Congressional Record, Volume 160 Issue 95 (Wednesday, June 18, 2014)

[Congressional Record Volume 160, Number 95 (Wednesday, June 18, 2014)]
[House]
[Pages H5413-H5425]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

PAY OUR GUARD AND RESERVE ACT

Mr. MILLER of Florida. Mr. Speaker, pursuant to House Resolution 628,
I call up the bill (H.R. 3230) making continuing appropriations during
a government shutdown to provide pay and allowances to members of the
reserve components of the Armed Forces who perform inactive-duty
training during such period, with the Senate amendments thereto, and
ask for its immediate consideration.
The Clerk read the title of the bill.
The SPEAKER pro tempore. The Clerk will designate the Senate
amendments.
The text of the Senate amendments is as follows:
Senate amendments:

H.R. 3230

Resolved, That the bill from the House of Representatives
(H.R. 3230) entitled ``An Act making continuing
appropriations during a Government shutdown to provide pay
and allowances to members of the reserve components of the
Armed Forces who perform inactive-duty training during such
period.'', do pass with the following amendments:
Strike all after the enacting clause, and insert in lieu
thereof:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Veterans'
Access to Care through Choice, Accountability, and
Transparency 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. Independent assessment of the scheduling of appointments and
other health care management processes of the Department
of Veterans Affairs.
Sec. 102. Technology task force on review of scheduling system and
software of the Department of Veterans Affairs.

TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

Sec. 201. Treatment of staffing shortage and biannual report on
staffing of medical facilities of the Department of
Veterans Affairs.
Sec. 202. Clinic management training for managers and health care
providers of the Department of Veterans Affairs.
Sec. 203. Use of unobligated amounts to hire additional health care
providers for the Veterans Health Administration.

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

Sec. 301. Expanded availability of hospital care and medical services
for veterans through the use of contracts.
Sec. 302. 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. 303. Enhancement of collaboration between Department of Veterans
Affairs and Indian Health Service.
Sec. 304. Enhancement of collaboration between Department of Veterans
Affairs and Native Hawaiian health care systems.
Sec. 305. Sense of Congress on prompt payment by Department of Veterans
Affairs.

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 construction projects of the Department of
Veterans Affairs.
Sec. 403. Commission on Access to Care.
Sec. 404. Improved performance metrics for health care provided by
Department of Veterans Affairs.
Sec. 405. Improved transparency concerning health care provided by
Department of Veterans Affairs.
Sec. 406. Information for veterans on the credentials of Department of
Veterans Affairs physicians.
Sec. 407. Information in annual budget of the President on hospital
care and medical services furnished through expanded use
of contracts for such care.
Sec. 408. Prohibition on falsification of data concerning wait times
and quality measures at Department of Veterans Affairs.
Sec. 409. Removal of Senior Executive Service employees of the
Department of Veterans Affairs for performance.

TITLE V--HEALTH CARE RELATED TO SEXUAL TRAUMA

Sec. 501. Expansion of eligibility for sexual trauma counseling and
treatment to veterans on inactive duty training.
Sec. 502. Provision of counseling and treatment for sexual trauma by
the Department of Veterans Affairs to members of the
Armed Forces.
Sec. 503. Reports on military sexual trauma.

TITLE VI--MAJOR MEDICAL FACILITY LEASES

Sec. 601. Authorization of major medical facility leases.
Sec. 602. Budgetary treatment of Department of Veterans Affairs major
medical facilities leases.

TITLE VII--VETERANS BENEFITS MATTERS

Sec. 701. Expansion of Marine Gunnery Sergeant John David Fry
Scholarship.
Sec. 702. Approval of courses of education provided by public
institutions of higher learning for purposes of All-
Volunteer Force Educational Assistance Program and Post-
9/11 Educational Assistance conditional on in-State
tuition rate for veterans.

TITLE VIII--APPROPRIATION AND EMERGENCY DESIGNATIONS

Sec. 801. Appropriation of emergency amounts.
Sec. 802. Emergency designations.

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

SEC. 101. INDEPENDENT ASSESSMENT OF THE SCHEDULING OF
APPOINTMENTS AND OTHER HEALTH CARE MANAGEMENT
PROCESSES OF THE DEPARTMENT OF VETERANS
AFFAIRS.

(a) Independent Assessment.--
(1) Assessment.--Not later than 30 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall enter into a contract with an independent third party
to assess the following:
(A) 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.
(B) The staffing level and productivity of each medical
facility of the Department, including the following:
(i) The case load of each health care provider of the
Department.
(ii) The time spent by each health care provider of the
Department on matters other than the case load of such health
care provider, including time spent by such health care
provider as follows:

(I) At a medical facility that is affiliated with the
Department.
(II) Conducting research.
(III) Training or overseeing other health care
professionals of the Department.

(C) The organization, processes, and tools used by the
Department to support clinical documentation and the
subsequent coding of inpatient services.
(D) The purchasing, distribution, and use of
pharmaceuticals, medical and surgical supplies,

[[Page H5414]]

and medical devices by the Department, including the
following:
(i) The prices paid for, standardization of, and use by the
Department of the following:

(I) High-cost pharmaceuticals.
(II) Medical and surgical supplies.
(III) Medical devices.

(ii) The use by the Department of group purchasing
arrangements to purchase pharmaceuticals, medical and
surgical supplies, medical devices, and health care related
services.
(iii) The strategy used by the Department to distribute
pharmaceuticals, medical and surgical supplies, and medical
devices to Veterans Integrated Service Networks and medical
facilities of the Department.
(E) The performance of the Department in paying amounts
owed to third parties and collecting amounts owed to the
Department with respect to hospital care, medical services,
and other health care, including any recommendations of the
independent third party as follows:
(i) To avoid the payment of penalties to vendors.
(ii) To increase the collection of amounts owed to the
Department for hospital care, medical services, or other
health care provided by the Department for which
reimbursement from a third party is authorized.
(iii) To increase the collection of any other amounts owed
to the Department.
(2) Elements of scheduling assessment.--In carrying out the
assessment required by paragraph (1)(A), 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.
(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.--
(1) In general.--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.
(2) Publication.--Not later than 30 days after submitting
the report under paragraph (1), the Secretary shall publish
such report in the Federal Register and on an Internet
website of the Department accessible to the public.

SEC. 102. TECHNOLOGY TASK FORCE ON REVIEW OF SCHEDULING
SYSTEM AND SOFTWARE OF THE DEPARTMENT OF
VETERANS AFFAIRS.

(a) Task Force Review.--
(1) In general.--The Secretary of Veterans Affairs shall,
through the use of a technology task force, conduct a review
of the needs of the Department of Veterans Affairs with
respect to the scheduling system and scheduling software of
the Department of Veterans Affairs that is used by the
Department to schedule appointments for veterans for hospital
care, medical services, and other health care from the
Department.
(2) Agreement.--
(A) In general.--The Secretary shall seek to enter into an
agreement with a technology organization or technology
organizations to carry out the review required by paragraph
(1).
(B) Prohibition on use of funds.--No Federal funds may be
used to assist the technology organization or technology
organizations under subparagraph (A) in carrying out the
review required by paragraph (1).
(b) Report.--
(1) In general.--Not later than 45 days after the date of
the enactment of this Act, the technology task force required
under subsection (a)(1) shall submit to the Secretary, the
Committee on Veterans' Affairs of the Senate, and the
Committee on Veterans' Affairs of the House of
Representatives a report setting forth the findings and
recommendations of the technology task force regarding the
needs of the Department with respect to the scheduling system
and scheduling software of the Department described in such
subsection.
(2) Elements.--The report required by paragraph (1) shall
include the following:
(A) Proposals for specific actions to be taken by the
Department to improve the scheduling system and scheduling
software of the Department described in subsection (a)(1).
(B) A determination as to whether an existing off-the-shelf
system would--
(i) meet the needs of the Department to schedule
appointments for veterans for hospital care, medical
services, and other health care from the Department; and
(ii) improve the access of veterans to such care and
services.
(3) Publication.--Not later than 30 days after the receipt
of the report required by paragraph (1), the Secretary shall
publish such report in the Federal Register and on an
Internet website of the Department accessible to the public.
(c) Implementation of Task Force Recommendations.--Not
later than one year after the receipt of the report required
by subsection (b)(1), the Secretary shall implement the
recommendations set forth in such report that the Secretary
considers are feasible, advisable, and cost-effective.

