[Congressional Record Volume 164, Number 80 (Wednesday, May 16, 2018)]
[House]
[Pages H4014-H4046]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
VETERANS CEMETERY BENEFIT CORRECTION ACT
Mr. ROE of Tennessee. Mr. Speaker, pursuant to House Resolution 891,
I call up the bill (S. 2372) to amend title 38, United States Code, to
provide outer burial receptacles for remains buried in National Parks,
and for other purposes, and ask for its immediate consideration in the
House.
The Clerk read the title of the bill.
The SPEAKER pro tempore. Pursuant to House Resolution 891, an
amendment in the nature of a substitute consisting of the text of H.R.
5674, as reported by the Committee on Veterans' Affairs, as modified by
the amendment printed in part B of House Report 115-677, is adopted,
and the bill, as amended, is considered read.
The text of the bill, as amended, is as follows:
[[Page H4015]]
S. 2372
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``John S.
McCain III, Daniel K. Akaka, and Samuel R. Johnson VA
Maintaining Internal Systems and Strengthening Integrated
Outside Networks Act of 2018'' or the ``VA MISSION Act of
2018''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--CARING FOR OUR VETERANS
Sec. 100. Short title; references to title 38, United States Code.
Subtitle A--Developing an Integrated High-Performing Network
Chapter 1--Establishing Community Care Programs
Sec. 101. Establishment of Veterans Community Care Program.
Sec. 102. Authorization of agreements between Department of Veterans
Affairs and non-Department providers.
Sec. 103. Conforming amendments for State veterans homes.
Sec. 104. Access standards and standards for quality.
Sec. 105. Access to walk-in care.
Sec. 106. Strategy regarding the Department of Veterans Affairs High-
Performing Integrated Health Care Network.
Sec. 107. Applicability of Directive of Office of Federal Contract
Compliance Programs.
Sec. 108. Prevention of certain health care providers from providing
non-Department health care services to veterans.
Sec. 109. Remediation of medical service lines.
Chapter 2--Paying Providers and Improving Collections
Sec. 111. Prompt payment to providers.
Sec. 112. Authority to pay for authorized care not subject to an
agreement.
Sec. 113. Improvement of authority to recover the cost of services
furnished for non-service-connected disabilities.
Sec. 114. Processing of claims for reimbursement through electronic
interface.
Chapter 3--Education and Training Programs
Sec. 121. Education program on health care options.
Sec. 122. Training program for administration of non-Department of
Veterans Affairs health care.
Sec. 123. Continuing medical education for non-Department medical
professionals.
Chapter 4--Other Matters Relating to Non-Department of Veterans Affairs
Providers
Sec. 131. Establishment of processes to ensure safe opioid prescribing
practices by non-Department of Veterans Affairs health
care providers.
Sec. 132. Improving information sharing with community providers.
Sec. 133. Competency standards for non-Department of Veterans Affairs
health care providers.
Sec. 134. Department of Veterans Affairs participation in national
network of State-based prescription drug monitoring
programs.
Chapter 5--Other Non-Department Health Care Matters
Sec. 141. Plans for Use of Supplemental Appropriations Required.
Sec. 142. Veterans Choice Fund flexibility.
Sec. 143. Sunset of Veterans Choice Program.
Sec. 144. Conforming amendments.
Subtitle B--Improving Department of Veterans Affairs Health Care
Delivery
Sec. 151. Licensure of health care professionals of the Department of
Veterans Affairs providing treatment via telemedicine.
Sec. 152. Authority for Department of Veterans Affairs Center for
Innovation for Care and Payment.
Sec. 153. Authorization to provide for operations on live donors for
purposes of conducting transplant procedures for
veterans.
Subtitle C--Family Caregivers
Sec. 161. Expansion of family caregiver program of Department of
Veterans Affairs.
Sec. 162. Implementation of information technology system of Department
of Veterans Affairs to assess and improve the family
caregiver program.
Sec. 163. Modifications to annual evaluation report on caregiver
program of Department of Veterans Affairs.
TITLE II--VA ASSET AND INFRASTRUCTURE REVIEW
Subtitle A--Asset and Infrastructure Review
Sec. 201. Short title.
Sec. 202. The Commission.
Sec. 203. Procedure for making recommendations.
Sec. 204. Actions regarding infrastructure and facilities of the
Veterans Health Administration.
Sec. 205. Implementation.
Sec. 206. Department of Veterans Affairs Asset and Infrastructure
Review Account.
Sec. 207. Congressional consideration of Commission report.
Sec. 208. Other matters.
Sec. 209. Definitions.
Subtitle B--Other Infrastructure Matters
Sec. 211. Improvement to training of construction personnel.
Sec. 212. Review of enhanced use leases.
Sec. 213. Assessment of health care furnished by the Department to
veterans who live in the Pacific territories.
TITLE III--IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS
Sec. 301. Designated scholarships for physicians and dentists under
Department of Veterans Affairs Health Professional
Scholarship Program.
Sec. 302. Increase in maximum amount of debt that may be reduced under
Education Debt Reduction Program of Department of
Veterans Affairs.
Sec. 303. Establishing the Department of Veterans Affairs Specialty
Education Loan Repayment Program.
Sec. 304. Veterans healing veterans medical access and scholarship
program.
Sec. 305. Bonuses for recruitment, relocation, and retention.
Sec. 306. Inclusion of Vet Center employees in Education Debt Reduction
Program of Department of Veterans Affairs.
TITLE IV--HEALTH CARE IN UNDERSERVED AREAS
Sec. 401. Development of criteria for designation of certain medical
facilities of the Department of Veterans Affairs as
underserved facilities and plan to address problem of
underserved facilities.
Sec. 402. Pilot program to furnish mobile deployment teams to
underserved facilities.
Sec. 403. Pilot program on graduate medical education and residency.
TITLE V--OTHER MATTERS
Sec. 501. Annual report on performance awards and bonuses awarded to
certain high-level employees of the department.
Sec. 502. Role of podiatrists in Department of Veterans Affairs.
Sec. 503. Definition of major medical facility project.
Sec. 504. Authorization of certain major medical facility projects of
the Department of Veterans Affairs.
Sec. 505. Department of Veterans Affairs personnel transparency.
Sec. 506. Program on establishment of peer specialists in patient
aligned care team settings within medical centers of
Department of Veterans Affairs.
Sec. 507. Department of Veterans Affairs medical scribe pilot program.
Sec. 508. Loans guaranteed under home loan program of Department of
Veterans Affairs.
Sec. 509. Extension of reduction in amount of pension furnished by
Department of Veterans Affairs for certain veterans
covered by Medicaid plans for services furnished by
nursing facilities.
Sec. 510. Appropriation of amounts.
Sec. 511. Technical correction.
TITLE I--CARING FOR OUR VETERANS
SEC. 100. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES
CODE.
(a) Short Title.--This title may be cited as the ``Caring
for Our Veterans Act of 2018''.
(b) References to Title 38, United States Code.--Except as
otherwise expressly provided, whenever in this title an
amendment or repeal is expressed in terms of an amendment to,
or repeal of, a section or other provision, the reference
shall be considered to be made to a section or other
provision of title 38, United States Code.
Subtitle A--Developing an Integrated High-Performing Network
CHAPTER 1--ESTABLISHING COMMUNITY CARE PROGRAMS
SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY CARE PROGRAM.
(a) Establishment of Program.--
(1) In general.--Section 1703 is amended to read as
follows:
``Sec. 1703. Veterans Community Care Program
``(a) In General.--(1) There is established a program to
furnish hospital care, medical services, and extended care
services to covered veterans through health care providers
specified in subsection (c).
``(2) The Secretary shall coordinate the furnishing of
hospital care, medical services, and extended care services
under this section to covered veterans, including
coordination of, at a minimum, the following:
``(A) Ensuring the scheduling of medical appointments in a
timely manner and the establishment of a mechanism to receive
medical records from non-Department providers.
``(B) Ensuring continuity of care and services.
``(C) Ensuring coordination among regional networks if the
covered veteran accesses care and services in a different
network than the regional network in which the covered
veteran resides.
``(D) Ensuring that covered veterans do not experience a
lapse in care resulting from errors or delays by the
Department or its contractors or an unusual or excessive
burden in accessing hospital care, medical services, or
extended care services.
``(3) A covered veteran may only receive care or services
under this section upon the authorization of such care or
services by the Secretary.
``(b) Covered Veterans.--For purposes of this section, a
covered veteran is any veteran who--
[[Page H4016]]
``(1) is enrolled in the system of annual patient
enrollment established and operated under section 1705 of
this title; or
``(2) is not enrolled in such system but is otherwise
entitled to hospital care, medical services, or extended care
services under subsection (c)(2) of such section.
``(c) Health Care Providers Specified.--Health care
providers specified in this subsection are the following:
``(1) Any health care provider that is participating in the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.), including any physician furnishing
services under such a program.
``(2) The Department of Defense.
``(3) The Indian Health Service.
``(4) Any Federally-qualified health center (as defined in
section 1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B))).
``(5) Any health care provider not otherwise covered under
any of paragraphs (1) through (4) that meets criteria
established by the Secretary for purposes of this section.
``(d) Conditions Under Which Care Is Required To Be
Furnished Through Non-Department Providers.--(1) The
Secretary shall, subject to the availability of
appropriations, furnish hospital care, medical services, and
extended care services to a covered veteran through health
care providers specified in subsection (c) if--
``(A) the Department does not offer the care or services
the veteran requires;
``(B) the Department does not operate a full-service
medical facility in the State in which the covered veteran
resides;
``(C)(i) the covered veteran was an eligible veteran under
section 101(b)(2)(B) of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note) as of the day before the date of the enactment of
the Caring for Our Veterans Act of 2018;
``(ii) continues to reside in a location that would qualify
the veteran for eligibility under such section; and
``(iii) either--
``(I) resides in one of the five States with the lowest
population density as determined by data from the 2010
decennial census; or
``(II) resides in a State not described in subclause (I)
and--
``(aa) received care or services under this title in the
year preceding the enactment of the Caring for Our Veterans
Act of 2018; and
``(bb) is seeking care or services within two years of the
date of the enactment of the Caring for Our Veterans Act of
2018;
``(D) the covered veteran has contacted the Department to
request care or services and the Department is not able to
furnish such care or services in a manner that complies with
designated access standards developed by the Secretary under
section 1703B of this title; or
``(E) the covered veteran and the covered veteran's
referring clinician agree that furnishing care and services
through a non-Department entity or provider would be in the
best medical interest of the covered veteran based upon
criteria developed by the Secretary.
``(2) The Secretary shall ensure that the criteria
developed under paragraph (1)(E) include consideration of the
following:
``(A) The distance between the covered veteran and the
facility that provides the hospital care, medical services,
or extended care services the veteran needs.
``(B) The nature of the hospital care, medical services, or
extended care services required.
``(C) The frequency that the hospital care, medical
services, or extended care services needs to be furnished.
``(D) The timeliness of available appointments for the
hospital care, medical services, or extended care services
the veteran needs.
``(E) Whether the covered veteran faces an unusual or
excessive burden to access hospital care, medical services,
or extended care services from the Department medical
facility where a covered veteran seeks hospital care, medical
services, or extended care services, which shall include
consideration of the following:
``(i) Whether the covered veteran faces an excessive
driving distance, geographical challenge, or environmental
factor that impedes the access of the covered veteran.
``(ii) Whether the hospital care, medical services, or
extended care services sought by the veteran is provided by a
medical facility of the Department that is reasonably
accessible to a covered veteran.
``(iii) Whether a medical condition of the covered veteran
affects the ability of the covered veteran to travel.
``(iv) Whether there is compelling reason, as determined by
the Secretary, that the veteran needs to receive hospital
care, medical services, or extended care services from a
medical facility other than a medical facility of the
Department.
``(v) Such other considerations as the Secretary considers
appropriate.
``(3) If the Secretary has determined that the Department
does not offer the care or services the covered veteran
requires under subparagraph (A) of paragraph (1), that the
Department does not operate a full-service medical facility
in the State in which the covered veteran resides under
subparagraph (B) of such paragraph, that the covered veteran
is described under subparagraph (C) of such paragraph, or
that the Department is not able to furnish care or services
in a manner that complies with designated access standards
developed by the Secretary under section 1703B of this title
under subparagraph (D) of such paragraph, the decision to
receive hospital care, medical services, or extended care
services under such subparagraphs from a health care provider
specified in subsection (c) shall be at the election of the
veteran.
``(e) Conditions Under Which Care Is Authorized To Be
Furnished Through Non-Department Providers.--(1)(A) The
Secretary may furnish hospital care, medical services, or
extended care services through a health care provider
specified in subsection (c) to a covered veteran served by a
medical service line of the Department that the Secretary has
determined is not providing care that complies with the
standards for quality the Secretary shall establish under
section 1703C.
``(B) In carrying out subparagraph (A), the Secretary
shall--
``(i) measure timeliness of the medical service line at a
facility of the Department when compared with the same
medical service line at different Department facilities; and
``(ii) measure quality at a medical service line of a
facility of the Department by comparing it with two or more
distinct and appropriate quality measures at non-Department
medical service lines.
``(C)(i) The Secretary may not concurrently furnish
hospital care, medical services, or extended care services
under subparagraph (A) with respect to more than three
medical service lines described in such subparagraph at any
one health care facility of the Department.
``(ii) The Secretary may not concurrently furnish hospital
care, medical services, or extended care services under
subparagraph (A) with respect to more than 36 medical service
lines nationally described in such subparagraph.
``(2) The Secretary may limit the types of hospital care,
medical services, or extended care services covered veterans
may receive under paragraph (1) in terms of the length of
time such care and services will be available, the location
at which such care and services will be available, and the
clinical care and services that will be available.
``(3)(A) Except as provided for in subparagraph (B), the
hospital care, medical services, and extended care services
authorized under paragraph (1) with respect to a medical
service line shall cease when the remediation described in
section 1706A with respect to such medical service line is
complete.
``(B) The Secretary shall ensure continuity and
coordination of care for any veteran who elects to receive
care or services under paragraph (1) from a health care
provider specified in subsection (c) through the completion
of an episode of care.
``(4) The Secretary shall publish in the Federal Register,
and shall take all reasonable steps to provide direct notice
to covered veterans affected under this subsection, at least
once each year stating the time period during which such care
and services will be available, the location or locations
where such care and services will be available, and the
clinical services available at each location under this
subsection in accordance with regulations the Secretary shall
prescribe.
``(5) When the Secretary exercises the authority under
paragraph (1), the decision to receive care or services under
such paragraph from a health care provider specified in
subsection (c) shall be at the election of the covered
veteran.
``(f) Review of Decisions.--The review of any decision
under subsection (d) or (e) shall be subject to the
Department's clinical appeals process, and such decisions may
not be appealed to the Board of Veterans' Appeals.
``(g) Tiered Network.--(1) To promote the provision of
high-quality and high-value hospital care, medical services,
and extended care services under this section, the Secretary
may develop a tiered provider network of eligible providers
based on criteria established by the Secretary for purposes
of this section.
``(2) In developing a tiered provider network of eligible
providers under paragraph (1), the Secretary shall not
prioritize providers in a tier over providers in any other
tier in a manner that limits the choice of a covered veteran
in selecting a health care provider specified in subsection
(c) for receipt of hospital care, medical services, or
extended care services under this section.
``(h) Contracts To Establish Networks of Health Care
Providers.--(1) The Secretary shall enter into consolidated,
competitively bid contracts to establish networks of health
care providers specified in paragraphs (1) and (5) of
subsection (c) for purposes of providing sufficient access to
hospital care, medical services, or extended care services
under this section.
``(2)(A) The Secretary shall, to the extent practicable,
ensure that covered veterans are able to make their own
appointments using advanced technology.
``(B) To the extent practicable, the Secretary shall be
responsible for the scheduling of appointments for hospital
care, medical services, and extended care services under this
section.
``(3)(A) The Secretary may terminate a contract with an
entity entered into under paragraph (1) at such time and upon
such notice to the entity as the Secretary may specify for
purposes of this section, if the Secretary notifies the
appropriate committees of Congress that, at a minimum--
``(i) the entity--
``(I) failed to comply substantially with the provisions of
the contract or with the provisions of this section and the
regulations prescribed under this section;
``(II) failed to comply with the access standards or the
standards for quality established by the Secretary;
``(III) is excluded from participation in a Federal health
care program (as defined in section 1128B(f) of the Social
Security Act (42 U.S.C. 1320a-7b(f))) under section 1128 or
1128A of the Social Security Act (42 U.S.C. 1320a-7 and
1320a-7a);
``(IV) is identified as an excluded source on the list
maintained in the System for Award Management, or any
successor system; or
``(V) has been convicted of a felony or other serious
offense under Federal or State law and the continued
participation of the entity would be detrimental to the best
interests of veterans or the Department;
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``(ii) it is reasonable to terminate the contract based on
the health care needs of veterans; or
``(iii) it is reasonable to terminate the contract based on
coverage provided by contracts or sharing agreements entered
into under authorities other than this section.
``(B) Nothing in subparagraph (A) may be construed to
restrict the authority of the Secretary to terminate a
contract entered into under paragraph (1) under any other
provision of law.
``(4) Whenever the Secretary provides notice to an entity
that the entity is failing to meet contractual obligations
entered into under paragraph (1), the Secretary shall submit
to the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on such failure. Such report shall
include the following:
``(A) An explanation of the reasons for providing such
notice.
``(B) A description of the effect of such failure,
including with respect to cost, schedule, and requirements.
``(C) A description of the actions taken by the Secretary
to mitigate such failure.
``(D) A description of the actions taken by the contractor
to address such failure.
``(E) A description of any effect on the community provider
market for veterans in the affected area.
``(5)(A) The Secretary shall instruct each entity awarded a
contract under paragraph (1) to recognize and accept, on an
interim basis, the credentials and qualifications of health
care providers who are authorized to furnish hospital care
and medical services to veterans under a community care
program of the Department in effect as of the day before the
date of the enactment of the Caring for Our Veterans Act of
2018, including under the Patient-Centered Community Care
Program and the Veterans Choice Program under section 101 of
the Veterans Access, Choice, and Accountability Act of 2014
(Public Law 113-146; 38 U.S.C. 1701 note), as qualified
providers under the program established under this section.
``(B) The interim acceptance period under subparagraph (A)
shall be determined by the Secretary based on the following
criteria:
``(i) With respect to a health care provider, when the
current certification agreement for the health care provider
expires.
``(ii) Whether the Department has enacted certification and
eligibility criteria and regulatory procedures by which non-
Department providers will be authorized under this section.
``(6) The Secretary shall establish a system or systems for
monitoring the quality of care provided to covered veterans
through a network under this subsection and for assessing the
quality of hospital care, medical services, and extended care
services furnished through such network before the renewal of
the contract for such network.
``(i) Payment Rates for Care and Services.--(1) Except as
provided in paragraph (2), and to the extent practicable, the
rate paid for hospital care, medical services, or extended
care services under any provision in this title may not
exceed the rate paid by the United States to a provider of
services (as defined in section 1861(u) of the Social
Security Act (42 U.S.C. 1395x(u))) or a supplier (as defined
in section 1861(d) of such Act (42 U.S.C. 1395x(d))) under
the Medicare program under title XI or title XVIII of the
Social Security Act (42 U.S.C. 1301 et seq.), including
section 1834 of such Act (42 U.S.C. 1395m), for the same care
or services.
``(2)(A) A higher rate than the rate paid by the United
States as described in paragraph (1) may be negotiated with
respect to the furnishing of care or services to a covered
veteran who resides in a highly rural area.
``(B) In this paragraph, the term `highly rural area' means
an area located in a county that has fewer than seven
individuals residing in that county per square mile.
``(3) With respect to furnishing care or services under
this section in Alaska, the Alaska Fee Schedule of the
Department of Veterans Affairs shall be followed, except for
when another payment agreement, including a contract or
provider agreement, is in effect.
``(4) With respect to furnishing hospital care, medical
services, or extended care services under this section in a
State with an All-Payer Model Agreement under section
1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3))
that became effective on or after January 1, 2014, the
Medicare payment rates under paragraph (2)(A) shall be
calculated based on the payment rates under such agreement.
``(5) Notwithstanding paragraph (1), the Secretary may
incorporate, to the extent practicable, the use of value-
based reimbursement models to promote the provision of high-
quality care.
``(6) With respect to hospital care, medical services, or
extended care services for which there is not a rate paid
under the Medicare program as described in paragraph (1), the
rate paid for such care or services shall be determined by
the Secretary.
``(j) Treatment of Other Health Plan Contracts.--In any
case in which a covered veteran is furnished hospital care,
medical services, or extended care services under this
section for a non-service-connected disability described in
subsection (a)(2) of section 1729 of this title, the
Secretary shall recover or collect reasonable charges for
such care or services from a health plan contract described
in section 1729 in accordance with such section.
``(k) Payment by Veteran.--A covered veteran shall not pay
a greater amount for receiving care or services under this
section than the amount the veteran would pay for receiving
the same or comparable care or services at a medical facility
of the Department or from a health care provider of the
Department.
``(l) Transplant Authority for Improved Access.--(1) In the
case of a covered veteran described in paragraph (2), the
Secretary shall determine whether to authorize an organ or
bone marrow transplant for that covered veteran at a non-
Department facility.
``(2) A covered veteran described in this paragraph--
``(A) requires an organ or bone marrow transplant; and
``(B) has, in the opinion of the primary care provider of
the veteran, a medically compelling reason to travel outside
the region of the Organ Procurement and Transplantation
Network, established under section 372 of the National Organ
Transplantation Act (Public Law 98-507; 42 U.S.C. 274), in
which the veteran resides, to receive such transplant.
``(m) Monitoring of Care Provided.--(1)(A) Not later than
540 days after the date of the enactment of the Caring for
Our Veterans Act of 2018, and not less frequently than
annually thereafter, the Secretary shall submit to
appropriate committees of Congress a review of the types and
frequency of care sought under subsection (d).
``(B) The review submitted under subparagraph (A) shall
include an assessment of the following:
``(i) The top 25 percent of types of care and services most
frequently provided under subsection (d) due to the
Department not offering such care and services.
``(ii) The frequency such care and services were sought by
covered veterans under this section.
``(iii) An analysis of the reasons the Department was
unable to provide such care and services.
``(iv) Any steps the Department took to provide such care
and services at a medical facility of the Department.
``(v) The cost of such care and services.
``(2) In monitoring the hospital care, medical services,
and extended care services furnished under this section, the
Secretary shall do the following:
``(A) With respect to hospital care, medical services, and
extended care services furnished through provider networks
established under subsection (i)--
``(i) compile data on the types of hospital care, medical
services, and extended care services furnished through such
networks and how many patients used each type of care and
service;
``(ii) identify gaps in hospital care, medical services, or
extended care services furnished through such networks;
``(iii) identify how such gaps may be fixed through new
contracts within such networks or changes in the manner in
which hospital care, medical services, or extended care
services are furnished through such networks;
``(iv) assess the total amounts spent by the Department on
hospital care, medical services, and extended care services
furnished through such networks;
``(v) assess the timeliness of the Department in referring
hospital care, medical services, and extended care services
to such networks; and
``(vi) assess the timeliness of such networks in--
``(I) accepting referrals; and
``(II) scheduling and completing appointments.
``(B) Report the number of medical service lines the
Secretary has determined under subsection (e)(1) not to be
providing hospital care, medical services, or extended care
services that comply with the standards for quality
established by the Secretary.
``(C) Assess the use of academic affiliates and centers of
excellence of the Department to furnish hospital care,
medical services, and extended care services to covered
veterans under this section.
``(D) Assess the hospital care, medical services, and
extended care services furnished to covered veterans under
this section by medical facilities operated by Federal
agencies other than the Department.
``(3) Not later than 540 days after the date of the
enactment of the Caring for Our Veterans Act of 2018 and not
less frequently than once each year thereafter, the Secretary
shall submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the information gathered under
paragraph (2).
``(n) Prohibition on Certain Limitations.--(1) The
Secretary shall not limit the types of hospital care, medical
services, or extended care services covered veterans may
receive under this section if it is in the best medical
interest of the veteran to receive such hospital care,
medical services, or extended care services, as determined by
the veteran and the veteran's health care provider.
``(2) No provision in this section may be construed to
alter or modify any other provision of law establishing
specific eligibility criteria for certain hospital care,
medical services, or extended care services.
``(o) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.
``(2) The term `medical service line' means a clinic within
a Department medical center.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 17 is amended by striking the item
relating to section 1703 and inserting the following new
item:
``1703. Veterans Community Care Program.''.
(b) Effective Date.--Section 1703 of title 38, United
States Code, as amended by subsection (a), shall take effect
on the later of--
[[Page H4018]]
(1) the date that is 30 days after the date on which the
Secretary of Veterans Affairs submits the report required
under section 101(q)(2) of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note); or
(2) the date on which the Secretary promulgates regulations
pursuant to subsection (c).
(c) Regulations.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall promulgate regulations to carry out section 1703 of
title 38, United States Code, as amended by subsection (a) of
this section.
(2) Updates.--
(A) Periodic.--Before promulgating the regulations required
under paragraph (1), the Secretary shall provide to the
appropriate committees of Congress periodic updates to
confirm the progress of the Secretary toward developing such
regulations.
(B) First update.--The first update under subparagraph (A)
shall occur no later than 120 days from the date of the
enactment of this Act.
(C) Appropriate committees of congress defined.--In this
paragraph, the term ``appropriate committees of Congress''
means--
(i) the Committee on Veterans' Affairs and the Committee on
Appropriations of the Senate; and
(ii) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.
(d) Continuity of Existing Agreements.--
(1) In general.--Notwithstanding section 1703 of title 38,
United States Code, as amended by subsection (a), the
Secretary of Veterans Affairs shall continue all contracts,
memorandums of understanding, memorandums of agreements, and
other arrangements that were in effect on the day before the
date of the enactment of this Act between the Department of
Veterans Affairs and the American Indian and Alaska Native
health care systems as established under the terms of the
Department of Veterans Affairs and Indian Health Service
Memorandum of Understanding, signed October 1, 2010, the
National Reimbursement Agreement, signed December 5, 2012,
arrangements under section 405 of the Indian Health Care
Improvement Act (25 U.S.C. 1645), and agreements entered into
under sections 102 and 103 of the Veterans Access, Choice,
and Accountability Act of 2014 (Public Law 113-146).
(2) Modifications.--Paragraph (1) shall not be construed to
prohibit the Secretary and the parties to the contracts,
memorandums of understanding, memorandums of agreements, and
other arrangements described in such paragraph from making
such changes to such contracts, memorandums of understanding,
memorandums of agreements, and other arrangements as may be
otherwise authorized pursuant to other provisions of law or
the terms of the contracts, memorandums of understanding,
memorandums of agreements, and other arrangements.
SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DEPARTMENT OF
VETERANS AFFAIRS AND NON-DEPARTMENT PROVIDERS.
(a) In General.--Subchapter I of chapter 17 is amended by
inserting after section 1703 the following new section:
``Sec. 1703A. Agreements with eligible entities or providers;
certification processes
``(a) Agreements Authorized.--(1)(A) When hospital care, a
medical service, or an extended care service required by a
veteran who is entitled to such care or service under this
chapter is not feasibly available to the veteran from a
facility of the Department or through a contract or sharing
agreement entered into pursuant to another provision of law,
the Secretary may furnish such care or service to such
veteran through an agreement under this section with an
eligible entity or provider to provide such hospital care,
medical service, or extended care service.
``(B) An agreement entered into under this section to
provide hospital care, a medical service, or an extended care
service shall be known as a `Veterans Care Agreement'.
``(C) For purposes of subparagraph (A), hospital care, a
medical service, or an extended care service may be
considered not feasibly available to a veteran from a
facility of the Department or through a contract or sharing
agreement described in such subparagraph when the Secretary
determines the veteran's medical condition, the travel
involved, the nature of the care or services required, or a
combination of these factors make the use of a facility of
the Department or a contract or sharing agreement described
in such subparagraph impracticable or inadvisable.
``(D) A Veterans Care Agreement may be entered into by the
Secretary or any Department official authorized by the
Secretary.
``(2)(A) Subject to subparagraph (B), the Secretary shall
review each Veterans Care Agreement of material size, as
determined by the Secretary or set forth in paragraph (3),
for hospital care, a medical service, or an extended care
service to determine whether it is feasible and advisable to
provide such care or service within a facility of the
Department or by contract or sharing agreement entered into
pursuant to another provision of law and, if so, take action
to do so.
``(B)(i) The Secretary shall review each Veterans Care
Agreement of material size that has been in effect for at
least six months within the first two years of its taking
effect, and not less frequently than once every four years
thereafter.
``(ii) If a Veterans Care Agreement has not been in effect
for at least six months by the date of the review required by
subparagraph (A), the agreement shall be reviewed during the
next cycle required by subparagraph (A), and such review
shall serve as its review within the first two years of its
taking effect for purposes of clause (i).
``(3)(A) In fiscal year 2019 and in each fiscal year
thereafter, in addition to such other Veterans Care
Agreements as the Secretary may determine are of material
size, a Veterans Care Agreement for the purchase of extended
care services that exceeds $5,000,000 annually shall be
considered of material size.
``(B) From time to time, the Secretary may publish a notice
in the Federal Register to adjust the dollar amount specified
in subparagraph (A) to account for changes in the cost of
health care based upon recognized health care market surveys
and other available data.
``(b) Eligible Entities and Providers.--For purposes of
this section, an eligible entity or provider is--
``(1) any provider of services that has enrolled and
entered into a provider agreement under section 1866(a) of
the Social Security Act (42 U.S.C. 1395cc(a)) and any
physician or other supplier who has enrolled and entered into
a participation agreement under section 1842(h) of such Act
(42 U.S.C. 1395u(h));
``(2) any provider participating under a State plan under
title XIX of such Act (42 U.S.C. 1396 et seq.);
``(3) an Aging and Disability Resource Center, an area
agency on aging, or a State agency (as defined in section 102
of the Older Americans Act of 1965 (42 U.S.C. 3002));
``(4) a center for independent living (as defined in
section 702 of the Rehabilitation Act of 1973 (29 U.S.C.
796a)); or
``(5) any entity or provider not described in paragraph (1)
or (2) of this subsection that the Secretary determines to be
eligible pursuant to the certification process described in
subsection (c).
``(c) Eligible Entity or Provider Certification Process.--
The Secretary shall establish by regulation a process for the
certification of eligible entities or providers or
recertification of eligible entities or providers under this
section. Such a process shall, at a minimum--
``(1) establish deadlines for actions on applications for
certification;
``(2) set forth standards for an approval or denial of
certification, duration of certification, revocation of an
eligible entity or provider's certification, and
recertification of eligible entities or providers;
``(3) require the denial of certification if the Secretary
determines the eligible entity or provider is excluded from
participation in a Federal health care program under section
1128 or section 1128A of the Social Security Act (42 U.S.C.
1320a-7 or 1320a-7a) or is currently identified as an
excluded source on the System for Award Management Exclusions
list described in part 9 of title 48, Code of Federal
Regulations, and part 180 of title 2 of such Code, or
successor regulations;
``(4) establish procedures for screening eligible entities
or providers according to the risk of fraud, waste, and abuse
that are similar to the standards under section 1866(j)(2)(B)
of the Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and
section 9.104 of title 48, Code of Federal Regulations, or
successor regulations; and
``(5) incorporate and apply the restrictions and penalties
set forth in chapter 21 of title 41 and treat this section as
a procurement program only for purposes of applying such
provisions.
