><text>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.</text></subparagraph></paragraph> <paragraph id="H973E09D78CFF44CB89F2A1E7BB8DCB53" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">A covered veteran may only receive care or services under this section upon the authorization of such care or services by the Secretary.</text></paragraph></subsection>
<subsection id="H98A20D76850241678764F99C122B1681"><enum>(b)</enum><header>Covered veterans</header><text>For purposes of this section, a covered veteran is any veteran who—</text> <paragraph id="H83180E4A1E53458FAF949118142B3F57"><enum>(1)</enum><text>is enrolled in the system of annual patient enrollment established and operated under <external-xref legal-doc="usc" parsable-cite="usc/38/1705">section 1705</external-xref> of this title; or</text></paragraph>
<paragraph id="HB2D4B5E3B4CF41669A7DAC451AEABCE2"><enum>(2)</enum><text>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.</text></paragraph></subsection> <subsection id="H3ED708AB635B42CBB566DC1CA70DB578"><enum>(c)</enum><header>Health care providers specified</header><text>Health care providers specified in this subsection are the following:</text>
<paragraph id="H6F84B0A4ABE3448F9536F852F7B98961"><enum>(1)</enum><text>Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.), including any physician furnishing services under such a program.</text></paragraph> <paragraph id="HF5193FDD7BA445A5A68A1D7F46128016"><enum>(2)</enum><text>The Department of Defense.</text></paragraph>
<paragraph id="HEA112F06CF6A4C21AB8614AE041D1CF0"><enum>(3)</enum><text>The Indian Health Service.</text></paragraph> <paragraph id="H6F59B07FADEE48C9B61DA2E98FB28FB8"><enum>(4)</enum><text>Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(l)(2)(B)</external-xref>)).</text></paragraph>
<paragraph id="H4C22207BF24A43EC93FCE8B2AA85B6BC"><enum>(5)</enum><text>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.</text></paragraph></subsection> <subsection id="HD47E60662FB24BE9AFEDA695C0668953"><enum>(d)</enum><header>Conditions under which care is required To be furnished through non-Department providers</header> <paragraph commented="no" display-inline="yes-display-inline" id="H8BFBD19CE9AF42F58D515888C19021EE"><enum>(1)</enum><text>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—</text>
<subparagraph id="H14287C8160CD493AA7B3087C515A48FD" indent="up1"><enum>(A)</enum><text>the Department does not offer the care or services the veteran requires;</text></subparagraph> <subparagraph id="H7772126BD69042E4954A0FE6A915A612" indent="up1"><enum>(B)</enum><text>the Department does not operate a full-service medical facility in the State in which the covered veteran resides;</text></subparagraph>
<subparagraph id="H04B8071ABAE7410C8232F1F7669D8B56" indent="up1"><enum>(C)</enum>
<clause commented="no" display-inline="yes-display-inline" id="H25EA9841C183431797FC9F78406BF909"><enum>(i)</enum><text>the covered veteran was an eligible veteran under section 101(b)(2)(B) of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) as of the day before the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title>;</text></clause> <clause id="HBE46E56B5331488A9EBBB1780E411D6F" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">continues to reside in a location that would qualify the veteran for eligibility under such section; and</text></clause>
<clause id="H623F43CFF5FD4AF2B5522B24EEEA7C2F" indent="up1"><enum>(iii)</enum><text display-inline="yes-display-inline">either—</text> <subclause display-inline="no-display-inline" id="H9595F64004634ED6BCFF13E775DB7CCB"><enum>(I)</enum><text display-inline="yes-display-inline">resides in one of the five States with the lowest population density as determined by data from the 2010 decennial census; or</text></subclause>
<subclause display-inline="no-display-inline" id="H4B72AF38DB8D4A8B8139DFCA5C92468C"><enum>(II)</enum><text display-inline="yes-display-inline">resides in a State not described in subclause (I) and—</text> <item id="H04E26B26D37946A68A499365D0C97F8F"><enum>(aa)</enum><text display-inline="yes-display-inline">received care or services under this title in the year preceding the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title>; and</text></item>
<item id="H64079A7BF7344C508D2A7C7298F55B74"><enum>(bb)</enum><text display-inline="yes-display-inline">is seeking care or services within 2 years of the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title>;</text></item></subclause></clause></subparagraph> <subparagraph id="HBD973F3638C04A8281070707F0D0D4C0" indent="up1"><enum>(D)</enum><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc" parsable-cite="usc/38/1703B">section 1703B</external-xref> of this title; or</text></subparagraph>
<subparagraph id="HCBC850F3F193491EB827F09C92042DDD" indent="up1"><enum>(E)</enum><text>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.</text></subparagraph></paragraph> <paragraph id="H4FFBD3021CF646C2BD25EB757BAE9185" indent="up1"><enum>(2)</enum><text>The Secretary shall ensure that the criteria developed under paragraph (1)(E) include consideration of the following:</text>
<subparagraph id="HC2B422977EFD4DB3BC052A6FCFFDCEED"><enum>(A)</enum><text>The distance between the covered veteran and the facility that provides the hospital care, medical services, or extended care services the veteran needs.</text></subparagraph> <subparagraph id="H4E18275623484817A76446834D6B7A07"><enum>(B)</enum><text>The nature of the hospital care, medical services, or extended care services required.</text></subparagraph>
<subparagraph id="HAE85AE8DA189407D9ACE1AD76D1D21E5"><enum>(C)</enum><text>The frequency that the hospital care, medical services, or extended care services needs to be furnished.</text></subparagraph> <subparagraph id="HB6FA0D29F9EA4B77A2A845AD2D411EB7"><enum>(D)</enum><text display-inline="yes-display-inline">The timeliness of available appointments for the hospital care, medical services, or extended care services the veteran needs.</text></subparagraph>
<subparagraph id="HCC1683BF1A1946A58B58E4A5A3EDDF30"><enum>(E)</enum><text>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:</text> <clause id="HDD520985EC384409962E3C03CCDB851D"><enum>(i)</enum><text>Whether the covered veteran faces an excessive driving distance, geographical challenge, or environmental factor that impedes the access of the covered veteran.</text></clause>
<clause id="HED0F667367964A6E9FD5CA1C2A3D224E"><enum>(ii)</enum><text>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.</text></clause> <clause id="HCA30C2D6588142E087D7ABB6761C0B1F"><enum>(iii)</enum><text>Whether a medical condition of the covered veteran affects the ability of the covered veteran to travel.</text></clause>
<clause id="H0F7ED2A344C14FC1A2F1BE2996A09B48"><enum>(iv)</enum><text>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.</text></clause> <clause id="HEDAC13A4F25F43A6A5DCE6BF2753B3ED"><enum>(v)</enum><text>Such other considerations as the Secretary considers appropriate.</text></clause></subparagraph></paragraph>
<paragraph id="HC17809B2D56749F7B60E08BB91EE1561" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc" parsable-cite="usc/38/1703B">section 1703B</external-xref> 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.</text></paragraph></subsection> <subsection id="H48AD20C17EB24538B3CF09E09200458D"><enum>(e)</enum><header>Conditions under which care is authorized To be furnished through non-Department providers</header> <paragraph commented="no" display-inline="yes-display-inline" id="H17BFF4BCFE744585BE8B598D01B94FF7"><enum>(1)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="HFFF5FE2ED09B4748A6EE345FF365A633"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="HD012AC65651841CD82835ACDCB375C55" indent="up2"><enum>(B)</enum><text>In carrying out subparagraph (A), the Secretary shall—</text> <clause id="H62F9605209544E5E88B2D0CACD4C822D"><enum>(i)</enum><text>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</text></clause>
<clause id="H60499099E57644ADACB7C154FE96F680"><enum>(ii)</enum><text>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.</text></clause></subparagraph> <subparagraph id="H94CA2A60B894446DA96AA44812AA5A00" indent="up2"><enum>(C)</enum> <clause commented="no" display-inline="yes-display-inline" id="H806B76B4F3724FC38C277ED5A6473DA0"><enum>(i)</enum><text>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.</text></clause>
<clause id="H014F4E731F3E4FFBA6CB632EA59E0791" indent="up1"><enum>(ii)</enum><text>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.</text></clause></subparagraph></paragraph> <paragraph id="HD5902EA8F2CD4AA49198E58D6119908D" indent="up1"><enum>(2)</enum><text>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.</text></paragraph>
<paragraph id="H09E2E73CC6B94AF396C11050A513BAFE" indent="up1"><enum>(3)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H3D97AFBA54B24040884A93C9B13836E4"><enum>(A)</enum><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph id="HB2168E2C901B495CB21CCDF426CF7AE5" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph>
<paragraph id="H90AAA89797FF4A23B23644FA79074EE1" indent="up1"><enum>(4)</enum><text>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.</text></paragraph> <paragraph id="HB6C104D02B5F48279DBA81CEA3230B55" indent="up1"><enum>(5)</enum><text>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.</text></paragraph></subsection>
<subsection id="H2F78DABA79D34E4D803D495C3CC6A0B8"><enum>(f)</enum><header>Review of decisions</header><text>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.</text></subsection> <subsection id="HB1F001C41AD04499B6F6D663DDCE49B8"><enum>(g)</enum><header>Tiered network</header> <paragraph commented="no" display-inline="yes-display-inline" id="H15F6A47CB1EF45B58895B4E0B7C6AA36"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph id="H47C345E32FF84551A0E53A577C11B0B8" indent="up1"><enum>(2)</enum><text>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.</text></paragraph></subsection> <subsection id="HC7033B8C5915494E8ABA4DB621D1BB67"><enum>(h)</enum><header>Contracts To establish networks of health care providers</header> <paragraph commented="no" display-inline="yes-display-inline" id="HCB2A353B801C4406B3569C093093B919"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph id="H5060DA91958D41209425141DDF1C7C99" indent="up1"><enum>(2)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H536325813B2B404A963DB125231E96B9"><enum>(A)</enum><text>The Secretary shall, to the extent practicable, ensure that covered veterans are able to make their own appointments using advanced technology.</text></subparagraph> <subparagraph id="HDB3127C575DD411DB8752E588DC6777B" indent="up1"><enum>(B)</enum><text>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.</text></subparagraph></paragraph>
<paragraph id="HC0CFFCD16DAA42DE93348F19B6FA9573" indent="up1"><enum>(3)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H4E58F2BBBD7C48E294A3D5998AF206D5"><enum>(A)</enum><text>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—</text> <clause id="H7A66CE0F129C4E2F9D09FC16CE62E6ED" indent="up1"><enum>(i)</enum><text>the entity—</text>
<subclause id="H07F384182BD94AD0A5B93B8D01AEDE5A"><enum>(I)</enum><text>failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section;</text></subclause> <subclause id="H40B3CE25714440BF8B3F2A2AD4224368"><enum>(II)</enum><text>failed to comply with the access standards or the standards for quality established by the Secretary;</text></subclause>
<subclause id="H8F28376968F642AEBC14E528D5954785"><enum>(III)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1320a-7">42 U.S.C. 1320a–7</external-xref> and 1320a–7a);</text></subclause> <subclause id="H204640B923D84A199CC88C3B059BB5A5"><enum>(IV)</enum><text>is identified as an excluded source on the list maintained in the System for Award Management, or any successor system; or</text></subclause>
<subclause id="H919278B11F674CEEB59790769A4E5B94"><enum>(V)</enum><text>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;</text></subclause></clause> <clause id="H4E6E43A97DD6455F923455C69200852A" indent="up1"><enum>(ii)</enum><text>it is reasonable to terminate the contract based on the health care needs of veterans; or</text></clause>
<clause id="HE74E20DF0BB0406AA2FB14776D76D8F8" indent="up1"><enum>(iii)</enum><text>it is reasonable to terminate the contract based on coverage provided by contracts or sharing agreements entered into under authorities other than this section.</text></clause></subparagraph> <subparagraph id="HE84B8F7BDF1A40C79A766C7A577261BD" indent="up1"><enum>(B)</enum><text>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.</text></subparagraph></paragraph>
<paragraph id="H477BF6821DE5440392E47E5AAAA5B875" indent="up1"><enum>(4)</enum><text>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:</text> <subparagraph id="H9169A71BD5B848A283EDC082E05AFAE9"><enum>(A)</enum><text>An explanation of the reasons for providing such notice.</text></subparagraph>
<subparagraph id="HE9E9BCED65A24743B4013851688A7A76"><enum>(B)</enum><text>A description of the effect of such failure, including with respect to cost, schedule, and requirements.</text></subparagraph> <subparagraph id="HD191C221AEFC4169A42D0A21DE883C8C"><enum>(C)</enum><text>A description of the actions taken by the Secretary to mitigate such failure.</text></subparagraph>
<subparagraph id="HFCF4A80CAB9E466FB52405616293E73D"><enum>(D)</enum><text>A description of the actions taken by the contractor to address such failure.</text></subparagraph> <subparagraph id="HD4910C125F004C2AAEB9684698817BCA"><enum>(E)</enum><text>A description of any effect on the community provider market for veterans in the affected area.</text></subparagraph></paragraph>
<paragraph id="H00729360147A4F9E9F24C987C02F1B99" indent="up1"><enum>(5)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H70CBFC557B3B4084A630652F9D8D63E9"><enum>(A)</enum><text>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 <short-title>Caring for Our Veterans Act of 2018</short-title>, 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 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note), as qualified providers under the program established under this section.</text></subparagraph> <subparagraph id="HB86B847E23AF48B5ABF5A19C3BD7D59C" indent="up1"><enum>(B)</enum><text>The interim acceptance period under subparagraph (A) shall be determined by the Secretary based on the following criteria:</text>
<clause id="H651D1F6244984866B005EEC494C82E4A"><enum>(i)</enum><text>With respect to a health care provider, when the current certification agreement for the health care provider expires.</text></clause> <clause id="H097C0786B1E04965922B00E031A896C5"><enum>(ii)</enum><text>Whether the Department has enacted certification and eligibility criteria and regulatory procedures by which non-Department providers will be authorized under this section.</text></clause></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H234C33CBBC7541B18BE7A7D09EF7822F" indent="up1"><enum>(6)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection commented="no" id="HDD6008C3E40B475E95DA523AEBF73D50"><enum>(i)</enum><header>Payment rates for care and services</header> <paragraph commented="no" display-inline="yes-display-inline" id="H29420BA378A2474A80DF2FABABFE04CC"><enum>(1)</enum><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(u)</external-xref>)) or a supplier (as defined in section 1861(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(d)</external-xref>)) under the Medicare program under title XI or title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1301">42 U.S.C. 1301</external-xref> et seq.), including section 1834 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m</external-xref>), for the same care or services.</text></paragraph>
<paragraph commented="no" id="HF821587446FF458B8F48EC87AF047106" indent="up1"><enum>(2)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H5097525A479B433A9F93725FE0974E70"><enum>(A)</enum><text>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.</text></subparagraph> <subparagraph commented="no" id="H8A3716BCF5A647609A709C99EFEF82A3" indent="up1"><enum>(B)</enum><text>In this paragraph, the term <term>highly rural area</term> means an area located in a county that has fewer than seven individuals residing in that county per square mile.</text></subparagraph></paragraph>
<paragraph commented="no" id="H45F6ABCD2A304743B32BC750AB0E2B2E" indent="up1"><enum>(3)</enum><text>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.</text></paragraph> <paragraph commented="no" id="H26D64D35618A41D08B63F39797222E9C" indent="up1"><enum>(4)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395f">42 U.S.C. 1395f(b)(3)</external-xref>) 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.</text></paragraph>
<paragraph commented="no" id="HD22EACC630954911857D84319CA36998" indent="up1"><enum>(5)</enum><text>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.</text></paragraph> <paragraph commented="no" id="H8AE00EC927F3451785FE7A2E3922769F" indent="up1"><enum>(6)</enum><text>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.</text></paragraph></subsection>
<subsection id="HFE62D46EC7024D35B540F617B8989B16"><enum>(j)</enum><header>Treatment of other health plan contracts</header><text>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 <external-xref legal-doc="usc" parsable-cite="usc/38/1729">section 1729</external-xref> 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.</text></subsection> <subsection id="H31E4A05952084145BB98A170FAAD5D23"><enum>(k)</enum><header>Payment by veteran</header><text>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.</text></subsection>
<subsection id="H3F1329CEB84945A4BF4619BB192F496C"><enum>(l)</enum><header>Transplant authority for improved access</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H4D21EF14DEB74A3FAF3C6D0FC8333C9D"><enum>(1)</enum><text>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.</text></paragraph> <paragraph id="H6EA2A336ADEB4205BA8118EE57705BAC" indent="up1"><enum>(2)</enum><text>A covered veteran described in this paragraph—</text>
<subparagraph id="H7EFCF9B118B7420C948346AF5FDEAA87"><enum>(A)</enum><text display-inline="yes-display-inline">requires an organ or bone marrow transplant; and</text></subparagraph> <subparagraph id="H2EB08E6CCD7C4A5A87E9A53D1FC0FD18"><enum>(B)</enum><text display-inline="yes-display-inline">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 (<external-xref legal-doc="public-law" parsable-cite="pl/98/507">Public Law 98–507</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/42/274">42 U.S.C. 274</external-xref>), in which the veteran resides, to receive such transplant.</text></subparagraph></paragraph></subsection>
<subsection id="HC4EEDF25786D4F3A9D1A7355D9B1922F"><enum>(m)</enum><header>Monitoring of care provided</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HFDDB8F6EE8A14BE48ED9AAAAC92D632C"><enum>(1)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H26516DFE3B864D758DBF55D5D3AE4302"><enum>(A)</enum><text>Not later than 540 days after the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title>, 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).</text></subparagraph> <subparagraph id="H4F2E29E7682C4FDD86402746B20BCACD" indent="up2"><enum>(B)</enum><text>The review submitted under subparagraph (A) shall include an assessment of the following:</text>
<clause commented="no" id="HBF003CD4DD574D629F06EC57D0E306FD"><enum>(i)</enum><text>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.</text></clause> <clause id="HBA8F644D7F2348E5A6D2EE8F860AF470"><enum>(ii)</enum><text>The frequency such care and services were sought by covered veterans under this section.</text></clause>
<clause id="H75E7A23D85954170A1E3CB91DE6FA3F5"><enum>(iii)</enum><text>An analysis of the reasons the Department was unable to provide such care and services.</text></clause> <clause id="HE75B7F0B832846AEAE653FC8571D1CF0"><enum>(iv)</enum><text>Any steps the Department took to provide such care and services at a medical facility of the Department.</text></clause>
<clause id="H8AB921B593264008A54CF26A8B3FC309"><enum>(v)</enum><text>The cost of such care and services.</text></clause></subparagraph></paragraph> <paragraph id="H9DEBE497B3A940DB81B2022C9F630D78" indent="up1"><enum>(2)</enum><text>In monitoring the hospital care, medical services, and extended care services furnished under this section, the Secretary shall do the following:</text>
<subparagraph id="HEC5662A1D610406DB12149F54F0D7E37"><enum>(A)</enum><text>With respect to hospital care, medical services, and extended care services furnished through provider networks established under subsection (i)—</text> <clause id="H688E2CBA127441FCA5AD9744AE6617DF"><enum>(i)</enum><text>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;</text></clause>
<clause id="HB1A5A72B66C6447F929C84B19B2CA312"><enum>(ii)</enum><text>identify gaps in hospital care, medical services, or extended care services furnished through such networks;</text></clause> <clause id="H1B307763C0854EDABDF0AC0DC1931A51"><enum>(iii)</enum><text>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;</text></clause>
<clause id="HEFDB30B1051B4A668F283128BFCCE179"><enum>(iv)</enum><text>assess the total amounts spent by the Department on hospital care, medical services, and extended care services furnished through such networks;</text></clause> <clause id="H6C821CC226DB4BEE8E488A95232EA577"><enum>(v)</enum><text>assess the timeliness of the Department in referring hospital care, medical services, and extended care services to such networks; and</text></clause>
<clause id="H4E95A13ADCC1437B9F5D1A6252C3FDDD"><enum>(vi)</enum><text>assess the timeliness of such networks in—</text> <subclause id="H2CF45575D75144BFBE34ABF03C82618F"><enum>(I)</enum><text>accepting referrals; and</text></subclause>
<subclause id="H46C3E1D45DB84CE3A1938C7203742D49"><enum>(II)</enum><text>scheduling and completing appointments.</text></subclause></clause></subparagraph> <subparagraph id="HB1AF49F8D5024EBD93D02E5B483D039F"><enum>(B)</enum><text>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.</text></subparagraph>
<subparagraph id="H8E6F7889F3214744B5C8938D2310B9E3"><enum>(C)</enum><text>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.</text></subparagraph> <subparagraph id="H71E260E0141D4097B636A7B16634A219"><enum>(D)</enum><text>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.</text></subparagraph></paragraph>
<paragraph id="HAFC3C058DFF24690A67AE1A9148261E4" indent="up1"><enum>(3)</enum><text>Not later than 540 days after the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title> 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).</text></paragraph></subsection> <subsection commented="no" id="HE969678C20644D88B14CEF07CD733C3C"><enum>(n)</enum><header>Prohibition on certain limitations</header> <paragraph commented="no" display-inline="yes-display-inline" id="H10D9861B4DED4C6A8CAD7B46401D0165"><enum>(1)</enum><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="H1C51E77D178C468393C3FF1B598F3474" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="HA9F99B7D685B47A58A9959B20FD93A88"><enum>(o)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H0FE7927102E14898BB11869E47790EBA"><enum>(1)</enum><text>The term <term>appropriate committees of Congress</term> means—</text> <subparagraph id="HF6F5824C1BDB4B06A9B5EA52318C20FE"><enum>(A)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</text></subparagraph>
<subparagraph id="HA316C97780664CFB848CB47363EAC7C1"><enum>(B)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</text></subparagraph></paragraph> <paragraph id="HE9B8471949854FF39D7060E55D2C015E"><enum>(2)</enum><text>The term <term>medical service line</term> means a clinic within a Department medical center.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph id="H66DC8CCCAC854D38BDC2C3243ABEF2EF"><enum>(2)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> is amended by striking the item relating to section 1703 and inserting the following new item:</text> <quoted-block display-inline="no-display-inline" id="H1B3E546AA81F4D2DB752E32B8240FB37" style="OLC"> <toc> <toc-entry bold="off" level="section">1703. Veterans Community Care Program.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="H0BDA80E1383D453FB761059CA9025492"><enum>(b)</enum><header>Effective date</header><text>Section 1703 of title 38, United States Code, as amended by subsection (a), shall take effect on the later of—</text>
<paragraph id="HDAF8B64260854ECD9B88419356E0463D"><enum>(1)</enum><text>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 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note); or</text></paragraph> <paragraph id="H6F798C2F3611454FAC0112C6F211CA00"><enum>(2)</enum><text>the date on which the Secretary promulgates regulations pursuant to subsection (c).</text></paragraph></subsection>
<subsection id="H7174B6B79A0B42D0AEE5C3F8FC1475FC"><enum>(c)</enum><header>Regulations</header>
<paragraph commented="no" display-inline="no-display-inline" id="H131C248A4DB041B781BE6D8494612CC4"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph display-inline="no-display-inline" id="H00457D5B43424568A704F996629CA832"><enum>(2)</enum><header>Updates</header> <subparagraph display-inline="no-display-inline" id="HF9EC236DC2694EF2907FDBC13C090163"><enum>(A)</enum><header>Periodic</header><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph display-inline="no-display-inline" id="H09452E2A081444879E6692E2B67E9874"><enum>(B)</enum><header>First update</header><text display-inline="yes-display-inline">The first update under subparagraph (A) shall occur no later than 120 days from the date of the enactment of this Act.</text></subparagraph> <subparagraph id="HF62EE3C13D694753A4BB42F915FD8B1B"><enum>(C)</enum><header>Appropriate committees of Congress defined</header><text display-inline="yes-display-inline">In this paragraph, the term <term>appropriate committees of Congress</term> means—</text>
<clause id="H72D33AD43F2142A489F1FBDE17BA8892"><enum>(i)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</text></clause> <clause id="H96284B6FF34C4D40956443E5D41765B4"><enum>(ii)</enum><text display-inline="yes-display-inline">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</text></clause></subparagraph></paragraph></subsection>
<subsection id="HFE958AC0A5B64D25AC030160D3C9DE3D"><enum>(d)</enum><header>Continuity of existing agreements</header>
<paragraph id="H8FA7922F8E464F1BB52B355771F8A2B4"><enum>(1)</enum><header>In general</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/25/1645">25 U.S.C. 1645</external-xref>), and agreements entered into under sections 102 and 103 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>).</text></paragraph> <paragraph id="H674B8BD142DA447CA2474B7C844CD00B"><enum>(2)</enum><header>Modifications</header><text>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.</text></paragraph></subsection></section>
<section id="H23832D2BD85B4D2CA4E3D513CBC67D95"><enum>102.</enum><header>Authorization of agreements between Department of Veterans Affairs and non-Department providers</header>
<subsection id="HE6F3196F54E541E98F291A4FFD608065"><enum>(a)</enum><header>In general</header><text>Subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> is amended by inserting after section 1703 the following new section:</text> <quoted-block display-inline="no-display-inline" id="H509B1D577040422093C49513C1571200" style="USC"> <section id="H0D93E1AFAD5A42138D4F72394DF0CD4D"><enum>1703A.</enum><header>Agreements with eligible entities or providers; certification processes</header> <subsection id="H078A011570AD4AACB45B913206F6ED37"><enum>(a)</enum><header>Agreements authorized</header> <paragraph commented="no" display-inline="yes-display-inline" id="H22A152A9EC6D4DF3A4F4187A962DD675"><enum>(1)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="H67499725FC4A4860866648F93365C915"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="H9F1336200E3F4891A19F75CA8A97E736" indent="up2"><enum>(B)</enum><text>An agreement entered into under this section to provide hospital care, a medical service, or an extended care service shall be known as a <quote>Veterans Care Agreement</quote>.</text></subparagraph> <subparagraph id="H84C9765D80FE49C2BB11B63AD01C3C4C" indent="up2"><enum>(C)</enum><text>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.</text></subparagraph>
<subparagraph id="H546A8EAC3E364FFCB005225D4719E3B8" indent="up2"><enum>(D)</enum><text>A Veterans Care Agreement may be entered into by the Secretary or any Department official authorized by the Secretary.</text></subparagraph></paragraph> <paragraph id="H1387E6783A7E45968F4DBD33407A0F54" indent="up1"><enum>(2)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="H96775A7F95964A778B3C01698DEDA99F"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="HEC3424F67D56415589A6E09E009F8C35" indent="up1"><enum>(B)</enum>
<clause commented="no" display-inline="yes-display-inline" id="H760B3A81DCF24DC9BD7A85AD6E22A4DC"><enum>(i)</enum><text>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.</text></clause> <clause id="HD5107ADC5DC240068F63A1E782F9379A" indent="up1"><enum>(ii)</enum><text>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).</text></clause></subparagraph></paragraph>
<paragraph id="HF1979F5F0A6B4825B4A5E2B5AA0AE690" indent="up1"><enum>(3)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H36139C72E9404A0F8688369A7D48635A"><enum>(A)</enum><text>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.</text></subparagraph> <subparagraph id="H19EE6FD08036490EB02D925779C4FC53" indent="up1"><enum>(B)</enum><text>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.</text></subparagraph></paragraph></subsection>
<subsection id="H1FA595C7153245B280DC1A76F6426E59"><enum>(b)</enum><header>Eligible entities and providers</header><text>For purposes of this section, an eligible entity or provider is—</text> <paragraph id="H7B18428E192D40BB98659640C46A99AD"><enum>(1)</enum><text>any provider of services that has enrolled and entered into a provider agreement under section 1866(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)</external-xref>) and any physician or other supplier who has enrolled and entered into a participation agreement under section 1842(h) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395u">42 U.S.C. 1395u(h)</external-xref>);</text></paragraph>
<paragraph id="H02C73DBBF50949B2B42D877D8B59B746"><enum>(2)</enum><text>any provider participating under a State plan under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.);</text></paragraph> <paragraph id="H623015E6A35140A18A12881DC211B78E"><enum>(3)</enum><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/42/3002">42 U.S.C. 3002</external-xref>));</text></paragraph>
<paragraph id="HA25EEC33BE8446E8AD0A8FEA4B69ECFC"><enum>(4)</enum><text>a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (<external-xref legal-doc="usc" parsable-cite="usc/29/796a">29 U.S.C. 796a</external-xref>)); or</text></paragraph> <paragraph id="HF2EED07478494A96A2FF27EECCCDB754"><enum>(5)</enum><text>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).</text></paragraph></subsection>
<subsection id="H95B7858FE6DA4093B863EBF29DF9A168"><enum>(c)</enum><header>Eligible entity or provider certification process</header><text>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—</text> <paragraph id="H7E8551B700DB41B3B622D742FF844CB4"><enum>(1)</enum><text>establish deadlines for actions on applications for certification;</text></paragraph>
<paragraph id="HE7864AC598784A7DBF02570BD28DB6AD"><enum>(2)</enum><text>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;</text></paragraph> <paragraph id="HC05310B889E1433C86A5BFC2AAC489ED"><enum>(3)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1320a-7">42 U.S.C. 1320a–7</external-xref> 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;</text></paragraph>
<paragraph id="HEBD011DF353F4030B038029BF4E6E25C"><enum>(4)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(j)(2)(B)</external-xref>) and section 9.104 of title 48, Code of Federal Regulations, or successor regulations; and</text></paragraph> <paragraph id="HB8513DF26E894BECA18BD91FC5CDABCA"><enum>(5)</enum><text>incorporate and apply the restrictions and penalties set forth in <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/41/21">chapter 21</external-xref> of title 41 and treat this section as a procurement program only for purposes of applying such provisions.</text></paragraph></subsection>
<subsection id="H69FBE4B66E3C4F07A352B0E46A9E7383"><enum>(d)</enum><header>Rates</header><text>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 <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703(i)</external-xref> of this title.</text></subsection> <subsection id="HC2945B094C5E414388B14DAF3BB634C9"><enum>(e)</enum><header>Terms of Veterans Care Agreements</header> <paragraph commented="no" display-inline="yes-display-inline" id="H024A9C1B3C5F4DCDAB5FDD5C424420AA"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph id="HC0E2D14C955C404393F3F04F5DC13BA6" indent="up1"><enum>(2)</enum><text>To furnish hospital care, medical services, or extended care services under this section, an eligible entity or provider shall agree—</text> <subparagraph id="H299BC1572F03429680A1D2D2DB769EAA"><enum>(A)</enum><text>to accept payment at the rates established in regulations prescribed under this section;</text></subparagraph>
<subparagraph id="H2CB5F6F60F3A408B8B71E781B14861C4"><enum>(B)</enum><text>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;</text></subparagraph> <subparagraph id="H30B2E0A6D38F49DEAD114B8A3CCBCCB6"><enum>(C)</enum><text>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;</text></subparagraph>
<subparagraph id="H46B86A5F1BB14E9E98F71C67E15A1A2D"><enum>(D)</enum><text>to bill the Department in accordance with the methodology outlined in regulations prescribed under this section;</text></subparagraph> <subparagraph id="H50A879320D6948D8BC89B515EA258569"><enum>(E)</enum><text>to not seek to recover or collect from a health plan contract or third party, as those terms are defined in <external-xref legal-doc="usc" parsable-cite="usc/38/1729">section 1729</external-xref> of this title, for any care or service that is furnished or paid for by the Department;</text></subparagraph>
<subparagraph id="H24B7746FE05647BF9DEC3C46386FDB19"><enum>(F)</enum><text>to provide medical records to the Department in the time frame and format specified by the Department; and</text></subparagraph> <subparagraph id="HBAC5EC2608EC4FF89A45D079E26CCEE5"><enum>(G)</enum><text>to meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify in regulation.</text></subparagraph></paragraph></subsection>
<subsection id="H7BC4EE1782254CFA92D82270843F204D"><enum>(f)</enum><header>Discontinuation or nonrenewal of a Veterans Care Agreement</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H02999AE3ED4640B3961AB7882F680844"><enum>(1)</enum><text>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.</text></paragraph> <paragraph id="HC57DDA8DFAAC4AF49C25D5EA6AA292E2" indent="up1"><enum>(2)</enum><text>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—</text>
<subparagraph id="H30E3B07B9A7049F297879F53CBD6E89C"><enum>(A)</enum><text>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;</text></subparagraph> <subparagraph id="HF243D53C2FA940758EA6D3006815D429"><enum>(B)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1320a-7">42 U.S.C. 1320a–7</external-xref> 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;</text></subparagraph>
<subparagraph id="H970339E7728649ACA750B1768EA59B83"><enum>(C)</enum><text>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</text></subparagraph> <subparagraph id="H49B107385CB9464997755B007A7FD0C5"><enum>(D)</enum><text>has determined that it is reasonable to terminate the agreement based on the health care needs of a veteran.</text></subparagraph></paragraph></subsection>