TITLE II--TRAINING AND HIRING OF HEALTH CARE STAFF

SEC. 201. 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 Inspector General of the Department
of Veterans Affairs shall determine, and the Secretary of
Veterans Affairs shall 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 Inspector
General under paragraph (1) 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 serve as
health care providers 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 201(a)(1) of the Veterans' Access to Care through
Choice, Accountability, and Transparency Act of 2014,
determined that there is one of the largest staffing
shortages 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
equivalents, 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 most current
determination of the Inspector General 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.

[[Page H5415]]

(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 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 as
administrative leave or sudden medical leave for senior
officials.
(G) The number of health care providers of the Department
who have been removed from their positions, have retired, or
have left their positions for another reason, disaggregated
by provider type, during the two-year period preceding the
submittal of the report.
(H) Of the health care providers specified in subparagraph
(G) who have been removed from their positions, the
following:
(i) The number of such health care providers who were
reassigned to other positions in the Department.
(ii) The number of such health care providers who left the
Department.
(iii) The number of such health care providers who left the
Department and were subsequently rehired by the Department.

SEC. 202. CLINIC MANAGEMENT TRAINING FOR MANAGERS AND HEALTH
CARE PROVIDERS OF THE DEPARTMENT OF VETERANS
AFFAIRS.

(a) Clinic Management Training Program.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall commence 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.
(2) Elements.--The clinic management training program
required by paragraph (1) shall include the following:
(A) Training on how to manage the schedules of health care
providers of the Department, including the following:
(i) Maintaining such schedules in a manner that allows
appointments to be booked at least eight weeks in advance.
(ii) Proper planning procedures for vacation, leave, and
graduate medical education training schedules.
(B) Training on the appropriate number of appointments that
a health care provider should conduct on a daily basis, based
on specialty.
(C) 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.
(D) Training on how to properly use the appointment
scheduling system of the Department, including any new
scheduling system implemented by the Department.
(E) Training on how to optimize the use of technology,
including the following:
(i) Telemedicine.
(ii) Electronic mail.
(iii) Text messaging.
(iv) Such other technologies as specified by the Secretary.
(F) 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.
(3) Sunset.--The clinic management training program
required by paragraph (1) shall terminate on the date that is
two years after the date on which the Secretary commences
such program.
(b) Training Materials.--
(1) In general.--After the termination of the clinic
management training program required by subsection (a), the
Secretary shall provide training materials on health care
management to each of the following employees of the
Department upon the commencement of employment of such
employee:
(A) Any manager of a medical facility of the Department.
(B) Any health care provider at a medical facility of the
Department.
(C) Such other employees of the Department as the Secretary
considers appropriate.
(2) Update.--The Secretary shall regularly update the
training materials required under paragraph (1).

SEC. 203. USE OF UNOBLIGATED AMOUNTS TO HIRE ADDITIONAL
HEALTH CARE PROVIDERS FOR THE VETERANS HEALTH
ADMINISTRATION.

(a) In General.--At the end of each of fiscal years 2014
and 2015, all covered amounts shall be made available to the
Secretary of Veterans Affairs to hire additional health care
providers for the Veterans Health Administration of the
Department of Veterans Affairs, or to carry out any provision
of this Act or the amendments made by this Act, and shall
remain available until expended.
(b) Priority in Hiring.--The Secretary shall prioritize
hiring additional health care providers under subsection (a)
at medical facilities of the Department and in geographic
areas in which the Secretary identifies the greatest shortage
of health care providers.
(c) Covered Amounts Defined.--In this section, the term
``covered amounts'' means amounts--
(1) that are made available to the Veterans Health
Administration of the Department for an appropriations
account--
(A) under the heading ``medical services'';
(B) under the heading ``medical support and compliance'';
or
(C) under the heading ``medical facilities''; and
(2) that are unobligated at the end of the applicable
fiscal year.

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

SEC. 301. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL
SERVICES FOR VETERANS THROUGH THE USE OF
CONTRACTS.

(a) Expansion of Available Care and Services.--
(1) Furnishing of care.--
(A) In general.--Hospital care and medical services under
chapter 17 of title 38, United States Code, shall be
furnished to an eligible veteran described in subsection (b),
at the election of such veteran, through contracts authorized
under subsection (d), or any other law administered by the
Secretary of Veterans Affairs, with entities specified in
subparagraph (B) for the furnishing of such care and services
to veterans.
(B) Entities specified.--The entities specified in this
subparagraph are the following:
(i) Any health care provider that is participating in the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.).
(ii) Any Federally-qualified health center (as defined in
section 1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B))).
(iii) The Department of Defense.
(iv) The Indian Health Service.
(2) Choice of provider.--An eligible veteran who elects to
receive care and services under this section may select the
provider of such care and services from among any source of
provider of such care and services through an entity
specified in paragraph (1)(B) that is accessible to the
veteran.
(3) Coordination of care and services.--The Secretary shall
coordinate, through the Non-VA Care Coordination Program of
the Department of Veterans Affairs, the furnishing of care
and services under this section to eligible veterans,
including by ensuring that an eligible veteran receives an
appointment for such care and services within the current
wait-time goals of the Veterans Health Administration for the
furnishing of hospital care and medical services.
(b) Eligible Veterans.--A veteran is an eligible veteran
for purposes of this section if--
(1)(A) the veteran is enrolled in the patient enrollment
system of the Department of Veterans Affairs established and
operated under section 1705 of title 38, United States Code;
or
(B) the veteran is enrolled in such system, has not
received hospital care or medical services from the
Department, and has contacted the Department seeking an
initial appointment from the Department for the receipt of
such care or services; and
(2) the veteran--
(A)(i) attempts, or has attempted under paragraph (1)(B),
to schedule an appointment for the receipt of hospital care
or medical services under chapter 17 of title 38, United
States Code, but is unable to schedule an appointment within
the current wait-time goals of the Veterans Health
Administration for the furnishing of such care or services;
and
(ii) elects, and is authorized, to be furnished such care
or services pursuant to subsection (c)(2);
(B) resides more than 40 miles from the nearest medical
facility of the Department, including a community-based
outpatient clinic, that is closest to the residence of the
veteran; or
(C) resides--
(i) in a State without a medical facility of the Department
that provides--

(I) hospital care;
(II) emergency medical services; and
(III) surgical care rated by the Secretary as having a
surgical complexity of standard; and

(ii) more than 20 miles from a medical facility of the
Department described in clause (i).
(c) Election and Authorization.--
(1) In general.--If the Secretary confirms that an
appointment for an eligible veteran described in subsection
(b)(2)(A) for the receipt of hospital care or medical
services under chapter 17 of title 38, United States Code, is
unavailable within the current wait-time goals of the
Department for the furnishing of such care or services, the
Secretary shall, at the election of the eligible veteran--
(A) place such eligible veteran on an electronic waiting
list described in paragraph (2) for such an appointment; or
(B)(i) authorize that such care and services be furnished
to the eligible veteran under this section for a period of
time specified by the Secretary; and
(ii) send a letter to the eligible veteran describing the
care and services the eligible veteran is eligible to receive
under this section.
(2) Electronic waiting list.--The electronic waiting list
described in this paragraph shall be maintained by the
Department and allow access by each eligible veteran via
www.myhealth.va.gov or any successor website for the
following purposes:
(A) To determine the place of such eligible veteran on the
waiting list.
(B) To determine the average length of time an individual
spends on the waiting list, disaggregated by medical facility
of the Department and type of care or service needed, for
purposes of allowing such eligible veteran to make an
informed election under paragraph (1).