``(d) Rates.--To the extent practicable, the rates paid by
the Secretary for hospital care, medical services, and
extended care services provided under a Veterans Care
Agreement shall be in accordance with the rates paid by the
United States under section 1703(i) of this title.
``(e) Terms of Veterans Care Agreements.--(1) Pursuant to
regulations promulgated under subsection (k), the Secretary
may define the requirements for providers and entities
entering into agreements under this section based upon such
factors as the number of patients receiving care or services,
the number of employees employed by the entity or provider
furnishing such care or services, the amount paid by the
Secretary to the provider or entity, or other factors as
determined by the Secretary.
``(2) To furnish hospital care, medical services, or
extended care services under this section, an eligible entity
or provider shall agree--
``(A) to accept payment at the rates established in
regulations prescribed under this section;
``(B) that payment by the Secretary under this section on
behalf of a veteran to a provider of services or care shall,
unless rejected and refunded by the provider within 30 days
of receipt, constitute payment in full and extinguish any
liability on the part of the veteran for the treatment or
care provided, and no provision of a contract, agreement, or
assignment to the contrary shall operate to modify, limit, or
negate this requirement;
``(C) to provide only the care and services authorized by
the Department under this section and to obtain the prior
written consent of the Department to furnish care or services
outside the scope of such authorization;
``(D) to bill the Department in accordance with the
methodology outlined in regulations prescribed under this
section;
``(E) to not seek to recover or collect from a health plan
contract or third party, as those terms are defined in
section 1729 of this title, for any care or service that is
furnished or paid for by the Department;
``(F) to provide medical records to the Department in the
time frame and format specified by the Department; and
``(G) to meet such other terms and conditions, including
quality of care assurance standards, as the Secretary may
specify in regulation.
``(f) Discontinuation or Nonrenewal of a Veterans Care
Agreement.--(1) An eligible entity or provider may
discontinue a Veterans Care Agreement at such time and upon
such notice to the Secretary as may be provided in
regulations prescribed under this section.
``(2) The Secretary may discontinue a Veterans Care
Agreement with an eligible entity or
[[Page H4019]]
provider at such time and upon such reasonable notice to the
eligible entity or provider as may be specified in
regulations prescribed under this section, if an official
designated by the Secretary--
``(A) has determined that the eligible entity or provider
failed to comply substantially with the provisions of the
Veterans Care Agreement, or with the provisions of this
section or regulations prescribed under this section;
``(B) has determined the eligible entity or provider is
excluded from participation in a Federal health care program
under section 1128 or section 1128A of the Social Security
Act (42 U.S.C. 1320a-7 or 1320a-7a) or is identified on the
System for Award Management Exclusions list as provided in
part 9 of title 48, Code of Federal Regulations, and part 180
of title 2 of such Code, or successor regulations;
``(C) has ascertained that the eligible entity or provider
has been convicted of a felony or other serious offense under
Federal or State law and determines the eligible entity or
provider's continued participation would be detrimental to
the best interests of veterans or the Department; or
``(D) has determined that it is reasonable to terminate the
agreement based on the health care needs of a veteran.
``(g) Quality of Care.--The Secretary shall establish a
system or systems for monitoring the quality of care provided
to veterans through Veterans Care Agreements and for
assessing the quality of hospital care, medical services, and
extended care services furnished by eligible entities and
providers before the renewal of Veterans Care Agreements.
``(h) Disputes.--(1) The Secretary shall promulgate
administrative procedures for eligible entities and providers
to present all disputes arising under or related to Veterans
Care Agreements.
``(2) Such procedures constitute the eligible entities' and
providers' exhaustive and exclusive administrative remedies.
``(3) Eligible entities or providers must first exhaust
such administrative procedures before seeking any judicial
review under section 1346 of title 28 (known as the `Tucker
Act').
``(4) Disputes under this section must pertain to either
the scope of authorization under the Veterans Care Agreement
or claims for payment subject to the Veterans Care Agreement
and are not claims for the purposes of such laws that would
otherwise require application of sections 7101 through 7109
of title 41, United States Code.
``(i) Applicability of Other Provisions of Law.--(1) A
Veterans Care Agreement may be authorized by the Secretary or
any Department official authorized by the Secretary, and such
action shall not be treated as--
``(A) an award for the purposes of such laws that would
otherwise require the use of competitive procedures for the
furnishing of care and services; or
``(B) a Federal contract for the acquisition of goods or
services for purposes of any provision of Federal law
governing Federal contracts for the acquisition of goods or
services except section 4706(d) of title 41.
``(2)(A) Except as provided in the agreement itself, in
subparagraph (B), and unless otherwise provided in this
section or regulations prescribed pursuant to this section,
an eligible entity or provider that enters into an agreement
under this section is not subject to, in the carrying out of
the agreement, any law to which providers of services and
suppliers under the Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) are not subject.
``(B) An eligible entity or provider that enters into an
agreement under this section is subject to--
``(i) all laws regarding integrity, ethics, or fraud, or
that subject a person to civil or criminal penalties; and
``(ii) all laws that protect against employment
discrimination or that otherwise ensure equal employment
opportunities.
``(3) Notwithstanding paragraph (2)(B)(i), an eligible
entity or provider that enters into an agreement under this
section shall not be treated as a Federal contractor or
subcontractor for purposes of chapter 67 of title 41
(commonly known as the `McNamara-O'Hara Service Contract Act
of 1965').
``(j) Parity of Treatment.--Eligibility for hospital care,
medical services, and extended care services furnished to any
veteran pursuant to a Veterans Care Agreement shall be
subject to the same terms as though provided in a facility of
the Department, and provisions of this chapter applicable to
veterans receiving such care and services in a facility of
the Department shall apply to veterans treated under this
section.
``(k) Rulemaking.--The Secretary shall promulgate
regulations to carry out this section.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1703 the following new item:
``1703A. Agreements with eligible entities or providers; certification
processes.''.
SEC. 103. CONFORMING AMENDMENTS FOR STATE VETERANS HOMES.
(a) In General.--Section 1745(a) is amended--
(1) in paragraph (1), by striking ``(or agreement under
section 1720(c)(1) of this title)'' and inserting ``(or an
agreement)''; and
(2) by adding at the end the following new paragraph:
``(4)(A) An agreement under this section may be authorized
by the Secretary or any Department official authorized by the
Secretary, and any such action is not an award for purposes
of such laws that would otherwise require the use of
competitive procedures for the furnishing of hospital care,
medical services, and extended care services.
``(B)(i) Except as provided in the agreement itself, in
clause (ii), and unless otherwise provided in this section or
regulations prescribed pursuant to this section, a State home
that enters into an agreement under this section is not
subject to, in the carrying out of the agreement, any
provision of law to which providers of services and suppliers
under the Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.) are not subject.
``(ii) A State home that enters into an agreement under
this section is subject to--
``(I) all provisions of law regarding integrity, ethics, or
fraud, or that subject a person to civil or criminal
penalties;
``(II) all provisions of law that protect against
employment discrimination or that otherwise ensure equal
employment opportunities; and
``(III) all provisions in subchapter V of chapter 17 of
this title.
``(iii) Notwithstanding subparagraph (B)(ii)(I), a State
home that enters into an agreement under this section may not
be treated as a Federal contractor or subcontractor for
purposes of chapter 67 of title 41 (known as the `McNamara-
O'Hara Service Contract Act of 1965').''.
(b) Effective Date.--The amendment made by subsection (a)
shall apply to care provided on or after the effective date
of regulations issued by the Secretary of Veterans Affairs to
carry out this section.
SEC. 104. ACCESS STANDARDS AND STANDARDS FOR QUALITY.
(a) In General.--Subchapter I of chapter 17, as amended by
section 102, is further amended by inserting after section
1703A the following new sections:
``Sec. 1703B. Access standards
``(a)(1) The Secretary shall establish access standards for
furnishing hospital care, medical services, or extended care
services to covered veterans for the purposes of section
1703(d).
``(2) The Secretary shall ensure that the access standards
established under paragraph (1) define such categories of
care to cover all care and services within the medical
benefits package of the Department of Veterans Affairs.
``(b) The Secretary shall ensure that the access standards
provide covered veterans, employees of the Department, and
health care providers in the network established under
section 1703(h) with relevant comparative information that is
clear, useful, and timely, so that covered veterans can make
informed decisions regarding their health care.
``(c) The Secretary shall consult with all pertinent
Federal entities (including the Department of Defense, the
Department of Health and Human Services, and the Centers for
Medicare & Medicaid Services), entities in the private
sector, and other nongovernmental entities in establishing
access standards.
``(d)(1) Not later than 270 days after the date of the
enactment of the Caring for Our Veterans Act of 2018, the
Secretary shall submit to the appropriate committees of
Congress a report detailing the access standards.
``(2)(A) Before submitting the report required under
paragraph (1), the Secretary shall provide periodic updates
to the appropriate committees of Congress to confirm the
Department's progress towards developing the access standards
required by this section.
``(B) The first update under subparagraph (A) shall occur
no later than 120 days from the date of the enactment of the
Caring for Our Veterans Act of 2018.
``(3) Not later than 540 days after the date on which the
Secretary implements the access standards established under
subsection (a), the Secretary shall submit to the appropriate
committees of Congress a report detailing the implementation
of and compliance with such access standards by Department
and non-Department entities or providers.
``(e) Not later than three years after the date on which
the Secretary establishes access standards under subsection
(a) and not less frequently than once every three years
thereafter, the Secretary shall--
``(1) conduct a review of such standards; and
``(2) submit to the appropriate committees of Congress a
report on the findings and any modification to the access
standards with respect to the review conducted under
paragraph (1).
``(f) The Secretary shall ensure health care providers
specified under section 1703(c) are able to comply with the
applicable access standards established by the Secretary.
``(g) The Secretary shall publish in the Federal Register
and on an internet website of the Department the designated
access standards established under this section for purposes
of section 1703(d)(1)(D).
``(h)(1) Consistent with paragraphs (1)(D) and (3) of
section 1703(d), covered veterans may contact the Department
at any time to request a determination regarding whether they
are eligible to receive care and services from a non-
Department entity or provider based on the Department being
unable to furnish such care and services in a manner that
complies with the designated access standards established
under this section.
``(2) The Secretary shall establish a process to review
such requests from covered veterans to determine whether--
``(A) the requested care is clinically necessary; and
``(B) the Department is able to provide such care in a
manner that complies with designated access standards
established under this section.
``(3) The Secretary shall promptly respond to any such
request by a covered veteran.
``(i)(1) The term `appropriate committees of Congress'
means--
``(A) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.
``(2) The term `covered veterans' refers to veterans
described in section 1703(b) of this title.
[[Page H4020]]
``Sec. 1703C. Standards for quality
``(a) In General.--(1) The Secretary shall establish
standards for quality regarding hospital care, medical
services, and extended care services furnished by the
Department pursuant to this title, including through non-
Department health care providers pursuant to section 1703 of
this title.
``(2) In establishing standards for quality under paragraph
(1), the Secretary shall consider existing health quality
measures that are applied to public and privately sponsored
health care systems with the purpose of providing covered
veterans relevant comparative information to make informed
decisions regarding their health care.
``(3) The Secretary shall collect and consider data for
purposes of establishing the standards under paragraph (1).
Such data collection shall include--
``(A) after consultation with veterans service
organizations and other key stakeholders on survey
development or modification of an existing survey, a survey
of veterans who have used hospital care, medical services, or
extended care services furnished by the Veterans Health
Administration during the most recent two-year period to
assess the satisfaction of the veterans with service and
quality of care; and
``(B) datasets that include, at a minimum, elements
relating to the following:
``(i) Timely care.
``(ii) Effective care.
``(iii) Safety, including, at a minimum, complications,
readmissions, and deaths.
``(iv) Efficiency.
``(4) The Secretary shall consult with all pertinent
Federal entities (including the Department of Defense, the
Department of Health and Human Services, and the Centers for
Medicare & Medicaid Services), entities in the private
sector, and other nongovernmental entities in establishing
standards for quality.
``(5)(A) Not later than 270 days after the date of the
enactment of the Caring for Our Veterans Act of 2018, the
Secretary shall submit to the appropriate committees of
Congress a report detailing the standards for quality.
``(B)(i) Before submitting the report required under
subparagraph (A), the Secretary shall provide periodic
updates to the appropriate committees of Congress to confirm
the Department's progress towards developing the standards
for quality required by this section.
``(ii) The first update under clause (i) shall occur no
later than 120 days from the date of the enactment of the
Caring for Our Veterans Act of 2018.
``(b) Publication and Consideration of Public Comments.--
(1) Not later than one year after the date on which the
Secretary establishes standards for quality under subsection
(a), the Secretary shall publish the quality rating of
medical facilities of the Department in the publicly
available Hospital Compare website through the Centers for
Medicare & Medicaid Services for the purpose of providing
veterans with information that allows them to compare
performance measure information among Department and non-
Department health care providers.
``(2) Not later than two years after the date on which the
Secretary establishes standards for quality under subsection
(a), the Secretary shall consider and solicit public comment
on potential changes to the measures used in such standards
to ensure that they include the most up-to-date and
applicable industry measures for veterans.
``(c)(1) The term `appropriate committees of Congress'
means--
``(A) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.
``(2) The term `covered veterans' refers to veterans
described in section 1703(b) of this title.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 17, as amended by section 102, is
further amended by inserting after the item relating to
section 1703A the following new items:
``1703B. Access standards.
``1703C. Standards for quality.''.
SEC. 105. ACCESS TO WALK-IN CARE.
(a) In General.--Chapter 17 is amended by inserting after
section 1725 the following new section:
``Sec. 1725A. Access to walk-in care
``(a) Procedures To Ensure Access to Walk-In Care.--The
Secretary shall develop procedures to ensure that eligible
veterans are able to access walk-in care from qualifying non-
Department entities or providers.
``(b) Eligible Veterans.--For purposes of this section, an
eligible veteran is any individual who--
``(1) is enrolled in the health care system established
under section 1705(a) of this title; and
``(2) has received care under this chapter within the 24-
month period preceding the furnishing of walk-in care under
this section.
``(c) Qualifying Non-Department Entities or Providers.--For
purposes of this section, a qualifying non-Department entity
or provider is a non-Department entity or provider that has
entered into a contract or other agreement with the Secretary
to furnish services under this section.
``(d) Federally-Qualified Health Centers.--Whenever
practicable, the Secretary may use a Federally-qualified
health center (as defined in section 1905(l)(2)(B) of the
Social Security Act (42 U.S.C. 1396d(l)(2)(B))) to carry out
this section.
``(e) Continuity of Care.--The Secretary shall ensure
continuity of care for those eligible veterans who receive
walk-in care services under this section, including through
the establishment of a mechanism to receive medical records
from walk-in care providers and provide pertinent patient
medical records to providers of walk-in care.
``(f) Copayments.--(1)(A) The Secretary may require an
eligible veteran to pay the United States a copayment for
each episode of hospital care or medical services provided
under this section if the eligible veteran would be required
to pay a copayment under this title.
``(B) An eligible veteran not required to pay a copayment
under this title may access walk-in care without a copayment
for the first two visits in a calendar year. For any
additional visits, a copayment at an amount determined by the
Secretary may be required.
``(C) An eligible veteran required to pay a copayment under
this title may be required to pay a regular copayment for the
first two walk-in care visits in a calendar year. For any
additional visits, a higher copayment at an amount determined
by the Secretary may be required.
``(2) After the first two episodes of care furnished to an
eligible veteran under this section, the Secretary may adjust
the copayment required of the veteran under this subsection
based upon the priority group of enrollment of the eligible
veteran, the number of episodes of care furnished to the
eligible veteran during a year, and other factors the
Secretary considers appropriate under this section.
``(3) The amount or amounts of the copayments required
under this subsection shall be prescribed by the Secretary by
rule.
``(4) Section 8153(c) of this title shall not apply to this
subsection.
``(g) Regulations.--Not later than one year after the date
of the enactment of the Caring for Our Veterans Act of 2018,
the Secretary shall promulgate regulations to carry out this
section.
``(h) Walk-In Care Defined.--In this section, the term
`walk-in care' means non-emergent care provided by a
qualifying non-Department entity or provider that furnishes
episodic care and not longitudinal management of conditions
and is otherwise defined through regulations the Secretary
shall promulgate.''.
(b) Effective Date.--Section 1725A of title 38, United
States Code, as added by subsection (a) shall take effect on
the date upon which final regulations implementing such
section take effect.
(c) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1725 the following new item:
``Sec. 1725A. Access to walk-in care.''.
SEC. 106. STRATEGY REGARDING THE DEPARTMENT OF VETERANS
AFFAIRS HIGH-PERFORMING INTEGRATED HEALTH CARE
NETWORK.
(a) In General.--Subchapter II of chapter 73 is amended by
inserting after section 7330B the following new section:
``Sec. 7330C. Quadrennial Veterans Health Administration
review
``(a) Market Area Assessments.--(1) Not less frequently
than every four years, the Secretary of Veterans Affairs
shall perform market area assessments regarding the health
care services furnished under the laws administered by the
Secretary.
``(2) Each market area assessment established under
paragraph (1) shall include the following:
``(A) An assessment of the demand for health care from the
Department, disaggregated by geographic market areas as
determined by the Secretary, including the number of requests
for health care services under the laws administered by the
Secretary.
``(B) An inventory of the health care capacity of the
Department of Veterans Affairs across the Department's system
of facilities.
``(C) An assessment of the health care capacity to be
provided through contracted community care providers and
providers who entered into a provider agreement with the
Department under section 1703A of title 38, as added by
section 102, including the number of providers, the
geographic location of the providers, and categories or types
of health care services provided by the providers.
``(D) An assessment obtained from other Federal direct
delivery systems of their capacity to provide health care to
veterans.
``(E) An assessment of the health care capacity of non-
contracted providers where there is insufficient network
supply.
``(F) An assessment of the health care capacity of academic
affiliates and other collaborations of the Department as it
relates to providing health care to veterans.
``(G) An assessment of the effects on health care capacity
of the access standards and standards for quality established
under sections 1703B and 1703C of this title.
``(H) The number of appointments for health care services
under the laws administered by the Secretary, disaggregated
by--
``(i) appointments at facilities of the Department of
Veterans Affairs; and
``(ii) appointments with non-Department health care
providers.
``(3)(A) The Secretary shall submit to the appropriate
committees of Congress the market area assessments
established in paragraph (1).
``(B) The Secretary also shall submit to the appropriate
committees of Congress the market area assessments completed
by or being performed on the day before the date of the
enactment of the Caring for Our Veterans Act of 2018.
``(4)(A) The Secretary shall use the market area
assessments established under paragraph (1) to--
``(i) determine the capacity of the health care provider
networks established under section 1703(h) of this title;
``(ii) inform the Department budget, in accordance with
subparagraph (B); and
``(iii) inform and assess the appropriateness of the access
standards established under section 1703B of this title and
standards for quality
[[Page H4021]]
under section 1703C and to make recommendations for any
changes to such standards.
``(B) The Secretary shall ensure that the Department budget
for any fiscal year (as submitted with the budget of the
President under section 1105(a) of title 31) reflects the
findings of the Secretary with respect to the most recent
market area assessments under paragraph (1) and health care
utilization data from the Department and non-Department
entities or providers furnishing care and services to covered
veterans as described in section 1703(b).
``(b) Strategic Plan To Meet Health Care Demand.--(1) Not
later than one year after the date of the enactment of the
Caring for Our Veterans Act of 2018 and not less frequently
than once every four years thereafter, the Secretary shall
submit to the appropriate committees of Congress a strategic
plan that specifies a four-year forecast of--
``(A) the demand for health care from the Department,
disaggregated by geographic area as determined by the
Secretary;
``(B) the health care capacity to be provided at each
medical center of the Department; and
``(C) the health care capacity to be provided through
community care providers.
``(2) In preparing the strategic plan under paragraph (1),
the Secretary shall--
``(A) assess the access standards and standards for quality
established under sections 1703B and 1703C of this title;
``(B) assess the market area assessments established under
subsection (a);
``(C) assess the needs of the Department based on
identified services that provide management of conditions or
disorders related to military service for which there is
limited experience or access in the national market, the
overall health of veterans throughout their lifespan, or
other services as the Secretary determines appropriate;
``(D) consult with key stakeholders within the Department,
the heads of other Federal agencies, and other relevant
governmental and nongovernmental entities, including State,
local, and tribal government officials, members of Congress,
veterans service organizations, private sector
representatives, academics, and other policy experts;
``(E) identify emerging issues, trends, problems, and
opportunities that could affect health care services
furnished under the laws administered by the Secretary;
``(F) develop recommendations regarding both short- and
long-term priorities for health care services furnished under
the laws administered by the Secretary;
``(G) after consultation with veterans service
organizations and other key stakeholders on survey
development or modification of an existing survey, consider a
survey of veterans who have used hospital care, medical
services, or extended care services furnished by the Veterans
Health Administration during the most recent two-year period
to assess the satisfaction of the veterans with service and
quality of care;
``(H) conduct a comprehensive examination of programs and
policies of the Department regarding the delivery of health
care services and the demand of health care services for
veterans in future years;
``(I) assess the remediation of medical service lines of
the Department as described in section 1706A in conjunction
with the utilization of non-Department entities or providers
to offset remediation; and
``(J) consider such other matters as the Secretary
considers appropriate.
``(c) Responsibilities.--The Secretary shall be responsible
for--
``(1) overseeing the transformation and organizational
change across the Department to achieve such high performing
integrated health care network;
``(2) developing the capital infrastructure planning and
procurement processes, whether minor or major construction
projects or leases; and
``(3) developing a multi-year budget process that is
capable of forecasting future year budget requirements and
projecting the cost of delivering health care services under
a high-performing integrated health care network.
``(d) Appropriate Committees of Congress Defined.--In this
section, the term `appropriate committees of Congress'
means--
``(1) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(2) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 7330B the following new item:
``7330C. Quadrennial Veterans Health Administration review.''.
SEC. 107. APPLICABILITY OF DIRECTIVE OF OFFICE OF FEDERAL
CONTRACT COMPLIANCE PROGRAMS.
(a) In General.--Notwithstanding the treatment of certain
laws under subsection (i) of section 1703A of title 38,
United States Code, as added by section 102 of this title,
Directive 2014-01 of the Office of Federal Contract
Compliance Programs of the Department of Labor (effective as
of May 7, 2014) shall apply to any entity entering into an
agreement under such section 1703A or section 1745 of such
title, as amended by section 103, in the same manner as such
directive applies to subcontractors under the TRICARE program
for the duration of the moratorium provided under such
directive.
(b) Applicability Period.--The directive described in
subsection (a), and the moratorium provided under such
directive, shall not be altered or rescinded before May 7,
2019.
(c) TRICARE Program Defined.--In this section, the term
``TRICARE program'' has the meaning given that term in
section 1072 of title 10, United States Code.
SEC. 108. PREVENTION OF CERTAIN HEALTH CARE PROVIDERS FROM
PROVIDING NON-DEPARTMENT HEALTH CARE SERVICES
TO VETERANS.
(a) In General.--On and after the date that is one year
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall deny or revoke the eligibility of a
health care provider to provide non-Department health care
services to veterans if the Secretary determines that the
health care provider--
(1) was removed from employment with the Department of
Veterans Affairs due to conduct that violated a policy of the
Department relating to the delivery of safe and appropriate
health care; or
(2) violated the requirements of a medical license of the
health care provider that resulted in the loss of such
medical license.
(b) Permissive Action.--On and after the date that is one
year after the date of the enactment of this Act, the
Secretary may deny, revoke, or suspend the eligibility of a
health care provider to provide non-Department health care
services if the Secretary determines such action is necessary
to immediately protect the health, safety, or welfare of
veterans and the health care provider is under investigation
by the medical licensing board of a State in which the health
care provider is licensed or practices.
(c) Suspension.--The Secretary shall suspend the
eligibility of a health care provider to provide non-
Department health care services to veterans if the health
care provider is suspended from serving as a health care
provider of the Department.
(d) Comptroller General Report.--Not later than two years
after the date of the enactment of this Act, the Comptroller
General of the United States shall submit to Congress a
report on the implementation by the Secretary of this
section, including the following:
(1) The aggregate number of health care providers denied or
suspended under this section from participation in providing
non-Department health care services.
(2) An evaluation of any impact on access to health care
for patients or staffing shortages in programs of the
Department providing non-Department health care services.
(3) An explanation of the coordination of the Department
with the medical licensing boards of States in implementing
this section, the amount of involvement of such boards in
such implementation, and efforts by the Department to address
any concerns raised by such boards with respect to such
implementation.
(4) Such recommendations as the Comptroller General
considers appropriate regarding harmonizing eligibility
criteria between health care providers of the Department and
health care providers eligible to provide non-Department
health care services.
(e) Non-Department Health Care Services Defined.--In this
section, the term ``non-Department health care services''
means services--
(1) provided under subchapter I of chapter 17 of title 38,
United States Code, at non-Department facilities (as defined
in section 1701 of such title);
(2) provided under section 101 of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-146;
38 U.S.C. 1701 note);
(3) purchased through the Medical Community Care account of
the Department; or
(4) purchased with amounts deposited in the Veterans Choice
Fund under section 802 of the Veterans Access, Choice, and
Accountability Act of 2014.
SEC. 109. REMEDIATION OF MEDICAL SERVICE LINES.
(a) In General.--Subchapter I of chapter 17 is amended by
inserting after section 1706 the following new section:
``Sec. 1706A. Remediation of medical service lines
``(a) In General.--Not later than 30 days after determining
under section 1703(e)(1) that a medical service line of the
Department is providing hospital care, medical services, or
extended care services that does not comply with the
standards for quality established by the Secretary, the
Secretary shall submit to Congress an assessment of the
factors that led the Secretary to make such determination and
a plan with specific actions, and the time to complete them,
to be taken to comply with such standards for quality,
including the following:
``(1) Increasing personnel or temporary personnel
assistance, including mobile deployment teams.
``(2) Special hiring incentives, including the Education
Debt Reduction Program under subchapter VII of chapter 76 of
this title and recruitment, relocation, and retention
incentives.
``(3) Utilizing direct hiring authority.
``(4) Providing improved training opportunities for staff.
``(5) Acquiring improved equipment.
``(6) Making structural modifications to the facility used
by the medical service line.
``(7) Such other actions as the Secretary considers
appropriate.
``(b) Responsible Parties.--In each assessment submitted
under subsection (a) with respect to a medical service line,
the Secretary shall identify the individuals at the Central
Office of the Veterans Health Administration, the facility
used by the medical service line, and the central office of
the relevant Veterans Integrated Service Network who are
responsible for overseeing the progress of that medical
service line in complying with the standards for quality
established by the Secretary.
``(c) Interim Reports.--Not later than 180 days after
submitting an assessment under subsection (a) with respect to
a medical service line, the Secretary shall submit to
Congress a report on the progress of that medical service
line in complying with the standards for quality established
by the Secretary and any other measures the Secretary will
take to assist the medical
[[Page H4022]]
service line in complying with such standards for quality.
``(d) Annual Reports.--Not less frequently than once each
year, the Secretary shall--
``(1) submit to Congress an analysis of the remediation
actions and costs of such actions taken with respect to each
medical service line with respect to which the Secretary
submitted an assessment and plan under paragraph (1) in the
preceding year, including an update on the progress of each
such medical service line in complying with the standards for
quality and timeliness established by the Secretary and any
other actions the Secretary is undertaking to assist the
medical service line in complying with standards for quality
as established by the Secretary; and
``(2) publish such analysis on the internet website of the
Department.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1706 the following new item:
``1706A. Remediation of medical service lines.''.
CHAPTER 2--PAYING PROVIDERS AND IMPROVING COLLECTIONS
SEC. 111. PROMPT PAYMENT TO PROVIDERS.
(a) In General.--Subchapter I of chapter 17 is amended by
inserting after section 1703C, as added by section 104 of
this title, the following new section:
``Sec. 1703D. Prompt payment standard
``(a) In General.--(1) Notwithstanding any other provision
of this title or of any other provision of law, the Secretary
shall pay for hospital care, medical services, or extended
care services furnished by health care entities or providers
under this chapter within 45 calendar days upon receipt of a
clean paper claim or 30 calendar days upon receipt of a clean
electronic claim.
``(2) If a claim is denied, the Secretary shall, within 45
calendar days of denial for a paper claim and 30 calendar
days of denial for an electronic claim, notify the health
care entity or provider of the reason for denying the claim
and what, if any, additional information is required to
process the claim.
``(3) Upon the receipt of the additional information, the
Secretary shall ensure that the claim is paid, denied, or
otherwise adjudicated within 30 calendar days from the
receipt of the requested information.
``(4) This section shall only apply to payments made on an
invoice basis and shall not apply to capitation or other
forms of periodic payment to entities or providers.
``(b) Submittal of Claims by Health Care Entities and
Providers.--A health care entity or provider that furnishes
hospital care, a medical service, or an extended care service
under this chapter shall submit to the Secretary a claim for
payment for furnishing the hospital care, medical service, or
extended care service not later than 180 days after the date
on which the entity or provider furnished the hospital care,
medical service, or extended care service.
``(c) Fraudulent Claims.--(1) Sections 3729 through 3733 of
title 31 shall apply to fraudulent claims for payment
submitted to the Secretary by a health care entity or
provider under this chapter.
``(2) Pursuant to regulations prescribed by the Secretary,
the Secretary shall bar a health care entity or provider from
furnishing hospital care, medical services, and extended care
services under this chapter when the Secretary determines the
entity or provider has submitted to the Secretary fraudulent
health care claims for payment by the Secretary.
``(d) Overdue Claims.--(1) Any claim that has not been
denied with notice, made pending with notice, or paid to the
health care entity or provider by the Secretary shall be
overdue if the notice or payment is not received by the
entity provider within the time periods specified in
subsection (a).
``(2)(A) If a claim is overdue under this subsection, the
Secretary may, under the requirements established by
subsection (a) and consistent with the provisions of chapter
39 of title 31 (commonly referred to as the `Prompt Payment
Act'), require that interest be paid on clean claims.
``(B) Interest paid under subparagraph (A) shall be
computed at the rate of interest established by the Secretary
of the Treasury under section 3902 of title 31 and published
in the Federal Register.
``(3) Not less frequently than annually, the Secretary
shall submit to Congress a report on payment of overdue
claims under this subsection, disaggregated by paper and
electronic claims, that includes the following:
``(A) The amount paid in overdue claims described in this
subsection, disaggregated by the amount of the overdue claim
and the amount of interest paid on such overdue claim.
``(B) The number of such overdue claims and the average
number of days late each claim was paid, disaggregated by
facility of the Department and Veterans Integrated Service
Network region.
``(e) Overpayment.--(1) The Secretary shall deduct the
amount of any overpayment from payments due a health care
entity or provider under this chapter.
``(2) Deductions may not be made under this subsection
unless the Secretary has made reasonable efforts to notify a
health care entity or provider of the right to dispute the
existence or amount of such indebtedness and the right to
request a compromise of such indebtedness.
``(3) The Secretary shall make a determination with respect
to any such dispute or request prior to deducting any
overpayment unless the time required to make such a
determination before making any deductions would jeopardize
the Secretary's ability to recover the full amount of such
indebtedness.
