[Congressional Record Volume 160, Number 85 (Tuesday, June 3, 2014)]
[Senate]
[Pages S3369-S3380]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SANDERS (for himself, Mr. Rockefeller, Mr. Begich, Mrs. 
        Shaheen, Mr. Kaine, Mr. Reed, Mr. Merkley, Mr. Casey, Mr. 
        Whitehouse, Mr. Blumenthal, Mr. Heinrich, Mr. Udall of New 
        Mexico, Mr. Schatz, Ms. Baldwin, Mr. Wyden, Mr. Leahy, Mr. 
        Brown, Ms. Heitkamp, Ms. Landrieu, Mr. Booker, Mr. Durbin, Mr. 
        Schumer, and Ms. Hirono):
  S. 2422. A bill to improve the access of veterans to medical services 
from the Department of Veterans Affairs, and for other purposes; read 
the first time.
  Mr. SANDERS. Mr. President, as chairman of the Senate Committee on 
Veterans' Affairs, I rise today to introduce the Ensuring Veterans 
Access to Care Act of 2014.
  I thank the 16 cosponsors of this legislation, and they are Senators 
Rockefeller, Begich, Shaheen, Kaine, Reed, Merkley, Casey, Whitehouse, 
Blumenthal, Heinrich, Udall of New Mexico, Schatz, Baldwin, Wyden, 
Hirono, and Leahy.
  It is safe to say there is broad bipartisan agreement among all of us 
that every veteran in this country who enters the VA health care system 
deserves high-quality care and deserves that care in a timely manner.
  Overall, talking to veterans in Vermont and, in fact, throughout this 
country, talking to the veterans service organizations who represent 
their interests and reading independent studies, they all confirm that 
by and large, once veterans get into the VA health care system, the 
system is, in fact, quite good.
  However, it has become clear--and I think all of us are aware of what 
has happened in the last month--that while quality is generally good, 
there are too many veterans throughout this country waiting too long to 
access this care.
  In recent years, the VA has seen a huge increase in its patient load.
  In fact, in the last 4 years, 2 million new veterans have come into 
the system, many of them with very complicated health care cases, 
including TBI, post-traumatic stress disorder, and many of the needs 
that older veterans and older people generally have.
  Despite this fact, it is still absolutely unacceptable that some 
veterans are forced onto long waiting lists for care, and it is totally 
intolerable--it is reprehensible--that any VA employee could be 
manipulating data in Phoenix or anyplace else to hide how long veterans 
have been on waiting lists to see doctors. This is an issue that must 
be dealt with and must be dealt with rapidly and strongly.
  These problems are real, and they have to be addressed. But they 
should not be an excuse to walk away from a system that serves 6.5 
million veterans every single year and 230,000 veterans every single 
day. This is a system we must fix, not a system that we should ditch.
  We must focus on the underlying problems and work to transform the 
VA.
  In general, what our legislation does is it works in three basic 
areas. No. 1, we give greater authority to the Secretary to fire 
incompetent senior officials. No. 2, we take very significant steps to 
shorten the wait times that many veterans are now experiencing. And No. 
3, we address the long-term health care needs of the VA in terms of a 
shortage of staff, doctors, and nurses that currently exists in various 
locations around the country.
  Let me go through some of those issues right now.
  Several weeks ago my Republican colleague from Florida requested a 
vote on legislation that would allow VA Secretaries to immediately 
remove senior executives due to poor performance.
  So let us be clear. I strongly support the effort to make sure that 
we get rid of incompetent or worse senior executives at the VA. There 
is no debate about that. But here is what the debate is about. I do not 
think it is a good idea to give the Secretary of an institution, of an 
agency that has some 300,000 employees, the ability to simply fire 
without any due process.
  What I worry about is that you can move toward a situation where the 
VA health care system is politicized in a way that it should not be.
  Let me give an example. A new President comes in with a new 
Secretary. The new Secretary says--whether it is a Democratic President 
or a Republican President--I want to get rid of 300 senior-level 
appointees and bring in 300 new people. Four years later, another 
President comes in--different party--and says: We are going to get rid 
of those 300 people and bring in 300 more people.
  I do not think that provides the kind of stability that the largest 
integrated

[[Page S3370]]

health care system in America needs or deserves. I worry about the 
politicization.
  Second, I worry about an instance where a whistleblower stands up who 
is critical of this or that aspect of the VA. That person could be 
fired without due process.
  I worry there may be a situation where somebody is fired--not because 
of bad performance; maybe they are a woman and somebody doesn't like a 
woman in that position; maybe they are gay, maybe they are black, maybe 
they are whatever--and that person does not have any ability to appeal 
that decision.
  I think that is wrong. I think that is bad policy. On the other hand, 
what I do believe is that person should be taken out of his or her job 
immediately, but that person must have the right to have an expedited 
appeal.
  What our legislation does is give the person a week to bring forth 
the appeal and gives the appropriate appeal body 3 weeks to make a 
decision.
  Now, we are dealing with people who are M.D.s, Ph.D.s, high-level 
people whose professionalism is on the line. I don't think you can fire 
people willy-nilly without giving them a chance in an expedited manner 
to express their point of view.
  That is one difference I have with my colleague from Florida on his 
proposal.
  Let me talk a little bit about the major concern I have; that is, how 
do we shorten wait times? How do we make certain in those areas of the 
country where there are long waiting periods or where veterans may be 
geographically a long distance away from a facility that they get 
timely care?
  The legislation that I have authored takes immediate action to 
provide timely access for care for our veterans. First, this 
legislation would standardize VA's process for providing non-VA care 
when the Department is unable to provide care to the veterans within 
its stated goal. As the DVA--Disabled American Veterans--pointed out in 
a release today, VA must continue to be responsible for coordinating 
their care amongst various VA and non-VA providers. This legislation 
accomplishes that goal by providing a framework for consistent 
decisionmaking regarding non-VA care. Under this legislation VA would 
coordinate non-VA care by taking into account wait times for care, the 
health of the veteran, the distance the veteran would be required to 
travel, as well as the veteran's choice.

  This bill also addresses VA systemwide health care provider 
shortages. But in terms of the wait lists, what we say in English is: 
If there is an unacceptable wait time or if a veteran is a long 
distance away from a provider, we are going to allow--and we must 
allow--that veteran to get health care through a private provider, 
through a federally qualified community health center, through a 
Department of Defense military base, if that is available, through an 
Indian health service, if that is available--and that exists now in 
Alaska--and that might be expanded. So the bottom line is if there are 
waiting lists beyond what is reasonable, the veterans in this country 
should be able to get into non-VA health care in a timely manner, and 
this bill does that.
  But importantly, this bill also addresses a very significant issue 
that I think we cannot ignore, and that is it appears to me that in 
many parts of this country we simply don't have the doctors and nurses 
we need when an influx of veterans is coming into the system.
  I was talking to some very knowledgeable people today who were 
telling me about burnout. Primary care physicians and psychiatrists are 
seeing many more patients and turnover rates are much too high. The 
last thing we want to do is to see rapid turnover because people are 
burnt out and don't have the time to do the quality work they want to 
do.
  Let me quote an article that appears in the New York Times on May 29 
which addresses this issue. This is what it says:

       Dr. Phyllis Hollenbeck, a primary care physician, took a 
     job at the Veterans Affairs medical center in Jackson, Miss., 
     in 2008 expecting fulfilling work and a lighter patient load 
     than she had in private practice. What she found was quite 
     different: 13-hour workdays fueled by large patient loads 
     that kept growing as colleagues quit and were not replaced.
       Appalled by what she saw, Dr. Hollenbeck filed a whistle-
     blower complaint and changed jobs. A subsequent investigation 
     by the Department of Veterans Affairs concluded last fall 
     that indeed the Jackson hospital did not have enough primary 
     care doctors, resulting in nurse practitioners' handling far 
     too many complex cases and in numerous complaints from 
     veterans about the delayed care. ``It was unethical to put us 
     in that position,'' Dr. Hollenbeck said of the overstressed 
     primary care unit in Jackson. ``Your heart gets broken.''

  In this case we had a physician who wanted to do the right thing, 
wanted to spend the appropriate amounts of time that were needed with 
the patients, and she was unable to do that. What we are hearing is in 
many parts of this country primary care physicians are saying: We 
cannot do it; too many people are coming in. This is an issue that has 
to be addressed, and our legislation does that.
  Our legislation gives the VA the ability to rapidly hire new doctors, 
nurses, and other health care providers in areas with identified 
shortages. It also enables VA's ability to recruit qualified health 
providers by enhancing scholarship and loan repayment opportunities.
  As the Presiding Officer well knows as a member of the committee that 
deals with this issue, we have a crisis in this country in terms of the 
lack of primary care practitioners. This is a very serious problem. 
There are experts who tell us, in fact, that we need 50,000 new primary 
care physicians in the next 10 to 15 years. This is a national problem, 
it is a problem within the VA, and what this legislation proposes is 
that the VA work with the National Health Service Corps in order to 
provide debt forgiveness, scholarships to medical school students, so 
when they graduate they can get into the VA and practice the quality 
medicine we need there.
  This bill addresses another issue that has been discussed a lot--and 
there is widespread bipartisan support for this and support in the 
House as well--and that is the authorization of 27 major medical 
facility leases. In many instances these leases would improve access to 
care closer to home and would increase the availability of specialty 
care services in those locations that would allow the VA to decompress 
overutilized VA facilities. This is an important issue in this 
legislation and I believe there is bipartisan support for it.
  Furthermore, this bill would require the President to create a 
commission to look at VA health care access issues and recommend action 
to bolster capacity. In the last couple of days I have heard a lot of 
good ideas about how we can deal with the issue, but we need a high-
level commission of some of the most knowledgeable people in this 
country appointed by the President to report within 90 days some ideas 
of how the VA can proceed.
  I want to thank the 16 or so cosponsors we have. I look forward to 
working with my Republican colleagues. We have got a problem we have to 
address, and I hope we can do it in a bipartisan way.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2422

       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 ``Ensuring 
     Veterans Access to Care Act of 2014''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.

 TITLE I--IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH CARE APPOINTMENTS

Sec. 101. Implementation of upgraded Department of Veterans Affairs 
              electronic scheduling system for appointments for receipt 
              of health care from the Department.
Sec. 102. Independent assessment of the scheduling process for medical 
              appointments for care from Department of Veterans 
              Affairs.

           TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

Sec. 201. Modification of liability for breach of period of obligated 
              service under Health Professionals Educational Assistance 
              Program for primary care physicians.

[[Page S3371]]

Sec. 202. Program of education at Uniformed Services University of the 
              Health Sciences with specialization in primary care.
Sec. 203. Treatment of staffing shortage and biannual report on 
              staffing of medical facilities of the Department of 
              Veterans Affairs.
Sec. 204. Clinic management training program of the Department of 
              Veterans Affairs.
Sec. 205. Inclusion of Department of Veterans Affairs facilities in 
              National Health Service Corps Scholarship and loan 
              repayment programs.
Sec. 206. Authorization of emergency appropriations.

    TITLE III--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF 
                       VETERANS AFFAIRS PROVIDERS

Sec. 301. Improvement of access by veterans to health care from non-
              Department of Veterans Affairs providers.
Sec. 302. Extension of and report on joint incentives program of 
              Department of Veterans Affairs and Department of Defense.
Sec. 303. Transfer of authority for payments for hospital care, medical 
              services, and other health care from non-Department 
              providers to the Chief Business Office of the Veterans 
              Health Administration of the Department.
Sec. 304. Enhancement of collaboration between Department of Veterans 
              Affairs and Indian Health Service.
Sec. 305. Enhancement of collaboration between Department of Veterans 
              Affairs and Native Hawaiian health care systems.
Sec. 306. Authorization of emergency appropriations.

              TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

Sec. 401. Improvement of access of veterans to mobile vet centers of 
              the Department of Veterans Affairs.
Sec. 402. Commission on Access to Care.
Sec. 403. Commission on Capital Planning for Department of Veterans 
              Affairs Medical Facilities.
Sec. 404. Removal of Senior Executive Service employees of the 
              Department of Veterans Affairs for performance.