[[Page H5416]]

(d) Care and Services Through Contracts.--
(1) In general.--The Secretary shall enter into contracts
with health care providers that are participating in the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) to furnish care and services to
eligible veterans under this section.
(2) Rates and reimbursement.--
(A) In general.--In entering into a contract under this
subsection, the Secretary shall--
(i) negotiate rates for the furnishing of care and services
under this section; and
(ii) reimburse the health care provider for such care and
services at the rates negotiated pursuant to clause (i) as
provided in such contract.
(B) Limit on rates.--
(i) In general.--Except as provided in clause (ii), rates
negotiated under subparagraph (A)(i) shall not be more than
the rates paid by the United States to a provider of services
(as defined in section 1861(u) of the Social Security Act (42
U.S.C. 1395x(u))) or a supplier (as defined in section
1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare
program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) for the same care and services.
(ii) Exception.--The Secretary may negotiate a rate that is
more than the rate paid by the United States as described in
clause (i) with respect to the furnishing of care or services
under this section to an eligible veteran if the Secretary
determines that there is no health care provider that will
provide such care or services to such eligible veteran at the
rate required under such clause--

(I) within the current wait-time goals of the Veterans
Health Administration for the furnishing of such care or
services; and
(II) at a location not more than 40 miles from the
residence of such eligible veteran.

(C) Limit on collection.--For the furnishing of care and
services pursuant to a contract under this section, a health
care provider may not collect any amount that is greater than
the rate negotiated pursuant to subparagraph (A)(i).
(3) Information on policies and procedures.--The Secretary
shall provide to any health care provider with which the
Secretary has entered into a contract under paragraph (1) the
following:
(A) Information on applicable policies and procedures for
submitting bills or claims for authorized care and services
furnished to eligible veterans under this section.
(B) Access to a telephone hotline maintained by the
Department that such health care provider may call for
information on the following:
(i) Procedures for furnishing care and services under this
section.
(ii) Procedures for submitting bills or claims for
authorized care and services furnished to eligible veterans
under this section and being reimbursed for furnishing such
care and services.
(iii) Whether particular care or services under this
section are authorized, and the procedures for authorization
of such care or services.
(e) Choice Card.--
(1) In general.--For purposes of receiving care and
services under this section, the Secretary shall issue to
each eligible veteran a card that the eligible veteran shall
present to a health care provider that is eligible to furnish
care and services under this section before receiving such
care and services.
(2) Name of card.--Each card issued under paragraph (1)
shall be known as a ``Choice Card''.
(3) Details of card.--Each Choice Card issued to an
eligible veteran under paragraph (1) shall include the
following:
(A) The name of the eligible veteran.
(B) An identification number for the eligible veteran that
is not the social security number of the eligible veteran.
(C) The contact information of an appropriate office of the
Department for health care providers to confirm that care and
services under this section are authorized for the eligible
veteran.
(D) Contact information and other relevant information for
the submittal of claims or bills for the furnishing of care
and services under this section.
(E) The following statement: ``This card is for qualifying
medical care outside the Department of Veterans Affairs.
Please call the Department of Veterans Affairs phone number
specified on this card to ensure that treatment has been
authorized.''.
(4) Information on use of card.--Upon issuing a Choice Card
to an eligible veteran, the Secretary shall provide the
eligible veteran with information clearly stating the
circumstances under which the veteran may be eligible for
care and services under this section.
(f) Information on Availability of Care.--The Secretary
shall provide information to a veteran about the availability
of care and services under this section in the following
circumstances:
(1) When the veteran enrolls in the patient enrollment
system of the Department under section 1705 of title 38,
United States Code.
(2) When the veteran attempts to schedule an appointment
for the receipt of hospital care or medical services from the
Department but is unable to schedule an appointment within
the current wait-time goals of the Veterans Health
Administration for delivery of such care or services.
(g) Providers.--To be eligible to furnish care and services
under this section, a health care provider must--
(1) maintain at least the same or similar credentials and
licenses as those credentials and licenses that are required
of health care providers of the Department, as determined by
the Secretary for purposes of this section; and
(2) submit, not less frequently than once each year,
verification of such licenses and credentials maintained by
such health care provider.
(h) Cost-sharing.--
(1) In general.--The Secretary shall require an eligible
veteran to pay a copayment to the Department for the receipt
of care and services under this section only if such eligible
veteran would be required to pay such copayment for the
receipt of such care and services at a medical facility of
the Department.
(2) Limitation.--The copayment required under paragraph (1)
shall not be greater than the copayment required of such
eligible veteran by the Department for the receipt of such
care and services at a medical facility of the Department.
(i) Claims Processing System.--
(1) In general.--The Secretary shall provide for an
efficient nationwide system for processing and paying bills
or claims for authorized care and services furnished to
eligible veterans under this section.
(2) Regulations.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall prescribe regulations for the implementation of such
system.
(3) Oversight.--The Chief Business Office of the Veterans
Health Administration shall oversee the implementation and
maintenance of such system.
(4) Accuracy of payment.--
(A) In general.--The Secretary shall ensure that such
system meets such goals for accuracy of payment as the
Secretary shall specify for purposes of this section.
(B) Annual report.--
(i) In general.--Not later than one year after the date of
the enactment of this Act, and annually thereafter until the
termination date specified in subsection (n), 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 goals for accuracy of such
system.
(ii) Elements.--Each report required by clause (i) shall
include the following:

(I) A description of the goals for accuracy for such system
specified by the Secretary under subparagraph (A).
(II) An assessment of the success of the Department in
meeting such goals during the year preceding the submittal of
the report.

(j) Medical Records.--The Secretary shall ensure that any
health care provider that furnishes care and services under
this section to an eligible veteran submits to the Department
any medical record related to the care and services provided
to such eligible veteran by such health care provider for
inclusion in the electronic medical record of such eligible
veteran maintained by the Department upon the completion of
the provision of such care and services to such eligible
veteran.
(k) Tracking of Missed Appointments.--The Secretary shall
implement a mechanism to track any missed appointments for
care and services under this section by eligible veterans to
ensure that the Department does not pay for such care and
services that were not furnished to an eligible veteran.
(l) Implementation.--Not later than 90 days after the date
of the enactment of this Act, the Secretary shall prescribe
interim final regulations on the implementation of this
section and publish such regulations in the Federal Register.
(m) Inspector General Report.--Not later than 540 days
after the publication of the interim final regulations under
subsection (l), the Inspector General of the Department shall
submit to the Secretary a report on the results of an audit
of the care and services furnished under this section to
ensure the accuracy and timeliness of payments by the
Department for the cost of such care and services, including
any findings and recommendations of the Inspector General.
(n) Termination.--The requirement of the Secretary to
furnish care and services under this section terminates on
the date that is two years after the date on which the
Secretary publishes the interim final regulations under
subsection (l).
(o) Reports.--
(1) Initial report.--Not later than 90 days after the
publication of the interim final regulations under subsection
(l), 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 furnishing of
care and services under this section that includes the
following:
(A) The number of eligible veterans who have received care
and services under this section.
(B) A description of the type of care and services
furnished to eligible veterans under this section.
(2) Final report.--Not later than 540 days after the
publication of the interim final regulations under subsection
(l), 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 furnishing of
care and services under this section that includes the
following:
(A) The total number of eligible veterans who have received
care and services under this section, disaggregated by--
(i) eligible veterans described in subsection (b)(2)(A);
and
(ii) eligible veterans described in subsection (b)(2)(B).
(B) A description of the type of care and services
furnished to eligible veterans under this section.
(C) An accounting of the total cost of furnishing care and
services to eligible veterans under this section.
(D) The results of a survey of eligible veterans who have
received care or services under this section on the
satisfaction of such eligible veterans with the care or
services received by such eligible veterans under this
section.
(E) An assessment of the effect of furnishing care and
services under this section on wait

[[Page H5417]]

times for an appointment for the receipt of hospital care and
medical services from the Department.
(F) An assessment of the feasibility and advisability of
continuing furnishing care and services under this section
after the termination date specified in subsection (n).
(p) Rules of Construction.--
(1) No modification of contracts.--Nothing in this section
shall be construed to require the Secretary to renegotiate
contracts for the furnishing of hospital care or medical
services to veterans entered into by the Department before
the date of the enactment of this Act.
(2) Filling and paying for prescription medications.--
Nothing in this section shall be construed to alter the
process of the Department for filling and paying for
prescription medications.

SEC. 302. 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) are
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.

SEC. 303. 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).
(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. 304. 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. 305. SENSE OF CONGRESS ON PROMPT PAYMENT BY DEPARTMENT
OF VETERANS AFFAIRS.

