[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2372 Enrolled Bill (ENR)]

        S.2372

                     One Hundred Fifteenth Congress

                                 of the

                        United States of America


                          AT THE SECOND SESSION

         Begun and held at the City of Washington on Wednesday,
           the third day of January, two thousand and eighteen


                                 An Act


 
    To establish a permanent community care program for veterans, to 
    establish a commission for the purpose of making recommendations 
regarding the modernization or realignment of facilities of the Veterans 
  Health Administration, to improve construction of the Department of 
Veterans Affairs, to make certain improvements in the laws administered 
 by the Secretary of Veterans Affairs relating to the home loan program 
     of the Department of Veterans Affairs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
    (a) Short Title.--This Act may be cited as the ``John S. McCain 
III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal 
Systems and Strengthening Integrated Outside Networks Act of 2018'' or 
the ``VA MISSION Act of 2018''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

                    TITLE I--CARING FOR OUR VETERANS

Sec. 100. Short title; references to title 38, United States Code.

      Subtitle A--Developing an Integrated High-Performing Network

             Chapter 1--Establishing Community Care Programs

Sec. 101. Establishment of Veterans Community Care Program.
Sec. 102. Authorization of agreements between Department of Veterans 
          Affairs and non-Department providers.
Sec. 103. Conforming amendments for State veterans homes.
Sec. 104. Access standards and standards for quality.
Sec. 105. Access to walk-in care.
Sec. 106. Strategy regarding the Department of Veterans Affairs High-
          Performing Integrated Health Care Network.
Sec. 107. Applicability of Directive of Office of Federal Contract 
          Compliance Programs.
Sec. 108. Prevention of certain health care providers from providing 
          non-Department health care services to veterans.
Sec. 109. Remediation of medical service lines.

          Chapter 2--Paying Providers and Improving Collections

Sec. 111. Prompt payment to providers.
Sec. 112. Authority to pay for authorized care not subject to an 
          agreement.
Sec. 113. Improvement of authority to recover the cost of services 
          furnished for non-service-connected disabilities.
Sec. 114. Processing of claims for reimbursement through electronic 
          interface.

               Chapter 3--Education and Training Programs

Sec. 121. Education program on health care options.
Sec. 122. Training program for administration of non-Department of 
          Veterans Affairs health care.
Sec. 123. Continuing medical education for non-Department medical 
          professionals.

Chapter 4--Other Matters Relating to Non-Department of Veterans Affairs 
                                Providers

Sec. 131. Establishment of processes to ensure safe opioid prescribing 
          practices by non-Department of Veterans Affairs health care 
          providers.
Sec. 132. Improving information sharing with community providers.
Sec. 133. Competency standards for non-Department of Veterans Affairs 
          health care providers.
Sec. 134. Department of Veterans Affairs participation in national 
          network of State-based prescription drug monitoring programs.

           Chapter 5--Other Non-Department Health Care Matters

Sec. 141. Plans for Use of Supplemental Appropriations Required.
Sec. 142. Veterans Choice Fund flexibility.
Sec. 143. Sunset of Veterans Choice Program.
Sec. 144. Conforming amendments.

    Subtitle B--Improving Department of Veterans Affairs Health Care 
                                Delivery

Sec. 151. Licensure of health care professionals of the Department of 
          Veterans Affairs providing treatment via telemedicine.
Sec. 152. Authority for Department of Veterans Affairs Center for 
          Innovation for Care and Payment.
Sec. 153. Authorization to provide for operations on live donors for 
          purposes of conducting transplant procedures for veterans.

                      Subtitle C--Family Caregivers

Sec. 161. Expansion of family caregiver program of Department of 
          Veterans Affairs.
Sec. 162. Implementation of information technology system of Department 
          of Veterans Affairs to assess and improve the family caregiver 
          program.
Sec. 163. Modifications to annual evaluation report on caregiver program 
          of Department of Veterans Affairs.

              TITLE II--VA ASSET AND INFRASTRUCTURE REVIEW

               Subtitle A--Asset and Infrastructure Review

Sec. 201. Short title.
Sec. 202. The Commission.
Sec. 203. Procedure for making recommendations.
Sec. 204. Actions regarding infrastructure and facilities of the 
          Veterans Health Administration.
Sec. 205. Implementation.
Sec. 206. Department of Veterans Affairs Asset and Infrastructure Review 
          Account.
Sec. 207. Congressional consideration of Commission report.
Sec. 208. Other matters.
Sec. 209. Definitions.

                Subtitle B--Other Infrastructure Matters

Sec. 211. Improvement to training of construction personnel.
Sec. 212. Review of enhanced use leases.
Sec. 213. Assessment of health care furnished by the Department to 
          veterans who live in the Pacific territories.

   TITLE III--IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS

Sec. 301. Designated scholarships for physicians and dentists under 
          Department of Veterans Affairs Health Professional Scholarship 
          Program.
Sec. 302. Increase in maximum amount of debt that may be reduced under 
          Education Debt Reduction Program of Department of Veterans 
          Affairs.
Sec. 303. Establishing the Department of Veterans Affairs Specialty 
          Education Loan Repayment Program.
Sec. 304. Veterans healing veterans medical access and scholarship 
          program.
Sec. 305. Bonuses for recruitment, relocation, and retention.
Sec. 306. Inclusion of Vet Center employees in Education Debt Reduction 
          Program of Department of Veterans Affairs.

               TITLE IV--HEALTH CARE IN UNDERSERVED AREAS

Sec. 401. Development of criteria for designation of certain medical 
          facilities of the Department of Veterans Affairs as 
          underserved facilities and plan to address problem of 
          underserved facilities.
Sec. 402. Pilot program to furnish mobile deployment teams to 
          underserved facilities.
Sec. 403. Pilot program on graduate medical education and residency.

                         TITLE V--OTHER MATTERS

Sec. 501. Annual report on performance awards and bonuses awarded to 
          certain high-level employees of the department.
Sec. 502. Role of podiatrists in Department of Veterans Affairs.
Sec. 503. Definition of major medical facility project.
Sec. 504. Authorization of certain major medical facility projects of 
          the Department of Veterans Affairs.
Sec. 505. Department of Veterans Affairs personnel transparency.
Sec. 506. Program on establishment of peer specialists in patient 
          aligned care team settings within medical centers of 
          Department of Veterans Affairs.
Sec. 507. Department of Veterans Affairs medical scribe pilot program.
Sec. 508. Extension of requirement to collect fees for housing loans 
          guaranteed by Secretary of Veterans Affairs.
Sec. 509. Extension of reduction in amount of pension furnished by 
          Department of Veterans Affairs for certain veterans covered by 
          Medicaid plans for services furnished by nursing facilities.
Sec. 510. Appropriation of amounts.
Sec. 511. Technical correction.
Sec. 512. Budgetary effects.

                    TITLE I--CARING FOR OUR VETERANS

    SEC. 100. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES CODE.
    (a) Short Title.--This title may be cited as the ``Caring for Our 
Veterans Act of 2018''.
    (b) References to Title 38, United States Code.--Except as 
otherwise expressly provided, whenever in this title an amendment or 
repeal is expressed in terms of an amendment to, or repeal of, a 
section or other provision, the reference shall be considered to be 
made to a section or other provision of title 38, United States Code.

      Subtitle A--Developing an Integrated High-Performing Network

            CHAPTER 1--ESTABLISHING COMMUNITY CARE PROGRAMS

    SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY CARE PROGRAM.
    (a) Establishment of Program.--
        (1) In general.--Section 1703 is amended to read as follows:
``Sec. 1703. Veterans Community Care Program
    ``(a) In General.--(1) There is established a program to furnish 
hospital care, medical services, and extended care services to covered 
veterans through health care providers specified in subsection (c).
    ``(2) The Secretary shall coordinate the furnishing of hospital 
care, medical services, and extended care services under this section 
to covered veterans, including coordination of, at a minimum, the 
following:
        ``(A) Ensuring the scheduling of medical appointments in a 
    timely manner and the establishment of a mechanism to receive 
    medical records from non-Department providers.
        ``(B) Ensuring continuity of care and services.
        ``(C) Ensuring coordination among regional networks if the 
    covered veteran accesses care and services in a different network 
    than the regional network in which the covered veteran resides.
        ``(D) Ensuring that covered veterans do not experience a lapse 
    in care resulting from errors or delays by the Department or its 
    contractors or an unusual or excessive burden in accessing hospital 
    care, medical services, or extended care services.
    ``(3) A covered veteran may only receive care or services under 
this section upon the authorization of such care or services by the 
Secretary.
    ``(b) Covered Veterans.--For purposes of this section, a covered 
veteran is any veteran who--
        ``(1) is enrolled in the system of annual patient enrollment 
    established and operated under section 1705 of this title; or
        ``(2) is not enrolled in such system but is otherwise entitled 
    to hospital care, medical services, or extended care services under 
    subsection (c)(2) of such section.
    ``(c) Health Care Providers Specified.--Health care providers 
specified in this subsection are the following:
        ``(1) Any health care provider that is participating in the 
    Medicare program under title XVIII of the Social Security Act (42 
    U.S.C. 1395 et seq.), including any physician furnishing services 
    under such a program.
        ``(2) The Department of Defense.
        ``(3) The Indian Health Service.
        ``(4) Any Federally-qualified health center (as defined in 
    section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
    1396d(l)(2)(B))).
        ``(5) Any health care provider not otherwise covered under any 
    of paragraphs (1) through (4) that meets criteria established by 
    the Secretary for purposes of this section.
    ``(d) Conditions Under Which Care Is Required To Be Furnished 
Through Non-Department Providers.--(1) The Secretary shall, subject to 
the availability of appropriations, furnish hospital care, medical 
services, and extended care services to a covered veteran through 
health care providers specified in subsection (c) if--
        ``(A) the Department does not offer the care or services the 
    veteran requires;
        ``(B) the Department does not operate a full-service medical 
    facility in the State in which the covered veteran resides;
        ``(C)(i) the covered veteran was an eligible veteran under 
    section 101(b)(2)(B) of the Veterans Access, Choice, and 
    Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 
    note) as of the day before the date of the enactment of the Caring 
    for Our Veterans Act of 2018;
        ``(ii) continues to reside in a location that would qualify the 
    veteran for eligibility under such section; and
        ``(iii) either--
            ``(I) resides in one of the five States with the lowest 
        population density as determined by data from the 2010 
        decennial census; or
            ``(II) resides in a State not described in subclause (I) 
        and--
                ``(aa) received care or services under this title in 
            the year preceding the enactment of the Caring for Our 
            Veterans Act of 2018; and
                ``(bb) is seeking care or services within 2 years of 
            the date of the enactment of the Caring for Our Veterans 
            Act of 2018;
        ``(D) the covered veteran has contacted the Department to 
    request care or services and the Department is not able to furnish 
    such care or services in a manner that complies with designated 
    access standards developed by the Secretary under section 1703B of 
    this title; or
        ``(E) the covered veteran and the covered veteran's referring 
    clinician agree that furnishing care and services through a non-
    Department entity or provider would be in the best medical interest 
    of the covered veteran based upon criteria developed by the 
    Secretary.
    ``(2) The Secretary shall ensure that the criteria developed under 
paragraph (1)(E) include consideration of the following:
        ``(A) The distance between the covered veteran and the facility 
    that provides the hospital care, medical services, or extended care 
    services the veteran needs.
        ``(B) The nature of the hospital care, medical services, or 
    extended care services required.
        ``(C) The frequency that the hospital care, medical services, 
    or extended care services needs to be furnished.
        ``(D) The timeliness of available appointments for the hospital 
    care, medical services, or extended care services the veteran 
    needs.
        ``(E) Whether the covered veteran faces an unusual or excessive 
    burden to access hospital care, medical services, or extended care 
    services from the Department medical facility where a covered 
    veteran seeks hospital care, medical services, or extended care 
    services, which shall include consideration of the following:
            ``(i) Whether the covered veteran faces an excessive 
        driving distance, geographical challenge, or environmental 
        factor that impedes the access of the covered veteran.
            ``(ii) Whether the hospital care, medical services, or 
        extended care services sought by the veteran is provided by a 
        medical facility of the Department that is reasonably 
        accessible to a covered veteran.
            ``(iii) Whether a medical condition of the covered veteran 
        affects the ability of the covered veteran to travel.
            ``(iv) Whether there is compelling reason, as determined by 
        the Secretary, that the veteran needs to receive hospital care, 
        medical services, or extended care services from a medical 
        facility other than a medical facility of the Department.
            ``(v) Such other considerations as the Secretary considers 
        appropriate.
    ``(3) If the Secretary has determined that the Department does not 
offer the care or services the covered veteran requires under 
subparagraph (A) of paragraph (1), that the Department does not operate 
a full-service medical facility in the State in which the covered 
veteran resides under subparagraph (B) of such paragraph, that the 
covered veteran is described under subparagraph (C) of such paragraph, 
or that the Department is not able to furnish care or services in a 
manner that complies with designated access standards developed by the 
Secretary under section 1703B of this title under subparagraph (D) of 
such paragraph, the decision to receive hospital care, medical 
services, or extended care services under such subparagraphs from a 
health care provider specified in subsection (c) shall be at the 
election of the veteran.
    ``(e) Conditions Under Which Care Is Authorized To Be Furnished 
Through Non-Department Providers.--(1)(A) The Secretary may furnish 
hospital care, medical services, or extended care services through a 
health care provider specified in subsection (c) to a covered veteran 
served by a medical service line of the Department that the Secretary 
has determined is not providing care that complies with the standards 
for quality the Secretary shall establish under section 1703C.
    ``(B) In carrying out subparagraph (A), the Secretary shall--
        ``(i) measure timeliness of the medical service line at a 
    facility of the Department when compared with the same medical 
    service line at different Department facilities; and
        ``(ii) measure quality at a medical service line of a facility 
    of the Department by comparing it with two or more distinct and 
    appropriate quality measures at non-Department medical service 
    lines.
    ``(C)(i) The Secretary may not concurrently furnish hospital care, 
medical services, or extended care services under subparagraph (A) with 
respect to more than three medical service lines described in such 
subparagraph at any one health care facility of the Department.
    ``(ii) The Secretary may not concurrently furnish hospital care, 
medical services, or extended care services under subparagraph (A) with 
respect to more than 36 medical service lines nationally described in 
such subparagraph.
    ``(2) The Secretary may limit the types of hospital care, medical 
services, or extended care services covered veterans may receive under 
paragraph (1) in terms of the length of time such care and services 
will be available, the location at which such care and services will be 
available, and the clinical care and services that will be available.
    ``(3)(A) Except as provided for in subparagraph (B), the hospital 
care, medical services, and extended care services authorized under 
paragraph (1) with respect to a medical service line shall cease when 
the remediation described in section 1706A with respect to such medical 
service line is complete.
    ``(B) The Secretary shall ensure continuity and coordination of 
care for any veteran who elects to receive care or services under 
paragraph (1) from a health care provider specified in subsection (c) 
through the completion of an episode of care.
    ``(4) The Secretary shall publish in the Federal Register, and 
shall take all reasonable steps to provide direct notice to covered 
veterans affected under this subsection, at least once each year 
stating the time period during which such care and services will be 
available, the location or locations where such care and services will 
be available, and the clinical services available at each location 
under this subsection in accordance with regulations the Secretary 
shall prescribe.
    ``(5) When the Secretary exercises the authority under paragraph 
(1), the decision to receive care or services under such paragraph from 
a health care provider specified in subsection (c) shall be at the 
election of the covered veteran.
    ``(f) Review of Decisions.--The review of any decision under 
subsection (d) or (e) shall be subject to the Department's clinical 
appeals process, and such decisions may not be appealed to the Board of 
Veterans' Appeals.
    ``(g) Tiered Network.--(1) To promote the provision of high-quality 
and high-value hospital care, medical services, and extended care 
services under this section, the Secretary may develop a tiered 
provider network of eligible providers based on criteria established by 
the Secretary for purposes of this section.
    ``(2) In developing a tiered provider network of eligible providers 
under paragraph (1), the Secretary shall not prioritize providers in a 
tier over providers in any other tier in a manner that limits the 
choice of a covered veteran in selecting a health care provider 
specified in subsection (c) for receipt of hospital care, medical 
services, or extended care services under this section.
    ``(h) Contracts To Establish Networks of Health Care Providers.--
(1) The Secretary shall enter into consolidated, competitively bid 
contracts to establish networks of health care providers specified in 
paragraphs (1) and (5) of subsection (c) for purposes of providing 
sufficient access to hospital care, medical services, or extended care 
services under this section.
    ``(2)(A) The Secretary shall, to the extent practicable, ensure 
that covered veterans are able to make their own appointments using 
advanced technology.
    ``(B) To the extent practicable, the Secretary shall be responsible 
for the scheduling of appointments for hospital care, medical services, 
and extended care services under this section.
    ``(3)(A) The Secretary may terminate a contract with an entity 
entered into under paragraph (1) at such time and upon such notice to 
the entity as the Secretary may specify for purposes of this section, 
if the Secretary notifies the appropriate committees of Congress that, 
at a minimum--
        ``(i) the entity--
            ``(I) failed to comply substantially with the provisions of 
        the contract or with the provisions of this section and the 
        regulations prescribed under this section;
            ``(II) failed to comply with the access standards or the 
        standards for quality established by the Secretary;
            ``(III) is excluded from participation in a Federal health 
        care program (as defined in section 1128B(f) of the Social 
        Security Act (42 U.S.C. 1320a-7b(f))) under section 1128 or 
        1128A of the Social Security Act (42 U.S.C. 1320a-7 and 1320a-
        7a);
            ``(IV) is identified as an excluded source on the list 
        maintained in the System for Award Management, or any successor 
        system; or
            ``(V) has been convicted of a felony or other serious 
        offense under Federal or State law and the continued 
        participation of the entity would be detrimental to the best 
        interests of veterans or the Department;
        ``(ii) it is reasonable to terminate the contract based on the 
    health care needs of veterans; or
        ``(iii) it is reasonable to terminate the contract based on 
    coverage provided by contracts or sharing agreements entered into 
    under authorities other than this section.
    ``(B) Nothing in subparagraph (A) may be construed to restrict the 
authority of the Secretary to terminate a contract entered into under 
paragraph (1) under any other provision of law.
    ``(4) Whenever the Secretary provides notice to an entity that the 
entity is failing to meet contractual obligations entered into under 
paragraph (1), the Secretary shall submit to the Committee on Veterans' 
Affairs of the Senate and the Committee on Veterans' Affairs of the 
House of Representatives a report on such failure. Such report shall 
include the following:
        ``(A) An explanation of the reasons for providing such notice.
        ``(B) A description of the effect of such failure, including 
    with respect to cost, schedule, and requirements.
        ``(C) A description of the actions taken by the Secretary to 
    mitigate such failure.
        ``(D) A description of the actions taken by the contractor to 
    address such failure.
        ``(E) A description of any effect on the community provider 
    market for veterans in the affected area.
    ``(5)(A) The Secretary shall instruct each entity awarded a 
contract under paragraph (1) to recognize and accept, on an interim 
basis, the credentials and qualifications of health care providers who 
are authorized to furnish hospital care and medical services to 
veterans under a community care program of the Department in effect as 
of the day before the date of the enactment of the Caring for Our 
Veterans Act of 2018, including under the Patient-Centered Community 
Care Program and the Veterans Choice Program under section 101 of the 
Veterans Access, Choice, and Accountability Act of 2014 (Public Law 
113-146; 38 U.S.C. 1701 note), as qualified providers under the program 
established under this section.
    ``(B) The interim acceptance period under subparagraph (A) shall be 
determined by the Secretary based on the following criteria:
        ``(i) With respect to a health care provider, when the current 
    certification agreement for the health care provider expires.
        ``(ii) Whether the Department has enacted certification and 
    eligibility criteria and regulatory procedures by which non-
    Department providers will be authorized under this section.
    ``(6) The Secretary shall establish a system or systems for 
monitoring the quality of care provided to covered veterans through a 
network under this subsection and for assessing the quality of hospital 
care, medical services, and extended care services furnished through 
such network before the renewal of the contract for such network.
    ``(i) Payment Rates for Care and Services.--(1) Except as provided 
in paragraph (2), and to the extent practicable, the rate paid for 
hospital care, medical services, or extended care services under any 
provision in this title may not exceed the rate paid by the United 
States to a provider of services (as defined in section 1861(u) of the 
Social Security Act (42 U.S.C. 1395x(u))) or a supplier (as defined in 
section 1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare 
program under title XI or title XVIII of the Social Security Act (42 
U.S.C. 1301 et seq.), including section 1834 of such Act (42 U.S.C. 
1395m), for the same care or services.
    ``(2)(A) A higher rate than the rate paid by the United States as 
described in paragraph (1) may be negotiated with respect to the 
furnishing of care or services to a covered veteran who resides in a 
highly rural area.
    ``(B) In this paragraph, the term `highly rural area' means an area 
located in a county that has fewer than seven individuals residing in 
that county per square mile.
    ``(3) With respect to furnishing care or services under this 
section in Alaska, the Alaska Fee Schedule of the Department of 
Veterans Affairs shall be followed, except for when another payment 
agreement, including a contract or provider agreement, is in effect.
    ``(4) With respect to furnishing hospital care, medical services, 
or extended care services under this section in a State with an All-
Payer Model Agreement under section 1814(b)(3) of the Social Security 
Act (42 U.S.C. 1395f(b)(3)) that became effective on or after January 
1, 2014, the Medicare payment rates under paragraph (2)(A) shall be 
calculated based on the payment rates under such agreement.
    ``(5) Notwithstanding paragraph (1), the Secretary may incorporate, 
to the extent practicable, the use of value-based reimbursement models 
to promote the provision of high-quality care.
    ``(6) With respect to hospital care, medical services, or extended 
care services for which there is not a rate paid under the Medicare 
program as described in paragraph (1), the rate paid for such care or 
services shall be determined by the Secretary.
    ``(j) Treatment of Other Health Plan Contracts.--In any case in 
which a covered veteran is furnished hospital care, medical services, 
or extended care services under this section for a non-service-
connected disability described in subsection (a)(2) of section 1729 of 
this title, the Secretary shall recover or collect reasonable charges 
for such care or services from a health plan contract described in 
section 1729 in accordance with such section.
    ``(k) Payment by Veteran.--A covered veteran shall not pay a 
greater amount for receiving care or services under this section than 
the amount the veteran would pay for receiving the same or comparable 
care or services at a medical facility of the Department or from a 
health care provider of the Department.
    ``(l) Transplant Authority for Improved Access.--(1) In the case of 
a covered veteran described in paragraph (2), the Secretary shall 
determine whether to authorize an organ or bone marrow transplant for 
that covered veteran at a non-Department facility.
    ``(2) A covered veteran described in this paragraph--
        ``(A) requires an organ or bone marrow transplant; and
        ``(B) has, in the opinion of the primary care provider of the 
    veteran, a medically compelling reason to travel outside the region 
    of the Organ Procurement and Transplantation Network, established 
    under section 372 of the National Organ Transplantation Act (Public 
    Law 98-507; 42 U.S.C. 274), in which the veteran resides, to 
    receive such transplant.
    ``(m) Monitoring of Care Provided.--(1)(A) Not later than 540 days 
after the date of the enactment of the Caring for Our Veterans Act of 
2018, and not less frequently than annually thereafter, the Secretary 
shall submit to appropriate committees of Congress a review of the 
types and frequency of care sought under subsection (d).
    ``(B) The review submitted under subparagraph (A) shall include an 
assessment of the following:
        ``(i) The top 25 percent of types of care and services most 
    frequently provided under subsection (d) due to the Department not 
    offering such care and services.
        ``(ii) The frequency such care and services were sought by 
    covered veterans under this section.
        ``(iii) An analysis of the reasons the Department was unable to 
    provide such care and services.
        ``(iv) Any steps the Department took to provide such care and 
    services at a medical facility of the Department.
        ``(v) The cost of such care and services.
    ``(2) In monitoring the hospital care, medical services, and 
extended care services furnished under this section, the Secretary 
shall do the following:
        ``(A) With respect to hospital care, medical services, and 
    extended care services furnished through provider networks 
    established under subsection (i)--
            ``(i) compile data on the types of hospital care, medical 
        services, and extended care services furnished through such 
        networks and how many patients used each type of care and 
        service;
            ``(ii) identify gaps in hospital care, medical services, or 
        extended care services furnished through such networks;
            ``(iii) identify how such gaps may be fixed through new 
        contracts within such networks or changes in the manner in 
        which hospital care, medical services, or extended care 
        services are furnished through such networks;
            ``(iv) assess the total amounts spent by the Department on 
        hospital care, medical services, and extended care services 
        furnished through such networks;
            ``(v) assess the timeliness of the Department in referring 
        hospital care, medical services, and extended care services to 
        such networks; and
            ``(vi) assess the timeliness of such networks in--
                ``(I) accepting referrals; and
                ``(II) scheduling and completing appointments.
        ``(B) Report the number of medical service lines the Secretary 
    has determined under subsection (e)(1) not to be providing hospital 
    care, medical services, or extended care services that comply with 
    the standards for quality established by the Secretary.
        ``(C) Assess the use of academic affiliates and centers of 
    excellence of the Department to furnish hospital care, medical 
    services, and extended care services to covered veterans under this 
    section.
        ``(D) Assess the hospital care, medical services, and extended 
    care services furnished to covered veterans under this section by 
    medical facilities operated by Federal agencies other than the 
    Department.
    ``(3) Not later than 540 days after the date of the enactment of 
the Caring for Our Veterans Act of 2018 and not less frequently than 
once each year thereafter, the Secretary shall submit to the Committee 
on Veterans' Affairs of the Senate and the Committee on Veterans' 
Affairs of the House of Representatives a report on the information 
gathered under paragraph (2).
    ``(n) Prohibition on Certain Limitations.--(1) The Secretary shall 
not limit the types of hospital care, medical services, or extended 
care services covered veterans may receive under this section if it is 
in the best medical interest of the veteran to receive such hospital 
care, medical services, or extended care services, as determined by the 
veteran and the veteran's health care provider.
    ``(2) No provision in this section may be construed to alter or 
modify any other provision of law establishing specific eligibility 
criteria for certain hospital care, medical services, or extended care 
services.
    ``(o) Definitions.--In this section:
        ``(1) The term `appropriate committees of Congress' means--
            ``(A) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the Senate; and
            ``(B) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the House of Representatives.
        ``(2) The term `medical service line' means a clinic within a 
    Department medical center.''.
        (2) Clerical amendment.--The table of sections at the beginning 
    of chapter 17 is amended by striking the item relating to section 
    1703 and inserting the following new item:

``1703. Veterans Community Care Program.''.