                 TITLE V--MAJOR MEDICAL FACILITY LEASES

Sec. 501. Authorization of major medical facility leases.
Sec. 502. Budgetary treatment of Department of Veterans Affairs major 
              medical facilities leases.

 TITLE I--IMPROVEMENT OF SCHEDULING SYSTEM FOR HEALTH CARE APPOINTMENTS

     SEC. 101. IMPLEMENTATION OF UPGRADED DEPARTMENT OF VETERANS 
                   AFFAIRS ELECTRONIC SCHEDULING SYSTEM FOR 
                   APPOINTMENTS FOR RECEIPT OF HEALTH CARE FROM 
                   THE DEPARTMENT.

       (a) Implementation.--
       (1) In general.--Not later than March 31, 2016, the 
     Secretary of Veterans Affairs shall fully implement an 
     upgraded and centralized electronic scheduling system 
     described in subsection (b) for appointments by eligible 
     individuals for health care from the Department of Veterans 
     Affairs.
       (2) Agile software development methodologies.--In 
     implementing the upgraded electronic scheduling system 
     required by paragraph (1), the Secretary shall use agile 
     software development methodologies to fully implement 
     portions of such system every 180 days beginning on the date 
     on which the Secretary begins the implementation of such 
     system, or enters into a contract for the implementation of 
     such system, and ending on the date on which such system is 
     fully implemented.
       (b) Electronic Scheduling System.--The upgraded electronic 
     scheduling system described in this subsection shall include 
     mechanisms to achieve the following:
       (1) An efficient and effective graphical user interface 
     with a calendar view for use by employees of the Department 
     in scheduling appointments that enables error-free scheduling 
     of the health care resources of the Department.
       (2) A capability to assist employees of the Department to 
     easily and consistently implement policies of the Department 
     with respect to scheduling of appointments, including with 
     respect to priority for appointments for certain eligible 
     individuals.
       (3) A capability for employees of the Department to sort 
     and view through a unified interface the availability for 
     each health care provider of the Department or other health 
     care resource of the Department.
       (4) A capability for employees of the Department to sort 
     and view appointments for and appointment requests made by a 
     particular eligible individual.
       (5) A capability for seamless coordination of appointments 
     for primary care, specialty care, consultations, or any other 
     health care matter among facilities of the Department.
       (6) A capability for eligible individuals to access the 
     system remotely and schedule appointments directly through 
     the system.
       (7) An electronic timestamp of each activity made by an 
     eligible individual or on behalf of such individual with 
     respect to an appointment or the scheduling of an appointment 
     that shall be kept in the medical record of such individual.
       (8) A seamless connection to the Computerized Patient 
     Record System of the Department so that employees of the 
     Department, when scheduling an appointment for an eligible 
     individual, have access to recommendations from the health 
     care provider of such individual with respect to when such 
     individual should receive an appointment.
       (9) A capability to provide automated reminders to eligible 
     individuals on upcoming appointments through various 
     electronic and voice media.
       (10) A capability to provide automated reminders to 
     employees of the Department when an eligible individual who 
     is on the wait-list for an appointment becomes eligible to 
     schedule an appointment.
       (11) A dashboard capability to support efforts to track the 
     following metrics in aggregate and by medical facility with 
     respect to health care provided to eligible individuals under 
     the laws administered by the Secretary:
       (A) The number of days into the future that the schedules 
     of health care providers are available to schedule an 
     appointment.
       (B) The number of providers available to see patients each 
     day.
       (C) The number of support personnel working each day.
       (D) The types of appointments available.
       (E) The rate at which patients fail to appear for 
     appointments.
       (F) The number of appointments canceled by a patient on a 
     daily basis.
       (G) The number of appointments canceled by a health care 
     provider on a daily basis.
       (H) The number of patients on the wait list at any given 
     time.
       (I) The number of appointments scheduled on a daily basis;
       (J) The number of appointments available to be scheduled on 
     a daily basis.
       (K) The number of patients seen on a daily, weekly, and 
     monthly basis.
       (L) Wait-times for an appointment with a health care 
     provider of the Department.
       (M) Wait-times for an appointment with a non-Department 
     health care provider.
       (N) Wait-times for a referral to a specialist or consult.
       (12) A capability to provide data on the capacity of 
     medical facilities of the Department for purposes of 
     determining the resources needed by the Department to provide 
     health care to eligible individuals.
       (13) Any other capabilities as specified by the Secretary 
     for purposes of this section.
       (c) Plan.--
       (1) 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 and the 
     Committee on Veterans' Affairs of the House of 
     Representatives a plan for implementing the upgraded 
     electronic scheduling system required by subsection (a).
       (2) Elements.--The plan required by paragraph (1) shall 
     include the following:
       (A) A description of the priorities of the Secretary for 
     implementing the requirements of the system under subsection 
     (b).
       (B) A detailed description of the manner in which the 
     Secretary will fully implement such system, including 
     deadlines for completing each such requirement.
       (3) Update.--Not later than 90 days after the submittal of 
     the plan required by paragraph (1), and not less frequently 
     than every 90 days thereafter until such system is fully 
     implemented, the Secretary shall submit to the Committee on 
     Veterans' Affairs of the Senate and the Committee on 
     Veterans' Affairs of the House of Representatives an update 
     on the status of the implementation of such plan.
       (d) Use of Amounts.--The Secretary may use amounts 
     available to the Department of Veterans Affairs for the 
     appropriations account under the heading ``medical services'' 
     in implementing and carrying out the upgraded electronic 
     scheduling system required by subsection (a).
       (e) Eligible Individual Defined.--In this section, the term 
     ``eligible individual'' means an individual eligible for 
     hospital, nursing home, domiciliary, medical care, or other 
     health care under the laws administered by the Secretary of 
     Veterans Affairs.

     SEC. 102. INDEPENDENT ASSESSMENT OF THE SCHEDULING PROCESS 
                   FOR MEDICAL APPOINTMENTS FOR CARE FROM 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) Independent Assessment.--
       (1) Contract.--Not later than 30 days after the date of the 
     enactment of this Act, the Secretary of Veteran Affairs shall 
     enter into a contract with an independent third party to 
     assess the process at each medical facility of the Department 
     of Veterans Affairs for scheduling appointments for veterans 
     to receive hospital care, medical services, or other health 
     care from the Department.
       (2) Elements.--In carrying out the assessment required by 
     paragraph (1), the independent third party shall do the 
     following:
       (A) Review all training materials pertaining to scheduling 
     of appointments at each medical facility of the Department.
       (B) Assess whether all employees of the Department 
     conducting tasks related to scheduling are properly trained 
     for conducting such tasks.
       (C) Assess whether changes in the technology or system used 
     in scheduling appointments are necessary to limit access to 
     the system to only those employees that have been properly 
     trained in conducting such tasks.

[[Page S3372]]

       (D) Assess whether health care providers of the Department 
     are making changes to their schedules that hinder the ability 
     of employees conducting such tasks to perform such tasks.
       (E) Assess whether the establishment of a centralized call 
     center throughout the Department for scheduling appointments 
     at medical facilities of the Department would improve the 
     process of scheduling such appointments.
       (F) Assess whether booking templates for each medical 
     facility or clinic of the Department would improve the 
     process of scheduling such appointments.
       (G) Recommend any actions to be taken by the Department to 
     improve the process for scheduling such appointments, 
     including the following:
       (i) Changes in training materials provided to employees of 
     the Department with respect to conducting tasks related to 
     scheduling such appointments.
       (ii) Changes in monitoring and assessment conducted by the 
     Department of wait-times of veterans for such appointments.
       (iii) Changes in the system used to schedule such 
     appointments, including changes to improve how the 
     Department--

       (I) measures wait-times of veterans for such appointments;
       (II) monitors the availability of health care providers of 
     the Department; and
       (III) provides veterans the ability to schedule such 
     appointments.

       (iv) Such other actions as the independent third party 
     considers appropriate.
       (3) Timing.--The independent third party carrying out the 
     assessment required by paragraph (1) shall complete such 
     assessment not later than 180 days after entering into the 
     contract described in such paragraph.
       (b) Report.--Not later than 90 days after the date on which 
     the independent third party completes the assessment under 
     this section, 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 results of such assessment.

           TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

     SEC. 201. MODIFICATION OF LIABILITY FOR BREACH OF PERIOD OF 
                   OBLIGATED SERVICE UNDER HEALTH PROFESSIONALS 
                   EDUCATIONAL ASSISTANCE PROGRAM FOR PRIMARY CARE 
                   PHYSICIANS.

       Section 7617 of title 38, United States Code, is amended--
       (1) In subsection (c)(1), by striking ``If a participant'' 
     and inserting ``Except as provided in subsection (d), if a 
     participant''; and
       (2) by adding at the end the following new subsection:
       ``(d) Liability shall not arise under subsection (c) in the 
     case of a participant otherwise covered by that subsection 
     who has pursued a course of education or training in primary 
     care if--
       ``(1) the participant--
       ``(A) does not obtain, or fails to maintain, employment as 
     a Department employee due to staffing changes approved by the 
     Under Secretary for Health; or
       ``(B) does not obtain, or fails to maintain, employment in 
     a position of primary care physician in the Veterans Health 
     Administration due, as determined by the Secretary, to a 
     number of primary care physicians in the Administration that 
     is excess to the needs of the Administration; and
       ``(2) the participant agrees to accept and maintain 
     employment as a primary care physician with another 
     department or agency of the Federal Government (with such 
     employment to be under such terms and conditions as are 
     jointly agreed upon by the participant, the Secretary, and 
     the head of such department or agency, including terms and 
     conditions relating to a period of obligated service as a 
     primary care physician with such department or agency) if 
     such employment is offered to the participant by the 
     Secretary and the head of such department or agency.''.

     SEC. 202. PROGRAM OF EDUCATION AT UNIFORMED SERVICES 
                   UNIVERSITY OF THE HEALTH SCIENCES WITH 
                   SPECIALIZATION IN PRIMARY CARE.

       (a) Program Required Under Health Professionals Educational 
     Assistance Program.--
       (1) In general.--Chapter 76 of title 38, United States 
     Code, is amended by adding after subchapter VII the following 
     new subchapter:

     ``SUBCHAPTER VIII--PROGRAM OF EDUCATION AT UNIFORMED SERVICES 
 UNIVERSITY OF THE HEALTH SCIENCES WITH SPECIALIZATION IN PRIMARY CARE

     ``Sec. 7691. Authority for program

       ``As part of the Educational Assistance Program, the 
     Secretary shall, in collaboration with the Secretary of 
     Defense, carry out a program to permit individuals to enroll 
     in the Uniformed Services University of the Health Sciences 
     under chapter 104 of title 10 to pursue a medical education 
     with a specialization in primary care. The program shall be 
     known as the Department of Veterans Affairs Primary Care 
     Educational Assistance Program (in this chapter referred to 
     as the `Primary Care Educational Assistance Program').

     ``Sec. 7692. Selection; agreement; ineligibility for certain 
       other educational assistance

       ``(a) Selection.--(1) Medical students at the Uniformed 
     Services University of the Health Sciences pursuant to the 
     Primary Care Educational Assistance Program shall be selected 
     by the Secretary, in consultation with the Secretary of 
     Defense, in accordance with procedures established by the 
     Secretaries for purposes of the Program.
       ``(2) The procedures referred to in paragraph (1) shall 
     emphasize the basic requirement that students demonstrate a 
     motivation and dedication to a medical career in primary 
     care.
       ``(3) The number of medical students selected each year for 
     first-year enrollment in the University pursuant to this 
     subsection shall be jointly determined by the Secretary and 
     the Secretary of Defense.
       ``(b) Agreement.--An agreement between the Secretary and a 
     participant in the Primary Care Educational Assistance 
     Program shall (in addition to the requirements set forth in 
     section 7604 of this title) include the following:
       ``(1) The Secretary's agreement to cover the costs of the 
     participant's education and training at the Uniformed 
     Services University of the Health Sciences under chapter 104 
     of title 10 as if the participant were a medical student 
     enrolled in the University pursuant to section 2114 of title 
     10.
       ``(2) The participant's agreement to serve as a full-time 
     employee in the Veterans Health Administration in a position 
     as a primary care physician for a period of time (in this 
     subchapter referred to as the `period of obligated service') 
     of one calendar year for each school year or part thereof for 
     which the participant was a medical student at the Uniformed 
     Services University of the Health Sciences pursuant to the 
     Primary Care Educational Assistance Program, but for not less 
     than one year.
       ``(c) Ineligibility for Other Educational Assistance.--An 
     individual who receives education and training under the 
     Primary Care Educational Assistance Program shall not be 
     eligible for other assistance under this chapter in 
     connection with such education and training.