<subsection id="H718030E23B6B4C4FACA6919660CB320F"><enum>(g)</enum><header>Quality of care</header><text>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.</text></subsection> <subsection id="H7142BF7E8B164472A0005F301ED88348"><enum>(h)</enum><header>Disputes</header> <paragraph commented="no" display-inline="yes-display-inline" id="H1962E5FFEB9E470286F9FEB53653A975"><enum>(1)</enum><text>The Secretary shall promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to Veterans Care Agreements.</text></paragraph>
<paragraph id="H2AD1F5D7D4A74FF0B41D1E577256DA20" indent="up1"><enum>(2)</enum><text>Such procedures constitute the eligible entities’ and providers’ exhaustive and exclusive administrative remedies.</text></paragraph> <paragraph id="HC84EAFACE835420EB78EC36CB127716F" indent="up1"><enum>(3)</enum><text>Eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under section 1346 of title 28 (known as the <quote>Tucker Act</quote>).</text></paragraph>
<paragraph id="H0F7029AB1AD74C93ADCDB261DFECFA81" indent="up1"><enum>(4)</enum><text>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.</text></paragraph></subsection> <subsection id="HA95D48AF856646A89546108484FAB8C4"><enum>(i)</enum><header>Applicability of other provisions of law</header> <paragraph commented="no" display-inline="yes-display-inline" id="HFFC31D4B427D472290962DD812775B16"><enum>(1)</enum><text>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—</text>
<subparagraph id="H164531914E304F488E2D11E09210FD58" indent="up1"><enum>(A)</enum><text>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</text></subparagraph> <subparagraph commented="no" id="H2C859D6CB7194F8CA2ECCF44D55C6BE3" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph>
<paragraph id="HF0E2D61279F349DE83EA34FBB3487F1D" indent="up1"><enum>(2)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H4599E50490774F3AA8BBF3F7BB65F144"><enum>(A)</enum><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.) are not subject.</text></subparagraph> <subparagraph id="HF5F8ADA0796D41A0B8D4616B32C6FFA9" indent="up1"><enum>(B)</enum><text>An eligible entity or provider that enters into an agreement under this section is subject to—</text>
<clause id="HE4D560EA416B4B01BF426D8471EC23C0"><enum>(i)</enum><text>all laws regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties; and</text></clause> <clause id="HC9361C437F4A4459849B5A48E41ABC48"><enum>(ii)</enum><text>all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities.</text></clause></subparagraph></paragraph>
<paragraph id="HAA5A6BA5B9844B37BBE39EA04701E53A" indent="up1"><enum>(3)</enum><text>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 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/41/67">chapter 67</external-xref> of title 41 (commonly known as the <quote>McNamara-O'Hara Service Contract Act of 1965</quote>).</text></paragraph></subsection> <subsection id="H7E020F48E63D42F2B288FA7DDDC908EC"><enum>(j)</enum><header>Parity of treatment</header><text>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.</text></subsection>
<subsection id="HCF411EB895D84A16A678154268140411"><enum>(k)</enum><header>Rulemaking</header><text>The Secretary shall promulgate regulations to carry out this section.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HEAC91C16039B49CBB6F6A70C8C00C8A5"><enum>(b)</enum><header>Clerical amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="HF5730128605F462B96368AF80ED87A14" style="OLC">
<toc>
<toc-entry bold="off" level="section">1703A. Agreements with eligible entities or providers; certification processes.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section id="H6D8FFD788255475E9CA515601178AB4F"><enum>103.</enum><header>Conforming amendments for State veterans homes</header>
<subsection id="H8265FDA39A32467F8E19604F1C0EE9DD"><enum>(a)</enum><header>In general</header><text><external-xref legal-doc="usc" parsable-cite="usc/38/1745">Section 1745(a)</external-xref> is amended—</text> <paragraph id="HFACA6C90D6704313BACF55183930D571"><enum>(1)</enum><text>in paragraph (1), by striking <quote>(or agreement under <external-xref legal-doc="usc" parsable-cite="usc/38/1720">section 1720(c)(1)</external-xref> of this title)</quote> and inserting <quote>(or an agreement)</quote>; and</text></paragraph>
<paragraph id="HE05AEFEF7BA84F8A9DFB73DC20A0867C"><enum>(2)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block display-inline="no-display-inline" id="H754ED2018022451FB201D0EAC9963B50" style="OLC"> <paragraph id="H5E547EBFBFCE43169913DC34317FE9DD" indent="up1"><enum>(4)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="H47F18489FD3E4E898F5923D876861E98"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="H8CCFCFFF5D294D2A9B4477A4239E01E9" indent="up1"><enum>(B)</enum>
<clause commented="no" display-inline="yes-display-inline" id="H8DA323DD8094458DB5C2B49999FD6635"><enum>(i)</enum><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.) are not subject.</text></clause> <clause id="H76CB141EDD1A4D26AEA83F4958A57796" indent="up1"><enum>(ii)</enum><text>A State home that enters into an agreement under this section is subject to—</text>
<subclause id="H574698ECE6394BC58382028075712BD4"><enum>(I)</enum><text>all provisions of law regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties;</text></subclause> <subclause id="H2AE46389A1954AEEBE256959483B6C88"><enum>(II)</enum><text>all provisions of law that protect against employment discrimination or that otherwise ensure equal employment opportunities; and</text></subclause>
<subclause id="HFF883866949248BBB474138FEBD52FF4"><enum>(III)</enum><text display-inline="yes-display-inline">all provisions in subchapter V of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of this title.</text></subclause></clause> <clause id="H1137433A98AA400DBC0C75648CFCB498" indent="up1"><enum>(iii)</enum><text>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 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/41/67">chapter 67</external-xref> of title 41 (known as the <quote>McNamara-O’Hara Service Contract Act of 1965</quote>).</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H91F8B370BFDC4B8D987DCB7DCAFE9D2B"><enum>(b)</enum><header>Effective date</header><text>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.</text></subsection></section> <section id="HB560F3C0B6F44A52828E72248E45B7EB"><enum>104.</enum><header>Access standards and standards for quality</header> <subsection id="H2D17184FAA9E4AC186E966EF0BA8234E"><enum>(a)</enum><header>In general</header><text>Subchapter I of chapter 17, as amended by section 102, is further amended by inserting after section 1703A the following new sections:</text>
<quoted-block display-inline="no-display-inline" id="H850FF47B20F741A69CDC2390147B2FE8" style="USC">
<section commented="no" id="HE3856ED3D68B425E81A5A8682D84060A"><enum>1703B.</enum><header>Access standards</header>
<subsection id="H3214235F5A3A47DE9A29DCEB34585394"><enum>(a)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="HF571C4CE68264A17B6F15E0832BC3DC2"><enum>(1)</enum><text display-inline="yes-display-inline">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).</text></paragraph> <paragraph id="HF4D2F8DA94094D66AA0A61A0EEA78DFB" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection>
<subsection id="HC62A569FE6EC4455846F56C0CDDF7A80"><enum>(b)</enum><text>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.</text></subsection> <subsection id="HBDC76EDDA5674E15BA4BF15B0819686D"><enum>(c)</enum><text>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.</text></subsection>
<subsection id="H6F9FC47F9B484FE7ADD8222B55C44BB0"><enum>(d)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="HDC06DCEFD1E1444F8BE30918C72EDB3C"><enum>(1)</enum><text>Not later than 270 days after the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title>, the Secretary shall submit to the appropriate committees of Congress a report detailing the access standards.</text></paragraph> <paragraph id="H31F420F02BA940218C73C9A205AC584B" indent="up1"><enum>(2)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="HE4256262C269471FA2447B380D700599"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="HC36366D771A548599AC9FE0AF44CB689" indent="up1"><enum>(B)</enum><text>The first update under subparagraph (A) shall occur no later than 120 days from the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title>.</text></subparagraph></paragraph> <paragraph id="H72A379E0F4BF46EE9781D7D0BE3F754E" indent="up1"><enum>(3)</enum><text>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.</text></paragraph></subsection>
<subsection id="H6D919BE0F53540ED9EBE68B2EB62AC0E"><enum>(e)</enum><text>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—</text> <paragraph id="H6FC077C9617B43FC8D303DE68973115E"><enum>(1)</enum><text>conduct a review of such standards; and</text></paragraph>
<paragraph id="H6B9FE234828D4681B03A8BED1F1D7E32"><enum>(2)</enum><text>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).</text></paragraph></subsection> <subsection id="H5E3BD8AB2A664ACE8E229A19C232CE89"><enum>(f)</enum><text>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.</text></subsection>
<subsection id="H116FE707676D48759F64B717271730C9"><enum>(g)</enum><text>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).</text></subsection> <subsection id="H07159027182F476CB53ED629E6FF26D3"><enum>(h)</enum> <paragraph commented="no" display-inline="yes-display-inline" id="H418478EA8D06494A9350F4B82C763399"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph id="HD1A656056A434FE59438A5D5283206C1" indent="up1"><enum>(2)</enum><text>The Secretary shall establish a process to review such requests from covered veterans to determine whether—</text> <subparagraph id="HF4AE8DF6A6524CC898D4CCAEA3EE8797"><enum>(A)</enum><text>the requested care is clinically necessary; and</text></subparagraph>
<subparagraph id="H1E3794FBD5764069AE33658F52307EB6"><enum>(B)</enum><text>the Department is able to provide such care in a manner that complies with designated access standards established under this section.</text></subparagraph></paragraph> <paragraph id="H69AB9DDF089A43178A3AD20BDD31EFA6" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">The Secretary shall promptly respond to any such request by a covered veteran.</text></paragraph></subsection>
<subsection id="HA53F7B225E8449B7BDB8ED6338EA6145"><enum>(i)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="H06064CDC7E1845AD9A08B198C44736A3"><enum>(1)</enum><text>The term <term>appropriate committees of Congress</term> means—</text> <subparagraph id="HDB57E9EA6E0C4FA28E856ABDF7060F75" indent="up1"><enum>(A)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</text></subparagraph>
<subparagraph id="HBE5BF2B375104310AADE29B0E586E61B" indent="up1"><enum>(B)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</text></subparagraph></paragraph> <paragraph id="H6814AF0835B54FBA9CE5A8AA93169292" indent="up1"><enum>(2)</enum><text>The term <term>covered veterans</term> refers to veterans described in <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703(b)</external-xref> of this title.</text></paragraph></subsection></section>
<section commented="no" id="H403F5F2D0ED64EF094FA6A2AA1C8E6BB"><enum>1703C.</enum><header>Standards for quality</header>
<subsection commented="no" id="HC1A01AF45FDC4A7C977553E263DFE2BE"><enum>(a)</enum><header>In general</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H4300BA55C208446DB4C4D95119525088"><enum>(1)</enum><text>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 <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703</external-xref> of this title.</text></paragraph> <paragraph commented="no" id="H28D2C9E0B0E945EE802D00DB3F76FE39" indent="up1"><enum>(2)</enum><text>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.</text></paragraph>
<paragraph commented="no" id="H45BEA15C5DE94765A5324AB288D886B1" indent="up1"><enum>(3)</enum><text>The Secretary shall collect and consider data for purposes of establishing the standards under paragraph (1). Such data collection shall include—</text> <subparagraph commented="no" id="H9C8ACDD27CEC4CE78E88EB28D5811218"><enum>(A)</enum><text>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</text></subparagraph>
<subparagraph commented="no" id="HC1B7C9B3069E4D81BC27E95BE71B984B"><enum>(B)</enum><text>datasets that include, at a minimum, elements relating to the following:</text> <clause commented="no" id="HDFBBE68A20634A0DB14676658DB214F5"><enum>(i)</enum><text>Timely care.</text></clause>
<clause commented="no" id="HBA41E96E7D434E7FA19DCC692FF7A145"><enum>(ii)</enum><text>Effective care.</text></clause> <clause commented="no" id="HCAD0B124E5E2493CB731005E260756E5"><enum>(iii)</enum><text>Safety, including, at a minimum, complications, readmissions, and deaths.</text></clause>
<clause commented="no" id="HADE8BCFE7F984B7A8EF5039E9DBFF88C"><enum>(iv)</enum><text>Efficiency.</text></clause></subparagraph></paragraph> <paragraph id="H5DDE09A2B93445809316065233CAB9DF" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="H25395C3C0D3D4E4D96530EEF52DABC1D" indent="up1"><enum>(5)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="HF4AF757943784ED680A1CE5DC4E9877A"><enum>(A)</enum><text display-inline="yes-display-inline">Not later than 270 days after the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title>, the Secretary shall submit to the appropriate committees of Congress a report detailing the standards for quality.</text></subparagraph> <subparagraph id="HF35ADC225F254CF5A1B2ED9DE09BF083" indent="up1"><enum>(B)</enum> <clause commented="no" display-inline="yes-display-inline" id="H06A7C94CF42A4C32990E0D2DAE4A59A7"><enum>(i)</enum><text>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.</text></clause>
<clause id="H537B26EBBF3D449EBF6C030D744B24C4" indent="up1"><enum>(ii)</enum><text>The first update under clause (i) shall occur no later than 120 days from the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title>.</text></clause></subparagraph></paragraph></subsection> <subsection commented="no" id="H7E5D9FBD2C634DCEA921E2BC4A2CCA0A"><enum>(b)</enum><header>Publication and consideration of public comments</header> <paragraph commented="no" display-inline="yes-display-inline" id="H0F1DBAB850B941FA9C481795F7CC9372"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph commented="no" id="HE65BC5DF46EA4364A217C66FC0F283B5" indent="up1"><enum>(2)</enum><text>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.</text></paragraph></subsection> <subsection id="H5EB80BFAE3A14CE8B62FE65F8B78E677"><enum>(c)</enum> <paragraph commented="no" display-inline="yes-display-inline" id="H4197E214DF544827901530A0CED07351"><enum>(1)</enum><text display-inline="yes-display-inline">The term <term>appropriate committees of Congress</term> means—</text>
<subparagraph id="HAE18EF39E96B4463A87E66F045198C6A" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</text></subparagraph> <subparagraph id="HDB8E42E501EB48059CB6ADE702F42337" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</text></subparagraph></paragraph>
<paragraph id="H3C3EF54D30314F83A5A7CE9B16E0F395" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">The term <term>covered veterans</term> refers to veterans described in <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703(b)</external-xref> of this title.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H5D8E0EE3B36D4627AF04E94D634B5B38"><enum>(b)</enum><header>Clerical amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H1A3AE66FB20644AA8943FF1DD44EA10C" style="OLC">
<toc>
<toc-entry bold="off" level="section">1703B. Access standards.</toc-entry>
<toc-entry bold="off" level="section">1703C. Standards for quality.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section id="H7CC17DE5367449FF9628D2EDD839659D"><enum>105.</enum><header>Access to walk-in care</header>
<subsection id="H7D1A1F3E2B4547F78C64034D060C382C"><enum>(a)</enum><header>In general</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">Chapter 17</external-xref> is amended by inserting after section 1725 the following new section:</text> <quoted-block display-inline="no-display-inline" id="H03641C7D538541A788CC5B80353439B1" style="USC"> <section id="HB1313CBB73CA4AD594A877E7E93A4F3A"><enum>1725A.</enum><header>Access to walk-in care</header> <subsection id="H3D3163F781BD49AFBE65D9C48066A590"><enum>(a)</enum><header>Procedures To ensure access to walk-In care</header><text>The Secretary shall develop procedures to ensure that eligible veterans are able to access walk-in care from qualifying non-Department entities or providers.</text></subsection>
<subsection id="HE56D433DE8F14B908D19B132701B7F8A"><enum>(b)</enum><header>Eligible veterans</header><text>For purposes of this section, an eligible veteran is any individual who—</text> <paragraph id="HBDA84DEE7CF74097A064493C8C4A05EC"><enum>(1)</enum><text>is enrolled in the health care system established under <external-xref legal-doc="usc" parsable-cite="usc/38/1705">section 1705(a)</external-xref> of this title; and</text></paragraph>
<paragraph id="H48E600EA714C4F67A2BA9C6304975DD3"><enum>(2)</enum><text>has received care under this chapter within the 24-month period preceding the furnishing of walk-in care under this section.</text></paragraph></subsection> <subsection id="H901E3485CCDE4044B01D38606730D62F"><enum>(c)</enum><header>Qualifying non-Department entities or providers</header><text>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.</text></subsection>
<subsection id="H08DF5E7A56ED455EAD5418C3B8FF67E8"><enum>(d)</enum><header>Federally-Qualified health centers</header><text>Whenever practicable, the Secretary may use a Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(l)(2)(B)</external-xref>)) to carry out this section.</text></subsection> <subsection commented="no" id="HFA3C7CF7B4CA42C1B8DDB276DA48B957"><enum>(e)</enum><header>Continuity of care</header><text>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.</text></subsection>
<subsection id="H261667634FE44E46A262731234CF5D46"><enum>(f)</enum><header>Copayments</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H655F2D7FCDA4488CA182AC7446583998"><enum>(1)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="HA9307CC475C94BB7809D06BF043DC5BE"><enum>(A)</enum><text>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.</text></subparagraph> <subparagraph commented="no" id="H90F00D2C327648148436650509CABF5A" indent="up2"><enum>(B)</enum><text>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.</text></subparagraph>
<subparagraph commented="no" id="HF339DB82820144BA910F2FEAC321A3C4" indent="up2"><enum>(C)</enum><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph> <paragraph commented="no" id="H02FAD859163C4DD588440D0FE1F299F0" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="HE25DCE8F996E4834AEE4BE25BB06D89A" indent="up1"><enum>(3)</enum><text>The amount or amounts of the copayments required under this subsection shall be prescribed by the Secretary by rule.</text></paragraph> <paragraph id="H758E9414422049B6B0667D393996D3BC" indent="up1"><enum>(4)</enum><text><external-xref legal-doc="usc" parsable-cite="usc/38/8153">Section 8153(c)</external-xref> of this title shall not apply to this subsection.</text></paragraph></subsection>
<subsection id="H9BB3B488112445DBB07A6F47219F8AE9"><enum>(g)</enum><header>Regulations</header><text>Not later than 1 year after the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title>, the Secretary shall promulgate regulations to carry out this section.</text></subsection> <subsection id="HABD0744107D94A5AA80DE2432B084636"><enum>(h)</enum><header>Walk-In care defined</header><text>In this section, the term <term>walk-in care</term> 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.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="HA24D89660BEC48C285F954739C468FE8"><enum>(b)</enum><header>Effective date</header><text>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.</text></subsection> <subsection id="H245F4E6A80564FAAA8561642390D52ED"><enum>(c)</enum><header>Clerical amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="HA502C3D279144023A61C25DDE9AB4225" style="OLC">
<toc>
<toc-entry bold="off" level="section">1725A. Access to walk-in care.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section id="H501C25EA706B4F909E488F54950BEAFF"><enum>106.</enum><header>Strategy regarding the Department of Veterans Affairs High-Performing Integrated Health Care Network</header>
<subsection id="HDFED8BEE47DD4A848C1AE46DD248671F"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subchapter II of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/73">chapter 73</external-xref> is amended by inserting after section 7330B the following new section:</text> <quoted-block display-inline="no-display-inline" id="HDD9D6C3FEF0946D9BB3F36EC2410D753" style="USC"> <section id="H9FBA45AF3A5049DEA9471EAC6EA7CF9B"><enum>7330C.</enum><header>Quadrennial Veterans Health Administration review</header> <subsection id="H0D1523A23D72472BBFC13E214FA23DED"><enum>(a)</enum><header>Market area assessments</header> <paragraph commented="no" display-inline="yes-display-inline" id="H7E33F0A9C94148E39180088AB29A31AD"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph id="H69A2C8669F7349058AC9A5F7F9B60AD1" indent="up1"><enum>(2)</enum><text>Each market area assessment established under paragraph (1) shall include the following:</text> <subparagraph id="H6B1DDE70E64F4FA7A15659549E1390B7"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="H17E6CF8EE81C41449323EA71F7BA5660"><enum>(B)</enum><text>An inventory of the health care capacity of the Department of Veterans Affairs across the Department’s system of facilities.</text></subparagraph> <subparagraph id="H346E3D058A1A409988A3C61A26F206E0"><enum>(C)</enum><text>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.</text></subparagraph>
<subparagraph id="H8378FC60AE3747E099E43F63E0688C82"><enum>(D)</enum><text>An assessment obtained from other Federal direct delivery systems of their capacity to provide health care to veterans.</text></subparagraph> <subparagraph id="H5E0BC2FCA2934292A2E5572611ADA28E"><enum>(E)</enum><text>An assessment of the health care capacity of non-contracted providers where there is insufficient network supply.</text></subparagraph>
<subparagraph id="H639BC69E566A44418FFDF84082A9D68A"><enum>(F)</enum><text>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.</text></subparagraph> <subparagraph id="H52B6425A1AE842E58EA98EA192107118"><enum>(G)</enum><text>An assessment of the effects on health care capacity of the access standards and standards for quality established under <external-xref legal-doc="usc" parsable-cite="usc/38/1703B">sections 1703B</external-xref> and <external-xref legal-doc="usc" parsable-cite="usc/38/1703C">1703C</external-xref> of this title.</text></subparagraph>
<subparagraph id="HC7CE208DA15C46C49F667876642FC46D"><enum>(H)</enum><text>The number of appointments for health care services under the laws administered by the Secretary, disaggregated by—</text> <clause id="HA812FF99BB094B52A67AAA064CD6D7DC"><enum>(i)</enum><text>appointments at facilities of the Department of Veterans Affairs; and</text></clause>
<clause id="HF31BB206C8FC4255913BC0A1A4DCA5AB"><enum>(ii)</enum><text>appointments with non-Department health care providers.</text></clause></subparagraph></paragraph> <paragraph id="H069D2700464346F98DE596D2E767079D" indent="up1"><enum>(3)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="HE9E86B7F68034F719D7A505D9007E5C9"><enum>(A)</enum><text display-inline="yes-display-inline">The Secretary shall submit to the appropriate committees of Congress the market area assessments established in paragraph (1).</text></subparagraph>
<subparagraph id="H880707154F324151B0D56187F2D2BCA4" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">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 <short-title>Caring for Our Veterans Act of 2018</short-title>.</text></subparagraph></paragraph> <paragraph id="H83ECE603899A4373B29868A9CF537305" indent="up1"><enum>(4)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="HAB80811948244A7DA1F0D4BD08E8534E"><enum>(A)</enum><text>The Secretary shall use the market area assessments established under paragraph (1) to—</text>
<clause id="H774F03133F80451D9431A621F5ACB61B" indent="up1"><enum>(i)</enum><text>determine the capacity of the health care provider networks established under <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703(h)</external-xref> of this title;</text></clause> <clause id="H772147FAD30F4710A0C9F03C5EF3C684" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">inform the Department budget, in accordance with subparagraph (B); and</text></clause>
<clause id="HF5BBD392AFA140E8B4C98EA138C97577" indent="up1"><enum>(iii)</enum><text>inform and assess the appropriateness of the access standards established under <external-xref legal-doc="usc" parsable-cite="usc/38/1703B">section 1703B</external-xref> of this title and standards for quality under section 1703C and to make recommendations for any changes to such standards.</text></clause></subparagraph> <subparagraph id="H00A6B90B21754193A578146C877BB38D" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">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).</text></subparagraph></paragraph></subsection>
<subsection id="H556AADCF5B974F82BBA98E5428320781"><enum>(b)</enum><header>Strategic plan To meet health care demand</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H5387E0662FB642159FBCE143B804ACB5"><enum>(1)</enum><text>Not later than 1 year after the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title> 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—</text> <subparagraph id="HD76BC5C2A7FA415CAF58B5D192219A81" indent="up1"><enum>(A)</enum><text>the demand for health care from the Department, disaggregated by geographic area as determined by the Secretary;</text></subparagraph>
<subparagraph id="HFC84B07FE564418F85EF2C829A5D4CEA" indent="up1"><enum>(B)</enum><text>the health care capacity to be provided at each medical center of the Department; and</text></subparagraph> <subparagraph id="H3C28C8EE745B40EDB3751E6198403F2C" indent="up1"><enum>(C)</enum><text>the health care capacity to be provided through community care providers.</text></subparagraph></paragraph>
<paragraph id="HC404ABC9F1144595B5D73091D8EDE226" indent="up1"><enum>(2)</enum><text>In preparing the strategic plan under paragraph (1), the Secretary shall—</text> <subparagraph id="H169A982B623048E7A97974D42DBB9993"><enum>(A)</enum><text>assess the access standards and standards for quality established under <external-xref legal-doc="usc" parsable-cite="usc/38/1703B">sections 1703B</external-xref> and <external-xref legal-doc="usc" parsable-cite="usc/38/1703C">1703C</external-xref> of this title;</text></subparagraph>
<subparagraph id="H983BAD54B4AB49E98E778E7572C449D0"><enum>(B)</enum><text>assess the market area assessments established under subsection (a);</text></subparagraph> <subparagraph id="H7BF66AD0EE4044F08FE031B70C423529"><enum>(C)</enum><text>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;</text></subparagraph>
<subparagraph id="HD4EA6C74C5A9494894BFB13D88CFA709"><enum>(D)</enum><text>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;</text></subparagraph> <subparagraph id="H0C3EACC3989D4F41982E25093C2C9E66"><enum>(E)</enum><text>identify emerging issues, trends, problems, and opportunities that could affect health care services furnished under the laws administered by the Secretary;</text></subparagraph>
<subparagraph id="H6B6F13194D7A430AB734066D69833C15"><enum>(F)</enum><text>develop recommendations regarding both short- and long-term priorities for health care services furnished under the laws administered by the Secretary;</text></subparagraph> <subparagraph id="HACE17753E6D44F6AAAB86C86899D19C2"><enum>(G)</enum><text>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;</text></subparagraph>
<subparagraph id="HB5497F044CB0489094CA87DCA01200B0"><enum>(H)</enum><text display-inline="yes-display-inline">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;</text></subparagraph> <subparagraph id="H7CEACAA4BF30428EAF4958D8B94F9F7B"><enum>(I)</enum><text>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</text></subparagraph>
<subparagraph id="H6ABEE90E28D94337BC061EB31FA3FF4A"><enum>(J)</enum><text>consider such other matters as the Secretary considers appropriate.</text></subparagraph></paragraph></subsection> <subsection id="HCCDEE30D8BDF4B218074534CEE70B358"><enum>(c)</enum><header>Responsibilities</header><text>The Secretary shall be responsible for—</text>
<paragraph id="H4D2F0F63BA514E96AF444D6DAB981F12"><enum>(1)</enum><text>overseeing the transformation and organizational change across the Department to achieve such high performing integrated health care network;</text></paragraph> <paragraph id="H5A6B6B753A0B47048B498118D6F09553"><enum>(2)</enum><text>developing the capital infrastructure planning and procurement processes, whether minor or major construction projects or leases; and</text></paragraph>
<paragraph id="H7C9510FFB40E4B988045E68E6CE1888B"><enum>(3)</enum><text>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.</text></paragraph></subsection> <subsection id="H6CEB4E3ABF07451EA258BB855B6668C6"><enum>(d)</enum><header>Appropriate committees of Congress defined</header><text>In this section, the term <term>appropriate committees of Congress</term> means—</text>
<paragraph id="H7A0D7AEA13E044D3B283992AE3025574"><enum>(1)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H1C499DE3E5E54169BCAA4E0CEE15F79D"><enum>(2)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H9CACB2F972B346A4B2443706D8E214D1"><enum>(b)</enum><header>Clerical amendment</header><text display-inline="yes-display-inline">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:</text> <quoted-block display-inline="no-display-inline" id="HC9FE6AC518614423951BFA44E38602C9" style="USC"> <toc regeneration="no-regeneration"> <toc-entry level="section">7330C. Quadrennial Veterans Health Administration review.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section> <section id="HA14718A4001D41609F15DFD84747F9C2"><enum>107.</enum><header>Applicability of Directive of Office of Federal Contract Compliance Programs</header> <subsection id="H9AD8517F2FD24F45A157EFAB9A6632CE"><enum>(a)</enum><header>In general</header><text>Notwithstanding the treatment of certain laws under subsection (i) of section 1703A of title 38, United States Code, as added by <external-xref legal-doc="usc" parsable-cite="usc/38/102">section 102</external-xref> 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 <external-xref legal-doc="usc" parsable-cite="usc/38/1745">section 1745</external-xref> 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.</text></subsection>
<subsection id="H7F8A0019717A422F890442C83AFAEB9E"><enum>(b)</enum><header>Applicability period</header><text>The directive described in subsection (a), and the moratorium provided under such directive, shall not be altered or rescinded before May 7, 2019.</text></subsection> <subsection id="H3279187B066942568065010632F6344B"><enum>(c)</enum><header>TRICARE program defined</header><text>In this section, the term <term>TRICARE program</term> has the meaning given that term in section 1072 of title 10, United States Code.</text></subsection></section>
<section id="HFC20098DFA4844F5B88F877AA8AB3AF3"><enum>108.</enum><header>Prevention of certain health care providers from providing non-Department health care services to veterans</header>
<subsection id="H8EDA225425474C5C8FB8870FB0139825"><enum>(a)</enum><header>In general</header><text>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—</text> <paragraph id="H527A7F37837D41538DA1A50113B43859"><enum>(1)</enum><text>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</text></paragraph>
<paragraph id="H8885C655D9F94937977F17B902DF958E"><enum>(2)</enum><text>violated the requirements of a medical license of the health care provider that resulted in the loss of such medical license.</text></paragraph></subsection> <subsection id="H13CB3965C85C4FD6A6E16DECD16A320D"><enum>(b)</enum><header>Permissive action</header><text>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.</text></subsection>
<subsection id="H4619053DFA3E47BEA26154542227E32A"><enum>(c)</enum><header>Suspension</header><text>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.</text></subsection> <subsection id="HEE19E1453834446DB270831953DCAA3C"><enum>(d)</enum><header>Comptroller General report</header><text>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:</text>
<paragraph id="HE129C3B1C06149E7A845C5D673E0CE66"><enum>(1)</enum><text>The aggregate number of health care providers denied or suspended under this section from participation in providing non-Department health care services.</text></paragraph> <paragraph id="H12A2114EDBB94117A3B1FCB4DCFDF8F0"><enum>(2)</enum><text>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.</text></paragraph>
<paragraph id="H2ECF8DBD809C41A7BCB970AA1B72F6FF"><enum>(3)</enum><text>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.</text></paragraph> <paragraph id="HA522E2FA9C324C54B2A9F6264833C975"><enum>(4)</enum><text>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.</text></paragraph></subsection>
<subsection id="HA00C5129A9F94D08A962F12256AA57BA"><enum>(e)</enum><header>Non-Department health care services defined</header><text>In this section, the term <term>non-Department health care services</term> means services—</text> <paragraph id="H125978B6E20D4962942B3FC44B09D1A6"><enum>(1)</enum><text>provided under subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code, at non-Department facilities (as defined in <external-xref legal-doc="usc" parsable-cite="usc/38/1701">section 1701</external-xref> of such title);</text></paragraph>
<paragraph id="H8A74374A2C2A4C1FA86D65DA207C1A86"><enum>(2)</enum><text>provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note);</text></paragraph> <paragraph id="H3A5BF85F207D4AE3AF07BB2D5C70BAEF"><enum>(3)</enum><text>purchased through the Medical Community Care account of the Department; or</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HE28086B46FF24FBEA474E32D5F7BCC77"><enum>(4)</enum><text>purchased with amounts deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014.</text></paragraph></subsection></section> <section id="H09E2FDC68C864F22B785582661124A95"><enum>109.</enum><header>Remediation of medical service lines</header> <subsection id="H782A72611C1A446B95B6C393431D0F91"><enum>(a)</enum><header>In general</header><text>Subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> is amended by inserting after section 1706 the following new section:</text>
<quoted-block id="HB9A09967802544D1953AC847C7852309" style="USC">
<section id="H1D59828A6BE24F378D92DBB4AE9A00BE"><enum>1706A.</enum><header>Remediation of medical service lines</header>
<subsection id="H9CA975774AE64DE89CB48FD0635E0369"><enum>(a)</enum><header>In general</header><text>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:</text> <paragraph id="H235E7D772F1549A992C87993D0B46D5D"><enum>(1)</enum><text>Increasing personnel or temporary personnel assistance, including mobile deployment teams.</text></paragraph>
<paragraph id="H99176103632948D5B710073435646DE4"><enum>(2)</enum><text>Special hiring incentives, including the Education Debt Reduction Program under subchapter VII of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/76">chapter 76</external-xref> of this title and recruitment, relocation, and retention incentives.</text></paragraph> <paragraph id="H7ABA701600CB4A8BA800482B6362DDB2"><enum>(3)</enum><text>Utilizing direct hiring authority.</text></paragraph>
<paragraph id="HE94246B76C954E9F91EEA985CAA0D4BB"><enum>(4)</enum><text>Providing improved training opportunities for staff.</text></paragraph> <paragraph id="H21ABB56937CA418097807CF9E82E7E1F"><enum>(5)</enum><text>Acquiring improved equipment.</text></paragraph>