    (b) Effective Date.--Section 1703 of title 38, United States Code, 
as amended by subsection (a), shall take effect on the later of--
        (1) the date that is 30 days after the date on which the 
    Secretary of Veterans Affairs submits the report required under 
    section 101(q)(2) of the Veterans Access, Choice, and 
    Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 
    note); or
        (2) the date on which the Secretary promulgates regulations 
    pursuant to subsection (c).
    (c) Regulations.--
        (1) In general.--Not later than 1 year after the date of the 
    enactment of this Act, the Secretary of Veterans Affairs shall 
    promulgate regulations to carry out section 1703 of title 38, 
    United States Code, as amended by subsection (a) of this section.
        (2) Updates.--
            (A) Periodic.--Before promulgating the regulations required 
        under paragraph (1), the Secretary shall provide to the 
        appropriate committees of Congress periodic updates to confirm 
        the progress of the Secretary toward developing such 
        regulations.
            (B) First update.--The first update under subparagraph (A) 
        shall occur no later than 120 days from the date of the 
        enactment of this Act.
            (C) Appropriate committees of congress defined.--In this 
        paragraph, the term ``appropriate committees of Congress'' 
        means--
                (i) the Committee on Veterans' Affairs and the 
            Committee on Appropriations of the Senate; and
                (ii) the Committee on Veterans' Affairs and the 
            Committee on Appropriations of the House of 
            Representatives.
    (d) Continuity of Existing Agreements.--
        (1) In general.--Notwithstanding section 1703 of title 38, 
    United States Code, as amended by subsection (a), the Secretary of 
    Veterans Affairs shall continue all contracts, memorandums of 
    understanding, memorandums of agreements, and other arrangements 
    that were in effect on the day before the date of the enactment of 
    this Act between the Department of Veterans Affairs and the 
    American Indian and Alaska Native health care systems as 
    established under the terms of the Department of Veterans Affairs 
    and Indian Health Service Memorandum of Understanding, signed 
    October 1, 2010, the National Reimbursement Agreement, signed 
    December 5, 2012, arrangements under section 405 of the Indian 
    Health Care Improvement Act (25 U.S.C. 1645), and agreements 
    entered into under sections 102 and 103 of the Veterans Access, 
    Choice, and Accountability Act of 2014 (Public Law 113-146).
        (2) Modifications.--Paragraph (1) shall not be construed to 
    prohibit the Secretary and the parties to the contracts, 
    memorandums of understanding, memorandums of agreements, and other 
    arrangements described in such paragraph from making such changes 
    to such contracts, memorandums of understanding, memorandums of 
    agreements, and other arrangements as may be otherwise authorized 
    pursuant to other provisions of law or the terms of the contracts, 
    memorandums of understanding, memorandums of agreements, and other 
    arrangements.
    SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DEPARTMENT OF 
      VETERANS AFFAIRS AND NON-DEPARTMENT PROVIDERS.
    (a) In General.--Subchapter I of chapter 17 is amended by inserting 
after section 1703 the following new section:
``Sec. 1703A. Agreements with eligible entities or providers; 
     certification processes
    ``(a) Agreements Authorized.--(1)(A) When hospital care, a medical 
service, or an extended care service required by a veteran who is 
entitled to such care or service under this chapter is not feasibly 
available to the veteran from a facility of the Department or through a 
contract or sharing agreement entered into pursuant to another 
provision of law, the Secretary may furnish such care or service to 
such veteran through an agreement under this section with an eligible 
entity or provider to provide such hospital care, medical service, or 
extended care service.
    ``(B) An agreement entered into under this section to provide 
hospital care, a medical service, or an extended care service shall be 
known as a `Veterans Care Agreement'.
    ``(C) For purposes of subparagraph (A), hospital care, a medical 
service, or an extended care service may be considered not feasibly 
available to a veteran from a facility of the Department or through a 
contract or sharing agreement described in such subparagraph when the 
Secretary determines the veteran's medical condition, the travel 
involved, the nature of the care or services required, or a combination 
of these factors make the use of a facility of the Department or a 
contract or sharing agreement described in such subparagraph 
impracticable or inadvisable.
    ``(D) A Veterans Care Agreement may be entered into by the 
Secretary or any Department official authorized by the Secretary.
    ``(2)(A) Subject to subparagraph (B), the Secretary shall review 
each Veterans Care Agreement of material size, as determined by the 
Secretary or set forth in paragraph (3), for hospital care, a medical 
service, or an extended care service to determine whether it is 
feasible and advisable to provide such care or service within a 
facility of the Department or by contract or sharing agreement entered 
into pursuant to another provision of law and, if so, take action to do 
so.
    ``(B)(i) The Secretary shall review each Veterans Care Agreement of 
material size that has been in effect for at least 6 months within the 
first 2 years of its taking effect, and not less frequently than once 
every 4 years thereafter.
    ``(ii) If a Veterans Care Agreement has not been in effect for at 
least 6 months by the date of the review required by subparagraph (A), 
the agreement shall be reviewed during the next cycle required by 
subparagraph (A), and such review shall serve as its review within the 
first 2 years of its taking effect for purposes of clause (i).
    ``(3)(A) In fiscal year 2019 and in each fiscal year thereafter, in 
addition to such other Veterans Care Agreements as the Secretary may 
determine are of material size, a Veterans Care Agreement for the 
purchase of extended care services that exceeds $5,000,000 annually 
shall be considered of material size.
    ``(B) From time to time, the Secretary may publish a notice in the 
Federal Register to adjust the dollar amount specified in subparagraph 
(A) to account for changes in the cost of health care based upon 
recognized health care market surveys and other available data.
    ``(b) Eligible Entities and Providers.--For purposes of this 
section, an eligible entity or provider is--
        ``(1) any provider of services that has enrolled and entered 
    into a provider agreement under section 1866(a) of the Social 
    Security Act (42 U.S.C. 1395cc(a)) and any physician or other 
    supplier who has enrolled and entered into a participation 
    agreement under section 1842(h) of such Act (42 U.S.C. 1395u(h));
        ``(2) any provider participating under a State plan under title 
    XIX of such Act (42 U.S.C. 1396 et seq.);
        ``(3) an Aging and Disability Resource Center, an area agency 
    on aging, or a State agency (as defined in section 102 of the Older 
    Americans Act of 1965 (42 U.S.C. 3002));
        ``(4) a center for independent living (as defined in section 
    702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)); or
        ``(5) any entity or provider not described in paragraph (1) or 
    (2) of this subsection that the Secretary determines to be eligible 
    pursuant to the certification process described in subsection (c).
    ``(c) Eligible Entity or Provider Certification Process.--The 
Secretary shall establish by regulation a process for the certification 
of eligible entities or providers or recertification of eligible 
entities or providers under this section. Such a process shall, at a 
minimum--
        ``(1) establish deadlines for actions on applications for 
    certification;
        ``(2) set forth standards for an approval or denial of 
    certification, duration of certification, revocation of an eligible 
    entity or provider's certification, and recertification of eligible 
    entities or providers;
        ``(3) require the denial of certification if the Secretary 
    determines the eligible entity or provider is excluded from 
    participation in a Federal health care program under section 1128 
    or section 1128A of the Social Security Act (42 U.S.C. 1320a-7 or 
    1320a-7a) or is currently identified as an excluded source on the 
    System for Award Management Exclusions list described in part 9 of 
    title 48, Code of Federal Regulations, and part 180 of title 2 of 
    such Code, or successor regulations;
        ``(4) establish procedures for screening eligible entities or 
    providers according to the risk of fraud, waste, and abuse that are 
    similar to the standards under section 1866(j)(2)(B) of the Social 
    Security Act (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 of title 
    48, Code of Federal Regulations, or successor regulations; and
        ``(5) incorporate and apply the restrictions and penalties set 
    forth in chapter 21 of title 41 and treat this section as a 
    procurement program only for purposes of applying such provisions.
    ``(d) Rates.--To the extent practicable, the rates paid by the 
Secretary for hospital care, medical services, and extended care 
services provided under a Veterans Care Agreement shall be in 
accordance with the rates paid by the United States under section 
1703(i) of this title.
    ``(e) Terms of Veterans Care Agreements.--(1) Pursuant to 
regulations promulgated under subsection (k), the Secretary may define 
the requirements for providers and entities entering into agreements 
under this section based upon such factors as the number of patients 
receiving care or services, the number of employees employed by the 
entity or provider furnishing such care or services, the amount paid by 
the Secretary to the provider or entity, or other factors as determined 
by the Secretary.
    ``(2) To furnish hospital care, medical services, or extended care 
services under this section, an eligible entity or provider shall 
agree--
        ``(A) to accept payment at the rates established in regulations 
    prescribed under this section;
        ``(B) that payment by the Secretary under this section on 
    behalf of a veteran to a provider of services or care shall, unless 
    rejected and refunded by the provider within 30 days of receipt, 
    constitute payment in full and extinguish any liability on the part 
    of the veteran for the treatment or care provided, and no provision 
    of a contract, agreement, or assignment to the contrary shall 
    operate to modify, limit, or negate this requirement;
        ``(C) to provide only the care and services authorized by the 
    Department under this section and to obtain the prior written 
    consent of the Department to furnish care or services outside the 
    scope of such authorization;
        ``(D) to bill the Department in accordance with the methodology 
    outlined in regulations prescribed under this section;
        ``(E) to not seek to recover or collect from a health plan 
    contract or third party, as those terms are defined in section 1729 
    of this title, for any care or service that is furnished or paid 
    for by the Department;
        ``(F) to provide medical records to the Department in the time 
    frame and format specified by the Department; and
        ``(G) to meet such other terms and conditions, including 
    quality of care assurance standards, as the Secretary may specify 
    in regulation.
    ``(f) Discontinuation or Nonrenewal of a Veterans Care Agreement.--
(1) An eligible entity or provider may discontinue a Veterans Care 
Agreement at such time and upon such notice to the Secretary as may be 
provided in regulations prescribed under this section.
    ``(2) The Secretary may discontinue a Veterans Care Agreement with 
an eligible entity or provider at such time and upon such reasonable 
notice to the eligible entity or provider as may be specified in 
regulations prescribed under this section, if an official designated by 
the Secretary--
        ``(A) has determined that the eligible entity or provider 
    failed to comply substantially with the provisions of the Veterans 
    Care Agreement, or with the provisions of this section or 
    regulations prescribed under this section;
        ``(B) has determined the eligible entity or provider is 
    excluded from participation in a Federal health care program under 
    section 1128 or section 1128A of the Social Security Act (42 U.S.C. 
    1320a-7 or 1320a-7a) or is identified on the System for Award 
    Management Exclusions list as provided in part 9 of title 48, Code 
    of Federal Regulations, and part 180 of title 2 of such Code, or 
    successor regulations;
        ``(C) has ascertained that the eligible entity or provider has 
    been convicted of a felony or other serious offense under Federal 
    or State law and determines the eligible entity or provider's 
    continued participation would be detrimental to the best interests 
    of veterans or the Department; or
        ``(D) has determined that it is reasonable to terminate the 
    agreement based on the health care needs of a veteran.
    ``(g) Quality of Care.--The Secretary shall establish a system or 
systems for monitoring the quality of care provided to veterans through 
Veterans Care Agreements and for assessing the quality of hospital 
care, medical services, and extended care services furnished by 
eligible entities and providers before the renewal of Veterans Care 
Agreements.
    ``(h) Disputes.--(1) The Secretary shall promulgate administrative 
procedures for eligible entities and providers to present all disputes 
arising under or related to Veterans Care Agreements.
    ``(2) Such procedures constitute the eligible entities' and 
providers' exhaustive and exclusive administrative remedies.
    ``(3) Eligible entities or providers must first exhaust such 
administrative procedures before seeking any judicial review under 
section 1346 of title 28 (known as the `Tucker Act').
    ``(4) Disputes under this section must pertain to either the scope 
of authorization under the Veterans Care Agreement or claims for 
payment subject to the Veterans Care Agreement and are not claims for 
the purposes of such laws that would otherwise require application of 
sections 7101 through 7109 of title 41, United States Code.
    ``(i) Applicability of Other Provisions of Law.--(1) A Veterans 
Care Agreement may be authorized by the Secretary or any Department 
official authorized by the Secretary, and such action shall not be 
treated as--
        ``(A) an award for the purposes of such laws that would 
    otherwise require the use of competitive procedures for the 
    furnishing of care and services; or
        ``(B) a Federal contract for the acquisition of goods or 
    services for purposes of any provision of Federal law governing 
    Federal contracts for the acquisition of goods or services except 
    section 4706(d) of title 41.
    ``(2)(A) Except as provided in the agreement itself, in 
subparagraph (B), and unless otherwise provided in this section or 
regulations prescribed pursuant to this section, an eligible entity or 
provider that enters into an agreement under this section is not 
subject to, in the carrying out of the agreement, any law to which 
providers of services and suppliers under the Medicare program under 
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not 
subject.
    ``(B) An eligible entity or provider that enters into an agreement 
under this section is subject to--
        ``(i) all laws regarding integrity, ethics, or fraud, or that 
    subject a person to civil or criminal penalties; and
        ``(ii) all laws that protect against employment discrimination 
    or that otherwise ensure equal employment opportunities.
    ``(3) Notwithstanding paragraph (2)(B)(i), an eligible entity or 
provider that enters into an agreement under this section shall not be 
treated as a Federal contractor or subcontractor for purposes of 
chapter 67 of title 41 (commonly known as the `McNamara-O'Hara Service 
Contract Act of 1965').
    ``(j) Parity of Treatment.--Eligibility for hospital care, medical 
services, and extended care services furnished to any veteran pursuant 
to a Veterans Care Agreement shall be subject to the same terms as 
though provided in a facility of the Department, and provisions of this 
chapter applicable to veterans receiving such care and services in a 
facility of the Department shall apply to veterans treated under this 
section.
    ``(k) Rulemaking.--The Secretary shall promulgate regulations to 
carry out this section.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1703 the following new item:

``1703A. Agreements with eligible entities or providers; certification 
          processes.''.
    SEC. 103. CONFORMING AMENDMENTS FOR STATE VETERANS HOMES.
    (a) In General.--Section 1745(a) is amended--
        (1) in paragraph (1), by striking ``(or agreement under section 
    1720(c)(1) of this title)'' and inserting ``(or an agreement)''; 
    and
        (2) by adding at the end the following new paragraph:
    ``(4)(A) An agreement under this section may be authorized by the 
Secretary or any Department official authorized by the Secretary, and 
any such action is not an award for purposes of such laws that would 
otherwise require the use of competitive procedures for the furnishing 
of hospital care, medical services, and extended care services.
    ``(B)(i) Except as provided in the agreement itself, in clause 
(ii), and unless otherwise provided in this section or regulations 
prescribed pursuant to this section, a State home that enters into an 
agreement under this section is not subject to, in the carrying out of 
the agreement, any provision of law to which providers of services and 
suppliers under the Medicare program under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.) are not subject.
    ``(ii) A State home that enters into an agreement under this 
section is subject to--
        ``(I) all provisions of law regarding integrity, ethics, or 
    fraud, or that subject a person to civil or criminal penalties;
        ``(II) all provisions of law that protect against employment 
    discrimination or that otherwise ensure equal employment 
    opportunities; and
        ``(III) all provisions in subchapter V of chapter 17 of this 
    title.
    ``(iii) Notwithstanding subparagraph (B)(ii)(I), a State home that 
enters into an agreement under this section may not be treated as a 
Federal contractor or subcontractor for purposes of chapter 67 of title 
41 (known as the `McNamara-O'Hara Service Contract Act of 1965').''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to care provided on or after the effective date of regulations 
issued by the Secretary of Veterans Affairs to carry out this section.
    SEC. 104. ACCESS STANDARDS AND STANDARDS FOR QUALITY.
    (a) In General.--Subchapter I of chapter 17, as amended by section 
102, is further amended by inserting after section 1703A the following 
new sections:
``Sec. 1703B. Access standards
    ``(a)(1) The Secretary shall establish access standards for 
furnishing hospital care, medical services, or extended care services 
to covered veterans for the purposes of section 1703(d).
    ``(2) The Secretary shall ensure that the access standards 
established under paragraph (1) define such categories of care to cover 
all care and services within the medical benefits package of the 
Department of Veterans Affairs.
    ``(b) The Secretary shall ensure that the access standards provide 
covered veterans, employees of the Department, and health care 
providers in the network established under section 1703(h) with 
relevant comparative information that is clear, useful, and timely, so 
that covered veterans can make informed decisions regarding their 
health care.
    ``(c) The Secretary shall consult with all pertinent Federal 
entities (including the Department of Defense, the Department of Health 
and Human Services, and the Centers for Medicare & Medicaid Services), 
entities in the private sector, and other nongovernmental entities in 
establishing access standards.
    ``(d)(1) Not later than 270 days after the date of the enactment of 
the Caring for Our Veterans Act of 2018, the Secretary shall submit to 
the appropriate committees of Congress a report detailing the access 
standards.
    ``(2)(A) Before submitting the report required under paragraph (1), 
the Secretary shall provide periodic updates to the appropriate 
committees of Congress to confirm the Department's progress towards 
developing the access standards required by this section.
    ``(B) The first update under subparagraph (A) shall occur no later 
than 120 days from the date of the enactment of the Caring for Our 
Veterans Act of 2018.
    ``(3) Not later than 540 days after the date on which the Secretary 
implements the access standards established under subsection (a), the 
Secretary shall submit to the appropriate committees of Congress a 
report detailing the implementation of and compliance with such access 
standards by Department and non-Department entities or providers.
    ``(e) Not later than 3 years after the date on which the Secretary 
establishes access standards under subsection (a) and not less 
frequently than once every 3 years thereafter, the Secretary shall--
        ``(1) conduct a review of such standards; and
        ``(2) submit to the appropriate committees of Congress a report 
    on the findings and any modification to the access standards with 
    respect to the review conducted under paragraph (1).
    ``(f) The Secretary shall ensure health care providers specified 
under section 1703(c) are able to comply with the applicable access 
standards established by the Secretary.
    ``(g) The Secretary shall publish in the Federal Register and on an 
internet website of the Department the designated access standards 
established under this section for purposes of section 1703(d)(1)(D).
    ``(h)(1) Consistent with paragraphs (1)(D) and (3) of section 
1703(d), covered veterans may contact the Department at any time to 
request a determination regarding whether they are eligible to receive 
care and services from a non-Department entity or provider based on the 
Department being unable to furnish such care and services in a manner 
that complies with the designated access standards established under 
this section.
    ``(2) The Secretary shall establish a process to review such 
requests from covered veterans to determine whether--
        ``(A) the requested care is clinically necessary; and
        ``(B) the Department is able to provide such care in a manner 
    that complies with designated access standards established under 
    this section.
    ``(3) The Secretary shall promptly respond to any such request by a 
covered veteran.
    ``(i)(1) The term `appropriate committees of Congress' means--
        ``(A) the Committee on Veterans' Affairs and the Committee on 
    Appropriations of the Senate; and
        ``(B) the Committee on Veterans' Affairs and the Committee on 
    Appropriations of the House of Representatives.
    ``(2) The term `covered veterans' refers to veterans described in 
section 1703(b) of this title.
``Sec. 1703C. Standards for quality
    ``(a) In General.--(1) The Secretary shall establish standards for 
quality regarding hospital care, medical services, and extended care 
services furnished by the Department pursuant to this title, including 
through non-Department health care providers pursuant to section 1703 
of this title.
    ``(2) In establishing standards for quality under paragraph (1), 
the Secretary shall consider existing health quality measures that are 
applied to public and privately sponsored health care systems with the 
purpose of providing covered veterans relevant comparative information 
to make informed decisions regarding their health care.
    ``(3) The Secretary shall collect and consider data for purposes of 
establishing the standards under paragraph (1). Such data collection 
shall include--
        ``(A) after consultation with veterans service organizations 
    and other key stakeholders on survey development or modification of 
    an existing survey, a survey of veterans who have used hospital 
    care, medical services, or extended care services furnished by the 
    Veterans Health Administration during the most recent 2-year period 
    to assess the satisfaction of the veterans with service and quality 
    of care; and
        ``(B) datasets that include, at a minimum, elements relating to 
    the following:
            ``(i) Timely care.
            ``(ii) Effective care.
            ``(iii) Safety, including, at a minimum, complications, 
        readmissions, and deaths.
            ``(iv) Efficiency.
    ``(4) The Secretary shall consult with all pertinent Federal 
entities (including the Department of Defense, the Department of Health 
and Human Services, and the Centers for Medicare & Medicaid Services), 
entities in the private sector, and other nongovernmental entities in 
establishing standards for quality.
    ``(5)(A) Not later than 270 days after the date of the enactment of 
the Caring for Our Veterans Act of 2018, the Secretary shall submit to 
the appropriate committees of Congress a report detailing the standards 
for quality.
    ``(B)(i) Before submitting the report required under subparagraph 
(A), the Secretary shall provide periodic updates to the appropriate 
committees of Congress to confirm the Department's progress towards 
developing the standards for quality required by this section.
    ``(ii) The first update under clause (i) shall occur no later than 
120 days from the date of the enactment of the Caring for Our Veterans 
Act of 2018.
    ``(b) Publication and Consideration of Public Comments.--(1) Not 
later than 1 year after the date on which the Secretary establishes 
standards for quality under subsection (a), the Secretary shall publish 
the quality rating of medical facilities of the Department in the 
publicly available Hospital Compare website through the Centers for 
Medicare & Medicaid Services for the purpose of providing veterans with 
information that allows them to compare performance measure information 
among Department and non-Department health care providers.
    ``(2) Not later than 2 years after the date on which the Secretary 
establishes standards for quality under subsection (a), the Secretary 
shall consider and solicit public comment on potential changes to the 
measures used in such standards to ensure that they include the most 
up-to-date and applicable industry measures for veterans.
    ``(c)(1) The term `appropriate committees of Congress' means--
        ``(A) the Committee on Veterans' Affairs and the Committee on 
    Appropriations of the Senate; and
        ``(B) the Committee on Veterans' Affairs and the Committee on 
    Appropriations of the House of Representatives.
    ``(2) The term `covered veterans' refers to veterans described in 
section 1703(b) of this title.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17, as amended by section 102, is further amended by inserting 
after the item relating to section 1703A the following new items:

``1703B. Access standards.
``1703C. Standards for quality.''.
    SEC. 105. ACCESS TO WALK-IN CARE.
    (a) In General.--Chapter 17 is amended by inserting after section 
1725 the following new section:
``Sec. 1725A. Access to walk-in care
    ``(a) Procedures To Ensure Access to Walk-In Care.--The Secretary 
shall develop procedures to ensure that eligible veterans are able to 
access walk-in care from qualifying non-Department entities or 
providers.
    ``(b) Eligible Veterans.--For purposes of this section, an eligible 
veteran is any individual who--
        ``(1) is enrolled in the health care system established under 
    section 1705(a) of this title; and
        ``(2) has received care under this chapter within the 24-month 
    period preceding the furnishing of walk-in care under this section.
    ``(c) Qualifying Non-Department Entities or Providers.--For 
purposes of this section, a qualifying non-Department entity or 
provider is a non-Department entity or provider that has entered into a 
contract or other agreement with the Secretary to furnish services 
under this section.
    ``(d) Federally-Qualified Health Centers.--Whenever practicable, 
the Secretary may use a Federally-qualified health center (as defined 
in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
1396d(l)(2)(B))) to carry out this section.
    ``(e) Continuity of Care.--The Secretary shall ensure continuity of 
care for those eligible veterans who receive walk-in care services 
under this section, including through the establishment of a mechanism 
to receive medical records from walk-in care providers and provide 
pertinent patient medical records to providers of walk-in care.
    ``(f) Copayments.--(1)(A) The Secretary may require an eligible 
veteran to pay the United States a copayment for each episode of 
hospital care or medical services provided under this section if the 
eligible veteran would be required to pay a copayment under this title.
    ``(B) An eligible veteran not required to pay a copayment under 
this title may access walk-in care without a copayment for the first 
two visits in a calendar year. For any additional visits, a copayment 
at an amount determined by the Secretary may be required.
    ``(C) An eligible veteran required to pay a copayment under this 
title may be required to pay a regular copayment for the first two 
walk-in care visits in a calendar year. For any additional visits, a 
higher copayment at an amount determined by the Secretary may be 
required.
    ``(2) After the first two episodes of care furnished to an eligible 
veteran under this section, the Secretary may adjust the copayment 
required of the veteran under this subsection based upon the priority 
group of enrollment of the eligible veteran, the number of episodes of 
care furnished to the eligible veteran during a year, and other factors 
the Secretary considers appropriate under this section.
    ``(3) The amount or amounts of the copayments required under this 
subsection shall be prescribed by the Secretary by rule.
    ``(4) Section 8153(c) of this title shall not apply to this 
subsection.
    ``(g) Regulations.--Not later than 1 year after the date of the 
enactment of the Caring for Our Veterans Act of 2018, the Secretary 
shall promulgate regulations to carry out this section.
    ``(h) Walk-In Care Defined.--In this section, the term `walk-in 
care' means non-emergent care provided by a qualifying non-Department 
entity or provider that furnishes episodic care and not longitudinal 
management of conditions and is otherwise defined through regulations 
the Secretary shall promulgate.''.
    (b) Effective Date.--Section 1725A of title 38, United States Code, 
as added by subsection (a) shall take effect on the date upon which 
final regulations implementing such section take effect.
    (c) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1725 the following new item:

``1725A. Access to walk-in care.''.
    SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF VETERANS AFFAIRS 
      HIGH-PERFORMING INTEGRATED HEALTH CARE NETWORK.
    (a) In General.--Subchapter II of chapter 73 is amended by 
inserting after section 7330B the following new section:
``Sec. 7330C. Quadrennial Veterans Health Administration review
    ``(a) Market Area Assessments.--(1) Not less frequently than every 
4 years, the Secretary of Veterans Affairs shall perform market area 
assessments regarding the health care services furnished under the laws 
administered by the Secretary.
    ``(2) Each market area assessment established under paragraph (1) 
shall include the following:
        ``(A) An assessment of the demand for health care from the 
    Department, disaggregated by geographic market areas as determined 
    by the Secretary, including the number of requests for health care 
    services under the laws administered by the Secretary.
        ``(B) An inventory of the health care capacity of the 
    Department of Veterans Affairs across the Department's system of 
    facilities.
        ``(C) An assessment of the health care capacity to be provided 
    through contracted community care providers and providers who 
    entered into a provider agreement with the Department under section 
    1703A of title 38, as added by section 102, including the number of 
    providers, the geographic location of the providers, and categories 
    or types of health care services provided by the providers.
        ``(D) An assessment obtained from other Federal direct delivery 
    systems of their capacity to provide health care to veterans.
        ``(E) An assessment of the health care capacity of non-
    contracted providers where there is insufficient network supply.
        ``(F) An assessment of the health care capacity of academic 
    affiliates and other collaborations of the Department as it relates 
    to providing health care to veterans.
        ``(G) An assessment of the effects on health care capacity of 
    the access standards and standards for quality established under 
    sections 1703B and 1703C of this title.
        ``(H) The number of appointments for health care services under 
    the laws administered by the Secretary, disaggregated by--
            ``(i) appointments at facilities of the Department of 
        Veterans Affairs; and
            ``(ii) appointments with non-Department health care 
        providers.
    ``(3)(A) The Secretary shall submit to the appropriate committees 
of Congress the market area assessments established in paragraph (1).
    ``(B) The Secretary also shall submit to the appropriate committees 
of Congress the market area assessments completed by or being performed 
on the day before the date of the enactment of the Caring for Our 
Veterans Act of 2018.
    ``(4)(A) The Secretary shall use the market area assessments 
established under paragraph (1) to--
        ``(i) determine the capacity of the health care provider 
    networks established under section 1703(h) of this title;
        ``(ii) inform the Department budget, in accordance with 
    subparagraph (B); and
        ``(iii) inform and assess the appropriateness of the access 
    standards established under section 1703B of this title and 
    standards for quality under section 1703C and to make 
    recommendations for any changes to such standards.
    ``(B) The Secretary shall ensure that the Department budget for any 
fiscal year (as submitted with the budget of the President under 
section 1105(a) of title 31) reflects the findings of the Secretary 
with respect to the most recent market area assessments under paragraph 
(1) and health care utilization data from the Department and non-
Department entities or providers furnishing care and services to 
covered veterans as described in section 1703(b).
    ``(b) Strategic Plan To Meet Health Care Demand.--(1) Not later 
than 1 year after the date of the enactment of the Caring for Our 
Veterans Act of 2018 and not less frequently than once every 4 years 
thereafter, the Secretary shall submit to the appropriate committees of 
Congress a strategic plan that specifies a 4-year forecast of--
        ``(A) the demand for health care from the Department, 
    disaggregated by geographic area as determined by the Secretary;
        ``(B) the health care capacity to be provided at each medical 
    center of the Department; and
        ``(C) the health care capacity to be provided through community 
    care providers.
    ``(2) In preparing the strategic plan under paragraph (1), the 
Secretary shall--
        ``(A) assess the access standards and standards for quality 
    established under sections 1703B and 1703C of this title;
        ``(B) assess the market area assessments established under 
    subsection (a);
        ``(C) assess the needs of the Department based on identified 
    services that provide management of conditions or disorders related 
    to military service for which there is limited experience or access 
    in the national market, the overall health of veterans throughout 
    their lifespan, or other services as the Secretary determines 
    appropriate;
        ``(D) consult with key stakeholders within the Department, the 
    heads of other Federal agencies, and other relevant governmental 
    and nongovernmental entities, including State, local, and tribal 
    government officials, members of Congress, veterans service 
    organizations, private sector representatives, academics, and other 
    policy experts;
        ``(E) identify emerging issues, trends, problems, and 
    opportunities that could affect health care services furnished 
    under the laws administered by the Secretary;
        ``(F) develop recommendations regarding both short- and long-
    term priorities for health care services furnished under the laws 
    administered by the Secretary;
        ``(G) after consultation with veterans service organizations 
    and other key stakeholders on survey development or modification of 
    an existing survey, consider a survey of veterans who have used 
    hospital care, medical services, or extended care services 
    furnished by the Veterans Health Administration during the most 
    recent 2-year period to assess the satisfaction of the veterans 
    with service and quality of care;
        ``(H) conduct a comprehensive examination of programs and 
    policies of the Department regarding the delivery of health care 
    services and the demand of health care services for veterans in 
    future years;
        ``(I) assess the remediation of medical service lines of the 
    Department as described in section 1706A in conjunction with the 
    utilization of non-Department entities or providers to offset 
    remediation; and
        ``(J) consider such other matters as the Secretary considers 
    appropriate.
    ``(c) Responsibilities.--The Secretary shall be responsible for--
        ``(1) overseeing the transformation and organizational change 
    across the Department to achieve such high performing integrated 
    health care network;
        ``(2) developing the capital infrastructure planning and 
    procurement processes, whether minor or major construction projects 
    or leases; and
        ``(3) developing a multi-year budget process that is capable of 
    forecasting future year budget requirements and projecting the cost 
    of delivering health care services under a high-performing 
    integrated health care network.
    ``(d) Appropriate Committees of Congress Defined.--In this section, 
the term `appropriate committees of Congress' means--
        ``(1) the Committee on Veterans' Affairs and the Committee on 
    Appropriations of the Senate; and
        ``(2) the Committee on Veterans' Affairs and the Committee on 
    Appropriations of the House of Representatives.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
7330B the following new item:

``7330C. Quadrennial Veterans Health Administration review.''.
    SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF FEDERAL CONTRACT 
      COMPLIANCE PROGRAMS.
    (a) In General.--Notwithstanding the treatment of certain laws 
under subsection (i) of section 1703A of title 38, United States Code, 
as added by section 102 of this title, Directive 2014-01 of the Office 
of Federal Contract Compliance Programs of the Department of Labor 
(effective as of May 7, 2014) shall apply to any entity entering into 
an agreement under such section 1703A or section 1745 of such title, as 
amended by section 103, in the same manner as such directive applies to 
subcontractors under the TRICARE program for the duration of the 
moratorium provided under such directive.
    (b) Applicability Period.--The directive described in subsection 
(a), and the moratorium provided under such directive, shall not be 
altered or rescinded before May 7, 2019.
    (c) TRICARE Program Defined.--In this section, the term ``TRICARE 
program'' has the meaning given that term in section 1072 of title 10, 
United States Code.
    SEC. 108. PREVENTION OF CERTAIN HEALTH CARE PROVIDERS FROM 
      PROVIDING NON-DEPARTMENT HEALTH CARE SERVICES TO VETERANS.
    (a) In General.--On and after the date that is 1 year after the 
date of the enactment of this Act, the Secretary of Veterans Affairs 
shall deny or revoke the eligibility of a health care provider to 
provide non-Department health care services to veterans if the 
Secretary determines that the health care provider--
        (1) was removed from employment with the Department of Veterans 
    Affairs due to conduct that violated a policy of the Department 
    relating to the delivery of safe and appropriate health care; or
        (2) violated the requirements of a medical license of the 
    health care provider that resulted in the loss of such medical 
    license.
    (b) Permissive Action.--On and after the date that is 1 year after 
the date of the enactment of this Act, the Secretary may deny, revoke, 
or suspend the eligibility of a health care provider to provide non-
Department health care services if the Secretary determines such action 
is necessary to immediately protect the health, safety, or welfare of 
veterans and the health care provider is under investigation by the 
medical licensing board of a State in which the health care provider is 
licensed or practices.
    (c) Suspension.--The Secretary shall suspend the eligibility of a 
health care provider to provide non-Department health care services to 
veterans if the health care provider is suspended from serving as a 
health care provider of the Department.
    (d) Comptroller General Report.--Not later than 2 years after the 
date of the enactment of this Act, the Comptroller General of the 
United States shall submit to Congress a report on the implementation 
by the Secretary of this section, including the following:
        (1) The aggregate number of health care providers denied or 
    suspended under this section from participation in providing non-
    Department health care services.
        (2) An evaluation of any impact on access to health care for 
    patients or staffing shortages in programs of the Department 
    providing non-Department health care services.
        (3) An explanation of the coordination of the Department with 
    the medical licensing boards of States in implementing this 
    section, the amount of involvement of such boards in such 
    implementation, and efforts by the Department to address any 
    concerns raised by such boards with respect to such implementation.
        (4) Such recommendations as the Comptroller General considers 
    appropriate regarding harmonizing eligibility criteria between 
    health care providers of the Department and health care providers 
    eligible to provide non-Department health care services.
    (e) Non-Department Health Care Services Defined.--In this section, 
the term ``non-Department health care services'' means services--
        (1) provided under subchapter I of chapter 17 of title 38, 
    United States Code, at non-Department facilities (as defined in 
    section 1701 of such title);
        (2) provided under section 101 of the Veterans Access, Choice, 
    and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 
    note);
        (3) purchased through the Medical Community Care account of the 
    Department; or
        (4) purchased with amounts deposited in the Veterans Choice 
    Fund under section 802 of the Veterans Access, Choice, and 
    Accountability Act of 2014.
    SEC. 109. REMEDIATION OF MEDICAL SERVICE LINES.
    (a) In General.--Subchapter I of chapter 17 is amended by inserting 
after section 1706 the following new section:
``Sec. 1706A. Remediation of medical service lines
    ``(a) In General.--Not later than 30 days after determining under 
section 1703(e)(1) that a medical service line of the Department is 
providing hospital care, medical services, or extended care services 
that does not comply with the standards for quality established by the 
Secretary, the Secretary shall submit to Congress an assessment of the 
factors that led the Secretary to make such determination and a plan 
with specific actions, and the time to complete them, to be taken to 
comply with such standards for quality, including the following:
        ``(1) Increasing personnel or temporary personnel assistance, 
    including mobile deployment teams.
        ``(2) Special hiring incentives, including the Education Debt 
    Reduction Program under subchapter VII of chapter 76 of this title 
    and recruitment, relocation, and retention incentives.
        ``(3) Utilizing direct hiring authority.
        ``(4) Providing improved training opportunities for staff.
        ``(5) Acquiring improved equipment.
        ``(6) Making structural modifications to the facility used by 
    the medical service line.
        ``(7) Such other actions as the Secretary considers 
    appropriate.
    ``(b) Responsible Parties.--In each assessment submitted under 
subsection (a) with respect to a medical service line, the Secretary 
shall identify the individuals at the Central Office of the Veterans 
Health Administration, the facility used by the medical service line, 
and the central office of the relevant Veterans Integrated Service 
Network who are responsible for overseeing the progress of that medical 
service line in complying with the standards for quality established by 
the Secretary.
    ``(c) Interim Reports.--Not later than 180 days after submitting an 
assessment under subsection (a) with respect to a medical service line, 
the Secretary shall submit to Congress a report on the progress of that 
medical service line in complying with the standards for quality 
established by the Secretary and any other measures the Secretary will 
take to assist the medical service line in complying with such 
standards for quality.
    ``(d) Annual Reports.--Not less frequently than once each year, the 
Secretary shall--
        ``(1) submit to Congress an analysis of the remediation actions 
    and costs of such actions taken with respect to each medical 
    service line with respect to which the Secretary submitted an 
    assessment and plan under paragraph (1) in the preceding year, 
    including an update on the progress of each such medical service 
    line in complying with the standards for quality and timeliness 
    established by the Secretary and any other actions the Secretary is 
    undertaking to assist the medical service line in complying with 
    standards for quality as established by the Secretary; and
        ``(2) publish such analysis on the internet website of the 
    Department.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1706 the following new item:

``1706A. Remediation of medical service lines.''.

         CHAPTER 2--PAYING PROVIDERS AND IMPROVING COLLECTIONS

    SEC. 111. PROMPT PAYMENT TO PROVIDERS.
    (a) In General.--Subchapter I of chapter 17 is amended by inserting 
after section 1703C, as added by section 104 of this title, the 
following new section:
``Sec. 1703D. Prompt payment standard
    ``(a) In General.--(1) Notwithstanding any other provision of this 
title or of any other provision of law, the Secretary shall pay for 
hospital care, medical services, or extended care services furnished by 
health care entities or providers under this chapter within 45 calendar 
days upon receipt of a clean paper claim or 30 calendar days upon 
receipt of a clean electronic claim.
    ``(2) If a claim is denied, the Secretary shall, within 45 calendar 
days of denial for a paper claim and 30 calendar days of denial for an 
electronic claim, notify the health care entity or provider of the 
reason for denying the claim and what, if any, additional information 
is required to process the claim.
    ``(3) Upon the receipt of the additional information, the Secretary 
shall ensure that the claim is paid, denied, or otherwise adjudicated 
within 30 calendar days from the receipt of the requested information.
    ``(4) This section shall only apply to payments made on an invoice 
basis and shall not apply to capitation or other forms of periodic 
payment to entities or providers.
    ``(b) Submittal of Claims by Health Care Entities and Providers.--A 
health care entity or provider that furnishes hospital care, a medical 
service, or an extended care service under this chapter shall submit to 
the Secretary a claim for payment for furnishing the hospital care, 
medical service, or extended care service not later than 180 days after 
the date on which the entity or provider furnished the hospital care, 
medical service, or extended care service.
    ``(c) Fraudulent Claims.--(1) Sections 3729 through 3733 of title 
31 shall apply to fraudulent claims for payment submitted to the 
Secretary by a health care entity or provider under this chapter.
    ``(2) Pursuant to regulations prescribed by the Secretary, the 
Secretary shall bar a health care entity or provider from furnishing 
hospital care, medical services, and extended care services under this 
chapter when the Secretary determines the entity or provider has 
submitted to the Secretary fraudulent health care claims for payment by 
the Secretary.
    ``(d) Overdue Claims.--(1) Any claim that has not been denied with 
notice, made pending with notice, or paid to the health care entity or 
provider by the Secretary shall be overdue if the notice or payment is 
not received by the entity provider within the time periods specified 
in subsection (a).
    ``(2)(A) If a claim is overdue under this subsection, the Secretary 
may, under the requirements established by subsection (a) and 
consistent with the provisions of chapter 39 of title 31 (commonly 
referred to as the `Prompt Payment Act'), require that interest be paid 
on clean claims.
    ``(B) Interest paid under subparagraph (A) shall be computed at the 
rate of interest established by the Secretary of the Treasury under 
section 3902 of title 31 and published in the Federal Register.
    ``(3) Not less frequently than annually, the Secretary shall submit 
to Congress a report on payment of overdue claims under this 
subsection, disaggregated by paper and electronic claims, that includes 
the following:
        ``(A) The amount paid in overdue claims described in this 
    subsection, disaggregated by the amount of the overdue claim and 
    the amount of interest paid on such overdue claim.
        ``(B) The number of such overdue claims and the average number 
    of days late each claim was paid, disaggregated by facility of the 
    Department and Veterans Integrated Service Network region.
    ``(e) Overpayment.--(1) The Secretary shall deduct the amount of 
any overpayment from payments due a health care entity or provider 
under this chapter.
    ``(2) Deductions may not be made under this subsection unless the 
Secretary has made reasonable efforts to notify a health care entity or 
provider of the right to dispute the existence or amount of such 
indebtedness and the right to request a compromise of such 
indebtedness.
    ``(3) The Secretary shall make a determination with respect to any 
such dispute or request prior to deducting any overpayment unless the 
time required to make such a determination before making any deductions 
would jeopardize the Secretary's ability to recover the full amount of 
such indebtedness.
    ``(f) Information and Documentation Required.--(1) The Secretary 
shall provide to all health care entities and providers participating 
in a program to furnish hospital care, medical services, or extended 
care services under this chapter a list of information and 
documentation that is required to establish a clean claim under this 
section.
    ``(2) The Secretary shall consult with entities in the health care 
industry, in the public and private sector, to determine the 
information and documentation to include in the list under paragraph 
(1).
    ``(3) If the Secretary modifies the information and documentation 
included in the list under paragraph (1), the Secretary shall notify 
all health care entities and providers described in paragraph (1) not 
later than 30 days before such modifications take effect.
    ``(g) Processing of Claims.--(1) In processing a claim for 
compensation for hospital care, medical services, or extended care 
services furnished by a non-Department health care entity or provider 
under this chapter, the Secretary may act through--
        ``(A) a non-Department entity that is under contract or 
    agreement for the program established under section 1703(a) of this 
    title; or
        ``(B) a non-Department entity that specializes in such 
    processing for other Federal agency health care systems.
    ``(2) The Secretary shall seek to contract with a third party to 
conduct a review of claims described in paragraph (3) that includes--
        ``(A) a feasibility assessment to determine the capacity of the 
    Department to process such claims in a timely manner; and
        ``(B) a cost benefit analysis comparing the capacity of the 
    Department to a third party entity capable of processing such 
    claims.
    ``(3) The review required under paragraph (2) shall apply to claims 
for hospital care, medical services, or extended care services 
furnished under section 1703 of this Act, as amended by the Caring for 
Our Veterans Act of 2018, that are processed by the Department.
    ``(h) Report on Encounter Data System.--(1) Not later than 90 days 
after the date of the enactment of the Caring for Our Veterans Act of 
2018, the Secretary shall submit to the appropriate committees of 
Congress a report on the feasibility and advisability of adopting a 
funding mechanism similar to what is utilized by other Federal agencies 
to allow a contracted entity to act as a fiscal intermediary for the 
Federal Government to distribute, or pass through, Federal Government 
funds for certain non-underwritten hospital care, medical services, or 
extended care services.
    ``(2) The Secretary may coordinate with the Department of Defense, 
the Department of Health and Human Services, and the Department of the 
Treasury in developing the report required by paragraph (1).
    ``(i) Definitions.--In this section:
        ``(1) The term `appropriate committees of Congress' means--
            ``(A) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the Senate; and
            ``(B) the Committee on Veterans' Affairs and the Committee 
        on Appropriations of the House of Representatives.
        ``(2) The term `clean electronic claim' means the transmission 
    of data for purposes of payment of covered health care expenses 
    that is submitted to the Secretary which contains substantially all 
    of the required data elements necessary for accurate adjudication, 
    without obtaining additional information from the entity or 
    provider that furnished the care or service, submitted in such 
    format as prescribed by the Secretary in regulations for the 
    purpose of paying claims for care or services.
        ``(3) The term `clean paper claim' means a paper claim for 
    payment of covered health care expenses that is submitted to the 
    Secretary which contains substantially all of the required data 
    elements necessary for accurate adjudication, without obtaining 
    additional information from the entity or provider that furnished 
    the care or service, submitted in such format as prescribed by the 
    Secretary in regulations for the purpose of paying claims for care 
    or services.
        ``(4) The term `fraudulent claims' means the knowing 
    misrepresentation of a material fact or facts by a health care 
    entity or provider made to induce the Secretary to pay a claim that 
    was not legally payable to that provider.
        ``(5) The term `health care entity or provider' includes any 
    non-Department health care entity or provider, but does not include 
    any Federal health care entity or provider.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
1703C, as added by section 104 of this title, the following new item:

``1703D. Prompt payment standard.''.
    SEC. 112. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT SUBJECT TO AN 
      AGREEMENT.
    (a) In General.--Subchapter IV of chapter 81 is amended by adding 
at the end the following new section:
``Sec. 8159. Authority to pay for services authorized but not subject 
    to an agreement
    ``(a) In General.--If, in the course of furnishing hospital care, a 
medical service, or an extended care service authorized by the 
Secretary and pursuant to a contract, agreement, or other arrangement 
with the Secretary, a provider who is not a party to the contract, 
agreement, or other arrangement furnishes hospital care, a medical 
service, or an extended care service that the Secretary considers 
necessary, the Secretary may compensate the provider for the cost of 
such care or service.
    ``(b) New Contracts and Agreements.--The Secretary shall take 
reasonable efforts to enter into a contract, agreement, or other 
arrangement with a provider described in subsection (a) to ensure that 
future care and services authorized by the Secretary and furnished by 
the provider are subject to such a contract, agreement, or other 
arrangement.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
8158 the following new item:

``8159. Authority to pay for services authorized but not subject to an 
          agreement.''.
    SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE COST OF SERVICES 
      FURNISHED FOR NON-SERVICE-CONNECTED DISABILITIES.
    (a) Broadening Scope of Applicability.--Section 1729 is amended--
        (1) in subsection (a)--
            (A) in paragraph (2)(A)--
                (i) by striking ``the veteran's'' and inserting ``the 
            individual's''; and
                (ii) by striking ``the veteran'' and inserting ``the 
            individual''; and
            (B) in paragraph (3)--
                (i) in the matter preceding subparagraph (A), by 
            striking ``the veteran'' and inserting ``the individual''; 
            and
                (ii) in subparagraph (A), by striking ``the veteran's'' 
            and inserting ``the individual's'';
        (2) in subsection (b)--
            (A) in paragraph (1)--
                (i) by striking ``the veteran'' and inserting ``the 
            individual''; and
                (ii) by striking ``the veteran's'' and inserting ``the 
            individual's''; and
            (B) in paragraph (2)--
                (i) in subparagraph (A)--

                    (I) by striking ``the veteran'' and inserting ``the 
                individual''; and
                    (II) by striking ``the veteran's'' and inserting 
                ``the individual's''; and

                (ii) in subparagraph (B)--

                    (I) in clause (i), by striking ``the veteran'' and 
                inserting ``the individual''; and
                    (II) in clause (ii)--

                        (aa) by striking ``the veteran'' and inserting 
                    ``the individual''; and
                        (bb) by striking ``the veteran's'' each place 
                    it appears and inserting ``the individual's'';
        (3) in subsection (e), by striking ``A veteran'' and inserting 
    ``An individual''; and
        (4) in subsection (h)--
            (A) in paragraph (1)--
                (i) in the matter preceding subparagraph (A), by 
            striking ``a veteran'' and inserting ``an individual'';
                (ii) in subparagraph (A), by striking ``the veteran'' 
            and inserting ``the individual''; and
                (iii) in subparagraph (B), by striking ``the veteran'' 
            and inserting ``the individual''; and
            (B) in paragraph (2)--
                (i) by striking ``A veteran'' and inserting ``An 
            individual'';
                (ii) by striking ``a veteran'' and inserting ``an 
            individual''; and
                (iii) by striking ``the veteran'' and inserting ``the 
            individual''.
    (b) Modification of Authority.--Subsection (a)(1) of such section 
is amended by striking ``(1) Subject'' and all that follows through the 
period and inserting the following: ``(1) Subject to the provisions of 
this section, in any case in which the United States is required by law 
to furnish or pay for care or services under this chapter for a non-
service-connected disability described in paragraph (2) of this 
subsection, the United States has the right to recover or collect from 
a third party the reasonable charges of care or services so furnished 
or paid for to the extent that the recipient or provider of the care or 
services would be eligible to receive payment for such care or services 
from such third party if the care or services had not been furnished or 
paid for by a department or agency of the United States.''.
    (c) Modification of Eligible Individuals.--Subparagraph (D) of 
subsection (a)(2) of such section is amended to read as follows:
        ``(D) that is incurred by an individual who is entitled to care 
    (or payment of the expenses of care) under a health-plan 
    contract.''.
    SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT THROUGH ELECTRONIC 
      INTERFACE.
    The Secretary of Veterans Affairs may enter into an agreement with 
a third-party entity to process, through the use of an electronic 
interface, claims for reimbursement for health care provided under the 
laws administered by the Secretary.

               CHAPTER 3--EDUCATION AND TRAINING PROGRAMS

    SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OPTIONS.
    (a) In General.--The Secretary of Veterans Affairs shall develop 
and administer an education program that teaches veterans about their 
health care options through the Department of Veterans Affairs.
    (b) Elements.--The program under subsection (a) shall--
        (1) teach veterans about--
            (A) eligibility criteria for care from the Department set 
        forth under sections 1703, as amended by section 101 of this 
        title, and 1710 of title 38, United States Code;
            (B) priority groups for enrollment in the system of annual 
        patient enrollment under section 1705(a) of such title;
            (C) the copayments and other financial obligations, if any, 
        required of certain individuals for certain services; and
            (D) how to utilize the access standards and standards for 
        quality established under sections 1703B and 1703C of such 
        title;
        (2) teach veterans about the interaction between health 
    insurance (including private insurance, Medicare, Medicaid, the 
    TRICARE program, the Indian Health Service, tribal health programs, 
    and other forms of insurance) and health care from the Department; 
    and
        (3) provide veterans with information on what to do when they 
    have a complaint about health care received from the Department 
    (whether about the provider, the Department, or any other type of 
    complaint).
    (c) Accessibility.--In developing the education program under this 
section, the Secretary shall ensure that materials under such program 
are accessible--
        (1) to veterans who may not have access to the internet; and
        (2) to veterans in a manner that complies with the Americans 
    with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).
    (d) Annual Evaluation and Report.--
        (1) Evaluation.--The Secretary shall develop a method to 
    evaluate the effectiveness of the education program under this 
    section and evaluate the program using the method not less 
    frequently than once each year.
        (2) Report.--Not less frequently than once each year, the 
    Secretary shall submit to Congress a report on the findings of the 
    Secretary with respect to the most recent evaluation conducted by 
    the Secretary under paragraph (1).
    (e) Definitions.--In this section:
        (1) Medicaid.--The term ``Medicaid'' means the Medicaid program 
    under title XIX of the Social Security Act (42 U.S.C. 1396 et 
    seq.).
        (2) Medicare.--The term ``Medicare'' means the Medicare program 
    under title XVIII of such Act (42 U.S.C. 1395 et seq.).
        (3) Tricare program.--The term ``TRICARE program'' has the 
    meaning given that term in section 1072 of title 10, United States 
    Code.
    SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF NON-DEPARTMENT OF 
      VETERANS AFFAIRS HEALTH CARE.
    (a) Establishment of Program.--The Secretary of Veterans Affairs 
shall develop and implement a training program to train employees and 
contractors of the Department of Veterans Affairs on how to administer 
non-Department health care programs, including the following:
        (1) Reimbursement for non-Department emergency room care.
        (2) The Veterans Community Care Program under section 1703 of 
    such title, as amended by section 101.
        (3) Management of prescriptions pursuant to improvements under 
    section 131.
    (b) Annual Evaluation and Report.--The Secretary shall--
        (1) develop a method to evaluate the effectiveness of the 
    training program developed and implemented under subsection (a);
        (2) evaluate such program not less frequently than once each 
    year; and
        (3) not less frequently than once each year, submit to Congress 
    the findings of the Secretary with respect to the most recent 
    evaluation carried out under paragraph (2).
    SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DEPARTMENT MEDICAL 
      PROFESSIONALS.
    (a) Establishment of Program.--
        (1) In general.--The Secretary of Veterans Affairs shall 
    establish a program to provide continuing medical education 
    material to non-Department medical professionals.
        (2) Education provided.--The program established under 
    paragraph (1) shall include education on the following:
            (A) Identifying and treating common mental and physical 
        conditions of veterans and family members of veterans.
            (B) The health care system of the Department of Veterans 
        Affairs.
            (C) Such other matters as the Secretary considers 
        appropriate.
    (b) Material Provided.--The continuing medical education material 
provided to non-Department medical professionals under the program 
established under subsection (a) shall be the same material provided to 
medical professionals of the Department to ensure that all medical 
professionals treating veterans have access to the same materials, 
which supports core competencies throughout the community.
    (c) Administration of Program.--
        (1) In general.--The Secretary shall administer the program 
    established under subsection (a) to participating non-Department 
    medical professionals through an internet website of the Department 
    of Veterans Affairs.
        (2) Curriculum and credit provided.--The Secretary shall 
    determine the curriculum of the program and the number of hours of 
    credit to provide to participating non-Department medical 
    professionals for continuing medical education.
        (3) Accreditation.--The Secretary shall ensure that the program 
    is accredited in as many States as practicable.
        (4) Consistency with existing rules.--The Secretary shall 
    ensure that the program is consistent with the rules and 
    regulations of the following:
            (A) The medical licensing agency of each State in which the 
        program is accredited.
            (B) Such medical credentialing organizations as the 
        Secretary considers appropriate.
        (5) User cost.--The Secretary shall carry out the program at no 
    cost to participating non-Department medical professionals.
        (6) Monitoring, evaluation, and report.--The Secretary shall 
    monitor the utilization of the program established under subsection 
    (a), evaluate its effectiveness, and report to Congress on 
    utilization and effectiveness not less frequently than once each 
    year.
    (d) Non-Department Medical Professional Defined.--In this section, 
the term ``non-Department medical professional'' means any individual 
who is licensed by an appropriate medical authority in the United 
States and is in good standing, is not an employee of the Department of 
Veterans Affairs, and provides care to veterans or family members of 
veterans under the laws administered by the Secretary of Veterans 
Affairs.