``(f) Information and Documentation Required.--(1) The
Secretary shall provide to all health care entities and
providers participating in a program to furnish hospital
care, medical services, or extended care services under this
chapter a list of information and documentation that is
required to establish a clean claim under this section.
``(2) The Secretary shall consult with entities in the
health care industry, in the public and private sector, to
determine the information and documentation to include in the
list under paragraph (1).
``(3) If the Secretary modifies the information and
documentation included in the list under paragraph (1), the
Secretary shall notify all health care entities and providers
described in paragraph (1) not later than 30 days before such
modifications take effect.
``(g) Processing of Claims.--(1) In processing a claim for
compensation for hospital care, medical services, or extended
care services furnished by a non-Department health care
entity or provider under this chapter, the Secretary may act
through--
``(A) a non-Department entity that is under contract or
agreement for the program established under section 1703(a)
of this title; or
``(B) a non-Department entity that specializes in such
processing for other Federal agency health care systems.
``(2) The Secretary shall seek to contract with a third
party to conduct a review of claims described in paragraph
(3) that includes--
``(A) a feasibility assessment to determine the capacity of
the Department to process such claims in a timely manner; and
``(B) a cost benefit analysis comparing the capacity of the
Department to a third party entity capable of processing such
claims.
``(3) The review required under paragraph (2) shall apply
to claims for hospital care, medical services, or extended
care services furnished under section 1703 of this Act, as
amended by the Caring for Our Veterans Act of 2018, that are
processed by the Department.
``(h) Report on Encounter Data System.--(1) Not later than
90 days after the date of the enactment of the Caring for Our
Veterans Act of 2018, the Secretary shall submit to the
appropriate committees of Congress a report on the
feasibility and advisability of adopting a funding mechanism
similar to what is utilized by other Federal agencies to
allow a contracted entity to act as a fiscal intermediary for
the Federal Government to distribute, or pass through,
Federal Government funds for certain non-underwritten
hospital care, medical services, or extended care services.
``(2) The Secretary may coordinate with the Department of
Defense, the Department of Health and Human Services, and the
Department of the Treasury in developing the report required
by paragraph (1).
``(i) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.
``(2) The term `clean electronic claim' means the
transmission of data for purposes of payment of covered
health care expenses that is submitted to the Secretary which
contains substantially all of the required data elements
necessary for accurate adjudication, without obtaining
additional information from the entity or provider that
furnished the care or service, submitted in such format as
prescribed by the Secretary in regulations for the purpose of
paying claims for care or services.
``(3) The term `clean paper claim' means a paper claim for
payment of covered health care expenses that is submitted to
the Secretary which contains substantially all of the
required data elements necessary for accurate adjudication,
without obtaining additional information from the entity or
provider that furnished the care or service, submitted in
such format as prescribed by the Secretary in regulations for
the purpose of paying claims for care or services.
``(4) The term `fraudulent claims' means the knowing
misrepresentation of a material fact or facts by a health
care entity or provider made to induce the Secretary to pay a
claim that was not legally payable to that provider.
``(5) The term `health care entity or provider' includes
any non-Department health care entity or provider, but does
not include any Federal health care entity or provider.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1703C, as added by section 104 of
this title, the following new item:
``1703D. Prompt payment standard.''.
SEC. 112. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT SUBJECT TO
AN AGREEMENT.
(a) In General.--Subchapter IV of chapter 81 is amended by
adding at the end the following new section:
``Sec. 8159. Authority to pay for services authorized but not
subject to an agreement
``(a) In General.--If, in the course of furnishing hospital
care, a medical service, or an extended care service
authorized by the Secretary and pursuant to a contract,
agreement, or other arrangement with the Secretary, a
provider who is not a party to the contract, agreement, or
other arrangement furnishes hospital care, a medical service,
or an extended care service that the Secretary considers
necessary, the Secretary may compensate the provider for the
cost of such care or service.
``(b) New Contracts and Agreements.--The Secretary shall
take reasonable efforts to enter into a contract, agreement,
or other arrangement with a provider described in subsection
(a)
[[Page H4023]]
to ensure that future care and services authorized by the
Secretary and furnished by the provider are subject to such a
contract, agreement, or other arrangement.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 8158 the following new item:
``8159. Authority to pay for services authorized but not subject to an
agreement.''.
SEC. 113. IMPROVEMENT OF AUTHORITY TO RECOVER THE COST OF
SERVICES FURNISHED FOR NON-SERVICE-CONNECTED
DISABILITIES.
(a) Broadening Scope of Applicability.--Section 1729 is
amended--
(1) in subsection (a)--
(A) in paragraph (2)(A)--
(i) by striking ``the veteran's'' and inserting ``the
individual's''; and
(ii) by striking ``the veteran'' and inserting ``the
individual''; and
(B) in paragraph (3)--
(i) in the matter preceding subparagraph (A), by striking
``the veteran'' and inserting ``the individual''; and
(ii) in subparagraph (A), by striking ``the veteran's'' and
inserting ``the individual's'';
(2) in subsection (b)--
(A) in paragraph (1)--
(i) by striking ``the veteran'' and inserting ``the
individual''; and
(ii) by striking ``the veteran's'' and inserting ``the
individual's''; and
(B) in paragraph (2)--
(i) in subparagraph (A)--
(I) by striking ``the veteran'' and inserting ``the
individual''; and
(II) by striking ``the veteran's'' and inserting ``the
individual's''; and
(ii) in subparagraph (B)--
(I) in clause (i), by striking ``the veteran'' and
inserting ``the individual''; and
(II) in clause (ii)--
(aa) by striking ``the veteran'' and inserting ``the
individual''; and
(bb) by striking ``the veteran's'' each place it appears
and inserting ``the individual's'';
(3) in subsection (e), by striking ``A veteran'' and
inserting ``An individual''; and
(4) in subsection (h)--
(A) in paragraph (1)--
(i) in the matter preceding subparagraph (A), by striking
``a veteran'' and inserting ``an individual'';
(ii) in subparagraph (A), by striking ``the veteran'' and
inserting ``the individual''; and
(iii) in subparagraph (B), by striking ``the veteran'' and
inserting ``the individual''; and
(B) in paragraph (2)--
(i) by striking ``A veteran'' and inserting ``An
individual'';
(ii) by striking ``a veteran'' and inserting ``an
individual''; and
(iii) by striking ``the veteran'' and inserting ``the
individual''.
(b) Modification of Authority.--Subsection (a)(1) of such
section is amended by striking ``(1) Subject'' and all that
follows through the period and inserting the following: ``(1)
Subject to the provisions of this section, in any case in
which the United States is required by law to furnish or pay
for care or services under this chapter for a non-service-
connected disability described in paragraph (2) of this
subsection, the United States has the right to recover or
collect from a third party the reasonable charges of care or
services so furnished or paid for to the extent that the
recipient or provider of the care or services would be
eligible to receive payment for such care or services from
such third party if the care or services had not been
furnished or paid for by a department or agency of the United
States.''.
(c) Modification of Eligible Individuals.--Subparagraph (D)
of subsection (a)(2) of such section is amended to read as
follows:
``(D) that is incurred by an individual who is entitled to
care (or payment of the expenses of care) under a health-plan
contract.''.
SEC. 114. PROCESSING OF CLAIMS FOR REIMBURSEMENT THROUGH
ELECTRONIC INTERFACE.
The Secretary of Veterans Affairs may enter into an
agreement with a third-party entity to process, through the
use of an electronic interface, claims for reimbursement for
health care provided under the laws administered by the
Secretary.
CHAPTER 3--EDUCATION AND TRAINING PROGRAMS
SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OPTIONS.
(a) In General.--The Secretary of Veterans Affairs shall
develop and administer an education program that teaches
veterans about their health care options through the
Department of Veterans Affairs.
(b) Elements.--The program under subsection (a) shall--
(1) teach veterans about--
(A) eligibility criteria for care from the Department set
forth under sections 1703, as amended by section 101 of this
title, and 1710 of title 38, United States Code;
(B) priority groups for enrollment in the system of annual
patient enrollment under section 1705(a) of such title;
(C) the copayments and other financial obligations, if any,
required of certain individuals for certain services; and
(D) how to utilize the access standards and standards for
quality established under sections 1703B and 1703C of such
title;
(2) teach veterans about the interaction between health
insurance (including private insurance, Medicare, Medicaid,
the TRICARE program, the Indian Health Service, tribal health
programs, and other forms of insurance) and health care from
the Department; and
(3) provide veterans with information on what to do when
they have a complaint about health care received from the
Department (whether about the provider, the Department, or
any other type of complaint).
(c) Accessibility.--In developing the education program
under this section, the Secretary shall ensure that materials
under such program are accessible--
(1) to veterans who may not have access to the internet;
and
(2) to veterans in a manner that complies with the
Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et
seq.).
(d) Annual Evaluation and Report.--
(1) Evaluation.--The Secretary shall develop a method to
evaluate the effectiveness of the education program under
this section and evaluate the program using the method not
less frequently than once each year.
(2) Report.--Not less frequently than once each year, the
Secretary shall submit to Congress a report on the findings
of the Secretary with respect to the most recent evaluation
conducted by the Secretary under paragraph (1).
(e) Definitions.--In this section:
(1) Medicaid.--The term ``Medicaid'' means the Medicaid
program under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.).
(2) Medicare.--The term ``Medicare'' means the Medicare
program under title XVIII of such Act (42 U.S.C. 1395 et
seq.).
(3) Tricare program.--The term ``TRICARE program'' has the
meaning given that term in section 1072 of title 10, United
States Code.
SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF NON-
DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE.
(a) Establishment of Program.--The Secretary of Veterans
Affairs shall develop and implement a training program to
train employees and contractors of the Department of Veterans
Affairs on how to administer non-Department health care
programs, including the following:
(1) Reimbursement for non-Department emergency room care.
(2) The Veterans Community Care Program under section 1703
of such title, as amended by section 101.
(3) Management of prescriptions pursuant to improvements
under section 131.
(b) Annual Evaluation and Report.--The Secretary shall--
(1) develop a method to evaluate the effectiveness of the
training program developed and implemented under subsection
(a);
(2) evaluate such program not less frequently than once
each year; and
(3) not less frequently than once each year, submit to
Congress the findings of the Secretary with respect to the
most recent evaluation carried out under paragraph (2).
SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DEPARTMENT
MEDICAL PROFESSIONALS.
(a) Establishment of Program.--
(1) In general.--The Secretary of Veterans Affairs shall
establish a program to provide continuing medical education
material to non-Department medical professionals.
(2) Education provided.--The program established under
paragraph (1) shall include education on the following:
(A) Identifying and treating common mental and physical
conditions of veterans and family members of veterans.
(B) The health care system of the Department of Veterans
Affairs.
(C) Such other matters as the Secretary considers
appropriate.
(b) Material Provided.--The continuing medical education
material provided to non-Department medical professionals
under the program established under subsection (a) shall be
the same material provided to medical professionals of the
Department to ensure that all medical professionals treating
veterans have access to the same materials, which supports
core competencies throughout the community.
(c) Administration of Program.--
(1) In general.--The Secretary shall administer the program
established under subsection (a) to participating non-
Department medical professionals through an internet website
of the Department of Veterans Affairs.
(2) Curriculum and credit provided.--The Secretary shall
determine the curriculum of the program and the number of
hours of credit to provide to participating non-Department
medical professionals for continuing medical education.
(3) Accreditation.--The Secretary shall ensure that the
program is accredited in as many States as practicable.
(4) Consistency with existing rules.--The Secretary shall
ensure that the program is consistent with the rules and
regulations of the following:
(A) The medical licensing agency of each State in which the
program is accredited.
(B) Such medical credentialing organizations as the
Secretary considers appropriate.
(5) User cost.--The Secretary shall carry out the program
at no cost to participating non-Department medical
professionals.
(6) Monitoring, evaluation, and report.--The Secretary
shall monitor the utilization of the program established
under subsection (a), evaluate its effectiveness, and report
to Congress on utilization and effectiveness not less
frequently than once each year.
(d) Non-Department Medical Professional Defined.--In this
section, the term ``non-Department medical professional''
means any individual who is licensed by an appropriate
medical authority in the United States and is in good
standing, is not an employee of the Department of Veterans
Affairs, and provides care to veterans or family members of
veterans under the laws administered by the Secretary of
Veterans Affairs.
[[Page H4024]]
CHAPTER 4--OTHER MATTERS RELATING TO NON-DEPARTMENT OF VETERANS AFFAIRS
PROVIDERS
SEC. 131. ESTABLISHMENT OF PROCESSES TO ENSURE SAFE OPIOID
PRESCRIBING PRACTICES BY NON-DEPARTMENT OF
VETERANS AFFAIRS HEALTH CARE PROVIDERS.
(a) Receipt and Review of Guidelines.--The Secretary of
Veterans Affairs shall ensure that all covered health care
providers are provided a copy of and certify that they have
reviewed the evidence-based guidelines for prescribing
opioids set forth by the Opioid Safety Initiative of the
Department of Veterans Affairs.
(b) Inclusion of Medical History and Current Medications.--
The Secretary shall implement a process to ensure that, if
care of a veteran by a covered health care provider is
authorized under the laws administered by the Secretary, the
document authorizing such care includes the available and
relevant medical history of the veteran and a list of all
medications prescribed to the veteran as known by the
Department.
(c) Submittal of Medical Records and Prescriptions.--
(1) In general.--The Secretary shall, consistent with
section 1703(a)(2)(A), as amended by section 101 of this
title, and section 1703A(e)(2)(F), as added by section 102 of
this title, require each covered health care provider to
submit medical records of any care or services furnished,
including records of any prescriptions for opioids, to the
Department in the timeframe and format specified by the
Secretary.
(2) Responsibility of department for recording and
monitoring.--In carrying out paragraph (1) and upon the
receipt by the Department of the medical records described in
paragraph (1), the Secretary shall--
(A) ensure the Department is responsible for the recording
of the prescription in the electronic health record of the
veteran; and
(B) enable other monitoring of the prescription as outlined
in the Opioid Safety Initiative of the Department.
(3) Report.--Not less frequently than annually, the
Secretary shall submit to the Committee on Veterans' Affairs
of the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report evaluating the compliance
of covered health care providers with the requirements under
this section.
(d) Use of Opioid Safety Initiative Guidelines.--
(1) In general.--If the Secretary determines that the
opioid prescribing practices of a covered health care
provider, when treating covered veterans, satisfy a condition
described in paragraph (3), the Secretary shall take such
action as the Secretary considers appropriate to ensure the
safety of all veterans receiving care from that health care
provider, including removing or directing the removal of any
such health care provider from provider networks or otherwise
refusing to authorize care of veterans by such health care
provider in any program authorized under the laws
administered by the Secretary.
(2) Inclusion in contracts.--The Secretary shall ensure
that any contracts, agreements, or other arrangements entered
into by the Secretary with third parties involved in
administering programs that provide care in the community to
veterans under the laws administered by the Secretary
specifically grant the authority set forth in paragraph (1)
to such third parties and to the Secretary, as the case may
be.
(3) Conditions for exclusion or limitation.--The Secretary
shall take such action as is considered appropriate under
paragraph (1) when the opioid prescribing practices of a
covered health care provider when treating covered veterans--
(A) conflict with or are otherwise inconsistent with the
standards of appropriate and safe care;
(B) violate the requirements of a medical license of the
health care provider; or
(C) may place at risk the veterans receiving health care
from the provider.
(e) Covered Health Care Provider Defined.--In this section,
the term ``covered health care provider'' means a non-
Department of Veterans Affairs health care provider who
provides health care to veterans under the laws administered
by the Secretary of Veterans Affairs, but does not include a
health care provider employed by another agency of the
Federal Government.
SEC. 132. IMPROVING INFORMATION SHARING WITH COMMUNITY
PROVIDERS.
Section 7332(b)(2) is amended by striking subparagraph (H)
and inserting the following new subparagraphs:
``(H)(i) To a non-Department entity (including private
entities and other Federal agencies) for purposes of
providing health care, including hospital care, medical
services, and extended care services, to patients or
performing other health care-related activities or functions.
``(ii) An entity to which a record is disclosed under this
subparagraph may not disclose or use such record for a
purpose other than that for which the disclosure was made or
as permitted by law.
``(I) To a third party in order to recover or collect
reasonable charges for care furnished to, or paid on behalf
of, a patient in connection with a non-service connected
disability as permitted by section 1729 of this title or for
a condition for which recovery is authorized or with respect
to which the United States is deemed to be a third party
beneficiary under the Act entitled `An Act to provide for the
recovery from tortiously liable third persons of the cost of
hospital and medical care and treatment furnished by the
United States' (Public Law 87-693; 42 U.S.C. 2651 et seq.;
commonly known as the `Federal Medical Care Recovery
Act').''.
SEC. 133. COMPETENCY STANDARDS FOR NON-DEPARTMENT OF VETERANS
AFFAIRS HEALTH CARE PROVIDERS.
(a) Establishment of Standards and Requirements.--The
Secretary of Veterans Affairs shall establish standards and
requirements for the provision of care by non-Department of
Veterans Affairs health care providers in clinical areas for
which the Department of Veterans Affairs has special
expertise, including post-traumatic stress disorder, military
sexual trauma-related conditions, and traumatic brain
injuries.
(b) Condition for Eligibility To Furnish Care.--(1) Each
non-Department of Veterans Affairs health care provider
shall, to the extent practicable as determined by the
Secretary or otherwise provided for in paragraph (2), meet
the standards and requirements established pursuant to
subsection (a) before furnishing care pursuant to a contract,
agreement, or other arrangement with the Department of
Veterans Affairs. Non-Department of Veterans Affairs health
care providers furnishing care pursuant to a contract,
agreement, or other arrangement shall, to the extent
practicable as determined by the Secretary, fulfill training
requirements established by the Secretary on how to deliver
evidence-based treatments in the clinical areas for which the
Department of Veterans Affairs has special expertise.
(2) Each non-Department of Veterans Affairs health care
provider who enters into a contract, agreement, or other
arrangement after the effective date identified in subsection
(c) shall, to the extent practicable, meet the standards and
requirements established pursuant to subsection (a) within 6
months of the contract, agreement, or other arrangement
taking effect.
(c) Effective Date.--This section shall take effect on the
day that is one year after the date of the enactment of this
Act.
SEC. 134. DEPARTMENT OF VETERANS AFFAIRS PARTICIPATION IN
NATIONAL NETWORK OF STATE-BASED PRESCRIPTION
DRUG MONITORING PROGRAMS.
(a) In General.--Chapter 17 is amended by inserting after
section 1730A the following new section:
``Sec. 1730B. Access to State prescription drug monitoring
programs
``(a) Access to Programs.--(1) Any licensed health care
provider or delegate of such a provider shall be considered
an authorized recipient or user for the purpose of querying
and receiving data from the national network of State-based
prescription drug monitoring programs to support the safe and
effective prescribing of controlled substances to covered
patients.
``(2) Under the authority granted by paragraph (1)--
``(A) licensed health care providers or delegates of such
providers shall query such network in accordance with
applicable regulations and policies of the Veterans Health
Administration; and
``(B) notwithstanding any general or specific provision of
law, rule, or regulation of a State, no State may restrict
the access of licensed health care providers or delegates of
such providers from accessing that State's prescription drug
monitoring programs.
``(3) No State shall deny or revoke the license,
registration, or certification of a licensed health care
provider or delegate who otherwise meets that State's
qualifications for holding the license, registration, or
certification on the basis that the licensed health care
provider or delegate queried or received data, or attempted
to query or receive data, from the national network of State-
based prescription drug monitoring programs under this
section.
``(b) Covered Patients.--For purposes of this section, a
covered patient is a patient who--
``(1) receives a prescription for a controlled substance;
and
``(2) is not receiving palliative care or enrolled in
hospice care.
``(c) Definitions.--In this section:
``(1) The term `controlled substance' has the meaning given
such term in section 102(6) of the Controlled Substances Act
(21 U.S.C. 802(6)).
``(2) The term `delegate' means a person or automated
system accessing the national network of State-based
prescription monitoring programs at the direction or under
the supervision of a licensed health care provider.
``(3) The term `licensed health care provider' means a
health care provider employed by the Department who is
licensed, certified, or registered within any State to fill
or prescribe medications within the scope of his or her
practice as a Department employee.
``(4) The term `national network of State-based
prescription monitoring programs' means an interconnected
nation-wide system that facilitates the transfer to State
prescription drug monitoring program data across State lines.
``(5) The term `State' means a State, as defined in section
101(20) of this title, or a political subdivision of a
State.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 17 of such title is amended by inserting
after the item relating to section 1730A the following new
item:
``1730B. Access to State prescription drug monitoring programs.''.
CHAPTER 5--OTHER NON-DEPARTMENT HEALTH CARE MATTERS
SEC. 141. PLANS FOR USE OF SUPPLEMENTAL APPROPRIATIONS
REQUIRED.
Whenever the Secretary submits to Congress a request for
supplemental appropriations or any other appropriation
outside the standard budget process to address a budgetary
issue affecting the Department of Veterans Affairs, the
Secretary shall, not later than 45 days before the date on
which such budgetary issue would start
[[Page H4025]]
affecting a program or service, submit to Congress a
justification for the request, including a plan that details
how the Secretary intends to use the requested appropriation
and how long the requested appropriation is expected to meet
the needs of the Department and certification that the
request was made using an updated and sound actuarial
analysis.
SEC. 142. VETERANS CHOICE FUND FLEXIBILITY.
Section 802 of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note) is amended--
(1) in subsection (c)--
(A) in paragraph (1), by striking ``by paragraph (3)'' and
inserting ``in paragraphs (3) and (4)''; and
(B) by adding at the end the following new paragraph:
``(4) Permanent authority for other uses.--Beginning on
March 1, 2019, amounts remaining in the Veterans Choice Fund
may be used to furnish hospital care, medical services, and
extended care services to individuals pursuant to chapter 17
of title 38, United States Code, at non-Department
facilities, including pursuant to non-Department provider
programs other than the program established by section 101.
Such amounts shall be available in addition to amounts
available in other appropriations accounts for such
purposes.''; and
(2) in subsection (d)(1), by striking ``to subsection
(c)(3)'' and inserting ``to paragraphs (3) and (4) of
subsection (c)''.
SEC. 143. SUNSET OF VETERANS CHOICE PROGRAM.
Subsection (p) of section 101 of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-146;
38 U.S.C. 1701 note) is amended to read as follows:
``(p) Authority To Furnish Care and Services.--The
Secretary may not use the authority under this section to
furnish care and services after the date that is one year
after the date of the enactment of the Caring for Our
Veterans Act of 2018.''.
SEC. 144. CONFORMING AMENDMENTS.
(a) In General.--
(1) Title 38.--Title 38, United States Code, is amended--
(A) in section 1712(a)--
(i) in paragraph (3), by striking ``under clause (1), (2),
or (5) of section 1703(a) of this title'' and inserting ``or
entered an agreement''; and
(ii) in paragraph (4)(A), by striking ``under the
provisions of this subsection and section 1703 of this
title'';
(B) in section 1712A(e)(1)--
(i) by inserting ``or agreements'' after ``contracts''; and
(ii) by striking ``(under sections 1703(a)(2) and
1710(a)(1)(B) of this title)''; and
(C) in section 2303(a)(2)(B)(i), by striking ``with section
1703'' and inserting ``with sections 1703A, 8111, and 8153''.
(2) Social security act.--Section 1866(a)(1)(L) of the
Social Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by
striking ``under section 603'' and inserting ``under chapter
17''.
(3) Veterans' benefits improvements act of 1994.--Section
104(a)(4)(A) of the Veterans' Benefits Improvements Act of
1994 (Public Law 103-446; 38 U.S.C. 1117 note) is amended by
striking ``in section 1703'' and inserting ``in sections
1703A, 8111, and 8153''.
(b) Effective Date.--The amendments made by subsection (a)
shall take effect on the date described in section 101(b).
Subtitle B--Improving Department of Veterans Affairs Health Care
Delivery
SEC. 151. LICENSURE OF HEALTH CARE PROFESSIONALS OF THE
DEPARTMENT OF VETERANS AFFAIRS PROVIDING
TREATMENT VIA TELEMEDICINE.
(a) In General.--Chapter 17 is amended by inserting after
section 1730B, as added by section 134, the following new
section:
``Sec. 1730C. Licensure of health care professionals
providing treatment via telemedicine
``(a) In General.--Notwithstanding any provision of law
regarding the licensure of health care professionals, a
covered health care professional may practice the health care
profession of the health care professional at any location in
any State, regardless of where the covered health care
professional or the patient is located, if the covered health
care professional is using telemedicine to provide treatment
to an individual under this chapter.
``(b) Covered Health Care Professionals.--For purposes of
this section, a covered health care professional is any
health care professional who--
``(1) is an employee of the Department appointed under the
authority under section 7306, 7401, 7405, 7406, or 7408 of
this title or title 5;
``(2) is authorized by the Secretary to provide health care
under this chapter;
``(3) is required to adhere to all standards for quality
relating to the provision of medicine in accordance with
applicable policies of the Department; and
``(4) has an active, current, full, and unrestricted
license, registration, or certification in a State to
practice the health care profession of the health care
professional.
``(c) Property of Federal Government.--Subsection (a) shall
apply to a covered health care professional providing
treatment to a patient regardless of whether the covered
health care professional or patient is located in a facility
owned by the Federal Government during such treatment.
``(d) Relation to State Law.--(1) The provisions of this
section shall supersede any provisions of the law of any
State to the extent that such provision of State law are
inconsistent with this section.
``(2) No State shall deny or revoke the license,
registration, or certification of a covered health care
professional who otherwise meets the qualifications of the
State for holding the license, registration, or certification
on the basis that the covered health care professional has
engaged or intends to engage in activity covered by
subsection (a).
``(e) Rule of Construction.--Nothing in this section may be
construed to remove, limit, or otherwise affect any
obligation of a covered health care professional under the
Controlled Substances Act (21 U.S.C. 801 et seq.).
``(f) State Defined.--In this section, the term `State'
means a State, as defined in section 101(20) of this title,
or a political subdivision of a State.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 17 of such title is amended by inserting
after the item relating to section 1730B, as added by section
134, the following new item:
``1730C. Licensure of health care professionals providing treatment via
telemedicine.''.
(c) Report on Telemedicine.--
(1) In general.--Not later than one year after the earlier
of the date on which services provided under section 1730B of
title 38, United States Code, as added by subsection (a),
first occur or regulations are promulgated to carry out such
section, the Secretary of Veterans Affairs shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the effectiveness of the use of
telemedicine by the Department of Veterans Affairs.
(2) Elements.--The report required by paragraph (1) shall
include an assessment of the following:
(A) The satisfaction of veterans with telemedicine
furnished by the Department.
(B) The satisfaction of health care providers in providing
telemedicine furnished by the Department.
(C) The effect of telemedicine furnished by the Department
on the following:
(i) The ability of veterans to access health care, whether
from the Department or from non-Department health care
providers.
(ii) The frequency of use by veterans of telemedicine.
(iii) The productivity of health care providers.
(iv) Wait times for an appointment for the receipt of
health care from the Department.
(v) The use by veterans of in-person services at Department
facilities and non-Department facilities.
(D) The types of appointments for the receipt of
telemedicine furnished by the Department that were provided
during the one-year period preceding the submittal of the
report.
(E) The number of appointments for the receipt of
telemedicine furnished by the Department that were requested
during such period, disaggregated by medical facility.
(F) Savings by the Department, if any, including travel
costs, from furnishing health care through the use of
telemedicine during such period.
SEC. 152. AUTHORITY FOR DEPARTMENT OF VETERANS AFFAIRS CENTER
FOR INNOVATION FOR CARE AND PAYMENT.
(a) In General.--Subchapter I of chapter 17, as amended by
this title, is further amended by inserting after section
1703D, as added by section 111, the following new section:
``Sec. 1703E. Center for Innovation for Care and Payment
``(a) In General.--(1) There is established within the
Department a Center for Innovation for Care and Payment (in
this section referred to as the `Center').
``(2) The Secretary, acting through the Center, may carry
out such pilot programs the Secretary determines to be
appropriate to develop innovative approaches to testing
payment and service delivery models in order to reduce
expenditures while preserving or enhancing the quality of
care furnished by the Department.
``(3) The Secretary, acting through the Center, shall test
payment and service delivery models to determine whether such
models--
``(A) improve access to, and quality, timeliness, and
patient satisfaction of care and services; and
``(B) create cost savings for the Department.
``(4)(A) The Secretary shall test a model in a location
where the Secretary determines that the model will addresses
deficits in care (including poor clinical outcomes or
potentially avoidable expenditures) for a defined population.
``(B) The Secretary shall focus on models the Secretary
expects to reduce program costs while preserving or enhancing
the quality of care received by individuals receiving
benefits under this chapter.
``(C) The models selected may include those described in
section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C.
1315a(b)(2)(B)).
``(5) In selecting a model for testing, the Secretary may
consider, in addition to other factors identified in this
subsection, the following factors:
``(A) Whether the model includes a regular process for
monitoring and updating patient care plans in a manner that
is consistent with the needs and preferences of individuals
receiving benefits under this chapter.
``(B) Whether the model places the individual receiving
benefits under this chapter (including family members and
other caregivers of such individual) at the center of the
care team of such individual.
``(C) Whether the model uses technology or new systems to
coordinate care over time and across settings.
``(D) Whether the model demonstrates effective linkage with
other public sector payers, private sector payers, or
statewide payment models.
``(6)(A) Models tested under this section may not be
designed in such a way that would allow
[[Page H4026]]
the United States to recover or collect reasonable charges
from a Federal health care program for care or services
furnished by the Secretary to a veteran under pilot programs
carried out under this section.
``(B) In this paragraph, the term `Federal health care
program' means--
``(i) an insurance program described in section 1811 of the
Social Security Act (42 U.S.C. 1395c) or established by
section 1831 of such Act (42 U.S.C. 1395j);
``(ii) a State plan for medical assistance approved under
title XIX of such Act (42 U.S.C. 1396 et seq.); or
``(iii) a TRICARE program operated under sections 1075,
1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title
10.
``(b) Duration.--Each pilot program carried out by the
Secretary under this section shall terminate no later than
five years after the date of the commencement of the pilot
program.
``(c) Location.--The Secretary shall ensure that each pilot
program carried out under this section occurs in an area or
areas appropriate for the intended purposes of the pilot
program. To the extent practicable, the Secretary shall
ensure that the pilot programs are located in geographically
diverse areas of the United States.
``(d) Budget.--Funding for each pilot program carried out
by the Secretary under this section shall come from
appropriations--
``(1) provided in advance in appropriations acts for the
Veterans Health Administration; and
``(2) provided for information technology systems.
``(e) Notice.--The Secretary shall--
``(1) publish information about each pilot program under
this section in the Federal Register; and
``(2) take reasonable actions to provide direct notice to
veterans eligible to participate in such pilot programs.
``(f) Waiver of Authorities.--(1) Subject to reporting
under paragraph (2) and approval under paragraph (3), in
implementing a pilot program under this section, the
Secretary may waive such requirements in subchapters I, II,
and III of this chapter as the Secretary determines necessary
solely for the purposes of carrying out this section with
respect to testing models described in subsection (a).
``(2) Before waiving any authority under paragraph (1), the
Secretary shall submit to the Speaker of the House of
Representatives, the minority leader of the House of
Representatives, the majority leader of the Senate, the
minority leader of the Senate, and each standing committee
with jurisdiction under the rules of the Senate and of the
House of Representatives to report a bill to amend the
provision or provisions of law that would be waived by the
Department, a report on a request for waiver that describes
in detail the following:
``(A) The specific authorities to be waived under the pilot
program.