It is the sense of Congress that the Secretary of Veterans
Affairs shall comply with section 1315 of title 5, Code of
Federal Regulations (commonly known as the ``prompt payment
rule''), or any corresponding similar regulation or ruling,
in paying for health care pursuant to contracts entered into
with non-Department of Veterans Affairs providers to provide
health care under the laws administered by the Secretary.

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 CONSTRUCTION PROJECTS OF THE
DEPARTMENT OF VETERANS AFFAIRS.

(a) Establishment of Commission.--
(1) Establishment.--There is established an Independent
Commission on Department of Veterans Affairs Construction
Projects (in this section referred to as the ``Commission'').
(2) Membership.--
(A) Voting members.--The Commission shall be composed of 10
voting members as follows:

[[Page H5418]]

(i) Three members to be appointed by the President from
among members of the National Academy of Engineering who are
nominated under subparagraph (B).
(ii) Three members to be appointed by the President from
among members of the National Institute of Building Sciences
who are nominated under subparagraph (B).
(iii) Four members to be appointed by the President from
among veterans enrolled in the patient enrollment system of
the Department of Veterans Affairs under section 1705 of
title 38, United States Code, who are nominated under
subparagraph (B).
(B) Nomination of voting members.--The majority leader of
the Senate, the minority leader of the Senate, the speaker of
the House of Representatives, and the minority leader of the
House of Representatives shall jointly nominate not less than
24 individuals to be considered by the President for
appointment under subparagraph (A).
(C) Nonvoting members.--The Commission shall be composed of
the following nonvoting members:
(i) The Comptroller General of the United States, or
designee.
(ii) The Secretary of Veterans Affairs, or designee.
(iii) The Inspector General of the Department of Veterans
Affairs, or designee.
(D) Date of appointment of members.--The appointments of
the members of the Commission under subparagraph (A) shall be
made not later than 14 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 five days after the
date on which all 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) Review.--The Commission shall review current
construction and maintenance projects and the medical
facility leasing program of the Department of Veterans
Affairs to identify any problems experienced by the
Department in carrying out such projects and program.
(2) Reports.--
(A) Commission report.--Not later than 120 days after the
date of the enactment of this Act, the Commission shall
submit to the Secretary of Veterans Affairs, the Committee on
Veterans' Affairs of the Senate, and the Committee on
Veterans' Affairs of the House of Representatives a report
setting forth recommendations, if any, for improving the
manner in which the Secretary carries out the projects and
program specified in paragraph (1).
(B) Department report.--Not later than 60 days after the
submittal of the report under subparagraph (A), the Secretary
of Veterans Affairs shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on
the feasibility and advisability of implementing the
recommendations of the Commission, if any, included in the
report submitted under such subparagraph, including a
timeline for the implementation of such recommendations.
(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 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 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 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 that 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 30 days after the date on which the Commission
submits its report under subsection (b)(2)(A).

SEC. 403. 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 10- to 20-year
period beginning on the date of the enactment of this Act.
(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 have
experience as senior management for a private integrated
health care system with an annual gross revenue of more than
$50,000,000.
(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 but are not
current employees of the Veterans Health Administration.
(v) At least two members from among persons who are
veterans or eligible for hospital care, medical services, or
other health care under the laws administered by the
Secretary of Veterans Affairs.
(B) Nonvoting members.--
(i) In general.--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 have
experience as senior management for a private integrated
health care system with an annual gross revenue of more than
$50,000,000.
(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 but are not
current employees of the Veterans Health Administration.
(V) At least two members from among persons who are
veterans or eligible for hospital care, medical services, or
other health care under the laws administered by the
Secretary of Veterans Affairs.

(ii) Additional nonvoting members.--In addition to members
appointed under subparagraph (A) and clause (i), the
Commission shall be composed of the following nonvoting
members:

(I) The Comptroller General of the United States, or
designee.
(II) The Inspector General of the Department of Veterans
Affairs, or designee.

(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.

[[Page H5419]]

(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.
(E) The results of the assessment conducted by an
independent third party under section 101(a), including any
data or recommendations included in such assessment.
(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.--
(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 that 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. 404. IMPROVED PERFORMANCE METRICS FOR HEALTH CARE
PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS.

(a) Prohibition on Use of Scheduling and Wait-time Metrics
in Determination of Performance Awards.--The Secretary of
Veterans Affairs shall ensure that scheduling and wait-time
metrics or goals are not used as factors in determining the
performance of the following employees for purposes of
determining whether to pay performance awards to such
employees:
(1) Directors, associate directors, assistant directors,
deputy directors, chiefs of staff, and clinical leads of
medical centers of the Department of Veterans Affairs.
(2) Directors, assistant directors, and quality management
officers of Veterans Integrated Service Networks of the
Department of Veterans Affairs.
(b) Modification of Performance Plans.--
(1) In general.--Not later than 30 days after the date of
the enactment of this Act, the Secretary shall modify the
performance plans of the directors of the medical centers of
the Department and the directors of the Veterans Integrated
Service Networks to ensure that such plans are based on the
quality of care received by veterans at the health care
facilities under the jurisdictions of such directors.
(2) Factors.--In modifying performance plans under
paragraph (1), the Secretary shall ensure that assessment of
the quality of care provided at health care facilities under
the jurisdiction of a director described in paragraph (1)
includes consideration of the following:
(A) Recent reviews by the Joint Commission (formerly known
as the ``Joint Commission on Accreditation of Healthcare
Organizations'') of such facilities.
(B) The number and nature of recommendations concerning
such facilities by the Inspector General of the Department in
reviews conducted through the Combined Assessment Program
(CAP), in the reviews by the Inspector General of community
based outpatient clinics and primary care clinics, and in
reviews conducted through the Office of Healthcare
Inspections during the two most recently completed fiscal
years.
(C) The number of recommendations described in subparagraph
(B) that the Inspector General of the Department determines
have not been carried out satisfactorily with respect to such
facilities.
(D) Reviews of such facilities by the Commission on
Accreditation of Rehabilitation Facilities.
(E) The number and outcomes of administrative investigation
boards, root cause analysis, and peer reviews conducted at
such facilities during the fiscal year for which the
assessment is being conducted.
(F) The effectiveness of any remedial actions or plans
resulting from any Inspector General recommendations in the
reviews and analyses described in subparagraphs (A) through
(E).
(3) Additional leadership positions.--To the degree
practicable, the Secretary shall assess the performance of
other employees of the Department in leadership positions at
Department medical centers, including associate directors,
assistant directors, deputy directors, chiefs of staff, and
clinical leads, and in Veterans Integrated Service Networks,
including assistant directors and quality management
officers, using factors and criteria similar to those used in
the performance plans modified under paragraph (1).
(c) Removal of Certain 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. 405. IMPROVED TRANSPARENCY CONCERNING HEALTH CARE
PROVIDED BY DEPARTMENT OF VETERANS AFFAIRS.

(a) Publication of Wait Times.--
(1) Goals.--
(A) Initial.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs
shall publish in the Federal Register, and on an Internet
website accessible to the public of each medical center of
the Department of Veterans Affairs, the wait-time goals of
the Department for the scheduling of an appointment by a
veteran for the receipt of health care from the Department.
(B) Subsequent changes.--
(i) In general.--If the Secretary modifies the wait-time
goals described in subparagraph (A), the Secretary shall
publish the new wait-times goals--

(I) on an Internet website accessible to the public of each
medical center of the Department not later than 30 days after
such modification; and

[[Page H5420]]

(II) in the Federal Register not later than 90 days after
such modification.