CHAPTER 4--OTHER MATTERS RELATING TO NON-DEPARTMENT OF VETERANS AFFAIRS 
                               PROVIDERS

    SEC. 131. ESTABLISHMENT OF PROCESSES TO ENSURE SAFE OPIOID 
      PRESCRIBING PRACTICES BY NON-DEPARTMENT OF VETERANS AFFAIRS 
      HEALTH CARE PROVIDERS.
    (a) Receipt and Review of Guidelines.--The Secretary of Veterans 
Affairs shall ensure that all covered health care providers are 
provided a copy of and certify that they have reviewed the evidence-
based guidelines for prescribing opioids set forth by the Opioid Safety 
Initiative of the Department of Veterans Affairs.
    (b) Inclusion of Medical History and Current Medications.--The 
Secretary shall implement a process to ensure that, if care of a 
veteran by a covered health care provider is authorized under the laws 
administered by the Secretary, the document authorizing such care 
includes the available and relevant medical history of the veteran and 
a list of all medications prescribed to the veteran as known by the 
Department.
    (c) Submittal of Medical Records and Prescriptions.--
        (1) In general.--The Secretary shall, consistent with section 
    1703(a)(2)(A), as amended by section 101 of this title, and section 
    1703A(e)(2)(F), as added by section 102 of this title, require each 
    covered health care provider to submit medical records of any care 
    or services furnished, including records of any prescriptions for 
    opioids, to the Department in the timeframe and format specified by 
    the Secretary.
        (2) Responsibility of department for recording and 
    monitoring.--In carrying out paragraph (1) and upon the receipt by 
    the Department of the medical records described in paragraph (1), 
    the Secretary shall--
            (A) ensure the Department is responsible for the recording 
        of the prescription in the electronic health record of the 
        veteran; and
            (B) enable other monitoring of the prescription as outlined 
        in the Opioid Safety Initiative of the Department.
        (3) Report.--Not less frequently than annually, the Secretary 
    shall submit to the Committee on Veterans' Affairs of the Senate 
    and the Committee on Veterans' Affairs of the House of 
    Representatives a report evaluating the compliance of covered 
    health care providers with the requirements under this section.
    (d) Use of Opioid Safety Initiative Guidelines.--
        (1) In general.--If the Secretary determines that the opioid 
    prescribing practices of a covered health care provider, when 
    treating covered veterans, satisfy a condition described in 
    paragraph (3), the Secretary shall take such action as the 
    Secretary considers appropriate to ensure the safety of all 
    veterans receiving care from that health care provider, including 
    removing or directing the removal of any such health care provider 
    from provider networks or otherwise refusing to authorize care of 
    veterans by such health care provider in any program authorized 
    under the laws administered by the Secretary.
        (2) Inclusion in contracts.--The Secretary shall ensure that 
    any contracts, agreements, or other arrangements entered into by 
    the Secretary with third parties involved in administering programs 
    that provide care in the community to veterans under the laws 
    administered by the Secretary specifically grant the authority set 
    forth in paragraph (1) to such third parties and to the Secretary, 
    as the case may be.
        (3) Conditions for exclusion or limitation.--The Secretary 
    shall take such action as is considered appropriate under paragraph 
    (1) when the opioid prescribing practices of a covered health care 
    provider when treating covered veterans--
            (A) conflict with or are otherwise inconsistent with the 
        standards of appropriate and safe care;
            (B) violate the requirements of a medical license of the 
        health care provider; or
            (C) may place at risk the veterans receiving health care 
        from the provider.
    (e) Covered Health Care Provider Defined.--In this section, the 
term ``covered health care provider'' means a non-Department of 
Veterans Affairs health care provider who provides health care to 
veterans under the laws administered by the Secretary of Veterans 
Affairs, but does not include a health care provider employed by 
another agency of the Federal Government.
    SEC. 132. IMPROVING INFORMATION SHARING WITH COMMUNITY PROVIDERS.
    Section 7332(b)(2) is amended by striking subparagraph (H) and 
inserting the following new subparagraphs:
        ``(H)(i) To a non-Department entity (including private entities 
    and other Federal agencies) for purposes of providing health care, 
    including hospital care, medical services, and extended care 
    services, to patients or performing other health care-related 
    activities or functions.
        ``(ii) An entity to which a record is disclosed under this 
    subparagraph may not disclose or use such record for a purpose 
    other than that for which the disclosure was made or as permitted 
    by law.
        ``(I) To a third party in order to recover or collect 
    reasonable charges for care furnished to, or paid on behalf of, a 
    patient in connection with a non-service connected disability as 
    permitted by section 1729 of this title or for a condition for 
    which recovery is authorized or with respect to which the United 
    States is deemed to be a third party beneficiary under the Act 
    entitled `An Act to provide for the recovery from tortiously liable 
    third persons of the cost of hospital and medical care and 
    treatment furnished by the United States' (Public Law 87-693; 42 
    U.S.C. 2651 et seq.; commonly known as the `Federal Medical Care 
    Recovery Act').''.
    SEC. 133. COMPETENCY STANDARDS FOR NON-DEPARTMENT OF VETERANS 
      AFFAIRS HEALTH CARE PROVIDERS.
    (a) Establishment of Standards and Requirements.--The Secretary of 
Veterans Affairs shall establish standards and requirements for the 
provision of care by non-Department of Veterans Affairs health care 
providers in clinical areas for which the Department of Veterans 
Affairs has special expertise, including post-traumatic stress 
disorder, military sexual trauma-related conditions, and traumatic 
brain injuries.
    (b) Condition for Eligibility To Furnish Care.--(1) Each non-
Department of Veterans Affairs health care provider shall, to the 
extent practicable as determined by the Secretary or otherwise provided 
for in paragraph (2), meet the standards and requirements established 
pursuant to subsection (a) before furnishing care pursuant to a 
contract, agreement, or other arrangement with the Department of 
Veterans Affairs. Non-Department of Veterans Affairs health care 
providers furnishing care pursuant to a contract, agreement, or other 
arrangement shall, to the extent practicable as determined by the 
Secretary, fulfill training requirements established by the Secretary 
on how to deliver evidence-based treatments in the clinical areas for 
which the Department of Veterans Affairs has special expertise.
    (2) Each non-Department of Veterans Affairs health care provider 
who enters into a contract, agreement, or other arrangement after the 
effective date identified in subsection (c) shall, to the extent 
practicable, meet the standards and requirements established pursuant 
to subsection (a) within 6 months of the contract, agreement, or other 
arrangement taking effect.
    (c) Effective Date.--This section shall take effect on the day that 
is 1 year after the date of the enactment of this Act.
    SEC. 134. DEPARTMENT OF VETERANS AFFAIRS PARTICIPATION IN NATIONAL 
      NETWORK OF STATE-BASED PRESCRIPTION DRUG MONITORING PROGRAMS.
    (a) In General.--Chapter 17 is amended by inserting after section 
1730A the following new section:
``Sec. 1730B. Access to State prescription drug monitoring programs
    ``(a) Access to Programs.--(1) Any licensed health care provider or 
delegate of such a provider shall be considered an authorized recipient 
or user for the purpose of querying and receiving data from the 
national network of State-based prescription drug monitoring programs 
to support the safe and effective prescribing of controlled substances 
to covered patients.
    ``(2) Under the authority granted by paragraph (1)--
        ``(A) licensed health care providers or delegates of such 
    providers shall query such network in accordance with applicable 
    regulations and policies of the Veterans Health Administration; and
        ``(B) notwithstanding any general or specific provision of law, 
    rule, or regulation of a State, no State may restrict the access of 
    licensed health care providers or delegates of such providers from 
    accessing that State's prescription drug monitoring programs.
    ``(3) No State shall deny or revoke the license, registration, or 
certification of a licensed health care provider or delegate who 
otherwise meets that State's qualifications for holding the license, 
registration, or certification on the basis that the licensed health 
care provider or delegate queried or received data, or attempted to 
query or receive data, from the national network of State-based 
prescription drug monitoring programs under this section.
    ``(b) Covered Patients.--For purposes of this section, a covered 
patient is a patient who--
        ``(1) receives a prescription for a controlled substance; and
        ``(2) is not receiving palliative care or enrolled in hospice 
    care.
    ``(c) Definitions.--In this section:
        ``(1) The term `controlled substance' has the meaning given 
    such term in section 102(6) of the Controlled Substances Act (21 
    U.S.C. 802(6)).
        ``(2) The term `delegate' means a person or automated system 
    accessing the national network of State-based prescription 
    monitoring programs at the direction or under the supervision of a 
    licensed health care provider.
        ``(3) The term `licensed health care provider' means a health 
    care provider employed by the Department who is licensed, 
    certified, or registered within any State to fill or prescribe 
    medications within the scope of his or her practice as a Department 
    employee.
        ``(4) The term `national network of State-based prescription 
    monitoring programs' means an interconnected nation-wide system 
    that facilitates the transfer to State prescription drug monitoring 
    program data across State lines.
        ``(5) The term `State' means a State, as defined in section 
    101(20) of this title, or a political subdivision of a State.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item 
relating to section 1730A the following new item:

``1730B. Access to State prescription drug monitoring programs.''.

          CHAPTER 5--OTHER NON-DEPARTMENT HEALTH CARE MATTERS

    SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIATIONS REQUIRED.
    Whenever the Secretary submits to Congress a request for 
supplemental appropriations or any other appropriation outside the 
standard budget process to address a budgetary issue affecting the 
Department of Veterans Affairs, the Secretary shall, not later than 45 
days before the date on which such budgetary issue would start 
affecting a program or service, submit to Congress a justification for 
the request, including a plan that details how the Secretary intends to 
use the requested appropriation and how long the requested 
appropriation is expected to meet the needs of the Department and 
certification that the request was made using an updated and sound 
actuarial analysis.
    SEC. 142. VETERANS CHOICE FUND FLEXIBILITY.
    Section 802 of the Veterans Access, Choice, and Accountability Act 
of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended--
        (1) in subsection (c)--
            (A) in paragraph (1), by striking ``by paragraph (3)'' and 
        inserting ``in paragraphs (3) and (4)''; and
            (B) by adding at the end the following new paragraph:
        ``(4) Permanent authority for other uses.--Beginning on March 
    1, 2019, amounts remaining in the Veterans Choice Fund may be used 
    to furnish hospital care, medical services, and extended care 
    services to individuals pursuant to chapter 17 of title 38, United 
    States Code, at non-Department facilities, including pursuant to 
    non-Department provider programs other than the program established 
    by section 101. Such amounts shall be available in addition to 
    amounts available in other appropriations accounts for such 
    purposes.''; and
        (2) in subsection (d)(1), by striking ``to subsection (c)(3)'' 
    and inserting ``to paragraphs (3) and (4) of subsection (c)''.
    SEC. 143. SUNSET OF VETERANS CHOICE PROGRAM.
    Subsection (p) of section 101 of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is 
amended to read as follows:
    ``(p) Authority To Furnish Care and Services.--The Secretary may 
not use the authority under this section to furnish care and services 
after the date that is 1 year after the date of the enactment of the 
Caring for Our Veterans Act of 2018.''.
    SEC. 144. CONFORMING AMENDMENTS.
    (a) In General.--
        (1) Title 38.--Title 38, United States Code, is amended--
            (A) in section 1712(a)--
                (i) in paragraph (3), by striking ``under clause (1), 
            (2), or (5) of section 1703(a) of this title'' and 
            inserting ``or entered an agreement''; and
                (ii) in paragraph (4)(A), by striking ``under the 
            provisions of this subsection and section 1703 of this 
            title'';
            (B) in section 1712A(e)(1)--
                (i) by inserting ``or agreements'' after ``contracts''; 
            and
                (ii) by striking ``(under sections 1703(a)(2) and 
            1710(a)(1)(B) of this title)''; and
            (C) in section 2303(a)(2)(B)(i), by striking ``with section 
        1703'' and inserting ``with sections 1703A, 8111, and 8153''.
        (2) Social security act.--Section 1866(a)(1)(L) of the Social 
    Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by striking 
    ``under section 603'' and inserting ``under chapter 17''.
        (3) Veterans' benefits improvements act of 1994.--Section 
    104(a)(4)(A) of the Veterans' Benefits Improvements Act of 1994 
    (Public Law 103-446; 38 U.S.C. 1117 note) is amended by striking 
    ``in section 1703'' and inserting ``in sections 1703A, 8111, and 
    8153''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date described in section 101(b).

   Subtitle B--Improving Department of Veterans Affairs Health Care 
                                Delivery

    SEC. 151. LICENSURE OF HEALTH CARE PROFESSIONALS OF THE DEPARTMENT 
      OF VETERANS AFFAIRS PROVIDING TREATMENT VIA TELEMEDICINE.
    (a) In General.--Chapter 17 is amended by inserting after section 
1730B, as added by section 134, the following new section:
``Sec. 1730C. Licensure of health care professionals providing 
     treatment via telemedicine
    ``(a) In General.--Notwithstanding any provision of law regarding 
the licensure of health care professionals, a covered health care 
professional may practice the health care profession of the health care 
professional at any location in any State, regardless of where the 
covered health care professional or the patient is located, if the 
covered health care professional is using telemedicine to provide 
treatment to an individual under this chapter.
    ``(b) Covered Health Care Professionals.--For purposes of this 
section, a covered health care professional is any health care 
professional who--
        ``(1) is an employee of the Department appointed under the 
    authority under section 7306, 7401, 7405, 7406, or 7408 of this 
    title or title 5;
        ``(2) is authorized by the Secretary to provide health care 
    under this chapter;
        ``(3) is required to adhere to all standards for quality 
    relating to the provision of medicine in accordance with applicable 
    policies of the Department; and
        ``(4) has an active, current, full, and unrestricted license, 
    registration, or certification in a State to practice the health 
    care profession of the health care professional.
    ``(c) Property of Federal Government.--Subsection (a) shall apply 
to a covered health care professional providing treatment to a patient 
regardless of whether the covered health care professional or patient 
is located in a facility owned by the Federal Government during such 
treatment.
    ``(d) Relation to State Law.--(1) The provisions of this section 
shall supersede any provisions of the law of any State to the extent 
that such provision of State law are inconsistent with this section.
    ``(2) No State shall deny or revoke the license, registration, or 
certification of a covered health care professional who otherwise meets 
the qualifications of the State for holding the license, registration, 
or certification on the basis that the covered health care professional 
has engaged or intends to engage in activity covered by subsection (a).
    ``(e) Rule of Construction.--Nothing in this section may be 
construed to remove, limit, or otherwise affect any obligation of a 
covered health care professional under the Controlled Substances Act 
(21 U.S.C. 801 et seq.).
    ``(f) State Defined.--In this section, the term `State' means a 
State, as defined in section 101(20) of this title, or a political 
subdivision of a State.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item 
relating to section 1730B, as added by section 134, the following new 
item:

``1730C. Licensure of health care professionals providing treatment via 
          telemedicine.''.

    (c) Report on Telemedicine.--
        (1) In general.--Not later than 1 year after the earlier of the 
    date on which services provided under section 1730B of title 38, 
    United States Code, as added by subsection (a), first occur or 
    regulations are promulgated to carry out such section, the 
    Secretary of Veterans Affairs shall submit to the Committee on 
    Veterans' Affairs of the Senate and the Committee on Veterans' 
    Affairs of the House of Representatives a report on the 
    effectiveness of the use of telemedicine by the Department of 
    Veterans Affairs.
        (2) Elements.--The report required by paragraph (1) shall 
    include an assessment of the following:
            (A) The satisfaction of veterans with telemedicine 
        furnished by the Department.
            (B) The satisfaction of health care providers in providing 
        telemedicine furnished by the Department.
            (C) The effect of telemedicine furnished by the Department 
        on the following:
                (i) The ability of veterans to access health care, 
            whether from the Department or from non-Department health 
            care providers.
                (ii) The frequency of use by veterans of telemedicine.
                (iii) The productivity of health care providers.
                (iv) Wait times for an appointment for the receipt of 
            health care from the Department.
                (v) The use by veterans of in-person services at 
            Department facilities and non-Department facilities.
            (D) The types of appointments for the receipt of 
        telemedicine furnished by the Department that were provided 
        during the 1-year period preceding the submittal of the report.
            (E) The number of appointments for the receipt of 
        telemedicine furnished by the Department that were requested 
        during such period, disaggregated by medical facility.
            (F) Savings by the Department, if any, including travel 
        costs, from furnishing health care through the use of 
        telemedicine during such period.
    SEC. 152. AUTHORITY FOR DEPARTMENT OF VETERANS AFFAIRS CENTER FOR 
      INNOVATION FOR CARE AND PAYMENT.
    (a) In General.--Subchapter I of chapter 17, as amended by this 
title, is further amended by inserting after section 1703D, as added by 
section 111, the following new section:
``Sec. 1703E. Center for Innovation for Care and Payment
    ``(a) In General.--(1) There is established within the Department a 
Center for Innovation for Care and Payment (in this section referred to 
as the `Center').
    ``(2) The Secretary, acting through the Center, may carry out such 
pilot programs the Secretary determines to be appropriate to develop 
innovative approaches to testing payment and service delivery models in 
order to reduce expenditures while preserving or enhancing the quality 
of care furnished by the Department.
    ``(3) The Secretary, acting through the Center, shall test payment 
and service delivery models to determine whether such models--
        ``(A) improve access to, and quality, timeliness, and patient 
    satisfaction of care and services; and
        ``(B) create cost savings for the Department.
    ``(4)(A) The Secretary shall test a model in a location where the 
Secretary determines that the model will addresses deficits in care 
(including poor clinical outcomes or potentially avoidable 
expenditures) for a defined population.
    ``(B) The Secretary shall focus on models the Secretary expects to 
reduce program costs while preserving or enhancing the quality of care 
received by individuals receiving benefits under this chapter.
    ``(C) The models selected may include those described in section 
1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)).
    ``(5) In selecting a model for testing, the Secretary may consider, 
in addition to other factors identified in this subsection, the 
following factors:
        ``(A) Whether the model includes a regular process for 
    monitoring and updating patient care plans in a manner that is 
    consistent with the needs and preferences of individuals receiving 
    benefits under this chapter.
        ``(B) Whether the model places the individual receiving 
    benefits under this chapter (including family members and other 
    caregivers of such individual) at the center of the care team of 
    such individual.
        ``(C) Whether the model uses technology or new systems to 
    coordinate care over time and across settings.
        ``(D) Whether the model demonstrates effective linkage with 
    other public sector payers, private sector payers, or statewide 
    payment models.
    ``(6)(A) Models tested under this section may not be designed in 
such a way that would allow the United States to recover or collect 
reasonable charges from a Federal health care program for care or 
services furnished by the Secretary to a veteran under pilot programs 
carried out under this section.
    ``(B) In this paragraph, the term `Federal health care program' 
means--
        ``(i) an insurance program described in section 1811 of the 
    Social Security Act (42 U.S.C. 1395c) or established by section 
    1831 of such Act (42 U.S.C. 1395j);
        ``(ii) a State plan for medical assistance approved under title 
    XIX of such Act (42 U.S.C. 1396 et seq.); or
        ``(iii) a TRICARE program operated under sections 1075, 1075a, 
    1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.
    ``(b) Duration.--Each pilot program carried out by the Secretary 
under this section shall terminate no later than 5 years after the date 
of the commencement of the pilot program.
    ``(c) Location.--The Secretary shall ensure that each pilot program 
carried out under this section occurs in an area or areas appropriate 
for the intended purposes of the pilot program. To the extent 
practicable, the Secretary shall ensure that the pilot programs are 
located in geographically diverse areas of the United States.
    ``(d) Budget.--Funding for each pilot program carried out by the 
Secretary under this section shall come from appropriations--
        ``(1) provided in advance in appropriations acts for the 
    Veterans Health Administration; and
        ``(2) provided for information technology systems.
    ``(e) Notice.--The Secretary shall--
        ``(1) publish information about each pilot program under this 
    section in the Federal Register; and
        ``(2) take reasonable actions to provide direct notice to 
    veterans eligible to participate in such pilot programs.
    ``(f) Waiver of Authorities.--(1) Subject to reporting under 
paragraph (2) and approval under paragraph (3), in implementing a pilot 
program under this section, the Secretary may waive such requirements 
in subchapters I, II, and III of this chapter as the Secretary 
determines necessary solely for the purposes of carrying out this 
section with respect to testing models described in subsection (a).
    ``(2) Before waiving any authority under paragraph (1), the 
Secretary shall submit to the Speaker of the House of Representatives, 
the minority leader of the House of Representatives, the majority 
leader of the Senate, the minority leader of the Senate, and each 
standing committee with jurisdiction under the rules of the Senate and 
of the House of Representatives to report a bill to amend the provision 
or provisions of law that would be waived by the Department, a report 
on a request for waiver that describes in detail the following:
        ``(A) The specific authorities to be waived under the pilot 
    program.
        ``(B) The standard or standards to be used in the pilot program 
    in lieu of the waived authorities.
        ``(C) The reasons for such waiver or waivers.
        ``(D) A description of the metric or metrics the Secretary will 
    use to determine the effect of the waiver or waivers upon the 
    access to and quality, timeliness, or patient satisfaction of care 
    and services furnished through the pilot program.
        ``(E) The anticipated cost savings, if any, of the pilot 
    program.
        ``(F) The schedule for interim reports on the pilot program 
    describing the results of the pilot program so far and the 
    feasibility and advisability of continuing the pilot program.
        ``(G) The schedule for the termination of the pilot program and 
    the submission of a final report on the pilot program describing 
    the result of the pilot program and the feasibility and 
    advisability of making the pilot program permanent.
        ``(H) The estimated budget of the pilot program.
    ``(3)(A) Upon receipt of a report submitted under paragraph (2), 
each House of Congress shall provide copies of the report to the 
chairman and ranking member of each standing committee with 
jurisdiction under the rules of the House of Representatives or the 
Senate to report a bill to amend the provision or provisions of law 
that would be waived by the Department under this subsection.
    ``(B) The waiver requested by the Secretary under paragraph (2) 
shall be considered approved under this paragraph if there is enacted 
into law a joint resolution approving such request in its entirety.
    ``(C) For purposes of this paragraph, the term `joint resolution' 
means only a joint resolution which is introduced within the period of 
five legislative days beginning on the date on which the Secretary 
transmits the report to the Congress under such paragraph (2), and--
        ``(i) which does not have a preamble; and
        ``(ii) the matter after the resolving clause of which is as 
    follows: `that Congress approves the request for a waiver under 
    section 1703E(f) of title 38, United States Code, as submitted by 
    the Secretary on ___', the blank space being filled with the 
    appropriate date.
    ``(D)(i) Any committee of the House of Representatives to which a 
joint resolution is referred shall report it to the House without 
amendment not later than 15 legislative days after the date of 
introduction thereof. If a committee fails to report the joint 
resolution within that period, the committee shall be discharged from 
further consideration of the joint resolution.
    ``(ii) It shall be in order at any time after the third legislative 
day after each committee authorized to consider a joint resolution has 
reported or has been discharged from consideration of a joint 
resolution, to move to proceed to consider the joint resolution in the 
House. All points of order against the motion are waived. Such a motion 
shall not be in order after the House has disposed of a motion to 
proceed on a joint resolution addressing a particular submission. The 
previous question shall be considered as ordered on the motion to its 
adoption without intervening motion. The motion shall not be debatable. 
A motion to reconsider the vote by which the motion is disposed of 
shall not be in order.
    ``(iii) The joint resolution shall be considered as read. All 
points of order against the joint resolution and against its 
consideration are waived. The previous question shall be considered as 
ordered on the joint resolution to its passage without intervening 
motion except two hours of debate equally divided and controlled by the 
proponent and an opponent. A motion to reconsider the vote on passage 
of the joint resolution shall not be in order.
    ``(E)(i) A joint resolution introduced in the Senate shall be 
referred to the Committee on Veterans' Affairs.
    ``(ii) Any committee of the Senate to which a joint resolution is 
referred shall report it to the Senate without amendment not later than 
15 session days after the date of introduction of a joint resolution 
described in paragraph (C). If a committee fails to report the joint 
resolution within that period, the committee shall be discharged from 
further consideration of the joint resolution and the joint resolution 
shall be placed on the calendar.
    ``(iii)(I) Notwithstanding Rule XXII of the Standing Rules of the 
Senate, it is in order at any time after the third session day on which 
the Committee on Veterans' Affairs has reported or has been discharged 
from consideration of a joint resolution described in paragraph (C) 
(even though a previous motion to the same effect has been disagreed 
to) to move to proceed to the consideration of the joint resolution, 
and all points of order against the joint resolution (and against 
consideration of the joint resolution) are waived. The motion to 
proceed is not debatable. The motion is not subject to a motion to 
postpone. A motion to reconsider the vote by which the motion is agreed 
to or disagreed to shall not be in order. If a motion to proceed to the 
consideration of the resolution is agreed to, the joint resolution 
shall remain the unfinished business until disposed of.
    ``(II) Consideration of the joint resolution, and on all debatable 
motions and appeals in connection therewith, shall be limited to not 
more than two hours, which shall be divided equally between the 
majority and minority leaders or their designees. A motion further to 
limit debate is in order and not debatable. An amendment to, or a 
motion to postpone, or a motion to proceed to the consideration of 
other business, or a motion to recommit the joint resolution is not in 
order.
    ``(III) If the Senate has voted to proceed to a joint resolution, 
the vote on passage of the joint resolution shall occur immediately 
following the conclusion of consideration of the joint resolution, and 
a single quorum call at the conclusion of the debate if requested in 
accordance with the rules of the Senate.
    ``(IV) Appeals from the decisions of the Chair relating to the 
application of the rules of the Senate, as the case may be, to the 
procedure relating to a joint resolution shall be decided without 
debate.
    ``(F) A joint resolution considered pursuant to this paragraph 
shall not be subject to amendment in either the House of 
Representatives or the Senate.
    ``(G)(i) If, before the passage by one House of the joint 
resolution of that House, that House receives the joint resolution from 
the other House, then the following procedures shall apply:
        ``(I) The joint resolution of the other House shall not be 
    referred to a committee.
        ``(II) With respect to the joint resolution of the House 
    receiving the joint resolution--
                ``(aa) the procedure in that House shall be the same as 
            if no joint resolution had been received from the other 
            House; but
                ``(bb) the vote on passage shall be on the joint 
            resolution of the other House.
        ``(ii) If the Senate fails to introduce or consider a joint 
    resolution under this paragraph, the joint resolution of the House 
    shall be entitled to expedited floor procedures under this 
    subparagraph.
        ``(iii) If, following passage of the joint resolution in the 
    Senate, the Senate then receives the companion measure from the 
    House of Representatives, the companion measure shall not be 
    debatable.
    ``(H) This subparagraph is enacted by Congress--
        ``(i) as an exercise of the rulemaking power of the Senate and 
    House of Representatives, respectively, and as such it is deemed a 
    part of the rules of each House, respectively, but applicable only 
    with respect to the procedure to be followed in that House in the 
    case of a joint resolution, and it supersedes other rules only to 
    the extent that it is inconsistent with such rules; and
        ``(ii) with full recognition of the constitutional right of 
    either House to change the rules (so far as relating to the 
    procedure of that House) at any time, in the same manner, and to 
    the same extent as in the case of any other rule of that House.
    ``(g) Limitations.--(1) The Secretary may not carry out more than 
10 pilot programs concurrently.
    ``(2)(A) Subject to subparagraph (B), the Secretary may not expend 
more than $50,000,000 in any fiscal year from amounts under subsection 
(d).
    ``(B) The Secretary may expend more than the amount in subparagraph 
(A) if--
        ``(i) the Secretary determines that the additional expenditure 
    is necessary to carry out pilot programs under this section;
        ``(ii) the Secretary submits to the Committees on Veterans' 
    Affairs of the Senate and the House of Representatives a report 
    setting forth the amount of the additional expenditure and a 
    justification for the additional expenditure; and
        ``(iii) the Chairmen of the Committees on Veterans' Affairs of 
    the Senate and the House of Representatives transmit to the 
    Secretary a letter approving of the additional expenditure.
    ``(3) The waiver provisions in subsection (f) shall not apply 
unless the Secretary, in accordance with the requirements in subsection 
(f), submits the first proposal for a pilot program not later than 18 
months after the date of the enactment of the Caring for Our Veterans 
Act of 2018.
    ``(4) Notwithstanding section 502 of this title, decisions by the 
Secretary under this section shall, consistent with section 511 of this 
title, be final and conclusive and may not be reviewed by any other 
official or by any court, whether by an action in the nature of 
mandamus or otherwise.
    ``(5)(A) If the Secretary determines that a pilot program is not 
improving the quality of care or producing cost savings, the Secretary 
shall--
        ``(i) propose a modification to the pilot program in the 
    interim report that shall also be considered a report under 
    subsection (f)(2) and shall be subject to the terms and conditions 
    of subsection (f)(2); or
        ``(ii) terminate such pilot program not later than 30 days 
    after submitting the interim report to Congress.
    ``(B) If the Secretary terminates a pilot program under 
subparagraph (A)(ii), for purposes of subparagraphs (F) and (G) of 
subsection (f)(2), such interim report will also serve as the final 
report for that pilot program.
    ``(h) Evaluation and Reporting Requirements.--(1) The Secretary 
shall conduct an evaluation of each model tested, which shall include, 
at a minimum, an analysis of--
        ``(A) the quality of care furnished under the model, including 
    the measurement of patient-level outcomes and patient-centeredness 
    criteria determined appropriate by the Secretary; and
        ``(B) the changes in spending by reason of that model.
    ``(2) The Secretary shall make the results of each evaluation under 
this subsection available to the public in a timely fashion and may 
establish requirements for other entities participating in the testing 
of models under this section to collect and report information that the 
Secretary determines is necessary to monitor and evaluate such models.
    ``(i) Coordination and Advice.--(1) The Secretary shall obtain 
advice from the Under Secretary for Health and the Special Medical 
Advisory Group established pursuant to section 7312 of this title in 
the development and implementation of any pilot program operated under 
this section.
    ``(2) In carrying out the duties under this section, the Secretary 
shall consult representatives of relevant Federal agencies, and 
clinical and analytical experts with expertise in medicine and health 
care management. The Secretary shall use appropriate mechanisms to seek 
input from interested parties.
    ``(j) Expansion of Successful Pilot Programs.--Taking into account 
the evaluation under subsection (f), the Secretary may, through 
rulemaking, expand (including implementation on a nationwide basis) the 
duration and the scope of a model that is being tested under subsection 
(a) to the extent determined appropriate by the Secretary, if--
        ``(1) the Secretary determines that such expansion is expected 
    to--
            ``(A) reduce spending without reducing the quality of care; 
        or
            ``(B) improve the quality of patient care without 
        increasing spending; and
        ``(2) the Secretary determines that such expansion would not 
    deny or limit the coverage or provision of benefits for individuals 
    receiving benefits under this chapter.''.
    (b) Conforming Amendment.--The table of sections at the beginning 
of such chapter, as amended by this title, is further amended by 
inserting after the item relating to section 1703D the following new 
item:

``1703E. Center for Innovation for Care and Payment.''.
    SEC. 153. AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE DONORS 
      FOR PURPOSES OF CONDUCTING TRANSPLANT PROCEDURES FOR VETERANS.
    (a) In General.--Subchapter VIII of chapter 17 is amended by adding 
at the end the following new section:
``Sec. 1788. Transplant procedures with live donors and related 
    services
    ``(a) In General.--Subject to subsections (b) and (c), in a case in 
which a veteran is eligible for a transplant procedure from the 
Department, the Secretary may provide for an operation on a live donor 
to carry out such procedure for such veteran, notwithstanding that the 
live donor may not be eligible for health care from the Department.
    ``(b) Other Services.--Subject to the availability of 
appropriations for such purpose, the Secretary shall furnish to a live 
donor any care or services before and after conducting the transplant 
procedure under subsection (a) that may be required in connection with 
such procedure.
    ``(c) Use of Non-Department Facilities.--In carrying out this 
section, the Secretary may provide for the operation described in 
subsection (a) on a live donor and furnish to the live donor the care 
and services described in subsection (b) at a non-Department facility 
pursuant to an agreement entered into by the Secretary under this 
chapter. The live donor shall be deemed to be an individual eligible 
for hospital care and medical services at a non-Department facility 
pursuant to such an agreement solely for the purposes of receiving such 
operation, care, and services at the non-Department facility.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 is amended by inserting after the item relating to section 
1787 the following new item:

``1788. Transplant procedures with live donors and related services.''.

                     Subtitle C--Family Caregivers

    SEC. 161. EXPANSION OF FAMILY CAREGIVER PROGRAM OF DEPARTMENT OF 
      VETERANS AFFAIRS.
    (a) Family Caregiver Program.--
        (1) Expansion of eligibility.--
            (A) In general.--Subparagraph (B) of subsection (a)(2) of 
        section 1720G is amended to read as follows:
        ``(B) for assistance provided under this subsection--
            ``(i) before the date on which the Secretary submits to 
        Congress a certification that the Department has fully 
        implemented the information technology system required by 
        section 162(a) of the Caring for Our Veterans Act of 2018, has 
        a serious injury (including traumatic brain injury, 
        psychological trauma, or other mental disorder) incurred or 
        aggravated in the line of duty in the active military, naval, 
        or air service on or after September 11, 2001;
            ``(ii) during the 2-year period beginning on the date on 
        which the Secretary submitted to Congress the certification 
        described in clause (i), has a serious injury (including 
        traumatic brain injury, psychological trauma, or other mental 
        disorder) incurred or aggravated in the line of duty in the 
        active military, naval, or air service--
                ``(I) on or before May 7, 1975; or
                ``(II) on or after September 11, 2001; or
            ``(iii) after the date that is 2 years after the date on 
        which the Secretary submits to Congress the certification 
        described in clause (i), has a serious injury (including 
        traumatic brain injury, psychological trauma, or other mental 
        disorder) incurred or aggravated in the line of duty in the 
        active military, naval, or air service; and''.
            (B) Publication in federal register.--Not later than 30 
        days after the date on which the Secretary of Veterans Affairs 
        submits to Congress the certification described in subsection 
        (a)(2)(B)(i) of section 1720G of such title, as amended by 
        subparagraph (A) of this paragraph, the Secretary shall publish 
        the date specified in such subsection in the Federal Register.
        (2) Expansion of needed services in eligibility criteria.--
    Subsection (a)(2)(C) of such section is amended--
            (A) in clause (ii), by striking ``; or'' and inserting a 
        semicolon;
            (B) by redesignating clause (iii) as clause (iv); and
            (C) by inserting after clause (ii) the following new clause 
        (iii):
            ``(iii) a need for regular or extensive instruction or 
        supervision without which the ability of the veteran to 
        function in daily life would be seriously impaired; or''.
        (3) Expansion of services provided.--Subsection (a)(3)(A)(ii) 
    of such section is amended--
            (A) in subclause (IV), by striking ``; and'' and inserting 
        a semicolon;
            (B) in subclause (V), by striking the period at the end and 
        inserting ``; and''; and
            (C) by adding at the end the following new subclause:
            ``(VI) through the use of contracts with, or the provision 
        of grants to, public or private entities--
                ``(aa) financial planning services relating to the 
            needs of injured veterans and their caregivers; and
                ``(bb) legal services, including legal advice and 
            consultation, relating to the needs of injured veterans and 
            their caregivers.''.
        (4) Modification of stipend calculation.--Subsection (a)(3)(C) 
    of such section is amended--
            (A) by redesignating clause (iii) as clause (iv); and
            (B) by inserting after clause (ii) the following new clause 
        (iii):
    ``(iii) In determining the amount and degree of personal care 
services provided under clause (i) with respect to an eligible veteran 
whose need for personal care services is based in whole or in part on a 
need for supervision or protection under paragraph (2)(C)(ii) or 
regular instruction or supervision under paragraph (2)(C)(iii), the 
Secretary shall take into account the following:
        ``(I) The assessment by the family caregiver of the needs and 
    limitations of the veteran.
        ``(II) The extent to which the veteran can function safely and 
    independently in the absence of such supervision, protection, or 
    instruction.
        ``(III) The amount of time required for the family caregiver to 
    provide such supervision, protection, or instruction to the 
    veteran.''.
        (5) Periodic evaluation of need for certain services.--
    Subsection (a)(3) of such section is amended by adding at the end 
    the following new subparagraph:
    ``(D) In providing instruction, preparation, and training under 
subparagraph (A)(i)(I) and technical support under subparagraph 
(A)(i)(II) to each family caregiver who is approved as a provider of 
personal care services for an eligible veteran under paragraph (6), the 
Secretary shall periodically evaluate the needs of the eligible veteran 
and the skills of the family caregiver of such veteran to determine if 
additional instruction, preparation, training, or technical support 
under those subparagraphs is necessary.''.
        (6) Use of primary care teams.--Subsection (a)(5) of such 
    section is amended, in the matter preceding subparagraph (A), by 
    inserting ``(in collaboration with the primary care team for the 
    eligible veteran to the maximum extent practicable)'' after 
    ``evaluate''.
        (7) Assistance for family caregivers.--Subsection (a) of such 
    section is amended by adding at the end the following new 
    paragraph:
    ``(11)(A) In providing assistance under this subsection to family 
caregivers of eligible veterans, the Secretary may enter into 
contracts, provider agreements, and memoranda of understanding with 
Federal agencies, States, and private, nonprofit, and other entities to 
provide such assistance to such family caregivers.
    ``(B) The Secretary may provide assistance under this paragraph 
only if such assistance is reasonably accessible to the family 
caregiver and is substantially equivalent or better in quality to 
similar services provided by the Department.
    ``(C) The Secretary may provide fair compensation to Federal 
agencies, States, and other entities that provide assistance under this 
paragraph.''.
    (b) Modification of Definition of Personal Care Services.--
Subsection (d)(4) of such section is amended--
        (1) in subparagraph (A), by striking ``independent'';
        (2) by redesignating subparagraph (B) as subparagraph (D); and
        (3) by inserting after subparagraph (A) the following new 
    subparagraphs:
            ``(B) Supervision or protection based on symptoms or 
        residuals of neurological or other impairment or injury.
            ``(C) Regular or extensive instruction or supervision 
        without which the ability of the veteran to function in daily 
        life would be seriously impaired.''.
    SEC. 162. IMPLEMENTATION OF INFORMATION TECHNOLOGY SYSTEM OF 
      DEPARTMENT OF VETERANS AFFAIRS TO ASSESS AND IMPROVE THE FAMILY 
      CAREGIVER PROGRAM.
    (a) Implementation of New System.--
        (1) In general.--Not later than October 1, 2018, the Secretary 
    of Veterans Affairs shall implement an information technology 
    system that fully supports the Program and allows for data 
    assessment and comprehensive monitoring of the Program.
        (2) Elements of system.--The information technology system 
    required to be implemented under paragraph (1) shall include the 
    following:
            (A) The ability to easily retrieve data that will allow all 
        aspects of the Program (at the medical center and aggregate 
        levels) and the workload trends for the Program to be assessed 
        and comprehensively monitored.
            (B) The ability to manage data with respect to a number of 
        caregivers that is more than the number of caregivers that the 
        Secretary expects to apply for the Program.
            (C) The ability to integrate the system with other relevant 
        information technology systems of the Veterans Health 
        Administration.
    (b) Assessment of Program.--Not later than 180 days after 
implementing the system described in subsection (a), the Secretary 
shall, through the Under Secretary for Health, use data from the system 
and other relevant data to conduct an assessment of how key aspects of 
the Program are structured and carried out.
    (c) Ongoing Monitoring of and Modifications to Program.--
        (1) Monitoring.--The Secretary shall use the system implemented 
    under subsection (a) to monitor and assess the workload of the 
    Program, including monitoring and assessment of data on--
            (A) the status of applications, appeals, and home visits in 
        connection with the Program; and
            (B) the use by caregivers participating in the Program of 
        other support services under the Program such as respite care.
        (2) Modifications.--Based on the monitoring and assessment 
    conducted under paragraph (1), the Secretary shall identify and 
    implement such modifications to the Program as the Secretary 
    considers necessary to ensure the Program is functioning as 
    intended and providing veterans and caregivers participating in the 
    Program with services in a timely manner.
    (d) Reports.--
        (1) Initial report.--
            (A) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary shall submit to the 
        Committee on Veterans' Affairs of the Senate, the Committee on 
        Veterans' Affairs of the House of Representatives, and the 
        Comptroller General of the United States a report that 
        includes--
                (i) the status of the planning, development, and 
            deployment of the system required to be implemented under 
            subsection (a), including any changes in the timeline for 
            the implementation of the system; and
                (ii) an assessment of the needs of family caregivers of 
            veterans described in subparagraph (B), the resources 
            needed for the inclusion of such family caregivers in the 
            Program, and such changes to the Program as the Secretary 
            considers necessary to ensure the successful expansion of 
            the Program to include such family caregivers.
            (B) Veterans described.--Veterans described in this 
        subparagraph are veterans who are eligible for the Program 
        under clause (ii) or (iii) of section 1720G(a)(2)(B) of title 
        38, United States Code, as amended by section 161(a)(1) of this 
        title, solely due to a serious injury (including traumatic 
        brain injury, psychological trauma, or other mental disorder) 
        incurred or aggravated in the line of duty in the active 
        military, naval, or air service before September 11, 2001.
        (2) Notification by comptroller general.--The Comptroller 
    General shall review the report submitted under paragraph (1) and 
    notify the Committee on Veterans' Affairs of the Senate and the 
    Committee on Veterans' Affairs of the House of Representatives with 
    respect to the progress of the Secretary in--
            (A) fully implementing the system required under subsection 
        (a); and
            (B) implementing a process for using such system to monitor 
        and assess the Program under subsection (c)(1) and modify the 
        Program as considered necessary under subsection (c)(2).
        (3) Final report.--
            (A) In general.--Not later than October 1, 2019, the 
        Secretary shall submit to the Committee on Veterans' Affairs of 
        the Senate, the Committee on Veterans' Affairs of the House of 
        Representatives, and the Comptroller General a report on the 
        implementation of subsections (a) through (c).
            (B) Elements.--The report required by subparagraph (A) 
        shall include the following:
                (i) A certification by the Secretary that the 
            information technology system described in subsection (a) 
            has been implemented.
                (ii) A description of how the Secretary has implemented 
            such system.
                (iii) A description of the modifications to the 
            Program, if any, that were identified and implemented under 
            subsection (c)(2).
                (iv) A description of how the Secretary is using such 
            system to monitor the workload of the Program.
    (e) Definitions.--In this section:
        (1) Active military, naval, or air service.--The term ``active 
    military, naval, or air service'' has the meaning given that term 
    in section 101 of title 38, United States Code.
        (2) Program.--The term ``Program'' means the program of 
    comprehensive assistance for family caregivers under section 
    1720G(a) of title 38, United States Code, as amended by section 161 
    of this title.
    SEC. 163. MODIFICATIONS TO ANNUAL EVALUATION REPORT ON CAREGIVER 
      PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
    (a) Barriers to Care and Services.--Subparagraph (A)(iv) of section 
101(c)(2) of the Caregivers and Veterans Omnibus Health Services Act of 
2010 (Public Law 111-163; 38 U.S.C. 1720G note) is amended by inserting 
``, including a description of any barriers to accessing and receiving 
care and services under such programs'' before the semicolon.
    (b) Sufficiency of Training for Family Caregiver Program.--
Subparagraph (B) of such section is amended--
        (1) in clause (i), by striking ``; and'' and inserting a 
    semicolon;
        (2) in clause (ii), by striking the period at the end and 
    inserting ``; and''; and
        (3) by adding at the end the following new clause:
                ``(iii) an evaluation of the sufficiency and 
            consistency of the training provided to family caregivers 
            under such program in preparing family caregivers to 
            provide care to veterans under such program.''.

              TITLE II--VA ASSET AND INFRASTRUCTURE REVIEW
              Subtitle A--Asset and Infrastructure Review

    SEC. 201. SHORT TITLE.
    This subtitle may be cited as the ``VA Asset and Infrastructure 
Review Act of 2018''.
    SEC. 202. THE COMMISSION.
    (a) Establishment.--There is established an independent commission 
to be known as the ``Asset and Infrastructure Review Commission'' (in 
this subtitle referred to as the ``Commission'').
    (b) Duties.--The Commission shall carry out the duties specified 
for it in this subtitle.
    (c) Appointment.--
        (1) In general.--
            (A) Appointment.--The Commission shall be composed of nine 
        members appointed by the President, by and with the advice and 
        consent of the Senate.
            (B) Transmission of nominations.--The President shall 
        transmit to the Senate the nominations for appointment to the 
        Commission not later than May 31, 2021.
        (2) Consultation in selection process.--In selecting 
    individuals for nominations for appointments to the Commission, the 
    President shall consult with--
            (A) the Speaker of the House of Representatives;
            (B) the majority leader of the Senate;
            (C) the minority leader of the House of Representatives;
            (D) the minority leader of the Senate; and
            (E) congressionally chartered, membership based veterans 
        service organizations concerning the appointment of three 
        members.
        (3) Designation of chair.--At the time the President nominates 
    individuals for appointment to the Commission under paragraph 
    (1)(B), the President shall designate one such individual who shall 
    serve as Chair of the Commission and one such individual who shall 
    serve as Vice Chair of the Commission.
        (4) Member representation.--In nominating individuals under 
    this subsection, the President shall ensure that--
            (A) veterans, reflecting current demographics of veterans 
        enrolled in the system of annual patient enrollment under 
        section 1705 of title 38, United States Code, are adequately 
        represented in the membership of the Commission;
            (B) at least one member of the Commission has experience 
        working for a private integrated health care system that has 
        annual gross revenues of more than $50,000,000;
            (C) at least one member has experience as a senior manager 
        for an entity specified in clause (ii), (iii), or (iv) of 
        section 101(a)(1)(B) of the Veterans Access, Choice, and 
        Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 
        note);
            (D) at least one member--
                (i) has experience with capital asset management for 
            the Federal Government; and
                (ii) is familiar with trades related to building and 
            real property, including construction, engineering, 
            architecture, leasing, and strategic partnerships; and
            (E) at least three members represent congressionally 
        chartered, membership-based, veterans service organizations.
    (d) Meetings.--
        (1) In general.--The Commission shall meet only during calendar 
    years 2022 and 2023.
        (2) Public nature of meetings and proceedings.--
            (A) Public meetings.--Each meeting of the Commission shall 
        be open to the public.
            (B) Open participation.--All the proceedings, information, 
        and deliberations of the Commission shall be available for 
        review by the public.
    (e) Vacancies.--A vacancy in the Commission shall be filled in the 
same manner as the original appointment, but the individual appointed 
to fill the vacancy shall serve only for the unexpired portion of the 
term for which the individual's predecessor was appointed.
    (f) Pay.--
        (1) In general.--Members of the Commission shall serve without 
    pay.
        (2) Officers or employees of the united states.--Each member of 
    the Commission who is an officer or employee of the United States 
    shall serve without compensation in addition to that received for 
    service as an officer or employee of the United States.
        (3) Travel expenses.--Members shall receive travel expenses, 
    including per diem in lieu of subsistence, in accordance with 
    sections 5702 and 5703 of title 5, United States Code.
    (g) Director of Staff.--
        (1) Appointment.--The Commission shall appoint a Director who--
            (A) has not served as an employee of the Department of 
        Veterans Affairs during the 1-year period preceding the date of 
        such appointment; and
            (B) is not otherwise barred or prohibited from serving as 
        Director under Federal ethics laws and regulations, by reason 
        of post-employment conflict of interest.
        (2) Rate of pay.--The Director shall be paid at the rate of 
    basic pay payable for level IV of the Executive Schedule under 
    section 5315 of title 5, United States Code.
    (h) Staff.--
        (1) Pay of personnel.--Subject to paragraphs (2) and (3), the 
    Director, with the approval of the Commission, may appoint and fix 
    the pay of additional personnel.
        (2) Exemption from certain requirements.--The Director may make 
    such appointments without regard to the provisions of title 5, 
    United States Code, governing appointments in the competitive 
    service, and any personnel so appointed may be paid without regard 
    to the provisions of chapter 51 and subchapter III of chapter 53 of 
    that title relating to classification and General Schedule pay 
    rates, except that an individual so appointed may not receive pay 
    in excess of the annual rate of basic pay payable for GS-15 of the 
    General Schedule.
        (3) Detailees.--
            (A) Limitation on number.--Not more than two-thirds of the 
        personnel employed by or detailed to the Commission may be on 
        detail from the Department of Veterans Affairs.
            (B) Professional analysts.--Not more than half of the 
        professional analysts of the Commission staff may be persons 
        detailed from the Department of Veterans Affairs to the 
        Commission.
            (C) Prohibition on detail of certain personnel.--A person 
        may not be detailed from the Department of Veterans Affairs to 
        the Commission if, within 6 months before the detail is to 
        begin, that person participated personally and substantially in 
        any matter within the Department of Veterans Affairs concerning 
        the preparation of recommendations regarding facilities of the 
        Veterans Health Administration.
        (4) Authority to request detailed personnel.--Subject to 
    paragraph (3), the head of any Federal department or agency, upon 
    the request of the Director, may detail any of the personnel of 
    that department or agency to the Commission to assist the 
    Commission in carrying out its duties under this subtitle.
        (5) Information from federal agencies.--The Commission may 
    secure directly from any Federal agency such information the 
    Commission considers necessary to carry out this subtitle. Upon 
    request of the Chair, the head of such agency shall furnish such 
    information to the Commission.
    (i) Other Authority.--
        (1) Temporary and intermittent services.--The Commission may 
    procure by contract, to the extent funds are available, the 
    temporary or intermittent services of experts or consultants 
    pursuant to section 3109 of title 5, United States Code.
        (2) Leasing and acquisition of property.--To the extent funds 
    are available, the Commission may lease real property and acquire 
    personal property either of its own accord or in consultation with 
    the General Services Administration.
    (j) Termination.--The Commission shall terminate on December 31, 
2023.
    (k) Prohibition Against Restricting Communications.--
        (1) In general.--Except as provided in paragraph (2), no person 
    may restrict an employee of the Department of Veterans Affairs in 
    communicating with the Commission.
        (2) Unlawful communications.--Paragraph (1) does not apply to a 
    communication that is unlawful.
    SEC. 203. PROCEDURE FOR MAKING RECOMMENDATIONS.
    (a) Selection Criteria.--
        (1) Publication.--The Secretary shall, not later than February 
    1, 2021, and after consulting with veterans service organizations, 
    publish in the Federal Register and transmit to the Committees on 
    Veterans' Affairs of the Senate and the House of Representatives 
    the criteria proposed to be used by the Department of Veterans 
    Affairs in assessing and making recommendations regarding the 
    modernization or realignment of facilities of the Veterans Health 
    Administration under this subtitle. Such criteria shall include the 
    preferences of veterans regarding health care furnished by the 
    Department.
        (2) Public comment.--The Secretary shall provide an opportunity 
    for public comment on the proposed criteria under paragraph (1) for 
    a period of at least 90 days and shall include notice of that 
    opportunity in the publication required under such paragraph.
        (3) Publication of final criteria.--The Secretary shall, not 
    later than May 31, 2021, publish in the Federal Register and 
    transmit to the Committees on Veterans' Affairs of the Senate and 
    the House of Representatives the final criteria to be used in 
    making recommendations regarding the closure, modernization, or 
    realignment of facilities of the Veterans Health Administration 
    under this subtitle.
    (b) Recommendations of the Secretary.--
        (1) Publication in federal register.--The Secretary shall, not 
    later than January 31, 2022, and after consulting with veterans 
    service organizations, publish in the Federal Register and transmit 
    to the Committees on Veterans' Affairs of the Senate and the House 
    of Representatives and to the Commission a report detailing the 
    recommendations regarding the modernization or realignment of 
    facilities of the Veterans Health Administration on the basis of 
    the final criteria referred to in subsection (a)(2) that are 
    applicable.
        (2) Factors for consideration.--In making recommendations under 
    this subsection, the Secretary shall consider each of the following 
    factors:
            (A) The degree to which any health care delivery or other 
        site for providing services to veterans reflect the metrics of 
        the Department of Veterans Affairs regarding market area health 
        system planning.
            (B) The provision of effective and efficient access to 
        high-quality health care and services for veterans.
            (C) The extent to which the real property that no longer 
        meets the needs of the Federal Government could be 
        reconfigured, repurposed, consolidated, realigned, exchanged, 
        outleased, replaced, sold, or disposed.
            (D) The need of the Veterans Health Administration to 
        acquire infrastructure or facilities that will be used for the 
        provision of health care and services to veterans.
            (E) The extent to which the operating and maintenance costs 
        are reduced through consolidating, colocating, and 
        reconfiguring space, and through realizing other operational 
        efficiencies.
            (F) The extent and timing of potential costs and savings, 
        including the number of years such costs or savings will be 
        incurred, beginning with the date of completion of the proposed 
        recommendation.
            (G) The extent to which the real property aligns with the 
        mission of the Department of Veterans Affairs.
            (H) The extent to which any action would impact other 
        missions of the Department (including education, research, or 
        emergency preparedness).
            (I) Local stakeholder inputs and any factors identified 
        through public field hearings.
            (J) The assessments under paragraph (3).
            (K) The extent to which the Veterans Health Administration 
        has appropriately staffed the medical facility, including 
        determinations whether there has been insufficient resource 
        allocation or deliberate understaffing.
            (L) Any other such factors the Secretary determines 
        appropriate.
        (3) Capacity and commercial market assessments.--
            (A) Assessments.--The Secretary shall assess the capacity 
        of each Veterans Integrated Service Network and medical 
        facility of the Department to furnish hospital care or medical 
        services to veterans under chapter 17 of title 38, United 
        States Code. Each such assessment shall--
                (i) identify gaps in furnishing such care or services 
            at such Veterans Integrated Service Network or medical 
            facility;
                (ii) identify how such gaps can be filled by--

