[Congressional Record Volume 170, Number 170 (Monday, November 18, 2024)]
[House]
[Pages H6038-H6070]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SENATOR ELIZABETH DOLE 21ST CENTURY VETERANS HEALTHCARE AND BENEFITS
IMPROVEMENT ACT
Mr. BOST. Madam Speaker, I move to suspend the rules and pass the
bill (H.R. 8371) to make certain improvements in the laws administered
by the Secretary of Veterans Affairs, and for other purposes, as
amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 8371
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 ``Senator
Elizabeth Dole 21st Century Veterans Healthcare and Benefits
Improvement Act''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--HEALTH CARE MATTERS
Subtitle A--Veterans Community Care Program Matters
Sec. 101. Implementation of provision of care under Veterans Community
Care Program upon determination of eligibility by veteran
and veteran's referring clinician.
Sec. 102. Outreach regarding care and services under Veterans Community
Care Program.
Sec. 103. Annual review and report on waivers of certain payment rates
under Veterans Community Care Program.
Sec. 104. Modification of requirements for standards for quality of
care from Department of Veterans Affairs.
Sec. 105. Pilot program to improve administration of care under
Veterans Community Care Program.
Sec. 106. Pilot program on consolidating approval process of Department
of Veterans Affairs for covered dental care.
Sec. 107. Strategic plan on value-based health care system for Veterans
Health Administration; pilot program.
Sec. 108. Plan on adoption of certain health information standards for
Department of Veterans Affairs and certain health care
providers.
Sec. 109. Report on use of value-based reimbursement models under
Veterans Community Care Program.
Sec. 110. Inspector General assessment of implementation of Veterans
Community Care Program.
Sec. 111. Comptroller General report on dentistry under Veterans
Community Care Program.
Subtitle B--Matters Relating to Nursing Home and Other Long Term Care
and Family Caregivers
Sec. 120. Increase of expenditure cap for noninstitutional care
alternatives to nursing home care.
Sec. 121. Coordination with Program of All-Inclusive Care for the
Elderly.
Sec. 122. Authority for Secretary of Veterans Affairs to award grants
or contracts to entities to improve provision of mental
health support to family caregivers of veterans.
Sec. 123. Home- and community-based services: programs.
Sec. 124. Coordination with assistance and support services for
caregivers.
Sec. 125. Improvements to program of comprehensive assistance for
family caregivers.
Sec. 126. Improvements relating to Homemaker and Home Health Aide
program.
Sec. 127. Pilot program to furnish assisted living services to certain
veterans.
Sec. 128. Provision of medicine, equipment, and supplies available to
Department of Veterans Affairs to State homes.
Sec. 129. Recognition of organizations and individuals to assist
veterans, family members, and caregivers navigating
programs and services of Veterans Health Administration.
Sec. 130. Reviews and other improvements relating to home- and
community-based services.
Sec. 131. GAO report on mental health support for caregivers.
Sec. 132. Development of centralized website for program information.
Sec. 133. Definitions.
Subtitle C--Medical Treatment and Other Matters
Sec. 140. Quarterly report on referrals for non-Department of Veterans
Affairs health care.
Sec. 141. Elimination of certain requirements for certain Department of
Veterans Affairs Assistant Under Secretaries.
Sec. 142. Modification of pay limitation for physicians, podiatrists,
optometrists, and dentists of Department of Veterans
Affairs.
Sec. 143. Reimbursement of ambulance cost for care for certain rural
veterans.
Sec. 144. Pilot program to furnish dental care from the Department of
Veterans Affairs to certain veterans diagnosed with
ischemic heart disease.
Sec. 145. Documentation of preferences of veterans for scheduling of
appointments for health care under laws administered by
Secretary of Veterans Affairs.
Sec. 146. Staffing model and performance metrics for certain employees
of the Department of Veterans Affairs.
Sec. 147. Online health education portal for veterans enrolled in
patient enrollment system of Department of Veterans
Affairs.
Sec. 148. Limitation on detail of directors of medical centers of
Department of Veterans Affairs to different positions.
Sec. 149. National Veteran Suicide Prevention Annual Report.
Sec. 150. Report on physical infrastructure required by medical
facilities of Department of Veterans Affairs to provide
dental care services.
Sec. 151. Comptroller General report on certain oral health care
programs under laws administered by Secretary of Veterans
Affairs.
[[Page H6039]]
Sec. 152. Review of workflows associated with processing referrals
between facilities of the Veterans Health Administration.
Sec. 153. Plan for timely scheduling of appointments at medical
facilities of Department of Veterans Affairs.
Sec. 154. Authorization of appropriations to support initiatives for
mobile mammography services for veterans.
TITLE II--ECONOMIC OPPORTUNITY MATTERS
Subtitle A--Educational Assistance
Sec. 201. Temporary expansion of eligibility for Marine Gunnery
Sergeant John David Fry Scholarship.
Sec. 202. Removal of expiration on entitlement to Marine Gunnery
Sergeant John David Fry Scholarship for surviving
spouses.
Sec. 203. Sole liability for transferred educational assistance by an
individual who fails to complete a service agreement.
Sec. 204. Notice to educational institutions of risk-based surveys.
Sec. 205. Relationship of participation by an educational institution
in certain Federal student financial aid programs to
approval of such institution for purposes of Department
of Veterans Affairs educational assistance programs.
Sec. 206. Expansion of Department of Veterans Affairs oversight of
certain educational institutions.
Sec. 207. Requirement that educational institutions approved for
purposes of Department of Veterans Affairs educational
assistance programs provide digital official transcripts.
Sec. 208. Payment of full monthly housing stipend for veterans enrolled
in final semester using educational assistance under
Post-9/11 Educational Assistance Program.
Sec. 209. Modification of rules for approval of commercial driver
education programs for purposes of educational assistance
programs of the Department of Veterans Affairs.
Sec. 210. Provision of certificates of eligibility and award letters
using electronic means.
Sec. 211. Retroactive effective date of law regarding charge to
entitlement to educational assistance for individuals who
do not transfer credits from certain closed or
disapproved programs of education.
Sec. 212. Department of Veterans Affairs high technology program.
Sec. 213. Notice of changes to Department of Veterans Affairs policies
and guidance affecting the educational assistance
programs of the Department.
Sec. 214. Payment of VA educational assistance via electronic fund
transfer to a foreign institution of higher education.
Sec. 215. Improving transparency and accountability of educational
institutions for purposes of veterans educational
assistance.
Subtitle B--Employment and Training
Sec. 221. Improvements to reemployment rights of members of the Armed
Forces.
Sec. 222. Review of investigations manual of Veterans' Employment and
Training Service.
Sec. 223. Warrior Training Advancement Course.
Subtitle C--Home Loans
Sec. 231. Improvements to program for direct housing loans made to
Native American veterans by the Secretary of Veterans
Affairs.
Sec. 232. Native community development financial institution relending
program.
TITLE III--DISABILITY AND MEMORIAL AFFAIRS MATTERS
Sec. 301. Burial allowance for certain veterans who die at home while
in receipt of hospice care furnished by Department of
Veterans Affairs.
Sec. 302. Authority for Secretary of Veterans Affairs to award grants
to States and Indian Tribes to improve outreach to
veterans.
Sec. 303. Definition of surviving spouse.
Sec. 304. Ensuring only licensed health care professionals perform
medical disability examinations under certain Department
of Veterans Affairs pilot program.
Sec. 305. Provision of information regarding an agent or attorney to a
licensed health care professional who performs a medical
disability examination under certain Department of
Veterans Affairs pilot program.
Sec. 306. Modernization of Department of Veterans Affairs disability
benefit questionnaires.
Sec. 307. Department of Veterans Affairs automatic processing of
certain claims for temporary disability ratings.
TITLE IV--HOMELESSNESS MATTERS
Sec. 401. Short title.
Sec. 402. Per diem payments provided by the Secretary of Veterans
Affairs for services furnished to homeless veterans.
Sec. 403. Authorization for Secretary of Veterans Affairs to use of
certain funds for improved flexibility in assistance to
homeless veterans.
Sec. 404. Access to Department of Veterans Affairs telehealth services.
TITLE V--OVERSIGHT AND INVESTIGATIONS MATTERS
Sec. 501. Department of Veterans Affairs employee training regarding
Office of Inspector General.
Sec. 502. Annual review of security at covered facilities of the
Department of Veterans Affairs.
Sec. 503. Modification of certain housing loan fees.
TITLE I--HEALTH CARE MATTERS
Subtitle A--Veterans Community Care Program Matters
SEC. 101. IMPLEMENTATION OF PROVISION OF CARE UNDER VETERANS
COMMUNITY CARE PROGRAM UPON DETERMINATION OF
ELIGIBILITY BY VETERAN AND VETERAN'S REFERRING
CLINICIAN.
(a) In General.--During the period specified in subsection
(c), the Secretary of Veterans Affairs shall implement
section 1703(d)(1)(E) of title 38, United States Code, in
compliance with the implementing regulations for such section
under section 17.4010(a)(5) of title 38, Code of Federal
Regulations, such that the determination of eligibility for
care is final and shall be made by the veteran and the
veteran's referring clinician.
(b) Correction of Errors.--A covered veteran and the
referring clinician of such veteran may correct any errors
made with respect to a determination described in subsection
(a).
(c) Period Specified.--The period specified in this
subsection is the two-year period beginning on the date that
is 90 days after the date of the enactment of this Act.
(d) Report.--Not later than one year and not later than two
years after the commencement of the period specified by
subsection (c), the Secretary of Veterans Affairs shall
submit to Congress a report on the care provided under
section 1703(d)(1)(E) of title 38, United States Code, during
the one-year period preceding the date of the report,
including--
(1) the number of instances of care provided;
(2) the type of care provided; and
(3) the cost of such care.
(e) Rule of Construction.--Nothing in this section shall be
construed to limit the Secretary's authority to prescribe,
amend, or rescind regulations under section 1703 of title 38,
United States Code.
(f) Covered Veteran Defined.--In this section, the term
``covered veteran'' has the meaning given that term in
section 1703(b) of title 38, United States Code.
SEC. 102. OUTREACH REGARDING CARE AND SERVICES UNDER VETERANS
COMMUNITY CARE PROGRAM.
(a) Requirement.--Section 1703 of title 38, United States
Code, is further amended--
(1) by redesignating subsection (o) as subsection (p); and
(2) by inserting after subsection (n) the following new
subsection (o):
``(o) Outreach Regarding Availability of Care and
Services.--(1) The Secretary shall conduct outreach to inform
veterans of the following:
``(A) The conditions for care or services under subsections
(d) and (e).
``(B) How to request such care or services.
``(C) How to appeal a denial of a request for such care or
services using the clinical appeals process of the Veterans
Health Administration.
``(2) Upon enrollment of a veteran in the system of annual
patient enrollment established and operated under section
1705 of this title, and not less frequently than every two
years thereafter, the Secretary shall inform the veteran of
information described in paragraph (1).
``(3) The Secretary shall ensure that information described
in paragraph (1) is--
``(A) publicly displayed in each medical facility of the
Department;
``(B) prominently displayed on a website of the Department;
and
``(C) included in other outreach campaigns and activities
conducted by the Secretary.''.
(b) Solid Start Program.--Section 6320(a)(2)(A) of title
38, United States Code, is amended by inserting ``, including
how to enroll in the system of annual patient enrollment
established and operated under section 1705 of this title and
the ability to seek care and services under sections 1703 and
1710 of this title'' before the semicolon.
(c) Comptroller General Report on Outreach.--Not later than
two years after the date of the enactment of this Act, the
Comptroller General of the United Stats shall submit to
Congress a report on the efforts of the Secretary of Veterans
Affairs to ensure that veterans are informed of the
conditions for eligibility for care and services under
section 1703 of title 38, United States Code, including such
efforts to conduct outreach pursuant to subsection (q) of
such section (as added by subsection (a)).
[[Page H6040]]
SEC. 103. ANNUAL REVIEW AND REPORT ON WAIVERS OF CERTAIN
PAYMENT RATES UNDER VETERANS COMMUNITY CARE
PROGRAM.
(a) In General.--Section 1703 of title 38, United States
Code, is further amended--
(1) by redesignating subsection (p) as subsection (q); and
(2) by inserting after subsection (p) the following new
subsection (q):
``(q) Annual Review and Report on Waivers of Payment
Rates.--(1) On an annual basis, the Secretary shall--
``(A) conduct a review of waivers of payment rates under
subsection (i) for Third Party Administrators to identify
whether such waivers help to alleviate community-specific
challenges, including scarcity of medical services associated
with access to health care; and
``(B) submit to Congress a report on the results of such
review.
``(2) Each report under paragraph (1)(B) shall include,
with respect to the period covered by the report--
``(A) a statement, disaggregated by region, of the total
number of waivers described in subparagraph (A) of such
paragraph requested by Third Party Administrators;
``(B) a statement of the total number of such waivers that
were--
``(i) granted by the Secretary;
``(ii) denied by the Secretary; or
``(iii) withdrawn by a Third Party Administrator;
``(C) a description of the process for the review required
under paragraph (1);
``(D) a statement, disaggregated by region, of the average
time to process such waivers;
``(E) an assessment, disaggregated by region, of the extent
to which such waivers that were granted by the Secretary
improved access to health care for covered veterans; and
``(F) a description of trends, if any, identified by the
Secretary with respect to such waivers.
``(3) In this subsection, the term `Third Party
Administrator' has the meaning given such term in section
1703B of this title.''.
(b) Deadline.--The Secretary shall submit the first report
required under subsection (q) of section 1703 of such title
(as added by subsection (a)) not later than 180 days after
the date of the enactment of this Act.
SEC. 104. MODIFICATION OF REQUIREMENTS FOR STANDARDS FOR
QUALITY OF CARE FROM DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Section 1703C of title 38, United States
Code, is amended--
(1) in subsection (a)--
(A) in paragraph (2)--
(i) by striking ``In establishing'' and inserting ``(A) In
establishing''; and
(ii) by adding at the end the following new subparagraph:
``(B) The Secretary shall ensure that the standards for
quality established under paragraph (1) are comparable to
industry standards to ensure there is adequate data
transference between care furnished by the Department and
care furnished by a non-Department provider.'';
(B) in paragraph (3), by adding at the end the following
new clause:
``(v) Outcomes relating to patient quality of life.'';
(C) in paragraph (4)--
(i) by striking ``and the Centers for Medicare & Medicaid
Services'' and inserting ``the Centers for Medicare &
Medicaid Services, and the Indian Health Service''; and
(ii) by striking ``and other nongovernmental entities'' and
inserting ``and other non-governmental entities including
Third Party Administrators''; and
(D) by striking paragraph (5) and inserting the following
new paragraphs:
``(5) When collecting, considering, and applying data
related to patient care for purposes of establishing
standards for quality under paragraph (1), the Secretary
shall ensure no metric is being over or under analyzed.
``(6) In establishing standards for quality under paragraph
(1), the Secretary shall--
``(A) utilize the most up-to-date practices for extracting
and analyzing relevant data;
``(B) utilize all relevant data available to the Secretary;
``(C) ensure the most efficient use of time and resources
related to the use of data scientists employed by the
Department; and
``(D) collaborate, as appropriate, with entities specified
in paragraph (4).
``(7)(A) Not less frequently than once every five years,
the Secretary shall update the standards for quality
established under paragraph (1) pursuant to the requirements
for the establishment of such standards under this
subsection.
``(B) Not later than 30 days after any date on which the
Secretary updates, pursuant to subparagraph (A), the
standards for quality under paragraph (1), the Secretary
shall submit to the appropriate committees of Congress a
report on such updated standards for quality.''; and
(2) in subsection (b)--
(A) in paragraph (1)--
(i) by striking ``Not later than 1 year after the date on
which the Secretary establishes standards for quality under
subsection (a)'' and inserting ``Not less frequently than
once every three years''; and
(ii) by inserting ``pursuant to standards for quality under
subsection (a)'' after ``medical facilities of the
Department''; and
(B) in paragraph (2), by inserting ``or updates'' after
``establishes''.
(b) Deadline for Update.--The Secretary, pursuant to
paragraph (7) of section 1703C(a) of title 38, United States
Code (as added by subsection (a)), shall make the first
update to the standards for quality established under
paragraph (1) of such section not later than the date that is
five years after the date on which the Secretary submits the
report under paragraph (2) of subsection (d).
(c) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs
shall submit to the appropriate committees of Congress a
report on how the Secretary--
(1) has consulted with entities specified in paragraph (4)
of section 1703C(a) of title 38, United States Code, before
the date of the enactment of this Act in establishing
standards for quality under such section;
(2) has continued to consult with those entities on and
after such date of enactment; and
(3) intends to leverage data sciences to improve standards
for quality care furnished by the Department of Veterans
Affairs.
(d) Updates to Quality Care Metrics.--
(1) Initial report.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans
Affairs shall submit to the appropriate committees of
Congress a report on how the Secretary plans to implement the
amendments made by subsections (a).
(2) Deadline; summary report.--Not later than two years
after the date of the enactment of this Act, the Secretary
shall--
(A) implement the amendments made by subsection (a),
including by updating the standards for quality established
under section 1703C of title 38, United States Code; and
(B) submit to the appropriate committees of Congress a
report detailing the standards for quality updated pursuant
to such amendments.
(e) Audit of Quality Care Metrics.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall enter into one or more contracts with a non-Department
entity described in paragraph (2) to conduct an audit on the
quality of care from the Department of Veterans Affairs,
including through non-Department health care providers
pursuant to section 1703 of title 38 United States Code.
(2) Non-department entity described.--A non-Department
entity described in this paragraph is an entity that--
(A) specializes in analyzing large-scale organizational
data collection and analysis efforts, especially with respect
to the health care sector; and
(B) has experience and proven outcomes in optimizing the
accuracy and comprehensiveness of data collection and
analysis related to the quality of health care services.
(3) Elements.--The audit required under paragraph (1) shall
include the following:
(A) An assessment of the methodology used by the Department
to collect and assess data on the quality of care furnished
by the Department, including any vulnerabilities in such
methodology.
(B) An assessment of the accuracy and reliability of the
data sources used by the Department to compile data on the
quality of care furnished by the Department.
(C) The extent to which the standards the Department uses
to assess the quality of care furnished by the Department
are--
(i) comparable with industry standards;
(ii) easily accessible to, and understood by--
(I) veterans;
(II) employees of the Department; and
(III) other individuals, as the private sector entity
considers appropriate.
(D) Any recommendations of such private sector entity with
respect to improvements that the Secretary could administer
to more accurately capture the quality of care furnished by
the Department.
(4) Reports on audit.--
(A) Report on findings and recommendations.--Not later than
60 days after any date on which a private sector entity
described in paragraph (2) completes an audit under paragraph
(1), such private sector entity shall submit to the
Secretary, the Committee on Veterans' Affairs of the Senate,
and the Committee on Veterans' Affairs of the House of
Representatives a report that includes--
(i) the findings of such audit; and
(ii) recommendations of such private sector entity with
respect to such audit.
(B) Report on planned improvements.--Not later than 60 days
after any date on which the Secretary receives a report under
subparagraph (A), 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
how the Secretary plans to improve the standards for quality
of care of the Department.
(f) Appropriate Committees of Congress Defined.--In this
section, the term ``appropriate committees of Congress'' has
the meaning given such term in section 1703C of title 38,
United States Code.
SEC. 105. PILOT PROGRAM TO IMPROVE ADMINISTRATION OF CARE
UNDER VETERANS COMMUNITY CARE PROGRAM.
(a) Establishment.--Pursuant to section 1703E of title 38,
United States Code, the Secretary of Veterans Affairs, acting
through the Center for Innovation for Care and Payment
established under such section, shall carry out a pilot
program to seek to develop and implement a plan--
(1) to provide monetary and non-monetary incentives to a
covered health care provider--
[[Page H6041]]
(A) to allow the Secretary to see the scheduling system of
the provider, to assess the availability of, and to assist in
scheduling appointments for, veterans under the Veterans
Community Care Program under section 1703 of such title,
including through synchronous, asynchronous, and asynchronous
assisted digital scheduling;
(B) to complete continuing professional educational
training available through the VHA TRAIN program (or any
successor program or initiative) regarding veteran cultural
competency, the opioid safety initiative (or any successor
program or initiative), and other subjects determined
appropriate by the Secretary;
(C) to improve methods of accounting for non-Department
training that is equivalent or substantially similar to the
continuing professional educational training described in
subparagraph (B);
(D) to improve the rate of the timely return to the
Secretary of medical record documentation for care or
services provided under the Veterans Community Care Program;
(E) to improve the timeliness and quality of the delivery
of care and services to veterans under such program; and
(F) to achieve other objectives determined appropriate by
the Secretary; and
(2) to decrease the rate of no-show appointments under such
program.
(b) Report.--Not later than one year after the date of the
establishment of the pilot program under this section, and
annually thereafter during the term of the pilot program, the
Secretary of Veterans Affairs shall submit to the Committees
on Veterans' Affairs of the House of Representatives and the
Senate a report on the pilot program that includes, with
respect to the period covered by the report--
(1) an assessment of the extent to which--
(A) the system of the Department of Veterans Affairs for
scheduling appointments for veterans under the Veterans
Community Care Program has improved;
(B) the rate of timely return to the Secretary of medical
record documentation described in subparagraph (D) of
subsection (a)(1) has improved;
(C) the timeliness and quality of the delivery of care and
services described in subparagraph (E) of such subsection has
improved; and
(D) the frequency of no-show appointments described in
paragraph (2) of such subsection decreased;
(2) a list of the continuing professional educational
training courses under subparagraph (B) of such subsection
available to covered health care providers;
(3) the rate of participation in such continuing
professional education training courses; and
(4) any other matter the Secretary determines appropriate.
(c) Definitions.--In this section:
(1) The term ``covered health care provider'' means a
health care provider--
(A) described in subsection (c) of section 1703 of title
38, United States Code, that furnishes care or services under
the Veterans Community Care Program pursuant to a contract or
agreement with a Third Party Administrator; or
(B) that otherwise furnishes care or services outside of
Department facilities pursuant to a contract or agreement
with the Secretary of Veterans Affairs.
(2) The term ``opioid safety initiative'' means the
programs, processes, and guidelines of the Veterans Health
Administration of the Department of Veterans Affairs relating
to the management of opioid therapy and chronic pain.
(3) The term ``Third Party Administrator'' means an entity
that manages a network of health care providers and performs
administrative services related to such network under section
1703 of such title.
(4) The term ``VHA TRAIN program'' means the free program
of the Veterans Health Administration that offers veteran-
specific continuing medical education courses.
SEC. 106. PILOT PROGRAM ON CONSOLIDATING APPROVAL PROCESS OF
DEPARTMENT OF VETERANS AFFAIRS FOR COVERED
DENTAL CARE.
(a) In General.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
acting through the Center for Innovation for Care and Payment
established under section 1703E of title 38, United States
Code, shall carry out a pilot program under which the
Secretary shall hire--
(1) general dentists at medical facilities of the
Department of Veterans Affairs to manage approval by the
Department of treatment plans requested by dental providers
in providing covered dental care; and
(2) dental specialists at Veterans Integrated Service
Networks of the Department to manage approval by the
Department of treatment plans for specialty dental care
requested by dental providers in providing covered dental
care.
(b) Locations.--The Secretary shall carry out the pilot
program in not fewer than two Veterans Integrated Service
Networks of the Department.
(c) Reports.--
(1) Initial report.--Not later than one year after the date
of the commencement of such pilot program, the Secretary
shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a report on the pilot
program, that includes--
(A) an identification of the Veterans Integrated Service
Networks participating in such pilot program;
(B) a description of the implementation of such pilot
program;
(C) an identification of any barriers or challenges to
implementing such pilot program;
(D) an assessment of the efficacy of hiring general
dentists and dental specialists pursuant to such pilot
program;
(E) aggregated feedback with respect to such pilot program
from dentists of the Department in Veterans Integrated
Service Networks participating in such pilot program; and
(F) aggregated feedback from dental providers providing
covered dental care within such Veterans Integrated Service
Networks regarding any changes in the timeliness of treatment
plan approvals by the Department.
(2) Final report.--Not later than 90 days before the date
of the completion of such pilot program, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate
and the House of Representatives a report on the pilot
program that--
(A) includes, with respect to the period covered by the
report, each element of the report required under paragraph
(1) described in subparagraphs (A) through (F) of such
paragraph;
(B) includes recommendations of the Secretary on whether
the pilot program should be--
(i) extended;
(ii) expanded; or
(iii) adopted throughout the Department; and
(C) indicates whether the Secretary requests action by
Congress to make the pilot program permanent.
(d) Sunset.--The authority to carry out the pilot program
under this section shall terminate on the date that is two
years after the date of the enactment of this Act.
(e) Covered Dental Care Defined.--In this section, the term
``covered dental care'' means dental care provided--
(1) under section 1703 of title 38, United States Code; or
(2) pursuant to a Veterans Care Agreement under section
1703A of such title.
SEC. 107. STRATEGIC PLAN ON VALUE-BASED HEALTH CARE SYSTEM
FOR VETERANS HEALTH ADMINISTRATION; PILOT
PROGRAM.
(a) Establishment of Working Group.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) establish a working group on value-based care; and
(B) submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate the strategic plan
developed by the working group pursuant to subsection (b).
(2) Membership.--
(A) Required members.--The working group shall include, at
a minimum, the following members:
(i) The Under Secretary for Health of the Department of
Veterans Affairs.
(ii) The Director of the Office of Mental Health and
Suicide Prevention of the Department of Veterans Affairs (or
any successor office).
(iii) The Director of the Office of Integrated Veteran Care
of the Department (or any successor office).
(iv) The Director of the Office of Rural Health of the
Department (or any successor office).
(v) The Director of the Office of Connected Care of the
Department (or any successor office).
(vi) The Assistant Secretary for the Office of Information
Technology (or any successor office).
(vii) The Chief Officer of the Office of Healthcare
Innovation and Learning of the Office of Discovery,
Education, and Affiliate Networks of the Veterans Health
Administration (or any successor office).
(viii) An individual designated by the Secretary from the
Center for Innovation for Care and Payment of the Department
under section 1703E of title 38, United States Code.
(ix) An individual designated by the Administrator of the
Centers for Medicare & Medicaid Services from the Center for
Medicare and Medicaid Innovation.
(x) An individual designated by the Secretary of Health and
Human Services from the Federal Office of Rural Health Policy
of the Health Resources and Services Administration.
(xi) The Chief of Human Capital Management for the Veterans
Health Administration.
(xii) An individual designated by the Secretary of Defense
that is a representative of the Defense Health Agency.
(xiii) An individual selected by the Secretary of Veterans
Affairs from the special medical advisory group established
under section 7312 of title 38, United States Code.
(B) Optional members.--The Secretary of Veterans Affairs
may appoint any of the following individuals as members of
the working group:
(i) An individual representing the Health and Medicine
Division of the National Academies of Sciences, Engineering,
and Medicine.
(ii) Three individuals representing a private health care
system that has made the transition to value-based care.
[[Page H6042]]
(iii) Three individuals representing an organization
recognized by the Secretary of Veterans Affairs under section
5902 of title 38, United States Code.
(3) Public availability.--All meetings deliberations, and
products of the working group shall be made publicly
available throughout the duration of the working group,
including to individuals representing organizations
recognized by the Secretary of Veterans Affairs under section
5902 of title 38, United States Code.
(4) Exemption from faca.--Chapter 10 of title 5, United
States Code, shall not apply to the working group established
under paragraph (1).
(b) Development of Strategic Plan.--The working group shall
develop a strategic plan to implement value-based care into
the Veterans Health Administration that includes the
following:
(1) An identification of the state of the Veterans Health
Administration as of the date of the enactment of this Act,
including an assessment of the current model of health care
delivery used by the Veterans Health Administration in
medical facilities of the Department of Veterans Affairs.
(2) An assessment of the capacity needs of the Veterans
Health Administration during the five-year period beginning
on the date of the enactment of this Act.
(3) An analysis of the leadership of the Veterans Health
Administration, including an assessment of leadership acumen
and ability to implement a clear, shared vision and effective
change management and care coordination.
(4) An identification of goals for the future of the
Veterans Health Administration.
(5) An identification and classification of the current
capabilities, capacity, and gaps in access and quality of the
health care system of the Department of Veterans Affairs.
(6) An analysis of value-based care models, including--
(A) a selection of potential models that would best work
for the Veterans Health Administration;
(B) the capacity and capabilities of each such model; and
(C) a thorough justification of the selection of each
selected model, including an summary of the ability of such
model to improve the metrics described under paragraph (9).
(7) A definition of what quality means with respect to--
(A) access to health care under the laws administered by
the Secretary of Veterans Affairs; and
(B) delivery of such health care.
(8) A definition of what value means with respect to care
furnished by the Veterans Health Administration,
(9) A system for measuring value within the Veterans Health
Administration that includes metrics for--
(A) outcomes;
(B) safety;
(C) service;
(D) access;
(E) productivity;
(F) capacity; and
(G) total cost of patient care.
(10) With respect to the system described in subparagraph
(H), an analysis of variable value with respect to patient
outcomes across different health care types and specialties.
(11) An assessment of--
(A) previous or ongoing assessments of the current
information technology infrastructure of the Veterans Health
Administration, including--
(i) such assessments conducted pursuant to the Electronic
Health Record Modernization program of the Department of
Veterans Affairs; and
(ii) any other ongoing information technology modernization
programs of such Department and any unimplemented relevant
recommendations from such assessments;
(B) the information technology infrastructure of the
Veterans Health Administration in effect as of the date of
the enactment of this Act;
(C) the value-driven framework of the Department, in effect
as of the date of the enactment of this Act, for evaluating
health care innovations, and how improvements in such
framework could be used to encourage innovation; and
(D) workforce challenges and needs of the Veterans Health
Administration based on--
(i) reviews of workforce assessment data available as of
the date of the enactment of this Act; and
(ii) the findings of--
(I) the report required by section 301(d) of the Veterans
Access, Choice, and Accountability Act of 2014 (Public Law
113-146);
(II) the reports required by section 505 of the John S.
McCain III, Daniel K. Akaka and Samuel R. Johnson VA
Maintaining Internal Systems and Strengthening Integrated
Outside Networks Act of 2018 (Public Law 115-182);
(III) the report required by section 301 of the VA Choice
and Quality Employment Act of 2017 (Public Law 115-46); and
(IV) any comprehensive health care inspection conducted by
the Inspector General of the Department of Veterans Affairs
as of the date of the enactment of this Act.
(12) Any recommendations of the working group with respect
to improving the information technology infrastructure
described in clause (i) of subparagraph (J).
(13) An analysis of how the value-driven framework
described in clause (iii) of such subparagraph could be used
to improve the model of care delivery by the Department.
(14) A description of how a value-based care system would
apply to primary care, inpatient and outpatient mental health
care, and inpatient and outpatient substance use treatment,
spinal cord injury disorder care, and polytrauma care
furnished by the Veterans Health Administration.
(15) With respect to legislative or administrative action
necessary to incorporate value-based care models into the
Veterans Health Administration, a description of the
estimated timelines, effect on workforce, and costs.