     ``Sec. 7693. Obligated service

       ``(a) In General.--Each participant in the Primary Care 
     Educational Assistance Program shall provide service as a 
     full-time employee of the Department in the Veterans Health 
     Administration in a primary care position for the period of 
     obligated service provided in the agreement of the 
     participant entered into for purposes of this subchapter. 
     Such service shall be provided in a full-time primary care 
     clinical practice in an assignment or location determined by 
     the Secretary.
       ``(b) Service Commencement Date.--(1) Not later than 60 
     days before a participant's service commencement date, the 
     Secretary shall notify the participant of that service 
     commencement date. That date is the date for the beginning of 
     the participant's period of obligated service.
       ``(2) As soon as possible after a participant's service 
     commencement date, the Secretary shall--
       ``(A) in the case of a participant who is not a full-time 
     employee in the Veterans Health Administration, appoint the 
     participant as such an employee; and
       ``(B) in the case of a participant who is an employee in 
     the Veterans Health Administration but is not serving in a 
     position for which the participant's course of education or 
     training prepared the participant, assign the participant to 
     such a position.
       ``(3) A participant's service commencement for purposes of 
     this subsection date is the date upon which the participant 
     becomes licensed to practice medicine in a State.
       ``(c) Commencement of Obligated Service.--A participant in 
     the Primary Care Educational Assistance Program shall be 
     considered to have begun serving the participant's period of 
     obligated service--
       ``(1) on the date on which the participant is appointed as 
     a full-time employee in the Veterans Health Administration 
     pursuant to subsection (b)(2)(A); or
       ``(2) if the participant is a full-time employee in the 
     Veterans Health Administration and assigned to a position 
     pursuant to subsection (b)(2)(B), on the date on which the 
     participant is so assigned to such position.

     ``Sec. 7694. Breach of agreement: liability

       ``(a) Liability During Course of Education or Training.--
     (1) A participant in the Primary Care Educational Assistance 
     Program shall be liable to the United States for the amount 
     which has been paid on behalf of the participant under the 
     agreement entered into for purposes of this subchapter if any 
     of the following occurs:
       ``(A) The participant fails to maintain an acceptable level 
     of academic standing in the Uniformed Services University of 
     the Health Sciences.
       ``(B) The participant is dismissed from the Uniformed 
     Services University of the Health Sciences for disciplinary 
     reasons.
       ``(C) The participant voluntarily terminates the course of 
     medical education and training in the Uniformed Services 
     University of the Health Sciences before the completion of 
     such course of education and training.
       ``(D) The participant fails to become licensed to practice 
     medicine in a State during a period of time determined under 
     regulations prescribed by the Secretary.
       ``(2) Liability under this subsection is in lieu of any 
     service obligation arising under a participant's agreement 
     for purposes of this subchapter.
       ``(b) Liability During Period of Obligated Service.--(1) 
     Except as provided in subsection (c) and subject to paragraph 
     (2), if

[[Page S3373]]

     a participant in the Primary Care Educational Assistance 
     Program breaches the agreement entered into for purposes of 
     this subchapter by failing for any reason to complete the 
     participant's period of obligated service, the United States 
     shall be entitled to recover from the participant an amount 
     equal to--
       ``(A) the total amount paid under this subchapter on behalf 
     of the participant; multiplied by
       ``(B) a fraction--
       ``(i) the numerator of which is--
       ``(I) the total number of months in the participant's 
     period of obligated service; minus
       ``(II) the number of months served by the participant 
     pursuant to the agreement; and
       ``(ii) the denominator of which is the total number of 
     months in the participant's period of obligated service.
       ``(2) Any period of internship or residency training of a 
     participant shall not be treated as satisfying the 
     participant's period of obligated service for purposes of 
     this subsection.
       ``(c) Exceptions.--Liability shall not arise under 
     subsection (b) in the case of a participant otherwise covered 
     by that subsection if--
       ``(1) the participant--
       ``(A) does not obtain, or fails to maintain, employment as 
     a Department employee due to staffing changes approved by the 
     Under Secretary for Health; or
       ``(B) does not obtain, or fails to maintain, employment in 
     a position of primary care physician in the Veterans Health 
     Administration due, as determined by the Secretary, to a 
     number of primary care physicians in the Administration that 
     is excess to the needs of the Administration; and
       ``(2) the participant agrees to accept and maintain 
     employment as a primary care physician with another 
     department or agency of the Federal Government (with such 
     employment to be under such terms and conditions as are 
     jointly agreed upon by the participant, the Secretary, and 
     the head of such department or agency, including terms and 
     conditions relating to a period of obligated service as a 
     primary care physician with such department or agency) if 
     such employment is offered to the participant by the 
     Secretary and the head of such department or agency.

     ``Sec. 7695. Funding

       ``(a) In General.--Amounts for the Primary Care Educational 
     Assistance Program shall be derived from amounts available to 
     the Secretary for the Veterans Health Administration.
       ``(b) Transfer.--(1) The Secretary shall transfer to the 
     Secretary of Defense amounts required by the Secretary of 
     Defense to carry out the Primary Care Educational Assistance 
     Program.
       ``(2) Amounts transferred to the Secretary of Defense 
     pursuant to paragraph (1) shall be credited to the 
     appropriation or account providing funding for the Uniformed 
     Services University of the Health Sciences. Amounts so 
     credited shall be merged with amounts in the appropriation or 
     account to which credited and shall be available, subject to 
     the terms and conditions applicable to such appropriation or 
     account, for the Uniformed Services University of the Health 
     Sciences.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of chapter 76 of such title is amended by adding 
     after the item relating to section 7684 the following:

     ``subchapter viii--program of education at uniformed services 
 university of the health sciences with specialization in primary care

``7691. Authority for program.
``7692. Selection; agreement; ineligibility for certain other 
              educational assistance.
``7693. Obligated service.
``7694. Breach of agreement: liability.
``7695. Funding.''.
       (b) Inclusion of Program in Health Professionals 
     Educational Assistance Program.--Section 7601(a) of such 
     title is amended--
       (1) in paragraph (4), by striking ``; and'' and inserting a 
     semicolon;
       (2) in paragraph (5), by striking the period at the end and 
     inserting ``; and''; and
       (3) by adding at the end the following new paragraph:
       ``(6) the enrollment of individuals in the Uniformed 
     Services University of the Health Sciences for specialization 
     in primary care provided for in subchapter VIII of this 
     chapter.''.
       (c) Application Requirements.--
       (1) In general.--Subsection (a)(1) of section 7603 of such 
     title is amended in the matter preceding subparagraph (A) by 
     striking ``, or VI'' and inserting ``, VI, or VIII''.
       (2) No priority for applications.--Subsection (d) of such 
     section is amended--
       (A) by striking ``In selecting'' and inserting ``(1) Except 
     as provided in paragraph (2), in selecting''; and
       (B) by adding at the end the following new paragraph:
       ``(2) Paragraph (1) shall not apply with respect to 
     applicants for participation in the Program of Education at 
     Uniformed Services University of the Health Sciences With 
     Specialization in Primary Care pursuant to subchapter VIII of 
     this chapter.''.
       (d) Agreement Requirements.--Section 7604 of such title is 
     amended by striking ``, or VI'' each place it appears and 
     inserting ``, VI, or VIII''.

     SEC. 203. TREATMENT OF STAFFING SHORTAGE AND BIANNUAL REPORT 
                   ON STAFFING OF MEDICAL FACILITIES OF THE 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) Staffing Shortage.--
       (1) In general.--Not later than 180 days after the date of 
     the enactment of this Act, and not later than September 30 
     each year thereafter, the Secretary of Veterans Affairs shall 
     determine, and publish in the Federal Register, the five 
     occupations of health care providers of the Department of 
     Veterans Affairs for which there is the largest staffing 
     shortage throughout the Department.
       (2) Recruitment and appointment.--Notwithstanding sections 
     3304 and 3309 through 3318 of title 5, United States Code, 
     the Secretary may, upon a determination by the Secretary 
     under paragraph (1) or a modification to such determination 
     under paragraph (2), that there is a staffing shortage 
     throughout the Department with respect to a particular 
     occupation of health care provider, recruit and directly 
     appoint highly qualified health care providers to a position 
     to serve as a health care provider in that particular 
     occupation for the Department.
       (3) Priority in health professionals educational assistance 
     program to certain providers.--Section 7612(b)(5) of title 
     38, United States Code, is amended--
       (A) in subparagraph (A), by striking ``and'' at the end;
       (B) by redesignating subparagraph (B) as subparagraph (C); 
     and
       (C) by inserting after subparagraph (A) the following new 
     subparagraph (B):
       ``(B) shall give priority to applicants pursuing a course 
     of education or training towards a career in an occupation 
     for which the Secretary has, in the most current 
     determination published in the Federal Register pursuant to 
     section 203(a)(1) of the Ensuring Veterans Access to Care Act 
     of 2014, determined that there is one of the largest staffing 
     shortage throughout the Department with respect to such 
     occupation; and''.
       (b) Reports.--
       (1) In general.--Not later than 180 days after the date of 
     the enactment of this Act, and not later than December 31 of 
     each even numbered year thereafter until 2024, 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 
     assessing the staffing of each medical facility of the 
     Department of Veterans Affairs.
       (2) Elements.--Each report submitted under paragraph (1) 
     shall include the following:
       (A) The results of a system-wide assessment of all medical 
     facilities of the Department to ensure the following:
       (i) Appropriate staffing levels for health care providers 
     to meet the goals of the Secretary for timely access to care 
     for veterans.
       (ii) Appropriate staffing levels for support personnel, 
     including clerks.
       (iii) Appropriate sizes for clinical panels.
       (iv) Appropriate numbers of full-time staff, or full-time 
     equivalent, dedicated to direct care of patients.
       (v) Appropriate physical plant space to meet the capacity 
     needs of the Department in that area.
       (vi) Such other factors as the Secretary considers 
     necessary.
       (B) A plan for addressing any issues identified in the 
     assessment described in subparagraph (A), including a 
     timeline for addressing such issues.
       (C) A list of the current wait times and workload levels 
     for the following clinics in each medical facility:
       (i) Mental health.
       (ii) Primary care.
       (iii) Gastroenterology.
       (iv) Women's health.
       (v) Such other clinics as the Secretary considers 
     appropriate.
       (D) A description of the results of the determination of 
     the Secretary under paragraph (1) of subsection (a) and a 
     plan to use direct appointment authority under paragraph (2) 
     of such subsection to fill staffing shortages, including 
     recommendations for improving the speed at which the 
     credentialing and privileging process can be conducted.
       (E) The current staffing models of the Department for the 
     following clinics, including recommendations for changes to 
     such models:
       (i) Mental health.
       (ii) Primary care.
       (iii) Gastroenterology.
       (iv) Women's health.
       (v) Such other clinics as the Secretary considers 
     appropriate.
       (F) A detailed analysis of succession planning at medical 
     facilities of the Department, including the following:
       (i) The number of positions in medical facilities 
     throughout the Department that are not filled by a permanent 
     employee.
       (ii) The length of time each such position described in 
     clause (i) remained vacant or filled by a temporary or acting 
     employee.
       (iii) A description of any barriers to filling the 
     positions described in clause (i).
       (iv) A plan for filling any positions that are vacant or 
     filled by a temporary or acting employee for more than 180 
     days.
       (v) A plan for handling emergency circumstances, such 
     administrative leave or sudden medical leave for senior 
     officials.
       (G) The number of health care providers who have been 
     removed from their position or have retired, by provider 
     type, during the two-year period preceding the submittal of 
     the report.