                    (I) entering into contracts or agreements with 
                network providers under this section or with entities 
                under other provisions of law;
                    (II) making changes in the way such care and 
                services are furnished at such Veterans Integrated 
                Service Network or medical facility, including--

                        (aa) extending hours of operation;
                        (bb) adding personnel; or
                        (cc) expanding space through the construction, 
                    leasing, or sharing of health care facilities; and

                    (III) the building or realignment of Department 
                resources or personnel;

                (iii) forecast, based on future projections and 
            historical trends, both the short- and long-term demand in 
            furnishing care or services at such Veterans Integrated 
            Service Network or medical facility and assess how such 
            demand affects the needs to use such network providers;
                (iv) include a commercial health care market assessment 
            of designated catchment areas in the United States 
            conducted by a non-governmental entity; and
                (v) consider the unique ability of the Federal 
            Government to retain a presence in an area otherwise devoid 
            of commercial health care providers or from which such 
            providers are at risk of leaving.
            (B) Consultation.--In carrying out the assessments under 
        subparagraph (A), the Secretary shall consult with veterans 
        service organizations and veterans served by each such Veterans 
        Integrated Service Network and medical facility.
            (C) Submittal.--The Secretary shall submit such assessments 
        to the Committees on Veterans' Affairs of the House of 
        Representatives and the Senate with the recommendations of the 
        Secretary under this subsection and make the assessments 
        publicly available.
        (4) Summary of selection process.--The Secretary shall include, 
    with the list of recommendations published and transmitted pursuant 
    to paragraph (1), a summary of the selection process that resulted 
    in the recommendation for each facility of the Veterans Health 
    Administration, including a justification for each recommendation. 
    The Secretary shall transmit the matters referred to in the 
    preceding sentence not later than 7 days after the date of the 
    transmittal to the Committees on Veterans' Affairs of the Senate 
    and the House of Representatives and the Commission of the report 
    referred to in paragraph (1).
        (5) Treatment of facilities.--In assessing facilities of the 
    Veterans Health Administration, the Secretary shall consider all 
    such facilities equally without regard to whether the facility has 
    been previously considered or proposed for reuse, closure, 
    modernization, or realignment by the Department of Veterans 
    Affairs.
        (6) Availability of information to congress.--In addition to 
    making all information used by the Secretary to prepare the 
    recommendations under this subsection available to Congress 
    (including any committee or Member of Congress), the Secretary 
    shall also make such information available to the Commission and 
    the Comptroller General of the United States.
        (7) Certification of accuracy.--
            (A) In general.--Each person referred to in subparagraph 
        (B), when submitting information to the Secretary or the 
        Commission concerning the modernization or realignment of a 
        facility of the Veterans Health Administration, shall certify 
        that such information is accurate and complete to the best of 
        that person's knowledge and belief.
            (B) Covered persons.--Subparagraph (A) applies to the 
        following persons:
                (i) Each Under Secretary of the Department of Veterans 
            Affairs.
                (ii) Each director of a Veterans Integrated Service 
            Network.
                (iii) Each director of a medical center of the 
            Department of Veterans Affairs.
                (iv) Each director of a program office of the 
            Department of Veterans Affairs.
                (v) Each person who is in a position the duties of 
            which include personal and substantial involvement in the 
            preparation and submission of information and 
            recommendations concerning the modernization or realignment 
            of facilities of the Veterans Health Administration.
    (c) Review and Recommendations by the Commission.--
        (1) Public hearings.--
            (A) In general.--After receiving the recommendations from 
        the Secretary pursuant to subsection (b), the Commission shall 
        conduct public hearings on the recommendations.
            (B) Locations.--The Commission shall conduct public 
        hearings in regions affected by a recommendation of the 
        Secretary to close a facility of the Veterans Health 
        Administration. To the greatest extent practicable, the 
        Commission shall conduct public hearings in regions affected by 
        a recommendation of the Secretary to modernize or realign such 
        a facility.
            (C) Required witnesses.--Witnesses at each public hearing 
        shall include at a minimum--
                (i) a veteran--

                    (I) enrolled under section 1705 of title 38, United 
                States Code; and
                    (II) identified by a local veterans service 
                organization; and

                (ii) a local elected official.
        (2) Transmittal to president.--
            (A) In general.--The Commission shall, not later than 
        January 31, 2023, transmit to the President a report containing 
        the Commission's findings and conclusions based on a review and 
        analysis of the recommendations made by the Secretary, together 
        with the Commission's recommendations, for modernizations and 
        realignments of facilities of the Veterans Health 
        Administration.
            (B) Authority to make changes to recommendations.--Subject 
        to subparagraph (C), in making its recommendations, the 
        Commission may change any recommendation made by the Secretary 
        if the Commission--
                (i) determines that the Secretary deviated 
            substantially from the final criteria referred to in 
            subsection (a)(2) in making such recommendation;
                (ii) determines that the change is consistent with the 
            final criteria referred to in subsection (a)(2);
                (iii) publishes a notice of the proposed change in the 
            Federal Register not less than 45 days before transmitting 
            its recommendations to the President pursuant to 
            subparagraph (A); and
                (iv) conducts public hearings on the proposed change.
        (3) Justification for changes.--The Commission shall explain 
    and justify in its report submitted to the President pursuant to 
    paragraph (2) any recommendation made by the Commission that is 
    different from the recommendations made by the Secretary pursuant 
    to subsection (b). The Commission shall transmit a copy of such 
    report to the Committees on Veterans' Affairs of the Senate and the 
    House of Representatives on the same date on which it transmits its 
    recommendations to the President under paragraph (2).
        (4) Provision of information to congress.--After the Commission 
    transmits its report to the President, the Commission shall 
    promptly provide, upon request, to any Member of Congress, 
    information used by the Commission in making its recommendations.
    (d) Review by the President.--
        (1) Report.--The President shall, not later than February 15, 
    2023, transmit to the Commission and to the Congress a report 
    containing the President's approval or disapproval of the 
    Commission's recommendations.
        (2) Presidential approval.--If the President approves all the 
    recommendations of the Commission, the President shall transmit a 
    copy of such recommendations to the Congress, together with a 
    certification of such approval.
        (3) Presidential disapproval.--If the President disapproves the 
    recommendations of the Commission, in whole or in part, the 
    President shall transmit to the Commission and the Congress, not 
    later than March 1, 2023, the reasons for that disapproval. The 
    Commission, after consideration of the President's reasons for 
    disapproval, shall then transmit to the President, not later than 
    March 15, 2023, a report containing--
            (A) the Commission's findings and conclusions based on a 
        review and analysis of those reasons for disapproval provided 
        by the President; and
            (B) recommendations that the Commission determines are 
        appropriate for modernizations and realignments of facilities 
        of the Veterans Health Administration.
        (4) Transmittal of recommendations to congress.--If the 
    President approves all recommendations of the Commission 
    transmitted to the President under paragraph (3), the President 
    shall transmit a copy of such recommendations to the Congress, 
    together with a certification of such approval.
        (5) Failure to transmit.--If the President does not transmit to 
    the Congress an approval and certification described in paragraph 
    (2) or (4) by March 30, 2023, the process by which facilities of 
    the Veterans Health Administration may be selected for 
    modernization or realignment under this subtitle shall be 
    terminated.
    SEC. 204. ACTIONS REGARDING INFRASTRUCTURE AND FACILITIES OF THE 
      VETERANS HEALTH ADMINISTRATION.
    (a) In General.--Subject to subsection (b), the Secretary shall 
begin to implement the recommended modernizations and realignments in 
the report under section 203(d) not later than 3 years after the date 
on which the President transmits such report to Congress. In any fiscal 
year, such implementation includes--
        (1) the planning of modernizations and realignments of 
    facilities of the Veterans Health Administration as recommended in 
    such report; and
        (2) providing detailed information on the budget for such 
    modernizations or realignments in documents submitted to Congress 
    by the Secretary in support of the President's budget for that 
    fiscal year.
    (b) Congressional Disapproval.--
        (1) In general.--The Secretary may not carry out any 
    modernization or realignment recommended by the Commission in a 
    report transmitted from the President pursuant to section 203(d) if 
    a joint resolution is enacted, in accordance with the provisions of 
    section 207, disapproving such recommendations of the Commission 
    before the earlier of--
            (A) the end of the 45-day period beginning on the date on 
        which the President transmits such report; or
            (B) the adjournment of Congress sine die for the session 
        during which such report is transmitted.
        (2) Computation of period.--For purposes of paragraph (1) and 
    subsections (a) and (c) of section 207, the days on which either 
    House of Congress is not in session because of an adjournment of 
    more than three days to a day certain shall be excluded in the 
    computation of a period.
    SEC. 205. IMPLEMENTATION.
    (a) In General.--
        (1) Modernizing and realigning facilities.--In modernizing or 
    realigning any facility of the Veterans Health Administration under 
    this subtitle, the Secretary may--
            (A) take such actions as may be necessary to modernize or 
        realign any such facility, including the alteration of such 
        facilities, the acquisition of such land, the leasing or 
        construction of such replacement facilities, the disposition of 
        such land or facilities, the performance of such activities, 
        and the conduct of such advance planning and design as may be 
        required to transfer functions from a facility of the Veterans 
        Health Administration to another such facility, and may use for 
        such purpose funds in the Account or funds appropriated to the 
        Department of Veterans Affairs for such purposes;
            (B) carry out activities for the purposes of environmental 
        mitigation, abatement, or restoration at any such facility, and 
        shall use for such purposes funds in the Account;
            (C) reimburse other Federal agencies for actions performed 
        at the request of the Secretary with respect to any such 
        closure or realignment, and may use for such purpose funds in 
        the Account or funds appropriated to the Department of Veterans 
        Affairs and available for such purpose; and
            (D) exercise the authority of the Secretary under 
        subchapter V of chapter 81 of title 38, United States Code.
        (2) Environmental restoration; historic preservation.--In 
    carrying out any closure or realignment under this subtitle, the 
    Secretary, with regards to any property made excess to the needs of 
    the Department of Veterans Affairs as a result of such closure or 
    realignment, shall carry out, as soon as possible with funds 
    available for such purpose, any of the following for which the 
    Secretary is responsible:
            (A) Environmental mitigation.
            (B) Environmental abatement.
            (C) Environmental restoration.
            (D) Compliance with historic preservation requirements.
    (b) Management and Disposal of Property.--
        (1) Existing disposal authorities.--To transfer or dispose of 
    surplus real property or infrastructure located at any facility of 
    the Veterans Health Administration that is modernized or realigned 
    under this title, the Secretary may exercise the authorities of the 
    Secretary under subchapters I and II of chapter 81 of title 38, 
    United States Code, or the authorities delegated to the Secretary 
    by the Administrator of General Services under subchapter III of 
    chapter 5 of title 40, United States Code.
        (2) Effects on local communities.--
            (A) Consultation with state and local government.--Before 
        any action may be taken with respect to the disposal of any 
        surplus real property or infrastructure located at any facility 
        of the Veterans Health Administration to be closed or realigned 
        under this subtitle, the Secretary of Veterans Affairs shall 
        consult with the Governor of the State and the heads of the 
        local governments concerned for the purpose of considering any 
        plan for the use of such property by the local community 
        concerned.
            (B) Treatment of roads.--If infrastructure or a facility of 
        the Veterans Health Administration to be closed or realigned 
        under this subtitle includes a road used for public access 
        through, into, or around the facility, the Secretary--
                (i) shall consult with the Government of the State and 
            the heads of the local governments concerned for the 
            purpose of considering the continued availability of the 
            road for public use after the recommended action is 
            complete; and
                (ii) may exercise the authority of the Secretary under 
            section 8108 of title 38, United States Code.
        (3) Leases; cercla.--
            (A) Lease authority.--
                (i) Transfer to redevelopment authority for lease.--The 
            Secretary may transfer title to a facility of the Veterans 
            Health Administration approved for closure or realignment 
            under this subtitle (including property at a facility of 
            the Veterans Health Administration approved for realignment 
            which will be retained by the Department of Veterans 
            Affairs or another Federal agency after realignment) to the 
            redevelopment authority for the facility if the 
            redevelopment authority agrees to lease, directly upon 
            transfer, one or more portions of the property transferred 
            under this subparagraph to the Secretary or to the head of 
            another department or agency of the Federal Government.
                (ii) Term of lease.--A lease under clause (i) shall be 
            for a term of not to exceed 50 years, but may provide for 
            options for renewal or extension of the term by the 
            department or agency concerned.
                (iii) Limitation.--A lease under clause (i) may not 
            require rental payments by the United States.
                (iv) Treatment of remaindered lease terms.--A lease 
            under clause (i) shall include a provision specifying that 
            if the department or agency concerned ceases requiring the 
            use of the leased property before the expiration of the 
            term of the lease, the remainder of the lease term may be 
            satisfied by the same or another department or agency of 
            the Federal Government using the property for a use similar 
            to the use under the lease. Exercise of the authority 
            provided by this clause shall be made in consultation with 
            the redevelopment authority concerned.
                (v) Facility services.--Notwithstanding clause (iii), 
            if a lease under clause (i) involves a substantial portion 
            of the facility, the department or agency concerned may 
            obtain facility services for the leased property and common 
            area maintenance from the redevelopment authority or the 
            redevelopment authority's assignee as a provision of the 
            lease. The facility services and common area maintenance 
            shall be provided at a rate no higher than the rate charged 
            to non-Federal tenants of the transferred property. 
            Facility services and common area maintenance covered by 
            the lease shall not include--

                    (I) municipal services that a State or local 
                government is required by law to provide to all 
                landowners in its jurisdiction without direct charge; 
                or
                    (II) firefighting or security-guard functions.

            (B) Application of cercla.--The provisions of section 
        120(h) of the Comprehensive Environmental Response, 
        Compensation, and Liability Act of 1980 (42 U.S.C. 9620(h)) 
        shall apply to any transfer of real property under this 
        paragraph.
            (C) Additional terms and conditions.--The Secretary may 
        require any additional terms and conditions in connection with 
        a transfer under this paragraph as such Secretary considers 
        appropriate to protect the interests of the United States.
        (4) Application of mckinney-vento homeless assistance act.--
    Nothing in this subtitle shall limit or otherwise affect the 
    application of the provisions of the McKinney-Vento Homeless 
    Assistance Act (42 U.S.C. 11301 et seq.) to facilities of the 
    Veterans Health Administration closed under this subtitle.
    (c) Applicability of National Environmental Policy Act of 1969.--
        (1) In general.--The provisions of the National Environmental 
    Policy Act of 1969 (42 U.S.C. 4321 et seq.) shall not apply to the 
    actions of the President, the Commission, and, except as provided 
    in paragraph (2), the Department of Veterans Affairs in carrying 
    out this subtitle.
        (2) Department of veterans affairs.--
            (A) Covered activities.--The provisions of the National 
        Environmental Policy Act of 1969 shall apply to actions of the 
        Department of Veterans Affairs under this subtitle--
                (i) during the process of property disposal; and
                (ii) during the process of relocating functions from a 
            facility of the Veterans Health Administration being closed 
            or realigned to another facility after the receiving 
            facility has been selected but before the functions are 
            relocated.
            (B) Other activities.--In applying the provisions of the 
        National Environmental Policy Act of 1969 to the processes 
        referred to in subparagraph (A), the Secretary shall not have 
        to consider--
                (i) the need for closing or realigning the facility of 
            the Veterans Health Administration as recommended by the 
            Commission;
                (ii) the need for transferring functions to any 
            facility of the Veterans Health Administration which has 
            been selected as the receiving facility; or
                (iii) facilities of the Veterans Health Administration 
            alternative to those recommended or selected.
    (d) Waiver.--
        (1) Restrictions on use of funds.--The Secretary may close or 
    realign facilities of the Veterans Health Administration under this 
    subtitle without regard to any provision of law restricting the use 
    of funds for closing or realigning facilities of the Veterans 
    Health Administration included in any appropriation or 
    authorization Act.
        (2) Restrictions on authorities.--The Secretary may close or 
    realign facilities of the Veterans Health Administration under this 
    subtitle without regard to the restrictions of section 8110 of 
    title 38, United States Code.
    (e) Transfer Authority in Connection With Payment of Environmental 
Remediation Costs.--
        (1) In general.--
            (A) Transfer by deed.--Subject to paragraph (2) of this 
        subsection and section 120(h) of the Comprehensive 
        Environmental Response, Compensation, and Liability Act of 1980 
        (42 U.S.C. 9620(h)), the Secretary may enter into an agreement 
        to transfer by deed a facility of the Veterans Health 
        Administration with any person who agrees to perform all 
        environmental restoration, waste management, and environmental 
        compliance activities that are required for the property or 
        facilities under Federal and State laws, administrative 
        decisions, agreements (including schedules and milestones), and 
        concurrences.
            (B) Additional terms or conditions.--The Secretary may 
        require any additional terms and conditions in connection with 
        an agreement authorized by subparagraph (A) as the Secretary 
        considers appropriate to protect the interests of the United 
        States.
        (2) Limitation.--A transfer of a facility of the Veterans 
    Health Administration may be made under paragraph (1) only if the 
    Secretary certifies to Congress that--
            (A) the costs of all environmental restoration, waste 
        management, and environmental compliance activities otherwise 
        to be paid by the Secretary with respect to the facility of the 
        Veterans Health Administration are equal to or greater than the 
        fair market value of the property or facilities to be 
        transferred, as determined by the Secretary; or
            (B) if such costs are lower than the fair market value of 
        the facility of the Veterans Health Administration, the 
        recipient of such transfer agrees to pay the difference between 
        the fair market value and such costs.
        (3) Payment by the secretary for certain transfers.--In the 
    case of a facility of the Veterans Health Administration covered by 
    a certification under paragraph (2)(A), the Secretary may pay the 
    recipient of such facility an amount equal to the lesser of--
            (A) the amount by which the costs incurred by the recipient 
        of the facility of the Veterans Health Administration for all 
        environmental restoration, waste, management, and environmental 
        compliance activities with respect to such facility exceed the 
        fair market value of such property as specified in such 
        certification; or
            (B) the amount by which the costs (as determined by the 
        Secretary) that would otherwise have been incurred by the 
        Secretary for such restoration, management, and activities with 
        respect to such facility of the Veterans Health Administration 
        exceed the fair market value of property as so specified.
        (4) Disclosure.--As part of an agreement under paragraph (1), 
    the Secretary shall disclose to the person to whom the facility of 
    the Veterans Health Administration will be transferred any 
    information of the Secretary regarding the environmental 
    restoration, waste management, and environmental compliance 
    activities described in paragraph (1) that relate to the facility 
    of the Veterans Health Administration. The Secretary shall provide 
    such information before entering into the agreement.
        (5) Applicability of certain environmental laws.--Nothing in 
    this subsection shall be construed to modify, alter, or amend the 
    Comprehensive Environmental Response, Compensation, and Liability 
    Act of 1980 (42 U.S.C. 9601 et seq.) or the Solid Waste Disposal 
    Act (42 U.S.C. 6901 et seq.).
    SEC. 206. DEPARTMENT OF VETERANS AFFAIRS ASSET AND INFRASTRUCTURE 
      REVIEW ACCOUNT.
    (a) Establishment.--There is hereby established in the ledgers of 
the Treasury an account to be known as the ``Department of Veterans 
Affairs Asset and Infrastructure Review Account'' which shall be 
administered by the Secretary as a single account.
    (b) Credits to Account.--There shall be credited to the Account the 
following:
        (1) Funds authorized for and appropriated to the Account.
        (2) Proceeds received from the lease, transfer, or disposal of 
    any property at a facility of the Veterans Health Administration 
    closed or realigned under this subtitle.
    (c) Use of Account.--The Secretary may use the funds in the Account 
only for the following purposes:
        (1) To carry out this subtitle.
        (2) To cover property management and disposal costs incurred at 
    facilities of the Veterans Health Administration closed, 
    modernized, or realigned under this subtitle.
        (3) To cover costs associated with supervision, inspection, 
    overhead, engineering, and design of construction projects 
    undertaken under this subtitle, and subsequent claims, if any, 
    related to such activities.
        (4) Other purposes that the Secretary determines support the 
    mission and operations of the Department of Veterans Affairs.
    (d) Consolidated Budget Justification Display for Account.--
        (1) Consolidated budget information required.--The Secretary 
    shall establish a consolidated budget justification display in 
    support of the Account that for each fiscal year--
            (A) details the amount and nature of credits to, and 
        expenditures from, the Account during the preceding fiscal 
        year;
            (B) separately details the environmental remediation costs 
        associated with facility of the Veterans Health Administration 
        for which a budget request is made;
            (C) specifies the transfers into the Account and the 
        purposes for which these transferred funds will be further 
        obligated, to include caretaker and environment remediation 
        costs associated with each facility of the Veterans Health 
        Administration; and
            (D) details any intra-budget activity transfers within the 
        Account that exceeded $1,000,000 during the preceding fiscal 
        year or that are proposed for the next fiscal year and will 
        exceed $1,000,000.
        (2) Submission.--The Secretary shall include the information 
    required by paragraph (1) in the materials that the Secretary 
    submits to Congress in support of the budget for a fiscal year 
    submitted by the President pursuant to section 1105 of title 31, 
    United States Code.
    (e) Closure of Account; Treatment of Remaining Funds.--
        (1) Closure.--The Account shall be closed at the time and in 
    the manner provided for appropriation accounts under section 1555 
    of title 31, United States Code, except that unobligated funds 
    which remain in the Account upon closure shall be held by the 
    Secretary of the Treasury until transferred to the Secretary of 
    Veterans Affairs by law after the Committees on Veterans' Affairs 
    of the Senate and the House of Representatives receive the final 
    report transmitted under paragraph (2).
        (2) Final report.--No later than 60 days after the closure of 
    the Account under paragraph (1), the Secretary shall transmit to 
    the Committees on Veterans' Affairs of the Senate and the House of 
    Representatives and the Committees on Appropriations of the House 
    of Representatives and the Senate a report containing an accounting 
    of--
            (A) all the funds credited to and expended from the Account 
        or otherwise expended under this subtitle; and
            (B) any funds remaining in the Account.
    SEC. 207. CONGRESSIONAL CONSIDERATION OF COMMISSION REPORT.
    (a) Disapproval Resolution.--For purposes of this subtitle, the 
term ``joint resolution'' means only a joint resolution which is 
introduced within the 5-day period beginning on the date on which the 
President transmits the report to the Congress under section 203(d), 
and--
        (1) which does not have a preamble;
        (2) the matter after the resolving clause of which is as 
    follows: ``that Congress disapproves the recommendations of the VHA 
    Asset and Infrastructure Review Commission as submitted by the 
    President on ___'', the blank space being filled with the 
    appropriate date; and
        (3) the title of which is as follows: ``Joint resolution 
    disapproving the recommendations of the VHA Asset and 
    Infrastructure Review Commission.''.
    (b) Consideration in the House of Representatives.--
        (1) Reporting and discharge.--Any committee of the House of 
    Representatives to which a joint resolution is referred shall 
    report it to the House without amendment not later than 15 
    legislative days after the date of introduction thereof. If a 
    committee fails to report the joint resolution within that period, 
    the committee shall be discharged from further consideration of the 
    joint resolution.
        (2) Proceeding to consideration.--It shall be in order at any 
    time after the third legislative day after each committee 
    authorized to consider a joint resolution has reported or has been 
    discharged from consideration of a joint resolution, to move to 
    proceed to consider the joint resolution in the House. All points 
    of order against the motion are waived. Such a motion shall not be 
    in order after the House has disposed of a motion to proceed on a 
    joint resolution addressing a particular submission. The previous 
    question shall be considered as ordered on the motion to its 
    adoption without intervening motion. The motion shall not be 
    debatable. A motion to reconsider the vote by which the motion is 
    disposed of shall not be in order.
        (3) Consideration.--The joint resolution shall be considered as 
    read. All points of order against the joint resolution and against 
    its consideration are waived. The previous question shall be 
    considered as ordered on the joint resolution to its passage 
    without intervening motion except 2 hours of debate equally divided 
    and controlled by the proponent and an opponent. A motion to 
    reconsider the vote on passage of the joint resolution shall not be 
    in order.
    (c) Consideration in the Senate.--
        (1) Referral.--A joint resolution introduced in the Senate 
    shall be referred to the Committee on Veterans' Affairs.
        (2) Reporting and discharge.--Any committee of the Senate to 
    which a joint resolution is referred shall report it to the Senate 
    without amendment not later than 15 session days after the date of 
    introduction of a joint resolution described in subsection (a). If 
    a committee fails to report the joint resolution within that 
    period, the committee shall be discharged from further 
    consideration of the joint resolution and the joint resolution 
    shall be placed on the calendar.
        (3) Floor consideration.--
            (A) In general.--Notwithstanding Rule XXII of the Standing 
        Rules of the Senate, it is in order at any time after the third 
        session day on which the Committee on Veterans' Affairs has 
        reported or has been discharged from consideration of a joint 
        resolution described in subsection (a) (even though a previous 
        motion to the same effect has been disagreed to) to move to 
        proceed to the consideration of the joint resolution, and all 
        points of order against the joint resolution (and against 
        consideration of the joint resolution) are waived. The motion 
        to proceed is not debatable. The motion is not subject to a 
        motion to postpone. A motion to reconsider the vote by which 
        the motion is agreed to or disagreed to shall not be in order. 
        If a motion to proceed to the consideration of the resolution 
        is agreed to, the joint resolution shall remain the unfinished 
        business until disposed of.
            (B) Consideration.--Consideration of the joint resolution, 
        and on all debatable motions and appeals in connection 
        therewith, shall be limited to not more than 2 hours, which 
        shall be divided equally between the majority and minority 
        leaders or their designees. A motion further to limit debate is 
        in order and not debatable. An amendment to, or a motion to 
        postpone, or a motion to proceed to the consideration of other 
        business, or a motion to recommit the joint resolution is not 
        in order.
            (C) Vote on passage.--If the Senate has voted to proceed to 
        a joint resolution, the vote on passage of the joint resolution 
        shall occur immediately following the conclusion of 
        consideration of the joint resolution, and a single quorum call 
        at the conclusion of the debate if requested in accordance with 
        the rules of the Senate.
            (D) Rulings of the chair on procedure.--Appeals from the 
        decisions of the Chair relating to the application of the rules 
        of the Senate, as the case may be, to the procedure relating to 
        a joint resolution shall be decided without debate.
    (d) Amendment Not in Order.--A joint resolution of disapproval 
considered pursuant to this section shall not be subject to amendment 
in either the House of Representatives or the Senate.
    (e) Coordination With Action by Other House.--
        (1) In general.--If, before the passage by one House of the 
    joint resolution of that House, that House receives the joint 
    resolution from the other House, then the following procedures 
    shall apply:
            (A) The joint resolution of the other House shall not be 
        referred to a committee.
            (B) With respect to the joint resolution of the House 
        receiving the joint resolution--
                (i) the procedure in that House shall be the same as if 
            no joint resolution had been received from the other House; 
            but
                (ii) the vote on passage shall be on the joint 
            resolution of the other House.
        (2) Treatment of joint resolution of other house.--If the 
    Senate fails to introduce or consider a joint resolution under this 
    section, the joint resolution of the House shall be entitled to 
    expedited floor procedures under this section.
        (3) Treatment of companion measures.--If, following passage of 
    the joint resolution in the Senate, the Senate then receives the 
    companion measure from the House of Representatives, the companion 
    measure shall not be debatable.
    (f) Rules of the House of Representatives and Senate.--This section 
is enacted by Congress--
        (1) as an exercise of the rulemaking power of the Senate and 
    House of Representatives, respectively, and as such it is deemed a 
    part of the rules of each House, respectively, but applicable only 
    with respect to the procedure to be followed in that House in the 
    case of a joint resolution, and it supersedes other rules only to 
    the extent that it is inconsistent with such rules; and
        (2) with full recognition of the constitutional right of either 
    House to change the rules (so far as relating to the procedure of 
    that House) at any time, in the same manner, and to the same extent 
    as in the case of any other rule of that House.
    SEC. 208. OTHER MATTERS.
    (a) Online Publication of Communications.--
        (1) In general.--Not later than 24 hours after the transmission 
    or receipt of any communication under this subtitle that is 
    transmitted or received by a party specified in paragraph (2), the 
    Secretary of Veterans Affairs shall publish such communication 
    online.
        (2) Parties specified.--The parties specified under this 
    paragraph are the following:
            (A) The Secretary of Veterans Affairs.
            (B) The Commission.
            (C) The President.
    (b) Continuation of Existing Construction Projects and Planning.--
During activities that the Commission, President, or Congress carry out 
under this subtitle, the Secretary of Veterans Affairs may not stop, 
solely because of such activities--
        (1) a construction or leasing project of the Veterans Health 
    Administration;
        (2) long term planning regarding infrastructure and assets of 
    the Veterans Health Administration; or
        (3) budgetary processes for the Veterans Health Administration.
    (c) Recommendations for Future Asset Reviews.--The Secretary of 
Veterans Affairs may, after consulting with veterans service 
organizations, include in budget submissions the Secretary submits 
after the termination of the Commission recommendations for future such 
commissions or other capital asset realignment and management 
processes.
    SEC. 209. DEFINITIONS.
    In this subtitle:
        (1) The term ``Account'' means the Department of Veterans 
    Affairs Asset and Infrastructure Review Account established by 
    section 206(a).
        (2) The term ``Commission'' means the Commission established by 
    section 202.
        (3) The term ``date of approval'', with respect to a 
    modernization or realignment of a facility of the Veterans Health 
    Administration, means the date on which the authority of Congress 
    to disapprove a recommendation of modernization or realignment, as 
    the case may be, of such facility under this subtitle expires.
        (4) The term ``facility of the Veterans Health 
    Administration''--
            (A) means any land, building, structure, or infrastructure 
        (including any medical center, nursing home, domiciliary 
        facility, outpatient clinic, center that provides readjustment 
        counseling, or leased facility) that is--
                (i) under the jurisdiction of the Department of 
            Veterans Affairs;
                (ii) under the control of the Veterans Health 
            Administration; and
                (iii) not under the control of the General Services 
            Administration; or
            (B) with respect to a colocated facility of the Department 
        of Veterans Affairs, includes any land, building, or 
        structure--
                (i) under the jurisdiction of the Department of 
            Veterans Affairs;
                (ii) under the control of another administration of the 
            Department of Veterans Affairs; and
                (iii) not under the control of the General Services 
            Administration.
        (5) The term ``infrastructure'' means improvements to land 
    other than buildings or structures.
        (6) The term ``modernization'' includes--
            (A) any action, including closure, required to align the 
        form and function of a facility of the Veterans Health 
        Administration to the provision of modern day health care, 
        including utilities and environmental control systems;
            (B) the construction, purchase, lease, or sharing of a 
        facility of the Veterans Health Administration; and
            (C) realignments, disposals, exchanges, collaborations 
        between the Department of Veterans Affairs and other Federal 
        entities, and strategic collaborations between the Department 
        and non-Federal entities, including tribal organizations.
        (7) The term ``realignment'', with respect to a facility of the 
    Veterans Health Administration, includes--
            (A) any action that changes the numbers of or relocates 
        services, functions, and personnel positions;
            (B) disposals or exchanges between the Department of 
        Veterans Affairs and other Federal entities, including the 
        Department of Defense; and
            (C) strategic collaborations between the Department of 
        Veterans Affairs and non-Federal entities, including tribal 
        organizations.
        (8) The term ``redevelopment authority'', in the case of a 
    facility of the Veterans Health Administration closed or modernized 
    under this subtitle, means any entity (including an entity 
    established by a State or local government) recognized by the 
    Secretary of Veterans Affairs as the entity responsible for 
    developing the redevelopment plan with respect to the facility or 
    for directing the implementation of such plan.
        (9) The term ``redevelopment plan'' in the case of a facility 
    of the Veterans Health Administration to be closed or realigned 
    under this subtitle, means a plan that--
            (A) is agreed to by the local redevelopment authority with 
        respect to the facility; and
            (B) provides for the reuse or redevelopment of the real 
        property and personal property of the facility that is 
        available for such reuse and redevelopment as a result of the 
        closure or realignment of the facility.
        (10) The term ``Secretary'' means the Secretary of Veterans 
    Affairs.
        (11) The term ``tribal organization'' has the meaning given 
    such term in section 3765 of title 38, United States Code.