(c) Pilot Program.--
(1) In general.--Not later than 180 days after the
submission of the strategic plan pursuant to subsection (b),
the Secretary of Veterans Affairs, acting through the Center
for Innovation for Care and Payment established under section
1703E of title 38, United States Code, shall commence a
three-year pilot program under which the Secretary shall
implement the elements of such strategic plan relating to the
delivery, by the Veterans Health Administration, of primary
care, inpatient and outpatient mental health treatment,
inpatient and outpatient substance abuse treatment, spinal
cord injury disorder care, and polytrauma care.
(2) Locations.--The Secretary shall carry out such pilot
program in four Veterans Integrated Service Networks that are
geographically dispersed and shall include the following:
(A) A Veterans Integrated Service Network that
predominately serves veterans in rural and highly rural
areas.
(B) A Veterans Integrated Service Network that
predominately serves veterans in urban areas.
(C) A Veterans Integrated Service Network that has a high
rate of suicide among veterans.
(D) A Veterans Integrated Service Network that has a high
rate of substance use disorder among veterans.
(E) A Veterans Integrated Service Network that has access
or productivity challenges.
(3) Reports to congress.--
(A) Annual report.--Not later than one year after the
commencement of the pilot program, and annually thereafter
during the duration of the pilot program, the Secretary shall
submit to Congress a report on the pilot program.
(B) Final report.--Not later than 90 days before the
conclusion of the pilot program, the Secretary shall submit
to Congress a final report on the pilot program that
includes--
(i) lessons learned during the administration of such pilot
program; and
(ii) specific health outcomes in veteran patient care
compared to the Veterans Health Administration system of care
in effect as of the date of the enactment of this Act.
SEC. 108. PLAN ON ADOPTION OF CERTAIN HEALTH INFORMATION
STANDARDS FOR DEPARTMENT OF VETERANS AFFAIRS
AND CERTAIN HEALTH CARE PROVIDERS.
(a) Plan for Certain Health Information Standards.--
(1) In general.--The Secretary of Veterans Affairs, in
consultation with the Secretary of Health and Human Services,
the Administrator of the Centers for Medicare & Medicaid
Services, and the National Coordinator for Health Information
Technology of the Department of Health and Human Services,
shall create and implement a plan to adopt, as rapidly and to
the most comprehensive extent feasible, national health
information interoperability standards for the Department of
Veterans Affairs and community care providers with respect
to--
(A) coordination of--
(i) care; and
(ii) benefits;
(B) patient identity matching;
(C) measurement and reporting of quality;
(D) population health; and
(E) public health.
(2) Consideration.--In developing the plan under paragraph
(1), the Secretary of Veterans Affairs shall consider
challenges faced by--
(A) small community care providers; and
(B) community care providers located in rural areas.
(b) Plan on Electronic Health Record Exchange.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and the House
of Representatives a plan to provide, at no cost, to
community care providers of the Department, through Third
Party Administrators, a capability to facilitate the
electronic direct exchange, between such providers and the
Department, of--
(A) the health records of veterans; and
(B) documents relating to health care of veterans, clinical
notes, and any other information the Secretary determines
necessary.
(2) Prioritization.--In developing the plan required under
paragraph (1), the Secretary shall prioritize providing the
capability described in such paragraph to community care
providers that--
(A) provide care under the laws administered by the
Secretary to--
(i) a lower volume of veterans; and
(ii) veterans who are located in rural areas; and
[[Page H6043]]
(B) are unable or unwilling to exchange the records and
documents described in subparagraphs (A) and (B) of such
paragraph with the Department through standards-based or
direct exchange mechanisms in effect as of the date of the
enactment of this Act.
(c) Reports on Plan for Interoperability Standards.--
(1) Initial report.--Not later than one year 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) the plan required by subsection (a); and
(B) a report that includes--
(i) an analysis of gaps, if any, between the use, by the
Department and other agencies, health information exchanges,
and technology companies, of national health information
interoperability standards and the potential, or optimal, use
of such national health information interoperability
standards;
(ii) an analysis and description of the participation by
the Department, community care providers, and other relevant
entities in the Trusted Exchange Framework and Common
Agreement program of the Department of Health and Human
Services as of the date of the enactment of this Act;
(iii) recommendations of the Secretary with respect to
development of health information interoperability standards;
(iv) timelines or schedules to implement the plan required
by subsection (a); and
(v) an identification of any legislative authorities or
resources the Secretary requires to implement such plan.
(2) Recurring report requirement.--
(A) In general.--Not later than 18 months after the date of
the enactment of this Act, and every 180 days thereafter for
four years, the Secretary of Veterans Affairs shall submit to
Committees on Veterans' Affairs of the Senate and the House
of Representatives a report on the status of implementation
of the plan required under subsection (a).
(B) Elements of subsequent reports.--Each report under
subparagraph (A) submitted after the date on which the first
report required by such subparagraph is submitted shall
include a description of any revisions to--
(i) the plan required by subsection (a) made during the
period covered by the report; and
(ii) the analysis, recommendations, timelines, and
legislative authorities reported pursuant to paragraph (1).
(d) Definitions.--In this section:
(1) The term ``community care provider'' means a non-
Department health care provider providing care (including
dental care)--
(A) under section 1703 of title 38, United States Code;
(B) pursuant to a Veterans Care Agreement under section
1703A of such title; or
(C) under any other law administered by the Secretary of
Veterans Affairs.
(2) The term ``Third Party Administrator'' means an entity
that manages a provider network and performs administrative
services related to such network under section 1703 of title
38, United States Code.
SEC. 109. REPORT ON USE OF VALUE-BASED REIMBURSEMENT MODELS
UNDER VETERANS COMMUNITY CARE PROGRAM.
(a) Report on Value-based Reimbursement Models.--Not later
than one year after the date of the enactment of this Act,
the Secretary of Veterans Affairs, in consultation with the
Center for Innovation for Care and Payment of the Department
of Veterans Affairs under section 1703E of title 38 United
States Code, the Office of Integrated Veteran Care of the
Department, or successor office, and Third Party
Administrators, shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a
report containing--
(1) an assessment of the efforts of the Department pursuant
to section 1703(i)(5) of such title, to incorporate value-
based reimbursement models under the Veterans Community Care
Program to promote the provision of high-quality care to
veterans; and
(2) such recommendations for legislative or administrative
action as the Secretary considers appropriate regarding the
use of value-based reimbursement models throughout the
Veterans Community Care Program under section 1703 of such
title.
(b) Rule of Construction.--This section shall not be
construed to be a pilot program subject to the requirements
of section 1703E of title 38, United States Code.
(c) Third Party Administrator Defined.--In this section,
the term ``Third Party Administrator'' means an entity that
manages a provider network and performs administrative
services related to such network under section 1703 of title
38, United States Code.
SEC. 110. INSPECTOR GENERAL ASSESSMENT OF IMPLEMENTATION OF
VETERANS COMMUNITY CARE PROGRAM.
(a) In General.--Not later than 18 months after the date of
the enactment of this Act, and periodically thereafter, the
Inspector General shall assess the performance of the
Department of Veterans Affairs in--
(1) appropriately identifying veterans eligible for care
and services under section 1703 of title 38, United States
Code;
(2) informing veterans of their eligibility for such care
and services; and
(3) delivering such care and services in a timely manner.
(b) Briefing on Assessments.--Upon the submission of the
assessment required by subsection (a), the Inspector General
of the Department of Veterans Affairs shall provide to the
Committees on Veterans Affairs of the House of
Representatives and the Senate a briefing on the results of
such assessment.
SEC. 111. COMPTROLLER GENERAL REPORT ON DENTISTRY UNDER
VETERANS COMMUNITY CARE PROGRAM.
(a) In General.--Not later than one year after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a
report on dental care furnished by the Secretary of Veterans
Affairs under the Veterans Community Care Program under
section 1703 of title 38, United States Code, that includes a
review of--
(1) the impact current reimbursement rates provided by the
Department of Veterans Affairs to dental providers under such
program have on--
(A) the availability of dental care for veterans; and
(B) the ability of Third Party Administrators to meet their
contractual obligations for network adequacy;
(2) the satisfaction of dental providers providing dental
care under such program with the processes of the Department
for approving dental care under such program; and
(3) the current processes of the Department for approving
emergent dental care under such program.
(b) Third Party Administrator Defined.--In this section,
the term ``Third Party Administrator'' means an entity that
manages a provider network and performs administrative
services related to such network under section 1703 of title
38, United States Code.
Subtitle B--Matters Relating to Nursing Home and Other Long Term Care
and Family Caregivers
SEC. 120. INCREASE OF EXPENDITURE CAP FOR NONINSTITUTIONAL
CARE ALTERNATIVES TO NURSING HOME CARE.
(a) Increase of Expenditure Cap.--Section 1720C(d) of title
38, United States Code, is amended--
(1) by striking ``The total cost'' and inserting ``(1)
Except as provided in paragraph (2), the total cost'';
(2) by striking ``65 percent'' and inserting ``100
percent''; and
(3) by adding at the end the following new paragraph:
``(2)(A) The total cost of providing services or in-kind
assistance in the case of any veteran described in
subparagraph (B) for any fiscal year under the program may
exceed 100 percent of the cost that would otherwise have been
incurred as specified in paragraph (1) if the Secretary
determines, based on a consideration of clinical need,
geographic market factors, and such other matters as the
Secretary may prescribe through regulation, that such higher
total cost is in the best interest of the veteran.
``(B) A veteran described in this subparagraph is a veteran
with amyotrophic lateral sclerosis, a spinal cord injury, or
a condition the Secretary determines to be similar to such
conditions.''.
(b) Applicability.--The amendments made by subsection (a)
shall apply with respect to fiscal years beginning on or
after the date of the enactment of this Act.
SEC. 121. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE CARE FOR
THE ELDERLY.
Section 1720C of title 38, United States Code, as amended
by section 120, is further amended by adding at the end the
following new subsection:
``(f) In furnishing services to a veteran under the program
conducted pursuant to subsection (a), if a medical center of
the Department through which such program is administered is
located in a geographic area in which services are available
to the veteran under a PACE program (as such term is defined
in sections 1894(a)(2) and 1934(a)(2) of the Social Security
Act (42 U.S.C. 1395eee(a)(2); 1396u-4(a)(2))), the Secretary
shall seek to enter into an agreement with the PACE program
operating in that area for the furnishing of such
services.''.
SEC. 122. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO
AWARD GRANTS OR CONTRACTS TO ENTITIES TO
IMPROVE PROVISION OF MENTAL HEALTH SUPPORT TO
FAMILY CAREGIVERS OF VETERANS.
Subchapter II of chapter 17 of title 38, United States
Code, is amended by adding at the end the following new
section (and conforming the table of sections at the
beginning of such chapter accordingly):
``Sec. 1720K. Grants or contracts to provide mental health
support to family caregivers of veterans
``(a) Authority.--The Secretary may award grants to carry
out, coordinate, improve, or otherwise enhance mental health
counseling, treatment, or support to the family caregivers of
veterans participating in the family caregiver program.
``(b) Application.--(1) To be eligible for a grant or
contract under this section, an entity shall submit to the
Secretary an application therefor at such time, in such
manner, and containing such information as the Secretary may
require.
``(2) Each application submitted under paragraph (1) shall
include the following:
``(A) A detailed plan for the use of the grant or contract.
[[Page H6044]]
``(B) A description of the programs or efforts through
which the entity will meet the outcome measures developed by
the Secretary under subsection (g).
``(C) A description of how the entity will distribute grant
or contract amounts equitably among areas with varying levels
of urbanization.
``(D) A plan for how the grant or contract will be used to
meet the unique needs of veterans residing in rural areas,
Native American, Native Hawaiian, or Alaska Native veterans,
elderly veterans, women veterans, and veterans from other
underserved communities.
``(c) Distribution.--The Secretary shall seek to ensure
that grants and contracts awarded under this section are
equitably distributed among entities located in States with
varying levels of urbanization.
``(d) Priority.--The Secretary shall prioritize awarding
grants or contracts under this section that will serve the
following areas:
``(1) Areas with high rates of veterans enrolled in the
family caregiver program.
``(2) Areas with high rates of--
``(A) suicide among veterans; or
``(B) referrals to the Veterans Crisis Line.
``(e) Required Activities.--Any grant or contract awarded
under this section shall be used--
``(1) to expand existing programs, activities, and
services;
``(2) to establish new or additional programs, activities,
and services; or
``(3) for travel and transportation to facilitate carrying
out paragraph (1) or (2).
``(f) Outcome Measures.--(1) The Secretary shall develop
and provide to each entity that receives a grant or contract
under this section written guidance on the following:
``(A) Outcome measures.
``(B) Policies of the Department.
``(2) In developing outcome measures under paragraph (1),
the Secretary shall consider the following goals:
``(A) Increasing the utilization of mental health services
among family caregivers of veterans participating in the
family caregiver program.
``(B) Reducing barriers to mental health services among
family caregivers of veterans participating in such program.
``(g) Tracking Requirements.--(1) The Secretary shall
establish appropriate tracking requirements with respect to
the entities receiving a grant or contract under this
section.
``(2) Not less frequently than annually, the Secretary
shall submit to Congress a report on such tracking
requirements.
``(h) Performance Review.--The Secretary shall--
``(1) review the performance of each entity that receives a
grant or contract under this section; and
``(2) make information regarding such performance publicly
available.
``(i) Remediation Plan.--(1) In the case of an entity that
receives a grant or contract under this section and does not
meet the outcome measures developed by the Secretary under
subsection (g), the Secretary shall require the entity to
submit to the Secretary a remediation plan under which the
entity shall describe how and when it plans to meet such
outcome measures.
``(2) The Secretary may not award a subsequent grant or
contract under this section to an entity described in
paragraph (1) unless the Secretary approves the remediation
plan submitted by the entity under such paragraph.
``(j) Maximum Amount.--The amount of a grant or contract
awarded under this section may not exceed 10 percent of
amounts made available for grants or contracts under this
section for the fiscal year in which the grant or contract is
awarded.
``(k) Supplement, Not Supplant.--Any grant or contract
awarded under this section shall be used to supplement and
not supplant funding that is otherwise available through the
Department to provide mental health support among family
caregivers of veterans participating in the family caregiver
program.
``(l) Outreach to Family Caregivers.--The Secretary shall
include, in the outreach materials regularly provided to a
family caregiver who participates in the family caregiver
program, notice of mental health support provided by
recipients of grants or contracts under this section that are
located in the relevant Veterans Integrated Service Network.
``(m) Funding.--(1) Amounts for the activities of the
Department under this section shall be budgeted and
appropriated through a separate appropriation account.
``(2) In the budget justification materials submitted to
Congress in support of the budget of the Department for any
fiscal year (as submitted with the budget of the President
under section 1105(a) of title 31), the Secretary shall
include a separate statement of the amount requested to be
appropriated for that fiscal year for the account specified
in paragraph (1).
``(n) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary, for each of fiscal years
2025 and 2026, $10,000,000 to carry out this section.
``(o) Definitions.--In this section:
``(1) The terms `caregiver' and `family caregiver' have the
meanings given those terms in section 1720G of this title.
``(2) The term `family caregiver program' means the program
of comprehensive assistance for family caregivers under
section 1720G of this title.
``(3) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F of this
title.''.
SEC. 123. HOME- AND COMMUNITY-BASED SERVICES: PROGRAMS.
(a) Programs.--Such subchapter is further amended by
inserting after section 1720K (as added by section 122) the
following new section (and conforming the table of sections
at the beginning of such chapter accordingly):
``Sec. 1720L. Home- and community-based services: programs
``(a) In General.--In furnishing noninstitutional
alternatives to nursing home care pursuant to the authority
of section 1720C of this title (or any other authority under
this chapter or other provision of law administered by the
Secretary of Veterans Affairs), the Secretary shall carry out
each of the programs specified in this section in accordance
with such relevant authorities except as otherwise provided
in this section.
``(b) Veteran-Directed Care Program.--(1) The Secretary of
Veterans Affairs, in collaboration with the Secretary of
Health and Human Services, shall carry out a program to be
known as the `Veteran-Directed Care program'. Under such
program, the Secretary of Veterans Affairs may enter into
agreements with the providers described in paragraph (2) to
provide to eligible veterans funds, to the extent
practicable, to obtain such in-home care services and related
items that support clinical need and improve quality of life,
as may be determined appropriate by the Secretary of Veterans
Affairs and selected by the veteran, including through the
veteran hiring individuals to provide such services and items
or directly purchasing such services and items.
``(2) The providers described in this paragraph are the
following:
``(A) An Aging and Disability Resource Center, an area
agency on aging, or a State agency.
``(B) A center for independent living.
``(C) An Indian tribe or tribal organization receiving
assistance under title VI of the Older Americans Act of 1965
(42 U.S.C. 3057 et seq.).
``(D) Any other entity that the Secretary, in consultation
with the Secretary of Health and Human Services, determines
appropriate.
``(3) In carrying out the Veteran-Directed Care program,
the Secretary of Veterans Affairs shall--
``(A) administer such program through each medical center
of the Department of Veterans Affairs;
``(B) seek to ensure the availability of such program in
American Samoa, Guam, the Commonwealth of the Northern
Mariana Islands, the Commonwealth of Puerto Rico, the Virgin
Islands of the United States, and any other territory or
possession of the United States, to the extent practicable;
and
``(C) seek to ensure the availability of such program for
eligible veterans who are Native American veterans receiving
care and services furnished by the Indian Health Service, a
tribal health program, an Urban Indian organization, or (in
the case of a Native Hawaiian veteran) a Native Hawaiian
health care system, to the extent practicable.
``(4) If a veteran participating in the Veteran-Directed
Care program is hospitalized, the veteran may continue to use
funds under the program during a period of hospitalization in
the same manner that the veteran would be authorized to use
such funds under the program if the veteran were not
hospitalized.
``(c) Homemaker and Home Health Aide Program.--(1) The
Secretary shall carry out a program to be known as the
`Homemaker and Home Health Aide program' under which the
Secretary may enter into agreements with home health agencies
to provide to eligible veterans such home health aide
services as may be determined appropriate by the Secretary.
``(2) In carrying out the Homemaker and Home Health Aide
program, the Secretary shall--
``(A) administer such program in the locations specified in
subparagraph (A) of subsection (b)(3);
``(B) seek to ensure the availability of such program in
the locations specified in subparagraph (B) of subsection
(b)(3); and
``(C) seek to ensure the availability of such program for
the veteran populations specified in subparagraph (C) of
subsection (b)(3).
``(d) Home-Based Primary Care Program.--The Secretary shall
carry out a program to be known as the `Home-Based Primary
Care program' under which the Secretary may furnish to
eligible veterans in-home health care, the provision of which
is overseen by a provider of the Department.
``(e) Purchased Skilled Home Care Program.--The Secretary
shall carry out a program to be known as the `Purchased
Skilled Home Care program' under which the Secretary may
furnish to eligible veterans such in-home care services as
may be determined appropriate and selected by the Secretary
for the veteran.
``(f) Caregiver Support.--(1) With respect to a resident
eligible caregiver of a veteran participating in a program
under this section, the Secretary shall--
``(A) if the veteran meets the requirements of a covered
veteran under section 1720G(b) of this title, provide to such
caregiver the option of enrolling in the program of general
caregiver support services under such section;
[[Page H6045]]
``(B) provide to such caregiver covered respite care of not
less than 30 days annually; and
``(C) conduct on an annual basis (and, to the extent
practicable, in connection with in-person services provided
under the program in which the veteran is participating), a
wellness contact of such caregiver.
``(2) Covered respite care provided to a resident eligible
caregiver of a veteran under paragraph (1) may exceed 30 days
annually if such extension is requested by the resident
eligible caregiver or veteran and determined medically
appropriate by the Secretary.
``(g) Rule of Construction.--Nothing in this section shall
be construed to limit the authority of the Secretary to carry
out programs providing home- and community-based services
under any other provision of law.
``(h) Definitions.--In this section:
``(1) The terms `Aging and Disability Resource Center',
`area agency on aging', and `State agency' have the meanings
given those terms in section 102 of the Older Americans Act
of 1965 (42 U.S.C. 3002).
``(2) The terms `caregiver' and `family caregiver', with
respect to a veteran, have the meanings given those terms,
respectively, under subsection (e) of section 1720G of this
title with respect to an eligible veteran under subsection
(a) of such section or a covered veteran under subsection (b)
of such section, as the case may be.
``(3) The term `center for independent living' has the
meaning given that term in section 702 of the Rehabilitation
Act of 1973 (29 U.S.C. 796a).
``(4) The term `covered respite care' has the meaning given
such term in section 1720G(d) of this title.
``(5) The term `eligible veteran' means any veteran--
``(A) for whom the Secretary determines participation in a
specific program under this section is medically necessary to
promote, preserve, or restore the health of the veteran; and
``(B) who absent such participation would be at increased
risk for hospitalization, placement in a nursing home, or
emergency room care.
``(6) The term `home health aide' means an individual
employed by a home health agency to provide in-home care
services.
``(7) The term `in-home care service' means any service,
including a personal care service, provided to enable the
recipient of such service to live at home.
``(8) The terms `Indian tribe' and `tribal organization'
have the meanings given those terms in section 4 of the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 5304).
``(9) The terms `Native American' and `Native American
veteran' have the meanings given those terms in section 3765
of this title.
``(10) The terms `Native Hawaiian' and `Native Hawaiian
health care system' have the meanings given those terms in
section 12 of the Native Hawaiian Health Care Improvement Act
(42 U.S.C. 11711).
``(11) The terms `tribal health programs' and `Urban Indian
organizations' have the meanings given those terms in section
4 of the Indian Health Care Improvement Act (25 U.S.C. 1603).
``(12) The term `resident eligible caregiver' means an
individual who--
``(A) is a caregiver, or a family caregiver, of a veteran
and resides with that veteran; and
``(B) has not entered into a contract, agreement, or other
arrangement for such individual to act as a caregiver for
that veteran unless such individual is a family member of the
veteran or is furnishing caregiver services through a medical
foster home.''.
(b) Deadline for Improved Administration.--The Secretary of
Veterans Affairs shall ensure that the Veteran-Directed Care
program and the Homemaker and Home Health Aide program are
administered through each medical center of the Department of
Veterans Affairs in accordance with section 1720L of title
38, United States Code (as added by subsection (a)), by not
later than two years after the date of the enactment of this
Act.
(c) Administration of Veteran-Directed Care Program.--
(1) Procedures.--
(A) The Secretary shall establish procedures to--
(i) identify the staffing needs for the Veteran-Directed
Care program of the Department of Veterans Affairs under such
section (as added by subsection (a)); and
(ii) define the roles and responsibilities for personnel of
the Department responsible for the administration of such
program, including such personnel employed at the national,
Veterans Integrated Service Network, or medical facility
level.
(B) The responsibilities described in clause (ii) of
subparagraph (A) shall include responsibilities for
engagement with--
(i) veterans participating in such program;
(ii) veterans interested in participating in such program;
and
(iii) providers described in section 1720L(b)(2) (as added
by subsection (a)).
(2) Staffing model; report.--Not later than two years after
enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) establish a staffing model for the administration of
such program at each medical facility of the Department of
Veterans Affairs; and
(B) submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate a report containing
the following:
(i) A description of--
(I) the staffing model described in subparagraph (A); and
(II) the rationale for such staffing model.
(ii) An identification of the ratio of staff required to
administer such program to the number of veterans served by
such program, disaggregated by each medical facility of the
Department of Veterans Affairs.
(iii) A description of budgetary resources or other
support, if any, required to accommodate an increase in
staffing at medical facilities of the Department of Veterans
Affairs pursuant to the requirements of the staffing model
described in subparagraph (A).
(iv) Such other matters as the Secretary of Veterans
Affairs determines appropriate.
SEC. 124. COORDINATION WITH ASSISTANCE AND SUPPORT SERVICES
FOR CAREGIVERS.
(a) Coordination With Program of Comprehensive Assistance
for Family Caregivers.--
(1) Coordination.--Section 1720G(a) of title 38, United
States Code, is amended by adding at the end the following
new paragraph:
``(14)(A) In the case of a veteran or caregiver who seeks
services under this subsection and is denied such services,
or a veteran or the family caregiver of a veteran who is
discharged from the program under this subsection, the
Secretary shall--
``(i) if the veteran meets the requirements of a covered
veteran under subsection (b), provide to such caregiver the
option of enrolling in the program of general caregiver
support services under such subsection;
``(ii) assess the veteran or caregiver for participation in
any other available program of the Department for home- and
community-based services (including the programs specified in
section 1720L of this title) for which the veteran or
caregiver may be eligible and, with respect to the veteran,
store (and make accessible to the veteran) the results of
such assessment in the electronic medical record of the
veteran; and
``(iii) provide to the veteran or caregiver written
information on any such program identified pursuant to the
assessment under clause (ii), including information about
facilities, eligibility requirements, and relevant contact
information for each such program.
``(B) The Secretary shall, to the extent practicable,
provide to a veteran or family caregiver the option of
obtaining clinically appropriate services under any other
available program of the Department for home- and community-
based services (including the programs specified in section
1720L of this title) for which the veteran or family
caregiver may be eligible prior to discharging the veteran or
family caregiver from the program under this subsection.
``(C) For each veteran or family caregiver who is
discharged from the program under this subsection, a
caregiver support coordinator shall provide for a smooth and
personalized transition from such program to an appropriate
program of the Department for home- and community-based
services (including the programs specified in section 1720L
of this title), including by integrating caregiver support
across programs.''.
(2) Applicability.--The amendments made by paragraph (1)
shall apply with respect to denials and discharges occurring
on or after the date that is 180 days after the date of the
enactment of this Act.
(3) Technical and conforming amendments.--Section 1720G(d)
of such title is amended--
(A) by striking ``or a covered veteran'' each place it
appears and inserting ``, a veteran denied or discharged as
specified in paragraph (14) of such subsection, or a covered
veteran''; and
(B) by striking ``under subsection (a), means'' each place
it appears and inserting ``under subsection (a) or a veteran
denied or discharged as specified in paragraph (14) of such
subsection, means''.
(b) Conformity of Respite Care Across Programs.--Section
1720G of title 38, United States Code, as amended by
subsection (a)(3), is further amended--
(1) in subsection (a)(3)--
(A) by amending subparagraph (A)(ii)(III) to read as
follows:
``(III) covered respite care of not less than 30 days
annually;''; and
(B) by striking subparagraph (B) and redesignating
subparagraphs (C) and (D) as subparagraphs (B) through (C),
respectively; and
(2) by amending subsection (b)(3)(A)(iii) to read as
follows:
``(iii) Covered respite care of not less than 30 days
annually.''; and
(3) in subsection (d)--
(A) by redesignating paragraphs (2) through (4) as
paragraphs (3) through (5), respectively; and
(B) by inserting after paragraph (1) the following new
paragraph:
``(2) The term `covered respite care' means, with respect
to a caregiver of a veteran, respite care under section 1720B
of this title that--
``(A) is medically and age appropriate for the veteran
(including 24-hour per day care of the veteran commensurate
with the care provided by the caregiver); and
``(B) includes in-home care.''.
(c) Review Relating to Caregiver Contact.--The Secretary
shall conduct a review of the capacity of the Department to
establish a streamlined system for contacting all caregivers
enrolled in the program of general
[[Page H6046]]
caregiver support services under section 1720G(b) of title
38, United States Code, to provide to such caregivers program
updates and alerts relating to emerging services for which
such caregivers or the veterans for which they provide care
may be eligible.
SEC. 125. IMPROVEMENTS TO PROGRAM OF COMPREHENSIVE ASSISTANCE
FOR FAMILY CAREGIVERS.
Section 1720G(a) of title 38, United States Code, as
amended by section 124, is further amended--
(1) in paragraph (12)--
(A) in subparagraph (A), by inserting ``, which shall
include all criteria used to determine eligibility for such
assistance and, in the case of a completed evaluation, how
such criteria were used to evaluate information provided in
assessments to determine such eligibility'' before the period
at the end; and
(B) in subparagraph (C)(i), by striking ``who submits'' and
all that follows through the end of the clause and inserting
the following: ``who--
``(I) submits an application for the program established
under paragraph (1); or
``(II) is being reassessed for eligibility to continue in
such program.''; and
(2) by adding at the end the following new paragraph:
``(15)(A) Not less frequently than annually, the Secretary
shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a comprehensive
report on the program required by paragraph (1) that
includes, with respect to one-year period preceding the date
of the submission of such report, the following:
``(i) The number of applications received for such program.
``(ii) The number, disaggregated by race, sex, and era and
branch of service in the Armed Forces of the applicant, of--
``(I) approvals of such applications; and
``(II) denials of such applications.
``(iii) The number of reassessments conducted for such
program.
``(iv) An identification of each decision made with respect
to a reassessment conducted for such program, disaggregated
by decisions resulting in--
``(I) disenrollment, including removal, discharge, or
voluntary withdrawal;
``(II) tier reduction; and
``(III) tier continuation.
``(v) The number of appeals of decisions made with respect
to such program, disaggregated by type of appeal.
``(vi) With respect to each appeal described in clause (v),
the decision rendered, if any.
``(vii) A description of all tools used in assessments
conducted for such program, including an explanation of how
and by whom such tools are administered.
``(viii) A description of procedures used under such
program for reviewing and integrating clinical records from
health care providers that includes an explanation of how
such records are used in determinations of eligibility for
such program.
``(ix) A description of procedures available under such
program for health care providers to communicate medical
opinions to the teams conducting assessments to determine
eligibility for such program, including health care providers
in the private sector and health care providers specified in
subsection (c) of section 1703 of this title.
``(x) A description of information technology systems and
processes used under such program to upload and integrate all
clinical records from all non-Department providers, including
providers in the private sector and providers under the
Veterans Community Care Program established under such
section.
``(B) The Secretary shall ensure that all data included in
a report under subparagraph (A)--
``(i) relating to a decision made under the program
required by paragraph (1), are disaggregated by the specific
reason for the decision;
``(ii) relating to a veteran, include comprehensive
demographic information of the veteran, including the time
period of the injuries, if any, of the veteran and the
Veterans Integrated Service Network in which the veteran is
located; and
``(iii) with respect to eligibility determinations relating
to a serious injury of a veteran, specify--
``(I) how many such determinations relate to the ability of
the veteran to perform activities of daily living; and
``(II) how many such determinations relate to the need of a
veteran for supervision and protection.
``(C) The Secretary shall provide the data under paragraph
(B) pursuant to Federal laws and in a manner that is wholly
consistent with applicable Federal privacy and
confidentiality laws, including but the Privacy Act (5 U.S.C.
552a), the Health Insurance Portability and Accountability
Act (Public Law 104-191; 42 U.S.C. 201 note) and regulations
(title 45, Code of Federal Regulations, parts 160 and 164, or
successor regulations), and sections 5701, 5705, and 7332 of
this title to ensure that the provided data, or some portion
of the data, will not undermine the anonymity of a
veteran.''.
SEC. 126. IMPROVEMENTS RELATING TO HOMEMAKER AND HOME HEALTH
AIDE PROGRAM.
(a) Pilot Program for Communities With Shortage of Home
Health Aides.--
(1) Program.--Beginning not later than 18 months after the
date of the enactment of this Act, the Secretary shall carry
out a three-year pilot program under which the Secretary
shall provide homemaker and home health aide services to
veterans who reside in communities with a shortage of home
health aides.