(ii) Effective date.--Any modification under clause (i)
shall take effect on the date of publication in the Federal
Register.
(C) Goals described.--Wait-time goals published under this
paragraph shall include goals for primary care appointments,
specialty care appointments, and appointments based on the
general severity of the condition of the veteran.
(2) Wait times at medical centers of the department.--Not
later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall publish on an
Internet website accessible to the public of each medical
center of the Department the current wait time for an
appointment for primary care and specialty care at the
medical center.
(b) Publicly Available Database of Patient Safety, Quality
of Care, and Outcome Measures.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary shall develop and
make available to the public a comprehensive database
containing all applicable patient safety, quality of care,
and outcome measures for health care provided by the
Department that are tracked by the Secretary.
(2) Update frequency.--The Secretary shall update the
database required by paragraph (1) not less frequently than
once each year.
(3) Unavailable measures.--For all measures that the
Secretary would otherwise publish in the database required by
paragraph (1) but has not done so because such measures are
not available, the Secretary shall publish notice in the
database of the reason for such unavailability and a timeline
for making such measures available in the database.
(4) Accessibility.--The Secretary shall ensure that the
database required by paragraph (1) is accessible to the
public through the primary Internet website of the Department
and through each primary Internet website of a Department
medical center.
(c) Hospital Compare Website of Department of Health and
Human Services.--
(1) Agreement required.--Not later than 180 days after the
date of the enactment of this Act, the Secretary of Veterans
Affairs shall enter into an agreement with the Secretary of
Health and Human Services for the provision by the Secretary
of Veterans Affairs of such information as the Secretary of
Health and Human Services may require to report and make
publicly available patient quality and outcome information
concerning Department of Veterans Affairs medical centers
through the Hospital Compare Internet website of the
Department of Health and Human Services or any successor
Internet website.
(2) Information provided.--The information provided by the
Secretary of Veterans Affairs to the Secretary of Health and
Human Services under paragraph (1) shall include the
following:
(A) Measures of timely and effective health care.
(B) Measures of readmissions, complications of death,
including with respect to 30-day mortality rates and 30-day
readmission rates, surgical complication measures, and health
care related infection measures.
(C) Survey data of patient experiences, including the
Hospital Consumer Assessment of Healthcare Providers and
Systems or any similar successor survey developed by the
Department of Health and Human Services.
(D) Any other measures required of or reported with respect
to hospitals participating in the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.).
(3) Unavailable information.--For any applicable metric
collected by the Department of Veterans Affairs or required
to be provided under paragraph (2) and withheld from or
unavailable in the Hospital Compare Internet website, the
Secretary of Veterans Affairs shall publish a notice in the
Federal Register stating the reason why such metric was
withheld from public disclosure and a timeline for making
such metric available, if applicable.
(d) Comptroller General Review of Publicly Available Safety
and Quality Metrics.--Not later than three years after the
date of the enactment of this Act, the Comptroller General of
the United States shall conduct a review of the safety and
quality metrics made publicly available by the Secretary of
Veterans Affairs under this section to assess the degree to
which the Secretary is complying with the provisions of this
section.

SEC. 406. INFORMATION FOR VETERANS ON THE CREDENTIALS OF
DEPARTMENT OF VETERANS AFFAIRS PHYSICIANS.

(a) Improvement of ``Our Providers'' Internet Website
Links.--
(1) Availability through department of veterans affairs
homepage.--A link to the ``Our Providers'' health care
providers database of the Department of Veterans Affairs, or
any successor database, shall be available on and through the
homepage of the Internet website of the Department that is
accessible to the public.
(2) Information on location of residency training.--The
Internet website of the Department that is accessible to the
public shall include under the link to the ``Our Providers''
health care providers database of the Department, or any
successor database, the location of residency training of
each licensed physician of the Department.
(3) Information on physicians at particular facilities.--
The ``Our Providers'' health care providers database of the
Department, or any successor database, shall identify whether
each licensed physician of the Department is a physician in
residency.
(b) Information on Credentials of Physicians for Veterans
Undergoing Surgical Procedures.--
(1) In general.--Each veteran who is undergoing a surgical
procedure by or through the Department shall be provided
information on the credentials of the surgeon to be
performing such procedure at such time in advance of the
procedure as is appropriate to permit such veteran to
evaluate such information.
(2) Other individuals.--If a veteran is unable to evaluate
the information provided under paragraph (1) due to the
health or mental competence of the veteran, such information
shall be provided to an individual acting on behalf of the
veteran.
(c) Comptroller General Report and Plan.--
(1) Report.--Not later than two years after the date of the
enactment of this Act, the Comptroller General of the United
States shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report setting forth an assessment
by the Comptroller General of the following:
(A) The manner in which contractors under the Patient-
Centered Community Care initiative of the Department perform
oversight of the credentials of physicians within the
networks of such contractors under the initiative.
(B) The oversight by the Department of the contracts under
the Patient-Centered Community Care initiative.
(C) The verification by the Department of the credentials
and licenses of health care providers furnishing hospital
care and medical services under section 301.
(2) Plan.--
(A) In general.--Not later than 30 days after the submittal
of the report under paragraph (1), the Secretary shall--
(i) submit to the Comptroller General, the Committee on
Veterans' Affairs of the Senate, and the Committee on
Veterans' Affairs of the House of Representatives a plan to
address any findings and recommendations of the Comptroller
General included in such report; and
(ii) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a request for additional amounts, if any,
that may be necessary to carry out such plan.
(B) Implementation.--Not later than 90 days after the
submittal of the report under paragraph (1), the Secretary
shall carry out such plan.

SEC. 407. INFORMATION IN ANNUAL BUDGET OF THE PRESIDENT ON
HOSPITAL CARE AND MEDICAL SERVICES FURNISHED
THROUGH EXPANDED USE OF CONTRACTS FOR SUCH
CARE.

The materials on the Department of Veterans Affairs in the
budget of the President for a fiscal year, as submitted to
Congress pursuant to section 1105(a) of title 31, United
States Code, shall set forth the following:
(1) The number of veterans who received hospital care and
medical services under section 301 during the fiscal year
preceding the fiscal year in which such budget is submitted.
(2) The amount expended by the Department on furnishing
care and services under such section during the fiscal year
preceding the fiscal year in which such budget is submitted.
(3) The amount requested in such budget for the costs of
furnishing care and services under such section during the
fiscal year covered by such budget, set forth in aggregate
and by amounts for each account for which amounts are so
requested.
(4) The number of veterans that the Department estimates
will receive hospital care and medical services under such
section during the fiscal years covered by the budget
submission.
(5) The number of employees of the Department on paid
administrative leave at any point during the fiscal year
preceding the fiscal year in which such budget is submitted.

SEC. 408. PROHIBITION ON FALSIFICATION OF DATA CONCERNING
WAIT TIMES AND QUALITY MEASURES AT DEPARTMENT
OF VETERANS AFFAIRS.

Not later than 60 days after the date of the enactment of
this Act, and in accordance with title 5, United States Code,
the Secretary of Veterans Affairs shall establish policies
whereby any employee of the Department of Veterans Affairs
who knowingly submits false data concerning wait times for
health care or quality measures with respect to health care
to another employee of the Department or knowingly requires
another employee of the Department to submit false data
concerning such wait times or quality measures to another
employee of the Department is subject to a penalty the
Secretary considers appropriate after notice and an
opportunity for a hearing, including civil penalties, unpaid
suspensions, or termination.

SEC. 409. 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 subsection (a), the Secretary shall
submit to the

[[Page H5421]]

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) Procedure.--(1) The procedures under section 7543 of
title 5 shall not apply to a removal or transfer under this
section.
``(2)(A) Subject to subparagraph (B), any removal or
transfer under subsection (a) may be appealed to the Merit
Systems Protection Board under section 7701 of title 5.
``(B) An appeal under subparagraph (A) of a removal or
transfer may only be made if such appeal is made not later
than 7 days after the date of 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.
``(5) A person who appeals under section 7701 of title 5 a
removal under subsection (a)(1) may not receive any pay,
awards, bonuses, incentives, allowances, differentials,
student loan repayments, special payments, or benefits from
the Secretary until the Merit Systems Protection Board has
made a final decision on such appeal.
``(6) A decision made by the Merit Systems Protection Board
with respect to a removal or transfer under subsection (a)
shall not be subject to any further appeal.''.
(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 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--HEALTH CARE RELATED TO SEXUAL TRAUMA

SEC. 501. EXPANSION OF ELIGIBILITY FOR SEXUAL TRAUMA
COUNSELING AND TREATMENT TO VETERANS ON
INACTIVE DUTY TRAINING.

Section 1720D(a)(1) of title 38, United States Code, is
amended by striking ``or active duty for training'' and
inserting ``, active duty for training, or inactive duty
training''.

SEC. 502. PROVISION OF COUNSELING AND TREATMENT FOR SEXUAL
TRAUMA BY THE DEPARTMENT OF VETERANS AFFAIRS TO
MEMBERS OF THE ARMED FORCES.