``(B) The standard or standards to be used in the pilot
program in lieu of the waived authorities.
``(C) The reasons for such waiver or waivers.
``(D) A description of the metric or metrics the Secretary
will use to determine the effect of the waiver or waivers
upon the access to and quality, timeliness, or patient
satisfaction of care and services furnished through the pilot
program.
``(E) The anticipated cost savings, if any, of the pilot
program.
``(F) The schedule for interim reports on the pilot program
describing the results of the pilot program so far and the
feasibility and advisability of continuing the pilot program.
``(G) The schedule for the termination of the pilot program
and the submission of a final report on the pilot program
describing the result of the pilot program and the
feasibility and advisability of making the pilot program
permanent.
``(H) The estimated budget of the pilot program.
``(3)(A) Upon receipt of a report submitted under paragraph
(2), each House of Congress shall provide copies of the
report to the chairman and ranking member of each standing
committee with jurisdiction under the rules of the House of
Representatives or the Senate to report a bill to amend the
provision or provisions of law that would be waived by the
Department under this subsection.
``(B) The waiver requested by the Secretary under paragraph
(2) shall be considered approved under this paragraph if
there is enacted into law a joint resolution approving such
request in its entirety.
``(C) For purposes of this paragraph, the term `joint
resolution' means only a joint resolution which is introduced
within the period of five legislative days beginning on the
date on which the Secretary transmits the report to the
Congress under such paragraph (2), and--
``(i) which does not have a preamble; and
``(ii) the matter after the resolving clause of which is as
follows: `that Congress approves the request for a waiver
under section 1703E(f) of title 38, United States Code, as
submitted by the Secretary on__', the blank space being
filled with the appropriate date.
``(D)(i) Any committee of the House of Representatives to
which a joint resolution is referred shall report it to the
House without amendment not later than 15 legislative days
after the date of introduction thereof. If a committee fails
to report the joint resolution within that period, the
committee shall be discharged from further consideration of
the joint resolution.
``(ii) It shall be in order at any time after the third
legislative day after each committee authorized to consider a
joint resolution has reported or has been discharged from
consideration of a joint resolution, to move to proceed to
consider the joint resolution in the House. All points of
order against the motion are waived. Such a motion shall not
be in order after the House has disposed of a motion to
proceed on a joint resolution addressing a particular
submission. The previous question shall be considered as
ordered on the motion to its adoption without intervening
motion. The motion shall not be debatable. A motion to
reconsider the vote by which the motion is disposed of shall
not be in order.
``(iii) The joint resolution shall be considered as read.
All points of order against the joint resolution and against
its consideration are waived. The previous question shall be
considered as ordered on the joint resolution to its passage
without intervening motion except two hours of debate equally
divided and controlled by the proponent and an opponent. A
motion to reconsider the vote on passage of the joint
resolution shall not be in order.
``(E)(i) A joint resolution introduced in the Senate shall
be referred to the Committee on Veterans' Affairs.
``(ii) Any committee of the Senate to which a joint
resolution is referred shall report it to the Senate without
amendment not later than 15 session days after the date of
introduction of a joint resolution described in paragraph
(C). If a committee fails to report the joint resolution
within that period, the committee shall be discharged from
further consideration of the joint resolution and the joint
resolution shall be placed on the calendar.
``(iii)(I) Notwithstanding Rule XXII of the Standing Rules
of the Senate, it is in order at any time after the third
session day on which the Committee on Veterans' Affairs has
reported or has been discharged from consideration of a joint
resolution described in paragraph (C) (even though a previous
motion to the same effect has been disagreed to) to move to
proceed to the consideration of the joint resolution, and all
points of order against the joint resolution (and against
consideration of the joint resolution) are waived. The motion
to proceed is not debatable. The motion is not subject to a
motion to postpone. A motion to reconsider the vote by which
the motion is agreed to or disagreed to shall not be in
order. If a motion to proceed to the consideration of the
resolution is agreed to, the joint resolution shall remain
the unfinished business until disposed of.
``(II) Consideration of the joint resolution, and on all
debatable motions and appeals in connection therewith, shall
be limited to not more than two hours, which shall be divided
equally between the majority and minority leaders or their
designees. A motion further to limit debate is in order and
not debatable. An amendment to, or a motion to postpone, or a
motion to proceed to the consideration of other business, or
a motion to recommit the joint resolution is not in order.
``(III) If the Senate has voted to proceed to a joint
resolution, the vote on passage of the joint resolution shall
occur immediately following the conclusion of consideration
of the joint resolution, and a single quorum call at the
conclusion of the debate if requested in accordance with the
rules of the Senate.
``(IV) Appeals from the decisions of the Chair relating to
the application of the rules of the Senate, as the case may
be, to the procedure relating to a joint resolution shall be
decided without debate.
``(F) A Joint resolution considered pursuant to this
paragraph shall not be subject to amendment in either the
House of Representatives or the Senate.
``(G)(i) If, before the passage by one House of the joint
resolution of that House, that House receives the joint
resolution from the other House, then the following
procedures shall apply:
``(I) The joint resolution of the other House shall not be
referred to a committee.
``(II) With respect to the joint resolution of the House
receiving the joint resolution--
``(aa) the procedure in that House shall be the same as if
no joint resolution had been received from the other House;
but
``(bb) the vote on passage shall be on the joint resolution
of the other House.
``(ii) If the Senate fails to introduce or consider a joint
resolution under this paragraph, the joint resolution of the
House shall be entitled to expedited floor procedures under
this subparagraph.
``(iii) If, following passage of the joint resolution in
the Senate, the Senate then receives the companion measure
from the House of Representatives, the companion measure
shall not be debatable.
``(H) This subparagraph is enacted by Congress--
``(i) as an exercise of the rulemaking power of the Senate
and the House of Representatives, respectively, and as such
it is deemed a part of the rules of each House, respectively,
but applicable only with respect to the procedure to be
followed in that House in the case of a joint resolution, and
it supersedes other rules only to the extent that it is
inconsistent with such rules; and
``(ii) with full recognition of the constitutional right of
either House to change the rules (so far as relating to the
procedures of that House) at any time, in the same manner,
and to the same extent as in the case of any other rule of
that House.''.
``(g) Limitations.--(1) The Secretary may not carry out
more than 10 pilot programs concurrently.
``(2)(A) Subject to subparagraph (B), the Secretary may not
expend more than $50,000,000 in any fiscal year from amounts
under subsection (d).
``(B) The Secretary may expend more than the amount in
subparagraph (A) if--
``(i) the Secretary determines that the additional
expenditure is necessary to carry out pilot programs under
this section;
``(ii) the Secretary submits to the Committees on Veterans'
Affairs of the Senate and the
[[Page H4027]]
House of Representatives a report setting forth the amount of
the additional expenditure and a justification for the
additional expenditure; and
``(iii) the Chairmen of the Committees on Veterans' Affairs
of the Senate and the House of Representatives transmit to
the Secretary a letter approving of the additional
expenditure.
``(3) The waiver provisions in subsection (f) shall not
apply unless the Secretary, in accordance with the
requirements in subsection (f), submits the first proposal
for a pilot program not later than 18 months after the date
of the enactment of the Caring for Our Veterans Act of 2018.
``(4) Notwithstanding section 502 of this title, decisions
by the Secretary under this section shall, consistent with
section 511 of this title, be final and conclusive and may
not be reviewed by any other official or by any court,
whether by an action in the nature of mandamus or otherwise.
``(5)(A) If the Secretary determines that a pilot program
is not improving the quality of care or producing cost
savings, the Secretary shall--
``(i) propose a modification to the pilot program in the
interim report that shall also be considered a report under
subsection (f)(2) and shall be subject to the terms and
conditions of subsection (f)(2); or
``(ii) terminate such pilot program not later than 30 days
after submitting the interim report to Congress.
``(B) If the Secretary terminates a pilot program under
subparagraph (A)(ii), for purposes of subparagraphs (F) and
(G) of subsection (f)(2), such interim report will also serve
as the final report for that pilot program.
``(h) Evaluation and Reporting Requirements.--(1) The
Secretary shall conduct an evaluation of each model tested,
which shall include, at a minimum, an analysis of--
``(A) the quality of care furnished under the model,
including the measurement of patient-level outcomes and
patient-centeredness criteria determined appropriate by the
Secretary; and
``(B) the changes in spending by reason of that model.
``(2) The Secretary shall make the results of each
evaluation under this subsection available to the public in a
timely fashion and may establish requirements for other
entities participating in the testing of models under this
section to collect and report information that the Secretary
determines is necessary to monitor and evaluate such models.
``(i) Coordination and Advice.--(1) The Secretary shall
obtain advice from the Under Secretary for Health and the
Special Medical Advisory Group established pursuant to
section 7312 of this title in the development and
implementation of any pilot program operated under this
section.
``(2) In carrying out the duties under this section, the
Secretary shall consult representatives of relevant Federal
agencies, and clinical and analytical experts with expertise
in medicine and health care management. The Secretary shall
use appropriate mechanisms to seek input from interested
parties.
``(j) Expansion of Successful Pilot Programs.--Taking into
account the evaluation under subsection (f), the Secretary
may, through rulemaking, expand (including implementation on
a nationwide basis) the duration and the scope of a model
that is being tested under subsection (a) to the extent
determined appropriate by the Secretary, if--
``(1) the Secretary determines that such expansion is
expected to--
``(A) reduce spending without reducing the quality of care;
or
``(B) improve the quality of patient care without
increasing spending; and
``(2) the Secretary determines that such expansion would
not deny or limit the coverage or provision of benefits for
individuals receiving benefits under this chapter.''.
(b) Conforming Amendment.--The table of sections at the
beginning of such chapter, as amended by this title, is
further amended by inserting after the item relating to
section 1703D the following new item:
``1703E. Center for Innovation for Care and Payment.''.
SEC. 153. AUTHORIZATION TO PROVIDE FOR OPERATIONS ON LIVE
DONORS FOR PURPOSES OF CONDUCTING TRANSPLANT
PROCEDURES FOR VETERANS.
(a) In General.--Subchapter VIII of chapter 17 is amended
by adding at the end the following new section:
``Sec. 1788. Transplant procedures with live donors and
related services
``(a) In General.--Subject to subsections (b) and (c), in a
case in which a veteran is eligible for a transplant
procedure from the Department, the Secretary may provide for
an operation on a live donor to carry out such procedure for
such veteran, notwithstanding that the live donor may not be
eligible for health care from the Department.
``(b) Other Services.--Subject to the availability of
appropriations for such purpose, the Secretary shall furnish
to a live donor any care or services before and after
conducting the transplant procedure under subsection (a) that
may be required in connection with such procedure.
``(c) Use of Non-Department Facilities.--In carrying out
this section, the Secretary may provide for the operation
described in subsection (a) on a live donor and furnish to
the live donor the care and services described in subsection
(b) at a non-Department facility pursuant to an agreement
entered into by the Secretary under this chapter. The live
donor shall be deemed to be an individual eligible for
hospital care and medical services at a non-Department
facility pursuant to such an agreement solely for the
purposes of receiving such operation, care, and services at
the non-Department facility.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 17 is amended by inserting after the
item relating to section 1787 the following new item:
``1788. Transplant procedures with live donors and related services.''.
Subtitle C--Family Caregivers
SEC. 161. EXPANSION OF FAMILY CAREGIVER PROGRAM OF DEPARTMENT
OF VETERANS AFFAIRS.
(a) Family Caregiver Program.--
(1) Expansion of eligibility.--
(A) In general.--Subparagraph (B) of subsection (a)(2) of
section 1720G is amended to read as follows:
``(B) for assistance provided under this subsection--
``(i) before the date on which the Secretary submits to
Congress a certification that the Department has fully
implemented the information technology system required by
section 162(a) of the Caring for Our Veterans Act of 2018,
has a serious injury (including traumatic brain injury,
psychological trauma, or other mental disorder) incurred or
aggravated in the line of duty in the active military, naval,
or air service on or after September 11, 2001;
``(ii) during the two-year period beginning on the date on
which the Secretary submitted to Congress the certification
described in clause (i), has a serious injury (including
traumatic brain injury, psychological trauma, or other mental
disorder) incurred or aggravated in the line of duty in the
active military, naval, or air service--
``(I) on or before May 7, 1975; or
``(II) on or after September 11, 2001; or
``(iii) after the date that is two years after the date on
which the Secretary submits to Congress the certification
described in clause (i), has a serious injury (including
traumatic brain injury, psychological trauma, or other mental
disorder) incurred or aggravated in the line of duty in the
active military, naval, or air service; and''.
(B) Publication in federal register.--Not later than 30
days after the date on which the Secretary of Veterans
Affairs submits to Congress the certification described in
subsection (a)(2)(B)(i) of section 1720G of such title, as
amended by subparagraph (A) of this paragraph, the Secretary
shall publish the date specified in such subsection in the
Federal Register.
(2) Expansion of needed services in eligibility criteria.--
Subsection (a)(2)(C) of such section is amended--
(A) in clause (ii), by striking ``; or'' and inserting a
semicolon;
(B) by redesignating clause (iii) as clause (iv); and
(C) by inserting after clause (ii) the following new clause
(iii):
``(iii) a need for regular or extensive instruction or
supervision without which the ability of the veteran to
function in daily life would be seriously impaired; or''.
(3) Expansion of services provided.--Subsection
(a)(3)(A)(ii) of such section is amended--
(A) in subclause (IV), by striking ``; and'' and inserting
a semicolon;
(B) in subclause (V), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new subclause:
``(VI) through the use of contracts with, or the provision
of grants to, public or private entities--
``(aa) financial planning services relating to the needs of
injured veterans and their caregivers; and
``(bb) legal services, including legal advice and
consultation, relating to the needs of injured veterans and
their caregivers.''.
(4) Modification of stipend calculation.--Subsection
(a)(3)(C) of such section is amended--
(A) by redesignating clause (iii) as clause (iv); and
(B) by inserting after clause (ii) the following new clause
(iii):
``(iii) In determining the amount and degree of personal
care services provided under clause (i) with respect to an
eligible veteran whose need for personal care services is
based in whole or in part on a need for supervision or
protection under paragraph (2)(C)(ii) or regular instruction
or supervision under paragraph (2)(C)(iii), the Secretary
shall take into account the following:
``(I) The assessment by the family caregiver of the needs
and limitations of the veteran.
``(II) The extent to which the veteran can function safely
and independently in the absence of such supervision,
protection, or instruction.
``(III) The amount of time required for the family
caregiver to provide such supervision, protection, or
instruction to the veteran.''.
(5) Periodic evaluation of need for certain services.--
Subsection (a)(3) of such section is amended by adding at the
end the following new subparagraph:
``(D) In providing instruction, preparation, and training
under subparagraph (A)(i)(I) and technical support under
subparagraph (A)(i)(II) to each family caregiver who is
approved as a provider of personal care services for an
eligible veteran under paragraph (6), the Secretary shall
periodically evaluate the needs of the eligible veteran and
the skills of the family caregiver of such veteran to
determine if additional instruction, preparation, training,
or technical support under those subparagraphs is
necessary.''.
(6) Use of primary care teams.--Subsection (a)(5) of such
section is amended, in the matter preceding subparagraph (A),
by inserting ``(in collaboration with the primary care team
for the eligible veteran to the maximum extent practicable)''
after ``evaluate''.
(7) Assistance for family caregivers.--Subsection (a) of
such section is amended by adding at the end the following
new paragraph:
[[Page H4028]]
``(11)(A) In providing assistance under this subsection to
family caregivers of eligible veterans, the Secretary may
enter into contracts, provider agreements, and memoranda of
understanding with Federal agencies, States, and private,
nonprofit, and other entities to provide such assistance to
such family caregivers.
``(B) The Secretary may provide assistance under this
paragraph only if such assistance is reasonably accessible to
the family caregiver and is substantially equivalent or
better in quality to similar services provided by the
Department.
``(C) The Secretary may provide fair compensation to
Federal agencies, States, and other entities that provide
assistance under this paragraph.''.
(b) Modification of Definition of Personal Care Services.--
Subsection (d)(4) of such section is amended--
(1) in subparagraph (A), by striking ``independent'';
(2) by redesignating subparagraph (B) as subparagraph (D);
and
(3) by inserting after subparagraph (A) the following new
subparagraphs:
``(B) Supervision or protection based on symptoms or
residuals of neurological or other impairment or injury.
``(C) Regular or extensive instruction or supervision
without which the ability of the veteran to function in daily
life would be seriously impaired.''.
SEC. 162. IMPLEMENTATION OF INFORMATION TECHNOLOGY SYSTEM OF
DEPARTMENT OF VETERANS AFFAIRS TO ASSESS AND
IMPROVE THE FAMILY CAREGIVER PROGRAM.
(a) Implementation of New System.--
(1) In general.--Not later than October 1, 2018, the
Secretary of Veterans Affairs shall implement an information
technology system that fully supports the Program and allows
for data assessment and comprehensive monitoring of the
Program.
(2) Elements of system.--The information technology system
required to be implemented under paragraph (1) shall include
the following:
(A) The ability to easily retrieve data that will allow all
aspects of the Program (at the medical center and aggregate
levels) and the workload trends for the Program to be
assessed and comprehensively monitored.
(B) The ability to manage data with respect to a number of
caregivers that is more than the number of caregivers that
the Secretary expects to apply for the Program.
(C) The ability to integrate the system with other relevant
information technology systems of the Veterans Health
Administration.
(b) Assessment of Program.--Not later than 180 days after
implementing the system described in subsection (a), the
Secretary shall, through the Under Secretary for Health, use
data from the system and other relevant data to conduct an
assessment of how key aspects of the Program are structured
and carried out.
(c) Ongoing Monitoring of and Modifications to Program.--
(1) Monitoring.--The Secretary shall use the system
implemented under subsection (a) to monitor and assess the
workload of the Program, including monitoring and assessment
of data on--
(A) the status of applications, appeals, and home visits in
connection with the Program; and
(B) the use by caregivers participating in the Program of
other support services under the Program such as respite
care.
(2) Modifications.--Based on the monitoring and assessment
conducted under paragraph (1), the Secretary shall identify
and implement such modifications to the Program as the
Secretary considers necessary to ensure the Program is
functioning as intended and providing veterans and caregivers
participating in the Program with services in a timely
manner.
(d) Reports.--
(1) Initial report.--
(A) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate, the Committee
on Veterans' Affairs of the House of Representatives, and the
Comptroller General of the United States a report that
includes--
(i) the status of the planning, development, and deployment
of the system required to be implemented under subsection
(a), including any changes in the timeline for the
implementation of the system; and
(ii) an assessment of the needs of family caregivers of
veterans described in subparagraph (B), the resources needed
for the inclusion of such family caregivers in the Program,
and such changes to the Program as the Secretary considers
necessary to ensure the successful expansion of the Program
to include such family caregivers.
(B) Veterans described.--Veterans described in this
subparagraph are veterans who are eligible for the Program
under clause (ii) or (iii) of section 1720G(a)(2)(B) of title
38, United States Code, as amended by section 161(a)(1) of
this title, solely due to a serious injury (including
traumatic brain injury, psychological trauma, or other mental
disorder) incurred or aggravated in the line of duty in the
active military, naval, or air service before September 11,
2001.
(2) Notification by comptroller general.--The Comptroller
General shall review the report submitted under paragraph (1)
and notify the Committee on Veterans' Affairs of the Senate
and the Committee on Veterans' Affairs of the House of
Representatives with respect to the progress of the Secretary
in--
(A) fully implementing the system required under subsection
(a); and
(B) implementing a process for using such system to monitor
and assess the Program under subsection (c)(1) and modify the
Program as considered necessary under subsection (c)(2).
(3) Final report.--
(A) In general.--Not later than October 1, 2019, the
Secretary shall submit to the Committee on Veterans' Affairs
of the Senate, the Committee on Veterans' Affairs of the
House of Representatives, and the Comptroller General a
report on the implementation of subsections (a) through (c).
(B) Elements.--The report required by subparagraph (A)
shall include the following:
(i) A certification by the Secretary that the information
technology system described in subsection (a) has been
implemented.
(ii) A description of how the Secretary has implemented
such system.
(iii) A description of the modifications to the Program, if
any, that were identified and implemented under subsection
(c)(2).
(iv) A description of how the Secretary is using such
system to monitor the workload of the Program.
(e) Definitions.--In this section:
(1) Active military, naval, or air service.--The term
``active military, naval, or air service'' has the meaning
given that term in section 101 of title 38, United States
Code.
(2) Program.--The term ``Program'' means the program of
comprehensive assistance for family caregivers under section
1720G(a) of title 38, United States Code, as amended by
section 161 of this title.
SEC. 163. MODIFICATIONS TO ANNUAL EVALUATION REPORT ON
CAREGIVER PROGRAM OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Barriers to Care and Services.--Subparagraph (A)(iv) of
section 101(c)(2) of the Caregivers and Veterans Omnibus
Health Services Act of 2010 (Public Law 111-163; 38 U.S.C.
1720G note) is amended by inserting ``, including a
description of any barriers to accessing and receiving care
and services under such programs'' before the semicolon.
(b) Sufficiency of Training for Family Caregiver Program.--
Subparagraph (B) of such section is amended--
(1) in clause (i), by striking ``; and'' and inserting a
semicolon;
(2) in clause (ii), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following new clause:
``(iii) an evaluation of the sufficiency and consistency of
the training provided to family caregivers under such program
in preparing family caregivers to provide care to veterans
under such program.''.
TITLE II--VA ASSET AND INFRASTRUCTURE REVIEW
Subtitle A--Asset and Infrastructure Review
SEC. 201. SHORT TITLE.
This subtitle may be cited as the ``VA Asset and
Infrastructure Review Act of 2018''.
SEC. 202. THE COMMISSION.
(a) Establishment.--There is established an independent
commission to be known as the ``Asset and Infrastructure
Review Commission'' (in this subtitle referred to as the
``Commission'').
(b) Duties.--The Commission shall carry out the duties
specified for it in this subtitle.
(c) Appointment.--
(1) In general.--
(A) Appointment.--The Commission shall be composed of 9
members appointed by the President, by and with the advice
and consent of the Senate.
(B) Transmission of nominations.--The President shall
transmit to the Senate the nominations for appointment to the
Commission not later than May 31, 2021.
(2) Consultation in selection process.--In selecting
individuals for nominations for appointments to the
Commission, the President shall consult with--
(A) the Speaker of the House of Representatives;
(B) the majority leader of the Senate;
(C) the minority leader of the House of Representatives;
(D) the minority leader of the Senate; and
(E) congressionally chartered, membership based veterans
service organizations concerning the appointment of three
members.
(3) Designation of chair.--At the time the President
nominates individuals for appointment to the Commission under
paragraph (1)(B), the President shall designate one such
individual who shall serve as Chair of the Commission and one
such individual who shall serve as Vice Chair of the
Commission.
(4) Member representation.--In nominating individuals under
this subsection, the President shall ensure that--
(A) veterans, reflecting current demographics of veterans
enrolled in the system of annual patient enrollment under
section 1705 of title 38, United States Code, are adequately
represented in the membership of the Commission;
(B) at least one member of the Commission has experience
working for a private integrated health care system that has
annual gross revenues of more than $50,000,000;
(C) at least one member has experience as a senior manager
for an entity specified in clause (ii), (iii), or (iv) of
section 101(a)(1)(B) of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note);
(D) at least one member--
(i) has experience with capital asset management for the
Federal Government; and
(ii) is familiar with trades related to building and real
property, including construction, engineering, architecture,
leasing, and strategic partnerships; and
(E) at least three members represent congressionally
chartered, membership-based, veterans service organizations.
(d) Meetings.--
(1) In general.--The Commission shall meet only during
calendar years 2022 and 2023.
(2) Public nature of meetings and proceedings.--
[[Page H4029]]
(A) Public meetings.--Each meeting of the Commission shall
be open to the public.
(B) Open participation.--All the proceedings, information,
and deliberations of the Commission shall be available for
review by the public.
(e) Vacancies.--A vacancy in the Commission shall be filled
in the same manner as the original appointment, but the
individual appointed to fill the vacancy shall serve only for
the unexpired portion of the term for which the individual's
predecessor was appointed.
(f) Pay.--
(1) In general.--Members of the Commission shall serve
without pay.
(2) Officers or employees of the united states.--Each
member of the Commission who is an officer or employee of the
United States shall serve without compensation in addition to
that received for service as an officer or employee of the
United States.
(3) Travel expenses.--Members shall receive travel
expenses, including per diem in lieu of subsistence, in
accordance with sections 5702 and 5703 of title 5, United
States Code.
(g) Director of Staff.--
(1) Appointment.--The Commission shall appoint a Director
who--
(A) has not served as an employee of the Department of
Veterans Affairs during the one-year period preceding the
date of such appointment; and
(B) is not otherwise barred or prohibited from serving as
Director under Federal ethics laws and regulations, by reason
of post-employment conflict of interest.
(2) Rate of pay.--The Director shall be paid at the rate of
basic pay payable for level IV of the Executive Schedule
under section 5315 of title 5, United States Code.
(h) Staff.--
(1) Pay of personnel.--Subject to paragraphs (2) and (3),
the Director, with the approval of the Commission, may
appoint and fix the pay of additional personnel.
(2) Exemption from certain requirements.--The Director may
make such appointments without regard to the provisions of
title 5, United States Code, governing appointments in the
competitive service, and any personnel so appointed may be
paid without regard to the provisions of chapter 51 and
subchapter III of chapter 53 of that title relating to
classification and General Schedule pay rates, except that an
individual so appointed may not receive pay in excess of the
annual rate of basic pay payable for GS-15 of the General
Schedule.
(3) Detailees.--
(A) Limitation on number.--Not more than two-thirds of the
personnel employed by or detailed to the Commission may be on
detail from the Department of Veterans Affairs.
(B) Professional analysts.--Not more than half of the
professional analysts of the Commission staff may be persons
detailed from the Department of Veterans Affairs to the
Commission.
(C) Prohibition on detail of certain personnel.--A person
may not be detailed from the Department of Veterans Affairs
to the Commission if, within 6 months before the detail is to
begin, that person participated personally and substantially
in any matter within the Department of Veterans Affairs
concerning the preparation of recommendations regarding
facilities of the Veterans Health Administration.
(4) Authority to request detailed personnel.--Subject to
paragraph (3), the head of any Federal department or agency,
upon the request of the Director, may detail any of the
personnel of that department or agency to the Commission to
assist the Commission in carrying out its duties under this
subtitle.
(5) Information from federal agencies.--The Commission may
secure directly from any Federal agency such information the
Commission considers necessary to carry out this subtitle.
Upon request of the Chair, the head of such agency shall
furnish such information to the Commission.
(i) Other Authority.--
(1) Temporary and intermittent services.--The Commission
may procure by contract, to the extent funds are available,
the temporary or intermittent services of experts or
consultants pursuant to section 3109 of title 5, United
States Code.
(2) Leasing and acquisition of property.--To the extent
funds are available, the Commission may lease real property
and acquire personal property either of its own accord or in
consultation with the General Services Administration.
(j) Termination.--The Commission shall terminate on
December 31, 2023.
(k) Prohibition Against Restricting Communications.--
(1) In general.--Except as provided in paragraph (2), no
person may restrict an employee of the Department of Veterans
Affairs in communicating with the Commission.
(2) Unlawful communications.--Paragraph (1) does not apply
to a communication that is unlawful.
SEC. 203. PROCEDURE FOR MAKING RECOMMENDATIONS.
(a) Selection Criteria.--
(1) Publication.--The Secretary shall, not later than
February 1, 2021, and after consulting with veterans service
organizations, publish in the Federal Register and transmit
to the Committees on Veterans' Affairs of the Senate and the
House of Representatives the criteria proposed to be used by
the Department of Veterans Affairs in assessing and making
recommendations regarding the modernization or realignment of
facilities of the Veterans Health Administration under this
subtitle. Such criteria shall include the preferences of
veterans regarding health care furnished by the Department.
(2) Public comment.--The Secretary shall provide an
opportunity for public comment on the proposed criteria under
paragraph (1) for a period of at least 90 days and shall
include notice of that opportunity in the publication
required under such paragraph.
(3) Publication of final criteria.--The Secretary shall,
not later than May 31, 2021, publish in the Federal Register
and transmit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives the final criteria to
be used in making recommendations regarding the closure,
modernization, or realignment of facilities of the Veterans
Health Administration under this subtitle.
(b) Recommendations of the Secretary.--
(1) Publication in federal register.--The Secretary shall,
not later than January 31, 2022, and after consulting with
veterans service organizations, publish in the Federal
Register and transmit to the Committees on Veterans' Affairs
of the Senate and the House of Representatives and to the
Commission a report detailing the recommendations regarding
the modernization or realignment of facilities of the
Veterans Health Administration on the basis of the final
criteria referred to in subsection (a)(2) that are
applicable.
(2) Factors for consideration.--In making recommendations
under this subsection, the Secretary shall consider each of
the following factors:
(A) The degree to which any health care delivery or other
site for providing services to veterans reflect the metrics
of the Department of Veterans Affairs regarding market area
health system planning.
(B) The provision of effective and efficient access to
high-quality health care and services for veterans.
(C) The extent to which the real property that no longer
meets the needs of the Federal Government could be
reconfigured, repurposed, consolidated, realigned, exchanged,
outleased, replaced, sold, or disposed.
(D) The need of the Veterans Health Administration to
acquire infrastructure or facilities that will be used for
the provision of health care and services to veterans.
(E) The extent to which the operating and maintenance costs
are reduced through consolidating, colocating, and
reconfiguring space, and through realizing other operational
efficiencies.
(F) The extent and timing of potential costs and savings,
including the number of years such costs or savings will be
incurred, beginning with the date of completion of the
proposed recommendation.
(G) The extent to which the real property aligns with the
mission of the Department of Veterans Affairs.
(H) The extent to which any action would impact other
missions of the Department (including education, research, or
emergency preparedness).
(I) Local stakeholder inputs and any factors identified
through public field hearings.
(J) The assessments under paragraph (3).
(K) The extent to which the Veterans Health Administration
has appropriately staffed the medical facility, including
determinations whether there has been insufficient resource
allocation or deliberate understaffing.
(L) Any other such factors the Secretary determines
appropriate.
(3) Capacity and commercial market assessments.--
(A) Assessments.--The Secretary shall assess the capacity
of each Veterans Integrated Service Network and medical
facility of the Department to furnish hospital care or
medical services to veterans under chapter 17 of title 38,
United States Code. Each such assessment shall--
(i) identify gaps in furnishing such care or services at
such Veterans Integrated Service Network or medical facility;
(ii) identify how such gaps can be filled by--
(I) entering into contracts or agreements with network
providers under this section or with entities under other
provisions of law;
(II) making changes in the way such care and services are
furnished at such Veterans Integrated Service Network or
medical facility, including--
(aa) extending hours of operation;
(bb) adding personnel; or
(cc) expanding space through the construction, leasing, or
sharing of health care facilities; and
(III) the building or realignment of Department resources
or personnel;
(iii) forecast, based on future projections and historical
trends, both the short- and long-term demand in furnishing
care or services at such Veterans Integrated Service Network
or medical facility and assess how such demand affects the
needs to use such network providers;
(iv) include a commercial health care market assessment of
designated catchment areas in the United States conducted by
a non-governmental entity; and
(v) consider the unique ability of the Federal Government
to retain a presence in an area otherwise devoid of
commercial health care providers or from which such providers
are at risk of leaving.