(2) Locations.--The Secretary shall select not fewer than
five geographic locations in which the Secretary determines
there is a shortage of home health aides at which to carry
out the pilot program under paragraph (1).
(3) Nursing assistants.--
(A) In general.--In carrying out the pilot program under
paragraph (1), the Secretary may hire nursing assistants as
new employees of the Department of Veterans Affairs, or
reassign nursing assistants who are existing employees of the
Department, to provide to veterans in-home care services
(including basic tasks authorized by the State certification
of the nursing assistant) under the pilot program, in lieu of
or in addition to the provision of such services through non-
Department home health aides.
(B) Relationship to home-based primary care program.--
Nursing assistants hired or reassigned under subparagraph (A)
may provide services to a veteran under the pilot program
under paragraph (1) while serving as part of a health care
team for the veteran under the Home-Based Primary Care
program.
(4) Report to congress.--Not later than one year before the
date of the termination of the pilot program under paragraph
(1), the Secretary shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the
Senate a report that includes--
(A) a statement of the results of such pilot program; and
(B) an assessment of the feasibility and advisability of--
(i) extending such pilot program; or
(ii) making such pilot program a permanent program of the
Department of Veterans Affairs.
(b) Report on Use of Funds.--Not later than one year after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a
report containing, with respect to the period beginning in
fiscal year 2012 and ending in fiscal year 2024, the
following:
(1) An identification of the amount of funds that were
included in a budget of the Department of Veterans Affairs
during such period for the provision of in-home care to
veterans under the Homemaker and Home Health Aide program but
were not expended for such provision, disaggregated by
medical center of the Department for which such unexpended
funds were budgeted (if such disaggregation is possible).
(2) To the extent practicable, an identification of the
number of veterans for whom, during such period, the hours
during which a home health aide was authorized to provide
services to the veteran under the Homemaker and Home Health
Aide program were reduced for a reason other than a change in
the health care needs of the veteran, and a detailed
description of the reasons why any such reductions may have
occurred.
(c) Updated Guidance on Program.--Not later than one year
after the date of the enactment of this Act, the Secretary
shall issue updated guidance for the Homemaker and Home
Health Aide program. Such updated guidance shall include the
following:
(1) A process for the transition of veterans from the
Homemaker and Home Health Aide program to other covered
programs.
(2) A requirement for the directors of the medical
facilities of the Department to complete such process
whenever a veteran with care needs has been denied services
from home health agencies under the Homemaker and Home Health
Aide program as a result of the clinical needs or behavioral
issues of the veteran.
SEC. 127. PILOT PROGRAM TO FURNISH ASSISTED LIVING SERVICES
TO CERTAIN VETERANS.
(a) Establishment.--Beginning not later than two years
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall carry out a pilot program to assess--
(1) the effectiveness of providing assisted living services
to eligible veterans, at the election of such veterans; and
(2) the satisfaction with the pilot program of veterans
participating in such pilot program.
(b) Program Locations.--
(1) Veterans integrated service networks.--The Secretary
shall select two Veterans Integrated Service Networks of the
Department of Veterans Affairs at which to carry out the
pilot program under subsection (a).
(2) Facilities.--
(A) In general.--Within the Veterans Integrated Service
Networks selected under paragraph (1), the Secretary shall
select facilities at which to carry out the pilot program
under subsection (a)(1).
(B) Selection criteria.--In selecting facilities under
subparagraph (A) at which to carry out the pilot program
under subsection (a)(1), the Secretary shall ensure that--
(i) the locations of such facilities are in geographically
diverse areas;
(ii) not fewer than one such facility serves veterans in
rural or highly rural areas (as determined through the use of
the Rural-Urban Commuting Areas coding system of the
Department of Agriculture);
[[Page H6047]]
(iii) not fewer than one such facility is located in each
Veterans Integrated Service Network selected under paragraph
(1); and
(iv) not fewer than one such facility is a State home.
(c) Program Participants.--Not more than 60 eligible
veterans may participate in the pilot program under
subsection (a)(1) in each Veterans Integrated Service Network
selected under subsection (b)(1).
(d) Provision of Assisted Living Services.--
(1) Agreements.--In carrying out the pilot program under
subsection (a)(1), the Secretary may enter into agreements
for the provision of assisted living services on behalf of
eligible veterans with--
(A) a provider participating under a State plan or waiver
under title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.); or
(B) a State home recognized and certified under subpart B
of part 51 of title 38, Code of Federal Regulations, or
successor regulations.
(2) Standards.--The Secretary may not place, transfer, or
admit a veteran to any facility for assisted living services
under the pilot program under subsection (a)(1) unless the
Secretary determines that--
(A) the facility meets the standards for community
residential care established under sections 17.61 through
17.72 of title 38, Code of Federal Regulations, or successor
regulations, and any additional standards of care as the
Secretary may specify; or
(B) in the case of a facility that is a State home, the
State home meets such standards of care as the Secretary may
specify.
(3) Inspection.--The Secretary shall inspect facilities at
which veterans are placed under the pilot program under
subsection (a)(1)--
(A) with respect to a facility that is a State home, not
less frequently than annually and in the same manner as the
Secretary conducts inspection of State homes under section
1742 of title 38, United States Code; and
(B) with respect to any other facility, not less frequently
than annually and in the same manner as the Secretary
conducts inspection of facilities under section 1730 of such
title.
(4) Payment to certain facilities.--
(A) State homes.--In the case of a facility participating
in the pilot program under subsection (a)(1) that is a State
home, the Secretary shall pay to the State home a per diem
for each veteran participating in the pilot program at a rate
agreed to by the Secretary and the State home.
(B) Community assisted living facilities.--In the case of a
facility participating in the pilot program under subsection
(a)(1) that is a community assisted living facility, the
Secretary shall--
(i) pay to the facility an amount that is less than the
average rate paid by the Department for placement in a
community nursing home in the same Veterans Integrated
Service Network; and
(ii) re-evaluate payment rates annually to account for
current economic conditions and current costs of assisted
living services.
(e) Continuity of Care.--Upon the termination of the pilot
program under subsection (a)(1), the Secretary shall--
(1) provide to all veterans participating in the pilot
program at the time of such termination the option to
continue to receive assisted living services at the site they
were assigned to under the pilot program, at the expense of
the Department; and
(2) for such veterans who do not opt to continue to receive
such services--
(A) ensure such veterans do not experience lapses in care;
and
(B) provide such veterans with information on, and furnish
such veterans with, other extended care services based on
their preferences and best medical interest.
(f) Determination of Quality.--The Secretary shall
determine a method for assessment of quality of care provided
to veterans participating in the pilot program under
subsection (a)(1) and shall communicate that method to
providers of services under the pilot program.
(g) Annual Report.--Not later than one year after the
initiation of the pilot program under subsection (a)(1), and
annually thereafter for the duration of such pilot program,
the Secretary shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a
report on the pilot program that includes--
(1) an identification of Veterans Integrated Services
Networks and facilities of the Department participating in
the pilot program and assisted living facilities and State
homes at which veterans are placed under the pilot program;
(2) the number of participants in the pilot program,
disaggregated by facility;
(3) general demographic information of participants in the
pilot program, including average age, sex, and race or
ethnicity;
(4) disability status of participants in the pilot program;
(5) an identification of any barriers or challenges to
furnishing care to veterans under the pilot program,
conducting oversight of the pilot program, or any other
barriers or challenges;
(6) the cost of care at each assisted living facility and
State home participating in the pilot program, including an
analysis of any cost savings by the Department when comparing
that cost to the cost of nursing home care;
(7) aggregated feedback from participants in the pilot
program, including from veteran resident surveys and
interviews; and
(8) such other matters the Secretary considers appropriate.
(h) Final Report.--Not later than one year after the pilot
program terminates under subsection (j), the Secretary shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the pilot program
that--
(1) includes the matters required under paragraphs (1)
through (8) of subsection (g);
(2) includes recommendations on whether the model studied
in the pilot program should be continued or adopted
throughout the Department; and
(3) indicates whether the Secretary requests action by
Congress to make the pilot program permanent.
(i) Inspector General Report.--
(1) In general.--Not later than three years after the
initiation of the pilot program under subsection (a)(1), the
Inspector General of the Department of Veterans Affairs shall
submit to the Secretary of Veterans Affairs and the
Committees on Veterans' Affairs of House of Representatives
and the Senate a report on the pilot program.
(2) Elements.--The report required by paragraph (1) shall
include an assessment of--
(A) the quality of care provided to veterans at facilities
participating in the pilot program, measured pursuant to the
method determined under subsection (f);
(B) the oversight of such facilities, as conducted by the
Department, the Centers for Medicare & Medicaid Services,
State agencies, and other relevant entities; and
(C) such other matters as the Inspector General considers
appropriate.
(3) Plan required.--Not later than 90 days after the
submission of the report under paragraph (1), the Secretary
shall submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate a plan to address the
deficiencies identified in the report, if any.
(j) Termination.--
(1) In general.--Subject to paragraph (2), the pilot
program under subsection (a)(1) shall terminate on September
30, 2026.
(2) Extension.--The Secretary may extend the duration of
the pilot program for an additional two-year period if the
Secretary, based on the results of the reports submitted
under subsection (g), determines such an extension is
appropriate.
(k) Definitions.--In this section:
(1) The term ``assisted living services'' means services of
a facility in providing room, board, and personal care for
and supervision of residents for their health, safety, and
welfare.
(2) The term ``eligible veteran'' means a veteran who is--
(A) receiving nursing home care paid for by the Department
of Veterans Affairs, eligible to receive such care pursuant
to section 1710A of title 38, United States Code, or requires
a higher level of care than the domiciliary care provided by
the Department of Veterans Affairs, but does not meet the
requirements for nursing home level care provided by the
Department pursuant to such section; and
(B) eligible for assisted living services, as determined by
the Secretary or meets such additional criteria for
eligibility for the pilot program under subsection (a)(1) as
the Secretary may establish.
(3) The term ``State home'' has the meaning given that term
in section 101 of title 38, United States Code.
SEC. 128. PROVISION OF MEDICINE, EQUIPMENT, AND SUPPLIES
AVAILABLE TO DEPARTMENT OF VETERANS AFFAIRS TO
STATE HOMES.
(a) Provision Authorized.--The Secretary of Veterans
Affairs may provide to State homes medicine, personal
protective equipment, medical supplies, and any other
equipment, supplies, and assistance available to the
Department of Veterans Affairs.
(b) Definition.--In this section:
(1) The term ``personal protective equipment'' means any
protective equipment required to prevent the wearer from
contracting an infectious disease, including gloves, N-95
respirator masks, gowns, goggles, face shields, or other
equipment required for safety.
(2) The term ``State home'' has the meaning given such term
in section 101 of title 38, United States Code.
SEC. 129. RECOGNITION OF ORGANIZATIONS AND INDIVIDUALS TO
ASSIST VETERANS, FAMILY MEMBERS, AND CAREGIVERS
NAVIGATING PROGRAMS AND SERVICES OF VETERANS
HEALTH ADMINISTRATION.
(a) In General.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall establish a process through which the Department of
Veterans Affairs may recognize organizations and individuals
to assist a veteran, a family member of a veteran, or a
caregiver of a veteran (as defined in section 1720G(d) of
title 38, United States Code) in navigating the programs and
services of the Veterans Health Administration.
(b) Solicitation of Feedback.--The Secretary shall solicit
feedback and recommendations in the creation of the process
under subsection (a) from such organizations as the Secretary
may consider relevant.
(c) Limitation.--The Secretary may not recognize an
organization or individual pursuant to the process
established under subsection (a) unless the organization or
individual has certified to the Secretary that no
[[Page H6048]]
fee or compensation of any nature will be charged to any
individual for services rendered in providing assistance
pursuant to such subsection.
SEC. 130. REVIEWS AND OTHER IMPROVEMENTS RELATING TO HOME-
AND COMMUNITY-BASED SERVICES.
(a) Office of Geriatric and Extended Care.--
(1) Review of programs.--The Under Secretary for Health of
the Department of Veterans Affairs shall conduct a review of
each program administered through the Office of Geriatric and
Extended Care of the Department and the Caregiver Support
Program Office of the Department, or any successor offices,
to--
(A) eliminate service gaps at the medical center level; and
(B) ensure--
(i) the clinical needs of veterans are met;
(ii) consistency in program management;
(iii) the availability of, and the access by veterans to,
home- and community-based services, including for veterans
living in rural areas; and
(iv) proper coordination between covered programs.
(2) Assessment of staffing needs.--The Secretary of
Veterans Affairs shall conduct an assessment of the staffing
needs of the Office of Geriatric and Extended Care of the
Department and the Caregiver Support Program Office of the
Department, or any successor offices.
(3) Goals for geographic alignment of care.--
(A) Establishment of goals.--The Director of the Office of
Geriatric and Extended Care, or successor office, shall
establish quantitative goals to enable aging or disabled
veterans who are not located near medical centers of the
Department to access extended care services (including by
improving access to home- and community-based services for
such veterans).
(B) Implementation timeline.--Each goal established under
subparagraph (A) shall include a timeline for the
implementation of the goal at each medical center of the
Department.
(4) Goals for in-home specialty care.--The Director of the
Office of Geriatric and Extended Care, or successor office,
shall establish quantitative goals to address the specialty
care needs of veterans through in-home care, including by
ensuring the education of home health aides and caregivers of
veterans in the following areas:
(A) Dementia care.
(B) Care for spinal cord injuries and diseases.
(C) Ventilator care.
(D) Other speciality care areas as determined by the
Secretary.
(5) Input on goals.--To the extent practicable, the head of
the Caregiver Support Program Office, or successor office,
shall provide to the Director of the Office of Geriatric and
Extended Care, or successor office, input with respect to the
establishment of the goals under paragraphs (3) and (4).
(6) Report to congress.--Not later than one year after the
date of the enactment of this Act, the Secretary shall submit
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report containing the
findings of the review under paragraph (1), the results of
the assessment under paragraph (2), and the goals established
under paragraphs (3) and (4).
(b) Review of Incentives and Efforts Relating to Home- and
Community-based Services.--
(1) Review.--The Secretary of Veterans Affairs shall
conduct a review of the following:
(A) The financial and organizational incentives or
disincentives for the directors of medical centers of the
Department to establish or expand covered programs at such
medical centers.
(B) Any incentives or disincentives for such directors to
provide to veterans home- and community-based services in
lieu of institutional care.
(C) The efforts taken by the Secretary to enhance spending
of the Department for extended care by balancing spending
between institutional care and home- and community-based
services consistent with the demand for such services.
(D) The plan of the Under Secretary for Health of the
Department to accelerate efforts to enhance spending as
specified in subparagraph (C), to match the progress of
similar efforts taken by the Administrator of the Centers for
Medicare & Medicaid Services with respect to spending of the
Centers for Medicare & Medicaid Services for extended care.
(2) Report to congress.--Not later than one year after the
date of the enactment of this Act, the Secretary shall submit
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the findings of
the review under paragraph (1).
(c) Review of Respite Care Services.--Not later than two
years after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall conduct a review of the
use, availability, cost,and effectiveness, of the respite
care services furnished by the Secretary under chapter 17 of
title 38, United States Code, including--
(1) the frequency at which the Department of Veterans
Affairs is unable to meet demand for such services;
(2) a detailed description of--
(A) the reasons the Department of Veterans Affairs is
unable to meet the demand for such services; and
(B) any actions, or planned actions, of the Secretary of
Veterans Affairs to ensure such demand is met.
(d) Collaboration to Improve Home- and Community-based
Services.--
(1) Recommendations.--
(A) Development.--The Secretary of Veterans Affairs shall
develop recommendations as follows:
(i) With respect to home- and community-based services for
veterans, the Secretary of Veterans Affairs shall develop
recommendations regarding new services (in addition to those
furnished as of the date of enactment of this Act) in
collaboration with the Secretary of Health and Human
Services.
(ii) With respect to the national shortage of home health
aides, the Secretary of Veterans Affairs shall develop
recommendations regarding methods to address such shortage in
collaboration with the Secretary of Health and Human Services
and the Secretary of Labor.
(B) Submission to congress.--The Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report
containing the recommendations developed under subparagraph
(A) and an identification of any changes in existing law or
new statutory authority necessary to implement the
recommendations, as determined by the Secretary.
(C) Consultation with secretary of labor.--In carrying out
this paragraph, the Secretary of Veterans Affairs shall
consult with the Secretary of Labor.
(2) Feedback and recommendations on caregiver support.--
(A) Feedback and recommendations.--The Secretary of
Veterans Affairs shall solicit from the entities described in
subparagraph (B) feedback and recommendations regarding
opportunities for the Secretary to enhance home- and
community-based services for veterans and the caregivers of
veterans, including through the potential provision by the
entity of care and respite services to veterans and
caregivers who may not be eligible for any program under
section 1720G of title 38, United States Code, or section
1720L of such title (as added by section 124), but have a
need for assistance.
(B) Covered entities.--The entities described in this
subparagraph are veterans service organizations and nonprofit
organizations with a focus on caregiver support or long term
care (as determined by the Secretary).
(3) Collaboration for certain veterans.--The Secretary of
Veterans Affairs shall collaborate with the Director of the
Indian Health Service and representatives from tribal health
programs and Urban Indian organizations to ensure the
availability of home- and community-based services for--
(A) Native American veterans, including Native American
veterans receiving health care and medical services under
multiple health care systems; and
(B) Native Hawaiian veterans, including Native Hawaiian
veterans receiving health care and medical services under the
Native Hawaiian health care system.
SEC. 131. GAO REPORT ON MENTAL HEALTH SUPPORT FOR CAREGIVERS.
(a) Report Required.--Not later than one year after the
date of the enactment of this Act, the Comptroller General of
the United States shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs
of the House of Representatives a report on the provision of
mental health support to caregivers of veterans.
(b) Contents.--The report submitted under subsection (a)
shall include the following:
(1) An assessment of the need for mental health support
among caregivers participating in the caregiver programs.
(2) An assessment of options for mental health support in
facilities of the Department of Veterans Affairs and in the
community for caregivers participating in the caregiver
programs.
(3) An assessment of the availability and accessibility of
mental health support in facilities of the Department and in
the community for caregivers participating in the caregiver
programs.
(4) An assessment of the awareness among caregivers of the
availability of mental health support in facilities of the
Department and in the community for caregivers participating
in the caregiver programs.
(5) An assessment of barriers to mental health support in
facilities of the Department and in the community for
caregivers participating in the caregiver programs.
(c) Definitions.--In this section:
(1) The term ``caregiver'' has the meaning given that term
in section 1720G of title 38, United States Code.
(2) The term ``caregiver programs'' means--
(A) the program of comprehensive assistance for family
caregivers under subsection (a) of section 1720G of title 38,
United States Code; and
(B) the program of support services for caregivers under
subsection (b) of such section.
SEC. 132. DEVELOPMENT OF CENTRALIZED WEBSITE FOR PROGRAM
INFORMATION.
(a) Centralized Website.--The Secretary shall develop and
maintain a centralized and publically accessible internet
website of the Department as a clearinghouse for information
and resources relating to covered programs.
(b) Contents.--The website under subsection (a) shall
contain the following:
[[Page H6049]]
(1) A description of each covered program.
(2) An informational assessment tool that--
(A) explains the administrative eligibility, if applicable,
of a veteran, or a caregiver of a veteran, for any covered
program; and
(B) provides information, as a result of such explanation,
on any covered program for which the veteran or caregiver (as
the case may be) may be eligible.
(3) A list of required procedures for the directors of the
medical facilities of the Department to follow in determining
the eligibility and suitability of veterans for participation
in a covered program, including procedures applicable to
instances in which the resource constraints of a facility (or
of a community in which a facility is located) may result in
the inability to address the health needs of a veteran under
a covered program in a timely manner.
(c) Updates.--The Secretary shall ensure the website under
subsection (a) is updated on a periodic basis.
SEC. 133. DEFINITIONS.
In this title:
(1) The terms ``caregiver'' and ``family caregiver'' have
the meanings given those terms under section 1720L(h) of
title 38, United States Code (as added by section 123).
(2) The term ``covered program''--
(A) means any program of the Department of Veterans Affairs
for home- and community-based services; and
(B) includes the programs specified in section 1720L of
title 38, United States Code (as added by section 123).
(3) The term ``home- and community-based services''--
(A) means the services referred to in section 1701(6)(E) of
title 38, United States Code; and
(B) includes services furnished under a program specified
in section 1720L of such title (as added by section 123).
(4) The terms ``Home-Based Primary Care program'',
``Homemaker and Home Health Aide program'', and ``Veteran-
Directed Care program'' mean the programs of the Department
of Veterans Affairs specified in subsection (d), (c), and (b)
of such section 1720L, respectively.
(5) The terms ``home health aide'', ``Native American'',
``Native American veteran'', ``tribal health programs'', and
``Urban Indian organizations'' have the meanings given those
terms in subsection (h) of such section 1720L.
(6) The term ``Vet Center'' has the meaning given that term
in section 1712A(h) of title 38, United States Code.
(7) The term ``veterans service organization'' means any
organization recognized by the Secretary under section 5902
of such title.
Subtitle C--Medical Treatment and Other Matters
SEC. 140. QUARTERLY REPORT ON REFERRALS FOR NON-DEPARTMENT OF
VETERANS AFFAIRS HEALTH CARE.
Subchapter I of chapter 5 of title 38, United States Code,
is amended by adding at the end the following new section
(and amending the table of sections at the beginning of such
chapter accordingly):
``Sec. 534. Quarterly report on referrals for non-Department
health care
``Not later than 180 days after the date of the enactment
of this section, and not less frequently than quarterly
thereafter, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives a report containing, with respect to
referrals for non-Department health care originating from a
medical facility of the Department during the quarter
preceding the date of the submission of the report, a
measurement of, for each such medical facility--
``(1) the period of time between--
``(A) the date on which a clinician employed by the
Department determines that a veteran requires care, or a
veteran presents to the Department requesting care, and the
date on which the referral for care is sent to a non-
Department health care provider;
``(B) the date on which such referral is sent to a non-
Department health care provider and the date on which such
non-Department health care provider accepts such referral;
``(C) the date on which such non-Department health care
provider accepts such referral and the date on which such
referral is completed;
``(D) the date on which such referral is completed and the
date on which an appointment with a non-Department health
care provider is made; and
``(E) the date on which such an appointment is made and the
date on which such appointment occurs; and
``(2) any other period of time that the Secretary
determines necessary.''.
SEC. 141. ELIMINATION OF CERTAIN REQUIREMENTS FOR CERTAIN
DEPARTMENT OF VETERANS AFFAIRS ASSISTANT UNDER
SECRETARIES.
Section 7306 of title 38, United States Code, is amended--
(1) by striking subsection (b);
(2) by redesignating subsections (c) through (g) as
subsections (b) through (f), respectively; and
(3) in subsection (c) (as so redesignated), by striking
``subsection (e)'' and inserting ``subsection (f)''.
SEC. 142. MODIFICATION OF PAY LIMITATION FOR PHYSICIANS,
PODIATRISTS, OPTOMETRISTS, AND DENTISTS OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) Pay.--
(1) In general.--Section 7431 of title 38, United States
Code, is amended--
(A) by inserting ``optometrists,'' after ``podiatrists,''
each place it appears;
(B) by inserting ``optometrist'' after ``podiatrist,'' each
place it appears;
(C) in subsection (c)--
(i) in paragraph (5), by adding at the end the following
new sentence: ``Such a notice shall include a statement of
whether the market pay will increase, decrease, or remain
unchanged following such evaluation.''; and
(ii) by adding at the end the following new paragraphs:
``(7) The Secretary shall ensure that each physician,
podiatrist, optometrist, and dentist in the Veterans Health
Administration is--
``(A) advised, on an annual basis, of the criteria
described in subparagraph (F) of paragraph (4);
``(B) evaluated in accordance with such criteria; and
``(C) compensated in accordance with--
``(i) applicable assignment and pay levels, subject to
relevant pay limitations; and
``(ii) the extent to which such criteria is met.
``(8) Not later than 120 days after the end of each fiscal
year, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives a report that includes the following:
``(A) A list of each facility and specialty that conducted
an evaluation of pay during the period covered by the report.
``(B) For each evaluation described in subparagraph (A)--
``(i) a list of occupations for which pay was evaluated,
disaggregated by medical specialty, number of authorized
full-time employees, and onsite full-time employees as of the
date of the evaluation;
``(ii) the date such evaluation was completed;
``(iii) whether a market pay adjustment was made following
the evaluation per each occupation and specialty evaluated;
``(iv) whether applicable employees were notified of such
evaluation;
``(v) whether local labor partners were notified of such
evaluation; and
``(vi) in the case of an evaluation that resulted in an
adjustment of pay--
``(I) the date such adjustment--
``(aa) was implemented; and
``(bb) became effective; and
``(II) the percentage of employees of each occupation and
specialty for which pay was adjusted pursuant to such
evaluation.
``(C) A list of facilities of the Department that have not
conducted an evaluation of market pay, pursuant to paragraph
(5), during the 18-month-period that precedes the date of the
submission of such report.'';
(D) in subsection (e)--
(i) in paragraph (1)(A), by inserting ``optometrists,''
after ``podiatrists,''; and
(ii) by adding at the end the following new paragraphs:
``(5) Notwithstanding any compensation or pay limitations
under this title or title 5, the Secretary may authorize the
Under Secretary for Health to pay physicians, podiatrists,
optometrists and dentists--
``(A) awards authorized under this title;
``(B) advance payments, recruitment or relocation bonuses,
and retention allowances authorized under section 7410(a) of
this title or as otherwise provided by law;
``(C) incentives or bonuses under section 706 of this title
or as otherwise provided by law; and
``(D) earnings from fee-basis appointments under section
7405(a)(2) of this title.
``(6)(A) The Secretary may waive any pay limitation
described in this section (including tier limitations) that
the Secretary determines necessary for the recruitment or
retention of critical health care personnel whom the
Secretary determines would provide direct patient care.
``(B) Priority for such waivers shall be given for
positions, locations, and care provided through contracts at
a high cost to the Department.
``(C) The Chief Human Capital Officer of the Department,
the Chief Financial Officer of the Department, and the Office
of the General Counsel of the Department shall review any
waiver issued under subparagraph (A).
``(D) During the period the authority under subparagraph
(A) is effective, the Secretary may not issue more than 300
waivers under such subparagraph.
``(E) The Secretary may prescribe requirements,
limitations, and other considerations for waivers under such
subparagraph.
``(F) Not later than 180 days after the date of the
enactment of the Senator Elizabeth Dole 21st Century Veterans
Healthcare and Benefits Improvement Act, and annually
thereafter, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives a report that includes--
``(i) any updates to the requirements, limitations, and
considerations prescribed under subparagraph (B) during the
period covered by the report;
``(ii) a description of the findings of each review, if
any, conducted pursuant to subparagraph (C);
``(iii) a description of each waiver under subparagraph (A)
in effect as of the date of the submission of the report,
including the--
``(I) duty location, position, specialty, market and
performance considerations for the waiver; and
[[Page H6050]]
``(II) impact, if any, of the waiver on contracted care
purchased by the Department for the region; and
``(iv) a list of any separation actions during the period
covered by the report with respect to a position for which a
waiver under subparagraph (A) is in effect.
``(G) The authority of the Secretary under subparagraph (A)
shall terminate on the last day of the third full fiscal year
following the date of the enactment of the Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits
Improvement Act.''.
(2) Report on waiver authority.--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 that includes a description of the requirements,
limitations, and other considerations prescribed under
section 7431(b)(6)(D) of title 38, United States Code, as
added by paragraph (1).
(3) Conforming amendments.--
(A) Pay of under secretary for health.--Section 7432(b)(1)
of such title is amended by inserting ``, podiatrist,
optometrist,'' after ``physician''.
(B) Administrative matters.--Section 7433 of such title is
amended by inserting ``optometrists,'' after ``physicians,''
each place it appears.
(C) Competitive pay.--Section 7451(a)(2)(C) of such title
is amended by inserting ``optometrist,'' after
``physician,''.
(4) Clerical amendments.--
(A) Subchapter heading.--Subchapter III of chapter 74 of
such title is amended in the heading by inserting
``Optometrists,'' after ``PODIATRISTS,''.
(B) Table of sections.--The table of sections for such
chapter is amended by striking the item relating to
subchapter III and inserting the following:
``subchapter iii--pay for physicians and other health-care
personnel''.
(5) Applicability dates.--The amendments made by this
subsection shall apply to any pay period of the Department of
Veterans Affairs beginning on or after the date that is 180
days after the date of the enactment of this Act.
(b) Modification and Clarification of Pay Grade for
Optometrists.--Section 7404 of title 38, United States Code,
is amended--
(1) in subsection (a)(2)(A), by striking ``podiatrists, and
dentists'' and inserting ``podiatrists, optometrists, and
dentists''; and
(2) in subsection (b)--
(A) by striking ``podiatrist (dpm), and dentist'' and
inserting ``podiatrist (dpm), optometrist (od), and
dentist'';
(B) by striking ``clinical chiropractor and optometrist
schedule,'' and inserting ``clinical chiropractor schedule'';
and
(C) by inserting ``optometrist grade'' after ``Podiatrist
grade''.
(c) Retroactive Authority for Compensation.--
(1) In general.--The Secretary of Veterans Affairs may pay
retroactive compensation to a covered employee in an amount
that equals the amount of compensation that was authorized to
be paid to such covered employee during the period specified
in paragraph (2), but was deferred and paid to such employee
in the calendar year following the calender year in which
such compensation was authorized because the payment such
compensation would have exceeded an applicable cap on annual
compensation.
(2) Period specified.--The period specified in this
paragraph is the period beginning on January 8, 2006, and
ending on December 31, 2017.
(3) Exclusion.--Compensation authorized under this
subsection shall not be included in the calculation of any
aggregate limit on compensation for a covered employee for
the year in which it is paid.
(4) Charging of compensation.--Compensation authorized
under this subsection shall be charged to the appropriate
medical care appropriation account of the Department of
Veterans Affairs for the fiscal year in which the work was
performed except as follows:
(A) In the case of an account that has closed pursuant to
section 1552 of title 31, United States Code, the
compensation shall be charged to a current appropriation
account in accordance with section 1553 of such title.
(B) In the case of an expired account that has not closed,
if charging the compensation to the expired account would
cause such account to have a negative unliquidated or
unexpended balance, the compensation may be charged to a
current appropriation account available for the same purpose.
(5) Definitions.--In this subsection:
(A) The term ``compensation'' means any pay, including
salary, awards, and incentives.
(B) The term ``covered employee'' means a physician,
podiatrist, or dentist subject to market pay under section
7431 of title 38, United States Code.
SEC. 143. REIMBURSEMENT OF AMBULANCE COST FOR CARE FOR
CERTAIN RURAL VETERANS.
(a) In General.--The Secretary of Veterans Affairs shall
pay, or reimburse a covered veteran for, the cost of
transporting the veteran by ambulance, including air
ambulance, from a covered location to a provider of the
Department of Veterans Affairs, a non-Department provider, or
the nearest hospital that can meet the needs of the veteran
(including a hospital that compacts with the Indian Health
Service) for covered care.
(b) Amount Covered.--The maximum cumulative amount covered
under this section for a covered veteran is $46,000.
(c) Sunset.--This section shall cease to be effective on
September 30, 2026.