[[Page S3374]]

       (H) Of the health care providers specified in subparagraph 
     (G) that have been removed from their position, the 
     following:
       (i) The number of such health care providers who were 
     reassigned to another position in the Department.
       (ii) The number of such health care providers who left the 
     Department.

     SEC. 204. CLINIC MANAGEMENT TRAINING PROGRAM OF THE 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) In General.--Not later than 180 days after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall implement a clinic management training program to 
     provide in-person, standardized education on health care 
     management to all managers of, and health care providers at, 
     medical facilities of the Department of Veterans Affairs.
       (b) Elements.--The clinic management training program 
     required by subsection (a) shall include the following:
       (1) Training on how to manage the schedules of health care 
     providers of the Department, including the following:
       (A) Maintaining such schedules in a manner that allows 
     appointments to be booked at least eight weeks in advance.
       (B) Proper planning procedures for vacation, leave, and 
     graduate medical education training schedules.
       (2) Training on the appropriate number of appointments that 
     a health care provider should conduct on a daily basis, based 
     on specialty.
       (3) Training on how to determine whether there are enough 
     available appointment slots to manage demand for different 
     appointment types and mechanisms for alerting management of 
     insufficient slots.
       (4) Training on how to properly use the data produced by 
     the scheduling dashboard required by section 101(b)(11) of 
     this Act to meet demand for health care, including the 
     following:
       (A) Training on determining the next available appointment 
     for each health care provider at the medical facility.
       (B) Training on determining the number of health care 
     providers needed to meet demand for health care at the 
     medical facility.
       (C) Training on determining the number of exam rooms needed 
     to meet demand for such health care in an efficient manner.
       (5) Training on how to properly use the appointment 
     scheduling system of the Department, including any new 
     scheduling system implemented by the Department.
       (6) Training on how to optimize the use of technology, 
     including the following:
       (A) Telemedicine.
       (B) Electronic mail.
       (C) Text messaging.
       (D) Such other technologies as specified by the Secretary.
       (7) Training on how to properly use physical plant space at 
     medical facilities of the Department to ensure efficient flow 
     and privacy for patients and staff.

     SEC. 205. INCLUSION OF DEPARTMENT OF VETERANS AFFAIRS 
                   FACILITIES IN NATIONAL HEALTH SERVICE CORPS 
                   SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.

       (a) In General.--The Secretary of Health and Human Services 
     shall use the funds transferred under subsection (e) to award 
     scholarship and loan repayment contracts under sections 338A 
     and 338B of the Public Health Service Act (42 U.S.C. 254l, 
     254l-1) to eligible individuals who agree to a period of 
     obligated service under section 338A(f)(1) or 338B(f)(1) of 
     such Act, as applicable, at a health facility of the 
     Department of Veterans Affairs.
       (b) Health Professional Shortage Areas.--For purposes of 
     selecting individuals eligible for the scholarships and loan 
     repayment contracts under subsection (a), all health 
     facilities of the Department of Veterans Affairs shall be 
     deemed health professional shortage areas, as defined in 
     section 332 of the Public Health Service Act (42 U.S.C. 
     254e).
       (c) Requirement.--The Secretary of Health and Human 
     Services shall ensure that a minimum of 5 scholarships or 
     loan repayment contracts are awarded to individuals who agree 
     to a period of obligated service at Veterans Affairs 
     facilities in each State.
       (d) Applicability of NHSC Program Requirements.--Except as 
     otherwise provided in this section, the terms of the National 
     Health Service Corps Scholarship Program and the National 
     Health Service Corps Loan Repayment Program shall apply to 
     participants awarded a grant or loan repayment contract under 
     subsection (a) in the same manner that such terms apply to 
     participants awarded a grant or loan repayment contract under 
     section 338A or 338B of the Public Health Service Act.
       (e) Inclusion of Geriatricians.--For purposes of awarding 
     scholarships and loan repayments contracts to eligible 
     individuals who agree to a period of obligated service at a 
     health facility of the Department of Veterans Affairs 
     pursuant to this section, in sections 338A and 338B of the 
     Public Health Service Act (42 U.S.C. 254l, 254l-1), the term 
     ``primary health services'' shall include geriatrics.
       (f) Funding.--The Secretary of Veterans Affairs shall 
     transfer $20,000,000 for fiscal year 2014, and such sums as 
     may be necessary for each fiscal year thereafter, from 
     accounts of the Veterans Health Administration to the 
     Secretary of Health and Human Services to award scholarships 
     and loan repayment contracts, as described in subsection (a). 
     All funds so transferred shall be used exclusively for the 
     purposes described in such subsection.

     SEC. 206. AUTHORIZATION OF EMERGENCY APPROPRIATIONS.

       There is authorized to be appropriated for the Department 
     of Veterans Affairs such sums as may be necessary to carry 
     out this title.

    TITLE III--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF 
                       VETERANS AFFAIRS PROVIDERS

     SEC. 301. IMPROVEMENT OF ACCESS BY VETERANS TO HEALTH CARE 
                   FROM NON-DEPARTMENT OF VETERANS AFFAIRS 
                   PROVIDERS.

       (a) Improvement of Access.--
       (1) In general.--The Secretary of Veterans Affairs shall 
     ensure timely access of all veterans to the hospital care, 
     medical services, and other health care for which such 
     veterans are eligible under the laws administered by the 
     Secretary through the enhanced use of authorities specified 
     in paragraph (2) on the provision of such care and services 
     through non-Department of Veterans Affairs providers 
     (commonly referred to as ``non-Department of Veterans Affairs 
     medical care'').
       (2) Authorities on provision of care through non-department 
     providers.--The authorities specified in this paragraph are 
     the following:
       (A) Section 1703 of title 38, United States Code, relating 
     to contracts for the provision of hospital care and medical 
     services through non-Department facilities.
       (B) Section 1725 of such title, relating to reimbursement 
     of certain veterans for the reasonable value of emergency 
     treatment at non-Department facilities.
       (C) Section 1728 of such title, relating to reimbursement 
     of certain veterans for customary and usual charges of 
     emergency treatment from sources other than the Department.
       (D) Section 1786 of such title, relating to health care 
     services furnished to newborn children of women veterans who 
     are receiving maternity care furnished by the Department at a 
     non-Department facility.
       (E) Any other authority under the laws administered by the 
     Secretary to provide hospital care, medical services, or 
     other health care from a non-Department provider, including 
     the following:
       (i) 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))).
       (ii) The Department of Defense.
       (iii) The Indian Health Service.
       (3) Requirements.--In ensuring timely access of all 
     veterans to the care and services described in paragraph (1) 
     through the enhanced use of authorities specified in 
     paragraph (2), the Secretary shall require the following:
       (A) That each veteran who has not received hospital care, 
     medical services, or other health care from the Department 
     and is seeking an appointment for primary care under the laws 
     administered by the Secretary receive an appointment for 
     primary care at a time consistent with timeliness measures 
     established by the Secretary for purposes of providing 
     primary care to all veterans.
       (B) That the determination whether to refer a veteran for 
     specialty care through a non-Department provider shall take 
     into account the urgency and acuity of such veteran's need 
     for such care, including--
       (i) the severity of the condition of such veteran requiring 
     specialty care; and
       (ii) the wait-time for an appointment with a specialist 
     with respect to such condition at the nearest medical 
     facility of the Department with the capacity to provide such 
     care.
       (C) That the determination whether a veteran shall receive 
     hospital care, medical services, or other health care from 
     the Department through facilities of the Department or 
     through non-Department providers pursuant to the authorities 
     specified in paragraph (2) shall take into account, in the 
     manner specified by the Secretary, the following:
       (i) The distance the veteran would be required to travel to 
     receive care or services through a non-Department provider 
     compared to the distance the veteran would be required to 
     travel to receive care or services from a medical facility of 
     the Department.
       (ii) Any factors that might limit the ability of the 
     veteran to travel, including age, access to transportation, 
     and infirmity.
       (iii) The wait-time for the provision of care or services 
     through a non-Department provider compared to the wait-time 
     for the provision of care or services from a medical facility 
     of the Department.
       (iv) Where the veteran would prefer to receive the care and 
     services described in paragraph (1), unless the preference of 
     the veteran conflicts with any of the other requirements of 
     this paragraph.
       (D) That the Department maximize the use of hospital care, 
     medical services, and other health care available to the 
     Department through non-Department providers, including 
     providers available to provide such care and services as 
     follows:
       (i) Pursuant to contracts under the Patient-Centered 
     Community Care Program of the Department.
       (ii) Pursuant to contracts between a facility or facilities 
     of the Department and a local facility or provider.
       (iii) Pursuant to contracts with Federally-qualified health 
     centers (as defined in section 1905(l)(2)(B) of the Social 
     Security Act (42 U.S.C. 1396d(l)(2)(B))), the Department of 
     Defense, or the Indian Health Service.
       (iv) On a fee-for-service basis.

[[Page S3375]]

       (b) Medical Records.--In providing hospital care, medical 
     services, and other health care to veterans through non-
     Department providers pursuant to the authorities specified in 
     paragraph (2), the Secretary shall ensure that any such 
     provider submits to the Department any medical record related 
     to the care and services provided to a veteran by that 
     provider for inclusion in the electronic medical record of 
     such veteran maintained by the Department upon the completion 
     of the provision of such care and services to such veteran.
       (c) Reports.--
       (1) Initial report.--Not later than 45 days 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 implementation of the 
     requirements under subsection (a) and (b), including a plan 
     to enforce the proper implementation of such requirements 
     systematically throughout the Department.
       (2) Periodic reports.--Not later than 90 days after the 
     submittal of the report required by paragraph (1), and every 
     90 days thereafter for one year, 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 that includes the following:
       (A) The progress of the Secretary in carrying out the plan 
     under paragraph (1) to enforce the proper implementation of 
     the requirements under subsection (a) and (b) systematically 
     throughout the Department.
       (B) The impact of the implementation of such requirements 
     on wait-times for veterans to receive hospital care, medical 
     services, and other health care, disaggregated by--
       (i) new patients;
       (ii) existing patients;
       (iii) primary care; and
       (iv) specialty care.
       (C) Any recommendations for changes or improvements to such 
     requirements.
       (D) Any requests for additional funding necessary to carry 
     out such requirements.

     SEC. 302. EXTENSION OF AND REPORT ON JOINT INCENTIVES PROGRAM 
                   OF DEPARTMENT OF VETERANS AFFAIRS AND 
                   DEPARTMENT OF DEFENSE.

       (a) Extension.--Section 8111(d)(3) of title 38, United 
     States Code, is amended by striking ``September 30, 2015'' 
     and inserting ``September 30, 2020''.
       (b) Reports.--
       (1) Report on implementation of recommendations.--Not later 
     than 60 days after the date of the enactment of this Act, the 
     Secretary of Veterans Affairs and the Secretary of Defense 
     shall jointly submit to Congress a report on the 
     implementation by the Department of Veterans Affairs and the 
     Department of Defense of the findings and recommendations of 
     the Comptroller General of the United States in the September 
     2012 report entitled ``VA and DoD Health Care: Department-
     Level Actions Needed to Assess Collaboration Performance, 
     Address Barriers, and Identify Opportunities'' (GAO-12-992).
       (2) Comptroller general report.--
       (A) In general.--Not later than one year after the date of 
     the enactment of this Act, the Comptroller General of the 
     United States shall submit to Congress a report assessing and 
     providing recommendations for improvement to the program to 
     identify, provide incentives to, implement, fund, and 
     evaluate creative coordination and sharing initiatives 
     between the Department of Veterans Affairs and the Department 
     of Defense required under section 8111(d) of such title.
       (B) Elements.--The report required by subparagraph (A) 
     shall include the following:
       (i) An assessment of the extent to which the program 
     described in subparagraph (A) has accomplished the goal of 
     such program to improve the access to, and quality and cost 
     effectiveness of, the health care provided by the Veterans 
     Health Administration and the Military Health System to the 
     beneficiaries of both the Department of Veterans Affairs and 
     the Department of Defense.
       (ii) An assessment of whether administration of such 
     program through the Health Executive Committee of the 
     Department of Veterans Affairs-Department of Defense Joint 
     Executive Committee established under section 320 of such 
     title provides sufficient leadership attention and oversight 
     to ensure maximum benefits to the Department of Veterans 
     Affairs and the Department of Defense through collaborative 
     efforts.
       (iii) An assessment of whether additional authorities to 
     jointly construct, lease, or acquire facilities would 
     facilitate additional collaborative efforts under such 
     program.
       (iv) An assessment of whether the funding for such program 
     is sufficient to ensure consistent identification of 
     potential opportunities for collaboration and oversight of 
     existing collaborations to ensure a meaningful partnership 
     between the Department of Veterans Affairs and the Department 
     of Defense and remove any barriers to integration or 
     collaboration.
       (v) An assessment of whether existing processes for 
     identifying opportunities for collaboration are sufficient to 
     ensure maximum collaboration between the Veterans Health 
     Administration and the Military Health System.
       (vi) Such legislative or administrative recommendations for 
     improvement to such program as the Comptroller General 
     considers appropriate to enhance the use of such program to 
     increase access to health care.