<paragraph id="H730101EA14E24FE4851F25D3D816BA97"><enum>(6)</enum><text>Making structural modifications to the facility used by the medical service line.</text></paragraph> <paragraph id="H6F96AC86587E4C2286522F557B5AF451"><enum>(7)</enum><text>Such other actions as the Secretary considers appropriate.</text></paragraph></subsection>
<subsection id="HA5CB633D463848C8B925272C9D55DDE9"><enum>(b)</enum><header>Responsible parties</header><text>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.</text></subsection> <subsection id="H743590067FE34DDBA984C68C86982D34"><enum>(c)</enum><header>Interim reports</header><text>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.</text></subsection>
<subsection id="H026CF573AA054726AC43731DC34B9501"><enum>(d)</enum><header>Annual reports</header><text>Not less frequently than once each year, the Secretary shall—</text> <paragraph id="H94C8ABE435EE4B5AB4798A340EFECBA7"><enum>(1)</enum><text>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</text></paragraph>
<paragraph id="HB1B2F4A70DCD4D7CA4CF276D8E61E3CC"><enum>(2)</enum><text>publish such analysis on the internet website of the Department.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HD2314A0A18764D8697019268DAB904F3"><enum>(b)</enum><header>Clerical amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="HCED0B478816C4268AF07FBCEA136182F" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="section">1706A. Remediation of medical service lines.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section></chapter>
<chapter id="H36AD54FA0322489F89AD64323DD3E1A7" style="OLC"><enum>2</enum><header>Paying Providers and Improving Collections</header>
<section id="H3BEE4922042E46AD8DB2BA689E020339"><enum>111.</enum><header>Prompt payment to providers</header>
<subsection id="HD4DFF65EBB654904929C05DCA2E6AA22"><enum>(a)</enum><header>In general</header><text>Subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> is amended by inserting after section 1703C, as added by <external-xref legal-doc="usc" parsable-cite="usc/38/104">section 104</external-xref> of this title, the following new section:</text> <quoted-block display-inline="no-display-inline" id="H588A5B34C35B4C72AF5C02A612F6EFEC" style="USC"> <section id="H27878F37109A4ACA9598556235E77F40"><enum>1703D.</enum><header>Prompt payment standard</header> <subsection id="HB573E37772A84E3993BCF00885114AA7"><enum>(a)</enum><header>In general</header> <paragraph commented="no" display-inline="yes-display-inline" id="H597DB30C70F44CFAB3C9F88379B9E602"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph id="HC1064CC63A444956800A048C9674D87D" indent="up1"><enum>(2)</enum><text>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.</text></paragraph> <paragraph id="HC26065AE82E34B96ABA4A01F0152BB9F" indent="up1"><enum>(3)</enum><text>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.</text></paragraph>
<paragraph id="H2C4628BB97734E758A7EEB8E8DF77A44" indent="up1"><enum>(4)</enum><text>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.</text></paragraph></subsection> <subsection id="HEBBFB92E85E04262B5751022F21332C8"><enum>(b)</enum><header>Submittal of claims by health care entities and providers</header><text>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.</text></subsection>
<subsection id="HA64C276995C54BFAB8A75BAAACC240B8"><enum>(c)</enum><header>Fraudulent claims</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H7A963878E25E474FAD2747F27E5FEB40"><enum>(1)</enum><text>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.</text></paragraph> <paragraph id="HFD780B4ACFD044F9803428FACD1419D4" indent="up1"><enum>(2)</enum><text>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.</text></paragraph></subsection>
<subsection id="HCCF233358D514DBFB11BF207C412A30A"><enum>(d)</enum><header>Overdue claims</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HBD7BFEC4D04049A1A2D681500844ADD2"><enum>(1)</enum><text>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).</text></paragraph> <paragraph id="HB1B10AB04A2546129140621A78769C84" indent="up1"><enum>(2)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="H80993BF8391B4814B2DA3C7896C7066D"><enum>(A)</enum><text>If a claim is overdue under this subsection, the Secretary may, under the requirements established by subsection (a) and consistent with the provisions of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/31/39">chapter 39</external-xref> of title 31 (commonly referred to as the <quote>Prompt Payment Act</quote>), require that interest be paid on clean claims.</text></subparagraph>
<subparagraph id="H53F7E9D849F543EF9DBAF6B5AC4AB6F4" indent="up1"><enum>(B)</enum><text>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.</text></subparagraph></paragraph> <paragraph id="HD0CB631ED8AC4144AE992E16516D1752" indent="up1"><enum>(3)</enum><text>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:</text>
<subparagraph id="HAA45EF8A7BFC446B9048E59391087D58"><enum>(A)</enum><text>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.</text></subparagraph> <subparagraph id="HF617EE93E4C34E35AEFB5DE073A85FDF"><enum>(B)</enum><text>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.</text></subparagraph></paragraph></subsection>
<subsection id="H48812723CFC849DA836587DB387C8271"><enum>(e)</enum><header>Overpayment</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H12FD08E4480041869B87D5BDEEFBFDED"><enum>(1)</enum><text>The Secretary shall deduct the amount of any overpayment from payments due a health care entity or provider under this chapter.</text></paragraph> <paragraph id="H9FACC1A6C6234269B561F2332D229EA2" indent="up1"><enum>(2)</enum><text>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.</text></paragraph>
<paragraph id="H71110F69ADFC4A0E9491C23F42EC1D43" indent="up1"><enum>(3)</enum><text>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.</text></paragraph></subsection> <subsection id="H72EEC6B68BA44964A0C47794485983EA"><enum>(f)</enum><header>Information and documentation required</header> <paragraph commented="no" display-inline="yes-display-inline" id="H93868724E1384E5AAEF60857B06C3C15"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph id="H3A9C039F36BC49E9B2EBF6996963C579" indent="up1"><enum>(2)</enum><text>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).</text></paragraph> <paragraph id="HC3326A24FC6C45CAB47914F0C00D7EC3" indent="up1"><enum>(3)</enum><text>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.</text></paragraph></subsection>
<subsection id="H3D3F5AA1158847519B36003CA629A565"><enum>(g)</enum><header>Processing of claims</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HBD6706903D0E4F9DA7E4B59611017B30"><enum>(1)</enum><text display-inline="yes-display-inline">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—</text> <subparagraph display-inline="no-display-inline" id="H6B5D3FD2810E4C3B8D34AF387360A8FE" indent="up1"><enum>(A)</enum><text>a non-Department entity that is under contract or agreement for the program established under <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703(a)</external-xref> of this title; or</text></subparagraph>
<subparagraph display-inline="no-display-inline" id="HED051BEEFBB3448CADD2216698C90F54" indent="up1"><enum>(B)</enum><text>a non-Department entity that specializes in such processing for other Federal agency health care systems.</text></subparagraph></paragraph> <paragraph id="H1110380316854EBF943054EB063B8EF0" indent="up1"><enum>(2)</enum><text>The Secretary shall seek to contract with a third party to conduct a review of claims described in paragraph (3) that includes—</text>
<subparagraph id="HA79F7147020A4CFEBA23B68406FCBFB3"><enum>(A)</enum><text>a feasibility assessment to determine the capacity of the Department to process such claims in a timely manner; and</text></subparagraph> <subparagraph id="HDD79761CCBCD4CAABCDD6982B42D412C"><enum>(B)</enum><text>a cost benefit analysis comparing the capacity of the Department to a third party entity capable of processing such claims.</text></subparagraph></paragraph>
<paragraph id="H9B5146FE93C0478DB6597AD2F70A0BE0" indent="up1"><enum>(3)</enum><text>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 <short-title>Caring for Our Veterans Act of 2018</short-title>, that are processed by the Department.</text></paragraph></subsection> <subsection id="H4BE4094B2BA2445188C2C15D47FCF9FC"><enum>(h)</enum><header>Report on encounter data system</header> <paragraph commented="no" display-inline="yes-display-inline" id="H47C17D7A090640D1BE0A883B18A36F3D"><enum>(1)</enum><text>Not later than 90 days after the date of the enactment of the <short-title>Caring for Our Veterans Act of 2018</short-title>, 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.</text></paragraph>
<paragraph id="HDCB0A0A458DB4495952B2A4EA60050ED" indent="up1"><enum>(2)</enum><text>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).</text></paragraph></subsection> <subsection id="H1C6D84F5C6784AD6A598BD3D560629D3"><enum>(i)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H2C63E4B24D06403E97F406CE605AC8B7"><enum>(1)</enum><text>The term <term>appropriate committees of Congress</term> means—</text> <subparagraph id="HCEB39123A2CC4ABEA6B673107DAABAE2"><enum>(A)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</text></subparagraph>
<subparagraph id="H3D15064B2DD6435089F63682259AE16F"><enum>(B)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</text></subparagraph></paragraph> <paragraph id="HC228EE9BF58542AE96A9E74B2D9FDE41"><enum>(2)</enum><text>The term <term>clean electronic claim</term> 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.</text></paragraph>
<paragraph id="HC9FDBD8325E94083BD13C8C82012548F"><enum>(3)</enum><text>The term <term>clean paper claim</term> 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.</text></paragraph> <paragraph id="H08341B4427934F3E854F07FC99E12CAD"><enum>(4)</enum><text>The term <term>fraudulent claims</term> 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.</text></paragraph>
<paragraph id="HBF0FC59A7E32495983D3862F23802717"><enum>(5)</enum><text>The term <term>health care entity or provider</term> includes any non-Department health care entity or provider, but does not include any Federal health care entity or provider.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H4D1BE1AF7701497B9558EE8D0B656996"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1703C, as added by <external-xref legal-doc="usc" parsable-cite="usc/38/104">section 104</external-xref> of this title, the following new item:</text>
<quoted-block display-inline="no-display-inline" id="H75B790A3743C4096843C6635F03CC9E0" style="OLC">
<toc>
<toc-entry bold="off" level="section">1703D. Prompt payment standard.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section id="HB8D6A151374F45DA9FDD5D3E30F8A886"><enum>112.</enum><header>Authority to pay for authorized care not subject to an agreement</header>
<subsection id="HB92979AA4C234A81A8F2CCC34B5377E4"><enum>(a)</enum><header>In general</header><text>Subchapter IV of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/81">chapter 81</external-xref> is amended by adding at the end the following new section:</text> <quoted-block display-inline="no-display-inline" id="HD4C74432AF964BA2BEA0D8020A5F07AE" style="USC"> <section id="H9F1B6536FDB142AAA579465A5A9B28D0"><enum>8159.</enum><header>Authority to pay for services authorized but not subject to an agreement</header> <subsection id="H3173B1A52D424634B3ACF12BDE4DBFB6"><enum>(a)</enum><header>In general</header><text>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.</text></subsection>
<subsection id="HC95287E0FD234E5992186FB681806947"><enum>(b)</enum><header>New contracts and agreements</header><text>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.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H83315D3B229A4B7CB7C15E4C8595B2B6"><enum>(b)</enum><header>Clerical amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H56C2786920714C269E2F84FD3BF33D5C" style="OLC">
<toc>
<toc-entry bold="off" level="section">8159. Authority to pay for services authorized but not subject to an agreement.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section id="HC69DF21B073243CF95E917FD6E1E69EC"><enum>113.</enum><header>Improvement of authority to recover the cost of services furnished for non-service-connected disabilities</header>
<subsection id="H37F5BABB66FA483D931BEA0832B7D3FB"><enum>(a)</enum><header>Broadening scope of applicability</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/38/1729">Section 1729</external-xref> is amended—</text> <paragraph id="H4302C8CE0CD644A4B06D172803EEF79A"><enum>(1)</enum><text>in subsection (a)—</text>
<subparagraph id="H2F34CEF8CA8B452097FDD949FD9B020E"><enum>(A)</enum><text>in paragraph (2)(A)—</text> <clause id="HDC0EDEB6281D45E49E19BA7292492E43"><enum>(i)</enum><text>by striking <quote>the veteran’s</quote> and inserting <quote>the individual’s</quote>; and</text></clause>
<clause id="HFF14A30DC4874383B2C904B37435F5B0"><enum>(ii)</enum><text>by striking <quote>the veteran</quote> and inserting <quote>the individual</quote>; and</text></clause></subparagraph> <subparagraph id="H257456B704404D42820A46DB463414BA"><enum>(B)</enum><text>in paragraph (3)—</text>
<clause id="H4F7D630CE3954D32BC6EE4C129EE022B"><enum>(i)</enum><text>in the matter preceding subparagraph (A), by striking <quote>the veteran</quote> and inserting <quote>the individual</quote>; and</text></clause> <clause id="H31C05DA833A54D22BB3A301D43FB192A"><enum>(ii)</enum><text>in subparagraph (A), by striking <quote>the veteran’s</quote> and inserting <quote>the individual’s</quote>;</text></clause></subparagraph></paragraph>
<paragraph id="H3A8C32CBF29C48AFAC7366E8B4B1A27C"><enum>(2)</enum><text>in subsection (b)—</text> <subparagraph id="H34B7D769F1CB4CB7921C5E0EC90CBC17"><enum>(A)</enum><text>in paragraph (1)—</text>
<clause id="H383C11A10DB1453596C7B20B805B884D"><enum>(i)</enum><text>by striking <quote>the veteran</quote> and inserting <quote>the individual</quote>; and</text></clause> <clause id="H8D980346AE4C4B4EAB91EBF3F5866092"><enum>(ii)</enum><text>by striking <quote>the veteran’s</quote> and inserting <quote>the individual’s</quote>; and</text></clause></subparagraph>
<subparagraph id="H41A581A008C54D9F92846B5233A2B075"><enum>(B)</enum><text>in paragraph (2)—</text> <clause id="H41E1729A51C14E96B7D2D475A82F7DA0"><enum>(i)</enum><text>in subparagraph (A)—</text>
<subclause id="H03BFBA0454EE41329CEC2AD6D0A4AEF6"><enum>(I)</enum><text>by striking <quote>the veteran</quote> and inserting <quote>the individual</quote>; and</text></subclause> <subclause id="H3845FF43EDCC4A60A63C9DEF0BE94D6A"><enum>(II)</enum><text>by striking <quote>the veteran’s</quote> and inserting <quote>the individual’s</quote>; and</text></subclause></clause>
<clause id="HAEF54E97672846DE9EE75259C0B185CB"><enum>(ii)</enum><text>in subparagraph (B)—</text> <subclause id="H63B302BC309043999AED4DD1781DE39D"><enum>(I)</enum><text>in clause (i), by striking <quote>the veteran</quote> and inserting <quote>the individual</quote>; and</text></subclause>
<subclause id="HBDC48E3F6B5B498899D9EC01C366A18F"><enum>(II)</enum><text>in clause (ii)—</text> <item id="HC9E5604DFB464F43A7232A50133EC035"><enum>(aa)</enum><text>by striking <quote>the veteran</quote> and inserting <quote>the individual</quote>; and</text></item>
<item id="HF68668F0E094418587D6AE476822A481"><enum>(bb)</enum><text>by striking <quote>the veteran’s</quote> each place it appears and inserting <quote>the individual’s</quote>;</text></item></subclause></clause></subparagraph></paragraph> <paragraph id="H9FB8CC0A720E4643AB3681EF8A7517CF"><enum>(3)</enum><text>in subsection (e), by striking <quote>A veteran</quote> and inserting <quote>An individual</quote>; and</text></paragraph>
<paragraph id="H7464AE61A04A4648BB1E1BC1CF1F985E"><enum>(4)</enum><text>in subsection (h)—</text> <subparagraph id="H6D6DD44A9B8646F18F8A61ACB2B20E9D"><enum>(A)</enum><text>in paragraph (1)—</text>
<clause id="H854DF4E4E8464E1A839778DA93D224F9"><enum>(i)</enum><text>in the matter preceding subparagraph (A), by striking <quote>a veteran</quote> and inserting <quote>an individual</quote>;</text></clause> <clause id="H81A84DACEC6F4CF3B3A56CF6A5AE928F"><enum>(ii)</enum><text>in subparagraph (A), by striking <quote>the veteran</quote> and inserting <quote>the individual</quote>; and</text></clause>
<clause id="H1030816EB39641098C6CEB0113536AE4"><enum>(iii)</enum><text>in subparagraph (B), by striking <quote>the veteran</quote> and inserting <quote>the individual</quote>; and</text></clause></subparagraph> <subparagraph id="HC5DBAF17D96947DF997FF670476DD6CB"><enum>(B)</enum><text>in paragraph (2)—</text>
<clause id="HC54710425A204DEA96369E9CE6140A11"><enum>(i)</enum><text>by striking <quote>A veteran</quote> and inserting <quote>An individual</quote>;</text></clause> <clause id="H64A6F83AB6B543B1BC0C10B7801186BD"><enum>(ii)</enum><text>by striking <quote>a veteran</quote> and inserting <quote>an individual</quote>; and</text></clause>
<clause id="H7C884CB9E1FA4687BE2923FB3B19B568"><enum>(iii)</enum><text>by striking <quote>the veteran</quote> and inserting <quote>the individual</quote>.</text></clause></subparagraph></paragraph></subsection> <subsection id="HABEF19AC8AB54166A854D85FE92BEC56"><enum>(b)</enum><header>Modification of authority</header><text>Subsection (a)(1) of such section is amended by striking <quote>(1) Subject</quote> and all that follows through the period and inserting the following: <quote>(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.</quote>.</text></subsection>
<subsection id="HDC8F540C937D47EDA906D7B87A32431F"><enum>(c)</enum><header>Modification of eligible individuals</header><text>Subparagraph (D) of subsection (a)(2) of such section is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H3C3651AE7A644DC0B963B4AC3271DC62" style="OLC"> <subparagraph commented="no" display-inline="no-display-inline" id="H7B60B54CA0DC4546AC5153E4955E4FCA" indent="up1"><enum>(D)</enum><text>that is incurred by an individual who is entitled to care (or payment of the expenses of care) under a health-plan contract.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section commented="no" display-inline="no-display-inline" id="H4002A7E3C4174E5B80811267E29A938C"><enum>114.</enum><header display-inline="yes-display-inline">Processing of claims for reimbursement through electronic interface</header><text display-inline="no-display-inline">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.</text></section></chapter> <chapter id="H92A0A5C15D1643C2BFFD74A5873BFDB7" style="OLC"><enum>3</enum><header>Education and Training Programs</header> <section id="H63173E1EFC864C07A8D204DBA2A47427"><enum>121.</enum><header>Education program on health care options</header> <subsection id="HDBAA695E6808461CB597D3F66753D47D"><enum>(a)</enum><header>In general</header><text>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.</text></subsection>
<subsection id="H6D04C7D0014841EB92E17A649E668FC9"><enum>(b)</enum><header>Elements</header><text>The program under subsection (a) shall—</text> <paragraph id="HE132BA64A466461F9E1EA668C149D657"><enum>(1)</enum><text>teach veterans about—</text>
<subparagraph id="HF36111988D9D44B9AB6286E5E180F6D5"><enum>(A)</enum><text>eligibility criteria for care from the Department set forth under sections 1703, as amended by <external-xref legal-doc="usc" parsable-cite="usc/38/101">section 101</external-xref> of this title, and 1710 of title 38, United States Code;</text></subparagraph> <subparagraph id="HA747968AFDE344DAB71E2CABC31A6BD5"><enum>(B)</enum><text>priority groups for enrollment in the system of annual patient enrollment under <external-xref legal-doc="usc" parsable-cite="usc/38/1705">section 1705(a)</external-xref> of such title;</text></subparagraph>
<subparagraph id="H101C638C3CEB48D785A672961AD38D03"><enum>(C)</enum><text>the copayments and other financial obligations, if any, required of certain individuals for certain services; and</text></subparagraph> <subparagraph id="H70D3B852D4DC44B18222186E2AC1D72F"><enum>(D)</enum><text>how to utilize the access standards and standards for quality established under <external-xref legal-doc="usc" parsable-cite="usc/38/1703B">sections 1703B</external-xref> and <external-xref legal-doc="usc" parsable-cite="usc/38/1703C">1703C</external-xref> of such title;</text></subparagraph></paragraph>
<paragraph id="HEF9A49B6CD9A45F28C72F63EE720F281"><enum>(2)</enum><text>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</text></paragraph> <paragraph id="H9C7B8BEE09064540B38C5AC5471E8786"><enum>(3)</enum><text>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).</text></paragraph></subsection>
<subsection id="H40EAF5CDB5674D9EB66F2903B91B6B2C"><enum>(c)</enum><header>Accessibility</header><text>In developing the education program under this section, the Secretary shall ensure that materials under such program are accessible—</text> <paragraph id="H6A2994A7F7F74EFFAAE4B5C075969FC4"><enum>(1)</enum><text>to veterans who may not have access to the internet; and</text></paragraph>
<paragraph id="H9A7CF53DE9B34F8B8AD32CFCA5903380"><enum>(2)</enum><text>to veterans in a manner that complies with the Americans with Disabilities Act of 1990 (<external-xref legal-doc="usc" parsable-cite="usc/42/12101">42 U.S.C. 12101</external-xref> et seq.).</text></paragraph></subsection> <subsection id="HF39C0573AF734E2B8F874E7919C3077D"><enum>(d)</enum><header>Annual evaluation and report</header> <paragraph id="H293F194C999E415B99CB48B3BA1D03BF"><enum>(1)</enum><header>Evaluation</header><text>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.</text></paragraph>
<paragraph id="H1D1DF16BA69F46CB840B4E6DB4BE2771"><enum>(2)</enum><header>Report</header><text>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).</text></paragraph></subsection> <subsection id="H2D0F2A97A5094F1B9E44627E65B07566"><enum>(e)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H2FFAFBBE1ACA420BA3680DD8F9BCACD9"><enum>(1)</enum><header>Medicaid</header><text>The term <term>Medicaid</term> means the Medicaid program under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.).</text></paragraph> <paragraph id="H7B067C775D784B7DBA344ED1C845BAD6"><enum>(2)</enum><header>Medicare</header><text>The term <term>Medicare</term> means the Medicare program under title XVIII of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.).</text></paragraph>
<paragraph id="HC1E34B822CCC429CABF6DC739898E268"><enum>(3)</enum><header>Tricare program</header><text>The term <term>TRICARE program</term> has the meaning given that term in section 1072 of title 10, United States Code.</text></paragraph></subsection></section> <section id="HC963168FDD87487495882EB906200B23"><enum>122.</enum><header>Training program for administration of non-Department of Veterans Affairs health care</header> <subsection id="H0DE00E1E419E4141BFA9BED370D724ED"><enum>(a)</enum><header>Establishment of program</header><text display-inline="yes-display-inline">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:</text>
<paragraph id="H181261726E0F41A7881A0E5176AEC838"><enum>(1)</enum><text>Reimbursement for non-Department emergency room care.</text></paragraph> <paragraph id="HBE7815B945E1401792FBCF8A1DBAE069"><enum>(2)</enum><text>The Veterans Community Care Program under <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703</external-xref> of such title, as amended by section 101.</text></paragraph>
<paragraph id="H33E677C1BC9F4C72B4967C178807C9D7"><enum>(3)</enum><text>Management of prescriptions pursuant to improvements under section 131.</text></paragraph></subsection> <subsection id="HDA346B09132E44359C26A73B2E38A059"><enum>(b)</enum><header>Annual evaluation and report</header><text>The Secretary shall—</text>
<paragraph id="H22A223D28BBA4C07BD96A374267B55E6"><enum>(1)</enum><text>develop a method to evaluate the effectiveness of the training program developed and implemented under subsection (a);</text></paragraph> <paragraph id="H0760BEA4672C4F8F861C97AFF0078274"><enum>(2)</enum><text>evaluate such program not less frequently than once each year; and</text></paragraph>
<paragraph id="HA6151186E8784ADEA86FCBC14D33B57C"><enum>(3)</enum><text>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).</text></paragraph></subsection></section> <section id="HDA57880E4E32454C9D7126BF93F95825"><enum>123.</enum><header>Continuing medical education for non-Department medical professionals</header> <subsection id="H1997DDC4A40E408FAC5A16E3E74F1694"><enum>(a)</enum><header>Establishment of program</header> <paragraph id="H294B461F3F644F238425B149D409C713"><enum>(1)</enum><header>In general</header><text>The Secretary of Veterans Affairs shall establish a program to provide continuing medical education material to non-Department medical professionals.</text></paragraph>
<paragraph id="H109840ECEE3243D0BCAF8872CE25F5F1"><enum>(2)</enum><header>Education provided</header><text>The program established under paragraph (1) shall include education on the following:</text> <subparagraph id="HB4BD8B6F79414673A06425A8A486AD66"><enum>(A)</enum><text>Identifying and treating common mental and physical conditions of veterans and family members of veterans.</text></subparagraph>
<subparagraph id="HACDF2205B625451887EAE18CE14AC65C"><enum>(B)</enum><text>The health care system of the Department of Veterans Affairs.</text></subparagraph> <subparagraph id="H93DC21B99969447C96CC9061EFAC2C39"><enum>(C)</enum><text>Such other matters as the Secretary considers appropriate.</text></subparagraph></paragraph></subsection>
<subsection id="HE6ED6CE01C4A424B9CC2954DD04890E2"><enum>(b)</enum><header>Material provided</header><text>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.</text></subsection> <subsection id="HFB5B97BF713746009957EA8889A9C7A7"><enum>(c)</enum><header>Administration of program</header> <paragraph id="HE305CC08E2E0400D9A0F36EAB499B78A"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph>
<paragraph id="H524EE62FD6AA479C9C2DD3AC37132600"><enum>(2)</enum><header>Curriculum and credit provided</header><text>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.</text></paragraph> <paragraph id="H0DE1B60713EA4C9EB22FBE996220D190"><enum>(3)</enum><header>Accreditation</header><text>The Secretary shall ensure that the program is accredited in as many States as practicable.</text></paragraph>
<paragraph id="HF600C1E9F9F6434A8E6BC144D941481A"><enum>(4)</enum><header>Consistency with existing rules</header><text>The Secretary shall ensure that the program is consistent with the rules and regulations of the following:</text> <subparagraph id="H2D78A3C4C3324735980981E862B7413D"><enum>(A)</enum><text>The medical licensing agency of each State in which the program is accredited.</text></subparagraph>
<subparagraph id="H3F95A76E908D4869B54D620A96B60DFB"><enum>(B)</enum><text>Such medical credentialing organizations as the Secretary considers appropriate.</text></subparagraph></paragraph> <paragraph id="H92328839F6CB49CC94D382DB68F81E54"><enum>(5)</enum><header>User cost</header><text>The Secretary shall carry out the program at no cost to participating non-Department medical professionals.</text></paragraph>
<paragraph id="HC1EB77A0EBCE44ABBFC3E42C9CACE7F1"><enum>(6)</enum><header>Monitoring, evaluation, and report</header><text>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.</text></paragraph></subsection> <subsection id="H9AC032CA0A6C48369E5B31FB65DBD363"><enum>(d)</enum><header>Non-Department medical professional defined</header><text>In this section, the term <term>non-Department medical professional</term> 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.</text></subsection></section></chapter>
<chapter id="H1C79ABA7E67B456098F62AD2C4C42D5D" style="OLC"><enum>4</enum><header>Other Matters Relating to Non-Department of Veterans Affairs Providers</header>
<section id="H1B742257C6D5488EA5AA6950A642FF6A"><enum>131.</enum><header>Establishment of processes to ensure safe opioid prescribing practices by non-Department of Veterans Affairs health care providers</header>
<subsection id="H3AEC6EFC3AB54BF2B0B8AA6054ED7DDB"><enum>(a)</enum><header>Receipt and review of guidelines</header><text>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.</text></subsection> <subsection id="H0E0975579F8549C0AC542632512E5BB0"><enum>(b)</enum><header>Inclusion of medical history and current medications</header><text display-inline="yes-display-inline">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.</text></subsection>
<subsection id="HE33C33E92A2846518D25FCE125936AAD"><enum>(c)</enum><header>Submittal of medical records and prescriptions</header>
<paragraph id="HF9BA1F55FE6745E6BAC7B295EF7089A9"><enum>(1)</enum><header>In general</header><text>The Secretary shall, consistent with section 1703(a)(2)(A), as amended by <external-xref legal-doc="usc" parsable-cite="usc/38/101">section 101</external-xref> of this title, and section 1703A(e)(2)(F), as added by <external-xref legal-doc="usc" parsable-cite="usc/38/102">section 102</external-xref> 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.</text></paragraph> <paragraph id="H74AF0C79A7A44A76B4E72AFC54481D4D"><enum>(2)</enum><header>Responsibility of department for recording and monitoring</header><text>In carrying out paragraph (1) and upon the receipt by the Department of the medical records described in paragraph (1), the Secretary shall—</text>
<subparagraph id="HC77DFE31ED724E8C8353DA8632692E85"><enum>(A)</enum><text>ensure the Department is responsible for the recording of the prescription in the electronic health record of the veteran; and</text></subparagraph> <subparagraph id="H81FAF13E2BDD429A904E7F23434D4B06"><enum>(B)</enum><text>enable other monitoring of the prescription as outlined in the Opioid Safety Initiative of the Department.</text></subparagraph></paragraph>
<paragraph id="HF0C67741EE6A4F1C808FAB4603F24199"><enum>(3)</enum><header>Report</header><text>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.</text></paragraph></subsection> <subsection id="H9966E2EBADBC4E11A038B8EFE8BE6C27"><enum>(d)</enum><header>Use of opioid safety initiative guidelines</header> <paragraph id="H58DED6CC02964629B7D89917E47BAA78"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph>
<paragraph id="H3618CAD7044648A9BD983C704406C4FA"><enum>(2)</enum><header>Inclusion in contracts</header><text>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.</text></paragraph> <paragraph id="H89394A3209F7476CBF2F918FB0014978"><enum>(3)</enum><header>Conditions for exclusion or limitation</header><text>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—</text>
<subparagraph id="H0558FCD7FCB54973B4D6F456E6D9C47F"><enum>(A)</enum><text>conflict with or are otherwise inconsistent with the standards of appropriate and safe care;</text></subparagraph> <subparagraph id="H881BB487A48E426A8B693BF0719C23E0"><enum>(B)</enum><text>violate the requirements of a medical license of the health care provider; or</text></subparagraph>
<subparagraph id="HAEDB86392FEF4F1891F8A8B671619482"><enum>(C)</enum><text>may place at risk the veterans receiving health care from the provider.</text></subparagraph></paragraph></subsection> <subsection id="HA533EC24F451400B9B518E4E31ECF58E"><enum>(e)</enum><header>Covered health care provider defined</header><text>In this section, the term <term>covered health care provider</term> 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.</text></subsection></section>
<section id="H2FD777AA2FBD43CE93605CF313EEB9B2"><enum>132.</enum><header>Improving information sharing with community providers</header><text display-inline="no-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/38/7332">Section 7332(b)(2)</external-xref> is amended by striking subparagraph (H) and inserting the following new subparagraphs:</text> <quoted-block display-inline="no-display-inline" id="HCBDD538DC36147ED9F5B908B0089ADE9" style="OLC"> <subparagraph id="HBB67565A047E492D942C9B879C27BC01" indent="up1"><enum>(H)</enum> <clause commented="no" display-inline="yes-display-inline" id="H463D756BF9F046429EB81EB152CF0F37"><enum>(i)</enum><text display-inline="yes-display-inline">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.</text></clause>
<clause id="HF508D67A2A01427C8BE9622D44298A60" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="HF1AD158D043C419DB7749823BF84118D" indent="up1"><enum>(I)</enum><text>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 <external-xref legal-doc="usc" parsable-cite="usc/38/1729">section 1729</external-xref> 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 <quote>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</quote> (<external-xref legal-doc="public-law" parsable-cite="pl/87/693">Public Law 87–693</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/42/2651">42 U.S.C. 2651</external-xref> et seq.; commonly known as the <quote>Federal Medical Care Recovery Act</quote>).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="H5DF136BA8734451C8EBCE979870CB2DC"><enum>133.</enum><header>Competency standards for non-Department of Veterans Affairs health care providers</header>
<subsection id="HF64AFBD3E063446B8ED9B27DD096A6C6"><enum>(a)</enum><header>Establishment of standards and requirements</header><text>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.</text></subsection> <subsection id="HD2238BA4D3104DF98EC8311854A99C5D"><enum>(b)</enum><header>Condition for eligibility To furnish care</header> <paragraph commented="no" display-inline="yes-display-inline" id="H66BE9EC9628241C39732CF7E36A30559"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph id="HCE863429DF3344758B5C44750055C379" indent="up1"><enum>(2)</enum><text>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.</text></paragraph></subsection> <subsection id="HA432F487B1BF4824B3312EA4E9F825EA"><enum>(c)</enum><header>Effective date</header><text>This section shall take effect on the day that is 1 year after the date of the enactment of this Act.</text></subsection></section>
<section id="HCA4A28AFFDC0486A9BC7CB01B6FDD78E"><enum>134.</enum><header>Department of Veterans Affairs participation in national network of State-based prescription drug monitoring programs</header>
<subsection id="H604919207676424498E3540D061F873B"><enum>(a)</enum><header>In general</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">Chapter 17</external-xref> is amended by inserting after section 1730A the following new section:</text> <quoted-block id="H4268577E732A4BB1AD81588F1D332B94" style="USC"> <section id="HA81DA8DC0BE9433BB9E52E0CC8EB9AC8"><enum>1730B.</enum><header>Access to State prescription drug monitoring programs</header> <subsection id="H984FB651EF4542ACBC6A0683899DB405"><enum>(a)</enum><header>Access to programs</header> <paragraph commented="no" display-inline="yes-display-inline" id="HF4C5B614D25042BFA806F5F8D626D87E"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph id="H0828FCC287EB45F89EFC532588C51D0F" indent="up1"><enum>(2)</enum><text>Under the authority granted by paragraph (1)—</text> <subparagraph id="H271D8C8E9D7F4380837A7A4C954BEBA1"><enum>(A)</enum><text>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</text></subparagraph>
<subparagraph id="H4A176383954C4C0386125DC60E74CB23"><enum>(B)</enum><text>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.</text></subparagraph></paragraph> <paragraph id="H51BF24D047D244699C13B3EDB6D8632D" indent="up1"><enum>(3)</enum><text>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.</text></paragraph></subsection>
<subsection id="HF1A00AC89D5F4C42A0E97402AA3746DD"><enum>(b)</enum><header>Covered patients</header><text>For purposes of this section, a covered patient is a patient who—</text> <paragraph id="H7C313EE7C77C4D84A243B204BCEBCE39"><enum>(1)</enum><text>receives a prescription for a controlled substance; and</text></paragraph>