(a) Expansion of Coverage to Members of the Armed Forces.--
Subsection (a) of section 1720D of title 38, United States
Code, is amended--
(1) by redesignating paragraph (2) as paragraph (3);
(2) by inserting after paragraph (1) the following new
paragraph (2):
``(2)(A) In operating the program required by paragraph
(1), the Secretary may, in consultation with the Secretary of
Defense, provide counseling and care and services to members
of the Armed Forces (including members of the National Guard
and Reserves) on active duty to overcome psychological trauma
described in that paragraph.
``(B) A member described in subparagraph (A) shall not be
required to obtain a referral before receiving counseling and
care and services under this paragraph.''; and
(3) in paragraph (3), as predesignated by paragraph (1)--
(A) by striking ``a veteran'' and inserting ``an
individual''; and
(B) by striking ``that veteran'' each place it appears and
inserting ``that individual''.
(b) Information to Members on Availability of Counseling
and Services.--Subsection (c) of such section is amended--
(1) by striking ``to veterans'' each place it appears; and
(2) in paragraph (3), by inserting ``members of the Armed
Forces and'' before ``individuals''.
(c) Inclusion of Members in Reports on Counseling and
Services.--Subsection (e) of such section is amended--
(1) in the matter preceding paragraph (1), by striking ``to
veterans'';
(2) in paragraph (2)--
(A) by striking ``women veterans'' and inserting
``individuals''; and
(B) by striking ``training under subsection (d).'' and
inserting ``training under subsection (d), desegregated by--
``(A) veterans;
``(B) members of the Armed Forces (including members of the
National Guard and Reserves) on active duty; and
``(C) for each of subparagraphs (A) and (B)--
``(i) men; and
``(ii) women.'';
(3) in paragraph (4), by striking ``veterans'' and
inserting ``individuals''; and
(4) in paragraph (5)--
(A) by striking ``women veterans'' and inserting
``individuals'' ; and
(B) by inserting ``, including specific recommendations for
individuals specified in subparagraphs (A), (B), and (C) of
paragraph (2)'' before the period at the end.
(d) Effective Date.--The amendments made by this section
shall take effect on the date that is one year after the date
of the enactment of this Act.

SEC. 503. REPORTS ON MILITARY SEXUAL TRAUMA.

(a) Report on Services Available for Military Sexual Trauma
in the Department of Veterans Affairs.--Not later than 630
days after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives a report on
the treatment and services available from the Department of
Veterans Affairs for male veterans who experience military
sexual trauma compared to such treatment and services
available to female veterans who experience military sexual
trauma.
(b) Reports on Transition of Military Sexual Trauma
Treatment From Department of Defense to Department of
Veterans Affairs.--Not later than 630 days after the date of
the enactment of this Act, and annually thereafter for five
years, the Department of Veterans Affairs-Department of
Defense Joint Executive Committee established by section
320(a) of title 38, United States Code, shall submit to the
appropriate committees of Congress a report on military
sexual trauma that includes the following:
(1) The processes and procedures utilized by the Department
of Veterans Affairs and the Department of Defense to
facilitate transition of treatment of individuals who have
experienced military sexual trauma from treatment provided by
the Department of Defense to treatment provided by the
Department of Veterans Affairs.
(2) A description and assessment of the collaboration
between the Department of Veterans Affairs and the Department
of Defense in assisting veterans in filing claims for
disabilities related to military sexual trauma, including
permitting veterans access to information and evidence
necessary to develop or support such claims.
(c) Definitions.--In this section:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the Committee on
Armed Services of the Senate; and
(B) the Committee on Veterans' Affairs and the Committee on
Armed Services of the House of Representatives.
(2) Military sexual trauma.--The term ``military sexual
trauma'' means psychological trauma, which in the judgment of
a mental health professional employed by the Department,
resulted from a physical assault of a sexual nature, battery
of a sexual nature, or sexual harassment which occurred while
the veteran was serving on active duty or active duty for
training.
(3) Sexual harassment.--The term ``sexual harassment''
means repeated, unsolicited verbal or physical contact of a
sexual nature which is threatening in character.
(4) Sexual trauma.--The term ``sexual trauma'' shall have
the meaning given that term by the Secretary of Veterans
Affairs for purposes of this section.
(d) Effective Date.--This section shall take effect on the
date that is 270 days after the date of the enactment of this
Act.

TITLE VI--MAJOR MEDICAL FACILITY LEASES

SEC. 601. 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.

[[Page H5422]]

(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 Capel 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 Riche,
Florida, an amount not to exceed $11,927,000.
(10) For an outpatient clinic, Pence, 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 Arere 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 multi specialty 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, Haines, 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.

SEC. 602. 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.

TITLE VII--VETERANS BENEFITS MATTERS

SEC. 701. EXPANSION OF MARINE GUNNERY SERGEANT JOHN DAVID FRY
SCHOLARSHIP.

(a) Expansion of Entitlement.--Subsection (b)(9) of section
3311 of title 38, United States Code, is amended by inserting
``or spouse'' after ``child''.
(b) Limitation and Election on Certain Benefits.--
Subsection (f) of such section is amended--
(1) by redesignating paragraph (2) as paragraph (4); and
(2) by inserting after paragraph (1) the following new
paragraphs:
``(2) Limitation.--The entitlement of an individual to
assistance under subsection (a) pursuant to paragraph (9) of
subsection (b) because the individual was a spouse of a
person described in such paragraph shall expire on the
earlier of--
``(A) the date that is 15 years after the date on which the
person died; and
``(B) the date on which the individual remarries.
``(3) Election on receipt of certain benefits.--A surviving
spouse entitled to assistance under subsection (a) pursuant
to paragraph (9) of subsection (b) who is also entitled to
educational assistance under chapter 35 of this title may not
receive assistance under both this section and such chapter,
but shall make an irrevocable election (in such form and
manner as the Secretary may prescribe) under which section or
chapter to receive educational assistance.''.
(c) Conforming Amendment.--Section 3321(b)(4) of such title
is amended--
(1) by striking ``an individual'' and inserting ``a
child''; and
(2) by striking ``such individual's'' each time it appears
and inserting ``such child's''.

SEC. 702. APPROVAL OF COURSES OF EDUCATION PROVIDED BY PUBLIC
INSTITUTIONS OF HIGHER LEARNING FOR PURPOSES OF
ALL-VOLUNTEER FORCE EDUCATIONAL ASSISTANCE
PROGRAM AND POST-9/11 EDUCATIONAL ASSISTANCE
CONDITIONAL ON IN-STATE TUITION RATE FOR
VETERANS.

(a) In General.--Section 3679 of title 38, United States
Code, is amended by adding at the end the following new
subsection:
``(c)(1) Notwithstanding any other provision of this
chapter and subject to paragraphs (3) through (6), the
Secretary shall disapprove a course of education provided by
a public institution of higher learning to a covered
individual pursuing a course of education with educational
assistance under chapter 30 or 33 of this title while living
in the State in which the public institution of higher
learning is located if the institution charges tuition and
fees for that course for the covered individual at a rate
that is higher than the rate the institution charges for
tuition and fees for that course for residents of the State
in which the institution is located, regardless of the
covered individual's State of residence.
``(2) For purposes of this subsection, a covered individual
is any individual as follows:
``(A) A veteran who was discharged or released from a
period of not fewer than 90 days of service in the active
military, naval, or air service less than three years before
the date of enrollment in the course concerned.
``(B) An individual who is entitled to assistance under
section 3311(b)(9) or 3319 of this title by virtue of such
individual's relationship to a veteran described in
subparagraph (A).
``(3) If after enrollment in a course of education that is
subject to disapproval under paragraph (1) by reason of
paragraph (2)(A) or

[[Page H5423]]

(2)(B) a covered individual pursues one or more courses of
education at the same public institution of higher learning
while remaining continuously enrolled (other than during
regularly scheduled breaks between courses, semesters or
terms) at that institution of higher learning, any course so
pursued by the covered individual at that institution of
higher learning while so continuously enrolled shall also be
subject to disapproval under paragraph (1).
``(4) It shall not be grounds to disapprove a course of
education under paragraph (1) if a public institution of
higher learning requires a covered individual pursuing a
course of education at the institution to demonstrate an
intent, by means other than satisfying a physical presence
requirement, to establish residency in the State in which the
institution is located, or to satisfy other requirements not
relating to the establishment of residency, in order to be
charged tuition and fees for that course at a rate that is
equal to or less than the rate the institution charges for
tuition and fees for that course for residents of the State.
``(5) The Secretary may waive such requirements of
paragraph (1) as the Secretary considers appropriate.
``(6) Disapproval under paragraph (1) shall apply only with
respect to educational assistance under chapters 30 and 33 of
this title.''.
(b) Effective Date.--Subsection (c) of section 3679 of
title 38, United States Code (as added by subsection (a) of
this section), shall apply with respect to educational
assistance provided for pursuit of programs of education
during academic terms that begin after July 1, 2015, through
courses of education that commence on or after that date.