(d) Definitions.--In this section:
(1) The term ``covered care'' means care for a veteran
eligible for care provided by the Department of Veterans
Affairs under title 38, United States Code, or any other law
administered by the Secretary of Veterans Affairs, even if
the care associated with the transport described in
subsection (a) is not authorized by the Department.
(2) The term ``covered location'' means a location that
is--
(A) in a State that is 100 miles or more from the nearest
medical center of the Department of Veterans Affairs; and
(B) in an area rated as a 10 or higher under the rural-
urban commuting areas coding system of the Department of
Agriculture.
(3) The term ``covered veteran'' means a veteran who--
(A) has a service-connected disability rated by the
Secretary as between 0 and 30 percent disabling;
(B) is not eligible for payments or reimbursements for
beneficiary travel or other transportation under the laws
administered by the Secretary of Veterans Affairs, other than
under this section; and
(C) is not entitled to care or services under a non-
Department of Veterans Affairs health-plan contract.
(4) The term ``health-plan contract'' has the meaning given
that term in section 1725 of title 38, United States Code.
(5) The term ``service-connected'' has the meaning given
that term in section 101 of such title.
SEC. 144. PILOT PROGRAM TO FURNISH DENTAL CARE FROM THE
DEPARTMENT OF VETERANS AFFAIRS TO CERTAIN
VETERANS DIAGNOSED WITH ISCHEMIC HEART DISEASE.
(a) In General.--Beginning not later than one year after
the date of the enactment of this Act, the Secretary of
Veterans Affairs shall carry out a two-year pilot program (in
this section referred to as the ``pilot program'') under
which the Secretary shall furnish covered care to covered
veterans through means that include the use of community
care.
(b) Locations.--
(1) In general.--The Secretary shall select not more than
four States in which to carry out the pilot program.
(2) Selection criteria.--In selecting States under
paragraph (1), the Secretary shall prioritize States in
which--
(A) the Department of Veterans Affairs serves a high
proportion, as determined by the Secretary, of veterans
residing in rural or highly rural areas (as determined
through the use of the Rural-Urban Commuting Areas coding
system of the Department of Agriculture);
(B) dental clinics operated by the Department of Veterans
Affairs currently utilize teledentistry;
(C) the Department of Veterans Affairs does not currently
operate a dental clinic; or
(D) the Secretary determines a large percentage of veterans
enrolled in the system of annual patient enrollment of the
Department of Veterans Affairs established and operated under
paragraphs (1) or (2) of section 1705(a) of title 38, United
States Code, visit emergency rooms for dental emergencies at
high rates.
(c) Participation Limitation.--Participation in a pilot
program established pursuant to this section shall be limited
to a covered veteran who receives health care in a facility
of the Department located in a State selected under
subsection (b).
(d) Use of Certain Methods to Provide Care.--
(1) Mobile dental clinics.--In carrying out the pilot
program, the Secretary shall test the efficacy of mobile
dental clinics to service rural areas that do not have a
population base to warrant a full-time clinic but where there
are covered veterans in need of dental care.
(2) Home-based dental care.--In carrying out the pilot
program, the Secretary shall test the efficacy of portable
dental care units to service rural veterans in their homes,
as the Secretary considers medically appropriate.
(e) Administration.--
(1) Community care network review.--
(A) In general.--Before commencing the pilot program, the
Secretary shall work with third party administrators to
conduct a review of dental providers who are part of the
community care network of the Department in each State
selected under subsection (b)(1) to ensure--
(i) dental providers who are no longer accepting patients
from the Department--
(I) are not still listed as providers accepting referrals
from the Department; and
(II) are not sent referrals from the Department; and
(ii) dental providers participating in each such network
are capable of receiving an influx of patients from the
Department under the pilot program.
(B) Expansion of network.--If, pursuant to a review under
subparagraph (A), the Secretary determines the community care
network in a State selected under subsection (b)(1) is not
capable of receiving an influx of patients under the pilot
program, the Secretary shall coordinate with the Third Party
[[Page H6051]]
Administrator for such State to ensure the dental provider
network of such community care network is sufficiently
expanded before the initiation of the pilot program.
(2) Notice to covered veterans.--In carrying out the pilot
program, the Secretary shall inform all covered veterans in
States selected under subsection (b)(1) of the covered care
available under the pilot program.
(3) Loss of eligibility.--Any veteran participating in the
pilot program who ceases to be a covered veteran shall be
removed from the pilot program on the date that is 90 days
after the Secretary determines the participant is no longer a
covered veteran.
(4) Continuity of care.--
(A) In general.--Upon the termination of the pilot program,
the Secretary shall provide to all veterans participating in
the pilot program at the time of such termination--
(i) information on how to enroll in the dental insurance
plan of the Department of Veterans Affairs under section
1712C of title 38, United States Code;
(ii) if appropriate, information on the VETSmile program of
the Department of Veterans Affairs, or any successor program;
or
(iii) contact information for dental providers in the
surrounding community who provide low- or no-cost dental care
and whom the Secretary has confirmed are available to take on
new patients.
(B) Continuation of treatment plan.--Any veteran
participating in the pilot program may continue to receive
services under the pilot program after the termination of the
pilot program to complete a treatment plan commenced under
the pilot program, as determined necessary by the Secretary.
(f) Reports.--
(1) Annual report.--Not later than one year after the
commencement of the pilot program, and annually thereafter
for the duration of the pilot program, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a
report on the pilot program that includes--
(A) an identification of the States participating in the
pilot program;
(B) a description of the implementation and operation of
the pilot program;
(C) the number of participants in the pilot program,
disaggregated by--
(i) State; and
(ii) disability rating;
(D) an identification of any barriers or challenges to
implementing the pilot program;
(E) aggregated feedback from participants in the pilot
program, including from interviews and surveys;
(F) the average annual cost of providing covered care to a
participant in the pilot program, disaggregated by--
(i) State;
(ii) disability rating; and
(iii) whether the care was provided through the community
care network or through a provider of the Department;
(G) an analysis of the communication and collaboration of
the Department with Third Party Administrators and community
care dental providers, disaggregated by State;
(H) an analysis of any cost savings by the Department with
respect to the treatment of ischemic heart disease;
(I) an assessment of the impact of the pilot program on
appointments for care, prescriptions, hospitalizations,
emergency room visits, wellness, employability, satisfaction,
and perceived quality of life of covered veterans related to
their diagnosis of ischemic heart disease;
(J) an analysis and assessment of the efficacy of mobile
clinics and portable dental care units, to the extent such
modalities are used, to service the needs of covered veterans
under the pilot program;
(K) an analysis and assessment of the usage of
teledentistry to service the needs of covered veterans under
the pilot program, to include a cost benefit analysis of such
services; and
(L) such other matters as the Secretary considers
appropriate.
(2) Final report.--Not later than 90 days before the
completion of the pilot program, the Secretary shall submit
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the pilot program
that--
(A) includes the matters required under paragraph (1);
(B) includes recommendations on whether the pilot program
should be continued, expanded, or adopted throughout the
Department; and
(C) indicates whether the Secretary requests action by
Congress to make the pilot program permanent.
(g) Impact on Community Care.--Participants in the pilot
program shall be able to access covered care in the community
under section 1703 of title 38, United States Code.
(h) Definitions.--In this section:
(1) The term ``covered care'' means dental care that is
consistent with the dental services and treatment furnished
by the Secretary of Veterans Affairs to veterans pursuant to
section 1712(a)(1)(G) of title 38, United States Code.
(2) The term ``covered veteran'' means a veteran who--
(A) is enrolled in the system of annual patient enrollment
of the Department established and operated under paragraphs
(1) or (2) of section 1705(a) of title 38, United States
Code;
(B) is not eligible for dental services and treatment and
related dental appliances under the laws administered by the
Secretary as of the date of the enactment of this Act; and
(C) has a diagnosis of ischemic heart disease.
(3) The term ``Third Party Administrator'' has the meaning
given such term in section 1703F of such title.
SEC. 145. DOCUMENTATION OF PREFERENCES OF VETERANS FOR
SCHEDULING OF APPOINTMENTS FOR HEALTH CARE
UNDER LAWS ADMINISTERED BY SECRETARY OF
VETERANS AFFAIRS.
(a) In General.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall develop a mechanism to solicit information regarding
the preference of veterans enrolled in the system of annual
patient enrollment of the Department of Veterans Affairs
established and operated under section 1705(a) of title 38,
United States Code, for scheduling of appointments for health
care and related services under the laws administered by the
Secretary, including through non-Department providers.
(b) Documentation of Preference.--Preferences provided
voluntarily by a veteran pursuant to subsection (a) shall be
documented on My HealtheVet or another system designated by
the Secretary that allows the veteran to view and change such
preferences at any time.
(c) Inclusion in Preference.--Preferences solicited under
subsection (a) shall include the following:
(1) How and when the veteran prefers to be contacted about
an appointment for health care.
(2) Whether the veteran prefers to schedule appointments
without the assistance of the Department, if able.
(3) Whether the veteran prefers to select a provider
without the assistance of the Department, if able.
(4) Whether the veteran prefers appointments to be
scheduled during certain days or times.
(d) Use of Preference.--The Secretary shall make the
preferences provided under subsection (a) easily accessible
to medical support assistants and other staff of the
Department, or non-Department staff, as the Secretary
determines appropriate, who assist in the appointment
scheduling process.
(e) Deployment of Mechanism.--
(1) In general.--Beginning after the date on which the
Secretary develops the mechanism required under subsection
(a), the Secretary shall--
(A) test the mechanism in not fewer than three
geographically diverse Veterans Integrated Service Networks;
and
(B) gather feedback about the effectiveness of such
mechanism from veterans, medical support assistants, staff
and other stakeholders as the Secretary determines
appropriate.
(2) Limitation.--The Secretary may not implement such
mechanism across the Veterans Health Administration of the
Department before the Secretary addresses the feedback
described in paragraph (1)(B).
SEC. 146. STAFFING MODEL AND PERFORMANCE METRICS FOR CERTAIN
EMPLOYEES OF THE DEPARTMENT OF VETERANS
AFFAIRS.
(a) Staffing Model.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) develop, validate, and implement a staffing model for
the Office of Integrated Veteran Care of the Department of
Veterans Affairs, or successor office, Veterans Integrated
Services Networks, and medical centers of the Department that
includes appropriate target staffing levels nationally,
regionally, and locally to ensure timely access to care and
effectively oversee the provision of care by the Department,
whether at a facility of the Department or through a non-
Department provider; and
(B) provide to Congress a briefing on such staffing model,
which shall include--
(i) the metrics and measures used by the Secretary in
developing such staffing model;
(ii) an analysis of how such staffing model compares to the
staffing models of other relevant Government-owned and
private sector health care systems; and
(iii) an estimate of the portion of the roles in such
staffing model that will be filled by contracted staff at any
given time.
(2) Report on implementation of staffing model.--Not later
than one year after the date on which the Secretary
implements the staffing model required under paragraph (1),
the Secretary shall submit to Congress and the Comptroller
General of the United States a report containing--
(A) an update on such implementation; and
(B) information on the outcomes yielded by such staffing
model in terms of improved access to care for veterans and
improved compliance with relevant laws, regulations, policy
directives, and guidance governing access to care.
(b) Performance Metrics.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary shall develop and
implement a plan, with an appropriate tracking system, to
incorporate appropriate standardized performance metrics and
oversight measures within the performance appraisal systems
for employees of the Department specified in paragraph (2).
(2) Employees of the department specified.--Employees of
the Department specified in this paragraph are employees who
are responsible for ensuring timely access to care from the
Department, compliance with
[[Page H6052]]
relevant statutes and regulations relating to the provision
of care, including section 1703 of title 38, United States
Code, and overseeing the provision of care, whether at a
facility of the Department or through a non-Department
provider, including employees within the Office of Integrated
Veteran Care of the Department, or successor office,
employees of a Veterans Integrated Service Network, and
employees of a medical center of the Department.
(3) Report on implementation of performance metrics.--Not
later than one year after implementing the performance
metrics required under paragraph (1), the Secretary shall
submit to Congress and the Comptroller General of the United
States a report containing--
(A) an update on such implementation; and
(B) information on the outcomes yielded by such performance
metrics in terms of improved access to care for veterans and
improved compliance with relevant laws, policy directives,
and guidance governing access to care.
(c) GAO Report.--Not later than two years after the later
of the date on which the Comptroller General receives the
report under subsection (a)(2) or the report under subsection
(b)(3), the Comptroller General shall submit to Congress a
report that includes--
(1) an assessment of the performance of the Office of
Integrated Veteran Care of the Department, or successor
office, in improving access to care for veterans in
facilities of the Department and pursuant to section 1703 of
title 38, United States Code; and
(2) such recommendations as the Comptroller General
considers appropriate with respect to improving access to the
care described in paragraph (1) for veterans.
SEC. 147. ONLINE HEALTH EDUCATION PORTAL FOR VETERANS
ENROLLED IN PATIENT ENROLLMENT SYSTEM OF
DEPARTMENT OF VETERANS AFFAIRS.
Not later than one year after the date of the enactment of
this Act, the Secretary of Veterans Affairs shall establish,
on an Internet website of the Department, a health education
portal that includes interactive educational modules to
ensure veterans enrolled in the patient enrollment system of
the Department of Veterans Affairs established and operated
under section 1705(a) of title 38, United States Code,
understand the basic health care eligibilities and
entitlements of veterans under the laws administered by the
Secretary, including under the Veterans Community Care
Program under section 1703 of such title.
SEC. 148. LIMITATION ON DETAIL OF DIRECTORS OF MEDICAL
CENTERS OF DEPARTMENT OF VETERANS AFFAIRS TO
DIFFERENT POSITIONS.
(a) Notification.--
(1) In general.--Not later than 90 days after detailing a
director of a medical center of the Department of Veterans
Affairs to a different position within the Department, the
Secretary of Veterans Affairs shall notify the Committee on
Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives of such
detail.
(2) Matters to be included.--The notification required by
paragraph (1) shall include, with respect to a director of a
medical center who is detailed to a different position within
the Department, the following information:
(A) The location at which the director is detailed.
(B) The position title of the detail.
(C) The estimated time the director is expected to be
absent from their duties at the medical center.
(D) Such other information as the Secretary may determine
appropriate.
(b) Appointment of Acting Director.--Not later than 120
days after detailing a director of a medical center of the
Department to a different position within the Department, the
Secretary shall appoint an individual as acting director of
such medical center with all of the authority and
responsibilities of the detailed director.
(c) Update on Detail.--Not later than 120 days after
detailing a director of a medical center of the Department to
a different position within the Department, and not less
frequently than every 30 days thereafter while the detail is
in effect or while the director position at the medical
center is vacant, the Secretary shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives an update
regarding the status of the detail.
(d) Return to Position or Reassignment.--
(1) In general.--Except as provided in paragraph (2), not
later than 180 days after detailing a director of a medical
center of the Department to a different position within the
Department, for a reason other than an ongoing investigation
or administrative action with respect to the director, the
Secretary shall--
(A) return the individual to the position as director of
the medical center; or
(B) reassign the individual from the position as director
of the medical center and begin the process of hiring a new
director for such position.
(2) Waiver.--
(A) In general.--The Secretary may waive the requirement
under paragraph (1) with respect to an individual for
successive 90-day increments for a total period of not more
than 540 days from the original date the individual was
detailed away from their position as director of a medical
center.
(B) Notification.--Not later than 30 days after exercising
a waiver under subparagraph (A), the Secretary shall notify
Congress of the waiver and provide to Congress information as
to why the waiver is necessary.
SEC. 149. NATIONAL VETERAN SUICIDE PREVENTION ANNUAL REPORT.
(a) National Veteran Suicide Prevention Annual Report.--
(1) In general.--Not later than 18 months after the date of
the enactment of this Act, and not later than September 30 of
each year thereafter, the Secretary of Veterans Affairs shall
submit to the appropriate congressional committees and
publish on a publicly available website of the Department of
Veterans Affairs a report to be known as the ``National
Veteran Suicide Prevention Annual Report''.
(2) Extension.--
(A) In general.--If the Secretary requires an extension of
the deadline for a report under subsection (a), the Secretary
shall submit to the appropriate congressional committees a
written request for such an extension.
(B) Elements.--Each written request under paragraph (1) for
an extension for a report shall include the following:
(i) The rationale for the delay in the submission of the
report.
(ii) An explanation of the need for an extension.
(iii) A proposed amended date for the submission and
publication of the report.
(3) Briefing.--With respect to each report required under
paragraph (1), the Secretary shall, before the date on which
the Secretary submits such report, provide to the appropriate
congressional committees a briefing on such report.
(4) Elements.--
(A) In general.--Each report required under paragraph (1)
shall include--
(i) the findings of the national analysis of veteran
suicide rates for the latest year for which data is
available;
(ii) an identification of trends, if any, demonstrated by
such data; and
(iii) a comparison of such data to data on veteran suicide
rates during preceding years.
(B) Additional elements.--Each report under paragraph (1)
shall include, for the year covered by the report, the
following:
(i) Suicide rates of veterans disaggregated by age, gender,
and race or ethnicity.
(ii) Trends in suicide rates of veterans compared to
engagement of those veterans with health care from the
Veterans Health Administration, including an examination of
trends in suicide rates or deaths among--
(I) veterans who have recently received health care from
the Veterans Health Administration as compared to veterans
who have never received health care from the Veterans Health
Administration;
(II) veterans who are enrolled in the patient enrollment
system of the Department of Veterans Affairs under section
1705(a) of title 38, United States Code, as compared to
veterans who have never enrolled in such system;
(III) veterans who have recently used services from a Vet
Center as compared to veterans who have never used such
services;
(IV) to the extent practicable, veterans who have a
diagnosis of substance use disorder; and
(V) other groups of veterans relating to engagement with
health care from the Veterans Health Administration, as the
Secretary considers practicable.
(iii) To the extent practicable, trends in suicide rates of
veterans compared to engagement of those veterans with
benefits from the Veterans Benefits Administration, including
an examination of trends in suicide rates or deaths among--
(I) veterans who are currently using, have previously used,
or have never used educational assistance under the laws
administered by the Secretary;
(II) veterans who are currently receiving, have previously
received, or have never received services or assistance under
chapter 31 of title 38, United States Code;
(III) with respect to compensation under chapter 11 of such
title--
(aa) veterans who were recipients of such compensation as
compared to veterans who never applied for such compensation
prior to death;
(bb) veterans who had a claim denied for such compensation
prior to death;
(cc) veterans who had a pending claim for such compensation
at time of death; and
(dd) veterans who had an entitlement for such compensation
reduced prior to death;
(IV) veterans who are currently receiving or have never
received pension under chapter 15 of title 38, United States
Code;
(V) veterans who are currently using, have recently used,
or have never used programs or services provided by the
Homeless Programs Office of the Department, including an
examination of trends in suicide rates or deaths among
veterans who made contact with such office but were denied or
deemed ineligible for any such program or service;
(VI) with respect to housing loans guaranteed by the
Secretary under chapter 37 of title 38, United States Code,
veterans who are current recipients of, were recent
recipients of, or have never received such a loan;
(VII) veterans owing debts to the Department;
(VIII) veterans who were involved in a veterans treatment
court program, whether they graduated successfully or not;
and
(IX) veterans who were successfully contacted,
unsuccessfully contacted, or never contacted by the
Department through the
[[Page H6053]]
Solid Start program under section 6320 of title 38, United
States Code.
(C) Strategy and recommendations.--
(i) Initial report.--The initial report under paragraph (1)
shall include a strategy and recommendations developed by the
Secretary of Veterans Affairs, in collaboration with the
Director of the Centers for Disease Control and Prevention,
for--
(I) improving data collection at the State and local levels
to accurately capture suicide deaths of veterans;
(II) improving the timeliness, efficacy, and
standardization of data reporting on suicide deaths of
veterans at the Federal level, including by the Centers for
Disease Control and Prevention and the Department of Veterans
Affairs;
(III) improving the timeliness of identification and
analysis of suicide deaths of veterans by Federal agencies,
including the Centers for Disease Control and Prevention, and
the Department of Veterans Affairs; and
(IV) any other necessary process improvements for improving
the timeliness, efficacy, and standardization of reporting of
data relating to suicide deaths of veterans, particularly
with respect to the annual report under this section.
(ii) Subsequent reports.--Each report after the initial
report under paragraph (1) shall include updates on actions
taken to meet the strategy and recommendations developed
under subparagraph (A).
(5) Definitions.--In this subsection:
(A) The term ``appropriate congressional committees'' means
the Committees on Veterans' Affairs of the Senate and the
House of Representatives.
(B) The term ``Vet Center'' means a center for readjustment
counseling and related mental health services for veterans
under section 1712A of title 38, United States Code.
(b) Independent Assessment of National Veteran Suicide
Prevention Annual Report.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall enter into one or more contracts with a private sector
entity described in paragraph (5) to conduct an independent
assessment of the National Veteran Suicide Prevention Annual
Report required under subsection (a).
(2) Frequency.--The private sector entity or entities
carrying out the assessment required under paragraph (1)
shall complete such assessment not later than 240 days after
entering into the contract described in such subsection and
not less frequently than every five years thereafter.
(3) Elements.--Each assessment required under paragraph (1)
shall analyze the following:
(A) The methodology used by the Department to track,
analyze, categorize, and report suicide deaths and suicide
rates among veterans.
(B) Whether data sources used by the Department to compile
data on suicide deaths and suicide rates among veterans are
accurately reflecting such data.
(C) Vulnerabilities in the methodology used by the
Department that could lead to inaccurate counting of suicide
deaths and suicide rates among veterans.
(D) The ability of the Department to cross reference
suicide deaths and suicide rates among veterans with trends
in usage of programs of the Veterans Health Administration or
the Veterans Benefits Administration or other programs that
could serve as widespread protective factors against suicide.
(E) Improvements that could be made to ensure the National
Veteran Suicide Prevention Annual Report required under
subsection (a) is accurate and comprehensive and provides
insights for making improvements to the suicide prevention
efforts of the Department.
(4) Report on assessment.--
(A) Report on findings and recommendations.--Not later than
60 days after completing an assessment required by paragraph
(1), the private sector entity or entities carrying out the
assessment shall submit to the Secretary of Veterans Affairs
and the Committees on Veterans' Affairs of the Senate and the
House of Representatives a report on the findings and
recommendations of the private sector entity or entities with
respect to such assessment.
(B) Report on planned improvements.--Not later than 60 days
after receiving a report under paragraph (1) with respect to
an assessment required by paragraph (1), the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate
and the House of Representatives a report on how the
Department plans to improve the National Veteran Suicide
Prevention Annual Report required under subsection (a) based
on such assessment.
(5) Private sector entity described.--A private sector
entity described in this paragraph is a private entity that--
(A) specializes in analyzing large-scale organizational
data collection and analysis efforts, especially with respect
to the health care sector; and
(B) has experience and proven outcomes in optimizing the
accuracy and comprehensiveness of data collection and
analysis related to suicide.
(c) Report on Additional Benefits and Services From
Department of Veterans Affairs to Prevent Veteran Suicide.--
(1) In general.--Not later than three years 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 and publish on
a publicly available website of the Department of Veterans
Affairs a report that analyzes which benefits and services
under the laws administered by such Secretary, including such
benefits and services furnished by the Veterans Benefits
Administration, have the greatest impact on the prevention of
suicide among veterans, including recommendations for
potential expansion of services and benefits to reduce the
number of veteran suicides.
(2) Assessment of solid start program.--The report required
by paragraph (1) shall include an analysis of the
effectiveness of the Solid Start program under section 6320
of title 38, United States Code, on prevention of suicide
among veterans.
(d) Toolkit for State and Local Coroners and Medical
Examiners on Best Practices for Identifying and Reporting on
Suicide Deaths of Veterans.--
(1) In general.--The Secretary of Veterans Affairs, in
collaboration with the Director of the Centers for Disease
Control and Prevention, shall develop a toolkit for State and
local coroners and medical examiners that contains best
practices for--
(A) accurately identifying and reporting suicide deaths of
veterans, including how to identify veteran status; and
(B) reporting such deaths to the Centers for Disease
Control and Prevention and other applicable entities.
(2) Availability.--Not later than two years after the date
of the enactment of this Act, the Secretary shall make the
toolkit developed under paragraph (1) available on a publicly
available website of the Department of Veterans Affairs.
(3) Outreach.--The Secretary, in collaboration with the
Director of the Centers for Disease Control and Prevention,
shall conduct outreach to appropriate State and local
agencies to promote the availability and use of the toolkit
developed under paragraph (1).
SEC. 150. REPORT ON PHYSICAL INFRASTRUCTURE REQUIRED BY
MEDICAL FACILITIES OF DEPARTMENT OF VETERANS
AFFAIRS TO PROVIDE DENTAL CARE SERVICES.
Not later than one year 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, for each medical center or
other relevant health care facility of the Department of
Veterans Affairs, that includes--
(1) an identification of the physical infrastructure,
including new facilities, renovations, remodels, leases, or
other infrastructure, such medical center or health care
facility requires to provide dental care services to veterans
eligible for such services under the laws administered by the
Secretary; and
(2) an analysis of the physical infrastructure such medical
center or health care facility would require if a greater
number of veterans became eligible for such dental care
services pursuant to a modification of the laws administered
by the Secretary.
SEC. 151. COMPTROLLER GENERAL REPORT ON CERTAIN ORAL HEALTH
CARE PROGRAMS UNDER LAWS ADMINISTERED BY
SECRETARY OF VETERANS AFFAIRS.
(a) In General.--Not later than one year after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a
report on the status of the oral health care programs of the
Department of Veterans Affairs, that includes an assessment
of--
(1) any issues with information technology programs,
including Dental Record Manager Plus, that affect dental care
staff of the Department;
(2) the implementation of the dental insurance plan of the
Department under section 1712C of title 38, United States
Code;
(3) the implementation and expansion of the VETSmile
program of the Department;
(4) barriers preventing the Department from expanding
dental care eligibility to all veterans with ischemic heart
disease, including such barriers relating to physical
infrastructure, workforce, and cost of such dental care;
(5) barriers preventing dental clinics of the Department,
if any, from adopting teledentistry;
(6) the demographic makeup of veterans eligible for dental
care paid for by the Department as of the commencement of the
pilot program under section 145 of this Act, including
information on--
(A) age;
(B) gender;
(C) race or ethnicity, disaggregated by--
(i) membership in an Indian Tribe; and
(ii) the major race groups used in the decennial census;
(D) employment status; and
(E) location of residence, disaggregated by rural, highly
rural, and urban locations; and
(7) changes to such demographic makeup if any, that would
result from an expansion of eligibility for dental care under
the laws administered by the Secretary to all veterans with
ischemic heart disease including changes to demographics
specified in paragraph (6).
(b) Third Party Administrator Defined.--In this section,
the term ``Third Party Administrator'' means an entity that
manages a provider network and performs administrative
services related to such network under section 1703 of title
38, United States Code.
[[Page H6054]]
SEC. 152. REVIEW OF WORKFLOWS ASSOCIATED WITH PROCESSING
REFERRALS BETWEEN FACILITIES OF THE VETERANS
HEALTH ADMINISTRATION.
(a) In General.--The Secretary of Veterans Affairs shall
conduct a review of the workflows directly associated with
processing referrals of patients between facilities of the
Veterans Health Administration of the Department of Veterans
Affairs to identify specific delays or bottlenecks in such
referrals.
(b) Elements of Review.--The review required under
subsection (a) shall include a review of--
(1) the interfacility consult management guidance of the
Veterans Health Administration that assists facilities
described in subsection (a) in constructing a workflow for
consults between such facilities; and
(2) the roles and responsibilities of the individuals
involved in the consult management process in managing such
consults, including the role of the referral coordination
team.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall submit to Congress
a report on the results of the review required under
subsection (a).
SEC. 153. PLAN FOR TIMELY SCHEDULING OF APPOINTMENTS AT
MEDICAL FACILITIES OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Plan Required.--To improve responsiveness in the
provision of hospital care and medical services at medical
facilities of the Department of Veterans Affairs, the
Secretary of Veterans Affairs shall develop a plan to--
(1) ensure that whenever a covered veteran contacts the
Department by telephone to request the scheduling of an
appointment for care or services for the covered veteran at
such a facility, the scheduling for the appointment occurs
during that telephone call (regardless of the prospective
date of the appointment being scheduled); and
(2) provide timely and, where applicable, same-day
scheduling for an appointment described in paragraph (1).
(b) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the plan under
subsection (a).
(c) Covered Veteran Defined.--In this section, the term
``covered veteran'' means a veteran who is enrolled in the
system of patient enrollment of the Department under section
1705(a) of title 38, United States Code.
SEC. 154. AUTHORIZATION OF APPROPRIATIONS TO SUPPORT
INITIATIVES FOR MOBILE MAMMOGRAPHY SERVICES FOR
VETERANS.
There is authorized to be appropriated to the Secretary of
Veterans Affairs $5,000,000 for fiscal year 2025 for the
Office of Women's Health of the Department of Veterans
Affairs under section 7310 of title 38, United States Code,
to be used by the Secretary to expand access of women
veterans to--
(1) mobile mammography initiatives;
(2) advanced mammography equipment; and
(3) outreach activities to publicize those initiatives and
equipment.
TITLE II--ECONOMIC OPPORTUNITY MATTERS
Subtitle A--Educational Assistance
SEC. 201. TEMPORARY EXPANSION OF ELIGIBILITY FOR MARINE
GUNNERY SERGEANT JOHN DAVID FRY SCHOLARSHIP.
(a) In General.--The Secretary of Veterans Affairs shall
treat an individual described in subsection (b) as a covered
individual described in section 3311(b) of title 38, United
States Code.
(b) Covered Individual Described.--An individual described
in this subsection is an individual who is the child or
spouse of a person--
(1) who dies from a service-connected disability during the
120-day period immediately following the day on which the
person was discharged or released from duty as a member of
the Armed Forces (without regard to whether such duty was
active duty); and
(2)(A) who received an honorable discharge; or
(B) whose service in the Armed Forces is characterized by
the Secretary concerned as honorable service.
(c) Applicability.--This section shall apply with respect
to--
(1) deaths that occur before, on, or after the date of the
enactment of this Act; and
(2) a quarter, semester, or term, as applicable,
commencing--
(A) on or after August 1, 2025; and
(B) before October 1, 2027.
SEC. 202. REMOVAL OF EXPIRATION ON ENTITLEMENT TO MARINE
GUNNERY SERGEANT JOHN DAVID FRY SCHOLARSHIP FOR
SURVIVING SPOUSES.
Section 3311(f) of title 38, United States Code, is
amended--
(1) by striking paragraph (2);
(2) by redesignating paragraphs (3) through (5) as
paragraphs (2) through (4), respectively;
(3) in paragraph (2), as redesignated by paragraph (2) of
this section, by striking ``in paragraph (4)'' and inserting
``in paragraph (3)''; and
(4) in paragraph (3)(A), as redesignated by paragraph (2)
of this section, by striking ``under paragraph (3)'' and
inserting ``under paragraph (2)''.
SEC. 203. SOLE LIABILITY FOR TRANSFERRED EDUCATIONAL
ASSISTANCE BY AN INDIVIDUAL WHO FAILS TO
COMPLETE A SERVICE AGREEMENT.