<paragraph id="HF9DC6B6EA6B348329D532CA84FA793C7"><enum>(2)</enum><text>is not receiving palliative care or enrolled in hospice care.</text></paragraph></subsection> <subsection id="H48B3441CCB4A430897E9FCEAC9BEB257"><enum>(c)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H561F2F497896403197AD49475F4505B4"><enum>(1)</enum><text>The term <term>controlled substance</term> has the meaning given such term in section 102(6) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/802">21 U.S.C. 802(6)</external-xref>).</text></paragraph> <paragraph id="H706B692FD8064DE2A72A5B2459408716"><enum>(2)</enum><text>The term <term>delegate</term> 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.</text></paragraph>
<paragraph id="H76D30151A2A244E08A15FC5602969398"><enum>(3)</enum><text>The term <term>licensed health care provider</term> 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.</text></paragraph> <paragraph id="HCF6FC86FDBD34116AF94013D2D40E62C"><enum>(4)</enum><text>The term <term>national network of State-based prescription monitoring programs</term> means an interconnected nation-wide system that facilitates the transfer to State prescription drug monitoring program data across State lines.</text></paragraph>
<paragraph id="HD8FA7FC345884CC7A2ACF8B83ACF3610"><enum>(5)</enum><text>The term <term>State</term> means a State, as defined in <external-xref legal-doc="usc" parsable-cite="usc/38/101">section 101(20)</external-xref> of this title, or a political subdivision of a State.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H23B1A9CA134E408C890C7CCB3CC36BE9"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of such title is amended by inserting after the item relating to section 1730A the following new item:</text>
<quoted-block id="H9CCB05EDA3504AED910E9F630FF2E5F4" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="section">1730B. Access to State prescription drug monitoring programs.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section></chapter>
<chapter id="H66A8BE34AA9940898583C563E0D55ADD" style="OLC"><enum>5</enum><header>Other Non-Department Health Care Matters</header>
<section commented="no" id="HF6000610726443008B962A2D628AE67C"><enum>141.</enum><header>Plans for Use of Supplemental Appropriations Required</header><text display-inline="no-display-inline">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.</text></section> <section id="H648E50282D7943BBAFC6F0A0E30C7E11"><enum>142.</enum><header>Veterans Choice Fund flexibility</header><text display-inline="no-display-inline">Section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) is amended—</text>
<paragraph commented="no" id="HC35200AAB65A4B979276327DB03C3974"><enum>(1)</enum><text>in subsection (c)—</text> <subparagraph commented="no" id="H758488E7C4B14DEAA71ED5CC34746B87"><enum>(A)</enum><text>in paragraph (1), by striking <quote>by paragraph (3)</quote> and inserting <quote>in paragraphs (3) and (4)</quote>; and</text></subparagraph>
<subparagraph commented="no" id="H01DF71CBB3EB499DB0DC8851868B3F26"><enum>(B)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block display-inline="no-display-inline" id="H66B0DACA8EE54AF3A554CFB70DACC31B" style="OLC"> <paragraph id="H0D0E6D127DFB4C67BB9373E6D838EDDC"><enum>(4)</enum><header>Permanent authority for other uses</header><text>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 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> 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.</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph commented="no" id="H883F4ED142C849749C75E03A9AF3E6B6"><enum>(2)</enum><text>in subsection (d)(1), by striking <quote>to subsection (c)(3)</quote> and inserting <quote>to paragraphs (3) and (4) of subsection (c)</quote>.</text></paragraph></section> <section commented="no" id="H84DE7CDEE7F14AE9BC388F3E6E2A1DB5"><enum>143.</enum><header>Sunset of Veterans Choice Program</header><text display-inline="no-display-inline">Subsection (p) of section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="H6CEF7FF39A314BBCBDB8F2B215B42CEB" style="OLC">
<subsection id="H8E78610FF31B414DA35BFC6F9A8B4993"><enum>(p)</enum><header>Authority To furnish care and services</header><text display-inline="yes-display-inline">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 <short-title>Caring for Our Veterans Act of 2018</short-title>.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section> <section id="HF90A9B1A0566417D8C7FB19AA6347E6E"><enum>144.</enum><header>Conforming amendments</header> <subsection id="H63DD785AEBF94CC49B9D6D20A4BB7E51"><enum>(a)</enum><header>In general</header> <paragraph id="H87A0DA53EF6B4992881B87CF748A5012"><enum>(1)</enum><header>Title 38</header><text>Title 38, United States Code, is amended—</text>
<subparagraph id="HCC42977169BC4FC68697466F84E29C68"><enum>(A)</enum><text>in section 1712(a)—</text> <clause id="HFF5981C4963E4A0CBAB8D5B53CB16DB3"><enum>(i)</enum><text>in paragraph (3), by striking <quote>under clause (1), (2), or (5) of <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703(a)</external-xref> of this title</quote> and inserting <quote>or entered an agreement</quote>; and</text></clause>
<clause id="HB51B91E0B7494997A58CABF8D963249A"><enum>(ii)</enum><text>in paragraph (4)(A), by striking <quote>under the provisions of this subsection and <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703</external-xref> of this title</quote>;</text></clause></subparagraph> <subparagraph id="HD1A2AB43572349AA96AA6E5AD0F515D8"><enum>(B)</enum><text>in section 1712A(e)(1)—</text>
<clause id="H4A556CA5839D428B9231BB69B885A9F4"><enum>(i)</enum><text>by inserting <quote>or agreements</quote> after <quote>contracts</quote>; and</text></clause> <clause id="HB1EA23C86A71445B8364D9363295142D"><enum>(ii)</enum><text>by striking <quote>(under <external-xref legal-doc="usc" parsable-cite="usc/38/1703">sections 1703(a)(2)</external-xref> and <external-xref legal-doc="usc" parsable-cite="usc/38/1710">1710(a)(1)(B)</external-xref> of this title)</quote>; and</text></clause></subparagraph>
<subparagraph id="HA2BC70FA457E4F3B894F1D891B69D78C"><enum>(C)</enum><text>in section 2303(a)(2)(B)(i), by striking <quote>with section 1703</quote> and inserting <quote>with sections 1703A, 8111, and 8153</quote>.</text></subparagraph></paragraph> <paragraph id="HDEDDC9C96658404992379FF767D49EC6"><enum>(2)</enum><header>Social Security Act</header><text>Section 1866(a)(1)(L) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)(1)(L)</external-xref>) is amended by striking <quote>under section 603</quote> and inserting <quote>under chapter 17</quote>.</text></paragraph>
<paragraph id="H30023DC9F5934F23BAF08250E5185AB8"><enum>(3)</enum><header>Veterans' Benefits Improvements Act of 1994</header><text>Section 104(a)(4)(A) of the Veterans' Benefits Improvements Act of 1994 (<external-xref legal-doc="public-law" parsable-cite="pl/103/446">Public Law 103–446</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1117">38 U.S.C. 1117</external-xref> note) is amended by striking <quote>in section 1703</quote> and inserting <quote>in sections 1703A, 8111, and 8153</quote>.</text></paragraph></subsection> <subsection commented="no" display-inline="no-display-inline" id="H477966815254415EA91BAC9309863EAA"><enum>(b)</enum><header>Effective date</header><text>The amendments made by subsection (a) shall take effect on the date described in section 101(b).</text></subsection></section></chapter></subtitle>
<subtitle id="H0533564EABBF4C748686667EDBC77741" style="OLC"><enum>B</enum><header>Improving Department of Veterans Affairs Health Care Delivery</header>
<section id="H660791C4FD6547E88F9B783F9823EE17"><enum>151.</enum><header>Licensure of health care professionals of the Department of Veterans Affairs providing treatment via telemedicine</header>
<subsection id="H272A7EB771AB47C3BEF73A94BBDB84AE"><enum>(a)</enum><header>In general</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">Chapter 17</external-xref> is amended by inserting after section 1730B, as added by section 134, the following new section:</text> <quoted-block display-inline="no-display-inline" id="HB15A471BAA8743448E6444EBD6EACD4F" style="USC"> <section id="H14BBDF59F2FD4C73B5B8E9E4E670AA7C"><enum>1730C.</enum><header>Licensure of health care professionals providing treatment via telemedicine</header> <subsection id="HA43A15E3AC3D4C3EA04DFC1D2E65BAAF"><enum>(a)</enum><header>In general</header><text>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.</text></subsection>
<subsection id="HC278205D2B704D44995ABC7EA3BC2760"><enum>(b)</enum><header>Covered health care professionals</header><text>For purposes of this section, a covered health care professional is any health care professional who—</text> <paragraph id="HA49770BBB7CC47DE9BE12E7D4B32CFDC"><enum>(1)</enum><text>is an employee of the Department appointed under the authority under section 7306, 7401, 7405, 7406, or 7408 of this title or title 5;</text></paragraph>
<paragraph id="H4A74C5FAD1944AE8B23C837387626C6A"><enum>(2)</enum><text>is authorized by the Secretary to provide health care under this chapter;</text></paragraph> <paragraph id="HB353F3F1853443FBA0FA192AC64B38A1"><enum>(3)</enum><text>is required to adhere to all standards for quality relating to the provision of medicine in accordance with applicable policies of the Department; and</text></paragraph>
<paragraph id="HC101BE5F7C954F2EBF274B1DD586CCC0"><enum>(4)</enum><text>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.</text></paragraph></subsection> <subsection id="HDC0ABB93A58A452E9C476C3145BB72E9"><enum>(c)</enum><header>Property of Federal Government</header><text>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.</text></subsection>
<subsection id="H6BD880D3E8E147DA833928701EB85055"><enum>(d)</enum><header>Relation to State law</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H380120E049AE40E0A71240D888B48602"><enum>(1)</enum><text>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.</text></paragraph> <paragraph id="H61D3F4E8CA62424CAE064CBC98B15A13" indent="up1"><enum>(2)</enum><text>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).</text></paragraph></subsection>
<subsection id="HE1619C6DE1C64F48B0B7EC16DB371DC6"><enum>(e)</enum><header>Rule of construction</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/21/801">21 U.S.C. 801</external-xref> et seq.).</text></subsection> <subsection id="H890FB45BBB1E4FE083A0D2C0C383B63A"><enum>(f)</enum><header>State defined</header><text display-inline="yes-display-inline">In this section, the term <term>State</term> means a State, as defined in <external-xref legal-doc="usc" parsable-cite="usc/38/101">section 101(20)</external-xref> of this title, or a political subdivision of a State.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H0D1844C516BC456DAA05FA0E40677A3B"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of such title is amended by inserting after the item relating to section 1730B, as added by section 134, the following new item:</text> <quoted-block display-inline="no-display-inline" id="H5FD328A9A95845F5B4ACEC08E73F4475" style="OLC"> <toc> <toc-entry bold="off" level="section">1730C. Licensure of health care professionals providing treatment via telemedicine.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HE99B51F5A69542D481DDE54A29047BD1"><enum>(c)</enum><header>Report on telemedicine</header> <paragraph id="HDB1E0C388F2141AB8C672EF56355F6BA"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph>
<paragraph id="HAB91EB2E0B1141A09EE8BD9F35B7CBE2"><enum>(2)</enum><header>Elements</header><text>The report required by paragraph (1) shall include an assessment of the following:</text> <subparagraph id="H89FB13A7D9724957AEEA7BE5BB4B9B1E"><enum>(A)</enum><text>The satisfaction of veterans with telemedicine furnished by the Department.</text></subparagraph>
<subparagraph id="H58142649835841A9AA3663C75EDA1ECC"><enum>(B)</enum><text>The satisfaction of health care providers in providing telemedicine furnished by the Department.</text></subparagraph> <subparagraph id="H8D18CD632B034281A08856A9954DE505"><enum>(C)</enum><text>The effect of telemedicine furnished by the Department on the following:</text>
<clause id="HEB5ADBC1C96B49F6BF831944A649E9E3"><enum>(i)</enum><text>The ability of veterans to access health care, whether from the Department or from non-Department health care providers.</text></clause> <clause id="HC4493CF89A6C49A6A7DCD9FA7E26D813"><enum>(ii)</enum><text>The frequency of use by veterans of telemedicine.</text></clause>
<clause id="HFEDF0616F20A4C2AAB16E3FBB621BEB9"><enum>(iii)</enum><text>The productivity of health care providers.</text></clause> <clause id="H8E00632BCA284C0CB7E2B11785FC5034"><enum>(iv)</enum><text>Wait times for an appointment for the receipt of health care from the Department.</text></clause>
<clause id="H5F46966833964A23B1D35DFABFE9DEB0"><enum>(v)</enum><text>The use by veterans of in-person services at Department facilities and non-Department facilities.</text></clause></subparagraph> <subparagraph id="H744A612D4DD64116AE433DC74973017C"><enum>(D)</enum><text>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.</text></subparagraph>
<subparagraph id="HCF36C67F15FB4EF584E440DD44D48B40"><enum>(E)</enum><text>The number of appointments for the receipt of telemedicine furnished by the Department that were requested during such period, disaggregated by medical facility.</text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="H0F1EB786D7A74DE5B9E726D44AEDFE46"><enum>(F)</enum><text>Savings by the Department, if any, including travel costs, from furnishing health care through the use of telemedicine during such period.</text></subparagraph></paragraph></subsection></section>
<section display-inline="no-display-inline" id="HBE4A8DDBEBDD450EA06680CE5D8BE5C9" section-type="subsequent-section"><enum>152.</enum><header>Authority for Department of Veterans Affairs Center for Innovation for Care and Payment</header>
<subsection id="H02C846CB3BE5428A92E6C17D099190C9"><enum>(a)</enum><header>In general</header><text>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:</text> <quoted-block display-inline="no-display-inline" id="HE4739623B7C64B8F991F108170FC7CC9" style="USC"> <section id="H02E02A54630E49978D31ED9B452B9C0A"><enum>1703E.</enum><header>Center for Innovation for Care and Payment</header> <subsection id="H1390ED7A71CF4C93A38576DD043DC952"><enum>(a)</enum><header>In general</header> <paragraph commented="no" display-inline="yes-display-inline" id="HCE133D22F92F4B7E83C64EA287F7C05A"><enum>(1)</enum><text>There is established within the Department a Center for Innovation for Care and Payment (in this section referred to as the <quote>Center</quote>).</text></paragraph>
<paragraph id="HBD266B1761C84397A9FCAD5EB2810D9D" indent="up1"><enum>(2)</enum><text>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.</text></paragraph> <paragraph id="H4E8DE334B51940ACBADA743F5CBC219B" indent="up1"><enum>(3)</enum><text>The Secretary, acting through the Center, shall test payment and service delivery models to determine whether such models—</text>
<subparagraph id="H796B8B6D3AC14554806ED8B03FE9F460"><enum>(A)</enum><text>improve access to, and quality, timeliness, and patient satisfaction of care and services; and</text></subparagraph> <subparagraph id="HC25FFDEA32B74A57ABA2BF003F6CA502"><enum>(B)</enum><text>create cost savings for the Department.</text></subparagraph></paragraph>
<paragraph id="H13442559935A4E0BA8090DE292AF974B" indent="up1"><enum>(4)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="HF4AACABB23274F9389879CD69FD424FE"><enum>(A)</enum><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph id="H4B0F73C642254BD4A6060FF3C0ED8478" indent="up1"><enum>(B)</enum><text>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.</text></subparagraph>
<subparagraph id="H4338E89CCB264F84945C95913AB17F30" indent="up1"><enum>(C)</enum><text>The models selected may include those described in section 1115A(b)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315a">42 U.S.C. 1315a(b)(2)(B)</external-xref>).</text></subparagraph></paragraph> <paragraph id="H52F1D67A56AD41FABDE97E413E3AEFAD" indent="up1"><enum>(5)</enum><text display-inline="yes-display-inline">In selecting a model for testing, the Secretary may consider, in addition to other factors identified in this subsection, the following factors:</text>
<subparagraph id="H0E2FFF7E0AB84D9DA8641488D791633C"><enum>(A)</enum><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph commented="no" id="H7E9F13CD3F2045288CB2777C0DCD15A9"><enum>(B)</enum><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="HAEB5283060634C72A76A66BB31025115"><enum>(C)</enum><text>Whether the model uses technology or new systems to coordinate care over time and across settings.</text></subparagraph> <subparagraph id="H8FB705D09C5F4126B597CA14FBB07ECB"><enum>(D)</enum><text>Whether the model demonstrates effective linkage with other public sector payers, private sector payers, or statewide payment models.</text></subparagraph></paragraph>
<paragraph id="H31BF94309E91457FB812E3796C3E1BD1" indent="up1"><enum>(6)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H03B95D09CCB24FD28FBBB6A3E2CFE79C"><enum>(A)</enum><text>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.</text></subparagraph> <subparagraph id="H6E7F8C7EE5104FBEB58E82EE27807DF6" indent="up1"><enum>(B)</enum><text>In this paragraph, the term <term>Federal health care program</term> means—</text>
<clause id="H8E5EE7D26D614F40A8A1FB645C519D25"><enum>(i)</enum><text>an insurance program described in section 1811 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395c">42 U.S.C. 1395c</external-xref>) or established by section 1831 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395j">42 U.S.C. 1395j</external-xref>);</text></clause> <clause id="HB324AB84C2164E55AF1752C876B9FBB3"><enum>(ii)</enum><text>a State plan for medical assistance approved under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.); or</text></clause>
<clause id="H2D2F797BE0DB42919D3A4AB5511170B9"><enum>(iii)</enum><text>a TRICARE program operated under sections 1075, 1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.</text></clause></subparagraph></paragraph></subsection> <subsection id="H5E5E57AAA6EB4F369A5CC47C256726BF"><enum>(b)</enum><header>Duration</header><text>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.</text></subsection>
<subsection id="HAFFB6778B5E741EEB817756411ECA7A7"><enum>(c)</enum><header>Location</header><text display-inline="yes-display-inline">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.</text></subsection> <subsection id="HACDD123339F34641AFBE21AFFD5FC92C"><enum>(d)</enum><header>Budget</header><text display-inline="yes-display-inline">Funding for each pilot program carried out by the Secretary under this section shall come from appropriations—</text>
<paragraph id="HCD17042A625849EF8427CFF36ECC8E41"><enum>(1)</enum><text>provided in advance in appropriations acts for the Veterans Health Administration; and</text></paragraph> <paragraph id="HF2DBC206DECC4B6180CB7E4B199E6F62"><enum>(2)</enum><text>provided for information technology systems.</text></paragraph></subsection>
<subsection id="HCBB0CD0457594A248F65CB6D245179F8"><enum>(e)</enum><header>Notice</header><text display-inline="yes-display-inline">The Secretary shall—</text> <paragraph id="H28E34B685A084E4B8BC74BB4A53641F9"><enum>(1)</enum><text>publish information about each pilot program under this section in the Federal Register; and</text></paragraph>
<paragraph id="H2EA4321A8BAB4C85A179D6DDB6B22837"><enum>(2)</enum><text>take reasonable actions to provide direct notice to veterans eligible to participate in such pilot programs.</text></paragraph></subsection> <subsection id="HEDD66F0636884A93B36691CB474F309E" commented="no"><enum>(f)</enum><header>Waiver of authorities</header> <paragraph commented="no" display-inline="yes-display-inline" id="HBE04FC62F3654881A50518BC418BCF5D"><enum>(1)</enum><text>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).</text></paragraph>
<paragraph id="HC0626D7129E04D5F8B5AB0C3629EE1CF" indent="up1" commented="no"><enum>(2)</enum><text>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:</text> <subparagraph id="H83487BFF0B8F4B049712E0B87E6E09BF" commented="no"><enum>(A)</enum><text>The specific authorities to be waived under the pilot program.</text></subparagraph>
<subparagraph id="HE0A7635DCEF343DEA956EABA0FF40936" commented="no"><enum>(B)</enum><text>The standard or standards to be used in the pilot program in lieu of the waived authorities.</text></subparagraph> <subparagraph id="H54ED697B0A0745DA8D31C6EB67D60226" commented="no"><enum>(C)</enum><text>The reasons for such waiver or waivers.</text></subparagraph>
<subparagraph id="H6106BB13BAAA4E6CBBAB49DF0E7F8B1A" commented="no"><enum>(D)</enum><text>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.</text></subparagraph> <subparagraph id="HAF8F888570144151A1B6A0CED73C8381" commented="no"><enum>(E)</enum><text>The anticipated cost savings, if any, of the pilot program.</text></subparagraph>
<subparagraph id="H0F036445B13A49AA8DF1AB034473283D" commented="no"><enum>(F)</enum><text>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.</text></subparagraph> <subparagraph id="H00A9C754AF6D4ADB8E4DC82B7EFD06A8" commented="no"><enum>(G)</enum><text>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.</text></subparagraph>
<subparagraph id="H4017EC983B2647F28DC40959841CCDA4" commented="no"><enum>(H)</enum><text>The estimated budget of the pilot program.</text></subparagraph></paragraph> <paragraph id="H3D513A3356BB4EF58DA2FE1F8C3F11CF" indent="up1" commented="no"><enum>(3)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="H8A79ED29DF1B444A9356C62FB30C9320"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="H605DE92517894A02AABBAFD134C6D015" indent="up1" commented="no"><enum>(B)</enum><text>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.</text></subparagraph> <subparagraph id="H3DE85F43F5FE48CE8BDBECA356B75151" commented="no" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">For purposes of this paragraph, the term <term>joint resolution</term> 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—</text>
<clause id="HB06BAB06DD6245EA93F2FA04A0FFC93E" commented="no"><enum>(i)</enum><text>which does not have a preamble; and</text></clause> <clause id="H661FA5F8DD6B407EBD568CFA226EBE51" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">the matter after the resolving clause of which is as follows: <quote>that Congress approves the request for a waiver under section 1703E(f) of title 38, United States Code, as submitted by the Secretary on ___</quote>, the blank space being filled with the appropriate date.</text></clause></subparagraph>
<subparagraph id="H7DFF4EEEEADB4302AAE3ECBECDFFC3BC" commented="no" indent="up1"><enum>(D)</enum>
<clause id="H237963B1C6CD4441B60924C1D0DDFA13" display-inline="yes-display-inline" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">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.</text></clause> <clause id="H213774E09EA5451296C207A073F2B1A1" indent="up1" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text></clause>
<clause id="HF16CBBEE809C47A9B7821AF533818B46" indent="up1" commented="no"><enum>(iii)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph> <subparagraph id="H8FBD7EC75FE7422B82C56D9ED693E938" indent="up1" commented="no"><enum>(E)</enum> <clause id="H56F91134B8D647B9AFF22DBC761FD868" display-inline="yes-display-inline" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">A joint resolution introduced in the Senate shall be referred to the Committee on Veterans’ Affairs.</text></clause>
<clause id="HA165414E872D40C484B050B474823C3E" indent="up1" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text></clause> <clause id="H985D37CE8CE74065ACC7A9AD673B0590" indent="up1" commented="no"><enum>(iii)</enum> <subclause id="HC64DB883CA244CCBB91A08341AF0FB53" display-inline="yes-display-inline" commented="no"><enum>(I)</enum><text display-inline="yes-display-inline">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.</text></subclause>
<subclause id="H62D55D54719244F5B5ADDDF713236D4F" indent="up1" commented="no"><enum>(II)</enum><text display-inline="yes-display-inline">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.</text></subclause> <subclause id="H75D2AFACEAC540BDB182C6FD79B02FC9" indent="up1" commented="no"><enum>(III)</enum><text display-inline="yes-display-inline">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.</text></subclause>
<subclause id="H0787522D1A854D2A995D0E0828DD6EE8" indent="up1" commented="no"><enum>(IV)</enum><text display-inline="yes-display-inline">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.</text></subclause></clause></subparagraph> <subparagraph id="H987B4C7873BF4FA0B8047F910F3AD42B" commented="no" indent="up1"><enum>(F)</enum><text display-inline="yes-display-inline">A joint resolution considered pursuant to this paragraph shall not be subject to amendment in either the House of Representatives or the Senate.</text></subparagraph>
<subparagraph id="H7D8B2AB258FE439A83CB0234E3802A16" indent="up1" commented="no"><enum>(G)</enum>
<clause id="HC89519AC0B7D4D7898AFEDE38C070137" display-inline="yes-display-inline" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">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:</text> <subclause id="H4E1B687F5E8B471DB58631D175EAFE00" indent="up1"><enum>(I)</enum><text display-inline="yes-display-inline">The joint resolution of the other House shall not be referred to a committee.</text></subclause>
<subclause id="HC422C07DF22A4425B47327D44E2220F6" indent="up1"><enum>(II)</enum><text>With respect to the joint resolution of the House receiving the joint resolution—</text> <item id="H1AD5E8A10F9C4676AFA46E8831ECC48E" indent="down1"><enum>(aa)</enum><text display-inline="yes-display-inline">the procedure in that House shall be the same as if no joint resolution had been received from the other House; but</text></item>
<item id="H17DB30C68F4448C4ABB5EE59C6D0C553" indent="down1"><enum>(bb)</enum><text display-inline="yes-display-inline">the vote on passage shall be on the joint resolution of the other House.</text></item></subclause></clause> <clause id="H5C8883E35D5549C88FDBD212FE9F829F" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text></clause>
<clause id="HD3CE227645E0409FA44A3B7A91709DE5" commented="no"><enum>(iii)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph> <subparagraph id="H522C53472A7D44FB8A332402D5110679" indent="up1" commented="no"><enum>(H)</enum><text display-inline="yes-display-inline">This subparagraph is enacted by Congress—</text>
<clause id="H9A117DC2288B4DCC8F16AA425E3BCD98" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">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</text></clause> <clause id="H2ECB9030C4184FB78BDF45262E75A81B" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph></paragraph></subsection>
<subsection id="H8E49FEBE18CC4C51B5E80AD2D18F6348"><enum>(g)</enum><header>Limitations</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H55233A702A5241AD953F8468424A1AC4"><enum>(1)</enum><text>The Secretary may not carry out more than 10 pilot programs concurrently.</text></paragraph> <paragraph id="H14B827F381814781ADB57C8B26E4F16F" indent="up1"><enum>(2)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="H7F73E3AC79624479842D472BAAC02836"><enum>(A)</enum><text>Subject to subparagraph (B), the Secretary may not expend more than $50,000,000 in any fiscal year from amounts under subsection (d).</text></subparagraph>
<subparagraph id="H6B43EF7C828D48AB8B96E71F87778214" indent="up1"><enum>(B)</enum><text>The Secretary may expend more than the amount in subparagraph (A) if—</text> <clause id="H82543B6A20844FB6825B503AD87DDD31"><enum>(i)</enum><text>the Secretary determines that the additional expenditure is necessary to carry out pilot programs under this section;</text></clause>
<clause id="HC121CCCB9EAD4470ADA1D0B36508DE4E"><enum>(ii)</enum><text display-inline="yes-display-inline">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</text></clause> <clause id="H8CC8B8761AC3485293A977A5FDD5A645"><enum>(iii)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HCB26EB3AFE6A4164A4F411786D6E0419" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">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 <short-title>Caring for Our Veterans Act of 2018</short-title>.</text></paragraph> <paragraph id="H9BF5D66D264E4E6B86333A7E2717840C" indent="up1"><enum>(4)</enum><text>Notwithstanding <external-xref legal-doc="usc" parsable-cite="usc/38/502">section 502</external-xref> of this title, decisions by the Secretary under this section shall, consistent with <external-xref legal-doc="usc" parsable-cite="usc/38/511">section 511</external-xref> 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.</text></paragraph>
<paragraph id="HDF2540612C6D423BAC8FC1D324A1D7D5" indent="up1"><enum>(5)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H213CA392AE3D4D0BAB98F8B201AB4FE2"><enum>(A)</enum><text>If the Secretary determines that a pilot program is not improving the quality of care or producing cost savings, the Secretary shall—</text> <clause id="H6957287F146A410EA1F752D24D5EFBF1" indent="up1"><enum>(i)</enum><text>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</text></clause>
<clause id="HC25F1224FE4F4982BE8D66AB5DDB360B" indent="up1"><enum>(ii)</enum><text>terminate such pilot program not later than 30 days after submitting the interim report to Congress.</text></clause></subparagraph> <subparagraph id="H6E5C6CCD12A94FBABA3E966974F32948" indent="up1"><enum>(B)</enum><text>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.</text></subparagraph></paragraph></subsection>
<subsection id="HC3D396BBEB234938934FF3459B8167F4"><enum>(h)</enum><header>Evaluation and reporting requirements</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HEE2044BDF2B04693B310A1DE4206A578"><enum>(1)</enum><text>The Secretary shall conduct an evaluation of each model tested, which shall include, at a minimum, an analysis of—</text> <subparagraph id="HA31C9FE417EB403488C4E27324258188" indent="up1"><enum>(A)</enum><text>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</text></subparagraph>
<subparagraph id="HC508FAC10EB1422B80C8526EE9D7F47A" indent="up1"><enum>(B)</enum><text>the changes in spending by reason of that model.</text></subparagraph></paragraph> <paragraph id="HD27A0CF19E8C431DA2CEC3435885DBC7" indent="up1"><enum>(2)</enum><text>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.</text></paragraph></subsection>
<subsection id="H0B51D145F0784AACBD7CE2BB97B32013"><enum>(i)</enum><header>Coordination and advice</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H9B48E992C74E43D08ECC73B03598A396"><enum>(1)</enum><text>The Secretary shall obtain advice from the Under Secretary for Health and the Special Medical Advisory Group established pursuant to <external-xref legal-doc="usc" parsable-cite="usc/38/7312">section 7312</external-xref> of this title in the development and implementation of any pilot program operated under this section.</text></paragraph> <paragraph id="H9130D9DC18754BF3896748EC8D85B1CB" indent="up1"><enum>(2)</enum><text>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.</text></paragraph></subsection>
<subsection id="H611DFDDF766F414AB8F20B82D4F1DD51"><enum>(j)</enum><header>Expansion of successful pilot programs</header><text>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—</text> <paragraph id="H054E92F04A654C9E813D56BA8F680159"><enum>(1)</enum><text>the Secretary determines that such expansion is expected to—</text>
<subparagraph id="HEB50A25AF3FF472E8073410583B188DC"><enum>(A)</enum><text>reduce spending without reducing the quality of care; or</text></subparagraph> <subparagraph id="HCD2463F734A741DB9AAECCCE6EC6EEDD"><enum>(B)</enum><text>improve the quality of patient care without increasing spending; and</text></subparagraph></paragraph>
<paragraph id="HBB4A18FCD00F48D380100F0504D5808A"><enum>(2)</enum><text display-inline="yes-display-inline">the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits for individuals receiving benefits under this chapter.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H574CEC41A02145F9848B873A370EAEC9"><enum>(b)</enum><header>Conforming amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H8797946450B5491E9A5BA49AA25D956D" style="OLC">
<toc>
<toc-entry bold="off" level="section">1703E. Center for Innovation for Care and Payment.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section id="HEC1B1D206EBB4D00AABF89DC703A2F18"><enum>153.</enum><header>Authorization to provide for operations on live donors for purposes of conducting transplant procedures for veterans</header>
<subsection id="HBB2FCADFC43946DD84BD51A3F4AC63A7"><enum>(a)</enum><header>In general</header><text>Subchapter VIII of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> is amended by adding at the end the following new section:</text> <quoted-block display-inline="no-display-inline" id="H80398D96ED9846069351F61BEE3D862B" style="USC"> <section id="H21DAE77BCC4E4D9DBC0550C76A412E0E"><enum>1788.</enum><header>Transplant procedures with live donors and related services</header> <subsection id="H63C6AC7A794C402E8DC8BAC1FD4AAEDB"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subsection>
<subsection id="H814900375CE54BD2842B8C0B4FBE8C29"><enum>(b)</enum><header>Other services</header><text display-inline="yes-display-inline">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.</text></subsection> <subsection commented="no" display-inline="no-display-inline" id="HC6A03AE266A44E7884240B06D4FA313D"><enum>(c)</enum><header>Use of non-Department facilities</header><text display-inline="yes-display-inline">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.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H5062BF84C1784B889A584FB4B85B8E33"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> is amended by inserting after the item relating to section 1787 the following new item:</text> <quoted-block id="HBD60F5E6F2B44057A533A15DA422B283" style="USC"> <toc> <toc-entry idref="H21DAE77BCC4E4D9DBC0550C76A412E0E" level="section">1788. Transplant procedures with live donors and related services.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section></subtitle> <subtitle id="H95B2B898027040708ABD72ED32695AE4" style="OLC"><enum>C</enum><header>Family Caregivers</header> <section id="H90FE237EED2546CD9F31CC69F96AB08F"><enum>161.</enum><header>Expansion of family caregiver program of Department of Veterans Affairs</header> <subsection id="H700B4D7A338040D79A513522F77820A0"><enum>(a)</enum><header>Family caregiver program</header> <paragraph id="HEE095EE385584F558FB4F1E8DD11B9CD"><enum>(1)</enum><header>Expansion of eligibility</header> <subparagraph id="HCE6702D36EFF4C0CBA4AF91FA06808B6"><enum>(A)</enum><header>In general</header><text>Subparagraph (B) of subsection (a)(2) of <external-xref legal-doc="usc" parsable-cite="usc/38/1720G">section 1720G</external-xref> is amended to read as follows:</text>
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<subparagraph id="HA30E1A4238944ED989AAC15AA51E3B2A" indent="up1"><enum>(B)</enum><text>for assistance provided under this subsection—</text> <clause id="H6B229925129D4C39A9EE05F4FA67C2F9"><enum>(i)</enum><text>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 <short-title>Caring for Our Veterans Act of 2018</short-title>, 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;</text></clause>
<clause id="H1CDC88C44057418CB41023E3F6046CD2"><enum>(ii)</enum><text>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—</text> <subclause id="HFDB3D82DEF6C49238E4EFD2925CFABDB"><enum>(I)</enum><text>on or before May 7, 1975; or</text></subclause>
<subclause id="HD5285939A28F464CBBC71469D10CFFCD"><enum>(II)</enum><text>on or after September 11, 2001; or</text></subclause></clause> <clause id="H5EE5CBE326114EC3B82F7F6FC6CAA037"><enum>(iii)</enum><text>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</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph>
