[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2906 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  2d Session
                                S. 2906

   To establish a permanent community care program for veterans, to 
 improve the recruitment of health care providers of the Department of 
 Veterans Affairs, to improve construction by the Department, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 22, 2018

Mr. Manchin (for himself, Mrs. McCaskill, Ms. Stabenow, Mr. Kaine, Mr. 
  Warner, Mr. Menendez, Mr. Donnelly, Ms. Harris, Ms. Klobuchar, Mr. 
Nelson, Mr. Van Hollen, Mrs. Murray, Mr. King, Mr. Jones, Mr. Schumer, 
  Mr. Brown, Ms. Baldwin, Mr. Durbin, Ms. Warren, Ms. Smith, and Mr. 
    Markey) introduced the following bill; which was read twice and 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
   To establish a permanent community care program for veterans, to 
 improve the recruitment of health care providers of the Department of 
 Veterans Affairs, to improve construction by the Department, 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 ``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.
Sec. 2. References to title 38, United States Code.
                    TITLE I--CARING FOR OUR VETERANS

Sec. 100. Short title.
      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--IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS

Sec. 201. Designated scholarships for physicians and dentists under 
                            Department of Veterans Affairs Health 
                            Professional Scholarship Program.
Sec. 202. Increase in maximum amount of debt that may be reduced under 
                            Education Debt Reduction Program of 
                            Department of Veterans Affairs.
Sec. 203. Establishing the Department of Veterans Affairs Specialty 
                            Education Loan Repayment Program.
Sec. 204. Veterans healing veterans medical access and scholarship 
                            program.
Sec. 205. Bonuses for recruitment, relocation, and retention.
Sec. 206. Inclusion of Vet Center employees in Education Debt Reduction 
                            Program of Department of Veterans Affairs.
              TITLE III--HEALTH CARE IN UNDERSERVED AREAS

Sec. 301. 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. 302. Pilot program to furnish mobile deployment teams to 
                            underserved facilities.
Sec. 303. Pilot program on graduate medical education and residency.
                    TITLE IV--INFRASTRUCTURE MATTERS

Sec. 401. Improvement to training of construction personnel.
Sec. 402. Review of enhanced use leases.
Sec. 403. Assessment of health care furnished by the Department to 
                            veterans who live in the Pacific 
                            territories.
                         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. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.

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

                    TITLE I--CARING FOR OUR VETERANS

SEC. 100. SHORT TITLE.

    This title may be cited as the ``Caring for Our Veterans Act of 
2018''.