(B) Consultation.--In carrying out the assessments under
subparagraph (A), the Secretary shall consult with veterans
service organizations and veterans served by each such
Veterans Integrated Service Network and medical facility.
(C) Submittal.--The Secretary shall submit such assessments
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate with the recommendations of
the Secretary under this subsection and make the assessments
publicly available.
(4) Summary of selection process.--The Secretary shall
include, with the list of recommendations published and
transmitted pursuant to paragraph (1), a summary of the
selection process that resulted in the recommendation for
each facility of the Veterans Health Administration,
including a justification for each recommendation. The
Secretary shall transmit the matters referred to in the
preceding sentence not
[[Page H4030]]
later than 7 days after the date of the transmittal to the
Committees on Veterans' Affairs of the Senate and the House
of Representatives and the Commission of the report referred
to in paragraph (1).
(5) Treatment of facilities.--In assessing facilities of
the Veterans Health Administration, the Secretary shall
consider all such facilities equally without regard to
whether the facility has been previously considered or
proposed for reuse, closure, modernization, or realignment by
the Department of Veterans Affairs.
(6) Availability of information to congress.--In addition
to making all information used by the Secretary to prepare
the recommendations under this subsection available to
Congress (including any committee or Member of Congress), the
Secretary shall also make such information available to the
Commission and the Comptroller General of the United States.
(7) Certification of accuracy.--
(A) In general.--Each person referred to in subparagraph
(B), when submitting information to the Secretary or the
Commission concerning the modernization or realignment of a
facility of the Veterans Health Administration, shall certify
that such information is accurate and complete to the best of
that person's knowledge and belief.
(B) Covered persons.--Subparagraph (A) applies to the
following persons:
(i) Each Under Secretary of the Department of Veterans
Affairs.
(ii) Each director of a Veterans Integrated Service
Network.
(iii) Each director of a medical center of the Department
of Veterans Affairs.
(iv) Each director of a program office of the Department of
Veterans Affairs.
(v) Each person who is in a position the duties of which
include personal and substantial involvement in the
preparation and submission of information and recommendations
concerning the modernization or realignment of facilities of
the Veterans Health Administration.
(c) Review and Recommendations by the Commission.--
(1) Public hearings.--
(A) In general.--After receiving the recommendations from
the Secretary pursuant to subsection (b), the Commission
shall conduct public hearings on the recommendations.
(B) Locations.--The Commission shall conduct public
hearings in regions affected by a recommendation of the
Secretary to close a facility of the Veterans Health
Administration. To the greatest extent practicable, the
Commission shall conduct public hearings in regions affected
by a recommendation of the Secretary to modernize or realign
such a facility.
(C) Required witnesses.--Witnesses at each public hearing
shall include at a minimum--
(i) a veteran--
(I) enrolled under section 1705 of title 38, United States
Code; and
(II) identified by a local veterans service organization;
and
(ii) a local elected official.
(2) Transmittal to president.--
(A) In general.--The Commission shall, not later than
January 31, 2023, transmit to the President a report
containing the Commission's findings and conclusions based on
a review and analysis of the recommendations made by the
Secretary, together with the Commission's recommendations,
for modernizations and realignments of facilities of the
Veterans Health Administration.
(B) Authority to make changes to recommendations.--Subject
to subparagraph (C), in making its recommendations, the
Commission may change any recommendation made by the
Secretary if the Commission--
(i) determines that the Secretary deviated substantially
from the final criteria referred to in subsection (a)(2) in
making such recommendation;
(ii) determines that the change is consistent with the
final criteria referred to in subsection (a)(2);
(iii) publishes a notice of the proposed change in the
Federal Register not less than 45 days before transmitting
its recommendations to the President pursuant to subparagraph
(A); and
(iv) conducts public hearings on the proposed change.
(3) Justification for changes.--The Commission shall
explain and justify in its report submitted to the President
pursuant to paragraph (2) any recommendation made by the
Commission that is different from the recommendations made by
the Secretary pursuant to subsection (b). The Commission
shall transmit a copy of such report to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives on the same date on which it transmits its
recommendations to the President under paragraph (2).
(4) Provision of information to congress.--After the
Commission transmits its report to the President, the
Commission shall promptly provide, upon request, to any
Member of Congress, information used by the Commission in
making its recommendations.
(d) Review by the President.--
(1) Report.--The President shall, not later than February
15, 2023, transmit to the Commission and to the Congress a
report containing the President's approval or disapproval of
the Commission's recommendations.
(2) Presidential approval.--If the President approves all
the recommendations of the Commission, the President shall
transmit a copy of such recommendations to the Congress,
together with a certification of such approval.
(3) Presidential disapproval.--If the President disapproves
the recommendations of the Commission, in whole or in part,
the President shall transmit to the Commission and the
Congress, not later than March 1, 2023, the reasons for that
disapproval. The Commission, after consideration of the
President's reasons for disapproval, shall then transmit to
the President, not later than March 15, 2023, a report
containing--
(A) the Commission's findings and conclusions based on a
review and analysis of those reasons for disapproval provided
by the President; and
(B) recommendations that the Commission determines are
appropriate for modernizations and realignments of facilities
of the Veterans Health Administration.
(4) Transmittal of recommendations to congress.--If the
President approves all recommendations of the Commission
transmitted to the President under paragraph (3), the
President shall transmit a copy of such recommendations to
the Congress, together with a certification of such approval.
(5) Failure to transmit.--If the President does not
transmit to the Congress an approval and certification
described in paragraph (2) or (4) by March 30, 2023, the
process by which facilities of the Veterans Health
Administration may be selected for modernization or
realignment under this subtitle shall be terminated.
SEC. 204. ACTIONS REGARDING INFRASTRUCTURE AND FACILITIES OF
THE VETERANS HEALTH ADMINISTRATION.
(a) In General.--Subject to subsection (b), the Secretary
shall begin to implement the recommended modernizations and
realignments in the report under section 203(d) not later
than three years after the date on which the President
transmits such report to Congress. In any fiscal year, such
implementation includes--
(1) the planning of modernizations and realignments of
facilities of the Veterans Health Administration as
recommended in such report; and
(2) providing detailed information on the budget for such
modernizations or realignments in documents submitted to
Congress by the Secretary in support of the President's
budget for that fiscal year.
(b) Congressional Disapproval.--
(1) In general.--The Secretary may not carry out any
modernization or realignment recommended by the Commission in
a report transmitted from the President pursuant to section
203(d) if a joint resolution is enacted, in accordance with
the provisions of section 207, disapproving such
recommendations of the Commission before the earlier of--
(A) the end of the 45-day period beginning on the date on
which the President transmits such report; or
(B) the adjournment of Congress sine die for the session
during which such report is transmitted.
(2) Computation of period.--For purposes of paragraph (1)
and subsections (a) and (c) of section 207, the days on which
either House of Congress is not in session because of an
adjournment of more than three days to a day certain shall be
excluded in the computation of a period.
SEC. 205. IMPLEMENTATION.
(a) In General.--
(1) Modernizing and realigning facilities.--In modernizing
or realigning any facility of the Veterans Health
Administration under this subtitle, the Secretary may--
(A) take such actions as may be necessary to modernize or
realign any such facility, including the alteration of such
facilities, the acquisition of such land, the leasing or
construction of such replacement facilities, the disposition
of such land or facilities, the performance of such
activities, and the conduct of such advance planning and
design as may be required to transfer functions from a
facility of the Veterans Health Administration to another
such facility, and may use for such purpose funds in the
Account or funds appropriated to the Department of Veterans
Affairs for such purposes;
(B) carry out activities for the purposes of environmental
mitigation, abatement, or restoration at any such facility,
and shall use for such purposes funds in the Account;
(C) reimburse other Federal agencies for actions performed
at the request of the Secretary with respect to any such
closure or realignment, and may use for such purpose funds in
the Account or funds appropriated to the Department of
Veterans Affairs and available for such purpose; and
(D) exercise the authority of the Secretary under
subchapter V of chapter 81 of title 38, United States Code.
(2) Environmental restoration; historic preservation.--In
carrying out any closure or realignment under this subtitle,
the Secretary, with regards to any property made excess to
the needs of the Department of Veterans Affairs as a result
of such closure or realignment, shall carry out, as soon as
possible with funds available for such purpose, any of the
following for which the Secretary is responsible:
(A) Environmental mitigation.
(B) Environmental abatement.
(C) Environmental restoration.
(D) Compliance with historic preservation requirements.
(b) Management and Disposal of Property.--
(1) Existing disposal authorities.--To transfer or dispose
of surplus real property or infrastructure located at any
facility of the Veterans Health Administration that is
modernized or realigned under this title, the Secretary may
exercise the authorities of the Secretary under subchapters I
and II of chapter 81 of title 38, United States Code, or the
authorities delegated to the Secretary by the Administrator
of General Services under subchapter III of chapter 5 of
title 40, United States Code.
(2) Effects on local communities.--
(A) Consultation with state and local government.--Before
any action may be taken with respect to the disposal of any
surplus real property or infrastructure located at any
facility of the Veterans Health Administration to be closed
or realigned under this subtitle, the Secretary of Veterans
Affairs shall consult with the
[[Page H4031]]
Governor of the State and the heads of the local governments
concerned for the purpose of considering any plan for the use
of such property by the local community concerned.
(B) Treatment of roads.--If infrastructure or a facility of
the Veterans Health Administration to be closed or realigned
under this subtitle includes a road used for public access
through, into, or around the facility, the Secretary--
(i) shall consult with the Government of the State and the
heads of the local governments concerned for the purpose of
considering the continued availability of the road for public
use after the recommended action is complete; and
(ii) may exercise the authority of the Secretary under
section 8108 of title 38, United States Code.
(3) Leases; cercla.--
(A) Lease authority.--
(i) Transfer to redevelopment authority for lease.--The
Secretary may transfer title to a facility of the Veterans
Health Administration approved for closure or realignment
under this subtitle (including property at a facility of the
Veterans Health Administration approved for realignment which
will be retained by the Department of Veterans Affairs or
another Federal agency after realignment) to the
redevelopment authority for the facility if the redevelopment
authority agrees to lease, directly upon transfer, one or
more portions of the property transferred under this
subparagraph to the Secretary or to the head of another
department or agency of the Federal Government.
(ii) Term of lease.--A lease under clause (i) shall be for
a term of not to exceed 50 years, but may provide for options
for renewal or extension of the term by the department or
agency concerned.
(iii) Limitation.--A lease under clause (i) may not require
rental payments by the United States.
(iv) Treatment of remaindered lease terms.--A lease under
clause (i) shall include a provision specifying that if the
department or agency concerned ceases requiring the use of
the leased property before the expiration of the term of the
lease, the remainder of the lease term may be satisfied by
the same or another department or agency of the Federal
Government using the property for a use similar to the use
under the lease. Exercise of the authority provided by this
clause shall be made in consultation with the redevelopment
authority concerned.
(v) Facility services.--Notwithstanding clause (iii), if a
lease under clause (i) involves a substantial portion of the
facility, the department or agency concerned may obtain
facility services for the leased property and common area
maintenance from the redevelopment authority or the
redevelopment authority's assignee as a provision of the
lease. The facility services and common area maintenance
shall be provided at a rate no higher than the rate charged
to non-Federal tenants of the transferred property. Facility
services and common area maintenance covered by the lease
shall not include--
(I) municipal services that a State or local government is
required by law to provide to all landowners in its
jurisdiction without direct charge; or
(II) firefighting or security-guard functions.
(B) Application of cercla.--The provisions of section
120(h) of the Comprehensive Environmental Response,
Compensation, and Liability Act of 1980 (42 U.S.C. 9620(h))
shall apply to any transfer of real property under this
paragraph.
(C) Additional terms and conditions.--The Secretary may
require any additional terms and conditions in connection
with a transfer under this paragraph as such Secretary
considers appropriate to protect the interests of the United
States.
(4) Application of mckinney-vento homeless assistance
act.--Nothing in this subtitle shall limit or otherwise
affect the application of the provisions of the McKinney-
Vento Homeless Assistance Act (42 U.S.C. 11301 et seq.) to
facilities of the Veterans Health Administration closed under
this subtitle.
(c) Applicability of National Environmental Policy Act of
1969.--
(1) In general.--The provisions of the National
Environmental Policy Act of 1969 (42 U.S.C. 4321 et seq.)
shall not apply to the actions of the President, the
Commission, and, except as provided in paragraph (2), the
Department of Veterans Affairs in carrying out this subtitle.
(2) Department of veterans affairs.--
(A) Covered activities.--The provisions of the National
Environmental Policy Act of 1969 shall apply to actions of
the Department of Veterans Affairs under this subtitle--
(i) during the process of property disposal; and
(ii) during the process of relocating functions from a
facility of the Veterans Health Administration being closed
or realigned to another facility after the receiving facility
has been selected but before the functions are relocated.
(B) Other activities.--In applying the provisions of the
National Environmental Policy Act of 1969 to the processes
referred to in subparagraph (A), the Secretary shall not have
to consider--
(i) the need for closing or realigning the facility of the
Veterans Health Administration as recommended by the
Commission;
(ii) the need for transferring functions to any facility of
the Veterans Health Administration which has been selected as
the receiving facility; or
(iii) facilities of the Veterans Health Administration
alternative to those recommended or selected.
(d) Waiver.--
(1) Restrictions on use of funds.--The Secretary may close
or realign facilities of the Veterans Health Administration
under this subtitle without regard to any provision of law
restricting the use of funds for closing or realigning
facilities of the Veterans Health Administration included in
any appropriation or authorization Act.
(2) Restrictions on authorities.--The Secretary may close
or realign facilities of the Veterans Health Administration
under this subtitle without regard to the restrictions of
section 8110 of title 38, United States Code.
(e) Transfer Authority in Connection With Payment of
Environmental Remediation Costs.--
(1) In general.--
(A) Transfer by deed.--Subject to paragraph (2) of this
subsection and section 120(h) of the Comprehensive
Environmental Response, Compensation, and Liability Act of
1980 (42 U.S.C. 9620(h)), the Secretary may enter into an
agreement to transfer by deed a facility of the Veterans
Health Administration with any person who agrees to perform
all environmental restoration, waste management, and
environmental compliance activities that are required for the
property or facilities under Federal and State laws,
administrative decisions, agreements (including schedules and
milestones), and concurrences.
(B) Additional terms or conditions.--The Secretary may
require any additional terms and conditions in connection
with an agreement authorized by subparagraph (A) as the
Secretary considers appropriate to protect the interests of
the United States.
(2) Limitation.--A transfer of a facility of the Veterans
Health Administration may be made under paragraph (1) only if
the Secretary certifies to Congress that--
(A) the costs of all environmental restoration, waste
management, and environmental compliance activities otherwise
to be paid by the Secretary with respect to the facility of
the Veterans Health Administration are equal to or greater
than the fair market value of the property or facilities to
be transferred, as determined by the Secretary; or
(B) if such costs are lower than the fair market value of
the facility of the Veterans Health Administration, the
recipient of such transfer agrees to pay the difference
between the fair market value and such costs.
(3) Payment by the secretary for certain transfers.--In the
case of a facility of the Veterans Health Administration
covered by a certification under paragraph (2)(A), the
Secretary may pay the recipient of such facility an amount
equal to the lesser of--
(A) the amount by which the costs incurred by the recipient
of the facility of the Veterans Health Administration for all
environmental restoration, waste, management, and
environmental compliance activities with respect to such
facility exceed the fair market value of such property as
specified in such certification; or
(B) the amount by which the costs (as determined by the
Secretary) that would otherwise have been incurred by the
Secretary for such restoration, management, and activities
with respect to such facility of the Veterans Health
Administration exceed the fair market value of property as so
specified.
(4) Disclosure.--As part of an agreement under paragraph
(1), the Secretary shall disclose to the person to whom the
facility of the Veterans Health Administration will be
transferred any information of the Secretary regarding the
environmental restoration, waste management, and
environmental compliance activities described in paragraph
(1) that relate to the facility of the Veterans Health
Administration. The Secretary shall provide such information
before entering into the agreement.
(5) Applicability of certain environmental laws.--Nothing
in this subsection shall be construed to modify, alter, or
amend the Comprehensive Environmental Response, Compensation,
and Liability Act of 1980 (42 U.S.C. 9601 et seq.) or the
Solid Waste Disposal Act (42 U.S.C. 6901 et seq.).
SEC. 206. DEPARTMENT OF VETERANS AFFAIRS ASSET AND
INFRASTRUCTURE REVIEW ACCOUNT.
(a) Establishment.--There is hereby established in the
ledgers of the Treasury an account to be known as the
``Department of Veterans Affairs Asset and Infrastructure
Review Account'' which shall be administered by the Secretary
as a single account.
(b) Credits to Account.--There shall be credited to the
Account the following:
(1) Funds authorized for and appropriated to the Account.
(2) Proceeds received from the lease, transfer, or disposal
of any property at a facility of the Veterans Health
Administration closed or realigned under this subtitle.
(c) Use of Account.--The Secretary may use the funds in the
Account only for the following purposes:
(1) To carry out this subtitle.
(2) To cover property management and disposal costs
incurred at facilities of the Veterans Health Administration
closed, modernized, or realigned under this subtitle.
(3) To cover costs associated with supervision, inspection,
overhead, engineering, and design of construction projects
undertaken under this subtitle, and subsequent claims, if
any, related to such activities.
(4) Other purposes that the Secretary determines support
the mission and operations of the Department of Veterans
Affairs.
(d) Consolidated Budget Justification Display for
Account.--
(1) Consolidated budget information required.--The
Secretary shall establish a consolidated budget justification
display in support of the Account that for each fiscal year--
(A) details the amount and nature of credits to, and
expenditures from, the Account during the preceding fiscal
year;
[[Page H4032]]
(B) separately details the environmental remediation costs
associated with facility of the Veterans Health
Administration for which a budget request is made;
(C) specifies the transfers into the Account and the
purposes for which these transferred funds will be further
obligated, to include caretaker and environment remediation
costs associated with each facility of the Veterans Health
Administration; and
(D) details any intra-budget activity transfers within the
Account that exceeded $1,000,000 during the preceding fiscal
year or that are proposed for the next fiscal year and will
exceed $1,000,000.
(2) Submission.--The Secretary shall include the
information required by paragraph (1) in the materials that
the Secretary submits to Congress in support of the budget
for a fiscal year submitted by the President pursuant to
section 1105 of title 31, United States Code.
(e) Closure of Account; Treatment of Remaining Funds.--
(1) Closure.--The Account shall be closed at the time and
in the manner provided for appropriation accounts under
section 1555 of title 31, United States Code, except that
unobligated funds which remain in the Account upon closure
shall be held by the Secretary of the Treasury until
transferred to the Secretary of Veterans Affairs by law after
the Committees on Veterans' Affairs of the Senate and the
House of Representatives receive the final report transmitted
under paragraph (2).
(2) Final report.--No later than 60 days after the closure
of the Account under paragraph (1), the Secretary shall
transmit to the Committees on Veterans' Affairs of the Senate
and the House of Representatives and the Committees on
Appropriations of the House of Representatives and the Senate
a report containing an accounting of--
(A) all the funds credited to and expended from the Account
or otherwise expended under this subtitle; and
(B) any funds remaining in the Account.
SEC. 207. CONGRESSIONAL CONSIDERATION OF COMMISSION REPORT.
(a) Disapproval Resolution.--For purposes of this subtitle,
the term ``joint resolution'' means only a joint resolution
which is introduced within the 5-day period beginning on the
date on which the President transmits the report to the
Congress under section 203(d), and--
(1) which does not have a preamble;
(2) the matter after the resolving clause of which is as
follows: ``that Congress disapproves the recommendations of
the VHA Asset and Infrastructure Review Commission as
submitted by the President on ___'', the blank space being
filled with the appropriate date; and
(3) the title of which is as follows: ``Joint resolution
disapproving the recommendations of the VHA Asset and
Infrastructure Review Commission.''.
(b) Consideration in the House of Representatives.--
(1) Reporting and discharge.--Any committee of the House of
Representatives to which a joint resolution is referred shall
report it to the House without amendment not later than 15
legislative days after the date of introduction thereof. If a
committee fails to report the joint resolution within that
period, the committee shall be discharged from further
consideration of the joint resolution.
(2) Proceeding to consideration.--It shall be in order at
any time after the third legislative day after each committee
authorized to consider a joint resolution has reported or has
been discharged from consideration of a joint resolution, to
move to proceed to consider the joint resolution in the
House. All points of order against the motion are waived.
Such a motion shall not be in order after the House has
disposed of a motion to proceed on a joint resolution
addressing a particular submission. The previous question
shall be considered as ordered on the motion to its adoption
without intervening motion. The motion shall not be
debatable. A motion to reconsider the vote by which the
motion is disposed of shall not be in order.
(3) CONSIDERATION.--The joint resolution shall be
considered as read. All points of order against the joint
resolution and against its consideration are waived. The
previous question shall be considered as ordered on the joint
resolution to its passage without intervening motion except
two hours of debate equally divided and controlled by the
proponent and an opponent. A motion to reconsider the vote on
passage of the joint resolution shall not be in order.
(c) Consideration in the Senate.--
(1) Referral.--A joint resolution introduced in the Senate
shall be referred to the Committee on Veterans' Affairs.
(2) Reporting and discharge.--Any committee of the Senate
to which a joint resolution is referred shall report it to
the Senate without amendment not later than 15 session days
after the date of introduction of a joint resolution
described in subsection (a). If a committee fails to report
the joint resolution within that period, the committee shall
be discharged from further consideration of the joint
resolution and the joint resolution shall be placed on the
calendar.
(3) Floor consideration.--
(A) In general.--Notwithstanding Rule XXII of the Standing
Rules of the Senate, it is in order at any time after the
third session day on which the Committee on Veterans' Affairs
has reported or has been discharged from consideration of a
joint resolution described in subsection (a) (even though a
previous motion to the same effect has been disagreed to) to
move to proceed to the consideration of the joint resolution,
and all points of order against the joint resolution (and
against consideration of the joint resolution) are waived.
The motion to proceed is not debatable. The motion is not
subject to a motion to postpone. A motion to reconsider the
vote by which the motion is agreed to or disagreed to shall
not be in order. If a motion to proceed to the consideration
of the resolution is agreed to, the joint resolution shall
remain the unfinished business until disposed of.
(B) Consideration.--Consideration of the joint resolution,
and on all debatable motions and appeals in connection
therewith, shall be limited to not more than 2 hours, which
shall be divided equally between the majority and minority
leaders or their designees. A motion further to limit debate
is in order and not debatable. An amendment to, or a motion
to postpone, or a motion to proceed to the consideration of
other business, or a motion to recommit the joint resolution
is not in order.
(C) Vote on passage.--If the Senate has voted to proceed to
a joint resolution, the vote on passage of the joint
resolution shall occur immediately following the conclusion
of consideration of the joint resolution, and a single quorum
call at the conclusion of the debate if requested in
accordance with the rules of the Senate.
(D) Rulings of the chair on procedure.--Appeals from the
decisions of the Chair relating to the application of the
rules of the Senate, as the case may be, to the procedure
relating to a joint resolution shall be decided without
debate.
(d) Amendment Not in Order.--A joint resolution of
disapproval considered pursuant to this section shall not be
subject to amendment in either the House of Representatives
or the Senate.
(e) Coordination With Action by Other House.--
``(1) In general.--If, before the passage by one House of
the joint resolution of that House, that House receives the
joint resolution from the other House, then the following
procedures shall apply:
``(A) The joint resolution of the other House shall not be
referred to a committee.
``(B) With respect to the joint resolution of the House
receiving the joint resolution--
``(i) the procedure in that House shall be the same as if
no joint resolution had been received from the other House;
but
(ii) the vote on passage shall be on the joint resolution
of the other House.''.
(2) Treatment of joint resolution of other house.--If the
Senate fails to introduce or consider a joint resolution
under this section, the joint resolution of the House shall
be entitled to expedited floor procedures under this section.
(3) Treatment of companion measures.--If, following passage
of the joint resolution in the Senate, the Senate then
receives the companion measure from the House of
Representatives, the companion measure shall not be
debatable.
(f) Rules of the House of Representatives and Senate.--This
section is enacted by Congress--
(1) as an exercise of the rulemaking power of the Senate
and House of Representatives, respectively, and as such it is
deemed a part of the rules of each House, respectively, but
applicable only with respect to the procedure to be followed
in that House in the case of a joint resolution, and it
supersedes other rules only to the extent that it is
inconsistent with such rules; and
(2) with full recognition of the constitutional right of
either House to change the rules (so far as relating to the
procedure of that House) at any time, in the same manner, and
to the same extent as in the case of any other rule of that
House.
SEC. 208. OTHER MATTERS.
(a) Online Publication of Communications.--
(1) In general.--Not later than 24 hours after the
transmission or receipt of any communication under this
subtitle that is transmitted or received by a party specified
in paragraph (2), the Secretary of Veterans Affairs shall
publish such communication online.
(2) Parties specified.--The parties specified under this
paragraph are the following:
(A) The Secretary of Veterans Affairs.
(B) The Commission.
(C) The President.
(b) Continuation of Existing Construction Projects and
Planning.--During activities that the Commission, President,
or Congress carry out under this subtitle, the Secretary of
Veterans Affairs may not stop, solely because of such
activities--
(1) a construction or leasing project of the Veterans
Health Administration;
(2) long term planning regarding infrastructure and assets
of the Veterans Health Administration; or
(3) budgetary processes for the Veterans Health
Administration.
(c) Recommendations for Future Asset Reviews.--The
Secretary of Veterans Affairs may, after consulting with
veterans service organizations, include in budget submissions
the Secretary submits after the termination of the Commission
recommendations for future such commissions or other capital
asset realignment and management processes.
SEC. 209. DEFINITIONS.
In this subtitle:
(1) The term ``Account'' means the Department of Veterans
Affairs Asset and Infrastructure Review Account established
by section 206(a).
(2) The term ``Commission'' means the Commission
established by section 202.
(3) The term ``date of approval'', with respect to a
modernization or realignment of a facility of the Veterans
Health Administration, means the date on which the authority
of Congress to disapprove a recommendation of modernization
or realignment, as the case may be, of such facility under
this subtitle expires.
(4) The term ``facility of the Veterans Health
Administration''--
(A) means any land, building, structure, or infrastructure
(including any medical center,
[[Page H4033]]
nursing home, domiciliary facility, outpatient clinic, center
that provides readjustment counseling, or leased facility)
that is--
(i) under the jurisdiction of the Department of Veterans
Affairs;
(ii) under the control of the Veterans Health
Administration; and
(iii) not under the control of the General Services
Administration; or
(B) with respect to a colocated facility of the Department
of Veterans Affairs, includes any land, building, or
structure--
(i) under the jurisdiction of the Department of Veterans
Affairs;
(ii) under the control of another administration of the
Department of Veterans Affairs; and
(iii) not under the control of the General Services
Administration.
(5) The term ``infrastructure'' means improvements to land
other than buildings or structures.
(6) The term ``modernization'' includes--
(A) any action, including closure, required to align the
form and function of a facility of the Veterans Health
Administration to the provision of modern day health care,
including utilities and environmental control systems;
(B) the construction, purchase, lease, or sharing of a
facility of the Veterans Health Administration; and
(C) realignments, disposals, exchanges, collaborations
between the Department of Veterans Affairs and other Federal
entities, and strategic collaborations between the Department
and non-Federal entities, including tribal organizations.
(7) The term ``realignment'', with respect to a facility of
the Veterans Health Administration, includes--
(A) any action that changes the numbers of or relocates
services, functions, and personnel positions;
(B) disposals or exchanges between the Department of
Veterans Affairs and other Federal entities, including the
Department of Defense; and
(C) strategic collaborations between the Department of
Veterans Affairs and non-Federal entities, including tribal
organizations.
(8) The term ``redevelopment authority'', in the case of a
facility of the Veterans Health Administration closed or
modernized under this subtitle, means any entity (including
an entity established by a State or local government)
recognized by the Secretary of Veterans Affairs as the entity
responsible for developing the redevelopment plan with
respect to the facility or for directing the implementation
of such plan.
(9) The term ``redevelopment plan'' in the case of a
facility of the Veterans Health Administration to be closed
or realigned under this subtitle, means a plan that--
(A) is agreed to by the local redevelopment authority with
respect to the facility; and
(B) provides for the reuse or redevelopment of the real
property and personal property of the facility that is
available for such reuse and redevelopment as a result of the
closure or realignment of the facility.
(10) The term ``Secretary'' means the Secretary of Veterans
Affairs.
(11) The term ``tribal organization'' has the meaning given
such term in section 3765 of title 38, United States Code.
Subtitle B--Other Infrastructure Matters
SEC. 211. IMPROVEMENT TO TRAINING OF CONSTRUCTION PERSONNEL.
Subsection (g) of section 8103 of title 38, United States
Code, is amended to read as follows:
``(g)(1)(A) Not later than September 30 of the fiscal year
following the fiscal year during which the VA Asset and
Infrastructure Review Act of 2018 is enacted, the Secretary
shall implement the covered training curriculum and the
covered certification program.
``(B) In designing and implementing the covered training
curriculum and the covered certification program under
paragraph (1), the Secretary shall use as models existing
training curricula and certification programs that have been
established under chapter 87 of title 10, United States Code,
as determined relevant by the Secretary.
``(2) The Secretary may develop the training curriculum
under paragraph (1)(A) in a manner that provides such
training in any combination of--
``(A) training provided in person;
``(B) training provided over an internet website; or
``(C) training provided by another department or agency of
the Federal Government.
``(3) The Secretary may develop the certification program
under paragraph (1)(A) in a manner that uses--
``(A) one level of certification; or
``(B) more than one level of certification, as determined
appropriate by the Secretary with respect to the level of
certification for different grades of the General Schedule.
``(4) The Secretary may enter into a contract with an
appropriate entity to provide the covered training curriculum
and the covered certification program under paragraph (1)(A).
``(5)(A) Not later than September 30 of the second fiscal
year following the fiscal year during which the VA Asset and
Infrastructure Review Act of 2018 is enacted, the Secretary
shall ensure that the majority of employees subject to the
covered certification program achieve the certification or
the appropriate level of certification pursuant to paragraph
(3), as the case may be.
``(B) After carrying out subparagraph (A), the Secretary
shall ensure that each employee subject to the covered
certification program achieves the certification or the
appropriate level of certification pursuant to paragraph (3),
as the case may be, as quickly as practicable.
``(6) In this subsection:
``(A) The term `covered certification program' means, with
respect to employees of the Department of Veterans Affairs
who are members of occupational series relating to
construction or facilities management, or employees of the
Department who award or administer contracts for major
construction, minor construction, or nonrecurring
maintenance, including as contract specialists or contracting
officers' representatives, a program to certify knowledge and
skills relating to construction or facilities management and
to ensure that such employees maintain adequate expertise
relating to industry standards and best practices for the
acquisition of design and construction services.
``(B) The term `covered training curriculum' means, with
respect to employees specified in subparagraph (A), a
training curriculum relating to construction or facilities
management.''.
SEC. 212. REVIEW OF ENHANCED USE LEASES.