Subsection (i) of section 3319 of title 38, United States
Code, is amended--
(1) in paragraph (1)--
(A) by striking ``In the event'' and inserting ``Subject to
paragraph (2), in the event''; and
(B) by inserting ``of this title'' after ``section 3685'';
(2) in subparagraph (A) of paragraph (2)--
(A) in the heading, by striking ``In general'' and
inserting ``Sole liability''; and
(B) by striking ``under paragraph (1)'' and inserting ``for
which the individual shall be solely liable to the United
States for the amount of the overpayment for purposes of
section 3685 of this title''; and
(3) in subparagraph (B) of paragraph (2)--
(A) in the matter preceding clause (i), by striking
``Subparagraph (A) shall not apply'' and inserting ``Neither
the individual nor the dependent shall be liable to the
United States for the amount of the overpayment for purposes
of section 3685 of this title''; and
(B) in clause (ii), by inserting ``of this title'' after
``section 3311(c)(4)''.
SEC. 204. NOTICE TO EDUCATIONAL INSTITUTIONS OF RISK-BASED
SURVEYS.
Section 3673A(d) of title 38, United States Code, is
amended by striking ``one business day'' and inserting ``two
business days''.
SEC. 205. RELATIONSHIP OF PARTICIPATION BY AN EDUCATIONAL
INSTITUTION IN CERTAIN FEDERAL STUDENT
FINANCIAL AID PROGRAMS TO APPROVAL OF SUCH
INSTITUTION FOR PURPOSES OF DEPARTMENT OF
VETERANS AFFAIRS EDUCATIONAL ASSISTANCE
PROGRAMS.
Paragraph (4) of section 3675(b) of title 38, United States
Code, is amended to read as follows:
``(4) The educational institution--
``(A) is approved and participates in a program under title
IV of the Higher Education Act of 1965 (20 U.S.C. 1070 et
seq.); or
``(B) does not participate in such a program and the
Secretary has waived the requirement under this paragraph
with respect to the educational institution, and submits to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives notice of such waiver, because the Secretary
determines that the educational institution--
``(i) elects not to participate in such a program;
``(ii) cannot participate in such a program; or
``(iii) is in the process of making a good-faith effort to
submit an initial application for approval to participate in
such a program, except that a waiver under this clause may
not be provided for a period of longer than 36 months.''.
SEC. 206. EXPANSION OF DEPARTMENT OF VETERANS AFFAIRS
OVERSIGHT OF CERTAIN EDUCATIONAL INSTITUTIONS.
(a) Additional Requirement for Approval.--Section 3675(b)
of title 38, United States Code, as amended by section 205,
is further amended by adding at the end the following new
paragraph:
``(5) The educational institution agrees to, not later than
30 days after any date on which such educational institution
becomes subject to an action or event described in section
3673(e)(3) of this title, submit to the State approving
agency, or the Secretary when acting in the role of a State
approving agency, a notification of such action or event in
such form and containing such information as the Secretary
determines appropriate.''.
(b) Additional Requirement for Approval of Nonaccredited
Courses.--
(1) In general.--Section 3676(c) of such title is amended--
(A) by redesignating paragraphs (14) through (16) as
paragraphs (15) through (17), respectively; and
(B) by inserting after paragraph (13) the following new
paragraph:
``(14) The institution agrees to, not later than 30 days
after any date on which such institution becomes subject to
an action or event described in section 3673(e)(3) of this
title, submit to the State approving agency, or the Secretary
when acting in the role of a State approving agency, a
notification of such action or event in such form and
containing such information as the Secretary determines
appropriate.''.
(2) Conforming amendments.--Such title is further amended--
(A) in section 3672(b)(2)(C), by striking ``paragraph (14)
or (15)'' and inserting ``paragraph (15) or (16)'';
(B) in section 3675(b)(3), by striking ``(14), (15), and
(16)'' and inserting ``(15), (16), and (17)'';
(C) in section 3679(d), by striking ``described in
paragraph (14) or (15)'' and inserting ``described in
paragraph (15) or (16)''; and
(D) in section 3680A(a)(4)(C)(iii), by striking ``section
3676(c)(14) and (15)'' and inserting ``section 3676(c)(15)
and (16)''.
(c) Additional Grounds for Suspension of Approval.--Section
3679(f)(1) of such title is amended by adding at the end the
following new subparagraph:
``(I) Comply with the notification requirements under
sections 3675(b)(5) and 3676(c)(14) of this title, when
applicable.''.
(d) Deadline for Risk-based Surveys Database.--The
Secretary of Veterans Affairs shall establish the database
required under section 3673A(c) of title 38, United States
Code, by not later than 180 days after the date of the
enactment of this Act.
[[Page H6055]]
SEC. 207. REQUIREMENT THAT EDUCATIONAL INSTITUTIONS APPROVED
FOR PURPOSES OF DEPARTMENT OF VETERANS AFFAIRS
EDUCATIONAL ASSISTANCE PROGRAMS PROVIDE DIGITAL
OFFICIAL TRANSCRIPTS.
(a) Requirement.--Section 3675(b) of title 38, United
States Code, as amended by sections 205 and 206, is further
amended by adding at the end the following new paragraph:
``(6) The educational institution makes available to each
eligible person or veteran a copy of the person or veteran's
official transcript in a digital format.''.
(b) Conforming Amendments.--
(1) Approval of courses.--Section 3672(b)(2)(A) of such
title is amended by striking ``(b)(1) and (b)(2)'' and
inserting ``paragraphs (1), (2), and (6) of section
3675(b)''.
(2) Approval of nonaccredited courses.--Section 3676(c) of
such title is amended--
(A) by redesignating paragraph (17) as paragraph (18); and
(B) by inserting after paragraph (16) the following new
paragraph (17):
``(17) In the case of a course that leads to a standard
college degree, the educational institution satisfies the
requirements of section 3675(b)(6) of this title.''.
(3) Conforming amendments.--Section 3675(b)(3) of such
title is amended by striking ``(15), (16), and (17)'' and
inserting ``(15), (16), and (18)''.
(c) Effective Date.--The amendments made by this section
shall take effect on August 1, 2025, and apply with respect
to a quarter, semester, or term, as applicable, commencing on
or after such date.
SEC. 208. PAYMENT OF FULL MONTHLY HOUSING STIPEND FOR
VETERANS ENROLLED IN FINAL SEMESTER USING
EDUCATIONAL ASSISTANCE UNDER POST-9/11
EDUCATIONAL ASSISTANCE PROGRAM.
(a) Housing Allowance.--Section 3680(a)(3) of title 38,
United States Code, is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii), respectively (and by redesignating each
subordinate provision and the margins thereof accordingly);
(2) by striking ``Notwithstanding paragraph (1)'' and
inserting ``(A) Notwithstanding paragraph (1)'';
(3) by striking ``, including a monthly housing stipend
described in section 3313(c) of this title,''; and
(4) by adding at the end the following new subparagraph
(B):
``(B) For purposes of providing a monthly housing stipend
described in section 3313(c) to an eligible veteran or
eligible person for whom the Secretary is providing
educational assistance under chapter 33 of this title during
a period that is the last semester, term, or academic period
pursuant to subparagraph (A), the Secretary shall treat the
veteran or person as pursuing a program of education on a
full-time basis.''.
(b) Application.--The amendments made by subsection (a)
shall take effect on the date of the enactment of this Act
and apply with respect to a quarter, semester, or term, as
applicable, commencing on or after January 1, 2025.
SEC. 209. MODIFICATION OF RULES FOR APPROVAL OF COMMERCIAL
DRIVER EDUCATION PROGRAMS FOR PURPOSES OF
EDUCATIONAL ASSISTANCE PROGRAMS OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Section 3680A(e) of title 38, United
States Code, is amended--
(1) by redesignating paragraphs (1) through (3) as
subparagraphs (A) though (C), respectively;
(2) in the matter before subparagraph (A), as redesignated
by paragraph (1), by inserting ``(1)'' before ``The
Secretary'';
(3) in paragraph (1)(B), as redesignated by paragraph (1),
by inserting ``except as provided in paragraph (2),'' before
``the course''; and
(4) by adding at the end the following new paragraph (2):
``(2)(A) Subject to this paragraph, a commercial driver
education program is exempt from paragraph (1)(B) for a
branch of an educational institution if the commercial driver
education program offered at the branch by the educational
institution--
``(i) is appropriately licensed; and
``(ii)(I) the branch is located in a State in which the
same commercial driver education program is offered by the
same educational institution at another branch of that
educational institution in the same State that is approved
for purposes of this chapter by a State approving agency or
the Secretary when acting in the role of a State approving
agency; or
``(II)(aa) the branch is located in a State in which the
same commercial driver education program is not offered at
another branch of the same educational institution in the
same State; and
``(bb) the branch has been operating for a period of at
least one year using the same curriculum as a commercial
driver education program offered by the educational
institution at another location that is approved for purposes
of this chapter by a State approving agency or the Secretary
when acting in the role of a State approving agency.
``(B)(i) In order for a commercial driver education program
of an educational institution offered at a branch described
in paragraph (1)(B) to be exempt under subparagraph (A) of
this paragraph, the educational institution shall submit to
the Secretary each year that paragraph (1)(B) would otherwise
apply a report that demonstrates that the curriculum at the
new branch is the same as the curriculum at the primary
location.
``(ii) Reporting under clause (i) shall be submitted in
accordance with such requirements as the Secretary shall
establish in consultation with the State approving agencies.
``(C)(i) The Secretary may withhold an exemption under
subparagraph (A) for any educational institution or branch of
an educational institution as the Secretary considers
appropriate.
``(ii) In making any determination under clause (i), the
Secretary may consult with the Secretary of Transportation on
the performance of a provider of a commercial driver program,
including the status of the provider within the Training
Provider Registry of the Federal Motor Carrier Safety
Administration when appropriate.
``(D) The Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives
a notification not later than 30 days after the Secretary
grants an exemption under this paragraph. Such notification
shall identify the educational institution and branch of such
educational institution granted such exemption.''.
(b) Implementation.--
(1) Establishment of requirements.--Not later than 180 days
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall establish requirements under section
3680A(e)(2)(B)(ii) of such title, as added by subsection (a).
(2) Rulemaking.--In promulgating any rules to carry out
paragraph (2) of section 3680A(e) of title 38, United States
Code, as added by subsection (a), the Secretary of Veterans
Affairs shall consult with State approving agencies.
(3) Applicability.--The amendments made by subsection (a)
shall apply to commercial driver education programs on and
after the day that is 365 days after the date on which the
Secretary establishes the requirements under paragraph (1) of
this subsection.
(c) Comptroller General of the United States Study.--Not
later than 365 days after the date of the enactment of this
Act, the Comptroller General of the United States shall--
(1) conduct a study to--
(A) ascertain the effects of the amendments made by
subsection (a); and
(B) the feasibility and advisability of similarly amending
the rules for approval of programs of education for other
vocational programs of education; and
(2) submit to the Committees on Veterans' Affairs of the
Senate and House of Representatives a report on the findings
of the Comptroller General with respect to such study.
SEC. 210. PROVISION OF CERTIFICATES OF ELIGIBILITY AND AWARD
LETTERS USING ELECTRONIC MEANS.
(a) In General.--Chapter 36 of title 38, United States
Code, is amended by inserting after section 3698 the
following new section (and conforming the table of sections
at the beginning of such chapter accordingly):
``Sec. 3698A. Provision of certificates of eligibility and
award letters using electronic means
``(a) Requirement.--Except as provided by subsection (b),
the Secretary shall provide to an individual the following
documents using electronic means:
``(1) A certificate of eligibility for the entitlement of
the individual to covered educational assistance.
``(2) An award letter regarding the authorization of the
individual to receive covered educational assistance.
``(b) Election to Opt Out.--An individual may elect to
receive the documents specified in subsection (a) by mail
rather than through electronic means under subsection (a). An
individual may revoke such an election at any time, by means
prescribed by the Secretary.
``(c) Covered Educational Assistance.--In this section, the
term `covered educational assistance' means educational
assistance under chapter 30, 33, or 35 of this title, or
section 3699C of this title.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 3698 the following new item:
``3698A. Provision of certificates of eligibility and award letters
using electronic means.''.
SEC. 211. RETROACTIVE EFFECTIVE DATE OF LAW REGARDING CHARGE
TO ENTITLEMENT TO EDUCATIONAL ASSISTANCE FOR
INDIVIDUALS WHO DO NOT TRANSFER CREDITS FROM
CERTAIN CLOSED OR DISAPPROVED PROGRAMS OF
EDUCATION.
Section 3699(c)(2) of title 38, United States Code, is
amended by striking subparagraph (C) and inserting the
following new subparagraph (C):
``(C) This paragraph, including clauses (ii) and (iii) of
subparagraph (A), shall apply with respect to the closure or
discontinuation of a course or program of education, as
described in subsection (b)(1), that occurs during the period
beginning on August 1, 2021, and ending on September 30,
2025.''.
SEC. 212. DEPARTMENT OF VETERANS AFFAIRS HIGH TECHNOLOGY
PROGRAM.
(a) High Technology Program.--
(1) In general.--Chapter 36 of title 38, United States
Code, as amended by section 210, is amended by adding at the
end the following new section:
``Sec. 3699C. High technology program
``(a) Establishment.--(1) The Secretary shall carry out a
program under which the
[[Page H6056]]
Secretary provides covered individuals with the opportunity
to enroll in high technology programs of education that the
Secretary determines provide training or skills sought by
employers in a relevant field or industry.
``(2) Not more than 4,000 covered individuals may
participate in the program under this section in any fiscal
year.
``(b) Amount of Assistance.--(1) The Secretary shall
provide, to each covered individual who pursues a high
technology program of education under this section,
educational assistance in amounts equal to the amounts
provided under section 3313(c)(1) of this title, including,
except as provided in paragraph (3), with respect to the
housing stipend described in that section and in accordance
with the treatment of programs that are distance learning and
programs that are less than half-time.
``(2) Under paragraph (1), the Secretary shall provide such
amounts of educational assistance to a covered individual for
each of the following:
``(A) A high technology program of education.
``(B) A second such program if--
``(i) the second such program begins at least 18 months
after the covered individual graduates from the first such
program; and
``(ii) the covered individual uses educational assistance
under chapter 33 of this title to pursue the second such
program.
``(3) No covered individual may receive a housing stipend
under this subsection for any month if such individual is in
receipt of a housing stipend under chapter 33 of this title
for that month.
``(c) Contracts.--(1) For purposes of carrying out
subsection (a), the Secretary shall seek to enter into
contracts with any number of qualified providers of high
technology programs of education for the provision of such
programs to covered individuals. Each such contract shall
provide for the conditions under which the Secretary may
terminate the contract with the provider and the procedures
for providing for the graduation of students who were
enrolled in a program provided by such provider in the case
of such a termination.
``(2) A contract under this subsection shall provide that
the Secretary shall pay to a provider--
``(A) upon the enrollment of a covered individual in the
program, 25 percent of the cost of the tuition and other fees
for the program of education for the individual;
``(B) upon graduation of the individual from the program,
25 percent of such cost; and
``(C) 50 percent of such cost upon--
``(i) the successful employment of the covered individual
for a period--
``(I) of 180 days in the field of study of the program; and
``(II) that begins not later than 180 days following
graduation of the covered individual from the program;
``(ii) the employment of the individual by the provider for
a period of one year; or
``(iii) the enrollment of the individual in a program of
education to continue education in such field of study.
``(3) For purposes of this section, a provider of a high
technology program of education is qualified if--
``(A) the provider employs instructors whom the Secretary
determines are experts in their respective fields in
accordance with paragraph (5);
``(B) the provider has successfully provided the high
technology program for at least one year;
``(C) the provider does not charge tuition and fees to a
covered individual who receives assistance under this section
to pursue such program that are higher than the tuition and
fees charged by such provider to another individual; and
``(D) the provider meets the approval criteria developed by
the Secretary under paragraph (4).
``(4)(A) The Secretary shall prescribe criteria for
approving providers of a high technology program of education
under this section.
``(B) In developing such criteria, the Secretary may
consult with State approving agencies.
``(C) Such criteria are not required to meet the
requirements of section 3672 of this title.
``(D) Such criteria shall include the job placement rate,
in the field of study of a program of education, of covered
individuals who complete such program of education.
``(5) The Secretary shall determine whether instructors are
experts under paragraph (3)(A) based on evidence furnished to
the Secretary by the provider regarding the ability of the
instructors to--
``(A) identify professions in need of new employees to
hire, tailor the programs to meet market needs, and identify
the employers likely to hire graduates;
``(B) effectively teach the skills offered to covered
individuals;
``(C) provide relevant industry experience in the fields of
programs offered to incoming covered individuals; and
``(D) demonstrate relevant industry experience in such
fields of programs.
``(6) In entering into contracts under this subsection, the
Secretary shall give preference to a provider of a high
technology program of education--
``(A) from which at least 70 percent of graduates find
full-time employment in the field of study of the program
during the 180-day period beginning on the date the student
graduates from the program; or
``(B) that offers tuition reimbursement for any student who
graduates from such a program and does not find employment
described in subparagraph (A).
``(d) Effect on Other Entitlement.--(1) If a covered
individual enrolled in a high technology program of education
under this section has remaining entitlement to educational
assistance under chapter 30, 32, 33, 34, or 35 of this title,
such entitlement shall be charged at the rate of one month of
such entitlement for each month of educational assistance
provided under this section.
``(2) If a covered individual enrolled in a high technology
program of education under this section does not have
remaining entitlement to educational assistance under chapter
30, 32, 33, 34, or 35 of this title, any educational
assistance provided to such individual under this section
shall be provided in addition to the entitlement that the
individual has used.
``(3) The Secretary may not consider enrollment in a high
technology program of education under this section to be
assistance under a provision of law referred to in section
3695 of this title.
``(4)(A) An application for enrollment in a high technology
program of education under this section shall include notice
of the requirements relating to use of entitlement under
paragraphs (1) and (2), including--
``(i) in the case of the enrollment of an individual
referred to under paragraph (1), the amount of entitlement
that is typically charged for such enrollment;
``(ii) an identification of any methods that may be
available for minimizing the amount of entitlement required
for such enrollment; and
``(iii) an element requiring applicants to acknowledge
receipt of the notice under this subparagraph.
``(B) If the Secretary approves the enrollment of a covered
individual in a high technology program of education under
this section, the Secretary shall deliver electronically to
the individual an award letter that provides notice of such
approval and includes specific information describing how
paragraphs (1) and (2) will be applied to the individual if
the individual chooses to enroll in the program.
``(e) Requirements for Educational Institutions.--(1) The
Secretary shall not approve the enrollment of any covered
individual, not already enrolled, in any high technology
programs of education under this section for any period
during which the Secretary finds that more than 85 percent of
the students enrolled in the program are having all or part
of their tuition, fees, or other charges paid to or for them
by the educational institution or by the Department of
Veterans Affairs under this title or under chapter 1606 or
1607 of title 10, except with respect to tuition, fees, or
other charges that are paid under a payment plan at an
educational institution that the Secretary determines has a
history of offering payment plans that are completed not
later than 180 days after the end of the applicable term,
quarter, or semester.
``(2) The Secretary may waive a requirement of paragraph
(1) if the Secretary determines, pursuant to regulations
which the Secretary shall prescribe, such waiver to be in the
interest of the covered individual and the Federal
Government. Not later than 30 days after the Secretary waives
such a requirement, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and House of
Representatives a report regarding such waiver.
``(3)(A)(i) The Secretary shall establish and maintain a
process by which an educational institution may request a
review of a determination that the educational institution
does not meet the requirements of paragraph (1).
``(ii) The Secretary may consult with a State approving
agency regarding such process or such a review.
``(iii) Not later than 180 days after the Secretary
establishes or revises a process under this subparagraph, the
Secretary shall submit to the Committees on Veterans' Affairs
of the Senate and House of Representatives a report regarding
such process.
``(B) An educational institution that requests a review
under subparagraph (A)--
``(i) shall request the review not later than 30 days after
the start of the term, quarter, or semester for which the
determination described in subparagraph (A) applies; and
``(ii) may include any information that the educational
institution believes the Department should have taken into
account when making the determination, including with respect
to any mitigating circumstances.
``(f) Annual Reports.--Not later than one year after the
date of the enactment of this section, and annually
thereafter until the termination date specified in subsection
(i), the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives
a report on the operation of program under this section
during the year covered by the report. Each such report shall
include each of the following:
``(1) The number of covered individuals enrolled in the
program, disaggregated by type of educational institution,
during the year covered by the report.
``(2) The number of covered individuals who completed a
high technology program of education under the program during
the year covered by the report.
``(3) The average employment rate of covered individuals
who completed such a program of education during such year,
as of 180 days after the date of completion.
[[Page H6057]]
``(4) The average length of time between the completion of
such a program of education and employment.
``(5) The total number of covered individuals who completed
a program of education under the program and who, as of the
date of the submission of the report, are employed in a
position related to technology.
``(6) The average salary of a covered individual who
completed a program of education under the program and who is
employed in a position related to technology, in various
geographic areas determined by the Secretary.
``(7) The average salary of all individuals employed in
positions related to technology in the geographic areas
determined under subparagraph (F), and the difference, if
any, between such average salary and the average salary of a
covered individual who completed a program of education under
the program and who is employed in a position related to
technology.
``(8) The number of covered individuals who completed a
program of education under the program and who subsequently
enrolled in a second program of education under the program.
``(g) Collection of Information; Consultation.--(1) The
Secretary shall develop practices to use to collect
information about covered individuals and providers of high
technology programs of education.
``(2) For the purpose of carrying out program under this
section, the Secretary may consult with providers of high
technology programs of education and may establish an
advisory group made up of representatives of such providers,
private employers in the technology field, and other relevant
groups or entities, as the Secretary determines necessary.
``(h) Definitions.--In this section:
``(1) The term `covered individual' means any of the
following:
``(A) A veteran whom the Secretary determines--
``(i) served an aggregate of at least 36 months on active
duty in the Armed Forces (including service on active duty in
entry level and skill training) and was discharged or
released therefrom under conditions other than dishonorable;
and
``(ii) has not attained the age of 62.
``(B) A member of the Armed Forces that the Secretary
determines will become a veteran described in subparagraph
(A) fewer than 180 days after the date of such determination.
``(2) The term `high technology program of education' means
a program of education--
``(A) offered by a public or private educational
institution;
``(B) if offered by an institution of higher learning, that
is provided directly by such institution rather than by an
entity other than such institution under a contract or other
agreement;
``(C) that does not lead to a degree;
``(D) that has a term of not less than six and not more
than 28 weeks; and
``(E) that provides instruction in computer programming,
computer software, media application, data processing, or
information sciences.
``(i) Termination.--The Secretary may not provide
educational assistance under this section for a high
technology program of education that begins after September
30, 2027.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 3699B the following new item:
``3699C. High technology program.''.
(b) Effect on High Technology Pilot Program.--Section 116
of the Harry W. Colmery Veterans Educational Assistance Act
of 2017 (Public Law 115-48; 38 U.S.C. 3001 note) is amended--
(1) by amending subsection (d) to read as follows:
``(d) Housing Stipend.--
``(1) In general.--Except as provided under paragraph (2),
the Secretary shall pay to each eligible veteran (not
including an individual described in the second sentence of
subsection (b)) who is enrolled in a high technology program
of education under the pilot program on a full-time or part-
time basis a monthly housing stipend equal to the product--
``(A) of--
``(i) in the case of a veteran pursuing resident training,
the monthly amount of the basic allowance for housing payable
under section 403 of title 37, United States Code, for a
member with dependents in pay grade E-5 residing in the
military housing area that encompasses all or the majority
portion of the ZIP code area in which is located the campus
of the institution where the individual physically
participates in a majority of classes; or
``(ii) in the case of a veteran pursuing a program of
education through distance learning, a monthly amount equal
to 50 percent of the national average of the monthly amount
of the basic allowance for housing payable under section 403
of title 37, United States Code, for a member with dependents
in pay grade E-5, multiplied by
``(B) the lesser of--
``(i) 1.0; or
``(ii) the number of course hours borne by the individual
in pursuit of the program of education involved, divided by
the minimum number of course hours required for full-time
pursuit of such program of education, rounded to the nearest
multiple of 10.
``(2) Bar to dual eligibility.--No covered individual may
receive a housing stipend under this subsection for any month
if such individual is in receipt of a housing stipend under
chapter 33 ot title 38, United States Code, for that
month.'';
(2) in subsection (g), by striking paragraph (6); and
(3) by striking subsection (h) and inserting the following
new subsection (h):
``(h) Termination.--The Secretary may not, under this
section, pay a provider for a high technology program of
education that begins after September 30, 2024.''.
(c) Approval of Certain High Technology Programs.--Section
3680A of title 38, United States Code, is amended--
(1) in subsection (a), by striking paragraph (4) and
inserting the following:
``(4) Any independent study program except--
``(A) an independent study program (including such a
program taken over open circuit television) that--
``(i) is accredited by an accrediting agency or association
recognized by the Secretary of Education under subpart 2 of
part H of title IV of the Higher Education Act of 1965 (20
U.S.C. 1099b);
``(ii) leads to--
``(I) a standard college degree;
``(II) a certificate that reflects educational attainment
offered by an institution of higher learning; or
``(III) a certificate that reflects graduation from a
course of study offered by--
``(aa) an area career and technical education school (as
defined in subparagraphs (C) and (D) of section 3(3) of the
Carl D. Perkins Career and Technical Education Act of 2006
(20 U.S.C. 2302(3))) that provides education at the
postsecondary level; or
``(bb) a postsecondary vocational institution (as defined
in section 102(c) of the Higher Education Act of 1965 (20
U.S.C. 1002(c))) that provides education at the postsecondary
level; and
``(iii) in the case of a program described in clause
(ii)(III)--
``(I) provides training aligned with the requirements of
employers in the State or local area where the program is
located, which may include in-demand industry sectors or
occupations;
``(II) provides a student, upon graduation from the
program, with a recognized postsecondary credential that is
recognized by employers in the relevant industry, which may
include a credential recognized by industry or sector
partnerships in the State or local area where the industry is
located; and
``(III) meets such content and instructional standards as
may be required to comply with the criteria under section
3676(c)(14) and (15) of this title; or
``(B) an online high technology program of education (as
defined in subsection (h)(2) of section 3699C of this
title)--
``(i) the provider of which has entered into a contract
with the Secretary under subsection (c) of such section;
``(ii) that has been provided to covered individuals (as
defined in subsection (h)(1) of such section) under such
contract for a period of at least five years;
``(iii) regarding which the Secretary has determined that
the average employment rate of covered individuals who
graduated from such program of education is 65 percent or
higher for the year preceding such determination; and
``(iv) that satisfies the requirements of subsection (e) of
such section.''; and
(2) in subsection (d), by adding at the end the following:
``(8) Paragraph (1) shall not apply to the enrollment of a
veteran in an online high technology program described in
subsection (a)(4)(B).''.
SEC. 213. NOTICE OF CHANGES TO DEPARTMENT OF VETERANS AFFAIRS
POLICIES AND GUIDANCE AFFECTING THE EDUCATIONAL
ASSISTANCE PROGRAMS OF THE DEPARTMENT.
(a) In General.--Subchapter III of chapter 36 of title 38,
United States Code, as amended by sections 210 and 212, is
further amended by adding at the end the following new
section:
``Sec. 3699D. Notice of changes to policies and guidance
relating to educational assistance programs
``In the case of any change to any policy or guidance
provided by the Secretary that relates to any educational
assistance program of the Department, the Secretary may not
implement the change before the date that is 90 days after
the date on which the Secretary makes available to students,
educational institutions, and the Committees on Veterans'
Affairs of the Senate and House of Representatives notice of,
and justification for, the change.''.
(b) Clerical Amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 3699B the following new item:
``3699D. Notice of changes to policies and guidance relating to
educational assistance programs.''.
SEC. 214. PAYMENT OF VA EDUCATIONAL ASSISTANCE VIA ELECTRONIC
FUND TRANSFER TO A FOREIGN INSTITUTION OF
HIGHER EDUCATION.
Not later than 90 days after the date of the enactment of
this Act, the Secretary of Veterans Affairs shall update the
payment system of the Department of Veterans Affairs to allow
for electronic fund transfer of educational assistance,
administered by the Secretary, to a foreign institution of
higher education that--
[[Page H6058]]
(1) provides an approved course of education to an eligible
recipient of such assistance; and
(2) does not have--
(A) an employer identification number; or
(B) an account with a domestic bank.
SEC. 215. IMPROVING TRANSPARENCY AND ACCOUNTABILITY OF
EDUCATIONAL INSTITUTIONS FOR PURPOSES OF
VETERANS EDUCATIONAL ASSISTANCE.
(a) Requirement Relating to G.I. Bill Comparison Tool.--
(1) Requirement to maintain tool.--The Secretary of
Veterans Affairs shall maintain the G.I. Bill Comparison Tool
that was established pursuant to Executive Order 13607 (77
Fed. Reg. 25861; relating to establishing principles of
excellence for educational institutions serving service
members, veterans, spouses, and other family members) and in
effect on the day before the date of enactment of this Act,
or a successor tool, to provide relevant and timely
information about programs of education approved under
chapter 36 of title 38, United States Code, and the
educational institutions that offer such programs.
(2) Data retention.--The Secretary shall ensure that
historical data that is reported via the tool maintained
under paragraph (1) remains easily and prominently accessible
on the benefits.va.gov website, or a successor website, for a
period of not less than six years from the date of initial
publication.
(b) Providing Timely and Relevant Education Information to
Veterans, Members of the Armed Forces, and Other
Individuals.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in consultation with the Secretary of Education, the
Secretary of the Treasury, and the heads of other relevant
Federal agencies, shall make such changes to the tool
maintained under subsection (a) as the Secretary of Veterans
Affairs determines appropriate to ensure that such tool is an
effective and efficient method for providing information
pursuant to section 3698(b)(5) of title 38, United States
Code.
(2) Memorandum of understanding required.--Not later than
two years after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall seek to enter into a
memorandum of understanding with the Secretary of Education
and the heads other relevant Federal agencies, as the
Secretary of Veterans Affairs determines appropriate, to
obtain information on outcomes with respect to individuals
who are entitled to educational assistance under the laws
administered by the Secretary of Veterans Affairs and who are
attending educational institutions. Such memorandum of
understanding may include data sharing or computer matching
agreements.
(3) Modification of scope of comprehensive policy on
providing education information.--Section 3698 of title 38,
United States Code, is amended--
(A) in subsection (a), by striking ``veterans and members
of the Armed Forces'' and inserting ``individuals entitled to
educational assistance under laws administered by the
Secretary of Veterans Affairs''; and
(B) in subsection (b)(5)--
(i) by striking ``veterans and members of the Armed
Forces'' and inserting ``individuals described in subsection
(a)''; and
(ii) by striking ``the veteran or member'' and inserting
``the individual''.