<subparagraph id="H78F908DAEDC14CD092C97FC7AD269737"><enum>(B)</enum><header>Publication in Federal Register</header><text>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 <external-xref legal-doc="usc" parsable-cite="usc/38/1720G">section 1720G</external-xref> 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.</text></subparagraph></paragraph> <paragraph id="H5FA7E2DF77D34FD9BEC4C2EABFFC1552"><enum>(2)</enum><header>Expansion of needed services in eligibility criteria</header><text>Subsection (a)(2)(C) of such section is amended—</text>
<subparagraph id="H03D45B92B0B74706BCA633861156FFBC"><enum>(A)</enum><text>in clause (ii), by striking <quote>; or</quote> and inserting a semicolon;</text></subparagraph> <subparagraph id="H12189ECEE6D14904854BACECD5D77CD4"><enum>(B)</enum><text>by redesignating clause (iii) as clause (iv); and</text></subparagraph>
<subparagraph id="H175EF7EA580D48EFAAE58B751AA68E45"><enum>(C)</enum><text>by inserting after clause (ii) the following new clause (iii):</text> <quoted-block display-inline="no-display-inline" id="H382490E3668247A8885C54E4EC31577E" style="OLC"> <clause commented="no" display-inline="no-display-inline" id="H04E4CB08C5974D3EBB68C75873B53470" indent="up1"><enum>(iii)</enum><text>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</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="H0E8580BF92B549E1A95CE49C743F550C"><enum>(3)</enum><header>Expansion of services provided</header><text>Subsection (a)(3)(A)(ii) of such section is amended—</text> <subparagraph id="H6492D8138D2543A1B835B75822720B28"><enum>(A)</enum><text>in subclause (IV), by striking <quote>; and</quote> and inserting a semicolon;</text></subparagraph>
<subparagraph id="HD55A71B448604B98A18567A9ABC0B989"><enum>(B)</enum><text>in subclause (V), by striking the period at the end and inserting <quote>; and</quote>; and</text></subparagraph> <subparagraph id="H58D75A0E4DF641FCBFFEDA0EFF269CDB"><enum>(C)</enum><text>by adding at the end the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="H3B16B2746CDB498F9F118A0ED0FACA15" style="OLC">
<subclause commented="no" id="HB95CFA2FA2444A459E497E054DB646C3" indent="up2"><enum>(VI)</enum><text>through the use of contracts with, or the provision of grants to, public or private entities—</text> <item commented="no" id="H7019C2761F5E434D8B5BF39A9DC4F1F9"><enum>(aa)</enum><text>financial planning services relating to the needs of injured veterans and their caregivers; and</text></item>
<item commented="no" id="H1803C6BFFD6446929EA3C4B0810CBD26"><enum>(bb)</enum><text>legal services, including legal advice and consultation, relating to the needs of injured veterans and their caregivers.</text></item></subclause><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph id="H3E6F1D07466848FF8BF3F9AE07438AD1"><enum>(4)</enum><header>Modification of stipend calculation</header><text>Subsection (a)(3)(C) of such section is amended—</text>
<subparagraph id="H8B22D2D7AB844D319FB4795409B4D785"><enum>(A)</enum><text>by redesignating clause (iii) as clause (iv); and</text></subparagraph> <subparagraph id="HD503E968127A485DA107E27EF5ED96C0"><enum>(B)</enum><text>by inserting after clause (ii) the following new clause (iii):</text>
<quoted-block display-inline="no-display-inline" id="H1B0D7F3E17864072A7FDBB285601C7E1" style="OLC">
<clause id="H8F62C77AAB564B4799E4F6D5F9922312" indent="up3"><enum>(iii)</enum><text>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:</text> <subclause id="HB6D4BBAF8B304617A3197442FFE15351"><enum>(I)</enum><text>The assessment by the family caregiver of the needs and limitations of the veteran.</text></subclause>
<subclause id="HED3338611B9C49B6B2E253A0D357244C"><enum>(II)</enum><text>The extent to which the veteran can function safely and independently in the absence of such supervision, protection, or instruction.</text></subclause> <subclause id="H00665F6C9A11410A95FE1729AF5A73FF"><enum>(III)</enum><text>The amount of time required for the family caregiver to provide such supervision, protection, or instruction to the veteran.</text></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="HD7DA5A70AFAE4864B57E58B373D7FF26"><enum>(5)</enum><header>Periodic evaluation of need for certain services</header><text>Subsection (a)(3) of such section is amended by adding at the end the following new subparagraph:</text> <quoted-block display-inline="no-display-inline" id="H4579176271664F59AC619B2672DE7DDA" style="OLC"> <subparagraph id="H2F6073A4A10E4054967B305AD112B620" indent="up2"><enum>(D)</enum><text>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.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H9E4F0E6CD6EF43639D6F3AB7B04C1279"><enum>(6)</enum><header>Use of primary care teams</header><text>Subsection (a)(5) of such section is amended, in the matter preceding subparagraph (A), by inserting <quote>(in collaboration with the primary care team for the eligible veteran to the maximum extent practicable)</quote> after <quote>evaluate</quote>.</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="HFCA05E084B9A4A5EB014B0B9B5B19245"><enum>(7)</enum><header display-inline="yes-display-inline">Assistance for family caregivers</header><text display-inline="yes-display-inline">Subsection (a) of such section is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HABB1D151211F454A809CA33525C70822" style="OLC">
<paragraph id="H06663C33E3D0420198EE0DF95900DF51" indent="up1"><enum>(11)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H46AAA761B51A44BA80C2C7F831444945"><enum>(A)</enum><text>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.</text></subparagraph> <subparagraph id="H6D64BC9A72FE4CC0A847A4CA73EB101D" indent="up1"><enum>(B)</enum><text>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.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HBFA6FC1012A4483F8C54BC1419D1C5DF" indent="up1"><enum>(C)</enum><text>The Secretary may provide fair compensation to Federal agencies, States, and other entities that provide assistance under this paragraph.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="HA14736DFC2F74FCEAAF99435C260045B"><enum>(b)</enum><header>Modification of definition of personal care services</header><text>Subsection (d)(4) of such section is amended—</text>
<paragraph id="HE01F4F74028347EE8EBB4FE87DA24972"><enum>(1)</enum><text>in subparagraph (A), by striking <quote>independent</quote>;</text></paragraph> <paragraph id="HE3E1F6BED4C641B6B02A9CAB8BDE7DD3"><enum>(2)</enum><text>by redesignating subparagraph (B) as subparagraph (D); and</text></paragraph>
<paragraph id="H4021D1A536EF4AA599B210402AA7483C"><enum>(3)</enum><text>by inserting after subparagraph (A) the following new subparagraphs:</text> <quoted-block display-inline="no-display-inline" id="H2B8D26961B25470B8FC3806306765AC8" style="OLC"> <subparagraph id="HFD07EB615CE24E2BA11722664D0FCE39"><enum>(B)</enum><text>Supervision or protection based on symptoms or residuals of neurological or other impairment or injury.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HA07D25A3AEC84BA4932F8F7FB7861E66"><enum>(C)</enum><text>Regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section> <section id="HC20F6BDB21D940A6BF628E671CD19B8A"><enum>162.</enum><header>Implementation of information technology system of Department of Veterans Affairs to assess and improve the family caregiver program</header> <subsection id="H2BD904E96AF34636A3BD0F8C7C8161FE"><enum>(a)</enum><header>Implementation of new system</header> <paragraph id="H5D2794EAE56B40689D53DBE5C027C161"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph>
<paragraph id="HD067A7B1E6AD4864A8D3C33DB82C4431"><enum>(2)</enum><header>Elements of system</header><text>The information technology system required to be implemented under paragraph (1) shall include the following:</text> <subparagraph id="H4276386197D94ACA91679C3637B38254"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="HF826C686688C486C8E89BD8C1BD55DB9"><enum>(B)</enum><text>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.</text></subparagraph> <subparagraph id="H008351B236EE4403938A12D837A7AB0E"><enum>(C)</enum><text>The ability to integrate the system with other relevant information technology systems of the Veterans Health Administration.</text></subparagraph></paragraph></subsection>
<subsection id="H35C671AE90B7444D882C5D4F17313A51"><enum>(b)</enum><header>Assessment of Program</header><text>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.</text></subsection> <subsection id="H092A13ACAD0A464BBAC39F0159310518"><enum>(c)</enum><header>Ongoing monitoring of and modifications to Program</header> <paragraph id="H0653B8C2B84E44859998C61A6102701B"><enum>(1)</enum><header>Monitoring</header><text>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—</text>
<subparagraph id="HC0373A0E832A45D6AF329E850ABA02E1"><enum>(A)</enum><text>the status of applications, appeals, and home visits in connection with the Program; and</text></subparagraph> <subparagraph id="HB4504AB663BB4A01B204532C0033456A"><enum>(B)</enum><text>the use by caregivers participating in the Program of other support services under the Program such as respite care.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H23326C2FD23C4719A9DB12E5B2E808C6"><enum>(2)</enum><header display-inline="yes-display-inline">Modifications</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="H0CF8A3B5630540B9A067F945FAB2501A"><enum>(d)</enum><header>Reports</header> <paragraph id="HD3E9EEC357B04E51AC2859E7015F6505"><enum>(1)</enum><header>Initial report</header> <subparagraph id="HB0E7C14FE93C486E97E2F0B1980A7F57"><enum>(A)</enum><header>In general</header><text>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—</text>
<clause id="H9F4D3A9DFA7643ED9AE44ADA309616E0"><enum>(i)</enum><text>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</text></clause> <clause commented="no" display-inline="no-display-inline" id="H55770358488E4AB7BF78BD569EE80066"><enum>(ii)</enum><text>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.</text></clause></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H0996C9C382D24B638A0FBC2207AAA310"><enum>(B)</enum><header display-inline="yes-display-inline">Veterans described</header><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc" parsable-cite="usc/38/161">section 161(a)(1)</external-xref> 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.</text></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H301AC52013F94E1FB9A4833FAF4E7F29"><enum>(2)</enum><header>Notification by Comptroller General</header><text>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—</text>
<subparagraph id="HC8BEACC7DD4F4433988272613A949617"><enum>(A)</enum><text>fully implementing the system required under subsection (a); and</text></subparagraph> <subparagraph id="H281155DE842540B19CAC3FC39E41A00C"><enum>(B)</enum><text>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).</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H69D1498DFF2D49138546E2843690EE25"><enum>(3)</enum><header display-inline="yes-display-inline">Final report</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H74D9525CA6014508B1347F8C7173B98E"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">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).</text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="H38F4E166951F46D785634F291FF5F15C"><enum>(B)</enum><header>Elements</header><text display-inline="yes-display-inline">The report required by subparagraph (A) shall include the following:</text>
<clause commented="no" display-inline="no-display-inline" id="HF51D95867AFE4110A89E75FCF4CDDD34"><enum>(i)</enum><text>A certification by the Secretary that the information technology system described in subsection (a) has been implemented.</text></clause> <clause commented="no" display-inline="no-display-inline" id="H2070EF9D16B04B04B0DF26F9B515EABA"><enum>(ii)</enum><text>A description of how the Secretary has implemented such system.</text></clause>
<clause commented="no" display-inline="no-display-inline" id="H074B08240B794483B777761BFFC876D5"><enum>(iii)</enum><text>A description of the modifications to the Program, if any, that were identified and implemented under subsection (c)(2).</text></clause> <clause commented="no" display-inline="no-display-inline" id="HA49B80D633734201B3407F491A87EE79"><enum>(iv)</enum><text>A description of how the Secretary is using such system to monitor the workload of the Program.</text></clause></subparagraph></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="HFE23C26E627B492A8DD7A82C00A61052"><enum>(e)</enum><header>Definitions</header><text>In this section:</text> <paragraph commented="no" display-inline="no-display-inline" id="HA96EE61E59574161AF3707348C772B5E"><enum>(1)</enum><header>Active military, naval, or air service</header><text>The term <term>active military, naval, or air service</term> has the meaning given that term in section 101 of title 38, United States Code.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HABD0256B0009476CAB849288352DC8EC"><enum>(2)</enum><header>Program</header><text>The term <term>Program</term> means the program of comprehensive assistance for family caregivers under section 1720G(a) of title 38, United States Code, as amended by <external-xref legal-doc="usc" parsable-cite="usc/38/161">section 161</external-xref> of this title.</text></paragraph></subsection></section> <section commented="no" display-inline="no-display-inline" id="H5089F86B07564B609CB44AD5496032DF"><enum>163.</enum><header>Modifications to annual evaluation report on caregiver program of Department of Veterans Affairs</header> <subsection commented="no" display-inline="no-display-inline" id="H9D25A844F9B04EF7B88E6C670C53EA2D"><enum>(a)</enum><header>Barriers to care and services</header><text>Subparagraph (A)(iv) of section 101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of 2010 (<external-xref legal-doc="public-law" parsable-cite="pl/111/163">Public Law 111–163</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1720G">38 U.S.C. 1720G</external-xref> note) is amended by inserting <quote>, including a description of any barriers to accessing and receiving care and services under such programs</quote> before the semicolon.</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H6D6337A3B6B14D9D8B1E38C8C3225CCF"><enum>(b)</enum><header>Sufficiency of training for family caregiver program</header><text>Subparagraph (B) of such section is amended—</text> <paragraph commented="no" display-inline="no-display-inline" id="HF3F19734200A4DD3944604CA6A2C7466"><enum>(1)</enum><text>in clause (i), by striking <quote>; and</quote> and inserting a semicolon;</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HBE08675F62C64C8CA9AF8B4031BE70EA"><enum>(2)</enum><text>in clause (ii), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="HF887C602EDD142B9A6D2505FE7739896"><enum>(3)</enum><text>by adding at the end the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="HFDDBF9E0C3B646D79C128DA4732F9C1E" style="OLC">
<clause commented="no" display-inline="no-display-inline" id="HB52C39A7831542C0AB367EA1892E47F2"><enum>(iii)</enum><text>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.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section></subtitle> <enum>II</enum><header>VA Asset and Infrastructure Review</header> <subtitle id="H0886C63E3AC74351AD63CC96A8E3C65D"><enum>A</enum><header>Asset and Infrastructure Review</header> <section id="H7941AF2525E14122A037DB4D9649851F"><enum>201.</enum><header>Short title</header><text display-inline="no-display-inline">This subtitle may be cited as the <quote><short-title>VA Asset and Infrastructure Review Act of 2018</short-title></quote>.</text></section>
<section id="HB24C1CDEB89C4C2BB68C677AC5349FBA"><enum>202.</enum><header>The Commission</header>
<subsection id="H50AFFAA549F24516B94C23A5F37777DA"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">There is established an independent commission to be known as the <quote>Asset and Infrastructure Review Commission</quote> (in this subtitle referred to as the <quote>Commission</quote>).</text></subsection> <subsection id="HF5A3B724FE664A688889EA164BDD69B4"><enum>(b)</enum><header>Duties</header><text>The Commission shall carry out the duties specified for it in this subtitle.</text></subsection>
<subsection id="H3A463E777ECE41489BCCBB654D8AAECD"><enum>(c)</enum><header>Appointment</header>
<paragraph display-inline="no-display-inline" id="H0D5F96F61EAD4821848E754A9AB02302"><enum>(1)</enum><header>In general</header>
<subparagraph display-inline="no-display-inline" id="H8A1C273A0B7046AB98BE59C1692135C7"><enum>(A)</enum><header>Appointment</header><text>The Commission shall be composed of nine members appointed by the President, by and with the advice and consent of the Senate.</text></subparagraph> <subparagraph commented="no" id="H15A9EDACEB624D5C9D1C47ED680CE855"><enum>(B)</enum><header>Transmission of nominations</header><text>The President shall transmit to the Senate the nominations for appointment to the Commission not later than May 31, 2021.</text></subparagraph></paragraph>
<paragraph commented="no" id="HB1F1F783E6FE475984B08D4F7D2E0F74"><enum>(2)</enum><header>Consultation in selection process</header><text>In selecting individuals for nominations for appointments to the Commission, the President shall consult with—</text> <subparagraph commented="no" id="HB15406C54F2A42A8A6A29247623059A7"><enum>(A)</enum><text>the Speaker of the House of Representatives;</text></subparagraph>
<subparagraph commented="no" id="HBEEF2A23A9C14368BD9D2611431C2277"><enum>(B)</enum><text>the majority leader of the Senate;</text></subparagraph> <subparagraph commented="no" id="H9F5521ABD12C4136A8D558A4CCA2B80F"><enum>(C)</enum><text>the minority leader of the House of Representatives;</text></subparagraph>
<subparagraph commented="no" id="H783CBB40B11D4EAA81E6925A92EEE8F1"><enum>(D)</enum><text>the minority leader of the Senate; and</text></subparagraph> <subparagraph commented="no" id="H4F5CE3079B4B4767B0C996A6DDF20233"><enum>(E)</enum><text display-inline="yes-display-inline">congressionally chartered, membership based veterans service organizations concerning the appointment of three members.</text></subparagraph></paragraph>
<paragraph id="HE548E6FFD1664DF3A5EEA2C754A07574"><enum>(3)</enum><header>Designation of Chair</header><text>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.</text></paragraph> <paragraph id="H047F17845A4F489296595EF4FBA0A5EA"><enum>(4)</enum><header>Member representation</header><text>In nominating individuals under this subsection, the President shall ensure that—</text>
<subparagraph id="HC83CB8EEF2F948E593D7319E4FE170D2"><enum>(A)</enum><text display-inline="yes-display-inline">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;</text></subparagraph> <subparagraph id="H5BFAF57A5E6146FBA5D5B4F72AE3D80A"><enum>(B)</enum><text display-inline="yes-display-inline">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;</text></subparagraph>
<subparagraph commented="no" id="H1C57A0EB7FAA41DBBF31231BBEBD59A4"><enum>(C)</enum><text display-inline="yes-display-inline">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 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note);</text></subparagraph> <subparagraph id="H04C625452BF94FAEA59C05B95644FAA6"><enum>(D)</enum><text display-inline="yes-display-inline">at least one member—</text>
<clause id="HAEA5FE350E014F188D94CDADDBE792FB"><enum>(i)</enum><text>has experience with capital asset management for the Federal Government; and</text></clause> <clause id="H348674098D844E6CAF721732BD64AE06"><enum>(ii)</enum><text>is familiar with trades related to building and real property, including construction, engineering, architecture, leasing, and strategic partnerships; and</text></clause></subparagraph>
<subparagraph id="H5C33BF4339FC4DF488CB0C8D3B10A962"><enum>(E)</enum><text>at least three members represent congressionally chartered, membership-based, veterans service organizations.</text></subparagraph></paragraph></subsection> <subsection id="H4AF711E2EEE04F0A8404F59CC61A06E8"><enum>(d)</enum><header>Meetings</header> <paragraph commented="no" display-inline="no-display-inline" id="HD628FAFE55E240689BE5B7E16E0A378F"><enum>(1)</enum><header>In general</header><text>The Commission shall meet only during calendar years 2022 and 2023.</text></paragraph>
<paragraph id="HAD0ED9A26BBC49FC92E1B633ECCCF8C1"><enum>(2)</enum><header>Public nature of meetings and proceedings</header>
<subparagraph display-inline="no-display-inline" id="HA57CA0766D484EFCB9F9682E5775FE91"><enum>(A)</enum><header>Public meetings</header><text>Each meeting of the Commission shall be open to the public.</text></subparagraph> <subparagraph id="H09D85BDA529F4E42B2B2AC851A7363FC"><enum>(B)</enum><header>Open participation</header><text display-inline="yes-display-inline">All the proceedings, information, and deliberations of the Commission shall be available for review by the public.</text></subparagraph></paragraph></subsection>
<subsection id="HD0263BC95D9A42ACAC00CA690A9B3BA8"><enum>(e)</enum><header>Vacancies</header><text>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.</text></subsection> <subsection id="HB13CDB87CC6F4E3186652E06F6F195F4"><enum>(f)</enum><header>Pay</header> <paragraph id="HADCDEFB25E274062B4B2F372F94892C1"><enum>(1)</enum><header>In general</header><text>Members of the Commission shall serve without pay.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H0045120565534BEF95A17F8517BC6718"><enum>(2)</enum><header>Officers or employees of the United States</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph commented="no" id="HBB7B7F68401749008939A4799C8E9A0C"><enum>(3)</enum><header>Travel expenses</header><text>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.</text></paragraph></subsection>
<subsection id="H04758E6871F347EAB3884632E380D5BD"><enum>(g)</enum><header>Director of staff</header>
<paragraph display-inline="no-display-inline" id="H80F5CE39E02D4EBF873CCC331FC3BB7D"><enum>(1)</enum><header>Appointment</header><text>The Commission shall appoint a Director who—</text> <subparagraph id="H493895A7229D42AA994AB152BBEF40C6"><enum>(A)</enum><text>has not served as an employee of the Department of Veterans Affairs during the 1-year period preceding the date of such appointment; and</text></subparagraph>
<subparagraph id="HBF8FB2A35CF44D479B17A2E256667B7B"><enum>(B)</enum><text display-inline="yes-display-inline">is not otherwise barred or prohibited from serving as Director under Federal ethics laws and regulations, by reason of post-employment conflict of interest.</text></subparagraph></paragraph> <paragraph id="H7B095B80F9504014B32408F489B505CE"><enum>(2)</enum><header>Rate of pay</header><text>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.</text></paragraph></subsection>
<subsection id="H4B76A93C245F41E48B216D8236ED788F"><enum>(h)</enum><header>Staff</header>
<paragraph display-inline="no-display-inline" id="H60E8D0C57CA34675B8A467A5A944FAC8"><enum>(1)</enum><header>Pay of personnel</header><text>Subject to paragraphs (2) and (3), the Director, with the approval of the Commission, may appoint and fix the pay of additional personnel.</text></paragraph> <paragraph id="H0545DACB5AA94443A41652C5B3F0B912"><enum>(2)</enum><header>Exemption from certain requirements</header><text>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 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/53">chapter 53</external-xref> 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.</text></paragraph>
<paragraph id="H4B9EC0BE8A8044C19EA1A775CC2803E3"><enum>(3)</enum><header>Detailees</header>
<subparagraph display-inline="no-display-inline" id="HD2947DBE66454B5EB28EE5DC50790837"><enum>(A)</enum><header>Limitation on number</header><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph display-inline="no-display-inline" id="H753100D5413F405088F1E1B2691F8293"><enum>(B)</enum><header>Professional analysts</header><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="H255CC929116E4691B52CE667B18A2188"><enum>(C)</enum><header>Prohibition on detail of certain personnel</header><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph> <paragraph id="H40992DD14EE84CCCBDD6FD0E6F68649F"><enum>(4)</enum><header>Authority to request detailed personnel</header><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="HF8CD0DD9B2EB4F2296D1E766CEAE0D86"><enum>(5)</enum><header>Information from Federal agencies</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="HEC4D30206052439F9EF2B1455C545D3F"><enum>(i)</enum><header>Other authority</header> <paragraph display-inline="no-display-inline" id="H0ABFFDC214AF40AE97F7CFCC450749D9"><enum>(1)</enum><header>Temporary and intermittent services</header><text>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.</text></paragraph>
<paragraph id="HFB93A78D26A54B8D9E72BB10FECB552F"><enum>(2)</enum><header>Leasing and acquisition of property</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="H38252FE76C234F25995E08036D29FDAA"><enum>(j)</enum><header>Termination</header><text display-inline="yes-display-inline">The Commission shall terminate on December 31, 2023.</text></subsection>
<subsection commented="no" id="H5C51C093D33D41F1A51214467234424C"><enum>(k)</enum><header>Prohibition against restricting communications</header>
<paragraph id="H8FC780758D4140E8BA22A1EF8E135900"><enum>(1)</enum><header>In general</header><text>Except as provided in paragraph (2), no person may restrict an employee of the Department of Veterans Affairs in communicating with the Commission.</text></paragraph> <paragraph id="HF144E074FF844784ABB0D88766A14091"><enum>(2)</enum><header>Unlawful communications</header><text>Paragraph (1) does not apply to a communication that is unlawful.</text></paragraph></subsection></section>
<section id="HA917D19D056445D3AE53FF287237FE01"><enum>203.</enum><header>Procedure for making recommendations</header>
<subsection commented="no" id="H74DCE72237B84712A319D0CB2E00533C"><enum>(a)</enum><header>Selection criteria</header>
<paragraph commented="no" display-inline="no-display-inline" id="H63DF298A6197418F97820EFED52AF2B6"><enum>(1)</enum><header>Publication</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph commented="no" id="H1483FB4228DF496C99268C7A1A492C28"><enum>(2)</enum><header>Public comment</header><text>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.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HA3B7CD6F87FC4BC1B24DCC7B1523B6F3"><enum>(3)</enum><header>Publication of final criteria</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="H97C98EF137B443F29C5E41AACCC05E9F"><enum>(b)</enum><header>Recommendations of the Secretary</header> <paragraph display-inline="no-display-inline" id="HB2C6C6BBC55C483FA7A8C4E4DF77D2C3"><enum>(1)</enum><header>Publication in Federal Register</header><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="H420932F3FF2440EAB775F1BD16DBC3EC"><enum>(2)</enum><header>Factors for consideration</header><text>In making recommendations under this subsection, the Secretary shall consider each of the following factors:</text> <subparagraph commented="no" display-inline="no-display-inline" id="HEF54E888A952486EB21889AD550C2E56"><enum>(A)</enum><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph commented="no" id="H1722E61176B34389BFA123816F1D2775"><enum>(B)</enum><text>The provision of effective and efficient access to high-quality health care and services for veterans.</text></subparagraph> <subparagraph commented="no" id="H7C3017E9E2454E5A94A82500705D1367"><enum>(C)</enum><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph commented="no" id="H931CD4FAAB3A4BD0BCF16946C880D472"><enum>(D)</enum><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph commented="no" id="HE3C808A6C8DA4CE78F44E89AB5BAEDD0"><enum>(E)</enum><text>The extent to which the operating and maintenance costs are reduced through consolidating, colocating, and reconfiguring space, and through realizing other operational efficiencies.</text></subparagraph>
<subparagraph commented="no" id="HDD9993AE5F0C470BA7C7D76DDB36E06A"><enum>(F)</enum><text>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.</text></subparagraph> <subparagraph commented="no" id="H51307E47054040A19F98FB91CB093039"><enum>(G)</enum><text display-inline="yes-display-inline">The extent to which the real property aligns with the mission of the Department of Veterans Affairs.</text></subparagraph>
<subparagraph id="H84EC6CA386AA4C9EAC061D8E92A6FEFA"><enum>(H)</enum><text display-inline="yes-display-inline">The extent to which any action would impact other missions of the Department (including education, research, or emergency preparedness).</text></subparagraph> <subparagraph id="H3964E2AFD81445F5A738F2137E03CA81"><enum>(I)</enum><text display-inline="yes-display-inline">Local stakeholder inputs and any factors identified through public field hearings.</text></subparagraph>
<subparagraph id="H005583A21C684A8EBA11BFE63AE4409C"><enum>(J)</enum><text display-inline="yes-display-inline">The assessments under paragraph (3).</text></subparagraph> <subparagraph id="H1FB386BAD34E46F0B5426B95C9C95F66"><enum>(K)</enum><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="HA8176D2B37F34345826AA3E4F6BCF5DA"><enum>(L)</enum><text display-inline="yes-display-inline">Any other such factors the Secretary determines appropriate.</text></subparagraph></paragraph> <paragraph commented="no" id="H280D9F6586734B9FA24A01DDB1011D14"><enum>(3)</enum><header>Capacity and commercial market assessments</header> <subparagraph commented="no" id="H290A86149E3D49B4ACC1A48781DA58F4"><enum>(A)</enum><header>Assessments</header><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code. Each such assessment shall—</text>
<clause commented="no" display-inline="no-display-inline" id="HEAEBE4A2A7954F6AACC4E62130D47520"><enum>(i)</enum><text display-inline="yes-display-inline">identify gaps in furnishing such care or services at such Veterans Integrated Service Network or medical facility;</text></clause> <clause commented="no" id="HC6F18DCAA0CE4D8DBEC4F5BF5E061CC9"><enum>(ii)</enum><text>identify how such gaps can be filled by—</text>
<subclause commented="no" id="HCE7BDFCDAFB54B76A3A84FB7DD0C657E"><enum>(I)</enum><text>entering into contracts or agreements with network providers under this section or with entities under other provisions of law;</text></subclause> <subclause commented="no" id="H7B23A3736D104354937EB70E16286376"><enum>(II)</enum><text>making changes in the way such care and services are furnished at such Veterans Integrated Service Network or medical facility, including—</text>
<item id="HE7686EF161ED47FFB374F42281466E0E"><enum>(aa)</enum><text display-inline="yes-display-inline">extending hours of operation;</text></item> <item id="H2475CE433FC949CFACD47577EE846B53"><enum>(bb)</enum><text display-inline="yes-display-inline">adding personnel; or</text></item>
<item id="H2A0333631174488DB32371B552BE5133"><enum>(cc)</enum><text display-inline="yes-display-inline">expanding space through the construction, leasing, or sharing of health care facilities; and</text></item></subclause> <subclause id="HCF8B0DF0EF554E499F01401C0C2CB4DE"><enum>(III)</enum><text display-inline="yes-display-inline">the building or realignment of Department resources or personnel;</text></subclause></clause>
<clause commented="no" id="HB5C2A6DB467A42B5A9F8C823490C0768"><enum>(iii)</enum><text display-inline="yes-display-inline">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;</text></clause> <clause commented="no" id="H22B21EEB2D444C65A91B7D9132E454F3"><enum>(iv)</enum><text>include a commercial health care market assessment of designated catchment areas in the United States conducted by a non-governmental entity; and</text></clause>
<clause id="HC077B21F830949648BB958DCAC9B4C55"><enum>(v)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph> <subparagraph commented="no" id="HCE52DECBDE2540DCB0F6951836664724"><enum>(B)</enum><header>Consultation</header><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph commented="no" id="H8A036C884F3F4D96BA755B0311A537DA"><enum>(C)</enum><header>Submittal</header><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph> <paragraph id="H067242C1F05A43D4A86A7A8A460366FB"><enum>(4)</enum><header>Summary of selection process</header><text display-inline="yes-display-inline">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).</text></paragraph>
<paragraph id="H3EF4FD1450354A529560F3DF9063B20D"><enum>(5)</enum><header>Treatment of facilities</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph id="H26B8C82944EC43BCB41DF1B1A884BE13"><enum>(6)</enum><header>Availability of information to Congress</header><text>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.</text></paragraph>
<paragraph id="HF92C875E7516477AAB72C331990BC50D"><enum>(7)</enum><header>Certification of accuracy</header>
<subparagraph display-inline="no-display-inline" id="H35E0AC3092CE47B2B7CD475CA35970C1"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph display-inline="no-display-inline" id="H855E40E2FF4C4066B51FD00B25637394"><enum>(B)</enum><header>Covered persons</header><text>Subparagraph (A) applies to the following persons:</text>
<clause commented="no" id="HE2E6C09CA09949DEA3353C6BE91B8EBA"><enum>(i)</enum><text display-inline="yes-display-inline">Each Under Secretary of the Department of Veterans Affairs.</text></clause> <clause commented="no" id="HCBA8F80D64F8459E86B442581DFBABD0"><enum>(ii)</enum><text>Each director of a Veterans Integrated Service Network.</text></clause>
<clause id="H8A0278F0CE7147BD8AD5A64E80017EBA"><enum>(iii)</enum><text display-inline="yes-display-inline">Each director of a medical center of the Department of Veterans Affairs.</text></clause> <clause id="H68A33CCBEE8E4AC1A4EE8A02551BFC95"><enum>(iv)</enum><text display-inline="yes-display-inline">Each director of a program office of the Department of Veterans Affairs.</text></clause>
<clause id="HEE491BC0261E40FDBADF1034671A8CBE"><enum>(v)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph></paragraph></subsection> <subsection commented="no" id="H06EC1161861C45A1A12B52FF59FE91FF"><enum>(c)</enum><header>Review and recommendations by the Commission</header> <paragraph commented="no" display-inline="no-display-inline" id="H857BA937875A4C2B950DF445A5CEAD62"><enum>(1)</enum><header>Public hearings</header> <subparagraph commented="no" id="HBDB44266F83A47FFA2CADC9392A8644B"><enum>(A)</enum><header>In general</header><text>After receiving the recommendations from the Secretary pursuant to subsection (b), the Commission shall conduct public hearings on the recommendations.</text></subparagraph>
<subparagraph commented="no" id="H31ACA75988254A6ABC86908BF51E51F5"><enum>(B)</enum><header>Locations</header><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph commented="no" id="H961F8F157A404F8D8CF1697D403AE51C"><enum>(C)</enum><header>Required witnesses</header><text>Witnesses at each public hearing shall include at a minimum—</text>
<clause id="H98034BD076F7462A84649AF9BF34FFE9"><enum>(i)</enum><text>a veteran—</text> <subclause id="H518F369A8FBA4D37856557256A4960D6"><enum>(I)</enum><text>enrolled under section 1705 of title 38, United States Code; and</text></subclause>
<subclause id="HB710434B99AA4D6EAC935F23596417DC"><enum>(II)</enum><text>identified by a local veterans service organization; and</text></subclause></clause> <clause id="H55A1E449419549948C65DC8628185620"><enum>(ii)</enum><text>a local elected official.</text></clause></subparagraph></paragraph>
<paragraph commented="no" id="HFAAAF1F3EED740088AD0ED4E89FC1A32"><enum>(2)</enum><header>Transmittal to President</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H739BF842278F47D3AB49B07A15AB9347"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph commented="no" id="HA9CB07D1551F495BB039004F62CB9D7D"><enum>(B)</enum><header>Authority to make changes to recommendations</header><text>Subject to subparagraph (C), in making its recommendations, the Commission may change any recommendation made by the Secretary if the Commission—</text>