TITLE VIII--APPROPRIATION AND EMERGENCY DESIGNATIONS

SEC. 801. APPROPRIATION OF EMERGENCY AMOUNTS.

There is authorized to be appropriated, and is
appropriated, to the Secretary of Veterans Affairs, out of
any funds in the Treasury not otherwise appropriated, for
fiscal years 2014, 2015, and 2016, such sums as may be
necessary to carry out this Act.

SEC. 802. EMERGENCY DESIGNATIONS.

(a) In General.--This Act is designated as an emergency
requirement pursuant to section 4(g) of the Statutory Pay-As-
You-Go Act of 2010 (2 U.S.C. 933(g)).
(b) Designation in Senate.--In the Senate, this Act is
designated as an emergency requirement pursuant to section
403(a) of S. Con. Res. 13 (111th Congress), the concurrent
resolution on the budget for fiscal year 2010.

Amend the title so as to read: ``To improve the access of
veterans to medical services from the Department of Veterans
Affairs, and for other purposes.''

Motion Offered by Mr. Miller of Florida

Mr. MILLER of Florida. Mr. Speaker, I have a motion at the desk.
The SPEAKER pro tempore. The Clerk will designate the motion.
The text of the motion is as follows:

Mr. Miller of Florida moves that the House concur in the
Senate amendment to the title of H.R. 3230 and concur in the
Senate amendment to the text of H.R. 3230 with the amendment
printed in House Report 113-475.

The text of the amendment to the Senate amendment to the text is as
follows:

In lieu of the matter proposed to be inserted by the
amendment of the Senate to the text of the bill, insert the
following:

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Veteran Access to Care Act
of 2014''.

SEC. 2. PROVISION OF HOSPITAL CARE AND MEDICAL SERVICES AT
NON-DEPARTMENT OF VETERANS AFFAIRS FACILITIES
FOR DEPARTMENT OF VETERANS AFFAIRS PATIENTS
WITH EXTENDED WAITING TIMES FOR APPOINTMENTS AT
DEPARTMENT FACILITIES.

(a) In General.--As authorized by section 1710 of title 38,
United States Code, the Secretary of Veterans Affairs (in
this Act referred to as the ``Secretary'') shall enter into
contracts with such non-Department facilities as may be
necessary in order to furnish hospital care and medical
services to covered veterans who are eligible for such care
and services under chapter 17 of title 38, United States
Code. To the greatest extent possible, the Secretary shall
carry out this section using contracts entered into before
the date of the enactment of this Act.
(b) Covered Veterans.--For purposes of this section, the
term ``covered veteran'' means a veteran--
(1) who is enrolled in the patient enrollment system under
section 1705 of title 38, United States Code;
(2) who--
(A) has waited longer than the wait-time goals of the
Veterans Health Administration (as of June 1, 2014) for an
appointment for hospital care or medical services in a
facility of the Department;
(B) has been notified by a facility of the Department that
an appointment for hospital care or medical services is not
available within such wait-time goals; or
(C) resides more than 40 miles from the medical facility of
the Department of Veterans Affairs, including a community-
based outpatient clinic, that is closest to the residence of
the veteran; and
(3) who makes an election to receive such care or services
in a non-Department facility.
(c) Follow-Up Care.--In carrying out this section, the
Secretary shall ensure that, at the election of a covered
veteran who receives hospital care or medical services at a
non-Department facility in an episode of care under this
section, the veteran receives such hospital care and medical
services at such non-Department facility through the
completion of the episode of care (but for a period not
exceeding 60 days), including all specialty and ancillary
services deemed necessary as part of the treatment
recommended in the course of such hospital care or medical
services.
(d) Report.--The Secretary shall submit to Congress a
quarterly report on hospital care and medical services
furnished pursuant to this section. Such report shall include
information, for the quarter covered by the report,
regarding--
(1) the number of veterans who received care or services at
non-Department facilities pursuant to this section;
(2) the number of veterans who were eligible to receive
care or services pursuant to this section but who elected to
continue waiting for an appointment at a Department facility;
(3) the purchase methods used to provide the care and
services at non-Department facilities, including the rate of
payment for individual authorizations for such care and
services; and
(4) any other matters the Secretary determines appropriate.
(e) Definitions.--For purposes of this section, the terms
``facilities of the Department'', ``non-Department
facilities'', ``hospital care'', and ``medical services''
have the meanings given such terms in section 1701 of title
38, United States Code.
(f) Implementation.--The Secretary shall begin implementing
this section on the date of the enactment of this Act.
(g) Construction.--Nothing in this section shall be
construed to authorize payment for care or services not
otherwise covered under chapter 17 of title 38, United States
Code.
(h) Termination.--The authority of the Secretary under this
section shall terminate with respect to any hospital care or
medical services furnished after the end of the 2-year period
beginning on the date of the enactment of this Act, except
that in the case of an episode of care for which hospital
care or medical services is furnished in a non-Department
facility pursuant to this section before the end of such
period, such termination shall not apply to such care and
services furnished during the remainder of such episode of
care but not to exceed a period of 60 days.

SEC. 3. EXPANDED ACCESS TO HOSPITAL CARE AND MEDICAL
SERVICES.

(a) In General.--To the extent that appropriations are
available for the Veterans Health Administration of the
Department of Veterans Affairs for medical services, to the
extent that the Secretary of Veterans Affairs is unable to
provide access, within the wait-time goals of the Veterans
Health Administration (as of June 1, 2014), to hospital care
or medical services to a covered veteran who is eligible for
such care or services under chapter 17 of title 38, United
States Code, under contracts described in section 2, the
Secretary shall reimburse any non-Department facility with
which the Secretary has not entered into a contract to
furnish hospital care or medical services for furnishing such
hospital care or medical services to such veteran, if the
veteran elects to receive such care or services from the non-
Department facility. The Secretary shall reimburse the
facility for the care or services furnished to the veteran at
the greatest of the following rates:
(1) VA payment rate.--The rate of reimbursement for such
care or services established by the Secretary of Veterans
Affairs.
(2) Medicare payment rate.--The payment rate for such care
or services or comparable care or services under the Medicare
program under title XVIII of the Social Security Act.
(3) TRICARE payment rate.--The reimbursement rate for such
care or services furnished to a member of the Armed Forces
under chapter 55 of title 10, United States Code.
(b) Covered Veterans.--For purposes of this section, the
term ``covered veteran'' means a veteran--
(1) who is enrolled in the patient enrollment system under
section 1705 of title 38, United States Code; and
(2) who--
(A) has waited longer than the wait-time goals of the
Veterans Health Administration (as of June 1, 2014) for an
appointment for hospital care or medical services in a
facility of the Department;
(B) has been notified by a facility of the Department that
an appointment for hospital care or medical services is not
available within such wait-time goals after the date for
which the veteran requests the appointment; or
(C) who resides more than 40 miles from the medical
facility of the Department of Veterans Affairs, including a
community-based outpatient clinic, that is closest to the
residence of the veteran.
(c) Definitions.--For purposes of this section, the terms
``facilities of the Department'', ``non-Department
facilities'', ``hospital care'', and ``medical services''
have the meanings given such terms in section 1701 of title
38, United States Code.
(d) Implementation.--The Secretary shall begin implementing
this section on the date of the enactment of this Act.

[[Page H5424]]

(e) Construction.--Nothing in this section shall be
construed to authorize payment for care or services not
otherwise covered under chapter 17 of title 38, United States
Code.
(f) Termination.--The authority of the Secretary under this
section shall terminate with respect to care or services
furnished after the date that is 2 years after the date of
the enactment of this Act.