     SEC. 303. TRANSFER OF AUTHORITY FOR PAYMENTS FOR HOSPITAL 
                   CARE, MEDICAL SERVICES, AND OTHER HEALTH CARE 
                   FROM NON-DEPARTMENT PROVIDERS TO THE CHIEF 
                   BUSINESS OFFICE OF THE VETERANS HEALTH 
                   ADMINISTRATION OF THE DEPARTMENT.

       (a) Transfer of Authority.--
       (1) In general.--Effective on October 1, 2014, the 
     Secretary of Veterans Affairs shall transfer the authority to 
     pay for hospital care, medical services, and other health 
     care through non-Department providers to the Chief Business 
     Office of the Veterans Health Administration of the 
     Department of Veterans Affairs from the Veterans Integrated 
     Service Networks and medical centers of the Department of 
     Veterans Affairs.
       (2) Manner of care.--The Chief Business Office shall work 
     in consultation with the Office of Clinical Operations and 
     Management of the Department of Veterans Affairs to ensure 
     that care and services described in paragraph (1) is provided 
     in a manner that is clinically appropriate and effective.
       (3) No delay in payment.--The transfer of authority under 
     paragraph (1) shall be carried out in a manner that does not 
     delay or impede any payment by the Department for hospital 
     care, medical services, or other health care provided through 
     a non-Department provider under the laws administered by the 
     Secretary.
       (b) Budgetary Effect.--The Secretary shall, for each fiscal 
     year that begins after the date of the enactment of this 
     Act--
       (1) include in the budget for the Chief Business Office of 
     the Veterans Health Administration amounts to pay for 
     hospital care, medical services, and other health care 
     provided through non-Department providers, including any 
     amounts necessary to carry out the transfer of authority to 
     pay for such care and services under subsection (a), 
     including any increase in staff; and
       (2) not include in the budget of each Veterans Integrated 
     Service Network and medical center of the Department amounts 
     to pay for such care and services.
       (c) Removal From Performance Goals.--For each fiscal year 
     that begins after the date of the enactment of this Act, the 
     Secretary shall not include in the performance goals of any 
     employee of a Veterans Integrated Service Network or medical 
     center of the Department any performance goal that might 
     disincentivize the payment of Department amounts to provide 
     hospital care, medical services, or other health care through 
     a non-Department provider.

     SEC. 304. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF 
                   VETERANS AFFAIRS AND INDIAN HEALTH SERVICE.

       (a) Outreach to Tribal-run Medical Facilities.--The 
     Secretary of Veterans Affairs shall, in consultation with the 
     Director of the Indian Health Service, conduct outreach to 
     each medical facility operated by an Indian tribe or tribal 
     organization through a contract or compact with the Indian 
     Health Service under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.) to raise 
     awareness of the ability of such facilities, Indian tribes, 
     and tribal organizations to enter into agreements with the 
     Department of Veterans Affairs under which the Secretary 
     reimburses such facilities, Indian tribes, or tribal 
     organizations, as the case may be, for health care provided 
     to veterans eligible for health care at such facilities.
       (b) Metrics for Memorandum of Understanding Performance.--
     The Secretary of Veterans Affairs shall implement performance 
     metrics for assessing the performance by the Department of 
     Veterans Affairs and the Indian Health Service under the 
     memorandum of understanding entitled ``Memorandum of 
     Understanding between the Department of Veterans Affairs (VA) 
     and the Indian Health Service (IHS)'' in increasing access to 
     health care, improving quality and coordination of health 
     care, promoting effective patient-centered collaboration and 
     partnerships between the Department and the Service, and 
     ensuring health-promotion and disease-prevention services are 
     appropriately funded and available for beneficiaries under 
     both health care systems.
       (c) Report.--Not later than 180 days after the date of the 
     enactment of this Act, the Secretary of Veterans Affairs and 
     the Director of the Indian Health Service shall jointly 
     submit to Congress a report on the feasibility and 
     advisability of the following:
       (1) Entering into agreements for the reimbursement by the 
     Secretary of the costs of direct care services provided 
     through organizations receiving amounts pursuant to grants 
     made or contracts entered into under section 503 of the 
     Indian Health Care Improvement Act (25 U.S.C. 1653) to 
     veterans who are otherwise eligible to receive health care 
     from such organizations.
       (2) Including the reimbursement of the costs of direct care 
     services provided to veterans who are not Indians in 
     agreements between the Department and the following:
       (A) The Indian Health Service.
       (B) An Indian tribe or tribal organization operating a 
     medical facility through a contract or compact with the 
     Indian Health Service under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.).
       (C) A medical facility of the Indian Health Service.
       (d) Definitions.--In this section:
       (1) Indian.--The terms ``Indian'' and ``Indian tribe'' have 
     the meanings given those terms in section 4 of the Indian 
     Health Care Improvement Act (25 U.S.C. 1603).

[[Page S3376]]

       (2) Medical facility of the indian health service.--The 
     term ``medical facility of the Indian Health Service'' 
     includes a facility operated by an Indian tribe or tribal 
     organization through a contract or compact with the Indian 
     Health Service under the Indian Self-Determination and 
     Education Assistance Act (25 U.S.C. 450 et seq.).
       (3) Tribal organization.--The term ``tribal organization'' 
     has the meaning given the term in section 4 of the Indian 
     Self-Determination and Education Assistance Act (25 U.S.C. 
     450b).

     SEC. 305. ENHANCEMENT OF COLLABORATION BETWEEN DEPARTMENT OF 
                   VETERANS AFFAIRS AND NATIVE HAWAIIAN HEALTH 
                   CARE SYSTEMS.

       (a) In General.--The Secretary of Veterans Affairs shall, 
     in consultation with Papa Ola Lokahi and such other 
     organizations involved in the delivery of health care to 
     Native Hawaiians as the Secretary considers appropriate, 
     enter into contracts or agreements with Native Hawaiian 
     health care systems that are in receipt of funds from the 
     Secretary of Health and Human Services pursuant to grants 
     awarded or contracts entered into under section 6(a) of the 
     Native Hawaiian Health Care Improvement Act (42 U.S.C. 
     11705(a)) for the reimbursement of direct care services 
     provided to eligible veterans as specified in such contracts 
     or agreements.
       (b) Definitions.--In this section, the terms ``Native 
     Hawaiian'', ``Native Hawaiian health care system'', and 
     ``Papa Ola Lokahi'' have the meanings given those terms in 
     section 12 of the Native Hawaiian Health Care Improvement Act 
     (42 U.S.C. 11711).

     SEC. 306. AUTHORIZATION OF EMERGENCY APPROPRIATIONS.

       There is authorized to be appropriated for the Department 
     of Veterans Affairs such sums as may be necessary to carry 
     out this title.

              TITLE IV--HEALTH CARE ADMINISTRATIVE MATTERS

     SEC. 401. IMPROVEMENT OF ACCESS OF VETERANS TO MOBILE VET 
                   CENTERS OF THE DEPARTMENT OF VETERANS AFFAIRS.

       (a) Improvement of Access.--
       (1) In general.--The Secretary of Veterans Affairs shall 
     improve the access of veterans to telemedicine and other 
     health care through the use of mobile vet centers of the 
     Department of Veterans Affairs by providing standardized 
     requirements for the operation of such centers.
       (2) Requirements.--The standardized requirements required 
     by paragraph (1) shall include the following:
       (A) The number of days each mobile vet center of the 
     Department is expected to travel per year.
       (B) The number of locations each center is expected to 
     visit per year.
       (C) The number of appointments each center is expected to 
     conduct per year.
       (D) The method and timing of notifications given by each 
     center to individuals in the area to which such center is 
     traveling, including notifications informing veterans of the 
     availability to schedule appointments at the center.
       (3) Use of telemedicine.--The Secretary shall ensure that 
     each mobile vet center of the Department has the capability 
     to provide telemedicine services.
       (b) Reports.--Not later than one year after the date of the 
     enactment of this Act, and not later than September 30 each 
     year thereafter, 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 following:
       (1) The use of mobile vet centers to provide telemedicine 
     services to veterans during the year preceding the submittal 
     of the report, including the following:
       (A) The number of days each mobile vet center was open to 
     provide such services.
       (B) The number of days each mobile vet center traveled to a 
     location other than the headquarters of the mobile vet center 
     to provide such services.
       (C) The number of appointments each center conducted to 
     provide such services on average per month and in total 
     during such year.
       (2) An analysis of the effectiveness of using mobile vet 
     centers to provide health care services to veterans through 
     the use of telemedicine.
       (3) Any recommendations for an increase in the number of 
     mobile vet centers of the Department.
       (4) Any recommendations for an increase in the telemedicine 
     capabilities of each mobile vet center.
       (5) The feasibility and advisability of using temporary 
     health care providers, including locum tenens, to provide 
     direct health care services to veterans at mobile vet 
     centers.
       (6) Such other recommendations on improvement of the use of 
     mobile vet centers by the Department as the Secretary 
     considers appropriate.

     SEC. 402. COMMISSION ON ACCESS TO CARE.