<clause commented="no" id="H340C83E813934D80A4147CE280572066"><enum>(i)</enum><text>determines that the Secretary deviated substantially from the final criteria referred to in subsection (a)(2) in making such recommendation;</text></clause> <clause commented="no" id="HBB126938CBD24855B8C762E0BB774F09"><enum>(ii)</enum><text>determines that the change is consistent with the final criteria referred to in subsection (a)(2);</text></clause>
<clause commented="no" id="HA2F67106E11E4900AC817A6A2BFB009C"><enum>(iii)</enum><text>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</text></clause> <clause commented="no" id="HD687AF2C599F4F1D98A7B9F6CDB33BF9"><enum>(iv)</enum><text>conducts public hearings on the proposed change.</text></clause></subparagraph></paragraph>
<paragraph commented="no" id="H909DAA20544944078564CE019DDF0FB5"><enum>(3)</enum><header>Justification for changes</header><text display-inline="yes-display-inline">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).</text></paragraph> <paragraph commented="no" id="H1F9AB17C59AE4CE6BE877D05006D4AE8"><enum>(4)</enum><header>Provision of information to Congress</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection>
<subsection id="H2CC81651D8A34E74B8315B959205614E"><enum>(d)</enum><header>Review by the President</header>
<paragraph display-inline="no-display-inline" id="H7B4475E78F954943832E5D1EB6B3B5C7"><enum>(1)</enum><header>Report</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph id="H3DF54E32C7ED433483A5CA3F0BA0F424"><enum>(2)</enum><header>Presidential approval</header><text>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.</text></paragraph>
<paragraph id="H638A1857CC084A8182BABF48B51BC585"><enum>(3)</enum><header>Presidential disapproval</header><text display-inline="yes-display-inline">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—</text> <subparagraph id="H12BFCDF61AC044B5BC231C82CAA0DBCF"><enum>(A)</enum><text>the Commission’s findings and conclusions based on a review and analysis of those reasons for disapproval provided by the President; and</text></subparagraph>
<subparagraph id="H64B2E57FB188480D8679BE8956A4087C"><enum>(B)</enum><text>recommendations that the Commission determines are appropriate for modernizations and realignments of facilities of the Veterans Health Administration.</text></subparagraph></paragraph> <paragraph id="H471DBC2B2CF64DA1B5B3B0E5EBA8483E"><enum>(4)</enum><header>Transmittal of recommendations to Congress</header><text>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.</text></paragraph>
<paragraph id="H0ECAC2F8C0E74921A00E1F26C1C17B46"><enum>(5)</enum><header>Failure to transmit</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection></section> <section commented="no" id="HA8E3D4E2225D4B61BD4F8CAF8D551206"><enum>204.</enum><header>Actions regarding infrastructure and facilities of the Veterans Health Administration</header> <subsection commented="no" id="H752FBC52741B45089199086E9B081E91"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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—</text>
<paragraph id="HF66436A9AAE74EB89669F7B59AC26443"><enum>(1)</enum><text>the planning of modernizations and realignments of facilities of the Veterans Health Administration as recommended in such report; and</text></paragraph> <paragraph id="H1B65CB12A94A4936915CDA5FC2E12F5C"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection>
<subsection commented="no" id="H8EE8C3B5B4E84256B0C3E82B87BA6C08"><enum>(b)</enum><header>Congressional disapproval</header>
<paragraph commented="no" display-inline="no-display-inline" id="HE851736019064E0EADAB70DFD8A31D04"><enum>(1)</enum><header>In general</header><text>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—</text> <subparagraph commented="no" id="HBC3AD7A1A2B74592AA729CF3EC878907"><enum>(A)</enum><text>the end of the 45-day period beginning on the date on which the President transmits such report; or</text></subparagraph>
<subparagraph commented="no" id="H18BF3DE7E9A2468D99ED2DA63FB7FAE6"><enum>(B)</enum><text>the adjournment of Congress sine die for the session during which such report is transmitted.</text></subparagraph></paragraph> <paragraph commented="no" id="HDEEAC29B10CC4C1E8810466D207D16CD"><enum>(2)</enum><header>Computation of period</header><text>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.</text></paragraph></subsection></section>
<section id="HA8E1E5B92B584E618775DD3AF16FFAA5"><enum>205.</enum><header>Implementation</header>
<subsection id="H4C74EC6184BF4BB08EFE4D9DBE0BE8AB"><enum>(a)</enum><header>In general</header>
<paragraph display-inline="no-display-inline" id="H36600D043CD044D1BB1C49507701AD11"><enum>(1)</enum><header>Modernizing and realigning facilities</header><text display-inline="yes-display-inline">In modernizing or realigning any facility of the Veterans Health Administration under this subtitle, the Secretary may—</text> <subparagraph id="H0E753D506F8D4AB7861CC56039A29B4A"><enum>(A)</enum><text display-inline="yes-display-inline">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;</text></subparagraph>
<subparagraph id="HAAB1E4E61B9844D2BE3ED8AA75EA40CF"><enum>(B)</enum><text display-inline="yes-display-inline">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;</text></subparagraph> <subparagraph id="H8FE083CDD2104D6FAAAA890489830986"><enum>(C)</enum><text>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</text></subparagraph>
<subparagraph id="HA37F20421D1D406AA6181C32D3447F4C"><enum>(D)</enum><text display-inline="yes-display-inline">exercise the authority of the Secretary under subchapter V of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/81">chapter 81</external-xref> of title 38, United States Code.</text></subparagraph></paragraph> <paragraph id="H98D69112BF80452AACA42784CB11BBC4"><enum>(2)</enum><header>Environmental restoration; historic preservation</header><text display-inline="yes-display-inline">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:</text>
<subparagraph id="H0C6FDE942D564F8CB6CC9BD123330BFA"><enum>(A)</enum><text display-inline="yes-display-inline">Environmental mitigation.</text></subparagraph> <subparagraph id="H7BA04E3EF7C4495984B75599F4A75772"><enum>(B)</enum><text display-inline="yes-display-inline">Environmental abatement.</text></subparagraph>
<subparagraph id="H3BD2F0E34CF54389BC20D393BEBB7733"><enum>(C)</enum><text display-inline="yes-display-inline">Environmental restoration.</text></subparagraph> <subparagraph id="H1774BC0AA2214D75A890776827EE4B5B"><enum>(D)</enum><text>Compliance with historic preservation requirements.</text></subparagraph></paragraph></subsection>
<subsection id="H2BA407FE1B214C2B8B471FE087FB63CE"><enum>(b)</enum><header>Management and disposal of property</header>
<paragraph commented="no" id="H3894A26E313C4BE9BF39D2B784EE5045"><enum>(1)</enum><header>Existing Disposal Authorities</header><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/81">chapter 81</external-xref> of title 38, United States Code, or the authorities delegated to the Secretary by the Administrator of General Services under subchapter III of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/40/5">chapter 5</external-xref> of title 40, United States Code.</text></paragraph> <paragraph id="H0D1A269CC5C24EE8928EB4F1698DADE9"><enum>(2)</enum><header>Effects on local communities</header> <subparagraph id="H37360D9E5A684BB896941F97DCECF59C"><enum>(A)</enum><header>Consultation with State and local government</header><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="H18541251E707426EA9B25D88AA800F32"><enum>(B)</enum><header>Treatment of roads</header><text display-inline="yes-display-inline">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—</text> <clause id="H3062902F18814D5591B337DC4D369834"><enum>(i)</enum><text>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</text></clause>
<clause id="HB892D6919D14446CA80C37B4005305F1"><enum>(ii)</enum><text display-inline="yes-display-inline">may exercise the authority of the Secretary under section 8108 of title 38, United States Code.</text></clause></subparagraph></paragraph> <paragraph id="H256AFFC6A0DB4CE3B6952D85E22B079E"><enum>(3)</enum><header>Leases; CERCLA</header> <subparagraph id="HC54CD1B86CB34947A99DFB43C86724C7"><enum>(A)</enum><header>Lease authority</header> <clause display-inline="no-display-inline" id="H753EAEC1B7CB403C9AB5B09D3DD16132"><enum>(i)</enum><header>Transfer to redevelopment authority for lease</header><text display-inline="yes-display-inline">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.</text></clause>
<clause id="H6AAA04AD129A4CFB9A5E764F660F90CE"><enum>(ii)</enum><header>Term of lease</header><text>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.</text></clause> <clause id="HB67396DE53EA498BBD36D6940C5B2B55"><enum>(iii)</enum><header>Limitation</header><text>A lease under clause (i) may not require rental payments by the United States.</text></clause>
<clause id="HA68EC2B9DFDC4D0296F3EE828BC986F8"><enum>(iv)</enum><header>Treatment of remaindered lease terms</header><text>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.</text></clause> <clause id="H6ABF43A0275641FE85B0F18DC0013772"><enum>(v)</enum><header>Facility services</header><text>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—</text>
<subclause id="H7CC622D4F7394AACBE8D93B84C5940D9"><enum>(I)</enum><text>municipal services that a State or local government is required by law to provide to all landowners in its jurisdiction without direct charge; or</text></subclause> <subclause id="HF878425E61F8419DA215730D6961D9BD"><enum>(II)</enum><text>firefighting or security-guard functions.</text></subclause></clause></subparagraph>
<subparagraph id="H387EE6FC7047453583D3E37FCD3F8689"><enum>(B)</enum><header>Application of CERCLA</header><text display-inline="yes-display-inline">The provisions of section 120(h) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (<external-xref legal-doc="usc" parsable-cite="usc/42/9620">42 U.S.C. 9620(h)</external-xref>) shall apply to any transfer of real property under this paragraph.</text></subparagraph> <subparagraph id="HD31A30FA5FF340CDB1C819C37A20950F"><enum>(C)</enum><header>Additional terms and conditions</header><text>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.</text></subparagraph></paragraph>
<paragraph commented="no" id="HFAA47B3AEE3D491D8FDE01DA4B39B6DA"><enum>(4)</enum><header>Application of McKinney-Vento Homeless Assistance Act</header><text display-inline="yes-display-inline">Nothing in this subtitle shall limit or otherwise affect the application of the provisions of the McKinney-Vento Homeless Assistance Act (<external-xref legal-doc="usc" parsable-cite="usc/42/11301">42 U.S.C. 11301</external-xref> et seq.) to facilities of the Veterans Health Administration closed under this subtitle.</text></paragraph></subsection> <subsection commented="no" id="HC6D6E49E49E943058BEAE192066D7840"><enum>(c)</enum><header>Applicability of National Environmental Policy Act of 1969</header> <paragraph commented="no" display-inline="no-display-inline" id="H5A453367A20D49A18845E67D90D2A78E"><enum>(1)</enum><header>In general</header><text>The provisions of the National Environmental Policy Act of 1969 (<external-xref legal-doc="usc" parsable-cite="usc/42/4321">42 U.S.C. 4321</external-xref> 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.</text></paragraph>
<paragraph commented="no" id="HDD605243EB9346EDAAC82F8EE7058E2E"><enum>(2)</enum><header>Department of Veterans Affairs</header>
<subparagraph commented="no" display-inline="no-display-inline" id="H2B0A9D4797BF46A3BA252EDDAF50F7A1"><enum>(A)</enum><header>Covered activities</header><text>The provisions of the National Environmental Policy Act of 1969 shall apply to actions of the Department of Veterans Affairs under this subtitle—</text> <clause id="HE3599DEEA00540A8B2CB455B81D46A56"><enum>(i)</enum><text>during the process of property disposal; and</text></clause>
<clause id="H1831FFDBA3BE4BB69CA16A7580E38337"><enum>(ii)</enum><text display-inline="yes-display-inline">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.</text></clause></subparagraph> <subparagraph commented="no" id="HF33EE890D1BE4702995CFC12962B5CDB"><enum>(B)</enum><header>Other activities</header><text>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—</text>
<clause commented="no" id="H9FC759E021944934B54E290BA9164610"><enum>(i)</enum><text display-inline="yes-display-inline">the need for closing or realigning the facility of the Veterans Health Administration as recommended by the Commission;</text></clause> <clause commented="no" id="H837AFEBA279B4D609EF16D863CBC85CA"><enum>(ii)</enum><text display-inline="yes-display-inline">the need for transferring functions to any facility of the Veterans Health Administration which has been selected as the receiving facility; or</text></clause>
<clause commented="no" id="H5E6CAFF0061E461B8771FF78D87C5A91"><enum>(iii)</enum><text display-inline="yes-display-inline">facilities of the Veterans Health Administration alternative to those recommended or selected.</text></clause></subparagraph></paragraph></subsection> <subsection id="HC7AFF1EDDA1D48D5A775095A2810DBF3"><enum>(d)</enum><header>Waiver</header> <paragraph id="HE0861C04B5F840E2A33767D2E62A081F"><enum>(1)</enum><header>Restrictions on use of funds</header><text>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.</text></paragraph>
<paragraph id="H1793433BA44B4ABE941B3C7979DA6E93"><enum>(2)</enum><header>Restrictions on authorities</header><text>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.</text></paragraph></subsection> <subsection id="H340F4FB6267248DBB051EE8F4444C65B"><enum>(e)</enum><header>Transfer authority in connection with payment of environmental remediation costs</header> <paragraph display-inline="no-display-inline" id="H24B49D7FA4EB4E2986339D93D8595D08"><enum>(1)</enum><header>In general</header> <subparagraph display-inline="no-display-inline" id="H9124FC7CC2064CE98480C504C92591DA"><enum>(A)</enum><header>Transfer by deed</header><text display-inline="yes-display-inline">Subject to paragraph (2) of this subsection and section 120(h) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (<external-xref legal-doc="usc" parsable-cite="usc/42/9620">42 U.S.C. 9620(h)</external-xref>), 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.</text></subparagraph>
<subparagraph id="H310E2CD0F5F64BA6AE48FB812B48A5C2"><enum>(B)</enum><header>Additional terms or conditions</header><text>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.</text></subparagraph></paragraph> <paragraph id="H855A28E353014B369409DE63B646794C"><enum>(2)</enum><header>Limitation</header><text display-inline="yes-display-inline">A transfer of a facility of the Veterans Health Administration may be made under paragraph (1) only if the Secretary certifies to Congress that—</text>
<subparagraph id="HF946BD9C7E37416DB19851D156B90E23"><enum>(A)</enum><text display-inline="yes-display-inline">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</text></subparagraph> <subparagraph id="H4353A8E0682A40E2BC9086EC65B5DE86"><enum>(B)</enum><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph>
<paragraph id="H47948BD2F64B4FA7B638CBCF0BC693E5"><enum>(3)</enum><header>Payment by the Secretary for certain transfers</header><text display-inline="yes-display-inline">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—</text> <subparagraph display-inline="no-display-inline" id="H6434DF01E2EF42548FCDC2543030308A"><enum>(A)</enum><text display-inline="yes-display-inline">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</text></subparagraph>
<subparagraph id="H4BDF7E8DF87143CAB98F47D7F88D2353"><enum>(B)</enum><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph> <paragraph id="H3AEA0246FC9D4DC8A5B78076B89812D1"><enum>(4)</enum><header>Disclosure</header><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="H564B4C205C02486AA9E9B8AE56AC1893"><enum>(5)</enum><header>Applicability of certain environmental laws</header><text>Nothing in this subsection shall be construed to modify, alter, or amend the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (<external-xref legal-doc="usc" parsable-cite="usc/42/9601">42 U.S.C. 9601</external-xref> et seq.) or the Solid Waste Disposal Act (<external-xref legal-doc="usc" parsable-cite="usc/42/6901">42 U.S.C. 6901</external-xref> et seq.).</text></paragraph></subsection></section> <section id="H3E19749BA8D34F00B6B59A252829693A"><enum>206.</enum><header>Department of Veterans Affairs Asset and Infrastructure Review Account</header> <subsection id="H03ECA663E3A647089D083C1B80D5C040"><enum>(a)</enum><header>Establishment</header><text>There is hereby established in the ledgers of the Treasury an account to be known as the <quote>Department of Veterans Affairs Asset and Infrastructure Review Account</quote> which shall be administered by the Secretary as a single account.</text></subsection>
<subsection id="H1F20A0F2AD194DA3B3C2433A16520BE2"><enum>(b)</enum><header>Credits to account</header><text>There shall be credited to the Account the following:</text> <paragraph id="H9C97DEDA4340477CB092CA1AEE67A2AF"><enum>(1)</enum><text>Funds authorized for and appropriated to the Account.</text></paragraph>
<paragraph id="HE93D2BAC0A33462D8805714E74F75A9B"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="H1EEF670FB362445CBC94E50969A20515"><enum>(c)</enum><header>Use of account</header><text>The Secretary may use the funds in the Account only for the following purposes:</text>
<paragraph commented="no" display-inline="no-display-inline" id="HE8EDDCD9C08847EEB6805F1514504DC1"><enum>(1)</enum><text display-inline="yes-display-inline">To carry out this subtitle.</text></paragraph> <paragraph commented="no" id="H202E8B6403B6432A967AA68564441C57"><enum>(2)</enum><text display-inline="yes-display-inline">To cover property management and disposal costs incurred at facilities of the Veterans Health Administration closed, modernized, or realigned under this subtitle.</text></paragraph>
<paragraph commented="no" id="HE2790FB805604CC4A528D7DD55407E4C"><enum>(3)</enum><text>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.</text></paragraph> <paragraph commented="no" id="H7931B1C91539480CB6920C3E3EA1D9B6"><enum>(4)</enum><text>Other purposes that the Secretary determines support the mission and operations of the Department of Veterans Affairs.</text></paragraph></subsection>
<subsection id="H949D438CFDD345ACA32787CB763BBD41"><enum>(d)</enum><header>Consolidated budget justification display for account</header>
<paragraph id="H78801D3C84A2459FADDC916A072DE348"><enum>(1)</enum><header>Consolidated budget information required</header><text>The Secretary shall establish a consolidated budget justification display in support of the Account that for each fiscal year—</text> <subparagraph id="HB5D020104ADA407D810EBA916A2FED2C"><enum>(A)</enum><text>details the amount and nature of credits to, and expenditures from, the Account during the preceding fiscal year;</text></subparagraph>
<subparagraph id="H430A6034C90A4EC881545B73C49740FA"><enum>(B)</enum><text display-inline="yes-display-inline">separately details the environmental remediation costs associated with facility of the Veterans Health Administration for which a budget request is made;</text></subparagraph> <subparagraph id="HDEEE8D122BC34ABE8150EEB943EAA1D4"><enum>(C)</enum><text display-inline="yes-display-inline">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</text></subparagraph>
<subparagraph id="H0911D15620B24FD9BD5C370BF1DE05AE"><enum>(D)</enum><text>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.</text></subparagraph></paragraph> <paragraph id="HC75CD937AF5B4194999FA3AD4F6BF88C"><enum>(2)</enum><header>Submission</header><text>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.</text></paragraph></subsection>
<subsection id="H9F477E8B73E94B13B292873D5CB514E6"><enum>(e)</enum><header>Closure of account; treatment of remaining funds</header>
<paragraph id="H171EFCB5EF784656831CDAFC404CDA02"><enum>(1)</enum><header>Closure</header><text display-inline="yes-display-inline">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).</text></paragraph> <paragraph id="H4437EFC3685A4B26AC208161D4531871"><enum>(2)</enum><header>Final report</header><text display-inline="yes-display-inline">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—</text>
<subparagraph id="H55196539951341BCBAE7A0E8F1C399B0"><enum>(A)</enum><text>all the funds credited to and expended from the Account or otherwise expended under this subtitle; and</text></subparagraph> <subparagraph id="H866817DE95FE4E9D866A6D6CDD61A0C4"><enum>(B)</enum><text>any funds remaining in the Account.</text></subparagraph></paragraph></subsection></section>
<section commented="no" display-inline="no-display-inline" id="HCCC9A8B6C12C4FA89503C3169769698A" section-type="subsequent-section"><enum>207.</enum><header>Congressional consideration of Commission report</header>
<subsection commented="no" id="H3FDE7806142F4A07AE6F7EA233803E0C"><enum>(a)</enum><header>Disapproval resolution</header><text>For purposes of this subtitle, the term <term>joint resolution</term> 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—</text> <paragraph commented="no" id="H7B2658C6FBEE4494B61835050B25E4C4"><enum>(1)</enum><text>which does not have a preamble;</text></paragraph>
<paragraph commented="no" id="HE91E9E9BED0D41CE814BCD3453363275"><enum>(2)</enum><text display-inline="yes-display-inline">the matter after the resolving clause of which is as follows: <quote>that Congress disapproves the recommendations of the VHA Asset and Infrastructure Review Commission as submitted by the President on ___</quote>, the blank space being filled with the appropriate date; and</text></paragraph> <paragraph commented="no" id="HBA5A288D0EB444B494D5D7E83FD75887"><enum>(3)</enum><text>the title of which is as follows: <quote>Joint resolution disapproving the recommendations of the VHA Asset and Infrastructure Review Commission.</quote>.</text></paragraph></subsection>
<subsection commented="no" id="HB3ABF889EDC24BB2AB1CF0F3718FB7DC"><enum>(b)</enum><header>Consideration in the House of Representatives</header>
<paragraph id="H5A83579DFF6C4548B80D1E9CB339CB90"><enum>(1)</enum><header>Reporting and discharge</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph id="H225157E13CA84C80A69B64F839C96CDF"><enum>(2)</enum><header>Proceeding to consideration</header><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="HA2B12D35D6944346981192F232C034D4"><enum>(3)</enum><header>Consideration</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="H7632F89F52DE41E4885A69F6410E79B4"><enum>(c)</enum><header>Consideration in the Senate</header> <paragraph id="H659B78771FB544748622373CC891A45A"><enum>(1)</enum><header>Referral</header><text display-inline="yes-display-inline">A joint resolution introduced in the Senate shall be referred to the Committee on Veterans’ Affairs.</text></paragraph>
<paragraph id="H1ED5618C4C834C6AA2339A0B403F79DF"><enum>(2)</enum><header>Reporting and discharge</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph id="HC6DDE325EEB74183AAEE56A06222FD14"><enum>(3)</enum><header>Floor consideration</header> <subparagraph id="HE7804F6C3EED431DAA9CBCCDFBF0C367"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="H5CFF97C9010141619E45E5B7F5FB7AE8"><enum>(B)</enum><header>Consideration</header><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph id="H7BCD5D23D10F4AD489303C512E9A75D2"><enum>(C)</enum><header>Vote on passage</header><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="H2E7CC25545A34F34938110DAEF15153E"><enum>(D)</enum><header>Rulings of the Chair on procedure</header><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph></subsection> <subsection commented="no" id="H546C6E33264D489CB1DB46535ED48683"><enum>(d)</enum><header>Amendment not in order</header><text display-inline="yes-display-inline">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.</text></subsection>
<subsection id="HCF0E2C2E94FA422EBFF5BD167AAB56B7"><enum>(e)</enum><header>Coordination with action by other House</header>
<paragraph id="H28918AA8082D41A89FA40FA75C86E6DC"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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:</text> <subparagraph id="HBE01470A9796442FA1BFFA7575BA1D04"><enum>(A)</enum><text display-inline="yes-display-inline">The joint resolution of the other House shall not be referred to a committee.</text></subparagraph>
<subparagraph id="HBA5759DDDAB444C4AC75A66B92C01412"><enum>(B)</enum><text display-inline="yes-display-inline">With respect to the joint resolution of the House receiving the joint resolution—</text> <clause id="HCB6120DA56F54C97B90B0D5547F107FD"><enum>(i)</enum><text display-inline="yes-display-inline">the procedure in that House shall be the same as if no joint resolution had been received from the other House; but</text></clause>
<clause id="HD1126A9678AF47249AA982EA3D8C7372"><enum>(ii)</enum><text>the vote on passage shall be on the joint resolution of the other House.</text></clause></subparagraph></paragraph> <paragraph id="HF36B913F9FA744398EC19285837B24CC"><enum>(2)</enum><header>Treatment of joint resolution of other House</header><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="HFDFDEF965DDA46B08960CEE7A2D5CEA7"><enum>(3)</enum><header>Treatment of companion measures</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection> <subsection id="H0AA8CD4021E1463EA4ED9B6F60CB97E9"><enum>(f)</enum><header>Rules of the House of Representatives and Senate</header><text display-inline="yes-display-inline">This section is enacted by Congress—</text>
<paragraph id="HB0C163A6B4854A8A978FB006C6D83FFA"><enum>(1)</enum><text display-inline="yes-display-inline">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</text></paragraph> <paragraph id="H36FE81B5D27D45C5A108DDAEE90542D5"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text></paragraph></subsection></section>
<section id="H7F38108E63C84A47A00A5B096E24B532"><enum>208.</enum><header>Other matters</header>
<subsection id="H893FA8A3A7524DFDB126CDD62E1D92FA"><enum>(a)</enum><header>Online publication of communications</header>
<paragraph id="H02BB83084487405BA3F6C6EE3ADB0929"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph id="HB19BE131DCF34EAE915D971B3BE0331C"><enum>(2)</enum><header>Parties specified</header><text>The parties specified under this paragraph are the following:</text>
<subparagraph id="HEF983C832EC5425CB813436D915C94F7"><enum>(A)</enum><text>The Secretary of Veterans Affairs.</text></subparagraph> <subparagraph id="H9FC26E9E809F4CF88EB865653A479227"><enum>(B)</enum><text>The Commission.</text></subparagraph>
<subparagraph id="H4DA9CB9D122240CCBEE35033B60C8368"><enum>(C)</enum><text>The President.</text></subparagraph></paragraph></subsection> <subsection id="HC5A9D79B54D44905AE8BDDD9912DFB97"><enum>(b)</enum><header>Continuation of existing construction projects and planning</header><text display-inline="yes-display-inline">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—</text>
<paragraph id="HCA671790D780496788D412A16036BF40"><enum>(1)</enum><text display-inline="yes-display-inline">a construction or leasing project of the Veterans Health Administration;</text></paragraph> <paragraph commented="no" id="H383864C4FC274000B858FADD81D717DB"><enum>(2)</enum><text display-inline="yes-display-inline">long term planning regarding infrastructure and assets of the Veterans Health Administration; or</text></paragraph>
<paragraph commented="no" id="HAB4E510F43304E6ABAD379BD748F4E10"><enum>(3)</enum><text display-inline="yes-display-inline">budgetary processes for the Veterans Health Administration.</text></paragraph></subsection> <subsection id="HF5ACA41323874B99AE9FD3AC413BA6D6"><enum>(c)</enum><header>Recommendations for future asset reviews</header><text display-inline="yes-display-inline">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.</text></subsection></section>
<section id="HDE2F2E5C1E194424A9402BD938FC8998"><enum>209.</enum><header>Definitions</header><text display-inline="no-display-inline">In this subtitle:</text> <paragraph id="H4F339BDD27B74A95A0BA4142F7CD5202"><enum>(1)</enum><text display-inline="yes-display-inline">The term <term>Account</term> means the Department of Veterans Affairs Asset and Infrastructure Review Account established by section 206(a).</text></paragraph>
<paragraph id="HC1CA7939F94C4FE7A41EAAF7297D85E3"><enum>(2)</enum><text>The term <term>Commission</term> means the Commission established by section 202.</text></paragraph> <paragraph id="H9DC9305F3E8542CDB47EDB3E8DA88F84"><enum>(3)</enum><text display-inline="yes-display-inline">The term <term>date of approval</term>, 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.</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HE4AA7CBF536C45C1B6A8ECD98E9AC46F"><enum>(4)</enum><text display-inline="yes-display-inline">The term <term>facility of the Veterans Health Administration</term>—</text> <subparagraph commented="no" id="H87E8E56A05834D588C6A64DAAEB92FB2"><enum>(A)</enum><text display-inline="yes-display-inline">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—</text>
<clause commented="no" id="H0F018F45B1A74CE5B0C8EFE774043584"><enum>(i)</enum><text>under the jurisdiction of the Department of Veterans Affairs;</text></clause> <clause commented="no" id="HF5E042742FAB48A7B6C057AEA1A735E0"><enum>(ii)</enum><text>under the control of the Veterans Health Administration; and</text></clause>
<clause commented="no" id="H3D21608DFCE64FB8961BED1983B3AC3A"><enum>(iii)</enum><text>not under the control of the General Services Administration; or</text></clause></subparagraph> <subparagraph commented="no" id="HFE0015E28F8A4D7AB8125BDAFD530564"><enum>(B)</enum><text display-inline="yes-display-inline">with respect to a colocated facility of the Department of Veterans Affairs, includes any land, building, or structure—</text>
<clause commented="no" id="H6F412521E012456090F6E064835309BB"><enum>(i)</enum><text>under the jurisdiction of the Department of Veterans Affairs;</text></clause> <clause commented="no" id="H527F18594826465E8E798AFFFB1B32CC"><enum>(ii)</enum><text display-inline="yes-display-inline">under the control of another administration of the Department of Veterans Affairs; and</text></clause>
<clause commented="no" id="H372E18770C8F40F8AC334A62EB50A532"><enum>(iii)</enum><text>not under the control of the General Services Administration.</text></clause></subparagraph></paragraph> <paragraph commented="no" id="HAFF255195F0145129877A06F9C598615"><enum>(5)</enum><text display-inline="yes-display-inline">The term <term>infrastructure</term> means improvements to land other than buildings or structures.</text></paragraph>
<paragraph id="H2F5DA7F912DE4E0699E830B5A30AF5F2"><enum>(6)</enum><text display-inline="yes-display-inline">The term <term>modernization</term> includes—</text> <subparagraph id="H8925684843A540499FAD0DA6C0ABB020"><enum>(A)</enum><text display-inline="yes-display-inline">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;</text></subparagraph>
<subparagraph commented="no" id="HF219E1A686CF4DC59102A8E33B56CF27"><enum>(B)</enum><text display-inline="yes-display-inline">the construction, purchase, lease, or sharing of a facility of the Veterans Health Administration; and</text></subparagraph> <subparagraph id="HAACB3B4725ED46C68A885161A3DD56C1"><enum>(C)</enum><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph>
<paragraph id="H3948B7239D0F4FA1B54FFAB0D0B230C1"><enum>(7)</enum><text display-inline="yes-display-inline">The term <term>realignment</term>, with respect to a facility of the Veterans Health Administration, includes—</text> <subparagraph id="H80FE46D09E3D4C44AC25A605CD404D35"><enum>(A)</enum><text display-inline="yes-display-inline">any action that changes the numbers of or relocates services, functions, and personnel positions;</text></subparagraph>
<subparagraph id="H06AC5908888E48FE808552E8CC0A5366"><enum>(B)</enum><text display-inline="yes-display-inline">disposals or exchanges between the Department of Veterans Affairs and other Federal entities, including the Department of Defense; and</text></subparagraph> <subparagraph id="HE3E42AF09E944AB1AD00AF07D0510775"><enum>(C)</enum><text display-inline="yes-display-inline">strategic collaborations between the Department of Veterans Affairs and non-Federal entities, including tribal organizations.</text></subparagraph></paragraph>
<paragraph id="HEED91D9092C7477C89E6AB9A16B4FED6"><enum>(8)</enum><text display-inline="yes-display-inline">The term <term>redevelopment authority</term>, 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.</text></paragraph> <paragraph id="H045671880157453BA0E8488B0B88FE3C"><enum>(9)</enum><text display-inline="yes-display-inline">The term <term>redevelopment plan</term> in the case of a facility of the Veterans Health Administration to be closed or realigned under this subtitle, means a plan that—</text>
<subparagraph id="HE23CC8E8C4FA4739BEA13CA26CF524F9"><enum>(A)</enum><text>is agreed to by the local redevelopment authority with respect to the facility; and</text></subparagraph> <subparagraph id="H1DBDB8AE059B43A69E76388ACF602CAD"><enum>(B)</enum><text>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.</text></subparagraph></paragraph>
<paragraph id="H52C328B4BA8844C29616E2526C6452B6"><enum>(10)</enum><text>The term <term>Secretary</term> means the Secretary of Veterans Affairs.</text></paragraph> <paragraph id="H835F960DAE314C26BA1A327E7271B406"><enum>(11)</enum><text>The term <term>tribal organization</term> has the meaning given such term in section 3765 of title 38, United States Code.</text></paragraph></section></subtitle>
<subtitle id="H14820CE9E390454E924FE765949E1A25"><enum>B</enum><header>Other Infrastructure Matters</header>
<section id="HCE3E23B693564FCEB575D1C03B2646D2" section-type="subsequent-section"><enum>211.</enum><header>Improvement to training of construction personnel</header><text display-inline="no-display-inline">Subsection (g) of section 8103 of title 38, United States Code, is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H43DECED063364973B1AD9E73A569284B" style="USC"> <subsection id="H00BCDE0967944C8C8135A695A5027C7A"><enum>(g)</enum> <paragraph commented="no" display-inline="yes-display-inline" id="H6559E6E274044D1EAEEF64E6FE6556D1"><enum>(1)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="HC301CF7F43CE497CA601036CA7101C4C"><enum>(A)</enum><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph display-inline="no-display-inline" id="H5DF4E8448C264298BC61662074FF3241" indent="up2"><enum>(B)</enum><text>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 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/10/87">chapter 87</external-xref> of title 10, United States Code, as determined relevant by the Secretary.</text></subparagraph></paragraph> <paragraph id="HF9CD5BECCE74422F9A13FA07C7B343EF" indent="up1"><enum>(2)</enum><text>The Secretary may develop the training curriculum under paragraph (1)(A) in a manner that provides such training in any combination of—</text>
<subparagraph id="H297B9A67F98647DF8493E21D353E73C3"><enum>(A)</enum><text>training provided in person;</text></subparagraph> <subparagraph id="H3676DC822747419B84E1FF750414A814"><enum>(B)</enum><text>training provided over an internet website; or</text></subparagraph>
<subparagraph id="H0E1577D2AFDF4AD4ACE3265431F03D98"><enum>(C)</enum><text>training provided by another department or agency of the Federal Government.</text></subparagraph></paragraph> <paragraph id="HB15DE6EEDE1A4089A86880D335D15A92" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">The Secretary may develop the certification program under paragraph (1)(A) in a manner that uses—</text>
<subparagraph id="H97C6F75FB9CD4E25A5E72AAEAD5C3A03"><enum>(A)</enum><text>one level of certification; or</text></subparagraph> <subparagraph id="H72176EBA5F704E47A1A56A1E1AA99A3A"><enum>(B)</enum><text>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.</text></subparagraph></paragraph>