SEC. 4. INDEPENDENT ASSESSMENT OF VETERANS HEALTH
ADMINISTRATION PERFORMANCE.

(a) Independent Assessment Required.--Not later than 120
days after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall enter into a contract or
contracts with a private sector entity or entities with
experience in the delivery systems of the Veterans Health
Administration and the private sector and in health care
management to conduct an independent assessment of hospital
care and medical services furnished in medical facilities of
the Department of Veterans Affairs. Such assessment shall
address each of the following:
(1) The current and projected demographics and unique care
needs of the patient population served by the Department of
Veterans Affairs.
(2) The current and projected health care capabilities and
resources of the Department, including hospital care and
medical services furnished by non-Department facilities under
contract with the Department, to provide timely and
accessible care to eligible veterans.
(3) The authorities and mechanisms under which the
Secretary may furnish hospital care and medical services at
non-Department facilities, including an assessment of whether
the Secretary should have the authority to furnish such care
and services at such facilities through the completion of
episodes of care.
(4) The appropriate system-wide access standard applicable
to hospital care and medical services furnished by and
through the Department of Veterans Affairs and
recommendations relating to access standards specific to
individual specialties and standards for post-care
rehabilitation.
(5) The current organization, processes, and tools used to
support clinical staffing and documentation.
(6) The staffing levels and productivity standards,
including a comparison with industry performance percentiles.
(7) Information technology strategies of the Veterans
Health Administration, including an identification of
technology weaknesses and opportunities, especially as they
apply to clinical documentation of hospital care and medical
services provided in non-Department facilities.
(8) Business processes of the Veterans Health
Administration, including non-Department care, insurance
identification, third-party revenue collection, and vendor
reimbursement.
(b) Assessment Outcomes.--The assessment conducted pursuant
to subsection (a) shall include the following:
(1) An identification of improvement areas outlined both
qualitatively and quantitatively, taking into consideration
Department of Veterans Affairs directives and industry
benchmarks from outside the Federal Government.
(2) Recommendations for how to address the improvement
areas identified under paragraph (1) relating to structure,
accountability, process changes, technology, and other
relevant drivers of performance.
(3) The business case associated with making the
improvements and recommendations identified in paragraphs (1)
and (2).
(4) Findings and supporting analysis on how credible
conclusions were established.
(c) Program Integrator.--If the Secretary enters into
contracts with more than one private sector entity under
subsection (a), the Secretary shall designate one such entity
as the program integrator. The program integrator shall be
responsible for coordinating the outcomes of the assessments
conducted by the private entities pursuant to such contracts.
(d) Submittal of Reports to Congress.--
(1) Report on independent assessment.--Not later than 10
months after entering into the contract under subsection (a),
the Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives the
findings and recommendations of the independent assessment
required by such subsection.
(2) Report on va action plan to implement recommendations
in assessment.--Not later than 120 days after the date of
submission of the report under paragraph (1), the Secretary
shall submit to such Committees on the Secretary's response
to the findings of the assessment and shall include an action
plan, including a timeline, for fully implementing the
recommendations of the assessment.

SEC. 5. LIMITATION ON AWARDS AND BONUSES TO EMPLOYEES OF
DEPARTMENT OF VETERANS AFFAIRS.

For each of fiscal years 2014 through 2016, the Secretary
of Veterans Affairs may not pay awards or bonuses under
chapter 45 or 53 of title 5, United States Code, or any other
awards or bonuses authorized under such title.

SEC. 6. OMB ESTIMATE OF BUDGETARY EFFECTS AND NEEDED TRANSFER
AUTHORITY.

Not later than 30 days after the date of the enactment of
this Act, the Director of the Office of Management and Budget
shall transmit to the Committees on Appropriations, the
Budget, and Veterans' Affairs of the House of Representatives
and of the Senate--
(1) an estimate of the budgetary effects of sections 2 and
3;
(2) any transfer authority needed to utilize the savings
from section 5 to satisfy such budgetary effects; and
(3) if necessary, a request for any additional budgetary
resources, or transfers or reprogramming of existing
budgetary resources, necessary to provide funding for
sections 2 and 3.

SEC. 7. REMOVAL OF SENIOR EXECUTIVE SERVICE EMPLOYEES OF THE
DEPARTMENT OF VETERANS AFFAIRS FOR PERFORMANCE.

(a) 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.--Notwithstanding any other provision of
law, 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 Federal service; or
``(2) transfer the individual to a General Schedule
position at any grade of the General Schedule the Secretary
determines appropriate.
``(b) Notice to Congress.--Not later than 30 days after
removing 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 and the
reason for such removal.
``(c) Manner of Removal.--A removal under this section
shall be done in the same manner as the removal of a
professional staff member employed by a Member of
Congress.''.
(b) 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.''.

SEC. 8. BUDGETARY EFFECTS OF ACT.

The budgetary effects of this Act, for the purpose of
complying with the Statutory Pay-As-You-Go-Act of 2010, shall
be determined by reference to the latest statement titled
``Budgetary Effects of PAYGO Legislation'' for this Act,
submitted for printing in the Congressional Record by the
Chairman of the House Budget Committee, provided that such
statement has been submitted prior to the vote on passage.

The SPEAKER pro tempore. Pursuant to House Resolution 628, the motion
shall be debatable for 1 hour equally divided and controlled by the
chair and ranking minority member of the Committee on Veterans'
Affairs.
The gentleman from Florida (Mr. Miller) and the gentleman from Maine
(Mr. Michaud) each will control 30 minutes.
The Chair recognizes the gentleman from Florida.
Mr. MILLER of Florida. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, this motion is to help us go to conference and to
quickly work out the differences between the House and Senate bills
that would provide meaningful reform to the Department of Veterans
Affairs.
This motion also ensures that the House has a position from which to
begin negotiations with the Senate in a conference.
Mr. Speaker, I reserve the balance of my time.
Mr. MICHAUD. Mr. Speaker, I support the motion to concur in the
Senate amendments, and a further amendment, and I support the motion to
go to conference.
The crisis within the VA is of national interest and must be a
congressional priority. America's veterans deserve timely access to the
care and benefits they have earned. They fought for us. Now is the time
that we fight for them.
But our fight should not be just about the failures in Phoenix and
other facilities. The House has worked hard to develop important and
much-needed legislation to address other failures within the VA.
Enhanced programs ensure the VA is working on behalf of the veterans.
I am disappointed that we have not included in this amendment all
relevant bills that have passed the House to ensure that these
important matters are included. I am disappointed that we are not
moving forward with a more comprehensive package of reforms.
I am also disappointed that the House amendment is limited to two
measures we have recently passed, H.R. 4031 and H.R. 4810. Limiting
ourselves

[[Page H5425]]

to just Republican-sponsored legislation, no matter how widely
supported, runs counter to the bipartisan spirit of the committee and
fails to recognize the great work of all committee Members. Republicans
and Democrats have worked together to improve programs for the VA.
Finally, I am disappointed that H.R. 4399 was not included in the
House amendment to H.R. 3230. Without it, we are falling short of our
responsibility to hold all VA executives--I want to emphasize all VA
executives--accountable for the grave failures lately.

{time} 1330

I will work with Chairman Miller and my Senate colleagues to ensure
that the final agreement we reach regarding the accountability
provisions of H.R. 3230 are as comprehensive and effective as possible.
I urge all conferees, once appointed, to adopt the spirit of
bipartisanship that is the tradition of the House Veterans' Affairs
Committee.
When our servicemembers do their jobs to earn these veterans
benefits, they work together in a spirit of cooperation toward a
national goal. We should do no less as we move forward with legislation
to address reforms within the Department of Veterans Affairs.
Mr. Speaker, I urge my colleagues to support the motion to concur
with the Senate amendments with a further amendment and the motion to
go to conference.
Let us work together quickly and effectively to begin to address the
problems facing the VA.
With that, I yield back the balance of my time.
Mr. MILLER of Florida. Mr. Speaker, I yield back the balance of my
time.
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to House resolution 628, the previous question is ordered.
The question is on the motion offered by the gentleman from Florida.
The motion was agreed to.
A motion to reconsider was laid on the table.

____________________