[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;

[[Page H4017]]

       ``(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.

                              {time}  1600

  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.

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