<paragraph id="HAABEDE723C10440F92EBE898430C6453" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">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).</text></paragraph> <paragraph id="HC248C0E945044145AA0438B7F98C9349" indent="up1"><enum>(5)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="H814C72701D234FAABC4B9E2114C70B50"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="H7A8AF7EA285646E899AC6C26DC846F3A" indent="up1"><enum>(B)</enum><text>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.</text></subparagraph></paragraph> <paragraph id="H0C315691FFFE49B084BFF4F87A851DED" indent="up1"><enum>(6)</enum><text display-inline="yes-display-inline">In this subsection:</text>
<subparagraph id="H855706FA68E24C6385686A5D9F994384"><enum>(A)</enum><text display-inline="yes-display-inline">The term <term>covered certification program</term> 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.</text></subparagraph> <subparagraph id="HEA61194D63A34F10A7DDBB7791E4DC86"><enum>(B)</enum><text>The term <term>covered training curriculum</term> means, with respect to employees specified in subparagraph (A), a training curriculum relating to construction or facilities management.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section display-inline="no-display-inline" id="H3F66A2C1DCE44B95975CCA21C27D5F49"><enum>212.</enum><header>Review of enhanced use leases</header><text display-inline="no-display-inline"><external-xref legal-doc="usc" parsable-cite="usc/38/8162">Section 8162(b)(6)</external-xref> is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H9C41CD26B4D4431987F1412C1C5EA0EF" style="OLC"> <paragraph id="HD26F21CE12134A08AD02206CA0DF7013" indent="up1"><enum>(6)</enum><text>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).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="H7F5F9CE20EDB4C63B5E9A751AFF06C8C"><enum>213.</enum><header>Assessment of health care furnished by the Department to veterans who live in the Pacific territories</header>
<subsection id="H139CF531EC7A4AEB95823295AC6FB5C3"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subsection> <subsection id="HD083B09FB5D349068CBBFF13148AB1D5"><enum>(b)</enum><header>Elements</header><text display-inline="yes-display-inline">The report under subsection (a) shall include assessments of the following:</text>
<paragraph id="H2FF38B5E39AA4FF99DF7A36358978ABA"><enum>(1)</enum><text display-inline="yes-display-inline">The ability of the Department to furnish to veterans who live in the Pacific territories the following:</text> <subparagraph id="H469EF4CD45FF4A76BBF69219127D743C"><enum>(A)</enum><text display-inline="yes-display-inline">Hospital care.</text></subparagraph>
<subparagraph id="H38BE196B97C64C518FD13A712E3C0923"><enum>(B)</enum><text>Medical services.</text></subparagraph> <subparagraph id="H201606DF9F674CD08B09ED734D572DAE"><enum>(C)</enum><text>Mental health services.</text></subparagraph>
<subparagraph id="HEBFAA3061EFA438DAA70350AE0EFACA0"><enum>(D)</enum><text>Geriatric services.</text></subparagraph></paragraph> <paragraph id="H6882F511A33A44C185D88A8E4227B32A"><enum>(2)</enum><text display-inline="yes-display-inline">The feasibility of establishing a community-based outpatient clinic of the Department in any Pacific territory that does not contain such a facility.</text></paragraph></subsection>
<subsection id="H57CBF5D019CD46718486636AF7F45821"><enum>(c)</enum><header>Definition</header><text display-inline="yes-display-inline">In this section, the term <term>Pacific territories</term> means American Samoa, Guam, and the Northern Mariana Islands.</text></subsection></section></subtitle> <enum>III</enum><header>Improvements to Recruitment of Health Care Professionals</header> <section id="H8484A757CAE64D1689F10FE4FB41E2A3" section-type="subsequent-section"><enum>301.</enum><header>Designated scholarships for physicians and dentists under Department of Veterans Affairs Health Professional Scholarship Program</header> <subsection id="HB8A3AA634440427D94A54146940DC1DC"><enum>(a)</enum><header>Scholarships for physicians and dentists</header><text display-inline="yes-display-inline">Section 7612(b) of title 38, United States Code, is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H9C9F3FD5AAA24EE78C940B30F8AB63DA" style="USC">
<paragraph id="HBB7D2C488DDC45FFB56DCBD3DA0F5B10" indent="up1"><enum>(6)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H5718F0D525EA43B5BE902FE344D742DF"><enum>(A)</enum><text>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.</text></subparagraph> <subparagraph id="HA2C10AD1758847068E51B2BEC56B2313" indent="up1"><enum>(B)</enum><text>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.</text></subparagraph>
<subparagraph id="H3AA3E7F94DE34479A76E7272ACF8E477" indent="up1"><enum>(C)</enum><text>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:</text> <clause id="H3E5779E362F249AF9CF266D52E2AD0E1"><enum>(i)</enum><text display-inline="yes-display-inline">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.</text></clause>
<clause id="H5BED77D6249341BB8D1FD8A9CB29486A"><enum>(ii)</enum><text display-inline="yes-display-inline">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 <quote>period of obligated service</quote>) of 18 months for each school year or part thereof for which the participant was provided a scholarship under the Scholarship Program.</text></clause></subparagraph> <subparagraph id="H3CE57F183CE54C8799F193A83B48AE4E" indent="up1"><enum>(D)</enum><text>In providing scholarships pursuant to this paragraph, the Secretary may provide a preference for applicants who are veterans.</text></subparagraph>
<subparagraph id="HA5A9407E5B884A21B5CB897FAF91EBBC" indent="up1"><enum>(E)</enum><text>On an annual basis, the Secretary shall provide to appropriate educational institutions informational material about the availability of scholarships under this paragraph.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H98960226882E4EB085DA365E6E72F8DD"><enum>(b)</enum><header>Breach of agreement</header><text>Section 7617 of such title is amended—</text>
<paragraph id="H8B66F14EEBE54E718A7BEBCD5C5716CD"><enum>(1)</enum><text>by redesignating paragraphs (4) and (5) as paragraphs (5) and (6), respectively; and</text></paragraph> <paragraph id="HFE33D72B34E54579951CC64E54E00D39"><enum>(2)</enum><text>by inserting after paragraph (3) the following new paragraph (4):</text>
<quoted-block display-inline="no-display-inline" id="HA24075E72FEC4811AEDEFEA2C6E5A614" style="USC">
<paragraph id="HE24A43C6F60044FCB963189DD4C352EE"><enum>(4)</enum><text display-inline="yes-display-inline">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.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="HB7001B3CDBB244A2A2FC7C56B9F16D23"><enum>(c)</enum><header>Extension of program</header><text>Section 7619 of such title is amended by striking <quote>December 31, 2019</quote> and inserting <quote>December 31, 2033</quote>.</text></subsection></section>
<section display-inline="no-display-inline" id="HAE1F30D6415444D89E900F9B9C3B8A16"><enum>302.</enum><header>Increase in maximum amount of debt that may be reduced under Education Debt Reduction Program of Department of Veterans Affairs</header>
<subsection id="H531094DA68104C658F50246672D37FA0"><enum>(a)</enum><header>Increase in amount</header><text>Section 7683(d)(1) is amended—</text> <paragraph id="H42C9E52BF6144947BD68D8AA8DCD2C96"><enum>(1)</enum><text>by striking <quote>$120,000</quote> and inserting <quote>$200,000</quote>; and</text></paragraph>
<paragraph id="HA52A654F7B2F44F1983FAED86FAD749C"><enum>(2)</enum><text>by striking <quote>$24,000</quote> and inserting <quote>$40,000</quote>.</text></paragraph></subsection> <subsection id="HE86FDD12A8A24735A95BA3BFF6EEFED7"><enum>(b)</enum><header>Study</header> <paragraph id="H68D0D24CABB740EA81BD183B64BFEC7A"><enum>(1)</enum><header>In general</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall—</text>
<subparagraph id="H22A20F482765482DB5721603302A1CD5"><enum>(A)</enum><text>conduct a study on the demand for education debt reduction under subchapter VII of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/76">chapter 76</external-xref> of title 38, United States Code; and</text></subparagraph> <subparagraph id="H0138079BC2424A62860D711283F87073"><enum>(B)</enum><text>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).</text></subparagraph></paragraph>
<paragraph id="HE32171E4BCCA4F73927B10D612D95899"><enum>(2)</enum><header>Considerations</header><text>In carrying out the study required by paragraph (1)(A), the Secretary shall consider the following:</text> <subparagraph id="H0880A5F529B14179A8E5EE2A543FA104"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="H3A85B64B3BAD4C8087A1F632EBD38A21"><enum>(B)</enum><text>The types of medical professionals in greatest demand in the United States.</text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="HC0DB1C4D28D146219C24320DB8256726"><enum>(C)</enum><text>Projections by the Secretary of the numbers and types of medical professions that meet the needs of veterans.</text></subparagraph></paragraph></subsection></section>
<section id="H42EBC892C0644D41905F89D71951175B" section-type="subsequent-section"><enum>303.</enum><header>Establishing the Department of Veterans Affairs Specialty Education Loan Repayment Program</header>
<subsection id="HE85F1C779A804EAA8BD659371591131C"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/76">Chapter 76</external-xref> of title 38, United States Code, is amended by inserting after subchapter VII the following new subchapter:</text> <quoted-block display-inline="no-display-inline" id="H7CE87D82660946DB954C4AA16779F960" style="USC"> <subchapter id="H792C237BD60C4DC992170858D4C68692"><enum>VIII</enum><header>Specialty Education Loan Repayment Program</header> <section id="H1128249763CD4AE08BBA3374002EC524"><enum>7691.</enum><header>Establishment</header><text display-inline="no-display-inline">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 <quote>Specialty Education Loan Repayment Program</quote>).</text></section>
<section id="HB42A433C107F4B9FA30717E0B7FF2EF1"><enum>7692.</enum><header>Purpose</header><text display-inline="no-display-inline">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.</text></section> <section id="H3B5A44B3F62C4BC6A47174652994C09B"><enum>7693.</enum><header>Eligibility; preferences; covered costs</header> <subsection id="HA8FFD30B3D7A43D394490F55A3A22989"><enum>(a)</enum><header>Eligibility</header><text>An individual is eligible to participate in the Specialty Education Loan Repayment Program if the individual—</text>
<paragraph id="H2F2AB66A47774AC283611BAB1F44645C"><enum>(1)</enum><text display-inline="yes-display-inline">is hired under section 7401 of this title to work in an occupation described in section 7692 of this title;</text></paragraph> <paragraph id="HD64F5B5C7E43488B9452854D9EC041B8"><enum>(2)</enum><text display-inline="yes-display-inline">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</text></paragraph>
<paragraph id="H0570C1A3C73340F2AA47F5651EE2A3BC"><enum>(3)</enum><text display-inline="yes-display-inline">is—</text> <subparagraph id="H8F9B0156A04D4AB9AD25E0407F05FD80"><enum>(A)</enum><text>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</text></subparagraph>
<subparagraph id="H75BE6601B3B14DDC8195033EBCFC383F"><enum>(B)</enum><text display-inline="yes-display-inline">a physician in training in a medical specialty described in section 7692 of this title with more than 2 years remaining in such training.</text></subparagraph></paragraph></subsection> <subsection id="H87E585F6F5EE4540BCB30D4B9E4EE55D"><enum>(b)</enum><header>Preferences</header><text display-inline="yes-display-inline">In selecting individuals for participation in the Specialty Education Loan Repayment Program under this subchapter, the Secretary may give preference to the following:</text>
<paragraph id="H0B482355E6C04DC1BBE2E49535E41E55"><enum>(1)</enum><text display-inline="yes-display-inline">Individuals who are, or will be, participating in residency programs in health care facilities—</text> <subparagraph id="HFDBCD2E35C1E4A23898A08C89F22D134"><enum>(A)</enum><text>located in rural areas;</text></subparagraph>
<subparagraph commented="no" id="H88EBAEA58F984FB98E45EE7294F3B46F"><enum>(B)</enum><text>operated by Indian tribes, tribal organizations, or the Indian Health Service; or</text></subparagraph> <subparagraph commented="no" id="H9EF15E5ABFF444489C929E225BDCBFB3"><enum>(C)</enum><text>affiliated with underserved health care facilities of the Department.</text></subparagraph></paragraph>
<paragraph id="HED9B4B147F11491C90098BEE78E3A695"><enum>(2)</enum><text>Veterans.</text></paragraph></subsection> <subsection id="H7E0632834C4F4BAD824D0AA15EF2009F"><enum>(c)</enum><header>Covered costs</header><text display-inline="yes-display-inline">For purposes of subsection (a)(2), costs relating to a course of education or training include—</text>
<paragraph id="H593F8A8A4AAA49198E7B67C5B648AACD"><enum>(1)</enum><text display-inline="yes-display-inline">tuition expenses;</text></paragraph> <paragraph id="H08B2A8D3554F48FEB4EC718C5CEE1703"><enum>(2)</enum><text display-inline="yes-display-inline">all other reasonable educational expenses, including expenses for fees, books, equipment, and laboratory expenses; and</text></paragraph>
<paragraph id="HBE8B111A0C634385B029C09F2547098D"><enum>(3)</enum><text display-inline="yes-display-inline">reasonable living expenses.</text></paragraph></subsection></section> <section id="HC7D00B564C8547F8B19E266287D3CD75"><enum>7694.</enum><header>Specialty education loan repayment</header> <subsection id="H503DFB4D6FC147F981F6DF4F9E792B73"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subsection>
<subsection id="HFFF10F9F06EB4F11988ACBD8F2B9769A"><enum>(b)</enum><header>Frequency of payment</header><text display-inline="yes-display-inline">The Secretary shall make payments for any given participant in the Specialty Education Loan Repayment Program on a schedule determined appropriate by the Secretary.</text></subsection> <subsection id="HF971AD8529524BF998C77BD74BD04DE3"><enum>(c)</enum><header>Maximum amount; waiver</header> <paragraph commented="no" display-inline="yes-display-inline" id="H5E232D0F644C44F990FB7BDD34F69567"><enum>(1)</enum><text display-inline="yes-display-inline">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.</text></paragraph>
<paragraph id="HFB4580C90C1D4CA4A9A57C7829695F62" indent="up1"><enum>(2)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H9849E00CD8194D349C4109CE28845BCD"><enum>(A)</enum><text display-inline="yes-display-inline">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).</text></subparagraph> <subparagraph id="H04A04389870B46EF8EF014EA59D07F42" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">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.</text></subparagraph></paragraph></subsection></section>
<section id="H39B97CED507347C9A2B2214B4CD20707"><enum>7695.</enum><header>Choice of location</header><text display-inline="no-display-inline">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.</text></section> <section id="HBF4F992DB0B34C57B455B8DC865DAFC2"><enum>7696.</enum><header>Term of obligated service</header> <subsection id="H92083F87BE6140258DE9EDD46BBACCFF"><enum>(a)</enum><header>In general</header><text>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—</text>
<paragraph id="H7C5B0CEA1A9F453896DD5CEC7DEE8D17"><enum>(1)</enum><text>obtain a license to practice medicine in a State;</text></paragraph> <paragraph id="HDF0030D67E1E41F5913F57561620C85F"><enum>(2)</enum><text>successfully complete post-graduate training leading to eligibility for board certification in a specialty;</text></paragraph>
<paragraph id="HEDF616766E224053961B5650EA509DB3"><enum>(3)</enum><text>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</text></paragraph> <paragraph id="H777B16F7271C4796BB7D8832973F186E"><enum>(4)</enum><text>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.</text></paragraph></subsection>
<subsection id="HABECCDC55A224DE6BB1BE983A27F9716"><enum>(b)</enum><header>Fellowship</header><text display-inline="yes-display-inline">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.</text></subsection> <subsection id="HB102E851485D4C69A4C5C15193F39F91"><enum>(c)</enum><header>Penalty</header> <paragraph commented="no" display-inline="yes-display-inline" id="H329E8168DC5F4A7E8C2D0795D05D739F"><enum>(1)</enum><text>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: <italic>A = B × ((T − S) ÷ T))</italic>.</text></paragraph>
<paragraph commented="no" id="HBEBCD5B5ADAD4E1DA599AC4D8A1F38BD" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">In the formula in paragraph (1):</text> <subparagraph commented="no" id="H1A9784ECC2B845ADB1EF1859E542E7AA"><enum>(A)</enum><text><quote><italic>A</italic></quote> is the amount the employee owes the Federal Government.</text></subparagraph>
<subparagraph commented="no" id="H3CA96DDEC9AD4F328A60292535580E2D"><enum>(B)</enum><text display-inline="yes-display-inline"><quote><italic>B</italic></quote> is the sum of all payments to or for the participant under the Specialty Education Loan Repayment Program.</text></subparagraph> <subparagraph commented="no" id="H07DA935F4B8E450E9587AFD2A4662FA6"><enum>(C)</enum><text><quote><italic>T</italic></quote> is the number of months in the period of obligated service of the employee.</text></subparagraph>
<subparagraph commented="no" id="H5AE0052BE1754C63A035732AC617C5AF"><enum>(D)</enum><text display-inline="yes-display-inline"><quote><italic>S</italic></quote> is the number of whole months of such period of obligated service served by the employee.</text></subparagraph></paragraph></subsection></section> <section id="HF6F2C54B56CB41CFA1586C0C761C1D5A"><enum>7697.</enum><header>Relationship to Educational Assistance Program</header><text display-inline="no-display-inline">Assistance under the Specialty Education Loan Repayment Program may be in addition to other assistance available to individuals under the Educational Assistance Program.</text></section></subchapter><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H0AB78B89A84B4BBEB0D617B7C346DC5E"><enum>(b)</enum><header>Conforming and technical amendments</header>
<paragraph id="HB5676C9E3DC74B4CA40C9BCAB8A91EA8"><enum>(1)</enum><header>Conforming amendments</header>
<subparagraph id="H02DB21F77F434D469510D482A836D7A2"><enum>(A)</enum><text display-inline="yes-display-inline">Section 7601(a) of title 38, United States Code, is amended—</text> <clause id="HDBF86EE6F58045EA92AF614073F34947"><enum>(i)</enum><text>in paragraph (4), by striking <quote>and</quote>;</text></clause>
<clause id="HD272E419804D493E9AF4C7FC9EC2F043"><enum>(ii)</enum><text>in paragraph (5), by striking the period and inserting <quote>; and</quote>; and</text></clause> <clause id="H4235874EC72F4A7F8F2D3AEAFF9CE5B6"><enum>(iii)</enum><text>by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HB0AE736D88AD4649A373E231662F3B72" style="USC">
<paragraph id="HE9806CCA2C7F4C7BBFFF7E1496183A0E"><enum>(6)</enum><text display-inline="yes-display-inline">the specialty education loan repayment program provided for in subchapter VIII of this chapter.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></clause></subparagraph> <subparagraph id="H3ABDA6072243499EB72A67CB07558C3E"><enum>(B)</enum><text>Section 7603(a)(1) of title 38, United States Code, is amended by striking <quote>or VI</quote> and inserting <quote>VI, or VIII</quote>.</text></subparagraph>
<subparagraph id="H2E763B10913D4BD59802299D62F09B92"><enum>(C)</enum><text>Section 7604 of title 38, United States Code, is amended by striking <quote>or VI</quote> each place it appears and inserting <quote>VI, or VIII</quote>.</text></subparagraph> <subparagraph id="H6E7B8B79B04A46B7B544F83D77DE1D6E"><enum>(D)</enum><text display-inline="yes-display-inline">Section 7631 of title 38, United States Code, is amended—</text>
<clause id="H8538332D271B41798D72729E589258BE"><enum>(i)</enum><text>in subsection (a)(1)—</text> <subclause id="H00B050FAA7EC4C118AB7F00C727281E8"><enum>(I)</enum><text>by striking <quote>and</quote> after <quote>scholarship amount,</quote>; and</text></subclause>
<subclause id="HD82DC2BDF32245E3962A8BDB1DF913A2"><enum>(II)</enum><text>by inserting <quote>, and the maximum specialty education loan repayment amount</quote> after <quote>reduction payments amount</quote>; and</text></subclause></clause> <clause id="HB8579EECB5C54CC4B7E8BAC58F2B1680"><enum>(ii)</enum><text>in subsection (b) by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H13BB269BFD8B4BDBB2B741A83E686F98" style="USC">
<paragraph id="HBF4F68750B59429F80E7080FAE13F58A" indent="up1"><enum>(7)</enum><text display-inline="yes-display-inline">The term <term>specialty education loan repayment amount</term> 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.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></clause></subparagraph> <subparagraph id="H6B382B3D6FEA4DECA220671A0DA980DC"><enum>(E)</enum><text display-inline="yes-display-inline">Section 7632 of title 38, United States Code, is amended—</text>
<clause id="H12E93E5BD49C4176B925091141FBE87F"><enum>(i)</enum><text>in paragraph (1), by striking <quote>and the Education Debt Reduction Program</quote> and inserting <quote>the Education Debt Reduction Program, and the Specialty Education Loan Repayment Program</quote>; and</text></clause> <clause id="H7BFC0876CEEE40E987EAE1835168CD7D"><enum>(ii)</enum><text>in paragraph (4), by striking <quote>and per participant in the Education Debt Reduction Program</quote> and inserting <quote>per participant in the Education Debt Reduction Program, and per participant in the Specialty Education Loan Repayment Program</quote>.</text></clause></subparagraph></paragraph>
<paragraph commented="no" id="H634FFB9D95424E438EF83070C0311D76"><enum>(2)</enum><header>Table of sections</header><text>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:</text> <quoted-block display-inline="no-display-inline" id="H1DE02EFAE8AC4BCE88E36D0766E70255" style="USC"> <toc regeneration="yes-regeneration"> <toc-entry idref="H792C237BD60C4DC992170858D4C68692" level="subchapter">Subchapter VIII—Specialty Education Loan Repayment Program</toc-entry> <toc-entry idref="H1128249763CD4AE08BBA3374002EC524" level="section">7691. Establishment.</toc-entry> <toc-entry idref="HB42A433C107F4B9FA30717E0B7FF2EF1" level="section">7692. Purpose.</toc-entry> <toc-entry idref="H3B5A44B3F62C4BC6A47174652994C09B" level="section">7693. Eligibility; preferences; covered costs.</toc-entry> <toc-entry level="section">7694. Specialty education loan repayment.</toc-entry> <toc-entry level="section">7695. Choice of location.</toc-entry> <toc-entry idref="HBF4F992DB0B34C57B455B8DC865DAFC2" level="section">7696. Term of obligated service.</toc-entry> <toc-entry idref="HF6F2C54B56CB41CFA1586C0C761C1D5A" level="section">7697. Relationship to Educational Assistance Program.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="HB333829CD7844C7896B6B2B482DF705F"><enum>(c)</enum><header>Needs of the VHA</header><text>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.</text></subsection>
<subsection commented="no" id="H75419B7A38594C4FAC11AAB90AE130EC"><enum>(d)</enum><header>Preference</header><text display-inline="yes-display-inline">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.</text></subsection> <subsection id="H49091AB7C4C24A67BBAB282050D88E1F"><enum>(e)</enum><header>Offer deadline</header><text display-inline="yes-display-inline">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—</text>
<paragraph id="H44A68A32F3FA46FEA0BAD4B5786EE76A"><enum>(1)</enum><text>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</text></paragraph> <paragraph id="H2000EC532581488588530C9F95CB3A92"><enum>(2)</enum><text>such match is published.</text></paragraph></subsection>
<subsection id="HBBFF4EBDF68B4980902B2F9FB6AF6CD2"><enum>(f)</enum><header>Publicity</header><text>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 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/76">chapter 76</external-xref> of title 38, United States Code, as enacted by subsection (a).</text></subsection></section> <section id="H7527F3860E444E19BF8FAA874D4FA315" section-type="subsequent-section"><enum>304.</enum><header>Veterans healing veterans medical access and scholarship program</header> <subsection id="H55709EC3C8994B6CB74A957F56FEEEE9"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">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.</text></subsection>
<subsection id="H02FAA866CC0E42A1956B02DB3A17F71E"><enum>(b)</enum><header>Eligible veterans</header><text>To be eligible to receive funding for medical education under this section, a veteran shall—</text> <paragraph id="HDCC15CF5C8CF4C9AB7D779750A059486"><enum>(1)</enum><text>have been discharged from the Armed Forces not more than 10 years before the date of application for admission to a covered medical school;</text></paragraph>
<paragraph id="H0BF10BDEEF1642B4B3EF8DDF1286F39B"><enum>(2)</enum><text display-inline="yes-display-inline">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;</text></paragraph> <paragraph id="H3078EB73AC794ECC9AA590FA317AC5C7"><enum>(3)</enum><text>apply for admission to a covered medical school for the entering class of 2019;</text></paragraph>
<paragraph id="HB78996CD32CA4C649845378C4B1BA5A3"><enum>(4)</enum><text>indicate on such application for admission that the veteran would like to be considered for an award of funding under this section;</text></paragraph> <paragraph id="HA5A4F986C3A14489BF1F2A16C4781821"><enum>(5)</enum><text>meet the minimum admissions criteria for the covered medical school to which the veteran applies; and</text></paragraph>
<paragraph id="HF9D51732E9CB4B489987E1D54B67D52C"><enum>(6)</enum><text>enter into an agreement described in subsection (e).</text></paragraph></subsection> <subsection id="H83F52BD421E64EECBD4CF2FC91D2E518"><enum>(c)</enum><header>Award of funding</header> <paragraph id="H84EDAB4487B242FAA70DE9ABD371C8D6"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph>
<paragraph id="HF27D9C2E37C34C87ACB3FA5806CD8E31"><enum>(2)</enum><header>Amount of funding</header><text>Each eligible veteran who receives funding under this section shall receive an amount equal to the actual cost of—</text> <subparagraph id="H23CD1A9A5CEE498F9B47689B4394F3C3"><enum>(A)</enum><text>tuition at the covered medical school at which the veteran enrolls for 4 years;</text></subparagraph>
<subparagraph id="HE43B7F0662454F138ED7F5989A612307"><enum>(B)</enum><text>books, fees, and technical equipment;</text></subparagraph> <subparagraph id="H62F5D3D3A1DF48F1A579B84341F648CC"><enum>(C)</enum><text>fees associated with the National Residency Match Program;</text></subparagraph>
<subparagraph id="HA962A1F6119E4A0995EA1D5505BA5391"><enum>(D)</enum><text>two away rotations performed during the fourth year at a Department of Veterans Affairs medical facility; and</text></subparagraph> <subparagraph id="H2EA238EA2DC44E0986ADE7CCD775E0C0"><enum>(E)</enum><text>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.</text></subparagraph></paragraph>
<paragraph id="HF432C79AD4594BC887FCED40CC1FDB30"><enum>(3)</enum><header>Distribution of funding</header><text>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.</text></paragraph></subsection> <subsection id="H77D4DDF9B0974FF090BFADAC4C31F632"><enum>(d)</enum><header>Agreement</header> <paragraph id="HA6672FF94A2F4F5EAE9A75991A0379A6"><enum>(1)</enum><header>Terms of agreement</header><text>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—</text>
<subparagraph id="H15CC1B33AF0244049FA020E3F7B52DA4"><enum>(A)</enum><text display-inline="yes-display-inline">to maintain enrollment and attendance in the medical school;</text></subparagraph> <subparagraph id="H47AF9442F50A4C45A3AE53A7137B774F"><enum>(B)</enum><text>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);</text></subparagraph>
<subparagraph id="H746204F9F16141E783A35E29FA9F002B"><enum>(C)</enum><text display-inline="yes-display-inline">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;</text></subparagraph> <subparagraph id="H3F99D1637DAA48BE9BB543DA217D2B9B"><enum>(D)</enum><text>after completion of medical school, to obtain a license to practice medicine in a State; and</text></subparagraph>
<subparagraph id="H49D6231690264EDC8F055F721BB90912"><enum>(E)</enum><text>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.</text></subparagraph></paragraph> <paragraph id="HFF774BB04B32400797F736C5E4D1F4BA"><enum>(2)</enum><header>Breach of agreement</header><text>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.</text></paragraph></subsection>
<subsection id="H1E9E40BA61AD4C62B7A583FB372915AA"><enum>(e)</enum><header>Rule of construction</header><text>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.</text></subsection> <subsection commented="no" id="H460398F05D404C8689E1861E397FFEF1"><enum>(f)</enum><header>Report to Congress</header><text>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.</text></subsection>
<subsection id="HFCA15496985B4770A2814BB258A7A233"><enum>(g)</enum><header>Covered medical schools</header><text>In this section, the term <term>covered medical school</term> means any of the following:</text> <paragraph id="H5A3035B7365A45F782E7DC6591D2E3B3"><enum>(1)</enum><text>The Teague-Cranston medical schools, consisting of—</text>
<subparagraph id="H3467A6C8E7D248359764E587ABAA2A46"><enum>(A)</enum><text>Texas A&M College of Medicine;</text></subparagraph> <subparagraph id="H6D0D11FC1DF54D37B57D5723553349A2"><enum>(B)</enum><text>Quillen College of Medicine at East Tennessee State University;</text></subparagraph>
<subparagraph id="HEA87CBFD4A3B45839CE03E0B711C4AED"><enum>(C)</enum><text>Boonshoft School of Medicine at Wright State University;</text></subparagraph> <subparagraph id="H389DC52D36884BE1BCF11D650633BA9B"><enum>(D)</enum><text>Joan C. Edwards School of Medicine at Marshall University; and</text></subparagraph>
<subparagraph id="H78D3A5D39BD4426B806416AA8491A6AA"><enum>(E)</enum><text>University of South Carolina School of Medicine.</text></subparagraph></paragraph> <paragraph id="HF3301CE5EB484E1A9A5E9D7280135929"><enum>(2)</enum><text display-inline="yes-display-inline">Charles R Drew University of Medicine and Science.</text></paragraph>
<paragraph id="HD3E85216CB4848B1BBC090BC20C51B2E"><enum>(3)</enum><text>Howard University College of Medicine.</text></paragraph> <paragraph id="H259E6A684F4646D1B3430EFD482BDD07"><enum>(4)</enum><text>Meharry Medical College.</text></paragraph>
<paragraph id="HF574ED0F0F784ACA87BA3E45F96D089E"><enum>(5)</enum><text>Morehouse School of Medicine.</text></paragraph></subsection></section> <section id="HA262FA88C83D41E6A70854362A3293C9"><enum>305.</enum><header>Bonuses for recruitment, relocation, and retention</header><text display-inline="no-display-inline">Section 705(a) of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/703">38 U.S.C. 703</external-xref> note) is amended—</text>
<paragraph id="H87F62910AD1A4814B2D9A923C0C15C45"><enum>(1)</enum><text>in paragraph (1), by striking <quote>$230,000,000</quote> and inserting <quote>$250,000,000, of which not less than $20,000,000 shall be for recruitment, relocation, and retention bonuses</quote>; and</text></paragraph> <paragraph id="HC3F5CE9E75A74078963DAA8F9E7261FC"><enum>(2)</enum><text>in paragraph (2), by striking <quote>$225,000,000</quote> and inserting <quote>$290,000,000, of which not less than $20,000,000 shall be for recruitment, relocation, and retention bonuses</quote>.</text></paragraph></section>
<section display-inline="no-display-inline" id="HA83ED6D8C2A0460DABE1D293E7DF6080" section-type="subsequent-section"><enum>306.</enum><header>Inclusion of Vet Center employees in Education Debt Reduction Program of Department of Veterans Affairs</header>
<subsection id="HC05CE38DFE2F4AB28357A1632E9BDF9B"><enum>(a)</enum><header>In general</header><text>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 <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/76">chapter 76</external-xref> of title 38, United States Code.</text></subsection> <subsection id="HA2084C7536B2494AB5E822F7F44F6FFC"><enum>(b)</enum><header>Report</header><text display-inline="yes-display-inline">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.</text></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H5AD3CEDB82314C41B587D8A799968BB7"><enum>(c)</enum><header>Vet Center defined</header><text>In this section, the term <term>Vet Center</term> has the meaning given that term in section 1712A(h) of title 38, United States Code.</text></subsection></section> <enum>IV</enum><header>Health Care in Underserved Areas</header> <section id="H7B62E9CA8F9D4257A835AF07A1DE9609"><enum>401.</enum><header>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</header> <subsection id="HE6672B269AD948C981B16C1DF2218F03"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subsection>
<subsection id="HCB52329C7C4D4F989E0DA181CAB264C7"><enum>(b)</enum><header>Consideration</header><text display-inline="yes-display-inline">Criteria developed under subsection (a) shall include consideration of the following with respect to a facility:</text> <paragraph id="HAABCD6B613EE4A55A53934B834DB2F70"><enum>(1)</enum><text>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.</text></paragraph>
<paragraph id="H9E026DDB1E294DD7872C04328E3E8C64"><enum>(2)</enum><text>The range of clinical specialties covered by such providers in such area.</text></paragraph> <paragraph id="HFAB89E6FB3A54AC7A6FB963F46C881D6"><enum>(3)</enum><text>Whether the local community is medically underserved.</text></paragraph>
<paragraph id="HE86BFB770CD849DF99F63A82CA1D50D1"><enum>(4)</enum><text>The type, number, and age of open consults.</text></paragraph> <paragraph id="H8796092A40624302ACDA296E0B0F7742"><enum>(5)</enum><text>Whether the facility is meeting the wait-time goals of the Department.</text></paragraph>
<paragraph id="HE6220C93DC5440D6A1BD6FC32ADD2AC0"><enum>(6)</enum><text>Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans.</text></paragraph></subsection> <subsection display-inline="no-display-inline" id="H7C496AD8000F4491A5BEFD8F5D773898"><enum>(c)</enum><header>Analysis of facilities</header><text>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).</text></subsection>
<subsection id="HD8CC4515DE484F22839905BD5D6B6D1F"><enum>(d)</enum><header>Annual plan To address underserved facilities</header>
<paragraph id="H0B2DD26A27BF43E582EF43A8F34137D7"><enum>(1)</enum><header>Plan required</header><text>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).</text></paragraph> <paragraph id="HFB4A3E34D87D42809007936019E1EE50"><enum>(2)</enum><header>Contents</header><text>Each plan submitted under paragraph (1) shall address the following:</text>
<subparagraph id="HCAD00F0150A6485C8F98D8FDA7F683A9"><enum>(A)</enum><text>Increasing personnel or temporary personnel assistance, including mobile deployment teams furnished under section 407 of this Act.</text></subparagraph> <subparagraph id="H1DD07F20C9084069A3F8BB24C39A2E02"><enum>(B)</enum><text>Providing special hiring incentives, including under the Education Debt Reduction Program under subchapter VII of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/76">chapter 76</external-xref> of title 38, United States Code, and recruitment, relocation, and retention incentives.</text></subparagraph>
<subparagraph id="H7AABDC2B7A364BBF80562B44178859E8"><enum>(C)</enum><text>Using direct hiring authority.</text></subparagraph> <subparagraph id="HEF0BD2DD47EC407A922E411DC25E909F"><enum>(D)</enum><text>Improving training opportunities for staff.</text></subparagraph>