       (a) Establishment of Commission.--
       (1) In general.--There is established the Commission on 
     Access to Care (in this section referred to as the 
     ``Commission'') to examine the access of veterans to health 
     care from the Department of Veterans Affairs and 
     strategically examine how best to organize the Veterans 
     Health Administration, locate health care resources, and 
     deliver health care to veterans during the next 10 to 20 
     years.
       (2) Membership.--
       (A) Voting members.--The Commission shall be composed of 10 
     voting members who are appointed by the President as follows:
       (i) At least two members who represent an organization 
     recognized by the Secretary of Veterans Affairs for the 
     representation of veterans under section 5902 of title 38, 
     United States Code.
       (ii) At least one member from among persons who are experts 
     concerning a public or private hospital system.
       (iii) At least one member from among persons who are 
     familiar with government health care systems, including those 
     systems of the Department of Defense, the Indian Health 
     Service, and Federally-qualified health centers (as defined 
     in section 1905(l)(2)(B) of the Social Security Act (42 
     U.S.C. 1396d(l)(2)(B))).
       (iv) At least two members from among persons who are 
     familiar with the Veterans Health Administration.
       (B) Nonvoting members.--In addition to members appointed 
     under subparagraph (A), the Commission shall be composed of 
     10 nonvoting members who are appointed by the President as 
     follows:
       (i) At least two members who represent an organization 
     recognized by the Secretary of Veterans Affairs for the 
     representation of veterans under section 5902 of title 38, 
     United States Code.
       (ii) At least one member from among persons who are experts 
     in a public or private hospital system.
       (iii) At least one member from among persons who are 
     familiar with government health care systems, including those 
     systems of the Department of Defense, the Indian Health 
     Service, and Federally-qualified health centers (as defined 
     in section 1905(l)(2)(B) of the Social Security Act (42 
     U.S.C. 1396d(l)(2)(B))).
       (iv) At least two members from among persons who are 
     familiar with the Veterans Health Administration.
       (C) Date.--The appointments of members of the Commission 
     shall be made not later than 60 days after the date of the 
     enactment of this Act.
       (3) Period of appointment; vacancies.--Members shall be 
     appointed for the life of the Commission. Any vacancy in the 
     Commission shall not affect its powers, but shall be filled 
     in the same manner as the original appointment.
       (4) Initial meeting.--Not later than 15 days after the date 
     on which seven voting members of the Commission have been 
     appointed, the Commission shall hold its first meeting.
       (5) Meetings.--The Commission shall meet at the call of the 
     Chairperson.
       (6) Quorum.--A majority of the members of the Commission 
     shall constitute a quorum, but a lesser number of members may 
     hold hearings.
       (7) Chairperson and vice chairperson.--The Commission shall 
     select a Chairperson and Vice Chairperson from among its 
     members.
       (b) Duties of Commission.--
       (1) Evaluation and assessment.--The Commission shall 
     undertake a comprehensive evaluation and assessment of access 
     to health care at the Department of Veterans Affairs.
       (2) Matters evaluated and assessed.--The matters evaluated 
     and assessed by the Commission shall include the following:
       (A) The appropriateness of current standards of the 
     Department of Veterans Affairs concerning access to health 
     care.
       (B) The measurement of such standards.
       (C) The appropriateness of performance standards and 
     incentives in relation to standards described in subparagraph 
     (A).
       (D) Staffing levels throughout the Veterans Health 
     Administration and whether they are sufficient to meet 
     current demand for health care from the Administration.
       (3) Reports.--The Commission shall submit to the President, 
     through the Secretary of Veterans Affairs, reports as 
     follows:
       (A) Not later than 90 days after the date of the initial 
     meeting of the Commission, an interim report on--
       (i) the findings of the Commission with respect to the 
     evaluation and assessment required by this subsection; and
       (ii) such recommendations as the Commission may have for 
     legislative or administrative action to improve access to 
     health care through the Veterans Health Administration.
       (B) Not later than 180 days after the date of the initial 
     meeting of the Commission, a final report on--
       (i) the findings of the Commission with respect to the 
     evaluation and assessment required by this subsection; and
       (ii) such recommendations as the Commission may have for 
     legislative or administrative action to improve access to 
     health care through the Veterans Health Administration.
       (c) Powers of the Commission.--
       (1) Hearings.--The Commission may hold such hearings, sit 
     and act at such times and places, take such testimony, and 
     receive such evidence as the Commission considers advisable 
     to carry out this section.
       (2) Information from federal agencies.--The Commission may 
     secure directly from any Federal department or agency such 
     information as the Commission considers necessary to carry 
     out this section. Upon request of the Chairperson of the 
     Commission, the head of such department or agency shall 
     furnish such information to the Commission.
       (d) Commission Personnel Matters.--

[[Page S3377]]

       (1) Compensation of members.--Each member of the Commission 
     who is not an officer or employee of the Federal Government 
     shall be compensated at a rate equal to the daily equivalent 
     of the annual rate of basic pay prescribed for level IV of 
     the Executive Schedule under section 5315 of title 5, United 
     States Code, for each day (including travel time) during 
     which such member is engaged in the performance of the duties 
     of the Commission. All members of the Commission who are 
     officers or employees of the United States shall serve 
     without compensation in addition to that received for their 
     services as officers or employees of the United States.
       (2) Travel expenses.--The members of the Commission shall 
     be allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Commission.
       (3) Staff.--
       (A) In general.--The Chairperson of the Commission may, 
     without regard to the civil service laws and regulations, 
     appoint and terminate an executive director and such other 
     additional personnel as may be necessary to enable the 
     Commission to perform its duties. The employment of an 
     executive director shall be subject to confirmation by the 
     Commission.
       (B) Compensation.--The Chairperson of the Commission may 
     fix the compensation of the executive director and other 
     personnel without regard to chapter 51 and subchapter III of 
     chapter 53 of title 5, United States Code, relating to 
     classification of positions and General Schedule pay rates, 
     except that the rate of pay for the executive director and 
     other personnel may not exceed the rate payable for level V 
     of the Executive Schedule under section 5316 of such title.
       (4) Detail of government employees.--Any Federal Government 
     employee may be detailed to the Commission without 
     reimbursement, and such detail shall be without interruption 
     or loss of civil service status or privilege.
       (5) Procurement of temporary and intermittent services.--
     The Chairperson of the Commission may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code, at rates for individuals which do not 
     exceed the daily equivalent of the annual rate of basic pay 
     prescribed for level V of the Executive Schedule under 
     section 5316 of such title.
       (e) Termination of the Commission.--The Commission shall 
     terminate 30 days after the date on which the Commission 
     submits its report under subsection (b)(3)(B).
       (f) Funding.--The Secretary of Veterans Affairs shall make 
     available to the Commission from amounts appropriated or 
     otherwise made available to the Secretary such amounts as the 
     Secretary and the Chairperson of the Commission jointly 
     consider appropriate for the Commission to perform its duties 
     under this section.
       (g) Executive Action.--
       (1) Action on recommendations.--The President shall require 
     the Secretary of Veterans Affairs and such other heads of 
     relevant Federal departments and agencies to implement each 
     recommendation set forth in a report submitted under 
     subsection (b)(3) that the President--
       (A) considers feasible and advisable; and
       (B) determines can be implemented without further 
     legislative action.
       (2) Reports.--Not later than 60 days after the date on 
     which the President receives a report under subsection 
     (b)(3), the President shall submit to the Committee on 
     Veterans' Affairs of the Senate and the Committee on 
     Veterans' Affairs of the House of Representatives and such 
     other committees of Congress as the President considers 
     appropriate a report setting forth the following:
       (A) An assessment of the feasibility and advisability of 
     each recommendation contained in the report received by the 
     President.
       (B) For each recommendation assessed as feasible and 
     advisable under subparagraph (A) the following:
       (i) Whether such recommendation requires legislative 
     action.
       (ii) If such recommendation requires legislative action, a 
     recommendation concerning such legislative action.
       (iii) A description of any administrative action already 
     taken to carry out such recommendation.
       (iv) A description of any administrative action the 
     President intends to be taken to carry out such 
     recommendation and by whom.

     SEC. 403. COMMISSION ON CAPITAL PLANNING FOR DEPARTMENT OF 
                   VETERANS AFFAIRS MEDICAL FACILITIES.

       (a) Establishment of Commission.--
       (1) Establishment.--There is established the Commission on 
     Capital Planning for Department of Veterans Affairs Medical 
     Facilities (in this section referred to as the 
     ``Commission'').
       (2) Membership.--
       (A) Voting members.--The Commission shall, subject to 
     subparagraph (B), be composed of 10 voting members as 
     follows:
       (i) 1 shall be appointed by the President.
       (ii) 1 shall be appointed by the Administrator of General 
     Services.
       (iii) 3 shall be appointed by the Secretary of Veterans 
     Affairs, of whom--

       (I) 1 shall be an employee of the Veterans Health 
     Administration;
       (II) 1 shall be an employee of the Office of Asset 
     Enterprise Management of the Department of Veterans Affairs; 
     and
       (III) 1 shall be an employee of the Office of Construction 
     and Facilities Management of the Department of Veterans 
     Affairs.

       (iv) 1 shall be appointed by the Secretary of Defense from 
     among employees of the Army Corps of Engineers.
       (v) 1 shall be appointed by the majority leader of the 
     Senate.
       (vi) 1 shall be appointed by the minority leader of the 
     Senate.
       (vii) 1 shall be appointed by the Speaker of the House of 
     Representatives.
       (viii) 1 shall be appointed by the minority leader of the 
     House of Representatives.
       (B) Requirement relating to certain appointments of voting 
     members.--Of the members appointed pursuant to clause (i), 
     (ii), and (iv) through (viii) of subparagraph (A), all shall 
     have expertise in capital leasing, construction, or health 
     facility management planning.
       (C) Non-voting members.--The Commission shall be assisted 
     by 10 non-voting members, appointed by the vote of a majority 
     of members of the Commission under subparagraph (A), of 
     whom--
       (i) 6 shall be representatives of veterans service 
     organizations recognized by the Secretary of Veterans 
     Affairs; and
       (ii) 4 shall be individuals from outside the Department of 
     Veterans Affairs with experience and expertise in matters 
     relating to management, construction, and leasing of capital 
     assets.
       (D) Date of appointment of voting members.--The 
     appointments of the members of the Commission under 
     subparagraph (A) shall be made not later than 60 days after 
     the date of the enactment of this Act.
       (3) Period of appointment; vacancies.--Members shall be 
     appointed for the life of the Commission. Any vacancy in the 
     Commission shall not affect its powers, but shall be filled 
     in the same manner as the original appointment.
       (4) Initial meeting.--Not later than 15 days after the date 
     on which 7 members of the Commission have been appointed, the 
     Commission shall hold its first meeting.
       (5) Meetings.--The Commission shall meet at the call of the 
     Chair.
       (6) Quorum.--A majority of the members of the Commission 
     shall constitute a quorum, but a lesser number of members may 
     hold hearings.
       (7) Chair and vice chair.--The Commission shall select a 
     Chair and Vice Chair from among its members.
       (b) Duties of Commission.--
       (1) In general.--The Commission shall undertake a 
     comprehensive evaluation and assessment of various options 
     for capital planning for Department of Veterans Affairs 
     medical facilities, including an evaluation and assessment of 
     the mechanisms by which the Department currently selects 
     means for the delivery of health care, whether by major 
     construction, major medical facility leases, sharing 
     agreements with the Department of Defense, the Indian Health 
     Service, and Federally Qualified Health Clinics under section 
     330 of the Public Health Service Act (42 U.S.C. 254b), 
     contract care, multisite care, telemedicine, extended hours 
     for care, or other means.
       (2) Context of evaluation and assessment.--In undertaking 
     the evaluation and assessment, the Commission shall 
     consider--
       (A) the importance of access to health care through the 
     Department, including associated guidelines of the Department 
     on access to, and drive time for, health care;
       (B) limitations and requirements applicable to the 
     construction and leasing of medical facilities for the 
     Department, including applicable laws, regulations, and costs 
     as determined by both the Congressional Budget Office and the 
     Office of Management and Budget;
       (C) the nature of capital planning for Department medical 
     facilities in an era of fiscal uncertainty;
       (D) projected future fluctuations in the population of 
     veterans; and
       (E) the extent to which the Department was able to meet the 
     mandates of the Capital Asset Realignment for Enhanced 
     Services Commission.
       (3) Particular considerations.--In undertaking the 
     evaluation and assessment, the Commission shall address, in 
     particular, the following:
       (A) The Major Medical Facility Lease Program of the 
     Department, including an identification of potential 
     improvements to the lease authorization processes under that 
     Program.
       (B) The management processes of the Department for its 
     Major Medical Facility Construction Program, including 
     processes relating to contract award and management, project 
     management, and processing of change orders.
       (C) The overall capital planning program of the Department 
     for medical facilities, including an evaluation and 
     assessment of--
       (i) the manner in which the Department determines whether 
     to use capital or non-capital means to expand access to 
     health care;
       (ii) the manner in which the Department determines the 
     disposition of under-utilized and un-utilized buildings on 
     campuses of Department medical centers, and any barriers to 
     disposition;
       (iii) the effectiveness of the facility master planning 
     initiative of the Department; and
       (iv) the extent to which sustainable attributes are planned 
     for to decrease operating costs for Department medical 
     facilities.