      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 
                        two 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 of this title 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) Appeal by Veterans of Decisions of Secretary.--The review of 
any decision under subsection (d) or (e) shall be subject to the 
clinical appeals process of the Department, and such decisions may not 
be appealed to the Board of Veterans' Appeals.
    ``(g) Review of Determinations by Secretary.--The Secretary shall 
review a determination of the Secretary to furnish hospital care, 
medical services, or extended care services to a covered veteran under 
this section not later than the day that is--
            ``(1) one year after the date of such determination, in the 
        case of a determination under subsection (d); or
            ``(2) 180 days after the date of such determination, in the 
        case of a determination under subsection (e).
    ``(h) 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.
    ``(i) 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) To the extent practicable, the Secretary shall 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.
    ``(j) 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.
    ``(k) 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.
    ``(l) 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.
    ``(m) 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.
    ``(n) 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 the 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 
annually 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).
    ``(o) 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.
    ``(p) 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 one year after the date of 
        the enactment of this Act, the Secretary of Veterans Affairs 
        shall promulgate regulations to carry out section 1703 of title 
        38, United States Code, as amended by subsection (a).
            (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 not later than 120 days 
                after 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; 38 U.S.C. 1701 note).
            (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 those factors make the use of a facility of the Department or a 
contract or sharing agreement described in such subparagraph 
impracticable or inadvisable.
    ``(D) A Veterans Care Agreement may be entered into by the 
Secretary or any Department official authorized by the Secretary.
    ``(2)(A) Subject to subparagraph (B), the Secretary shall review 
each Veterans Care Agreement of material size, as determined by the 
Secretary or set forth in paragraph (3), for hospital care, a medical 
service, or an extended care service to determine whether it is 
feasible and advisable to provide such care or service within a 
facility of the Department or by contract or sharing agreement entered 
into pursuant to another provision of law and, if so, take action to do 
so.
    ``(B)(i) The Secretary shall review each Veterans Care Agreement of 
material size that has been in effect for at least six months within 
the first two years of its taking effect, and not less frequently than 
once every four years thereafter.
    ``(ii) If a Veterans Care Agreement has not been in effect for at 
least six months by the date of the review required by subparagraph 
(A), the agreement shall be reviewed during the next cycle required by 
subparagraph (A), and such review shall serve as its review within the 
first two 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) 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(j) 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.
    ``(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 related 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 this subchapter.
    ``(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) In General.--(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) 
of this title.
    ``(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.
    ``(b) Comparative Information.--The Secretary shall ensure that the 
access standards established under paragraph (1) provide covered 
veterans, employees of the Department, and health care providers in the 
network established under section 1703(i) of this title with relevant 
comparative information that is clear, useful, and timely, so that 
covered veterans can make informed decisions regarding their health 
care.
    ``(c) Consultation.--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 under this section.
    ``(d) Report.--(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 established under this section.
    ``(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 not later 
than 120 days after 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) Review of Standards.--Not later than three years after the 
date on which the Secretary establishes access standards under 
subsection (a) and not less frequently than once every three years 
thereafter, the Secretary shall--
            ``(1) conduct a review of such standards; and
            ``(2) submit to the appropriate committees of Congress a 
        report on the findings and any modification to the access 
        standards with respect to the review conducted under paragraph 
        (1).
    ``(f) Compliance With Standards.--The Secretary shall ensure health 
care providers specified under section 1703(c) of this title are able 
to comply with the applicable access standards established by the 
Secretary.
    ``(g) Publication of Standards.--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) of this title.
    ``(h) Request for Determination of Eligibility.--(1) Consistent 
with paragraphs (1)(D) and (3) of section 1703(d) of this title, 
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) 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 `covered veterans' means 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 two-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 under this section.
    ``(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 established under this section.
    ``(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 not later than 
120 days after 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 one 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 two 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) 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 `covered veterans' means 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) Frequency; Copayments.--(1) An eligible veteran may only 
access walk-in care under this section for not more than two episodes 
of hospital care or medical services per year.
    ``(2)(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.
    ``(C) The amount of the copayments required under this paragraph 
shall be prescribed by the Secretary by rule.
    ``(3) Section 8153(c) of this title shall not apply to this 
subsection.
    ``(g) Regulations.--Not later than one 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 related to section 
1725 the following new item:

``Sec. 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 
four years, the Secretary shall perform market area assessments 
regarding the health care services furnished under the laws 
administered by the Secretary.
    ``(2) Each market area assessment 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 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 this title, including the 
        number of providers, the geographic location of the providers, 
        and categories or types of health care services provided by the 
        providers.
            ``(D) An assessment obtained from other Federal direct 
        delivery systems of their capacity to provide health care to 
        veterans.
            ``(E) An assessment of the health care capacity of non-
        contracted providers where there is insufficient network 
        supply.
            ``(F) An assessment of the health care capacity of academic 
        affiliates and other collaborations of the Department as it 
        relates to providing health care to veterans.
            ``(G) An assessment of the effects on health care capacity 
        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; 
                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(i) 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) of this title.
    ``(b) Strategic Plan To Meet Health Care Demand.--(1) Not later 
than one year after the date of the enactment of the Caring for Our 
Veterans Act of 2018, and not less frequently than once every four 
years thereafter, the Secretary shall submit to the appropriate 
committees of Congress a strategic plan that specifies a four-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 two-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 of this title 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 a 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 
        such 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 related 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 Act, 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 of this Act, 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 one year after the 
date of the enactment of this Act, the Secretary of Veterans Affairs 
shall deny or revoke the eligibility of a health care provider to 
provide non-Department health care services to veterans if the 
Secretary determines that the health care provider--
            (1) was removed from employment with the Department of 
        Veterans Affairs due to conduct that violated a policy of the 
        Department relating to the delivery of safe and appropriate 
        health care; or
            (2) violated the requirements of a medical license of the 
        health care provider that resulted in the loss of such medical 
        license.
    (b) Permissive Action.--On and after the date that is one year 
after the date of the enactment of this Act, the Secretary may deny, 
revoke, or suspend the eligibility of a health care provider to provide 
non-Department health care services if the Secretary determines such 
action is necessary to immediately protect the health, safety, or 
welfare of veterans and the health care provider is under investigation 
by the medical licensing board of a State in which the health care 
provider is licensed or practices.
    (c) Suspension.--The Secretary shall suspend the eligibility of a 
health care provider to provide non-Department health care services to 
veterans if the health care provider is suspended from serving as a 
health care provider of the Department.
    (d) Comptroller General Report.--Not later than two years after the 
date of the enactment of this Act, the Comptroller General of the 
United States shall submit to Congress a report on the implementation 
by the Secretary of this section, including the following:
            (1) The aggregate number of health care providers denied or 
        suspended under this section from participation in providing 
        non-Department health care services.
            (2) An evaluation of any impact on access to health care 
        for patients or staffing shortages in programs of the 
        Department providing non-Department health care services.
            (3) An explanation of the coordination of the Department 
        with the medical licensing boards of States in implementing 
        this section, the amount of involvement of such boards in such 
        implementation, and efforts by the Department to address any 
        concerns raised by such boards with respect to such 
        implementation.
            (4) Such recommendations as the Comptroller General 
        considers appropriate regarding harmonizing eligibility 
        criteria between health care providers of the Department and 
        health care providers eligible to provide non-Department health 
        care services.
    (e) Non-Department Health Care Services Defined.--In this section, 
the term ``non-Department health care services'' means 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) of this title 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 subsection (a) 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 related 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 Act, the following 
new section:
``Sec. 1703D. Prompt payment standard
    ``(a) In General.--(1) Notwithstanding any other provision of this 
title or 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 title 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 related 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 Act, 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, as added by section 104 of 
                this Act;
            (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 title 38, United States Code, 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) of title 38, United States Code, as 
        amended by section 101 of this Act, and section 1703A(e)(2)(F) 
        of such title, as added by section 102 of this Act, 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 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 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 one 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 
such chapter 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 of Veterans Affairs 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 one 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 1703'' and inserting ``under chapter 
        17''.
            (3) Veterans' benefits improvements act of 1994.--Section 
        104(a)(4)(A) of the Veterans' Benefits Improvements Act of 1994 
        (Public Law 103-446; 38 U.S.C. 1117 note) is amended by 
        striking ``in section 1703'' and inserting ``in sections 1703A, 
        8111, and 8153''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date described in section 101(b).

   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 
such chapter 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 one 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 one-year period preceding the 
                submittal of the report.
                    (E) The number of appointments for the receipt of 
                telemedicine furnished by the Department that were 
                requested during such period, disaggregated by medical 
                facility.
                    (F) Savings by the Department, if any, including 
                travel costs, from furnishing health care through the 
                use of telemedicine during such period.