Section 8162(b)(6) is amended to read as follows:
``(6) The Office of Management and Budget shall review each
enhanced-use lease before the lease goes into effect to
determine whether the lease is in compliance with paragraph
(5).''.
SEC. 213. ASSESSMENT OF HEALTH CARE FURNISHED BY THE
DEPARTMENT TO VETERANS WHO LIVE IN THE PACIFIC
TERRITORIES.
(a) In General.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a report regarding
health care furnished by the Department of Veterans Affairs
to veterans who live in the Pacific territories.
(b) Elements.--The report under subsection (a) shall
include assessments of the following:
(1) The ability of the Department to furnish to veterans
who live in the Pacific territories the following:
(A) Hospital care.
(B) Medical services.
(C) Mental health services.
(D) Geriatric services.
(2) The feasibility of establishing a community-based
outpatient clinic of the Department in any Pacific territory
that does not contain such a facility.
(c) Definition.--In this section, the term ``Pacific
territories'' means American Samoa, Guam, and the Northern
Mariana Islands.
TITLE III--IMPROVEMENTS TO RECRUITMENT OF HEALTH CARE PROFESSIONALS
SEC. 301. DESIGNATED SCHOLARSHIPS FOR PHYSICIANS AND DENTISTS
UNDER DEPARTMENT OF VETERANS AFFAIRS HEALTH
PROFESSIONAL SCHOLARSHIP PROGRAM.
(a) Scholarships for Physicians and Dentists.--Section
7612(b) of title 38, United States Code, is amended by adding
at the end the following new paragraph:
``(6)(A) Of the scholarships awarded under this subchapter,
the Secretary shall ensure that not less than 50 scholarships
are awarded each year to individuals who are accepted for
enrollment or enrolled (as described in section 7602 of this
title) in a program of education or training leading to
employment as a physician or dentist until such date as the
Secretary determines that the staffing shortage of physicians
and dentists in the Department is less than 500.
``(B) After such date, the Secretary shall ensure that of
the scholarships awarded under this subchapter, a number of
scholarships is awarded each year to individuals referred to
in subparagraph (A) in an amount equal to not less than ten
percent of the staffing shortage of physicians and dentists
in the Department, as determined by the Secretary.
``(C) Notwithstanding subsection (c)(1), the agreement
between the Secretary and a participant in the Scholarship
Program who receives a scholarship pursuant to this paragraph
shall provide the following:
``(i) The Secretary's agreement to provide the participant
with a scholarship under this subchapter for a specified
number (from two to four) of school years during which the
participant is pursuing a course of education or training
leading to employment as a physician or dentist.
``(ii) The participant's agreement to serve as a full-time
employee in the Veterans Health Administration for a period
of time (hereinafter in this subchapter referred to as the
`period of obligated service') of 18 months for each school
year or part thereof for which the participant was provided a
scholarship under the Scholarship Program.
``(D) In providing scholarships pursuant to this paragraph,
the Secretary may provide a preference for applicants who are
veterans.
``(E) On an annual basis, the Secretary shall provide to
appropriate educational institutions informational material
about the availability of scholarships under this
paragraph.''.
(b) Breach of Agreement.--Section 7617 of such title is
amended--
(1) by redesignating paragraphs (4) and (5) as paragraphs
(5) and (6), respectively; and
(2) by inserting after paragraph (3) the following new
paragraph (4):
``(4) In the case of a participant who is enrolled in a
program or education or training leading to employment as a
physician, the participant fails to successfully complete
post-graduate training leading to eligibility for board
certification in a specialty.''.
(c) Extension of Program.--Section 7619 of such title is
amended by striking ``December 31, 2019'' and inserting
``December 31, 2033''.
SEC. 302. INCREASE IN MAXIMUM AMOUNT OF DEBT THAT MAY BE
REDUCED UNDER EDUCATION DEBT REDUCTION PROGRAM
OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Increase in Amount.--Section 7683(d)(1) is amended--
(1) by striking ``$120,000'' and inserting ``$200,000'';
and
[[Page H4034]]
(2) by striking ``$24,000'' and inserting ``$40,000''.
(b) Study.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) conduct a study on the demand for education debt
reduction under subchapter VII of chapter 76 of title 38,
United States Code; and
(B) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the findings of the Secretary
with respect to the study carried out under subparagraph (A).
(2) Considerations.--In carrying out the study required by
paragraph (1)(A), the Secretary shall consider the following:
(A) The total number of vacancies within the Veterans
Health Administration whose applicants are eligible to
participate in the Education Debt Reduction Program pursuant
to section 7682(a) of such title.
(B) The types of medical professionals in greatest demand
in the United States.
(C) Projections by the Secretary of the numbers and types
of medical professions that meet the needs of veterans.
SEC. 303. ESTABLISHING THE DEPARTMENT OF VETERANS AFFAIRS
SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM.
(a) In General.--Chapter 76 of title 38, United States
Code, is amended by inserting after subchapter VII the
following new subchapter:
``SUBCHAPTER VIII--SPECIALTY EDUCATION LOAN REPAYMENT PROGRAM
``Sec. 7691. Establishment
``As part of the Educational Assistance Program, the
Secretary may carry out a student loan repayment program
under section 5379 of title 5. The program shall be known as
the Department of Veterans Affairs Specialty Education Loan
Repayment Program (in this chapter referred to as the
`Specialty Education Loan Repayment Program').
``Sec. 7692. Purpose
``The purpose of the Specialty Education Loan Repayment
Program is to assist, through the establishment of an
incentive program for certain individuals employed in the
Veterans Health Administration, in meeting the staffing needs
of the Veterans Health Administration for physicians in
medical specialties for which the Secretary determines
recruitment or retention of qualified personnel is difficult.
``Sec. 7693. Eligibility; preferences; covered costs
``(a) Eligibility.--An individual is eligible to
participate in the Specialty Education Loan Repayment Program
if the individual--
``(1) is hired under section 7401 of this title to work in
an occupation described in section 7692 of this title;
``(2) owes any amount of principal or interest under a
loan, the proceeds of which were used by or on behalf of that
individual to pay costs relating to a course of education or
training which led to a degree that qualified the individual
for the position referred to in paragraph (1); and
``(3) is--
``(A) recently graduated from an accredited medical or
osteopathic school and matched to an accredited residency
program in a medical specialty described in section 7692 of
this title; or
``(B) a physician in training in a medical specialty
described in section 7692 of this title with more than two
years remaining in such training.
``(b) Preferences.--In selecting individuals for
participation in the Specialty Education Loan Repayment
Program under this subchapter, the Secretary may give
preference to the following:
``(1) Individuals who are, or will be, participating in
residency programs in health care facilities--
``(A) located in rural areas;
``(B) operated by Indian tribes, tribal organizations, or
the Indian Health Service; or
``(C) affiliated with underserved health care facilities of
the Department.
``(2) Veterans.
``(c) Covered Costs.--For purposes of subsection (a)(2),
costs relating to a course of education or training include--
``(1) tuition expenses;
``(2) all other reasonable educational expenses, including
expenses for fees, books, equipment, and laboratory expenses;
and
``(3) reasonable living expenses.
``Sec. 7694. Specialty education loan repayment
``(a) In General.--Payments under the Specialty Education
Loan Repayment Program shall consist of payments for the
principal and interest on loans described in section
7682(a)(2) of this title for individuals selected to
participate in the Program to the holders of such loans.
``(b) Frequency of Payment.--The Secretary shall make
payments for any given participant in the Specialty Education
Loan Repayment Program on a schedule determined appropriate
by the Secretary.
``(c) Maximum Amount; Waiver.--(1) The amount of payments
made for a participant under the Specialty Education Loan
Repayment Program may not exceed $160,000 over a total of
four years of participation in the Program, of which not more
than $40,000 of such payments may be made in each year of
participation in the Program.
``(2)(A) The Secretary may waive the limitations under
paragraph (1) in the case of a participant described in
subparagraph (B). In the case of such a waiver, the total
amount of payments payable to or for that participant is the
total amount of the principal and the interest on the
participant's loans referred to in subsection (a).
``(B) A participant described in this subparagraph is a
participant in the Program who the Secretary determines
serves in a position for which there is a shortage of
qualified employees by reason of either the location or the
requirements of the position.
``Sec. 7695. Choice of location
``Each participant in the Specialty Education Loan
Repayment Program who completes residency may select, from a
list of medical facilities of the Veterans Health
Administration provided by the Secretary, at which such
facility the participant will work in a medical specialty
described in section 7692 of this title.
``Sec. 7696. Term of obligated service
``(a) In General.--In addition to any requirements under
section 5379(c) of title 5, a participant in the Specialty
Education Loan Repayment Program must agree, in writing and
before the Secretary may make any payment to or for the
participant, to--
``(1) obtain a license to practice medicine in a State;
``(2) successfully complete post-graduate training leading
to eligibility for board certification in a specialty;
``(3) serve as a full-time clinical practice employee of
the Veterans Health Administration for 12 months for every
$40,000 in such benefits that the employee receives, but in
no case for fewer than 24 months; and
``(4) except as provided in subsection (b), to begin such
service as a full-time practice employee by not later than 60
days after completing a residency.
``(b) Fellowship.--In the case of a participant who
receives an accredited fellowship in a medical specialty
other than a medical specialty described in section 7692 of
this title, the Secretary, on written request of the
participant, may delay the term of obligated service under
subsection (a) for the participant until after the
participant completes the fellowship, but in no case later
than 60 days after completion of such fellowship.
``(c) Penalty.--(1) An employee who does not complete a
period of obligated service under this section shall owe the
Federal Government an amount determined in accordance with
the following formula: A = B ((T - S) T)).
``(2) In the formula in paragraph (1):
``(A) `A' is the amount the employee owes the Federal
Government.
``(B) `B' is the sum of all payments to or for the
participant under the Specialty Education Loan Repayment
Program.
``(C) `T' is the number of months in the period of
obligated service of the employee.
``(D) `S' is the number of whole months of such period of
obligated service served by the employee.
``Sec. 7697. Relationship to Educational Assistance Program
``Assistance under the Specialty Education Loan Repayment
Program may be in addition to other assistance available to
individuals under the Educational Assistance Program.''.
(b) Conforming and Technical Amendments.--
(1) Conforming amendments.--
(A) Section 7601(a) of title 38, United States Code, is
amended--
(i) in paragraph (4), by striking ``and'';
(ii) in paragraph (5), by striking the period and inserting
``; and''; and
(iii) by adding at the end the following new paragraph:
``(6) the specialty education loan repayment program
provided for in subchapter VIII of this chapter.''.
(B) Section 7603(a)(1) of title 38, United States Code, is
amended by striking ``or VI'' and inserting ``VI, or VIII''.
(C) Section 7604 of title 38, United States Code, is
amended by striking ``or VI'' each place it appears and
inserting ``VI, or VIII''.
(D) Section 7631 of title 38, United States Code, is
amended--
(i) in subsection (a)(1)--
(I) by striking ``and'' after ``scholarship amount,''; and
(II) by inserting ``, and the maximum specialty education
loan repayment amount'' after ``reduction payments amount'';
and
(ii) in subsection (b) by adding at the end the following
new paragraph:
``(7) The term `specialty education loan repayment amount'
means the maximum amount of specialty education loan
repayment payments payable to or for a participant in the
Department of Veterans Affairs Specialty Education Loan
Repayment Program under subchapter VIII of this chapter, as
specified in section 7694(c)(1) of this title and as
previously adjusted (if at all) in accordance with this
section.''.
(E) Section 7632 of title 38, United States Code, is
amended--
(i) in paragraph (1), by striking ``and the Education Debt
Reduction Program'' and inserting ``the Education Debt
Reduction Program, and the Specialty Education Loan Repayment
Program''; and
(ii) in paragraph (4), by striking ``and per participant in
the Education Debt Reduction Program'' and inserting ``per
participant in the Education Debt Reduction Program, and per
participant in the Specialty Education Loan Repayment
Program''.
(2) Table of sections.--The table of sections at the
beginning of chapter 76 of such title is amended by inserting
after the items relating to subchapter VII the following:
``subchapter viii--specialty education loan repayment program
``7691. Establishment.
``7692. Purpose.
``7693. Eligibility; preferences; covered costs.
``7694. Specialty education loan repayment.
``7695. Choice of location.
[[Page H4035]]
``7696. Term of obligated service.
``7697. Relationship to Educational Assistance Program.''.
(c) Needs of the VHA.--In making determinations each year
under section 7692 of title 38, United States Code, as
enacted by subsection (a), the Secretary of Veterans Affairs
shall consider the anticipated needs of the Veterans Health
Administration during the period two to six years in the
future.
(d) Preference.--In granting preference under section 7693
of title 38, United States Code, as enacted by subsection
(a), the Secretary of Veterans Affairs shall determine
whether a facility of the Department is underserved based on
the criteria developed under section 401 of this Act.
(e) Offer Deadline.--In the case of an applicant who
applies before receiving a residency match and whom the
Secretary of Veterans Affairs selects for participation in
the Specialty Education Loan Repayment Program established by
subsection (a), the Secretary shall offer participation to
the applicant not later than 28 days after--
(1) the applicant matches with a residency in a medical
specialty described in section 7692 of title 38, United
States Code, as enacted by subsection (a); and
(2) such match is published.
(f) Publicity.--The Secretary of Veterans Affairs shall
take such steps as the Secretary determines are appropriate
to publicize the Specialty Education Loan Repayment Program
established under subchapter VIII of chapter 76 of title 38,
United States Code, as enacted by subsection (a).
SEC. 304. VETERANS HEALING VETERANS MEDICAL ACCESS AND
SCHOLARSHIP PROGRAM.
(a) Establishment.--The Secretary of Veterans Affairs,
acting through the Office of Academic Affiliations of the
Department of Veterans Affairs, shall carry out a pilot
program under which the Secretary shall provide funding for
the medical education of a total of 18 eligible veterans.
Such funding shall be provided for two veterans enrolled in
each covered medical schools in accordance with this section.
(b) Eligible Veterans.--To be eligible to receive funding
for medical education under this section, a veteran shall--
(1) have been discharged from the Armed Forces not more
than ten years before the date of application for admission
to a covered medical school;
(2) not be entitled to educational assistance under chapter
30, 31, 32, 33, 34, or 35 of title 38, United States Code, or
chapter 1606 or 1607 of title 10, United States Code;
(3) apply for admission to a covered medical school for the
entering class of 2019;
(4) indicate on such application for admission that the
veteran would like to be considered for an award of funding
under this section;
(5) meet the minimum admissions criteria for the covered
medical school to which the veteran applies; and
(6) enter into an agreement described in subsection (e).
(c) Award of Funding.--
(1) In general.--Each covered medical school that opts to
participate in the program under this section shall reserve
two seats in the entering class of 2019 for eligible veterans
who receive funding under such program. Such funding shall be
awarded to the two eligible veterans with the highest
admissions rankings for such class at such school.
(2) Amount of funding.--Each eligible veteran who receives
funding under this section shall receive an amount equal to
the actual cost of--
(A) tuition at the covered medical school at which the
veteran enrolls for four years;
(B) books, fees, and technical equipment;
(C) fees associated with the National Residency Match
Program;
(D) two away rotations performed during the fourth year at
a Department of Veterans Affairs medical facility; and
(E) a monthly stipend for the four-year period during which
the veteran is enrolled in medical school in an amount to be
determined by the Secretary.
(3) Distribution of funding.--In the event that two or more
eligible veterans do not apply for admission at one of the
covered medical schools for the entering class of 2019, the
Secretary shall distribute the available funding to eligible
veterans who applied for admission at other covered medical
schools.
(d) Agreement.--
(1) Terms of agreement.--Each eligible veteran who accepts
funding for medical education under this section shall enter
into an agreement with the Secretary that provides that the
veteran agrees--
(A) to maintain enrollment and attendance in the medical
school;
(B) while enrolled in such medical school, to maintain an
acceptable level of academic standing (as determined by the
medical school under regulations prescribed by the
Secretary);
(C) to complete post-graduate training leading to
eligibility for board certification in a speciality
applicable to the Department of Veterans Affairs, as
determined by the Secretary;
(D) after completion of medical school, to obtain a license
to practice medicine in a State; and
(E) after completion of medical school and post-graduate
training, to serve as a full-time clinical practice employee
in the Veterans Health Administration for a period of four
years.
(2) Breach of agreement.--If an eligible veteran who
accepts funding under this section breaches the terms of the
agreement described in paragraph (1), the United States shall
be entitled to recover damages in an amount equal to the
total amount of such funding received by the veteran.
(e) Rule of Construction.--Nothing in this section shall be
construed to prevent any covered medical school from
accepting more than two eligible veterans for the entering
class of 2019.
(f) Report to Congress.--Not later than December 31, 2020,
and annually thereafter for the subsequent three years, the
Secretary shall submit to Congress a report on the pilot
program under this section. Such report shall include the
evaluation of the Secretary of the success of the pilot
program, including the number of veterans who received
funding under the program who matriculated and an evaluation
of the academic progress of such veterans.
(g) Covered Medical Schools.--In this section, the term
``covered medical school'' means any of the following.
(1) The Teague-Cranston medical schools, consisting of--
(A) Texas A&M College of Medicine;
(B) Quillen College of Medicine at East Tennessee State
University;
(C) Boonshoft School of Medicine at Wright State
University;
(D) Joan C. Edwards School of Medicine at Marshall
University; and
(E) University of South Carolina School of Medicine.
(2) Charles R Drew University of Medicine and Science.
(3) Howard University College of Medicine.
(4) Meharry Medical College.
(5) Morehouse School of Medicine.
SEC. 305. BONUSES FOR RECRUITMENT, RELOCATION, AND RETENTION.
Section 705(a) of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 703
note) is amended--
(1) in paragraph (1), by striking ``$230,000,000'' and
inserting ``$250,000,000, of which not less than $20,000,000
shall be for recruitment, relocation, and retention
bonuses''; and
(2) in paragraph (2), by striking ``$225,000,000'' and
inserting ``$290,000,000, of which not less than $20,000,000
shall be for recruitment, relocation, and retention
bonuses''.
SEC. 306. INCLUSION OF VET CENTER EMPLOYEES IN EDUCATION DEBT
REDUCTION PROGRAM OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall
ensure that clinical staff working at Vet Centers are
eligible to participate in the Education Debt Reduction
Program of the Department of Veterans Affairs under
subchapter VII of chapter 76 of title 38, United States Code.
(b) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on the number of participants in the
Education Debt Reduction Program of the Department under such
subchapter who work at Vet Centers.
(c) Vet Center Defined.--In this section, the term ``Vet
Center'' has the meaning given that term in section 1712A(h)
of title 38, United States Code.
TITLE IV--HEALTH CARE IN UNDERSERVED AREAS
SEC. 401. DEVELOPMENT OF CRITERIA FOR DESIGNATION OF CERTAIN
MEDICAL FACILITIES OF THE DEPARTMENT OF
VETERANS AFFAIRS AS UNDERSERVED FACILITIES AND
PLAN TO ADDRESS PROBLEM OF UNDERSERVED
FACILITIES.
(a) In General.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall develop criteria to designate medical centers,
ambulatory care facilities, and community based outpatient
clinics of the Department of Veterans Affairs as underserved
facilities.
(b) Consideration.--Criteria developed under subsection (a)
shall include consideration of the following with respect to
a facility:
(1) The ratio of veterans to health care providers of the
Department of Veterans Affairs for a standardized geographic
area surrounding the facility, including a separate ratio for
general practitioners and specialists.
(2) The range of clinical specialties covered by such
providers in such area.
(3) Whether the local community is medically underserved.
(4) The type, number, and age of open consults.
(5) Whether the facility is meeting the wait-time goals of
the Department.
(6) Such other criteria as the Secretary considers
important in determining which facilities are not adequately
serving area veterans.
(c) Analysis of Facilities.--Not less frequently than
annually, directors of Veterans Integrated Service Networks
of the Department shall perform an analysis to determine
which facilities within that Veterans Integrated Service
Network qualify as underserved facilities pursuant to
criteria developed under subsection (a).
(d) Annual Plan To Address Underserved Facilities.--
(1) Plan required.--Not later than one year after the date
of the enactment of this Act and not less frequently than
once each year, the Secretary shall submit to Congress a plan
to address the problem of underserved facilities of the
Department, as designated pursuant to criteria developed
under subsection (a).
(2) Contents.--Each plan submitted under paragraph (1)
shall address the following:
(A) Increasing personnel or temporary personnel assistance,
including mobile deployment teams furnished under section 407
of this Act.
(B) Providing special hiring incentives, including under
the Education Debt Reduction Program under subchapter VII of
chapter 76 of title 38, United States Code, and recruitment,
relocation, and retention incentives.
[[Page H4036]]
(C) Using direct hiring authority.
(D) Improving training opportunities for staff.
(E) Such other actions as the Secretary considers
appropriate.
SEC. 402. PILOT PROGRAM TO FURNISH MOBILE DEPLOYMENT TEAMS TO
UNDERSERVED FACILITIES.
(a) In General.--The Secretary of Veterans Affairs shall
carry out a pilot program to furnish mobile deployment teams
of medical personnel to underserved facilities.
(b) Elements.--In furnishing mobile deployment teams under
subsection (a), the Secretary shall consider the following
elements:
(1) The medical positions of greatest need at underserved
facilities.
(2) The size and composition of teams to be deployed.
(3) Such other elements as the Secretary considers
necessary for effective oversight of the program established
under subsection (a).
(c) Use of Annual Analysis.--The Secretary shall use the
results of the annual analysis conducted under section 401(c)
of this Act to form mobile deployment teams under subsection
(a) that are composed of the most needed medical personnel
for underserved facilities.
(d) Reporting.--
(1) Progress report.--Not later than one year after the
date of the enactment of this Act, the Secretary shall submit
a report to Congress on the implementation of the pilot
program under this section.
(2) Final report.--Not later than the termination of the
pilot program under this section, the Secretary shall submit
a final report to Congress that contains the recommendations
of the Secretary regarding the feasibility and advisability
of--
(A) extending or expanding the pilot program; and
(B) making the pilot program (or any aspect thereof)
permanent.
(e) Duration.--The pilot program under this section shall
terminate three years after the date of the enactment of this
Act.
(f) Underserved Facility Defined.--In this section, the
term ``underserved facility'' means a medical center,
ambulatory care facility, or community based outpatient
clinic of the Department of Veterans Affairs designated by
the Secretary of Veterans Affairs as underserved pursuant to
criteria developed under section 401 of this Act.
SEC. 403. PILOT PROGRAM ON GRADUATE MEDICAL EDUCATION AND
RESIDENCY.
(a) Establishment.--
(1) In general.--Subject to paragraph (5), the Secretary of
Veterans Affairs shall establish a pilot program to establish
medical residency positions authorized under section
301(b)(2) of the Veterans Access, Choice, and Accountability
Act of 2014 (Public Law 113-146; 38 U.S.C. 7302 note) at
covered facilities.
(2) Covered facilities.--For purposes of this section, a
covered facility is any of the following:
(A) A health care facility of the Department of Veterans
Affairs.
(B) A health care facility operated by an Indian tribe or a
tribal organization, as those terms are defined in section 4
of the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 5304).
(C) A health care facility operated by the Indian Health
Service.
(D) A Federally-qualified health center, as defined in
section 1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B)).
(E) A health care facility operated by the Department of
Defense.
(F) Such other health care facility as the Secretary
considers appropriate for purposes of this section.
(3) Agreements.--To carry out the pilot program under this
section, the Secretary may enter into agreements with
entities that operate covered facilities in which the
Secretary places residents under paragraph (1).
(4) Parameters for location, affiliate sponsor, and
duration.--When determining in which covered facilities to
place residents under paragraph (1), the Secretary shall
consider the extent to which there is a clinical need for
providers in an area, as determined by the following:
(A) The ratio of veterans to health care providers of the
Department for a standardized geographic area surrounding a
facility, including a separate ratio for general
practitioners and specialists.
(B) The range of clinical specialties of providers in
standardized geographic areas surrounding a facility.
(C) Whether the specialty of a provider is included in the
most recent staffing shortage determination of the Department
under section 7412 of title 38, United States Code.
(D) Whether the local community is designated by the
Secretary of Veterans Affairs as underserved pursuant to
criteria developed under section 401 of this Act.
(E) Whether the facility is located in a community that is
designated by the Secretary of Health and Human Services as a
health professional shortage area under section 332 of the
Public Health Service Act (42 U.S.C. 254e).
(F) Whether the facility is located in a rural or remote
area.
(G) Such other criteria as the Secretary considers
important in determining which facilities are not adequately
serving area veterans.
(5) Priority in placements.--During the pilot program under
this section, the Secretary shall place no fewer than 100
residents in covered facilities--
(A) operated by the Indian Health Service;
(B) operated by an Indian tribe;
(C) operated by a tribal organization; or
(D) located in communities designated by the Secretary as
underserved pursuant to criteria developed under section 401
of this Act.
(6) Stipends and benefits.--The Secretary may pay stipends
and provide benefits for residents in positions under
paragraph (1), regardless of whether they have been assigned
in a Department facility.
(b) Reimbursement.--If a covered facility establishes a new
residency program in which the Secretary places a resident
under the pilot program, the Secretary shall reimburse that
covered facility for costs of the following:
(1) Curriculum development.
(2) Recruitment and retention of faculty.
(3) Accreditation of the program by the Accreditation
Council for Graduate Medical Education.
(4) The portion of faculty salaries attributable to duties
under an agreement subsection (a)(3).
(5) Expenses relating to educating a resident under the
pilot program.
(c) Reporting.--
(1) In general.--Not later than one year after the date of
the enactment of this Act and not less frequently than once
each year thereafter until the termination of the pilot
program, the Secretary shall submit to Congress a report on
the implementation of the pilot program.
(2) Elements.--Each report submitted under paragraph (1)
shall include the following with regard to the immediately
preceding year, and in comparison to the year immediately
preceding that year:
(A) The number of veterans who received care from residents
under the pilot program.
(B) The number of veterans who received care from each
resident per position described in subsection (a)(1) under
the pilot program.
(C) The number of veterans who received care from residents
under the pilot program expressed as a percentage of all
individuals who received care from such residents.
(D) The number of clinical appointments for veterans
conducted by each resident under the pilot program.
(E) The number of clinical appointments for veterans
conducted by residents per position described in subsection
(a)(1) under the pilot program.
(F) The number of clinical appointments for veterans
expressed as a percentage of all clinical appointments
conducted by residents under the pilot program.
(G) The number of positions described in subsection (a)(1)
at each covered facility under the pilot program.
(H) For each position described in subsection (a)(1) in a
residency program affiliated with a health care facility of
the Department, the time a resident under the pilot program
spent training at that facility of the Department, expressed
as a percentage of the total training time for that resident
position.
(I) For each residency program affiliated with a health
care facility of the Department, the time all residents under
the pilot program spent training at that facility of the
Department, expressed as a percentage of the total training
time for those residents.
(J) The time that all residents under the pilot program who
are assigned to programs affiliated with health care
facilities of the Department spent training at facilities of
the Department, expressed as a percentage of the total
training time for those residents.
(K) The cost to the Department of Veterans Affairs under
the pilot program in the year immediately preceding the
report and since the beginning of the pilot program.
(L) The cost to the Department of Veterans Affairs per
resident placed under the pilot program at each covered
facility.
(M) The number of residents under the pilot program hired
by the Secretary to work in the Veterans Health
Administration after completion of residency in the year
immediately preceding the report and since the beginning of
the pilot program.
(N) The medical specialties pursued by residents under the
pilot program.
(d) Duration.--The pilot program under this section shall
terminate on August 7, 2024.
TITLE V--OTHER MATTERS
SEC. 501. ANNUAL REPORT ON PERFORMANCE AWARDS AND BONUSES
AWARDED TO CERTAIN HIGH-LEVEL EMPLOYEES OF THE
DEPARTMENT.
(a) In General.--Chapter 7 of title 38, United States Code,
is amended by adding at the end the following new section:
``Sec. 726. Annual report on performance awards and bonuses
awarded to certain high-level employees
``(a) In General.--Not later than 100 days after the end of
each fiscal year, the Secretary shall submit to the
appropriate committees of Congress a report that contains,
for the most recent fiscal year ending before the submittal
of the report, a description of all performance awards or
bonuses awarded to each of the following:
``(1) Regional Office Director of the Department.
``(2) Director of a Medical Center of the Department.
``(3) Director of a Veterans Integrated Service Network.
``(4) Senior executive of the Department.
``(b) Elements.--Each report submitted under subsection (a)
shall include the following with respect to each performance
award or bonus awarded to an individual described in such
subsection:
``(1) The amount of each award or bonus.
``(2) The job title of the individual awarded the award or
bonus.
``(3) The location where the individual awarded the award
or bonus works.
``(c) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means
the Committees on Veterans' Affairs and Appropriations of the
Senate and House of Representatives.
``(2) The term `senior executive' means--
[[Page H4037]]
``(A) a career appointee; or
``(B) an individual--
``(i) in an administrative or executive position; and
``(ii) appointed under section 7306(a) or section 7401(1)
of this title.
``(3) The term `career appointee' has the meaning given
that term in section 3132(a) of title 5, United States
Code.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 725 the following new item:
``726. Annual report on performance awards and bonuses awarded to
certain high-level employees.''.
SEC. 502. ROLE OF PODIATRISTS IN DEPARTMENT OF VETERANS
AFFAIRS.
(a) Inclusion as Physician.--
(1) In general.--Subchapter I of chapter 74 is amended by
adding at the end the following new section:
``Sec. 7413. Treatment of podiatrists; clinical oversight
standards
``(a) Podiatrists.--Except as provided by subsection (b), a
doctor of podiatric medicine who is appointed as a podiatrist
under section 7401(1) of this title is eligible for any
supervisory position in the Veterans Health Administration to
the same degree that a physician appointed under such section
is eligible for the position.
``(b) Establishment of Clinical Oversight Standards.--The
Secretary, in consultation with appropriate stakeholders,
shall establish standards to ensure that specialists
appointed in the Veterans Health Administration to
supervisory positions do not provide direct clinical
oversight for purposes of peer review or practice evaluation
for providers of other clinical specialties.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 74 is amended by inserting after the
item relating to section 7412 the following new item:
``7413. Treatment of podiatrists; clinical oversight standards.''.
(b) Modification and Clarification of Pay Grade.--
(1) Grade.--The list in section 7404(b) of such title is
amended--
(A) by striking ``PHYSICIAN AND DENTIST SCHEDULE'' and
inserting ``PHYSICIAN AND SURGEON (MD/DO), PODIATRIC SURGEON
(DPM), AND DENTIST AND ORAL SURGEON (DDS, DMD) SCHEDULE'';
(B) by striking ``Physician grade'' and inserting
``Physician and surgeon grade''; and
(C) by striking ``PODIATRIST, CHIROPRACTOR, AND'' and
inserting ``CHIROPRACTOR AND''.
(2) Application.--The amendments made by paragraph (1)
shall apply with respect to a pay period of the Department of
Veterans Affairs beginning on or after the date that is 30
days after the date of the enactment of this Act.
SEC. 503. DEFINITION OF MAJOR MEDICAL FACILITY PROJECT.
(a) Modification of Definition of Medical Facility.--
Section 8101(3) is amended by striking ``Secretary'' and all
that follows through ``nursing home,'' and inserting
``Secretary, or as otherwise authorized by law, for the
provision of health-care services (including hospital,
outpatient clinic, nursing home,''.