(4) G.I. bill comparison tool required disclosures.--
Paragraph (1) of subsection (c) of such section is amended--
(A) by striking subparagraph (B) and inserting the
following:
``(B) for each individual described in subsection (a)
seeking information provided under subsection (b)(5), the
name of each Federal student aid program, and a description
of each such program, from which the individual may receive
educational assistance; and'';
(B) in subparagraph (C)--
(i) in clause (i), by inserting ``and a definition of each
type of institution'' before the semicolon;
(ii) in clause (iv), by inserting ``and if so, which
programs'' before the semicolon;
(iii) by striking clause (v) and inserting the following:
``(v) the average annual cost and the total cost to earn an
associate's degree and a bachelor's degree, with available
cost information on any other degree or credential the
institution awards;'';
(iv) in clause (vi), by inserting before the semicolon the
following: ``disaggregated by--
``(I) the type of beneficiary of educational assistance;
``(II) individuals who received a credential and
individuals who did not; and
``(II) individuals using educational assistance under laws
administered by the Secretary and individuals who are not;'';
(v) in clause (xiv), by striking ``and'' at the end;
(vi) in clause (xv), by striking the period at the end and
inserting a semicolon; and
(vii) by adding at the end the following new clauses:
``(xvi) the number of veterans or members who completed
covered education at the institution leading to--
``(I) a degree, disaggregated by type of program,
including--
``(aa) an associate degree;
``(bb) a bachelor's degree; and
``(cc) a postbaccalaureate degree; and
``(II) a certificate or professional license, disaggregated
by type of certificate or professional license;
``(xvii) programs available and the average time for
completion of each program;
``(xviii) employment rate and median income of graduates of
the institution in general two and five years after
graduation, disaggregated by--
``(I) specific program; and
``(II) individuals using educational assistance under laws
administered by the Secretary and individuals who are not;
and
``(xix) the number of individuals using educational
assistance under laws administered by the Secretary who are
enrolled in the both the institution and specific program per
year.''.
(5) Clarity and anonymity of information provided.--
Paragraph (2) of such subsection is amended--
(A) by inserting ``(A)'' before ``To the extent''; and
(B) by adding at the end the following new subparagraph:
``(B) The Secretary shall ensure that information provided
pursuant to subsection (b)(5) is provided in a manner that is
easy for, and accessible to, individuals described in
subsection (a).
``(C) In providing information pursuant to subsection
(b)(5), the Secretary shall maintain the anonymity of
individuals described in subsection (a) and, to the extent
that a portion of any data would undermine such anonymity,
ensure that such data is not made available pursuant to such
subsection.''.
(c) Improvements for Student Feedback.--
(1) In general.--Subsection (b)(2) of such section is
amended--
(A) by amending subparagraph (A) to read as follows:
``(A) provides institutions of higher learning--
``(i) up to 30 days to review and respond to feedback from
individuals described in subsection (a) and address issues
regarding the feedback before the feedback is published; and
``(ii) if an institution of higher learning contests the
accuracy of the feedback, the opportunity to challenge the
inclusion of such data with an official appointed by the
Secretary;'';
(B) in subparagraph (B), by striking ``and'' at the end;
(C) in subparagraph (C), by striking ``that conforms with
criteria for relevancy that the Secretary shall determine.''
and inserting ``, and responses from institutions of higher
learning to such feedback, that conform with criteria for
relevancy that the Secretary shall determine;''; and
(D) by adding at the end the following new subparagraphs:
``(D) for each institution of higher learning that is
approved under this chapter, retains, maintains, and
publishes all of such feedback for not less than six years;
and
``(E) is easily accessible to individuals described in
subsection (a) and to the general public.''.
(2) Accessibility from g.i. bill comparison tool.--The
Secretary shall ensure that--
(A) the feedback tracked and published under subsection
(b)(2) of such section, as amended by paragraph (1), is
prominently displayed in the tool maintained under subsection
(a) of this section; and
(B) when such tool displays information for an institution
of higher learning, the applicable feedback is also displayed
for such institution of higher learning.
(d) Training for Provision of Education Counseling
Services.--
(1) In general.--Not less than one year after the date of
the enactment of this Act, the Secretary shall ensure that
personnel employed by the Department of Veteran Affairs, or a
contractor of the Department, to provide education benefits
counseling, vocational or transition assistance, or similar
functions, including employees or contractors of the
Department who provide such counseling or assistance as part
of the Transition Assistance Program, are trained on how--
(A) to use properly the tool maintained under subsection
(a); and
(B) to provide appropriate educational counseling services
to individuals described in section 3698(a) of such title, as
amended by subsection (b)(3)(A).
(2) Transition assistance program defined.--In this
subsection, the term ``Transition Assistance Program'' means
the program of counseling, information, and services under
section 1142 of title 10, United States Code.
Subtitle B--Employment and Training
SEC. 221. IMPROVEMENTS TO REEMPLOYMENT RIGHTS OF MEMBERS OF
THE ARMED FORCES.
(a) USERRA Purposes.--Section 4301(a)(1) of title 38,
United States Code, is amended by striking ``encourage
noncareer service in the uniformed services'' and inserting
``encourage service in the uniformed services''.
(b) Prohibition of Retaliation.--Subsection (b) of section
4311 of title 38, United States Code, is amended by inserting
``or other retaliatory action'' after ``employment action''.
(c) Expansion of Injunctive Relief.--Subsection (e) of
section 4323 of such title is amended--
(1) by striking ``The court shall use'' and inserting ``(1)
The court shall use''; and
(2) by adding at the end the following new paragraphs:
[[Page H6059]]
``(2) A person bringing an action to enforce a provision of
this chapter pursuant to subsection (a) shall be entitled to
an injunction under paragraph (1) if such person
demonstrates--
``(A) a violation--
``(i) of the provisions of this chapter; or
``(ii) of the provisions of this chapter is threatened or
is imminent;
``(B) the harm to the person outweighs the injury to the
employer;
``(C) a likelihood of success on the merits of such action;
and
``(D) awarding such relief is in the public interest.
``(3) The court may not deny a motion for injunctive relief
on the basis that a party bringing an action to enforce a
provision of this chapter may be awarded wages unearned due
to an unlawful termination or denial of employment at the
conclusion of such action.''.
(d) Damages Against a State or Private Employer.--Section
4323 of such title is further amended, in paragraph (1) of
subsection (d), by striking subparagraph (C) and inserting
the following new subparagraphs:
``(C) The court may require the employer to pay the person
the amount referred to in subparagraph (B) and interest on
such amount, calculated at a rate of 3 percent per year.
``(D) The court may require the employer to pay the person
the greater of $50,000 or the amount equal to the amounts
referred to in subparagraphs (B) and (C) as liquidated
damages, if the court determines that the employer knowingly
failed to comply with the provisions of this chapter.''.
(e) Mandatory Attorney Fees Award in Successful Actions for
Reemployment.--
(1) MSPB actions.--Paragraph (4) of subsection (c) of
section 4324 of such title is amended--
(A) by striking ``may, in its discretion,'' and inserting
``shall''; and
(B) by adding at the end the following new sentence: ``The
Board may, in its discretion, award reasonable attorney fees
in a case settled before the issuance of an order if the
person can demonstrate that significant attorney fees were
incurred and that justice requires such an award.''.
(2) Federal circuit actions.--Subsection (d) of such
section is amended by adding at the end the following new
paragraph:
``(3) In such Federal Circuit proceeding, the court shall
award such person reasonable attorney fees, expert witness
fees, and other litigation expenses if such person--
``(A) prevails in such Federal Circuit proceeding; and
``(B) is not represented by the Special Counsel in such
Federal Circuit proceeding.''.
(3) Actions against a state or private employer.--Paragraph
(2) of section 4323(h) of such title is amended--
(A) by striking ``subsection (a)(2)'' and inserting
``subsection (a)(3)''; and
(B) by striking ``the court may award any such person who
prevails in such action or proceeding reasonable attorney
fees'' and inserting ``the court shall award any such person
who prevails in such action or proceeding reasonable attorney
fees''.
(f) GAO Review and Report on USERRA.--
(1) Review.--The Comptroller General of the United States
shall review the methods through which the Secretary of
Labor, acting through the Veterans' Employment and Training
Service, processes actions for relief under chapter 43 of
title 38, United States Code.
(2) Elements.--Not later than one year after the date of
the enactment of this Act, the Comptroller General shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report that includes--
(A) the findings of the review required under paragraph
(1);
(B) an identification of the number of actions for relief
under chapter 43 of title 38, United States Code, initiated
during the period covered by the report, disaggregated by
size of employer and geographic region;
(C) an identification of the number of such actions for
relief that were erroneously dismissed, as determined by the
Comptroller General;
(D) an identification of the number of such actions for
relief that were referred to the Department of Justice; and
(E) an assessment of trends, if any, in such actions for
relief initiated during such period.
(g) GAO Review of Protections for Members of the Uniformed
Services by Federal Intelligence Agencies.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the appropriate congressional
committees a report on the processes and procedures adopted
and used by the intelligence community to provide the
protections for members of the uniformed services otherwise
established under chapter 43 of title 38, United States Code.
(2) Definitions.--In this subsection:
(A) The term ``appropriate congressional committees'' means
the Committees on Veterans' Affairs of the House of
Representatives and Senate, the Permanent Select Committee on
Intelligence of the House of Representatives, and the Select
Committee on Intelligence of the Senate.
(B) The term ``intelligence community'' has the meaning
given such term in section 3(4) of the National Security Act
of 1947 (50 U.S.C. 3003(4)).
SEC. 222. REVIEW OF INVESTIGATIONS MANUAL OF VETERANS'
EMPLOYMENT AND TRAINING SERVICE.
(a) In General.--Not later than one year after the date of
the enactment of this Act, and once every two years
thereafter for the period of five years beginning on such
date, the Secretary of Labor, shall review the manual of the
Department of Labor titled ``Veterans' Employment and
Training Service Investigations Manual: USERRA, VEOA, and
VP'' (or a successor manual) and make such revisions to such
manual as the Secretary determines appropriate.
(b) Report.--Not later than 90 days after any date on which
the Secretary completes a review required under subsection
(a), the Secretary shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the
Senate--
(1) a report that includes a description of any revision to
such manual made pursuant to such review; and
(2) a copy of the entire such manual which--
(A) shall be provided to the Chairman and Ranking Member of
each such committee; and
(B) may contain a separate addendum for portions of the
manual that contain law enforcement sensitive materials.
SEC. 223. WARRIOR TRAINING ADVANCEMENT COURSE.
(a) Reporting on the Warrior Training Advancement Course.--
(1) Reports required.--
(A) Initial report.--Not later than six months 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 House of Representatives a report on
WARTAC.
(B) Annual report.--One year after the submission of the
report required under paragraph subparagraph (A) and annually
thereafter, the Secretary shall submit to such Committees a
report that contains the elements under subparagraphs (A) and
(C) of paragraph (2) with regards to the preceding year.
(2) Elements.--Except as provided in paragraph (1)(B), the
reports under this subsection shall include the following
elements:
(A) Best practices.--With regards to best practices of
WARTAC--
(i) how many covered members have applied to participate in
WARTAC;
(ii) how many covered members have participated in WARTAC;
(iii) how the Secretary provides training to covered
members during TAP;
(iv) how many covered members have completed WARTAC; and
(v) any other information the Secretary determines
appropriate.
(B) Cost savings.--With regards to cost savings of WARTAC--
(i) how much money the Secretary determines WARTAC saves
the United States each fiscal year;
(ii) how much money the Secretary determines WARTAC has
saved the United States since its establishment; and
(iii) the determination of the Secretary whether other
Federal agencies may save money by establishing a program
similar to WARTAC.
(C) Hiring.--With regards to hiring covered members who
complete WARTAC--
(i) how the Secretary identifies positions in the
Department of Veterans Affairs for which such covered members
may qualify;
(ii) the grades of such positions on the General Schedule
under section 5332 of title 5, United States Code; and
(iii) how many such covered members the Secretary has hired
to such positions.
(3) Distribution.--Not later than 30 days after submitting
the report under paragraph (1)(A), the Secretary of Veterans
Affairs shall transmit a copy of the report under this
section to the head of each Federal agency.
(4) Definitions.--In this subsection:
(A) The term ``covered member'' means members of the Armed
Forces participating in TAP.
(B) The term ``TAP'' means the Transition Assistance
Program under sections 1142 and 1144 of title 10, United
States Code.
(C) The term ``WARTAC'' means the Warrior Training
Advancement Course of the Veterans Benefit Administration, in
which the Secretary provides training to covered members so
such covered members may qualify for certain employment in
the Veterans Benefit Administration.
(b) Pilot Program to Employ Veterans in Positions Relating
to Conservation and Resource Management Activities.--
(1) Best practices for other departments.--The Assistant
Secretary of Labor for Veterans' Employment and Training, in
consultation with the Secretary of Veterans Affairs, shall
establish guidelines containing best practices for
departments and agencies of the Federal Government that carry
out programs to employ veterans who are transitioning from
service in the Armed Forces. Such guidelines shall include
the findings of the initial report required under subsection
(a)(1).
(2) Pilot program.--
(A) Establishment.--The Secretary of the Interior, in
consultation with the Assistant Secretary of Labor for
Veterans' Employment and Training and the Secretary of
Veterans Affairs, shall establish a pilot program under which
veterans are employed by the Federal Government in positions
that relate
[[Page H6060]]
to the conservation and resource management activities of the
Department of the Interior.
(B) Positions.--The Secretary of the Interior shall--
(i) identify vacant positions in the Department of the
Interior that are appropriate to fill using the pilot
program; and
(ii) to the extent practicable, fill such positions using
the pilot program.
(C) Application of civil service laws.--A veteran employed
under the pilot program shall be treated as an employee as
defined by section 2105 of title 5, United States Code.
(D) Briefings and report.--
(i) Initial briefing.--Not later than 60 days after the
date of the submission of the report required under
subsection (a)(1)(A), the Secretary of the Interior and the
Assistant Secretary of Labor for Veterans' Employment and
Training shall jointly provide to the appropriate
congressional committees a briefing on the pilot program
under this subsection, which shall include a description of
how the pilot program will be carried out in a manner to
reduce the unemployment of veterans and any recommendations
for legislative actions to improve the pilot program.
(ii) Implementation briefing.--Not later than one year
after the date on which the pilot program under this
paragraph commences, the Secretary of the Interior and the
Assistant Secretary of Labor for Veterans' Employment and
Training shall jointly provide to the appropriate
congressional committees a briefing on the implementation of
the pilot program.
(iii) Final report.--Not later than 30 days after the date
on which the pilot program under this paragraph is completed,
the Secretary of the Interior and the Assistant Secretary of
Labor for Veterans' Employment and Training shall jointly
submit to the appropriate congressional committees a report
on the pilot program that includes the following:
(I) The number of veterans who applied to participate in
the pilot program.
(II) The number of such veterans employed under the pilot
program.
(III) The number of veterans identified in subclause (II)
who transitioned to full-time positions with the Federal
Government after participating in the pilot program.
(IV) Any other information the Secretary and the Assistant
Secretary determine appropriate with respect to measuring the
effectiveness of the pilot program.
(E) Duration.--The authority to carry out the pilot program
under this paragraph shall terminate on the date that is two
years after the date on which the pilot program commences.
(3) Outdoor recreation program attendance.--The Secretary
of each of the military department is encouraged to allow
members of the Armed Forces serving on active duty to
participate in programs related to environmental stewardship
or guided outdoor recreation.
(4) Appropriate congressional committees defined.--In this
subsection, the term ``appropriate congressional committees''
means--
(A) the Committee on Veterans' Affairs and the Committee on
Natural Resources of the House of Representatives; and
(B) the Committee on Veterans' Affairs and the Committee on
Energy and Natural Resources of the Senate.
Subtitle C--Home Loans
SEC. 231. IMPROVEMENTS TO PROGRAM FOR DIRECT HOUSING LOANS
MADE TO NATIVE AMERICAN VETERANS BY THE
SECRETARY OF VETERANS AFFAIRS.
(a) General Authorities and Requirements.--
(1) Direct housing loans to native american veterans.--
Section 3762(a) of title 38, United States Code, is amended
to read as follows:
``(a) The Secretary may make a direct housing loan to a
Native American veteran under this subchapter if the
Secretary ensures the following:
``(1) That each Native American veteran to whom the
Secretary makes a direct housing loan under this subchapter--
``(A) holds, possesses, or purchases using the proceeds of
the loan a meaningful interest in a lot or dwelling (or both)
that is located on trust land; and
``(B) will purchase, construct, or improve (as the case may
be) a dwelling on the lot using the proceeds of the loan.
``(2) That each such Native American veteran will convey to
the Secretary by an appropriate instrument the interest
referred to in paragraph (1)(A) as security for a direct
housing loan under this subchapter.
``(3) That the Secretary, including the Secretary's
employees or agents, may enter upon the trust land for the
purposes of carrying out such actions as the Secretary
determines are necessary, including--
``(A) to evaluate the advisability of the loan;
``(B) to monitor any purchase, construction, or
improvements carried out using the proceeds of the loan; and
``(C) to manage any servicing or post-foreclosure
activities, including acquisition, property inspections, and
property management.
``(4) That there are established standards and procedures
that apply to the foreclosure of the interest conveyed by a
Native American veteran pursuant to paragraph (2),
including--
``(A) procedures for foreclosing the interest; and
``(B) procedures for the resale of the lot or dwelling (or
both) purchased, constructed, or improved using the proceeds
of the loan.
``(5) That the loan is made in a responsible and prudent
manner, subject to standards and procedures as are necessary
for the reasonable protection of the financial interests of
the United States.''.
(2) Memorandums of understanding, agreements, and
determinations.--Section 3762(b) of such title is amended to
read as follows:
``(b)(1) To carry out the purpose of subsection (a), the
Secretary may--
``(A) enter into a memorandum of understanding with a
tribal organization, other entity, or individual;
``(B) rely on agreements or determinations of other Federal
agencies to guarantee, insure, or make loans on trust land;
and
``(C) enter into other agreements or take such other
actions as the Secretary determines necessary.
``(2) If the Secretary determines that the requirements
under subsection (a) are not being enforced by a tribal
organization, other entity, or individual that is a party to
any memorandum of understanding, agreement, or determination
described in paragraph (1), the Secretary may cease making
new direct housing loans to Native American veterans under
this subchapter within the area of the authority of the
tribal organization, other entity, or individual (as the case
may be).''.
(b) Direct Loans to Native American Veterans To Refinance
Existing Mortgage Loans.--Section 3762(h) of such title is
amended to read as follows:
``(h) The Secretary may make direct loans to Native
American veterans in order to enable such veterans to
refinance existing mortgage loans for any of the following
purposes:
``(1) To refinance an existing loan made under this
section, if the loan--
``(A) meets the requirements set forth in subparagraphs
(B), (C), and (E) of paragraph (1) of section 3710(e) of this
title;
``(B) will bear an interest rate at least one percentage
point less than the interest rate borne by the loan being
refinanced; and
``(C) complies with paragraphs (2) and (3) of section
3710(e) of this title, except that for the purposes of this
subsection the reference to subsection (a)(8) of section 3710
of this title in such paragraphs (2) and (3) shall be deemed
to be a reference to this subsection.
``(2) To refinance an existing mortgage loan not made under
this section on a dwelling owned and occupied by the veteran
as the veteran's home, if all of the following requirements
are met:
``(A) The loan will be secured by the same dwelling as was
the loan being refinanced.
``(B) The loan will provide the veteran with a net tangible
benefit.
``(C) The nature and condition of the property is such as
to be suitable for dwelling purposes.
``(D) The amount of the loan does not exceed either of the
following:
``(i) 100 percent of the reasonable value of the dwelling,
with such reasonable value determined under the procedures
established by the Secretary under subsection (d)(2).
``(ii) An amount equal to the sum of the balance of the
loan being refinanced and such closing costs (including any
discount points) as may be authorized by the Secretary to be
included in the loan.
``(E) Notwithstanding subparagraph (D), if a loan is made
for both the purpose of this paragraph and to make energy
efficiency improvements, the loan must not exceed either of
the following:
``(i) 100 percent of the reasonable value of the dwelling
as improved for energy efficiency, with such reasonable value
determined under the procedures established by the Secretary
under subsection (d)(2).
``(ii) The amount referred to under subparagraph (D)(ii),
plus the applicable amount specified under section 3710(d)(2)
of this title.
``(F) The loan meets all other requirements the Secretary
may establish under this subchapter.
``(G) The existing mortgage being refinanced is a first
lien on the property and secured of record.
``(3) To refinance an existing mortgage loan to repair,
alter, or improve a dwelling owned by the veteran and
occupied by the veteran as the veteran's home, if all of the
following requirements are met:
``(A) The loan will be secured by the same dwelling as was
the loan being refinanced.
``(B) The nature and condition of the property is such as
to be suitable for dwelling purposes, and the repair,
alteration, or improvement substantially protects or improves
the basic livability or utility of such property.
``(C) The amount of the loan, including the costs of
repairs, alterations, and improvements, does not exceed
either of the following:
``(i) 100 percent of the reasonable value of the dwelling
as repaired, altered, or improved, with such reasonable value
determined under the procedures established by the Secretary
under subsection (d)(2).
``(ii) An amount equal to the sum of--
``(I) the balance of the loan being refinanced;
``(II) the actual cost of repairs, alterations, or
improvements; and
``(III) such closing costs (including any discount points)
as may be authorized by the Secretary to be included in the
loan.
[[Page H6061]]
``(D) The loan meets all other requirements the Secretary
may establish under this subchapter.
``(E) The existing mortgage loan being refinanced is a
first lien on the property and secured of record.''.
(c) Expansion of Outreach Program on Availability of Direct
Housing Loans for Native American Veterans.--Section
3762(i)(2) of such title is amended by adding at the end the
following new subparagraph:
``(G) Pursuant to subsection (g)(4), assisting Native
American veterans in qualifying for mortgage financing by--
``(i) partnering with local service providers, such as
tribal organizations, tribally designated housing entities,
Native community development financial institutions, and
nonprofit organizations, for conducting outreach, homebuyer
education, housing counseling, and post-purchase education;
and
``(ii) providing other technical assistance as needed.
``(H) Attending conferences and conventions conducted by
the network of Native community development financial
institutions and other Native American homeownership
organizations to provide information and training to Native
community development financial institutions about the
availability of the relending program under section 3762A of
this title.''.
(d) Adequate Personnel.--Section 3762 of such title is
amended by adding at the end the following new subsection:
``(k) The Secretary shall assign a sufficient number of
personnel of the Department dedicated to carrying out the
authority of the Secretary under this subchapter, including
construction and valuation specialists to assist with issues
unique to new construction and renovations on trust land.''.
(e) Definitions.--Section 3765 of such title is amended--
(1) in paragraph (1)--
(A) by amending subparagraph (C) to read as follows:
``(C) is located in the State of Alaska within a region
established under section 7(a) of the Alaska Native Claims
Settlement Act (43 U.S.C. 1606(a));'';
(B) in subparagraph (D), by striking the period at the end
and inserting a semicolon; and
(C) by adding at the end the following new subparagraphs:
``(E) is defined by the Secretary of the Interior and
recognized by the United States as land over which an Indian
Tribe has governmental dominion; or
``(F) is on any land that the Secretary determines is
provided to Native American veterans because of their status
as Native Americans.''; and
(2) by adding at the end the following new paragraphs:
``(6) The term `community development financial
institution' has the meaning given that term in section 103
of the Community Development Banking and Financial
Institutions Act of 1994 (12 U.S.C. 4702).
``(7) The term `Indian Tribe' means any Indian tribe, band,
nation, or other organized group or community, including any
Alaska Native village or regional or village corporation as
defined in or established pursuant to the Alaska Native
Claims Settlement Act (43 U.S.C. 1601 et seq.), which is
recognized as eligible for the special programs and services
provided by the United States to Indians because of their
status as Indians.
``(8) The term `Native community development financial
institution' means any entity--
``(A) that has been certified as a community development
financial institution by the Secretary of the Treasury;
``(B) that is not less than 51 percent owned or controlled
by Native Americans; and
``(C) for which not less than 51 percent of the activities
of the entity serve Native Americans.
``(9) The term `net tangible benefit' shall have such
meaning as the Secretary determines appropriate, but shall
include the refinance of an interim construction loan.
``(10) The term `other technical assistance' means services
to assist a Native American veteran to navigate the steps
necessary for securing a mortgage loan on trust land,
including pre-development activities related to utilities,
identifying appropriate residential construction services,
and obtaining lease clearances and title status reports from
the applicable tribal organization or the Bureau of Indian
Affairs.
``(11) The term `tribally designated housing entity' has
the meaning given that term in section 4 of the Native
American Housing Assistance and Self-Determination Act of
1996 (25 U.S.C. 4103).''.
(f) Interest Rate Reduction Financing Loan.--Section
3729(b)(4)(F) of such title is amended by striking
``3762(h)'' and inserting ``3762(h)(1)''.
(g) Regulations.--Section 3761 of such title is amended by
adding at the end the following new subsection:
``(c) The Secretary shall prescribe such regulations as may
be necessary to carry out this subchapter.''.
SEC. 232. NATIVE COMMUNITY DEVELOPMENT FINANCIAL INSTITUTION
RELENDING PROGRAM.
(a) In General.--Subchapter V of chapter 37 of title 38,
United States Code, is amended by inserting after section
3762 the following new section:
``Sec. 3762A. Native community development financial
institution relending program
``(a) Purpose.--The Secretary may make a loan to a Native
community development financial institution for the purpose
of allowing the institution to relend loan amounts to
qualified Native American veterans, subject to the
requirements of this section.
``(b) Standards.--(1) The Secretary shall establish
standards to be used in evaluating whether to make a loan to
a Native community development financial institution under
this section.
``(2) In establishing standards under paragraph (1), the
Secretary shall ensure that a Native community development
financial institution--
``(A) is able to originate and service loans for single-
family homes;
``(B) is able to operate the relending program in a manner
consistent with the mission of the Department to serve
veterans; and
``(C) uses loan amounts received under this section only
for the purpose of relending, as described in subsection (c),
to Native American veterans.
``(c) Relending Requirements.--(1) A Native community
development financial institution that receives a loan under
this section shall use the loan amounts to make loans to
Native American veterans residing on trust land.
``(2) A loan to a Native American veteran made by a Native
community development financial institution under paragraph
(1) shall--
``(A) be limited either to the purpose of purchase,
construction, or improvement of a dwelling located on trust
land or to the refinance of an existing mortgage loan for a
dwelling on trust land, consistent with the requirements of
section 3762(h) of this title; and
``(B) comply with such terms and conditions as the
Secretary determines are necessary to protect against
predatory lending, including the interest rate charged on a
loan to a Native American veteran.
``(d) Repayment.--A loan made to a Native community
development financial institution under this section shall--
``(1) be payable to the Secretary upon such terms and
conditions as are prescribed in regulations pursuant to this
subchapter; and
``(2) bear interest at a rate of one percent.
``(e) Oversight.--Subject to notice and opportunity for a
hearing, whenever the Secretary finds with respect to loans
made under subsection (a) or (c) that any Native community
development financial institution has failed to maintain
adequate loan accounting records, to demonstrate proper
ability to service loans adequately, or to exercise proper
credit judgment, or that such Native community development
financial institution has willfully or negligently engaged in
practices otherwise detrimental to the interest of veterans
or of the Government, the Secretary may take such actions as
the Secretary determines necessary to protect veterans or the
Government, such as requiring immediate repayment of any
loans made under subsection (a) and the assignment to the
Secretary of loans made under subsection (c).
``(f) Sunset.--The Secretary may not make a loan under this
section after September 30, 2027.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 37 of such title is amended by inserting
after the item relating to section 3762 the following new
item:
``3762A. Native community development financial institution relending
program.''.
(c) Native American Veteran Housing Loan Program Account.--
Section 3763 of such title is amended by adding at the end
the following new subsection:
``(c) Of amounts available in the Account, the Secretary
may use for loans made under section 3762A of this title--
``(1) in fiscal year 2025, not more than $5,000,000; and
``(2) in any fiscal year after fiscal year 2025, an amount
determined necessary by the Secretary to meet the demand for
such loans.''.
TITLE III--DISABILITY AND MEMORIAL AFFAIRS MATTERS
SEC. 301. BURIAL ALLOWANCE FOR CERTAIN VETERANS WHO DIE AT
HOME WHILE IN RECEIPT OF HOSPICE CARE FURNISHED
BY DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall
treat a veteran described in subsection (b) as a veteran
described in subparagraph (A) of section 2303(a)(2) of title
38, United States Code.
(b) Veteran Described.--A veteran described in this
subsection is a veteran who dies in a home or other setting
at which the deceased veteran was, at the time of death,
receiving hospice care pursuant to section 1717(a) of such
title if such care was directly preceded by the Secretary
furnishing to the veteran hospital care or nursing home care
described in clause (ii) of such subparagraph.
(c) Effective Date; Applicability.--This section shall
apply with respect to deaths that occur--
(1) on or after the date that is 180 days after the date of
the enactment of this Act; and
(2) before October 1, 2026.
SEC. 302. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO
AWARD GRANTS TO STATES AND INDIAN TRIBES TO
IMPROVE OUTREACH TO VETERANS.
(a) In General.--Chapter 63 of title 38, United States
Code, is amended--
[[Page H6062]]
(1) by redesignating sections 6307 and 6308 as sections
6308 and 6309, respectively; and
(2) by inserting after section 6306 the following new
section 6307:
``Sec. 6307. Grants to States and Indian Tribes to improve
outreach to veterans
``(a) Purpose.--It is the purpose of this section to
provide for assistance by the Secretary to States and Indian
Tribes to carry out programs that improve covered outreach
and assistance to veterans and the spouses, children, and
parents of veterans, to ensure that such individuals are
fully informed about, and assisted in applying for, any
veterans and veterans-related benefits and programs
(including veterans programs of a State or Indian Tribe) for
which they may be eligible and facilitate opportunities for
such individuals to receive competent, qualified services in
the preparation, presentation and prosecution of veterans
benefits claims.
``(b) Authority.--The Secretary may award grants to States
and Indian Tribes--
``(1) to carry out, coordinate, improve, or otherwise
enhance--
``(A) covered outreach activities; or
``(B) activities to assist in the development and submittal
of claims for veterans and veterans-related benefits; or
``(2) to increase the number of county or Tribal veterans
service officers serving in the State by hiring new,
additional such officers.
``(c) Application.--(1) To be eligible for a grant under
this section, a State or Indian Tribe shall submit to the
Secretary an application therefor at such time, in such
manner, and containing such information as the Secretary may
require.
``(2) Each application submitted under paragraph (1) shall
include the following:
``(A) A detailed plan for the use of the grant.
``(B) A description of the programs through which the State
or Indian Tribe will meet the outcome measures developed by
the Secretary under subsection (j).
``(C) A description of how the State or Indian Tribe will
distribute grant amounts equitably among counties or Tribal
lands with varying levels of urbanization.
``(D) A plan for how the grant will be used to meet the
unique needs of American Indian veterans, Alaska Native
veterans, or Native Hawaiian veterans, elderly veterans, and
veterans from other underserved communities.
``(d) Distribution.--The Secretary shall seek to ensure
that grants awarded under this section are equitably
distributed among States and Indian Tribes with varying
levels of urbanization.
``(e) Set-aside.--Of the amounts authorized to be
appropriated or otherwise made available for grants under
this section for any fiscal year, the Secretary shall ensure
that not less than five percent is used to make grants to
Indian Tribes.