SEC. 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 section 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 not later than five 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 
describing in detail the following:
            ``(A) The specific authorities to be waived under the pilot 
        program.
            ``(B) The standard or standards to be used in the pilot 
        program in lieu of the waived authorities.
            ``(C) The reasons for such waiver or waivers.
            ``(D) A description of the metric or metrics the Secretary 
        will use to determine the effect of the waiver or waivers upon 
        the access to and quality, timeliness, or patient satisfaction 
        of care and services furnished through the pilot program.
            ``(E) The anticipated cost savings, if any, of the pilot 
        program.
            ``(F) The schedule for interim reports on the pilot program 
        describing the results of the pilot program so far and the 
        feasibility and advisability of continuing the pilot program.
            ``(G) The schedule for the termination of the pilot program 
        and the submission of a final report on the pilot program 
        describing the result of the pilot program and the feasibility 
        and advisability of making the pilot program permanent.
            ``(H) The estimated budget of the pilot program.
    ``(3)(A) Upon receipt of a report submitted under paragraph (2), 
each House 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)(i) The waiver requested by the Secretary under paragraph (2) 
shall be considered approved under this paragraph if there is enacted 
into law a bill or joint resolution approving such request in its 
entirety. Such bill or joint resolution shall be passed by recorded 
vote to reflect the vote of each member of Congress thereon.
    ``(ii) The provisions of this paragraph are enacted by Congress--
            ``(I) as an exercise of the rulemaking power of the Senate 
        and the House of Representatives and as such shall be 
        considered as part of the rules of each House of Congress, and 
        shall supersede other rules only to the extent that they are 
        inconsistent therewith; and
            ``(II) with full recognition of the constitutional right of 
        either House of Congress to change the rules (so far as they 
        relate to the procedures of that House) at any time, in the 
        same manner, and to the same extent as in the case of any other 
        rule of that House.
    ``(C) During the 60-calendar-day period beginning on the date on 
which the Secretary submits the report described in paragraph (2) to 
Congress, it shall be in order as a matter of highest privilege in each 
House of Congress to consider a bill or joint resolution, if offered by 
the majority leader of such House (or a designee), approving such 
request in its entirety.
    ``(g) Limitations.--(1) The 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 (h), 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 
such chapter 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 two-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 two 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 title 38, United States Code, as amended by 
                subparagraph (A), 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 Act, 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 Act.

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--IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS

SEC. 201. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS AND DENTISTS UNDER 
              DEPARTMENT OF VETERANS AFFAIRS HEALTH PROFESSIONAL 
              SCHOLARSHIP PROGRAM.

    (a) Scholarships for Physicians and Dentists.--Section 7612(b) 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(b) 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 is amended by striking 
``December 31, 2019'' and inserting ``December 31, 2033''.

SEC. 202. 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 one 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. 203. ESTABLISHING THE DEPARTMENT OF VETERANS AFFAIRS SPECIALTY 
              EDUCATION LOAN REPAYMENT PROGRAM.