(b) Modification of Definition of Major Medical Facility
Project.--Paragraph (3) of section 8104(a) is amended to read
as follows:
``(3) For purposes of this subsection, the term `major
medical facility project' means a project for the
construction, alteration, or acquisition of a medical
facility involving a total expenditure of more than
$20,000,000, but such term does not include an acquisition by
exchange, nonrecurring maintenance projects of the
Department, or the construction, alteration, or acquisition
of a shared Federal medical facility for which the
Department's estimated share of the project costs does not
exceed $20,000,000.''.
SEC. 504. AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY
PROJECTS OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Authorization.--The Secretary of Veterans Affairs may
carry out the following major medical facility project, to be
carried out in an amount not to exceed the amount specified
for that project: Construction of the new East Bay Community
Based Outpatient Clinic and all associated site work,
utilities, parking, and landscaping, construction of the
Central Valley Engineering and Logistics support facility,
and enhanced flood plain mitigation at the Central Valley and
East Bay Community Based Outpatient Clinics as part of the
realignment of medical facilities in Livermore, California,
in an amount not to exceed $117,300,000.
(b) Authorization of Appropriations for Construction.--
There is authorized to be appropriated to the Secretary of
Veterans Affairs for fiscal year 2018 or the year in which
funds are appropriated for the Construction, Major Projects
account, $117,300,000 for the project authorized in
subsection (a).
(c) Submittal of Information.--Not later than 90 days after
the date of the enactment of this Act, for the project
authorized in subsection (a), the Secretary of Veterans
Affairs shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the
House of Representatives the following information:
(1) A line item accounting of expenditures relating to
construction management carried out by the Department of
Veterans Affairs for such project.
(2) The future amounts that are budgeted to be obligated
for construction management carried out by the Department for
such project.
(3) A justification for the expenditures described in
paragraph (1) and the future amounts described in paragraph
(2).
(4) Any agreement entered into by the Secretary regarding a
non-Department of Veterans Affairs Federal entity providing
management services relating to such project, including
reimbursement agreements and the costs to the Department for
such services.
SEC. 505. DEPARTMENT OF VETERANS AFFAIRS PERSONNEL
TRANSPARENCY.
(a) Publication of Staffing and Vacancies.--
(1) Website required.--Subject to paragraph (2) and not
later than 90 days after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall make publicly
available on an Internet website of the Department of
Veterans Affairs the following information, which shall,
subject to subparagraph (D), be displayed by departmental
component or, in the case of information relating to Veterans
Health Administration positions, by medical facility:
(A) The number of personnel encumbering positions.
(B) The number of accessions and separation actions
processed during the quarter preceding the date of the
publication of the information.
(C) The number of vacancies, by occupation.
(D) The percentage of new hires for the Department who were
hired within the time-to-hire target of the Office of
Personnel Management, disaggregated by administration.
(2) Exceptions.--The Secretary may withhold from
publication under paragraph (1) information relating to law
enforcement, information security, or such positions in the
Department that the Secretary determines to be sensitive.
(3) Update of information.--The Secretary shall update the
information on the website required under paragraph (1) on a
quarterly basis.
(4) Treatment of contractor positions.--Any Department of
Veterans Affairs position that is filled with a contractor
may not be treated as a Department position for purposes of
the information required to be published under paragraph (1).
(5) Inspector general review.--On a semi-annual basis, the
Inspector General of the Department shall review the
administration of the website required under paragraph (1)
and make recommendations relating to the improvement of such
administration.
(b) Report to Congress.--The Secretary of Veterans Affairs
shall submit to Congress an annual report on the steps the
Department is taking to achieve full staffing capacity. Each
such report shall include the amount of additional funds
necessary to enable the Department to reach full staffing
capacity.
SEC. 506. PROGRAM ON ESTABLISHMENT OF PEER SPECIALISTS IN
PATIENT ALIGNED CARE TEAM SETTINGS WITHIN
MEDICAL CENTERS OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Program Required.--The Secretary of Veterans Affairs
shall carry out a program to establish not fewer than two
peer specialists in patient aligned care teams at medical
centers of the Department of Veterans Affairs to promote the
use and integration of services for mental health, substance
use disorder, and behavioral health in a primary care
setting.
(b) Timeframe for Establishment of Program.--The Secretary
shall carry out the program at medical centers of the
Department as follows:
(1) Not later than May 31, 2019, at not fewer than 15
medical centers of the Department.
(2) Not later than May 31, 2020, at not fewer than 30
medical centers of the Department.
(c) Selection of Locations.--
(1) In general.--The Secretary shall select medical centers
for the program as follows:
(A) Not fewer than five shall be medical centers of the
Department that are designated by the Secretary as polytrauma
centers.
(B) Not fewer than ten shall be medical centers of the
Department that are not designated by the Secretary as
polytrauma centers.
(2) Considerations.--In selecting medical centers for the
program under paragraph (1), the Secretary shall consider the
feasibility and advisability of selecting medical centers in
the following areas:
(A) Rural areas and other areas that are underserved by the
Department.
(B) Areas that are not in close proximity to an active duty
military installation.
(C) Areas representing different geographic locations, such
as census tracts established by the Bureau of the Census.
(d) Gender-Specific Services.--In carrying out the program
at each location selected under subsection (c), the Secretary
shall ensure that--
(1) the needs of female veterans are specifically
considered and addressed; and
(2) female peer specialists are made available to female
veterans who are treated at each location.
(e) Engagement With Community Providers.--At each location
selected under subsection (c), the Secretary shall consider
ways in which peer specialists can conduct outreach to health
care providers in the community who are known to be serving
veterans to engage with those providers and veterans served
by those providers.
(f) Reports.--
(1) Periodic reports.--
(A) In general.--Not later than 180 days after the date of
the enactment of this Act, and not less frequently than once
every 180 days thereafter until the Secretary determines that
the program is being carried out at the last location to be
selected under subsection (c), the Secretary shall submit to
Congress a report on the program.
(B) Elements.--Each report required by subparagraph (A)
shall, with respect to the 180-day period preceding the
submittal of the report, include the following:
(i) The findings and conclusions of the Secretary with
respect to the program.
(ii) An assessment of the benefits of the program to
veterans and family members of veterans.
[[Page H4038]]
(iii) An assessment of the effectiveness of peer
specialists in engaging under subsection (e) with health care
providers in the community and veterans served by those
providers.
(2) Final report.--Not later than 180 days after the
Secretary determines that the program is being carried out at
the last location to be selected under subsection (c), the
Secretary shall submit to Congress a report detailing the
recommendations of the Secretary as to the feasibility and
advisability of expanding the program to additional
locations.
SEC. 507. DEPARTMENT OF VETERANS AFFAIRS MEDICAL SCRIBE PILOT
PROGRAM.
(a) In General.--The Secretary of Veterans Affairs shall
carry out a two-year pilot program under which the Secretary
shall increase the use of medical scribes at Department of
Veterans Affairs medical centers.
(b) Locations.--The Secretary shall carry out the pilot
program at the 10 medical centers of the Department as
follows:
(1) At least four such medical centers located in rural
areas.
(2) At least four such medical centers located in urban
areas.
(3) Two such medical centers located in areas with need for
increased access or increased efficiency, as determine by the
Secretary.
(c) Medical Scribes.--
(1) Hiring.--Under the pilot program the Secretary shall--
(A) hire 20 new Department of Veterans Affairs term
employees as medical scribes; and
(B) seek to enter into contracts with appropriate entities
for the employment of 20 additional medical scribes.
(2) Distribution.--The Secretary shall assign four medical
scribes to each of the 10 medical centers of the Department
where the Secretary carries out the pilot program as follows:
(A) Two scribes shall be assigned to each of two
physicians.
(B) Thirty percent of the scribes shall be employed in the
provision of emergency care.
(C) Seventy percent of the scribes shall be employed in the
provision of speciality care in specialties with the longest
patient wait times or lowest efficiency ratings, as
determined by the Secretary.
(d) Reports.--
(1) Reports to congress.--Not later than 180 days after the
commencement of the pilot program required under this
section, and every 180 days thereafter for the duration of
the pilot program, the Secretary of Veterans Affairs shall
submit to Congress a report on the pilot program. Each such
report shall include each of the following:
(A) A separate analysis of each the following with respect
to medical scribes employed by the Department of Veterans
Affairs and medical scribes performing Department of Veterans
Affairs functions under a contract:
(i) Provider efficiency.
(ii) Patient satisfaction.
(iii) Average wait time.
(iv) The number of patients seen per day by each physician
or practitioner.
(v) The amount of time required to hire and train an
employee to perform medical scribe functions under the pilot
program.
(B) Metrics and data for analyzing the effects of the pilot
program, including an evaluation of the each of the elements
under clauses (i) through (iv) of subparagraph (A) at medical
centers who employed scribes under the pilot program for an
appropriate period preceding the hiring of such scribes.
(2) Comptroller general report.--Not later than 90 days
after the termination of the pilot program under this
section, the Comptroller General of the United States shall
submit to Congress a report on the pilot program. Such report
shall include a comparison of the pilot program with similar
programs carried out in the private sector.
(e) Definitions.--In this section:
(1) The term ``medical scribe'' means an unlicensed
individual hired to enter information into the electronic
health record or chart at the direction of a physician or
licensed independent practitioner whose responsibilities
include the following:
(A) Assisting the physician or practitioner in navigating
the electronic health record.
(B) Responding to various messages as directed by the
physician or practitioner.
(C) Entering information into the electronic health record,
as directed by the physician or practitioner.
(2) The terms ``urban'' and ``rural'' have the meanings
given such terms under the rural-urban commuting codes
developed by the Secretary of Agriculture and the Secretary
of Health and Human Services.
(f) Funding.--The pilot program under this section shall be
carried out using amounts otherwise authorized to be
appropriated for the Department of Veterans Affairs. No
additional amounts are authorized to be appropriated to carry
out such program.
SEC. 508. EXTENSION OF REQUIREMENT TO COLLECT FEES FOR
HOUSING LOANS GUARANTEED BY SECRETARY OF
VETERANS AFFAIRS.
Section 3729(b)(2) of title 38, United States Code, is
amended by striking ``2027'' each place it appears and
inserting ``2028''.
SEC. 509. EXTENSION OF REDUCTION IN AMOUNT OF PENSION
FURNISHED BY DEPARTMENT OF VETERANS AFFAIRS FOR
CERTAIN VETERANS COVERED BY MEDICAID PLANS FOR
SERVICES FURNISHED BY NURSING FACILITIES.
Section 5503(d)(7) of title 38, United States Code, is
amended by striking ``September 30, 2027'' and inserting
``September 30, 2028''.
SEC. 510. APPROPRIATION OF AMOUNTS.
(a) Veterans Choice Program.--There is authorized to be
appropriated, and is appropriated, to the Secretary of
Veterans Affairs, out of any funds in the Treasury not
otherwise appropriated, $5,200,000,000 to be deposited in the
Veterans Choice Fund under section 802 of the Veterans
Access, Choice, and Accountability Act of 2014 (Public Law
113-146; 38 U.S.C. 1701 note).
(b) Availability of Amounts.--The amounts appropriated
under subsection (a) shall be available for obligation or
expenditure without fiscal year limitation.
SEC. 511. TECHNICAL CORRECTION.
Section 1712I of title 38, United States Code, is
redesignated as section 1720I of such title.
SEC. 512. BUDGETARY EFFECTS.
(a) Statutory Pay-As-You-Go Scorecards.--The budgetary
effects of this Act shall not be entered on either PAYGO
scorecad maintained pursuant to section 4(d) of the Statutory
Pay-As-You-Go Act of 2010.
(b) Senate PAYGO Scorecards.--The budgetary effects of this
Act shall not be entered on any PAYGO scorecard maintained
for purposes of section 4106 of H. Con. Res. 71 (115th
Congress).
The SPEAKER pro tempore. The bill, as amended, 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 Tennessee (Mr. Roe) and the gentleman from
Minnesota (Mr. Walz) each will control 30 minutes.
The Chair recognizes the gentleman from Tennessee.
General Leave
Mr. ROE of Tennessee. Mr. Speaker, I ask unanimous consent that all
Members have 5 legislative days in which to revise and extend their
remarks and insert extraneous material in the Record on S. 2372, as
amended.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Tennessee?
There was no objection.
Mr. ROE of Tennessee. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise today in support of my bill, the John S. McCain
III; the Daniel K. Akaka; and with great honor, the Samuel R. Johnson
Department of Veterans Affairs Maintaining Internal Systems and
Strengthening Integrated Outside Networks Act of 2018, or the VA
MISSION Act.
This bill exemplifies exactly how Congress should work. It is a
bipartisan, bicameral compromise agreement between the House and Senate
Veterans' Affairs Committees that was crafted over the last year and a
half through regular order and in close coordination with stakeholders
and advocates in VA, the White House, the military and veterans service
organizations, and the broader health community.
It is also aptly named after Senator McCain, late Senator Akaka, and
Congressman Sam Johnson, three great Americans whose lives and work
exemplify service and statesmanship. The MISSION Act is also aptly
named in that it would address and reaffirm Congress' commitment to
VA's core and most important mission: caring for, as President Lincoln
said, those who have borne the battle.
There are five main components of the MISSION Act. Each of these
components on their own would be noteworthy and significant. Together,
they are transformational.
The first component of the MISSION Act would consolidate and improve
VA's community care programs. VA uses several different methods to
refer veterans to community providers today. The most recent and
notable method is the Choice Program, which Congress created following
the nationwide access and accountability crisis in 2014. All of those
methods serve different purposes and employ different business
processes, reimbursement rates, and eligibility criteria. That creates
a tremendous and increasing amount of confusion and consternation from
VA employees, community providers, and VA patients.
The MISSION Act would consolidate all of those methods into a single,
streamlined VA community care program that is easier to understand,
administer, and deliver to veterans who need it. This would increase
access to timely quality care in every community across the country
and, in doing so, expand VA's reach and veterans' choice. It would also
return all VA community care funding to the discretionary side of the
ledger, thereby increasing transparency and accountability for the
hard-earned taxpayer dollars that VA receives.
[[Page H4039]]
The second component of the MISSION Act would address the pending
shortfall in the Choice fund. When Congress created the Choice Program
4 years ago, it also created the Choice fund and stipulated that the
program would end when the fund ran dry. Congress has acted time and
time again to prevent that from happening in recognition of the
millions of veterans who rely on the Choice Program despite its
imperfections.
However, Acting VA Secretary Wilkie sent a letter just last week
declaring that the remaining funds in the Choice fund will be exhausted
as early as May 31, just 2 weeks from today. The consequences of that
have the potential to be catastrophic for veterans, with Acting
Secretary Wilkie warning that wait times will increase, access to care
will decrease, continuity of care will be disrupted, and valuable
community partnerships will be damaged.
To prevent that, the MISSION Act would authorize and appropriate $5.2
billion to the Choice fund. This would prevent an access-to-care crisis
from occurring in the immediate future and provide sufficient funding
to allow the Choice Program to continue serving veteran patients over
the next year until the new, consolidated community care program is
implemented.
The third component of the MISSION Act would address VA's massive and
misaligned physical footprint. VA is one of the largest property-
holding entities in the Federal Government with a capital asset
portfolio that includes thousands of medical facilities spanning
hundreds of millions of square feet.
The average VA medical facility building is more than five times
older than the average building in the not-for-profit system in this
country, with some VA facilities being much older than that. For
example, the VA medical center in my hometown of Johnson City,
Tennessee, was built in 1903 to care for Civil War veterans. It is
still seeing patients today.
Since being named chairman of the Committee on Veterans' Affairs a
year and a half ago, I have made it a priority to travel to VA
facilities across the country. While many of them are doing great work,
they are operating out of facilities that were designed and built to
meet antiquated healthcare needs and delivery models.
Those facilities are increasingly impossible to manage and maintain
in accordance with modern standards and the ever-changing shifts in the
veteran population, not to mention that demand for care is growing
progressively more costly and complex in Tennessee and across the
country.
The Asset and Infrastructure Review, or AIR, Act process that the
MISSION Act would create is based on a recommendation from the
bipartisan Commission on Care that was put together by President Obama.
It would create an open, objective, politically insulated process to
recommend how VA's massive physical footprint can be realigned and
brought up to date. This would transform the VA healthcare system that
we know today into one that is stronger, more efficient, and better
able to meet the healthcare needs of veterans, now and for generations
of veterans to come.
None of us who are lucky enough to have a VA facility in their
backyard, as I do, want to contemplate a future where that facility may
change or disappear. But without action as bold, brave, and potentially
transformative as the AIR Act is, the long-term success and
sustainability of the VA healthcare system is in serious question, and
veterans will suffer the consequences.
I want to assure those who may still be concerned about AIR that they
will have nothing to fear from it. I worked closely with a wide variety
of veteran service organizations to ensure that the AIR process takes
and includes a high level of veteran, VSO, stakeholder, and community
involvement--both locally and nationally--and to make sure no AIR
recommendation would occur behind closed doors without an open
discussion and a review of all the relevant facts, with every option
and opportunity left on the table.
It is my firm belief that AIR will result in a modern, streamlined VA
healthcare system but not necessarily a markedly smaller one. VA is
going to remain a presence in communities large and small, and no
facility that is needed to care for veteran patients or that has a
worthy service to provide them will be negatively impacted.
The fourth component of the MISSION Act will be to expand the Family
Caregiver Program to the caregivers of pre-9/11 veterans. Congress
created the Family Caregiver Program in 2010 to provide services and
supports, including a monthly stipend payment and healthcare coverage,
if needed, to caregivers of post-9/11 veterans.
Caregivers provide an invaluable service, often at great personal
sacrifice, to those veterans who have been seriously injured in the
line of duty. Caregivers know no age or era, but for far too long the
Family Caregiver Program has been restricted to an inequality based on
era of service. The MISSION Act would correct that serious inequity and
finally give pre-9/11 caregivers the recognition they deserve.
The fifth and the final component of the MISSION Act would be to
enhance the internal capacity of the VA healthcare system to care for
veteran patients internally. Opponents of this bill will tell you
falsely that it is aimed at eventual privatization of the VA healthcare
system. That misconception is based on nothing but fear and rhetoric, I
think.
The MISSION Act contains numerous provisions that would make it
easier for VA to attract high-quality commissions and other
professionals and put them to work in VA medical facilities, just as I
have done. It also contains numerous provisions that would make it
easier for the providers already working in VA hospitals and clinics to
see more veteran patients and to be recognized and rewarded for their
great work.
Together, these provisions would fortify the VA healthcare system and
make sure it stays strong and able to provide the care that it is meant
to provide.
Before closing, I want to take a moment to recognize some people:
Chairman Johnny Isakson and Ranking Member Tester of the Senate
Committee on Veterans' Affairs. Chairman Isakson and Ranking Member
Tester have been steadfast partners over the last year and over the
last several weeks, in particular. The MISSION Act would not be a
reality without their good-faith efforts to work hand in hand with me
and with our veteran service organization partners to overcome our
differences and craft a bipartisan, bicameral compromise bill that
veterans and their families can be proud of. Mr. Speaker, I want to
thank them for their leadership and for their friendship.
I am also grateful for the many members of the committee from both
sides of the aisle and both sides of the Capitol, including Ranking
Member Walz, and to our VSO partners in the community, the VA, and in
the White House who have worked hard over the last year and a half to
craft and consider many of the provisions that make up the MISSION Act.
Finally, I want to thank President Trump for his leadership and
steadfast commitment to veterans since taking office. This bill would
not have been possible without his vocal leadership. This may well be
the most impactful vote that any of us will ever take for our Nation's
veterans.
And before I finish, I also want to thank the staffs on both sides of
the aisle, both in the Senate and in the House, both Republican and
Democrat, for their incredible hard work, the many hours behind the
scenes that you never see, that the public never sees, that I certainly
appreciate and I believe Ranking Member Walz does too, the hard work of
our staffs.
A ``yes'' vote is a vote for access, for quality, for choice, for the
long-term success and sustainability of the VA healthcare system, for
caregivers and for veterans. And for that I would recommend a positive
``yes'' vote.
The MISSION Act is supported by every major military and veteran
service organization that rightfully recognizes this as a monumental
and historic opportunity to support a bill that will positively impact
the daily lives and well-being of millions of veterans and their
families and fundamentally shape and improve the second largest agency
in the Federal Government.
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I urge every single one of my colleagues to stand today with me and
[[Page H4040]]
these organizations dedicated to the service of veterans,
servicemembers, and their families, and, most importantly, our Nation's
veterans, and support the VA MISSION Act.
Mr. Speaker, I include in the Record a letter from the VSO in support
of the MISSION Act.
May 7, 2018.
Hon. Phil Roe,
Chairman, House Veterans' Affairs Committee, Washington, DC.
Hon. Johnny Isakson,
Chairman, Senate Veterans Affairs Committee, Washington, DC.
Hon. Tim Walz,
Ranking Member, House Veterans' Affairs Committee,
Washington, DC.
Hon. Jon Tester,
Ranking Member, Senate Veterans' Affairs Committee,
Washington, DC.
Dear Chairman Roe, Ranking Member Walz, Chairman Isakson
and Ranking Member Tester: On behalf of the millions of
veterans, service members and family members we represent and
advocate for, we offer our strong support for the ``VA
Maintaining Internal Systems and Strengthening Integrated
Outside Networks Act of 2018,'' also known as the ``VA
MISSION Act of 2018.'' This historic veterans legislation
would consolidate and reform VA's community care programs;
extend funding for the current Veterans Choice Program for
one year; strengthen VA's ability to recruit, hire and retain
quality medical personnel; review, realign and modernize VA's
health care infrastructure; and extend eligibility to VA's
comprehensive caregiver assistance program to aging and
disabled veterans injured before September 11, 2001.
Our organizations strongly support expanding eligibility
for VA's comprehensive caregiver program to all generations
of seriously disabled veterans, while maintaining the
caregiver benefits that are currently available. Today, this
program provides full comprehensive caregiver assistance only
to veterans injured on or after September 11, 2001, leaving
family caregivers and veterans injured during World War II,
the Korean, Vietnam and Gulf Wars ineligible for this
critical support. The legislation will help to correct this
injustice and we--along with millions of members in our
organizations--applaud you for taking this action and look
forward to working in the future to ensure that both injured
and ill veterans from all eras are eligible for this benefit.
The legislation would consolidate VA's community care
programs and develop integrated networks of VA and community
providers to supplement, not supplant VA health care, so that
all enrolled veterans have timely access to quality medical
care. The bill includes funding to continue the current
Choice Program for an additional year until the new community
care program is implemented as well as important workforce
improvement provisions to strengthen VA's internal capacity
to delivery care. This carefully crafted compromise
represents a balanced approach to ensuring timely access to
care while continuing to strengthen the VA health care system
that millions of veterans choose and rely on.
The legislation also includes a new Asset and
Infrastructure Review (AIR) process intended to design and
implement a comprehensive plan to optimize and modernize VA's
medical care facilities. The AIR process would provide
meaningful stakeholder involvement, transparency and other
safeguards during the review process to help ensure the final
result leads to a stronger and better aligned VA
infrastructure able to deliver care to veterans when and
where they need it.
Since the access and waiting list crisis exploded in 2014,
Congress, VA and veterans leaders have debated how best to
strengthen and reform the delivery of veterans health care to
ensure timely and seamless access for enrolled veterans. The
legislation before the Committee would take a major step
towards that goal by making improvements to and investments
in the VA health care system, creating integrated networks so
that veterans have access to care when and where they need
it, and providing the further recognition and assistance to
family caregivers of severely disabled veterans deserve.
As leaders of the nation's veterans and military service
organizations, we thank you for your steadfast leadership in
crafting this important bipartisan bill and call on all
members of Congress to seize this historic opportunity to
improve the lives of veterans, their families and caregivers
by swiftly passing the ``VA MISSION Act of 2018.'' The men
and women who have served, are serving and will serve in the
future are counting on Congress' support.
Respectfully,
Garry J. Augustine, Washington Executive Director, DAV
(Disabled American Veterans); Verna L Jones, Executive
Director, The American Legion; Joseph R. Chenelly,
Executive Director, AMVETS; Dana T. Atkins, Lieutenant
General, U.S. Air Force (Ret.), President, Military
Officers Association of America; Robert E. Wallace,
Executive Director, Veterans of Foreign Wars of the
United States; Carl Blake, Executive Director,
Paralyzed Veterans of America; Rick Weidman, Executive
Director of Policy, Vietnam Veterans of America; Rene
Bardof, Senior Vice President, Government & Community
Relations, Wounded warrior Project; Paul Rieckhoff,
Founder and CEO, Iraq and Afghanistan Veterans of
America; Joseph C. Bogart MA, Executive Director,
Blinded Veterans Association; Thomas J. Snee, National
Executive Director, Fleet Reserve Association; Kristina
Kaufmann, Executive director, Code of Support
Foundation.
Paul K. Hopper, Colonel, USMC (Ret.), National President,
Marine Corps Reserve Association; James T. (Jim)
Currie, Ph.D., Colonel, USA (Ret.), Executive Director,
Commissioned Officers Association of the U.S. Public
Health Service; Neil Van Ess, National Commander,
Military Order of the Purple Heart; Steve Schwab,
Executive Director, Elizabeth Dole Foundation; Bonnie
Carroll, President and Founder, Tragedy Assistance
Program for Survivors; Jon Ostrowski, Senior Chief
USCGR, Retired, Director, Government Affairs, Non
Commissioned Officers Association; Michael Cowan MD,
VADM USN (Ret), Executive Director, AMSUS; Randy Reid,
Executive Director, U.S. Coast Guard Chief Petty
Officers, Association; Deirdre Park Holleman, Esq.
Washington Executive Director, The Retired Enlisted
Association; John H. Madigan, Jr, Vice President and
Chief Public Policy Officer, American Foundation for
Suicide Prevention; CW4 (Ret.) Jack Du Teil, Executive
Director, United States Army Warrant Officers,
Association; Jim Lorraine, President & CEO, America's
Warrior Partnership.
Mr. ROE of Tennessee. Mr. Speaker, I reserve the balance of my time.
Mr. WALZ. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I would like to say the chairman's description of how
this process was done was absolutely 100 percent accurate. The sense of
bipartisanship that went into the writing of this bill, the sense of
purpose in shared values on caring for our veterans, the sense of
dignity and respect that was given to the minority side in dissenting
opinions both from the chairman and his staff was exemplary and what we
should all expect out of our leadership.
This is a piece of legislation that has components of it that have
literally been with me or been on my mind or things that I have tried
to effect for literally two-thirds of my life--24 years in that uniform
and 12 years here.
Much of this, I am proud to have been part of the original authors
with the chairman in writing that, and it brings me to a strange
position today. I am rising personally in opposition, and I say that
this will be my last opportunity to vote on the Choice Act.
I will be leaving this Congress after this term, and after many
positive things--and I have said it time and time again. The leadership
that the gentleman from Tennessee (Mr. Roe) is showing will probably
not be parallel in terms of care for veterans in the way that he has
approached this. This piece of legislation is critically important--the
caregivers piece in it, the piece on dealing with VA assets and how we
look at capacity going forward, and, of course, Choice.
And I would like to say--and especially to my friend, Sam Johnson--
very few words need to be said about Sam Johnson. We served on the POW/
MIA Commission in dealing with finding the lost remains of our warriors
and dealing directly with the Russian Government. And when Sam
Johnson's name is mentioned anywhere around the world, people stop and
listen. So it is appropriate. I thank the chairman for naming that,
and, of course, with Senators Akaka and McCain.
My concerns on this. This is not a symptom of the VA Committee. The
VA Committee did exactly what it was supposed to do. The chairman did
exactly what he was supposed to do. The VSOs did exactly what they were
supposed to do. But I think this is my last chance to voice, how do we
ever get to the point where we look at long-term stability. How do we
ever get to the point--three times we had to do--and the chairman is
right. I have no doubt that this body, because of the care for veterans
on both sides, will do whatever is necessary when we run short, and we
will.
And next May, when we hit the discretionary spending caps and things
had to be made, I have no doubt, under the chairman's leadership, we
will find a fix, or whoever sits in that chair will try and find that
fix. I thought, and still believe to this day, this was our opportunity
to look at that long-term care--the issue that was going to be the
stability of VA care.
The Congressional Budget Office estimates this bill is going to cost
$47 billion over 5 years. There is not an
[[Page H4041]]
American taxpayer that would not pay every penny of that to go to care
of veterans. This is not about trying to figure that piece of it out.
Paying for veterans care in the community is going to cost $22 billion
on that.
I agree that reforming Choice Programs, consolidating the VA's seven
other community care programs is needed. And I agree transferring this
funding of the Choice Program to discretionary funding so the VA can
budget for the increased cost and all healthcare is paid by that fund.
We must ensure the high cost of community care, though, does not force
the VA to cut other critical veterans services.
It is unfortunate that we have chosen to solve this problem on the
mandatory side by exempting VA care from statutory PAYGO, but we are
not going to do that in the future on the care in the community. It is
not a problem that is going to occur years from now. Everybody in here
who is coming back--and the voters will tell you if you are or not--is
coming. The cost of community care is so expensive, we will not get
through fiscal year 2019 without a similar exemption on the
discretionary side.
This bill fails to address how VA will fund all of its other programs
once this transfer occurs. The Bipartisan Budget Act deal raised VA's
caps by $4 billion to improve VA infrastructure. This increased
discretionary funding responsibility for community care is going to
undermine that deal, forcing VA to cut its own programs and use money
designated for VA infrastructure to fund community care.
That is a choice we can make, and it is a choice that has to be made.
I am just suggesting today that with the good will, the smart policies,
the leadership that was here, maybe we should have gone for the whole
one on this.
I will take the critique that looking for the perfect and throwing
away the good is a fair critique. I am just not sure, in a Congress
with a $21 trillion deficit and a discretionary spending budget that
could be eaten up across there, when is that hard decision ever going
to be made?
It could mean that care provided in VA hospitals and clinics,
construction and maintenance of those facilities, veterans homelessness
programs, and VA research will have to see cuts under the way the law
is made to make sure community care is funded. It could cause cuts to
programs across the Federal Government, including programs that help
veterans with job training, employment assistance, or veterans
treatment courts. Even the expansion of eligibility for caregiver
assistance for all veterans of all generations--a key part of this bill
supported by everyone here--could face cuts if VA hits those spending
caps.
Now, all of us here, it is the job of this committee to be the
authorizing committee, so don't get me wrong. I am not going to put the
pressure where the White House was or to the appropriators, but the
fact of the matter is, after this vote, the Caregiver Support Program
has zero dollars in it. No dollars in it. They are going to have to
come from somewhere, and a budget that the chairman has rightfully told
us has increased fourfold in the last 10 years, we are going to have to
come to grips with that.
I am not suggesting you cut it. I am just suggesting that we budget
honestly on this so we don't run into this nightmare scenario that is
coming in May of 2019. There are concerns over long-term sustainability
without qualified leadership in place to successfully implement the
program.
Here is what I am worried about. If this committee and even this
Congress were responsible for implementation, but once it leaves here,
it goes to the executive branch, I, as the ranking member of the House
VA Committee, am not quite sure who to call up there right now in this
transition. We have been 40 days without a VA Secretary. We don't have
one, that I know of, scheduled to go in front of the Senate for
confirmation at this point in time.
So we are willing to capitulate the authority, the ability to give
this over there, and decisions that are going to affect generational
care in the VA to somebody yet to be placed. That leadership piece
scares me. But again, some of it is relieved because I know you have
got leadership in this House. I know you have got a chairman who cares,
wants to get this right, I trust, to carry that oversight out.