<subparagraph id="H8557C404BA6F4C56956301A642285A66"><enum>(E)</enum><text>Such other actions as the Secretary considers appropriate.</text></subparagraph></paragraph></subsection></section> <section id="H56100AC0F694460192CBD9016F4950FD"><enum>402.</enum><header>Pilot program to furnish mobile deployment teams to underserved facilities</header> <subsection id="H341DD9AE0F7547AFA727DD21727D4800"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs shall carry out a pilot program to furnish mobile deployment teams of medical personnel to underserved facilities.</text></subsection>
<subsection id="H057820DA8D4B4781BFFD092C935BE3CC"><enum>(b)</enum><header>Elements</header><text>In furnishing mobile deployment teams under subsection (a), the Secretary shall consider the following elements:</text> <paragraph id="H7B1F59AD3CB34C118D880EB994B05235"><enum>(1)</enum><text>The medical positions of greatest need at underserved facilities.</text></paragraph>
<paragraph id="H96DAD8B46857441A8C967C1D513F0EC5"><enum>(2)</enum><text>The size and composition of teams to be deployed.</text></paragraph> <paragraph id="HB740B4971DFD40FE870662957A805A99"><enum>(3)</enum><text>Such other elements as the Secretary considers necessary for effective oversight of the program established under subsection (a).</text></paragraph></subsection>
<subsection display-inline="no-display-inline" id="H58F20BBC6AD54E1C806101784060CD53"><enum>(c)</enum><header>Use of annual analysis</header><text>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.</text></subsection> <subsection id="H8051C918155147168F90BB7EA8648C0A"><enum>(d)</enum><header>Reporting</header> <paragraph id="H877D4142C9754E5CB519F41DA9F8F1BA"><enum>(1)</enum><header>Progress report</header><text>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.</text></paragraph>
<paragraph id="HCFBE0B60AF7D474683E752329F6B8F6B"><enum>(2)</enum><header>Final report</header><text>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—</text> <subparagraph id="H45D6D7346D0748C9BAE216651B1292DE"><enum>(A)</enum><text>extending or expanding the pilot program; and</text></subparagraph>
<subparagraph id="H00577BD648344C409D475A084533C6C3"><enum>(B)</enum><text>making the pilot program (or any aspect thereof) permanent.</text></subparagraph></paragraph></subsection> <subsection id="H9227D69987B846F0B9F272EDBA244C2B"><enum>(e)</enum><header>Duration</header><text display-inline="yes-display-inline">The pilot program under this section shall terminate 3 years after the date of the enactment of this Act.</text></subsection>
<subsection id="HD70B4B56AABA4D0F994BF4316F60FBB5"><enum>(f)</enum><header>Underserved facility defined</header><text>In this section, the term <term>underserved facility</term> 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.</text></subsection></section> <section display-inline="no-display-inline" id="H40A8DA0750CA437DB1CBB7468E26BE47"><enum>403.</enum><header>Pilot program on graduate medical education and residency</header> <subsection id="HB5552E8D68DC46BC8E6C967D34F33D0D"><enum>(a)</enum><header>Establishment</header> <paragraph commented="no" id="H27F374E4C66E4DE5A994B81A93AD1C20"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">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 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/7302">38 U.S.C. 7302</external-xref> note) at covered facilities.</text></paragraph>
<paragraph id="H829647288CD74B3B817B9D9DD01ABADA"><enum>(2)</enum><header>Covered facilities</header><text>For purposes of this section, a covered facility is any of the following:</text> <subparagraph id="H24AF277A436B4C8099048E8842A7B173"><enum>(A)</enum><text>A health care facility of the Department of Veterans Affairs.</text></subparagraph>
<subparagraph id="H8D948401887A48E183C212D046AE776E"><enum>(B)</enum><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/25/5304">25 U.S.C. 5304</external-xref>).</text></subparagraph> <subparagraph id="H780E72D9395F440F83DD41AC5203668A"><enum>(C)</enum><text display-inline="yes-display-inline">A health care facility operated by the Indian Health Service.</text></subparagraph>
<subparagraph id="HD51869FC5D894925B7B0AC8A66A1E2A8"><enum>(D)</enum><text>A Federally-qualified health center, as defined in section 1905(l)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(l)(2)(B)</external-xref>).</text></subparagraph> <subparagraph id="HBC3EDEE3CDA14AD08DA04B9327B79F0F"><enum>(E)</enum><text display-inline="yes-display-inline">A health care facility operated by the Department of Defense.</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="H69198616B3EC40419FD90FB5784CD136"><enum>(F)</enum><text>Such other health care facility as the Secretary considers appropriate for purposes of this section.</text></subparagraph></paragraph> <paragraph id="HE14EFDE285E447F88CA03262D2CA8138"><enum>(3)</enum><header>Agreements</header><text>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).</text></paragraph>
<paragraph id="H0E7CD2ACD3C9446EACE30C1B8ECB0F17"><enum>(4)</enum><header>Parameters for location, affiliate sponsor, and duration</header><text>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:</text> <subparagraph id="H4A8B0351F57C497690579E050460A909"><enum>(A)</enum><text>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.</text></subparagraph>
<subparagraph id="H603B0944251D4AC2A8A8D6D9EC4AC574"><enum>(B)</enum><text display-inline="yes-display-inline">The range of clinical specialties of providers in standardized geographic areas surrounding a facility.</text></subparagraph> <subparagraph id="H6BC20B81BD914225826A9699711A832C"><enum>(C)</enum><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="H9286F12F29B44A5D9B603C46BCFD22BD"><enum>(D)</enum><text display-inline="yes-display-inline">Whether the local community is designated by the Secretary of Veterans Affairs as underserved pursuant to criteria developed under section 401 of this Act.</text></subparagraph> <subparagraph id="H520571B28C8342AD947149ABEB788196"><enum>(E)</enum><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/42/254e">42 U.S.C. 254e</external-xref>).</text></subparagraph>
<subparagraph id="HDCF3CE87371A462EADCE77E574C83FB9"><enum>(F)</enum><text>Whether the facility is located in a rural or remote area.</text></subparagraph> <subparagraph id="HCCB18C8CF6D543F999518E88E37BCC31"><enum>(G)</enum><text>Such other criteria as the Secretary considers important in determining which facilities are not adequately serving area veterans.</text></subparagraph></paragraph>
<paragraph id="HB9326F4A5EB24A30BBCCA09F1D1FFE19"><enum>(5)</enum><header>Priority in placements</header><text display-inline="yes-display-inline">During the pilot program under this section, the Secretary shall place no fewer than 100 residents in covered facilities—</text> <subparagraph id="HB620D8A81DCE4C0CA2F91117D012FA76"><enum>(A)</enum><text>operated by the Indian Health Service;</text></subparagraph>
<subparagraph id="H53389FBE164F4B23B8976578D07FFD6D"><enum>(B)</enum><text display-inline="yes-display-inline">operated by an Indian tribe;</text></subparagraph> <subparagraph id="H0D76AB5B44BF4959BCB9F621C9CBEF32"><enum>(C)</enum><text display-inline="yes-display-inline">operated by a tribal organization; or</text></subparagraph>
<subparagraph id="HF51282A743C2479E95E99E3B954D8380"><enum>(D)</enum><text>located in communities designated by the Secretary as underserved pursuant to criteria developed under section 401 of this Act.</text></subparagraph></paragraph> <paragraph id="HC22608E6B2744D499820C4A5FA7BFF8E"><enum>(6)</enum><header>Stipends and benefits</header><text>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.</text></paragraph></subsection>
<subsection commented="no" id="HAD9C1F152D99492684C5370EB9B3B568"><enum>(b)</enum><header>Reimbursement</header><text display-inline="yes-display-inline">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:</text> <paragraph commented="no" id="H012B0ADA474B40E0849A3683ED33E0CB"><enum>(1)</enum><text display-inline="yes-display-inline">Curriculum development.</text></paragraph>
<paragraph commented="no" id="H6D15B3434A96437F8364608348522ACD"><enum>(2)</enum><text display-inline="yes-display-inline">Recruitment and retention of faculty.</text></paragraph> <paragraph commented="no" id="H082FE7A5258248E8895386A2FCEC33B0"><enum>(3)</enum><text display-inline="yes-display-inline">Accreditation of the program by the Accreditation Council for Graduate Medical Education.</text></paragraph>
<paragraph commented="no" id="H6FAF957D96694999A6F63D5741161A36"><enum>(4)</enum><text display-inline="yes-display-inline">The portion of faculty salaries attributable to duties under an agreement subsection (a)(3).</text></paragraph> <paragraph commented="no" id="H2975AECEB9CA4FAEBB7D97348B5977A6"><enum>(5)</enum><text display-inline="yes-display-inline">Expenses relating to educating a resident under the pilot program.</text></paragraph></subsection>
<subsection commented="no" id="H693617E45A1742889601720B04184336"><enum>(c)</enum><header>Reporting</header>
<paragraph commented="no" id="HA3CC4D5AA4AA4AFB839F50B7E4AE8AF3"><enum>(1)</enum><header>In general</header><text>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.</text></paragraph> <paragraph commented="no" id="H8160F7B1135845CC9D80CA948410A073"><enum>(2)</enum><header>Elements</header><text display-inline="yes-display-inline">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:</text>
<subparagraph commented="no" id="H618C7E9711FF44CBA4290639F8289E0B"><enum>(A)</enum><text display-inline="yes-display-inline">The number of veterans who received care from residents under the pilot program.</text></subparagraph> <subparagraph id="H730DC2F0174C41C69CE5C0E5195F9F9D"><enum>(B)</enum><text display-inline="yes-display-inline">The number of veterans who received care from each resident per position described in subsection (a)(1) under the pilot program.</text></subparagraph>
<subparagraph commented="no" id="HB080225CA97B470BBC0A35E1F1060C4A"><enum>(C)</enum><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph commented="no" id="H38570199A1BD4F48853FAB90B1299846"><enum>(D)</enum><text display-inline="yes-display-inline">The number of clinical appointments for veterans conducted by each resident under the pilot program.</text></subparagraph>
<subparagraph id="H5DB1C842693943B7A862FCBAF5BF0A39"><enum>(E)</enum><text display-inline="yes-display-inline">The number of clinical appointments for veterans conducted by residents per position described in subsection (a)(1) under the pilot program.</text></subparagraph> <subparagraph id="H35B9D138F42D4B49A005E724494191E8"><enum>(F)</enum><text>The number of clinical appointments for veterans expressed as a percentage of all clinical appointments conducted by residents under the pilot program.</text></subparagraph>
<subparagraph id="HEAC9069321BD4DBD8FD8419D35F1C1DC"><enum>(G)</enum><text>The number of positions described in subsection (a)(1) at each covered facility under the pilot program.</text></subparagraph> <subparagraph id="H5C100A3302AE4575BD52FB25C6AF2871"><enum>(H)</enum><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="HAFC2E88AE0624AC5BCB502D426EB7FF1"><enum>(I)</enum><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph id="HAB92268A3F664D39A3E8D52DCE95FFC5"><enum>(J)</enum><text display-inline="yes-display-inline">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.</text></subparagraph>
<subparagraph id="H3790DC6523264504856BFF73DDA50D0D"><enum>(K)</enum><text>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.</text></subparagraph> <subparagraph id="H6CDD42BCE841419B8BE077A3B0E4F43E"><enum>(L)</enum><text display-inline="yes-display-inline">The cost to the Department of Veterans Affairs per resident placed under the pilot program at each covered facility.</text></subparagraph>
<subparagraph id="H8BE8298E1302455787D6E668DB8120A1"><enum>(M)</enum><text display-inline="yes-display-inline">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.</text></subparagraph> <subparagraph id="HB7E6DB953950497BA5937DCFB5668420"><enum>(N)</enum><text>The medical specialties pursued by residents under the pilot program.</text></subparagraph></paragraph></subsection>
<subsection id="H40F86F7F837F4BB1A812FE12D2963788"><enum>(d)</enum><header>Duration</header><text display-inline="yes-display-inline">The pilot program under this section shall terminate on August 7, 2024.</text></subsection></section> <enum>V</enum><header>Other Matters</header> <section id="H6833F7F648EA43368E16DB62252D0226"><enum>501.</enum><header>Annual report on performance awards and bonuses awarded to certain high-level employees of the department</header> <subsection id="H9E18F1F321D341FF999C414CE75D51EE"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline"><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/7">Chapter 7</external-xref> of title 38, United States Code, is amended by adding at the end the following new section:</text>
<quoted-block id="HCCB3F762D35741E5AC0E7F2D9C27AFEB" style="USC">
<section id="H2D218036C1B74474B0764BE345E83D07"><enum>726.</enum><header>Annual report on performance awards and bonuses awarded to certain high-level employees</header>
<subsection id="HBED763CC456742F3AC0BAEED911BB4BB"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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:</text> <paragraph id="H0A4231DE6F25496EA8CC405B2C3BE302"><enum>(1)</enum><text>Regional Office Director of the Department.</text></paragraph>
<paragraph id="HCAC735C35218491AA0AE9A414639D528"><enum>(2)</enum><text>Director of a Medical Center of the Department.</text></paragraph> <paragraph id="HC3E08727514846A487A38E786F814849"><enum>(3)</enum><text>Director of a Veterans Integrated Service Network.</text></paragraph>
<paragraph id="HCDEB433B707F4260B2754D9BD45A8901"><enum>(4)</enum><text>Senior executive of the Department.</text></paragraph></subsection> <subsection id="HBD00D262C9A34D26965F3CDA75749B2A"><enum>(b)</enum><header>Elements</header><text>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:</text>
<paragraph id="HFC365CD9FBDC4CBFAC99A03848922F35"><enum>(1)</enum><text>The amount of each award or bonus.</text></paragraph> <paragraph id="H80A0B4A4579C4B19BE07C7E6FDC9F884"><enum>(2)</enum><text>The job title of the individual awarded the award or bonus.</text></paragraph>
<paragraph id="H4B61FA2315734A928280823A2DCF1003"><enum>(3)</enum><text>The location where the individual awarded the award or bonus works.</text></paragraph></subsection> <subsection id="H982EE6B162274FBC81DB05F1A5BFCD30"><enum>(c)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H2650EEC3121A4DD5B0579E2BF5AEF2BE"><enum>(1)</enum><text>The term <term>appropriate committees of Congress</term> means the Committees on Veterans’ Affairs and Appropriations of the Senate and House of Representatives.</text></paragraph> <paragraph id="HCE994B42E6514F0AA88A4FE184F9C8F2"><enum>(2)</enum><text>The term <term>senior executive</term> means—</text>
<subparagraph id="H4665B544393949C9A98AA54C25897C64"><enum>(A)</enum><text display-inline="yes-display-inline">a career appointee; or</text></subparagraph> <subparagraph id="H4C044F48EDD74FEC81D5AB8F5493AFEE"><enum>(B)</enum><text display-inline="yes-display-inline">an individual—</text>
<clause id="HA511998592B64F5C9E63064B1D4A1175"><enum>(i)</enum><text>in an administrative or executive position; and</text></clause> <clause id="H43F508606B6448B1B9983C461B9264D9"><enum>(ii)</enum><text>appointed under section 7306(a) or section 7401(1) of this title.</text></clause></subparagraph></paragraph>
<paragraph id="HD53E1FBC19664BA7844369BD05E5F9EE"><enum>(3)</enum><text>The term <term>career appointee</term> has the meaning given that term in section 3132(a) of title 5, United States Code.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="H811F07443C474F9F8AB32BC983A2F846"><enum>(b)</enum><header>Clerical amendment</header><text display-inline="yes-display-inline">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:</text>
<quoted-block id="HE6E3EE055E07480A8E018D3202B30E6F" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="section">726. Annual report on performance awards and bonuses awarded to certain high-level employees.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section id="H2DE3AAE18A204994B592E6033F435AED"><enum>502.</enum><header>Role of podiatrists in Department of Veterans Affairs</header>
<subsection commented="no" id="H87B786FF64F645EC90B6ED679EC9455E"><enum>(a)</enum><header>Inclusion as physician</header>
<paragraph id="HD9FFD8ADAB064DC590793DEF596FEB1E"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Subchapter I of chapter 74 is amended by adding at the end the following new section:</text> <quoted-block display-inline="no-display-inline" id="H3BA534F5E2594C879ECF020D757CFD8A" style="USC"> <section id="HA890207C6D924BCEA2CF1D3C7BA147E7"><enum>7413.</enum><header>Treatment of podiatrists; clinical oversight standards</header> <subsection id="H30C9423FD8064BFC9A8B0100BDEEE065"><enum>(a)</enum><header>Podiatrists</header><text display-inline="yes-display-inline">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.</text></subsection>
<subsection id="H5FF6364C4FF040BEA3A434681E361793"><enum>(b)</enum><header>Establishment of clinical oversight standards</header><text display-inline="yes-display-inline">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.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></paragraph> <paragraph id="H09213FF720F14ACE969E072547F678BD"><enum>(2)</enum><header>Clerical amendment</header><text>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:</text>
<quoted-block display-inline="no-display-inline" id="H9FF7923E3B4B41268F2C9BD8BA447F48" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="section">7413. Treatment of podiatrists; clinical oversight standards.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection id="HD0A0F3FC3D2D46E88A3063100BCEEBC5"><enum>(b)</enum><header>Modification and clarification of pay grade</header>
<paragraph id="H9326823F290645BCA3EC0DCA8F4ED297"><enum>(1)</enum><header>Grade</header><text display-inline="yes-display-inline">The list in section 7404(b) of such title is amended—</text> <subparagraph id="H026C69AE2B00469E9169C0C40118E4CE"><enum>(A)</enum><text>by striking <quote>PHYSICIAN AND DENTIST SCHEDULE</quote> and inserting <quote>PHYSICIAN AND SURGEON (MD/DO), PODIATRIC SURGEON (DPM), AND DENTIST AND ORAL SURGEON (DDS, DMD) SCHEDULE</quote>;</text></subparagraph>
<subparagraph display-inline="no-display-inline" id="H9F371D47E0054ED8B41066181869EF2F"><enum>(B)</enum><text>by striking <quote>Physician grade</quote> and inserting <quote>Physician and surgeon grade</quote>; and</text></subparagraph> <subparagraph id="H1B91BCEF04BD4466BD4643341EA9B552"><enum>(C)</enum><text>by striking <quote>PODIATRIST, CHIROPRACTOR, AND</quote> and inserting <quote>CHIROPRACTOR AND</quote>.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HBB15A4E348444FACA1FA9E8F4011B606"><enum>(2)</enum><header>Application</header><text display-inline="yes-display-inline">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.</text></paragraph></subsection></section> <section id="HB65CD6446FDC4C03933AD09F6FA2E947"><enum>503.</enum><header>Definition of major medical facility project</header> <subsection commented="no" id="HB27E7090177C4B00847709AF911DCDCD"><enum>(a)</enum><header>Modification of definition of medical facility</header><text>Section 8101(3) is amended by striking <quote>Secretary</quote> and all that follows through <quote>nursing home,</quote> and inserting <quote>Secretary, or as otherwise authorized by law, for the provision of health-care services (including hospital, outpatient clinic, nursing home,</quote>.</text></subsection>
<subsection id="H087D47ECF4AA49DAA190D866F9556E07"><enum>(b)</enum><header>Modification of definition of major medical facility project</header><text>Paragraph (3) of section 8104(a) is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H2FD19D95547E49E3909C10B593DF5A91" style="OLC"> <paragraph id="HC01E275FD4B047FA94843566979FEB5B" indent="up1"><enum>(3)</enum><text>For purposes of this subsection, the term <term>major medical facility project</term> 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.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section>
<section display-inline="no-display-inline" id="H4A2E7A55801B47FB9343B163847AB96C" section-type="subsequent-section"><enum>504.</enum><header>Authorization of certain major medical facility projects of the Department of Veterans Affairs</header>
<subsection id="H3AD77919EE0D48C1ADEE68AFBE4FCCED"><enum>(a)</enum><header>Authorization</header><text>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.</text></subsection> <subsection id="H9C162FD9292F47C4A2970279F8F3463B"><enum>(b)</enum><header>Authorization of appropriations for construction</header><text>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).</text></subsection>
<subsection id="H47ED2420C66846CBB0E5B55D846DE8CC"><enum>(c)</enum><header>Submittal of information</header><text>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:</text> <paragraph id="H77145C5B762F43CD985E31EA61E4B3A3"><enum>(1)</enum><text>A line item accounting of expenditures relating to construction management carried out by the Department of Veterans Affairs for such project.</text></paragraph>
<paragraph id="H10110291DD30482ABF9D592901A3C2ED"><enum>(2)</enum><text>The future amounts that are budgeted to be obligated for construction management carried out by the Department for such project.</text></paragraph> <paragraph id="H694D21BD9C56496993E4298B01E1DB5C"><enum>(3)</enum><text>A justification for the expenditures described in paragraph (1) and the future amounts described in paragraph (2).</text></paragraph>
<paragraph id="HAC2027939FCF42428CDA27715439FA7E"><enum>(4)</enum><text>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.</text></paragraph></subsection></section> <section display-inline="no-display-inline" id="H8D109BF4E66C479DA61483B22D09184D" section-type="subsequent-section"><enum>505.</enum><header>Department of Veterans Affairs personnel transparency</header> <subsection id="H3C36CA69BFC6429BB50647E4F039C4BF"><enum>(a)</enum><header>Publication of staffing and vacancies</header> <paragraph id="HB44CA6323B4B43739A93E3A414DE1C0F"><enum>(1)</enum><header>Website required</header><text>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:</text>
<subparagraph id="HECB7C7DB7A3A45189E7E2678E7D3FB62"><enum>(A)</enum><text display-inline="yes-display-inline">The number of personnel encumbering positions.</text></subparagraph> <subparagraph id="H37298AC884924831BBF5ABA1E20075C9"><enum>(B)</enum><text>The number of accessions and separation actions processed during the quarter preceding the date of the publication of the information.</text></subparagraph>
<subparagraph id="H3C56D3349196476C94C0221B911D9343"><enum>(C)</enum><text>The number of vacancies, by occupation.</text></subparagraph> <subparagraph id="H335B8FC168AE4B58B725A3A387DB2411"><enum>(D)</enum><text>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.</text></subparagraph></paragraph>
<paragraph id="H524F82D2316543588BACDEECF31463D0"><enum>(2)</enum><header>Exceptions</header><text display-inline="yes-display-inline">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.</text></paragraph> <paragraph id="HE989C482C0F748069E9B02F3ECAF88C3"><enum>(3)</enum><header>Update of information</header><text>The Secretary shall update the information on the website required under paragraph (1) on a quarterly basis.</text></paragraph>
<paragraph id="H1576C2BAFB6B4BB6940C77D931F6D0E5"><enum>(4)</enum><header>Treatment of contractor positions</header><text>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).</text></paragraph> <paragraph id="H1B11E671F4FF43ADB1127C2E0C5A88C9"><enum>(5)</enum><header>Inspector General review</header><text>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.</text></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H7DADAFFD999941328A534ABBFFC3E8B3"><enum>(b)</enum><header>Report to Congress</header><text>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.</text></subsection></section> <section display-inline="no-display-inline" id="HE377A734AC6E4BAE8709C4A23A746FB5" section-type="subsequent-section"><enum>506.</enum><header>Program on establishment of peer specialists in patient aligned care team settings within medical centers of Department of Veterans Affairs</header> <subsection id="H529B2C29F877497FB8F77D73FF99604B"><enum>(a)</enum><header>Program required</header><text>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.</text></subsection>
<subsection id="HD6130BBA833F44C9A386867E11B6FF5A"><enum>(b)</enum><header>Timeframe for establishment of program</header><text>The Secretary shall carry out the program at medical centers of the Department as follows:</text> <paragraph id="H023391EAAE1E4E33A6CBC8AA59022AED"><enum>(1)</enum><text>Not later than May 31, 2019, at not fewer than 15 medical centers of the Department.</text></paragraph>
<paragraph id="H0B857254FF894A0684AE4C027A25FD6B"><enum>(2)</enum><text>Not later than May 31, 2020, at not fewer than 30 medical centers of the Department.</text></paragraph></subsection> <subsection id="HD42176B7B9714A9AA681458C4F2D7121"><enum>(c)</enum><header>Selection of locations</header> <paragraph id="HD4AC79BE2FAB4C0B8E4FB550AE397576"><enum>(1)</enum><header>In general</header><text>The Secretary shall select medical centers for the program as follows:</text>
<subparagraph id="HFC1BEFCBD27D40FD9306142A200168D9"><enum>(A)</enum><text>Not fewer than five shall be medical centers of the Department that are designated by the Secretary as polytrauma centers.</text></subparagraph> <subparagraph id="H5E4D5C536C7B49139925F96CC1BAF18E"><enum>(B)</enum><text>Not fewer than 10 shall be medical centers of the Department that are not designated by the Secretary as polytrauma centers.</text></subparagraph></paragraph>
<paragraph id="H1929352D766B469B9C3CBDDE957328F7"><enum>(2)</enum><header>Considerations</header><text>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:</text> <subparagraph id="HCC4F742D16DC4753B6F108DE295CA8A0"><enum>(A)</enum><text>Rural areas and other areas that are underserved by the Department.</text></subparagraph>
<subparagraph id="H6787F49E2DFA466FA370EBE64B3EA984"><enum>(B)</enum><text>Areas that are not in close proximity to an active duty military installation.</text></subparagraph> <subparagraph id="H38E0A628E5A24478AE2F5AA803A05390"><enum>(C)</enum><text>Areas representing different geographic locations, such as census tracts established by the Bureau of the Census.</text></subparagraph></paragraph></subsection>
<subsection id="H39739EA3DF02412E880E136FE75F7EC3"><enum>(d)</enum><header>Gender-Specific services</header><text>In carrying out the program at each location selected under subsection (c), the Secretary shall ensure that—</text> <paragraph id="HAD9464276C984A69B7489705F57B02B1"><enum>(1)</enum><text>the needs of female veterans are specifically considered and addressed; and</text></paragraph>
<paragraph id="HA03A8B39FD3D46C19923DA8779EDAB78"><enum>(2)</enum><text>female peer specialists are made available to female veterans who are treated at each location.</text></paragraph></subsection> <subsection id="HB445E740F95D44599754A65EC53BF68A"><enum>(e)</enum><header>Engagement with community providers</header><text>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.</text></subsection>
<subsection id="H68C0DBFE76F745ADB3BCBDEF2CFE3D10"><enum>(f)</enum><header>Reports</header>
<paragraph id="H7AD5E4BCF9054BA2A85BEA4A81237089"><enum>(1)</enum><header>Periodic reports</header>
<subparagraph id="H6FF62278E3E2474590184F28EF3916F8"><enum>(A)</enum><header>In general</header><text>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.</text></subparagraph> <subparagraph id="H84D6252ED8E14BB8A944DD67A10ED1BC"><enum>(B)</enum><header>Elements</header><text>Each report required by subparagraph (A) shall, with respect to the 180-day period preceding the submittal of the report, include the following:</text>
<clause id="H2FC59B3B14414446958396AC84E0D46A"><enum>(i)</enum><text>The findings and conclusions of the Secretary with respect to the program.</text></clause> <clause id="H4D6701A153284194ADA747D842C01468"><enum>(ii)</enum><text>An assessment of the benefits of the program to veterans and family members of veterans.</text></clause>
<clause id="H455344D823214369A72AA2D739DB9AEE"><enum>(iii)</enum><text>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.</text></clause></subparagraph></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H3F83E3D2158C44A48CB68468480DF24A"><enum>(2)</enum><header>Final report</header><text>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.</text></paragraph></subsection></section>
<section id="H75E5B8B7AD494093A5F577605366B8D8"><enum>507.</enum><header>Department of Veterans Affairs medical scribe pilot program</header>
<subsection id="HC7271D3DC8A8425DBC417CE63FA918C8"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">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.</text></subsection> <subsection id="HE9F0A499DA4B4023AF85F08BE792AA8C"><enum>(b)</enum><header>Locations</header><text>The Secretary shall carry out the pilot program at the 10 medical centers of the Department as follows:</text>
<paragraph id="H4AB244F2BA2B441EB70491CA9BB2A356"><enum>(1)</enum><text>At least four such medical centers located in rural areas.</text></paragraph> <paragraph id="HBD33E581F0DD42E6A20238F432838401"><enum>(2)</enum><text>At least four such medical centers located in urban areas.</text></paragraph>
<paragraph id="H58489EC23B564D009B0ABAABAA4B5291"><enum>(3)</enum><text display-inline="yes-display-inline">Two such medical centers located in areas with need for increased access or increased efficiency, as determine by the Secretary.</text></paragraph></subsection> <subsection id="HF0A4AA8EAEC844FAB59021E4DCD4900A"><enum>(c)</enum><header>Medical scribes</header> <paragraph id="HE57E9F576D76425FBE63A1A07114DBD4"><enum>(1)</enum><header>Hiring</header><text>Under the pilot program the Secretary shall—</text>
<subparagraph id="H90B9503DC1FB4DBE87F63A87B1D4B826"><enum>(A)</enum><text>hire 20 new Department of Veterans Affairs term employees as medical scribes; and</text></subparagraph> <subparagraph id="H88A93E5DEC16404388E165AD557DB9B0"><enum>(B)</enum><text>seek to enter into contracts with appropriate entities for the employment of 20 additional medical scribes.</text></subparagraph></paragraph>
<paragraph id="H484ACDD1138B453DA9CE14216F735387"><enum>(2)</enum><header>Distribution</header><text>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:</text> <subparagraph id="H512909FEB8914E8E97B9F6EFBCB4772E"><enum>(A)</enum><text>Two scribes shall be assigned to each of two physicians.</text></subparagraph>
<subparagraph id="HEF36300A1CC947D0B90272FF6DFF6ED1"><enum>(B)</enum><text>Thirty percent of the scribes shall be employed in the provision of emergency care.</text></subparagraph> <subparagraph id="HA7563087032645EAB243EC97982119E6"><enum>(C)</enum><text>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.</text></subparagraph></paragraph></subsection>
<subsection id="H82437D80B83D4C2381D3A3A182E13BEA"><enum>(d)</enum><header>Reports</header>
<paragraph id="H3AE8A9B1E91040A8B4556C043467C97B"><enum>(1)</enum><header>Reports to Congress</header><text display-inline="yes-display-inline">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:</text> <subparagraph id="HD7B89F6F10A948328E0965D90C4FF404"><enum>(A)</enum><text>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:</text>
<clause id="HFA87E3CA33FC4A08AE796E452059CAC7"><enum>(i)</enum><text>Provider efficiency.</text></clause> <clause id="H0B5E0D368C8F49278FC4925458924335"><enum>(ii)</enum><text>Patient satisfaction.</text></clause>
<clause id="H2B986B59307B4822BE564DFECDB0AC97"><enum>(iii)</enum><text>Average wait time.</text></clause> <clause id="H0D5B98E754AF4332B6986220B799CF8D"><enum>(iv)</enum><text>The number of patients seen per day by each physician or practitioner.</text></clause>
<clause id="H5A17AF2891F14B02AB5DFCD360167B25"><enum>(v)</enum><text display-inline="yes-display-inline">The amount of time required to hire and train an employee to perform medical scribe functions under the pilot program.</text></clause></subparagraph> <subparagraph id="H2FFF01E2E35F4DFFBE81F73DC1B891EC"><enum>(B)</enum><text>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.</text></subparagraph></paragraph>
<paragraph id="H8198A3FE2975439B893092AF54DA0777"><enum>(2)</enum><header>Comptroller General report</header><text>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.</text></paragraph></subsection> <subsection id="H619D8134EAB348BD8E7FA708B9A3B3E4"><enum>(e)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text>
<paragraph id="HED3A860F139A456A83A95C2D9410A768"><enum>(1)</enum><text>The term <term>medical scribe</term> 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:</text> <subparagraph id="H42E86D69A86345AFB86C61BCF460BEA5"><enum>(A)</enum><text>Assisting the physician or practitioner in navigating the electronic health record.</text></subparagraph>
<subparagraph id="H3AF4506BB5D9417FB7F874261AA91E27"><enum>(B)</enum><text>Responding to various messages as directed by the physician or practitioner.</text></subparagraph> <subparagraph id="H46E79CC47AED4BF4BDCE10A6351A85BC"><enum>(C)</enum><text>Entering information into the electronic health record, as directed by the physician or practitioner.</text></subparagraph></paragraph>
<paragraph id="H4F820704414F437BAD7725DA46BB57CC"><enum>(2)</enum><text display-inline="yes-display-inline">The terms <term>urban</term> and <term>rural</term> 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.</text></paragraph></subsection> <subsection id="H75B4B99BCD254758A997C0042D5BF82D"><enum>(f)</enum><header>Funding</header><text>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.</text></subsection></section>
<section display-inline="no-display-inline" id="H5F65579BE9A24403AFA02349015D5335" section-type="subsequent-section"><enum>508.</enum><header>Extension of requirement to collect fees for housing loans guaranteed by Secretary of Veterans Affairs</header><text display-inline="no-display-inline">Section 3729(b)(2) of title 38, United States Code, is amended by striking <quote>2027</quote> each place it appears and inserting <quote>2028</quote>.</text></section> <section id="H37222213D8ED4A3C840AB8DC91BA98E5"><enum>509.</enum><header>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</header><text display-inline="no-display-inline">Section 5503(d)(7) of title 38, United States Code, is amended by striking <quote>September 30, 2027</quote> and inserting <quote>September 30, 2028</quote>.</text></section>
<section id="H37AEDC3BD9C040F981B36E569ECA29A3"><enum>510.</enum><header>Appropriation of amounts</header>
<subsection display-inline="no-display-inline" id="H36629B6B54424C2A90F57A75991E6AB5"><enum>(a)</enum><header>Veterans Choice Program</header><text display-inline="yes-display-inline">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 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note).</text></subsection> <subsection id="H2F2E78934E9F420A9ADB34720C2A9EAC"><enum>(b)</enum><header>Availability of amounts</header><text>The amounts appropriated under subsection (a) shall be available for obligation or expenditure without fiscal year limitation.</text></subsection></section>
<section id="H0FB5BE8A1F4E438ABAB8480E7F94D555"><enum>511.</enum><header>Technical correction</header><text display-inline="no-display-inline">Section 1712I of title 38, United States Code, is redesignated as section 1720I of such title.</text></section> <section id="H80250BD85CB94BAE8BBECB4F5B4CA0DD"><enum>512.</enum><header>Budgetary effects</header> <subsection id="H7EB0A575863E4CD7818D2F86629B61BB"><enum>(a)</enum><header>Statutory Pay-As-You-Go scorecards</header><text>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.</text></subsection>
<subsection id="H90D72A8B2A5F4C9DA1B5264FA86AE9B4"><enum>(b)</enum><header>Senate PAYGO scorecards</header><text>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).</text></subsection></section> Karen L. HaasClerk.