    (a) In General.--Chapter 76 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 two 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 four years of participation in the 
Program, of which not more than $40,000 of such payments may be made in 
each year of participation in the Program.
    ``(2)(A) The Secretary may waive the limitations under paragraph 
(1) in the case of a participant described in subparagraph (B). In the 
case of such a waiver, the total amount of payments payable to or for 
that participant is the total amount of the principal and the interest 
on the participant's loans referred to in subsection (a).
    ``(B) A participant described in this subparagraph is a participant 
in the Program who the Secretary determines serves in a position for 
which there is a shortage of qualified employees by reason of either 
the location or the requirements of the position.
``Sec. 7695. Choice of location
    ``Each participant in the Specialty Education Loan Repayment 
Program who completes residency may select, from a list of medical 
facilities of the Veterans Health Administration provided by the 
Secretary, at which such facility the participant will work in a 
medical specialty described in section 7692 of this title.
``Sec. 7696. Term of obligated service
    ``(a) In General.--In addition to any requirements under section 
5379(c) of title 5, a participant in the Specialty Education Loan 
Repayment Program must agree, in writing and before the Secretary may 
make any payment to or for the participant, to--
            ``(1) obtain a license to practice medicine in a State;
            ``(2) successfully complete post-graduate training leading 
        to eligibility for board certification in a specialty;
            ``(3) serve as a full-time clinical practice employee of 
        the Veterans Health Administration for 12 months for every 
        $40,000 in such benefits that the employee receives, but in no 
        case for fewer than 24 months; and
            ``(4) except as provided in subsection (b), to begin such 
        service as a full-time practice employee by not later than 60 
        days after completing a residency.
    ``(b) Fellowship.--In the case of a participant who receives an 
accredited fellowship in a medical specialty other than a medical 
specialty described in section 7692 of this title, the Secretary, on 
written request of the participant, may delay the term of obligated 
service under subsection (a) for the participant until after the 
participant completes the fellowship, but in no case later than 60 days 
after completion of such fellowship.
    ``(c) Penalty.--(1) An employee who does not complete a period of 
obligated service under this section shall owe the Federal Government 
an amount determined in accordance with the following formula: A = B 
x  ((T - S) <divide> T)).
    ``(2) In the formula in paragraph (1):
            ``(A) `A' is the amount the employee owes the Federal 
        Government.
            ``(B) `B' is the sum of all payments to or for the 
        participant under the Specialty Education Loan Repayment 
        Program.
            ``(C) `T' is the number of months in the period of 
        obligated service of the employee.
            ``(D) `S' is the number of whole months of such period of 
        obligated service served by the employee.
``Sec. 7697. Relationship to Educational Assistance Program
    ``Assistance under the Specialty Education Loan Repayment Program 
may be in addition to other assistance available to individuals under 
the Educational Assistance Program.''.
    (b) Conforming and Technical Amendments.--
            (1) Conforming amendments.--
                    (A) Section 7601(a) 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) is amended by striking ``or 
                VI'' and inserting ``VI, or VIII''.
                    (C) Section 7604 is amended by striking ``or VI'' 
                each place it appears and inserting ``VI, or VIII''.
                    (D) Section 7631 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 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 is amended by inserting after the items 
        relating to subchapter VII the following:

      ``subchapter viii--specialty education loan repayment program

``Sec.
``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 added by subsection 
(a), the Secretary of Veterans Affairs shall consider the anticipated 
needs of the Veterans Health Administration during the period two to 
six years in the future.
    (d) Preference.--In granting preference under section 7693 of title 
38, United States Code, as added by subsection (a), the Secretary of 
Veterans Affairs shall determine whether a facility of the Department 
of Veterans Affairs is underserved based on the criteria developed 
under section 301 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 under subchapter VIII of title 38, United States Code, as added 
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 added 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 added by 
subsection (a).

SEC. 204. 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 school 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 ten 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 (d).
    (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 four 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 four-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 four 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 three 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. 205. 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. 206. 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 one 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 III--HEALTH CARE IN UNDERSERVED AREAS

SEC. 301. 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 one year after the date 
        of the enactment of this Act and not less frequently than once 
        each year thereafter, the Secretary shall submit to 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 302.
                    (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. 302. 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 301(c) 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 one 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 
three 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 301.

SEC. 303. 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 301.
                    (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 not 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 301.
            (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 under subsection (a)(3).
            (5) Expenses relating to educating a resident under the 
        pilot program.
    (c) Reporting.--
            (1) In general.--Not later than one year after the date of 
        the enactment of this Act and not less frequently than once 
        each year thereafter 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 IV--INFRASTRUCTURE MATTERS

SEC. 401. IMPROVEMENT TO TRAINING OF CONSTRUCTION PERSONNEL.

    Subsection (g) of section 8103 is amended to read as follows:
    ``(g)(1)(A) Not later than September 30, 2019, 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 subparagraph (A), the 
Secretary shall use as models existing training curricula and 
certification programs that have been established under chapter 87 of 
title 10, 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, 2020, 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 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. 402. REVIEW OF ENHANCED USE LEASES.

    Paragraph (6) of section 8162(b) is amended to read as follows:
    ``(6) The Director of 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. 403. 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 Committee on Veterans' Affairs of the Senate and the Committee 
on Veterans' Affairs of 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 clinic.
    (c) Definition.--In this section, the term ``Pacific territories'' 
means American Samoa, Guam, and the Northern Mariana Islands.

                         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 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.''.
    (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) 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 ten 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 two-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 
ten 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 ten 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 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) 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) 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.
                                 <all>