                Subtitle B--Other Infrastructure Matters

    SEC. 211. IMPROVEMENT TO TRAINING OF CONSTRUCTION PERSONNEL.
    Subsection (g) of section 8103 of title 38, United States Code, is 
amended to read as follows:
    ``(g)(1)(A) Not later than September 30 of the fiscal year 
following the fiscal year during which the VA Asset and Infrastructure 
Review Act of 2018 is enacted, the Secretary shall implement the 
covered training curriculum and the covered certification program.
    ``(B) In designing and implementing the covered training curriculum 
and the covered certification program under paragraph (1), the 
Secretary shall use as models existing training curricula and 
certification programs that have been established under chapter 87 of 
title 10, United States Code, as determined relevant by the Secretary.
    ``(2) The Secretary may develop the training curriculum under 
paragraph (1)(A) in a manner that provides such training in any 
combination of--
        ``(A) training provided in person;
        ``(B) training provided over an internet website; or
        ``(C) training provided by another department or agency of the 
    Federal Government.
    ``(3) The Secretary may develop the certification program under 
paragraph (1)(A) in a manner that uses--
        ``(A) one level of certification; or
        ``(B) more than one level of certification, as determined 
    appropriate by the Secretary with respect to the level of 
    certification for different grades of the General Schedule.
    ``(4) The Secretary may enter into a contract with an appropriate 
entity to provide the covered training curriculum and the covered 
certification program under paragraph (1)(A).
    ``(5)(A) Not later than September 30 of the second fiscal year 
following the fiscal year during which the VA Asset and Infrastructure 
Review Act of 2018 is enacted, the Secretary shall ensure that the 
majority of employees subject to the covered certification program 
achieve the certification or the appropriate level of certification 
pursuant to paragraph (3), as the case may be.
    ``(B) After carrying out subparagraph (A), the Secretary shall 
ensure that each employee subject to the covered certification program 
achieves the certification or the appropriate level of certification 
pursuant to paragraph (3), as the case may be, as quickly as 
practicable.
    ``(6) In this subsection:
        ``(A) The term `covered certification program' means, with 
    respect to employees of the Department of Veterans Affairs who are 
    members of occupational series relating to construction or 
    facilities management, or employees of the Department who award or 
    administer contracts for major construction, minor construction, or 
    nonrecurring maintenance, including as contract specialists or 
    contracting officers' representatives, a program to certify 
    knowledge and skills relating to construction or facilities 
    management and to ensure that such employees maintain adequate 
    expertise relating to industry standards and best practices for the 
    acquisition of design and construction services.
        ``(B) The term `covered training curriculum' means, with 
    respect to employees specified in subparagraph (A), a training 
    curriculum relating to construction or facilities management.''.
    SEC. 212. REVIEW OF ENHANCED USE LEASES.
    Section 8162(b)(6) is amended to read as follows:
    ``(6) The Office of Management and Budget shall review each 
enhanced-use lease before the lease goes into effect to determine 
whether the lease is in compliance with paragraph (5).''.
    SEC. 213. ASSESSMENT OF HEALTH CARE FURNISHED BY THE DEPARTMENT TO 
      VETERANS WHO LIVE IN THE PACIFIC TERRITORIES.
    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall submit 
to the Committees on Veterans' Affairs of the Senate and the House of 
Representatives a report regarding health care furnished by the 
Department of Veterans Affairs to veterans who live in the Pacific 
territories.
    (b) Elements.--The report under subsection (a) shall include 
assessments of the following:
        (1) The ability of the Department to furnish to veterans who 
    live in the Pacific territories the following:
            (A) Hospital care.
            (B) Medical services.
            (C) Mental health services.
            (D) Geriatric services.
        (2) The feasibility of establishing a community-based 
    outpatient clinic of the Department in any Pacific territory that 
    does not contain such a facility.
    (c) Definition.--In this section, the term ``Pacific territories'' 
means American Samoa, Guam, and the Northern Mariana Islands.

  TITLE III--IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS

    SEC. 301. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS AND DENTISTS UNDER 
      DEPARTMENT OF VETERANS AFFAIRS HEALTH PROFESSIONAL SCHOLARSHIP 
      PROGRAM.
    (a) Scholarships for Physicians and Dentists.--Section 7612(b) of 
title 38, United States Code, is amended by adding at the end the 
following new paragraph:
    ``(6)(A) Of the scholarships awarded under this subchapter, the 
Secretary shall ensure that not less than 50 scholarships are awarded 
each year to individuals who are accepted for enrollment or enrolled 
(as described in section 7602 of this title) in a program of education 
or training leading to employment as a physician or dentist until such 
date as the Secretary determines that the staffing shortage of 
physicians and dentists in the Department is less than 500.
    ``(B) After such date, the Secretary shall ensure that of the 
scholarships awarded under this subchapter, a number of scholarships is 
awarded each year to individuals referred to in subparagraph (A) in an 
amount equal to not less than ten percent of the staffing shortage of 
physicians and dentists in the Department, as determined by the 
Secretary.
    ``(C) Notwithstanding subsection (c)(1), the agreement between the 
Secretary and a participant in the Scholarship Program who receives a 
scholarship pursuant to this paragraph shall provide the following:
        ``(i) The Secretary's agreement to provide the participant with 
    a scholarship under this subchapter for a specified number (from 
    two to four) of school years during which the participant is 
    pursuing a course of education or training leading to employment as 
    a physician or dentist.
        ``(ii) The participant's agreement to serve as a full-time 
    employee in the Veterans Health Administration for a period of time 
    (hereinafter in this subchapter referred to as the `period of 
    obligated service') of 18 months for each school year or part 
    thereof for which the participant was provided a scholarship under 
    the Scholarship Program.
    ``(D) In providing scholarships pursuant to this paragraph, the 
Secretary may provide a preference for applicants who are veterans.
    ``(E) On an annual basis, the Secretary shall provide to 
appropriate educational institutions informational material about the 
availability of scholarships under this paragraph.''.
    (b) Breach of Agreement.--Section 7617 of such title is amended--
        (1) by redesignating paragraphs (4) and (5) as paragraphs (5) 
    and (6), respectively; and
        (2) by inserting after paragraph (3) the following new 
    paragraph (4):
        ``(4) In the case of a participant who is enrolled in a program 
    or education or training leading to employment as a physician, the 
    participant fails to successfully complete post-graduate training 
    leading to eligibility for board certification in a specialty.''.
    (c) Extension of Program.--Section 7619 of such title is amended by 
striking ``December 31, 2019'' and inserting ``December 31, 2033''.
    SEC. 302. INCREASE IN MAXIMUM AMOUNT OF DEBT THAT MAY BE REDUCED 
      UNDER EDUCATION DEBT REDUCTION PROGRAM OF DEPARTMENT OF VETERANS 
      AFFAIRS.
    (a) Increase in Amount.--Section 7683(d)(1) is amended--
        (1) by striking ``$120,000'' and inserting ``$200,000''; and
        (2) by striking ``$24,000'' and inserting ``$40,000''.
    (b) Study.--
        (1) In general.--Not later than 1 year after the date of the 
    enactment of this Act, the Secretary of Veterans Affairs shall--
            (A) conduct a study on the demand for education debt 
        reduction under subchapter VII of chapter 76 of title 38, 
        United States Code; and
            (B) submit to the Committee on Veterans' Affairs of the 
        Senate and the Committee on Veterans' Affairs of the House of 
        Representatives a report on the findings of the Secretary with 
        respect to the study carried out under subparagraph (A).
        (2) Considerations.--In carrying out the study required by 
    paragraph (1)(A), the Secretary shall consider the following:
            (A) The total number of vacancies within the Veterans 
        Health Administration whose applicants are eligible to 
        participate in the Education Debt Reduction Program pursuant to 
        section 7682(a) of such title.
            (B) The types of medical professionals in greatest demand 
        in the United States.
            (C) Projections by the Secretary of the numbers and types 
        of medical professions that meet the needs of veterans.
    SEC. 303. ESTABLISHING THE DEPARTMENT OF VETERANS AFFAIRS SPECIALTY 
      EDUCATION LOAN REPAYMENT PROGRAM.
    (a) In General.--Chapter 76 of title 38, United States Code, is 
amended by inserting after subchapter VII the following new subchapter:

     ``SUBCHAPTER VIII--SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM

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

                    (I) by striking ``and'' after ``scholarship 
                amount,''; and
                    (II) by inserting ``, and the maximum specialty 
                education loan repayment amount'' after ``reduction 
                payments amount''; and

                (ii) in subsection (b) by adding at the end the 
            following new paragraph:
    ``(7) The term `specialty education loan repayment amount' means 
the maximum amount of specialty education loan repayment payments 
payable to or for a participant in the Department of Veterans Affairs 
Specialty Education Loan Repayment Program under subchapter VIII of 
this chapter, as specified in section 7694(c)(1) of this title and as 
previously adjusted (if at all) in accordance with this section.''.
            (E) Section 7632 of title 38, United States Code, is 
        amended--
                (i) in paragraph (1), by striking ``and the Education 
            Debt Reduction Program'' and inserting ``the Education Debt 
            Reduction Program, and the Specialty Education Loan 
            Repayment Program''; and
                (ii) in paragraph (4), by striking ``and per 
            participant in the Education Debt Reduction Program'' and 
            inserting ``per participant in the Education Debt Reduction 
            Program, and per participant in the Specialty Education 
            Loan Repayment Program''.
        (2) Table of sections.--The table of sections at the beginning 
    of chapter 76 of such title is amended by inserting after the items 
    relating to subchapter VII the following:

      ``subchapter viii--specialty education loan repayment program

``7691. Establishment.
``7692. Purpose.
``7693.  Eligibility; preferences; covered costs.
``7694. Specialty education loan repayment.
``7695. Choice of location.
``7696. Term of obligated service.
``7697. Relationship to Educational Assistance Program.''.

    (c) Needs of the VHA.--In making determinations each year under 
section 7692 of title 38, United States Code, as enacted by subsection 
(a), the Secretary of Veterans Affairs shall consider the anticipated 
needs of the Veterans Health Administration during the period 2 to 6 
years in the future.
    (d) Preference.--In granting preference under section 7693 of title 
38, United States Code, as enacted by subsection (a), the Secretary of 
Veterans Affairs shall determine whether a facility of the Department 
is underserved based on the criteria developed under section 401 of 
this Act.
    (e) Offer Deadline.--In the case of an applicant who applies before 
receiving a residency match and whom the Secretary of Veterans Affairs 
selects for participation in the Specialty Education Loan Repayment 
Program established by subsection (a), the Secretary shall offer 
participation to the applicant not later than 28 days after--
        (1) the applicant matches with a residency in a medical 
    specialty described in section 7692 of title 38, United States 
    Code, as enacted by subsection (a); and
        (2) such match is published.
    (f) Publicity.--The Secretary of Veterans Affairs shall take such 
steps as the Secretary determines are appropriate to publicize the 
Specialty Education Loan Repayment Program established under subchapter 
VIII of chapter 76 of title 38, United States Code, as enacted by 
subsection (a).
    SEC. 304. VETERANS HEALING VETERANS MEDICAL ACCESS AND SCHOLARSHIP 
      PROGRAM.
    (a) Establishment.--The Secretary of Veterans Affairs, acting 
through the Office of Academic Affiliations of the Department of 
Veterans Affairs, shall carry out a pilot program under which the 
Secretary shall provide funding for the medical education of a total of 
18 eligible veterans. Such funding shall be provided for two veterans 
enrolled in each covered medical schools in accordance with this 
section.
    (b) Eligible Veterans.--To be eligible to receive funding for 
medical education under this section, a veteran shall--
        (1) have been discharged from the Armed Forces not more than 10 
    years before the date of application for admission to a covered 
    medical school;
        (2) not be entitled to educational assistance under chapter 30, 
    31, 32, 33, 34, or 35 of title 38, United States Code, or chapter 
    1606 or 1607 of title 10, United States Code;
        (3) apply for admission to a covered medical school for the 
    entering class of 2019;
        (4) indicate on such application for admission that the veteran 
    would like to be considered for an award of funding under this 
    section;
        (5) meet the minimum admissions criteria for the covered 
    medical school to which the veteran applies; and
        (6) enter into an agreement described in subsection (e).
    (c) Award of Funding.--
        (1) In general.--Each covered medical school that opts to 
    participate in the program under this section shall reserve two 
    seats in the entering class of 2019 for eligible veterans who 
    receive funding under such program. Such funding shall be awarded 
    to the two eligible veterans with the highest admissions rankings 
    for such class at such school.
        (2) Amount of funding.--Each eligible veteran who receives 
    funding under this section shall receive an amount equal to the 
    actual cost of--
            (A) tuition at the covered medical school at which the 
        veteran enrolls for 4 years;
            (B) books, fees, and technical equipment;
            (C) fees associated with the National Residency Match 
        Program;
            (D) two away rotations performed during the fourth year at 
        a Department of Veterans Affairs medical facility; and
            (E) a monthly stipend for the 4-year period during which 
        the veteran is enrolled in medical school in an amount to be 
        determined by the Secretary.
        (3) Distribution of funding.--In the event that two or more 
    eligible veterans do not apply for admission at one of the covered 
    medical schools for the entering class of 2019, the Secretary shall 
    distribute the available funding to eligible veterans who applied 
    for admission at other covered medical schools.
    (d) Agreement.--
        (1) Terms of agreement.--Each eligible veteran who accepts 
    funding for medical education under this section shall enter into 
    an agreement with the Secretary that provides that the veteran 
    agrees--
            (A) to maintain enrollment and attendance in the medical 
        school;
            (B) while enrolled in such medical school, to maintain an 
        acceptable level of academic standing (as determined by the 
        medical school under regulations prescribed by the Secretary);
            (C) to complete post-graduate training leading to 
        eligibility for board certification in a speciality applicable 
        to the Department of Veterans Affairs, as determined by the 
        Secretary;
            (D) after completion of medical school, to obtain a license 
        to practice medicine in a State; and
            (E) after completion of medical school and post-graduate 
        training, to serve as a full-time clinical practice employee in 
        the Veterans Health Administration for a period of 4 years.
        (2) Breach of agreement.--If an eligible veteran who accepts 
    funding under this section breaches the terms of the agreement 
    described in paragraph (1), the United States shall be entitled to 
    recover damages in an amount equal to the total amount of such 
    funding received by the veteran.
    (e) Rule of Construction.--Nothing in this section shall be 
construed to prevent any covered medical school from accepting more 
than two eligible veterans for the entering class of 2019.
    (f) Report to Congress.--Not later than December 31, 2020, and 
annually thereafter for the subsequent 3 years, the Secretary shall 
submit to Congress a report on the pilot program under this section. 
Such report shall include the evaluation of the Secretary of the 
success of the pilot program, including the number of veterans who 
received funding under the program who matriculated and an evaluation 
of the academic progress of such veterans.
    (g) Covered Medical Schools.--In this section, the term ``covered 
medical school'' means any of the following:
        (1) The Teague-Cranston medical schools, consisting of--
            (A) Texas A&M College of Medicine;
            (B) Quillen College of Medicine at East Tennessee State 
        University;
            (C) Boonshoft School of Medicine at Wright State 
        University;
            (D) Joan C. Edwards School of Medicine at Marshall 
        University; and
            (E) University of South Carolina School of Medicine.
        (2) Charles R Drew University of Medicine and Science.
        (3) Howard University College of Medicine.
        (4) Meharry Medical College.
        (5) Morehouse School of Medicine.
    SEC. 305. BONUSES FOR RECRUITMENT, RELOCATION, AND RETENTION.
    Section 705(a) of the Veterans Access, Choice, and Accountability 
Act of 2014 (Public Law 113-146; 38 U.S.C. 703 note) is amended--
        (1) in paragraph (1), by striking ``$230,000,000'' and 
    inserting ``$250,000,000, of which not less than $20,000,000 shall 
    be for recruitment, relocation, and retention bonuses''; and
        (2) in paragraph (2), by striking ``$225,000,000'' and 
    inserting ``$290,000,000, of which not less than $20,000,000 shall 
    be for recruitment, relocation, and retention bonuses''.
    SEC. 306. INCLUSION OF VET CENTER EMPLOYEES IN EDUCATION DEBT 
      REDUCTION PROGRAM OF DEPARTMENT OF VETERANS AFFAIRS.
    (a) In General.--The Secretary of Veterans Affairs shall ensure 
that clinical staff working at Vet Centers are eligible to participate 
in the Education Debt Reduction Program of the Department of Veterans 
Affairs under subchapter VII of chapter 76 of title 38, United States 
Code.
    (b) Report.--Not later than 1 year after the date of the enactment 
of this Act, the Secretary shall submit to the Committee on Veterans' 
Affairs of the Senate and the Committee on Veterans' Affairs of the 
House of Representatives a report on the number of participants in the 
Education Debt Reduction Program of the Department under such 
subchapter who work at Vet Centers.
    (c) Vet Center Defined.--In this section, the term ``Vet Center'' 
has the meaning given that term in section 1712A(h) of title 38, United 
States Code.