[[Page S3378]]

       (D) The current backlog of construction projects for 
     Department medical facilities, including an identification of 
     the most effective means to quickly secure the most critical 
     repairs required, including repairs relating to facility 
     condition deficiencies, structural safety, and compliance 
     with the Americans With Disabilities Act of 1990.
       (4) Reports.--Subject to paragraph (5), the Commission 
     shall submit to the Secretary of Veterans Affairs, and to the 
     Committee Veterans' Affairs of the Senate and the Committee 
     on Veterans' Affairs of the House of Representatives, reports 
     as follows:
       (A) Not later than six months after its initial meeting 
     under subsection (a)(4), a report on the Major Medical 
     Facility Lease Program and the Congressional lease 
     authorization process.
       (B) Not later than one year after its initial meeting, a 
     report--
       (i) on the management processes of the Department for the 
     construction of Department medical facilities; and
       (ii) setting forth an update of any matters covered in the 
     report under subparagraph (A).
       (C) Not later than 18 months after its initial meeting, a 
     report--
       (i) on the overall capital planning program of the 
     Department for medical facilities; and
       (ii) setting forth an update of any matters covered in 
     earlier reports under this paragraph.
       (D) Not later than two years after its initial meeting, a 
     report--
       (i) on the current backlog of construction projects for 
     Department medical facilities;
       (ii) setting forth an update of any matters covered in 
     earlier reports under this paragraph; and
       (iii) including such other matters relating to the duties 
     of the Commission that the Commission considers appropriate.
       (E) Not later than 27 months after its initial meeting, a 
     report on the implementation by the Secretary of Veterans 
     Affairs pursuant to subsection (g) of the recommendations 
     included pursuant to paragraph (5) in the reports under this 
     paragraph.
       (5) Recommendations.--Each report under paragraph (4) shall 
     include, for the aspect of the capital asset planning process 
     of the Department covered by such report, such 
     recommendations as the Commission considers appropriate for 
     the improvement and enhancement of such aspect of the capital 
     asset planning process.
       (c) Powers of Commission.--
       (1) Hearings.--The Commission may hold such hearings, sit 
     and act at such times and places, take such testimony, and 
     receive such evidence as the Commission considers advisable 
     to carry out this section.
       (2) Information from federal agencies.--The Commission may 
     secure directly from any Federal department or agency such 
     information as the Commission considers necessary to carry 
     out this section. Upon request of the Chair of the 
     Commission, the head of such department or agency shall 
     furnish such information to the Commission.
       (d) Commission Personnel Matters.--
       (1) Compensation of members.--Each member of the Commission 
     who is not an officer or employee of the Federal Government 
     shall be compensated at a rate equal to the daily equivalent 
     of the annual rate of basic pay prescribed for level IV of 
     the Executive Schedule under section 5315 of title 5, United 
     States Code, for each day (including travel time) during 
     which such member is engaged in the performance of the duties 
     of the Commission. All members of the Commission who are 
     officers or employees of the United States shall serve 
     without compensation in addition to that received for their 
     services as officers or employees of the United States.
       (2) Travel expenses.--The members of the Commission shall 
     be allowed travel expenses, including per diem in lieu of 
     subsistence, at rates authorized for employees of agencies 
     under subchapter I of chapter 57 of title 5, United States 
     Code, while away from their homes or regular places of 
     business in the performance of services for the Commission.
       (3) Staff.--
       (A) In general.--The Chair of the Commission may, without 
     regard to the civil service laws and regulations, appoint and 
     terminate an executive director and such other additional 
     personnel as may be necessary to enable the Commission to 
     perform its duties. The employment of an executive director 
     shall be subject to confirmation by the Commission.
       (B) Compensation.--The Chair of the Commission may fix the 
     compensation of the executive director and other personnel 
     without regard to chapter 51 and subchapter III of chapter 53 
     of title 5, United States Code, relating to classification of 
     positions and General Schedule pay rates, except that the 
     rate of pay for the executive director and other personnel 
     may not exceed the rate payable for level V of the Executive 
     Schedule under section 5316 of such title.
       (4) Detail of government employees.--Any Federal Government 
     employee may be detailed to the Commission without 
     reimbursement, and such detail shall be without interruption 
     or loss of civil service status or privilege.
       (5) Procurement of temporary and intermittent services.--
     The Chair of the Commission may procure temporary and 
     intermittent services under section 3109(b) of title 5, 
     United States Code, at rates for individuals which do not 
     exceed the daily equivalent of the annual rate of basic pay 
     prescribed for level V of the Executive Schedule under 
     section 5316 of such title.
       (e) Termination of Commission.--The Commission shall 
     terminate 60 days after the date on which the Commission 
     submits its report under subsection (b)(4)(E).
       (f) Funding.--The Secretary of Veterans Affairs shall make 
     available to the Commission such amounts as the Secretary and 
     the Chair of the Commission jointly consider appropriate for 
     the Commission to perform its duties under this section.
       (g) Action on Recommendations.--
       (1) In general.--The Secretary of Veterans Affairs shall 
     implement each recommendation included in a report under 
     subsection (b)(4) that the Secretary considers feasible and 
     advisable and can be implemented without further legislative 
     action.
       (2) Reports.--Not later than 120 days after receipt of a 
     report under subparagraphs (A) through (D) of subsection 
     (b)(4), the Secretary shall submit to the Committee Veterans' 
     Affairs of the Senate and the Committee on Veterans' Affairs 
     of the House of Representatives a report setting forth the 
     following:
       (A) An assessment of the feasibility and advisability of 
     each recommendation contained in such report.
       (B) For each recommendation assessed as feasible and 
     advisable--
       (i) if such recommendation does not require further 
     legislative action for implementation, a description of the 
     actions taken, and to be taken, by the Secretary to implement 
     such recommendation; and
       (ii) if such recommendation requires further legislative 
     action for implementation, recommendations for such 
     legislative action.

     SEC. 404. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOYEES OF 
                   THE DEPARTMENT OF VETERANS AFFAIRS FOR 
                   PERFORMANCE.

       (a) Removal or Transfer.--
       (1) In general.--Chapter 7 of title 38, United States Code, 
     is amended by adding at the end the following new section:

     ``Sec. 713. Senior Executive Service: removal based on 
       performance

       ``(a) In General.--The Secretary may remove any individual 
     from the Senior Executive Service if the Secretary determines 
     the performance of the individual warrants such removal. If 
     the Secretary so removes such an individual, the Secretary 
     may--
       ``(1) remove the individual from the civil service (as 
     defined in section 2101 of title 5); or
       ``(2) transfer the individual to a General Schedule 
     position at any grade of the General Schedule for which the 
     individual is qualified and that the Secretary determines is 
     appropriate.
       ``(b) Notice to Congress.--Not later than 30 days after 
     removing or transferring an individual from the Senior 
     Executive Service under paragraph (1), the Secretary shall 
     submit to the Committees on Veterans' Affairs of the Senate 
     and House of Representatives notice in writing of such 
     removal or transfer and the reason for such removal or 
     transfer.
       ``(c) Appeal of Removal or Transfer.--Any removal or 
     transfer under subsection (a) may be appealed to the Merit 
     Systems Protection Board under section 7701 of title 5 not 
     later than 7 days after such removal or transfer.
       ``(d) Expedited Review by Merit Systems Protection Board.--
     (1) The Merit Systems Protection Board shall expedite any 
     appeal under section 7701 of title 5 of a removal or transfer 
     under subsection (a) and, in any such case, shall issue a 
     decision not later than 21 days after the date of the appeal.
       ``(2) In any case in which the Merit Systems Protection 
     Board determines that it cannot issue a decision in 
     accordance with the 21-day requirement under paragraph (1), 
     the Merit Systems Protection Board shall submit to Congress a 
     report that explains the reason why the Merit Systems 
     Protection Board is unable to issue a decision in accordance 
     with such requirement in such case.
       ``(3) There is authorized to be appropriated such sums as 
     may be necessary for the Merit Systems Protection Board to 
     expedite appeals under paragraph (1).
       ``(4) The Merit Systems Protection Board may not stay any 
     personnel action taken under this section.''.
       (2) Clerical amendment.--The table of sections at the 
     beginning of such chapter is amended by adding at the end the 
     following new item:

``713. Senior Executive Service: removal based on performance.''.
       (b) Establishment of Expedited Review Process.--
       (1) In general.--Not later than 30 days after the date of 
     the enactment of this Act, the Merit Systems Protection Board 
     shall establish and put into effect a process to conduct 
     expedited reviews in accordance with section 713(d) of title 
     38, United States Code.
       (2) Inapplicability of certain regulations.--Section 
     1201.22 of title 5, Code of Federal Regulations, as in effect 
     on the day before the date of the enactment of this Act, 
     shall not apply to expedited reviews carried out under 
     section 713(d) of title 38, United States Code.
       (3) Report by merit systems protection board.--Not later 
     than 30 days after the date of the enactment of this Act, the 
     Merit Systems Protection Board shall submit to Congress a 
     report on the actions the Board plans to take to conduct 
     expedited reviews under section 713(d) of title 38, United 
     States Code, as added by subsection (a). Such report shall 
     include a description of the resources the

[[Page S3379]]

     Board determines will be necessary to conduct such reviews 
     and a description of whether any resources will be necessary 
     to conduct such reviews that were not available to the Board 
     on the day before the date of the enactment of this Act.
       (c) Temporary Exemption From Certain Limitation on 
     Initiation of Removal From Senior Executive Service.--During 
     the 120-day period beginning on the date of the enactment of 
     this Act, an action to remove an individual from the Senior 
     Executive Service at the Department of Veterans Affairs 
     pursuant to section 713 of title 38, United States Code, as 
     added by subsection (a), or section 7543 of title 5, United 
     States Code, may be initiated, notwithstanding section 
     3592(b) of title 5, United States Code, or any other 
     provision of law.
       (d) Construction.--Nothing in this section or section 713 
     of title 38, United States Code, as added by subsection (a), 
     shall be construed to apply to an appeal of a removal, 
     transfer, or other personnel action that was pending before 
     the date of the enactment of this Act.

                 TITLE V--MAJOR MEDICAL FACILITY LEASES

     SEC. 501. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

       The Secretary of Veterans Affairs may carry out the 
     following major medical facility leases at the locations 
     specified, and in an amount for each lease not to exceed the 
     amount shown for such location (not including any estimated 
     cancellation costs):
       (1) For a clinical research and pharmacy coordinating 
     center, Albuquerque, New Mexico, an amount not to exceed 
     $9,560,000.
       (2) For a community-based outpatient clinic, Brick, New 
     Jersey, an amount not to exceed $7,280,000.
       (3) For a new primary care and dental clinic annex, 
     Charleston, South Carolina, an amount not to exceed 
     $7,070,250.
       (4) For the Cobb County community-based Outpatient Clinic, 
     Cobb County, Georgia, an amount not to exceed $6,409,000.
       (5) For the Leeward Outpatient Healthcare Access Center, 
     Honolulu, Hawaii, including a co-located clinic with the 
     Department of Defense and the co-location of the Honolulu 
     Regional Office of the Veterans Benefits Administration and 
     the Kapolei Vet Center of the Department of Veterans Affairs, 
     an amount not to exceed $15,887,370.
       (6) For a community-based outpatient clinic, Johnson 
     County, Kansas, an amount not to exceed $2,263,000.
       (7) For a replacement community-based outpatient clinic, 
     Lafayette, Louisiana, an amount not to exceed $2,996,000.
       (8) For a community-based outpatient clinic, Lake Charles, 
     Louisiana, an amount not to exceed $2,626,000.
       (9) For outpatient clinic consolidation, New Port Richey, 
     Florida, an amount not to exceed $11,927,000.
       (10) For an outpatient clinic, Ponce, Puerto Rico, an 
     amount not to exceed $11,535,000.
       (11) For lease consolidation, San Antonio, Texas, an amount 
     not to exceed $19,426,000.
       (12) For a community-based outpatient clinic, San Diego, 
     California, an amount not to exceed $11,946,100.
       (13) For an outpatient clinic, Tyler, Texas, an amount not 
     to exceed $4,327,000.
       (14) For the Errera Community Care Center, West Haven, 
     Connecticut, an amount not to exceed $4,883,000.
       (15) For the Worcester community-based Outpatient Clinic, 
     Worcester, Massachusetts, an amount not to exceed $4,855,000.
       (16) For the expansion of a community-based outpatient 
     clinic, Cape Girardeau, Missouri, an amount not to exceed 
     $4,232,060.
       (17) For a multispecialty clinic, Chattanooga, Tennessee, 
     an amount not to exceed $7,069,000.
       (18) For the expansion of a community-based outpatient 
     clinic, Chico, California, an amount not to exceed 
     $4,534,000.
       (19) For a community-based outpatient clinic, Chula Vista, 
     California, an amount not to exceed $3,714,000.
       (20) For a new research lease, Hines, Illinois, an amount 
     not to exceed $22,032,000.
       (21) For a replacement research lease, Houston, Texas, an 
     amount not to exceed $6,142,000.
       (22) For a community-based outpatient clinic, Lincoln, 
     Nebraska, an amount not to exceed $7,178,400.
       (23) For a community-based outpatient clinic, Lubbock, 
     Texas, an amount not to exceed $8,554,000.
       (24) For a community-based outpatient clinic consolidation, 
     Myrtle Beach, South Carolina, an amount not to exceed 
     $8,022,000.
       (25) For a community-based outpatient clinic, Phoenix, 
     Arizona, an amount not to exceed $20,757,000.
       (26) For the expansion of a community-based outpatient 
     clinic, Redding, California, an amount not to exceed 
     $8,154,000.
       (27) For the expansion of a community-based outpatient 
     clinic, Tulsa, Oklahoma, an amount not to exceed $13,269,200.