The problem is, administrations come and go; secretaries comes and
go; Members of Congress come and go. That is why we do statutory
requirements on spending. That is why this is now discretionary
spending. That is why there are caps in place that cannot be violated,
and decisions will be made where that is going to come from.
Also, a shortage of 33,000 health providers in the VA and a $10
billion backlog to fix needed facilities that have ``D'' or ``F'' life
conditions, that we should be doing more to address that internal care.
I agree. These reforms are needed. I agree that these programs were
debated in a logical, a fair, and open manner. We got much of what
needed to be done in this. We got much of what is good.
The chairman took this process--exactly what should be expected of
us. My responsibility, as the final time that I will stand here to talk
about how we fund Choice and how we get going for long-term
sustainability, is to ask us to just put in--and we had a couple of
amendments that could do this--ask us with some capacity to be able to
fix that cap piece in this and look for that long-term sustainability.
Mr. Speaker, I reserve the balance of my time.
Mr. ROE of Tennessee. Mr. Speaker, I yield 4 minutes to the gentleman
from Texas (Mr. Sam Johnson), one of my personal heroes. One of the
greatest privileges I have had in the 9\1/2\ years I have served in
this U.S. Congress is to serve with Sam Johnson.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I first want to thank Chairman
Roe for his strong support of our veterans and for the incredible honor
he does Senators Akaka, McCain, and myself with the bipartisan bill
before us. I am truly humbled by this gesture, and I am sure it also
means a lot to my buddy John, his family, and Senator Akaka's family as
well. Both of these men served during wartime.
Many folks know that John and I were POWs at Hanoi Hilton, and I will
always admire his courage in rejecting the North Vietnamese offer to go
home early. They, of course, did this in an effort to break the spirit
of other POWs. No one but another POW knows the strength and heartbreak
it takes to deny yourself the hope of home when your future and life
are uncertain. I say this as a fellow POW who spent nearly 7 years in
that hellhole Earth.
Mr. Speaker, I served 29 years in the United States Air Force and
fought in both the Korean and Vietnam wars, so I understand the
sacrifices our servicemembers make to protect the freedom of every
American. It is only right that in return for their faithful service,
our veterans get the quality healthcare they need and deserve when they
return home. That is why one of my proudest accomplishments is the
establishment of a VA community-based outpatient clinic in my hometown
of Plano, Texas. This facility was much needed in our community, and I
am proud to report it is expanding services for our veterans all the
time.
But as important as a VA facility is, they are not always convenient
for our veterans to visit. To address the fact that some veterans live
far from VA facilities or face longer wait times to see doctors,
Congress created the Choice Program.
Today's bill makes the Choice Program even better by bringing it
fully into the VA health system. That means all veterans actively
enrolled in the VA can go to a doctor in their community. You know that
is the right thing to do in the spirit, and I think this bill is
something we should all support.
Politics aside, may we all be mindful that our veterans have answered
the call to duty. They put their lives on the line on our behalf, and
their families serve alongside them as well. At the very at least, they
deserve to be treated with respect and appreciation for their service
and their sacrifice.
To all our veterans: God bless you and God bless America. I salute
you.
Mr. WALZ. Mr. Speaker, I thank the gentleman from Texas for bringing
inspiration to everybody in this body and across the country.
Mr. Speaker, I yield 3 minutes to the gentleman from California (Mr.
Takano), the vice ranking member of the House Committee on Veterans'
Affairs.
Mr. TAKANO. Mr. Speaker, I thank Ranking Member Walz for yielding me
[[Page H4042]]
the time and his steadfast leadership on the Veterans' Affairs
Committee. He has been tireless in his support of veterans and their
families. I am, likewise, inspired by the gentleman from Texas' service
to our country. I thank him for his service.
Mr. Speaker, the bill before us today is the culmination of years of
ongoing discussion about how to guarantee veterans have timely access
to quality care. It streamlines existing programs that allow veterans
to get care in the community, creates a process for aligning VA
facilities to meet the changing needs of the veteran population, and it
expands the Caregiver Support Program to all veterans.
{time} 1615
It should come as no surprise that I have serious concerns with this
bill. I voted against it when it was reported out of committee to
signal that it is not a perfect bill and that there are still
improvements to be made.
One of my biggest concerns has to do with funding. In that regard, I
share the concern of the ranking member. While previous funding for
Choice came from emergency mandatory funding, moving forward, the
program will receive discretionary funding and could break the budget
caps that trigger sequestration.
That is why I offered an amendment at the Rules Committee last night
that guaranteed that moving community care funding to the discretionary
side wouldn't count against the bipartisan budget caps we agreed to
just a few short months ago. It would help guarantee that we continue
to keep our promises to veterans by funding the full range of supports
and benefits that they are owed.
Unfortunately, that amendment was not made in order for us to
consider on the floor today. Without this critical amendment, I am
concerned we will be facing difficult choices, and I fear that veterans
will ultimately pay the price, and I mean that in a literal sense.
I have concerns about the process that brought us here today. I think
this bill needs a greater emphasis on building the VA's capacity, its
internal capacity, to provide veterans the specialized care that many
of them need. We need to do more to recruit and retain the best
providers to care for our veterans.
I wish that there were more guardrails in place as we begin asset
realignment, and I wish that we had a strong VA leadership in place
before moving forward with sweeping reforms. But, at the end of the
day, Mr. Speaker, I realize we can't keep doing emergency patches to
fund community care. We can't continue to look veterans in the eye when
we don't offer caregiver support services just because they served in
an era before 9/11. That is why I will reluctantly vote in favor of
this bill today.
The SPEAKER pro tempore (Mr. Mitchell). The time of the gentleman has
expired.
Mr. WALZ. Mr. Speaker, I yield an additional 30 seconds to the
gentleman from California.
Mr. TAKANO. I will reluctantly vote for this bill today.
Mr. ROE of Tennessee. Mr. Speaker, just for clarification, we have
been under cap since 2011. The VA budget has grown exponentially since
then. We have always done the right thing for our Nation's heroes and
will continue to do that.
Mr. Speaker, it is my privilege to yield 2 minutes to the gentleman
from Ohio (Mr. Wenstrup), my good friend. He served until he recently
moved to a different committee, as chairman of the Health Subcommittee.
He has been an active member of the Veterans' Affairs Committee and has
been a very valued member.
Mr. WENSTRUP. Mr. Speaker, I am humbled to follow Sam Johnson here at
this podium. I have been in Congress 6 years, and to think that he
spent 7 years incarcerated as a POW.
Mr. Speaker, I rise in support of the VA MISSION Act. This
legislation is about keeping our promises to those who safeguard our
freedoms.
As a member of the Army Reserve and a doctor in the Army, I am all
too familiar with the challenges plaguing the VA today. In 2014,
America witnessed the heartbreaking results of hidden VA wait lists,
and Congress quickly responded with the Veterans Choice Program to
ensure that no veteran was kept from care. Now, with the leadership of
Chairman Roe, we are delivering a lasting solution to get our deserving
veterans the care that they have earned and enacting real reforms for
the VA to succeed in the 21st century.
This bill will improve and streamline the VA's community care
programs, those outside the walls of the VA, into one cohesive program
and give a patient and their doctor more say in the process. This will
create a nonpartisan, transparent process to review the VA's
infrastructure assets, in line with the recommendation from the
Commission on Care.
This bill will expand the VA's post-9/11 caregiver program to all
eras of veterans.
The VA MISSION Act also includes my legislation, the VA Provider
Equity Act, which aims to enhance the ability of the VA to recruit and
retain in-demand surgical specialists, due, in part, to increased use
of IEDs in the last decade of war.
Mr. Speaker, if we don't act by May 31, 2018, the funding for the
Veterans Choice Program will run out, and veterans across America will
be unable to access healthcare.
Finally, I want to extend my sincere thanks and gratitude for the
tireless work of the entire VA Committee staff, and specifically
Christine Hill and Samantha Gonzalez, for the countless hours that they
have put in to getting this across the finish line.
Mr. Speaker, I am proud to sponsor the John McCain, Daniel Akaka, and
Samuel Johnson VA MISSION Act, named in honor of three American veteran
heroes, and I urge my colleagues to vote ``yes.''
Mr. WALZ. Mr. Speaker, I yield 4 minutes to the gentlewoman from
California (Ms. Brownley), my good friend, the ranking member of the
Subcommittee on Health.
Ms. BROWNLEY of California. Mr. Speaker, I thank the gentleman from
Minnesota for yielding, and I thank him, also, for his leadership on
the committee.
Mr. Speaker, I rise today in support of the VA MISSION Act because it
makes significant improvements to the VA that our Nation's veterans
have long been asking for, which will help deliver better care to the 9
million veterans enrolled in the VA.
While I recognize that this bill is not a perfect one, my mission and
the Veterans' Affairs Committee's mission has always been to provide
better access to high-quality care for our Nation's veterans, and this
bill advances that goal in a few very important ways.
First, the VA MISSION Act consolidates the various community care
programs, which will make it easier for veterans to use and for
providers to participate in.
The bill also expands the caregiver program, which is critical for
improving outcomes and quality of life for our veterans. This has been
a key priority for our Nation's veterans service organizations for
years.
Community nursing homes are five times more expensive than the
average cost of the caregiver program. Expanding the caregiver program
will save the VA and taxpayers money in the long run, all the while
allowing veterans to receive quality care and better care at home from
the people they trust the most.
The bill also makes important improvements to community care
eligibility, which are more closely aligned with the veterans' needs
rather than the arbitrary criteria currently in place.
Finally, I am planning to vote ``yes'' because time is of the
essence. As you may know, the acting VA Secretary recently informed
Congress that the Choice account will run out of funds by the beginning
of June, meaning tens of thousands of veterans could lose access to
community care in a few short weeks. The VA MISSION Act will ensure
that this does not happen, which is another reason why the legislation
is supported by 39 veterans service organizations.
With that said, I fully recognize that the bill's approach to
realigning facilities, in my opinion, is flawed.
I also share the ranking member's concerns about the budget caps.
Reimposing the sequester would be devastating for the VA and for other
Federal discretionary programs. This is a real issue that must be
addressed.
Since I have been in Congress, we have raised budget caps three times
in
[[Page H4043]]
a bipartisan manner. We can and we must do so again in order to avoid
devastating cuts to programs our constituents depend on.
As the ranking member noted, during the committee markup, Democrats
tried to fix this issue, but his amendment was voted down. Today, our
new colleague from Pennsylvania also has offered legislation to address
this issue, which I supported, but the House did not adopt it.
While I am disappointed that the budget cap issue has not yet been
fully addressed, I plan to vote for the VA MISSION Act today. It is
past that time. Congress must take action to consolidate the community
care programs and to expand the caregiver program.
Mr. Speaker, I urge my colleagues to also support the bill.
Mr. ROE of Tennessee. Mr. Speaker, I yield 2 minutes to the gentleman
from Florida (Mr. Bilirakis), the vice chair of the committee and a
tireless worker on the Veterans' Affairs Committee.
Mr. BILIRAKIS. Mr. Speaker, what an honor it is, an honor and a
privilege, to serve with Mr. Sam Johnson, a true American hero.
Mr. Speaker, I rise today in support of S. 2372, the VA MISSION Act,
which will provide significant reforms and improvements to the Veterans
Choice Program.
Since its implementation, the Veterans Choice Program has served over
1.7 million unique veterans seeking timely and high-quality healthcare
for their physical and invisible wounds. Although progress has been
made, there is more work to be done to ensure we balance resources from
community care and the VA healthcare system.
The VA MISSION Act will streamline and consolidate the Veterans
Choice Program with the other duplicative VA community care programs to
create one new cohesive Veterans Community Care Program. This new
program allows eligible veterans to seek care from non-VA providers in
the community if the VA is not providing the quality care the veterans
deserve, and timely care. It also requires access to community
providers if the veteran and doctor believe it is in the veteran's best
medical interest to seek such care.
Mr. Speaker, I thank Chairman Roe, who did an outstanding job with
this bill, for his hard work on this bicameral, bipartisan piece of
legislation, which is the result of a long negotiation process, where
both sides of the aisle put aside differences and compromised to strike
a balance between each stakeholder. This is how Congress should work. I
am proud of the work that we have done on this committee.
I want to thank the staff, as well. The committee ensured that we
have a great work product for our true American heroes. Again, I want
to thank the sponsors of the bill.
Mr. Speaker, let's have a great vote for our true American heroes.
Let's pass this VA MISSION Act and get it to the Senate as soon as
possible.
Mr. WALZ. Mr. Speaker, could I inquire how much time I have
remaining.
The SPEAKER pro tempore. The gentleman from Minnesota has 15\1/2\
minutes remaining. The gentleman from Tennessee has 10\1/4\ minutes
remaining.
Mr. WALZ. Mr. Speaker, I yield 3 minutes to the gentlewoman from New
Hampshire (Ms. Kuster), my good friend, the ranking member of the
Subcommittee of Oversight and Investigations.
Ms. KUSTER of New Hampshire. Mr. Speaker, today I rise to speak as a
cosponsor of the VA MISSION Act. I appreciate the work of Chairman Roe
and Ranking Member Walz in putting this bill together. This bill is
almost unanimously supported by the veterans service organization
community.
I am proud to cosponsor this legislation because it will enact needed
reforms to the Veterans Choice Program and finally extend benefits to
family caregivers for veterans of all eras.
I am pleased that the committee retained provisions that Senator
Sullivan of Alaska and I fought for that would recognize the unique
access issues for States that lack a full-service VA hospital. While I
will continue to fight for improved and expanded facilities at our
Manchester, New Hampshire, VA Medical Center, it is important to
recognize that we have unique challenges in New Hampshire where we do
not have a full-service hospital.
I also want to speak to this: the provisions that expand the
caregiver benefits provided to post-9/11 veterans to veterans of all
eras are necessary and long overdue.
I have heard repeatedly from Granite State veterans of eras prior to
the global war on terror that the differences and benefits are simply
unfair. The way these benefits are currently structured essentially
pits veterans against veterans. That is unacceptable.
I thank Chairman Roe for working with us on finding a way forward for
family caregiver benefits. I am sure thousands of Granite State
veterans will agree.
While this bill embodies the kind of bipartisanship for which our
committee is well known, it is not perfect. As the ranking member of
the Oversight and Investigations Subcommittee, I believe it is
important to acknowledge parts of the bill that will need continued
oversight. I remain committed to ensuring that the VA follows through
in a manner that befits the veterans they serve.
Number one, the asset infrastructure review portion of the bill is
promising, but I have concerns that it will be insufficient to
accomplish its goals. The VA is in desperate need of improved
facilities and a realignment of facilities to better serve veterans'
needs.
In my own State of New Hampshire, the veterans of the North Country
must rely on the Veterans Choice Program, rather than have ease of
access to services they would prefer. I am encouraged by the continued
work to improve our existing facilities, but Granite State veterans
need more, and I hope this bill will further empower the VA to expand
services in Manchester and across our State.
Recent experiences has shown that the VA's ability to accurately
assess the needs of the veterans' population is in doubt. I remain
committed to ensuring that the VA can paint an accurate picture of
veterans' needs, especially veterans living in rural America. Too
often, our veterans in rural America have seen promised infrastructure
expansion stripped away from them. I urge the veterans service
organizations community to continue to work with us to keep the VA
honest.
{time} 1630
Mr. ROE of Tennessee. Mr. Speaker, it is my great honor to welcome
Ms. Kuster back. She has been out for a little bit due to some work,
and I am glad to see her back on the floor.
Mr. Speaker, I yield 2 minutes to the gentleman from Maine (Mr.
Poliquin), my good friend and a very active member of the Veterans'
Affairs Committee.
Mr. POLIQUIN. Mr. Speaker, I thank the chairman for yielding.
Mr. Speaker, this is a great day, a great week for America. Here we
are celebrating not only our great veterans, who have given us our
freedom and our way of life, but also our great police officers, who
stand between ourselves and a more chaotic environment. We are grateful
for everybody that steps up, not only our men and women in uniform who
have represented us, but also our men and women in blue.
Mr. Speaker, I represent the Second Congressional District of the
great State of Maine. This is the largest geographic district east of
the Mississippi River. We have an 8-hour drive if you go from Fryeburg
to Van Buren over beautiful country roads, all kinds of critters in the
roads, including moose, so you have got to be careful when you are
driving, but let me tell you, we also have 125,000 veterans in the
State of Maine, more than half of which, Mr. Speaker, are in the Second
District.
We love our veterans in the State of Maine. We absolutely love our
veterans. We honor them, but we only have, Mr. Speaker, one veterans
hospital in the State of Maine. It is in Togus, the first VA Hospital
in America to take care of our veterans coming back from the Civil War.
But, you know, if you live in Frenchville, Maine, or you live in Van
Buren, you might have a 3-, 4-, or 5-hour drive to Togus at 2 o'clock
in the morning when the snow is blowing sideways in February.
We need to make sure we give folks an opportunity--who served our
country--to get healthcare closer to them. It just makes sense.
Now, a lot of people, Mr. Speaker, say, ``Well, we don't want to
privatize the VA.'' Neither do I, and nobody wants to, but it makes
sense to make sure we augment what they can do so our veterans can get
healthcare closer
[[Page H4044]]
to home, and that is exactly what this program does.
Now, one thing I have to mention to you, Mr. Speaker, is that some of
our rural hospitals who have contracted with the VA and provided great
services to our veterans have not been getting paid on time. This is a
real problem when you have got a small hospital that might not have
bills paid for 1 to 2 years.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. ROE of Tennessee. Mr. Speaker, I yield an additional 15 seconds
to the gentleman.
Mr. POLIQUIN. Mr. Speaker, we need to make sure all of our rural
hospitals in the State of Maine and throughout the country get paid,
and this bill says if they are not paid within 30 days, then interest
starts accruing on that.
This is a great win for our veterans, for our small community
hospitals that need to stay open for everybody, and for this country.
Mr. WALZ. Mr. Speaker, I yield 3 minutes to the gentleman from
California (Mr. Correa), my good friend and a member of the House
Committee on Veterans' Affairs, who also served a very long time in the
California Senate serving veterans there.
Mr. CORREA. Mr. Speaker, I rise today in support of S. 2372, the VA
MISSION Act.
Mr. Speaker, I support the VA MISSION Act because it will improve
access to timely care for all our veterans through consolidation and
reform of the various care and community programs and through expansion
of the caregiver program.
Like my colleague from Maine said, in California, we are the proud
home to the largest number of veterans in the United States, and we
want more of them in California.
Let me say that I know there may be some issues with this
legislation, but at the end of the day, I have got to ask myself, is
this about Wall Street or is this about the beltway? No. This is about
Main Street, Main Street Santa Ana, Anaheim, Orange County, California.
This VA MISSION Act is supported by 38 veteran and military service
groups, including The American Legion.
One of my constituents, Ken George, the District 29 Commander of the
Department of California American Legion, represents more than 8,000
American Legion members in Orange County, he called me and he said: If
Congress wants to help veterans and caregivers, there is no better way
than to support this legislation.
As Ken said, the bill will help veterans and caregivers through
expansion of benefits available to our caregivers of veterans of all
eras.
Mr. Speaker, I urge passage of this legislation. Yes, there are some
issues there, but at the end of the day, if you listen to our veterans,
our friends, and neighbors, the folks we represent, this is an ``aye''
vote.
Mr. ROE of Tennessee. Mr. Speaker, I yield 2 minutes to the gentleman
from Florida (Mr. Dunn), my good friend, a U.S. Army veteran, and an
active member of the Veterans' Affairs Committee.
Mr. DUNN. Mr. Speaker, I thank the chairman for yielding.
Mr. Speaker, I rise today in support of the VA MISSION Act of 2018.
This important legislation secures veterans' ability to access quality
healthcare and ensures that we are fulfilling our promise to care for
them following their service to our Nation.
It builds on the success of the Choice Program by streamlining
community care programs so a veteran can access care from a provider
outside of the VA when they need to. It also expands caregiver benefits
for seriously injured pre-9/11 veterans and for their families.
The VA MISSION Act includes two healthcare initiatives from
legislation that I have introduced that protects our veterans receiving
organ transplants and also helps with the opioid crisis.
Currently, there are only 13 facilities in the Nation where a veteran
may receive a transplant in the VA healthcare system, and none of these
facilities performs all types of transplants. Timely organ transplants
are often the difference between life and death.
The transplant language from my bill included in the VA MISSION Act
eliminates the roadblocks that veterans face and increases the access
to care for our veterans, the care that they have earned by their
service to our Nation.
We are also fighting the opioid epidemic among veterans. My
legislative initiative increases transparency in opioid prescribing at
the VA by allowing doctors to identify high users of controlled drugs
who are therefore at risk for addiction. My language in the VA MISSION
Act instructs the VA to do what most private doctors already do:
connect to the prescription drug monitoring databases nationwide so
that no one slips through the cracks.
Mr. Speaker, we are standing up and fighting for those who fought for
our freedoms. As a surgeon and a veteran, I believe the VA MISSION Act
is good medicine and good public policy.
Mr. Speaker, I urge all of my colleagues to support this important
legislation.
Mr. WALZ. Mr. Speaker, I yield 4 minutes to the gentlewoman from
Connecticut (Ms. Esty), my good friend, the ranking member of the
Subcommittee on Disability Assistance and Memorial Affairs.
Ms. ESTY of Connecticut. Mr. Speaker, I thank the gentleman for
yielding.
Mr. Speaker, I rise today in support of the VA MISSION Act of 2018. I
am proud to support the VA MISSION Act of 2018, especially because of
its important expansion of support for family caregivers of veterans of
all service eras.
Since my first days in Congress, I have heard from veterans and their
caregivers about the important support provided through the VA's
Program of Comprehensive Assistance for Family Caregivers.
Family caregivers provide loving and essential care at home for our
injured veterans, from bathing and dressing, housework and
transportation, to administering physical and medical therapies.
Caregivers are true partners in the delivery of healthcare to our
veterans, and it is important that we recognize their tremendous
service and their worth.
In 2010, Congress wisely stepped up to offer the family caregivers of
veterans support in performing these vital tasks, but the program was
only made available to the family caregivers of post-9/11 veterans.
Clearly, those who served in World War II, Korea, and Vietnam, and
their families are deserving of the same respect and support.
That is why, since being elected to Congress, I have authored
legislation in every session to expand this assistance for family
caregivers to pre-9/11 veterans.
Today, this Congress has the opportunity to honor and support
veterans of all service eras by voting for this excellent bill.
Mr. Speaker, I thank Congressman Ryan Costello for leading with me on
these important caregiver issues. I thank the chairman and the ranking
member for their hard work on including this vital provision in the VA
MISSION Act.
Mr. Speaker, it is time that we treat our injured veterans of all
eras equally by expanding the VA caregivers program to all injured
veterans.
I do want to note that I share the ranking member's concerns with the
long-term sustainability of this program. Congress will have to work
closely with the VA as this expanded community care program is
implemented to ensure that this program is sustainable without cuts to
other veterans or other important domestic programs.
The bill we are considering today will ensure that our veterans are
getting the care they need when they need it, but in addition to timely
care, we must ensure that veterans have access to quality care. As we
send veterans outside the VA system to private medical providers, we
need to ensure that these doctors and other healthcare professionals
are capable of delivering the quality care that each and every one of
our veterans deserves.
So, while I applaud the expansion of care in this bill, I am
concerned about the potential for fraud, waste, and abuse as VA begins
to send many more veterans outside the VA system to private medical
providers. That is why it is vital that Congress remain engaged with
the implementation of this program to make sure that our veterans are
receiving high-quality healthcare from qualified providers and that we
in Congress are being careful stewards of the taxpayer dollars.
[[Page H4045]]
Mr. Speaker, I again thank the gentleman for yielding, and I thank
the chairman and ranking member for their leadership.
Mr. Speaker, I am proud to serve on this committee with such
extraordinary public servants who share a commitment to serving those
who have been willing to put their lives on the line to defend our
freedom. It has been a pleasure and an honor serving with them.
Mr. Speaker, I congratulate everyone on their hard work in bringing
this bill, admittedly not perfect but very important, forward for our
consideration, and I urge my colleagues to adopt it when we have the
opportunity to vote later today.
Mr. ROE of Tennessee. Mr. Speaker, I yield 2 minutes to the gentleman
from Florida (Mr. Rutherford), a very active member of the Veterans'
Affairs Committee.
Mr. RUTHERFORD. Mr. Speaker, I thank the chairman for this
opportunity, and I thank Ranking Member Walz for such bipartisan
support and work on this bill. I am very proud to serve on this
committee because of the kind of work that goes on here under the
leadership of Chairman Roe.
Mr. Speaker, I am proud to cosponsor this bill. I can tell you, since
coming to Congress, I have had the distinct honor of serving with Dr.
Roe, our chairman, and colleagues on the House Veterans' Affairs
Committee, and during this time, we on the committee have heard
from veterans services organizations, from the Veterans Administration,
and from veterans themselves about the challenges in the VA healthcare
system.
We have learned about the barriers to timely care, the troubling
provider shortage, also the lack of prompt payment to our community
providers, and so many other issues.
I am proud to say that I believe this is, in the words of 38 VSOs who
wrote in strong support of this legislation, truly a ``historic
opportunity to improve the lives of veterans, their families, and their
caregivers.''
That is one reason I am very proud to be on this committee. I think
this is a historic move.
It is our duty as legislators and as Americans to ensure that our
veterans receive the best care possible. This bill accomplishes that by
streamlining community care programs; improving access to timely care;
funding the Choice Program; and, until this new program can be
implemented, creating a fair access review process, greatly expanding
the VA caregiver program, and improving VA's own in-house capacity.
One item that I would like to thank the leaders in both Chambers for,
but especially Dr. Roe and his staff and the White House, is including
in this language on provider recruitment and retention within the VA,
sections 301, 303, and 304 of this bill, which is language that I had
asked to have placed in there.
These provisions expand the tools the VA can use to recruit and
retain quality providers by requiring the use of scholarships and
improving and expanding the loan repayment system that targets newly
graduated medical students.
Mr. WALZ. Mr. Speaker, I reserve the balance of my time.
Mr. ROE of Tennessee. Mr. Speaker, I yield 3 minutes to the gentleman
from Michigan (Mr. Bergman), a lieutenant general and an incredibly
valued member of our committee.
Mr. BERGMAN. Mr. Speaker, I thank the chairman for his tireless
effort, along with the committee staff, to highlight that the House
Veterans' Affairs Committee is truly how a congressional committee is
supposed to operate: together.
{time} 1645
The name of the act is the VA MISSION Act. Any member of the military
understands that mission accomplishment is always first, and with this
VA MISSION Act of 2018, what you are going to see is some extremely
important elements in accomplishing that long-term mission of providing
results for the veterans.
The community care improvement consolidates seven duplicative
community care programs into one cohesive program. It removes arbitrary
one-size-fits-all parameters in the Choice Program.
Previously, the Choice Program limited accessing care to convenient
and affordable. It wasn't good enough. The VA MISSION Act provides
Choice funding shortfalls, ensuring that the 1-year funding bridge is
complete so that the veterans have a continuity of care during the
implementation of the new program.
It also provides for the Asset and Infrastructure Review. This
transforms the VA from relying on outdated inpatient facilities to more
modern facilities meant for outpatient care of the future that includes
delivery through telehealth, through different and unique circumstances
that our veterans expect and deserve today.
The VA is one of the Federal Government's largest property holders
and needs to make sure that its resources aren't wasted keeping lights
on in unused buildings. Those limited resources need to be focused on
the veterans.
And finally, the caregiver expansion, this VA MISSION Act expands
caregiver support to both pre- and post-9/11 veterans. That is
essential and long overdue.
When you reform the VA and allow for greater veteran choices but do
not--and I repeat, do not--privatize, this is making the VA the best it
needs to be going forward in support of our veterans.
Mr. Speaker, I again thank the chairman for his efforts.
Mr. WALZ. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, again, to the chairman, I am not writing his eulogy
here, but I would say that is a pretty impressive resume of
accomplishments, going back to the Forever GI Bill, appeals reform,
Clay Hunt Suicide, as just a few, and then this piece of legislation.
The gentleman's work and tenacity for veterans, Mr. Speaker, is second
to none. His dignity and respect for all Members of this House in the
process is legendary.
And for giving this space today for us to talk about and debate on
this floor our shared values, compromise disagreements, but always with
the goal that we are in this together, that is created by an atmosphere
of leadership. It is created by an atmosphere of respecting our
democratic process. It is understanding that this is not about gotcha,
who is this and who is that. It is about looking at what is possible.
So I congratulate the gentleman for putting together a piece of
legislation that serves so many veterans. It has the support of so many
folks, and allowing me on this last opportunity to express those long-
term concerns to make sure we don't undermine that, I am forever
grateful for that.
I appreciate the comments and the gentleman from Michigan talking
about the capacity inside the VA, too. We have got incredible providers
there serving veterans every day, and many of them veterans themselves.
I know his commitment to making sure they have the resources necessary
to do their job. It is a priority.
I think the concern that I am showing on the budget gap is just to
make sure that we don't pick one over the other or where veterans care
is. And, as I said, again, if it were left on the shoulders of the
chairman to ensure that would happen, I would sleep well at night. I
just worry that when we don't codify these things, when we have the
uncertainty in the VA right now, that is where my concern came from,
but not from this process, not from an openness, not from a commitment,
and not from the gentleman's willingness to get this thing across the
finish line.
Mr. Speaker, I yield back the balance of my time.
Mr. ROE of Tennessee. Mr. Speaker, I yield myself the balance of my
time.
Mr. Speaker, I want to thank everyone who was involved in this
process, beginning with the staff, who have been heavily involved in
this. Both the Republican side and Democratic side worked for the last,
really, almost 18 months.
I want to thank our Senate colleagues on the other side of this
Capitol who worked very hard and the hours that went into this. The
real winners here are our Nation's heroes, the veterans.
This VA MISSION Act does a community care where veterans can get
high-quality care both inside the VA and out when the VA can't do that.
We have heard speakers down here from areas that don't have a VA
hospital. They absolutely rely on that.
[[Page H4046]]
I was in Oregon a few months ago and realized that some veterans had
to drive 5 hours to a VA facility. They need the community care bill in
their community. We provide the funding for that bill to bridge us over
until the new Secretary implements that.
We have a caregiver. I am a Vietnam-era veteran, and I have seen many
catastrophically injured Vietnam veterans whose families struggled for
decades. 520-plus Vietnam veterans are dying every day. It is time we
implement this bill and get these needed benefits to those World War II
and veterans up to 9/11.
We need to rightsize the VA. Healthcare is not provided like it used
to be. It has become much more sophisticated and streamlined. And
outpatient, the VA needs to get to be able to do that also. That is
what the AIR Act is about. We are increasing the internal capacity so
we can train and get new clinicians and providers in.
The speaker, Sam Johnson, who spoke a minute ago, said it all. We
should be able to look at that hero, who is a true American hero, and
listen to his speech, which brought tears to my eyes, and vote for this
bill.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Rutherford). All time for debate has
expired.
Pursuant to House Resolution 891, the previous question is ordered on
the bill, as amended.
The question is on the third reading of the bill.
The bill was ordered to be read a third time, and was read the third
time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. ROE of Tennessee. Mr. Speaker, I demand a recorded vote.
The Speaker pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.
____________________