``(f) Priority.--The Secretary shall prioritize awarding
grants under this section that will serve the following
areas:
``(1) Areas with a critical shortage of county or Tribal
veterans service officers.
``(2) Areas with high rates of--
``(A) suicide among veterans; or
``(B) referrals to the Veterans Crisis Line.
``(g) Use of County or Tribal Veterans Service Officers.--A
State or Indian Tribe that receives a grant under this
section to carry out an activity described in subsection
(b)(1) shall carry out the activity through--
``(1) a county or Tribal veterans service officer of the
State; or
``(2) if the State or Indian Tribe does not have a county
or Tribal veterans service officer, or if the county or
Tribal veterans service officers of the State or Indian Tribe
cover only a portion of that State or Indian Tribe, an
appropriate entity of a State, local, or Tribal government,
as determined by the Secretary.
``(h) Required Activities.--Any grant awarded under this
section shall be used--
``(1) to expand existing programs, activities, and
services;
``(2) to hire new, additional county or Tribal veterans
service officers; or
``(3) for travel and transportation to facilitate carrying
out paragraph (1) or (2).
``(i) Authorized Activities.--A grant under this section
may be used to provide education and training, including on-
the-job training, for State, county, local, and Tribal
government employees who provide (or when trained will
provide) covered outreach services in order for those
employees to obtain accreditation in accordance with
procedures approved by the Secretary.
``(j) Outcome Measures.--(1) The Secretary shall develop
and provide to each State or Indian Tribe that receives a
grant under this section written guidance on the following:
``(A) Outcome measures.
``(B) Policies of the Department.
``(2) In developing outcome measures under paragraph (1),
the Secretary shall consider the following goals:
``(A) Increasing the use of veterans and veterans-related
benefits, particularly among vulnerable populations.
``(B) Increasing the number of county and Tribal veterans
service officers recognized by the Secretary for the
representation of veterans under chapter 59 of this title.
``(k) Tracking Requirements.--(1) With respect to each
grant awarded under this section, the Secretary shall track
the use of veterans and veterans-related benefits among the
population served by the grant, including the average period
of time between the date on which a veteran applies for such
a benefit and the date on which the veteran receives the
benefit, disaggregated by type of benefit.
``(2) Not less frequently than annually during the life of
the grant program established under this section, the
Secretary shall submit to Congress a report on--
``(A) the information tracked under paragraph (1);
``(B) how the grants awarded under this section serve the
unique needs of American Indian veterans, Alaska Native
veterans, or Native Hawaiian veterans, elderly veterans, and
veterans from other underserved communities; and
``(C) other information provided by States and Indian
Tribes pursuant to the grant reporting requirements.
``(l) Performance Review.--The Secretary shall--
``(1) review the performance of each State or Indian Tribe
that receives a grant under this section; and
``(2) make information regarding such performance publicly
available.
``(m) Remediation Plan.--(1) In the case of a State or
Indian Tribe that receives a grant under this section and
does not meet the outcome measures developed by the Secretary
under subsection (j), the Secretary shall require the State
or Indian Tribe to submit a remediation plan under which the
State shall describe how and when it plans to meet such
outcome measures.
``(2) The Secretary may not award a subsequent grant under
this section to a State or Indian Tribe described in
paragraph (1) unless the Secretary approves the remediation
plan submitted by the State or Indian Tribe.
``(n) Definitions.--In this section:
``(1) The term `county or Tribal veterans service officer'
includes a local equivalent veterans service officer.
``(2) The term `covered outreach' means outreach with
respect to--
``(A) benefits administered by the Under Secretary for
Benefits; or
``(B) similar benefits administered by a State or Indian
Tribe.
``(3) The term `Indian Tribe' has the meaning given such
term in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304).
``(4) The term `State' includes the District of Columbia,
the Commonwealth of Puerto Rico, the Commonwealth of the
Northern Mariana Islands, and any territory or possession of
the United States.
``(5) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of
this title.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 63 of such title is amended by striking
the items relating to sections 6307 and 6308 and inserting
the following new items:
``6307. Grants to States and Indian Tribes to improve outreach to
veterans
``6308. Outreach for eligible dependents
``6309. Biennial report to Congress''.
(c) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary of Veterans Affairs for
each of fiscal years 2026 and 2027, $10,000,000 to carry out
section 6307 of title 28, United States Code, as added by
subsection (a).
SEC. 303. DEFINITION OF SURVIVING SPOUSE.
Paragraph (3) of section 101 of title 38, United States
Code, is amended to read as follows:
``(3) The term `surviving spouse' means (except for
purposes of chapter 19 of this title) a person who was the
spouse of a veteran at the time of the veteran's death, and
who lived with the veteran continuously from the date of
marriage to the date of the veteran's death (except where
there was a separation which was due to the misconduct of, or
procured by, the veteran without the fault of the spouse) and
who has not remarried.''.
SEC. 304. ENSURING ONLY LICENSED HEALTH CARE PROFESSIONALS
PERFORM MEDICAL DISABILITY EXAMINATIONS UNDER
CERTAIN DEPARTMENT OF VETERANS AFFAIRS PILOT
PROGRAM.
(a) Prohibition on Use of Certain Health Care
Professionals.--Section 504(c)(1) of the Veterans' Benefits
Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101
note) is amended by inserting ``only'' before ``a health care
professional''.
(b) Remedies.--The Secretary of Veterans Affairs shall take
such actions as the Secretary considers appropriate to ensure
compliance with section 504(c) of the Veterans' Benefits
Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101
note), as amended by subsection (a).
(c) Annual Report.--Not later than one year after the date
of the enactment of this Act and not less frequently than
once each year thereafter, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of
Representatives a report on--
(1) the conduct of the pilot program established under
section 504 of the Veterans' Benefits Improvements Act of
1996 (Public Law 104-275; 38 U.S.C. 5101 note); and
(2) the actions of the Secretary under subsection (b).
(d) Technical Corrections.--Section 504 of the Veterans'
Benefits Improvements Act of 1996 (Public Law 104-275; 38
U.S.C. 5101 note) is amended, in the section heading, by
striking ``physicians'' and inserting ``health care
professionals''.
[[Page H6063]]
SEC. 305. PROVISION OF INFORMATION REGARDING AN AGENT OR
ATTORNEY TO A LICENSED HEALTH CARE PROFESSIONAL
WHO PERFORMS A MEDICAL DISABILITY EXAMINATION
UNDER CERTAIN DEPARTMENT OF VETERANS AFFAIRS
PILOT PROGRAM.
(a) In General.--Section 504 of the Veterans' Benefits
Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101
note), as amended by section 304, is further amended by
adding at the end the following new subsection:
``(f) Certain Information Provided to Health Care
Professional.--The Secretary shall provide to a health care
professional who performs an examination under subsection
(a), or a contractor performing a contract under such
subsection, the contact information of any agent or attorney
recognized by the Secretary under chapter 59 of title 38,
United States Code, with regards to a claim for benefits that
gives rise to such examination.''.
(b) Applicability.--The amendment made by this section
shall apply to an examination described in subsection (a) of
such section that is performed on or after the date of the
enactment of this Act.
SEC. 306. MODERNIZATION OF DEPARTMENT OF VETERANS AFFAIRS
DISABILITY BENEFIT QUESTIONNAIRES.
(a) Requirement for Transmission of Certain Information in
Machine-readable Format.--
(1) Requirement.--Not later than 180 days after enactment
of this Act, the Secretary of Veterans Affairs shall require
all disability benefit questionnaire data collected in the
course of medical disability examinations made by covered
non-Department providers to be transmitted to the Department
in a machine-readable format.
(2) Issuance of standards.--Not later than 90 days after
the date of the enactment of this Act, the Secretary shall
issue standards for the transmission of disability benefit
questionnaire data in a machine-readable format as required
under paragraph (1).
(3) Updates.--In making updates to disability benefit
questionnaires after the date specified in paragraph (1), the
Secretary shall--
(A) ensure that the updates are made in a manner that
allows for the data collected under the questionnaires to be
in a machine-readable format as of the date on which the
update goes into effect; and
(B) not later than 30 days before an update goes into
effect, notify the covered non-Department providers (or the
contractor performing a contract under section 504 of the
Veterans Benefits Improvement Act of 1996 (Public Law 104-
275; 38 U.S.C. 5101 note)) described in such paragraph of
such updates.
(b) Plan for Information Technology System Modification.--
Not later than 180 days after the date of the enactment of
this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives
a plan to modify the information technology systems and
processes of the Department to enable a non-Department health
care professional, assigned to or selected by a claimant, to
transmit to the Department, in a machine-readable format,
disability benefit questionnaire data, including complete
disability benefit questionnaires rather than partial
questionnaires or elements of medical evidence.
(c) Public Availability of Information.--The Secretary
shall make publicly available on the internet website of the
Department referred to in section 5101(d) of title 38, United
States Code--
(1) a description of the standards issued under subsection
(a)(2); and
(2) the plan required under subsection (b).
(d) Definitions.--In this section:
(1) The term ``claimant'' has the meaning given such term
in section 5100 of title 38, United States Code.
(2) The term ``covered non-Department provider'' means a
health care provider who--
(A) is not an employee of the Department of Veterans
Affairs; and
(B) pursuant to a contract under section 504 of the
Veterans Benefits Improvement Act of 1996 (Public Law 104-
275; 38 U.S.C. 5101 note), as amended by sections 304 and
305, examines a claimant for a medical disability.
SEC. 307. DEPARTMENT OF VETERANS AFFAIRS AUTOMATIC PROCESSING
OF CERTAIN CLAIMS FOR TEMPORARY DISABILITY
RATINGS.
(a) In General.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall modify the information technology systems of the
Department of Veterans Affairs to use automation technology
for claims for temporary disability ratings for veterans
described in section 1156(a)(1)(C) of title 38, United States
Code.
(b) Additional Requirements.--In providing for the
automatic processing of claims as required under subsection
(a), the Secretary shall ensure that--
(1) medical evidence is obtained from the corporate data
warehouse of the Department or other sources of data, the
Secretary determines appropriate;
(2) employees of the Department continue to determine
whether a veteran is entitled to a temporary disability
rating under section 1156(a)(1)(C) of title 38, United States
Code; and
(3) claims may be processed manually if the evidence of
record is not sufficient to decide the claim or if the
medical evidence is provided in a format that is not
compatible with the system developed under subsection (a).
TITLE IV--HOMELESSNESS MATTERS
SEC. 401. SHORT TITLE.
This title may be cited as the ``Housing our Military
Veterans Effectively Act of 2024'' or the ``HOME Act of
2024''.
SEC. 402. PER DIEM PAYMENTS PROVIDED BY THE SECRETARY OF
VETERANS AFFAIRS FOR SERVICES FURNISHED TO
HOMELESS VETERANS.
(a) In General.--Section 2012 of title 38, United States
Code, is amended--
(1) in subsection (a)--
(A) in paragraph (2)(B)--
(i) in clause (i)(II)(aa)(BB), by striking ``115 percent''
and inserting ``115 percent (or, during the period beginning
on the date of the enactment of the the Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits
Improvement Act and ending on September 30, 2027, 133
percent)''; and
(ii) by adding at the end the following:
``(iii) For each of fiscal years 2025 through 2027, the
Secretary may waive the maximum rate for per diem payments
under clause (i)(II)(aa)(BB) or (ii) and, subject to the
availability of appropriations, provide such payments at a
rate that does not exceed 200 percent of the rate authorized
for State homes for domiciliary care under subsection
(a)(1)(A) of section 1741 of this title, as the Secretary may
increase from time to time under subsection (c) of that
section, if the Secretary notifies Congress of such waiver.
``(iv) The Secretary may not, pursuant to clause (iii),
waive the maximum rate described in such clause for more than
50 percent of all grant recipients and eligible entities for
a fiscal year.''; and
(B) by adding at the end the following new paragraph:
``(4) The Secretary may not provide more than 12,000 per
diem payments under this section for a fiscal year.''; and
(2) by adding at the end the following new subsection:
``(f) Reports Required.--Not later than 90 days after the
date of the enactment of the HOME Act of 2024, and not less
frequently than twice 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 rate for per diem payments
under this section that includes, for each Veterans
Integrated Service Network of the Department, the following
data:
``(1) The average rate for such a payment.
``(2) A list of locations where the rate for such a payment
is within 10 percent of the maximum rate for such a payment
authorized under this section.
``(3) The average length of stay by a veteran participating
in a program described in section 2012(a) of this title.''.
(b) Regulatory Authority.--The Secretary of Veterans
Affairs may carry out the amendments made by subsection (a)
through interim guidance in advance of the issuance of
regulations for such purpose.
(c) Strategic Plan.--
(1) In general.--Not later than September 30, 2025, 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 strategic
plan for the provision of grants and per diem payments for
services furnished to homeless veterans under sections 2011
and 2012 of title 38, United States Code.
(2) Elements.--The plan required by paragraph (1) shall
include the following:
(A) A method for administering grant funding equitably
without using the rate authorized for State homes for
domiciliary care under subsection (a)(1)(A) of section 1741
of title 38, United States Code, as the Secretary may
increase from time to time under subsection (c) of that
section, that takes into account--
(i) the wide variety of services furnished by grant
recipients and eligible entities under sections 2011 and 2012
of title 38, United States Code;
(ii) varying costs of living across different geographic
locations;
(iii) varying availability of affordable housing in
different geographic locations;
(iv) circumstances of housing insecurity in rural and
Tribal communities;
(v) veterans with significant medical care needs; and
(vi) the changing dynamic of the veteran population
nationwide.
(B) A plan and timeline for implementation of the method
included under subparagraph (A).
(C) An estimate of increased costs or savings per year
under the plan.
(D) An overview of the different grants that will be
available once the plan is implemented.
SEC. 403. AUTHORIZATION FOR SECRETARY OF VETERANS AFFAIRS TO
USE OF CERTAIN FUNDS FOR IMPROVED FLEXIBILITY
IN ASSISTANCE TO HOMELESS VETERANS.
(a) Use of Funds.--During the period beginning on the date
of the enactment of this Act and ending on the termination
date specified in subsection (d), the Secretary of Veterans
Affairs may provide to a covered veteran, as the Secretary
determines necessary--
(1) food, shelter, clothing, blankets, and hygiene items
required for the safety and survival of the veteran;
[[Page H6064]]
(2) transportation required to support the stability and
health of the veteran for appointments with service
providers, the conduct of housing and employment searches,
and the obtainment of food and supplies; and
(3) tablets, smartphones, disposable phones and other
technology, and related service plans required to support the
stability and health of the veteran through the maintenance
of contact with service providers, prospective landlords, and
family members.
(b) Homeless Veterans on Department of Veterans Affairs
Land.--
(1) In general.--The Secretary may collaborate, to the
extent practicable, with one or more organizations to manage
the use of land of the Department of Veterans Affairs for
homeless veterans for living and sleeping.
(2) Forms of collaboration.--Collaboration under paragraph
(1) may include the provision by either the Secretary or the
head of the organization concerned of food services and
security for property, buildings, and other facilities owned
or controlled by the Department of Veterans Affairs.
(c) Report Required.--Not later than six months after the
date of the enactment of this Act, and annually thereafter
until the date specified in subsection (d), the Secretary
shall submit to Congress a report that includes, with respect
to the period covered by such report--
(1) a statement, disaggregated by each medical center of
the Department of Veterans Affairs, of the amount of funds
under this section--
(A) each such medical center requested from the Secretary;
and
(B) to which the Secretary provided each such medical
center;
(2) data, disaggregated by each such medical center,
relating to how each such medical center used amounts
provided by the Secretary under this section;
(3) the number of covered veterans to which the Secretary
provided assistance under this section;
(4) the total amount of assistance the Secretary provided
to covered veterans pursuant to subsection (a)(3) for
communications equipment, broken down by the type of
equipment provided;
(5) the total amount of assistance the Secretary provided
covered veterans pursuant to subsection (a)(2) for
ridesharing;
(6) the number of covered veterans who received such
assistance; and
(7) a description, for each rideshare used by a covered
veteran with such assistance, of the reasons such covered
veteran used such rideshare.
(8) the number of covered veterans who lived or slept on
Department land;
(9) the amount of funds used to make available Department
land for covered veterans to live and sleep;
(10) the number of Department employees whose primary
responsibilities involved providing services for covered
veterans living or sleeping on Department land;
(11) the average length of time a covered veteran lived or
slept on Department land, and
(12) the period of time the Secretary expects Department
land will be made available for covered veterans to live and
sleep.
(d) Termination Date.--The termination date specified in
this subsection is September 30, 2027.
(e) Definitions.--In this section, the term ``covered
veteran'' means--
(1) a homeless veteran, as such term is defined in section
2002 of title 38, United States Code; and
(2) a veteran participating in the program carried out
under section 8(o)(19) of the United States Housing Act of
1937 (42 U.S.C. 1437f(o)(19)).
SEC. 404. ACCESS TO DEPARTMENT OF VETERANS AFFAIRS TELEHEALTH
SERVICES.
(a) In General.--Subtitle VII of chapter 20 of title 38,
United States Code is amended by adding at the end the
following new section:
``Sec. 2069. Access to telehealth services
``To the extent practicable, the Secretary shall ensure
that veterans participating in or receiving services from a
program under this chapter have access to telehealth services
to which such veterans are eligible under the laws
administered by the Secretary, including by ensuring that
telehealth capabilities are available to--
``(1) such veterans;
``(2) case managers of the Department of programs for
homeless veterans authorized under this chapter; and
``(3) community-based service providers for homeless
veterans receiving funds from the Department through grants
or contracts.''.
(b) Clerical Amendment.--The table of sections at the
beginning of chapter 20 of title 38, United States Code, is
amended by adding at the end the following new item:
``2069. Access to telehealth services.''.
TITLE V--OVERSIGHT AND INVESTIGATIONS MATTERS
SEC. 501. DEPARTMENT OF VETERANS AFFAIRS EMPLOYEE TRAINING
REGARDING OFFICE OF INSPECTOR GENERAL.
(a) Training.--The Secretary of Veterans Affairs shall
require each employee of the Department of Veterans Affairs
who begins employment with the Department on or after the
date of the enactment of this Act to receive training that
the Inspector General of the Department shall develop on the
reporting of wrongdoing to, responding to requests from, and
the duty of cooperating with the Office of Inspector General
of the Department.
(b) Timing of Training.--In carrying out subsection (a),
the Secretary shall require each employee of the Department
covered under such subsection to undergo the training
required by such subsection not later than one year after the
date on which the employee begins employment with the
Department.
(c) Elements.--Training developed and required under
subsection (a) shall include the following:
(1) Definition of the role, responsibilities, and legal
authority of the Inspector General of the Department and the
duties of employees of the Department for engaging with the
Office of Inspector General.
(2) Identification of Federal whistleblower protection
rights, including the right to report fraud, waste, abuse,
and other wrongdoing to Congress.
(3) Identification of the circumstances and mechanisms for
reporting fraud, waste, abuse, and other wrongdoing to the
Inspector General, including making confidential complaints
to the Inspector General.
(4) Identification of the prohibitions and remedies that
help to protect employees of the Department from retaliation
when reporting wrongdoing to the Inspector General.
(5) Recognition of opportunities to engage with staff of
the Office of Inspector General to improve programs,
operations, and services of the Department.
(6) Notification of the authority of the Inspector General
to subpoena the attendance and testimony of witnesses,
including former employees of the Department, as necessary to
carry out the duties of the Office of Inspector General under
section 312 of title 38, United States Code.
(d) Design and Update.--The Inspector General of the
Department shall design, and update as the Inspector General
considers appropriate, the training developed and required by
subsection (a).
(e) System.--The Secretary shall provide, via the talent
management system of the Department, or successor system, the
training developed and required under subsection (a).
(f) Relation to Certain Training.--The Secretary shall
ensure that training developed and required under subsection
(a) is separate and distinct from training provided under
section 733 of title 38, United States Code.
(g) Notice to Employees.--The Secretary shall ensure that
the Inspector General is afforded the opportunity, not less
frequently than twice each year and more frequently if the
Inspector General considers appropriate under extraordinary
circumstances, to use the electronic mail system of the
Department to notify all authorized users of such system of
the following:
(1) The roles and responsibilities of the employees of the
Department when engaging with the Office of Inspector
General.
(2) The availability of training provided under subsection
(a).
(3) How to access training provided under subsection (a).
(4) Information about how to contact the Office of
Inspector General, including a link to any website-based
reporting form of the Office.
SEC. 502. ANNUAL REVIEW OF SECURITY AT COVERED FACILITIES OF
THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Annual Survey.--Not later than one year after the date
of the enactment of this Act, and annually thereafter for
each of the following five fiscal years, the Secretary of
Veterans Affairs, in coordination with the Director of the
Office of Security and Law Enforcement of the Department of
Veterans Affairs, shall conduct a survey of the covered
employees at each covered facility to collect information
regarding security. Each annual survey shall include
questions about--
(1) the type and frequency of criminal activity experienced
at the covered facility during the fiscal year which most
recently concluded including whether or not the criminal
activity was related to residents at the facility or campus
such as those in a residential rehabilitation treatment
program or enhanced-use lease facility;
(2) the number of vacancies and number of days vacant for
Department police officers at the covered facility at the
time of the survey delineated by recruitment status and
stage;
(3) the availability and adequacy of covered equipment;
(4) the availability and adequacy of resources, classes, or
other time set aside for training Department police officers
who work at each covered facility about any skill or tactic
related to law enforcement, including the proper use of
force, firearms qualifications and training, procedures for
responding to an active threat, and any other training
required for Department police officers;
(5) any security weakness at covered facilities;
(6) the relationship between the covered facility
(including the Department police officers who work at the
covered facility) and local, state, and federal law
enforcement agencies including what agreements or memorandums
of understanding exist between each covered facility and
external law enforcement agencies;
(7) efforts by the personnel of the covered facility to
address and reduce criminal activity at, or in close
proximity to, the covered facility; and
(8) recommendations for the Secretary to better address and
reduce criminal activity at, or in close proximity to,
covered facilities so as to improve the safety of veterans,
employees, visitors, other authorized personnel, and the
surrounding community.
[[Page H6065]]
(b) Report.--Not later than 30 days after the end of the
next full Fiscal Year after the enactment of this Act and for
each of the following five fiscal years, the Secretary shall
submit to each of the Committees on Veterans' Affairs of the
Senate and the House of Representatives a report regarding
the results of the surveys conducted under subsection (a)
during the previous fiscal year. The report shall include--
(1) the results of the annual survey described under
subsection (a) for the year covered by the report;
(2) an analysis, made in coordination with the Director of
the Office of Security and Law Enforcement of such
Department, each director and police chief of a Veterans
Integrated Service Network, and the directors and police
chiefs of the medical centers within the Veterans Integrated
Service Network of the results of the triannual security
inspections conducted in prior fiscal year, to include a plan
of action that describes how the Secretary plans to address
any security weakness identified in the results of the
triannual security inspections and includes clearly-stated
goals with measurable benchmarks for each goal and deadlines
for each benchmark; and
(3) a list of all vacant positions for police chief or
deputy police chief at each covered facility during the prior
fiscal year, the number of individuals who filled those
positions over the two years prior to the date of the survey,
the number of days the positions were vacant without someone
serving in an acting capacity, and the number of days the
positions were filled by individuals serving in an acting
capacity.
(c) Definitions.--In this section:
(1) The term ``covered equipment'' means any item issued by
the Secretary of Veterans Affairs to a Department police
officer (including firearms, weapons detecting technology,
ballistic vests, body-worn cameras, and radios) for use in
the provision of services under section 902 of title 38,
United States Code.
(2) The term ``covered employee'' means an employee of the
Department of Veterans Affairs who is employed and
responsible for security operations at a covered facility
including a covered facility's police chief, facility
emergency management leader, facility director, or person
carrying out the responsibilities of one of these positions
in an acting capacity.
(3) The term ``covered facility'' means any facility of the
Department of Veterans Affairs where Department police
officers have jurisdiction.
(4) The term ``Department police officer'' is used as such
term as used in section 902 of title 38, United States Code.
(5) The term ``security weakness'' means a deficiency in
the facilities, staffing, or covered equipment at a covered
facility that a covered employee of the covered facility
determines presents a risk to the safety of visitors or
staff, including an unsecured door, inoperable security
camera, unsecured police operations room, a lack of security
presence at an entrance to the covered facility, and a lack
of security presence in an area of the covered facility or
the grounds of the covered facility that the director of the
covered facility determines requires an increased security
presence.
SEC. 503. MODIFICATION OF CERTAIN HOUSING LOAN FEES.
The loan fee table in section 3729(b)(2) of title 38,
United States Code, is amended by striking ``November 29,
2031'' each place it appears and inserting ``June 9, 2034''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Illinois (Mr. Bost) and the gentleman from California (Mr. Takano) each
will control 20 minutes.
The Chair recognizes the gentleman from Illinois.
General Leave
Mr. BOST. Madam Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks on
H.R. 8371, as amended.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Illinois?
There was no objection.
Mr. BOST. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I rise today in strong support of H.R. 8371, as
amended, offered by the gentleman from Arizona (Mr. Ciscomani), my
friend and colleague.
For nearly the entire 118th Congress, the House and Senate Committees
on Veterans' Affairs have worked together to develop a bipartisan
package of commonsense proposals. The Dole act is the result of that
work and would enhance, reform, and modernize nearly every part of the
VA.
Specifically, the Dole act would change the landscape for elderly
veterans and finally give them a choice in where they choose to live
out their sunset years; reform VA's homeless programs to embrace data
and help lift veterans out of homelessness permanently; expand
nontraditional education and employment programs, like VET TEC, to
allow even more students to receive the training they need to land
high-paying tech jobs; protect the MISSION Act to ensure that veterans
have access to the timely healthcare they want and where they want it;
cut red tape for schools to allow students using the GI Bill to use
their benefits; and so much more.
Simply put, the Dole act would help deliver on the promises we have
made to the veterans and their families.
Madam Speaker, some of the provisions in the Dole act would, quite
literally, save veterans' lives. Since COVID, homeless prevention
providers haven't been able to keep pace with rising costs and help as
many veterans as they would like. The Dole act would fix that.
Veterans across the country are having their healthcare restricted by
VA bureaucracy, who think they get to decide where veterans should get
their healthcare. The Dole act would fix that.
The Dole act would rightfully make sure that a VA bureaucrat cannot
veto a doctor's medical decisions.
Under current law, veterans' caregivers have limited options on where
they can get mental health support services. The Dole act would not
only fix that but would expand where they can reach these services.
Right now, only veterans who pass away at a VA facility are allowed
burial or funeral allowances. The Dole act will fix that.
Madam Speaker, there are a lot of good things in this bill, and it is
past time for us to send it to the President's desk before it is too
late.
I thank the over 50 veterans service organizations, advocacy
organizations, and stakeholders from every corner of this country for
their support of the Dole act. Their advocacy and work in collaborating
with the House and the Senate Committees on Veterans' Affairs has
finally brought this bill to the finish line.
I ask unanimous consent to include in the Record two letters of
support from these organizations.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Illinois?
There was no objection.
November 13, 2024.
Re: Letter of Support for H.R. 8371, The Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits
Improvement Act.
Hon. Mike Bost,
Chairman, Veterans' Affairs Committee,
House of Representatives, Washington, DC.
Hon. Mark Takano,
Ranking Member, Veterans' Affairs Committee,
House of Representatives, Washington, DC.
Dear Chairman Bost and Ranking Member Takano: As the
country turned its attention this week to celebrating and
honoring our nation's veterans, the undersigned also express
our gratitude and offer strong support for H.R. 8371, The
Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act. We represent the advocates for
older adults, including those suffering from Alzheimer's and
related dementia, and the leading senior living industry
organizations who have made this legislation a priority for
the lame duck session of Congress. The time is now to get
this important bill over the finish line to deliver much
needed options for long-term care to our veterans. Please
place this important legislation on the Suspension calendar
next week.
This legislation includes several bipartisan and bicameral
proposals to reform and improve the delivery of healthcare,
benefits, and services at the Department of Veterans Affairs
(VA) for veterans, their families, and their survivors. In
addition to the groups represented in this request, the broad
support for this legislation includes 20 veteran service
organizations (VSOs), major homelessness prevention
organizations, education training providers, health and aging
services organizations, as well as private companies, which
underscores the urgency for immediate action. (See list of
supporters).
Included in this bill under Subtitle B, Section 127, is the
key provisions of the ``Expanding Veterans' Options for Long
Term Care Act,'' which the undersigned organizations have
endorsed and strongly supported this Congress. This
particular section authorizes the VA to offer assisted living
settings for aging and disabled veterans who would otherwise
require more costly nursing home care. This pilot program
will give veterans additional options for how and where they
can get the long-term care they need as well as inform future
policy decisions to meet the growing care needs of our
nation's aging veterans.
The VA has acknowledged the challenges relative to the
aging veteran population and the need and value of
rebalancing its long-term care programs. The proposal is an
economically sound and sensible approach to demonstrate the
benefits of assisted living settings to the resident veteran,
their families, friends, and fellow veterans. It provides the
VA critical flexibility to address the
[[Page H6066]]
needs of a rapidly growing population of aging or disabled
veterans who are not able to live at home and future costs
savings will help more veterans receive the assistance they
need.
Please take action to advance this legislation this year
and place it on the Suspension calendar.
Thank you for your work to improve the lives of our
veterans.
Sincerely,
Alzheimer's Association.
Alzheimer's Impact Movement.
American Seniors Housing Association.
Argentum.
LeadingAge.
National Center for Assisted Living.
____
May 24, 2024.
Hon. Mike Johnson,
Speaker, House of Representatives,
Washington, DC.
Hon. Hakeem Jeffries,
Minority Leader, House of Representatives,
Washington, DC.
Hon. Chuck Schumer,
Majority Leader, U.S. Senate,
Washington, DC.
Hon. Mitch McConnell,
Minority Leader, U.S. Senate,
Washington, DC.
Since the beginning of the 118th Congress, we, the
undersigned organizations, have been working with the House
and Senate Committees on Veterans' Affairs on legislation to
improve the health care and benefits provided to our nation's
veterans, their caregivers, their families, and their
survivors. Over the course of many months, our collective
engagement with Members and staff through congressional
hearings, committee briefings, stakeholder roundtables, and
informal discussions have led to the development of bills
that address several of our highest legislative priorities
for those we serve.
We were pleased to see many of these bills incorporated
into the recently introduced Senator Elizabeth Dole 21st
Century Veterans Healthcare and Benefits Improvement Act
(H.R. 8371). From improving access to mental health and long-
term care for the veterans who need it, to supporting those
who care for them, as well as their survivors, this
bipartisan and bicameral measure would have a tremendous
impact on the entire veteran community if enacted. We have
been patient and collaborative as these proposals have been
reviewed and adjusted to fit into a meticulously crafted
legislative package. The time to act has arrived.
We recognize that this legislation is a compromise package,
one that requires all sides and interested parties to engage
in good faith, as we did with the House and Senate
committees. We appreciated receiving regular updates from
committee staff as this omnibus package progressed, and were
pleased to help resolve many differences throughout the
entire process leading to the introduction of this bill. We
assumed committee leaders were doing the same as the
negotiations moved behind closed doors. As engaged and
involved stakeholders, we were deeply disappointed to learn
that the bill will not advance to the House floor for a vote
before Memorial Day.