               TITLE IV--HEALTH CARE IN UNDERSERVED AREAS

    SEC. 401. DEVELOPMENT OF CRITERIA FOR DESIGNATION OF CERTAIN 
      MEDICAL FACILITIES OF THE DEPARTMENT OF VETERANS AFFAIRS AS 
      UNDERSERVED FACILITIES AND PLAN TO ADDRESS PROBLEM OF UNDERSERVED 
      FACILITIES.
    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall develop 
criteria to designate medical centers, ambulatory care facilities, and 
community based outpatient clinics of the Department of Veterans 
Affairs as underserved facilities.
    (b) Consideration.--Criteria developed under subsection (a) shall 
include consideration of the following with respect to a facility:
        (1) The ratio of veterans to health care providers of the 
    Department of Veterans Affairs for a standardized geographic area 
    surrounding the facility, including a separate ratio for general 
    practitioners and specialists.
        (2) The range of clinical specialties covered by such providers 
    in such area.
        (3) Whether the local community is medically underserved.
        (4) The type, number, and age of open consults.
        (5) Whether the facility is meeting the wait-time goals of the 
    Department.
        (6) Such other criteria as the Secretary considers important in 
    determining which facilities are not adequately serving area 
    veterans.
    (c) Analysis of Facilities.--Not less frequently than annually, 
directors of Veterans Integrated Service Networks of the Department 
shall perform an analysis to determine which facilities within that 
Veterans Integrated Service Network qualify as underserved facilities 
pursuant to criteria developed under subsection (a).
    (d) Annual Plan To Address Underserved Facilities.--
        (1) Plan required.--Not later than 1 year after the date of the 
    enactment of this Act and not less frequently than once each year, 
    the Secretary shall submit to Congress a plan to address the 
    problem of underserved facilities of the Department, as designated 
    pursuant to criteria developed under subsection (a).
        (2) Contents.--Each plan submitted under paragraph (1) shall 
    address the following:
            (A) Increasing personnel or temporary personnel assistance, 
        including mobile deployment teams furnished under section 407 
        of this Act.
            (B) Providing special hiring incentives, including under 
        the Education Debt Reduction Program under subchapter VII of 
        chapter 76 of title 38, United States Code, and recruitment, 
        relocation, and retention incentives.
            (C) Using direct hiring authority.
            (D) Improving training opportunities for staff.
            (E) Such other actions as the Secretary considers 
        appropriate.
    SEC. 402. PILOT PROGRAM TO FURNISH MOBILE DEPLOYMENT TEAMS TO 
      UNDERSERVED FACILITIES.
    (a) In General.--The Secretary of Veterans Affairs shall carry out 
a pilot program to furnish mobile deployment teams of medical personnel 
to underserved facilities.
    (b) Elements.--In furnishing mobile deployment teams under 
subsection (a), the Secretary shall consider the following elements:
        (1) The medical positions of greatest need at underserved 
    facilities.
        (2) The size and composition of teams to be deployed.
        (3) Such other elements as the Secretary considers necessary 
    for effective oversight of the program established under subsection 
    (a).
    (c) Use of Annual Analysis.--The Secretary shall use the results of 
the annual analysis conducted under section 401(c) of this Act to form 
mobile deployment teams under subsection (a) that are composed of the 
most needed medical personnel for underserved facilities.
    (d) Reporting.--
        (1) Progress report.--Not later than 1 year after the date of 
    the enactment of this Act, the Secretary shall submit a report to 
    Congress on the implementation of the pilot program under this 
    section.
        (2) Final report.--Not later than the termination of the pilot 
    program under this section, the Secretary shall submit a final 
    report to Congress that contains the recommendations of the 
    Secretary regarding the feasibility and advisability of--
            (A) extending or expanding the pilot program; and
            (B) making the pilot program (or any aspect thereof) 
        permanent.
    (e) Duration.--The pilot program under this section shall terminate 
3 years after the date of the enactment of this Act.
    (f) Underserved Facility Defined.--In this section, the term 
``underserved facility'' means a medical center, ambulatory care 
facility, or community based outpatient clinic of the Department of 
Veterans Affairs designated by the Secretary of Veterans Affairs as 
underserved pursuant to criteria developed under section 401 of this 
Act.
    SEC. 403. PILOT PROGRAM ON GRADUATE MEDICAL EDUCATION AND 
      RESIDENCY.
    (a) Establishment.--
        (1) In general.--Subject to paragraph (5), the Secretary of 
    Veterans Affairs shall establish a pilot program to establish 
    medical residency positions authorized under section 301(b)(2) of 
    the Veterans Access, Choice, and Accountability Act of 2014 (Public 
    Law 113-146; 38 U.S.C. 7302 note) at covered facilities.
        (2) Covered facilities.--For purposes of this section, a 
    covered facility is any of the following:
            (A) A health care facility of the Department of Veterans 
        Affairs.
            (B) A health care facility operated by an Indian tribe or a 
        tribal organization, as those terms are defined in section 4 of 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 5304).
            (C) A health care facility operated by the Indian Health 
        Service.
            (D) A Federally-qualified health center, as defined in 
        section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
        1396d(l)(2)(B)).
            (E) A health care facility operated by the Department of 
        Defense.
            (F) Such other health care facility as the Secretary 
        considers appropriate for purposes of this section.
        (3) Agreements.--To carry out the pilot program under this 
    section, the Secretary may enter into agreements with entities that 
    operate covered facilities in which the Secretary places residents 
    under paragraph (1).
        (4) Parameters for location, affiliate sponsor, and duration.--
    When determining in which covered facilities to place residents 
    under paragraph (1), the Secretary shall consider the extent to 
    which there is a clinical need for providers in an area, as 
    determined by the following:
            (A) The ratio of veterans to health care providers of the 
        Department for a standardized geographic area surrounding a 
        facility, including a separate ratio for general practitioners 
        and specialists.
            (B) The range of clinical specialties of providers in 
        standardized geographic areas surrounding a facility.
            (C) Whether the specialty of a provider is included in the 
        most recent staffing shortage determination of the Department 
        under section 7412 of title 38, United States Code.
            (D) Whether the local community is designated by the 
        Secretary of Veterans Affairs as underserved pursuant to 
        criteria developed under section 401 of this Act.
            (E) Whether the facility is located in a community that is 
        designated by the Secretary of Health and Human Services as a 
        health professional shortage area under section 332 of the 
        Public Health Service Act (42 U.S.C. 254e).
            (F) Whether the facility is located in a rural or remote 
        area.
            (G) Such other criteria as the Secretary considers 
        important in determining which facilities are not adequately 
        serving area veterans.
        (5) Priority in placements.--During the pilot program under 
    this section, the Secretary shall place no fewer than 100 residents 
    in covered facilities--
            (A) operated by the Indian Health Service;
            (B) operated by an Indian tribe;
            (C) operated by a tribal organization; or
            (D) located in communities designated by the Secretary as 
        underserved pursuant to criteria developed under section 401 of 
        this Act.
        (6) Stipends and benefits.--The Secretary may pay stipends and 
    provide benefits for residents in positions under paragraph (1), 
    regardless of whether they have been assigned in a Department 
    facility.
    (b) Reimbursement.--If a covered facility establishes a new 
residency program in which the Secretary places a resident under the 
pilot program, the Secretary shall reimburse that covered facility for 
costs of the following:
        (1) Curriculum development.
        (2) Recruitment and retention of faculty.
        (3) Accreditation of the program by the Accreditation Council 
    for Graduate Medical Education.
        (4) The portion of faculty salaries attributable to duties 
    under an agreement subsection (a)(3).
        (5) Expenses relating to educating a resident under the pilot 
    program.
    (c) Reporting.--
        (1) In general.--Not later than 1 year after the date of the 
    enactment of this Act and not less frequently than once each year 
    thereafter until the termination of the pilot program, the 
    Secretary shall submit to Congress a report on the implementation 
    of the pilot program.
        (2) Elements.--Each report submitted under paragraph (1) shall 
    include the following with regard to the immediately preceding 
    year, and in comparison to the year immediately preceding that 
    year:
            (A) The number of veterans who received care from residents 
        under the pilot program.
            (B) The number of veterans who received care from each 
        resident per position described in subsection (a)(1) under the 
        pilot program.
            (C) The number of veterans who received care from residents 
        under the pilot program expressed as a percentage of all 
        individuals who received care from such residents.
            (D) The number of clinical appointments for veterans 
        conducted by each resident under the pilot program.
            (E) The number of clinical appointments for veterans 
        conducted by residents per position described in subsection 
        (a)(1) under the pilot program.
            (F) The number of clinical appointments for veterans 
        expressed as a percentage of all clinical appointments 
        conducted by residents under the pilot program.
            (G) The number of positions described in subsection (a)(1) 
        at each covered facility under the pilot program.
            (H) For each position described in subsection (a)(1) in a 
        residency program affiliated with a health care facility of the 
        Department, the time a resident under the pilot program spent 
        training at that facility of the Department, expressed as a 
        percentage of the total training time for that resident 
        position.
            (I) For each residency program affiliated with a health 
        care facility of the Department, the time all residents under 
        the pilot program spent training at that facility of the 
        Department, expressed as a percentage of the total training 
        time for those residents.
            (J) The time that all residents under the pilot program who 
        are assigned to programs affiliated with health care facilities 
        of the Department spent training at facilities of the 
        Department, expressed as a percentage of the total training 
        time for those residents.
            (K) The cost to the Department of Veterans Affairs under 
        the pilot program in the year immediately preceding the report 
        and since the beginning of the pilot program.
            (L) The cost to the Department of Veterans Affairs per 
        resident placed under the pilot program at each covered 
        facility.
            (M) The number of residents under the pilot program hired 
        by the Secretary to work in the Veterans Health Administration 
        after completion of residency in the year immediately preceding 
        the report and since the beginning of the pilot program.
            (N) The medical specialties pursued by residents under the 
        pilot program.
    (d) Duration.--The pilot program under this section shall terminate 
on August 7, 2024.

                         TITLE V--OTHER MATTERS

    SEC. 501. ANNUAL REPORT ON PERFORMANCE AWARDS AND BONUSES AWARDED 
      TO CERTAIN HIGH-LEVEL EMPLOYEES OF THE DEPARTMENT.
    (a) In General.--Chapter 7 of title 38, United States Code, is 
amended by adding at the end the following new section:
``Sec. 726. Annual report on performance awards and bonuses awarded to 
   certain high-level employees
    ``(a) In General.--Not later than 100 days after the end of each 
fiscal year, the Secretary shall submit to the appropriate committees 
of Congress a report that contains, for the most recent fiscal year 
ending before the submittal of the report, a description of all 
performance awards or bonuses awarded to each of the following:
        ``(1) Regional Office Director of the Department.
        ``(2) Director of a Medical Center of the Department.
        ``(3) Director of a Veterans Integrated Service Network.
        ``(4) Senior executive of the Department.
    ``(b) Elements.--Each report submitted under subsection (a) shall 
include the following with respect to each performance award or bonus 
awarded to an individual described in such subsection:
        ``(1) The amount of each award or bonus.
        ``(2) The job title of the individual awarded the award or 
    bonus.
        ``(3) The location where the individual awarded the award or 
    bonus works.
    ``(c) Definitions.--In this section:
        ``(1) The term `appropriate committees of Congress' means the 
    Committees on Veterans' Affairs and Appropriations of the Senate 
    and House of Representatives.
        ``(2) The term `senior executive' means--
            ``(A) a career appointee; or
            ``(B) an individual--
                ``(i) in an administrative or executive position; and
                ``(ii) appointed under section 7306(a) or section 
            7401(1) of this title.
        ``(3) The term `career appointee' has the meaning given that 
    term in section 3132(a) of title 5, United States Code.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such chapter is amended by inserting after the item relating to section 
725 the following new item:

``726. Annual report on performance awards and bonuses awarded to 
          certain high-level employees.''.
    SEC. 502. ROLE OF PODIATRISTS IN DEPARTMENT OF VETERANS AFFAIRS.
    (a) Inclusion as Physician.--
        (1) In general.--Subchapter I of chapter 74 is amended by 
    adding at the end the following new section:
``Sec. 7413. Treatment of podiatrists; clinical oversight standards
    ``(a) Podiatrists.--Except as provided by subsection (b), a doctor 
of podiatric medicine who is appointed as a podiatrist under section 
7401(1) of this title is eligible for any supervisory position in the 
Veterans Health Administration to the same degree that a physician 
appointed under such section is eligible for the position.
    ``(b) Establishment of Clinical Oversight Standards.--The 
Secretary, in consultation with appropriate stakeholders, shall 
establish standards to ensure that specialists appointed in the 
Veterans Health Administration to supervisory positions do not provide 
direct clinical oversight for purposes of peer review or practice 
evaluation for providers of other clinical specialties.''.
        (2) Clerical amendment.--The table of sections at the beginning 
    of chapter 74 is amended by inserting after the item relating to 
    section 7412 the following new item:

``7413. Treatment of podiatrists; clinical oversight standards.''.

    (b) Modification and Clarification of Pay Grade.--
        (1) Grade.--The list in section 7404(b) of such title is 
    amended--
            (A) by striking ``PHYSICIAN AND DENTIST SCHEDULE'' and 
        inserting ``PHYSICIAN AND SURGEON (MD/DO), PODIATRIC SURGEON 
        (DPM), AND DENTIST AND ORAL SURGEON (DDS, DMD) SCHEDULE'';
            (B) by striking ``Physician grade'' and inserting 
        ``Physician and surgeon grade''; and
            (C) by striking ``PODIATRIST, CHIROPRACTOR, AND'' and 
        inserting ``CHIROPRACTOR AND''.
        (2) Application.--The amendments made by paragraph (1) shall 
    apply with respect to a pay period of the Department of Veterans 
    Affairs beginning on or after the date that is 30 days after the 
    date of the enactment of this Act.
    SEC. 503. DEFINITION OF MAJOR MEDICAL FACILITY PROJECT.
    (a) Modification of Definition of Medical Facility.--Section 
8101(3) is amended by striking ``Secretary'' and all that follows 
through ``nursing home,'' and inserting ``Secretary, or as otherwise 
authorized by law, for the provision of health-care services (including 
hospital, outpatient clinic, nursing home,''.
    (b) Modification of Definition of Major Medical Facility Project.--
Paragraph (3) of section 8104(a) is amended to read as follows:
    ``(3) For purposes of this subsection, the term `major medical 
facility project' means a project for the construction, alteration, or 
acquisition of a medical facility involving a total expenditure of more 
than $20,000,000, but such term does not include an acquisition by 
exchange, nonrecurring maintenance projects of the Department, or the 
construction, alteration, or acquisition of a shared Federal medical 
facility for which the Department's estimated share of the project 
costs does not exceed $20,000,000.''.
    SEC. 504. AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY PROJECTS 
      OF THE DEPARTMENT OF VETERANS AFFAIRS.
    (a) Authorization.--The Secretary of Veterans Affairs may carry out 
the following major medical facility project, to be carried out in an 
amount not to exceed the amount specified for that project: 
Construction of the new East Bay Community Based Outpatient Clinic and 
all associated site work, utilities, parking, and landscaping, 
construction of the Central Valley Engineering and Logistics support 
facility, and enhanced flood plain mitigation at the Central Valley and 
East Bay Community Based Outpatient Clinics as part of the realignment 
of medical facilities in Livermore, California, in an amount not to 
exceed $117,300,000.
    (b) Authorization of Appropriations for Construction.--There is 
authorized to be appropriated to the Secretary of Veterans Affairs for 
fiscal year 2018 or the year in which funds are appropriated for the 
Construction, Major Projects account, $117,300,000 for the project 
authorized in subsection (a).
    (c) Submittal of Information.--Not later than 90 days after the 
date of the enactment of this Act, for the project authorized in 
subsection (a), the Secretary of Veterans Affairs shall submit to the 
Committee on Veterans' Affairs of the Senate and the Committee on 
Veterans' Affairs of the House of Representatives the following 
information:
        (1) A line item accounting of expenditures relating to 
    construction management carried out by the Department of Veterans 
    Affairs for such project.
        (2) The future amounts that are budgeted to be obligated for 
    construction management carried out by the Department for such 
    project.
        (3) A justification for the expenditures described in paragraph 
    (1) and the future amounts described in paragraph (2).
        (4) Any agreement entered into by the Secretary regarding a 
    non-Department of Veterans Affairs Federal entity providing 
    management services relating to such project, including 
    reimbursement agreements and the costs to the Department for such 
    services.
    SEC. 505. DEPARTMENT OF VETERANS AFFAIRS PERSONNEL TRANSPARENCY.
    (a) Publication of Staffing and Vacancies.--
        (1) Website required.--Subject to paragraph (2) and not later 
    than 90 days after the date of the enactment of this Act, the 
    Secretary of Veterans Affairs shall make publicly available on an 
    Internet website of the Department of Veterans Affairs the 
    following information, which shall, subject to subparagraph (D), be 
    displayed by departmental component or, in the case of information 
    relating to Veterans Health Administration positions, by medical 
    facility:
            (A) The number of personnel encumbering positions.
            (B) The number of accessions and separation actions 
        processed during the quarter preceding the date of the 
        publication of the information.
            (C) The number of vacancies, by occupation.
            (D) The percentage of new hires for the Department who were 
        hired within the time-to-hire target of the Office of Personnel 
        Management, disaggregated by administration.
        (2) Exceptions.--The Secretary may withhold from publication 
    under paragraph (1) information relating to law enforcement, 
    information security, or such positions in the Department that the 
    Secretary determines to be sensitive.
        (3) Update of information.--The Secretary shall update the 
    information on the website required under paragraph (1) on a 
    quarterly basis.
        (4) Treatment of contractor positions.--Any Department of 
    Veterans Affairs position that is filled with a contractor may not 
    be treated as a Department position for purposes of the information 
    required to be published under paragraph (1).
        (5) Inspector general review.--On a semi-annual basis, the 
    Inspector General of the Department shall review the administration 
    of the website required under paragraph (1) and make 
    recommendations relating to the improvement of such administration.
    (b) Report to Congress.--The Secretary of Veterans Affairs shall 
submit to Congress an annual report on the steps the Department is 
taking to achieve full staffing capacity. Each such report shall 
include the amount of additional funds necessary to enable the 
Department to reach full staffing capacity.
    SEC. 506. PROGRAM ON ESTABLISHMENT OF PEER SPECIALISTS IN PATIENT 
      ALIGNED CARE TEAM SETTINGS WITHIN MEDICAL CENTERS OF DEPARTMENT 
      OF VETERANS AFFAIRS.
    (a) Program Required.--The Secretary of Veterans Affairs shall 
carry out a program to establish not fewer than two peer specialists in 
patient aligned care teams at medical centers of the Department of 
Veterans Affairs to promote the use and integration of services for 
mental health, substance use disorder, and behavioral health in a 
primary care setting.
    (b) Timeframe for Establishment of Program.--The Secretary shall 
carry out the program at medical centers of the Department as follows:
        (1) Not later than May 31, 2019, at not fewer than 15 medical 
    centers of the Department.
        (2) Not later than May 31, 2020, at not fewer than 30 medical 
    centers of the Department.
    (c) Selection of Locations.--
        (1) In general.--The Secretary shall select medical centers for 
    the program as follows:
            (A) Not fewer than five shall be medical centers of the 
        Department that are designated by the Secretary as polytrauma 
        centers.
            (B) Not fewer than 10 shall be medical centers of the 
        Department that are not designated by the Secretary as 
        polytrauma centers.
        (2) Considerations.--In selecting medical centers for the 
    program under paragraph (1), the Secretary shall consider the 
    feasibility and advisability of selecting medical centers in the 
    following areas:
            (A) Rural areas and other areas that are underserved by the 
        Department.
            (B) Areas that are not in close proximity to an active duty 
        military installation.
            (C) Areas representing different geographic locations, such 
        as census tracts established by the Bureau of the Census.
    (d) Gender-Specific Services.--In carrying out the program at each 
location selected under subsection (c), the Secretary shall ensure 
that--
        (1) the needs of female veterans are specifically considered 
    and addressed; and
        (2) female peer specialists are made available to female 
    veterans who are treated at each location.
    (e) Engagement With Community Providers.--At each location selected 
under subsection (c), the Secretary shall consider ways in which peer 
specialists can conduct outreach to health care providers in the 
community who are known to be serving veterans to engage with those 
providers and veterans served by those providers.
    (f) Reports.--
        (1) Periodic reports.--
            (A) In general.--Not later than 180 days after the date of 
        the enactment of this Act, and not less frequently than once 
        every 180 days thereafter until the Secretary determines that 
        the program is being carried out at the last location to be 
        selected under subsection (c), the Secretary shall submit to 
        Congress a report on the program.
            (B) Elements.--Each report required by subparagraph (A) 
        shall, with respect to the 180-day period preceding the 
        submittal of the report, include the following:
                (i) The findings and conclusions of the Secretary with 
            respect to the program.
                (ii) An assessment of the benefits of the program to 
            veterans and family members of veterans.
                (iii) An assessment of the effectiveness of peer 
            specialists in engaging under subsection (e) with health 
            care providers in the community and veterans served by 
            those providers.
        (2) Final report.--Not later than 180 days after the Secretary 
    determines that the program is being carried out at the last 
    location to be selected under subsection (c), the Secretary shall 
    submit to Congress a report detailing the recommendations of the 
    Secretary as to the feasibility and advisability of expanding the 
    program to additional locations.
    SEC. 507. DEPARTMENT OF VETERANS AFFAIRS MEDICAL SCRIBE PILOT 
      PROGRAM.
    (a) In General.--The Secretary of Veterans Affairs shall carry out 
a 2-year pilot program under which the Secretary shall increase the use 
of medical scribes at Department of Veterans Affairs medical centers.
    (b) Locations.--The Secretary shall carry out the pilot program at 
the 10 medical centers of the Department as follows:
        (1) At least four such medical centers located in rural areas.
        (2) At least four such medical centers located in urban areas.
        (3) Two such medical centers located in areas with need for 
    increased access or increased efficiency, as determine by the 
    Secretary.
    (c) Medical Scribes.--
        (1) Hiring.--Under the pilot program the Secretary shall--
            (A) hire 20 new Department of Veterans Affairs term 
        employees as medical scribes; and
            (B) seek to enter into contracts with appropriate entities 
        for the employment of 20 additional medical scribes.
        (2) Distribution.--The Secretary shall assign four medical 
    scribes to each of the 10 medical centers of the Department where 
    the Secretary carries out the pilot program as follows:
            (A) Two scribes shall be assigned to each of two 
        physicians.
            (B) Thirty percent of the scribes shall be employed in the 
        provision of emergency care.
            (C) Seventy percent of the scribes shall be employed in the 
        provision of speciality care in specialties with the longest 
        patient wait times or lowest efficiency ratings, as determined 
        by the Secretary.
    (d) Reports.--
        (1) Reports to congress.--Not later than 180 days after the 
    commencement of the pilot program required under this section, and 
    every 180 days thereafter for the duration of the pilot program, 
    the Secretary of Veterans Affairs shall submit to Congress a report 
    on the pilot program. Each such report shall include each of the 
    following:
            (A) A separate analysis of each the following with respect 
        to medical scribes employed by the Department of Veterans 
        Affairs and medical scribes performing Department of Veterans 
        Affairs functions under a contract:
                (i) Provider efficiency.
                (ii) Patient satisfaction.
                (iii) Average wait time.
                (iv) The number of patients seen per day by each 
            physician or practitioner.
                (v) The amount of time required to hire and train an 
            employee to perform medical scribe functions under the 
            pilot program.
            (B) Metrics and data for analyzing the effects of the pilot 
        program, including an evaluation of the each of the elements 
        under clauses (i) through (iv) of subparagraph (A) at medical 
        centers who employed scribes under the pilot program for an 
        appropriate period preceding the hiring of such scribes.
        (2) Comptroller general report.--Not later than 90 days after 
    the termination of the pilot program under this section, the 
    Comptroller General of the United States shall submit to Congress a 
    report on the pilot program. Such report shall include a comparison 
    of the pilot program with similar programs carried out in the 
    private sector.
    (e) Definitions.--In this section:
        (1) The term ``medical scribe'' means an unlicensed individual 
    hired to enter information into the electronic health record or 
    chart at the direction of a physician or licensed independent 
    practitioner whose responsibilities include the following:
            (A) Assisting the physician or practitioner in navigating 
        the electronic health record.
            (B) Responding to various messages as directed by the 
        physician or practitioner.
            (C) Entering information into the electronic health record, 
        as directed by the physician or practitioner.
        (2) The terms ``urban'' and ``rural'' have the meanings given 
    such terms under the rural-urban commuting codes developed by the 
    Secretary of Agriculture and the Secretary of Health and Human 
    Services.
    (f) Funding.--The pilot program under this section shall be carried 
out using amounts otherwise authorized to be appropriated for the 
Department of Veterans Affairs. No additional amounts are authorized to 
be appropriated to carry out such program.
    SEC. 508. EXTENSION OF REQUIREMENT TO COLLECT FEES FOR HOUSING 
      LOANS GUARANTEED BY SECRETARY OF VETERANS AFFAIRS.
    Section 3729(b)(2) of title 38, United States Code, is amended by 
striking ``2027'' each place it appears and inserting ``2028''.
    SEC. 509. EXTENSION OF REDUCTION IN AMOUNT OF PENSION FURNISHED BY 
      DEPARTMENT OF VETERANS AFFAIRS FOR CERTAIN VETERANS COVERED BY 
      MEDICAID PLANS FOR SERVICES FURNISHED BY NURSING FACILITIES.
    Section 5503(d)(7) of title 38, United States Code, is amended by 
striking ``September 30, 2027'' and inserting ``September 30, 2028''.
    SEC. 510. APPROPRIATION OF AMOUNTS.
    (a) Veterans Choice Program.--There is authorized to be 
appropriated, and is appropriated, to the Secretary of Veterans 
Affairs, out of any funds in the Treasury not otherwise appropriated, 
$5,200,000,000 to be deposited in the Veterans Choice Fund under 
section 802 of the Veterans Access, Choice, and Accountability Act of 
2014 (Public Law 113-146; 38 U.S.C. 1701 note).
    (b) Availability of Amounts.--The amounts appropriated under 
subsection (a) shall be available for obligation or expenditure without 
fiscal year limitation.
    SEC. 511. TECHNICAL CORRECTION.
    Section 1712I of title 38, United States Code, is redesignated as 
section 1720I of such title.
    SEC. 512. BUDGETARY EFFECTS.
    (a) Statutory Pay-As-You-Go Scorecards.--The budgetary effects of 
this Act shall not be entered on either PAYGO scorecard maintained 
pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.
    (b) Senate PAYGO Scorecards.--The budgetary effects of this Act 
shall not be entered on any PAYGO scorecard maintained for purposes of 
section 4106 of H. Con. Res. 71 (115th Congress).

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.