     SEC. 502. BUDGETARY TREATMENT OF DEPARTMENT OF VETERANS 
                   AFFAIRS MAJOR MEDICAL FACILITIES LEASES.

       (a) Findings.--Congress finds the following:
       (1) Title 31, United States Code, requires the Department 
     of Veterans Affairs to record the full cost of its 
     contractual obligation against funds available at the time a 
     contract is executed.
       (2) Office of Management and Budget Circular A-11 provides 
     guidance to agencies in meeting the statutory requirements 
     under title 31, United States Code, with respect to leases.
       (3) For operating leases, Office of Management and Budget 
     Circular A-11 requires the Department of Veterans Affairs to 
     record up-front budget authority in an ``amount equal to 
     total payments under the full term of the lease or [an] 
     amount sufficient to cover first year lease payments plus 
     cancellation costs''.
       (b) Requirement for Obligation of Full Cost.--
       (1) In general.--Subject to the availability of 
     appropriations provided in advance, in exercising the 
     authority of the Secretary of Veterans Affairs to enter into 
     leases provided in this Act, the Secretary shall record, 
     pursuant to section 1501 of title 31, United States Code, as 
     the full cost of the contractual obligation at the time a 
     contract is executed either--
       (A) an amount equal to total payments under the full term 
     of the lease; or
       (B) if the lease specifies payments to be made in the event 
     the lease is terminated before its full term, an amount 
     sufficient to cover the first year lease payments plus the 
     specified cancellation costs.
       (2) Self-insuring authority.--The requirements of paragraph 
     (1) may be satisfied through the use of a self-insuring 
     authority consistent with Office of Management and Budget 
     Circular A-11.
       (c) Transparency.--
       (1) Compliance.--Subsection (b) of section 8104 of title 
     38, United States Code, is amended by adding at the end the 
     following new paragraph:
       ``(7) In the case of a prospectus proposing funding for a 
     major medical facility lease, a detailed analysis of how the 
     lease is expected to comply with Office of Management and 
     Budget Circular A-11 and section 1341 of title 31 (commonly 
     referred to as the `Anti-Deficiency Act'). Any such analysis 
     shall include--
       ``(A) an analysis of the classification of the lease as a 
     `lease-purchase', `capital lease', or `operating lease' as 
     those terms are defined in Office of Management and Budget 
     Circular A-11;
       ``(B) an analysis of the obligation of budgetary resources 
     associated with the lease; and
       ``(C) an analysis of the methodology used in determining 
     the asset cost, fair market value, and cancellation costs of 
     the lease.''.
       (2) Submittal to congress.--Such section 8104 is further 
     amended by adding at the end the following new subsection:
       ``(h)(1) Not less than 30 days before entering into a major 
     medical facility lease, the Secretary shall submit to the 
     Committees on Veterans' Affairs of the Senate and the House 
     of Representatives--
       ``(A) notice of the Secretary's intention to enter into the 
     lease;
       ``(B) a detailed summary of the proposed lease;
       ``(C) a description and analysis of any differences between 
     the prospectus submitted pursuant to subsection (b) and the 
     proposed lease; and
       ``(D) a scoring analysis demonstrating that the proposed 
     lease fully complies with Office of Management and Budget 
     Circular A-11.
       ``(2) Each committee described in paragraph (1) shall 
     ensure that any information submitted to the committee under 
     such paragraph is treated by the committee with the same 
     level of confidentiality as is required by law of the 
     Secretary and subject to the same statutory penalties for 
     unauthorized disclosure or use as the Secretary.
       ``(3) Not more than 30 days after entering into a major 
     medical facility lease, the Secretary shall submit to each 
     committee described in paragraph (1) a report on any material 
     differences between the lease that was entered into and the 
     proposed lease described under such paragraph, including how 
     the lease that was entered into changes the previously 
     submitted scoring analysis described in subparagraph (D) of 
     such paragraph.''.
       (d) Rule of Construction.--Nothing in this section, or the 
     amendments made by this section, shall be construed to in any 
     way relieve the Department of Veterans Affairs from any 
     statutory or regulatory obligations or requirements existing 
     prior to the enactment of this section and such amendments.

  Mr. BLUMENTHAL. Mr. President, I am pleased to follow my friend and 
colleague from Vermont, Senator Sanders, and I want to begin by 
thanking him for his leadership, his persistence, and his perseverance 
in the face of resistance that should not exist. This cause ought to be 
one that galvanizes the Nation, and perhaps it will, since the Nation 
has been appalled and astonished by reports of not only cooking the 
books but covering up that potential criminality--destruction of 
documents, falsification of records, secret waiting lists, delays that 
are unacceptable and intolerable for basic, necessary health care our 
veterans need.
  But these issues are longstanding, decades old in this system, and 
they need to be addressed with system-wide reform.
  I am strongly in support, and proudly so, in advocating the Ensuring 
Veterans Access to Health Care Act that Senator Sanders has just 
introduced. It is a version of the omnibus bill and

[[Page S3380]]

other measures that have been introduced. It has essential features 
that will provide better health care sooner and more accessibly to our 
veterans. It is necessary to pass, but these provisions should have 
passed literally years ago. In fact, the very first piece of 
legislation I introduced in the Senate, S. 1060, called the Honoring 
All Veterans Act, included a provision to deal with this shortage of 
doctors in this system. It included other health care-related measures 
to expand the availability and accessibility of health care. These 
problems, far from new, have been existent for some time. And the 
coverup, the lying, and falsification of records is potentially now 
criminal and beyond a failure of public policy; it is a failure in 
integrity.
  I am pleased to join Senator Sanders to make sure the 9.3 million of 
the Nation's 22 million who are enrolled in the VA health care system--
which is up from about 2.5 million at the end of the first gulf war--
have the kind of service they need. This bill will address some basic 
needs. It provides authority to remove senior executives based on poor 
job performance and preventing wholesale political firings. The 
legislation would provide veterans who cannot get timely appointments 
access to private clinics and the option of going to community health 
care centers, military hospitals, or private doctors. It would 
authorize the Veterans' Administration to lease 27 new health 
facilities in 18 States, including funds for the enhanced lease of the 
Errera Community Care Center in West Haven, CT, which does profoundly 
important and excellent work.
  The legislation authorizes emergency funding to hire new doctors and 
nurses and other providers in order to address systemwide health care 
provider shortages and to take other necessary steps to ensure timely 
access to care. It addresses the health care primary care shortage for 
the long term as well by authorizing the National Health Service Corps 
to award scholarships to medical school students and to forgive college 
loans for doctors and nurses who work at the VA. These kinds of 
measures and others in the bill will act to fulfill our basic 
obligation to our veterans, just as I attempted to do in the Honoring 
All Veterans Act some years ago, and others have joined since in 
seeking to do.
  My hope is we can reach across the aisle. In fact, I am working with 
Senator McCain on a bipartisan letter to the Attorney General urging 
all possible involvement and leadership in a criminal investigation. I 
hope a similar spirit of bipartisanship will enable us to work with 
Senators McCain, Burr, and Coburn on their Veterans Choice Act and 
combine these measures, enlist them in supporting a bipartisan solution 
and join Senator Sanders in hoping for that bipartisan effort in this 
measure because there is no question that the VA budget has grown, but 
simply has failed to keep pace with surging demand, especially in 
mental health services and primary care. Too many of our veterans are 
coming home with serious mental health issues, including post-traumatic 
stress, traumatic brain injury, and need the care we owe them. We need 
accountability. Part of it will be firing the officials who should be 
held responsible, but part of it may also be prosecuting them, and that 
is the reason I have asked the Attorney General to take the lead to 
assume much more immediate, significant involvement in any criminal 
investigation that may be necessary.
  In fact, there is credible and significant evidence of criminal 
wrongdoing here. The Department of Justice must be involved and in my 
view must take a leadership role, and that is the reason Senator McCain 
and I have joined in a letter that we are seeking support for our 
colleagues to send that would request the Attorney General to take such 
steps. Only the Attorney General has the resources, expertise, and 
authority, along with the FBI, to do a prompt and effective criminal 
investigation. Only the Department of Justice can convene a grand jury 
and take other necessary steps. Only the FBI can bring to bear the 
expertise as well as the resources.
  The inspector general of the Veterans' Administration has only 165 
investigators for the entire Nation. This investigation now spans more 
than 40 centers where criminality has been alleged. Of the 216 sites 
visited by the auditors recently, many were found to have issues of 
scheduling practice defects and potential integrity problems. So there 
is a reason for the VA inspector general to not only consult with the 
Department of Justice but also involve the Department of Justice in an 
active leadership role here, and for the Acting Secretary of the VA to 
request that involvement, which I hope he will do. I commend what he 
has done so far, but now is the time for the Department of Justice to 
be involved in leading.
  The audit of the facilities around the country is to be made public--
not just the overall results which have been delivered to the President 
in a report last Friday, but all of the results--site-specific results 
for locations, for example, the two hospitals in Connecticut in West 
Haven and in Newington as well as the six medical centers in 
Connecticut. All of those site-specific audits should be made public.

  I have written to the Acting Secretary Sloan Gibson, urging that he 
make those face-to-face audits of the VA medical facilities public, not 
only for Connecticut but for the whole country. Restoring trust and 
credibility will be achieved only if there is more transparency. 
Nondisclosure would be a bad way to begin a new era of leadership at 
the VA. Full transparency is absolutely vital to help restore trust and 
confidence, which has been so gravely threatened and, indeed, 
undermined.
  Finally, I have a few words to say about Secretary Shinseki. The 
immediate challenge is not about replacing one person, it is about 
fixing a system that is desperately wrong. I deeply respect Secretary 
Shinseki's decision to resign last week after concluding that his 
continued service would be a distraction from the urgent and necessary 
overhaul of the Veterans' Administration. I respect even more his 
dedicated service to our Nation. He is a decorated combat veteran who 
led into battle many of the men and women who now use the Veterans' 
Administration. His mentors and models, as he so eloquently told our 
committee, now use the Veterans' Administration. In his heart, I 
believe he is passionately committed to the cause of serving our 
veterans, and he deserves gratitude and respect from the American 
people for his service in the U.S. military and his telling truth to 
power as the President so powerfully observed.
  The Nation must recognize it owes our veterans world-class, first-
class medical care that is second to none. Putting them at risk in 
medical facilities after they have put their lives on the line on the 
battlefield is a disservice to them and our Nation.
  It is abhorrent and atrocious that there have been these potentially 
criminal acts--destruction of documents and falsification of records--
at many of the VA facilities around the country. There is no excuse for 
it. Whether it is arbitrary deadlines or timelines, there is simply no 
excuse for that kind of lying. The lying that happened within the VA 
was not only to General Shinseki, but to the American people. The ones 
who committed that kind of wrongdoing should be held accountable 
administratively and criminally.
  The wars in Iraq and Afghanistan, and the ongoing global military 
operations since 9/11, have cast a long shadow on this Nation's 
history. It involved less than 1 percent of the population, including 
the families of the brave warriors who have been sent to battle. All of 
us will live with the consequences, and all of us have an obligation to 
keep faith with them, leave no veteran behind, and give them prompt and 
world-class, first-class medical care when they need it right away.
  The ``greatest generation'' set a model for them, and they are, 
indeed, the next greatest generation. We have to do right by them as 
they have done right by us. No matter what the era, conflict, or war, 
let us keep faith with all of the veterans and leave no veteran behind.
                                 ______