While the path forward for this bill is now unclear, we
continue to stand united in our belief that Congress must
pass this vital legislation as quickly as possible. The
Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act addresses some of the most urgent
needs of veterans and the people who care for them; they
should not have to wait any longer. On their behalf, we call
on all of you to put aside politics, work together in good
faith to find a path forward through the House and the
Senate, and enact this critical legislation before the Fourth
of July. America's veterans, their caregivers, families and
survivors deserve no less.
Sincerely,
Carl Blake, Chief Executive Officer, Paralyzed Veterans of
America; Ryan M. Gallucci, Executive Director, VFW Washington
Office; Steve Schwab, Chief Executive Officer, Elizabeth Dole
Foundation; Jose Ramos, Vice President for Government and
Community Relations, Wounded Warrior Project; Cara Rinkoff,
USAWOA Executive Director.
Daniel Seehafer, National Commander, The American Legion;
Edward R. Reese, Jr., Executive Director, DAV Washington
Headquarters; Brian T. Kelly, Lieutenant General, U.S. Air
Force (Ret), President and CEO, Military Officers Association
of America (MOAA); Donald D. Overton, Jr., National Executive
Director, Blinded Veterans Association; Allison Jaslow, Chief
Executive Officer, Iraq and Afghanistan Veterans of America.
CAPT Jacqueline Rychnovsky, USN (Ret.), PhD, CAE, Executive
Director, Commissioned Officers Association of the USPHS;
Michael D. Zeiders, President, Quality of Life Foundation;
Keith A. Reed, Executive Director, Air Force Sergeants
Association, President and Secretary, Board of Directors,
Airmen Memorial Foundation; James McCormick, Director,
Government Affairs, Vietnam Veterans of America; Deborah
Oelschig, TREA National President; Calaneet Balas, President
& CEO, The ALS Association; Carder Ferguson, National
Commander, Military Order of the Purple Heart USA.
Additional Supporting Organizations:
Christopher & Dana Reeve Foundation, Team Services Group, I
AM ALS, National PACE Association, U.S. Coast Guard Chief
Petty Officers Association & Enlisted Association, Military
Chaplains Association, Tragedy Assistance Program for
Survivors.
Mr. BOST. Madam Speaker, while I think we could and should have been
able to pass this bill months ago, I am pleased to be here today. I
know that some of my colleagues on the other side of the aisle took
issue with some provisions in the Dole act due to a disagreement on the
provision's intent.
The provision that was opposed only affected about 6 percent of the
VA's current community referrals. This provision would rightfully make
sure that VA bureaucracy cannot veto a doctor's medical decisions.
Veterans groups understand this, and that is why they support this
bill from the start and without reservation. Thanks to the hard work of
these groups of pushing Members to do the right thing, we have come to
a compromise on the language before us today. I think it is obvious to
everyone that our veterans and their families simply can't wait.
{time} 1645
Before I reserve my time, I will thank Representative Ciscomani and
dozens of Members that have provisions in this bill. I am so happy to
have Members like Representative Ciscomani on our team.
I also thank my friend, Majority Leader Steve Scalise, for bringing
the Dole act to the floor. He has reaffirmed his and the rest of the
House Republicans' commitment to veterans, servicemembers, and their
families.
Last but certainly not least, I will personally thank my friend and
recent Presidential Medal of Freedom recipient, this bill's namesake,
Senator Elizabeth Dole, for working for months to get this bill to
where it is today. Our Nation's veterans have no better friend than
Senator Dole, and I am honored that she is with us here today.
Madam Speaker, 2 weeks ago the American people voted and gave us a
mandate to fix problems they talk about at their kitchen tables that
affect their families and communities every single day. The Dole act is
the foundation for that work to begin for the veteran community, and I
urge my colleagues to do right by the veterans and support the bill.
Madam Speaker, I reserve the balance of my time.
House of Representatives,
Committee on Natural Resources,
Washington, DC, November 4, 2024.
Hon. Mike Bost,
Chairman, Committee on Veterans' Affairs,
Washington, DC.
Dear Mr. Chairman: I write regarding H.R. 8371, the
``Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act,'' which contains legislative
provisions within the jurisdiction of the Committee on
Natural Resources.
In the interest of permitting your committee to proceed
expeditiously to floor consideration, the Committee on
Natural Resources will forgo formal consideration of the
legislation. I do so with the understanding that the
Committee on Natural Resources does not waive any future
jurisdictional claim over the subject matters contained in
the bill that fall within its jurisdiction. I also request
that you urge the Speaker to name members of this committee
to any conference committee which is named to consider such
provisions.
Please place this letter into the Congressional Record
during consideration of this legislation on the House floor.
Sincerely,
Bruce Westerman,
Chairman, Committee on Natural Resources.
____
House of Representatives,
Committee on Veterans' Affairs,
Washington, DC, November 6, 2024.
Hon. Bruce Westerman,
Chairman, Committee on Natural Resources,
House of Representatives, Washington, DC.
Dear Chairman Westerman: Thank you for your letter
regarding H.R. 8371, the ``Senator Elizabeth Dole 21st
Century Veterans Healthcare and Benefits Improvement Act''. I
acknowledge that provisions of the bill fall within the
jurisdiction of the Committee on Natural Resources.
I agree that your forgoing further action on this measure
does not in any way diminish or alter the jurisdiction of the
Committee on Natural Resources over the subject matters
contained in this bill or similar legislation in the future.
In addition, I would support your request to have the
Committee on Natural Resources appropriately consulted on any
issues in this bill or similar legislation that fall under
the jurisdiction of the Committee on Natural Resources.
I will place copies of this exchange into the Congressional
Record during consideration of this legislation on the House
floor.
Sincerely,
Mike Bost,
Chairman.
[[Page H6067]]
____
Committee on Armed Services,
House of Representatives,
Washington, DC, November 15, 2024.
Hon. Mike Bost,
Chairman, House Committee on Veterans' Affairs, Washington,
DC.
Dear Chairman Bost: I write concerning H.R. 8371, the
Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act offered by Representative Juan
Ciscomani. As a result of your having consulted with us on
provisions within H.R. 8371 that fall within the Rule X
jurisdiction of the Committee on Armed Services, I agree to
forego any further consideration of this resolution so that
it may proceed expeditiously to the House floor for
consideration.
The Committee on Armed Services takes this action with our
mutual understanding that by foregoing consideration of H.R.
8371 at this time, we do not waive any jurisdiction over
subject matter contained in this or similar legislation and
that our committee will be appropriately consulted and
involved as this resolution or similar legislation moves
forward so that we may address any remaining issues in our
jurisdiction.
Finally, I ask that a copy of our exchange of letters on
this matter be included by House Committee on Veterans'
Affairs in the Congressional Record during floor
consideration, to memorialize our understanding. Thank you
for the cooperative spirit in which you have worked regarding
this matter and others between our respective committees.
Sincerely,
Michael D. Rogers,
Chairman,
House Committee on Armed Services.
____
House of Representatives,
Committee on Veterans' Affairs,
Washington, DC, November 18, 2024.
Hon. Mike Rogers,
Chairman, Committee on Armed Services,
House of Representatives, Washington, DC.
Dear Chairman Rogers: Thank you for your letter regarding
H.R. 8371, the ``Senator Elizabeth Dole 21st Century Veterans
Healthcare and Benefits Improvement Act''. I acknowledge that
provisions of the bill fall within the jurisdiction of the
Committee on Armed Services.
I agree that your forgoing further action on this measure
does not in any way diminish or alter the jurisdiction of the
Committee on Armed Services over the subject matters
contained in this bill or similar legislation in the future.
In addition, I would support your request to have the
Committee on Armed Services appropriately consulted on any
issues in this bill or similar legislation that fall under
the jurisdiction of the Committee on Armed Services.
I will place copies of this exchange into the Congressional
Record during consideration of this legislation on the House
floor. I appreciate your willingness to work together to
advance this important legislation.
Sincerely,
Mike Bost,
Chairman.
Mr. TAKANO. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I rise in support of H.R. 8371, as amended, the
Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits
Improvement Act.
This omnibus package of veterans' legislation isn't perfect; such
packages rarely are. However, it achieves progress on many of the goals
we set out to accomplish at the beginning of the 118th Congress.
The backbone of this bill is legislation that was originally
introduced by my colleague, Julia Brownley, the ranking member of the
House Veterans' Affairs Subcommittee on Health.
Representative Brownley has worked tirelessly for nearly 3 years to
pass the Elizabeth Dole Home Care Act, H.R. 542. This bill will enable
veterans to remain at home, safely age in place, and avoid or delay
admission to nursing homes and other costly institutional settings of
care by expanding veterans' access to home- and community-based
services such as home health aides.
This legislation will also help connect veterans' caregivers to
respite care and other support services that help them care for
veterans at home. Further, it will help improve VA's coordination with
other Federal long-term care programs that promote aging at home.
I am very thankful to my colleague Julia Brownley for her important
work, but I know she worked very closely with Senator Elizabeth Dole,
and Senator Dole has risen to an amazing stature in our country. I am
so proud that she is also here in this Chamber with us today as the
chairman mentioned. I hope someone will get her a blanket because it is
so dang cold in this Chamber that I don't want her to freeze up there.
This legislation is an investment in care for millions of veterans
and current servicemembers who need this help now and in the future.
Despite the great need for this bill, it has been an uphill battle to
get it passed. This Chamber had an opportunity almost a year ago to
pass the Elizabeth Dole Home Care Act as a stand-alone bill.
Unfortunately, House Republicans decided to bring a version to the
floor they knew the Senate wouldn't pass.
Why would they do that you may ask? Well, because they decided to
hold the Elizabeth Dole Home Care Act and other bipartisan policy
priorities hostage, attempting to use them as leverage to achieve their
goal of outsourcing more VA care to for-profit healthcare providers.
The Democratic Caucus stood firmly against these efforts.
It can be difficult and isolating to stand on policy principles, but
I will always do so when the future of veterans' healthcare is on the
line, and it is. The system is already straining, and if we don't take
real and serious action, it will break.
House Republicans attempted nearly for a year to use H.R. 8371 to
advance harmful provisions that would have undermined healthcare
directly provided by VA, driving veterans to for-profit, lower-quality
care from contracted providers. We want VA to remain a strong provider
of care instead of diminishing it to nothing more than an insurance
company where profits are prioritized over outcomes for veterans.
Madam Speaker, if we have learned anything during the 118th Congress,
it is that anything meaningful that we have accomplished has been done
on a bipartisan basis with Democratic votes.
It should never have taken this long to get here, but last week, we
successfully negotiated a compromise on the most objectionable
provision of H.R. 8371, which will preserve VA healthcare for current
and future generations of veterans.
Unfortunately, in the year it took to get to this point, House
Republicans also held hostage critical legislation to help homeless
veterans. In December 2023, my colleagues in the majority knowingly and
intentionally took a flawed version of the HOME Act, which includes two
Democratic-led bills to the House floor to use these provisions as
leverage in negotiations for this package. They used homeless veterans
as political pawns in the same way that they did with elderly and
disabled veterans and their caregivers.
Meanwhile, VA and its community partners continued doing the hard
work to help veterans experiencing homelessness. On Veterans Day, the
VA announced that veteran homelessness dropped to its lowest level on
record, and that VA had helped place nearly 48,000 veterans into
permanent housing in 2024.
While I celebrate VA's success in addressing this issue, there are
still nearly 300,000 veterans who interact with VA's homelessness
programs each year. We must continue investing resources into these
programs and into our communities to ensure that every veteran has a
stable place to call home. We hope the next administration will
continue this work and adhere to the models that have proven effective
like Housing First.
Therefore, the second pillar of this legislation supports our shared
goal of ending veteran homelessness. H.R. 8371 includes provisions from
Congresswoman Williams' H.R. 491, the Return Home to Housing Act and
Congresswoman Cherfilus-McCormick's H.R. 645, the Healthy Foundations
for Homeless Veterans Act. These provisions will provide direct
investments in communities across the country as they move veterans
from the streets into stable housing.
During the pandemic, VA used authorities contained in Representative
Williams' bill to enhance the services that traditional housing
providers could offer to veterans through an increased per diem
reimbursement rate. It used the flexible authorities in Representative
Cherfilus-McCormick's bill to save lives by bringing veterans out of
unsafe living conditions into stable, permanent housing and meeting
their basic needs of food, shelter, and clothing.
It also ensured homeless veterans had the transportation needed to
get to and from medical appointments and job interviews.
[[Page H6068]]
These long overdue reauthorizations will ensure VA and its community
partners can continue to address the veteran homelessness crisis in
this country with the urgency and focus it deserves.
There is still more work to do to get every veteran into housing, and
I look forward to working with my colleagues in Congress to provide VA,
HUD, and communities across the country the support they need to end
veteran homelessness.
Madam Speaker, I will also acknowledge several Democratic Members who
have contributed to the drafting of this package. Representatives
Mike Levin, Don Davis, Elissa Slotkin, Frank Mrvan, Dean Phillips,
Morgan McGarvey, Chris Pappas, and Lauren Underwood all have provisions
in their own bills included in this package. Many of them are or have
been members of our committee, and their commitment to serving veterans
continues with our work here today.
Among other things, these provisions will increase outreach to
veterans about their eligibility for benefits, mandate training for VA
employees on reporting wrongdoing to the inspector general, and remove
statutory restrictions on the qualifications of senior leaders within
the Veterans Health Administration.
Madam Speaker, that does not mean this bill is perfect, and I will
stress my objection, once again, to the backward practice of the
majority to offset discretionary spending along with mandatory spending
in every bill. This means taxpayers will be paying for these programs
twice and many remaining legislative priorities from the VSOs who are
with us here today are at risk of being left undone next Congress when
we must unnecessarily waste our limited offsets in order to advance
this legislation.
Also missing from this package is a strong piece of bipartisan,
bicameral, good-government legislation that would have installed much-
needed guardrails on VA's electronic health record modernization
project.
It is no secret that the Oracle-driven modernization effort has
struggled at VA. The program is woefully behind schedule and is only
operational at 6 of 172 medical centers. I am not convinced the system
is fully functional. The EHR Program RESET Act would have required
minimum operational criteria to be met before Oracle could be deployed
to any further facilities, which would have prevented many of the
current problems.
Further, this key legislation would have improved coordination with
the Department of Defense and instituted major contracting and
acquisition reforms over VA's IT modernization efforts that are long
overdue.
Unfortunately, RESET was stripped from the package, which is not
surprising given the army of lobbyists that Oracle unleashed to kill
it.
That said, I thank the Veterans Service Organization community and
other stakeholders whose tireless efforts and refusal to compromise
their values proved critical in finally getting our Republican majority
back to the negotiating table to reach a compromise on H.R. 8371 last
week.
As we saw with the passage of the PACT Act, we know good things can
be accomplished when VSOs are unified and committed to doing the right
thing. I am glad that House Democrats also held firm to our values in
negotiations and fought to preserve VA healthcare for current and
future generations of veterans.
This package has taken more than a year to get to the finish line,
but I am pleased that we as a caucus will be able to support passage on
this compromise today.
Madam Speaker, I reserve the balance of my time.
The SPEAKER pro tempore. The Chair reminds Members that the rules do
not permit Members to refer to persons in the gallery.
Mr. BOST. Madam Speaker, I yield 2 minutes to the gentleman from
Michigan (Mr. Bergman).
Mr. BERGMAN. Madam Speaker, I rise today in support of H.R. 8371.
This important bill package will strengthen VA community care,
streamline the disability benefits process, and improve oversight and
accountability at VA. Its consideration here today is the culmination
of months of committee work, negotiation, and fine-tuning on behalf of
our Nation's veterans. Included in this package is language from the
Elizabeth Dole Home Care Act of 2023, which will improve support for
aging veterans and their caregivers.
I was proud to join Congresswoman Brownley in introducing the bill
last year, and I am proud to support this larger bill package as a
veteran and as a member of the House VA Committee.
While I could fill an hour of time discussing this and the many other
important reforms of this bill, I will focus on a relatively small
provision that exemplifies the good advocacy and policymaking that
often goes unnoticed by the media. Gerald's Law, which I originally
introduced as H.R. 234, is named after Gerald Elliott, a U.S. Army
veteran and a resident of the Upper Peninsula of Michigan in my
district.
Jerry passed away in 2019 while receiving VA hospice care at his
home. Following his death, Jerry's family discovered that, even though
he received hospice care through the VA, the fact that he received this
care at home meant his family did not qualify for burial benefits after
his death.
I was made aware of this injustice by Denise Formolo, the Veterans
Service Officer who was assisting Jerry's family. Her advocacy led me
to create Gerald's Law, a bill to fix this legislative oversight and
ensure that no veteran will have to worry about losing VA benefits for
their family when choosing to spend their last days in the comfort of
their own home.
I am grateful for the inclusion of Gerald's Law in this package, and
I thank Chairman Bost and the VA committee staff for their tireless
work getting this across the finish line.
Madam Speaker, I urge my colleagues to support H.R. 8371.
Mr. TAKANO. Madam Speaker, I yield 5 minutes to the gentlewoman from
California (Ms. Brownley), my good friend and the ranking member of the
Subcommittee on Health.
{time} 1700
Ms. BROWNLEY. Madam Speaker, I rise in support of the Elizabeth Dole
21st Century Veterans Healthcare and Benefits Improvement Act.
As you know, last week on Veterans Day, many of us attended events in
our congressional districts to commemorate Veterans Day and to honor
the men and women who have served our Nation in uniform. As Members of
Congress, on Veterans Day, we recognize every man and woman who has
answered the call to duty. In fact, it has been nearly a century since
Veterans Day was first established as a Federal holiday in 1938.
While celebrating Veterans Day is an important tradition, we also owe
our Nation's veterans more than words of thanks. Our words ring hollow
if we don't do our part to fulfill our Nation's solemn promise to serve
our veterans and their families as well as they have served our
country.
As you may know, access to long-term care is one of the biggest
challenges facing our aging veteran population and the families who
care for them. I have been working for several years now to address
this need, working with former Senator Elizabeth Dole, the Elizabeth
Dole Foundation, veterans service organizations, and with my colleagues
on both sides of the aisle and in both Houses of Congress.
I was proud when the bill passed the House in November of 2023 with
overwhelming bipartisan support. It has been a year, and we simply
cannot deny our veterans this crucial care any longer. We must get the
Elizabeth Dole 21st Century Veterans Healthcare and Benefits
Improvement Act across the finish line and signed into law.
Passage of my legislation would be the most impactful change in VA
long-term care in decades. It would also be one of the smartest.
Currently, every veteran enrolled in the VA has the right to nursing
home care if clinically eligible, but it is important to note that
nursing homes are not where veterans want to live their golden years.
They want to be at home with their families and in their communities.
It turns out care at home is also less expensive than
institutionalized care. Probably most important of all, health outcomes
are far, far better by having received care at home than it is in an
institutionalized setting.
As you know all too well, our healthcare system is facing a silver
tsunami as baby boomers enter their
[[Page H6069]]
later years. The VA is not exempt from this tsunami, and immediate
preparation is critical. Almost half of the VA's patient population is
over 65. Without fixing veteran home and community care in the next 15
years, the VA will double its spending on institutionalized long-term
care services, nearing $15 billion to meet these needs.
Congress has a great deal of difficulty coming to agreement on most
things, but we all agree that long-term care at home is better for our
veterans. It is better for the VA, and it is better for our country.
I am proud to say my bill has been incorporated into the Elizabeth
Dole 21st Century Veterans Healthcare and Benefits Improvement Act. The
package before us also includes legislation that Senator Sanders and I
have worked on to create a new pilot program to expand VA comprehensive
dental care to veterans diagnosed with diabetes and other heart
disease, as well as numerous bipartisan, bicameral provisions to
improve VA's benefits for veterans.
I thank Chairman Bost, and I thank Ranking Member Takano for their
work to reach an agreement on this package that will help veterans all
over the country by delivering the relief caregivers and veterans need
and what they have been advocating for. I also thank Senator Elizabeth
Dole for her help and support in making this the perfect bill.
Mr. TAKANO. Mr. Speaker, I reserve the balance of my time.
Mr. BOST. Mr. Speaker, I yield 2 minutes to the gentlewoman from Iowa
(Mrs. Miller-Meeks).
Mrs. MILLER-MEEKS. Mr. Speaker, I rise today in support of H.R. 8371,
the Elizabeth Dole 21st Century Veterans Healthcare and Benefits
Improvement Act.
As a veteran, physician, a caregiver myself, and a Member of Congress
actively addressing these issues, I have witnessed firsthand the
immense challenges that caregivers face, especially as our veteran
population continues to age.
Access to mental health services remains inconsistent, leaving many
caregivers struggling to find the support they desperately need. The
weight of caring for veterans with complex conditions can lead to
significant stress, anxiety, and burnout. That is why it is crucial for
us to pass this bill which includes critical provisions to enhance and
reform the delivery of care and services at the Department of Veterans
Affairs.
Among its key measures, this legislation expands access to home- and
community-based services, allowing aging veterans to receive care at
home instead of at institutions. It also fully funds the VA's VET TEC
program which provides high-tech career training for veterans, with an
84 percent graduation rate and an average starting salary of over
$66,000.
This bill would also improve the timeliness and quality of care for
veterans under community care, ensuring that medical records are
returned more quickly, and veterans receive the care they need in a
timely manner.
Additionally, it includes important provisions to help address
veteran homelessness by increasing funding for services that assist
veterans with transportation to medical, housing, and employment
appointments.
As a Member of Congress and as Americans, we have a responsibility to
care for those who bravely fought for our country. By advocating for
meaningful solutions that genuinely support our veterans and their
caregivers, we can take important steps toward improving the lives of
our Nation's heroes and those who care for them.
Mr. TAKANO. Mr. Speaker, I yield 2 minutes to the gentleman from
North Carolina (Mr. Davis), a member of the House Armed Services
Committee and the House Committee on Agriculture and a veteran himself.
Mr. DAVIS of North Carolina. Mr. Speaker, I rise in support of H.R.
8371, the Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act, which, among several provisions, includes the
Veteran Caregiver Application and Appeals Reform Act of 2023.
As we recognize National Veterans and Military Families Month and
National Family Caregivers Month, we must recommit ourselves to helping
our Nation's veterans and their caregivers, often the unsung heroes of
the healthcare system. Support of the CARE Act does exactly that. We
must always lend a helping hand to our veterans and their families. I
urge my colleagues to support H.R. 8371.
Mr. BOST. Madam Speaker, I yield 2 minutes to the gentleman from
Wisconsin (Mr. Van Orden).
Mr. VAN ORDEN. Madam Speaker, I rise today in strong support of H.R.
8371, the Elizabeth Dole 21st Century Veterans Healthcare and Benefits
Improvement Act.
I do this for two individuals in one group, the two individuals being
Robert Francis Mulligan and Mary Jean Mulligan, my Uncle Bob and Aunt
Mary Jean. They were both World War II veterans and members of the
Greatest Generation who, unfortunately, died in nursing homes in poor
conditions because of the fact that they were not able to have funding
through this act. I am very supportive of it.
The group that I stand in strong support of today is our Gold Star
families. When a member passes and their family members remain, that is
not a mortgage. It is not a 30-year commitment. It is a lifetime
commitment. We have to do everything we possibly can so that they can
move on with their lives in memory of their loved ones that served our
Nation and allowed us to have this debate in freedom.
Mr. TAKANO. Madam Speaker, I reserve the balance of my time.
Mr. BOST. Madam Speaker, I yield 2 minutes to the gentleman from
Texas (Mr. Luttrell).
Mr. LUTTRELL. Madam Speaker, I am honored to speak on H.R. 8371, the
Elizabeth Dole 21st Century Veterans Healthcare and Benefits
Improvement Act.
H.R. 8371 includes provisions from H.R. 4461, the Modernizing
Department of Veterans Affairs Disability Benefit Questionnaire Act.
Current practice does not require VA contractors who perform disability
exams to submit disability benefits questionnaires, or DBQs, in a
format that can be easily processed by VA claims automation software.
This currently leads to backlogs and delays that can be avoided by
submitting the DBQs based on a standard that computers can read.
Computerizing the data is the key to helping VA process and
adjudicate veterans' claims faster. The Modernizing Department of
Veterans Affairs Disability Benefit Questionnaires Act would improve
these DBQs which are a critical part of the disability compensation
process. As the VA moves forward with automation, standardizing the DBQ
data will be critical to timely and accurate claims processing.
Our veterans, who have sacrificed so much for our country, deserve a
system that works for them. I urge my colleagues to support H.R. 8371.
Mr. TAKANO. Madam Speaker, I reserve the balance of my time.
Mr. BOST. Madam Speaker, I yield 2 minutes to the gentleman from
Arizona (Mr. Ciscomani), the chief sponsor of this bill.
Mr. CISCOMANI. Madam Speaker, I rise today in support of my
legislation, the Senator Elizabeth Dole 21st Century Veterans
Healthcare and Benefits Improvement Act, the flagship bipartisan,
bicameral veterans package of the 118th Congress.
Simply put, our veterans are our Nation's heroes. When duty called,
these brave men and women answered, risking life and limb in service to
their fellow citizens.
In my district, I organized the Veterans Advisory Council to hear
directly from those who served about the unique challenges facing all
of our veterans. As I continue to hear from our veterans, it is clear
there is still work to be done to close the gaps in economic
opportunity, care, and access to housing.
This legislation encompasses a number of bipartisan and bicameral
proposals to address veteran homelessness by increasing reimbursement
rates to partner organizations; improve the delivery of healthcare by
increasing coordination with providers and expanding access to home and
community care; modernize delivery of benefits by cutting red tape; and
overall improvement to the delivery of services for veterans, their
families, and survivors.
Specifically, I am proud my bill includes a provision I have
spearheaded to reauthorize and fund the VET TEC program to cover costs
for veterans seeking job training in high-tech industries. Currently,
the program has an 84
[[Page H6070]]
percent graduation rate for the 12,000 veterans who have already
completed it. By reauthorizing this program, we are creating the same
opportunity for thousands of veterans to come.
Additionally, I want to highlight that it authorizes appropriations
for the Office of Women's Health at the VA to expand access for women
to mobile mammography units and outreach.
I urge my colleagues to support this legislation, to ensure we
provide our veterans and their families with the support and benefits
they earned through their service.
Mr. TAKANO. Madam Speaker, I reserve the balance of my time.
Mr. BOST. Madam Speaker, I yield 30 seconds to the Representative
from Nebraska (Mr. Bacon).
Mr. BACON. Madam Speaker, I rise today in support of the Senator
Elizabeth Dole 21st Century Veterans Healthcare and Benefits
Improvement Act.
One percent of Americans answered the call to defend our Nation with:
Send me. We owe them a debt of gratitude. Our veterans should receive
healthcare and benefits they have earned without having to battle the
VA.
The Dole act expands economic opportunities, broadens nontraditional
educational programs, and does so much for our veterans. Today, 60
percent of our Nation is veterans. We owe them a debt of gratitude.
Mr. TAKANO. Madam Speaker, I reserve the balance of my time.
Mr. BOST. Madam Speaker, I yield 1 minute to the gentleman from
Indiana (Mr. Baird).
Mr. BAIRD. Madam Speaker, I am a decorated Army combat veteran who
served in the Vietnam war. I know how well and how much the sacrifices
our servicemembers make to defend our Nation. Access to timely
healthcare for our veterans is mission critical for the VA, and failure
to deliver is unacceptable.
In 2014, the House Committee on Veterans' Affairs discovered that 40
veterans died while waiting for medical care. This is just one example.
My bill, the VA Same-Day Scheduling Act, will ensure that no veteran is
more than one phone call away from the care they have been promised.
I am encouraged that the spirit of the bill is included in the
Elizabeth Dole act which requires a plan to get the VA to same-day
scheduling. This is a step in the right direction to fix that
bureaucratic travesty.
{time} 1715
Mr. BOST. Madam Speaker, may I inquire of the Chair as to how much
time is remaining.
The SPEAKER pro tempore (Mrs. Miller-Meeks). The gentleman from
Illinois has 4\1/2\ minutes remaining.
Mr. BOST. Madam Speaker, I have no further speakers, and I reserve
the balance of my time.
Mr. TAKANO. Madam Speaker, I yield myself the balance of my time to
close.
I have said as much as I can about this important piece of
legislation. What I will finally say is I am very glad that we got
here, and I thank the chairman. We spent all this time, and we have
reached a compromise. That is what we have to do in Congress, put our
veterans and the people first. I think the American people want to see
more of this sort of thing happening.
Madam Speaker, I am very pleased that we could get this done before
the Thanksgiving weekend.
I urge all of my colleagues to support H.R. 8371, the Senator
Elizabeth Dole 21st Century Veterans Healthcare and Benefits
Improvement Act, and I yield back the balance of my time.
Mr. BOST. Madam Speaker, I yield myself the balance of my time to
close. I offer a very special thank-you to the ranking member, the
staff who have been involved in the negotiations back and forth, the
Senate, all of our VSOs that came out--as I said in my opening, there
were over 50--in support of this bill, and for the hard work and
pushing forward that Senator Elizabeth Dole has done on this bill. We
are so glad that we can call it up tonight.
Madam Speaker, I encourage all Members to support H.R. 8371, as
amended, the Senator Elizabeth Dole 21st Century Veterans Healthcare
and Benefits Improvement Act, and I yield back the balance of my time.
Mrs. KIGGANS of Virginia. Madam Speaker, I rise today in support of
the Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act.
This bipartisan legislation contains consequential reforms that will
significantly improve the lives of veterans and their families across
the country.
I'm very proud that my bill, the Caregiver Outreach and Program
Enhancement Act, is included in this package.
Known as the COPE Act, my bill would authorize the VA to award grants
to organizations that provide mental health resources to those who care
for our nation's veterans.
Caregivers play a critical role in the lives of older Americans--
especially our veterans--and as the only geriatric nurse practitioner
in Congress, I know being a caregiver comes with immense emotional
challenges.
By ensuring veteran caregivers can properly take care of their mental
health, the COPE Act will improve the lives of our nation's heroes and
solidify the support system they need to age with dignity.
In addition to the COPE Act, this package also includes the VA
Medical Center Security Report Act of 2023, which I introduced to
increase veterans' safety and support police officers at VA Medical
Centers amid an uptick in violent crime.
Madam Speaker, I am the granddaughter of a veteran, the daughter of a
veteran, the wife of a veteran, the mother of future veterans, and I
served 10 years in the U.S. Navy myself.
I'm blessed to represent one of the largest veteran populations in
the U.S. in Hampton Roads.
Improving the lives of our nation's heroes is, and always will be,
one of my top priorities in Congress . . . and the legislation before
us on the House Floor today helps Congress do just that.
I'd like to thank my colleagues on the other side of the aisle--
Representatives Chrissy Houlahan and Chris Pappas--who joined me in
originally introducing the COPE Act.
I'd also like to thank Chairman Bost for his commitment to our
veterans and for spearheading the Senator Elizabeth Dole 21st Century
Veterans Healthcare and Benefits Improvement Act.
I'm confident with the passage of this impactful legislation, we will
move closer to fulfilling our promise to provide for America's veteran
population and those who care for them.
I urge all my colleagues on both sides to support the Elizabeth Dole
Act.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Illinois (Mr. Bost) that the House suspend the rules and
pass the bill, H.R. 8371, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. BOST. Madam Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this motion will be postponed.
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